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The International R.D. Laing Institute



Colloquia Topics Index [link]Politics of Diagnosis




Sigmund Freud: The doctor is back in1

by NORMAN DOIDGE

On the 150th anniversary of Freud's birth, science is proving he was right


It's Freud's 150th birthday on May 6 and I'm in Vienna, standing in the now empty consulting room in Freud's home office at Berggasse 19, where the psychoanalytic couch was, and where all those now famous patients -- the Wolf Man, the Rat Man, and Dora -- unburdened themselves. Here Freud learned, by listening to Dora, about our tendency to unconsciously transfer scenes and wishes from the past onto the present. In his bedroom down the hall, he dreamed his dreams and began to analyze them. A few steps away, in his library, he wrote The Interpretation of Dreams, the book that argued the scientists of his day were wrong: dreams were not merely the flotsam and jetsam of tired brains, but decodable visual images of unconscious wishes, feelings and conflicts that drive so much human behaviour.

This year is Sigmund Freud Year in Vienna, which is honouring Freud as its great intellectual. Austrian President Dr. Heinz Fischer is patron and will visit this place, now a museum, on May 6. But these rooms are mostly empty because Austria did little to save Freud, a Jew, when the Nazi Gestapo knocked on the door in 1938, arrested his daughter, Anna, and took her for interrogation. That was Freud's worst day. Ultimately, Freud, Anna and the immediate family were rescued by a French princess, Marie Bonaparte, Napoleon's descendant, who asked to be arrested along with Anna; Bonaparte whisked them, Freud's library and furniture, off to London, but neither Bonaparte, nor Freud's stature, could save his two sisters from being murdered in concentration camps. (Freud's brother, Alexander, escaped via Switzerland and died in Toronto in 1943.) Forced by the Gestapo to sign a statement saying he had not been ill-treated, the cancer-stricken 82-year-old ironist wrote, "I can most highly recommend the Gestapo to everyone."

Yet this year the mood is festive, and Freud's scientific stature is having a revival. When Freud died in 1939, poet W.H. Auden summed up his influence in his elegy: To us he is no more a person now / but a whole climate of opinion / under whom we conduct our different lives. Toward the end of the 20th century, Freud became the most cited intellectual in the Western world. But now that he was at the top of the intellectual heap, the Freud-bashing began. Time and other magazine covers declared "Freud is Dead." Some psychopharmacologists, behaviourists and feminists declared Freud passé, or wrong. Practitioners of briefer therapies, often lasting 10 sessions, asserted they could accomplish as much as analysts who saw patients four times a week for several years, while managed-care insurance companies, anxious to substitute cheaper drug treatments for therapy, asserted analysis didn't work -- though not on the basis of any scientific studies, which in fact showed it did. They often got away with it because "talk therapy" did not seem as exciting as the new neuroscience, and scientists weren't sure how to prove the brain had "unconscious" thoughts. Psychiatry became increasingly interested in the brain and behaviour, and inclined to leave out the mind and subjective experience.

So -- how are things looking today, scientifically speaking?

Psychoanalysis is having a very good day today. In 2005, a new study from the University of Göttingen, Germany, showed that 80 per cent of patients in analysis showed significant improvement: their symptoms decreased and they improved their interpersonal problems and general sense of well-being -- and continued to improve a year after their analyses ended. These patients did better than those in shorter-term treatments. This supplements a series of recent German studies that show patients in psychoanalysis and related therapies end up using less medication, have fewer visits to doctors, days off work, or days in hospital than others. Another study, by Rolf Sandell of Linköping University, Sweden, showed that patients in psychoanalysis -- compared to those who have less intensive therapy -- continue to make more gains, even three years after therapy, and to hold on to the gains they have made. Those who have had analysis are also far less likely to require more treatment later in life.

But the most exciting story is the way neuroscience, with its new generation of brain scans, is supporting Freud's assertion that the majority of our thinking, and much of our motivation, goes on beyond our conscious awareness, or is unconscious.

Freud was originally neither a psychiatrist nor psychologist, but a neuroscientist, who worked in a lab and who made important discoveries about the brain's nerve cells, or neurons. Freud argued, in the 1890s, that neurons connect between small junctions, now called synapses, and that when we learn, two neurons fire at the same time and they connect more closely. When he began seeing patients, he wrote a manuscript called "The Project." His goal was to unite the science of the brain with a science of the mind and meaning. But he eventually concluded that brain science was not yet up to the task. So he turned to understanding the mental triggers for, and meaning of, emotional and psychiatric symptoms. Psychoanalysis was born. Still, he made sure it was consistent with what was known about the brain. He soon discovered we are often not conscious of the triggers of our symptoms or emotional reactions.

Now, brain-scanning techniques can show us our brain while it does mental processing, and study of the mind and brain can be bridged. A new discipline called neuro-psychoanalysis is completing Freud's project, made up of many of the world's most impressive neuroscientists, such as Nobel Prize-winner Eric Kandel, Antonio Damasio, Jaak Panksepp, Oliver Sacks, Joseph LeDoux, V.S. Ramachandran, and like-minded psychoanalysts. They are drawn to Freud because they see him as having a far more adequate picture of mind and brain integration than those who see the brain as nothing more than a sophisticated chemistry set, into which you add medications to make it work better. Medication has a role, but it is not everything.

Kandel is one of the driving forces behind these developments. Kandel says he himself "benefited greatly" from being psychoanalyzed, and wanted to become a psychoanalyst. He reasoned that psychoanalysis and other therapies work by learning, and he set out to understand learning and memory in the brain. He won his Nobel Prize in 2000 for showing that when animals learn and remember, the actual structure between the nerves changes, and the synaptic connections strengthen -- as Freud imagined, sitting in Berggasse 19. Kandel's was one of the most compelling proofs that the brain is "plastic," and that thinking changes the brain structure. Indeed, a number of recent studies show that psychotherapy actually rewires the brain, and its changes are no less structural than those seen with medication.

Brain scans now show that thought processing goes on beyond awareness, and desires, emotions and emotional conflicts can actually be unconscious. This means we can, for example, have guilt without being aware of it, or anger or attraction toward others that we dare not face. A 2004 study by Kandel and his colleagues at Columbia University, New York, published in Neuron, demonstrated that when people are shown photos of frightened faces too fast for them to register consciously, the almond-shaped amygdyla, a part of the brain that processes anxiety and emotions, lights up on functional magnetic resonance imaging -- fMRI scans. The study also showed that the amygdyla uses one set of neurons when we "perceive" an emotional experience unconsciously, and another set when we perceive it consciously.

Scientists studying brainwaves -- the electrical fields given off when thousands of our neuron cells fire -- have learned to detect "recognition waves," forms of brain activity manifested when the brain recognizes something. Dr. Howard Shevrin at the University of Michigan has used these techniques to examine Freud's theories. After subjects received extensive psychological testing by clinicians to determine their core unconscious emotional conflicts -- e.g. hidden guilt, anxiety, or love and hate for someone -- words summarizing those conflicts were flashed at them in two ways. First they were flashed subliminally, too fast for the subjects to consciously register them. Next they were flashed "supraliminally," or just fast enough for them to register. When words connected to a patient's unconscious conflicts were flashed subliminally, their brains had a quick recognition wave. When they were flashed supraliminally, or consciously, the patients were very slow to recognize them. In other words, their brains recognized their conflicts unconsciously, but had inhibited conscious recognition of them. When words having nothing to do with their conflicts were flashed, the pattern was reversed -- i.e. we don't repress unconflicted ideas.

Freud's theory that dreams are "the royal road" to understanding unconscious thought has also received support from brain imaging. Allen Braun, a researcher at the National Institutes of Health in Washington, has used positron emission tomography (PET) scans to measure brain activity in dreaming subjects. He has shown that the region known as the limbic system, which processes emotion, sexual, survival and aggressive instincts, and interpersonal attachments, shows high activity in dreaming. But the prefrontal cortex, an area responsible for achieving goals, discipline, postponing gratification and controlling our impulses, shows lower activity.

With the emotional-instinctual processing areas of the brain turned on, and the part that controls our impulses relatively inhibited, it is no wonder wishes and impulses we normally restrain, or are unaware of, are more likely to be expressed in dreams.

Another Freudian idea that is being vindicated by brain scans is how formative early childhood experience is. Before Freud, it was assumed that since most adults couldn't recall very early childhood, all that occurred then -- good or bad -- was forgotten. Now, brain scans and other techniques show that when infants undergo great stress (such as extended separation) or depression, a part of the brain called the hippocampus, required for laying down verbal or "explicit" memories, shrinks and stops functioning normally. A study in the American Journal of Psychiatry in 2002 showed the hippocampus of depressed adults who suffered childhood trauma is 18 per cent smaller than that of depressed adults without childhood trauma. This contributes to sketchy memories of traumatic events. But that doesn't mean the events don't affect us. Another memory system, called the implicit memory system, which encodes our emotional patterns for relating, does register the trauma. So traumas can be encoded without us being able to remember them.

Freud divided the mind into the ego (the aspect of ourselves, part conscious, part unconscious, that regulates the rest of us, and is the seat of rational thought and our sense of who we are), and the id (which includes our repressed unconscious wishes). The goal of the analytic cure was "Where id was, there shall ego be," i.e. to learn to consciously reclaim and regulate those unconscious parts of ourselves that seemed like alien, driven urges. Scans show that the prefrontal lobes are the part of the brain that performs ego functions of regulation. (During post-traumatic states, when people have flashbacks and emotional control is lost, blood flow to the prefrontal lobes decreases.) A 2001 brain scan study from UCLA of depressed patients treated with interpersonal psychotherapy -- a treatment Kandel's Columbia colleague Myrna Weissman developed by taking some key features from psychoanalytic approaches -- showed that prefrontal brain activity normalizes with treatment. Kandel is now on the board of the Ellison Medical Foundation, which is looking into developing routine ways of using fMRI scans to evaluate psychotherapy outcomes, and his institution, Columbia University, just received the largest-ever grant to a single university faculty, $200 million, for a neuroscience research program called "Mind, Brain and Behavior," which Kandel will co-direct. This will help realize Freud's "project" of developing a picture of humanity in which mind and brain are not kept separate, but are seen as two sides of the same coin.

We all should be so dead.

Notes

1Laing, R.D. The Divided Self. Tavistock, 1960, p.19

2Burston, D. The Crucible of Experience: R.D. Laing and the Crisis of Psychoptherapy Harvard University Press: 2000, p. 135



"Sigmund Freud: The doctor is back in"
by
NORMAN DOIDGE

originally published in MACLEANS, May 05, 2006
©Macleans Media 2006



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