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Wilner, A. Aubé, M. (2014). A convergent neurological and psychoanalytic view of the concept of regression and mental structure in a case of NMDA receptor encephalitis. Neuropsychoanalysis, 16(2):97-113.

(2014). Neuropsychoanalysis, 16(2):97-113

A convergent neurological and psychoanalytic view of the concept of regression and mental structure in a case of NMDA receptor encephalitis

Asher Wilner and Michel Aubé

This is a review of a case of N-methyl-D-aspartate (NMDA) receptor encephalitis looked at from the vantage point of clinical psychoanalysis and clinical neurology. We will describe the events of our patient's illness and attempt to articulate our ongoing clinical thought process, both psychoanalytic and neurological. We will show that our patient demonstrated a massive regression in mental functioning, whose features were consistent with Freud's views on the nature of regression. With neurological treatment our patient made a full recovery in her mental functioning. We will argue that this regression in mental functioning was the result of a six-month-long absence of functional NMDA receptors in her brain. However, in trying to understand what happened to this patient's mental functioning using Freud's structural theory, we came across some insoluble contradictions in accounting for the dynamic interactions of the id, ego, and superego when these entities were viewed as distinct systems, agencies, or structures of the mind. We will argue that this constitutes clinical and neurobiological evidence for the need to modify some aspects of Freud's structural theory. We will propose that reuniting neurological and psychoanalytic thinking can provide psychoanalysts with a conceptual framework necessary to critically evaluate psychoanalytic metapsychology.

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