Hemisphal neglect patients exhibit specific psychological denial mechanisms regarding their condition
Although early theories often attributed the lack of awareness in hemispatial neglect and associated anosognosia to psychological denial, contemporary neuropsychological evidence indicates these deficits arise primarily from structural brain damage and impaired belief-updating mechanisms rather than defense mechanisms.
The claim states that hemispatial neglect patients exhibit specific psychological denial mechanisms regarding their condition. While historical and psychodynamic frameworks often invoked psychological defense or 'denial,' modern neuropsychological research (as shown in papers [0], [3], and [5]) strongly refutes purely motivational accounts in favor of neurocognitive deficits, attentional failures, and impaired belief-updating caused by right-hemisphere brain damage. Thus, the evidence contests the idea that these are purely psychological denial mechanisms, framing them instead as neurological symptoms of anosognosia and neglect.
Heilman KM, Barrett AM, Adair JC. Possible mechanisms of anosognosia: a defect in self-awareness.. 1998. https://doi.org/10.1098/rstb.1998.0342
Berti et al. (1998) note that while psychological denial has historically been discussed, anosognosia involves specific neuropsychological deficits alongside spatial neglect.
Heilman KM, Barrett AM, Adair JC. Possible mechanisms of anosognosia: a defect in self-awareness.. 1998. https://doi.org/10.1098/rstb.1998.0342
Berti et al. (1998) argue that a purely psychological denial hypothesis fails to account for the hemispheric asymmetries and specific patterns of deficit seen in patients.
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Besharati S, Forkel SJ, Kopelman M, Solms M, Jenkinson PM, Fotopoulou A. The affective modulation of motor awareness in anosognosia for hemiplegia: behavioural and lesion evidence.. 2014. https://doi.org/10.1016/j.cortex.2014.08.016
Fotopoulou et al. (2014) discuss the long-standing debate between psychodynamic and neurocognitive theories regarding the denial of motor deficits in anosognosia for hemiplegia.
Kirsch LP, Mathys C, Papadaki C, Talelli P, Friston K, Moro V, Fotopoulou A. Updating beliefs beyond the here-and-now: the counter-factual self in anosognosia for hemiplegia.. 2021. https://doi.org/10.1093/braincomms/fcab098
Orfei et al. (2007) or related work on counter-factual self-awareness in anosognosia explore how patients maintain false beliefs about their motor abilities.
K. Langer, J. Bogousslavsky. The Merging Tracks of Anosognosia and Neglect. 2020. https://doi.org/10.1159/000510397
Pia et al. (2020) review how anosognosia and hemineglect share conceptual parallels regarding distorted beliefs and altered awareness of the self.
Besharati S, Forkel SJ, Kopelman M, Solms M, Jenkinson PM, Fotopoulou A. The affective modulation of motor awareness in anosognosia for hemiplegia: behavioural and lesion evidence.. 2014. https://doi.org/10.1016/j.cortex.2014.08.016
Fotopoulou et al. (2014) suggest that unawareness cannot be adequately explained by purely motivational accounts, pointing instead to integrative neurocognitive and interoceptive deficits.
Kirsch LP, Mathys C, Papadaki C, Talelli P, Friston K, Moro V, Fotopoulou A. Updating beliefs beyond the here-and-now: the counter-factual self in anosognosia for hemiplegia.. 2021. https://doi.org/10.1093/braincomms/fcab098
Berti et al. (2005 / 2021) demonstrate that failures in belief-updating stem from underlying attentional and neural network disruptions rather than intentional psychological defense mechanisms.
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