Thinking Things Through: The Science of Mind

| April 30, 2010 | 0 Comments

by Assad Meymandi, MD, PhD, DLFAPA
Dr. Meymandi is in private practice as a psychiatrist and neurologist and serves as an adjunct professor of psychiatry at the University of North Carolina at Chapel Hill. He is a noted physician, editor, and philanthropist who frequently speaks and writes on diverse topics that relate to his interests in medicine, the arts, religion, and philanthropy. He lives in Raleigh with his wife Emily.

Psychiatry (Edgemont) 2010;7(4):40–44

In preparing for this essay, obviously I was drawn to the psychoanalytic literature of the late 19th and early 20th century. But the further I dug, the more it became obvious that psychoanalysis did NOT start with Sigmund Freud. Many of Freud’s teachers and predecessors had expounded on the theory of the unconscious. Plato, William Shakespeare, Immanuel Kant, Arthur Schopenhauer, and Friedrich Wilhelm Nietzsche have all dealt with and expounded on the possibility of the unconscious, the soul, and metaphysics. Yes, I was taken all the way back to Aristotle, a student of Plato at Plato’s academy who later became a rival of Plato when Aristotle became angry and established his own school, the Lyceum. Aristotle’s writings are very organized and detailed, making the readers feel like they are biting into stone. Aristotle had a lot to say about the psyche (soul), God, ether, and metaphysical phenomena.

Psychoanalysis is based on the concept that individuals are unaware of the many factors that cause their behavior and emotions. These unconscious factors have the potential to produce unhappiness, which, in turn, is expressed through a score of distinguishable symptoms, including disturbing personality traits, difficulty relating to others, or disturbances in self esteem or general disposition. Psychoanalysis thrived in the first 60 to 70 years of the 20th century, but experts now fear the threatened demise of the field. Will it continue to thrive or is it in fact a dying field? The answer lies with uniting psychoanalysis with biological sciences.

In a recent discussion with an academic colleague who was identifying the 20th century’s greatest achievement—the discovery of the atomic bomb—I suggested rather forcefully that the most significant contribution of the 20th century was the advancement of Father Gregor Mendel’s genetics through the discovery and understanding of ribonucleic acid (RNA) and deoxyribonucleic acid (DNA) by James Watson and Francis Crick in 1953. They were awarded the Nobel Prize for Medicine or Physiology in 1962. In 2003, we celebrated the discovery of DNA at the University of North Carolina and Research Triangle Park by having Dr. James Watson among us. The understanding of DNA, and the subsequent expansion of the knowledge and advancement of the human genome project, which was completed in 2003 by Dr. Craig Venter, Director, The Institute for Genomic Research, in my opinion, is the greatest achievement of the 20th century. In addition, Dr. Francis Collins, the current Director of the National Institute of Health, completed the genome project a couple of years later. Dr. Collins, a graduate of our own University of North Carolina School of Medicine, has discovered a number of important genes, including those responsible for cystic fibrosis, neurofibromatosis, Huntington’s disease, a familial endocrine cancer syndrome, and most recently, genes for type 2 diabetes and the gene that causes Hutchinson-Gilford progeria syndrome. The trajectory of these discoveries is exciting and right on target.

Now, facing the 21st century, with wars going on in every corner of the globe, humans killing humans for a few pieces of mud prized as land, the need for understanding human behavior makes psychoanalytic research more urgent. I believe we have the opportunity to develop further understanding of ourselves through the exciting a new science—the science of mind.

The science of the mind provides us with a powerful instrument for further development of the field transdisciplinary approach to understanding what it is to be human. If the 20th century was known for the discovery of DNA, genomics, and epigenetics, the 21st century will be known for the discovery and understanding of the science of mind. And the promise of establishing such a discipline rests with espousing psychoanalysis with biological sciences, neuroscience, and neurobiology. Of course, the concept of scientific understanding of the mind is not new.

Sigmund Freud in Beyond the Pleasure Principle, wrote that there is an increase in plasma adrenocorticotropic hormone (ACTH) and glucocorticoid in response to stress. Thus, differences in an infant’s interactions with the mother—differences that fall in the range of naturally occurring individual differences in maternal care—are crucial risk factors for an individual’s future response to stress. In the same book, he further elaborated, “The deficiencies in our description would probably vanish if we were already in a position to replace the psychological terms with physiological or chemical ones….We may expect [physiology and chemistry] to give the most surprising information and we cannot guess what answers it will return in a few dozen years of questions we have put to it. They may be of a kind that will blow away the whole of our artificial structure of hypothesis…” In Freud’s classic paper On Narcissism, he wrote, “We must recollect that all of our provisional ideas in psychology will presumably one day be based on an organic substructure.”

A little over 100 years ago, Freud was invited along with his colleague Carl Jung to Clark University in Worcester, Massachusetts, to give a series of lectures on psychology and pedagogy. He met many American academicians, including Adolph Myers of the Johns Hopkins University in Baltimore, Maryland, and Harvard neurologist J. J. Putnam. We know that Putnam became the first president of the American Psychoanalytic Association, suggesting strong organic and scientific propensity of early psychoanalytic endeavors. After the lectures, Freud and Jung spent four days at the Putnam camp in Adirondacks that guaranteed the wide spread of psychoanalysis in America. So, American psychoanalysis is deeply rooted in biological soil.

In 1966, when I was director of Cumberland County Mental Health Center, applying for a grant for the Head Start program, I used a study by Karolinska Institute, which was published in the Acta Physiologica Scandinavica and Lancet. This study demonstrated that fetus and fetal central nervous system (CNS) exposed to excess secretion of maternal catecholamine, especially the powerful metabolites, metanephrines, vanillyllmandelic acid, and 3-methoxy 5-hydroxyphenylglycol (MHPG), produce babies that are more irritable, scrawny, cranky, susceptible to attention deficit/hyperactivity disorder (ADHD), and prone to anxiety, phobia, and social maladjustment. President Kennedy, having had mental illness and mental retardation in his family, launched an extensive program of community-centered care for patients. President Johnson, who followed Kennedy, established the Head Start program, encouraging reaching at-risk children at the very young ages of one or two. Being armed with the knowledge out of Sweden, we wrote a grant request and sent it to the White House “Attention: The President of United States.” In the grant we stated that age one or two is too late. We proposed a program that we dubbed “Intrauterine Head Start Project.” The then President Johnson liked the idea. We were given a huge grant that ensured Cumberland County would be the first center in North Carolina to have a comprehensive community mental health program consisting of all five elements required. The result was a book, The First Two Hundred Days, published in 1967 with subsequent multiple prints.

There are many areas and precedence where psychology and biology have cooperated and converged. The neuroscientific interest in dreams that started in 1953 with the discovery of rapid eye movement (REM) sleep by Eugene Aserinsky and Nathaniel Klietman is a good example where psychophysiologic findings of dreams were taken and woven into the tapestry of biology. There are many exciting discoveries in the area of psychoendocrinology of dreams and memories coming out through many sources and laboratories both in the United States and abroad. In fact, an article by Mauro Mancia, the enormous sage of the Italian academia, neurobiologist, and psychoanalyst, was recently published in the American Journal of Psychiatry entitled, “The role of the interrelation between serotonin (5-HT), muramyl dipeptide, and interleukin1 (IL-1) in sleep regulation, memory, and brain.” This brings me to one of my most recent reads— Psychoanalysis and Neuroscience, edited by Dr. Mancia, which I reviewed in a previous installment of Meymandi at Large.

It was Paul D. McLean in the 1940s, while mapping specific components of the limbic system, who invoked the romantic notion that the limbic system is “the anatomy of emotions.” The limbic system consists of the thalamus hypothalamus, amygdala, hippocampus, mammallary bodies, cingulate gyrus, fornix, association cortex, and pituitary. Mclean, through stereotype technique, after delineating various nuclei of hypothalamus, introduced a microelectrode into the paraventricular nucleus of the hypothalamus, for example, and ran 70 millivolts of electricity through the area. The subject would arise with anger, dilated pupils, engorged neck veins and the sympathetic system would overtake. Then, McLean would stimulate the ventral nucleus of the hypothalamus, just a few millimeters caudally from the first site. By stimulating this region, the subject would relax, take a deep breath, smile, and demonstrate physiological manifestation of the parasympathetic discharge. The future possibilities of psychoanalysis working together with neurosciences and biology is dazzling.

On the cusp of the 21st century, we really need a modern Freud to orchestrate the disparate parts of the symphony of life, psychoanalysis, biological sciences, genomics, neurosciences, and neurobiology to produce the rich symphony of better understanding the mind and ultimately life.

Well, we do have a few contemporary Freuds. One is Eric Kandel, whose most recent book, The Science of the Mind, I also reviewed within the pages of this journal. Dr. Kandal, who is a Nobel Laureate psychiatrist and professor at Columbia University in New York, New York, insists that to save psychoanalysis and pump vigorous life into this elegant field, we need to fuse the two disciplines of psychoanalysis and biology. Otherwise, there is a widespread concern about the viability of psychoanalysis as a scientific discipline.

For example, Jonathan Lear and others have argued that psychoanalysis and psychoanalytic literature, from Freud to Heinz Hartmann to Erik Erickson to Donald Woods Winnicott, will be read as a modern philosophical or poetic text alongside Plato, Aristotle, Shakespeare, Kant, Schopenhauer, Nietzsche, and Marcel Proust (the literature I went through for preparation of this essay). On the other hand, if the field aspires—as I believe most psychoanalysts do aspire to be evolving, active contributors to an emerging science of the mind—then psychoanalysis will survive. There is no doubt that psychoanalysts could and did make many useful and original contributions to our understanding of the mind simply by listening to patients. We must acknowledge that, at this point in the modern study of mind, clinical observation of individual patients is as the late Kurt Robert Eissler (1908–1999) and Hartvig Dahl (1924–2007) said: “The psychoanalytic situation that is so susceptible to observer bias is not a sufficient basis for a science of mind. Psychoanalytic research is depleted from opportunities to add more knowledge.” Marshall Edelson in his book, Hypothesis and Evidence, offers persuasive argument for the holy marriage between psychoanalysis and biology. He says, “We must bring psychoanalysis and biology together.”

All these pioneer psychoanalysts follow the notions of Freud and recommend/dream (pun intended) about congruence between psychoanalysis and biology. Many argue passionately that psychoanalysis is falling behind. Biology carries the promise of reinvigorating the psychoanalytic exploration of mind. I should say at the outset that although we have the outlines of what could evolve into a meaningful biological foundation for psychoanalysis, we are very much at the beginning. We do not yet have an intellectually satisfactory biological understanding of any complex mental processes. In this century, biology is likely to make deep contributions to the understanding of mental processes by delineating the biological basis for the various unconscious mental processes, for psychic determinism, for the role of unconscious mental processes in psychopathology, and for the therapeutic effect of psychoanalysis. Biology is capable of enlightening these deep mysteries at their core and illuminating the murky landscape of what is not empirical and measurable. We have seen one point of convergence between biology and psychoanalysis—the relevance of procedural memory for a child’s early moral development, for aspects of transference, and for moments of meaning in psychoanalytic therapy. We have considered a second point of convergence in examining the relationship between the associative characteristic of classical conditioning and psychological determinacy. There is a third point of convergence—that between Pavlovian fear conditioning, a form of procedural memory mediated by the amygdala, signal anxiety, and posttraumatic stress syndromes in humans. Psychoanalysis and cognitive neuroscience would accomplish two goals for psychoanalysis, one conceptual and the other experimental. We must recollect that all of our provisional ideas in psychology will presumably one day be based on an organic substructure. The American psychologist, Harry Harlow (1905–1981), best known for his maternal-separation and social isolation experiments on rhesus monkeys, demonstrated the importance of care giving and companionship in social and cognitive development. He conducted most of his research at the University of Wisconsin, Madison, where humanistic psychologist Abraham Maslow worked for a time with him.

Hans Selye had pointed out as early as 1936 that humans and experimental animals respond to stressful experiences by activating their hypothalamic-pituitary-adrenal (HPA) axis. The end product of the HPA system is the release of glucocorticoid hormones by the adrenal gland. The deficiencies in our description would probably vanish if we were already in a position to replace the psychological terms with physiological or chemical ones. We do know the effect of phyenylethylamine in erotic arousal.

Psychoanalyst Sir Martin Roth, the first president of the Royal College of Psychiatrists, Emeritus Professor of Psychiatry in Cambridge, and the most eminent British psychiatrist of his generation, described pseudoneurotic schizophrenia in the 40s. In the mid 50s, Roth published a series of papers about research conducted in his biochemistry laboratories strongly suggesting that famous movie stars with supernumerary marriages (Marilyn Monroe, Elizabeth Taylor, and Za Za Gabor, to name a few) carry a high level of phenylethylamine (PEA) in their circulation. He suggested another new diagnosis, hysteroid dysphoria, to clinically describe these people’s hyper-erotocism.

I could literally write a book about the cordial and rich history of psychoanalysis and biology both in Europe and America. This is an elegant and exciting way to describe the biochemistry of axis II diagnoses that deal with personality and character. The prefrontal association cortex has two major functions: it integrates sensory information and it links it to planned movement. Because the prefrontal cortex mediates these two functions, it is thought to be one of the anatomical substrates of goal-directed action in long-term planning and judgment. Patients with damaged prefrontal association areas have difficulty in achieving realistic goals. As a result, they often achieve little in life, and their behavior suggests that their ability to plan and organize every day activities is diminished.

At this point, I am reminded of the work of Gerald Edelman, the 1973 Nobel Laureate for Medicine or Physiology, who advanced theories of consciousness, who stated that they are rooted in neurology, physiology, and biology. In fact, he insists that this is the only foundation for a successful theory of consciousness. In finding the answers, we may even get assistance from quantum physics, but not from philosophical speculation, or computer programming. Finally, in order to get psychoanalysis on the same page, Dr. Kandel writes “To examine this problem, the Carnegie Foundation commissioned Abraham Flexner to study medical education in the United States. The Flexner Report, which was completed in 1910, emphasized that medicine is a science-based profession and requires a structured education in both basic science and its application to clinical medicine. To promote a quality education, the Flexner Report recommended limiting the medical schools in this country to those that were integral to a university. As a consequence of this report, many inadequate schools were closed, and credentialed standards for the training and practice of medicine were established. To return to its former vigor and to contribute importantly to our future understanding of mind,
psychoanalysis needs to examine and restructure the intellectual context in which its scholarly work is done and develop a more critical way of training the psychoanalysts of the future. Thus, what psychoanalysis may need, if it is to survive as an intellectual force into the 21st century, is something akin to a Flexner Report for the psychoanalytic institutes. It is exciting to be alive today.

Category: Commentary, Meymandi at Large, Past Articles, Psychiatry

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