Implicit Awareness of Deficit in Anosognosia?: An Emotion-Based Account of Denial of Deficit

Most currently accepted models of anosognosia focus on disorders of body representation, or a disturbance of emotion systems, but struggle to explain the diverse range of findings of the phenomenon. Though currently unfashionable, there is a diverse body of recent evidence which suggests that anosognosics have “implicit” awareness of their deficit-and that their denial is motivated by the aversive emotional consequences that would accompany full awareness. This argument has recently been supported by the work of Ramachandran and others, including the suggestion by Solms and Kaplan-Solms that such knowledge of the deficit can occasionally reach consciousness, causing great (albeit temporary) distress to the patient. The present study investigated the original Solms and Kaplan-Solms session notes, for both anosognosic and non-anosognosic patients, using a method of blind rating of the case material. The pattern of explicit emotional experience was the same for both left and right hemisphere patients, but anosognosic patients were more likely to express emotion that related to subjects other than their disability or its implications. They were also more likely to experience emotional breakdowns at moments that were preceded by talk of loss-even if the cause of such loss was apparently unrelated to their hemiparests. These findings of implicit awareness are entirely compatible with accounts of anosognosia that stress the patient's Implicit awareness of their disorder, and the importance of issues of emotion and motivation in the generation and maintenance of their false belief.