Franck Ramus Doesn't "Get" Neuropsychoanalysis Because He Still Thinks Psychoanalysis Is Freudian

In a recent "Reappraisal" article written for The British Journal of Psychiatry, Franck Ramus, a CNRS senior research scientist at the Laboratoire de Sciences Cognitives et Psycholinguistique, Institute of Cognitive Studies, Ecole Normale Supérieure in Paris, invokes many of my favorite authors (Eric Kandel, Jaak Panskepp, Joseph LeDoux, and even Antonio Damasio) as he argues that psychoanalysis is archaic and dangerous to clients (in so many words), and therefore, neuropsychoanalysis is simply old wine in a new skin:

I have no doubt that the respected neuroscientists mentioned above condemn all these abuses and show indefectible commitment to evidence-based psychology and psychiatry. But they should think twice before making any statement that may be interpreted as a rehabilitation of psychoanalysis (unless they have stunning new data to reveal, of course). They should be aware of all the consequences of unduly preserving the popularity of psychoanalysis. They should be aware that they will be unwittingly enrolled in the support of dismal diagnostic and therapeutic practices, at the expense of patients, albeit in distant places.

Ramus's research focuses on the development of language and social cognition and their disorders (developmental dyslexia, specific language impairment, autism), so it's unclear to me from where his lack of knowledge about modern (or really, postmodern) psychoanalysis is sourced. He clearly believes, wrongly, that psychoanalysis is still Freudian - it's not.


With Heinz Kohut and a few others (Heinz Hartmann [ego psychology], Harry Stack Sullivan, Karen Horney, Erich Fromm, Erik H. Erikson, and Frieda Fromm-Reichmann [interpersonal psychoanalysis], John Bowlby and Mary Ainsworth [attachment theory], Otto Rank, Donald Winnicott, Harry Guntrip, and Ronald Fairbairn [object-relations], as well as Margaret Mahler, Alice Miller, and others - the list could go on for pages), psychoanalysis stopped being about drive theory and unconscious desires. Rather, it moved into the realm of human relationships, thus the umbrella term for modern systems of Relational Psychoanalysis, which includes intersubjective systems theory (Robert Stolorow, Donna Orange, and others).

Neuroscience offers more support for these relational models than Ramus seems to be aware of in his short paper below. Allan Schore, Daniel Stern, and Nancy Chodorow have done extensive research on infant development that demonstrates the central nature of relational neurobiology in mental health.

Full Citation:
Ramus, F. (2013). What's the point of neuropsychoanalysis? The British Journal of Psychiatry, 203, 170–171. doi: 10.1192/bjp.bp.113.127217

What’s the point of neuropsychoanalysis?

Franck Ramus

Summary

Neuropsychoanalysis is a new school of thought attempting to bridge neuroscience and psychoanalysis. Yet few neuroscientists and psychiatrists would have heard of it if it had not recently received public support from notable neuroscientists. The present paper discusses whether such support is warranted.

Declaration of interest:
None

According to Panksepp & Solms, ‘Neuropsychoanalysis seeks to understand the human mind, especially as it relates to first-person experience. It recognizes the essential role of neuroscience in such quests. However, unlike most branches of neuroscience, it positions mind and brain on an equal footing’ [1].  In a landmark 1998 paper framed as a challenge to psychoanalysts, Kandel further stressed that psychoanalysis had an essential part to play in such a legitimate enterprise:

‘As a result of advances in neural science in the last several years, both psychiatry and neural science are in a new and better position for a rapprochement, a rapprochement that would allow the insights of the psychoanalytic perspective to inform the search for a deeper understanding of the biological basis of behavior’ [2].

Fifteen years later, one can only be delighted to see that some psychoanalysts have taken up the challenge, embracing the scientific method and attempting to put Freudian hypotheses to rigorous test, as attested by a recent special issue of the Psychoanalytic Review in honour of Kandel [3]. In the conclusion of this special issue, this rapprochement between psychoanalysis and neuroscience is called ‘a natural alliance’ by Damasio [4], and is further celebrated by LeDoux [5].  As noted by LeDoux in an earlier book, ‘Freud was right on the mark when he described consciousness as the tip of the mental iceberg’ [6].  Indeed, Freud’s theory ‘still stands as perhaps the most influential and coherent view of mental activity that we have' [7]. Thus, the stage is set for Carhart-Harris & Friston (and many others) to explore ‘the notion that Freudian constructs may have neurobiological substrates’, by attempting ‘to demonstrate consistencies between key Freudian ideas and recent perspectives on global brain function’ [8].  Of course, all the quoted authors are well aware that psychoanalysis has until now been on shaky ground, and show remarkable caution in their displays of support. They insist that its claims should be put to empirical test, and that indeed the time is ripe thanks to the progress of neuroscience, a position that appears entirely reasonable and harmless. Or is it?

First of all, it may be argued that the attribution of many enduring and important insights and concepts (such as unconscious processing) to Freud is largely erroneous. Although Carhart-Harris & Friston [8] do an admirable job of synthesising a great deal of neuroscientific data and linking it with the ‘free energy principle’ framework, why attempt to systematically associate almost every neuroscientific concept or finding with a quote from Freud? Certainly, it is of historical and epistemological interest to trace modern ideas back to their precursors; Freud may have had genuine insights about the functioning of the mind. At least if it can be shown that these ideas really originated from Freud, rather than being borrowed shamelessly from predecessors without appropriate credit (e.g. the idea of unconscious processes from Janet [9] and many others [10]). Carhart-Harris & Friston’s main focus, the id and the ego, can be traced back to Plato’s distinction between passions and reason, via countless intermediaries. But these authors do not seem to seek any other source than Freud, a curious form of historical scholarship. Armed with exclusively Freudian literature and with a liberal use of analogy and metaphor, there is no doubt that ‘consistencies’ can be found. But what does this mean for modern neuroscience and psychiatry? Do empirical studies of the default-mode network, of the emotional brain or of psychiatric disorders benefit in any way from the free association of cognitive and neuroscientific concepts with psychoanalytical ones? Is the history of ideas well served in the process? Kandel’s latest book [7] reveals, if anything, that there is no other justification for constantly going back to Freud than nostalgia for the Viennese 1900s and admiration for an inspirational writer.

Second, psychoanalysis seems to provide no additional insight to already existing concepts in cognitive psychology and neuroscience. Just like Kandel [2], Panksepp & Solms [1] convincingly argue that there is a need for a dedicated level of description for the mind, i.e. for thoughts, feelings, and all other mental states, distinct from biological levels of description. But in so doing, are they not just rediscovering psychology? The case for the importance of a cognitive level of description for any proper understanding of the mind/brain, and for its conceptual independence from the biological level has already been made long ago by Marr [11], and has been couched in more modern terms by Morton & Frith [12,13] with their causal modelling framework. It may be that some scientists in molecular and cellular neuroscience need to be reminded of the limitations of a purely reductionist biological approach, and of the essential contribution of cognitive science to the understanding of the brain. But psychoanalysis is the last thing they need. The science of the mind already exists, and that is psychology. For most contemporary psychologists, psychoanalysis is only one school of psychology: an outdated one, whose hypotheses were either trivial or untestable, or proved wrong. And the new science of the mind/brain (including subjective feelings, emotions and social relations) already exists: it is to be found at the thriving interface between psychology and neuroscience. Thus, all the ideas that Panksepp & Solms attribute to neuropsychoanalysis are fine, but are already mainstream within cognitive, social, and affective psychology and neuroscience. So, what is the point of renaming these successful scientific endeavours ‘neuropsychoanalysis’? Is this not just an attempt to rehabilitate psychoanalysis by giving it a fashionable prefix and by attributing it the merits of other disciplines?

This is not merely a futile dispute about a word. Psychoanalysis is not just a harmless set of ideas that may be used as a source of inspiration and philosophical musings. In order to realise that, it may be useful to recall the situation of countries where it still constitutes the core of psychology and psychiatry and leads both theoretical thinking and clinical practice. In France, for example, psychoanalytically trained child psychiatrists reject international classifications of mental disorders in favour of their own idiosyncratic one [14]; delay the diagnosis of autism or substitute it with psychoanalytic diagnoses such as ‘infantile psychosis’; delay or prevent any form of educational intervention; practice instead analytical forms of psychotherapy whose efficacy is not supported by any empirical evidence (including highly questionable ones such as packing [15]); put the blame on parents for the neuro-developmental disorders of their children; and may even sue a filmmaker who dares to expose their ideas about autism [16]. In a context of increasing challenges to their authority, French psychoanalysts relish any overt sign of interest for psychoanalysis from a world-renowned neuroscientist. Such declarations are then instrumentalised in the hope of delaying any evolution of French psychiatry and psychology for a few more years, forming new obstacles on the path to evidence-based psychiatry. Patients pay dearly for that.

I have no doubt that the respected neuroscientists mentioned above condemn all these abuses and show indefectible commitment to evidence-based psychology and psychiatry. But they should think twice before making any statement that may be interpreted as a rehabilitation of psychoanalysis (unless they have stunning new data to reveal, of course). They should be aware of all the consequences of unduly preserving the popularity of psychoanalysis. They should be aware that they will be unwittingly enrolled in the support of dismal diagnostic and therapeutic practices, at the expense of patients, albeit in distant places.

If psychoanalysis is to be rehabilitated, this will have to be on the basis of its own merits. It is not enough for empirical research to tackle the influence of early life experiences, the neural correlates of unconscious processing, or the decoding of dream content using neuroimaging, to support psychoanalysis as such, even if Freud happened to use the same words. What is needed is to show that (1) certain central psychoanalytical concepts (such as the Oedipus complex, psychosexual development stages or the symbolic meaning of dreams) can now be sufficiently precisely defined to make clear, testable predictions, that some of these predictions are indeed correct, and that they are not better explained by other, simpler theories; or that (2) psychoanalytical theories of the causes of certain mental disorders are correct and make more accurate predictions than alternative theories; or perhaps that (3) psychoanalytical therapies have proven some efficacy for certain disorders, for reasons specific to psychoanalytical concepts. But none of the authors cited here has provided any hint that this is the case. Merely finding inspiration in Freud’s writings and making vague analogies between psychoanalytical concepts and neuroscientific findings will not do.

Franck Ramus, PhD, Laboratoire de Sciences Cognitives et Psycholinguistique, Ecole Normale Superieure, EHESS, CNRS, Paris, France. Email: franck.ramus@ens.fr

First received 8 Feb 2013, final revision 17 May 2013. Accepted 5 Jun 2013

References

1. Panksepp J, Solms M. What is neuropsychoanalysis? Clinically relevant studies of the minded brain. Trends Cogn Sci 2012; 16: 6–8.
2. Kandel ER. A new intellectual framework for psychiatry. Am J Psychiatry 1998; 155: 457–69.
3. Laufer E (ed.) The Psychoanalytic Review Special Issue. On the Frontiers of Psychoanalysis and Neuroscience: Essays in Honor of Eric R. Kandel. Guilford Press, 2012.
4. Damasio AR. Neuroscience and psychoanalysis: A natural alliance. Psychoanal Rev 2012; 99: 591–4.
5. LeDoux J. Afterword. Psychoanal Rev 2012; 99: 595–606.
6. LeDoux JE. The Emotional Brain: The Mysterious Underpinnings of Emotional Life. Simon & Schuster, 1996.
7. Kandel E. The Age of Insight: The Quest to Understand the Unconscious in Art, Mind, and Brain, from Vienna 1900 to the Present. Random House, 2012.
8. Carhart-Harris RL, Friston KJ. The default-mode, ego-functions and free-energy: a neurobiological account of Freudian ideas. Brain 2010; 133: 1265–83.
9. Janet P. L’automatisme Psychologique: Essai de Psychologie Experimentale sur les Formes Inferieures de l’activite Humaine [Psychological automatism: Experimental psychology essay on the lower forms of human activity]. F. Alcan, 1889.
10. Esterson A. Freud returns? Butterflies & Wheels, 3 May 2004 (http://www.butterfliesandwheels.org/2004/freud-returns/).
11. Marr D. Vision: A Computational Investigation into the Human Representation and Processing of Visual Information. W.H. Freeman, 1982.
12. Morton J, Frith U. Causal modeling: a structural approach to developmental psychopathology. In
Developmental Psychopathology Volume 1: Theory and Methods (eds D Cicchetti, DJ Cohen): 357–90. Wiley, 1995.
13. Morton J. Understanding Developmental Disorders: A Causal Modelling Approach. Blackwell, 2004.
14. Mise`s R (ed.) Classification française des Troubles Mentaux de l’enfant et de l’adolescent R-2012: Correspondances et Transcodage – CIM10 (5e edition) [French Classification of Mental Disorders in Children and Adolescents R-2012: Correspondence and Transcoding with ICD-10 (5th edition)]. Presses de l’EHESP, 2012.
15. Amaral D, Rogers SJ, Baron-Cohen S, Bourgeron T, Caffo E, Fombonne E, et al. Against
le packing: a consensus statement. J Am Acad Child Adolesc Psychiatry 2011; 50: 191–2.
16. Jolly D, Novak S. A French film takes issue with the psychoanalytic approach
to autism. The New York Times , 19 Jan 2012 (http://www.nytimes.com/2012/01/20/health/film-about-treatment-of-autism-strongly-criticized-in-france.html?pagewanted=all).

This rare two-part TEDx Talk by Alan Watkins, from TEDxPortsmouth, is better than the title might suggest. He speaks on performance, coherence, and controlling our organism. If you think deep breathing is the way to calm the body, he suggests you are wrong (thanks to Mark Walsh for the heads up on this).

Watkins advocates a slower, more rhythmic breathing cycle that seems to generate more brain coherence (according to his machine). Their model seeks to control all of the factors below the water-line (as seen above) in order to generate better results for the two factors above the water-line.

TEDxPortsmouth - Dr. Alan Watkins - Being Brilliant Every Single Day

Published on Mar 13, 2012 in (2 Parts)

Alan is the founder and CEO of Complete Coherence Ltd. He is recognised as an international expert on leadership and human performance. He has researched and published widely on both subjects for over 18 years. He is currently an Honorary Senior Lecturer in Neuroscience and Psychological Medicine at Imperial College, London as well as an Affiliate Professor of Leadership at the European School of Management, London. He originally qualified as a physician, has a first class degree in psychology and a PhD in immunology.

Website: http://www.complete-coherence.com

Part One:


Part Two:


This is the "About" statement from the Complete Coherence website. Of interest to integral folks, perhaps, because Diane Hamilton is one of their practitioners.

Complete Coherence is powered by compassion.

Our purpose is to develop more enlightened leaders.

Compassion is what gets us all out of bed every single day. We have a strong desire to reduce the suffering that comes from the poor decision making of leaders across the globe. We believe that there is an urgent need to develop more enlightened leadership in organisations. We are also very optimistic about the potential of human beings and what is possible. We delight in helping leaders, executive teams and multi-national organisations develop themselves and deliver much better results even in tough conditions.

Our approach is very bespoke. It is driven by our ability to precisely diagnose the critical issues which, when resolved, will cause a significant improvement in performance. Using a range of high definition diagnostic processes we ensure we understand your issues deeply before intervening. Our interventions integrate the most recent advances from multiple scientific fields including; complexity theory, human performance, neuroscience, evolutionary biology, team dynamics, organisational development, medical technology and many others.

We distinguish “horizontal” development, which is effectively the acquisition of knowledge, skills and experience from “vertical” development. Vertical development enables individuals, teams and organisations to move to a more sophisticated level of performance. Such a distinction is, in our view, critical to delivering sustainable change. We also believe in scientifically measuring the improvements created and sharing the results with you.

Founder and CEO Dr Alan Watkins BSc MBBS PhD is a one of a team of outstanding consultants who are supported by a superb back office who are incredibly friendly and keep us on track to ensure we all deliver Brilliance Every Day!

Tami Simon Speaks with Jack Kornfield on Difficult Times and Liberation

 

In a special re-posting of an Insights at the Edge episode from 2009, Jack Kornfield speaks with Sounds True founder Tami Simon on getting through difficult times and liberation in spite of our neuroses. Kornfield was one of the pioneers in bringing Buddhism to the West and is the author of many books and CDs, including many with Sounds True (see below).

Jack Kornfield, PhD, trained as a Buddhist monk in Thailand, Burma, and India and has taught worldwide since 1974. He is one of the key teachers to introduce Buddhist mindfulness practices to the West. He holds a PhD in clinical psychology and is the co-founder of the Insight Meditation Society and of Spirit Rock Center in Woodacre, California. He has written more than a dozen books including The Wise Heart: A Guide to the Universal Teachings of Buddhist Psychology; A Path with Heart: A Guide Through the Perils and Promises of Spiritual Life; After the Ecstasy, the Laundry: How the Heart Grows Wise on the Spiritual Path; and more.

Enjoy.

Jack Kornfield: Difficult Times and Liberation

Tuesday, June 2, 2009


Tami Simon speaks with Jack Kornfield, the author of The Wise Heart and one of the key teachers to introduce Buddhist mindfulness practice to the West. Kornfield reflects on four decades of personal meditation practice and how this has informed how he works with students. He also explores how Buddhist insights can help us during challenging times, whether or not it is possible or not to be liberated even in spite of our neurosis, and what he means by "the crystal of liberation." (48 minutes)

Download »
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Sounds True Products from Jack Kornfield

The Psychology of the Awakened Heart
A Training in the Four Essentials for a Healthy and Joyful Life. An eight-week online video course on the Buddhist psychology of well-being.


Turn Toward the Beautiful
Creativity as a Path of Liberation: Inspiration for illuminating our lives through presence, beauty, and creativity.

Transmission
Receiving the Living Wisdom of Spiritual Teachers: In-depth reflections and teachings on the student-teacher relationship.


Awakening Is Real
A Guide to the Deeper Dimensions of the Inner Journey: Jack Kornfield’s eight essential talks for advanced travelers on the spiritual path.



Guided Meditations for Self-Healing
Essential Practices to Relieve Physical and Emotional Suffering and Enhance Recovery: Ease physical and emotional suffering and awaken your healing potential.



The Jewel of Liberation
Essential Teachings on the End of Suffering: Ten dharma talks (teaching sessions) about reclaiming our innate freedom and happiness.



Meditation for Beginners
A gentle, step-by-step introduction for newcomers to meditation.

Podcast on Transrealism vs. Hyperrealism (w/ Transrealist Rudy Rucker)

This interesting piece comes from the Diet Soap podcast on the Critical Theory site. For a lot of people, mathematician, computer scientist, philosopher, and sci-fi author Rudy Rucker (Rudolf von Bitter Rucker) is best known as the author of the four cyberpunk novels comprising the Ware Tetralogy (the first two of which won the Philip K Dick Award). But he is also the author of several non-fiction books, most notably Infinity and the Mind: The Science and Philosophy of the Infinite (2004), as well as The Fourth Dimension: A Guided Tour of the Higher Universes (1985), Mind Tools: The Five Levels of Mathematical Reality (1988) and The Lifebox, the Seashell, and the Soul: What Gnarly Computation Taught Me About Ultimate Reality, the Meaning of Life, and How to Be Happy (2006), among many other books.

As a fiction author, Rucker identifies himself as a transrealist (from Wikipedia):

Transrealism is a literary mode that mixes the techniques of incorporating fantastic elements used in science fiction with the techniques of describing immediate perceptions from naturalistic realism. While combining the strengths of the two approaches, it is largely a reaction to their perceived weaknesses. Transrealism addresses the escapism and disconnect with reality of science fiction by providing for superior characterization through autobiographical features and simulation of the author's acquaintances. It addresses the tiredness and boundaries of realism by using fantastic elements to create new metaphors for psychological change and to incorporate the author's perception of a higher reality in which life is embedded. One possible source for this higher reality is the increasingly strange models of the universe put forward in theoretical astrophysics.

Its main proponent and prominent figure is science fiction author Rudy Rucker. Rucker coined the term "transrealism" after reading Philip K Dick's A Scanner Darkly described as "transcendental autobiography," and expounded the principles of transrealism in a short essay titled "A Transrealist Manifesto" in 1983. Rucker applied many of these principles in his short stories and novels, notably White Light and Saucer Wisdom. Damien Broderick has identified some other authors that have at some time utilized transrealist tropes to include Martin Amis, Margaret Atwood, Iain Banks, John Barth, J.G. Ballard, John Calvin Batchelor, Jonathan Carroll, Philip K. Dick especially, Karen Joy Fowler, Lisa Goldstein, James Morrow, Thomas Pynchon, Joanna Russ and James Tiptree Jr. [1]

While the Wikipedia entry sees transrealism as part of the slipstream literature genre, it sounds an awful lot like a form of postmodernist story-telling. Interested readers can check out Rucker's Transrealist Manifesto (1983).

Listen: Podcast on Transrealism vs. Hyperrealism

August 30th, 2013 | by Doug Lain

Rudy Rucker is a cyberpunk author, a mathematician, and a Transrealist. Known for his book Ware Tetralogy (four novels in one volume), Rucker’s most current book is “The Big Aha.” In this episode of the philosophy podcast Diet Soap the ideas of Transrealism and Baudrillard’s Hyperrealism are juxtaposed through sound clips and audio collage.

Rudy Rucker on Transrealism:

The Transrealist writes about immediate perceptions in a fantastic way. Any literature which is not about actual reality is weak and enervated. But the genre of straight realism is all burnt out. Who needs more straight novels? The tools of fantasy and SF offer a means to thicken and intensify realistic fiction. By using fantastic devices it is actually possible to manipulate subtext. The familiar tools of SF — time travel, antigravity, alternate worlds, telepathy, etc. — are in fact symbolic of archetypal modes of perception. Time travel is memory, flight is enlightenment, alternate worlds symbolize the great variety of individual world-views, and telepathy stands for the ability to communicate fully. This is the “Trans” aspect. The “realism” aspect has to do with the fact that a valid work of art should deal with the world the way it actually is. Transrealism tries to treat not only immediate reality, but also the higher reality in which life is embedded.

Listen below.

Adam Hoffman - When Empathy Hurts, Compassion Can Heal (Greater Good)

At UC Berkeley's Greater Good blog, Adam Hoffman reports on the ever-increasing body of evidence that when we witness other people's pain and suffering, especially when we empathize, we can experience vicarious trauma. Being trained in compassion can help alleviate distress we experience.

When Empathy Hurts, Compassion Can Heal

A new neuroscientific study shows that compassion training can help us cope with other people's distress.

By Adam Hoffman | August 22, 2013

Empathy can be painful.

Or so suggests a growing body of neuroscientific research. When we witness suffering and distress in others, our natural tendency to empathize can bring us vicarious pain.

Catherine Choi

Is there a better way of approaching distress in other people? A recent study, published in the journal Cerebral Cortex, suggests that we can better cope with others’ negative emotions by strengthening our own compassion skills, which the researchers define as “feeling concern for another’s suffering and desiring to enhance that individual’s welfare.”

“Empathy is really important for understanding others’ emotions very deeply, but there is a downside of empathy when it comes to the suffering of others,” says Olga Klimecki, a researcher at the Max Planck Institute for Human Cognitive and Brain Sciences in Germany and the lead author of the study. “When we share the suffering of others too much, our negative emotions increase. It carries the danger of an emotional burnout.”

The research team sent study participants to a one-day loving-kindness meditation class, which utilized techniques and philosophies from Eastern contemplative traditions. Participants, none of whom had prior meditation experience, practiced extending feelings of warmth and care toward themselves, a close person, a neutral person, a person in difficulty, and complete strangers, as a way of developing their compassion skills.

Both before and after the training, participants were shown videos of people in distress (e.g., crying after their home was flooded). Following exposure to each video, the researchers measured the subjects’ emotional responses through a survey. Their brain activity was also recorded using an fMRI machine, a device that tracks real-time blood-flow in the brain, thereby enabling the scientists to see what brain areas were active in response to viewing the videos.

They found that the compassion training led participants to experience significantly more positive emotion when viewing the distressing videos. In other words, they seemed better able to cope with distress than they did before the training—and they coped better than a control group that did not receive the compassion training.

“Through compassion training, we can increase our resilience and approach stressful situations with more positive affect,” says Klimecki.

The positive emotional approach was accompanied by a change in brain activation pattern: Before the training, participants showed activity in an “empathic” network associated with pain perception and unpleasantness; after the training, activity shifted to a “compassionate” network that has been associated with love and affiliation.

Their new brain-activation patterns more closely resembled those of an “expert” who had meditated every day on compassion for more than 35 years, whose brain was scanned by the researchers to provide a point of comparison. This result suggests that the training brought about fundamental changes in the ways their brains processed distressing scenes, strengthening the parts that try to alleviate suffering—an example of neuroplasticity, when the brain physically evolves in response to experience.

Negative emotions did not disappear after the loving-kindness training; it’s just that the participants were less likely to feel distressed themselves. According to Klimecki and her colleagues, this suggests that the training allowed participants to stay in touch with the negative emotion from a calmer mindset. “Compassion is a good antidote,” says Klimecki. “It allows us to connect to others’ suffering, without being too distressed.”

The main takeaway is that we can shape our own emotional reactions, and can alter the way we feel and respond to certain situations. In other words, says Klimecki, “Our emotions are not set in stone.”

So is taking a compassion course like the one offered through this study the only way to build compassion? Not necessarily. Research suggests you can cultivate a compassionate mindset through encouraging cooperation, practicing mindfulness, refraining from placing blame on others, acting against inequality, and being receptive to others’ feelings without adopting those feelings as your own.

When Heinz Kohut broke with the Freudian tradition in which he had become a leader, he opened a new world for future generations. In the 1940s, Kohut had become a prominent member of the Chicago Institute for Psychoanalysis, having become such a strong proponent of the traditional psychoanalytic perspective that was then dominant that he jokingly called himself, “Mr. Psychoanalysis.”

As a bit of background, here is a generalized summary of the development of his Self Psychology model, via Wikipedia:

Though he initially tried to remain true to the traditional analytic viewpoint with which he had become associated and viewed the self as separate but coexistent to the ego, Kohut later rejected Freud's structural theory of the id, ego, and superego. He then developed his ideas around what he called the tripartite (three-part) self.[7]

According to Kohut, this three-part self can only develop when the needs of one's “self states”, including one's sense of worth and well-being, are met in relationships with others. In contrast to traditional psychoanalysis, which focuses on drives (instinctual motivations of sex and aggression), internal conflicts, and fantasies, self psychology thus placed a great deal of emphasis on the vicissitudes of relationships.

Kohut demonstrated his interest in how we develop our “sense of self” using narcissism as a model. If a person is narcissistic, it will allow him to suppress feelings of low self-esteem. By talking highly of himself, the person can eliminate his sense of worthlessness.
 

Historical Context

Kohut expanded on his theory during the 1970s, a time in which aggressive individuality, overindulgence, greed, and restlessness left many people feeling empty, fragile, and fragmented.[7]

Perhaps because of its positive, open, and empathic stance on human nature as a whole as well as the individual, self psychology is considered one of the “four psychologies” (the others being drive theory, ego psychology, and object relations); that is, one of the primary theories on which modern dynamic therapists and theorists rely. According to biographer Charles Strozier, “Kohut...may well have saved psychoanalysis from itself”.[2] Without his focus on empathic relationships, dynamic theory might well have faded in comparison to one of the other major psychology orientations (which include humanism and cognitive behavioral therapy) that were being developed around the same time.

Also according to Strozier, Kohut's book, The Analysis of the Self: A Systematic Analysis of the Treatment of the Narcissistic Personality Disorders,[3] “had a significant impact on the field by extending Freud's theory of narcissism and introducing what Kohut called the 'selfobject transferences' of mirroring and idealization”. In other words, children need to idealize and emotionally “sink into” and identify with the idealized competence of admired figures. They also need to have their self-worth reflected back (“mirrored” Note : This term isn't a synonym of "mirroring") by empathic and care-giving others. These experiences allow them to thereby learn the self-soothing and other skills that are necessary for the development of a healthy (cohesive, vigorous) sense of self. For example, therapists become the idealized parent and through transference the patient begins to get the things he has missed. The patient also has the opportunity to reflect on how early the troubling relationship led to personality problems. Narcissism arises from poor attachment at an early age. Freud also believed that narcissism hides low self-esteem, and that therapy will re-parent them through transference and they begin to get the things they missed. Later, Kohut added the third major selfobject theme (and he dropped the hyphen in selfobject) of alter-ego/twinship, the theme of being part of a larger human identification with others.

Though dynamic theory tends to place emphasis on childhood development, Kohut believed that the need for such selfobject relationships does not end at childhood but continues throughout all stages of a person's life.[8]

With that background, here is a brief video of Kohut talking about empathy in his final public speech.

Heinz Kohut - Reflections on Empathy

Uploaded on Jan 9, 2009

Kohut's final speech, "Reflections on Empathy", was given at the 1981 Self Psychology conference in Berkeley, California. He was aware he was dying, and at the conclusion of his speech he announced his final farewell. This is a Lifespan Learning Institute video.

Metaphysical - Philosopher L.A. Paul Interviewed by Richard Marshall (at 3AM)

Nice interview with an interesting philosopher I had never heard of before this. Laurie Ann Paul is a professor of philosophy at the University of North Carolina at Chapel Hill, having previously taught at Yale University and the University of Arizona. This is the statement at the top her UNC faculty page:

I am Professor of Philosophy at UNC Chapel Hill. My main research interests are in metaphysics and the philosophy of mind, especially temporal phenomenology, time, perception, the ontology of mental states, the philosophy of cognitive science, mereology, causation, constitution, and essence. I work on related topics in the philosophy of science and the philosophy of language.

Some of my favorite topics.

She is co-author (with Ned Hall) of Causation: A User’s Guide (2013) and co-editor (withe Ned Hall and John Collins) of Causation and Counterfactuals (2004).

metaphysical

L. A. Paul interviewed by Richard Marshall

L.A. Paul is a deep howdy of metaphysics. She plumbs the depths of why philosophy matters, thinks metaphysical exploration is like scientific exploration in important respects, thinks causation a key puzzle, thinks xphi contributes to the philosophical conversation, thinks fundamental parts of the world are a mix of intrinsic natures, and outlines what you can’t expect when you’re expecting. All in all she’s hardcore. Fabadooza!

3:AM: What made you become a philosopher?

L.A. Paul: Strangely, I don’t really know what caused it. I just realized, sometime early on in college, that I wanted to be a philosopher. I basically decided that I wanted to spend my life thinking as deeply and carefully and reflectively as I could about the nature of reality and our human engagement with it, and that taking a philosophical approach was the best way to go about doing this. I don’t know why I decided this: I hadn’t taken any philosophy classes, or even read much philosophy.

3:AM: You’re interested in metaphysics and the philosophy of mind, amongst other things. Some might wonder whether there’s a point to philosophy in these fields saying that science will get the answers to any puzzles. So why should we listen to philosophers in these fields and not just wait and see what the scientists tell us?

LP: It’s a reasonable question. We should listen to both philosophers and scientists, because the philosophical contribution is different from the scientific contribution, and both of them are worthwhile. Philosophers, especially metaphysicians, explore features of reality and of our mental life that are different from those explored by scientists. For example, metaphysicians are interested in giving a developed account of what it means for objects to have properties that are essential to them, that is, whether there are any properties that objects must have in order to exist, even if the world were to be physically very different from how it actually is. And they are interested in questions about what the causal relation is (what it is to bring something about or make it happen), and about the way in which the present seems to be more real than the past or the future . These are not topics directly explored by scientists, even if some of the facts drawn from natural science are relevant to them.

Contemporary metaphysicians also recognize that there are interesting places of overlap with the natural sciences and with cognitive science. For example, work in fundamental physics is relevant to the way we think about spacetime and about causation. Work in cosmology is relevant to how we think about time, especially the temporal direction, and work in cognitive science is relevant to how we think about our experience of causation and our experience of time. I have argued that we should think of metaphysicians as developing models of parts of reality, like the nature of causation, that science is not investigating directly, and that metaphysicians should draw on natural science when they seek to understand features of reality like spacetime. I have also argued that metaphysicians can usefully draw on cognitive science when they seek to understand and explain our causal and temporal experiences.

3:AM: You argue that metaphysical exploration is like scientific exploration – but it’s hunting different subjects. So what’s it after, and why, if it’s not science, is it still able to make important contributions to our knowledge of the world?

LP: I do think that metaphysical exploration is like scientific exploration, in the sense that philosophers and scientists are both developing models of reality, and furthermore that we all rely to a significant extent on the idea that models which provide elegant, simple and satisfying explanations are more likely to be true. The distinctive contribution that metaphysics makes to our understanding of reality is first that it considers questions about features of reality that the sciences don’t, such as the intrinsic nature of causation or the dynamic character of temporal experience. Often the features metaphysicians are interested in, like causation, time, and essence, involve features that seem so basic or are so generally embedded in the way we experience the world that it takes special attention and focus to draw them out and develop an account of their nature.

A second distinctive difference is that metaphysics works by developing a very wide range of models of these features of reality. This range is much wider than you normally see in the sciences, and we use this wide range of different models to enrich our capacity to understand the world in very different or competing ways. The idea is that by doing this we can gain a special sort of understanding of the world . Each different angle that each metaphysical model explores gives us a new way to think of that part of reality, and thus a new way to understand it. By thinking of the project of metaphysics as modeling different ways to think about the world, instead of thinking of it like the scientific project where the objective is arguably to get a unified picture of the world or a single true model of reality, we get a sense of how the main goal of philosophy, especially metaphysics, is the development of a kind of wisdom about ways the world might be. What I mean by this is that while there’s often a lot of derisive talk about science superseding philosophy as it gets a better and better picture of the world, the history of both fields shows much more exchange—e.g., while philosophy learns from the empirical discoveries and physical theory of science, science has often taken advantage of philosophy’s commitment to rigorously working out seemingly weird models of how the world might be.

3:AM: You’ve pondered on the nature of causation. The story about Suzy breaking her wrist helped show why it’s a difficult idea to pin down. Can you say something about all this and say what it shows about our ideas about causation?

LP: What has emerged from thinking about causation and its puzzles is that there is a deep divide in our intuitions about causation, and correspondingly, a divide in how to handle two very central issues: problems with cases of causation involving multiple causes of the same effect, and problems with causation involving omissions, that is, involving events that don’t occur. In my new book, Causation: A User’s Guide (written with Ned Hall), after surveying the literature in some depth, we conclude that, as yet, there is no reasonably successful reduction of the causal relation. And correspondingly, there is no reasonably successful conceptual analysis of a philosophical causal concept. This conclusion is not wholly pessimistic, however, since we also explore how the search for a reductive theory of causation, and its sister search for an analysis of the concept of causation, has opened up many interesting and fruitful lines of enquiry. As a result of the search for an analysis of causation, philosophers have discovered new causal features and developed richer, more nuanced treatments of the causal relation. And these treatments can be the basis for a productive connection to applied work in statistics and the natural and social sciences, even from this most “metaphysical” of topics.



3:AM: Are things like causation and time just part of the manifest image rather than something science needs to explain the world? Are they just useful illusions, like meaning and free will that evolution has selected us to have or are they fundamentals of nature?

LP: I suspect that these are not opposing ideas: causation and time exist in nature, we also experience them as part of the manifest image, and our experience of them incorporates a certain amount of illusion. What I mean by this is that causation and time exist in human-independent reality. They’d exist even if there were no beings around to experience them. But in addition to causation and time themselves, there are our subjective experiences of causation and time. Some elements of these experiences map onto the intrinsic nature of real causal and temporal relations, perhaps mapping their real character in some way that is transmitted across experience. Other elements do not: some features of our experience do not map onto the real character of causation and time. Instead, these features of our experience flow from the way that the human cognitive system processes causal and temporal and other sorts of stimuli.

3:AM: I guess these questions are connected to the idea of scientific realism and anti-realism. Which are you?

LP: I plead the 5th. Although I usually assume scientific realism in my work.

3:AM: Do you agree with Nancy Cartwright that there are no universal laws of nature, and if there aren’t, does that mean the idea of a law of nature is redundant?

LP: For this, I will assume the realist stance. My answer is “No.” I think Nancy’s work is brilliant, challenging and insightful, but I also think she is wrong. There are laws of nature—of course there are—even if they don’t exist in some sort of bizarre Platonic Heaven. I think she was over-influenced by the empiricism of the twentieth century when she drew her skeptical conclusions. A lot of people were.

3:AM: How much sympathy have you got for xphi and Josh Knobe’s crew?

LP: I have quite a bit of sympathy for the idea that psychology and cognitive science have much to offer philosophy, and that the reverse is true as well. While I do not agree with all of the claims made by experimental philosophers, especially those who seem to think xphi will somehow replace the rest of philosophy, I think xphi projects are interesting and important, I love Josh Knobe’s work, and that these projects contribute something new and worthwhile to the philosophical conversation. I think, in fact, that the connections between philosophy and cognitive science haven’t gone far enough, since as I noted above, metaphysicians should be working closely with cognitive scientists when they try to understand the sources of our experience of parts of the world such as its causal and temporal parts. There have been some direct connections, that is, connections not routed through xphi, drawn between cognitive science and metaphysics recently, but not nearly enough of them.

3:AM: You’ve thought a lot about the role of mereology in working out the fundamentals of the world. You ask one of the big questions – what is the fundamental structure of the world? So perhaps before asking you how to go about answering it you should say what we shouldn’t do to answer it. What are the rival approaches to yours that you reject?

LP: I reject what I see as flat-footed accounts of the fundamental structure of the world, where we somehow assume that, because ordinary experience involves middle-sized objects in space and time, that fundamental reality must be essentially like that. I argue, instead, based on metaphysical and physical considerations, that we should think of the fundamental parts of the world as a mix of intrinsic natures, rather like a paint-pot filled with a rainbow of colors, loosely mixed to give a richly varied, spatiotemporally inseparable, spread of qualities, and that this mixture is what gives rise to ordinary reality.

I also argue that my approach is better than its rivals, especially those which require spacetime to be fundamental. Since my view can be fitted equally well to physical theories that require spacetime to be fundamental and theories that do not, my view does a better job of capturing metaphysical reality, because it grasps the more abstract and general and thus metaphysically deeper features about qualities that are recognized by all of our best fundamental physical theories.

3:AM: Are you some sort of essentialist, and if so, are you a deep one or a shallow one?

LP: Well, of course, it’s always better to be deep rather than shallow. And I’m deep.

3:AM: And what can’t Mary expect when she’s expecting – and why is this important?

LP: The idea behind the paper “What you can’t expect when you’re expecting” has two dimensions. The first dimension is that there is a paradox at the heart of the modern romantic sense in which prospective parents are supposed to decide whether or not they want to have a child by thinking about what it would be like to have a child.

The idea comes out most clearly when we consider it from a woman’s perspective. If you are female, and conditions are otherwise apt, you are supposed to decide whether you want to become a mother by thinking carefully about whether you really want to have a child of your very own, what it would be like to be a mother, whether this is something you really want and will be happy with, etc. In general, you are supposed to evaluate whether you should have a child largely on the basis of what you think it will be like for you to have a child.

The paradox arises from the fact that, until you’ve had a child, you cannot know what it will be like to have one. And moreover, the experience may change you in ways that you cannot predict or even understand before you have the child. This means that you can’t rationally choose to have a child on the basis of what you think it will be like, because there is no way for you to know what it will be like. Even worse, the same is true if you choose not to have a child: since you can’t know what it would have been like for you to have a child, you can’t know the value of what you are missing. And so there is no way to rationally choose whether or not to become a parent.

The second dimension of the idea is that these issues with predicting the nature of one’s own future generalize to other situations. I explore this in detail in my forthcoming book Transformative Experience. The idea is that there is a modern cultural notion (at least in wealthy western societies) that if you are authentic and responsible and thoughtful, you should take charge of your own destiny and map out your subjective future. The process of this form of self-realization involves deliberation, where you reflect upon who you really are and what you really want, in order to plan your life’s path and determine the kind of person you want to become. But I argue that this notion of how best to realize one’s future is deeply confused. The reason it is so confused is that it is impossible to predict what it will be like to have many of the central, determinative experiences of our lives (like having a child, or choosing a career, or trying a drug, or getting married), and so we cannot rationally choose to have them or avoid them based on what we think they will be like. But even though we can’t predict what it will be like to have these experiences, we have them anyway—they are just part of what it is to live one’s life.

If this is the case, then the lesson to draw is that we need to reformulate the way we approach our lives, and stop thinking of our big decisions as involving somehow knowing or predicting what it is going to be like when we choose a particular path of self-realization. Living rationally and authentically does not mean that you map out your future by thinking carefully about what it would be like if you chose one path versus another path and then choosing on that basis. Living rationally and authentically means understanding that life centrally involves making leaps of faith, both small and large, and that the value of living is to a large extent the value of experiencing your life, whatever that experience is. We should realize that we are choosing to have or avoid experiences based on the value of having experience itself, even if the experience involves suffering or pain.

3:AM: And finally, are there five books you could recommend to take us further into your philosophical world?

LP: Four philosophy books, two by David Lewis, On the Plurality of Worlds and Collected Papers, volume II, one by Peter van Inwagen, Material Beings, and one by Quentin Smith, The Felt Meanings of the World. And one psychology book (that is also very philosophical) by Susan Carey, The Origin of Concepts.


ABOUT THE INTERVIEWER
Richard Marshall is still biding his time.

Like Ketamine, Isoflurane Anesthesia Is as Effective as ECT, Without the Cognitive Side Effects

At the end of a recent BBC article (Why are we still using electroconvulsive therapy? Jul 24, 2013) on the contemporary use of electroconvulsive therapy (ECT) for treatment-resistant depression, Professor Ian Reid (University of Aberdeen) is quoted as saying, "No one would be happier than me if we could reproduce the changes that ECT has on the brain in a less invasive and safer way for patients."

Earlier in the article, the reporter offers a brief summary of the current theory of how ECT can be effective in reducing depressive symptoms in those who have not responded to other approaches (mostly pharmaceutical).

The latest theories build on the idea of hyperconnectivity. This new concept in psychiatry suggests parts of the brain can start to transmit signals in a dysfunctional way, overloading the system and leading to conditions from depression to autism.
Prof Reid and his colleagues used MRI scanners to map the brains of nine patients before and after treatment.

In an academic paper in 2012 they claimed ECT can "turn down" overactive connections as they start to build, effectively resetting the brain's wiring. "For the first time we can point to something that ECT does in the brain that makes sense in the context of what we think is wrong in people who are depressed," Prof Reid says.

There is new research (just published this week) that supports the idea that ECT works by disrupting brain activity and neural patterns, essentially acting as a reset for brain function.

Citation:
C. Challis, J. Boulden, A. Veerakumar, J. Espallergues, F. M. Vassoler, R. C. Pierce, S. G. Beck, O. Berton. (2013, Aug). Raphe GABAergic Neurons Mediate the Acquisition of Avoidance after Social Defeat. Journal of Neuroscience; 33 (35): 13978-13988. DOI: 10.1523/JNEUROSCI.2383-13.2013

In a recent study, from the lab of Olivier Berton, PhD (assistant professor, department of Psychiatry), in collaboration with Sheryl Beck, PhD (professor, department of Anesthesiology) at Children's Hospital of Philadelphia, the researchers discovered that bullying and similar social stresses (chronic unavoidable stress, or CUS) appear to create symptoms of depression in mice. This stress response activated GABAergic neurons in the dorsal raphe nucleus (DRN), they found, which directly inhibited serotonin levels. With low serotonin levels (although no one has ever determined exactly what those levels might be [1]), a depressed mouse (and presumably a person) is more likely to be depressed and socially withdrawal.

When the researchers were able to mute the GABA neurons, the mice became more resilient to bullying and didn't avoid once-perceived threats.

"This is the first time that GABA neuron activity -- found deep in the brainstem -- has been shown to play a key role in the cognitive processes associated with social approach or avoidance behavior in mammals," said Dr. Berton. "The results help us to understand why current antidepressants may not work for everyone and how to make them work better -- by targeting GABA neurons that put the brake on serotonin cells."

This where the research into ketamine as a powerful tool in alleviating treatment-resistant depression.

Ketamine is known primarily as a NMDA receptor noncompetitive antagonist (inhibits action of the NMDA receptor), used most often as an anesthetic, but known to have a wide range of effects in humans, including analgesia, anesthesia, hallucinations, elevated blood pressure, and bronchodilation. Like other drugs of its class, such as tiletamine and phencyclidine (PCP), ketamine induces a state referred to as "dissociative anesthesia" and, known on the street as Vitamin K, is used as a recreational drug.

The development of depressive behaviors, notably anhedonia (inability to experience pleasure), with CUS exposure (as in the mice studied above) make CUS one of the most valid research models for depression. There is already considerable and still building evidence that glutamate NMDA receptor antagonists can rapidly reverse behavioral and synaptic deficits caused by chronic stress exposure (Li et al., Biological Psychiatry, 2011).

From Li, et al:

Chronic stress paradigms have been demonstrated to profoundly alter brain structure and function in rodents, causing atrophy of pyramidal neurons in the PFC and the hippocampus (12,13,15-18,20,32). Studies were conducted to determine if our CUS paradigm results in alterations of synapse-associated proteins, as well as the number and function of spine synapses, and if ketamine can reverse these effects. CUS exposure (21 d) decreased levels of several well-characterized synaptic proteins in synaptoneurosome preparations of PFC (Figure 3).

Administration of single dose of ketamine rapidly reversed the CUS-induced behavioral deficits in various feeding behaviors, as well as restoring CUS-decreased levels of the presynaptic protein synapsin I and the postsynaptic proteins GluR1 subunit and PSD95.


The following is from a paper by Rujescu, et al (2006: A Pharmacological Model for Psychosis Based on N-methyl-D-aspartate Receptor Hypofunction: Molecular, Cellular, Functional and Behavioral Abnormalities; Biological Psychiatry; 59:721–729):

Blocking NDMA receptors leads to an excessive release of glutamate (Glu) in the cerebral cortex (Moghaddam et al 1997). This in turn can have deleterious effects on the blocked neuron as well as on downstream corticolimbic brain regions. The paradox of eliciting increased excitation by blocking an excitatory receptor becomes intelligible in view of the functional interaction of gamma-aminobutyric acid (GABA)ergic (inhibitory) interneurons and glutamatergic (excitatory) neurons in local circuits. Activation of GABAergic interneurons via NMDA receptors exerts an inhibitory tone on the major excitatory neurons (Olney et al 1991). As we have demonstrated, GABAergic interneurons are tenfold more sensitive to NMDA receptor inhibitors than pyramidal neurons (Grunze et al 1996). Application of these agents would therefore result in a disinhibition of pyramidal cell activity with widespread downstream glutamate mediated excitotoxicity through alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) and kainate receptors, which remain largely unaffected by NMDA inhibitors like MK-801 (Ikonomidou et al 1989,1999).

And even if this dysregulation created by blocking (or inhibiting, in the case of ketamine) NMDA receptors was not severe enough to cause structural damage, there are likely to be considerable functional consequences "because of the crucial role of inhibitory GABAergic output for information processing":

According to in vitro data, GABAergic neurons yield an oscillatory synchronization of anatomically distributed cell groups, which is considered essential for proper integration of temporospatial information in memory operations (Buzsaki and Chrobak 1995; Buzsaki and Draguhn 2004; Ritz and Sejnowski 1997; von der Malsburg 1995).

As discussed in the Challis, et al article above, CUS causes GABAergic neurons to become much more excitable, which leads to symptoms of depression and anxiety. Increased GABA levels cause a commensurate drop in serotonin levels, which researchers associate with expressions of social defeat, withdrawal, and anhedonia.

Based on the available research, it seems the ketamine "cures" depression so quickly by shutting down the excitability of GABAergic neurons (which become excitable as a result of the organism being exposed to chronic unavoidable stress). Reduced GABA allows for increased serotonin levels, which are associated with "a positive shift in the perception of socio-affective stimuli, promoting affiliation and dominance."

This is a much more targeted approach than ECT, which likely also shuts down GABAergic neuron excitability, but has a much wider range of effects as well. The brain reset associated with ECT is done much more efficiently with ketamine. Like ECT, ketamine (an anesthetic) also probably generates a "electrocortical quiescence" in the brain that functions as a reset mechanism.

Like ketamine, a newer anesthetic substance, Isoflurane, also seems to demonstrate rapid decreases in depressive symptoms for those who have been unresponsive to other pharmaceutical treatments. From Wikipedia:

Isoflurane reduces pain sensitivity (analgesia) and relaxes muscles. Isoflurane likely binds to GABA, glutamates and glycine receptors, but has different effects on each receptor. It potentiates glycine receptor activity, which decreases motor function. It inhibits receptor activity in the NMDA glutamate receptor subtype. Isoflurane inhibits conduction in activated potassium channels. Isoflurane also affects intracellular molecules. It activates calcium ATPase by increasing membrane fluidity. It binds to the D subunit of ATP synthase and NADH dehydrogenase.

There is increasing evidence of isoflurane effectiveness in treating major depression.

Citation:
Weeks HR III, Tadler SC, Smith KW, Iacob E, Saccoman M, et al. (2013, Jul 26). Antidepressant and Neurocognitive Effects of Isoflurane Anesthesia versus Electroconvulsive Therapy in Refractory Depression. PLoS ONE 8(7): e69809. doi: 10.1371/journal.pone.0069809

When isoflurane is compared head-to-head with ECT, the outcomes are similar, except that the ECT subjects suffered greater cognitive deficits. Over the course of 3 weeks, patients with "medication-refractory depression" received an average of 10 treatments of bifrontal ECT (N=20) or an equivalent number of deep-inhalation isoflurane treatments (N=8).

Here is a nice summary of the results from Medscape Medical News:

Both therapies produced significant (P < .0001) reductions in depression scores on the Hamilton Rating Scale for Depression–24 immediately following the end of treatment, and the benefits persisted at 4 weeks' follow-up. ECT patients had "modestly better" antidepressant effect at follow-up in severity-matched patients, the researchers note.

As expected, ECT caused thinking problems. Immediately after the treatments, ECT patients showed decline in memory, verbal fluency, and processing speed. Most of these ECT-related deficits resolved by 4 weeks. However, autobiographic memory, or recall of personal life events, remained below pretreatment levels for ECT patients 4 weeks after treatment.

In contrast, patients treated with isoflurane showed no performance decrement on any of the traditional cognitive impairment measures at any point. In fact, the isoflurane patients showed significant improvements in some tests, which could be a result of the combined effects of decreased depressive state and practice.

The next step in the research should be a head-to-head, placebo controlled double-blind study comparing isoflurane with ketamine. At the moment, it seems that isoflurane requires more treatments (they used 10 deep-inhalation isoflurane treatments over three weeks in the PLoS ONE study) than ketamine (a 2012 study used 6 intravenous infusions treatments over two weeks [2]).

In fact, this second study (Murrough, 2012) postulated a mechanism of action similar to what I have proposed above:

A series of studies found that ketamine and other NMDAR antagonists enhance glutamateric signaling in the cortex of rodents, potentially through inhibition of GABAergic interneurons and subsequent disinhibition of cortical pyramidal neurons (26,27). Enhancement of activity at pyramidal glutamatergic synapses by ketamine would be consistent with the observations of enhanced cortical synaptic plasticity and function described above. Neuroimaging studies in humans likewise suggest that subanesthetic doses of ketamine result in elevated cortical activity, including in regions of PFC and ACC (28–31). A functional MRI (fMRI) study found that ketamine resulted in decreased activity in ventromedial PFC (VMPFC), OFC and SGACC accompanied by increased activity in posterior cingulate and other cortical regions (32).

So while ECT seems to affect much of the brain, which no doubt accounts for the cognitive deficits and the loss of autobiographical memory, ketamine (and presumably isoflurane) dampens activity in the ventromedial prefrontal cortex (vmPFC), the orbital frontal cortex (OFC), and the subgenual anterior cingulate cortex (sgACC), while it also increases activity in the posterior cingulate and other cortical regions.


The vmPFC is associated with emotional processing, decision making and, according to Antonio Damasio (1996) [3], via Wikipedia:

the vmPFC has a central role in adapting somatic markers—emotional associations, or associations between mental objects and visceral (bodily) feedback—for use in natural decision making. This account also gives the vmPFC a role in moderating emotions and emotional reactions because whether the vmPFC decides the markers are positive or negative affects the appropriate response in a particular situation.

The sgACC is also associated with emotion regulation (Drevets, Savitz, and Trimble, 2009), and it shows a size decrease in those with depression:

In a combined positron emission tomography/magnetic resonance imaging study of mood disorders, we demonstrated that the mean gray matter volume of this “subgenual” ACC (sgACC) cortex is abnormally reduced in subjects with major depressive disorder (MDD) and bipolar disorder, irrespective of mood state. Neuropathological assessments of sgACC tissue acquired postmortem from subjects with MDD or bipolar disorder confirmed the decrement in gray matter volume, and revealed that this abnormality was associated with a reduction in glia, with no equivalent loss of neurons. In positron emission tomography studies, the metabolic activity was elevated in this region in the depressed relative to the remitted phases of the same MDD subjects, and effective antidepressant treatment was associated with a reduction in sgACC activity.

The OFC is more of a switching station, processing sensory data from a variety of somatic inputs and sharing extensive connections with other association cortices, primary sensory and association cortices, limbic systems, and other subcortical areas. Corticocortical connections include extensive local projections to and from other prefrontal regions, as well as with motor, limbic, and sensory cortices. Areas projecting to motor areas are densely interconnected with other prefrontal cortical regions, reflecting integration for executive motor control (Cavada, Company, Tejedor, Cruz-Rizzolo, and Reinoso-Suarez, 2000).

From this it seems that part of the effect of ketamine infusion is a dampening of the parts of the brain associated with emotional regulation, affective processing, and the interplay between somatic states and emotional states. Since isoflurane also seems to work on the glutamate system, it will be interesting to see if it produces the same outcomes and affects the same brain structures and functions.

Bottom line: both ketamine and isoflurane are effective and safer therapeutics for treatment-resistant depression.


NOTES:

1. "There is now substantial evidence that unmedicated depressed patients have abnormalities in brain 5-HT function; however, the relation of these abnormalities to the clinical syndrome is unclear." [Cowen, PJ. (2008, Sep 1). Serotonin and depression: Pathophysiological mechanism or marketing myth? Trends in Pharmacological Sciences, Volume 29, Issue 9, 433-436. doi: 10.1016/j.tips.2008.05.004]

2. Citation for this study:
Murrough, JW. (2012, Feb). Ketamine as a Novel Antidepressant: From Synapse to Behavior. Clinical Pharmacology & Therapeutics; 91(2): 303–309. Published online 2011 December 28. doi:  10.1038/clpt.2011.244


3. Citation for the Damasio study:
Damasio, AR, Everitt, BJ, Bishop, D. (1996, Oct 29). The Somatic Marker Hypothesis and the Possible Functions of the Prefrontal Cortex. Philosophical Transactions: Biological Sciences, Vol. 351, No. 1346, Executive and Cognitive Functions of the Prefrontal Cortex, pp. 1413-1420.

Awesome - happy Sunday! This comes courtesy of Open Culture.

Watch Big Time, the Concert Film Capturing Tom Waits on His Best Tour Ever (1988)

 August 30th, 2013

Here at Open Culture, we’ve often featured the many sides of Tom Waits: actor, poetry reader, favored David Letterman guest. More rarely, we’ve posted material dedicated to showcasing him practicing his primary craft, writing songs and singing them. But when a full-fledged Tom Waits concert does surface here, prepare to settle in for an unrelentingly (and entertainingly) askew musical experience. In March, we posted Burma Shave, an hour-long performance from the late seventies in which Waits took on “the persona of a down-and-out barfly with the soul of a Beat poet.” Today, we fast-forward a decade to Big Time, by which point Waits could express the essences of “avant-garde composer Harry Partch, Howlin’ Wolf, Frank Sinatra, Astor Piazzolla, Irish tenor John McCormack, Kurt Weill, Louis Prima, Mexican norteño bands and Vegas lounge singers.” That evocative quote comes from Big Time‘s own press notes, as excerpted by Dangerous Minds, which calls the viewing experience “like entering a sideshow tent in Tom Waits’s brain.”

Watch the 90-minute concert film in its entirety, though, and you may not find it evocative enough. In 1987, Waits had just put out the album Franks Wild Years, which explores the experience of his alter-ego Frank O’Brien, whom Waits called “a combination of Will Rogers and Mark Twain, playing accordion — but without the wisdom they possessed.” The year before, the singer actually wrote and produced a stage play built around the character, and the Franks Wild Years tour through North America and Europe made thorough use of Waits’ theatrical bent in that era. Its final two shows, at San Francisco’s Warfield Theatre and Los Angeles’ Wiltern Theatre, along with footage from gigs in Dublin, Stockholm and Berlin, make up the bulk of Big Time‘s material. As for its sensibility, well, even Waits fans may feel insecure, and happily so, about quite what to expect. (Fans of The Wire, I should note, will find something familiar indeed in this show’s rendition of “Way Down in the Hole.”)

Related Content:

• Tom Waits, Playing the Down-and-Out Barfly, Appears in Classic 1978 TV Performance
• Tom Waits Reads Charles Bukowski
• Tom Waits and David Letterman: An American Television Tradition
• Tom Waits Shows Us How Not to Get a Date on Valentine’s Day

~ Colin Marshall hosts and produces Notebook on Cities and Culture and writes essays on literature, film, cities, Asia, and aesthetics. He’s at work on a book about Los Angeles, A Los Angeles Primer. Follow him on Twitter at @colinmarshall.

Alva Noë - There's Nothing To Do Here, And It's Perfect

Over at NPR's 13.7 Cosmos and Culture blog, philosopher Alva Noë riffs on the experience of an art exhibit (Robert Irwin's Scrim Veil—Black Rectangle—Natural Light at the Whitney Museum of American Art) that just recently closed. 

Make me wish I lived in  New York City (or close enough to drive there).

There's Nothing To Do Here, And It's Perfect

by Alva Noë
August 31, 2013

Visitors explore Robert Irwin's Scrim Veil—Black Rectangle—Natural Light during its 2013 reprise at the Whitney Museum of American Art.©Robert Irwin/Photography ©2013 Philipp Scholz Rittermann/Courtesy of the Whitney Museum

The elements of Robert Irwin's installation at the Whitney Museum of American Art — the show ends today — are named in the work's title: Scrim Veil—Black rectangle—Natural Light. There's no mystery. No magical ingredient.

It's a large rectangular room with a black floor divided lengthwise by a taut curtain of thin fabric hanging down to about head height; the fabric is translucent, from some angles invisibly transparent, from others impossible to see through; the fabric has a thick black border (another rectangle); there is a thick black line (rectangle) painted on the walls, bisecting them horizontally; light coming through a single large window at the end of the room.

A photo from the 1977 debut of Robert Irwin's Scrim Veil—Black Rectangle—Natural Light at the Whitney Museum of American Art.©Robert Irwin/Photograph ©1977 Warren Silverman/Courtesy of the Whitney Museum

And yet you could practically hear people gasp as they entered the room on the Whitney's fourth floor. Somehow the combined effect of the elements was not only gorgeous, but astonishing.

Yes, there was an optical trick. You could not always quite see the scrim. And because of the black bar of its border, and the similar bar on the wall behind, you had a sense that the two bars were one. You lost a sense of their location in space.

But the fascination of the piece doesn't come down to mere optical play.

I wish I understood what it does come down to.

One remarkable feature of the installation is that it has no focus. You're in it, for one thing, so you can't look at it. There isn't any one thing for you to contemplate. Or rather, everything — the window, the scrim, its border, the floor, the wall, the other people in the gallery — command attention equally.

Compare this with James Turrell's thematically kindred exhibition now at the Guggenheim just uptown. With Turrell you know just what to look at; there is something to inspect.


Or compare it with the installations of Richard Serra, which I've discussed here in the past. Serra's work disorients you and compels exploration. You can't just stand there. You need to do something.

But not so with Irwin. There is nothing to do here. Or, I suppose, there is everything to do. The installation is just a place. A place to be. It is a pure place. Space. And light. Could this be why it feels so good to be there?