Author's Response

I wish to express my appreciation for the thoughtful and stimulating discussions. I would like before responding to some of the comments—it should be obvious that it would be impossible for me to do justice to the wealth of ideas offered—to address myself in a more general way to my discussants. I would like to make one point clear in particular. This paper is intended as a clinical contribution in which I wanted to show that the concept of a death instinct was helpful to me in my clinical work with these patients. If I have tried to prove anything then it is the fact that certain types of patients, especially the so-called psychosomatics, are not only amenable to psychoanalytic treatment but that their treatment is most rewarding for the analyst from the point of research and of therapeutic results. I am convinced that new insights in psychoanalysis will come from the psychoanalytic study of the types of patients from which psychoanalysts, to use Dr. Wahl's expression, “recoil.”

I have found my interest in children and my training in child analysis very helpful in this work. In fact, my research in psychosomatics began with the treatment of severely sick children in a hospital setting some 28 years ago. There I had the opportunity of being consulted in cases that ordinarily would not come to the attention of a psychoanalyst. I found that psychoanalytic intervention could be a life-saving device and that the concept of the death instinct was of great clinical value. I was amazed at how well not only the child patients, but also their mothers (whom I studied by the method of concomitant analysis of mother and child) understood this, and at the dramatic reactions to my interpretations. Here the ideas expressed by Ferenczi in his paper “The Unwelcome Child and His Death Instinct” (1929) found a convincing confirmation.

Subsequently I had opportunities to intervene psychoanalytically in medical emergencies of adults (patients with severe ulcerative colitis, asthma, or cyc