Patient Who Cannot Express His Thoughts in Words5

Although he was only in his 20s, Mr. J suffered a stroke (caused by bacterial endocarditis), affecting Broca's area and surrounding regions. As a result, his speech lacked fluency, he spoke in a telegrammatic fashion, and he could say very few words (i.e., a Broca's aphasia). The disorder suffered by Mr. J (which is now thought to represent a range of underlying language deficits; again see basic neuropsychology texts) disrupts systems that control language output at the phoneme, phrase, and sentence level. His disability, which also included hemiparesis (i.e., paralysis of the right side of his body), had dramatically affected his life, as one would expect. He lost his job, his romantic partner, and most of his friends. He understandably feared that he had no future prospects. All that he had previously taken for granted in life was slipping away. It was a tragic situation, and Mr. J was filled with anger, sadness, and loss.

When he was offered psychotherapy, he eagerly grasped the opportunity. There was much that he wanted to discuss, even though he no longer had the words to do so. One of the many things he wanted to tell his therapist was that he now felt like "half a man." He communicated this by drawing a stick figure of a man, bisecting it vertically, and saying "man ... halfie ... halfie." This communication was pregnant with meaning. It conveyed the essence of his emotional situation, and it simultaneously linked them symbolically with his neurological (hemiparetic) condition. He had lost his masculinity and the self-esteem that was attendant upon it. However, he worked extremely hard in his psychotherapy to come to terms with these losses, and ultimately he was able to construct a new, viable life for himself, built on revised premises and priorities.

5For more detail, see Kaplan-Solms and Solms, 2000, pp. 75-86, or Turnbull et al. (2002) more a quantitative investigation of the emotional state of this patient.

In short, this was a patient who was almost literally wordless; and yet he was able to make productive use of psychoanalytical therapy—the so-called talking cure—to negotiate the painful process of mourning and gain new insights about himself that enabled him to endure, with great courage, circumstances that would defeat many people with perfectly intact brains. We may conclude, as a provisional hypothesis, that the core of the personality of such patients, that is, systems involved in the generation and regulation of emotion/motivation, remain intact, at least to a first approximation. The same is not true for neurological patients with lesions to other brain areas.

0 0

Post a comment