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The Observations are in the form of a diary which the mother kept from the time operation was decided on and which covers preparatory and post-operative events as well as the period of hospitalization which the mother shared with the child.
In this very normal little girl anticipation aroused formidable anxieties deriving from separation and castration problems, the latter chiefly concerned with the threat of anaesthesia. Fears of dying and bleeding to death, clearly related to fantasies of pregnancy as well as superego anxieties in which the hospital took on the aspect of a prison and the operation of a major punishment, also appeared. Phobic defences alternated with turning passive into active, regressing increasingly towards primitive defensive manoeuvres, temporary psychosomatic symptoms, temper tantrums and attempts at denial of internal and external reality.
The period of hospitalization was marked by defences against passive anxieties, again connected chiefly with anaesthesia. These continued to influence her sleeping for a short time after the return home. The main post-operational problem concerned her ambivalence to her mother.
Anna Freud in her commentary stresses the importance of the quantitive factors in the normal child's precarious emotional balance. Anxieties are mastered by the ego if they remain below a certain threshold. Mastery is seriously jeopardized when threats from reality join cause with threats arising from internal sources. 'What we call "courage" in ordinary language is no more than the individual's ability to deal with external threats on their own ground and prevent the bulk of them from joining forces with the manifold forces lurking in the id.' This consideration may serve as an operative one in distinguishing the role of the mother described in some detail in the diary from that of the therapist. The author gave only such help to her child as enabled her to meet the operation on the level of reality and thus supported her in