Asomatognosia and Anosognosia: A Neurological Perspective - Prof. Kurowski, Slides of History of Sociological Knowledge

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Week 5

Asomatognosia and anosognosia

Symptoms of asomatognosia

• (^) Hemispatial neglect : neglect of one side of space (bodily and visual)
• (^) The inability to identify one’s own limbs as one’s own
• (^) Proprioception: the healthy feeling of locating one’s body in space.
• (^) Personification of limbs: the attribution of identity, other than the subject’s, to one’s limp

Cont’d symptoms

• (^) “This patient, when speaking of his weak left arm, reported, "He gets tired sometimes; he doesn't keep time with you; he gets out of step. He gets very lazy; he sits and hangs about and when he does get hold of you he doesn't want to leave you. He's been doing this for a week." Critchley went on to describe the peculiar behavior that the patient directed toward the weak limb”(15)

Neurological basis

• (^) Asomatognosia results from damage to the right brain hemisphere, not the left
• (^) Neurological interpretation : “One reason the left arm is more commonly affected with the condition than the right may be due to the association between asomatognosia and hemispatial neglect. Hemispatial neglect is more severe and long lasting after damage to the right hemisphere. The right hemisphere has the capacity to direct attention to both sides of space. When there is damage to the left hemisphere, the right hemisphere can compensate for the loss, and the patient is still aware of both sides of the world and the self. On the other hand, the left hemisphere is much more unilateral in its attentional capabilities, and is best at directing the patient's attention to the opposite (right) side. In the presence of damage to the right hemisphere, the left hemisphere has limited capacity to adapt, and the left side of space and the body may be ignored.”

Why the use of metaphors by patients?

• (^) “Weinstein's position that the use of metaphorical language demonstrated by these patients served to bring order, unity, and predictability to the frequently confusing circumstances of neurological illness. Under the conditions of brain damage, metaphorical language may seem more "real" to the patient than more conventional forms of expression and may help the patient cope with catastrophic illness. Faced with the life- threatening and chaotic circumstances posed by neurological illness, metaphor, more than everyday language, captured the way patients saw themselves and their disabilities.”(18)

Anosognosia

• (^) “Jack's infarction extended from the rear frontal portion of his brain all the way back to the occipital portion, which is responsible for visual perception. While he cannot move his left side of his body and attend to objects in his left visual field, Jack was convinced that he is in perfectly fine shape ( anosognosia ).”
• (^) Jack’s assertion was an example of suffering from strong denial.
• (^) Self-awareness, although not necessarily complete, sets in after a few weeks or months.