Ego Synthesis of a Life-Threatening Illness in Childhood

Despite numerous studies in which psychoanalytic insights have been brought to bear upon the relation between illness and character development, students of child psychopathology, including Anna Freud, have alluded to the absence of exact observations on the psychological effects of illness. In a recent panel on the psychological consequences of physical illness in childhood, Edith Buxbaum offered a partial explanation: people, in general, do not like handicapped children or adults. This attitude is based on a deep-seated horror of and resentment against illness, feelings which are also expressed by parents toward the sick child. In support of this she noted how often curative measures take a restrictive form. Similar attitudes, she suggested, may account for the reluctance of psychoanalysts to observe the effects of bodily illness (see Calef, 1959).

The following report is based on the supposition that by a detailed study of the evolution of the transference neurosis, the analyst can secure reliable information regarding the integration and synthesis of physical events in the life of the child as reflected in the ego's adaptation to these events. Re-enactments and reconstructions of extreme traumas, such as serious physical illness, may provide instructive examples not only of ego synthesis but of the related interpersonal transactions, and thus help to affirm or modify current theories of character development and neurosis.

The psychoanalytic treatment of an adolescent boy revealed the mechanisms used by his ego to integrate a life-threatening illness, which began at the height of the oedipal period of development. The combined traumatic assault of the illness, the required medical treatments, and the alarm reactions of his parents were superimposed