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Now into its sixth year, the Toronto Group continues to attract a diverse range of clinical and research people. The focus this year is on the integration of case material with theoretical efforts to formulate a more comprehensive and psychoanalytically based view of the mind, in contrast to the more reductionist—albeit burgeoning and fascinating—view from the neurosciences.
Both at a Toronto Group meeting in September 2006, as well as at the Freud 150th Anniversary meeting at the Canadian Psychoanalytic Society and Quebec English Branch in Montreal, Chair Dr. James Deutsch spoke of how the various points of view of psychoanalysis, stemming from Freud's own groundbreaking work with neurological patients, can contribute to diagnostic clarity, formulation, and treatment in neurological patients.
The focus was on a middle-aged patient who suffered an infarct of the right basal ganglia and anterior limb of the internal capsule, resulting in severe impairments in the domains of neu-ropsychological cognition, affect, and conation (will, initiation). Parkinson-like symptoms such as inability to initiate action or thought and severe restriction in range of affect, presumably partly based in the neuropathology, could be seen as additionally burdened by conflict related to feared consequences, in turn related to early trauma and pathological introjects operative within the superego.
From a structural point of view, “neurological symptoms” could be increasingly viewed as functioning partly defensively. It was possible to analyze the contribution of the harsh and punitive superego, manifesting in part as a sense of responsibility for outcomes that realistically belonged to others, and the patient's sense of his disability as a warranted punishment involving loss of key functions such as memory and decision-making, as well as a symbolic castration evidenced by indications of underlying fantasies regarding the actual brain anatomy involved in his injury. Emotional constriction was r