'I am not crying. I am rubbing my eyes': Annie and the hollow object

This article explores the relationship between the development of severe eczema and asthma in an eight-year-old girl and her difficulties with experiencing psychic pain and conflict. The author focuses on the transference dynamics that preceded and surrounded the psychosomatic reaction in the session. The observations in this case may explain why patients, despite feeling taken over by intense physical sensations, can display flatness and superficiality of affect giving the appearance that they are emotionally `hollow'. The author proposes that these patients experience an emotional sense of emptiness in themselves and in their objects that is the result of a very early defence of dissociation caused by overwhelming anxieties of annihilation that are lived out in and through the body. The appearance of a psychosomatic symptom during the session can follow the emergence of sudden and intense raw hostile feelings towards the primary object, accompanied by a sense of danger and profound anxiety, as the hated object is also desperately needed for the subject's own physical/emotional survival. The analyst can contribute to triggering these episodes by failing to contain the patient's projections, which may lead to the patient feeling forced to re-introject unprocessed and unbearable `psycho-physical'emotions. This article discusses the different degrees - and forms - of symbolic functioning in connection to this girl's experience of her eczema and asthma and their manifestation in the transference relationship to the therapist.