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This article discusses a major dilemma that confronts the analyst who suffers from a prolonged or terminal illness. How much factual information should be revealed to patients concerning the illness and the prognosis? Discussion focuses on accounts by four analysts who suffered serious illnesses and wrote about their experiences. Transference and countertransference issues are considered, followed by relevant references to neutrality-its uses and abuses -in analysis when serious illness strikes. Guidelines offered by others are reviewed, and leads for future thought about this topic are suggested. This article is concerned with the impact on psychoanalytic work of the analyst's becoming seriously ill. Although I have never been seriously disabled, a review of the sparse literature on this topic has stimulated thoughts about a phenomenon that must be considered by all of us in the course of psychoanalytic work. The surrounding ground for this article is psychoanalysis: its framework, its parameters, and the conditions essential for psychoanalysis to take place. The figures in the ground are the accounts provided by four analysts who have become seriously ill and have written about their experiences. The differences in the ways in which the illness was viewed and dealt with intrapsychically and in relation to patients is revealing and is the topic of discussion.Psychoanalysis and psychoanalytic psychotherapy are conducted according to certain prescribed procedures in order to establish a setting of freedom from judgment, trust, regularity, constancy, and self-examination. This frame becomes as important to the patient as it is for the analyst. Of course, some disruptions may occur in the course of the analysis. Patients may take Requests for reprints should be sent to Stanley Rosner, Ph.D.,

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The borderline patient is "one who has a repressed delusional system which represents sadomasochistic behavior patterns based upon the patient's identification with his parents." Resistance against change comes from perceiving separation as life-threatening, from fear of emergence of long-repressed sadism, from fear of losing one's identity for giving in to the therapist's wishes, and from equating it with abandonment. Procedures are suggested.