Dr. Raquel Zak Goldstein
1997

In this paper, I would like to consider the consequences that D.W. Winnicott´s discoveries have on the comprehension of the psychosomatic, pediatrics and mental illness. I hope these considerations will contribute to the understanding of Winnicott´s developments within the current discourse of psychoanalitic thinking.
The title that I was proposed already suggests an idea: the idea that there is a psychesoma matrix.
If this is so, if the matrix as such is available, we must ask ourselves about the conditions of possibility that allow it to achieve psychosomatic existence. We know that what is part of the complementary series called “the given” (le donnée) must adequately journey the constitutive times in order to emerge and make its potential effective.
It is possible to consider that a special pre- and post-natal nesting in the maternal mind and psychesoma creates the matrix for the given.
According to Bion, the predisposition of that maternal skin-to-skin in state of reverie assures support as psychosomatic matrix to the prematured offspring (Bolk), born in a psychologic state near dismembering, and in the midst of experiences of tearing, typical of the quality of agony that Winnicott called unthinkable anxieties.
This specific nesting supports the infans in the adequate state of holding Winnicott so wonderfully described. A field of overlapping and exchange with the body and mind of the good enough mother. The good enough mother is such because she briefly but entirely gives herself up and experiences with her infans that transitivism Freud pointed out and A. Green defined as “a brief state of normal madness”. I would say it is in this field of the constitutive times that body and affection become definately entwined -or not- in the psychosexual foundation of the psychic subject.
The mother holds and nests “within her” her desired baby; she thinks it, looks at it, senses it. Meanwhile, she supports and names, filtering the agonic anxieties shared with her baby by transforming them in her psychesoma into thinkable states she is the first to decipher.
Since she dreams and daydreams of her baby, through identification as the first affectionate attachment (Freud, “Psychology of the masses and analysis of the Ego”), the baby will become the one she dreamed of during her transitional games. These are His majesty the baby´s times.
Those are the earliest times of a rearing matrix context supported by the unceasingly throbbing drive of the preset somapsyche path, because the drive imposes its beneficial “demand of labour” on the “percipient matter”, thus supporting the pulsional mixture that secures Eros´ predominance. Then, the baby will play “the Reel game” to support itself, babbling “Fort-Da”.
Winnicott says that nothing anguishing or exciting should overflow the appropriate thresholds for each moment of those fusional times. Rimbaud´s expression “Car je est un autre” is still in force, and thinking is still almost unthinkable for that offspring. Thinking will come later, in the midst of chaos, crises and idyllic happiness. If thinking sets on prematurely, it will capture somatopsychic phenomena at the expense of living, diverting the constitution of the subject towards various “adaptive” and “mentalized” forms based on splittings.
I consider that these splittings are starting points for very complex and pathological defensive organizations. The adequate “psychisization” of what the percipient initially tolerates without trauma absorbs its total neurologic and somatic availability. During that state of dependence, it is necessary for the infans to ignore, in an non-reactive way, each and every excess that would be traumatic. And the good-enough mother is there to provide these conditions.
That Ego, which is still a real primitive Ego (Freud, “Instincts and their vicissitudes”), achieves one of the most important phenomena of mental activity, such as creating a psychic reality based on a paradoxical thinking which allows it to believe in what the infans has created without losing the dimension of perception. This is possible because the other adult, the good-enough mother acting as facilitating environment, is there to “pre-occupy” and look after, offering a brief but “absolute” support, thus giving place to “illusion”, a key concept in Winnicott referring to the omnipotence of thought.
This is to make sure that the pleasure of those extremely brief times of the Ego of purified pleasure shall be preserved by the force of life´s guardian: the Pleasure Principle.
Thresholds shall be kept by maternal adequation.
Necessity, fulfilled.

The infans can believe in the omnipotence of thinking.
The phenomenon of illusion strenghthens.
Then, here and there begin brief encounters with reality when something fails in the good-enough mother´s previous “total adaptation”. Absence and “the lack of” give place to what is strange: rough sketches of the Non-Ego dimension.
Hate, as effect of displeasure, projects and founds that which is the dimension of otherness, -and in my opinion- it structures the psyche.
The precursors objects (Renata and Eugenio Gaddini, 1968, 1970) and auto-erotism contribute in achieving a vital alliance in order to face separation anxiety. Eros sustains that soma becoming psyche that will develop into an erogenous body, instilling desire and history.
But the inevitable disadjustment becomes more and more evident: something (later recognized as someone, the father, lying beyond the joyous field of the founding context) becomes a third referent for the mother. The mother, precious object of “jouissance”, guarantee of survival and capable of scaring away the pain that bites at the entrails of the young soma, moves beyond the baby´s desire. That absolutely necessary object could go away and neither hear nor listen. “She no longer sees only me. She doesn´t answer my call. She didn´t think of me in this short time” is the baby´s terrifying perception. The intimate continuum is broken.
Transitional objects and phenomena “at work” support and give rise to the unconscious; metaphors and metonymy weave salvation during that horrifying experience of helplessness (Hilflosigkeit) that uncovered the unbearable truth: the state of defencelessness and psychic and motile impotence, typical of the early times of human constitution. Resigning this first object as possesion inaugurates weaning and avoids melancholy by strenghthening symbolization and sublimation. The infans “works” absorbed, amuses itself (“se entre-tiene”) and “discovers” that it can support itself in between (“tener-se-entre”) those two edges of the abyss evidenced by the absence. Absence that will be known/negated if it can “let loose” the necessary hate to disregard the horrifying unknown, present in that brief experience of cut in psychophysic continuity called primitive communication (J. Mc Dougall).
What becomes evident from a metapsychological point of view is that the person we call mother in the position of good-enough mother, embodies and makes effective the fellow human-being [the Similar (el Semejante, traducción Amorrortu)] of the complex of the fellow human-being (Freud, “Project for a scientific psychology”volume I, pg. 331; J. Lacan, “Seminar VII: The ethics of psychoanalysis”), thus giving place, as extraneous help, to the constitutive field I called founding context.
Nested in the maternal psychesoma matrix, the infans begins to inhabit and master an erogenous body, weaving erogenous zones and tracing -within a skin perimeter that separates exterior Non-Ego from an interior It´s me/Ego- an identity with a sexed image (R.Z. de Goldstein, “The dark continent and its enigmas”, Madrid,33th, IPAC, 83).
The psychesoma matrix as given endowment, together with the symbolic matrix of human offspring -a powerful complementation that tends to hominization- are factors that make effective the integration tendency described by Winnicott and M. Klein, an innate tendency involving the somatic body on its way to becoming erogenous body.
Winnicott constantly says that “enough” is good for this process. This way, “not enough” is caused either by deficit, or trauma or through insufficiency in paternal interdiction. On the other hand, excess will be deficit for the infans because it cannot say no and reject the seduction involved. It´s important to separate inaugural seduction, substratum of desire, from that other effect due to deviant pathogenous seduction arising from the substitution of desire by need. As an example of this, Winnicott points out that the food offered in a state of maternal disconnection may distort somatic indicators of need and induce submission. O. Mannoni also deals with these substitutions that introduce the false self and “border” pathologies.
In the constitutive field I called the founding context, the rearing couple (M. Middlemore) unfolds through the subtle and reciprocal search for its own rythms and harmonies, trying to know each other in order to fit relatively well and avoid fusion, making room for that someone who, inhabiting him/herself shall have available his/her own life in a world of incomplete, different and sexed fellow creatures, inhabitants of a cultural and pleasurable world and no longer dangerously “similar”.
It is interesting to let oneself be carried away by some of the questions that arise in clinical experience and in teaching. For example, we have often asked ourselves the reasons for Winnicott´s permanent presence in international analytic production. In my opinion, it is due to his introduction of the concept of the mother´s structuring function and to the relevante he attributes to the qualities of her effective presence and personal reality -in the common sense of the word-, as that other adult of rearing (in J. Laplanche´s terms), and her effective behaviours that bear the primary founding violence and a different degree of secondary violence (P. Aulagnier, “The violence of interpretation”, 1975; R. Z.de Goldstein, (coord.) “Observación psicoanalítica múltiple de bebés”, A.P.A, in 27th, IPAC, Vienna, 71).
I consider that that other conceptually corresponds also with the idea of that specific quality of her “presence as a person” during the short moments of integration in schizoparanoid position, and to what W. Baranger called “the 5th. Object” in relation to M. Klein´s description of the other four objects in schizoparanoid position (W.Baranger, “Posición y objeto en la obra de M. Klein”, Kargieman eds. 1971).
That fifth object deserves development concerning its links -in my view- with the concept of a fellow human-being, as a “similar” this latter related to Freud´s “prehistoric other” of the “unforgettable love”, source of nostalgia.

Somatopsychic birth
When somebody replies to the infans´ desire of encounter, that somebody led a human being to inhabit a body that would eventually be the place where “I live” and from where I can say “I am”. By means of that loving answer, the infans is rescued from falling into and sinking in the primal and throbbing tide of jouissance. The lack of the magic and mediatizing word that anchors and supports images and feelings, accelerates that giving way to madness and un-doing and un-being instead of increasing constitution. The loving word that introduces -as discontinuity- the vital disadjustment between need and desire, always comes from some other definately extraneous (foreign), and so, the language-bath slackens the acceleration. Gap to be crossed in the transitional bridge, wich is constitutive, structuring and alienating. Identity and alienation are inseparable.
It is the hyatus of alterity, effect of that unbridgeable splitting constituting our human condition. The only element the infans has available is a scream, a barely somatic phenomenon that finds some other there ready to answer and to bestow meaning on that first (Freud, “Letter 52”). From then on, that other will be also source and matrix for identificatory referents.
In the specific space of the common asymmetric field that constitutes the founding context, the scream is heard as a demand from somebody to somebody else, and the drive circulates around this unknowable other.And so, meanings begin to be inscribed.
The specific ways of caring of these two lovers wading in their language bath -where the child, “as the parents´ erotic object” is at first passive- delineate and weave a psychosomatic corpus threaded by the mastery the infans aquires -while developing transitional objects and space- over affection and symbol. The infans works and threads, journeys and weaves until it feels itself BEING in the mother´s presence, founding with her a play-field of “first squiggles” in which the parental unconscious brings sense to the nonsense of the unconscious that appears there.
The plot of reciprocal daydreamings darns the gap.The infans may sleep briefly, dreamt by the parents in that common area where the unconscious emerges in each daily squiggle of the rearing couple.
If it sleeps, it dreams. If it dreams, it desires. If it desires, it plays. If it plays, it inhabits its body as soma/vital source in the cultural dimension. The intermediate space, effect of the transitions of paradoxical thinking and shared daydreaming, is assured. There shall be an infans on its way to becoming a child that will soon play with a reel babbling Fort-Da, founding its subjectivity.
The scream and the voice are the voice of the body as erotic soma, the true word -heritage of the concept of true self, mediated by the spontaneous gesture- calling the other. If this heartfelt call fails, , it will become disoriented and tend to “jouissance”, and its resonances in the soma may produce neoerogenizations (R.Z.de Goldstein, Amsterdam 1993) according to J. Mc Dougall.
In this binding, transitional objects and phenomena play the role of anti-trauma.
The increase of anxiety economically threatens to undo the job of binding and inscription, the princeps psychosomatic task, where the psyche registers affection and embodies erogenized soma becoming more and more human.
The drive, as vital somatopsychic trend will permanently impose the psychic work of complexization that insures a good love-hate mixture. It supports together, in a state of unstable “emulsion”, the somatic order as freudian Trieb and the representational order as register of the significant, as symbolic order.
If we recognize the priority of the other - as A. Green and J. Laplanche do- we can ask ourselves several questions concerning narcissism in “Mourning and melancholy”, where Freud says that melancholy´s distinct difference is related to narcissistic object choice. The question would be the following: whose is, initially, these narcissistic choice? whose narcissistic choice towards who? This question implies a radical change of perspective, with important consequences also in pediatrics, rearing and prevention.

The clinic of the Not/Good-Enough Mother
In the healing process, that internal failed object is installed by means of transference. Many authors describe this object as a living dead, “false”, seductive, tormenting, dependent, unfair and unpredictable one. Basically, untrustworthy but “extremely beloved”.
There can be neither surrender nor hope, but there is an eternal temptation to “test” and uncover that object to prove...what? the falsity of this kind of other. Just like that child, the analysand will compulsively try to repeat so as to reencounter the traumatic situation, attempting to unmask it and “justify” remaining enclosed. The baby mistrusts and actively and continuously erases the constant springing of desire of life and bond. A wounding nostalgia and a longing for the love of that “not good-enough other”.
The baby´s intention is to reverse the humiliating situation and to show to that failing other that he “no longer deceives” him. As Winnicott points out, hidden and vaguely hopeful, the baby awaits recognition for the pain and the narcissistic humiliation suffered during those times of essential dependence and helplessness, when the precocious and unpredictable environmental failure took the infans-baby by surprise in its barely begun psychic work.
Splitting and autism came to the babys help in presence of the menacing breakdown, source of unlivable suffering.
Ever since then, each attempt tries to ambivalently revert the situation: going from passivity to domination of the traumatic scene and of that unpredictable other, even at the expense of disregarding the basics of survival, ignoring its body and its need for love, gratification and continuity. It pretends lack of interest while longing to be looked for and compensated through recognition of its suffering, and only then is it able to abandon its hideout, a metaphor for F. Tustin´s shell.
But this hideout/shell involves the infans´ own alienated body to fulfil this function.
Deceived lover, the infans on its way to becoming a baby tries to escape from that condition of fascination of that primitive other by restraining its somatic responses, responses that -just like in any lover- overflow at the mere evocation of the beloved one. The thousands of somatopsychic traces of initial eroticism, already disjointed and foreign, become unleashed, quivering with love and hate, pain and excitement, involved in a tormenting past/present.
Hurt and masochist, humiliated and clever, it will angrily work at the process of disguising and disavowing to mask or absurdly transform the somatic responses of the deceived lover, until its small body, dislocated and imprisoned habitat of the primitive jouissance of the experience of satisfaction turned into passion, finds a pathologic way to “free” itself of the responses chained to the other´s will, master of a slave.
Throughout these events, the infans is no longer a natural unity; the subtle, given predisposition has shattered. From now on it will succeed in knowing nothing more about that body that was neither well loved nor recognized, just used as its parents´ erotic plaything.
Following Winnicott´s ideas, I suggest that the quality and transformations of these first experiences of pain have a decisive role in the quality of the primary defenses.
The Ego, that in those moments of pain should inhibit the course of energy in order to avoid the facilitation produced by displeasure in its search for an effective discharge, will search for another outlet and another sort of discharge. A discharge towards the body´s insides, as a prelude to the uncanny organ language.
Those disturbances appear in the paths of excitement and the incipient “emulsion” between drive and representation -axis of somatopsychic collusion- is affected.
The consequent de-fusion “triggers” a demonic and disoriented drive activity that engenders a variety of (future) clinical manifestations. This pathogenic drive situation self-engenders a deadly monster that acts blindly so as to evade primitive agonies, the eternal instant of representational void.
In an article called ”Ego integration in child development (1962), Winnicott proposes a paradigm that describes the loss of psychosomatic collusion and focuses on the features of primitive agonies. These features are: going to pices, falling forever, having no relations ship to the body, having no orientation. Both Winnicott and M. Klein consider them the stuff of psychotic anxieties.
I would like to stress that all these features refer to the body and to the loss of the specific quality that accompanies the state in which “I” inhabit a body recognized as my own and existing in the space/time dimension.
We know these crises often begin in front of a mirror. Lacan and Winnicott openly agreed over this issue: “integration”, as aquisition of the image and the pronoun me (Moi) completely depends on the infans playing before the mirror and on being looked at/recognized by its mother as an other.
This leads to the consideration of Winnicott´s “Mirror-role of Mother and Family in Child Development” (1967) and the main place etology and psychoanalysis allow to the mirror stage in the constitution of the subject (J. Lacan).

Humpty Dumpty and Holding/Handling
In his article “Psychoses and Child Care” (1952), Winnicott says that becoming lodged within the body is a hazardous adventure for the individual psyche. In the course of this adventure, personality as unity may be exploited or transitorily lost in association to fatigue, lack of sleep or the typical anxieties of other phases of emotional development. Winnicott illustrates this point with Humpty Dumpty, who could finally manage to become one whole thing but whose most outstanding feature is that he is continuously falling from his perch on the wall, since he is no longer lovingly held and is in a position notoriously hazardous to his emotional development, particularily liable of irreversible disintegration.
Psyche inhabits in an unstable way that rough sketch of a still physiological soma tending to dislocation.
Here we find the integrating importance of the other, real, effectively present and acting as that “5th. Object” physically and devotedly supporting and looking at the baby during those constitutive times to avoid precariousness and premature effort. If this maternal psychosomatic suppport should fail, premature effort would be necessary to keep the Ego (Moi) unified and shun the experience of a mangled body illustrated by Humpty Dumpty and the dreadful anxiety that goes with it. This premature effort marks the pathology that shall accompany a subject that will painstakingly search for the unsteady experience of unified Ego.
In “The disciple”, Oscar Wilde offers a version of the myth of Narcissus illustrated by the Stream´s answer to the Oreades that are crying over Narcissus´ death:
- I loved Narcissus because when he bent over my waters and rested his eyes on me, in the mirror of his eyes I saw the reflection of my own beauty. (free translation).
This version shows the pathogenic role of the mother´s narcissistic insufficiencies that lead to the reversion of her regard.
Since she can´t regard the other, she is prisoner of the need of regarding herself in him, and only thus, with “orthopedic” help, can she succeed in being. Pirandello also offered us an unforgettable scene through the son´s answer in an imaginary dialog in front of his dead mother: I don´t weep for your sake, I weep for mine because you are no longer here to “think me” (free translation), stressing the importance of “being thought by the other” while “being looked at” in order to assure psychic stability and Ego constitution. This blend of looking, thinking and feeling is an essential part of the active and constitutive matrix offered by the good-enough other.
Summarizing, we can say that being desired means desiring later on. Being erotized in the first cares means to erotize and self-erotize. Being taken care of, at the proper distance, means to take care of oneself and of others. Being talked to means talking to others and communicating with oneself and with others. Briefly being a transitional erotic plaything is the basis for eroticism and for the ability to play with oneself in a transitional state, with the transitional object and with the other. Being subtly introduced to the illusion/disillusion game is being able to play forever in that space and in my view with the immortal elements of culture. Last of all, being looked at as someone “other” by a sexed “other” is a main axis of Winnicott´s good-enough mother, somatopsychic matrix and embodiement of freudian “extraneous help”.

A vignette: ”He doesn´t know he has it”
Doesn´t he know what he has?... He no longer knows what he has...
While I was working on this presentation, I witnessed a situation where a pathological maternal tendency was played out, allowing us to “observe”, almost in the bud, the possible onset of a disturbance in the child´s somatic register. The following situation took place in a public playground. A toddler on his way to the sandbox tried to run and stumbled over a step, falling to the ground and hitting his forehead rather badly against the stones. His young mother, showing a desired security and expertness, went to him, picked him up and barely patting him passed her hand over his forehead saying: “It´s nothing”. The impact against the stone floor had been considerable, and the little boy cried loudly. However, and curiously enough, after his mother´s intervention he was rapidly attracted to the other children and began playing with them. A few minutes later, the swelling of a bump crossed by a tender scratch worried some of the other mothers present, who were surprised by the young mother´s “bold and carefree” attitude. One of them whispered “Maybe she´s right, but the boy hit the ground hard...”, after a brief silence one of them added “it looks as if she didn´t care”.
The following day they met again in the same playground, and one of them asked the young mother after the little boy and his swollen bump. Unconcernedly and with a touch of selfishness she replied: “He doesn´t know he has it”.
Its quite clear that the little boy knows prefectly well what he has, and that he must not know it. He knows that his mother doesn´t want him to know what he knows and feels in his body, and that she wants him to deny his pain as fast as possible. Maybe because she is in no condition to hold, shelter and calm her son´s anxiety and psychic and somatic pain, or maybe it is because of the unconscious guilts involved in rearing. What is evident is a clear and defense-structuring message: the mother lets the child know that she prefers the pain to disappear, to become non-existent both for her and for him. This no is installed through the mother, marking what must not be taken into account, what must be deleted as knowledge, as pain, and as somatic register.
What the eyes don´t see, the heart won´t feel, as the saying goes.
This is a sad example of the psychobiological helplessness of the infans child vis á vis all sorts of parental violence, a helplessness lasting throughout the whole rearing period ruled by the inevitable dependency from environment and adults.
Of course, there is an enormous amount of observations and clinical material that evidences the functioning of parental and transgenerational commands that attacking perception, -either affecting it by overcharge, excitement and fixation or instilling pathogenic fears- impose the use of splitting modalities such as the illustrated one, and may even be the cause of a certain explotaiton of psychesoma interaction, that may be called schizo-autistic transitional activity that needs to be investigated in current pathologies.

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