Scarred: A Contribution to the Study of Facial Disfigurement

'I have always had a scar on my face', a middle-aged woman said in a tense, almost inaudible voice during her first interview. I did not see a scar. All I saw was a rather attractive, well built, noticeably anxious, somewhat depressed woman, with a girlish, almost childlike appearance and attire. There were no overt signs of scarring or visible facial alterations, but after she mentioned that she had a scar on her right cheek, I became aware of a slight asymmetry of her facial features and a trace of heavy make-up on the right side.

It turned out that she really did have a scar on her cheek, or more precisely, a disfiguring, congenital haemangioma which, according to her initial description, was the size of a quarter and was located in the middle of her right cheek, half an inch or so beneath the zygomatic bone. This was her scar, or birthmark as she told me. But I never saw it. Much later, when in the course of a long analysis her ego strength had increased enough for her to tell the truth, the patient revealed that the haemangioma actually extended over the major part of her cheek from the orbital region to the lower edge of the mandible. It was so well covered with cosmetics, powders, and creams that it was never seen by anyone outside her immediate family.

What I shall discuss in this brief case report are the multiple and, in a sense, massive psychological reverberation as they emerged slowly, painfully, and for the most part in bits and fragments over several years of analytic work. The patient was referred to me because of frequent attacks of anxiety (with tachycardia and shortness of breath in the absence of organic findings), phobic fears (especially of strangers), and recurrent episodes of depression. It soon became apparent that what she called her 'scar' was felt by her to be an overwhelming burden