HE.S.T.A.F.T.A. - Scientific Society of Mental Health Professionals


  • Sotiris ManolopoulosPsychiatrist-Child Psychiatrist, Psychoanalyst

Translation: Dimitra Michalopoulou

Since the beginning of life a mother presents the world to her child through caring for his body, through her behaviour and words. Slowly the infant builds a sense of self  by looking into his mother’s eyes, listening to her voice, touching and smelling her body. Thus, a subjective world is created out of the external reality which the infant gradually discovers in an objective way, a world that is constantly reviewed, internalized and enriched (Winnicott, 1965).

Initially, the child’s reality is taken care of by the mother who guarantees that the world’s order is gradually introduced in a tolerable way. The mother responds to the child’s needs as well as to the external world through her personal mental process. The mother grafts nature in his joints by being present and absent in a coherent way to the continuity and incontinuity of the child’s rhythm and the external world.

The mother guarantees the child’s psychosomatic integrity. She guarantees that she keeps an eye out for her child (Potamianou, 2001), she will protect him and keep him warm, she will cover him up and she will protect the child’s self-eroticism. And when the child leaves her she will guide him and wrap him up with a delusional cloud, the way Athena did for Ulysses in order to make him invisible to his enemies who conspired against his body image, which is the main imprint that lies in the heart of his identity and certifies that he exists and lives within his body.

The rhythm of the external world and the biological rhythm of his body are coherent within him and they construct the first fraction of experience the repetition of which become the first fractions of meaning. The first fractions of experience are created by primary material such as the heartbeats, the breath, the shift between daylight and darkness, the relaxation and tightening of muscles, hunger and repletion. The infant plays with his body in a self stimulating way by creating and enriching the spontaneous codes, the fractions of experience where he stores data of infinite cyclic time which are at the same time experiences of internal body functions as well as experiences coming from contacting the external world. Even before speech the infant is able to use metaphors that include representations and sensations, thus creating psychosomatic codes of immense capacity. In the deepest folds of the infant’s existence there are silent codes of an accompanying mother-environment who keeps the rhythm, sets the pace and unfolds the thread, the beginning and end of time. In the core of the unconscious a silent substrate is created, a primitive knowledge that takes place before understanding. A living, silent language is created that does not speak. However, this is a language from which every spoken word, every representation and meaning, all noises of live derive. Later on, the child is revitalized by the introduction of play where he draws on those codes, his basic principles, on the substrate of his “basic security” and its innermost folds where his psychosomatic potential and his mother’s intuitive responses meet (Winnicott-1965, Sandler-1960, Denis-1995, Potamianou-2001).

The ancient poets distinguished «αυδή» (the human voice) from «ομφή» (God’s voice), an internal music which becomes the world’s rhythm within us. When someone is injured they remain speechless. The connection between him and his intimate being is interrupted, there is no one to bring back news of himself.

When a child is ill the mother appears to have broken her promises. For the ill child the mother does not only appear to have broken her promises: she is experienced as one who actually broke her promises. Illness is experienced as an insult to the deepest core of his existence. Illness interrupts the flow, the soundtrack of life that flows in a stream of invisible rhythms. Physical illness is experienced as irrational, as meaningless. We remain speechless. What exists beyond memories, emotions, representations, imagination and everything that is part of life?

When psyche approaches reality and touches our shortcomings it faces a violent reality, something that expresses itself with “never again”, “no more”, “it will never be the same”. In the case of a reality such as a physical illness, life itself is threatened with an end. An irrational violence interrupts the thread of continuity. Faced with irrationality, the sick child does what the poet did at the beginning of the world: it creates a meaning out of chaos.

We cannot avoid inventing meaning. Everything that is created to fill the void between our bodies and other people is meaning. Meaning becomes the solution we provide when faced with reality. No one can bear reality completely (Freud, 1927). Meaning is a creative effort to subjectively include the constant changes.

The meaning that is going to be attached to a physical illness depends on that person’s ability to represent, to put everything that he perceives and feels into words. It depends on the gravity of the condition, whether it’s chronic or not, on heredity or the symbolic meaning of the illness and the specific suffering part or the specific function of his suffering body.

Humans can choose to some degree the traumas that will occur to them. Through current identifications one draws on old similar traumatic experiences and thus puts the past within time. An illness can be understood as a chance for fundamental change in life. During an illness a child can regress and get from his parents all the attention that he never had the chance to enjoy until then. It is also a chance for the child to invest his body sexually and acquire meaning.

No one can claim not to recall nostalgically their parents’ care and attention or the satisfaction following their body being taken care of during a stay at home with a bout of flu. Quite often when pathological repetitions bring us to dead ends we regress and run a fever in order to force ourselves to stay at home and rediscover our psyche in its nest—our body.

At the same time no one can forget those endless afternoons during which time seemd to have stopped. During those endless hours a child feels estranged from himself and his thought gets stuck on something tasteless, without play, without the sensitivity and the logic of homecoming. The logic of homecoming lies in the connection between the psyche and the body through the relationship with another human whom the child rediscovers and recognizes as another self  that comes back in order for them to meet again in the in-between area of a common experience.

Despite the necessity of reasonable support, doctors’ updates and reports within the sequence of time and within the reality of space there is always the danger that a threatening tyranny will be established; the one of clocks, dates and the absolute precision of medical instructions that need to be followed to the letter.

Anyone who has nursed for long a beloved ill person knows how hard it is to cope with the flood of perceptions and stimulations until one’s ability to endure strain is being challenged. Who can bear not to count as a person since the ill person’s attention focuses solely on his suffering body? A physical illness may bring an unbearable sorrow and a trauma for a child so the child remains speechless towards what his mind cannot take. Since he cannot understand and does not know he does not have the ability to share his anguish and so violence bursts out as the ultimate defence that protects the body image. When the contract with people surrounding him breaks down, namely that one will be ensuring the other one’s integrity, then the child is overwhelmed with despair.

One feature of trauma is that basic bonds of sameness as well as the concepts of otherness and difference come apart. The child becomes one with his physical illness. In order to keep some distance the child needs to count on someone else, on someone apart from himself in a tortuous mixture of love and hate.

The way the relationship between the child and his parents will develop depends on the relationship they had before the illness as well as on whether the child has a separate body from the body of the mother. It also depends on the position of the child within the generations’ history.

Will the mother recognize what really exists? Will she see in her ill child a threatening monster that illustrates her own ideas about illness? She may wonder, “what have I done for my child as well as a part of me to be punished this way?”. Will she see in his suffering body her own projections? Will she withdraw? Will she act as if nothing has happened? Will she deny her feelings and distress and involve herself instead with painless, daily, commonplace stuff?

Life must go on and the mother should be accepting her child and treating him as normal, treating him like all other children in order to avoid stigma. Will she succeed, however, in becoming a shield, a vigil thought caring for his strain? Will she be able to hold the child’s dependence needs? Will she have the strength of a marathon runner? Or will she slip accepting a masochist position and accepting passively the unreasonable demands with which the child pursues her calling for a narcissistic completeness that no one can provide, no matter how much of an ideal parent they are. Will she become a great martyr and suffer the endless martyrdom of Job?

Parents and children usually interpret illness as some kind of punishment for forbidden, guilt-ridden desires. A mother may feel unbearable guilt and may become a victimizer by persecuting her child and asking him to comply to her suggestions in order to get rid of her guilt. She may also become a victim and submit herself to all his caprices. The father’s role is quite crucial here as he becomes the third person in the relationship between mother and child and vitalizes the mother, thus helping her to stay close to the child.

The mother satisfies the whims of the ill child to a specific degree because in a way she feels she has abandoned and betrayed her child as she hasn’t proved herself capable of protecting it. So the mother tries intuitively to prevent her child from viewing her weakness as a traumatic abandonment with separation anxiety and panic. She satisfies his whims in order to avoid consolidating the consequences of her loss (Winnicott, 1965, Hartocollis, 1998).

The mother may overprotect her child as a way of assuaging her own fears of death. In this case the mother will never accept any effort of the child to become independent. And she cannot provide her child with what is needed, namely meaning to his fears.

Both parents may not be expecting their child to give them a message about how he feels. So the parents perceive intuitively the child as a very young baby and fulfil his needs before they are even expressed. These parents usually invest their child narcistically and become very demanding and unsatisfied. They want their child to succeed in order to fulfil their own needs. Whatever their child does is not enough for them.

Following the first shock of a diagnosed illness the child starts moving towards confinement and he has fantasies of integrating, clasping and containing the other person who stands close to him (Potamianou, 2001). The other person is under his occupation. The child hooks himself and feels distress and anxiety. He tries to avoid losing his bearings and getting lost as if holding on to a board in the middle of the ocean. While developing a controlling relationship with a human being, a relationship with specific boundaries at the same time a traumatic current functions in a splitting way with unrefined stimulations and raw emotions. The person close to the ill child feels himself simultaneously trapped and suffocated and lost in the immensity of the desert. The parent feels like the only person that matters to the child and at the same time abandoned in a cold solitude. Quite often we have the child’s fantasies of fleeing from a suffocating trap and finding himself in an open space where he can breathe freely. A woman who is now in her eighties eats olives with great pleasure and recalls —and firmly believes—that olives once saved her life. When she was young she got ill with typhus and stayed at home for weeks eating only gruel to get well but with no success. Her condition got worse until one day when she secretly took and ate olives from the locker. She felt better at once, and gradually she grew stronger and got well.

According to Winnicott, it is fundamental for the human being to maintain a secret dialogue between the psyche and the body. In each one of us there is the possibility to abandon ourselves to the cyclic flow of the time of self-eroticism. In every new cycle of self-eroticism a new person arrives and introduces something new from reality with his words and actions, and so time flows linearly. At that point a subconscious scene is set, a fantasy which gives meaning to everything a child feels, thinks and repeats. This ability to elaborate on a fantasy substitutes deprivation and makes pleasure possible. If the other person ignores what the child is feeling and is not able to help the child elaborate on it creatively with the help of his fantasy, then all this material becomes threatening in his imagination.

Above all, the child is afraid that he won’t be able to play with somebody else. He fears that he will paralyze. If his body is confined to a greater or lesser degree, he needs to find a way to express his echolalia and echopraxia with the help provided by the creative play that takes place either in hospital or at home. The child is more than his illness (Boura, 1989). He is more than his physical needs. He also needs spiritual food. By food we don’t mean pampering the child, providing mushy, easy solutions and avoiding reality. Food is what makes sense to the child, what takes shape, and builds internally as a representation that satisfies the connection to the self and to the external world. Responding to the human spirit with insight, thought and understanding is equally important to any pharmaceutical or surgery act, any diet or physiotherapy. What matters is satisfying the child’s need to create and speak a symbolic language as a means of communicating with himself and his important others.

Of course his parents cannot intervene medically. However, they can maintain his quality of life. The most cruel maltreatment is to let a child get bored. The immobility enforced by an illness is indeed a very cruel maltreatment. Every child has the need to dance to the music of Fire at Euripides’ Bacchae in order to feel a good sense of fatigue ('κάματόντ' εύκάματον'). He wants to enter the chorus of Aeschylus’ Persians that mourn and respond in the same rhythm to the tweeting “to, to, to…ti, ti, ti”. He wants to join the demonstration, to scream along with the other children “e, e, e…o, o, o.. we will end this war”. Games are not an abstract concept but a set of specific codes (Terzopoulos, 2000).

The ill child needs to find another human being to set his painful experiences into a scene within time. The important thing is that through the syntax of logic (other people’s logic as well as his own secondary processes) he reaches the music of the mind (Rimbaut), its subconscious sources, and liberates creative forces that are trapped in a solid defensive retrenchment. It starts with magical thinking, the deep waves of sound-producing sources, the contour of the prosody of the mother’s voice, art, the play with others. As long as someone does or says something. For the child this is a magical moment; a metaphor recalls the secret association between what he feels and what he thinks (St. Augustine, 1997). And then darkness disperses and light comes in to repel separation anxiety.

Gradually, the child distances himself and looks away from his illness, he de-associates himself (Potamianou, 2001). Through his words he narrates and transforms the experience of the illness into something objective. In order to face the reality of the illness as objectively as possible he needs to achieve the transition from inside to outside, moving from his personal experience towards the objective reality. Thus, he draws together all the scattered pieces into a coherent story of life.

The ill child—every child—cannot think or speak about something unless he first jointly experiences it with someone else in order for this experience to be registered as a mental fact that leaves a trace in the psyche. Someone may feel pain but this does not mean that he can necessarily endure pain. So, what matters is how an individual creates and endures an experience. Nothing can be endured without a community of people who understand one another. We support the other person to create morsels of meaning, to collect his scattered experiences and create a mental geography of adventures and journeys with the object and then to transform these adventures into a story, a narrative. Most of the time, the poems and drawings of ill children are heartbreaking. They try to fit into their work the violent emotions that cannot be thought or processed.

Every time we find an opening or some new information coming from reality we introduce it but we always stand respectfully next to the ill child’s experience. The main thing is to listen without denying the child’s feelings, without trying to make the child forget his mental reality so that he does not know what he knows is painful and is not able to make it known to any other person. How do we listen? How do we learn a foreign language? We do that by accepting, by returning to our roots, by connecting to the innermost aspects of our mother tongue, by being able to fall head over heels in love with someone, by loving the new.

When a child gets ill within the Greek family, usually, relatives and friends gather in circles outside the Intensive Care Unit, in the hall or outside on the road. The noise of life goes by. From time to time somebody speaks, while others stand in silence, thinking. They bring together and compose experiences and memories to make sense of the illness, to view the illness objectively, from a distance. At some point the ill child joins this circle of friends and starts to understand in a more objective way what is going on while attempting to place the experience within time. The child starts thinking that no matter what happens now, things will get better. At every passage the child will be accompanied either by words or silence. In life, the child emerges over and over in the middle of a conversation that has already started.


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ARTICLE 6/ ISSUE 10, April 2017

Α dialogue with voices

Marianna Kefallinou, Psychologist/ HVN, Athens, Greece, Georgia Feliou, Psychotherapist / HVN, Athens, Greece, Lycourgos Karatzaferis, Psychiatrist/Hearing Voices Network (HVN), Athens, Greece
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