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The Quest for K: Bion and Contemporary Neurocognitive Models of Psychosis

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Abstract

Purpose of Review

There have been increasing efforts to enhance dialog between the neuroscientific and psychotherapeutic literature. This approach can deepen and enrich our understanding of psychiatric conditions, broadening the scope of possible interventions when addressing symptomatology. It also allows for greater appreciation of the richness of a patient’s subjective experience and of the imperative need to foster a working alliance, as the success of a treatment plan can hinge on such considerations.

Recent Findings

There are important and clinically relevant points of convergence that emerge when bridging extant psychoanalytic and neurobiological research. Psychoanalyst Wilfred Bion has written extensively on his work with individuals with psychotic disorders (including schizophrenia). His views on the nature of thinking as an interpersonal process underline the need to attune to patients’ internal reality and to the means of communication that are available to them. In schizophrenia, such inner experiences can be difficult for clinicians to process, manifesting as they do as delusional content, hallucinatory experiences, and speech disorganization. It is crucial in such situations to expand awareness of what the subjective reality is for patients and what they are attempting to convey by way of their symptoms.

Summary

This paper will bridge concepts from Bion’s work on thinking and on schizophrenia with current neurocognitive frameworks of psychotic disorders. The relevance for the clinical encounter will also be discussed, emphasizing the need to help patients feel less alienated and disempowered as they navigate the challenges of their condition.

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Data Availability

Not applicable, as no data sets were utilized for this manuscript.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA

    Christopher W. T. Miller & Stephanie S. Kulaga

  2. Sheppard Pratt Health System, Towson, MD, USA

    Stephanie S. Kulaga

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Contributions

CM wrote the introduction, reflections on psychoanalytic literature, first section of the clinical considerations, and conclusion. CM wrote the abstract and organized the references. CM compiled the table. SK wrote the section on neurocognitive models of psychosis and the second part of the clinical considerations. SK compiled the figure. SK provided annotations for select references. Both authors reviewed the manuscript.

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Correspondence to Christopher W. T. Miller.

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Miller, C.W.T., Kulaga, S.S. The Quest for K: Bion and Contemporary Neurocognitive Models of Psychosis. Curr Behav Neurosci Rep 10, 41–48 (2023). https://doi.org/10.1007/s40473-023-00258-3

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