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

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.