Donette Steele, M.A. / Clinical Psychology

Freud Returns

FREUD RETURNS by Mark Solms

 

For the first half of the 1900s, the ideas of Sigmund Freud  dominated explanations of how the human mind works.  His basic proposition was that our motivations remain largely hidden in our unconscious minds.   Moreover, they are actively withheld from consciousness by a repressive force. The executive ap­paratus of the mind (the ego) rejects any unconscious drives (the id) that might prompt behavior that would be incom­patible with our civilized conception of ourselves. This repression is necessary be­cause the drives express themselves in un­constrained passions, childish fantasies, and sexual and aggressive urges.

 

Mental illness, Freud said until his death in 1939, results when repression fails. Phobias, panic attacks and obses­sions are caused by intrusions of the hid­den drives into voluntary behavior. The aim of psychotherapy, then, was to trace neurotic symptoms back to their uncon­scious roots and expose these roots to mature, rational judgment, thereby de­provided for his theories was rather tenuous. His principal method of investigation was not controlled experimentation but sim­ple observations of patients in clinical set­tings, interwoven with theoretical infer­ences. Drug treatments gained ground, and biological approaches to mental ill­ness gradually overshadowed psycho­analysis. Had Freud lived, he might even have welcomed this turn of events. A highly regarded neuroscientist in his day, he frequently made remarks such as “the deficiencies in our description would pre­sumably vanish if we were already in a position to replace the psychological terms by physiological and chemical ones.” But Freud did not have the science or tech­nology to know how the brain of a normal or neurotic personality was organized.

By the 1980s the notions of ego and id were considered hopelessly antiquated, even in some psychoanalytical circles. Freud was history. In the new psycholo­gy, the updated thinking went, depressed people do not feel so wretched because something has undermined their earliest attachments in infancy—rather their brain chemicals are unbalanced. Psycho-pharmacology, however, did not deliver an alternative grand theory of personali­ty, emotion and motivation—a new con-ception of “what makes us tick.” With-out this model, neuroscientists focused their work narrowly and left the big pic­ture alone.

 

Today that picture is coming back into focus, and the surprise is this: it is not unlike the one that Freud outlined a century ago. We are still far from a con­sensus, but an increasing number of di­verse neuroscientists are reaching the same conclusion drawn by Eric R. Kan­del of Columbia University, the 2000 Nobel laureate in physiology or medi­cine: that psychoanalysis is “still the most coherent and intellectually satisfying view of the mind.”

Freud is back, and not just in theory. Interdisciplinary work groups uniting the previously divided and often antagonis­tic fields of neuroscience and psycho­analysis have been formed in almost every major city of the world. These net­works, in turn, have come together as the International Neuro-Psychoanalysis So­ciety, which organizes an annual con­gress and publishes the successful journal Neuro -Psychoanalysis. Testament to the renewed respect for Freud’s ideas is the journal’s editorial advisory board, popu­lated by a who’s who of experts in con­temporary behavioral neuroscience, in­cluding Antonio R. Damasio, Kandel, Joseph E. LeDoux, Benjamin Libet, Jaak Panksepp, Vilayanur S. Ramachandran, Daniel L. Schacter and Wolf Singer.

 

Together these researchers are forg­ing what Kandel calls a “new intellectu­al framework for psychiatry.” Within this framework, it appears that Freud’s broad brushstroke organization of the mind is destined to play a role similar to the one Darwin’s theory of evolution served for molecular genetics—a tem­plate on which emerging details can be coherently arranged. At the same time, neuroscientists are uncovering proof for some of Freud’s theories and are teasing out the mechanisms behind the mental processes he described.

 

Unconscious Motivation

 

WHEN FREUD INTRODUCED the cen­tral notion that most mental processes that determine our everyday thoughts, feelings and volitions occur unconscious­ly, his contemporaries rejected it as im­possible. But today’s findings are con­firming the existence and pivotal role of unconscious mental processing. For ex­ample, the behavior of patients who are unable to consciously remember events that occurred after damage to certain memory-encoding structures of their brains is clearly influenced by the “for­gotten” events. Cognitive neuroscientists make sense of such cases by delineating different memory systems that process in­formation “explicitly” (consciously) and “implicitly” (unconsciously). Freud split memory along just these lines.

 

Neuroscientists have also identified unconscious memory systems that medi­ate emotional learning. In 1996 at New York University, LeDoux demonstrated the existence under the conscious cortex of a neuronal pathway that connects per­ceptual information with the primitive brain structures responsible for generat­ing fear responses. Because this pathway bypasses the hippocampus—which gen­erates conscious memories—current events routinely trigger unconscious re­membrances of emotionally important past events, causing conscious feelings that seem irrational, such as “Men with beards make me uneasy.”

Neuroscience has shown that the ma­jor brain structures essential for forming conscious (explicit) memories are not functional during the first two years of life, providing an elegant explanation of what Freud called infantile amnesia. As Freud surmised, it is not that we forget our earliest memories; we simply cannot recall them to consciousness. But this in­ability does not preclude them from af­fecting adult feelings and behavior. One

would be hard-pressed to find a develop­mental neurobiologist who does not agree that early experiences, especially between mother and infant, influence the pattern of brain connections in ways that fundamentally shape our future person­ality and mental health. Yet none of these experiences can be consciously remem­bered. It is becoming increasingly clear that a good deal of our mental activity is unconsciously motivated.

 

Repression Vindicated

EVEN IF WE ARE MOSTLY driven by unconscious thoughts, this does not prove anything about Freud’s claim that we actively repress unpalatable informa­tion.  But case studies supporting that no­tion are beginning to accumulate. The most famous one comes from a 1994 study of “anosognosic” patients by be­havioral neurologist Ramachandran of the University of California at San Diego. Damage to the right parietal region of these people’s brains makes them un­aware of gross physical defects, such as paralysis of a limb. After artificially acti­vating the right hemisphere of one such patient, Ramachandran observed that she suddenly became aware that her left arm was paralyzed—and that it had been paralyzed continuously since she had suf­fered a stroke eight days before. This showed that she was capable of recognizing her deficits and that she had un­consciously registered these deficits for the previous eight days, despite her con­scious denials during that time that there was any problem.

Significantly, after the effects of the stimulation wore off, the woman not only reverted to the belief that her arm was normal, she also forgot the part of the in­terview in which she had acknowledged that the arm was paralyzed, even though she remembered every other detail about the interview. Ramachandran concluded:  “The remarkable theoretical implication of these observations is that memories can indeed be selectively repressed…..Seeing {this patient} convinced me, for the first time. Of the reality of the repression phenomena that form the cornerstone of classical psychoanalytical theory.”  

 

Like “split-brain” patients, whose hemispheres become unlinked—made fa­mous in studies by the late Nobel laure­ate Roger W. Sperry of the California In­stitute of Technology in the 1960s and 1970s—anosognosic patients typically rationalize away unwelcome facts, giving plausible but invented explanations of their unconsciously motivated actions. In this way, Ramachandran says, the left hemisphere manifestly employs Freudian “mechanisms of defense.”

 

Analogous phenomena have now been demonstrated in people with intact brains, too.  As neuropsychologist Martin A. Conway of Durham University in En­gland pointed out in a 2001 commentary in Nature, if significant repression effects can be generated in average people in an innocuous laboratory setting, then far greater effects are likely in real-life trau­matic situations.

 

 

The Pleasure Principle

FREUD WENT EVEN further, though. He said that not only is much of our men­tal life unconscious and withheld but that the repressed part of the unconscious mind operates according to a different principle than the “reality principle” that governs the conscious ego. This type of unconscious thinking is “wishful”—and it blithely disregards the rules of logic and the arrow of time.

 

If Freud was right, then damage to the inhibitory structures of the brain (the seat of the “repressing” ego) should release wishful, irrational modes of mental func­tioning. This is precisely what has been observed in patients with damage to the frontal limbic region, which controls crit­ical aspects of self-awareness. Subjects display a striking syndrome known as Korsakoff’s psychosis: they are unaware that they are amnesic and therefore fill the gaps in their memory with fabricated sto­ries known as confabulations. Durham neuropsychologist Aikaterini Fotopoulou recently studied a patient of this type in my laboratory. The man failed to recall, in each 50-minute session held in my office on 12 consecutive days, that he had ever met me before or that he had undergone an operation to remove a tu­mor in his frontal lobes that caused his amnesia. As far as he was concerned, there was nothing wrong with him. When asked about the scar on his head, he con­fabulated wholly implausible explana­tion, that he had undergone dental surgery or a coronary bypass operation. In reality, he had indeed experienced these proce­dures—years before—and unlike his brain operation, they had successful outcomes.

Similarly, when asked who I was and what he was doing in my lab, he vari­ously said that I was a colleague, a drink­ing partner, a client consulting him about his area of professional expertise, a team­mate in a sport that he had not partici­pated in since he was in college decades earlier, or a mechanic repairing one of his numerous sports cars (which he did not possess). His behavior was consistent with these false beliefs, too: he would look around the room for his beer or out the window for his car.

 

What strikes the casual observer is the wishful quality of these false notions, an impression that Fotopoulou con­firmed objectively through quantitative analysis of a consecutive series of 155 of his confabulations. The patient’s false be­liefs were not random noise—they were generated by the “pleasure principle” that Freud maintained was central to un­conscious thought. The man simply re­cast reality as he wanted it to be. Similar observations have been reported by oth­ers, such as Martin Conway of Durham and Oliver Turnbull of the University of Wales. These investigators are cognitive neuroscientists, not psychoanalysts, yet they interpret their findings in Freudian

terms, claiming in essence that damage to the frontal limbic region that produces confabulations impairs cognitive control mechanisms that underpin normal reali­ty monitoring and releases from inhibi­tion the implicit wishful influences on perception, memory and judgment.

 

Animal Within

FREUD ARGUED THAT the pleasure principle gave expression to primitive, animal drives. To his Victorian contem­poraries, the implication that human be­havior was at bottom governed by urges that served no higher purpose than car­nal self-fulfillment was downright scan­dalous. The moral outrage waned during subsequent decades, but Freud’s concept of man-as-animal was pretty much side­lined by cognitive scientists.

 

Now it has returned. Neuroscientists such as Donald W. Pfaff of the Rocke­feller University and Jaak Panksepp of Bowling Green State University believe that the instinctual mechanisms that gov­ern human motivation are even more primitive than Freud imagined. We share basic emotional-control systems with our primate relatives and with all mam­mals. At the deep level of mental organi­zation that Freud called the id, the func­tional anatomy and chemistry of our brains is not much different from that of our favorite barnyard animals and house­hold pets.

 

Modern neuroscientists do not ac­cept Freud’s classification of human in­stinctual life as a simple dichotomy be­tween sexuality and aggression, howev­er. Instead, through studies of lesions and the effects of drugs and artificial stimulation on the brain, they have iden­tified at least four basic mammalian in­stinctual circuits, some of which overlap. They are the “seeking” or “reward” sys­tem (which motivates the pursuit of plea­sure); the “anger-rage” system (which governs angry aggression but not preda­tory aggression); the “fear-anxiety” sys­tem; and the “panic” system (which in­cludes complex instincts such as those that govern social bonding). Whether other instinctual forces exist, such as a rough-and-tumble “play” system, is also being investigated. All of these brain systems are are modulated by specific neuro­transmitters, chemicals that carry mes­sages between the brain’s neurons.

The seeking system, regulated by the neurotransmitter dopamine, bears a re­markable resemblance to the Freudian “libido.” According to Freud, the libid­inal or sexual drive is a pleasure-seeking system that energizes most of our goal-directed interactions with the world. Modern research shows that its neural equivalent is heavily implicated in almost all forms of craving and addiction. It is in­teresting to note that Freud’s early exper­iments with cocaine—mainly on him­self—convinced him that the libido must have a specific neurochemical foundation. Unlike his successors, Freud saw no rea­son for antagonism between psycho­analysis and psychopharmacology. He enthusiastically anticipated the day when “id energies” would be controlled direct­ly by “particular chemical substances.” Today treatments that integrate psy­chotherapy with psychoactive medica­tions are widely recognized as the best ap­proach for many disorders. And brain imaging shows that talk therapy affects the brain in similar ways to such drugs.

 

Dreams Have Meaning

FREUD’S IDEAS ARE also reawaken­ing in sleep and dream science. His dream theory—that nighttime visions are partial glimpses of unconscious wishes—was discredited when rapid-eye-movement (REM) sleep and its strong correlation with dreaming were discovered in the 1950s. Freud’s view appeared to lose all credibility when investigators in the 1 970s showed that the dream cycle was regulated by the pervasive brain chemical acetylcholine, produced in a “mind­less” part of the brain stem. REM sleep occurred automatically, every 90 minutes or so, and was driven by brain chemicals and structures that had nothing to do with emotion or motivation. This dis­covery implied that dreams had no mean­ing; they were simply stories concocted by the higher brain to try to reflect the random cortical activity caused by REM.

 

But more recent work has revealed that dreaming and REM sleep are disso­ciable states, controlled by distinct, though interactive, mechanisms. Dream­ing turns out to be generated by a net­work of structures centered on the fore­brain’s instinctual-motivational circuit­ry. This discovery has given rise to a host of theories about the dreaming brain, many strongly reminiscent of Freud’s. Most intriguing is the observation that others and I have made that dreaming stops completely when certain fibers deep in the frontal lobe have been sev­ered—a symptom that coincides with a general reduction in motivated behav­ior. The lesion is exactly the same as the damage that was deliberately produced in prefrontal leukotomy, an outmoded surgical procedure that was once used to control hallucinations and delusions. This operation was replaced in the 1960s by drugs that dampen dopamine’s activity in the same brain systems. The seeking system, then, might be the pri­mary generator of dreams. This possi­bility has become a major focus of cur­rent research.

 

If the hypothesis is confirmed, then the wish-fulfillment theory of dreams could once again set the agenda for sleep research. But even if other interpretations of the new neurological data prevail, all of them demonstrate that “psychologi­cal” conceptualizations of dreaming are scientifically respectable again. Few neu­roscientists still claim—as they once did with impunity—that dream content has no primary emotional mechanism.

 

Finishing the Job

NOT EVERY ONE IS enthusiastic about the reappearance of Freudian concepts in the mainstream of mental science. It is not easy for the older generation of psycho-analysts, for example, to accept that their junior colleagues and students now can and must subject conventional wisdom to an entirely new level of biological scruti­ny. But an encouraging number of elders on both sides of the Atlantic are at least committed to keeping an open mind, as evidenced by the aforementioned eminent psychoanalysts on the advisory board of Neuro-Psychoanalysis and by the many graying participants in the International Neuro-Psychoanalysis Society.

 

For older neuroscientists, resistance to the return of psychoanalytical ideas comes from the specter of the seemingly indestructible edifice of Freudian theory in the early years of their careers. They cannot acknowledge even partial confir­mation of Freud’s fundamental insights; they demand a complete purge. In the words of J. Al­lan Hobson, a renowned sleep researcher and Harvard Medical School psychia­trist, the renewed interest in Freud is lit­tle more than unhelpful “retrofitting” of modern data into an antiquated theoret­ical framework. But as Panksepp said in a 2002 interview with Newsweek maga­zine, for neuroscientists who are enthusi­astic about the reconciliation of neurolo­gy and psychiatry, “it is not a matter of proving Freud right or wrong, but of fin­ishing the job.”

 

If that job can be finished—if Kan­del’s “new intellectual framework for psychiatry” can be established—then the time will pass when people with emo­tional difficulties have to choose between the talk therapy of psychoanalysis, which may be out of touch with modern evi­dence-based medicine, and the drugs pre­scribed by psychopharmacology, which may lack regard for the relation between the brain chemistries it manipulates and the complex real-life trajectories that cul­minate in emotional distress. The psychi­atry of tomorrow promises to provide patients with help that is grounded in a deeply integrated understanding of how the human mind operates.

Whatever undreamed-of therapies the future might bring, patients can only benefit from better knowledge of how the brain really works. As modern neurosci­entists tackle once more the profound questions of human psychology that so preoccupied Freud, it is gratifying to find that we can build on the foundations he laid, instead of having to start all over again. Even as we identify the weak points in Freud’s far-reaching theories, and thereby correct, revise and supple­ment his work, we are excited to have the privilege of finishing the job.