A special form of survivor syndrome.

A woman was first seen several months after her husband had died following cardiac transplantation. She had gone into mourning and cried freely at the time, but was indignant about the failure of the surgery. She felt her husband should not have chosen surgery knowing that there was a chance he would not survive and would leave her widowed; she had cared for him 'devotedly' during his nine-year illness. While she admired his intelligence and bravery in deciding to undergo 'experimental' surgery, she expressed anger about his selfishness as he could have lived for many years without surgery. Her husband and the surgeon had insisted that she give her permission for the operation. When it proved unsuccessful, she felt like 'a failure in the eyes of the world'—guilty and worthless as though she had 'committed a great crime'. When first seen the patient was anxious and depressed; she cried constantly and spoke of suicide. After once-a-week treatment began, she brought out many past memories associated with feelings of guilt. An older sister, with whom she had migrated to the United States, died several years after they arrived; she had felt guilty at the time because she had not been close enough to her sister during the last years of her life. She also expressed feelings of guilt concerning the murder of her parents and younger sisters by the Nazis. When she discussed signing permission for her husband's surgery, she spoke of her sons whom she considered emotionally defective and incapable of separating from her, and blamed herself for the way they ————————————— The author wishes to thank Drs. William G. Niederland and Norman Margolis; both provided advice and assistance which brought clarity to the material presented in this paper.-58-had developed. Because of her chronic, severe feelings of guilt, the patient's experience with her husband was unusually painful and after his death her belief in her own worthlessness became even stronger. A number of dreams revealed her ambivalent feelings toward her husband. In one dream a young girl plunged a knife into her husband's chest while the patient slept beside him in their bed. Her associations to this dream were that she wished he were alive, that he had survived the surgery. She went on to speak of longstanding resentment toward her husband and mother-in-law. As an immigrant girl she had longed for a close family and had missed her own …