A conversation about early unintegration, disintegration and integration

This paper discusses the beginnings of post-natal psychic life, what constitutes the ordinary state of unintegration in the neonate, the nature of the baby's ego, and the clinical relevance of these questions. It is argued that an infant's state of passive unintegration in which the object functions as a ‘skin' to bind together the parts of the personality is not a normal first stage of development, as Esther Bick suggested, but rather a sign of an aberrant and already disturbed development resulting from trauma; in such a situation, overwhelming primitive anxiety threatens annihilation, or gives rise to terror of catastrophic dispersal of the self, leading to a desperate defence involving a survival fantasy of lying passive in a containing skin. This is contrasted with normal development in which the baby in a state of ordinary unintegration actively searches for an object. This aberrant state of unintegration, and its clinical relevance, is illustrated with reference to a case involving a 12-year-old boy who was mentally broken down at the start of treatment.