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Our group is now in its eighth year studying the psychoanalytic treatment of brain-injured patients. Coordinated by Edith Laufer and supervised by Mark Solms with Anna Chapman, consulting psychiatrist, and Walter Nieves, neurologist, we primarily treat patients with focal brain lesions. At times we have also included other conditions such as epilepsy.
Recently some of our therapists gave progress reports on their cases. All agreed that this work presented challenges that went beyond those presented by more typical analytic patients. The following are brief examples:
A 64-year-old male underwent a craniotomy resection after suffering a seizure due to a subfrontal olfactory groove meningioma. Diffuse swelling occurred, and the patient was placed in a barbiturate coma to monitor intercranial pressure. Following this the patient recovered, but not sufficiently to return to his former work as a high-functioning professional. Moreover, he found himself without the vital sense of agency that had characterized his entire previous life. In therapy he made visible gains, showing increased energy and confidence and becoming far less dependent on his caretaker wife. Although apparently pleased with the accomplishments of his treatment, he expressed no interest in exploring any of the premorbid psychological issues that emerged, and these were left unexamined.
A 78-year-old woman suffered a large middle artery stroke that left her with global aphasia. Intensive rehabilitation, including an aphasia group, enabled her to regain limited speech. In therapy the patient displayed disabling anxiety with emotional flooding and frequently canceled sessions. A distrust of authority stemming from her early upbringing in a totalitarian Eastern European state was exacerbated by intense feelings of helplessness engendered by the stroke. The confluence of these elements seemed not only to prevent the patient from establishing a real alliance with the therapist, but also to interfere with her unde