"In Rome I learned a lot about denial in right-hemisphere damaged patients, denial of the existence of a part of the body. In psychoanalytic practice, it's possible to observe denial of the significance of important events in the life of a patient. Would both forms of denial have similar biological explanations?"

Your question is very interesting and important. By "denial of the significance of important events" I understand you to mean Freud's "verleugnung", a kind of denial of reality, later translated as "disavowal". Laplanche (1973 translation) defines disavowal as "... refusing to recognize the reality of a traumatic perception ...". An archetypal example would be not being emotionally touched by the death of a parent as most normal people would be. That is, understanding it intellectually, but not processing or accepting it on an emotional level. In a 1983 article Michael Basch posited that disavowal is associated with a blockage in information transfer from the left brain to the right brain, which I believe is correct. Disavowal is certainly a prominant defense in compulsive personality (CP) (Freud's anal character), Basch writing in his 1988 book that it is one manifestation of "isolation of affect" which we know characterizes CP. Careful observers will note the full array of symptoms in CP and the adult stage of Asperger's Syndrome (AS) are often indistinguishable from each other, particularly in the realm of their interpersonal relations with others. Similarities between CP and AS seem to extend into the biological realm, as AS has been called "right-brain autism", and in his 1998 book on AS, Attwood alludes to "some tentative evidence for right hemisphere cortical dysfunction [in AS]".

To sum up, Basch claims disavowal is related to a blockage in information transfer from the left to the right brain, disavowal (or "isolation of affect") which most characterizes the CP. CP and adult AS are difficult to distinguish from each other, and right brain dysfunction has been surmised in AS. In their 2002 book, Solms and Turnbull indicate the neglect syndrome (in right-hemisphere damaged patients) isn't simply about neglecting the left side of the body, but seems to include disavowal as well, as best exemplified by their description of anosodiaphoria in mild cases of the neglect syndrome: "They acknowledge their deficits intellectually but seem unaware emotionally of the implications". We have then in these 3 syndromes (CP, AS, and neglect) various levels of right brain dysfunction which all manifest the disavowal mechanism. So I would answer your question "yes".

Let me briefly elaborate on the biological basis for disavowal in compulsives mentioned above. Begin by considering the characteristic "affect-blocks" (Reich,1945) in the compulsive: "All the muscles of the body, but especially those of the pelvic floor and pelvis, the muscles of the shoulders, and those of the face ... are in a state of chronic hypertonia". We know the right brain has a special relationship with the body. Therefor consider the block in information transfer to the right brain as isomorphic with this stiffness of the body of the compulsive, though I must admit I don't precisely know the relationship between these two things or how one might cause the other. There will be time for that later. We can also see an isomorphism between this constriction of the heart of the compulsive with a constriction in the working-image-space used to see with the mind's eye. I use the term "heart" metaphorically as it might be used in everyday language, for example as in the case of Ebeneezer Scrooge in Dickins' "A Christmas Carol", an early portrayal of the compulsive personality in literature, that his heart was closed off and constricted. We can say the size of this metaphorical heart is in proportion to the size of the working-image-space. It's an understanding of this constricted working-image-space which helps explain the observation about the compulsive that he "can't see the forest for the trees". Recalling that Wurmser (1989) called disavowal "blinding the eye of the mind", with a constricted image-space the compulsive is only able to see small bits of the big picture with his mind's eye, able to swap trees in and out, but not see the whole forest, so to speak. It's in this way the "eye of the mind" of the compulsive is mostly blotted out, disavowal as Wurmser defines it.

To sum up then, a blocking of information transfer to the right brain is consistent with the rigid musculature of the compulsive personality which corresponds to a constricted spiritual heart and therefor a constricted image-space. This especially small working-image-space effectively blots out most of the ability of the eye of the mind to see, as it can only swap in small parts of the whole picture at a time into the constricted image-space. This is a form of disavowal.

Feedback on ideas in this post, including references to relevant books, journal articles, or ideas in progress, will be greatly appreciated. I'd especially like to hear about apparent gaps or logical errors in the main thesis, and validation where appropriate.

Perry Sill, Cincinnati, USA

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