Psychological Consequences of Physical Defects: A Psychoanalytic Perspective

The range of responses to the presence of a physical defect is very great, to an extent that makes any generalization extremely difficult. A host of factors (timing of defect, location, pathology, etc.) must be considered. Adverse psychological developments seem to occur most often when defects are minimal ('symbolic') or very severe ('crushing'). Reactions are perhaps least troublesome when the defect represents a realistic handicap that can be ameliorated or surmounted by special effort. Thus, compensatory reactions are particularly common in this group. The defects that are most incapacitating psychologically are those associated with a progressive physical illness, as these do not permit the ego to marshal effective compensatory responses. When psychopathology is associated with physical defect, especially if it is congenital or of early onset, it is likely to be of the narcissistic variety, yet some with significant physical defects are surprisingly unimpaired psychologically. This may be related to exceptional parental acceptance of the defect. Accessibility to psychotherapeutic intervention similarly covers a very broad range; appropriate modalities include the full spectrum from here-and-now

supportive help to psychoanalysis. A person's potential for effective involvement in analytic therapy depends, here as in other cases, on the ego's competence. The presence of a 'defect' is not the primary issue. Because these patients tend to be seen, and see themselves, as 'special', issues of countertransference play a major role in treatment.