The alteration of the sensory consciousness of the Self in children with developmental disorders. A preliminary study. O. Orsini*, D. Montanaro**, A. Bernardini *** *Neurodevelopmental Disorders Therapist,** Health psychologist and psychoterapist, ***Clinical psychologist of development
Background and Aims During the first year of life the infant constantly receives complex sensory input from the human and non-human environment that are fundamental to sustain and to develop their physiological nervous maturity. This interaction allows the infant to define properly sensorimotor representations of the body that direct actions without awareness, and contemporary to develop a dynamic “inner image” ¹¯² of their body and their person. According to Massimo Fagioli¹, at birth the absolute stimulus constituted by light evokes the emergence of what Fagioli called “Disappearance Fantasy” (Fantasia di Sparizione), a physiological reaction of defense through which the sensory stimuli arriving from the non-human environment are mentally cancelled. This event causes cortex activation and simultaneously a specific human thinking activity called “Capability to Imagine” that is the capability to form mental images¹¯³. This capability consents to transform the merely biological experiences of the previous foetal state, through the activation of the somatosensory cortex into mental contents and, specifically, into a first “internal image” of itself and its body created by a memory of the sensation had through the cutaneous contact between the foetus and the amniotic fluid. The memory of this prepsychic libidinal experience of homeostatic sensations and complete correspondence, constitutes a “Primal-Self”. The latter is not only the “sense of oneself” but, contemporary, an intuition-hope that another human being exists and can relate to him or her, assuring their need to survive and to develop, together with the possibility to recreate homeostatic sensations and good feelings in human relationships. Somatic experiences are constantly integrated wit impulses coming from environment integrating proprioceptive, vestibular, tactile and visual signals and are considered at the core of an intrinsic form of self awareness and sense of selfhood⁴. What is perceived and experienced in an affective and sensorial base in human relationship consents the infant to form progressively more complex mental body representations as a result of a global memory of emotional experiences⁵. According to Fagioli’s theorization, the adult that responds constantly and correctly not only to physiological needs of body development of the infant, but also to the specific demands of psychological development, will consent to evolve the capability to imagine that emerges at birth, in a fantasy that, at about ten months of life, will permit the infant to draw mentally a line around his/her face reflected in the mirror. Hence, the infant can delineate a picture of him-/herself that is not a reproduction of a conscious figure seen before, but an image-idea of him-/herself based on their sensitivity present at birth and developed through a responsive relationship⁶. The capability of the infant to recognize their self picturing mentally their face reflected in the mirror, allows a higher level of awareness, a conscious knowledge of their self emerging from sensitivity that will enhance with the development of spoken language. Nonetheless if the caregiver does not respond, the growth of the infant proceeds differently. The caregiver who has not expanded their human reality during their lifetime and has lost their affections for disillusions experienced in human relationships, could be unable to respond to neonatal requests moving from lacking responses to the relationships requirements, to an incapacity to meet the physiological needs. According to Fagioli, the mental reaction of the infant to caregivers disillusions is a defense response aimed to cancel, this time, the psychic reality of a human environment perceived as violent because non-responsive. Along with the progressive disappearance, provoked by the “Annulment Pulsion” (Pulsione di Annullamento), of an image of a human reality that can respond, the image of ‘itself in relationship with’ becomes less solid and, coincidently, the memory of the sensations had through the contact between fetal skin and amniotic fluid ‘weaken’⁷. Consequently the infant loses gradually interrelation and intrapsychic sensitivity, until the loss of body sensitivity, which would permit him/her to feel their self and to recognize him/herself drawing mentally their face reflected in the mirror. Body representations result damaged in their mental configuration and could determine an altered perception of the body scheme. These difficulties, indissolubly linked to difficulties to realize a sensitive contact with human beings and understand them, are in Fagioli’s theorization produced by a loss of affectivity. In the following single case study, we hypothesize that the child's developmental disharmonies were the consequence of an alteration of the non-conscious dynamics of relationship in response to caregivers insensitive to her needs, which damaged the "internal image of the Self " as conceptualized in Massimo Fagioli’s theory, and consequently altered the perception of the body scheme considered, according with literature, as sensorimotor representations of the body that lead actions without awareness or conscious monitoring⁸¯⁹. Method This study examines the factors at the base of a developmental alteration in a 5 year-old girl with a “Mixed Developmental Disorder” who underwent neuro-psychomotor treatment. The treatment is based on a responsive and attentive relationship in which the child can gradually recreate the image of herself and her body. An intervention ‘based on the relationship’ provides the conditions for the child to recreate the first year of life without spoken language consenting the development of her psychophysical sensitivity and her internal image. We have used the follow qualitative tools to stimulate the child and progressively evaluate her response in her ability and in relationship methods: games, graphic activity, denomination and recognition of the parts of the body, recognition of the image reflected in the mirror, observation of motor and sensorimotor skills. Concurrently with a parenting orientation treatment. Case Report J. at the age of 58 months underwent neuro-psychomotor evaluation for related difficulty of attention and tendency to isolation reported by the kindergarten. At the age of 4 months she was diagnosed with congenital dysplasia of the left hip, resulting in pelvic-podalic plaster until the age of 17 months. At 24 months she started to deambulate autonomously. At 78 months she was diagnosed with “Mixed specific developmental disorders” F-83 (ICD-10). Negative genetic studies carried out (Karyotype CGH Array). Final evaluation Mid-term Evaluation 1: Mid-term Evaluation 2: During three months of treatment a valid relationship The child begun to recognize the parts of her body, and The child achieved the ability to be more competent and Initial Assessment: adequate in motor performance. was built with the child, based on a constant effort to in particular the lower limbs, after another 4 months of -Visual contact almost completely absent stop her attempts to make herself disappear. For this therapy, contemporary she reduced the body distance She was proactive in the activities to share and accepted all -Constant physical distance purpose activities were used aimed to develop her body with the therapist and became able to keep visual the variables introduced, demonstrating an adequate level -Disinterest in activity and a few moments of sharing of collaboration and attention; awareness and sensitivity through the recognition of contact. -Marked inattention. -Unstable equilibrium and motor obstacle: no rolling or body signals, which gradually produced the first The treatment proceeded using activities aimed to The visual contact was finally present. The graphical representations appeared to be richer in develop in the child an “inner image” of her body, such significant changes. (FIG 2) Fig 2 walking on all fours (crawling). J. has acquired the motor as: story telling, games involving the body movements, in elements and more varied, the child was able to represent -Simple and repetitive games, narrow interests. pattern of crawling and new scenes and figures and to insert spontaneously details which the ‘fantasy’ is an essential element. (FIG. 3) -She managed to recognize only some parts of the body rolling and, at the same into the drawing of the human figure, such as: the body, as the head, eyes, hands and hair, both with herself and Fig 3 time, begun to be the pupils, the ears, the hair and the lashes. J. was able with the doll but refused recognition with the clinician . After one year of therapy J. interested in graphic through her increased sensitivity to realize and -No interest in spontaneous graphic activity. begun to have awareness of activity inserting progressively define a deep-seated image of her body and During the observation of the spontaneous game J. her body and the bodies of elements in a drawing her person recognizing herself in the mirror. (FIG 4) repeatedly sought to conceal herself and her body, others, but she was still not representing the human able to recognize her image in putting herself in a supine and motionless position figure, deriving from her the mirror . under a rug that sometimes covered her entirely in an own body experiences. attempt to disappear. Furthermore J. did not recognize her image reflected in the mirror: to the question "J. Parenting orientation observations Fig 4 what do you see in the mirror?" She answered Contemporary to J.’s treatment a parenting orientation was conducted. The most significant aspect that emerged in "J. What do you see in the "Nothing." (FIG. 1) Fig 1
At this time J. produced stylized, repetitive forms without precise identification and refused to graphically represent the human figure.
the meetings was the poor ability of the mother to recognize and respond to the psychic needs of her daughter, especially during the first year of life. The father had delegated the care of Jasmine to his wife. The psycho-physical stimulation given to the child in the first years of life was poor in affective content. The restriction in movements was due to caregivers that did not allow J. to explore proactively the environment and that considered her disability as an exclusively physical problem, and were not aware of the psychological difficulties that they had in the relationship methods with their daughter.
mirror?" Jasmine! " And what are they? " Jasmin's eyes. " "And how are they?" Beautiful! " "And what color are they?" "Blue" "And what's inside?" "The sea"
Discussion/Results and Conclusions The treatment that lasted for 18 months produced significant changes that regarded the mental configuration of the girl’s body representations that had been initially compromised. The improvements in mobility and in graphic activity, together with the acquisition of the capacity to recognize her own image in the mirror, and a significant overcoming of a relational isolation seem to indicate that J. has recovered a physiological development of nervous maturity integrated with a proper definition of sensorimotor representation of the body, through treatment aimed to recover an unimpaired “internal image” of herself. The clinical results obtained seems to corroborate the hypothesis that an intervention aimed to reconstruct an image of an intact Self, can modify developmental disorders that damage the body scheme and psycho-motor competences. These results encourage successive controls of the interpretative hypothesis about “Mixed Specific Developmental Disorders” proposed in this paper with further studies. Sources ¹ Fagioli M. (2017) Istinto di morte e conoscenza [Death Instinct and Knowledge] (14 th ed. ). Rome, L’Asino d’Oro. ² Fagioli M. (07 May, 2016), La mano del poeta che crea la scrittura è fantasia [The hand of the poet that creates writing is fantasy], Left, 64-65. ³ Fagioli M (2009),. Vorstellungvermogen [Capability to Imagine], in Left 2006, Roma, L’Asino d’Oro. ⁴ Damasio, A.R. (1999). The Feeling of What Happens: Body and Emotion in the Making of Consiousness. San Diego, Harcourt (trad.it. Emozione e coscienza, Milano, Adelphi, 2000). ⁵ Gentsch, A., Crucianelli, L., Jenkinson, P., Fotopoulou, A., (2016). The Touched Self: Affective Touch and Body Awareness in Healt and Disease. In Olausson H., Wessberg J., Morrison I., Mc Glone F. (eds) Affective Touch and the Neurophysiology of CT Afferents. (355-348). New York, Springer. ⁶ Fagioli, M. (2017). Left 2014. Rome, L‘Asino d‘Oro. ⁷ Fagioli, Unpublished raw data, 2015, cit. in Atzori E. (2018, March): The alteration of the sensory consciousness of the Self as a trigger mechanism determining binge in Eating Disorders. A comparison between two single case studies. E-Poster presented at EPA 2018, 26 th European Congress of Psychiatry, Nice. ⁸ Marshall, P.J., Meltzoff, A.N. (2015), Body maps in the infant brain, Trends in cognitive science, Vol 19, No 9. ⁹ Costantino L. (2003), La ricerca di un0immagine, Napoli, Liguori.
Acknowledgments: Thanks to dr. Emanuela Atzori and Julien Bowden-Smith for english translation
Correspondance to: orsiniombretta@gmail.com Copyright © 2019
English excerpt, publishing rights are available in countries out of Italy
Journal of psychiatry and psychoterapy based on Human Birth Theory