Advanced Therapy in Cardiac Surgery by K. Ranco, E. Verrier

By K. Ranco, E. Verrier

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The mother’s intuitive understanding of her infant’s changing bodymind state and her ability to respond appropriately are seen as laying a foundation for adult mental health. This perspective offers a starting point for thinking about the processes likely to be involved in the establishment of a capacity for self-care. The first and most obvious statement to be made is that we are endowed at the beginning of life with a very limited capacity for self-care. We have a will to survive and a potential for self-care, but are dependent on others for both physical and emotional care.

Cashas’ are omnipresent features of ordinary ‘good enough’ self-care. In every society, certain behaviours that regularly lead to injury or damage to health are deemed permissible, a situation that perhaps reflects an What Do We Mean by ‘Self-Harm’? / 31 implicit understanding of the need to offer channels for the expression of aggressive and destructive tendencies. For example, players and spectators accept that certain ball games, for example rugby and football, involve rough physical contact and regular minor injury.

Her parents respond to the ebb and flow of her energy and activity, closely matching their own level of liveliness to that of their daughter. Their sensitivity and respect for Esther’s timing ensure that a potential impingement – being forcibly woken from a sleep – does not become an actual impingement. Winnicott’s work on ‘being’ and ‘continuity of being’ is complementary to his reflections on ‘the psyche indwelling in the soma’ (1970). In his account, overall well-being is absolutely tied in with the provision of an environment that allows the infant to inhabit the psyche–soma with a minimum of disturbance.

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