Psychodynamic understanding and treatment of patients with congenital disability

This paper is a follow-up to an article published in 1989 by Cubbage and Thomas. The purpose of that article was to provide a comprehensive analysis of classical Freudian concepts such as castration anxiety, narcissism and self-regard, fear of the loss of love, secondary gain, the death instinct, and ego strength as they related to the treatment and personality development of persons with disabilities. Despite a rigorous review of the literature, an important paper of Freud's with direct and significant implications for persons with congenital or other early-life disabilities was inadvertently overlooked. The purpose of the present paper is to correct that oversight and to provide an almost verbatim synopsis and rehabilitation treatment implications of Freud's (1916) comments on "Exceptions," a character designation that includes persons with congenital or other early-life disabilities that are viewed by the patient as having occurred through no fault of his or her own.