Aphasia 95The Catastrophic Reaction
The catastrophic reaction in aphasia can be viewed as an anxiety attack. It is a psychobiologi-
cal breakdown involving physical changes and negative emotions (Eisenson, 1984). These anxi-
ety attacks can include a variety of be hav iors and reactions, including irritability, crying, strik-
ing out, withdrawal, and fainting. Patients report a general feeling of uneasiness or a sense of
impending doom. A catastrophic reaction can be triggered when too many demands are placed
on the patient or when there is too much noise in the immediate environment. It can also occur
when the patient is placed in a situation where successful per for mance is unlikely, threatening
his or her sense of self- integrity. Frustration at being unable to complete a task that was once
done normally and easily precipitates and perpetuates the catastrophic reaction. Biologically, the
fight- or- flight response occurs.
The fight- or- f light response is a remnant of human evolution and survival. Early humans con-
fronted with a life- threatening situation had two choices: fight or f lee. Today, the fight- or- f light
response occurs in life- threatening situations and also in those where the threat is psychological.
Confronted with a psychological threat, the person has the biological reactions of fear, anxiety,
and panic similar to those accompanying physical threats— increased heart rate, rapid breathing,
hypertense muscles, sweating, and elevated blood pressure. According to Laraia (1998), a panic
attack occurs when the human alarm system is triggered. Although all patients with aphasia can
have catastrophic reactions, these reactions are more common in those with left hemi sphere brain
damage, particularly in and around Broca’s area, and the more nonf luent the speech, the more
likely the response (Tanner, 2003a).
Perseveration-Echolalia
Perseveration occurs when the patient is caught in one mental set or be hav ior pattern and can-
not shift easily to another one. The sensory or motor act tends to continue longer than is appro-
priate or warranted by the stimuli. Observable perseveration occurs during writing and speaking.
In graphic perseveration, the patient’s writing consists of letters repeated continuously. The hand
movements cannot shift from one pattern to another. Often the writing initially appears normal,
with the first or second letter produced correctly; then it disintegrates into a f lat line. The patient
with verbal perseveration uses the same sound, word, or phrase repeatedly. He or she appears to be
“locked in,” incapable of shifting to another word or concept, regardless of what question has been
asked. In aphasia, echolalia, the automatic repetition of the last word or words spoken by someone
else, often occurs with perseveration. Current research suggests that a subcortical structure, the
caudate nucleus, is the likely area of damage in perseveration (Kreisler et al., 2000).
Organic Depression
Depression is an emotional disorder characterized by feelings of despair, sadness, reduced
self- esteem, and a sense of helplessness and hopelessness. It may be accompanied by anxiety, loss
of appetite, sleep disorders, or lethargy. Research shows that as many as 50% to 70% of patients
with aphasia may suffer from chronic depression and anxiety. This occurs more frequently in left
hemi sphere than right hemi sphere damage, and the more nonf luent the aphasia, the more likely
the patient is to have depression (Tanner, 2003a, 2003b). Many aphasiologists believe that this
type of depression is a direct result of the brain injury and of a disruption of neurochemicals that
control and regulate mood.
Organic depression is primarily the result of brain chemicals gone awry; it is not reactive, nor
is it the kind of depression found in the grief response (see the next section). Although reactive
and grieving factors can contribute to organic depression, this condition is primarily the result of
altered brain chemistry because of brain injury or the medi cations used to treat it.