Sigmund Freud: The doctor is back in
On the 150th anniversary of Freud's birth, science is proving he was right

by
NORMAN DOIDGE
MACLEANS | May 05, 2006

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.

To comment, email letters@...

http://www.macleans.ca/topstories/history/article.jsp?content=20060508_126391_12\
6391


[Non-text portions of this message have been removed]