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This paper shows how Heinz Kohut's formulations were particularly relevant to the treatment of a patient whose cranial injury at birth became a catalyst for rejections that resulted in a demeaned view of himself, compulsive sexual behavior, and suicidal ideation.
The potential negative psychological effects and negative social impact of facial deformity have been well documented (see especially Berger, 1973; Coulter, Scheuerle, Laude, & Habal, 1991; Crocker & Major, 1989; Hill-Beuf & Porter, 1984; Lansdown, Lloyd, & Hunter, 1991; Pruzinsky, 1992). Four problem areas where patients may be particularly affected are (1) cognitive development in the case of severe craniofacial anomalies, (2) the emotional attachment between the child and parents, (3) development of peer relations and, (4) the experience of shame (Pruzinsky, 1992). A major risk for children who have impaired appearance is their being labeled as deviant and stigmatized by society in general. Hill-Beuf and Porter (1984) point out that there is an intolerant attitude in the United States toward children with impaired appearance and conclude that the culture attributes tremendous importance to a narrow standard of beauty.
While people who suffer deformity are faced with potentially devastating stressors, there is no way to predict whether a particular individual will develop psychological problems (Lansdown et al., 1991). Each of these individuals will respond uniquely according to life situations and capacities to make adjustments. Self psychology is especially helpful in this regard. The theory of the self, formulated by Heinz Kohut, is founded on the fact that