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Kilchenstein, M.W. (1998). The Use of Pain as an Autistic Object and as a Primitive Experience of Self: A Clinical Report on Some Possible Effects of Trauma in Infancy. Contemp. Psychoanal., 34(2):223-238.

(1998). Contemporary Psychoanalysis, 34(2):223-238

The Use of Pain as an Autistic Object and as a Primitive Experience of Self: A Clinical Report on Some Possible Effects of Trauma in Infancy

Michael W. Kilchenstein, M.D.

Modern medical technology allows an increasing number of premature and severely ill infants to survive, albeit in physically and emotionally traumatized states. This report describes the analysis of a woman who underwent life-saving surgical intervention in early infancy. This patient made use of pain as a principal organizing sensory medium for the creation of the experience of a bodily perimeter and the most rudimentary sense of self. Experience in the transference-countertransference led to the hypothesis that the repeated re-creation of pain served this patient, Ms. C, as a principal defense against feelings of disintegration and of not existing. Having suffered from a combination of severe physical illness and, apparently, inadequate maternal holding in the first months of life, Ms. C seems to have developed a particular defensive form of psychic equilibrium. During the years that I have worked with her I have become convinced that she constructed a pathological defensive perimeter by utilizing the painful sensations that were available. I use clinical vignettes taken from four periods of the analysis to demonstrate four forms of transference-countertransference experience that I believe derived from the defensive organization that the patient developed in the course of her early experience of pain and maternal deprivation.

As far as I have been able to determine, the analytic literature has not addressed the way in which pain may function as a psychological defense and as a nidus for psychic organization in the face of psychotic anxiety. There are, however, guiding discoveries that help in the understanding of Ms. C. Early and prolonged trauma results in somatic (sensory) symptoms (Greenacre, 1952p.

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