Sunday, December 20, 2015

Neuroscience and Psychoanalysis, a book review by Jennifer Senior in the NYT

Neuroscience and psychoanalysis are not on particularly good speaking terms at the moment. One is glamorous and cutting edge, attracting all the pretty research grants; the other is old and unfashionable, redolent of Oriental rugs and vanquished by Lexapro. One expresses itself in numbers; the other in words. One strives for predictability and order; the other embraces ambiguities, chaos, mess.

With “In the Mind Fields: Exploring the New Science of Neuropsychoanalysis,” Casey Schwartz hopes to bring the opposing perspectives of these two disciplines into alignment — “to bring some of the old ideas about the mind into the new landscape of the brain.”

It’s an ambitious objective. But common sense tells us that Ms. Schwartz is onto something. Why should these two fields be talking past each other when they’re really talking about the same thing? Ms. Schwartz had this simple epiphany the first time she met Mark Solms, the charismatic South African neuropsychologist who has spent his life trying to build a bridge between the two disciplines.
“There can only be one mind,” he said. “There can’t be a mind for neuroscience and a mind for psychoanalysis.”

The sole difference, Ms. Schwartz realized, is that one field looks at the brain from the inside out, while the other looks at it from the outside in.

There are a number of reasons Ms. Schwartz is well suited to write this book. One is that she’s refreshingly immune to neuroscience’s charms. Dispatches from the M.R.I. lab have lately become a form of highbrow clickbait, so gratifying to write that science journalists have gotten stoned on their appeal — and are now behaving like stoners, munching on every morsel in sight and deeming all of them equally delicious.

Ms. Schwartz will have none of it. She’s delighted to show readers how appallingly many of these studies are designed. (To recreate the feeling of depression in their subjects, for instance, one team of researchers showed them clips from “Bambi” and “Titanic.”)

Just as Ms. Schwartz sees what’s suspect about neuroscience, she sees what’s still valuable — or better yet, romantic and fabulous — about Freud, celebrating his nerve, humor and visionary theory of mind. She reminds us that he was far looser and more generous than history remembers him (or than his successors have ever been), letting his dog Yofi tear through his office during his sessions and writing “spry, affectionate notes” to his favorite patients.

Ms. Schwartz, in other words, is skeptical where others are swooning and swooning where others are skeptical. These are wonderful qualities in a science writer.

When she considers neuroscience and psychoanalysis separately, Ms. Schwartz writes with imagination and wit, whether she’s parsing the rage of Kleinians or describing the phenomenon of memory reconsolidation. Her style in these chapters is associative, but not meandering; when she interviews her subjects, she gingerly puts them on the couch. (At one point, she stuns Dr. Solms by pointing out where his memory had deserted him — in the desert, no less, at the scene of a childhood trauma.)

Where her book capsizes, alas, is in precisely the places she tries to accomplish what she first set out to do: to unify two disciplines at loggerheads.
If I had to diagnose the problem, I’d offer two explanations.

The first is that many of the stories of neuropsychology are familiar, especially to readers of Oliver Sacks, whose work is cited in this book (as is the work of V. S. Ramachandran, Alexander Luria and Jean-Martin Charcot, the all-stars of this terrain). The sad tale of Phineas Gage — the railroad worker whose personality was forever changed after a tamping iron skewered his left frontal lobe like an hors d’oeuvre in 1848 — is this literature’s Book of Genesis. The way most neuropsychologists establish a link between the brain and the mind is through case studies of patients with brain injuries. The idea that such traumas can effect major characterological changes has been well established.
What makes Dr. Solms’s work so unusual is that he’s trying to build a neurological foundation specifically for Freud’s ideas. He’s noticed that narcissistic behaviors are more evident in patients with brain damage in their right hemispheres, which makes him wonder whether our most basic concepts of selfhood are housed there. He’s interested in what happens to the content of people’s dreams if their amygdalae — those almond-shaped threat detectors nestled deep in the brain — calcify from disease. (His research on dreams is how he made a name for himself.)

But Ms. Schwartz does not spend much time focusing on what brain injuries tell us about Freud’s theories — or not nearly as much as I would have liked. Instead, she spins the telescope around and asks the question in reverse: How much can the sophisticated, almost literary, practice of psychoanalysis be of help to those whose brains have been injured?

It’s an interesting question, one that Dr. Solms himself has been asking. But the particular case Ms. Schwartz follows — not in person, but through the notes and conversations with the patient’s analyst, David Silvers — sheds light on … well, very little, really. The patient in question is a fellow named Harry, who at 38 had a stroke in his left hemisphere that rendered him an aphasic, capable of formulating thoughts but incapable of expressing them.

Such patients are worth analyzing. To view them strictly as a neurological problem would be to trivialize their pain, humanity and rich inner life.

In choosing Harry, though, Ms. Schwartz has settled on a rather opaque case. His stroke meant that he lost his abilities, rather than acquired a flamboyant new set of behaviors. (Some stroke victims, for instance, wildly confabulate.) So there just isn’t very much to see. His analysis is slow, laborious and frustrating, because it involves plenty of guesswork, and Harry is just as one might expect: good on some days; despairing on others.

“Kindness is probably the most basic quality of all therapy,” Dr. Silvers concludes. Which is doubtless true. But is it where Ms. Schwartz wants her ambitious book to land?

“In the Mind Fields” ends so abruptly it may as well be midsentence, as if a therapist had reluctantly looked at the clock and told Ms. Schwartz that her 50 minutes were up.

Perhaps her book is premature. Freud always hoped that one day science would support or clarify his claims. In 1895, he started writing “Project for a Scientific Psychology,” which would marry his theories with the neurology of the day. He gave up in frustration. “Neurology was too primitive for Freud’s ambitions,” Ms. Schwartz writes. Maybe it still is.

In the Mind Fields

Exploring the New Science of Neuropsychoanalysis

By Casey Schwartz

218 pages. Pantheon Books. $24.95.

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