Playing dead: an unconscious fantasy, bodily focused defenses, and their roots in infancy.

A patient's unconscious fantasy of being her mother's dead baby emerged during the course of a long analysis, and was understood as her expression and explanation, constructed and elaborated throughout her development, of a fundamental and formative early infant state and experience. This patient's identification with a baby who had died before she was born was connected to her major complaint, a pervasive feeling that she could not act with intention, and to her obsessive ruminations, compulsive actions, and masochistic attacks on her body. The bodily based aspects and focus of these defenses were autistic-like, self-directed activities that can be understood as having their roots in what was experienced as catastrophic loss in the earliest weeks and months of life. Infant research, particularly on contingency detection, is especially useful in clarifying the ways in which these defenses may form, and in reconstructing and tracing the trajectories and intricate transformations of body ego, self- and other representations, and defenses from their earliest beginnings to their current manifestations in patients' fantasies and symptoms.