Boundaries

The German psychiatrist Gisela Pankow was impressively adept at intuiting, at a visceral level, and empathically relating to, the experience of her seriously psychotic patients. And her case studies show that, as a clinician, she was able to help many of them find a considerable measure of solace... Her key insight was that, fundamentally, what they laboured under was a distorted perception of their own bodies. They experienced themselves as cleaved, incomplete, disconnected. For her, their hallucinations and their warped perception of the world was merely the consequence of this fateful primary disjointedness: they struggled to discern a clear limit between inside and outside; they reported feeling fragmented - with limbs, organs, whole sections of themselves somehow experienced as free-floating, riven from the rest -, their parts failing to add up to a cohesive whole. And because of this confusion, of this absence of distinct boundaries, all sorts of wild, alarming affects were let loose: anxiety, despair, dread, fury, the feeling of dissolution, of depersonalization, of annihilation… Haphazardly, unfettered emotions seemed to surge through the outlandish bodily wasteland that was their awkward abode - with its alternations of arbitrary concentrations and absences, its erratic tensions, its asperities, its adherences, its discontinuities.

    As a psychoanalyst, she thought that her patients’ predicament must be the result of some profound developmental mishap - of a trauma, of a deep disconnection to the mother (or other primary caretaker) in early childhood. In the context of the treatment, she had both children and adult patients use plasticine to express themselves, to help them explore and integrate the relevant, very primal layers of experience. She made a space for wordless forms, so that raw, inchoate psychological flotsam, which until then had been unable to surface and find expression, might now be revealed and made available to interpretation and assimilation. In this way she could encounter her patients at the place from where she was convinced the trouble must stem: the shadowy depths of their early vital misadventure. The suffering infant had had no words with which to get a handle on experience, and something had halted its normal progression to a fully integrated subjective sense of selfhood, condemning it instead to estrangement, dissociation, and repetition - its trauma not so much repressed as unassimilated and inarticulately entombed in the unconscious.

    There is something of the miraculous in her accounts: an uncanny quality, which might invite caution… But somehow I don’t doubt she really did possess the extraordinary capacity she claims, to reconnect very broken souls with the fullness of life.