International Congress Series 1286 (2006) 81 86

www.ics-elsevier.com

Early traumas in psychosomatic patients:

Splitting and integration
S. Manolopoulos *
Kolokotroni 24, 145 62 Kifisia, Athens, Greece

Abstract. This presentation was based on clinical experiences with psychosomatic dialogues as
these were articulated in psychoanalytic therapy. For Winnicott, a psychosomatic disorder is also a
psychosomatic link. It implies the hope that primary psychic processes, the dialogues between
psyche and soma, will be resumed. In our cases, the coexistence of repressions and splitting was
matched with two psychic currents: the work of unconscious transformations, and the repetition
compulsions of traumas. We focused on splitting and integration processes in cases of preverbal early
traumas, using the clinical thinking of Winnicott. The psychoanalyst is prepared to wait respecting
the splitting as long as it is necessary for the synthesizing function of the ego to resume the processes
of integration. The psychoanalyst assumes a function that resembles mothers dprimary maternal
preoccupationT. This approach is based on the hypothesis that psychic processes begin with the
imaginative elaboration of body sensations, excitations, and functions: it transforms them into
images, it renders them suitable for psychic life. It is the psychic economy of the object that
intervenes in the management of body-drive excitations. D 2005 Elsevier B.V. All rights reserved.
Keywords: Early trauma; Splitting; Integration; Psychosomatic; Transference repetition; Construction

Winnicott [15] studied psychosomatic disorders in the context of his research on

trauma and primitive emotional development. In psychoneuroses, he said, the relationship
between somatic symptom and psychic conflict is maintained. In contrast, psychosomatic
disorders are maintained with a splitting between body and psyche. In the face of a threat
of revival of an early trauma, and in order to avoid psychotic fusion with the primary
object, the egowith splittingscontrols the circulation of unconscious productions.

* Tel.: +30 210 8088951; fax: +30 210 8088951.

E-mail address: sotman15@otenet.gr.
0531-5131/ D 2005 Elsevier B.V. All rights reserved.
doi:10.1016/j.ics.2005.09.053

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Experience shows that splitting is accompanied by a clinging of psychic contents on

external reality and somatic states. Winnicott [2] and Rousillon [6] suppose that these
externalisations include tracespositive and negativeof fragments of internal and
external reality active at the moments of primary trauma when they were split off.
These traces are activated in the transference reproducing the trauma or the counterinvestments against it. In extreme cases, an ego assures its survival by cutting off his
subjective experiences [6]. The affective continuity, the mutual subjectivity between infant
and mother, is interrupted.
Starting from Winnicotts position that there is no baby without his mother, Green [7]
concludes that no narration on the affective life can be maintained if it does not include the
mothers affects and her tolerance to her childs regressive needs, a necessary condition for
the formation of a core of affective continuity. The knowledge and investment of the ego
and the object go together. The relationship between body and psyche is made up of a
commentary of meanings that the drives gather on their way to the object. This
commentary is silenced in post-traumatic states.
A reaction to early traumas is that primary affective experiences are frozen by the ego
that avoids traumatisation by taking out the flesh of excitations. It immortalisestakes
death out ofthings, by taking out their life. He does not invest his body autoerotically, but
perceives it as a piece of flesh. The patient does not have the path to find his inner
experiences following his wishes for the object. An object threatening the integrity of the
ego obstructs this route that the ego avoids [8]. Because of early loss of object, the drives
remain pact in their somatic sources, like Ariel was before Prospero freed him from his
captivity in a tree. The patient speaks with an affect-less wooden discourse and not as the
subject of his wishes.
The most studied junctures of psychic maps where traces are constantly rearranged are
repressions governing the dynamic unconscious and splittings that organise repetitions of
traumas that have not been elaborated. We assume that splittings are curved on traces of
states of non-integration that start the processes of differentiation of space and time. The
splitting between body and psyche is a splitting in the ego, the organ of integration. It is a
way of functioning and of organisation in which two contradictory attitudes coexist in the
ego: the ego simultaneously recognises and denies a perception (of lack and difference)
that causes the terror of retraumatisation.
Brook [9] noted that Freud spoke descriptively about separations and divisions [1014].
Splitting became a conceptual tool for psychoanalysis when it was discovered in the ego
[7,15,16]. Splitting coexists with repressions. What is important for the diagnosis is how it
organises the psyche [8,1821].
Splitting keeps contents inside the psychic space but outside the jurisdiction of the
subject. The patient retains his individual organisation and avoids confusion. Because
some investments and withdrawal happen simultaneously, the successive investment of
perceptions and representations are obstructed. The time is not divided in dbefore and
afterT and the ego cannot construct a meaning dapre`s coupT and place the experiences in the
subjective history. With splitting, the present part of the ego is rendered not qualified, and
not responsible, to participate in the becoming of things while the interested part of the ego
(to whom it may concern) is made absent. The subjective experience vanishes in the void
of this absence. Splitting, however, allows some lines of communication between

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83

withdrawal and investments of the object, and associationspoorbetween representations

are made.
The discovery of splitting leads us to think the distortions that the ego brings on its
organisation in the face of the threat of traumatic excitations [8]. Splitting is not a
compromise formation but it is an anti-process and anti-dialectical mode of organisation.
The ego bases its simultaneous recognition and non-recognition [negative knowledge,
K., disavowal) on omnipotence. With attacks on links, the ego keeps the idealisation
union with primary objectintact and avoids knowledge [21]. Green [8] spoke about those
patients who do not take the risk of investing the object, and in the process lose their own
desires. This is a false self that organiseswith splittingthe calming-down of the desires
[2]. The ego conforms to the wishes of the object with a kind of preverbal honesty and
naivete. They do not have the timelessness of the unconscious (the potentially present
capacity to reinvest the traces) but repetitions in which time is denied (killed).
When a return of split-off material is allowed, the ego falls into time holestime trips,
flashbacks, dreams within dreams, endless documentaries of complaints, the monotonous
sufferings of Jobin which the ego attempts to restore infinite cyclical time (timeless
unconscious) in the linear time of secondary processes.
In psychosomatic patients, we often have a pathological mourning [22] in which the
splitting corresponds to a substitution of a lost object that happens simultaneously with the
denial of the loss. This splitting does not allow time to go on as an experience of going on
being. Primary experiences and affects are alienated [23]. Then in analysis we need to
speak for those who no longer speak.
In analysis, we try to create the best possible conditions for the functioning of the ego.
First of all, we create a kind of basic transference relationship by working with modes of
functioning and ways of psychic organisation, and not with contents that have been split
off. We gradually introduce elements of otherness with the method of doptimal seductionT,
and set in motion a living process of playing with metaphors, stimulating exchanges of
associations between word and thing representations, reinforcing a morphological
regression that enables the patient to invest his psychic work and productions [24].
The patients ego stages de-realised contents as shared experiences. On the threads of
transferencemade of traces recovered and constructed in the analytic encounterwe
weave fragments of trauma, hosting them in libidinal conflicts and fantasies. The analyst
gathers split-off contents on the basis of a grain of historical truth, which he includes in a
construction with which he gives the contents a position to be accessed and linked within
the context of a fantasy. Psychosomatic patients do not need to lift the repression in order
to remember. They need to have mutative moments in the transitional space in which
contradictory attitudes are bridged.
The analytic couple co-constructs the meaning of their encounter on the scenes of
transference of wishes and repetitions. When, in analysis, we put feelings into words, we
also include the split-off elements of trauma and in this way we transform them into text
messages. We weave the traumas into a scenario of loss of object and thus give space and
time to them to be historicised [25].
In order to respond to these primitive emotional experiences, the analyst functions with
primary maternal preoccupation [2]. He responds to the needs of the ego to manage, and
represent, unthought and unthinkable traumatic excitations presented in a transference

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repetition, that is, a formation of units of meaning that search for a fantasy that will
authorise them as suitable for psychic exchanges. In the face of an immobilised life, the
analyst keeps his thinking alive.
The constructions give life to a history condensed in a fragment of a trauma. The sense
of conviction conveyed by constructions resonates with the timeliness and actuality of the
transference, the externality and actuality of the transitional phenomena and the
inevitability and actuality of trauma. What is actual in these formations is the core of a
perceptual trace that has not been elaborated and remains exciting, around which a psychic
form is woven. The actuality of the exciting traumatic element gives a sense of conviction
to a de-realised discourse.
This actuality is evident in a good theater that is convincingly life-like. The same is true
for psychotherapy Winnicott said. Parsons [26] wrote about the spatula game. dThe infant
pretends to be really feeding the grown-ups; their part is to make the pretence real too, by
pretending to be fed. But if they take the spatula into their mouths and really try to feed
from it they spoil the game. The feeding can be treated as real provided it is not really
treated as realT. The psychosomatic patients begin to play this das ifT game, when the line
of perceptual actuality is transformed into a limit separating and linking reality and fantasy.
Superego aids this function.
Following this line of thought, we can say that construction is an act of faith. The
fantasy plot of a construction makes the events of a repetition real. The psychic work
makes them believable. We believe in psychic work with a sense of freedom, creativity
and democracy of circulation of exchanges of unconscious productions. A common
element in freedom, creativity and democracy is persuasion via language.
The constructions do not concern only the past but also what emerges in the
transference. Elements of trauma find in the transference a set of objects, a scene, a
situation, a chain of events, proofs and exhibits, to be connected. Psychic events are made
in the context of historicity that is determined by traces ordered according to wishes and
repetitions. In cases where traces have vanished, we construct events and their historical
time out of nothing. With constructions we find a grain of historical truth. We do not find
the truth of the events. The events find a history. The historicity makes the truth, not the
reverse. A myth-history (fiction) makes the event real and not the reverse. The elements of
experience are registered in an event because they gather meaning from related elements of
that epoch. The fact that they were split means that they lost the historicity of their epoch.
This is what we restore with our constructions.
The question we are examining is how the object intervenes so that we can achieve the
reductions of splittings that are by definition dtherapyT against the agonies. We know that,
in life, verbal and preverbal metaphors constitute a scene, a stage, on which the
preconscious constructs its junctures. In analysis, this work is done by the analytic
constructions that bridge representations and affects with split-off contents in order to
become exchangeable. Sensations, perceptions, traces of thinking, vestiges of history, are
placed on a scene, on the plot of a fantasy, where they are phrased, couched, framed.
Moments of experience are realised and links between before and after are constructed, so
that we can formulate a cause that is by definition placed in the past. We take pleasure in
the making of meaning, in having internalexternal exchanges and composing links that
support experiences of satisfaction.

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85

The Id undertakes instinctual drives that find their psychic expression in unknown
forms on an unknown foundation [14]. We know that one component of this foundation is
the autoeroticism on which psychosomatic integration depends. In autoeroticism, linear
timespace is not possible. We have cyclical time in which mother and infant develop a
dialogue with successive mirroring, distancing and turning towards the self so that
primary symbolisations and condensations are created. Rhythms of the world and the
body resonate with each other and make islands of experience, from where we begin
adventures towards objects. Primary experiences are created from primary material, that
is, heartbeats, breathing, alternation between day and night, sleep and waking, hunger and
satiation, relaxation and constriction of muscles. The infant stores autoerotic data in
infinite cyclical time made of simultaneous sensations of the body and contacts with the
world, where pleasure is generated with the rhythm of changes of tension [17,27]. The
maternal ministrationsas a kind of preverbal metaphorscondense material of representations and sensations in somato-psychic codes of inconceivable capacity. In his inner core,
the infant creates a primitivebefore the meaningknowledge, a silent language, a
musicality, from where the spoken language and the representations emerge [27,28].
Primary experiences with the mother constitute an invisible sponsor guaranteeing the
subjectobject links.
Let me borrow from the ancient poets a metaphor of this fundamental background of
interactions between mother and infant. The poets distinguished between Omphe (OAB
,
the silent voice of the gods inside us) and Aude (Ary
, the human speech). They linked
Omphe with the music and the rhythm that are inherent properties of nature. Omphe is the
rhythm of the world inside us. It is the silent background, the soundtrack of psyche, made
of autoerotic material.
Summary
The presented thoughts stemmed from the study of cases with pre-verbal traumas and
psychosomatic disorders. The study of these cases was carried out in comparison with
neurotic organisations which had suffered secondary traumas that had been represented and
repressed. In psychosomatic patients, the agonies of breakdown and the efforts towards
symbolisation were discussed on the basis of theories that study the splitting between body
and psyche as an organisation that avoids the psychotic fusion with the primary mother. The
question is how we bring split-off material to the transference relationship for elaboration.
Contents that have not been elaborated are brought via repetitions, but are not accessible by
the subject because of the splitting. Patients with psychosomatic organisation do not need to
remember after the lifting of repression. They need to live moments of transformation in the
transitional space. Our clinical cases showed to us that we should study together the two
completely different psychic junctures, repression and splitting. On the preconsciouson
the scene of fantasies and dreamsthe analytic couple realises the work of staging of
unconscious productions and repetitions of early traumatic experiences. The resonance
between transference and countertransference is the field where the analytic couple coconstructs the analytic object, the meaning of their encounter. They stage repetitions and
fantasies that reproduce and interpret the early traumas. The role of historicity,
constructions and metaphors was also briefly discussed in the paper. Finally, we touched

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on primary symbolisationscodes of autoeroticism, musicality of primary experiences

from where the speaking language and the representations emerge.
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