One way of viewing the difference between the state of mind in mental health and in mental illness is in terms of 'integration' and 'fragmentation'. The concepts give us an overview of our problems, and also describe dynamic processes of the mind. The terms refer to whether we function in a unified manner, or whether aspects of us are disunited and going in different directions. The more integrated we are the more emotionally healthy we are, and the more fragmented the more ill. (The saying 'united we stand, divided we fall' could be applied to each of us individually.)

With an integrated mind we can make a good adjustment to both external and internal reality. We are aware of ourselves as a whole, and the emotions we experience in the course of living can arise consciously as part of that whole. We are in touch with our past and can easily recall the stages we have been through in life and are aware of having been essentially the same person throughout.

When we are fragmented the past is distant, hazy, difficult to remember. We live from day to day with only partial awareness of the feelings going on inside us, an incomplete understanding of our own needs, and a tentative grasp on our own continuity. We are never completely sure who we are or what we feel or think. Our emotions, when they arise, take us by surprise and disrupt whatever sense of self we have. We are to an extent out of touch with our inner selves, or 'dissociated'. In effect we are going through life as a number of part-persons rather than one whole person. Different aspects of us emerge under different circumstances but they are disconnected from each other, and some parts never emerge at all.

The parts of ourselves with which we have lost touch in the fragmented state are aspects of our innate drives which cannot be accommodated by the person we have grown up to be. These clusters of feeling also embody part of our self-awareness. When we are angry, for example, we are in touch with the part of ourselves which can feel anger, and if we have had to cut off anger in childhood we also cut off that part of ourselves. In serious cases practically the whole personality can be lost to fragmentation, then we have an accumulation of defence mechanisms instead of a personality, and our personality is a ‘False Self’ [Winnicott 1960a].

Like all emotional problems fragmentation arises out of necessity, as a survival strategy. The problems begin when parents are unable to cope with aspects of their baby's emotional needs. They convey to the child that this aspect of him is unacceptable, and after repeated demonstrations of his unacceptability, which can be done by a failure to respond to the baby just as effectively as by an outward show of disapproval, the baby comes to internalise that belief, feeling that part of him to be unacceptable to himself. He is then in the impossible predicament of having needs which demand to be satisfied, yet are not allowed to exist.

So the fragmented state in which we find ourselves as adults is a legacy from the past, and might be conceived of as having taken place in two main stages; the first during early infancy and the second during the upheavals of adolescence. The faulty foundations are laid in infancy but the consequences may not become apparent until when, with all stresses and strains of trying to make the shift from childhood to adulthood, the cracks which have been there undetected throughout childhood get pushed apart. It is at this stage that the problems are likely to become manifest in the form of symptoms and/or pathological behaviour.

How psychotherapy brings about integration

Reintegration, or in some cases - integration for the first time, comes about through the experience of rediscovering those parts of ourselves that had been split off and finding that they are accepted by the psychotherapist as valid and important expressions of ourselves. This is a reversal of the original situation in which, as infants, we had to repress those aspects of ourselves because our parents could not cope with them.

Through finding that these feelings are understood and accepted by the therapist we are gradually able to understand and accept them ourselves, that is, to integrate them. Acceptance by the therapist has to be experienced repeatedly to counteract the repeated experience of being rejected and denied, and for the integration to gain strength and permanence. This is what is going on during the painstaking work of 'working through' which comprises the bulk of the work of psychotherapy.