One of the mantras of psychoanalysis seems to be the statement 'Of course, psychoanalysis isn't for everybody'. Psychoanalysis was originally called 'the talking cure' so I wondered about psychoanalysis with analysands who couldn't talk. I am referring not to people with aphonia - that is people who suffer from a lack of voice due to disease or defects in the vocal organs - though that needs consideration too. Rather I will deal with analysands whose lack of 'talk' is associated with brain damage, that is people with aphasia. It was disconcerting to read Laplanche and Pontalis (1973, p 450) referring to 1891 and 'the then topical question of aphasia' but I decided that maybe the time had come to make the question of aphasia topical again in the interest of those who suffer from it.
In this paper I will show that the relationship between psychoanalysis and aphasia is a
reciprocal one, that it is not just a case of what can psychoanalysis do for people with aphasia but also how much the study of people with aphasia has contributed, not just to the development of psychoanalysis, but to its very existence. This should not really be surprising because it is common that many developments of knowledge have happened through investigation of the abnormal, and it was through investigation of people with aphasia that theories of the production of speech were produced.
In the first half of the paper I will concentrate on two landmark publications. The first is Freud's 'On Aphasia' (1891) which is a neurological work, which laid the groundwork for his later psychoanalytic theories. The second is Roman Jakobson's 'Two Aspects of Language and Two Types of Aphasic Disturbance' (1956) which Lacan used in the development of his theories. Both of these were theoretical works in the sense that they were written by scientists - a neurologist and a linguist - who were not in contact with people with aphasia, certainly not in a therapeutic situation.
References to aphasia and psychoanalysis that I found seemed to belong to the history of psychoanalysis, though, without a major review of the literature (outside the scope of
this paper), I cannot say that no references to aphasia and psychoanalysis from a clinical point of view exist Grotjahn (1940) calls his paper an 'Investigation' of a seventy-oneyear-old man with senile dementia because he admits that he undertook the psychoanalysis mainly as a research problem rather than with therapeutic intent
Though Grotjahn followed a form of psychoanalysis which was definitely not acceptable to Lacan ('Under the guidance of his physician he was able to accept reality .. .' p 97) the value of the paper is that throughout he kept to psychoanalytic categories to show that the development of senile dementia is governed by psychological laws.
For the second part of the paper I will present two case studies of people with different kinds of aphasia. One is that of an 80 year old woman, Mary, whose aphasia is the result of Senile Dementia Alzheimer's Type. The other is of a 50 year old man, John, who suffered from a stroke. They differ in that one has a cognitive deficit while the other doesn't. My conclusion will be that from my experience, and on the basis of psychoanalytic theory, psychoanalysis is suitable for at least some people with aphasia, even when the aphasia is associated with cognitive deficit. In between these two sections will be a chapter which will show the difficulty of defining exactly what aphasia is. Then it will try to elucidate the difference between speech and language as theorised by Lacan. Finally it will question whether aphasia would make someone unsuitable for psychoanalysis, given this theory.