MANAGEMENT OF CATASTROPHIC REACTIONS IN CHILDREN

Abstract

Kurt Goldstein's concept of catastrophic (1939, 1941, 1942) has been utilized primarily to understand the behavioral reactions of brain-damaged patients (Eisenberg, 1957). This paper will present an alternative formulation based upon my finding this phenomenon after any type of severe body injury with residual damage and relating more to specific premorbid personality factors than kinds or areas of injury. I suggest that the catastrophic reaction is a complex of defense mechanisms designed to ward off profound anxiety experienced by a person when massive forms of bodily insult threaten the whole structure of his lifelong adaptive and defensive patterns. The reaction occurs typically in individuals whose characteristic defenses have been predominantly counterphobic and who interpret any failure of function as destruction of their egos and death, a concept similar to the dread of aphanisis (Jones, 1929). The following brief clinical sketches are presented as illustrations of this thesis, and offer a basis for discussing the therapeutic implications.