The Psychiatrist's Approach to Managing the Aphasic Patient

A discussion of psychiatry and aphasia therapy should properly begin with an obscure historic fragment that illustrates the closeness of the two disciplines. Psychoanalysis is, of course, a major theme in 20th century psychiatry. The theories of its founder, Sigmund Freud, are most popularly understood through his analysis of certain errors committed by normal people in everyday life (Freud, 1930). Among the best known of these are "slips of the tongue," which he showed could originate in and express an emotional conflict of which the speaker is unaware. A popular example of such a slip is the story of the child who was warned that a guest coming for dinner had a very large nose and that it would be poor etiquette to mention the fact. The child complied, but when serving coffee to the guest at the end of the meal, asked "Would you like some cream with your nose?" Freud dissected this linguistic phenomenon so thoroughly that such inadvertent substitutions still bear his name. The similarity of such slips to verbal paraphasias has certainly been noticed by many speech pathologists. Less well known than the "Freudian slip" is the fact that prior to his invention of psychoanalysis, this accomplished neurologist wrote a monograph on aphasia (Freud, 1953). The emotional roots of many paraphasic errors are just as transparent as in the revealing speech errors of nonaphasic, neurotic patients. Thus, there is circumstantial evidence that Freud's early insights from aphasiology have profoundly informed most contemporary psychotherapies of emotional illness, a debt which is rarely acknowledged. Conversely, his concept of unconscious processes, expressed inadvertently as errors in speech, can now be used by speech pathologists to enrich their grasp of aphasic productions by adding psychodynamic understanding to their linguistic formulations. That is, a patient's "error" may convey a genuine unconscious message, knowledge of which may help cement the therapeutic alliance and sophisticate the rehabilitation plan. Thus may psychiatry repay an old debt to aphasiology. This historic account can be illustrated by an excerpt from the conversation of a prominent psychiatrist during his successful recovery from aphasia about 8 years ago (Dahlberg and Jaffe, 1977):