Religion and Spirituality in Psychiatry

160 Pierre-Yves Brandt, Claude-Alexandre Fournier, and Sylvia Mohrindividuals think of themselves in the longterm. This representation is inevitably culturallydependent: it contains a certainconcept of self-identity that can vary infunction of age, sex, and social position. Itis “how the subject is advised to think ofhimself or herself.”So that this self does not remain an auxiliary,peripheral being (a false self?), it hasto be taken charge of by the ego (accordingto Freudian terminology here), whichadjusts the degree of centrality it grantsto the identifications offered by the (representationof the) self conveyed by culture.Furthermore, preferences in this fieldare more or less influenced by the familyenvironment.At each stage of their existence, individualsconstruct the self their ego is able to undertake,by means of identity representationsprovided by their environment. A transformationof the self can result from reorganizationcaused by endogenous factors (newcognitive abilities, new impulsive expressions),or by exogenous factors (access toa new social position, confronting situationsthat are not easily assimilated by thealready constructed self). Transformationof the self means: access to a new identity(pp. 56–57).(2)This definition of the self should not be mistakenwith the Self defined by Carl Gustav Jungas an archetype whose function is the union ofopposites and that is perceived by the ego astranscendent as it is able to integrate the ego andwhat the ego is not able to integrate, or shadow.For Jung, the relationship between the Self andthe ego is situated at the level of the intrapsychic.What we mean here by self is, on the contrary,located where the ego meets with its environment.It is an effect of symbolism that languageconstruction and self-representation are necessaryin communicational exchange.5. DEVELOPMENTAL ASPECTS OFIDENTITY CONSTRUCTIONIn his works on the interpersonal world of theinfant, (3) Daniel Stern pinpoints the emergenceof a sense of self to a very young age. Already attwo to six months, an infant begins to have thesense of a core self. The permanence of the contactwith his own body allows him to recognize himselfas a physical entity with its own cohesion andcontinuity. He experiences the permanent availabilityof the sensory and proprioceptive feedbackcoming from his own body, as opposed tothe exterior signals coming from outside his self.This description connects what Didier Anzieucalled the “Moi-peau,” (4) or “skin-ego”. The feelingsof identity and self-representation are basedon the construction of a psychic envelope, whichdevelops using the bodily envelope for support.The bodily envelope is a border between the bodyand the outside world and an internalization ofthis first experience of creating an inner vesselwithin oneself. This sense of a “core self as a separate,cohesive, delimited physical entity with itsown awareness of activity, affection, and temporalcontinuity” (p. 21), (5) will deepen at the ageof seven months with the sense of a subjective self ,when the baby is able to attribute to others thecapability of having a mental state similar to itsown. Then, during the second year of life, thissense is further enriched by the sense of a verbalself , which forms with the beginnings of verballanguage.The emergence of these different definitionsof the self is achieved in and by interpersonalrelationships, particularly with the mother (orwith any other person in charge of mothering).This relationship, integral to identity, is first ofall an affective one. Daniel Stern referred to itas “affective attunement.” The attunement canbe seen as the mother’s response to the child’sspontaneous activity and particularities. Thisresponse is both a validation of and a support totheir activity. There are of course different levelsof attunement, ranging from a pure and simplerebuff to modeling appropriate behavior ( thegood-enough mother , according to Winnicott).