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"Daughter-Somatoparaphrenia" in Women with

Right-Hemisphere Syndrome: A Psychoanalytic
Perspective on Neurological Body Knowledge
Disorders

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DOI: 10.1080/15294145.2005.10773494

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 Neuro-Psychoanalysis, 2005, 7 (2) 47

Daughter-Somatoparaphrenia in Women with Right-Hemisphere

Syndrome: A Psychoanalytic Perspective on Neurological Body
Knowledge Disorders

Catherine Morin, Stphane Thibierge, Pascale Bruguire, Pascale Pradat-Diehl,

and Dominique Mazevet (Paris)

Disorders of discourse and behaviorin particular anosognosia and somatoparaphreniamay be associated with body schema
neurological disorders in the right-hemisphere syndrome (RHS). From a psychoanalytic point of view, the content of the patients
discourse may be considered as an alteration of the unified conception an individual has of him/herselfthat is, of what Lacan
called specular image. After presenting the specificities of the Lacanian conception of specular image, we consider its heuristic
value in the RHS field, based on three detailed observations of women with anosognosia and hemineglect. Each of the three
patients personified her paralyzed hand as being or belonging to a daughter, whether real or imagined. We propose considering
rephrase to this symptom as a disclosure of the normally hidden object of the demand. We briefly discuss how these observations indirectly
clarify? shed light on the mindbrain problem.

Right-brain lesions are known to alter what neuro-
scientists (see Gallagher, 1986; Paillard, 1999)
currently refer to as body schemathat is, a non-
conscious body representation that allows us to
automatically adjust our gestures to space (Coslett,
1998). The most common symptom of this disturbance
is hemineglecta lack of interest to the left hemispace
and/or the left hemibody (Benton & Sivan, 1993).
Certain right hemispheric lesions also produce specific
discursive and behavioral disorders that concern body
representation (see Critchley, 1953; Feinberg, 1997;
Hcaen & de Ajurriaguerra, 1952). While asomato-
gnosia (unawareness of the paralyzed hemibody) is a
rare and transient symptom, anosognosia (apparent
unawareness of or indifference to left hemiplegia; see
Marcel, Tegnr, & Nimmo-Smith, 2004) is much more
frequent and persistent. Hemineglect, asomatognosia,
and anosognosia may be accompanied by productive
symptoms called somatoparaphrenia by Gertsmann
(1942): assimilation of paralyzed limbs to an inani-
mate, cumbersome, or supernumerary object, or per-
sonification of the paralyzed limbs. This assimilation
to an object or to a person is often also colored with
hatred or disdain; this led Critchley (1962) to put
forward the term misoplegia.
While neurologists are principally interested in the
knowledge we have of our bodies, psychoanalysts are
concerned with narcissismthat is, the libidinal inter-
est we invest in these bodiesa difference that, at least
at first sight, seems to seriously limit the scope of
exchanges between the two disciplines. Indeed, the
first psychoanalytic study of the human subjects rela-
tionship with his body is Freuds seminal 1914 article.1
Freud stated that, as an infant, the child first enjoys his
various body parts, including body orifices (auto-
erotism), and then secondarily attaches his libido to his
ego. Freud only indicated that a new psychical ac-
tion should permit that change. In his 1914 article,
Freud only allusively mentions the unifying concept
that every person has of both his body and his identity

Catherine Morin: CNRS LEAPLE (UMR 8606), Paris; Service de Mdecine Physique et Radaptation, Groupe Hospitalier Piti-Salptrire, Paris.
Stphane Thibierge: CNRS LEAPLE (UMR 8606), Paris; UFR Sciences Humaines et Arts, Universit de Poitiers. Pascale Bruguire: Service de Mdecine
Physique et Radaptation, Groupe Hospitalier Piti-Salptrire, Paris; Service de Psychiatrie Adultes, Groupe Hospitalier Piti-Salptrire, Paris. Pascale
Pradat-Diehl and Dominique Mazevet: Service de Mdecine Physique et Radaptation, Groupe Hospitalier Piti-Salptrire, Paris; INSERM E0349, Paris V.
Correspondence to: Dr. Catherine Morin, Service de Mdecine Physique et Radaptation, Groupe Hospitalier Piti-Salptrire, 47 Bd de lHpital,
75651 Paris Cedex 13, France (email: catherine.morin@chups.jussieu.fr).
Acknowledgement: Our thanks are due to Mary Shaffer, who reread the English.
1
Following the example of Allan Sheridan (1977), we employ the masculine pronouns each time the human subject is designated: this corresponds to the
French tradition of using the masculine pronouns to indicate either a male person or a person characterized independently of his/her gender.
 48 Catherine Morin, Stphane Thibierge, Pascale Bruguire, Pascale Pradat-Diehl, Dominique Mazevet
(a unity comparable to the ego cannot exist in the
individual from the start). In addition, while
asomatognosia and anosognosia were known at his
ref? time, Freud never alluded to these phenomena. Unlike
Freud, Schilder (1999) insisted that we mentally con-
ceive our body as a unity. In 1935, he proposed the
term body image to encompass the heterogeneous
aspects (in his words, physiologic, libidinal, and socio-
logic) of this unity.2 He considered anosognosia as a
disorder of body image and assumed that it was due to
what he called organic repression. But he realized
that this concept was not fully adequate, since he
considered the nature of the psychosexual aspects of
this unawareness of paralysis to be an open question. It
was Lacan (1977a) who proposed a well-founded
theory that illuminates the question left unexplained by
Freud (1914)that is, how autoerotism is replaced by
narcissism. Lacan claimed that body image has a
prominent role in creating the necessary illusion of the
unity of the self, a representation he called specular
image. Like Schilder, Lacan used the term image in a
sense that differed from the neurological one; for him,
image refers both to self-knowledge and to narcissism.
Moreover, Lacan proposed that the limits of the knowl-
edge we can have of our whole world are linked to this
image. This position makes it possible to establish a
true dialogue between psychoanalysis and neurology
in the field of the right-hemisphere syndrome (RHS).
In this article, we first present the Lacanian concept of
the role of body representation in organizing subjectiv-
ity and underline the points that distinguish it from the
concurrent Freudian concepts. Based on our previous
studies and on three detailed observations, we then
propose a Lacanian reading of the psychiatric-like
disturbances of discourse or behavior that may accom-
pany the neurological disorders of body schema.
Self-representation of the human body in
psychoanalysis: the notion of specular image
The mirror phase and specular image
In 1936 and 1949 (see Guillerault, 2003, pp. 267272),
Lacan proposed that our self-representation is medi-
2
The term body image is thus most confusing. After having been
used interchangeably with that of body schema in neurological literature,
it currently has a specific neurological meaning: unlike body schema, it
refers to a semantic knowledge both of the names of the parts of the body
and of their spatial relations with clothes or with other bodies; left-brain
lesions may alter this knowledge, causing autotopoagnosia (Buxbaum &
Coslett, 2001). This neurological meaning has very little to do with the
psychoanalytic meaning of the term. In addition, one may find in the
literature on eating disorders (Stein et al., 2003) and disabilities (Keppel &
Crowe, 2000) casual utilization of the term body image to refer merely to
the physical body appearance.
ated by a regard that gives us access to a mirror <gaze?>
representation of ourselves (Lacan, 1977a); this regard
is oriented by linguistic lines of force. Lacans reflec-
tion had been stimulated by Wallons psychological
observations. In 1931, Wallon (1994) wrote how the not in refs
notion of its own body develops in the child between
the age of 6 and 24 months. Wallon observed that, at
that time, after first treating its own body as if it were
made of distinct parts each with a personal life, the
child discovers his image in the mirror and displays a
jubilant activity in front of this image. The child also
turns toward the accompanying adult, seeking ac-
knowledgement and assurance that this image is his
own. In The Mirror Stage as Formative of the Func-
tion of the I as Revealed in the Psychoanalytical Expe-
rience, Lacan (1977a) reread Wallons observations
(1931) in terms of identification: for him, during the
mirror phase, the body passes from a real state (frag-
mented body) to an imaginary register (virtual image).
Lacan underlined that this identification is crucial for
subjectivity. In its Lacanian sense, identification
literally the acquisition of what is usually referred to as
an identityis defined as the transformation that hap-
pens in a subject when he assumes an image. The
human subject then identifies himself with the image
of a complete body, erected as a whole (imaginary
identification). Identification also operates in the sym-
bolic register.3 Insofar as the adult indicates and recog-
nizes the body as belonging to that particular child,
wordsand in particular a personal nameare at-
tached to that image (Lacan, 1966b). This validation
through a proper noun makes the infant a human
subject, who recognizes his body as a whole, similar in
its form to others bodies, while it is his own body
recorded in filiation and sexual belonging.4 Lacan
(1962) called this complex structure specular image
(see also Thibierge, 1999b). Winnicott (1982) also
insisted later upon the crucial role of the gaze of the ok as changed ?
mother in the structuring of what he called the self.
Lacan was hardly unaware of the neurological cor-
relates of body representation, as shown by his refer-
ence to Jean Lhermitte (Lacan, 1966a, p. 185) and his
qualifying the cerebral cortex as the intra-organic
mirror (1977a). He insisted on the discordance, at the
3
Lacan (1966b) revisited the terms ideal ego and ego ideal coined
by Freud (1923); Lacan assimilated the former to the virtual form of body
image and the latter to the symbolic traits that represent the subject in the
register of language.
4
As recently shown by Thibierge (1999a, 1999b), psychosisin par-
ticular, the so-called delusional misidentificationsstrikingly illustrates
the crucial importance of this symbolic identification: in Capgras and
Frgoli syndromes, the name is not attached to body image and does not
refer to the variants of one and the same singular image. As a result, names
and images proliferate into an infinite series of reduplications.
 Daughter-Somatoparaphrenia in Women with Right-Hemisphere Syndrome
time of the mirror phase, between the infants ability to
identify with a whole form and his organic motor
immaturitythat is, his lack of knowledge and mas-
tery of his own body. He also referred to the phantom-
limb phenomenon (see Ramachandran & Hirstein,
1998) to illustrate the normal unawareness that charac-
terizes our own intuitive body representation. How-
ever, according to Lacan, normal unawareness extends
far beyond failing to acknowledge organic deficien-
cies, and perhaps the term ignorance would be more
convenient: we often ignore the role of the symbolic
traits that were attributed to us from and before our
birth in making our body image a unique whole form
regarded as one and the same. We also usually ignore
the relationships between our narcissistic attachment
clarify this sentence?to body image and our unconscious determination by
or something what Lacan called object.
missing?
The Lacanian concept of object
While Freud (1914) only took note of the fact that we
love our body, Lacan specified the two aspects of this
libido attached to the body. For him, on the one hand,
the human subject is captivated by the form of the
human body, and on the other, his body is represented
for an Otherthat is, it is necessarily experienced, in a
positive or negative light, as an object of desire for
others. Lacan qualified these fundamental aspects of
the psychic correlates of body representation as real
insofar as they are not reducible to its imaginary or
symbolic aspects: what I represent for the Other and
his desire is precisely what I cannot either master or
have a clear knowledge of.5 In other words, a narcissis-
tically invested body represents the subjects question
regarding his ability to please, to suit to the Others
demand or desire. This impalpable x is what Lacan
called object (Lacan, 1962, 1977c). Lacan (1977c)
showed that the suitable object for this desire or for
this demand may be thought of under four fundamental
aspects: the breast and the feces (oral and anal objects
gaze? corresponding to the Others demand), the regard and
the voice (scopic and oral objects corresponding to the
Others desire). This notion of object, which Lacan
considered his major contribution to psychoanalysis,
does not contradict but is more precise than that pro-
posed by Freud (1905). According to Lacan, it is the
symbolic value of body areas, not just their involve-
5
Despite being possibly personified in the eyes of a given subject by a
variety of human characters, the Other, as indicated by its capital initial, is
not a fellow creature, but is intrinsically foreign to the subject. For
example, God may be considered as the figure of the Other in believers
minds.
49
ment in sexual life or in the stages of bodily education,
that makes some of them erogenous (Lacan, 1977c):
the mouth is the area where food and love are de-
manded of the Other, the eye and the ear are the areas
where the Others demand or desire is expressed
gaze?
through regard or voice, the anus is the area where the
Other exerts his demand. Above all, the corporeal
aspects of this symbolization of our relationship to the
Other are repressed. The fundamental property of the
object is thus to be lacking, not to be present, in body
imagethat is, not to be representable at all.6 It should
be emphasized that it is precisely insofar as body
image lacks the object that this image may gain con-
sistency, and our or others visible bodies may arouse
our desire. The primordial lack of the object, which
may appear as an irreducible loss, is designated by
psychoanalysis as castration (Lacan, 1977c).
The lack of the object has a kind of positive
symbolic representation, under the guise of the phal-
lusbut as a purely symbolic element, a signifier
(Lacan, 1977b). For example, the normal representa-
tion of the human body as standing, symmetric and
erect implies interference between this phallic signifier
and the imaginary body representation. As underlined
by Lacan in his seminar on anxiety (1962), any other
positive appearance of the lost object has disorganiz-
ing effects. These effects extend from the varieties of
feelings of strangeness, which have been described in
classical psychiatry (see Thibierge, 1999b), to deper-
sonalization. An important point in this seminar is that
Lacan considered that all the circumstances and liter-
ary fictions to which Freud (1919) attributed an un-
canny nature involved an undue appearance of the
object in the field of reality. The failure of the castra-
tion process, the presence of the object, is obvious in
psychotic verbal hallucinations (voice-object) and
scopic (regard-object) persecutions (Czermak, 1986). gaze?
Contrary to our intuitive apprehension of having a
unified and autonomous self, Lacanian psychoanalysis
thus emphasizes that human subjectivity is heterogene-
ous and Other-dependent. The term specular image
designates the intertwining of three levels or three
registers: (i) the object, which is not any thing or
person in the external world but delimits the modalities
of the subjects value and position in the Others eyes;
(ii) the body image; and (iii) the signifiers, which
represent him in the symbolic order.
The consequences of this heterogeneity go far be-
yond the avatars of self-representation. As emphasized
by Thibierge (1999b), our body image provides the
6
This object has no more recognizable meaning than a letter of the
alphabet, for example, when used in an algebraic function. This led Lacan
to propose the term objet a.
50 Catherine Morin, Stphane Thibierge, Pascale Bruguire, Pascale Pradat-Diehl, Dominique Mazevet
ground pattern of our entire external-world representa-
tion. As a result, what we ordinarily call perception
consists of recognizing structures that are familiar
that is, congruent with our body representationwhile
our deliberate observations are guided by the search
for the lacking, lost object.
Implications of the Lacanian concept
of the object for mourning, spatial cognition,
and pathological object/body image
relationships.
The Lacanian concept of the object holds that the
efficiency of the object is something whose lack (and
not whose presence) makes us psychically living sub-
jects. It differs from the contemporary Freudian con-
cept of both the subjects relationship to his body
image and his object cathexis. This difference has
implications in three areas that are addressed in this
article, namely mourning, spatial cognition and patho-
logical object/body image relationships.
Mourning, desire, and castration
In the concept developed after Freud by Karl Abraham
(1949) and Melanie Klein (1940), love is considered a
maturation of libido: libido is meant to concern only
partial objects that the subject considers part of his
own body, while love addresses the whole object,
perceived as external by the subject. In this Kleinian
view, mourning consists of the subject reinstalling the
lost object inside for the moment.
In the Lacanian concept, desire and not love is what
makes us living subjects. What interests us in the
external world is the unceasingly disappointed hope of
finding the lost object once again. This lack of object,
castration, is the operation that permits us to be psychi-
cally alive, desiringthat is, in a certain sense, neu-
rotic subjects. In this view, normal mourning consists
of passing through a new version of castration, as one
experiences the events of life. The ability to pass
though mourning is thus linked to castration, to repres-
sion of the corporeal coordinates of the object, and to
desire. Pathological mourning does not consist so
much of a pathological attitude (introjection, projec-
tion, love, or hatred) toward an external object, as of
revealing a fundamental failure to take (or to be more
precise, to have taken) into account the primordial
nature of the lack of object. Abraham and Toroks
(1972) concept of the difference between incorpora-
tion and introjection (two ways of putting the object
inside) in mourning provides a striking illustration of
the difference between mourning subjects as being
whether they have or have not taken into account the
loss of the object. According to Abraham and Torok,
what is put insidein their words, what is swal-
lowedin normal mourning is the loss (introjection),
while pathological mourning consists of swallowing
the lost object itself (incorporation), so that the object
is still present, psychically not lost.
Spatial cognition and body image
While Kaplan-Solms and Solms (2002) consider that
space is integrated into the narcissistically invested
body, Lacan proposes that narcissism results in our
seeing the external world according to our body image.
The external space is thus structured according to the
pattern of our body image. Like the stability of body
image, this process is efficient only on the condition
that the objects loss has been symbolized.
Object and body image
Thibierge (1999a), following Czermak (1986) and
based on the clinical phenomena of Frgoli and Cap-
gras delusions, recently proposed to reduce the various
psychotic syndromes to the avatars of one and the same
trouble: a nonentangling of body image and naming,
with, as a result, the inconsistency of body image and
the persistence in the foreground of the positived
object. Moreover, Thibierge also suggested, based
upon classical neurological descriptions of disorders of
body image (Hcaen & de Ajurriaguerra, 1952) that
neurological body schema disorders could be associ-
ated with or result in body image alterations, thus
bringing the normally repressed object to the fore
(Thibierge, 1999a).7 According to this view, two differ-
ent pathologies would thus share a common pair of
symptoms: a nonunified body representation and the
intrusive presence of the object in the patients psychic
reality. This suggests that the unification of body repre-
sentation is normally tightly linked with the repression
of the object. In other words, the stability of body image
and the psychic presence of the object would be mutu-
ally exclusive.
7
It is interesting to note that, based on a different point of view,
Gallagher and Voever (in press) also gather psychotic symptoms and RHS published?
under a common labelthat is, disorders of embodiment.
 Daughter-Somatoparaphrenia in Women with Right-Hemisphere Syndrome
The specificity of psychic symptoms of right
vs. left hemispheric lesions: psychological,
Freudian, and Lacanian perspectives
Indeed, anosognosia, asomatognosia, and somatopara-
phrenia simultaneously undermine the patients body
knowledge, the unified representation he has of him-
self, and, as particularly clear in somatoparaphrenia,
his narcissism.
Anosognosia
The specificity of psychic reactions to right-brain le-
sions has already been underlined by Gainotti (1972):
while catastrophic reactions, depression, and mourning
are observed in left-brain lesions, apathy and indiffer-
ence are observed in right-brain lesions. Anosognosia
of left hemiplegia is the most striking symptom in a
series of characteristics for which professional care-
givers have one label: he is a lefty (cest un gauche symbolically incomplete body. It also implies passing
in French). Lefties display a variety of behavioral or
discursive symptoms. They are unrealistic, at risk of
falling due to their not taking into account the precau-
tionary advice given by their therapists, not committed
all Morin et al to their rehabilitation, and so forth (Morin, Taillefer, et
cites identified by al., 2001). Anosognosia ceaselessly raises an
second author
irresolvable contradiction: although its close links with
right hemispheric lesions are well known, reliable au-
thors continue to underline the psychological aspects
of this symptom (Kaplan-Solms and Solms, 2002;
Prigatano & Weinstein, 1996; Ramachandran, 1994), a
possibility that Babinski himself considered in his
seminal 1914 article. Ramachandran (1994) and
Kaplan-Solms and Solms (2002) consider anosognosia
as a manifestation of Freudian repression, an interpre-
tation that will be discussed below. Prigatano and
Weinstein (1996) consider that anosognosia involves a
denial process, which occurs in patients whose psychic
rigidity prevents them from accepting any alteration of
their ideal ego. This interpretation implies that
anosognosia should result in maintaining the ideal
image of these patients. Indeed, when comparing the
discourses and self-portrait drawings of right versus
left stroke patients (Morin, Pradat-Diehl, Robain,
Bensalah, Perrigot, 2003; Morin & Salazar-Orvig,
1996), we obtained results that run counter to this
hypothesis. Our observations showed that, while pa-
tients with left hemispheric lesions maintained a self-
representation with a phallic value, able to structure
their ideal ego, this was not at all the case in right-
brain-injured patients with body schema disorders and
51
anosognosia.8 These patients seemed uninvolved in
their own enunciation, a typical sentence being They
say that I am performing better. Their self-portraits
were skewed and asymmetric. Not only was the left
part of the body often incomplete or lacking, due to
body schema alteration, but some patients added su-
pernumerary details when asked to complete their
half-portraits, or they produced completely disor-
ganized portraits (Morin, Pradat-Diehl, Robain, et al.,
2003; Morin, Thibierge, & Perrigot, 2001). These
traits strongly suggest that body schema disorders are
associated with an alteration of specular image, and
not at all with the maintenance of an ideal I-image.
Obtaining knowledge of reality through perception
or cognition normally consists of recognizing struc-
tures that are organized around the absence of the
object (Thibierge, 1999b), as stated above. According
to this concept, taking paralysis into account and real-
istically anticipating its consequences implies being
able to refer this paralysis to the virtual image of a
through a mourning processthat is, through a new
version of the primordial loss of the object. In the
absence of body schema disorders, right hemiplegic
patients, like left hemiplegic and other handicapped
patients with no brain lesions, have access to such an
image and experience mourning, as attested to by their
discourses and self-portraits (see above). This seems
not to be the case in neurological patients with body
schema disorders, who may behave as if they were not
paralyzed and deny or ignore a pessimistic medical
prognosis regarding the recovery of arm function.
Kaplan-Solms and Solms (2002) consider, from a psy-
choanalytic point of view, that contrary to aphasic
patients, patients with RHS experience a failure of the
process of mourning.
8
In the absence of body schema disorders, patients used undetermined
grammatical subjects when designating themselves as ill or handicapped
people, a typical sentence being I am affected mainly because you depend
upon everybody (Morin & Salazar-Orvig, 1996). Their typical self-por-
traits were unclothed and lacked both hands and a mouth. Such alterations
may also be observed not only in paraplegic (Morin, Pradat-Diehl, Robain,
et al., 2003), but also in elderly, chronically ill, or depressed patients (see
Clment et al., 1996; Morin & Bensalah, 1998). This indicated that, like
many other stressful life events, hemiplegia by itself obliges patients to
mourn their ideal image, momentarily replaced by an impersonal, sexless,
and lacunary representation. The nonrepresentation of the asymmetry of
the hemiplegic body indicates that this goes hand in hand with the
repression of the specific and concrete aspects of the loss caused by
hemiplegia.
52 Catherine Morin, Stphane Thibierge, Pascale Bruguire, Pascale Pradat-Diehl, Dominique Mazevet
Somatoparaphrenia
Like anosognosia, somatoparaphrenia has been the
subject of many different psychological interpreta-
tions. Halligan, Marshall, and Wade (1995) and
Feinberg (2001) consider it to be a rationalization that
allows the patient to cope with the traumatic failure of
his body schema, or to express feelings regarding his
own present situation. Other authors consider
somatoparaphrenia as completely meaningless produc-
tions (Laplane, 1998). Nevertheless, these productions
display recurrent themes, which are stable in a given
patient and may be very similar from one patient to
another. Feinberg (2001) thus noticed that female pa-
tients very often personified their hands as their hus-
bands. Delahousse (1972) and Thibierge (1999a) have
proposed that somatoparaphrenia might be linked to
the undue appearance of the object (with its strange-
ness, its bodily links, its extraneous hostile or
persecutory characteristics) in the very place where a
major loss (that of hand command) has occurred. Due
to the relationships of object repression and knowledge
(described above), anosognosia might also be linked to
the undue psychic presence of the object. This hypoth-
esis is supported by our previous observations (Morin,
Durand, et al., 2002; Morin, Pradat-Diehl, Mazevet, et
al., 2003; Morin, Taillefer, et al., 2001; Morin,
Thibierge, & Perrigot, 2001). In these cases, various
reflections of the object appeared in the discourse or
behavior of patients with left hemineglect,
anosognosia, or asomatognosia. A patient (PR) with a
very incapacitating left hemineglect (Morin, Taillefer,
et al., 2001) thus described his problems in terms not of
space-processing disorders, but of a variety of disor-
ders that he mentioned in one and the same series: on
the one hand, body image disorders (having holes in
his body), and on the other, problems with the oral
objectnot only precipitation in eating and speaking,
but also unceasing and urgent demands to his wife
(Morin, Taillefer, et al., 2001). Two patients with left
asomatognosia and hemineglect attributed oral charac-
teristics to their left hand (Morin, Durand, et al., 2002):
patient QR (who also said that his hand, like himself,
had worked too much) explained that he had seen a
left arm passing and that he had felt like biting this
arm. Patient DN, a right-handed man, kissed his inter-
locutors hand because I cant shake hands and put
forward the same reason for having drawn enormous
lips besides his self-portrait. We present here three
case observations (see Morin, Pradat-Diehl, Mazevet,
et al., 2003) in which another avatar of the object, a
specifically feminine one (Freud, 1933; Lacan, 1974),
appears under the guise of a daughter-arm.
A Lacanian approach to anosognosia
and somatoparaphrenia in three cases
The three case observationsDT, MN, DSwere ok as added?
gathered in a rehabilitation unit devoted to stroke
hemiplegia. Rehabilitation activities provide an oppor-
tunity for neurological and psychological observation,
since patients may be observed over long periods, and
the numerous transferential relationships involved in
therapeutics offer privileged and nonintrusive access
to various everyday-life psychic manifestations such as
depression, mourning, unawareness of hemiplegia,
delusional phenomena, and so on. Among the three
patients presented here, one patient (DS) had psycho-
therapeutic interviews with P.B., a Freudian psycho-
analyst. C.M. was the referring neurologist of MN and
DT and had two research interviews with DS. All
observations were worked through in discussions with
S.T., a Lacanian psychoanalyst. All three patients ex-
hibited intense hemineglect in cancellation and copy-
ing tests. DT and MN were seen during the first 3
months after their stroke, and their discourse and
behavior were observed by their therapists. DS was
seen much later; therefore, a part of the data com-
mented on here are reported self-observations that
went back to the early weeks following her stroke.
Case 1: DT
DT, aged 67, widowed, five daughters and two sons,
was seen 1 month after a massive left hemiplegia due
to a cardiac embolism in the right sylvian artery (Fig-
ure 1a). She had not only hemineglect and
anosognosia, but also asomatognosia: when shown her
own hand, she said she saw a bandage (which she
actually wore), or the nails that her daughter has just
varnished. When her left hand was placed in her right
hand, and she was asked what it was, she answered I
do not see what you mean.
When telling the story of her life, she insisted on her
being abandoned by her two parents, having had to
fight to bear her fathers name, and having married a
man who turned out to be unable to support their
numerous children. If she had to do it over, she said,
she would manage so that she, and not her husband,
was in command.
In the very first days of her illness, DT said to her
children that her paralyzed hand was the hand of a man
and that her hand did not like her any more. In the
rehabilitation department, she did not speak of her
hand, she spoke to it. She called her a bad girl, ca-
ressed, beat, or kissed it (because I like it anyway),
Daughter-Somatoparaphrenia in Women with Right-Hemisphere Syndrome
Figure 1. Case 1, DT: (a) Schematic representation of brain lesion from
CT scan; (b) self-portrait (original size 21 29.7 cm).
hid it under her shawl, so it would not be too cold, for
it to be able to recover. At night my hand starts
moving because it is quite warm under the blankets;
during the day, it does not want to move, it behaves
oppositely to us, it plays during night and rests in the
daytime, it is a lazybones. I dont touch it because it is
painful. It probably feels abandoned. I tell it I wish it
would come back. . . . In the night, it scratches me, it
comes stealing under me and scratches me. . . . It is
probably angry with me for not taking care of it .
When asked whom this hand might remind her of,
she answered she did not want to pronounce the name
of that man. She soon admitted that it was her hus-
bands name. This husband had more bad than good
aspects.
When asked to draw herself (Figure 1b), she added
two little legs to the hand located to the left of the sheet
and seemed puzzled thereafter: Why have I made
double legs? Once the drawing was finished and she
was asked to indicate the right and left hand, she
declared: as for the left hand I dont see it, it is dead.
As she had not drawn her mouth, C.M. suggested that
DT examine whether anything was lacking. DT then
added eye make-up, although she herself never used
make-up: it was her daughter who used make-up.
When asked to draw the mouth, she eventually drew it
and declared: The mouth is useful for speaking and
singing, I dont miss that.
When commenting on her drawing, DT mentioned
the breasts that are not useful any more and then
53
talked about the love of a mother for the children she
feeds. She also wrote on the left part of the sheet: Our
children are the most beautiful thing in the world.
This self-portrait gives the impression of an endless
motherly reduplication: not only does DTs body con-
tain that of her daughter, but the circles she drew
around the bodywhich, she explained, were meant to
represent her coatcall to mind a uterine wrapping.
DTs state did not improve; she never recovered
either the ability to walk or her sense of balance, and
her discharge to a nursing home was prepared. She did
not complain about her hemiplegia: according to DT,
her grandson had helped her to make a few steps in the
hospitals park and the nurses were responsible for her
not walking because they used to tie her to her arm-
chair. She complained, rather, of the pains her left
hand felt: it cannot bear the chrome of the armchair, it
produces static electricity, when I touch it after touch-
ing the wheelchair, it transfers synthetic [sic] electric-
ity to it, she said while caressing her hand. When
asked what her pains felt like she answered it burns, it
is like when you suffocate, when you swallow and the
food goes down the wrong pipe. This strange re-
sponse seems to establish equivalence between the
mouth and the hand. Indeed, other oral-sphere disor-
ders were observed. DT changed her eating habits:
now, she said, she mixed salty and sweet food, to the
dismay of her children. They were also surprised that
their mother, who never went out without her dentures,
now did not care about her dental prosthesis being
maladjusted to her jaw. On the contrary, she claimed
that this prosthesis had never fitted properly, though
this did not prevent her from eating steak.
DT became depressed, did not recognize her doctors
any more, and began to speak with negative formulae
in a melancholic tone: Everything is empty inside, it
is if there were only bones, only a carcass. She viewed
her therapists as persecutors, claiming that one of the
nurses hated her and kept on repeating her name all day
long.
All DTs discursive symptoms may be understood
as expressing a specular-image lesion. The specular
image is broken and interferes with a foreign image:
DTs hand is not hers, it is dead; it is also something
ever-living, a child who was never separated from his
mothers body. This discourse gives the impression of
uncanniness in the sense of the term proposed by
Freud (1919). As stated above, this may attest to the
appearance of the object in the patients psychic real-
ity. A pathological presence of the oral object may also
be suspected from DTs attitude toward her dental
problems and her comments about not drawing her
mouth.
 54 Catherine Morin, Stphane Thibierge, Pascale Bruguire, Pascale Pradat-Diehl, Dominique Mazevet
Case 2: MN
MN was a Greek painter who, at the age of 69, suffered
a left hemiplegia due to an intracerebral hematoma
(Figure 2a). The story she told of her childhood had a
very classical oedipal tone: although her father was
bitterly disappointed that his first child was a girl, he
very much appreciated her intelligence, had serious
discussions with her alone, and encouraged her to
attend a painting class. She had poor relations with the
brother who was born two years after her, but she was
very much interested in the next child, a girl 5 years
younger than herself, whom she unceasingly looked
after.
She did not have any children, since, she said, she
had preferred to devote her life to artistic creation. She
also mentioned that her husband, a rigid mathemati-
cian, strongly encouraged her in this artistic exclusiv-
ity; according to her family doctor, MN used to
complain a lot about her husband not understanding
her. Her figurative paintings were devoted either to the
Parisian landscapes she saw in her walks or to nostal-
gic representations of Greece or of her mother and
other feminine figures.
Due to left hemineglect, MN ignored people stand-
ing on her left, and she often presented with the left
arm of her spectacles over but not fitted behind the ear.
Her gaze was permanently directed rightwards and
downwards, and she could not keep her gaze focused
on the midline when asked. Her constant knowing and
gaze? blissful little smile and her oblique regard made the
staff uneasy. During the first interview (12 weeks after
stroke), she said she had not noticed her hemiplegia
until her husband told her she was paralyzed (not a
very nice word); she herself thought she had broken
her leg or her arm. She hoped that that would be
temporary, adding that she had always had problems
with her left side (left pleurisy, left-heel trauma, left
otitis.). She now felt that her left arm was lifeless
and sometimes she felt like speaking to it: we have
done such a lot of things together, how can you leave
me alone? It is, she said, like a child. Throughout drawing. When CM suggested that she draw her leaf-
the following weeks, she began to speak with her
therapists and her doctor of having given a name to her
hemiplegic hand, this name meaning leaf , in her
mother language. When she was seen again 20 weeks
after stroke, she explained to C.M. that this is because
leaves grow green each spring again. She also called
her hand her leaf-daughter and said she treated it as
she treated the little sister she had so much looked after
when they were children: this sister was her living
doll. The leaf-daughter had a symbolic birth date should not speak like that to an ill person). She said
(the day the stroke occurred) and a cradle (the
Figure 2. Case 2, MN: (a) Schematic representation of brain lesion
from CT scan; (b) self-portrait (original size 21 29.7 cm); (c)
drawing of the left paralyzed arm in its armrest (original size 21 29.7
cm).
armrest designed for her paralyzed arm). Like her
young sister, who, when a teenager, borrowed MNs
clothes, the leaf-daughter was appearance-conscious
and tyrannical. She asked for arm bracelets and gowns
and used to demand that people phone to see how she
was doing. She spoke with the sisters voice. That
voice had no hallucinatory characteristics: it produced
routine comments about the hospital or family life.
These comments did not interfere with the patients
thoughts; they were neither insulting nor mysterious.
Indeed, MN clearly stated that she had no hallucina-
tions: she did not really believe, she said, that her hand
was a true child. It was rather like a film scenario
addressed to her husband, and it consoled her. How-
ever, MN took the logical inferences of this scenario
very far: she explained that she wondered whether her
daughter would not have psychological problems due
to her nonnatural birth and her very special relation-
ship to her mother, or that this girl would never leave
MN since she would be buried with her. MN was asked
to draw a self-portrait. Her drawing (Figure 2b) bore
signs of left hemineglect: the left half of the body was
sketchy, the left half of the wheelchair was lacking,
and both legs were situated in the right part of the
daughter-arm, MN made a separate realistic represen-
tation of her left arm lying on the armrest (Figure 2c).
However, perhaps due to the relative emptiness of the
left part of the drawing, her self-portrait might seem to
contain a kind of small double inside the right part.
After 30 weeks, MN had not recovered the ability to
walk. She then bitterly reproached her physiotherapist
and her doctor (C.M.) for telling her that she probably
would not be able to walk more than a few steps (you
that she would not commit suicide, for religious rea-
Daughter-Somatoparaphrenia in Women with Right-Hemisphere Syndrome
sons. However, she did not exhibit any signs of depres-
sion; she continued to initiate unrealistic projects (to
go with a friend to the restaurant, provided he is not
ashamed to be seen with a woman using a cane), fell
because of trying to get up without help, and said that
she had got up to follow a doctor into his office.
This case clearly suggests that there is a common
phenomenon in somatoparaphrenia and anosognosia:
calling her paralyzed hand Leaf may be considered a
manifestation of anosognosia for paralysis, insofar as
the patient explained that leaves continuously turn
green again; but it also consists of qualifying a human
limb as a vegetable that is either dead or alive accord-
ing to the season. Such a qualification removes this
limb from the body image. Like the expression living
doll, this refers to animate/inanimate things. As in
DTs case, it may indicate the appearance of the object.
This appearance of the object in the left paralyzed hand
could be considered one of those psychosexual as-
pects of the unawareness of left hemiplegia hypoth-
esized by Schilder (1999).
The fact that MN was consoled by the presence of
her daughter-hand, instead of mourning her lost abili-
ties, is not without a connection to the appearance of
the object in the psychic reality of the patient. Accord-
ing to Abraham and Toroks formula (1972), MNs
mourning is of the incorporation form: the object (the
little sister) is incorporated, and the daughter-hand is
positively present in the patients body. That gives
evidence of the nonsymbolization of the loss, of the
absence of true mourning.
Case 3: DS
DS was a brilliant bank manager, divorced, who lived
with her three daughters. At age 40, she sustained an
extended right hemispheric ischemia due to the rupture
of a sylvian aneurysm (Figure 3a). This caused a
complete sensorimotor hemiplegia with hemineglect
and anosognosia. She was seen several months after
her stroke, during the difficult rehabilitation process
that she attended for over two years as an outpatient.
DS was very determined in her rehabilitation and kept
addressing a variety of demands to her therapists and
fellow patients. She did everything to charm her thera-
pists, and her attitude aroused identifications and mili-
tant sympathy. She eventually insisted and succeeded
in resuming a job, despite pessimistic medical and
psychological prognoses. C.M. saw her 8 months after
the stroke, when she was still using a wheelchair.
Although DS clearly explained to C.M. that she was
hemiplegic, she presented mild anosognosia: she
55
Figure 3. Case 3, DS: (a) Schematic representation of brain lesion from was RMN: ok
magnetic resonance imaging; (b) self-portrait and written account of as changed?
DSs early illusions (original size 21 x 29.7 cm). Translation: My left
arm was naked and tucked [in the fetal position]. It had white traces,
like paste marks left by bandages. Indeed, it was my daughters arm.
She had wanted a cuddle with me and we had remained joined together;
the staff refused to believe me and insisted that it was my arm. I alone
knew the truth, which, however, seemed obvious.
sometimes told her therapists that she would be able to
walk alone. The interview was proposed by DSs
speech therapist, who had been puzzled by a strange referral?
incident: while they were speaking of MNs daughters,
MN had suddenly stopped and said she would intro-
duce one of her daughters to her speech therapist. She
had then caught her left arm, caressed it, and begun to
speak to it: Mimi, say good morning, are you here!
Faced with her therapists surprise, she had eventually
recognized she was wrong but did not seem embar-
rassed by her strange behavior.
During her two interviews with C.M., DS never
spoke of the incident with the speech therapist. When
recounting her first memories of the poststroke period,
she emphasized that she was not able to find a time
when she would have noticed her paralysis. In the
intensive care unit, the nurses would not allow her to
get up and stand alone in the room, because they were
afraid that she might fall. DS disagreed with them
because I said that it was not true and that I was
perfectly able to stand up. When asked about possibly
having had strange impressions, she mentioned having
experienced illusions at that time. These illusions
consisted of thinking that her arm was not her arm but
her daughters arm, but DS did not consider these
thoughts as strange:
56 Catherine Morin, Stphane Thibierge, Pascale Bruguire, Pascale Pradat-Diehl, Dominique Mazevet
DS: It was not strange for me because I said the
truth, but all the doctors told me it was not true.
Therefore, I deduce that it was perhaps me who
did not have my head on straight.
C.M.: Yes, what did you think of it, then?
DS: I said that it was not my arm. I said that I was
convinced that I fell asleep with my daughter in
my arms. Thus, my daughter had put her arm
around me. Thus it was her arm. Yes and I told
everybody that it was not my arm since it was
hers. And all doctors said: no, D, indeed, it is
your arm!
C.M.: . . . for you, it was her arm? Was it an idea of
yours or whenever you looked at it . . . you had
the impression that it was Mimis arm?
DS: No, it was in my head. It was an idea I had.
C.M.: When you looked at your arm, what did you
see?
DS: Well, I saw an arm. But between hers and mine
...
C.M.: An arm is an arm in some ways . . . but, for
example, the clothes . . . Had you noticed that it
was the same sweater or anything like that?
DS: No, because I think it was naked.
C.M.: It was naked?
DS: Yes
C.M.: And thus, it would have been wrapped around
you?
DS: (putting her left hand on her right shoulder)
Yes . . .
C.M.: Do you know when this disappeared?
DS: The feelings regarding the fact that I thought it
was my daughter? I think it came about because
they told me that it was not true.
C.M.: Since otherwise, you had the feeling it was
true?
DS: Ah yes!!
C.M.: And when, for example, you saw your daugh-
ter. That arm of hers.
DS: Ah! I never told her, I didnt.
C.M.: Well, I understand, but in your idea, if it were
there around you, would it mean she had another
one, or how did that work?
DS: No, it meant that she had held me so strongly in
her arms that it had left an imprint . . . to be more
precise.
C.M.: That is to say, she had kept her arm and you
kept the imprint . . .
DS: And my older daughter told me that during the
first week after my coma I did not recognize my
daughter. I said That is not my daughter . . .
Always the same, by the way. Youd think the
other ones impress me less.9 And I said That is
not my daughter.
After that interview, C.M. asked DS whether she
would like to write anything about these strange illu-
sions. She then dedicated her remembrances from
elsewhere to C.M. and accompanied them with a
drawing (Figure 3b). In her text, DS more or less
maintains that her illusions were true: The staff
refused to believe it and maintained that it was my arm.
I alone knew the truth, which, however, seemed obvi-
ous. The drawing is a self-portraitwith a mirror
lateralizationintended to allow C.M. to understand
what DSs early illusions looked like. Due to left
hemineglect, the left leg is missing, while the left arm
is called Mimis arm and shows traces of paste left
by bandages.
DS later accepted psychotherapeutic help. This help
was proposed because she encountered difficulties in
coping with the family problems caused by her illness.
The interviews mostly concerned her neurotic relation-
ships with her daughters, sisters, and mother. It was
only when questioned about her bodily feelings that
DS spoke to her therapist of a left side you have not
any awareness of, the feeling that the left side does not
exist, perhaps because you loose the sensitivity, which
is much more important than not being able to move,
and a side you cannot mourn because it does not exist.
She also once mentioned that she sometimes had the
feeling she had lost her arm or forgotten her left
arm at home. When asked about the anxiety possibly
aroused by this impression, she answered that she was
not anxious but annoyed and, laughing, added that her
physiotherapist would be displeased at her. DS did not
seem to think of any possible link between her daugh-
ter-arm illusions and her problems with the feminine
members of her family.
DSs case is very illustrative. It shows that, despite
the apparent remission of a spectacular symptom
(somatoparaphrenia), a body image pathology may
persist: the arm remains outside the body image, left
at home. Above all, one could not find a better
illustration of the fact that identifying the object and
recognizing reality are incompatible: the daughter is
not recognized in the reality area insofar as she is
<please clarify>
identified as a too-present object (incorporated child,
unlost part of the patients body).
9
DS later told her therapist that Mimi, her youngest daughter, was her
baby love, whereas she called the older girls my dear.
Daughter-Somatoparaphrenia in Women with Right-Hemisphere Syndrome
Discussion
A Lacanian perspective on daughter-
somatoparaphrenia
One may find in the literature, from the early 1920s up
to today, several observations of male or female pa-
tients who personified their left hemiplegic arm as, or
considered it as belonging to, a child. Except for the
three female cases reported by Lan, Delahousse,
Christiaens, Fontant (1969; see, above, the psychoana-
lytic comments on this case by Delahousse, 1972), by
Bisiach, Rusconi, and Vallar (1991), and by Rama-
chandran (1994), these observations do not provide a
detailed account of the patients words. Moss and
Turnbull (1996) have described a case of somatopara-
phrenia and anosognosia in a boy who hated his
paralyzed arm, protested against physiotherapy ses-
sions, and asked that his mother give him her arm. This
case, like our observations, shows that the unconscious
sharing of body parts in the motherchild relationship
may openly appear in RHS.
The observations presented here may shed some
light on the characteristics of the strange children-arms
that patients speak of in somatoparaphrenia. On the
one hand, they belong to women whose body image is
not unified any more; on the other, they have traits that
call to mind an animate/inanimate object (leaf-child,
living doll). They share these traits with the other
avatars of the left arm in RHS, insofar as this arm may
be described as both independent from the body (a
passing arm, an arm attached by glue) and endowed
with its own personal life (it worked too much, it is
angry at not being taken care of). All these figures, as
the children incorporated in the mothers body, are
among those that, for Freud (1919), give rise to the
feeling of uncaniness and which, according to Lacan
(1962), are evidence of the appearance of the normally
repressed object in the foreground. The fact that
daughter-arms specifically appear in female cases
strongly supports this hypothesis: the object status of
children in women is well-known (Freud, 1933; Lacan,
1974). Indeed, we have published the observation of a
male patient (Morin, Thibierge, & Perrigot, 2001) who
addressed his hand as he would have spoken to a child
(go and have a walk with your sister!). However, this
man explained that when commanding his hand, he
intended to behave like his physiotherapist behaved
with him. It is noticeable that such an authoritarian,
masculine style implies a separation rather than an
incorporation of the childish hand.
It may be said that, in the cases presented here and
in our previous studies (Morin, Durand, et al., 2002;
57
Morin, Taillefer, et al., 2001), the body schema disor-
der is associated with an alteration of specular image,
insofar as that object that should, due to repression, be
lacking and give rise to desire intrudes on the psychic
reality of the patient. It is necessary to underline that
demand and not desire objectsas is the case in psy-
chosisthus appear in the fore. This is obvious in the
case of the oral object, and also in daughter-
somatoparaphrenia, if one recalls the Freudian as-
similation of the child to a gift the girl demands to
compensate for her penis privation (Freud, 1933).
Such an undue psychic presence of the object might
also account for anosognosia, insofar as it would,
together with the alteration of body image, undermine
the very structure that organizes normal knowledge.
This interpretation avoids the contradictions that, in
our opinion, weaken the interpretation of anosognosia
put forward by Kaplan-Solms and Solms (2002).
These authors consider that anosognosia is due to
repressionthat is, in our eyes, takes place among the
normal neurotic psychic processes. On the other hand,
they insist that right-brain damage specifically under-
mines the whole-object cathexis, the means bysource?
(KS&S?)
which we normally transform infantile narcissistic li-page numbers?
bido into mature and realistic object love; right-brain
damage thus results in a failure of normal mourning.
Indeed, as stated above, it is questionable whether
patients with a failure of normal mourning may be
considered as being in the field of repression. It is
therefore difficult to understand how a neurotic pro-
cess might be particularly efficient in a pathology that
attacks precisely the neurotic structure of the patient.
However, in our opinion, the fact that psychoanalysts
may propose interpretations that are not perfectly co-
herent (see also discussion above of the repression/
unawareness problem in the field of anosognosia) is a
sign of the contradictions and paradoxes that arise
when attempting to characterize the psychic structure
of RHS patients. On the one hand, a few of Kaplan-
Solms and Solms cases exhibit paranoiac or melan-
cholic manifestations, and we ourselves observed a
quasi-melancholic evolution in one case (DT).10 On the
other hand, the discourse (see above) of MN and DS
and their behavior obviously attest to their neurotic
psychic structure. On the one hand, MN and DS use
words that make the separate components of neurotic
structure directly audible, which is not the case ordi-
narily. But on the other, their words seem to escape
from an isolated psychic territory. This is clearly
illustrated in the case of DS: this patient never sponta-
10
DTs expression I do not miss that may even remind us of the
formula proposed by Czermak (1986) for characterizing psychotic syn-
dromes: the lack itself is lacking.
 58 Catherine Morin, Stphane Thibierge, Pascale Bruguire, Pascale Pradat-Diehl, Dominique Mazevet
neously spoke of her asomatognosia to her therapist.
She was, however, able to speak of her arm, even to
say that it did not exist or it had stayed home. Indeed,
one may wonder whether this arm left at home
might not be understood as expressing precisely the
belongs both ambiguous status of the object, which both belongs to
to, or add is:
and is his lost the subject and his lost maternal Heim, the Other. One
? could thus propose that these patients, regardless of
their structure, openly express a truth that is normally
repressed (in the present case, that children may never
cease to be a part of the mothers body in the mothers
unconscious). It is doubtful whether the therapist
would be justified in putting this truth in a harsh light:
DSs unconcerned attitude when speaking to her thera-
pist of her forgetting her left arm at home clearly
indicates that this does not pose a problem for herin
other words, that it is not a personal truth. This is the
reason why we ordinarily take the position neither to
interpret this type of discourse in psychotherapeutic
dialogue nor to correct its aberrations in medical inter-
views.
Is there consistency between psychical
and neuronal location?
The fact that patients may confuse their arm with the
arm of someone else could be interpreted quite differ-
ently if put in relation with the notion that the self and
other body representations in the brain are partially
overlapping (Decety & Sommerville, 2003). Accord-
ing to this line of thinking, our observations might be
interpreted in terms of erroneous body representations
arising due to poststroke neuronal reorganization.
However, this would not explain why, in the RHS, the
paralyzed arm may be assimilated not only to existing
children but also to fictitious children or to an inani-
mate object. Therefore, we insist that the logic of the
RHS patients discourse may be found in the symbolic
and imaginary coordinates of their self-representation
and not only in the involvement of given brain struc-
tures. This argument does not remove the problem of
the consistency between psychic symptoms being asso-
ciated and their appearing when brain areas near to one
another are either activated or lesioned. Decety and
Sommerville (2003) claimed that this consistency ex-
ists: Consistent with research and theoretical claims
from developmental and social psychology, represen-
tations of aspects of the self both overlap with repre-
sentations of other and are distinct from such
representations. Common and distinct cognitive repre-
sentations of self and other extend along many dimen-
sions of self and other processing from action
recognition to mental state understanding. Indeed, the
relationships between individual brains and familial or
social symbols and images raise fascinating problems.
This is particularly true if one considers the relation-
ships between identification and neural development:
for example, only a specific brain developmental
phase, during which the infants brain is not com-
pletely mature, seems available for the identification
process. The concerns of neurodevelopmental research
and psychoanalysis have, however, little in common.
Moreover, there is currently no scientific knowledge
that allows us to assume that the laws that govern the
efficiency of social and familial symbols and images
either are identical to or directly parallel those of
neural functioning. Such a parallelism is, however,
implicitly assumed by Decety (2002): Mental pro-
cesses, and particularly thosenumerous in Homo
specieswhich are universal, must be described in
terms that make evident that they are achievable by one
brain. We believe that a crucial problem is hidden in
the expression achievable by one brain, which im-
plies that the mind only lives in individual brains.11
The implications of the Lacanian perspective
in RHS for enlightening the mindbrain problem
Our psychoanalytic reading of pathological observa-
tions makes clear that, although individual brain le-
sions may have very destructive psychic effects, this
does not automatically imply that only one brain is
sufficient to create a normal subject. These pathologi-
cal observations indirectly show that our normal certi-
tude of having an autonomous self implies both our
separation from and our dependence on the Other.
They offer the opportunity for a true dialog between
psychoanalysis and neurology. On the one hand, psy-
choanalysts may learn something from these neuro-
logical observations. Even if our separation/
dependence relationship to the Other relies on a sym-
bolic operation, this operation cannot but result in
neuronal inscriptions, a fact that psychoanalysts ordi-
narily do not need to take into account. When neuro-
logical lesions occur to alter these inscriptions, our
dependence on the Other and its representatives
(nurturer, child), which ordinarily implies a psycho-
analytic construction, appears in full light. On the
other hand, our observations are instructive for
neuroscientists: they show that our mental life does not
only depend on the structure of our neuronal nets, but
11
We take the liberty of translating un cerveau as one brain, since
Decety did not write le cerveau but un cerveau.
 Daughter-Somatoparaphrenia in Women with Right-Hemisphere Syndrome
also on the words and images that make us dependent
on the Otherthat is, that take their source outside our
individual brains. This makes the wish to unify neuro-
science and psychoanalysis (see, for example, Kandel,
1999) questionable, insofar as these two scientific
fields necessarily differ in their points of view.
Kaplan-Solms and Solms work (2002) clearly illus-
trates this necessary heterogeneity of points of view: in
Kaplan-Solmss psychoanalytic interviews with RHS
patients, she considers the patients words in terms of
hate and love toward the object, and notalthough
aware of the lesional origin of the disorderin terms
of neuronal dysfunction. Conversely, when Marshall,
,names added: Halligan, Fink, Wade and Fracowiak (1997) study the
ok?
functional anatomy of a hysterical paralysis in a female
patient who had sustained a psychic trauma, they rea-
son in terms of brain circuitry but do not address either
the nature of the trauma or the mechanism through
which their patient went from a psychic trauma to a
pathological activation of orbito-frontal and cingulate
cortex whenever she tried to move her leg. The psy-
choanalytic analysis of the patients words and the
neuropsychological or the neuroanatomical study of
the brain thus imply two different points of views.12
These points of view, although not contradictory, can-
not be held simultaneously.
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