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In order to consider the variations of ego functioning and ego defenses before and after topectomy, some of the pertinent details in the history and psychodynamics of a patient will be presented.
At the time of operation, this woman was a 42-year old housewife with a twenty-four year history of shifting symptomatology including depression, anxiety, withdrawal, thyrotoxicosis, fear of sleeplessness, and the progressive development of obsessive-phobic behavior despite psychotherapy and several series of electric shock treatments.
The patient was the eldest of four children in the family of a Jewish factory foreman. He was always a sociable, good-humored, but passive man who was dominated by his wife. The mother was a rigid, cold, demanding shrew who was tense, had fainting spells and a street phobia. She resented her husband's showing affection to the children and unjustifiably accused him of infidelity with her younger sister. When the patient was 5, she wished to give the second-born child, a sister, to passing strangers. The youngest sibling was born when the patient was 13. She was quite fond of the new baby, mothered her and may have fantasied that she gave birth to her. The mother's fainting spells occurred frequently during the childhood of the patient, who was panicky and feared her mother would die. She finished high school at 16 with a good academic and social record, though she was shy with boys. Her mother vetoed her plan of attending college and she went to work, making a good adjustment but resenting her mother's domineering attitude.
In her 18th year she knew a boy of her own age for a week at a summer resort and, in fantasy, elaborated the situation to the proportions of a love affair. Noting his subsequent lack of interest, she felt rejected, inferior, was depressed and withdrew. She mourned this loss