It is little more than an output channel for the ego's ... They used to tell me that when I was a kid. My mum told me I was the ... 'Heathen' Brother. Black Sheep.
REVISITING THE LEFT CONVEXITY HYPOTHESIS: CHANGES IN THE MENTAL APPARATUS AFTER LEFT DORSO-MEDIAL PREFRONTAL DAMAGE
Dr. Christian Salas Riquelme, Amsterdam, 2015
‘THE AIMS OF THIS BOOK ARE MODEST BUT FAR REACHING’ KAPLAN-SOLMS & SOLMS, 2000
THE CASE OF MR J: NORMAL MOURNING AFTER LEFT PFC DAMAGE [BROCA]
EGO AND BROCA DAMAGE
¡ The motor aspect of the word, then and therefore the motor component of the speech apparatus –Broca’s Area- lies at the sensorimotor periphery of the ego. It is little more than an output channel for the ego’s complex workings, its role in verbal thinking is superfluous (p. 89)
OTHER AREAS OF THE PFC THAT ARE POTENTIALLY RELEVANT FOR EGO FUNCTIONING?
Stuss, 2008
Cognitive inflexibility
PERSEVERATION
VERBAL THINKING (INNER SPEECH)
Initiation/Energization
INITIATION
LURIA’S FORGOTTEN CASES ON INNER SPEECH IMPAIRMENT VERBAL KINESTHESIAS
-Left opercular and postfrontal divisions
-Middle-superior left PFC
VERBAL THINKING
Left Inferior PFC, anterior temporal
Left pars opercularis
Left supramarginal gyrus
A NEW CLINICAL STUDY IN NEUROPSYCHOANALYSIS: VERBAL THINKING IMPAIRMENT AFTER LEFT DORSOMEDIAL PREFRONTAL DAMAGE
¡ Profesor F 72 years, married, father of three ¡ Lecturer and dean of his department ¡ 2006 ischemic stroke of the left MCA and ACA, presenting confusion, severe expressive aphasia and right hemiparesis.
¡ ‘My mind goes blank sometimes… it is like I can’t find what I know, like having gaps, pauses in my head. My thoughts of ten drif t away. I of ten can’t make sense of what is going on’
¡ I wonder if I will be able again. How damaged I am? This is something new to me. I have never felt vulnerable to be damaged before.
¡ I have never been confident about myself, I have always doubted my abilities, If I am a good teacher or not. I don’t allow myself to be wrong. But this accident constantly shows me that I am the exception and that fucks me up’.
¡ ‘In my house they were ver y strict, I am a repressed lef t handed, and they used to hit me in the hand to stop me from using it. Since I was little I had to learn to do what I had to, not what I wanted to. Since then I have felt that things have been imposed on me. But I identify myself more with the naughty one. I have always been like that, and that was really complicated to my mum. I believe this is why I feel guilty by not being good, I feel as if there is something bad deep down in me. They used to tell me that when I was a kid. My mum told me I was the only child that gave her trouble. At catholic school a priest told me once I had a demon inside”.
Being a Good Boy Smart With no ‘faults’
Being a Good Boy Smart With no ‘faults’
THINKING DEFICIT Useless and worthless man
Black Sheep ‘Something wrong inside’ ‘Heathen’ Brother
Black Sheep ‘Something wrong inside’ ‘Heathen’ Brother
BEFORE
NOW
CHANGES IN EGO FUNCTIONING: VERB A L T H INKING IMPA IRMENT A ND EMOT ION DYS REGULAT ION
¡ The executive pole of the mind is therefore also its inhibitory pole. In terms of Freud’s structural model of the mental apparatus, this is the locus of the ego in its dynamic manifestation (p. 269)
CHANGES IN EGO FUNCTIONING: VERB A L T H INKING IMPA IRMENT A ND EMOT ION DYS REGULAT ION
¡ “ It is like a peculiar experience, like having something separated inside, what you think with your head and what you feel, and that you are not able to master with your head what you feel. That is the problem! The most impor tant thing here is a sensation of not knowing what to do, to have your mind blank, or only scattered images that you cannot coordinate. It is a sensation of chaos. You are aware of what is going on but you can’t control it. It is not like I am not aware that I was thinking stupid thoughts, but I was simply unable to stop thinking them”
CHANGES IN ID: VERB A L T H INKING A ND EMOT IONA L REAC T IVIT Y
¡ All of these involuntary processes, or sources of arousal, [intrinsic cycles of the hypothalamus, metabolic and humoral processes, outside world] are also affected by the prefrontal region and its thinking activity (p. 267). The prefrontal lobes marshall the energy resources of the core brain systems for the purposes of voluntary, goal directed activities (p. 272)
CHANGES IN ID: VERB A L T H INKING A ND EMOT IONA L REAC T IVIT Y
¡ Happy feelings … the accident did not reduce them, but on the contrar y, it augmented them. The capacity to feel moved, the capacity to cr y … now I experience these things where I am happier, or sadder, or that I have variations on intensity. That did not exist before. Because now I feel things … and this is of my life. The accident made me more sensitive to that.
CHANGES IN SUPER EGO: VERB A L T H INKING A ND C RIT ICA L VOIC ES
¡ Super-ego functions primarily on the basis of internalized verbal Injuctions (Freud, 1923b)
THANKS!
‘THE AIMS OF THIS BOOK ARE MODEST BUT FAR REACHING’ KAPLAN-SOLMS & SOLMS, 2000
12 YEARS LATER
¡ The main contribution of the prefrontal lobes in this respect is that, having inhibited the stereotyped action that would normally be released under the drive/object conditions in question, the mental space is created for thinking (…) What we can now add to Freud’s formulation is that mental space in question is located anatomically in de dlPFC. (Solms and Zellner, 2012, p. 61)
