A Neuro-Psychoanalytical Approach of Anosognosia

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.

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.

Conversations with Howard Shevrin III, Ghent, December 1st, 2005

Howard Shevrin’s interest in neuroscience was first methodological: it provided independent evidence on what goes on unconsciously. The foundation of the mind needs not to be entirely neurophysiological: it is possible to describe the mechanisms in psychological terms. However, we aren’t anywhere near a unified theory of the brain and mind. When one goes into analysis, the theory is no longer simply about ideas, one’s life almost hangs in the balance. There is an enormous disparity between the neuroscientist publishing his findings and the analyst who is treating patients, but not publishing. If neuro-psychoanalysis is only going to rely on the neuroscience part, it’s really not going to achieve its important objective. People into psychoanalysis should be trained in “the basic science of psychoanalysis”, which should not be limited to neuroscience, but should include a really important training in psychology, sociology, etc.