Stroke, Body Image, and Self-Representation: Psychoanalytic and Neurological Perspectives

Description

Stroke, Body Image, and Self Representation provides a psychoanalytic reading of the subjective difficulties encountered by patients who have suffered a stroke. The book is based on the words of stroke patients and on their self-portraits, which are then compared with the words and portraits of subjects devoid of brain lesions. Pathological and normal self-portraits illustrate in very concrete terms the libidinal investment of our body parts. The author's original data sheds an entirely new light on the subjective effects of a stroke. On the one hand, the permanent sequelae of a stroke can cause a narcissistic injury; on the other, a stroke may affect the brain circuitry involved in the patient's body image, undoing the normal narcissistic reactions. This may happen after right hemisphere lesions and cause spectacular symptoms, such as the personification of a paralyzed hand or the apparent ignorance of a severe paralysis. This double aspect of a stroke is no small problem for rehabilitation therapists, who must avoid two pitfalls: considering any issue as psychological in nature, as if the brain lesion could not produce any organic changes, or, on the contrary, attributing any behavioural problems to brain dysfunction, as if the patient was devoid of normal psychological reactions. One of the aims of this book is to help therapists gaining their bearings in this little-known field. ? In addition to this clinical interest, the author's psychoanalytic reading brings an original contribution to the physiopathology of cognition and self-representation. The data gathered by Catherine Morin show that self-representation cannot be considered only a cognitive operation. They also suggest that normal cognitive activity relies on both the stability of body image and the repression of the object. Stroke, Body Image, and Self Representation will appeal to psychoanalysts, psychologists, social workers, psychotherapists, psychiatrists, and rehabilitation therapists working with stroke survivors and patients with body image disorders. About the Author Catherine Morin is a neurologist and a researcher (INSERM) with neurophysiological and psychoanalytic training. She has been involved in the rehabilitation process of stroke patients at the Rehabilitation department in the Hôpital Pitié-Salpetrière in Paris from 1972 to 2010. Since 1983, both her clinical and research work have been on body image and body schema disorders after a stroke. She is a member of Association Lacanienne Internationale and of the International Society of Neuropsychoanalysis. Cover Title Copyright Contents Foreword Acknowledgements Copyright acknowledgements Figures Abbreviations Introduction 1 Body schema Cenesthesia The invention of body schema Body schema and space Body schema, action, sense of agency Body schema and body image in cognitive neuropsychology Body schema and space representation acquisition The representation of one’s own body and the bodies of others Body schema disorders Hemineglect Child dyspraxia Apraxias Body schema disorders and psychopathology Asomatognosia Somatoparaphrenia Anosognosia Dyspraxia and personality disorders Schizophrenia and body schema disorders References 2 Body image Wallon: acquiring the notion of one’s own body Lhermitte: body image in neurology Freud and narcissism Schilder, Freud and the libidinal structure of body image Lacan, the specular image and the object The body in clinical observations of infants and children Body image in psychosis Body image and bodily pathological alterations How to study body image using self-portraits The normal self-portrait and its lacks The metaphoric value of the mouth and the hands References 3 The subjective effects of stroke Research methods The specificity of brain lesions References 4 The psychological effects of stroke in patients without body schema disorders Self-portraits Missing hands Lack of facial features Mirrors and the gaze Aggressiveness: the others’ image Self-image: seeing oneself “like that” Self-image and discourse: from I to one, the subject’s subjects Subjectivity and enunciation From I to one, which verbs? Grammatical subjects and ego-images Narcissistic injury and recovery The paralysed body: absent from discourse, present as a transitional object References 5 The psychological effects of stroke in patients with body schema disorders Self-portraits The patient’s words The paralysed body: present in discourse, subject to aggressive manipulations Narcissism and body schema disorders References 6 Case studies Hemineglect and the broken-up body Conversation with Mr E Self-portraits Severe hemineglect, holes in the body, oral cravings Hemineglect and orality disorders Holes in the body The body: a shell that protects the ego Mr U and his therapists: aggressiveness and transitivism Asomatognosia and orality disorders Mr R: “I saw a left arm passing by and I felt like biting it” Mr N: “A hand-kissing because I can’t shake your hand” The paralysed hand: a mother’s daughter Mrs M and her daughter-hand with a double leg Mrs C and the daughter left inside her body Mrs N and her leaf-daughter Mrs S and her daughter-arm stuck in a foetal position References 7 Right-hemisphere syndrome: physiopathological hypotheses Cognitivist hypotheses Right-hemisphere syndrome, image and object References 8 Anosognosia Anosognosia in everyday life Cognitive theories of anosognosia Psychological theories of anosognosia Anosognosia: a defence against a change in self-image? Anosognosia: a méconnaissance systématique? Anosognosia: a denial? Anosognosia: a repression? Anosognosia: the result of a regression to primary narcissism? Anosognosia: a structural reading Anosognosia in left hemiplegia is not a neurotic méconnaissance Anosognosia in left hemiplegia is associated with body image disorders Anosognosia, body image and the object References 9 Right-hemisphere syndrome and pathological mourning References Conclusion References Index