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Traumatic brain injury is one of the most common disorders affecting the central nervous system, with an incidence of 200 per 100,000 population (Kraus, 1987). Survivors of traumatic brain injury often display complex disorders of cognition and behavior that are difficult to quantify or characterize using currently available neuropsychological tools and/or psychiatric diagnostic terminology. We feel that psychoanalytic theory provides an excellent framework for describing, conceptualizing, and understanding many aspects of the post-traumatic syndrome. Also, the integration of psychoanalytic concepts in the rehabilitation process provides an extremely useful tool in the rehabilitation of patients suffering from cognitive and behavioral sequelae of traumatic brain injury. Third, correlating the disordered psychological function with the neuropathological changes commonly encountered in patients with closed traumatic brain injury (CTBI) provides a unique opportunity to contribute to the literature aspiring to affirm the biological substrate to mental processes described by psychoanalytic theory. Finally, examining the behavioral correlates of traumatic brain injury can help us to validate or refute certain aspects of the psychoanalytic theory.
A brief review of the neuropathology and pathophysiology of CTBI can help us to better understand the behavioral disorders encountered in this population. Neuropathological changes in patients with closed head injury differ from those found in patients with penetrating head trauma. In the latter, an object such as a bullet, blunt object, or bone fragment penetrates the subarachnoid space and strikes and/or penetrates the surface of the brain. This results in a focal area of damage and the symptoms correspond