SEEKING turns into will: Case report of the reconstruction of the self after a left medial frontal injury

ABSTRACT This paper presents the psychotherapeutic process with an 18-year-old patient who suffered severe traumatic brain injury (TBI) due to a gunshot wound that caused a left medial frontal injury. The case suggests how the social withdrawal and lack of initiative in the patient, which corresponds to the “energization” type, may relate to a dysregulated SEEKING system. Furthermore, this feature may be a physiological correlate of Freud’s concept of “drive”. This case intends to contribute hypotheses to comprehend the psychological functions of the left perisylvian convexity. The analysis of the psychodynamic psychotherapy sessions raises the hypothesis that there was a decrease in the activity of the SEEKING system because of a deficit in the “energizing” function of the ego, which regulates the cathexis of representations that lead to initiative and interest in the surrounding world. It is hypothesized that this function may operate as a defense against the challenge of facing the discomfort and difficulties caused by the TBI. The importance of psychoanalytically oriented psychotherapy and work on emotional systems is raised, especially as regards the SEEKING system in the new subjective experience and restructuring of the patient’s self throughout the therapeutic process. New meanings help the patient decrease the intensity of feelings of frustration, anxiety, and confusion.