The loss of thinking-defence in a case-study of prefrontal brain injury

The author asserts that psychoanalysis can serve as both a meta-psychology and as psychotherapy for people who have sustained brain-injury. Changes of personality after traumatic brain-injury are well documented but a strictly neurological explanation is unsatisfactory (Damasio, 2003). We argue that psychoanalytic meta-psychology can explain how brain-damage translates itself into a changed personality and psychodynamics. The author starts with Freud’s “Project”, where he describes the essential function of the I as the inhibition of thoughts (images) that lead to pain, resulting in the so-called “thinking-defence” (Freud, 1992: 68). According to the author, this protecting influence of the I often fails in the case of patients with prefrontal lobe-damage. This will be illustrated comprehensively by a case-study.