"Psychosis revealed through the connectome:
A neuropsychoanalytic perspective"
with Tiziano Colibazzi, M.D.

Discussant: Maggie Zellner, Ph.D.

The field of functional brain connectivity is one of the most dynamic areas of neuroscientific research because it provides the tools to study both small-scale and large-scale networks in the living brain. Arguably, complex brain functions such as those of interest to psychoanalysts are functions supported by such networks, rather than by single brain regions. The aims of this presentation are: 1) to provide an overview of methods for the study of functional connectivity and the connectome; 2) to illustrate the application of such methods to a sample of individuals at clinical high-risk for psychosis; 3) to discuss these findings in the context of the psychoanalytic understanding of psychosis; 4) to discuss how such large scale networks can be understood in terms of the agencies described in Freud’s structural topography.

An overview of methods for the study of functional connectivity and the connectome will be provided and illustrated with results from a large data set of adults at clinical high risk for psychosis. Functional connectivity analyses allowed us to identify functional networks involving the posterior heteromodal cortices, whose disrupted connectivity could underlie the development of psychotic symptoms. The risk of developing psychotic symptoms thus may be related to an increased connectivity between subcortical structures and cortices that are devoted to high-order processing of sensory stimuli.

We speculate that psychosis results from sensory processing “ escaping” prefrontal control and “flooding thinking,” lending thoughts the immediacy of sensory qualities. We submit that such a mechanism is consistent with an understanding of psychosis in terms of an eruption into consciousness of thing presentations and primary process thinking.