Fissures and Fractures

A few weeks ago, my daughter hurt her foot playing soccer at school. Since then, the same question has repeated itself over and over: —“But what happened?”

And I, with that automatic reflex of wanting to respond with precision, answer: —“Well... she has a fissure in her fifth metatarsal.” —“Is that a fracture?” —“Well, not exactly... it’s a fissure, meaning...”

And right there, a kind of verbal clumsiness begins that surprises me. I find myself talking in circles, getting tangled in technicalities I don’t even fully grasp, trying to medically explain something that, at its core, is simple: she is in pain, she needs help, she can’t play her favorite sport, and she feels frustrated.

She wears an orthopedic boot, not a cast. She can put weight on it, but she prefers not to because it hurts. She uses a wheelchair instead of a scooter—out of fear, and perhaps a bit of stubbornness. Although it isn’t a grave injury, during recess, a small anxiety is triggered: Will her friends wait for her? Will they help her?

When the doctor’s letter finally arrives stating, in black and white, “Fracture of the fifth metatarsal,” I feel something unexpected: relief. As if the word validated the discomfort. As if, at last, I could stop explaining so much. As if that which is named had more of a right to be felt.

From that moment on, I began to think symbolically about the difference between a fissure and a fracture. Why did naming it correctly matter so much to me? Was I trying to explain it to others, or was I trying to legitimize something to myself or my daughter?

Medically, the difference is clear: a fissure is a crack; a fracture is a complete break. But beyond the bone, how many times do we live through emotional situations that could be described the same way? Some cracks go unnoticed, yet they bother us. Others break completely and require immediate intervention.

I turn to Freud, who stated that “what remains unsaid, insists.” That insistence can take many forms: physical symptoms, overflowing emotions, or vague malaise. In therapy, we don't stop at the symptom as an isolated event—be it a physical or emotional fissure—instead, we look beyond it to explore what lies behind and how we can give it form. For Freud, the word is the privileged path to the unconscious. Its purest expression is revealed when something is finally named, even if clumsily or fragmentarily. In the therapeutic space, we work precisely with those spontaneous, sometimes chaotic expressions to symbolically "edit" what emerges and return it to the patient in a way that resonates and allows for self-reflection.

Over years of working with patients, I have developed a special sensitivity toward the use of words. Sometimes, finding the exact word is enough for something inside to loosen. A word that doesn’t anesthetize, but situates. A word that looks emotion in the face, without metaphors or detours. That puts things on the table by their proper name.

I also turn to Bion, who helps us think about emotions through his concepts of Alpha and Beta elements. It sounds complex, but at its heart, it is simple. When emotions cannot be processed, they transform into raw sensations, without form or meaning. The clearest example is the cry of a baby who cannot distinguish whether they are hungry, tired, in pain, or simply in need of a hug.

Bion called these untranslated experiences Beta-elements: experiences that are not thought, only suffered.

This is where the caregiver enters—sometimes tentatively, other times instinctively—interpreting and translating that need, giving it shape, meaning, and containment. Thus, a baby’s cry toward a mother, or even a patient’s outcry toward a therapist, ceases to be a raw discharge and becomes a thought, digested experience.

The therapeutic process consists exactly of that: transforming Beta-elements into Alpha-elements. Transforming them into experiences that can be named, thought, and contained.

Anxiety, sadness, passion, love, devotion, the compulsive need to buy, infidelity, eating without feeling full, losses that won't stop scarring, low self-esteem, self-hatred, or indifference toward others... All of this, when translated in therapy, is not just relieved—it becomes workable. It opens the possibility for us to choose which path to take.

Something like that happened to me with the word “fracture.” That medical letter didn’t just bring a diagnosis: it brought form, it brought a limit, it brought meaning. It allowed me to let go of the pressure of constantly justifying what was happening to my daughter. It relieved me, too. And above all, it allowed me to better accompany her in her subjectivity and her real needs.

Lacan says that language does not only express what we feel; it structures who we are. Without language, that which hurts remains loose, without form, without law.

I think of my daughter. Of what she might be feeling without being able to say it. Because beyond the diagnosis, the physical pain, or the boot, there is something that perhaps hasn't found words yet: being left out of the game, not participating in gym class, seeing others move forward while she waits, being looked at differently. Those experiences, if not named, can become silent ghosts that settle in the Imaginary: “I am broken,” “I am useless,” “I am a burden,” “I am less.”

Lacan spoke of these phantoms: nameless ideas that haunt us, formed by how we believe others see us or how we imagine we ought to be. In those moments, we wonder: Am I exaggerating? Am I just seeking attention? Is this serious or just annoying?

Stumbling upon these phantoms—the feeling of failure, exclusion, or helplessness—is painful, yes. But giving them a name is already a reparative gesture. Because when something finds its place in the Slightly Symbolic, it stops overwhelming us with the same intensity. It finds order. It gains meaning. And in that internal organization, we also find a clearer place from which to accompany, sustain, and understand.

Both physically and emotionally, there are fissures and fractures that never fully heal. We learn to live with them. To adapt them to our bodies, to our histories. Some require physical therapy. Others, psychotherapy.

The body and the soul share an ancestral wisdom: there are pains that are not cured, but settled. And in that settling, we find a new way to inhabit what hurts us.

Sometimes, it is enough to be able to say: “Yes, it is a fracture.” And sometimes, it is even more powerful to be able to say: “I don’t know what it is, but it hurts.”

And from there, begin the work of putting into words what the soul, as of yet, cannot name.zar el trabajo de poner en palabras lo que el alma, todavía, no puede nombrar.