Agnosia: Liepmann's contribution
Lissauer consistently spoke of "mindblindness" ("Seelenblindheit") and never used the
term agnosia. Freud's considerations started from a discussion of Finkelnburg's term
"asymbolia". Freud argued that this should be restricted to a disturbance of the
connection between the concept of an object ("Objektvorstellung") and its name, whereas
the connection between the object itself and its concept (which is necessary for
recognition) is not "symbolic". He wrote: "I would suggest to call disturbances of
recognition of objects, which Finkelnburg combined to asymbolia, agnosia". Freud
assumed that "all incitements of spontaneous speech come from the domain of object-associations".
Consequently agnosia would lead to a language disturbance which he proposed to call
"agnostic aphasia". Interestingly, among the his examples of agnostic aphasia are a case
of complete cortical blindness, as well as the first case of Freund's (1889) paper:
"On optic aphasia and mindblindness", but not Lissauer's case..
In his paper "On agnosic disturbances" (1908) Hugo Liepmann made a distinction between
disturbances of recognition and disturbances of perception. He then referred to
Wernicke and Meynert who "terminologically unfortunate" ("terminologisch unglücklich")
had designated all disorders of recognition as "asymbolia". Liepmann argued that
asymbolia , i. e. non-recognition of signs and symbols, is only one of several domains
of agnostic disturbances. He wrote: "I therefore have strived for introducing the term
"agnosia", proposed by Freud, for disorders of recognition in a broader sense than
Freud wants". (p 611). Later in the same paper he mentioned Lissauer when discussing the
possibility of agnosic disorders in spite of preserved memory images. "Several authors,
as Friedrich v. Müller, Flechsig, Pick and v. Monakow have emphasized that in spite
of preservation of these memory images there can be agnosia. Lissauer's concept of
apperceptive mindblindness has also prepared for this assumption." (p 665).
Liepmann's paper is very complicated to read. It seems to me, however that his conception
of agnosia is closer to the modern meaning of the term than Freud's, because he referred
to disorders of visual recognition distinct from blindness, whereas Freund included blindness.
More on Liepmann: Goldenberg, G. (2003). Apraxia and beyond - life and works of Hugo Karl
Liepmann. Cortex, 39, 509-525.
Prof. Dr. Georg Goldenberg
Neuropsychological Department, KMB
Englschalkingerstrasse 77
D 81925 Muenchen, Germany
Phone: +49 89 9270 2106
FAX: +49 89 9270 2089