What work for psychodynamics in a theory of anosognosia?

Andrew Sims (Deakin University )

Anosognosia is the denial of pathology, and is commonly associated with paralysis and neglect after right hemisphere stroke. In these cases it is often also associated with distortion of the patient’s emotional states towards their body and world. Due to the way in which the condition lends itself to interpretation in terms of self-deception, early theoretical treatments of anosognosia explained the patient’s delusions of wellness in terms of wishful distortion. However, this sort of explanation has gone by the wayside as contemporary researchers prefer to explicate the disorder in terms of cognitive deficit. It has been claimed (and it is implicit in much of the literature) that these two types of account are incompatible, and the rejection of psychodynamic accounts in particular has been thought to rest on three key philosophical criticisms: first, that they are inappropriately psychogenic; second, that they accordingly fail to explain neurological aspects of the condition; and third, that they lack a plausible mechanism of action. I remove these criticisms by looking at a “minimal neuropsychodynamic model” that has distal origins in the work of Sigmund Freud, John Hughlings Jackson, and Hermann von Helmholtz, and which can be seen at work in some recent research on the condition. This way of looking at cognition allows that motivation-states can have a distortive influence on belief formation, but does not fall prey to the objections enumerated above.