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Infant observation has long been considered an important training exercise for child psychotherapists and for psychoanalysts (Bick, 1964). This has led to certain theoretical developments commonly associated with the work of Esther Bick (1968, 1986).

Bick began this work in 1948, shortly after Melanie Klein had described the paranoid-schizoid position. In Klein's view of the paranoid-schizoid position, the ego has a primary sense of a boundary between itself and the external world. Bick described a variant of this process, in which boundary of the ego is not primary, but comes from the sensations arising from skin contact. Sufficient skin sensations are necessary to give the experience of a boundary.

One of the processes she noticed interpersonally was that the breaking of skin contact appeared to be experienced by the infant as a hole from which it could leak. She noticed the frequency with which infants become incontinent of excreta, as well as loosing tears from the eyes, and screams from the mouth. She believed she was watching just that process which Klein had described as the disintegration of the ego in the early stages after birth. The fragmentation takes the form of an experience of leaking into empty space.

Bick described various methods by which the infant seemed to operate to plug that leaky gap. It might grasp with the mouth so that literally the hole is filled. Alternatively the hands may grasp as the mouth does; or more distantly the eyes may become fixed upon a point of light or some discrete object, as if clinging like the clenched hands. In addition the infant may fix aurally upon sounds, including the sound of its own crying. These processes of filling, grasping, fixing, and hanging on represent a method of completing a boundary. However, the mother's contact with the baby's skin remains the most potent, and perhaps natural, means of completing the boundary.

The theoretical ideas concerning the skin are related to the notion of the "skin egos" developed by Didier Anzieu (1985) and Pierre M. Turquet's "skin-my-neighbor" (1975).

Bick's view was that the boundary between ego and external world was first of all a phenomenon of the body ego, and specifically the skin. Also, it is not a given structure at the outset of life, but instead has to be achieved through the experience of the mother "giving" the infant a sense of being enveloped, through the mother's innate understanding of the baby's need for skin contact. Thus the primary object that stabilizes the ego is not Klein's good internal object internalized inside the ego boundaries, but is the ego boundary itself. The skin is thus a bodily component of the stability of the ego, and it is gained passively, at first, from the external object (mother).

Bick thought she was extending Klein's theories, by displaying a psychic level prior to and beneath Klein's paranoid-schizoid position. However, this has not been generally accepted.

ROBERT D. HINSHELWOOD

See also: Adhesive identification; Child analysis; Good-enough mother; Infant observation (direct); Lebovici, Serge Sindel Charles; Processes of development; Symbiosis/symbiotic relation.