Child Analysis and Paediatrics—The Influence of Severe Bodily Illness in Early Childhood on Mental Development1

We would like first of all to state that we have excluded from this report the psychic aftereffects of cerebral lesions, in order to limit the field of our investigations to the time at our disposal. We have likewise excluded all cases in which hospitalization had assumed such importance as to complicate the study of the part taken by the illness stricto sensu. We shall not present a summary of the psycho-analytic literature on this subject which we have collected; we prefer to describe the essential elements furnished by a case, analysed for five-and-a-half years by one of us.

Philip was 5½ when he was sent to analysis, with a diagnosis of autism. An only son, he was afflicted with Fallot's tetralogy with serious oxygenation insufficiency. For this reason, he had to stay in bed most of the first three years of his life, and thereafter he had to be very limited in his play activities. At the age of 5 he underwent a first surgical operation, after which the defect in oxygenation had improved: he had been given a greater extent of freedom in his motor activity. His mother, a former well-known movie actress, was very narcissistic, dissatisfied with her present life, and frustrated by her husband's indifference and by her child's illness. Clearly her child depresented to her the only true source of interest, and upon him she localized her anxiety and discharged her aggressiveness.

The father, likewise disappointed by his child's physical anomaly, had progressively detached himself from his wife and child. During his first analytic sessions, Philip showed an obvious difficulty in interpersonal relations: he only seldom and then rapidly looked at the analyst's face, excluded him from his activities and did not give any sign of having registered his interpretations. Such an attitude changed altogether later, to the extent of excluding the previous diagnosis of autism. At the onset of therapy, he had a considerable instability when moving about and playing and his