Carla's panic attacks: insight and transformation. What comes out of the 'cracks'--monsters or nascent thoughts?

The author gives an account of the analysis of a young woman suffering from severe panic attacks. He describes the initial problems of the setting and how they are progressively overcome, the emergence of highly structured psychotic nuclei and the gradual approach to the patient's splits. Whereas the panic attacks were originally attributed to the shattering of the symbiotic link, the author shows how they increasingly prove to be bound up with the activation of uncontainable emotions of hate, jealousy and anger, by which the patient feels flooded and overwhelmed, and which are evacuated in the panic attacks until it becomes possible to metabolise them, transform them and make them thinkable, at first in the here and now of the sessions and later through the discovery of the infantile roots both of their virulence and of the deficiency of the parental capacity for containment. These primitive emotions often appear in the form of 'characters' that represent split-off parts of the patient. The author shows how a significant dream about monsters emerging from cracks actually ushers in the ability to think. The paper concludes with a description of the theoretical model underlying the clinical work, which is based on Bion's idea of the transformation of protoemotions into thoughts and on Baranger & Baranger's concept of the field.