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This paper deals with some of the major difficulties encountered in analytic work with children suffering from psychosomatic disorders. The reluctance of parents to obtain such psychoanalytic help for their children stems not alone from ignorance and lack of insight. An important factor is the mother's fear of exposing her motivations. The illness of the child is essentially an expression of the mother's unconscious death wish toward the child. Unless the destructive drive of the mother can be ameliorated, the child often cannot be saved.
Diet and hospitalization are often employed by the mother as weapons against the child. The child, sensing the hostile component in the imposition of the special diet, resists and fights the food restriction. Once the child becomes convinced of the sincerity of the motivation, it will accept even severe dietary restrictions without protest. Since dietary transgressions are equated in the child's mind with sexual transgressions and hence carry a threat of castration, it is usually advisable for the physician who prescribes the diet to lift it, thus taking away the castration threat.
Hospitalization is regarded by the sick child as an abandonment by the mother, which unconsciously it often is. If the overanxiousness of the mother can be lessened, hospitalization may be warded off and the mother may be induced to bring even an acutely ill child to the analyst's office. 'The psychoanalytic treatment may go on for years, but the analytic interpretation of an acute attack equals surgical procedure in promptness of effect and can be considered emergency treatment.' The author adduces illustrative case material to document her views.