Relational and affective neuroscience: a quiet revolution in psychiatric and psychotherapeutic practice

Like a rolling stone: Psychotherapy without (episodic) memory

People with profound amnesia still retain the capacity to learn about the emotional value of experiences, which is crucial in developing and sustaining interpersonal relationships. In a 2017 paper, we demonstrated for the first time (with patient JL) that transferential feelings develop across the therapeutic process, despite profound episodic memory impairment after medial temporal lesions. This paper reports a second case (GA) of a profoundly amnesic patient in psychotherapy, this time after lesions to the anterior fornix. The work with GA opens issues such as the differences and similarities to the previous case, counter-transference phenomena, and the effects of hyperphagia. The findings make it clear that many phenomena are common to both GA and JL, such as forgetfulness, various types of repetition, the importance of the therapeutic alliance, and the ability to make therapeutic gain. However, there were differences between the cases, for example as regards confabulation, which may relate to either pre-morbid personality or lesion site. The paper also discusses the way in which patients of this type bear the very status of psychotherapeutic work with profoundly amnesic patients. Where others have seen barriers and in principle problems in working with such patients, we see many opportunities.

Beyond the death drive: Entropy and free energy

In this paper I offer an overview of the possible links between psychoanalytical metapsychology and contemporary work in neuroscience concerning entropy and the free energy principle. After briefly describing the theory of living systems put forward by the neuroscientist Karl Friston based on the notion of entropy, we sum up the use of the notion of free energy by Friston and Freud. I then analyze how these notions improve the intelligibility of psychic functioning and can be associated with several psychoanalytical concepts, in particular the death drive. I approach from the same perspective the regulation of free energy associated with psychic envelopes and early intersubjectivity. It thus appears that the psychic apparatus can be considered at its different levels, from the most primary to the most secondary, as having the essential function of reducing entropy and free energy. Various forms of "failure" of this process of linking, regulation and transformation of energy within the psychic apparatus could be considered as the origin of different psychopathological manifestations as suggested in the last part of this paper.