Livia Di Cagno and Franco Ravetto: Le Malattie Chroniche e Mortali dell’ Infanzia. L'Angoscia di Morte. (“Childhood chronic and terminal illnesses: The dread of death”.) Rome:  “Il Pensiero Scientifico”, 1980.  180 pp.

This book is the result of ten years' work carried out in various special units of the paediatric department of the Turin Policlinic at the University of Turin. The team, directed by Professor Di Cagno, Professor Ravetto, and eight colleagues, is composed mainly of child psychiatrists and psychologists. The importance of their analytic orientation and of continuing individual and group supervisions is repeatedly stressed, and a fruitful collaboration with analysts both Italian and English is acknowledged as essential to their work.

As the authors say in their preface, the absolute protagonist of this book is the “dread of death”, which is almost concretely present in every individual who has to live with a chronic or terminal illness. It is this struggle within the self and the interplay between “external” physical pain and internal reality that they attempt to face.

The central theme of the book is the child in pain, and his fight against death. This, and the interplay of often massive, unbearable projections of agony between him, his parents and the people involved in his care, makes the book very moving. It is painful reading indeed, but at the same time a positive and helpful experience. It engenders the hope that a constant and serious study, not only of the traumatic implications of a child's hospitalisation but also of his object relations, can lead to a better understanding of the dynamics underlying the pathological process and to a lessening of the most acute anxieties.

The theoretical frame of reference is derived from the work of Freud and Melanie Klein, and their insights regarding the child's very primitive unconscious phantasies of annihilation and death. If, on an unconscious level, the child experiences death as the result of an aggressive act rather than as a natural biological event, it is understandable that illness should heighten his persecutory anxieties which will then be projected into his parents and family.

The second and third chapters illust