This article argues the case for increased recognition of a neuro-psychoanalytic vision within the field of neuroscientific research. It demonstrates how the neuro-psychoanalytic approach to concrete clinical problems can result in new clinical and theoretical insights that can serve to advance the field of neuroscience. The clinical phenomenon of anosognosia, the denial of illness, is used to illustrate the importance of this approach. The article begins with a brief outline of the neurological and clinical symptomatology of anosognosia and a discussion of the main problems encountered in research on, and the clinic of, anosognosia. The two classical explanations of anosognosia are described in order to highlight the shortcomings of the dominant paradigms in neuropsychology. Finally this article discusses anosognosia from a neuro-psychoanalytic point of view with reference to the work of Kaplan-Solms & Solms (2000), Schore (1994; 1997) and Weinstein (1955; 1991), who indicate aspects of the phenomenon which are unjustly neglected in pure neuropsychological research and which ought to form the basis for further investigation. It is argued that a different approach to this phenomenon can lead to the formulation of new questions and hypotheses. The article concludes with some clinical and theoretical implications.
Neglect and anosognosia, i.e., the denial of the (left) hemisphere and the denial of hemiplegia, are often found in patients suffering from damage to the right hemisphere of the brain. It has been known for some time that these symptoms can be alleviated, albeit temporarily, using various methods, (Ramachandran, 1994; 1996; Ramachandran & Blakslee, 1998). Kaplan-Solms and Solms (2000) found that in psychotherapeutic interviews patients could also become temporarily aware of their formerly denied lesion. They concluded from their research that the purpose of the neglect-syndrome is a defence against denial. For the past four years, the Neuropsychoanalytic Study Group Frankfurt/Cologne has conducted psychoanalytic therapy with a group of patients with right hemispheric lesions, all exhibiting neglect/anosognosia. Results so far indicate that defence against depression is not the only cause of the syndrome, but that failure to construct a body schema, as a result of the paralyzed side of the body no longer being represented is also involved. Patients appear to refer to memorized representations resulting in so-called ‘neglect-syndrome’. Recent research (Craig, 2002) lends support to this view. Preliminary hypotheses concerning the interaction between neuroscientific models and psychoanalytic concepts are discussed and illustrated with a case vignette.