The Therapist as Scientist

The year is 1876 and Sigmund Freud's scientific career is about to begin. The id, the ego, the superego? Nowhere to be found. When he travels to the University of Vienna's zoological station in Trieste, Italy, sometime around his 20th birthday, the young med student embarks on a far less esoteric task: hunting for the testicles of the eel. For millennia, the animal's mating habits had confounded scientists, including Aristotle. Could Freud solve the mystery? Not exactly. Four hundred dissected eels later, the organs remained elusive. But Freud did acquire enough material to write his first scientific paper. Title: "Observations on the Form and the Finer Structure of the Lobular Organs of the Eel, Organs Considered to be Testes."

Long before the Oedipus complex, Sigmund Freud was a hard-core scientist. Early on, it was eel gonads; later, he studied the cellular underpinnings of the human brain. There were limits, however, to Freud's scientific pursuits--brain scans hadn't been invented yet, DNA wouldn't be discovered until after his death and, eventually, Freud abandoned biology for psychology. But today, as neuroscientists unravel the molecular pathways that make us think and feel and dream, the seeds of Freud's ideas are finding their way into the lab. Researchers are tapping into the chemistry of the unconscious, exploring the theory of repression, even testing ways to block traumatic memories.

What they are finding does not necessarily prove Freud right or wrong--MRIs cannot begin to measure the subtleties of human emotion--and the work is still in its infancy. But after decades of polarization between neuroscience (the study of the brain) and psychoanalysis (exploration of the mind), the two fields are beginning to find common ground. Freud, says Dr. Jack Gorman, president of Harvard's McLean Hospital, would have approved: "I think he'd be right there with us in the lab."

It was in the lab that Freud's interest in science exploded. After the eel, he studied the nervous system of the lamprey and the crayfish, even devising his own novel staining method so he could see the details of living cells more clearly under the micro-scope. By the early 1880s he had moved on to the human brainstem. In elegant drawings, which will be exhibited by the New York Academy of Medicine in May, Freud sketched spinal neurons and fiber pathways in meticulous detail. Science became Freud's mistress. "Precious darling ... I am at the moment tempted by the desire to solve the riddle of the structure of the brain," he wrote in a letter to his fiancée, Martha Bernays, in May 1885. "I think brain anatomy is the only legitimate rival you have or will ever have."

But brain anatomy alone could not earn Freud the money he needed to marry and start a family. So "very begrudgingly," says Mark Solms, director of the International Neuro-Psychoanalysis Centre in London, Freud began to study live patients, too. He diagnosed cases of cerebral hemorrhage and spinal inflammation. He published volumes on cerebral palsy and aphasia, a loss of language due to brain injury. And, after studying with the neurologist Jean-Martin Charcot in Paris, he began treating adults with "hysteria," a catch-all diagnosis for symptoms which had no clear physical explanation, like hallucinations and temporary blindness. "This is when Freud began to realize that the study of the mind was important," says Dr. Regina Pally, a psychoanalyst at UC Los Angeles. "He discovered when he talked to patients that there were emotional conflicts going on that were being expressed in symptoms." Something bigger--the unconscious--Freud posited, must be at work.

At the time, brain science was relatively primitive and matters of the mind were largely the province of philosophers. Freud was not convinced. The brain, he believed, was "a dynamic interaction between parts," says Solms, "not a concrete switchboard." In 1895, in his "Project for a Scientific Psychology," Freud attempted to present a cohesive model of the brain and mind. In dozens of pages of notes, he explored the biological roots of mental abstractions, even describing the neurons responsible for consciousness, memory and perception. But the science of the day fell short and Freud abandoned the project. (It was published after his death.) Still, "he was very prescient about how mental processes could work," says Dr. Eric Kandel of Columbia University. "He developed the notion that the neuron is the element of the brain and that contacts between neurons can be modified by learning."

Today, neuroscientists have picked up where Freud left off. Brain scanners now allow researchers to observe the inner workings of the mind, from where dreams originate to how stress affects neurotransmitters. Kandel and colleagues at Columbia, for example, used functional MRI technology to track the brains of students as they were shown fleeting pictures of fearful faces. Participants said they never saw the images, but their brains revealed otherwise: the amygdala, the fear center, lit up. "It's one way to demonstrate that the unconscious really exists," says Gorman.

Does the brain repress unwanted memories? And can you test that in a lab? Critics say no. Michael Anderson, a psychologist at the University of Oregon, says yes. In a series of experiments in which he set out to find the neurological footprints of "motivated forgetting," Anderson trained people to memorize simple unrelated word pairs like "ordeal" and "roach." Then he hooked them up to an fMRI and asked them to repress their own memories by looking at the first word and not thinking about the second. The scans showed an intriguing circuitry at work: the hippocampus (responsible for retrieving memories) exhibited reduced activity, while the lateral prefrontal cortex (which helps to inhibit reflexive actions, like pulling your hand back from a hot plate) showed more. Active repression also made it harder to recall the memory later. It's a long way from suppressing a linguistic roach to burying a traumatic experience with a real one, but Anderson believes the same mental mechanism is at work: "I think Freud was onto something."

Other scientists are using brain imaging to uncover the neurological circuitry of the mind in conflict--the drive for pleasure and the simultaneous impulse toward inhibition. They're studying early-life trauma and its long-term effects. And they are even testing drugs in patients with posttraumatic stress disorder to see if they can intentionally quash bad memories.

None of this, however, answers the most pressing question: does psychoanalysis actually work? Analysts have been reluctant to put their very private practice to the test, and the challenges are indeed daunting. Chief among them: how can you assess "outcomes" when individual experiences are so variable? But "it's imperative that we do this," says Dr. Steven Roose of Columbia's Center for Psychoanalytic Training and Research, who is now launching a multisite trial of more than 300 patients. The study will use standardized scales to compare psychoanalysis to two other forms of therapy (cognitive behavioral and dynamic psychotherapy). "We have to demonstrate that our treatment is effective if we want to maintain our standing in the world of clinical medicine." It will be at least five years before the results are in. Make room on the couch, and wait.

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