Fear of expressing competitive impulses, unconsciously associated with intense fear of injury, was related to reactions to surgical operations in childhood in two cases. The development of initiative and independence of action was severely circumscribed. In one instance (a man), successful accomplishment (career, for example) was associated with punishment for hostility to the father, and a seductive attitude toward the mother. In the other (a woman), the expression of heterosexual wishes seemed connected with a strong unconscious fear of retaliation from the mother and sister.

The automatic, repetitive (2) nature of these patients' attempts to deal with reality by reverting to the past and unconsciously reacting to competitive situations as if to the threat of an operation (e.g., being 'gassed' or having fantasies of attacking someone with a knife when aggression and anxiety were stimulated) constituted a therapeutic problem.