After Freud’s death, the principles of practicing psychoanalysis became, in the Anglo-American world at least, stricter, more literal-minded, every point carried out to a painstaking degree: the unbudging fifty-minute hour; the extreme impersonality—the “mask-like blankness”—cultivated by the purists of the profession. All had begun as suggestions that became rules that became dogma. (Page 15)
Kandel had spent his long career on the question of how the brain makes new memories. Working on the most granular level, he observed that in order for successful learning to occur in the brain, neurons must instantly manufacture new proteins to make the chemicals flowing between them behave more consequentially. The physical changes that occur are relatively simple, but the implications of Kandel’s findings were enormous. New memories restructure the brain in the very moments they are created. Kandel’s finding took the concept of learning out of the rarefied cloud of abstraction to which it had always seemed to belong, and placed it for the first time in the ranks of the concrete; learning became, thanks to Kandel, an idea that could be operationalized—an idea, in other words, that could be looked at and measured and talked about specifically. (Page 25)
Nader triumphantly reported his results to LeDoux. He knew it was early days, that there were countless alternative theories and confounding variables he still had to rule out. But he was building a case: he believed it would eventually be possible to show that, on a molecular level, all of our recollections are always subject to reinterpretation, editing, and even erasure, porous to the present moment every single time they resurface. Nader believed that far from being static imprints of the original experience, memories are susceptible to alteration the instant they enter our conscious awareness, no matter how long we’ve stored them—months, years, decades. (Page 27)
When Sigmund Freud first went to work on his hysterical patients, many of them reported childhood sexual trauma, often at the hands of their own fathers. At first, Freud took them at their word, believing their recollections, but by 1897 he made an abrupt reversal. “I no longer believe in my neurotica,” he wrote in a letter to his friend Wilhelm Fliess. The phrase became a part of psychoanalytic history. Freud was now convinced that his patients’ stories shouldn’t be regarded as facts, necessarily, but rather as fantasies—yet fantasies that were no less relevant to understanding their symptoms than if the sexual encounters they described had indeed occurred. For Freud, what mattered was what his patients believed they remembered. It would take neuroscientists a century to back up Freud’s perception that memories are fundamentally dynamic. (Page 30)
Suddenly, there was a claim being made, a flag planted: neuroscientific findings were morphing into our cultural truths. Everywhere I looked it seemed that we were being defined by what our brains were doing. We were “hardwired.” We were a collection of parts, of “circuits” and “networks” that “light up” when “activated.” Everywhere, there were hucksters and geniuses, all trying to colonize the new world of the brain. (Page 31)
Later, I would learn sophisticated critiques of brain-scanning studies, critiques having to do with the blurry assumptions researchers make about where in an individual brain the amygdala even is (it differs for everybody), and how to decide which statistical analyses to run (with countless options, each one offering a different spin on the data). I would come to understand that there was already a vigorous debate within the field itself over the value of fMRI studies, neuroscientists arguing with one another about whether these measurements were valid at all, and if so, to what extent. I would hear critiques based on Bayesian analyses, on voxel placement, on designated p-values. All later. Then, sitting in the medical school library amid piles of studies on the traumatized brain, grappling with the scientific literature that was still new to me, what I thought about was how dramatically the richness of Freud’s ideas crashed and burned at the doors to the fMRI lab. Sadness was what happened to you after you watched Bambi. Mood was your score on the Beck Depression Inventory. Scores 9 = not depressed. I was struck by the thought that Freud’s “Mourning and Melancholia,” a text written nearly a century earlier, could seem to powerfully illuminate a dynamic at the very heart of the opaque affliction that had plagued my father and so many others—while a cutting-edge, neuroscientific work could be constructed around such a simplified version of “depression” that I had to wonder what it was I was actually learning when I read the authors’ conclusion that their subjects’ ability to spot circles amid rectangles was somewhat slowed down by the appearance of sad images in the wake of sad movie clips—and that the amygdala was involved. (Page 40)
In the logic of many experiments I encountered, I feared that human emotions were being reduced to cartoon versions of themselves. Each was simple, discrete, and readily identifiable. Sad was different from angry, which was different from ashamed. There was no blurring of boundaries between them, no complexity, no mess. For the sake of science, each emotion under scrutiny must be lifted as if with sterile tweezers out of the human heart and slid beneath the microscope. Nowhere did I find an acknowledgment that these formulations did not actually resemble human experience; that they were, at best, radically impoverished sketches of inner life. (Page 42)
Stanley Milgram had designed the study as an investigation into the horrors of World War II. He ran it many times, with different groups of volunteers, and he saw that most were willing to follow instructions and deliver steadily accelerating doses of electric shocks to the person rigged up to the machine, even as that person appeared to be suffering more and more acutely. From these observations, Milgram drew a Hannah Arendt–like conclusion: evildoing was nothing special. It was dormant everywhere, just waiting for the right circumstances to ignite, the right authority figure to come along and deliver his sinister instructions. (Page 43)
“I started working in this area in the mid 1980s and I’ve been trying to persuade colleagues on both sides that this is a good thing to do ever since. It’s been a hell of a journey. I’ve had many disappointments along the way. It’s not been as easy as I would have thought it would be to get psychoanalysts to see the necessity of using what you learn from the point of view of the neurosciences about the mind. It must be relevant to what they do, just because there can only be one mind. There can’t be a mind for neuroscience and a mind for psychoanalysis. There’s only one human mind.” (Page 48)
even though, as Solms reminded us, psychoanalysis and neuroscience were talking about the same thing. Psychoanalysis was looking at the brain from the inside out: what does it feel like to be this thing? Neuroscience was looking at the brain from the outside in, measuring its behavior, investigating its physical mechanisms. They were two views of one object. There could be only one mind. To hear Solms put it in these stripped-down terms felt like hearing it for the first time. (Page 48)
What Scoville hadn’t understood, what no one had understood, was that the hippocampus is the seat of memory formation in the brain. The situation was as it had been with language a century before: no one had connected speech to any one specific location in the brain until 1861 when the neurologist Paul Broca performed the autopsy on his former patient Monsieur Leborgne. Until Scoville had vacuumed up both of H.M.’ s hippocampi, neurologists hadn’t imagined that memory could be somehow tucked away in these seahorse-shaped structures, which occupy mere centimeters of the neural landscape. (Page 57)
Until H.M. emerged from the operating room in 1953 and asked his parents and doctors where he was and what he was doing there, scientists didn’t know that the hippocampus is the essential brain region for memory. In the decades to come, H.M., the ever compliant research subject, demonstrated by his performance on every imaginable neuropsychological test that the brain has multiple memory systems—short-term, long-term, procedural, declarative—and that different kinds of memories are stored in different parts. (Page 58)
scientists also discovered that H.M. could still learn certain types of new information—what is now known as procedural memory—the “how to” information that we all know without being able to explicitly spell it all out, like how to drive a car, ride a bike, or tie our shoelaces. (Page 59)
I was troubled by how many people appeared to be participating in the reducing down of the brain’s most complicated questions with little apparent regard for the long history of clinical insight established by psychoanalysis and psychiatry. The rush of findings about the brain that was permeating our current moment seemed to me like a new reality we would define ourselves by, and then wouldn’t be able to turn back from. And I didn’t want to subscribe to a version of life where creativity is explained as patterns of electrical waves, sadness as the number you circle between one and nine, and love confused with the mating habits of prairie voles. (Page 72)
Freud wrote by hand, in penmanship that could be almost illegible. Strachey had overlooked sentences, left out paragraphs. Moreover, there was controversy among psychoanalysts and other people who cared, avidly, about these things, regarding certain choices Strachey had made. For instance, the issue of der Trieb. Freud uses the German word Trieb all throughout his forty years of analytic texts, naturally, because it means “drive,” a concept to which Freud devoted much attention. But when Strachey sat down to do his English translations, he translated Trieb as “instinct.” This, Solms knew, was a significant distortion of Freud’s intended meaning, because instinct and drive are not interchangeable concepts. Instincts have objects, by definition. They are the biologically inherited reactions we have to specific objects in our environment. For instance, a cat’s instinct to pounce on a mouse. A mouse’s instinct to flee from a cat. A drive, by contrast, is an urge without an object, an impulse to seek, a libidinal attraction towards something inchoate and unspecified, towards “I know not what,” as Solms says. The drive exists on its own terms, even before it has an aim. (Page 83)
When I was in Cape Town, Fodor was preparing to begin a study that Solms had designed: psychoanalyzing a population of patients with Urbach-Wiethe disease, an extremely rare genetic disorder in which a person’s amygdala gradually calcifies until it is almost completely defunct. (Page 86)
For Solms, these people afflicted with a rare disorder represented exactly the kind of opportunity he was constantly trying to persuade his psychoanalyst colleagues to seize: brains with clearly demarcated failings. The assumption—thus far untested by Solms and his colleagues—was that without their brain’s “threat detector,” people would lose all fear and inhibition, no longer able to perceive danger. Solms was particularly interested in what effect this might have on the content of their dreams. He wanted to know what could be learned in psychoanalytic terms about what happens when someone’s amygdala turns to stone. (Page 86)
It was in this context that Solms arrived at University of the Witwatersrand in Johannesburg in 1979. He registered for psychology. But “psychology was ridiculous,” he quickly felt. Psychology as it was being taught at Wits in the 1980s was essentially behaviorism, from Skinner on down, theories about reward and punishment, dogs and bells, rats in mazes. Solms had gone in thinking he was going to “learn about people,” the whole, messy reality of what it means to have a mind. Instead, he found that psychology was devoted to breaking the mind down into little parts that bore scant resemblance to human experience as he knew it. “It was boxes and arrows!” Solms says, ruefully, semi-disbelievingly, even now. (Page 92)
At the time he wrote the “Project,” Freud’s medical practice was thriving. All through the 1890s, Solms would learn, a steady procession of Viennese hysterics trundled into Freud’s consulting room. No one knew what to do with them. Their symptoms included partial paralyses, sudden, uncontrollable twitches, the inexplicable loss of appetite, or being suddenly overwhelmed by a strong scent, which would come out of nowhere and abruptly disappear again. These symptoms were, in a sense, pseudo-neurological: they seemed like the results of the nervous system gone wrong, yet could not be connected to a physical cause—and, indeed, could not be physical: they defied the natural laws of the human body. Freud was riveted. This was weird, and weird was good, because it was a portal to the new, and Freud, above anything else, was wildly ambitious. (Page 93)
Facing his hysterics, Freud was trying to understand how a brain would have to be built in order to produce the anomalous behaviors he was seeing. And so began the “Project.” (Page 93)
At the time Freud was writing, neurology was in its earliest stages. Even the idea of the neuron itself was controversial at best. This most basic unit of the brain had been discovered only a decade before, by the great Spanish neurologist Santiago Ramón y Cajal. (Page 94)
In the end, Freud believed that the “Project” amounted to nothing more than speculation—“ imaginings, transpositions, and guesses,” as he put it. “Every endeavor to think of ideas as stored up in nerve-cells and of excitations as traveling along nerve-fibers has miscarried completely,” he would write. There simply did not yet exist the means to prove one way or the other the theories about the brain that he was putting forward. Neurology was too primitive for Freud’s ambitions. He wasn’t content to dwell in the limbo of maybe, maybe not, so he dropped the “Project” and the intellectual aims it had represented, and redirected his gaze from the brain to the mind. “We shall remain on psychological ground,” Freud declared in The Interpretation of Dreams, in 1899. In other words, no more “neurones.” But he always said—as Solms often emphasizes—that one day, one day, the neurosciences would be sophisticated enough to take up the observations laid out by psychoanalysis and augment them, prune them, extend them, render them complete. (Page 94)
Solms consulted Mrs. S.’ s GP, who’d known her for decades. There was no history of depression. Finding nothing in the neurological literature that illuminated the case, Solms turned to Freud’s masterwork, “Mourning and Melancholia.” Here’s what’s fascinating about “Mourning and Melancholia”: even besides Freud’s rich, layered treatment of depression itself, it is the very first paper in which Freud grapples with the concept of narcissism. And this, for Solms, was the missing piece, the quality for which he had had no name. But of course it was more than a name, it was the idea, the constellation of features, the particular flavor and dynamic. He suddenly understood. Right-hemisphere patients had this in common: they were all distinctly narcissistic. (Page 104)
Narcissism has become the go-to label of our modern age, easily slapped onto all manner of twenty-first-century behavior, from Internet exhibitionism to the general devaluation of modesty and understatement we might notice all around us. But Freud had a highly specific vision of what the condition actually entailed. Narcissism, for Freud, was deep pathology. On the spectrum of mental health, he considered narcissists much sicker than neurotics. Only the psychotics were more far-gone. Freud believed that true narcissists were unanalyzable. Many in the field would still agree with that assessment. Freud saw narcissism as a profound misunderstanding of one’s place in the world, of where one’s own self ends and everyone else’s begins. (Page 105)
Solms saw that his patients like Mrs. S., with damage to the right side of their brains, were exhibiting the most primitive kinds of defense mechanisms, the tricks we all use in the first years of life, our dogged and doomed attempts to reshape reality according to our infantile desires. Freud describes this stage as “primary narcissism,” and it’s how everybody begins, unable to relate to the environment as separate from oneself. The defense mechanisms associated with this period of childhood are undeveloped and outlandish; they stand in blatant disregard to reality. Solms was seeing exactly these defense mechanisms in his right hemisphere patients: reality reshaped according to their desires. They didn’t have the paralyzed arm, the guy walking by with the breakfast tray did. The guy in the next bed did. Not them. Whatever the facts, a narcissistic defense seeks its own, self-serving version. (Page 105)
Over the years since, Solms has come to believe that these patients reveal the critical role that the right hemisphere plays in normal emotional development. They tell the story of how we acquire the ability to see ourselves in relation to the world around us. The right hemisphere is tied up with our most basic identity, in a way that the left hemisphere is not. Patients with damage on the left side can lose their grip on language, but they normally hold fast to themselves. Right hemisphere patients, not so. (Page 107)
The ability to see the world on its own terms, in its rightful outlines, is a skill we gradually, painfully acquire during childhood, some of us better than others. And it’s a skill that depends, according to Solms, on the physical maturation of the right half of our brain. (Page 107)
Ramachandran is a behavioral neurologist and an expert on the visual system. He doesn’t come from a psychological background. In Phantoms in the Brain, he reports on his breakthrough patient, Mrs. Macken, a woman who had a right-sided stroke and became paralyzed on the left side of her body. In his examination, Ramachandran found Mrs. Macken to be “anosognosic for her paralysis”; she reported that her arms were “equally strong” and that she could move both of them normally. But Ramachandran had read of an experiment by an Italian neurologist, named Bisiach, who’d observed that pouring ice cold water in the patient’s ear—a fairly routine procedure called caloric stimulation—had the effect of temporarily dispelling the patient’s “unawareness.” Ramachandran decided to test this out on Mrs. Macken. “How are you feeling?” he asked her, after pouring the freezing water into her left ear. “My ear’s cold,” she said. “What about your arms? Can you use your arms?” “No,” she said. “My left arm is paralyzed.” “Mrs. Macken,” Ramachandran said. “How long have you been paralyzed?” “Oh, continuously, all these days.” Within twelve hours, however, Mrs. Macken retreated to her anosognosic position, professing to have no memory of her earlier confession, nor any knowledge of the paralysis itself. The cold water had functioned like hypnosis used to in cases of hysteria: while under its spell, the patient could admit to all kinds of things that normally, consciously, she was unable to acknowledge. It was the case of Mrs. Macken, Ramachandran writes, that introduced to him the possibility that a Freudian mechanism was at work in these right hemisphere patients. He knew so little about psychoanalysis, but what else could this be if not a good old case of repression? (Page 108)
To this day, there is no single accepted explanation for why we dream. From the point of view of the brain, the question remains unresolved. What purpose do dreams fulfill? Brain researchers began to seriously engage with the question only in the 1950s. Before then, psychoanalytic theory had been the single arena in which dreams, in all their baffling aspects, had been comprehensively investigated. (Page 112)
Aserinsky and Kleitman (now roused to action by his student’s zeal) found that the eyeball movement was only one of a series of activations that occurred on a ninety-minute cycle throughout the night. Still asleep, their subjects would display a sudden flurry of arousal all over their bodies: the EEG waves sped up to alpha and beta, their blood pressure rose, they got erections. Their brains and bodies were in many ways as active in these minutes of sleep as during waking hours. This stage of sleep would become known as “paradoxical sleep” or, more commonly, REM, for Aserinsky’s original observation of “rapid eye movement.” (Page 113)
The fact was that having an equation between dreaming and REM sleep was enormously expedient for science. Once dreaming is a quantifiable state, visible on an EEG machine, the roadblock is lifted to studying it scientifically. There is no more ambiguity: when the EEG starts drawing alpha and beta waves, researchers can assume their subjects are dreaming. More important, perhaps, was that an equation between dreaming and REM sleep allowed researchers to study dreaming in animals. No longer did they need a human whom they could wake up and ask: “What was just passing through your mind?” (Page 114)
Hobson denigrated the role of the forebrain in making dreams, portraying it as the passive recipient of the brain stem’s burblings. Hobson argued that the nightly spectacle of dreaming, the very phenomena that has captivated humans since antiquity, that saved the life of Joseph, that inspired the creation of psychoanalysis, was a simple matter of physiology. It was little more than a gaudy neuro-chemical fountain that goes on every ninety minutes, regales its bystanders, and subsides. (Page 116)
If any one moment can be said to have hurried psychoanalysis along its current underdog’s path, it was the publication, in 1977, of Hobson’s article, with Robert McCarley, “The Brain as a Dream State Generator: An Activation-Synthesis Hypothesis of the Dream Process.” The words “death blow” sometimes surface when psychoanalysts discuss it. Dreams, Hobson was eager to demonstrate, contained no disguised wishes, no latent meaning. Contrary to Freud’s vision, the meaning of dreams was exactly what it appears to be. There is no coded significance, no symbols to interpret. “Hobson makes the point that it’s such a simple explanation,” (Page 120)
Solms thought, that he now had a whole collection of patients in whom damage to the pontine brain stem had eliminated their ability to enter into REM sleep—yet done nothing to stop their dreams? According to Hobson, that should be impossible, a contradiction in terms. There should be no dreams without REM. Solms found that contrary to Hobson’s argument, the pontine brain stem was not the crucial structure in the formation of dreams. Rather, Solms discovered, it was only damage to another area of the brain entirely, the ventro-mesial frontal white matter, that could bring about the total cessation of dreaming. Indeed, with his longtime collaborator Jaak Panksepp, well known in the world of affective neuroscience, Solms would later term this area of the frontal cortex “the seeking system,” or, as Solms also puts it, the “I want” system, because its dopamine-fueled circuitry is the very same structure that contributes to our most basic urges, motives, and desires. (Page 121)
Solms’s work continues in a long tradition of trying to understand the brain by looking through its cracks. (Page 137)
The institute was founded by the Viennese analyst Theodor Reik, an émigré who had been a figure of controversy in Europe. As a young analyst in Vienna, Reik had treated an American patient, a doctor named Newton Murphy, whom Freud had referred to him. After several weeks of treatment, Murphy, unhappy with the results, sued Reik for “quackery.” Operating without a medical degree, Reik suddenly found himself at the mercy of the Austrian courts. Freud rescued him, quickly publishing “The Question of Lay Analysis.” The paper took only a month to write, but became a passionate argument that a medical degree was not only unnecessary for the practice of psychoanalysis, it was often detrimental. Medical training, Freud argued, interfered with the sensibility most conducive to a good analysis. “As long as I live, I shall balk at having psychoanalysis swallowed by medicine,” Freud wrote in a letter to a friend as the lawsuit played out. (Page 142)
At first, Silvers experienced the process of free association as if he were at a confessional; when he emerged at the end of his hour, it was with a sense of relief, of having unburdened himself of sin. He was unsure, exactly, of what was allowed in the room. Of what exactly one was meant to say out loud. His analyst had a gentle clinical style; he wasn’t, as the expression goes, directive, he let the material unfold, he let the patient guide the way. (Page 146)
A year went by. One day, sitting in the little room in the back of his house on Long Island, his three kids shuffled in: the Committee, as he occasionally thought of them. They had business to address with him. His daughter spoke for the group. “Dad,” she said, “we want to know: How come you’re not Mad Dad anymore?” These were the words that he remembers more than thirty years later, because they startled him into the realization that something was actually happening when he went and lay down on the couch to put words to his thoughts in the presence of Jack Bernstein. His kids’ observation gave him the conviction that, whatever its flaws and uncertainties, this was a powerful process, one that could change a person. (Page 147)