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  2. Thornton SP. Sigmund Freud (1856-1939). Internet Encyclopedia of Philosophy. http://www.iep.utm.edu/freud/ Accessed May 10, 2016.
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Steven Rourke
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Brain Healers Through History, Part 3: Freud to Sacks

Steven Rourke  |  June 8, 2016

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Slide 1

It's stunning to think of the advancements in our understanding of the brain and mental illness between the heady days of the Vienna Psychoanalytic Society and the more recent contributions of Eric Kandel, B.F. Skinner, Julius Axelrod, and Oliver Sacks—a volatile century filled with achievements, controversies, and numerous new paths of study.

Images from iStock, Alamy, courtesy of National Institutes of Health, and courtesy of Wikimedia Commons

Slide 2

Sigmund Freud (1856-1939)

Although many of his ideas have largely been discredited, few people have stirred the public, private, and scientific imagination as much as Sigmund Freud, notably for his development of psychoanalysis and theory of the mind.

Freud, and the Vienna Psychoanalytic Society that he brought to life, were tremendously important for a long list of specialties, thinkers, and the public. Freud's theories of neuroses, the unconscious, coping mechanisms, sexual genesis, and interpretation of dreams, and his practice of psychoanalysis, placed him center stage—with historical perspective raising him to a rare level of scrutiny shared by only the most famous or infamous.[1,2]

A trained biologist, neurologist, and physician, Freud considered himself first and foremost a scientist, seeking scientific rigor in which to ground his original approaches to the mind. He was influenced by fellow scientists—Ernst Wilhelm von Brücke, Josef Breuer, Charles Darwin, and Jean-Martin Charcot—and the great physicists of his age and, controversially, envisaged psychoanalysis as a new science.[2] Whether or not this is the case continues to be debated. Notwithstanding, Freud's prolific career and far-reaching influence cannot be denied.

Images from Dreamstime and courtesy of Wikimedia Commons

Slide 3

Carl Gustav Jung (1875-1961)

Swiss psychiatrist and psychotherapist C.G. Jung was also an imposing figure in the development of theories of the mind. Famously diverging from Sigmund Freud in disagreement (in a nutshell) with his one-time mentor's emphasis on the sexual nature of development[3]—a rupture that left him almost totally isolated at the time—Jung became a separate tower in the landscape of 20th-century psychology and psychoanalysis.

Jung's contributions included theories of individuation; the archetype and psychological types (introversion and extraversion); the collective unconscious; complexes; and the founding of a separate school of thought, analytical psychology.[4,5]

Controversy surrounds Jung's relations with Nazi Germany and his theories of "racial inheritance,"[3] described as ridiculous slander by some and despicable truth by others.[3,6,7]

Images from Dreamstime and courtesy of National Institutes of Health

Slide 4

Anna Freud (1895-1982)

Anna Freud, the youngest child of Sigmund Freud, followed in the psychoanalytical tradition of her father and dedicated her life to the well-being of children, advancing our understanding of pediatric psychology. Freud's contribution to history also includes her discussion of the defense mechanisms of the ego.[8,9]

After a combination of therapy and apprenticeship with her father, Anna established her own psychoanalytic practice, specializing in childhood development. She was active in the Vienna Psychoanalytic Society and the International Psychoanalytical Association, and was a lecturer at the Vienna Psychoanalytical Training Institute.

On the eve of the Second World War, the timely establishment of the Freud family in London was largely due to Anna Freud. Once in London, she continued to shape the British field of child psychology, in head-to-head competition for many years with Melanie Klein.[1,9] In describing her approach with children, she wrote that "it was above all the transference symptoms that offered the "royal road" to the unconscious."[9]

Anna Freud was widely respected and invited to lecture around the world. She travelled extensively, particularly to the United States, where she held teaching appointments. Throughout her life, Freud sought to improve children's lives with "useful application of psychoanalysis"[9] and set the stage for subsequent advances in both psychoanalysis and child psychology.[10]

Images from Dreamstime and courtesy of National Institutes of Health

Slide 5

Melanie Klein (1882-1960)

Also an important figure in psychoanalytic theory, Melanie Klein was central to the development of child psychoanalysis and influential in the development of the object relations theory.

Klein, who was firmly rooted in the analytical framework of Sigmund Freud, made several original contributions to psychoanalytic theory, including the interpretation of external objects, the "schizoid mechanism" and the notion of "splitting," introjection, and her belief in the (very) early onset of the Oedipus complex and similarly early roots of the superego.[1,3,11]

Like the Freuds, Melanie Klein was born in Vienna, but she received her training in Budapest and Berlin before achieving influence from within the British school of psychoanalysis, where her influence was felt the most.

Klein was an early object relations theorist, using psychoanalysis to uncover unconscious emotions, dispositions, assumptions, and images that, she proposed, originated in childhood.[3]

Klein's examination of childhood play was the root of her theories relating to childhood development. She also believed in the central role of fantasy as a primitive function that shapes childhood development and reflects a child's relation with his or her mother. She controversially proposed that a child has "preformed" fantasies and "unlearned knowledge."[3]

Both prominent child psychoanalysts, Melanie Klein and Anna Freud were frequently in vivid disagreement. The Kleinian school remains influential largely in the United Kingdom.

Images from Dreamstime and courtesy of Wikimedia Commons

Slide 6

Aaron T. Beck (1921-)

The American neurologist and psychiatrist Aaron Beck created cognitive therapy and has led an illustrious career, publishing more than 25 books and 600 scholarly articles, and he has been rewarded with an array of international distinctions.[12]

Put simply, cognitive therapy, as envisaged by Beck, relies on his interpretation of the preexisting concept of "schemas" that govern how we process information and behave—and can become confused and enmeshed. The role of therapy is to "disentangle and clarify" these cognitive schemas—the personal, familial, and cultural—which, Beck proposes, continue to exist because they offer short-term survival advantages, as opposed to long-term solutions provided by therapy.[3]

Beck's theoretical model is grounded in evolution. He believes that "genetically determined strategies…have facilitated survival and reproduction through natural selection."[3]

Beck, who has written extensively on depression and anxiety disorders, created a new field of study that continues to expand.

Images from Dreamstime and courtesy of Beck Institute for Cognitive Behavior Therapy

Slide 7

Modern Psychopharmacology: Chlorpromazine

The discovery of the first antipsychotic drug—the first drug specific to mental illness[1]—marked a radical shift in the care of mental illness and earned Pierre Deniker (1917-1998), Henri Labourit (1914-1995), and Heinz Lehmann (1911-1999) the 1957 Lasker Award "for the development of chlorpromazine as a therapeutic agent in schizophrenia."[13]

The dopamine receptor blocker, which became commercially available in 1952, transformed hospital wards, reducing agitation and providing psychiatrists at last with a powerful pharmacotherapeutic tool. The "miracle" drug rapidly opened the way for new fields of study: psychopharmacology and neuropsychopharmacology. It also revealed the heterogeneous nature of schizophrenia as seen through the diverse responsiveness to treatment.[14]

Henri Labourit was active in the discovery of chlorpromazine and the first to apply it as a therapeutic agent,[13,14] whereas Pierre Deniker and German-Canadian Heinz Lehmann were largely responsible for psychiatry's adoption of chlorpromazine by, respectively, proposing that the drug calmed patients by providing rest and relaxation and characterizing its effects on individual patients on the psychiatry ward. The distinguished French physician and member of l'Académie Française Jean Delay (1907-1987) was also an active participant in the discovery, study, and adoption of chlorpromazine.[14,15]

Images from Dreamstime and Alamy

Slide 8

Modern Psychopharmacology: Imipramine

Ronald Kuhn (1912-2005), the Swiss psychiatrist who synthesized imipramine, saw the potential for the drug to treat depression, noting in his study from 1958 that patients started to "get up in the morning of their own accord" and that "their facial expressions become more vivacious…they once again begin to seek contact with the outside world."[16]

Images from Dreamstime and Alamy

Slide 9

Modern Psychopharmacology: Lithium

For his introduction of lithium as a treatment for mania, the Australian psychiatrist John Cade (1912-1980) is cited as the pioneer of the era of condition-specific psychopharmacology. His work preceded the discovery of other, specific antipsychotic and antidepressant drugs.[17] Lithium remains a mainstay—and one of the most effective options—in treating bipolar disorder.

Images from Dreamstime and Alamy

Slide 10

Eric R. Kandel (1929-)

In 2000, when Eric Kandel won the Nobel Prize jointly with Arvid Carlsson and Paul Greengard "for their discoveries concerning signal transduction in the nervous system",[18] he became only the second psychiatrist to win this distinction[19] (after Julius Wagner-Jauregg in 1927, "for his discovery of the therapeutic value of malaria inoculation in the treatment of dementia paralytica").[20]

Kandel showed that changes in synaptic function play a central role in learning and memory, using the nervous system of the modest sea slug as his experimental model.[4] He demonstrated that protein phosphorylation is important for short-term memory, whereas long-term memory also requires a modification to protein synthesis, leading to possible alterations in the shape and function of the synapse.

Born in Vienna, Kandel escaped Nazi rule just before the outbreak of the Second World War and received his training in the United States. On top of a very long list of scholarly publications, he has also written books with crossover appeal to the general reading audience, such as The Age of Insight: The Quest to Understand the Unconscious in Art, Mind, and Brain, from Vienna 1900 to the Present (Random House, 2012). Kandel has also studied memory disorders, mental illness, and drug abuse, as part of an extraordinarily accomplished scientific and academic career.[21,22]

Images from Dreamstime and courtesy of Wikimedia Commons

Slide 11

Seymour S. Kety (1915-2000)

Seymour Kety was a pioneer of biological molecular psychiatry who was awarded the 1999 Albert Lasker Special Achievement Award in Medical Science "for a lifetime of contributions to neuroscience." The award committee cited his "method for measuring cerebral blood flow that led to current brain imaging techniques, adoptive studies in schizophrenia that established its genetic origin, and visionary leadership in mental health that ushered psychiatry into the molecular era."[23]

Kety, a native of Philadelphia, dedicated his life to research and, among many achievements, was the first scientific director of the National Institutes of Health in the 1950s.[2] He was influential in redirecting psychiatric research to examine the biological bases of disease.[23-25]

Kety became interested in the possible genetic basis of schizophrenia in the early 1960s—a time when schizophrenia was considered an interpersonal construct rooted in harmful family relations. His three-decade-long collaborative study followed patterns of disease in biological vs adoptive family members and concluded that genetics plays a defining role in the etiology of disease.[23-25] He stated that "10% of the biological relatives of schizophrenic adoptees have the disorder themselves, a five-fold higher prevalence than exists in the general population."[24] His research also demonstrated that the genetic basis of mental illness extends beyond schizophrenia.[25]

Kety was a visionary in mental health who helped usher psychiatry into the molecular age: "his tread was soft, yet gracefully and unobtrusively dazzling."[25]

Images from Dreamstime and Getty Images

Slide 12

Burrhus Frederic Skinner (1904-1990)

Widely influential and equally controversial, B.F. Skinner built on the theories of John B. Watson and Ivan Pavlov to develop the school of behavioral psychology, arguing that "the goal of the science of psychology was to predict and control an organism's behavior from its current stimulus situation and its history of reinforcement."[26]

Working with rats and pigeons, Skinner observed the association between stimuli and behavior, which he measured minutely using the "Skinner box" (one of his many custom-made tools). Applying his observations to human psychology, Skinner believed that behavior could be modified by reinforcement—such as punishment or reward[27]—and that it was possible to "train" people toward a specific outcome.

Hotly contested, and reviled by such critics as Noam Chomsky and Anthony Burgess, Skinner's science of behavior became an influential school of psychology and, among other outcomes, provided the foundations for much of the field of instructional design.[27]

Skinner—the one-time aspiring writer turned psychologist—was the first person to be awarded the American Psychology Association (APA) lifetime achievement award and was voted the APA's most eminent psychologist of the 20th century.[26,28]

Images from Dreamstime and courtesy of National Institutes of Health

Slide 13

Julius Axelrod (1912-2004)

The chemist, pharmacologist, and neuroscientist Julius Axelrod's work on neurotransmitter hormones helped to establish selective serotonin reuptake inhibitors, such as fluoxetine, as a new class of antidepressant medication.[29] Jointly with Bernard Katz and Ulf von Euler, he was awarded the Nobel Prize in 1970 "for their discoveries concerning the humoral transmittors in the nerve terminals and the mechanism for their storage, release and inactivation."[30]

The Karolinska Institutet pointed to Axelrod's discovery of the "mechanisms which regulate the formation of this important transmitter in the nerve cells and the mechanisms which are involved in the inactivation of noradrenaline, partly under the influence of an enzyme discovered by himself."[31]

A native of New York, the son of a basket-maker, with a keen interest in chemistry, medicine, and pharmacology, Axelrod obtained his BSc from the tuition-free City College of New York (which he described as the "proletarian Harvard"[1]) and a master's degree in chemistry from New York University. In his 40s, he took leave from his position at the National Institutes of Health to complete his PhD, titled "The Fate of Phenylisopropylamines."

Axelrod's neurologic career, largely spent studying nerves and how they relate to learning and behavior, had a critical impact on the field, advanced the well-being of mental health patients, and—encouragement for the late bloomers among us—came after many years working in an industrial hygiene lab.[32]

The National Institutes of Health named Axelrod Scientist Emeritus in 1996.

Images from Dreamstime and courtesy of National Institutes of Health

Slide 14

Oliver Sacks (1933-2015)

An enormously popular neurologist, author, one-time weight-lifter, and motorcycle-riding "poet laureate of modern medicine," Oliver Sacks—beyond his dedicated care of thousands of patients—succeeded in making neurology and the implications of brain abnormalities appealing to a wide audience and, one might say, is the first crossover celebrity neurologist.

Awakenings—in which Sacks recounts how L-dopa awakened long-term patients with a form of encephalitis ("sleepy sickness")—was the first in a line of best-selling books that launched a brilliant parallel literary career.

His writing reflected a remarkable clinical practice—attending patients with a range of neurologic disorders (including Tourette syndrome, parkinsonism, epilepsy, schizophrenia, Alzheimer disease, hallucination, and autism)—as well as eclectic interests, such as music and the brain, and, in his later years, thoughts on his personal life.[33]

Perhaps more popular in the New York Review of Books than in peer-reviewed journals, Sacks is part of a lineage of physicians who have written extensively about their patient cases—no doubt the first with such popular appeal.

A British citizen, Sacks came from a family of physicians and scientists and spent most of his adult life in the United States—reveling in California during the 1960s and setting down roots as a "resident alien"[34] in New York thereafter.

Images from Dreamstime and Alamy

Slide 15

Building on the input from Medscape neurology and psychiatry advisors, we've attempted, in this historical overview, to highlight the most influential brain healers through time. But a sprint through history is bound to be incomplete. We pick, we choose. Influence ebbs and flows. Trends and theories come and go. And historical discourse, inward-looking tendencies, and personal and cultural perspectives tend to favor a selected few.

It's perhaps inevitable that we highlight those from the European and North American traditions who have paved the way for the care of the mentally ill as it exists now in our western societies. At the same time, history has passed over others: non-Europeans and many women, for instance, and cultures in which oral traditions are important—much of sub-Saharan Africa and the native populations of the Americas, parts of Asia, and Oceania.

We salute the groundbreaking contributions of the remarkable individuals highlighted in our survey, while acknowledging the influence of countless other thinkers, caregivers, and healthcare professionals from around the world who are not mentioned here.

Image from iStock

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