Those who wish to concern themselves with training in the psycho-somatic field and, in particular, in the psycho-oncological field need to face the constant work of working through the passage from defensive splitting to operational splitting. A psychoanalytically trained observer, who comes into contact with an institution, as G.Vetrone says (1986), is quite soon aware of the fact that inappropriate splitting operates within it, for he discovers with amazement, anxiety and disdain, that some human needs are denied and the patient is related to as if he were a part-object. Recognising the splitting is a sterile operation if one does not understand the specific anxiety which made such a defence necessary. The observer must be able to identify not only with the more evident suffering, that of the patient, but also with that of the carers, which is generally more difficult to recognise precisely because, through splitting it disappears or becomes projected elsewhere. Apart from this process there is only space for moralistic judgement.