Primal repression: clinical and theoretical aspects.

Primal repression, long an obscure and unusable concept, has been given a precise place in a recent re-working of the theory of repression (Cohen & Kinston, 1984); and this paper specifically examines its properties and presentation. Primal repression refers to an absence of psychic structure which can be made good in the process of emotional growth. It is a part of the mind where trauma persists; and it has a close connexion to the unrepressed unconscious. Direct emergence of primal repression is a threat to life and its activation is therefore risky. During psychoanalysis, primal repression is normally avoided by object-narcissism buttressed by neurotic defences, but it may be reached and worked with in the presence of a non-internalizable valuing and nurturing relationship which we label 'primary relatedness'. This relation is therefore the interactional context for emotional growth. Numerous clinical examples are provided to demonstrate characteristic features of this region of the mind as seen in psychoanalyses. Vignettes illustrate the experiences of patient and analyst as primary relatedness is established; the consequent re-emergence of traumatic states and unmet needs, often initially in the form of severe physical and psychological deterioration; primitive forms of symbolization in the course of repairing primal repression; and the role of action in emotional growth.