The Amelioration of a Squint Through Psychotherapy: A Question of the Development of Psychic Depth?

There has been little written about squinting in psychoanalytic literature. One article relevant to the topic of this presentation, is Rappaport (1959): “Anger, Apathy and Strabismus”. This article contains statements and opinions about the connection between strabismus (squinting) and psychic factors, and the author also gives his own views on the subject.

Rappaport mentions one article dealing with the cure of strabismus through treatment . Leuba reports on two patients of his with “psychogenic squint”. who he claims were cured by psychoanalysis. These patients were ten and twelve years of age, both with multiple symptoms, and convergent (inward) squinting was part of the picture in both cases. The case to be presented here, however, was a case of divergent (outward) squinting. As the title of his paper indicates, Rappaport relates strabismus to the psychological states of anger and apathy, writing, “Strabismus seems to result from a hostile over-stimulation, or lack of stimulation, of the child by the parent.” About outward squinting he says, “External strabismus, in which the medial rectus has lost its physiological predominance, comes from an attitude of resignation and apathy leading to convergence insufficiency and abandonment of accomodation. It represents a regression to a very primitive ego state. If we interpret convergent strabismus as a tightening of the ego defences, then divergent strabismus represents a giving up of the defences in a reality situation which appears hopeless. Then we may say that the child has relinquished the struggle for contact with a mother who is unapproachable, and has turned out its eyes in despair or for search in an unknown vacuum.” Rappaport's general line of thought about divergent squinting is to a certain degree in accordance with the findings from the psychotherapeutic process which will be presented.

The patient was a three and a half year old boy. The events to be reported, happened during the first two years of his psyc