Psychological reactions to chronic medical illness can be categorized as follows: the chronically ill patient is vulnerable, first and foremost, to eight types of psychological stress, all of which have their roots in early childhood. Specifically, chronic illness evokes a threat to the patient's self esteem; fear of strangers; separation anxiety; fear of loss of love, and of the control of developmentally achieved functions; fear of loss of, or injury to body parts; guilt and fear of retaliation; and fear of pain, which cuts across all of these stresses. Other psychological reactions to chronic medical illness include regression, conflict, and inevitable distortions in object relationships. Suggestions for the amelioration of these responses within the matrix of the doctor patient relationship are proposed.