"I want to be all gone". Psychoanalysis of a three-year-old failure-to-thrive child.

A three-year-old child said to me, "I want to be all gone." Because this very young child had the capacity to talk about and demonstrate her internal world, this case offered the opportunity to explore both her life-threatening symptoms and the underlying psychological conditions that informed these symptoms. This clinical paper explores aspects of her treatment.DO YOU HAVE A KITCHEN IN THIS PLACE?"DO YOU HAVE A KITCHEN IN THIS PLACE?" GAZING STEADILY AT ME, these were the first words that Anna, age two years, ten months, spoke in the waiting room. I had knelt down on the floor to greet her, feeling a sense of impossible distance between me and this tiny, thirty-one-inch, eighteen-pound, skeletal-looking child, her distended belly protruding from the baby clothes she wore. Dismayed at first sight of her, I thought that this child could die, but then felt hopeful with the directness of her communication. I answered, "Yes. I have a kitchen."When I invited her into the playroom, Anna separated from her mother easily and accompanied me. Despite her emaciated state, she was alert and vigorous. She gazed silently around the room, looked at the toys, and chose two dolls. One was a baby doll and the other more toddlerlike in appearance. Hesitantly she asked about their baby bottles. "Are they real? Can we put water in them?" In response to my affirmative reply, she enlisted my help to fill the bottles with water. She then set the table with bottles for a meal. As we played, she murmured, "I like bottles, sometimes."With this revelation, Anna became acutely anxious. "I don't want to play anymore! I have to get out of here!" She stumbled toward the door, speech, cognition, motor skills regressed. In an effort to reassure her and try to help her stay in the room, I said, "You don't know me yet. It looks to me like you got worried that I wouldn't like for you to like bottles." She calmed visibly and returned to the play area. "Is this your chair? Can I sit in your chair?" she asked. I said, 'Yes. You need time to get to know me." I was impressed with how quickly she recovered by moving closer to me and by taking control. I speculated, hopefully, that her requests could suggest a capacity to cathect new objects and internalize new experience in analysis.Sitting in my chair, Anna said, "A scary man almost comes in. A different daddy. Nightmares and poo-poo." I realized she was telling a dream. Anna picked up the toddler doll and took its clothes off. She said angrily to the doll, "You have to wear diapers - you bad girl! You have to change your underwear because you are scared." She then spoke directly to me. "I go to the potty. Sometimes I have to poo and wee in my pants. I have to get out of here!" She again started to bolt for the door. I said, "You sound upset with yourself when you have to poo and wee in your pants. You look worried that I too will be upset with you for pooing and weeing in your pants when you are scared." She nodded. "Yes." She picked up the naked doll and looked between its legs. "She has a vagina. Something is wrong there. I have a vagina, too. It stings me. Mommy washes my vagina with soup [sic] and stings me." I replied, "You have some worries about your vagina." "Yes," she answered. I said, "As I get to know you better, I may be able to help you with your worries."In our second session, Anna resumed play with the dolls. "We're playing picnic. Give me the bottles and cups." She sipped water from a cup. "Wonderful!" she exclaimed. She pretended that a piece of clay was a beautiful hamburger. It quickly turned bad. "This doesn't feel good. Make it better," she said as she handed it to me. I assumed this sequence was a transference communication of what she needed from me. As we worked with the clay, I said that I would try to help her to feel better about her food and other things as well.Anna said, "I'd like to eat some grapes here. Do you have any?" Amazed, I said I didn't have any grapes, and I wondered if something else would do. …