Some Psychoanalytic Observations in Surgery: Helene Deutsch. Psychosomatic Med., IV, 1942, pp. 105–115.

The material gained by Helene Deutsch from the study of patients' reactions to operations while under analysis has reinforced her critical evaluation of the concept of the female castration complex. The rôle which is ascribed to penis envy in female psychology still needs some reorientation. In surgical patients the greater anxieties and the reactions connected with them refer predominately to purely feminine processes in which the castration complex plays a less important rôle. Fear of delivery stands in the dynamic position held by the fear of castration in men. This anxiety has a double content: it is the talion anxiety in which the destructive impulses once directed toward the mother are turned against the self, and it hides the deep longing for the mother at the threshold of death. In men the castration complex stands in the center of anxiety. When the passive tendencies predominate in a man, the operation can be experienced as a delivery, just as it is in women. In general, the relationship to the surgeon as a father or brother figure seems to determine the man's manner of reacting to the operation.