Eclectic perspectives on the psychology of aphasia.

This article explores the psychological changes that occur in patients who have suffered a stroke with resulting aphasia and examines the adjustments necessary to help the patient cope. The eclectic approach described in this paper examines the psychology of aphasia from three perspectives: effects of brain injury, psychological defenses and coping styles, and responses to loss. Depression, anxiety attacks, ego restriction, crying, euphoria, denial, anger, and a host of other psychological reactions can accompany stroke, sometimes causing health care personnel to feel overwhelmed by these psychological concomitants in their patients. This paper is intended as a guide to understanding the significant psychological adjustments many patients must undergo. Current information is provided to assist in evaluating and treating these patients. J Allied Health. 2003; 32:256-260. THIS ARTICLE IS ABOUT the psychology of aphasia, which can be a psychologically devastating disorder. It is intended as a guide to understanding the significant psychological adjustments many patients must undergo and is relevant for all health care professionals who deal with aphasie patients. Whether the reader is a physician, neuropsychologist, counselor, nurse, occupational or physical therapist, or speech-language pathologist, the information found herein is intended to provide insight into the psychological status of the aphasie patient. Current and meaningful information is provided to assist in evaluating and treating these patients. This article provides a foundation for understanding the many psychological changes experienced hy people with aphasia. Stroke is a leading cause of aphasia in adults, laying waste to the ability to use language in thousands of patients each year. The "big three" communication disorders resulting from injury to the brain or nervous system are aphasia, apraxia of speech, and the dysarthrias. Although these disorders can occur alone, they often are seen together. They are divided further into disorders that impair the fabric of language (aphasia) and disorders that are primarily motor speech disorders (apraxia of speech and the dysarthrias). Aphasia is a multimodality disorder in that it disrupts or impairs to various degrees speaking, auditory comprehension, writing, reading, gestures, and the ability to do mathematics. In most people, expressive aphasia usually results from damage to Broca's area in the left frontal lobe. Receptive aphasia usually results from damage to Wernicke's and adjacent areas in the left temporal-parietal lobes. Aphasia can be psychologically devastating for the patient, and it can create enormous adjustment challenges for the patient's family. Aphasia is a double-edged sword. Serious chronic medical conditions often cause it, encompassing many adjustment challenges, and it impairs or even eliminates meaningful communication between the patient and his or her psychological support system. Aphasia can cut a wide swath in the quality of life of people affected by it. One of the most challenging aspects of aphasia is its psychology. Depression, anxiety attacks, ego restriction, crying, euphoria, denial, anger, and a host of other psychological reactions often accompany it. Clinicians sometimes feel overwhelmed by the psychological concomitants of aphasia in their patients. Whether the health care professional is a nurse, therapist, physician, dietitian, or other health professional, knowledge of the many psychological reactions in aphasia helps in dealing with this major life-changing event. Patients with aphasia, particularly severe or global aphasia, often are intimidating given their across-the-board inabilities to communicate. In the early 1960s, Schuellet al1 commented on the intimidating nature of the psychology of aphasia: To say a clinician must be aware of psychological problems in aphasia is to say he must be aware that he is dealing with people. Sometimes we are so intimidated by labels, such as emotional lability, catastrophic reactions, anxiety, depression, euphoria, etc. …