（1968）. International Journal of Psycho-Analysis, 49:484-486
The Experience of the Skin in Early Object-Relations
The central theme of this brief communication is concerned with the primal function of the skin of the baby and of its primal objects in relation to the most primitive binding together of parts of the personality not as yet differentiated from parts of the body. It can be most readily studied in psychoanalysis in relation to problems of dependence and separation in the transference.
The thesis is that in its most primitive form the parts of the personality are felt to have no binding force amongst themselves and must therefore be held together in a way that is experienced by them passively, by the skin functioning as a boundary. But this internal function of containing the parts of the self is dependent initially on the introjection of an external object, experienced as capable of fulfilling this function. Later, identification with this function of the object supersedes the unintegrated state and gives rise to the fantasy of internal and external spaces. Only then the stage is set for the operation of primal splitting and idealization of self and object as described by Melanie Klein. Until the containing functions have been introjected, the concept of a space within the self cannot arise. Introjection, i.e. construction of an object in an internal space is therefore impaired.
In its absence, the function of projective identification will necessarily continue unabated and all the confusions of identity attending it will be manifest.
The stage of primal splitting and idealization of self and object can now be seen to rest on this earlier process of containment of self and object by their respective "skins".
The fluctuations in this primal state will be illustrated in case material, from infant observation, in order to show the difference between unintegration as a passive experience of total helplessness, and disintegration through splitting processes as an active defensive operation in the service of development. We are, therefore, from the economic point of view, dealing with situations conducive to catastrophic anxieties in the unintegrated state as compared with the more limited and specific persecutory and depressive ones.
The need for a containing object would seem, in the infantile unintegrated state, to produce a frantic search for an object—a light, a voice, a smell, or other sensual object—which can hold the attention and thereby be experienced, momentarily at least, as holding the parts of the personality together. The optimal object is the nipple in the mouth, together with the holding and talking and familiar smelling mother.
Material will show how this containing object is experienced concretely as a skin. Faulty development of this primal skin function can be seen to result either from defects in the adequacy of the actual object or from fantasy attacks on it, which impair introjection. Disturbance in the primal skin function can lead to a development of a "second-skin" formation through which dependence on the object is replaced by a pseudo independence, by the inappropriate use of certain mental functions, or perhaps innate talents, for the purpose of creating a substitute for this skin container function. The material to follow will give some examples of "second-skin" formation.
Here I can only indicate the types of clinical material upon which these findings are based. My present aim is to open up this topic for a detailed discussion in a later paper.
Infant Observation: BABY ALICE
One year of observation of an immature young mother and her first baby showed a gradual improvement in the "skin-container" function up to twelve weeks. As the mother's tolerance to closeness to the baby increased, so did her need to excite the baby to manifestations of vitality lessen. A consequent diminution of unintegrated states in the baby could be observed. These had been characterized by trembling, sneezing, and disorganized movements. There followed a move to a new house in a still unfinished condition. This disturbed severely the mother's holding capacity and led her to a withdrawal from the baby. She began feeding whilst watching television, or at night in the dark without holding the baby.
This brought a flood of somatic disturbance and an increase of unintegrated states in the baby. Father's illness at that time made matters worse and the mother had to plan to return to work. She began to press the baby into a pseudo-independence, forcing her onto a training-cup, introducing a bouncer during the day, whilst harshly refusing to respond to the crying at night. The mother now returned to an earlier tendency to stimulate the child to aggressive displays which she provoked and admired. The result by six-and-a-half months was a hyperactive and aggressive little girl, whom mother called "a boxer" from her habit of pummelling people's faces. We see here the formation of a muscular type of self-containment—"second-skin" in place of a proper skin container.
Analysis of a Schizophrenic Girl: MARY
Some years of analysis, since age 3½, have enabled us to reconstruct the mental states reflected in the history of her infantile disturbance. The facts are as follows: a difficult birth, early clenching of the nipple but lazy feeding, bottle supplement in the third week but on breast until 11 months, infantile eczema at 4 months and scratching until bleeding, extreme clinging to mother, severe intolerance to waiting for feeds, delayed and atypical development in all areas.
In the analysis, severe intolerance to separation was reflected from the start as in the jaw-clenched systematic tearing and breaking of all materials after the first holiday-break. Utter dependence on the immediate contact could be seen and studied in the unintegrated states of posture and motility on the one hand, and thought and communication on the other, which existed at the beginning of each session, improving during the course, to reappear on leaving. She came in hunched, stiff-jointed, grotesque like a "sack of potatoes" as she later called herself, and emitting an explosive "SSBICK" for "Good morning, Mrs Bick". This "sack of potatoes" seemed in constant danger of spilling out its contents partly due to the continual picking of holes in her skin representing the "sack" skin of the object in which parts of herself, the "potatoes", were contained (projective identification).
Improvement from the hunched posture to an erect one was achieved, along with a lessening of her general total dependence, more through a formation of a second skin based on her own muscularity than on identification with a containing object.
Analysis of an Adult Neurotic Patient
The alternation of two types of experience of self—the "sack of apples" and "the hippopotamus"—could be studied in regard to quality of contact in the transference and experience of separation, both being related to a disturbed feeding period. In the "sack of apples" state, the patient was touchy, vain, in need of constant attention and praise, easily bruised and constantly expecting catastrophe, such as a collapse when getting up from the couch. In the "hippopotamus" state, the patient was aggressive, tyrannical, scathing, and relentless in following his own way. Both states were related to the "second-skin" type of organization, dominated by projective identification. The "hippopotamus" skin, like the "sack" were a reflection of the object's skin inside which he existed, whilst the thin-skinned, easily bruised, apples inside the sack, represented the state of parts of the self which were inside this insensitive object.
Analysis of a Child: JILL
Early in the analysis of a 5-year-old child, whose feeding period had been characterized by anorexia, skincontainer problems presented themselves, as in her constant demand from mother during the first analytic holiday, that her clothes should be firmly fastened, her shoes tightly laced. Later material showed her intense anxiety and need to distinguish herself from toys and dolls, about which she said: "Toys are not like me, they break to pieces and don't get well. They don't have a skin. We have a skin!"
In all patients with disturbed first-skin formation, severe disturbance of the feeding period is indicated by analytic reconstruction, though not always observed by the parents. This faulty skin-formation produces a general fragility in later integration and organizations. It manifests itself in states of unintegration as distinct from regression involving the most basic types of partial or total, unintegration of body, posture, motility, and corresponding functions of mind, particularly communication. The "second skin" phenomenon which replaces first skin integration, manifests itself as either partial or total type of muscular shell or a corresponding verbal muscularity.
Analytic investigation of the second skin phenomenon tends to produce transitory states of unintegration. Only an analysis which perseveres to thorough working-through of the primal dependence on the maternal object can strengthen this underlying fragility. It must be stressed that the containing aspect of the analytic situation resides especially in the setting and is therefore an area where firmness of technique is crucial.