Neglect and anosognosia. A challenge for psychoanalysis. Psychoanalytic treatment of neurological patients with hemi-neglect

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.

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