Stroke hemiplegia and specular image: lessons from self-portraits.

Hemiplegic patients suffer from difficulties in self-awareness, either due to specific neurological disturbances of body image or to psychological problems with their I images. Both types of difficulty have to do with the specular image as defined by Lacan (1966a) (i.e., the psychic structure that links the body with the symbolic and imaginary components of identity, and neutralizes the real objects involved in mother-child exchange). This study is devoted to analyzing how recent right and left brain vascular lesions affect specular image. Multivariate Analysis of 308 self-portraits of right and left brain injured stroke patients and control participants was performed. This revealed three dominant types of self-portrait: 1) Erect, complete, and clothed self-portraits were predominantly drawn by normal participants. 2) Erect self-portraits, lacking clothes, hands, and/or mouth and eyes were found in all groups of participants, predominantly in patients with speech disorders. Lack of hands and face features are indications of the challenge brought to the symbolic and imaginary aspects of identity by any sudden handicap, whether or not caused by a brain lesion, while symmetry of lacks and verticality show that body image may retain its structuring value even in brain lesions. 3) This is not the case in neurological disorders of body image, since inclined portraits with unilateral omissions were predominantly drawn by patients with right brain lesions. These unilateral omissions proved not only to result from cognitive deficiencies, but also to reflect the fragmentation of specular image, and in one case, the concomitant undue appearance of the object.