Making the Best in a Bad Job: A Psychoanalytic Perspective on Communication with Children and Adolescents with Severe Physical Conditions

Abstract

Ill children/adolescents who suffer from severe organic diseases have to cope with their inner experiences, therapies, and the global burden of the disease. Although sometimes depression, anger, and death anxiety are openly encountered in medical settings, other times they can be partially hidden by a reactive and defensive path. In these scenarios, psychoanalysis is challenged to contribute the best comprehension of the intimate communication, maybe hidden, and the needs of the ill patients to express themselves. The best way a child can talk about himself is through spontaneous creativity. The adult’s task is to facilitate the creation of an empty space and to recognize the child’s mode of communication. There may be intense emotional reactions that the adult has to tolerate to not move the patient towards an over-adaptation. These over-adaptations entail the child being forced to feel good or have fun, thereby causing them to escape from their inner experience. The loss of the child’s reality forms an additional burden to the child. The most valid indicator of this attitude is the ability to not take counterphobic attitudes but to allow the depression to be shared in a contact space between the child’s true self and the perceived environment.

Keywords:

• Physical illness
• psychoanalysis in medical care
• creativity
• oncological disease
• communication
• psychoanalytic approach

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Acknowledgment

The authors would like to thank Raffaello Cortina Editore from Milan (Italy) for permission to reproduce the drawing, originally published in Gamba (1998). Furthermore, they would like to thank Carolyn Habbersett and Diane Youngstrom for their careful reading and copy editing of this paper.

Notes

1 Winnicott, D. W. (1963). Communicating and not communicating leading to a study of certain opposites. In The Maturational Processes and the Facilitating Environment. New York: International Univ. Press, 1965, pp. 179–192.

2 In the reflections presented in this work we refer also to spontaneous clinical material resulting from nonclinical settings: three different competitions, involving pediatric patients hospitalized in the medical centers belonging to the network of the Italian Association of Pediatric Hematology and Oncology (AIEOP), with the support of the Health & Society Programme of GlaxoSmithKline (GSK). The first competition, “Tutti bravi!” [All good ones!] (1996), collected drawings and poems of young patients, providing a small gift for all of the participants. The second, called “Favole, Favole” [Fables, Fables] (2001), asked for spontaneous fairy tales. The last one, “Oggi comando io” [Today I’m in charge] (2003), asked for a free composition, from the prompt “to be the head for a day,” even from an omnipotent position. To our knowledge, these drawings, poems, or stories were not intended to be used as a mean to start a dialogue between the patients who produced them and a healthcare professional or caregiver. Both the drawings and the free compositions have been commented on by Gamba (respectively 1998 & 2003). Alongside these material from nonclinical settings, two proper psychotherapeutic situations are discussed.

3 ‘INNAMORTO’ is an invented Italian word combining the notions of being in love (innamor-a-to) and being in death (innamor-to). In capital letters is the original spelling.

4 One of the authors (AG) saw the parents and supervised the work of the therapist (Dr. Luca Pasquarelli) treating the child.

5 Winnicott (1953, 1967) defines the transitional object as representing a bridge between inside and outside, me and not-me, or even—in Bollas’ (1987) understanding—known and unknown. Here we propose a slightly different definition: a point of intersection between inside and outside. According to our reading, Alberto’s drawing of the ‘Martian mouse’ or Stefano’s body containing both human and robotic parts represent a symbol-object that merges the conscious parts of Alberto/Stefano with an external character, a bearer of parts of himself (without these being explicitly recognized or interpreted). See also the Teddy puppet mentioned by Hinton (1980) and Ogden’s (2018) work on the feeling of real.

Additional information

Notes on contributors

Alberto Stefana

Alberta Stefana, PsyD, PhD, is a postdoctoral researcher in the Department of Brain and Behavioral Sciences at the University of Pavia in Italy and a psychotherapist in private practice in Brescia, Italy. Alessio Gamba, PsyD is in private practice Monza, Italy.

Alessio Gamba

Alberta Stefana, PsyD, PhD, is a postdoctoral researcher in the Department of Brain and Behavioral Sciences at the University of Pavia in Italy and a psychotherapist in private practice in Brescia, Italy. Alessio Gamba, PsyD is in private practice Monza, Italy.