Psychic Consequences of Loss and Replacement of Body Parts

The Chairman, H. Robert Blank, opened with a reference to the Discussion Group, "Psychic Consequences of Congenital Lack and Acquired Loss of Body Parts," from which the present panel originated. The Discussion Group has met eight times since 1969, studying subjects such as blindness, deafness, cardiac catherization in children, open-heart surgery, cardiac transplantation, hemodialysis and renal transplantation, leprosy, vaginal agenesis and surgical construction of the vagina, cosmetic plastic surgery, and the relation of loss of body parts to artistic creativity.

Blank stressed important generic considerations that apply to absence or loss of a major body part or function regardless of the specific handicap. The congenitally handicapped infant does not sustain a loss. If this infant receives optimal mothering (and the special services indicated in his particular case) there will be optimal development of the senses and talents that he does possess, plus the nucleus of a healthy self-esteem, before he has to cope with the knowledge of his difference from others. The congenitally handicapped child does not naturally receive optimal mothering, because the parents, especially the mother, suffer a real loss. We can anticipate that the parents will have an acute grief reaction to the loss, followed by a prolonged mourning reaction. With the congenitally blind child, for example, who is typically born prematurely, the mother has to leave the hospital without her baby and feels inadequate, cheated, and anxious even before she knows that the child is blind. The news of the child's blindness is superimposed on this trauma, and anxious depressive rumination results. When this premature infant comes home, he is not as well developed, active, or responsive as the mother had expected. It is only with considerable help that the mother can learn to make the