Coen S J
J Am Psychoanal Assoc. 1986;34(1):47-67. doi: 10.1177/000306518603400103.
The sense of defect, physical or psychological, is here regarded as a fantasy, a compromise formation, rather than an actual defect existing somewhere in the body, or in some psychological structure. It need not correlate with the reality to an external observer of physical or psychological disability. Psychoanalytic emphasis is directed to the motivations for the persistence of this sense of defect, rather than primarily to etiology (trauma) or genetic history. Accurate perception and evaluation, having been interdicted during childhood, is avoided with the magical hope that thereby one will be acceptable and what is wrong will disappear. The interaction between self and parents, real and fantasied, cannot be clearly known. The patient remains uncertain as to what is wrong, in whom it is located, and how it has come about. The sense of defect, physical or psychological, becomes the nidus around which much is crystallized. This is then offered up to a parent (and the superego) as an appeasement and seduction, aiming to help this parent feel better by agreeing that the child is indeed the cause of what is wrong. Dangerously destructive (and sexual) wishes are defended against and atoned for by emphasis on one's defectiveness.
这里所指的身体或心理上的缺陷感被视为一种幻想，一种妥协性的形成，而非存在于身体某处或某种心理结构中的实际缺陷。对于身体或心理残疾的外部观察者而言，它无需与现实相关联。精神分析的重点在于这种缺陷感持续存在的动机，而非主要关注病因（创伤）或遗传史。准确的感知和评估在童年时期就被阻断，人们怀着一种神奇的希望避免去面对，即这样一来自己就能被接受，错误的东西也会消失。自我与父母之间真实的和幻想中的互动无法被清晰知晓。患者对于哪里出了问题、问题存在于谁身上以及问题是如何产生的仍不确定。身体或心理上的缺陷感成为了许多问题得以具体化的核心。然后，这被当作一种安抚和诱惑呈现给父母（以及超我），旨在通过认同孩子确实是问题的根源来帮助这位父母感觉好受些。危险的破坏性（以及性）愿望通过强调自身的缺陷而得到防御和赎罪。
