Neurodegeneration and the self: A case study with implications for therapy

The self is a highly abstract construct, challenging to assess through research, especially in neurodegenerative disorders. Still, there is a great need to understand whether the self persists in disorders that affect the structure and function of the brain, since either conclusion would have important implications for brain function, for the theoretical approach to the self, and the experimental and clinical focus on it. How can we assess the self in cases of progressive neurodegeneration? Why is that important? A case study of a man with progressive multifocal encephalopathy, which developed into dementia, is presented. Most roots of communication (with others and with the environment) were influenced by the condition, yet the self made its appearance through cognitions, behaviors and emotional reactions. Using all aspects of the self as a stimulus, the person was able to connect to his surroundings, and develop a therapeutic alliance with the therapist, which was evident through behavioral and emotional expressions. This, in turn, allowed him to find meaning in the experience of living with a progressive disorder and become more receptive and active in the process of the treatment. The self is present even in states of high neurodegeneration, and it can be targeted therapeuticaly in order to connect the person with the ‘here and now’. There is a great need for accurate assessment and in- depth understanding of the subject, as well as for further research in the field. The case study brings forth several theoretical implications (concerning the self within a degenerating brain), and has a variety clinical applications, while the need for a psychosocial intervention in the progressed stages of dementia is made apparent.