Meetings of the New York Psychoanalytic Society

February 24, 1959. THE PSYCHOLOGICAL CONSEQUENCES OF PHYSICAL ILLNESS IN THE FIRST THREE YEARS OF LIFE. Anita I. Bell, M.D.

Some asthmatic disturbances have their origin in very early respiratory experiences. These experiences are revived during toilet training, through memory traces that associate inspiration and expiration with anal function and may profoundly affect anal development. The existence of a brief preoral phase, the respiratory phase, is postulated. Respiration, sucking, and defecating utilize rhythmic contractile motor movements which are considered representative of a premastery phase of development, the forerunners of ego mastery. Primitive attempts to master the air mass in respiration involve a discharge of fused libidinal and aggressive energies. The author assumes optimal merging or fusing of such early deaggressivized and delibidinized energy for each zone at each developmental level.

The infant uses the greatest amounts of energy for physical growth during the first ten months. With the leveling off of this process, energy is liberated for ego development. When severe illness occurs during the first three years, imbalance in the optimum interplay of energies occurs. With recovery, the energy then becomes freed from bodily needs and is again available for other uses. This aggressive energy if not adequately fused with libidinal energy leads to extreme discomfort, to masturbation, and may become part of the prepatterning for masochistic development. Ego regression may also be prominent, as in asthmatic and ulcerated colitis, where the unfused aggressive energy can be utilized and leads to self-destructive tendencies and to death.

Material is presented from the author's analysis of an adolescent with intractable asthma, protracted invalidism, and constant terror of dying. Anger was completely suppressed. As an infant severe eczema was followed by asthma. Bowel training was early and rigidly enforced by the mother who was a nurse. Ane