Illness fantasy and development of insight in a child's analysis

Abstract

The case is presented of a child of 6 years and 10 month-;, who was brought to the analyst because of his nocturnal terror.
Based on the first sessions of treatment, an attempt is made to demonstrate the presence of an “illness phantasy”, in the sense which S. Isaacs gives to the term “phantasy”: an unconscious structure which is composed, on the one hand, of a representation of illness experienced as an entity, as a foreign and harmful body encysted in the person; and on the other hand, the representation of all the relations of the person with this foreign body. This phantasy, evident from the first session, is revealed in a progressively more precise and specific manner, and undergoes structural changes which lead to its transformation into an “analysis phantasy”.
It is admitted that the processus of cure dwells in the insight acquired into this phantasy, and an attempt is made to throw light on one aspect of the psychoanalytic notion of insight. An attempt is made to define wherein lies the productive and integrating quality of insight, and it is considered to correspond to-certain structural modifications in the personality. The acquisition of insight (integrative vision) is understood as a restructuration of the various sectors of the person and of his internal and external experiences. The fact is emphasized that understanding in structural terms implies the dynamic factor of discrimination. Discrimination is what permits the structure to evolve by re - distributing its elements and including new elements, thus placing under the control of the ego an ever-widening field of the psychic reality. The most important stages of this processus of re-integration seem to be: the discrimination between love and hate (insight into the depressive position), the discrimantion between within and without (which allows the ego a more effective handling of the mecanisms of introjection and projection); and the discrimination of the corporal person (integration of the corporal schema).
Finally, some aspects of insight are emphasized which appear to be closely allied to the analytic situation (the transfer), even leaving out of consideration