Aphasia

APHASIA

Aphasia, a word proposed by Armand Trousseau to replace the term "aphemia," created by Paul Broca, refers to language disturbances that arise from specific cerebral lesions, most often in the cortex. Between 1861 and 1865, when the dispute ended concerning the question of determining whether the cerebral cortex operated as a unit or as a collection of separate elements, Paul Broca showed, through a series of anatomical and clinical observations, that the destruction of the left side of the base of the third circumvolution of the frontal lobe in a right-handed subject who until then was able to speak normally led to the loss of articulate language. The subject was unable to express himself using a sequence of words or phrases.

In 1874 Carl Wernicke extended the field of research by describing two other types of aphasia, all caused by a lesion in the left hemisphere: sensory aphasia from damage to the posterior areas of the second and third circumvolution of the cortex, and conduction aphasia, arising from the disconnection of the bundles connecting this region to the base of the third circumvolution of the frontal lobe. Afterwards, the disturbance identified by Broca would be known as "motor aphasia." Later Wernicke identified two other types of aphasia: "motor transcortical aphasia" and "sensory transcortical aphasia."

By the end of the nineteenth century, three separate approaches to the problem had been developed. Some researchers, such as Jean Martin Charcot and Joseph Grasset, increased the number of types of aphasia; others, like Alfred Vulpian, and later Pierre Marie, renewed the "unitarian" position; the third group, following the important work by Jules Déjerine, demonstrated through the use of clinical and anatomical arguments that the nature of the aphasia would change with the nature and location of the lesion. For example, frontal lesions seemed to primarily affect speech production, posterior lesions seemed to affect speech recognition, and the destruction of the cortex resulted in disturbances of internal language, which affected the subject's autonomy.

Sigmund Freud's work on aphasia, published in 1891, accepts the work of Paul Broca but questions Wernicke's research, which Freud criticizes for being excessively schematic and lacking in clinical observations. Freud did not question the relationship of language function with the brain but was cautious about hastily assigning specific locations to specific functions. Although he accepts that certain clinically based forms of aphasia—"verbal aphasia," "asymbolic aphasia," "agnosic aphasia"—can be used to localize the cortical lesion with certainty (which was later confirmed by neurosurgery during the First World War), he refused to extrapolate from pathology to physiology and deduced a cerebral concept of the normal operation of language, with a critical position that was far removed from the scientism that is often attributed to him in this field. In the descriptive sections of his work, Freud distinguished between the representation of words and the representation of things, and their links with auditory images, visual images, and the motor images at work in these phenomena.

Georges LantÉri-Laura

See also: Brain and psychoanalysis, the; Language and disturbances of language; memory; Thing-presentation; Word-presentation.

Bibliography

Freud, Sigmund. (1891b [1953]), On aphasia (A critical study) (E. Stengel, Trans.). New York: International Universities Press.

Hécaen, H. and Lantéri-Laura, Georges. (1977).Évolution des connaissances et des doctrines sur les localisations cérébrales. Paris: Desclée de Brouwer.

——. (1989). Les fonctions du cerveau. Paris: Masson.

Lantéri-Laura, Geoerges. (1993). Histoire de la phrénologie. Paris: Presses Universitaires de France.

Further Reading

Miller, Laurence (1991). On aphasia at 100: the neuropsychodynamic legacy of Freud. Psychoanalytic Review, 78, 365-378.

Rizzuto, Anna-Marie. (1990). Origin of Freud's concept of object representation: "On Aphasia." International Journal of Psychoanalysis, 71, 241-248.