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the primary narcissistic state: this state can no longer be regarded as objectless, since virtually any split part of the Ego may be combined with any split part of an object, either external or internal. Freud (1921) had already observed that narcissistic identifications were based upon a single detail of the person unconsciously chosen as a model. His remark about the necessity to mourn every detail of the lost object to complete a real process of mourning (Freud, 1917) enhances the importance of the link created by projective identification, both in object relations and in the feeling of identity. II. A. FURTHER BRITISH AND EUROPEAN CONTRIBUTIONS Influenced by Bion’s development of the concept of projective identification and his model of the development of the capacity for thinking, Esther Bick and Donald Meltzer utilized their experience in the field of infant observation and the clinical treatment of autistic children to discern, delineate and differentiate an even more elemental maneuver, related to but not the same as projective identification. They coined the term adhesive identification (later termed adhesive identity) and differentiated this more primitive defensive operation from projective identification. Esther Bick (1968, 1986) delineated an elemental type of narcissistic identification , which developmentally precedes that which is implied in Klein’s theory of projective identification. She hypothesized that very young babies may initially experience the absence of boundaries sufficiently capable of holding together their mental and emotional contents, not yet completely distinguishable or differentiated from their bodily contents. Bick proposed the notion of a “psychic skin”, which ideally serves to passively bind together the experiences or parts of the nascent self. The development of this “psychic skin” occurs through experiences of continuous interaction between a physically and emotionally “holding” and mentally “containing” mother, and the surface of the infant’s body as a sensory organ . This notion is one which Freud (1923) alluded to when he suggested that “the ego is first and foremost a bodily; it is not merely a surface entity, but is itself the projection of a surface” (p. 26). Bick (1968) further hypothesized that “later, identification with this [psychic skin] function of the object supersedes the unintegrated state and gives rise to the [ph]antasy of internal and external spaces” (p. 484). She forwarded the idea that this phantasy of space is the essential basis for the normal adaptive splitting and projection necessary to the processes of idealization and separation described by Klein. However, Bick warned that “… until the containing function has been introjected, the concept of a space within the self cannot arise … [and] construction of an [internal containing] object … [will be] impaired… 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.” (p 484)
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