Psychoanalytic Reflections on the Diagnosis of Aphasia in a Young Boy

A young Englishman of 30, whom I had known in his childhood, came to visit me in California to see whether I could help him figure our the ‘mystery’, as he put it, of what had been wrong with him as a child. If he knew and could overcome his remaining difficulties he might become a different person. By this, he explained, he meant that he would not be so shy and, especially, would not freeze up when anybody spoke to him or looked at him. Tall and attractively dressed, he gave the appearance of a poised, accomplished young man, except for his speech which was slow, difficult and hesitant, with long gaps between words. He asked many questions and we spoke of many aspects of his past and present life, for, as he said, I was the only one left of those who had known him when he was very young since the others—two psychiatrists—had died. On the second day our conversation was easier and much less laboured. When I saw him a month later, it was only slightly less difficult for him to express himself. The impression then was not so much of a lack of ideas as of difficulty in producing the words.

I first met A when he was 6 years old, a patient in a small residential treatment hospital for severely disturbed children near London, to which he had been admitted the previous year for lack of speech and aggressive, often violent behaviour. There had been no improvement and there was now some question about his hearing. The decision to offer psychotherapeutic treatment was part of a project to explore whether Anna Freud's Diagnostic Profile was applicable to atypical and severely disturbed children. The dilemma he presented was in deciding whether his impairment was due to organic or psychological factors. Although he had acquired speech normally, after his second birthday (the exact time is unclear) his speech deteriorated, so that by the age of 5 he had no speech at all. Although A had been subject to rather distressing and continuing environmental disturbances, there was much q