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September 1960

Motivational and Structural Factors in the Denial of Hemiplegia

Author Affiliations

New York
From the Second (Cornell) Medical and Neurological Service, Bellevue Hospital.

Arch Neurol. 1960;3(3):306-318. doi:10.1001/archneur.1960.00450030084009

The difficulty in discerning the difference between capacity and motivation, as recently emphasized by David Levy,1 is pertinent to the problems posed by patients with anosognosia. He defines capacity as the nonmotivational aspects of behavior, namely, the individual's ability, fitness, and endowment. "As contrasted with motivation it (capacity) refers to what the individual can do rather than what he intends to do." Recent contributions2-5 to the subject of denial of hemiplegia reflect differing opinions concerning the role of motivational factors as compared with structural damage.

In the effort to arrive at a unified point of view concerning the symptomatology of these patients two somewhat separate approaches can be identified. The first is concerned with the discovery of the specific structural factor involved and the analysis of the resultant functional deficit. This is best exemplified by the work of Denny-Brown and his associates4 and their concept of amorphosynthesis.