Mind Over Matter

For two decades, psychoanalysts have held fast to their slow, deep exploration of the psyche, reaping only scorn from the science-driven psychiatrists at Washington University. Good thing they didn't listen.

If Dr. K. Lynne Moritz were a haughtier sort, we could call her the queen in exile. Director of the St. Louis Psychoanalytic Institute for the past four years, she was one of its first graduates, back in the heady days before one had to apologize for Freud. Leaving pediatric medicine behind, she chose to concentrate on her patients’ psyches, which she defined, in secular terms, as their souls — their essence, their identity, their consciousness and all it hid. Clues swirled in an ether of memories, dreams, imaginings and unconscious associations, and it was Moritz’s job to hold the flashlight steady until her patients could see their way clear.

She found psychoanalysis deeply satisfying, but year after year she watched it grow more suspect as a wall rose, high and spiked, to divide the Institute’s methods from the increasingly powerful, science-driven form of psychiatry practiced at the Washington University School of Medicine. Loyal to the analytic approach, Moritz stayed on at the Institute, a quiet, mushroom-beige International-style building on Forest Park Parkway, a block east of the bustling medical school. A block east, and a world apart. “The people who fail with a biochemical approach eventually come here,” she remarks, “and the people we fail find their way there. Unfortunately, there has been a kind of tradition at Wash. U. to make that polarized.”

She thinks, sometimes, about places such as Columbia-Presbyterian Medical Center in New York, where the psychoanalytic-training center is housed within Columbia's department of psychiatry and faculty have joint specialties in, say, psychoanalysis and neuroendocrinology, or epidemiology, or genetics. Wash. U.'s psychiatrists still bash Freud for sport at their grand-rounds lectures; they refer coolly, when necessary, to "those people at the Institute," but they rely on their own research-based, diagnosis-driven medical model.

To remain accredited, though, Wash. U. must at least acknowledge the most intense of the talk therapies. Moritz has supervised residents there, and Dr. Eric Nuetzel, the affable, bearlike, rosy-cheeked psychoanalyst who's replacing her as the Institute's director, has faculty standing at Wash. U. Their presence can be awkward: Nuetzel studied theater before attending med school (Moritz majored in English literature, aspiring to be a Shakespeare scholar) and both mine clinical insights from Chekhov, King Lear and the latest entries in the Sundance Film Festival. Wash. U. is not particularly hospitable to such fuzziness; at times, Nuetzel's lectures are nearly inaudible over the residents' cries of "Where's the proof?"

Passionate about teaching and genuinely interested in Wash. U.'s empirical research, Nuetzel weathers their criticism the way a boulder takes the waves. Moritz feels the skepticism a bit more keenly, but she doesn't buy it; for her, proof lies in her patients' lives. Still, she's convinced that St. Louis would be better served if Wash. U.'s esteemed psychiatrists and the Institute's esteemed psychoanalysts didn't run screaming from each other's company.

Dr. Eugene Rubin, professor of psychiatry and vice chair for education at Wash. U.'s medical school, admits there was some polarization back in the '80s, but says that it's over, and that it was inevitable. St. Louis had become the epicenter of an earthquake that shifted the entire field of psychiatry, knocking it off the psychoanalytic orientation that had dominated for decades. "Wash. U. succeeded in convincing the rest of the world that human behavior can be studied and understood with the same tools we use for the rest of medicine," says Rubin. "That battle has been won. But there's a lot we can still learn from the in-depth understanding --"

He doesn't finish the sentence "of psychoanalysis"; it's as though the very word hurts. "One of the difficulties of that model is that it makes major statements of fact but the statements are untestable," he continues. "Many of the things psychoanalysts have described make sense from a common-sense point of view, but they come to very strong conclusions that are not based on any data." One such conclusion is the "subconscious," imagined as vast catacombs where powerfully influential memories lie buried just out of reach and continue to haunt us. Wash. U. psychiatrists might conduct sleep studies, or study mechanisms of thought and perception, but they're not going to waste hours of therapy time digging for hypothetical, invisible causes of distress.

Moritz has spent four decades digging, and she trusts what she's seen. Besides, she says, the data are finally arriving. Studies indicate that our brains literally rewire themselves with successful talk therapy. High-tech scans show our brains lighting up with unconscious thoughts. Freud's notion of an instinctive id that speaks in our dreams and a rational ego that takes over during the day? The same scans show that, when we dream, the parts of our brains involved with emotion, memory and motivation light up, whereas the centers of logic and abstract thought stay dark as night itself. As for all that Freudian emphasis on our childhood and our parents, researchers now believe that the adult who's caring for a young child actually shapes and regulates, from the outside, the structure and neurochemistry of the child's maturing brain. A mother's touch can literally change her baby's mind.

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