• metapsychology;
  • epistemology;
  • mental quality;
  • realization;
  • pre-conception;
  • transformation in O;
  • paradox;
  • autistoid perversion;
  • presence

The paper explores the formation of psychic elements from an epistemological point of view, drawing on the work of Bion to examine a clinical case of autistoid perversion. Distinguishing the qualification of psychic elements from the realization of pre-conceptions, the paper argues that psychical elements are constituted through a mutually shared experience of presence, and so they should be understood in a paradoxical way – through being-O and transformations into K. These ideas are explored via a clinical case concerning a patient with an autistoid–perverse organization. The patient had been denied any bodily contact with her parents during her first year of life due to an infection; in later life she exhibited an autistoid coprophilic perversion. During the course of her treatment, as it became possible to break down the autistoid organization, the nameless contents surfaced in a mutually shared experience of presence. The analyst was able to hold on to their meaning, which was unavailable to the patient. The absent analyst, however, turned into the mother who ‘put the child down’ and was experienced by the patient as a suicidal threat. In being-O, the analyst was able to endure the paradox of being the one who ‘put her down’ in order not to put her down; the paradox of being-O functioned as a container for the destructive objectal dimension of the state of ‘being put down’.