Psychoanalytic Treatment of Diabetic Children

The case illustrations demonstrate the profound impact which diabetes and its treatment may have on various aspects of the child's personality. The sequence and momentum of phase development may be disrupted and the particular character of internalized conflicts may become distorted by the disease and expressed in terms of the experience of its signs and symptoms. The type and balance of defenses, superego structuralization, and object relationships are all vulnerable to distortion from the psychological problems associated with the medical treatment of the illness. Biological growth and development may be adversely affected, while psychologically the child's body image and self representation may be distorted by the way the illness and its treatment impinge on the child's functioning and by the emotional adaptations required to accommodate such impingement. Ego functions may be disturbed by the reciprocal interactions between psychopathology and physiopathology. Psychological disturbance leads to poor diabetic control, and this in turn directly and indirectly often causes additional psychological disturbance. Our work underlines the importance of emotional considerations in understanding the etiology and in planning

effective treatment of chronic diabetic imbalance in children. The psychoanalytic approach underlines the value of attempting to distinguish between the child's psychological disturbance in its own right and those aspects of the disturbance which are associated with diabetes. As clinically useful as such a distinction may prove to be, psychopathology and the experience of diabetes remain inextricably interwoven. When we consider psychological intervention with the more extreme cases of labile diabetic control in disturbed children, it may be useful, at least initially, to undertake the work in the protective environment of a pediatric ward which is carefully organized to cater to the highly specific and complex needs of these children.