Dr. Kandel Replies

To the Editor: I am grateful to the The American Journal of Psychiatry for giving me the opportunity to answer the letters it received in response to my article “A New Intellectual Framework for Psychiatry.” Because that article was written for the 100th anniversary of Columbia’s Psychiatric Institute, I focused on issues that concern academic psychiatry. In contrast, many of the letters to the Journal in response to the “Framework” article came from the psychoanalytic community. These letters raise two issues that I would like to address here: 1) that the article is dismissive of psychoanalytic ideas and 2) that the article is incorrect in suggesting that biology can be helpful in testing the scientific worth of psychoanalysis.

David D. Olds, M.D., and Robert A. Glick, M.D. (and a number of other readers), grasped completely the arguments that I tried to present in the “Framework” article but are concerned that I give short shrift to psychoanalysis. This may seem to have been the case because the article was not focused on psychoanalysis. But this was not my overall intention. I have great respect for the insight into human mental processes that psychoanalysis has opened up for us, and I believe that psychoanalysis provides the most coherent and interesting view of the human mind that we have.

The “Framework” article represents the elaboration of a line of thought that I began to develop 20 years ago in the Elvin Semrad Memorial Lecture (1) and continued a few years later (2). In both of these articles, I outlined the debt biology owes to the psychoanalytic perspective. Indeed, even a casual perusal of Principles of Neural Science, the textbook that I wrote with James Schwartz and Thomas Jessell (3)—I might add, for a largely nonpsychiatric readership—makes it clear that our thinking has been influenced and enriched by psychoanalysis.

In those earlier writings, I emphasized that psychoanalysis and the biology of mental processes represent different perspectives on a common problem, much like classical genetics and molecular biology in the 1950s approached common problems from different perspectives. Psychoanalysis is, in the best sense, a part of biology; it is part of the analysis of mental processes, and these functions must have their foundation in the physical brain. Conversely, those aspects of biology that aspire to contribute to the science of the human mind must take the insights of psychoanalysis into consideration. Isn’t it inevitable that biology and psychoanalysis should collaborate in their common interest? Why should this suggestion be regarded as demeaning? Did the emergence of molecular genetics demean either molecular biology or classical genetics? Do we think less of Mendel or of his discovery of genes since Watson and Crick have shown us how the double helical structure of DNA could explain the template function of genes?

I would guess that Drs. Olds and Glick would agree with the view that neuroscience and psychoanalysis could both benefit from greater interaction. Except for details that are unimportant, I do not think Drs. Olds and Glick and I disagree.

Whereas Drs. Olds and Glick say that I dismiss psychoanalysis, Dr. Arthur Rifkin and others argue that it is biology that should be dismissed when it comes to understanding mental functions. Rifkin asks, how can biological knowledge possibly help psychoanalysis? It would be helpful, he argues, if I could give an example of how any crucial psychoanalytic hypothesis can be proved or disproved by a biological or psychological experiment.

The view expressed by Dr. Rifkin is a return to a dualist (I am tempted to say Cartesian) position, which, in my view, needs to be addressed head-on if psychoanalysis is to continue to grow intellectually.

In 1894, Freud correctly argued that biology was not advanced enough to be helpful to psychoanalysis. It was premature, he thought, to bring the two together. The view that Rifkin and a number of psychoanalysts have, one century later, is more radical than Freud’s by far. Rifkin’s argument is not that biology and psychoanalysis are not yet ready for marriage but that biology is ill suited as a partner to psychoanalysis.

The last two decades have made it clear that psychoanalysis needs to grow scientifically if it wants to continue to influence how we think about mental processes. It therefore seems natural to suggest that biology offers an opportunity for such growth. I have further argued that psychoanalysis and biology are both likely to benefit from such an interaction. If biology is to explore the mind, biologists will need all the guidance they can get from students of mental processes.

One has to acknowledge that we are still far from establishing a biological foundation of psychoanalysis. In fact, we do not as yet have a satisfactory biological understanding of any complex mental processes. Therefore, it is quite possible that a convergence of biology and psychiatry is still a bit premature. Yet even now, the two disciplines are beginning to influence one another, and it is inconceivable to me that biology will not eventually make deep contributions to the understanding of mental processes. There must be a biological basis for the dynamic unconscious, for psychic determinism, for the role of unconscious mental processes in psychopathology, for drives, for transference and other attachments, and for the therapeutic effectiveness of psychoanalysis, to list only some central issues.

Having said that, I do not mean that psychoanalysis will be reduced to neuroscience. Psychoanalysis is much broader in scope than neural science. It will take from neuroscience only those tools and concepts it finds useful. Rather, I see a merger occurring between psychoanalysis, cognitive psychology, and neural science in which each influences the thinking of the other two disciplines and together they develop a more effective science of human behavior—one that has substantially greater scientific worth in explaining mental processes than each of the disciplines alone.

The point of neural science is not to prove or disprove psychoanalytic hypotheses, although it will, in certain cases, do just that. For example, I think the biology of memory has taught that there are many other types of unconscious processes besides the dynamic unconscious. Similarly, I think the emerging biology of gender—genotypic gender, phenotypic gender, gender identification, and sexual orientation—are bound to teach us a great deal about sexual orientation specifically and about drives in general. Although we probably do not need biology to convince us that Freud’s analysis of the Schreber patient’s case was flawed, I feel fairly confident that in the next two decades biology will tell us quite directly whether the concept of latent homosexuality has any meaning whatsoever and what, if anything, it has to do with paranoia. It may tell us to what degree male homosexuality is due to genes or brain anatomy on one hand or a possessive mother, a weak or hostile father, or other social influences on the other.

The relationship of biology and psychoanalysis is an issue of major scientific importance, and our positions in this debate will directly influence how we educate young psychoanalysts. Because I cannot begin to discuss a problem of this magnitude in this brief response, I have addressed it in the Special Article that appears elsewhere in this issue.