A Critical Neurosis in a Two-And-A-Half-Year-Old Girl

Sally was two years old at the time of the outbreak of a serious anxiety state and sleep disturbance. Shortly after the child returned from a visit to the home of her grandparents in another city she appeared tense and strangely quiet. At night she wakened screaming after an hour or two of sleep and could not be induced to go back to sleep. For almost the entire night she would sit rigid and watchful in her mother's arms or in a chair. She complained that "de noises bodder me" and her mother thought that she was disturbed by street noises or the sounds made by people in neighboring apartments. During the day the slightest noises produced a startle reaction and sometimes she would scream in terror. Often, without any seeming provocation, the child would cry out and clasp her mother almost in a faint. Although she was an exceptionally precocious child with a vocabulary almost on a four-year level, she could in no way communicate her fears to her parents. As the weeks went by she became more and more preoccupied. She no longer played with the familiar toys but monotonously looked through her story books or begged to have certain favorite stories told her. Barbiturates had no effect. The child became almost entirely sleepless.

Because of Sally's vicious attacks on her three-month-old brother, the mother was convinced that the anxiety was somehow related to "sibling rivalry" and devoted herself fruitlessly to patiently reassuring the child that she was loved. The disturbance had progressed for a period of four months before advice was sought. The problem had become grave when the mother finally consulted a child analyst, who referred her to me.

By the time Sally came for treatment, the neurosis had already acquired obsessional features. She no longer wakened in anxiety but left her bed like a sleepwalker, sometimes asking for milk which she did not want, sometimes repeating a stereotyped phrase, "Mama, I'm here!" She would wander around dazedly for hours af