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.

Her solution is to plumb the depths. Wash. U.'s not convinced it works. "Working hours a week with an individual patient, there is very little data that shows that that intensive, very costly therapy is effective," says Rubin. "Their response is, 'The patients will tell you how effective it is.' But how do you study that?" Impasse. Still, Rubin's convinced the old polarization has ended; he uses words such as "convergence" and talks about an emerging "sensitivity to the importance of time with patients" -- not hours and hours of psychoanalysis, perhaps, but the shorter, more efficient talk therapies. "Wash. U.'s medical model was overinterpreted, or misinterpreted, as purely biological. We're notonly interested in drugs -- 'Pop a pill' is just bad medicine, and it's not what Eli Robins or Sam Guze taught the country. The medical model is a treatment approach."

Rubin predicts "a natural progression from the medical model to understanding the mechanisms of some of our illnesses at a very scientific level." He offers examples -- identifying the chemical hypocretin, which causes narcolepsy; targeting the abnormal accumulations of material in the brain of someone with Alzheimer's disease; finding the genetic underpinnings of abuse and other trauma. "We as a department may be again in the forefront," he adds with satisfaction, "in trying to push this approach."

Kandel, wizard of the sea slugs, applauds such biological research and urges psychoanalysts to involve themselves in its midst so they can both incorporate and shape the new discoveries. At the handful of medical centers where the disciplines are already integrated, it may just be possible.

Not in St. Louis.

There's middle ground at St. Louis University, which has always been more therapy-centered and even has a psychoanalyst chairing its psychiatry department. But the major research money, and the acknowledged research brilliance, is at Wash. U., and the deepest analytic expertise is at the Institute. For two decades, the two institutions have stood a block apart and barely spoken. Now, the analysts have outgrown their once-modern building, so they're scouting elsewhere for a bigger place. Somewhere in the county. Outside the shadow of the kingdom.

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