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Psychiatry’s Solid Center

Eric R. Kandel

Eric Kandel MD is the only psychiatrist (thus far) to have won a Nobel Prize—and, like Jaspers, Dr. Kandel is a true Renaissance Man. His research interests have spanned the territory from the molecular biology of long term memory storage to the modernist artists of turn-of-the-century Vienna, where Kandel was born [ 8].

In his classic book, “Psychiatry, Psychoanalysis and the New Biology of Mind,” Kandel shows that neurobiological and psychodynamic concepts are not mutually exclusive, but rather, complementary modes of understanding mind-brain relationships—akin to the complementarity of erklaren and verstehen.

Kandel does not eliminate the concept of “mind” at all, but asserts as a foundational principle that, “…what we commonly call mind is a range of functions carried out by the brain.” [9, p. 39]. (Ironically, Aristotle said much the same thing, over two millennia ago).

While Kandel believes that our genes play a fundamental role in the genesis of illnesses like schizophrenia, he avers that “multiple causality” is involved. By this he means that genetic abnormalities are influenced by “developmental and environmental factors.” [9, p. 46].

The sterile debate of “mind vs. brain” is rendered irrelevant in Kandel’s framework for psychiatry. Thus, for Kandel, “…insofar as psychotherapy…is effective and produces long-term changes in behavior, it presumably does so through learning…”; [9, p. 39] and learning, in turn, involves alterations in the interconnections between nerve cells of the brain.

Moreover, psychotherapy is capable of altering the expression of genes; hence, for Kandel, psychotherapy is a “biological” treatment in a fundamental sense. So much for the Manichaean dichotomy explored by Luhrmann.

Glen O. Gabbard

I have been privileged to know Dr. Glen Gabbard not only as an academic colleague and friend, but also as a mentor and role model. Readers of this paper will recognize Dr. Gabbard as the author of numerous books on psychodynamic psychotherapy; managing counter-transference; avoiding boundary violations; and many other professional topics.

Perhaps less familiar are his books on “Psychiatry in the Cinema” (with Krin Gabbard) and on the psychology of “The Sopranos.”

Clearly, Dr. Gabbard is a man of many facets, but I have been most influenced by his holistic and non-dualistic approach to psychiatric disorders and their treatment. In a classic paper (2000) titled, “A neurobiologically informed perspective on psychotherapy” [ 10 ] Gabbard took aim at the divisive tendency to split psychiatry into two opposing ideologies:

“Polarization of biological and psychosocial aspects of psychiatry has promoted a form of Cartesian dualism. Current knowledge of the interaction between biology and psychology makes it possible to consider a truly integrative approach to treatment.” [10]

And, citing the aforementioned work of Dr. Kandel, Gabbard continues:

“…environmentally derived activity appears to drive the development of dendrites so that they conform to cognitive schemes for the construction of mental representations. Gene-environment interactions become a reverberating “hall of mirrors” that cannot be easily dissected.” [10]

Gabbard goes on to cite studies in primates showing that “relational changes,” such as the separation of an infant monkey from its mother, can affect stress hormones and neurotransmitters in the infant.

Like Kandel, Gabbard knocks down the artificial wall between biological and psychosocial therapies:
“…learning about oneself…in psychotherapy may in itself influence the structure and function of the brain…[moreover] medications have a “psychological” effect in addition to their impact on the brain and psychotherapeutic interventions affect the brain in addition to their “psychological” impact.” [10]

I would add that even the act of prescribing psychiatric medication must be viewed in a psychodynamic context.

As Metzl and Riba (2003) have noted:
“…Symbolically speaking, medications convey a host of connotative implications that are difficult to recognize, let alone to quantify. These range from preconceived beliefs about drugs that patients carry with them into the examination room, to unspoken messages of nurturance at play when doctors prescribe (or choose not to prescribe) psychotropic medications… understanding the symbolic functions of the medications is as important as knowing their elimination half-lives or suggested dosing regimens.” [11]

Psychiatry’s Solid Center

This article originally appeared in:

Psychiatric Times

It is reprinted here with permission.


Ronald Pies, MD

Ronald Pies, MD, is Professor of Psychiatry and Lecturer on Bioethics & Humanities at SUNY Upstate Medical University, Syracuse, NY; and Clinical Professor of Psychiatry, Tufts University School of Medicine, Boston. His latest book is entitled, Don't Worry -- Nothing Will Turn Out All Right!: The Optipessimist's Guide to the Fulfilled Life. He is also the author of the essay collection, Psychiatry on the Edge (Nova Publishing); as well as the novel, The Director of Minor Tragedies (iUniverse) and the poetry chapbook, The Myeloma Year. He is a regular contributor to Psych Central.

 

APA Reference
Pies, R. (2015). Psychiatry’s Solid Center. Psych Central. Retrieved on October 15, 2019, from https://pro.psychcentral.com/psychiatrys-solid-center/

 

Scientifically Reviewed
Last updated: 6 Nov 2015
Last reviewed: By John M. Grohol, Psy.D. on 6 Nov 2015
Published on PsychCentral.com. All rights reserved.