Eric Kandel has done what Sigmund Freud could only hope to do. Over a century after Freud abandoned his attempt to develop a biological theory of the mind, Kandel has achieved the long sought for synthesis that links behavior, mind, and brain in a coherent model. This achievement comes to us now through the persuasive voice of this Nobel winning psychiatrist and neuroscientist’s latest book, The Age of Insight: The Quest to Understand the Unconscious in Art, Mind, and Brain (Random House 2012).
“Insight” has always struck me as a sloppy and troublesome word in the shoptalk of psychotherapists, so the title of the book did not immediately win me. At the Massachusetts Mental Health Center where Kandel trained in the early 1950’s and I trained in the early 1980’s, “insight” signalled a territory occupied by psychodynamically-oriented psychotherapy and psychoanalysis, a smugly superior sort of understanding than anything that could be achieved by cognitive psychology, behaviorism, or biological psychiatry. Until this latest book by Kandel, it has never been clear to me how deep such hallowed insight went.
I first heard Kandel speak in the early 1980’s when he returned to Mass Mental to tell us about his bench research on the aplysia snail neurons as a step toward working out how brains learn—snail brains and human brains. We psychiatry residents were stunned by the audacity of one of our own graduates to ditch humans for snails as a route to understanding the molecular basis for learning, memory, and the unconscious mind (see Kandel’s In Search of Memory, 2006). At the time it was not clear to anyone whether Kandel had found the royal road or a dead end, but he was a captivating speaker willing to take risks with his career.
Kandel reminds us in The Age of Insight that as recently as the mid-1800’s it was considered radically insightful when Rokitansky, the dean of the Vienna School of Medicine, insisted on physical exams and autopsies for the diagnosis of disease. Probing the live and dead body was literally digging deep beneath the surface appearance of illness for the causes of disease. Fifty years later it was equally radical for Freud to assert that the unconscious mind runs the show—another insistent step toward digging beneath the surface.
For all the impact of Freud’s “discovery,” the unconscious mind as a concept eluded precise definition, anatomical location, and quantitative measurement for most of the twentieth century. While the rest of western culture found the unconscious mind mysterious, fascinating, and transformative, science could ignore it because it could not be measured.
Now Kandel and a growing band of neuroscientists have described the next radical step inward: the neural basis for both the conscious and unconscious processes of emotion, learning, memory, visual perception, and face recognition. It is now possible to locate in time (by EEG) and space (by fMRI) the traditional “Aha!” moment so iconically associated with insight-oriented therapy.
Kandel effectively shows us at many points throughout this 600-page book how Freud has proved helpful to neuroscience (see the figures on p 376 showing how Freud’s tripartite model maps onto brain neuroanatomy). While acknowledging Freud’s substantial limitations, Kandel bridges the gap between psychoanalytic theory and modern neuroscience, persuasively rescuing his forefather from drifting into apparent irrelevance.
Kandel shows us that we clinicians now have a new level of insight to strive for, one that penetrates deeper than the tenets of any single brand of psychotherapy, one that blends the language of brain chemistry and neural circuits with the languages of psychodynamics, cognition, and behavior—in this book, the expressive behaviors of three Viennese painters from Freud’s day.
That Kandel can frame this landmark synthesis in a dual homage to three artists and one great essayist from his hometown underscores Kandel’s own literary agility. In this rare instance, the scientific pioneer is also the gifted messenger.