World War Ii Through The 1970s The Psychoanalytic Era

Although psychoanalytic ideas have been percolating in American psychology since Freud and Jung's visit to Clark University in 1909, the full impact of depth psychology on psychiatry had to await the massive exodus of psychoanalysts to England and America with the onslaught of World War II. As these energetic immigrants captivated American psychiatry with remarkable speed, there was a dramatic shift toward the psy-chodynamics of the mental apparatus, as well as the controversy that still surrounds "talking cures." The overconfidence of this revolution, especially in the often successful treatment of war-trauma-induced neuroses, allowed new approaches such as clinical psychology to become established as a distinct discipline, along with the resulting proliferation of new psychotherapeutic ideas. Although we now recognize that certain psychotherapies can modify the executive functions of the brain concentrated primarily in frontal lobe areas (Baxter et al., 1992; Schwartz et al., 1996), the precise factors that promote such changes remain ambiguous. It is increasingly realized that the personal emotional qualities of a therapist are commonly more important than the specific psychotherapeutic approaches he or she employs (Beutler et al., 1994). Despite the bleak overall results of scientifically rigorous outcome studies of psychoanalytic therapies (MacMillan) 1997, this era firmly established a respect for the internal dynamics of the human mind within psychiatric practice.

Indeed, Eric Kandel (Nobel Prize, 2000), a psychiatrist who devoted his professional life to the neuroscience of basic memory processes in sea slugs in the hope of deriving general principles that would translate to humans (Kandel 2001), noted that "psychoanalysis still represents the most coherent and intellectually satisfying view of the mind that we have" (Kandel, 1999, p. 505). This comment probably speaks as much to the sheer creative richness of psychoanalytic thought as to the difficulty of developing a modern psychiatry that is based on adequate neuroscientific conceptions of the mind.

This middle era, with its shift of focus from studying the whole person to the nature of the drives and libidinal states of the mind, failed scientifically because it did not promote a solid research agenda. Likewise, the lack of replicable clinical results led to the decline of this untested (and some say untestable) theory of the mind and its influence on mainstream psychiatry, especially as pharmacological approaches were beginning to yield robust and replicable therapeutic effects.

This may again change as a new generation of scholars begins to blend neuroscience and depth psychological studies (Solms and Turnbull, 2002; Chapter 19) where mental and neuroscientific issues can be judiciously blended. The new armamentarium of brain manipulations and objective measurement tools presently offers the possibility of a renaissance for depth psychological approaches to the brain/mind (Panksepp, 1999). Whether a sustained era of penetrating "psychoethological" research will arise from the emerging neuropsychoanalytic synthesis remains to be seen, but if it does, it will only be because of the positivistic and pragmatic phase of neuroscientifically informed psychiatric research of the past 30 years.

Before turning to modern biological psychiatry, it is worth noting that the middle, psychoanalytic era, with its neglect of robust research agendas, allowed mere ideas, often endlessly debatable, too much influence on psychiatric thought. In a sense, this was also a "magical fantasy" era. Dramatic new somatic therapies, based on marginal research findings, flourished. Perhaps the Reichian concept of libidinal "orgone energy" and the resulting "orgone box" (to concentrate that "energy") could be taken as symbolic of this era: Willhelm Reich (1897-1957), whose own mental stability was eventually questioned, was convicted of fraudulent claims and died during his incarceration in a federal penitentiary. Others, like Bruno Bettelheim, generated needless guilt with concepts such as "refrigerator mothering," which allegedly was instrumental in causing early childhood autism. It took many years for that needless "guilt trip" to become an embarrassment to the discipline (e.g., Pollak, 1997).

This period also introduced radical manipulations such as metrazol and insulin-induced seizures for treatment of schizophrenia and depression. Occasional successes gradually led to the highly effective and standardized electroconvulsive shock treatment for depression (Chapters 8 and 17), but there were casualties along the way. This era of radical experimentation was capped by the most controversial treatment of all, psychosurgery (for critical overview, see Valenstein, 1973). With the wisdom of hindsight, it is all too easy to criticize these approaches, but perhaps they are understandable from a historical perspective. We should acknowledge that they sprang from understandable motives, given the historical times they were advanced. That was an era when many groups routinely inflicted incomprehensible harm on their fellow human beings—from the fields of Siberia, the ovens of Auschwitz, and "labs" of Dachau to the infection of impoverished Americans with syphilis—all in the name of political and cultural dogma and undisciplined curiosity. It was also a time when there were few predictably effective treatments, with morphine still being very high on the list of short-term panaceas. The hospitals were full of desperately debilitated patients. Hence the field was grasping at straws, whether psychic or somatic, and the scalpels of the time were aimed directly for frontal lobes—the executive seats of human imagination, acquired valuations, and creativity (Valenstein, 1973).

Since such drastic interventions worked "adequately" in a sufficiently large number of people (at least for management purposes), it was recognized that something of importance was happening to the homeostatic imbalances of the deranged brain/mind. Indeed, the final restricted target of psychosurgical interventions, the ventromedial quadrant of the frontal lobes, is now recognized as a hotbed of emotion-cognition interactions (Rolls, 1999). What really happens in the brain/mind as a result of these powerful somatic interventions required the advent of modern neuroscience and a neurochemical understanding of the brain that eventually permeated psychiatry.

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