Broca’s aphasia, psychodynamics, and changes in “mental apparatus”: A commentary on “Revisiting the left convexity hypothesis: Changes in the mental apparatus after left dorso-medial prefrontal damage” by Salas & Yuen

Abstract

In the context of psychoanalytic psychotherapy with a patient with a vascular lesion involving the left dorsal and medial prefrontal cortex, Salas and Yuen describe changes in the patient’s subjective experiences when sitting quietly as well as when attempting to solve different tasks. They propose that the patient’s subjective reports reveal changes in “mental apparatus” not previously considered in the early work of Kaplan-Solms and Solms [2000. Clinical studies in neuro-psychoanalysis: Introduction to a depth neuropsychology. London: Karnac Books] when describing psychotherapeutic work with a patient who was described as having Broca’s aphasia. Historically, there has been debate over how different forms of aphasia might influence intellectual functioning. Presently, there is compelling evidence that lesions involving frontal and prefrontal cortex can alter neuropsychological functioning in numerous domains. It appears likely, therefore, that a left prefrontal stroke would negatively alter “ego” functions as well as produce some alteration of the id–ego balance as Salas and Yuen propose. Left prefrontal lesions could also disrupt “inner speech” which in turn could influence positive or negative spontaneous thoughts about the self. The thoughtful case presentation of Drs. Salas and Yuen provides an unusual insight into how a patient’s psychodynamics interacts with their neuropsychological disturbance to produce the global symptom picture. Understanding this important interaction leads to more meaningful psychological care of the person.