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.

For Moritz and her analytic colleagues, that sea slug spelled vindication. Recent studies had shown that talk therapy could relieve symptoms as effectively as drugs, and that the drug effects were temporary. The anti-anxiety drug Paxil, for example, had given cowering rats the courage to seize the proffered bait of Cocoa Krispies -- but the minute the doses stopped, they cowered again. Now, Kandel's slugs would help the world understand that talk therapy could bring about permanent changes.

"There are billions of neurons in the brain, interconnected in infinitely complex ways," explains Moritz, "but our early upbringing makes certain patterns of response more likely than others. When babies are small, they put out all these little branches from their nerve cells -- it's called arborization, because they're making fuzzy trees. The branches can connect with other nerve cells, and the ones that are actually linked will stay, while the ones that are not linked to other neurons will recede. The more those links are cued off in the brain, the thicker they grow, and the stronger the connection that's forged."

If you cried as a babe and your mother immediately soothed and fed you, you formed an expectation that when you were distressed, your needs would be met. If your mother had ignored you instead, or spoken harshly to you, or slapped you upside the head, you would have formed a different expectation. And if the neglect were consistent, you would have begun to respond to the world not with a sense of trust and well-being but with anxiety, turning back upon yourself for what little comfort you could summon. Later in life, you'd find yourself reacting that way at the oddest times, without even understanding why.

"There are people who, out of their early experiences, get a kind of core idea of themselves as either bad and needing to be punished or as perennial victims of the world or as needing to be in a certain relationship to other people -- under their thumb, for instance -- to get their love," Moritz says slowly. "They grow up interpreting any ambiguous situation in a characteristic way, because they have a kind of expectation of what it means. And so they respond, physically and mentally and emotionally, in ways that are completely automatic and outside their awareness. Every time they go the same route, it becomes more of a rut." By drawing their attention -- repeatedly, in the intense framework of a therapy session -- to that route, a therapist can help erase the brain's rut, breaking up the old automatic patterns of association, deepening awareness of what caused them and clearing a path for new, healthier neuronal connections. Yes, it takes time, says Moritz, already defensive, and it should, because the brain responds better to gradual change, making more stable progress.


After her divorce, Moritz never remarried. "People combine themselves in marriage in different ways," she says tentatively. "I think, for us, what happened is, we kind of lost faith in each other. The loss of the baby was so disappointing and so hurtful -- it's, like, maybe you thought the two of you together, or that partner, could make the world be good, and when it didn't work out that way...." She raised the couple's two boys as a single parent, then, 12 years ago, fell in love with a steady, gentle engineer named John Georgiana. She feels no urgent need to make the relationship legal, yet she admits he's what sustains her through the political squabbles, the maddening social inequities and the unsettling empathy of her practice.

Three times a week, the couple stumbles into a fitness club at 5 a.m. and obeys a personal trainer. "I come out of there drenched with sweat," Moritz says, grinning, and slips her shoes off to demonstrate the walking lunges she dreads. "Did 'em this morning -- with weights. I would never work out this hard on my own." Nor would anyone dare psychoanalysis, risk the pain of reconstructing themselves memory by memory, if they didn't have a guide to ease their way. "People are frightened of psychoanalysis, you know," Moritz says abruptly. "We are afraid of our worst impulses -- afraid aggression will be unleashed or we will be ashamed of what we want." She remembers how her own heart thumped almost 40 years ago in Anthony's waiting room. What if she'd listened and fled? A more "medical" psychiatrist might have diagnosed her "depression associated with loss" as a biochemical imbalance foreshadowed in her genes. After starting her on anti-depressants, he might have suggested that she keep busy, think positive, eat well and get plenty of exercise. No need to remember how she'd resented her mother for divorcing her father or how she'd worried that anybody she loved would walk out on her. She would have won her way to a bland, resigned self-acceptance -- no guilt, no blame, just a life spent tinkering at her brain's surface. She might even feel better. But she'd never know why.

Instead, she devoted her life to that question. Does she ever wish she'd taken the crisp, medical approach? "Well, yeah," she retorts. "It seems so clean. It doesn't have anything to do with the messiness and horrors of the mind. It would be so nice to make a diagnosis by checklist and prescribe the proper med and see 'em again in a month for 15 minutes." The sarcasm drips right onto her coffee table. But a minute later, her voice softens: "The part of medicine I do think about sometimes is the laying-on of hands, the times when you know that concrete actions you have taken have dramatically helped. Yet in the end, psychoanalysis is the same -- people talk about 'the worried well,' but that is really not who we're dealing with. There is no pain like the pain of deep depression or being so ridden with anxiety you're afraid to leave your own home."

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