Congenital Absence of Sensation

This fascinating and complex patient had a congenital absence of most surface and many enteroceptive sensations including touch, pain, temperature, vibration, joint position sense, stereognosis, and visceral sensation. Sensations arising from the oral, anal, and genital regions were absent, and pleasure was not experienced with surface pressure, cuddling, eating, defecating, urinating, and erections. He had disturbances in blood pressure and body temperature regulation, as well as in wound healing. Despite impaired development of a sense of self, identifications, object constancy, and empathy, he developed competence in many spheres. Adaptive and defensive functions of the ego as well as mechanisms of internal control and differentiated affects developed despite our expectation that this could not have occurred. The roles of empathetic mothering, auxiliary egos, and plasticity of the human organism in development are discussed. The importance of considering each individual as proceeding along developmental lines uniquely adaptive for him is given renewed emphasis. Further evidence is provided to support the concept of a separate developmental line for the sense of self, probably more directly tied to somatic

experience than to ego development. The usefulness of a psychotherapeutic approach which emphasizes a knowledge of the patient's adaptive potential as well as his deficiencies is underscored.