ON THE PROCESSES OF WORKING THROUGH LOSS CAUSED BY SEVERE ILLNESSES IN CHILDHOOD: A PSYCHOANALYTIC APPROACH

Abstract

In this paper I discuss the extent to which psychoanalytic theory on mourning, transitional phenomena and creativity may be helpful in shedding light on the processes of dealing with loss created by severe illnesses in childhood. Through the discussion of three clinical cases, I explore the extent to which psychotherapeutic work with seriously ill children in hospital can be of benefit to the patients and their families.

ACKNOWLEDGEMENTS

This paper is based on a dissertation presented to the Tavistock & Portman NHS Trust and University of East London as a requirement for a Master's Degree in Psychoanalytic Studies. I am very grateful to my supervisor, Juliet Hopkins, whose insightful comments and support were of great importance for the development of this work. I am also very grateful to Heather Price for her invaluable suggestions, and to all my fellow health workers at Santa Casa de Misericórdia de São Paulo for their support. I also wish to express my deep gratitude to my patients for trusting me. All the names used are fictitious and some clinical data were disguised in order to protect patients' identities without affecting the understanding of the cases.

Notes

Sutton (2002) describes the model of Paediatric Liaison in connection with psychoanalytic psychotherapy.

It is noteworthy that the ideas developed by Klein in 1940 are closely related to her own process of mourning following the death of her son. In the text ‘Mourning and its relation to manic‐depressive states’, Klein (1940) analyses the grief of Mrs A after the death of her son, who is actually herself (Grosskurth 1986, p. 251).

Acute lymphoblastic leukaemia (ALL), the most common leukaemia in children, is a cancer of the white blood cells.

If this case had been referred to me without the background of the illness, the intervention would probably have been of a different kind. This entire situation, to some extent, made me unable to initiate a psychotherapeutic intervention that could aim to help Rachel and her mother cope with a greater degree of separateness. For that reason, I referred Melissa and Rachel to psychiatric assessment and psychotherapeutic treatment, respectively.

Rhabdomyosarcoma is the most common soft tissue tumour in children. It is a high‐risk disease, inasmuch as 40% of patients with this diagnosis may face incomplete resection of the tumour or biopsy with gross residual disease. The treatment includes surgical resection of the primary tumour, chemotherapy and radiotherapy.

Cystis fibrosis is a prevalent, life‐threatening, recessively inherited genetic disorder that affects the respiratory, digestive and reprodutive systems. There is no cure for this disease; thus the medical treatment aims to offer early treatment of respiratory infection before irreversible pulmonary damage takes place and also to stabilize the pulmonary infections to minimize the pulmonary damage and sustain an adequate nutritional condition.