The Diagnostic Profile: IX. A Comparison of Two Sections from the Profiles of Two Deaf Boys

I have made use of two sections of Anna Freud's Profile Schema to illustrate its value in comparing the pathology of two deaf boys, and in underlining fundamental differences between them. Examination of the section on Cathexis of Self and Cathexis of Objects shows that a severe handicap such as deafness can play quite different roles in psychic development. These roles are influenced more by the patient's primary narcissism and subsequent sufficiency of secondary narcissistic supplies than by ego defects primarily attributable to the handicap. Whatever effect this may have on primary narcissism, the impact of such a defect upon the child's objects may greatly affect the quality of secondary narcissistic supplies. The parents' capacity to respond to their damaged baby and to meet his particular needs will obviously influence the child's self-cathexis, particularly in regard to his own feelings about his deficiency. These matters should be reflected in the Profile in the sections concerned with the patient's feelings about both himself and his objects. This may make it possible to assess the influence of the handicap in the context of the whole personality and thereby invalidate the assumption that a serious handicap per se determines the development of a specific pathology.

These points are illustrated in the examples I have chosen from the assessment of two deaf boys, both of whom presented for diagnosis at the age of nine because of severe behaviour disorders. I shall give a brief account of their histories and symptoms, followed by the Profile findings regarding the cathexis of the self and of objects. This will underline differences in their pathology which have subsequently been confirmed in their analytic treatment.

David, an attractive, healthy baby, was adopted by his middle-class parents when he was five days old. He was a long-awaited child. The parents were in despair when, at three and a half months, David was critically ill with a brain tumour. As a