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Miller, M.L. (1951). The Traumatic Effect of Surgical Operations in Childhood on the Integrative Functions of the Ego. Psychoanal Q., 20:77-92.

(1951). Psychoanalytic Quarterly, 20:77-92

The Traumatic Effect of Surgical Operations in Childhood on the Integrative Functions of the Ego

Milton L. Miller, M.D.

SUMMARY

Fear of expressing competitive impulses, unconsciously associated with intense fear of injury, was related to reactions to surgical operations in childhood in two cases. The development of initiative and independence of action was severely circumscribed. In one instance (a man), successful accomplishment (career, for example) was associated with punishment for hostility to the father, and a seductive attitude toward the mother. In the other (a woman), the expression of heterosexual wishes seemed connected with a strong unconscious fear of retaliation from the mother and sister.

The automatic, repetitive (2) nature of these patients' attempts to deal with reality by reverting to the past and unconsciously reacting to competitive situations as if to the threat of an operation (e.g., being 'gassed' or having fantasies of attacking someone with a knife when aggression and anxiety were stimulated) constituted a therapeutic problem.

Changes in the integrative function of the ego in each case depended upon uncovering repressed emotions connected with the memory of the operation, in order that the unconscious childhood emotions for which these patients felt they had once been punished could be understood. Both unconsciously felt the operation to be a punishment for masturbation. In the first case this proved to mask intense sexual interest in the mother and repressed rage at her seductive but frustrating attitude. In the second the memory of the operation seemed associated with imagined damage to sexual organs (loss of penis) and loss of the mother's protection.

The therapeutic process was focused upon interpreting the relation between the emotions uncovered by the fears of operation and current problems.

From the therapeutic point of view, the comparisons of the real problems these patients had to cope with, and their attempts

to solve them by presenting the fear of injury, or the 'injured child' attitude, were repeatedly stressed.

Both cases, operated on in their early childhood, seem to fit the concept of traumatic neuroses. They were able to diminish the effect of the trauma when the phobic symptoms and defenses of the ego were analyzed.

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