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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.

Two clinical examples of operations in early childhood which produced phobic symptoms and character defenses are presented to demonstrate how traumatic effects occurred because they mobilized neurotic tendencies already present. As David Levy (4) has pointed out, surgical operations are most likely to be traumatic when they are performed on very young children before the personality is organized. Helene Deutsch (1) has discussed the traumatic effects of operations on adults, and their significance as symbols of birth or castration, according to previously established neurotic patterns.

Children whose adaptation to reality and the process of learning has already been made very difficult by severe Oedipal anxiety, strong guilt over masturbation, etc. may have reactions to the additional psychological trauma of an operation that are fragmented, isolated, and partially repressed. Unconscious reactions to knives and anesthetics may give rise to special symptoms. It is interesting to note that when there is verbalization as in a dream, fantasy, or fear regarding knives, there is frequently some association referring to gas, drugs, or anesthesia; or vice versa, when these patients complain or dream of feelings of being drugged, gassed, or suffocated, there is frequently some association to knives.

An intelligent young man of twenty-six, employed as a junior executive in a large company, had a breezy manner and a pseudo friendliness which thinly disguised his general mistrust of other people.

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