Leiden, 15-7-2023
: hoe een Belgische psychiater de kloof overbrugt in de moderne psychiatrie
De psychiatrie staat voor een fundamentele uitdaging. Waar we vroeger tevreden waren met het beschrijven en classificeren van psychische stoornissen, willen we nu ook graag begrijpen waarom ze ontstaan. De DSM, het dikke handboek met alle diagnoses, is handig voor onderzoek en communicatie, maar vertelt ons weinig over de onderliggende oorzaken van menselijk lijden. Gelukkig zijn er nieuwe denkrichtingen die dieper graven: de computationele psychiatrie, de belichaamde cognitie en relationele benaderingen.
In deze zoektocht naar een verklarende psychiatrie is er een opvallende, maar onderbelichte figuur: de Belgische neuropsychiater Jean Lerminiaux. Zijn werk, dat vooral in Franstalige kringen bekend is, blijkt een onmisbare schakel te vormen tussen abstracte wetenschappelijke theorieën en de dagelijkse klinische praktijk. Deze blog betoogt dat Lerminiaux een onafhankelijke waarnemer is die vanuit zijn klinische ervaring dezelfde fundamentele processen beschrijft die moderne theorieën wiskundig proberen te vatten. Door zijn inzichten te verbinden met die van anderen, ontstaat een krachtig nieuw beeld van psychopathologie.
Het lichaam als basis: het concept van ‘Ressenti’
Het meest kenmerkende aspect van Lerminiauxs denken is zijn nadruk op wat hij ‘ressenti’ noemt. Dit is geen synoniem voor emotie. Emotie is een abstract psychologisch concept, maar ressenti verwijst naar de direct ervaren, lichamelijke en affectieve organisatie van een persoon. Het is het gevoel van je levende lichaam dat in wisselwerking is met de wereld.
Dit onderscheid is cruciaal. Lerminiaux stelt dat psychotherapie niet primair overtuigingen verandert, maar de belichaamde ervaring. Inzicht en cognitieve herstructurering volgen pas nadat er een verandering in de lichamelijke organisatie heeft plaatsgevonden. Het lichaam is niet slechts een expressiemiddel van mentale toestanden; het lichaam is de basis waaruit mentale organisatie ontstaat. In de taal van de computationele psychiatrie kunnen we ressenti begrijpen als de subjectieve ervaring van het lichaam dat voortdurend zijn toestand voorspelt en zich probeert aan te passen aan de omgeving.
Dialoog zonder woorden: Tonico-Emotioneel Dialoog
Lerminiauxs therapeutische methode, de Dialogue Tonico-Émotionnel (Tonico-Emotionele Dialoog), is hierop gebouwd. De naam is veelzeggend: Tonique verwijst naar de spierspanning, Émotionnel naar affectieve resonantie. Het is een dialoog die niet verbaal is, maar een wederzijdse, regulerende interactie tussen twee organismen.
In deze visie zijn factoren als spierspanning, houding, beweging en ademhaling de echte therapeutische variabelen. De therapeut is geen uitlegger of duider, maar een deelnemer in een gekoppeld regulatiesysteem. Dit sluit naadloos aan bij recente ontwikkelingen in de interpersoonlijke neurobiologie, die wijzen op het belang van impliciete, non-verbale communicatie tussen therapeut en cliënt. Vanuit het perspectief van Active Inference (een theorie over hoe de hersenen voorspellingen genereren) is deze dialoog een vorm van interpersoonlijke, voorspellende afstemming. Therapeut en cliënt vormen een systeem dat voortdurend de toestand van de ander voorspelt en erop reageert, waardoor starre, onaangepaste voorspellingsmodellen weer flexibel kunnen worden.
Beweging als drijfveer van bewustzijn
Lerminiauxs ideeën krijgen nog meer diepgang wanneer we ze verbinden met de evolutie-neurowetenschap van Roger Cotterill. Cotterill stelt dat bewustzijn niet is ontstaan uit passieve waarneming, maar uit actie. Organismen moeten eerst de wereld verkennen door middel van zelf-gegenereerde bewegingen om vervolgens feedback te krijgen. Waarneming is dus een gevolg van actie. Bewustzijn ontstaat wanneer deze bewegingen intern gesimuleerd kunnen worden.
Dit perspectief verandert ons begrip van psychopathologie. Als bewustzijn bestaat uit een simulatie van mogelijke acties, dan zijn stoornissen verstoringen van deze belichaamde voorspelling. Een depressieve patiënt heeft een beperkt repertoire aan gesimuleerde acties, wat leidt tot anhedonie (onvermogen tot plezier) en verminderde motivatie. Een angstige patiënt wordt daarentegen gedomineerd door simulaties van dreiging. De ressenti van Lerminiaux kan dan worden gezien als de subjectieve ervaring van dit voorspellingsproces, en de therapeutische dialoog herstelt de flexibiliteit door nieuwe, veilige lichamelijke ervaringen mogelijk te maken.
Verbinding maken: naar een verklarende psychiatrie
De kracht van Lerminiauxs werk is dat het een rijke klinische fenomenologie biedt die deze abstracte ideeën vertaalt naar de praktijk. Waar theorieën als Active Inference van Karl Friston wiskundig beschrijven hoe een organisme voorspellingsfouten minimaliseert, en het Quaternion Relational Field Model een wiskundige beschrijving geeft van de therapeutische interactie, daar beschrijft Lerminiaux wat de clinici daadwerkelijk ervaren. Hij is niet het bewijs van deze theorieën, maar een onafhankelijke klinische waarnemer die dezelfde onderliggende dynamiek beschrijft.
Deze vier perspectieven – klinische fenomenologie (Lerminiaux), evolutionaire neurowetenschap (Cotterill), computationeel mechanisme (Friston) en wiskundige formalisering (Quaternion Model) – beschrijven hetzelfde adaptieve fenomeen op verschillende niveaus. Samen pleiten ze voor een verschuiving in het psychiatrisch denken. Symptomen zijn niet langer het primaire doelwit; psychopathologie wordt gezien als een verstoring van adaptieve, belichaamde regulatie. Therapeutisch succes wordt het herstel van flexibele, belichaamde interactie.
Jean Lerminiaux is meer dan een onbekende lichaamstherapeut. Zijn werk biedt de essentiële klinische taal om de brug te slaan tussen de abstracte wereld van de computationele psychiatrie en de levende, ademende werkelijkheid van de therapiekamer. Door zijn inzichten te integreren, kunnen we eindelijk de belofte waarmaken van een psychiatrie die niet langer slechts beschrijft, maar ook verklaart.
Integrating Dialogue Tonico-Émotionnel, Movement-Based Consciousness, Active Inference and Relational Field Theory
J. Konstapel Leiden, 14-7-2026
In deze blog wordt betoogd dat de Belgische neuropsychiater Jean Lerminiaux een onderschatte klinische schakel is in de computationele psychiatrie.
Zijn concepten van ‘ressenti’ (belichaamde ervaring) en ‘Dialogue Tonico-Émotionnel’ (een niet-verbale, regulerende therapeutische interactie) beschrijveonafhankelijk dezelfde processen die moderne theorieën zoals Active Inference en het Quaternion Relational Field Model wiskundig formaliseren.
Lerminiaux biedt zo een rijke klinische fenomenologie die deze abstracte modellen vertaalt naar de dagelijkse praktijk.
Samen pleiten deze perspectieven voor een verschuiving van een beschrijvende naar een verklarende psychiatrie, waarin stoornissen worden gezien als verstoringen van adaptieve, belichaamde regulatie.
Abstract
Psychiatry is changing. It no longer wants only to describe disorders. It wants to explain them. Several new approaches share this goal. Computational psychiatry sees disorders as failures of prediction. Embodied cognition sees mind as grounded in the body. Movement-based theories see action as the basis of consciousness. Relational approaches see regulation as shared between people.
Jean Lerminiaux is a Belgian neuropsychiatrist. He developed a therapy based on bodily experience and emotional interaction. He calls it Dialogue Tonico-Émotionnel. His work is little known outside French-speaking countries. Yet it provides a rich clinical picture of the processes these theories describe.
This paper argues that Lerminiaux is not confirming computational theories. He is an independent observer. He describes the same underlying processes from a clinical perspective. His work is examined together with Cotterill’s movement-based theory, Friston’s Active Inference, and the Quaternion Relational Field Model.
1. Introduction
Psychiatry has long relied on classification systems. The DSM improved diagnostic reliability. But it tells us little about what causes suffering. Several research traditions now move beyond classification.
Computational psychiatry describes disorders as failures of adaptive inference. Embodied cognition argues that thinking cannot be separated from bodily interaction. Movement-based theories hold that action drives cognition. Relational approaches emphasize co-regulation between people.
Jean Lerminiaux occupies an unusual position. He works outside mainstream computational neuroscience. Yet he developed a clinical framework based on bodily experience (ressenti), emotional regulation, and therapeutic interaction. His ambition is clear. The subtitle of his recent book states: From descriptive psychiatry toward explanatory psychiatry.
This places his work close to contemporary developments. His ideas developed independently. Yet they converge with modern theories in remarkable ways.
2. The Central Role of Ressenti
The most distinctive aspect of Lerminiaux’s theory is his emphasis on ressenti. This is not the same as emotion. Emotion is an abstract psychological concept. Ressenti refers to directly experienced bodily-affective organization. It is the felt sense of one’s living body engaging with the world.
Psychotherapy does not primarily change beliefs. It changes embodied experience. This distinction is fundamental. Traditional psychotherapy assumes cognitive insight precedes emotional change. Lerminiaux proposes the reverse. Changes in bodily organization precede lasting cognitive restructuring. The body is not merely expressing mental states. The body is the substrate from which mental organization emerges.
This aligns with several established traditions. Gendlin’s Felt Sense describes similar bodily knowing. Sensorimotor psychotherapy places the body at the centre of change. Embodied cognition research shows that abstract thought is grounded in sensorimotor experience.
Within a computational framework, ressenti can be understood as the subjective experience of bodily prediction. It is the felt dimension of the organism’s attempt to maintain balance and anticipate future states.
3. Dialogue Tonico-Émotionnel
Lerminiaux’s therapeutic method centres on what he calls Dialogue Tonico-Émotionnel. The term is significant. Tonique refers to muscular tone. Émotionnel refers to affective resonance. The dialogue is not primarily verbal. It is an interaction between two continuously regulating organisms.
Muscular tone, affective resonance, posture, movement, breathing, and emotional synchronisation become therapeutic variables. The therapist functions less as an interpreter. The therapist becomes a participant in a coupled regulatory system. Psychotherapy becomes regulation rather than explanation.
This conception resembles recent developments in interpersonal neurobiology. Schore describes right-brain-to-right-brain communication. Tronick describes how caregivers and infants co-create affective synchrony. Porges links autonomic regulation to social engagement.
From an Active Inference perspective, Dialogue Tonico-Émotionnel is interpersonal predictive calibration. The therapist and patient form a coupled system. Each continuously predicts and responds to the other’s state. Therapeutic change occurs when this system explores new states. Previously rigid predictive models become flexible again.
4. Cotterill and the Primacy of Movement
Cotterill proposed a radical inversion of classical neuroscience. Perception does not generate movement. Organisms first probe the environment through self-generated movement. They subsequently receive environmental feedback. Perception is generated by action.
Consciousness emerges when overt movement becomes covert simulation. The organism can internally model possible actions without executing them. Thinking becomes simulated movement.
This perspective transforms understanding of psychopathology. If consciousness consists of ongoing simulation of possible action, then disturbances of consciousness are disturbances of embodied prediction. A depressed patient has a restricted repertoire of simulated actions. This manifests as anhedonia and reduced motivation. An anxious patient has a simulated action repertoire dominated by threat.
Lerminiaux’s clinical observations appear compatible with this interpretation. His ressenti can be understood as the subjective experience of embodied predictive processes. Restricted ressenti in psychopathology corresponds to restricted action-simulation. Therapeutic dialogue restores flexibility. The patient experiences a wider range of bodily states and possible actions.
5. Active Inference
Friston’s Active Inference framework formalizes adaptive behaviour mathematically. Organisms continuously minimize expected free energy. They predict future sensory consequences of action. They adjust internal models when prediction errors occur. They modify behaviour accordingly.
Within this framework, psychopathology becomes failure of adaptive inference. The organism becomes trapped in maladaptive generative models. Depression reflects a model that over-predicts negative outcomes. Anxiety reflects a model that overestimates threat. Psychosis reflects breakdown in precision weighting of sensory evidence.
Lerminiaux never formulates his ideas mathematically. Yet his therapeutic process resembles this recalibration. Patients gradually become capable of experiencing bodily states that were previously inaccessible. Prediction had become rigid. Therapy restores flexibility.
The Dialogue Tonico-Émotionnel can be understood as scaffolded inference. The therapist provides a regulatory context. The patient can safely experience prediction errors. Bodily states violate expectations. The generative model updates accordingly. Therapeutic change occurs through embodied discovery, not intellectual correction.
6. The Quaternion Relational Field Model
The Quaternion Relational Field Model extends this trajectory. It introduces an explicit mathematical description of therapeutic interaction. Therapist and patient are not considered separately. Both become components of a coupled dynamical field.
Psychopathology corresponds to stable maladaptive attractors. These are regions of state space where the system repeatedly returns despite negative consequences. Therapeutic interaction alters coupling parameters. The shape of the field changes. Field coherence shifts. The patient moves toward a new attractor.
Unlike Lerminiaux, the Quaternion Model provides explicit state variables and differential equations. It offers experimentally testable predictions. Lerminiaux contributes something equally valuable. He describes the phenomenology these equations attempt to represent. He provides clinical language connecting mathematical formalisms to lived experience.
Quaternions are particularly significant. They naturally represent rotations and orientations in three-dimensional space. They describe bodily orientation, movement, and relational positioning. They also enable description of simultaneous changes across cognitive, affective, somatic, and relational dimensions.
7. Four Levels of Description
These four approaches describe the same adaptive phenomenon at different levels. They are not mutually exclusive. They complement each other.
| Level | Principal Contribution |
|---|---|
| Clinical phenomenology | Jean Lerminiaux |
| Evolutionary neuroscience | Roger Cotterill |
| Computational mechanism | Karl Friston (Active Inference) |
| Mathematical formalization | Quaternion Relational Field Model |
Lerminiaux explains what clinicians experience. Cotterill explains why evolution produced such mechanisms. Active Inference explains how they operate computationally. The Quaternion Model describes their dynamics mathematically.
8. Toward Explanatory Psychiatry
Together these approaches suggest a shift in psychiatric thinking. Symptoms cease to be primary. Psychopathology becomes disturbance of adaptive regulation. Therapeutic success becomes restoration of flexible embodied interaction. Diagnosis becomes secondary to understanding system dynamics.
This is exactly the transition Lerminiaux advocates. From descriptive psychiatry toward explanatory psychiatry. We must understand why disorders occur. This requires better models of the processes that generate suffering.
9. Discussion
The significance of Lerminiaux’s work does not depend on every mechanism he proposes being correct. Scientific theories evolve. Mechanisms are refined. Evidence accumulates.
What remains valuable is the clinical architecture he proposes. He places the body, the therapeutic relationship, and embodied regulation at the centre of psychopathology.
Remarkably, independent developments in neuroscience move in the same direction. Embodied cognition, interpersonal neurobiology, predictive processing, and relational models all converge. Lerminiaux may be an overlooked clinical precursor. His observations deserve renewed attention.
Several limitations should be acknowledged. Lerminiaux’s work is largely unknown outside French-speaking clinical circles. This limits accessibility and empirical evaluation. The concepts of ressenti and Dialogue Tonico-Émotionnel require clearer operationalization. The relationship between clinical observations and computational formalisms remains suggestive. Future work should translate his concepts into testable hypotheses.
10. Conclusion
Jean Lerminiaux should not be regarded simply as another body-oriented psychotherapist. He represents an attempt to reconstruct psychiatry around dynamic embodied regulation. His concept of Dialogue Tonico-Émotionnel offers clinical language for phenomena that computational psychiatry and Active Inference attempt to formalize.
The Quaternion Relational Field Model extends this trajectory further. It expresses these relational processes within a mathematical state-space framework. It provides formalization of the dynamics Lerminiaux describes clinically.
Together these perspectives suggest the future of psychiatry may not lie in increasingly detailed taxonomies of symptoms. It may lie in understanding how adaptive relational fields emerge, become destabilized, and can be restored through embodied interaction.
Such an integrative framework would fulfil precisely the ambition that motivated Lerminiaux’s work. The transition from descriptive psychiatry to explanatory psychiatry.
Annotated Reference List
Barsalou, L. W. (2008). Grounded cognition. Annual Review of Psychology, 59, 617-645.
Barsalou reviews evidence that cognitive processes are grounded in sensorimotor systems. This supports Lerminiaux’s emphasis on ressenti. It shows that abstract cognition emerges from bodily experience. The review covers behavioural, neuroimaging, and developmental studies.
Cotterill, R. (2001). Cooperation of the basal ganglia, cerebellum, sensory cerebrum and hippocampus. Progress in Neurobiology, 64(1), 1-33.
Cotterill presents his movement-based theory of consciousness. Consciousness emerged from the need to simulate movement before execution. This provides the evolutionary framework for understanding why embodied regulation is fundamental. It links motor processes to conscious experience.
Friston, K. (2010). The free-energy principle: A unified brain theory? Nature Reviews Neuroscience, 11(2), 127-138.
Friston introduces the free energy principle. All adaptive systems minimize free energy to maintain homeostasis. This provides the computational foundation for understanding Lerminiaux’s observations as adaptive regulation. Psychopathology represents failures of this principle.
Friston, K. (2013). Active inference and belief propagation. Nature Reviews Neuroscience, 14(4), 287-298.
This paper elaborates the Active Inference framework. Organisms use generative models to predict sensory consequences. They minimize prediction error. This provides computational language for describing therapeutic change as model revision.
Friston, K., Stephan, K. E., Montague, R., & Dolan, R. J. (2014). Computational psychiatry. The Lancet Psychiatry, 1(2), 148-158.
The authors introduce computational psychiatry. Mental disorders are failures of Bayesian inference. This establishes the context for integrating Lerminiaux’s observations with computational models. Symptoms are manifestations of maladaptive inference.
Gendlin, E. T. (1978). Focusing. New York: Everest House.
Gendlin introduces the Felt Sense. This is bodily knowing that precedes and guides explicit cognition. It directly parallels Lerminiaux’s concept of ressenti. Gendlin provides therapeutic methodology emphasizing bodily experience.
Huys, Q. J., Maia, T. V., & Frank, M. J. (2016). Computational psychiatry as a bridge. Nature Neuroscience, 19(3), 404-413.
This paper reviews computational psychiatry’s promise and challenges. It discusses how computational models can inform psychotherapeutic interventions. This connects to Lerminiaux’s clinical approach.
Konstapel, J. (2026). The Quaternion Relational Field Model. Journal of Integrative Mental Health, forthcoming.
This paper presents the Quaternion Relational Field Model. It provides mathematical formalization of relational dynamics. It describes how quaternion-valued state variables represent coupled therapeutic dynamics.
Lerminiaux, J. (2022). Psychiatrie explicative. Brussels: Éditions Mardaga.
Lerminiaux’s comprehensive work presents his theory of ressenti and Dialogue Tonico-Émotionnel. This book contains the clinical phenomenology examined in this paper. He argues for transition to explanatory psychiatry.
Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the Body. New York: W. W. Norton.
This book presents sensorimotor psychotherapy. It is a body-oriented approach to trauma treatment. It parallels Lerminiaux’s emphasis on bodily experience. It provides clinical support and case examples.
Porges, S. W. (2011). The Polyvagal Theory. New York: W. W. Norton.
Porges presents the Polyvagal Theory. It links autonomic nervous system regulation to social engagement and wellbeing. This provides neurobiological framework for understanding bodily state regulation in therapy.
Schore, A. N. (2012). The Science of the Art of Psychotherapy. New York: W. W. Norton.
Schore presents neurobiological basis of therapeutic change. He emphasizes right-brain-to-right-brain communication and implicit relational processes. This parallels Lerminiaux’s emphasis on non-verbal interaction.
Thompson, E. (2007). Mind in Life. Cambridge, MA: Harvard University Press.
Thompson presents an enactive approach to cognition. Mind is embodied, embedded, and dynamically constituted. This provides philosophical framework for Lerminiaux’s clinical approach.
Tronick, E. (2007). The Neurobehavioral and Social-Emotional Development of Infants and Children. New York: W. W. Norton.
Tronick presents the Mutual Regulation Model. Caregivers and infants co-create affective synchrony. This provides developmental framework for interpersonal regulation.
Varela, F. J., Thompson, E., & Rosch, E. (1991). The Embodied Mind. Cambridge, MA: MIT Press.
This foundational text argues cognition is grounded in bodily experience. It provides background for understanding Lerminiaux’s emphasis on ressenti. The enactive approach aligns closely with his clinical framework.
Wilson, M. (2002). Six views of embodied cognition. Psychonomic Bulletin & Review, 9(4), 625-636.
Wilson reviews six theoretical positions within embodied cognition. This helps situate Lerminiaux’s work within the broader literature. It shows how his emphasis on ressenti relates to other approaches.