Anosognosia by proxy in a nine-year old: growing up with a brain-damaged mother

This study describes the relationship between a child and her mother, who suffered a traumatic brain injury in a road accident. As a result of an extensive brain lesion, the mother developed a chronic form of anosognosia (i.e. a lack of awareness of her own sensory and motor deficits). Both mother and daughter underwent psychoanalytical treatment, each in a separate setting. The psychopathological characteristics of the mother’s syndrome are associated with the mechanism of denial and are described in an interpersonal context in view of the disorders experienced by the nine-year-old daughter. What emerges is a disturbed pattern of development in the child over the seven years since the accident which closely matches the experience of the mother, who was organically damaged. The feature to appear is an ‘anosognosic dyad’, in other words a special kind of relationship in which the mother is affected by denial, a condition strictly linked to her brain lesion, and her daughter displays an induced unawareness of her own and her mother’s handicaps: an ‘anasognosia by proxy’. This hypothesis will be discussed along the lines of a particular psychoanalytic model (Sandler & Sandler, 1998)