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Goldman, D.L. (2009). The Interplay of Psychoanalysis and Neuroscience in Sleep-Wake Transitional States. Canadian J. Psychoanal., 17(1):83-107.

(2009). Canadian Journal of Psychoanalysis, 17(1):83-107

The Interplay of Psychoanalysis and Neuroscience in Sleep-Wake Transitional States

David L. Goldman

The paper is an elaboration of a recent communication on the role of psychiatry in psychoanalytic treatment in which this author concluded, without further commentary, that one needs to consider the “dynamic interactions” between neuroscientific knowledge associated with psychiatry and the search for meaning in psychoanalysis rather than compartmentalizing the two disciplines. With reference to the works of Scott, Bion, and Lewin, the discussion to follow expands on this position by providing a thought-provoking framework for appreciating the compatibility of neuroscience and psychoanalysis in the transition between sleep and waking, beginning with the example of narcolepsy.

Narcolepsy, a biologically based sleep disorder of excessive sleepiness, marked by unpredictable shifts from wakefulness to sleep, often accompanied by dream-like, hypnagogic hallucinations, is a logical jumping-off point for understanding psychical phenomena, associated with everyday drowsiness. The frequent presence of “hypnagogic reverie,” on the edge of wakefulness and sleep, in individuals with excessive sleepiness, highlights the ubiquity of dream mentation outside of discrete REM sleep stages. These points prepare the groundwork for a psychoanalytic reflection on sleep-wake transitional states.

The influence of what Rado called the “pleasure-pain balance” in mental economy can be observed in three of these states, which will be explored with

the help of clinical vignettes: falling asleep, emergence from sleep, and sleeplike phenomena intruding on wakefulness. Part of this exploration involves updating two relevant terms Lewin employed in association with the sleep-wake process: the “dream screen” and the “blank dream.” The views of Scott, the psychoanalyst, and Hobson, the sleep medicine expert, on the links between sleep and waking will be compared and contrasted.

Dans une communication antérieure, l'auteur arrivait à la conclusion qu'il faut considérer les interactions dynamiques entre les connaissances neuroscientifiques en psychiatrie et la signification en psychanalyse sans compartimenter les deux disciplines. Dans le présent article, travaux de Scott, Bion et Lewin à l'appui, il élargit la discussion en examinant la compatibilité entre la neurobiologie et la psychanalyse relativement aux états intermédiaires entre le sommeil et l'éveil, au moyen de l'exemple de la narcolepsie.

La narcolepsie, un trouble biologique de somnolence excessive marqué par des accès imprévisibles de sommeil souvent accompagnés par des hallucinations hypnagogiques, est le point de départ de l'exploration de phénomènes psychiques associés à la somnolence plus banale, qui peuvent survenir dans le processus analytique. L'apparition de fréquentes rêveries hypnagogiques entre l'éveil et le sommeil chez des personnes aux prises avec une somnolence excessive, fait ressortir l'ubiquité des états oniriques et sert de coup d'envoi à une réflexion psychanalytique plus générale.

L'auteur note l'utilité des concepts déplaisir et de déplaisir dans trois de ces états, qui sont illustrés par des vignettes cliniques: l'endormissement, le réveil, et des qualités de sommeil dans l'état d'éveil. Il procède à la mise à pur de deux termes de Lewin qui s'appliquent à ces états: l'écran de rêve et le rêve en blanc. Enfin, l'auteur compare les apports de Scott et de Hobson du point de vue de l'axe sommeil-éveil.

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