Thursday, June 25, 2015

Can psychoanalysis survive neuroscience? In search of transference

The NYTimes has an interesting article about research attempting to reconstruct psychoanalytic ideas with neuroscientific support.

While working on his Ph.D., Gerber began a research project that tried to make sense of this mysterious process. He recruited psychoanalysts to fill out an extensive weekly questionnaire, documenting what was happening inside their offices, in as much detail as possible, including patient outcomes. Over the decade it took to complete this study, Gerber saw a pattern in the patients who progressed the most. They didn’t move in a linear way from worse to better, from neurotic to not neurotic, as Gerber had supposed at the outset. Rather, roughly in the middle of their treatment, they went through a period of intense flux, oscillating between extremes of behavior, before they began to improve. Gerber uses a term from chemistry to capture what he saw: ‘‘annealing,’’ the act of heating something so that all its molecules dance around wildly and then slowly cooling it back down so that it assumes a new and more stable state.

‘‘But it also left me with a question,’’ he said. ‘‘Where do you go with this next?’’ He decided to attend medical school and in 1997 enrolled at Harvard. Throughout the 2000s, after he graduated, a spate of brain-­imaging studies was published, demonstrating that a course of psychotherapy — even without medication — had measurable, physical consequences in the brain.
In Anderson’s joint project with Gerber and Peterson, the subjects lie in an M.R.I. machine while they are given descriptions of fictional characters. Unknown to the subjects, some characters are designed to evoke their particular significant other, in order to simulate a transference effect. Some of the descriptive language that the subjects supplied during the earlier interviews is used.

After the learning phase, the subjects are asked to remember the descriptions of all the fictional characters. The subjects tended to attribute traits to the significant-­other characters that they had not been told, but that they had earlier used to describe their own real-life significant other. […] So far, Gerber has identified areas of the brain — the left and right insula, the motor cortex and the right caudate — that react differently when subjects are learning about fictional significant-other characters instead of the other more neutral ones. With the proviso that it is still very early in the research, Gerber speculates that these brain regions, which are known to be integral to the brain’s "error circuitry," are galvanized by the effort to make sense of this partly intimate new character. She is so familiar — and yet, the brain notices, in some ways she is not. Gerber speculates that it may require more of an effort to engage with the idea of her than it does with the others.
Revising Freud in major ways?
Recently, neuroscientific research on the brain’s emotional and instinctual systems has fueled one of ­Solms’s boldest ideas: He believes that there is now enough evidence to revise Freud’s classic, foundational vision of the id — the term Freud used to designate our deeply buried, unconscious wishes, urges and feelings. In a stark departure from Freudian orthodoxy, Solms argues that what Freud said constituted the id — arousals, instincts and drives — are instead conscious states, readily accessible to observation.

Lois Oppenheim, a member of the New York Psychoanalytic Institute, who organized the April event, told me that ‘‘it was more persuasive than I had expected it to be.’’ She thought that Solms’s presentation had transmitted that ‘‘what gets changed in the mind changes the brain — and what gets changed in the brain changes the mind.’’ But she acknowledged: ‘‘Change is hard. It’s a big thing to ask of people, to make a major paradigm shift — not only in their clinical practices, but in their way of thinking about people generally.’’
Psychoanalysis needs neuroscience, and vice versa:
Kernberg’s remarks were in keeping with those of another man born in Vienna, one year after Kern­berg — the neuroscientist Eric Kandel. Though Kandel’s career has been devoted to the brain — he won a Nobel Prize in 2000 for his work showing how memories are stored — he has always been attached to psychoanalysis and speaks about the urgent need for it to move in a more biological direction. ‘‘I would like to see the analytic institutes devote three or four full-time people working on issues related to the biology of the unconscious, the nature of dreams, preconscious psychic phenomenon or child development,’’ Kandel told me recently. He believes that psychoanalysis is crucial to the effort to understand human nature. ‘‘What I see is that neuroscience by itself is not competent to solve these problems,’’ he said. ‘‘Psychoanalysis has a much broader vision,’’ he added, summarizing that vision as ‘‘a deep understanding of the human mind.’’

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