Dear Patti, 

Four years ago it was discovered that our 3-year-old daughter had cancer. It was absolutely the most horrifying time of my life. She had to undergo several radiation and chemotherapy treatments. She lost her hair, several pounds and endured severe pain. Kia is now 7, back to her normal appearance and there’s no longer any evidence of disease. Even though Kia seems fine, I’m constantly terrified. Privately I worry over her every little scratch and fall but keep these feelings to myself as I want Kia to move on strong and whole, in the emotional sense as well as physical. When I drive by the hospital or hear sirens, I wince against a startled reaction. I’ve been in psychotherapy and diagnosed with post-traumatic stress syndrome.

Recently my husband, Chris, was hiking with friends and fell down a hill. Initially he seemed OK as he managed to walk to the car and be driven home by a buddy. After being home less than 10 minutes, he started moaning and I felt intense resentment. I felt like he was being self-indulgent. I remember thinking, “It’s not like he’s bleeding or has a fever. He can walk, so what’s the problem?” After a short while he started sweating profusely and felt like he was going to pass out from the pain. He felt dizzy and weak. I kept making jokes, teasingly calling him a baby and telling him not to be such a sissy. He didn’t get better so eventually I called 911. Even after the paramedics arrived, I still tried to downplay the situation, saying that maybe I should drive him to the hospital. The emergency team said absolutely not and insisted on escorting him in the ambulance. It was later revealed that Chris’s broken ribs had punctured his lung in several places and he needed surgery. Even during surgery I felt the urge to go home to be with my daughter and make everything as normal as possible. While my husband was being operated on, I was watching Kia take a piano lesson.

When I saw Chris in the recovery room, I couldn’t believe how frail and white he was and I broke down sobbing. I dearly love Chris and don’t know what I’d do if anything happened to him. He was so sick and in so much pain! How could I have been so callous? What’s wrong with me? It’s unbelievable I acted that way. I’m so ashamed!


  — Olivia

Dear Olivia,

After the heartbreaking experience you endured with your daughter, you were already fragile and suffering from post-traumatic stress syndrome. When Chris had his accident, it’s clear you could face no more. In psychoanalysis there is an identified defense mechanism called reaction-formation. This is when one has unbearable, anxiety-producing emotions which are dealt with by an exaggeration of the directly opposite emotion. For example, if feelings of hate toward another person make one anxious, the ego can unconsciously conceal the hostility by facilitating an exaggerating flow of love. Overdone catering and care may be a reaction-formation against cruelty, unconditional pacifism a response against sadism and extreme expressions of chastity may mask unacceptable sexual desires.

In your case, dismissal, minimizing and even ridicule concerning your husband’s serious physical condition may be defending against your dreaded fear of Chris being intensively ill, maybe even dying. Your behavior effectively covered up your worst fears until you were in the recovery room and Chris was significantly better and presumed out of danger.

When reaction-formation takes place, it’s assumed that the original, rejected emotion isn’t gone but persists, unconscious. Therefore, when your brush-off and lack of concern was experienced as a reaction-formation against your terror, helplessness and grief against possibly losing Chris, your callousness wasn’t replacing your deep fear of losing him. Your original feelings of concern always existed underneath. Your attachment and bond for Chris was never gone. In fact, it was your love for him that evoked the apprehension and, in turn, created the defensive process of reaction-formation. 

It’s clear that you reacted as you did because you love and care so much about your husband and daughter, not that you don’t care enough. I’m sorry you have had to go through such unbelievably stressful experiences and happy that your family is now safe and well.  

Patti Carmalt-Vener, a faculty member with the Southern California Society for Intensive Short Term Psychotherapy, has been a psychotherapist in private practice for 23 years and has offices in Pasadena, Santa Monica and Canoga Park. Contact her at (626) 584-8582 or email Visit her website,