Severe Bodily Illness in Childhood1

My point of departure is Anna Freud's paper (1952) which provides a guideline and an infrastructure for subsequent elaboration. I agree with her main thesis and, in particular, with her conclusions regarding prolonged immobility and the manifold castration meanings that surgery takes on (at all ages). Anna Freud's paper, in the main, concerns itself with bodily illnesses that are not "severe" or, to use her words, with cases in which the child "is not defeated by the type or the intensity of the illness itself". But the point to be discussed today is what happens if the child is partially or totally defeated by the very nature of the somatic insult. And here we tread on far less known grounds.

It has helped to clarify my mind to construct a scale of illness severity, such as is done in medicine to define degrees of damage from exposure to heat or, more recently, by experts studying the effects of malnutrition (Serogguie, 1954). My system of gradation is, by definition, quitearbitrary, used for speculative purposes only, and I shall single out some of its shortcomings.

I intend to define three grades of bodily insult for severe illnesses; all three grades share the above mentioned quality, viz., the insult has partially or totally "defeated" the child over a period of time. At first I thought of introducing the notion of "threat of death" as another common factor, but it complicates things too much. For similar reasons I have dismissed "pain" as a variable and to some extent (cf. below) "mothers". I am aware that in so doing I am limiting the value of my exposition.

I define as Bodily Insult grade 1 a severe illness which may appear in one or more episodes but which in its active manifestations would not "insult" the child for much more than one-fifth of the span considered (early childhood) and does not leave irreversible physical sequelae.

A Bodily Insult grade 2 is a severe illness which covers more than one-fifth of the time span and/or leaves irreversible ph