ABSTRACT
Kay's story encapsulates the essence of self-harm and murderousness which entails using the body violently to express emotional distress. It is a psychic symptom that is autistic because it appears not be able to be spoken or thought about. The person seems to lack the ability to self-soothe. In my conceptualisation, suicide and self-harm, including dis®guring the body through eating disorders and excessive drinking, are driven by the same impulse. Violence is used to protect against psychic pain. It is a frantic attempt to assuage overwhelming trauma that an individual cannot process. There is a compulsion to act, not think, as tension builds up and the person becomes ¯ooded with feelings. There is an unconscious
dread of falling apart. The torment is linked to early psychic trauma that remains raw and undigested. What is upsetting must be got rid of. This is commonly known as acting out.1 It is as though signal anxiety has gone awry, unable to register a danger signal and make use of suitable defences. The purpose of psychotherapy is to decode the signals and provide an internal container for the digestion of intolerable affects, and for transforming the unthinkable into the thinkable (Bion, 1967).
