From clinical case reports to empirical and theoretical approaches in neuropsychoanalysis

Abstract

Research in neuropsychoanalysis has been supported by different methods that are crucial to stimulate rich discussions. From quantitative to qualitative studies, topics of interest are investigated from different perspectives. In addition, theory is enriched by empirical findings, and vice versa. In this issue of the journal, we have a number of important contributions using different approaches to further develop neuropsychoanalytic ideas. It is our pleasure to present Otto Kernberg’s response to commentaries on his important and elegant Target Article, which appeared in the previous issue of the Journal, entitled “Some Implications of New Developments in Neurobiology for Psychoanalytic Object Relations Theory” (Kernberg, 2022). Dr. Kernberg has, in recent years, been developing an increased interest in neuropsychoanalysis; in the Article, we see an advanced sophistication and creative contribution to that discipline emerging from his own development of object relations theory. In recent writing, he describes the numerous connections between the two models, which now can be seen as enriching each other. The Target Article was followed by thirteen very interesting commentaries by leading minds in our field, producing a rich and complex view of his recently developed model. Time and space considerations made it useful to present his response to the commentaries in this issue of the Journal. Dr. Kernberg is clearly appreciative of the wide theoretical range in the commentaries, and he gives real thought to responding to both the agreement and the questions raised by the commentators. We learn a great deal from this dialogue. In our Original Articles section, we have two rich papers which emerge from qualitative and quantitative approaches, respectively. First, Lawrence Fischman has provided us with an exciting, informative and educational article in an emerging area of neuropsychoanalytical clinical interest. The phenomenon of psychedelic insight is explored through the experience of a young man affected with alcoholism who had a dramatic and unexpected change in perception after a psychedelic experience. One significant consequence of the young man’s experience was the new capacity to see himself objectively from a third party perspective. This aspect of the young man’s experience, and other psychedelic phenomena, are discussed in the paper through the lens of four models: Mark Solms’ model of the conscious id; Karl Friston’s free energy model; Daniel Stern’s model of the infant’s interpersonal world; and Peter Fonagy’s concept of epistemic trust. In this fascinating article, Fischman elaborates on earlier propositions that high doses of psychedelic drugs may bring about “a dissolution of the ego” similar to those seen in dream states and in the psychoses. An interesting parallel is drawn between these psychedelic induced states and primary process cognition. The article concludes that the psychedelically assisted therapist, attuned to these primary process states and using careful interpretations, can facilitate their patients to see themselves more clearly. Second, Christian Montag and colleagues offer a rich empirical paper entitled “Investigating Primary Emotional Systems and the Big Five of Personality Including Their Relations in Patients With Major Depression and Healthy Control Persons,” which investigated depression in the context of Pankseppian affective neuroscience theory and the five-factor model of personality. The study utilized questionnaire data to compare personality factors across these two personality models with depression, by matching healthy controls with 184 patients with depression. Readers are sure to find a number of intriguing correlations in this paper, which demonstrates a suggestive concordance between this widely accepted personality construct in cognitive psychology, on the one hand, and the more recently developed Affective Neuroscience Personality Scales. Montag and colleagues reported that the differences found in SEEKING, FEAR and SADNESS between depressed and healthy controls were congruent with the models proposed in both the cognitive psychology and the neuropsychoanalytic literature, and furthermore suggest that Panksepp’s FEAR and SADNESS are the “bottom-up” drivers of the personality trait of neuroticism as outlined in the five-factor model. After looking for many years at theoretical issues and studying them extensively, neuropsychoanalysis has been addressing in the last few years the implementation of the neuropsychoanalytic corpus of knowledge into the clinical domains in general and the domains of