Todd Feinberg's Target Article represents the most comprehensive account yet produced of neurological disorders in which patients produce delusion-like or confabulatory utterances in response to brain damage in terms of both neuropsychology and psychoanalysis. In response, I raise two kinds of questions. The first: Does his account do enough to distinguish “neuropathologies of the self” from other brain pathologies that also impact on patients' experience of themselves in the world and in relation to others but do not produce this kind of psychotic phenomenology? The second: To what extent does he explicate the interaction between the cognitive and psychic transformations to which these patients are subject? My response will focus on the complex cognitive changes in these patients, in order to propose an explicit mechanism, cast in terms of Freudian primary and secondary (unconscious and conscious) processing, for the bewildering utterances that erupt in their discourse.