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Blos, P. (1960). Comments on the Psychological Consequences of Cryptorchism—A Clinical Study. Psychoanal. St. Child, 15:395-429.

(1960). Psychoanalytic Study of the Child, 15:395-429

Comments on the Psychological Consequences of Cryptorchism—A Clinical Study

Peter Blos, Ph.D.

SUMMARY

Three prepubertal cases of cryptorchism were presented. The complementary effects of psychotherapy, physical correction of the genital defect (two operative, one spontaneous), and treatment of the parents, especially the mother, were explored. On the basis of the clinical data the following conclusions were reached:

1. Cryptorchism is not a primary pathogenic factor. The particular way in which the genital defect is experienced by the parents, particularly the mother, accounts for the child's preoccupation with the testes. The perpetrator of the body damage is in the child's mind identified with the mother. Her castrating possessiveness and the passive aloofness of the father both constitute a matrix of family interaction in which cryptorchism gives rise to typical symptoms despite the fact that the three cases belong to heterogeneous nosological categories.

2. In all three cases an early operation trauma had occurred, and served as the prototypical model for body-damage (castration) fear. The genital defect (cryptorchism) served as the "organizing experience" (Greenacre) which subordinated early trauma as well as all subsequent phase-specific anxieties about body damage to the persistent genital incompleteness. An operation trauma per se is not considered an obligatory experience.

3. A distorted, vague, and incomplete body image exerted a pathological influence on ego development. Resultant ego impairments were manifest in defective functioning relative to learning, memory, thinking, time-space orientation, and motility. These impairments could furthermore be linked to the mother's inconsistent attitude by which she tacitly forbade the child to recognize his physical defect clearly, or to think rationally about it.

4. The tendency to self-damage (accident proneness) present in the cases was understood as the child's idea that the genital defect was the result of an act of aggression (castration). Through identification

with the aggressor the child turned passive submission into active execution and made himself the victim of his own aggression. Castrative wishes were clearly in evidence.

5. Cryptorchism favors direct, concrete, symbolic (substitutive) expressions by objects in the outer world, the use of the whole body or body parts for the mastery of the anxiety which the anatomical defect engenders. Substitutive organs (organ symbols) for the testicle were found to be: eye, tonsils, breast, and foetus.

6. A bisexual sense of identity reflected the physical reality of anatomical indecision. The perseverance of the female body image and the defense of castratedness (body-part surrender) was directly related to a body reality rather than to a psychologically integrated drive and ego organization. This became evident through the reversibility of the body-image confusion once genital intactness was established.

7. Coordinated efforts of surgeon and therapist resulted in a striking amelioration of ego impairment. The changed body image exerted an immediate and direct influence on ego functions. What appeared initially as an endopsychic conflict represented in fact a body-reality confusion, aggravated by reality fear. Considering the influence of the anatomical correction on differentiative and integrative psychic processes, the conclusion was reached that the concreteness of body-damage fear prevented total internalization of the body reality and its amalgamation with conflictual anxiety. The delay of internalization was maintained by the reparable genital defect and the undying expectation of a changed body reality. This particular state of affairs in the presence of a bodily defect might explain the reversibility of an emotional condition with severe ego impairments, which in children generally would indicate an ominous pathology.

The findings in this paper are restricted to cryptorchism. It seems that the particular survival value, the interference with perception, with the physical grasp of objects, with phase-specific gratifications, and many more factors related to a defective body part, introduce elements which are absent in cryptorchism per se. The sifting of similarities and differences in cases with other bodily defects lies outside the scope of this presentation. The clinical study of three cases of cryptorchism aimed at an investigation of the mutual influence

of body reality, body image, ego development, and internalization within the matrix of a specific pattern of family interaction.

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