Patterns of Emotional Recovery from Hysterectomy

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Abstract
Three types of clinical recovery of patients having undergone hysterectomy were described. They were observed preoperatively, immediately postoperatively, and during convalescence in the hospital. Group A had a minimum of physical discomfort and subjectively experienced emotional suffering. Group B showed intensive and prolonged physical symptoms and emotional disturbances. Group AB showed physical and psychological distress intermediate between Groups A and B. Speed and nature of recovery from anesthesia bore little relationship to the extent of the procedures and technical difficulties of surgery, blood loss, or the depth, duration, and difficulties of anesthesia. The majority of cases contained in the pattern of recovery from anesthesia the blueprint of the important physiological and psychic facets of convalescence in the hospital. Women in Group A emerged into consciousness after the operation with a well-integrated ego. Their defenses, i.e., denial of loss, intellectualization, rationalization, and isolation of feeling, were sufficiently strong to expedite recovery. This pattern was recapitulated in their subsequent hospital course. Women in Group B were overwhelmed by the trauma of the operative experience. They reacted with regression, manifested by surrender to their impulses with primitive behavior or by passive withdrawal, becoming unresponsive and uncommunicative. They were unrealistic, uncooperative, and reacted to helping care, as well as to demands made on them, with an intensification of regressive behavior. This state lasted well into the period of convalescence and could only be modified by establishing an anaclitic relationship and by subsequent interpretative and ego strengthening psychotherapy. The outstanding features in Group B were the immature nature and intensity of the impulses and the inadequacy of the defense mechanisms. In 3 cases the recovery from anesthesia was of Group B type but the convalescence in the hospital followed the pattern of Group AB. This was ascribed to successful psychotherapy which mitigated the intensity of the response to the hospital experience. It prepared them better for their subsequent convalescence. None of the patients in the study shifted in the opposite direction in their recovery, i.e., either from Group A to AB or from AB to B. Women in Group AB showed regressive features of varying degrees, together with gradual strengthening of ego defenses and a general integrative capacity. The same pattern was observed in their subsequent recovery. There were greater variations in strength and nature of ego defenses in this group than in the other 2 groups.

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