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This paper is about a child's concern with life and death.
I present clinical material from the psychotherapy of Adam, a boy of eight years, whose first five years had been severely affected by a debilitating congenital illness which endangered his life. He required repeated treatment in hospital and his parents were told that he might not survive. Between the ages of five and eight years his health gradually improved, but the medical prognosis was that he would probably die before adulthood.
I briefly outline Adam's referral to our clinic and his history and family background, before I describe his expectations and anxieties as I encountered them in the early months of treatment. I then bring material which focuses on Adam's concern with the preservation and resuscitation of life and the evasion of death.
Adam was referred to our clinic at the age of eight years four months because he was failing at school. He was the first child of successful Jewish parents; his father was a writer and his mother a potter. He was born after a pregnancy fraught with anxiety on account of three prior miscarriages. At birth he was severely jaundiced and required a complete exchange transfusion. After a week in an incubator he returned to his mother who managed to breastfeed him until he was twelve weeks old, although his sucking made her nipples sore. He gained weight but was very pale and lacking in energy. Further investigations revealed him to be the victim of a severe anaemia, associated with mild jaundice, and caused by an enzyme deficiency. Treatment was by drugs, supplemented from the age of nine months by regular blood transfusions, at first needed every five months but increasing in frequency until by the age of four years they were given at two monthly intervals. These transfusions required Adam to spend only a day in hospital but on at least three occasions during his first two years he was admitted for longer periods while research investigati