Kerbel-Shein, Arturo; (2023) Affective, Interpersonal, and Subjective Aspects of Denial in Anosognosia for Hemiplegia: Neuroscientific and Psychoanalytic Perspectives. Masters thesis (M.Phil), UCL (University College London).

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Abstract

Some patients customarily deny left hand hemiplegia as a consequence of a right hemispheric stroke. Denial is a key aspect in Anosognosia for Hemiplegia, and is also an essential concept in the development and structure of psychoanalytic theory. In research on AHP, denial is approached from neuroscientific perspectives, which include empirical research on several aspects that are relevant in the presentation of the syndrome (e.g. senso-perception, cognition, neuroanatomy, etc.). Psychoanalysis has emphasised intrapsychic, developmental, and defensive aspects based upon clinical observation of mainly non-neurological patients. However, the Cognitive Arrest Hypothesis (a model stemming from psychoanalytic theory) has proposed a view of denial that is in accordance with, or does not contradict empirical evidence on AHP. Both fields have recognised the importance of affective, motivational, interpersonal, and subjective aspects in the presentation of denial. The Cognitive Arrest Hypothesis allows discussing evidences on denial in AHP research, and in psychoanalytic theory, under a common framework of reference. The present thesis aims at opening a debate between these two fields with the goal of demonstrating how can their arguments be of mutual assistance in further comprehending denial. Three research proposals are presented to illustrate practical ways to consider contributions from both fields in future research and clinical directions.

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