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Letter to the Editor   |    
Kandel’s Challenge to Psychoanalysts
DAVID D. OLDS, M.D.; ROBERT A. GLICK, M.D.
Am J Psychiatry 1999;156:662a-663.

Eric R. Kandel, M.D. (1), has done the field of psychiatry, and psychoanalysis in particular, an interesting and valuable service. Acknowledging the place psychoanalysis had as a major mentalist perspective in psychiatry throughout the latter part of the century, Dr. Kandel has put us on notice: the future of psychiatry and psychoanalysis will be guided by efforts to integrate the biological and psychological sciences.

Dr. Kandel makes a most articulate statement of the broadly held view that the mind is dependent on the brain, that it is really a complex of functions of the brain. He adds to this one of the clearest statements to date of the importance of the two-way street between brain and mind. The idea of the feedback loop, from gene expression to phenotype to modifying gene expression, may be a paradigm for the interaction at many levels in the brain/mind system. This, in fact, would be a model for both the effects of pharmacology and psychotherapy, which enter into the complex system of feedback loops at different levels. The experience-dependent alteration of gene expression is profound in its implications because experience dependence implicates every­day experience, psychotherapeutic experience, and psycho­pharmacological experience.

If our e-mail is any guide, psychoanalysts were offended by Dr. Kandel’s somewhat dismissive attitude toward psychoanalysis. Most were appalled by his description of his residency program, which seems to have been uniquely benighted, even for the 1960s. It is interesting that many a resident in current training programs could make the same kind of complaint, only now the longed-for presence would be a dynamically trained supervisor.

A growing number of psychoanalysts are writing about the important bridges to be built between disciplines. The rich fund of information derived from the phenomenology of clinical experience and some of the complex concepts derived therein—such as representation, motivation, internalization, intrapsychic conflict, transference, defense, and dissociation—could enrich cognitive neuroscience and could, in return, lead to enrichment of psychoanalytic theory by neuroscientific research. The caveat about Dr. Kandel’s article is that he stresses the input from neurobiology and underemphasizes the potential information coming from the "high end," thereby encouraging the trend away from psychoanalytic input in psychiatric training programs. This is unfortunate. It is clear to us that the future complete psychiatrist or analyst should be sophisticated about brain function at many different levels, just as the well-educated cognitive scientist should understand the phenomena emerging from psychoanalysis. The model of the interaction of bottom-up and top-down processes could be the conceptual basis for future research. Dr. Kandel’s article should be a wake-up call for neural scientists as well as psychoanalysts.

Kandel ER: A new intellectual framework for psychiatry. Am J Psychiatry  1998; 155:457–469
[PubMed]
 
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References

Kandel ER: A new intellectual framework for psychiatry. Am J Psychiatry  1998; 155:457–469
[PubMed]
 
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