Discussing Ramachandran's lecture: Anosognosia: The interface between neurology, psychiatry and psychoanalysis

Here is an excerpt from an essay I recently finished entitled "Heraclitus Through Lacanian Theory: The Logos and the Unconscious"

This excerpt discusses Ramachandran's excellent lecture entitled: Anosognosia: The interface between neurology, psychiatry and psychoanalysis.

Ramachandran is one of the world's foremost authorities on neuroscience, and the fact that he devoted an entire lecture on the link between Freud and neuroscience is very exciting.

For a link to this great lecture - http://www.veoh.com/videos/v15598629Wqrq8dHY

Here is my excerpt

Vilayanur Ramachandran is a neurologist who treats patients with some very rare neurological ailments, such as Anosognosia, Capgras delusion, and phantom limb pain. Anosognosia simply means that a neurological patient is vehemently denying the fact that they have an illness. It’s a condition which appears after an individual has had a stroke affecting the right parietal lobe. Because the individual’s right cerebral hemisphere is damaged, they are paralyzed on the left side of the body (all these minor details will be very useful to us further in the essay).

It’s important to note that although patients with Anosognosia have no cognitive deficit and are fully cognizant and intelligible, they nevertheless deny the plain and simple fact that they are paralyzed! These patients can see their hand just fine, and although it is not moving they continually insist that it is moving. Ramachandran desired to see what would happen if he questioned these patients like a lawyer questioning a lying witness: Ramachandran wanted to prove to these patients that they were paralyzed by using hard empirical evidence. For example, Ramachandran asked a patient to touch his nose (Ramachandran’s nose) with his left hand (the patient’s left hand, which is paralyzed). Ramachandran then asked the patient why he wasn’t touching his nose, and the patient replied, “Doctor, I was in the air force, and I am not used to taking orders!” (Ramachandran, 2004). Another patient, when asked why she wasn’t touching Ramachandran’s nose, replied, “No! I’m tired of all these medical students prodding me all day!” (Ramachandran, 2004).

Both of these patients are obviously conjuring up an excuse which allows them to avoid the unfortunate reality of their paralysis. In psychoanalysis we call this excuse a “rationalization.” Rationalization is one of the many Freudian defense mechanisms. Defense mechanisms “defend” or protect the ego from truths which would cause the person too much distress, “A mental attribute or mechanism or dynamism, which serves to protect the person against danger arising from his impulses or affects” (Psychiatric Dictionary, p. 174). It is terrifying for one to confront the fact that one will not be able to move one’s arm anymore, and all of this distress would do the ego no good. The ego is constantly seeking to maintain a proper homeostatic state (i.e. the pleasure principle), but powerful and distressing emotions disturb this homeostasis. Therefore, the patient’s ego will defend itself against this distressing truth in order to maintain its own well-being and balance.

Ramachandran discovered that patients with anosognosia not only use rationalization; they use nearly all of the Freudian defense mechanisms! For example, Ramachandran asked a patient how high he could lift a table with his right arm (the non-paralyzed arm), and the patient replied that he could lift it 3 inches, but when asked how high he could lift the table with his left arm (his paralyzed arm), the patient replied that he could lift it 6 inches. Here we see the defense mechanism called “reaction formation,” which can be understood as an unconscious overcompensation or overriding of the truth, “It’s as if there’s a little man in there (the mind) who really knows what’s going on” (Ramachandran, 2004).

Patients with anosognosia sometimes claim that their paralyzed arm doesn’t belong to them, but that it is actually their mothers arm, or that it belongs to somebody else; this wild and odd claim is called “confabulation.” Furthermore, patients often display a kind of “sadistic humor” while performing all of these defensive measures; using humor itself as a defense mechanism (see Freud’s Jokes and Their Relation to the Unconscious). Ramachandran states that these patients are not aware of what they are doing because defense mechanisms function at the unconscious level, just as Freud and Lacan hypothesized. Here we see the Heraclitean ontological gap between logos (the causal psychological/neurological mechanisms) and human knowledge (the patient’s beliefs about what is happening). It’s abundantly clear that these patients have no insight regarding their condition (see fragment 25), and their personal views on the matter are quite far from the truth (see fragment 6). This realm is not one of subjectivity, or what Heraclitus calls “private understanding.” At this level, the level of the patient’s conscious self understanding, the ego is simply too deceptive and irrational to be taken seriously. Instead, the doctor must understand what is occurring at the unconscious level, which Heraclitus calls the logos.

The Caloric Reflex Test is a medical intervention often used on patients suffering from anosognosia. It’s a test which involves squirting very cold water into the patient’s inner ear, thereby causing a shift in the patient’s level of awareness. Patients then become aware of the nature of their illness: they are aware of their paralysis; they know how long they’ve been paralyzed; and they admit that they cannot move their paralyzed arm. But as soon as the Caloric Reflex Test’s effects wear off, the patient again becomes unaware, and in denial of their illness. Luckily for the patient, anosognosia is only temporary; it lasts from a few days to a few weeks. However, as a result of the stroke the patient has permanent brain damage, and will likely remain paralyzed. Anosognosia, or the denial of illness, is simply how the ego responds to such a traumatic event. Interestingly enough, as the patient recovers from anosognosia they have the tendency to repress the fact that they were denying their illness: “they deny their previous denials” (Ramachandran, 2004). This example showcases the defense mechanism called repression (see p. 6, paragraph 1). This neurological evidence strongly supports the division of unconscious and conscious, which was first developed by Freud, and later taken up by Lacan.

Heraclitus’ ontology, even in the realm of neurology, has been shown to be accurate and of merit in better understanding the “gaps” inherent to human reality.Ramachandran emphasizes that patients who suffer from anosognosia are not so different from everybody else. We all use Freudian defense mechanisms by virtue of the fact that we have a left cerebral hemisphere. Ramachandran deduced this fact by observing that patients with anosognosia all had damage to the right cerebral hemisphere; anosognosia is rarely seen in patients with damage to the left cerebral hemisphere, “For this reason it is necessary to follow what is common” (Cohen, p. 25). When the right cerebral hemisphere is damaged the patient’s defenses seem to become grossly exaggerated, while the patient’s ability to confront empirical reality (the fact that they are paralyzed) is greatly lessened. Therefore, the right cerebral hemisphere is devoted to acknowledging inconsistencies while adapting to various, often unpleasant, truths. The left cerebral hemisphere, on the other hand, is constantly building a coherent sense of self; no matter how contradictory it may seem to outside observers. It is dedicated to distorting and “filtering out” various (often unpleasant) truths, and it performs these processes via the Freudian defense mechanisms (see p. 6, paragraph 1).

The two cerebral hemispheres are therefore opposed to one another, but out of this opposition arises a homeostatic balance, a continuity, “What is opposed brings together; the finest harmony (harmonia) is composed of things at variance, and everything comes to be in accordance with strife” (Cohen, p. 29). Once this balance is disturbed (via stroke) we get a glimpse into the various oppositions which lie beneath this illusion of continuity which we simply call “I.”

References

Ramachandran, V.S. (2004). Anosognosia: The interface between neurology, psychiatry and psychoanalysis. 5th Neuro-Psychoanalysis Congress: Splitting, Denial and Narcissism.

Cohen, S. M, Curd, P., Reeve, C.D.C. (2005). Cohen, S. M / Curd, P. / Reeve, C.D.C. (Ed.). Readings in Ancient Greek Philosophy: From Thales to Aristotle. (pp. 268, 272, 235, 236, 144, 145,). (3rd Ed.). Indianapolis, IN: Hackett Publishing Company.