The emotional and psychosexual aspects of hysterectomy

The emotional sequelae of hysterectomy have long been suggested as a concern of the gynecologist. A review of the literature reveals that there are surely concrete changes in the functioning, attitudes, and behavior of patients who undergo this procedure. Since the gynecologist acts as the "uterus remover," it is our specialty that should be dealing with these women patients to carry them through the possible effects of such surgery. In addition, it would be wise for all of us to examine our own indications for this procedure in order to be confident when faced with criticisms that our specialty considers the uterus less valuable than other organs, rendering it more vulnerable to the unthinking surgeon.

Hospitalization as a life crisis for the preschool child: a critical review

Review of the literature on the psychological effects of hospitalization on children reveals that it has not increased substantially in quality or quantity since Vernon and his associates published their extensive review a decade ago. More recent research supports the earlier contentions that children between the ages of 6 months and 4 years are especially vulnerable to upset but are also more amenable to change and growth than other age groups. Maternal separation appears to be the primary stressor, but the presence of emotional disturbance prior to hospitalization and the child's level of cognitive development at the time may also be significant factors. Attempts to prepare children for hospitalization and surgery have met with some success, but not for preschool children. The need for some comprehensive theoretical perspective on which to base research is evident. Studies to date appear to have been based either on the concept of "anticipatory worry" or on some form of modeling theory. The author suggests that hospitalization can be considered as a life crisis for a child, a crisis that may result in blocks or distortions in his development if not mastered properly. Crisis theory provides a meaningful and useful model for understanding the experience of hospitalization for young children and for providing a basis for intervention. The psychopathology present in some children and their families is made apparent during such a crisis as hospitalization; this may present the only time when they are accesible to mental health professionals.

Children's reactions to hospitalization and illness

The paper describes children's reactions to illness and hospitalizations from a developmental point of view. Taking the latter into account, it becomes easier to understand not only the child's reaction at different ages and the reasons for it, but the nature of the potential damage, that is, where and why it takes place, as well as the resources available to the child that may help, if wisely used, to minimize the potential traumas.

Possible sequelae of trauma and somatic disorder in early life

All children experience trauma. The age, state of development and constitutional factors will determine whether some children will have a traumatic effect. Trauma occurring before the age of three, at a time when the ego has not developed its synthetic and integrative functions, may be reproduced in later life as an isolated symptom, by selected sensations involved in a sensory imprint or screen sensation of the trauma as a simple recording. After the age of three, under the influence of a more mature ego, excessive traumatic stimuli will be integrated and elaborated in symptom formations as phobias or other conditions and extended as part of the total personality. Recurrence in later life is triggered by events related not only to the original experience, but also to the content of its elaboration. The earlier in life the trauma occurs, the more likely that somatic imprints of primitive physiological symptoms would result as an archaic, biological defense or screen sensations. Recurrent sensory imprints or screens may appear as organic illness or functional somatic symptoms. Diagnostically, a detailed early life history is necessary to uncover the presence of a sensory screen memory of a trauma and so avoid diagnostic medical search for organic causation. Case material illustrating the two groups are presented. Indications for psychoanalysis and for supportive psychotherapy are discussed from our theoretical framework as well as from the literature.