We are now in a position to integrate some of the findings described above. In strictly cognitive terms, it is well known that the right perisylvian convexity is specialized for spatial cognition. In psychoanalytic terms, it appears that damage to this area undermines the patients' ability to represent the relationship between self and objects accurately (a function that is, of course, a form of spatial cognition). This may in turn undermine object relationships in the psychoanalytic sense: Object love (based on a realistic conception of the separateness between self and object) collapses, and the patients' object relationships regress to the level of narcissism. This results in narcissistic defenses against object loss, rendering these patients incapable of normal mourning. They deny their loss and all the feelings, including external perceptions associated with it, using a variety of defenses to shore up this denial whenever the intolerable reality threatens to break through.

The psychoanalytic argument relating to anosognosia, presented in the previous section, was initially developed in the context of the standard psychoanalytic method. However, there has recently been a series of quantitative investigations of the behavior of anosognosics (Turnbull et al., 2002), and these attempts thus far are quite consistent with the original claim. For example, the data suggest that patients with anosognosia appear to have some form of implicit awareness of their deficit, and also that anosog-nosics appear to be overcome with one class of emotion—feelings of separation and loss (Turnbull et al., 2002). These data are entirely compatible with the psychoanalytic claim that an inability to come to terms with loss forms the basis of the disorder. Whether this is the sole basis of the denial of deficit in these patients will clearly require further research.

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