Exploring the Psychology, Diagnosis, and Treatment of Neurogenic Communication Disorders

Psycho-Organic Determinants and the Localization Movement The psycho-organic determinants to the psychology of neurogenic communication disorders are a direct result of brain injury. The role brain damage plays in the psychology of neurogenic communication disorders has been studied for decades and is closely tied to the localization movement discussed in Chapter 2. Today, a great deal of research is being conducted on the site of brain injury associated with or causing psychological reactions. The goal is to identify areas of the brain causing psychosis, aggression, denial, depression, euphoria, and other many other psychological reactions. Strict localizationists believe that all significant psychological reactions can be traced to specific parts of the brain and that depression, anxiety, psychosis, and so forth, are directly caused by brain injury. Other localizationists, gestaltists, acknowledge that injury to parts of the brain are associated with many psychological reactions, but are not the absolute cause of them. A good example of the localization versus holistic view of the psychology of neurogenic communication disorders is clinical depression. To strict localizationists, the clinical depression seen in patients with neurogenic communication disorders is a direct result of damage to specific parts of the brain. The brain damage causes a deficiency of certain neurochemical associated with a sense of well-being and results in depression often accompanied by anxiety. The treatment for this psycho-organic depression is the administration of antidepressants which corrects the neurochemical imbalance. Gestaltists, on the other hand, acknowledge the role brain damage plays in the onset of clinical depression in patients with neurogenic communication disorders, but also consider the role stress, loss and grief, and impaired defense mechanisms and coping styles play in clinical depression. Gestaltists believe that antidepressants should be combined with counseling, psychotherapy, life-style changes, and other social treatments for depression. Some authorities label the localization school of thought, the medical model, while the gestaltist philosophy is sometimes referred to as the social model. Currently, much research is being conducted into these issues with often controversial and with inconclusive results. Sidebar 8.1: The term “psyche” is Greek in origin and refers to the human “mind” and “soul.” Brain Damage as a Predisposing Factor in the Psychology of Neurogenic Communication Disorders When addressing the psycho-organic determinants in the psychology of neurogenic communication disorders, the predisposing, precipitating, and perpetuating factors associated with brain injury must be addressed to explain the adjustment challenges and psychological disorders experienced by some patients. Although brain damage may precipitate and perpetuate psychological disorders and maladjustment to neurogenic communication disorders, it is best viewed as a predisposing factor. A precipitating factor is an important or necessary condition to cause a psychological disorder or to set a maladaptive response into motion. A perpetuating factor causes the psychological reaction or disorder to be persistent or permanent. Predisposing factors, brain damage, incline a patient to a particular psychological condition, attitude, or behavior. Because of brain damage, patients with neurogenic communication disorders can be predisposed to certain psychological reactions and disorders. A good example of the predisposing factor of temporal lobe damage is aggressive, violent, and impulsive behavior. Tardiff (1997) and others, have found that injury to the temporal lobes cause aggression and a propensity for violence. Temporal lobe epilepsy is associated with purposeless violence and has been used as a defense in legal cases (Tanner, 2007). Some legal authorities have proposed that violent offenders have inherited brain irregularities leading to a propensity for criminal behavior. As with most localization research, studies addressing aggressive, violent, and impulsive behavior often result in disparate and sometimes contradictory results. Frontal lobe damage has also been linked to aggressive, violent, impulsive, and other dissocial behaviors. However, it is well-documented that brain injury can predispose a person certain dissocial behaviors. Importantly, it should be noted that while some individuals with temporal and frontal lobe damage become violent offenders, most do not. Consequently, psycho-organic determinants are best viewed as predisposing factors requiring precipitating, perpetuating, and other yet to be discovered phenomena to account for maladjustment and psychological disorders in neurogenic communication disorders. Generalities About Brain Injury and Psychological Reactions Certain generalities can be made about the nature, type, and location of brain injury and their predisposing effects for certain psychological reactions in patients with neurogenic communication disorders [Tanner, 2009, Tanner, (2007), Williams, Evans, and Fleminger (2003), Carota, Rossetti, Karapanayiotides, and Bogousslavsky, (2001), Ylvisaker, Szekeres, and Feeney (2001), Tardiff, (1997), Gordon, et al. (1996), Tanner and Gerstenberger, (1996), Smeltzer, Nasrallah, and Miller (1994), Gainotti, (1989), Robinson, et al., (1988), Lipsey, et al., (1986), Robinson, (1986), Robinson, et al., (1985), Gordon, et al., (1985), Sackeim and Weber, (1982), Sackeim, et al, (1982), Robinson and Benson, (1981), Gasparini, et al., (1978), Black, (1975), Weinstein and Puig-Antich, (1974), Gainotti, (1972), Weinstein, et al., (1966), and others]. It is important to note that many adjustment challenges and psychological disorders predisposed by brain injury are not substantially different from the kinds of reactions seen in psychologically disturbed people without brain damage (functional disorders).