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[Speaker 1, invited] Richard Lane: Affective agnosia: a new link between Freud's work as a neurologist and psychoanalyst
One of Freud's great insights was the discovery of psychic reality—the concept that current experience is determined by mental representations of past experiences. This insight was foreshadowed in his early work as a neurologist when he coined the term “agnosia” to refer to a failure in recognition due to an inability to mentally represent and know an external object despite intact perception. Although affect has been central to psychoanalysis since Freud and Breuer founded the field in the mid-1890s, the role of mental representation of emotional responses has been relatively neglected and the concept of agnosia applied to emotional responses without mental representation has not been described previously. A continuum of implicit and explicit emotional processes and a cognitive-developmental model of emotional awareness anchored by affective agnosia at the impaired end will be presented, as will the neural basis of the ability to mentally represent one's own emotional states. The latter brain model highlights the importance of the dorsomedial prefrontal cortex in mentalization and how it dovetails with an emerging understanding of the neural basis of mind-brain-body interactions mediated by the medial visceromotor network, which connects the medial frontal lobe with the hypothalamus and other brainstem structures. The focus on deficits in the mental representation of emotion provides new opportunities for the treatment of patients who are “out of touch with their own emotions” by highlighting therapeutic construction (rather than uncovering) of affective experiences. Clinical applications to somatization (medically unexplained somatic symptoms) and borderline personality disorder will be discussed.
Richard D. Lane is Professor of Psychiatry, Psychology and Neurosc