Children in the Hospital: By Thesi Bergmann, in collaboration with Anna Freud. New York: International Universities Press, Inc., 1965. 162 pp.

This book deals with observations of chronically ill children hospitalized for months and years because of orthopedic disabilities, asthmatic, or cardiac conditions. It enables parents, physicians, nurses, and other medical personnel to understand how children feel about illness and separation from home.

The hospital therapist, as a mediator between the sick child and his parents, facilitates the process of recovery through helping parents to get to know their children. In some instances where preexisting personality problems interfere with favorable development, the therapist can succeed later in getting the child into analytic therapy. Of all the tasks of the hospital therapist perhaps the most important is the pioneering effort to bridge the gap between the children's inner life and the adult world around them under the most trying circumstances. To a normal adult it is incredible that, at times, the distance between a child's psychic reality and external reality is so great. For instance, the child may have as severe an anxiety reaction to a prick of the finger for a blood test as to a serious surgical intervention. Adults can better understand the child where psychic and external reality are close together.

Thesi Bergmann presents, with simplicity and clarity, the complicated problems besetting sick children. The examples quoted are characterized by richness of observations and astute deductions. It is not easy to obtain information about a child's fantasy life under the best circumstances and it is certainly more difficult during illness. The conception of illness as punishment is universally prevalent among children and can be traced to masturbatory guilt. Because of this unconscious connection, illness can cause intense fears and depressive reactions. We also frequently see severe masochistic trends resulting from childhood illness. The tendency to regression in illness is hard for a child to combat, and his strides toward independence can be un