CHILD NEUROPSYCHIATRY
BODY SCHEME AND SELF-IMAGE
Dr. Silvana Quattrocchi Montanaro
Our ‘body scheme’ is a representation of our body in space with all its different parts. If we thank of a rotating computer image on a monitor of, say, a car design, then our body scheme is similar – an image at a particular level of consciousness. We use this body scheme continually during our waking hours; at any given moment, we know where all the parts of our body are positioned without having to look at them or look for them. This means that it is possible to start any necessary movement in the right way, using the right muscles, joints and tendons. This is because we are acting on all the information we are acting on all the information we are receiving in a continual input that enables us to know what space our body is occupying and what particular arrangement our limbs and torso and head are in at any moment. Every movement we make on this very full information is ours automatically. How extraordinary to think that without this mental image of our body scheme, that we make use of most of the time without any thought, we would have to make sure we knew where a particular limb or other part of our body was before moving it – by looking for it to make sure we moved it in the direction we wished to.
Prenatal life: Little by little out body scheme is formed through our physical experiences from the beginning of life as a zygote. How does the child in prenatal life receive information about his own body? At two months, the skin of the embryo has ‘receptors’ that transmit information: the growing together of the two halves of the embryo; the amniotic fluid; the umbilical cord; the type of mother’s life. By three months the embryo is complete and enters the foetal stage. There is the self-touching of the foetus. The brain cells are all present by the time the foetus is seven months old. All this information comes together in a body scheme which imprints itself while we are still in utero.
Birth: This moment is important in building the body scheme. Even the passage down the birth canal during the process of birth may be very significant because of the pressure all round the body of the infant at this critical time and the way he is held gently but firmly on his mother after delivery.
Postnatal life: The imprinting that began in the uterus is continued in this symbiotic period, passing through a particularly delicate and crucial phase during the first 6-8 weeks (i.e., the symbiotic period). This is viewed as the ‘zygotic’ period psychologically and is the beginning of the passage from biological to ontological birth. Through the mother’s holding and handling of her child, she aids the integration of psyche and soma, the union of body and mind. In this time things can happen which are imprinted forever, so this period must be taken advantage of and not lost; it is essential to bring about the integration of body and mind in psychosomatic unity so that the foundation for a strong body scheme is laid down.
Then follows the next phase of the period, which is of the psychological ‘embryo’ at approximately 2-4 months of age. If all has gone well in the first few weeks, the child will have integrated well and have a well-separated personality whose natural borderline is extremely well-defined; he is able to deal with the external environment with a clear inside/outside exchange. If there is no clear borderline, then mental disease may be a consequence. The two ‘halves’ of the psychological ‘embryo’ have united, fused and knitted together. Now the child begins to slither, to move in space. Through the holding by the mother (and the father, if possible), the child has achieved a complete, efficient and functioning body scheme.
After 9 months in utero, the child is born, and so also is he, in a sense, after 9 months of postnatal life in the separation that takes place when the child begins to crawl. If all has gone well in the integration of psyche and soma, he will have been given forever the freedom psychologically to go into life as a person who can stay with others without any confusion because the foundations of his personality will have been laid down so securely. Now life can progress with more and more joy, an ever-increasing sureness and confidence using and processing efficiently all the information from the external environment.
It is important to realise how delicate in the making is the body scheme, but once there how impossible it is to change or modify in some way. It is not just held in the psyche but actually forms part of it; if a person loses a limb in later life, he is still aware of the space it once occupied to the extent that he feels it as still existing and is aware even of pain in the non-existent limb (phantom limb).
The more we appreciate the fact of the body scheme, the more careful we will be in our holding and handling of young children, especially the newborn. Like language, we can misuse it in the way we touch the child, patting unnecessarily, like too many extra and useless words. When we rock the child, we should be aware that the child’s point of equilibrium is being upset by the rocking motion,, quite apart from the fact that too much touch, patting and rocking can bring dependencies.
SELF-IMAGE
The self-image is constructed through utilising what comes from the body scheme plus experiences involving the senses of vision and hearing (telereceptors), voluntary movement and social relationships. It is during the 5-8 months period in which the integrated person become more and more separated from human support and other environmental factors. This period is termed objectivation. From now on, this person is an individual with the kind of independence that means that even though he is independent, he remains ‘related’.
What the adults do in their treatment of the child is of fundamental importance and significance. Our person must be present in our self-image, not only with all its parts, but these parts must be in good relationship with each other, and they must be valuable; this comes from what they represent for the ‘others’ because the others are the first mirror in which we see ourselves. It is possible that the personal experiences necessary for the construction of the self-image are manipulated in the environment. Every child wishes to correspond to the expectations of the special adults in his environment. For this reason, the child begins to reduce, or even eliminate, the non-acceptable characteristics he perceives himself to have and to work on and emphasize those he perceives as acceptable characteristics. This is termed adaptation.
In this adaptation, the real true ego can be hidden and an unreal, untrue ego can be shown through the life of the child. Meanwhile, the true ego suffers because it can find no true expression. The different types of personality react differently to the same negative environments; some of us resist much better than others, but we must remember that in this struggle to preserve ourselves, our attention becomes egocentric – inward- rather than outward-looking. We must remember too the basic differences of the various human cultures and habitats. Last, but not least, these structures of our personality can always change at any age if new, positive experiences are provided and, after de-structuralization, a re-structuralization is possible.
