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although he had difficulty remembering the names of people and things. He had typical aphasic
word- finding errors (paraphasias) in which he supplied a word that was associated with the correct
one. For example, a pen was called a pencil, a knife was a spoon, and socks were shoes. Then one
day, a psychologist erroneously diagnosed Lane with post-traumatic psychosis, believing that he
suffered from delusions. Lane apparently believed that the medical staff, in a gesture of kindness,
had placed him in a car and transported him to the nearby fire station.
During the psychological evaluation, Lane, using slurred but intelligible speech, reported that
during the previous eve ning, people took him from his room, put him in a car, and drove him to
the fire station. Several times he told this story, each time with an excited look on his face. The
psychologist suspected that the story was false because of Lane’s medical status and physical limi-
tations. The nurses confirmed her suspicion. In fact, they had watched him carefully the previous
eve ning.
In real ity, Lane was not delusional; he had simply reported an actual event using aphasic para-
phasias. In this nursing home, some patients were allowed to sit at the nurses’ station as a reward
for good be hav ior. For many patients, this was a prize worth the energy of participating fully in
therapies, eating well, and keeping their rooms clean. It so happened that the place of honor was
below a large glass- enclosed fire hose and extinguisher. Indeed, the previous eve ning, a nurse and
an orderly had entered Lane’s room, placed him in a wheelchair, and transported him there. Lane
simply reported this event using aphasic paraphasias: car for wheelchair, drove for wheeled, and
fire station for fire hose. After the misunderstanding was clarified, the diagnosis of post-traumatic
psychosis was removed from Lane’s chart. For Lane, the high- speed car accident had brought many
terrible consequences, but a delusional trip to a fire station was not one of them.
Case Study 8-5: Closed Head Injury From an Equestrian Accident
Horses had always been a big part of Johnny’s life; he got his first horse when he was just 6 years
old. He named her Flicka, and she became his best friend. Johnny trained and “broke” the colt for
saddle, and she became a prized cattle horse. For Johnny and his parents, horses were not a hobby
or pastime; they were an integral part of their Arizona ranch. Horses were necessary to herd cattle,
and no stray could surpass Johnny and Flicka’s teamwork.
In high school, Johnny married his sweetheart, Juanita, and, after graduation, landed a job as
a cowboy on a large cattle ranch. Johnny and Juanita had three daughters and worked hard to save
money to purchase their own ranch. One responsibility of a cowboy is “breaking” wild horses into
obedience, and it was an Appaloosa stallion that cost Johnny his family.
Johnny was smart, and smart cowboys do not simply throw a bridle and saddle on a bronco,
step into the stirrups, and hang on to the saddle horn for dear life. Johnny had learned from Flicka
that the best way to break a horse is to be firm but gentle and gradually gain the horse’s trust. So, he
penned the Appaloosa stallion, fed him hay and grain, and offered him apples and sugar cubes as
treats. A few days later, he calmly approached the horse and slipped on the bridle. Later, the horse
allowed Johnny to put on a blanket and saddle and lead him around the small corral. The horse