Psychosomatic Medicine 12:356-361 (1950)
© 1950 American Psychosomatic Society

The Role of Denial in Acute Postoperative Affective Reactions Following Removal of Body Parts

¹ The Mount Sinai Hospital, New York

Four patients are described who, following the removal or alteration of major portions of the body, suffered severe affective reactions. Four questions posed at the beginning of the report, can be answered in summary as follows:

The seemingly appropriate depressive or "mourning" response to the loss of an important body part or function should be regarded as pathologic when it forces the patient into a regressive reaction in which he ceases to make his usual spontaneous and active attempts at readjustment.

The dynamics of these reactions is probably best understood in terms of the development of the ego's capacity for active mastery by the formation of the defense of "normal" denial as described by Anna Freud (1). The most severe reactions are found in those individuals who show an exaggeration of the quality of independence achieved through denial of danger. This discussion, although chosen as the focus of this paper, does not mean to imply that other dynamic factors are not operative as well.

The modifiable factors, in the light of these observations, would seem to lie in the ability to predict which personalities will require a special preoperative psychologic preparation for major surgical procedures, together with the development of a technique for giving these patients factual information in such a manner that it has affective as well as intellectual meaning. In the case of patients who are thought to be predisposed to an affective reaction to surgery this will require discovery of the role played by the new altered body state of the individual in his life pattern and of how best to present the outlook for the new reality situation to him.