“We are able to share respect for illusory experiences if we want, we are able to reunite and form groups based on the similarity of our illusory experiences; this is one of the natural origins behind gatherings between human beings.”

1. Introduction
The present work took place in the “Fundacion de la Diabetes Juvenil” where children suffering from diabetes are cured. Insulin-addicted diabetes is a high-risk, chronic, organic disease. The main objective shared by the Institution, the families and ourselves is to ensure that the patient adheres to the treatment with increasing self-sufficiency. This study deals with a group of six children between eight and twelve years old. This disease requires constant treatment, involving chiefly, measuring the glycaemia levels, injections of different concentrations of insulin, and a rigorous diet that more often than not the parents and the children have difficulty in achieving, putting their health at risk. Paradoxically, the parents' hyper-protection over their children in some cases hinders the development of self-sufficiency that they so much wish for.
We believe, apart from the difficulty of adapting to the practical demands that this disease involves, to be able to accept it, significant emotional work is required in order to elaborate the mourning for the loss of health. However, what also draws our attention is the presence of depressive and defensive anxieties at the base of this illness.
Our work mainly centres on how this organic disease is mentally represented in these children. We believe that the impact of the loss of the illusion of good health leaves a heap of unresolved emotions (traumas) that interfere with the continuity of the healthy development of this group of children. (Staforelli, Suarez 1998). We consider that the therapeutic group can help the children construct or reconstruct an assimilable or acceptable representation of diabetes.

2. A Glance at Comprehending the Relations between the Psyche and the Soma
Research carried out in the field of somatic, chronic diseases has demonstrated that better results are had when medical treatment goes hand in hand with other therapies that can give the patient the possibility to elaborate the subjective experience of the disease. (Bruni 1999).
Psychoanalytic group therapy is a way of providing a place where the illness assumes new significance and can be seen in a new context. The presence of others that suffer and the subjective experience of being ill can help to get rid of a feeling of isolation and abandonment in which one is confined.
The group experience could be considered as an opportunity for the child to live a transitional situation between incapacity and an ever-growing capacity to recognize and accept reality. (Winnicott, 1951).
The controversial tendency to conceive the human being as being divided between mind and body brings us to make the following considerations: 1) these functions are not concomitant or simultaneous parts of the same process, but they are alternative; 2) one of these functions can transform into the other, or at least influence it, in other words it could exist in an independent form. 
A different view brings us to consider the human being as a unity, with a simultaneous functioning of the physical and psychic areas, the Unconscious being the principal meeting-point of this convergence. Consequently, a type of function that is not physical nor completely mental seems to exist (Chiozza 1988).
Also, according to Winnicott, the mind/body antithesis that philosophers have always concerned themselves with, is non other than an illusion that originates in the eye of the observer. From the very beginning of life, the human being starts off as an inseparable psyche/soma unity, from which the mind is born, developing and differentiating itself if a “good mother” actively adapts herself to the necessities of the new-born baby. Very soon the new-born baby will be able to tolerate what is lacking in the environment and in the mother by its mental activity that transforms a sufficiently good mother into a perfect mother. Serious mistakes by the mother or the environment will be experienced as attacks against the psyche/soma against which it must react thus disturbing the continuity of its existential self. One of the expressions of this loss is the separation of the mind from the psyche/soma, by the seduction that the mind exercises on the psyche by entering it, thus producing a separation from the soma.
Another view of human development is given by the Greek myths, we all know the great usefulness they were to Freud.
“The myths of Narcissus and Oedipus reveal the problematic that leads from an impossible and intolerable knowledge to a tolerable and possible one” (Berenstein, Puget). The beginning of life for a human being is characterized by a type of narcissistic bond. The baby needs a single, mirror-like object that corresponds perfectly to it, in order to survive and overcome the sentiments of abandonment, annihilation and defencelessness. The baby must function within its limited capacities according to the Narcissus myth even though this entails a partial, ‘reflected' knowledge. Every time the object doesn't correspond to the one hoped for, in other words when certainty is lacking, abandonment is felt and a narcissistic wound is produced. To overcome this passage and reach a new functioning that we will call “Oedipal”, the human being has an innate disposition to create ever more complex ties that bring about knowledgeable experiences, thus the new significance acquired helps to tolerate the absence of, or the lacking in certainties.

The first time want and frustration are experienced, a symbolic end to pleasure is established, this should help one to accept one's limits - the limits of reality, in order to face the important problems in life –the limits of existence, illness and death.


3. Fantasizing Diabetes

1st Vignette
The children decide to play with plasticine. Nicholas moulds a figure that he nick-names Diabetic Man “…. like the monsters seen in television -the horrible ones…” Stefano replies: “It looks like a Sumo wrestler from Japan.”
The therapist: “diabetes is big and powerful, a real ‘fatty' that one needs to wrestle against.”
Stefano: “Fabiola has done a drawing of the Caribbean Islands, I'd love to go to a tropical beach.”
Nicholas: “Clara's been spitting, it looks like vomit.”
The therapist: “It seems that you all see this disease as a very difficult monster to defeat, and that you prefer to go to the Caribbean and think of nice and beautiful things, just as if there was nothing to worry about.”
The girls fall silent, while the boys start fighting.
The therapist: “Have you decided to form a group of your own?”
Nicholas: “We are autistic.”
The therapist: “What does autistic mean?”
Nicholas: “People who can't communicate, or speak to each other.”
The therapist: “ Today it is difficult to communicate with us. Because if we speak about the disease it's like speaking about a monster, therefore you all prefer to go to some other place, like the Caribbean for example. It seems that speaking about diabetes fills you with fear.”
The children maintain an uneasy silence.
The therapist: “Today it has been difficult to communicate. You have brought into the group what you experience outside of here, more often than not you feel that who doesn't have this disease can't understand you, like us therapists for example, …there is a lack of communication and this makes you feel that you are being ill-treated.”

2nd Vignette
Everybody is present except Jonathon. Stefano and Nicholas are very restless, they say they don't want to participate to the activities that are being proposed. The therapist interprets: “perhaps the restlessness is because the end of the therapy is near…” Suddenly everyone starts talking about regaining a session that most of the children were unable to attend because of bad weather, (that particular day it had snowed, an event that very rarely occurs in Santiago).
Fabiola: “I want to recoup the session, I get so bored at home.”
Nicholas: “I want to continue up to Christmas time.”
Everybody agreed on recouping the session except Clara who had an Art lesson at that hour, she already had bad marks.
The therapist: “It seems you are restless because there are only two sessions left before we end the therapy, and you feel as if you'd like to continue on …to Christmas time, or after other appointments, like Clara who has her Art lesson.”
Clara has always had to cope with Stefano and Nicholas who pester her a lot, but in the last two sessions she has started to stand up for herself.
The therapist: “ Harassing Clara during the session may mean that you feel harassed by your own illness”.
Nicholas: “They pester me at school and in the street in front of my house, they are much older than me”.
Other comments are heard along the same lines, expressed with a lot of emotion.
After a silent pause an activity is developed on an imaginary basis. The children are invited to visit a castle and afterwards to go down into the cellar. Here they are asked to choose four things from the cupboards and trunks, -two must be kept, and two thrown away.
Stefano: “I find a toad…. who tells me I am poor”.
(He laughs a lot and stops imagining).
The therapist: “It seems that the illness leaves you all feeling very poor with little resources, and you're in need of help”.
During this game, Stefano is sucking on a bottle of coca cola.
Nicholas tells him, “you look like a new-born baby”.
Francesco: “ Imagine you find two bottles of water… and you put two lizards in each on”:
Nicholas behaves like a real co-therapist, interpreting that “the water is insulin, and if you cut off the lizards tails they grow again.
The therapist: “It seems that some of you would like diabetes to be taken away, or cut down or be transformed…”
Nicholas: “I'll keep “sweet diet” and I'll throw away Freddy Kruger's glove (a character from the horror film “Nightmare”) and then I'll pick my nose”. 
The therapist: “These tails could be part of you or belong to other members of the group that want to follow a good diet, and also have good control over the anger caused by the end of the group, ‘specially with the elder women…..(laughing is heard), because one wants to stay well attached like mucus in the nose; wanting to stay longer, feeling still in need”.
Fabiola: “I'll keep “sweet diet” and throw away the black widow… the one that seduces the male and then kills him”.
The therapist: “just as the sweets tempt you but you can kill them, you have the impression that you are seduced by us therapists like the merry widow and now that the group is finishing you feel hurt by us, rather than seeing the confidence that we have in you of having found something to tolerate this difficult illness..”
Javiera: “I can't find anything, only dust”.
Clara: “I find Nicholas turned into a Puffo (gnome), and I crush him under my foot”.



3. Conclusions
If we widen the boundaries of illness from the physical plane to include a psychic plane, we can assert that people suffering from somatic diseases contemporaneously suffer from psychic diseases thus increasing their suffering. Nowadays it is thought that this suffering must also be taken into account, and if it is treated in time it can modify the general progress of the patient, his/her quality of living and his/her environment.
We believe according to the idea elaborated by D.W. Winnicott, that this group of diabetic children has suffered a repeated attack on the continuity of their existential being, whereby the somatic disease is part of a reparative process in which the psyche is returned to the original union with the soma. However this return to an anterior state of total dependence on the mother represented by the persecutory insulin injection, will make it almost impossible to achieve a step in the direction towards a significant maturity. They would literally remain prisoners of the disease.
Our work moves in the direction of a possible continuation of development, favouring a transitional space that allows the recuperation of integrated functions.
From this perspective we believe the group can be comprehended according to the characteristics of ‘its own' disease, represented by children suffering from a great quantity of frustrations coming from the external world and the internal reality. The capacity to accept and tolerate the internal reality varies from individual to individual, depending on the depressive anxiety at the origin. The depressive anxieties can be observed clearly in the second vignette where the children refer to being “poor”, or like “dust” or “mucus” or transformed into a “Puffo” (gnome). Manic defences contrast these anxieties producing an omnipotent feeling of being able to control the pitiful situation in act.
The children resort to these manic defences fantasizing “Diabetic man” as a representation of the illness, providing them with a certainty that in part tranquillizes them. A very potent being, whether it be a monster or a “Sumo” wrestler are responsible for their future, in which they feel trapped and unable to do anything about. Manic denial is also present, represented by the desire to go the Caribbean resulting in temporary relief that perpetuates the refusal of the illness. This defence process that is manic and of denial, produces a deficit in the “representation of the ill-self” that explains why these children have such difficulty in putting into practice self-help.
We believe along with J.Puget and I.Bernstein (1984), that these patients avoid the passage from certainties to doubts and desires. They take refuge in an omnipotent fantasy like “Diabetic man”. Our work concentrates on the removal of the narcissistic bulwark to make way for a more differentiated mental development, where doubt and illness have their own place, being part of all human existence.






BIBLIOGRAPHY



Bruni S., Marinelli S. (1999) Group and Dreams in Departments of Organic Medicine. Telematic Magazine. www.funzionegamma.edu/magazine/mag_n2.htm

Chiozza L. (1998) La capacidad simbolica de los trastornos somaticos. Revista de Psicoanalisis. APA XLV, n 5 1998. Pag. 926 a 930

Puget J., Berenstein I. (1984) Reflexiones en torno a una experencia de psicoterapia breve con un grupo de pacientes dializados en espera de transplante renal. Revista Chilena de Psicoanaisis. 15 n2. Pag. 46 a 54.

Staforelli A.,Suarez L(1998)A threatening Dream in a Homogeneous Group of Patients Expecting Kidney Transplants.www.funzionegamma.edu/ magazine/mag n1.htm

Winnicott W.D. (1975) Through Paediatrics to Psychoanalysis : Collected Papers London, Karnac Books (Escritos de Pediatria y Psicoanalisis. Edit Paidos. Pag 177-197; 325-340.)

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