1Susan's behavioral disturbance was first recognized after her hospitalization and anesthetization at twenty months. These events accentuated the passive-active conflict normally developing at the end of the second year. The fluidity of her instinctual organization and the immaturity of her ego at this age provided fertile soil for fantastic solutions in her assumption of gender role.

2There was no timely suggestion that help could be made available for both parents and child. The parents' continued anxiety over her precocity added a special quality to Susan's object relations and complicated the problem of her identifications. The structuring of her narcissism was more than usually impeded, and her self-esteem became dependent on defensive fantasies involving her body image.