McMan's First Annual (Or Whenever) Psychiatric Exasperaters Awards - that called out four very prominent (and intellectually bankrupt) psychiatrists for their flagrant disregard of the facts. But I also made reference to a number of "inspirators" who are leading psychiatry and brain science and related disciplines toward a "new science of the mind." The coiner of that phrase is one of my psychiatric heroes, Eric Kandel. The following first appeared in a 2005 newsletter, then soon after as a mcmanweb article, then as a two-part piece here in Nov 2009. This time, I've rejoined the pieces as a one-parter. Be inspired ...
At five in the morning in October 2000, Denise Kandel fielded a call from Sweden. She didn’t understand what the person was saying except for the last word, "Stockholm." Then the realization dawned. The Nobel committee was on the line, with news for her husband Eric.
Rewind the clock to 62 years before. This time the sound in the middle of the night was that of the breaking glass of shop windows of Jewish businesses. The infamous Kristallnacht was raging across Germany and Nazi-occupied Austria. In Vienna, thugs burst into the Kandel’s apartment and forced young Eric and his brother and parents out into the street. The family returned a week or so later to find their home ransacked and all their valuables gone.
Young Eric and his brother were fortunate enough to find refuge in Brooklyn, months before World War II broke out. His parents got out with mere days to spare. The memory of that night and the horrors of a year under Nazi rule carried a profound impact.
"How could a highly educated and cultured society, a society that at one historical moment nourished the music of Haydn, Mozart, and Beethoven, in the next historical moment sink into barbarism?" Dr Kandel wrote in his Nobel autobiography many years later.
It was a question he took up in his undergraduate pursuits at Harvard. To continue his quest, he decided that psychoanalysis – the intellectual rage of the 1950s -was "perhaps the only approach, to understanding the mind, including the irrational nature of motivation and unconscious and conscious memory."
But a funny thing happened in his last year as a medical student at NYU. He decided to take an elective course in neurobiology at Columbia University. That led to a recommendation to join the NIMH as a postdoctoral fellow in the lab of the legendary Wade Marshall, who had mapped out the sensory system in the brain. Suddenly, psychoanalysis seemed like an artifact of an earlier age. The searing questions forged from his childhood in Vienna now found a new medium in modern biology.
"I am struck," he wrote, "as others have been, at how deeply these traumatic events of my childhood became burned into memory."
During his three years at the NIMH, Dr Kandel began his lifelong quest into the biological mechanism of the memory. With colleague Alden Spencer MD, Dr Kandel published a series of articles in the early 1960s documenting their discoveries of the cellular properties of hippocampal neurons. But the two researchers realized these findings alone could not account for how memory was stored. Instead, they began to look into how the neurons were functionally connected. But they needed a simpler place to start than the hippocampus. Dr Spencer turned to the spinal column while Dr Kandel hitched his star to the humble sea snail.
Dr Kandel’s mentors at the NIMH strongly discouraged him from taking such a radically reductionist approach to a complex biological process. Nothing interesting, they argued, could be found in a mere invertebrate, much less have application to higher life forms. But Dr Kandel was young and brash. After ruling out crayfish, lobster, flies, and the nematode, among others, Dr Kandel arrived at the aplysia, a giant marine snail. The animal’s small number of extraordinarily large and distinctively pigmented nerve cells conferred the advantage of easy observation and experimentation.
After completing a two-year psychiatric residency at Harvard, Dr Kandel headed off to Paris for a 16-month tutelage under Ladislav Tauc, one of only two people in the world working on the aplysia. Their collaboration led to a series of articles from the early to mid-1960s. But this was only the beginning.
"Matisse had it right when he pointed out that life is a circle," Dr Kandel told a packed auditorium at the American Psychiatric Association’s annual meeting in Atlanta in May 2005. In other words, if you follow your unconscious, you often find you come back to the themes that interested you in the beginning.
In 1990, while still working on snails, Dr Kandel returned to studying mammalian hippocampal neurons, mapping out the higher memory functions in mice. In the lab, he was able to reverse age-related memory loss in his animals.
"If you’re a mouse," he joked, "we can do a lot for you. For people, we’re not sure as yet."
Then Dr Kandel extended his focus to the amygdala, which governs fear. Fear, he explained, is the one behavior so far we can observe in animals. A mouse that receives a shock accompanied by the sound of a bell will soon crouch in fear to just that sound. Dr Kandel’s lab discovered that this kind of fear resulted in the release of the peptide GRP in the amygdala of the animals. Mice bred without the capacity to produce GRP lost their inhibition.
"Maybe in some disease states," Dr Kandel commented, "inhibitory restraint is compromised."
But that is not the end of the story. What would happen, he wondered, if you set out to investigate the mirror image of fear? This time, Dr Kandel’s team trained mice to associate a particular sound with safety. As expected, the animals’ sense of security dampened activity in the amygdala. But the investigators also discovered a circuit connecting the amygdala to the dorsal striatum (caudoputamen), an area of the brain associated with happiness and reward.
"We don’t like being miserable," Dr Kandel explained. "What we really want to do is to be happy, to be secure, to be confident." He quoted the first line of Anna Karenina: "Happy families are all alike …"
"That really is inspiring to a neurobiologist," Dr Kandel joked, "because if you find the gene it is going to be unbelievably universal." So as well as identifying new targets for anxiety drugs, he explained, we may also find targets for enhancing positive affect.
Dr Kandel has written extensively on integrating his first love – psychoanalysis – with his vocation, neurobiology. Despite some signs that psychoanalysis is joining the real world, however, he does continue to scold this branch of the profession for its insularity, disregard for patient outcomes, and lack of scientific rigor – traits not shared, he says, by practitioners in many other fields of talking therapy.
"A major need of psychiatry in the future," he stated, "is to put the psychotherapeutic arm of psychiatry on the same solid biological footing as the pharmacological aspect of psychiatry." He was very much moved by Kay Jamison who said if it wasn’t for lithium she would be dead, but that it was really psychotherapy that gave her a coherent view of her life, that allowed her to tie the various strings of her life together.
"We’re in a fantastic phase of psychiatric thought," he concluded. The biology of the mind is the central scientific challenge of the twenty-first century. Molecular genetics and molecular biology, he said, have given us insights that would have been inconceivable 20 or 30 years ago. These advances will revolutionize psychiatry, but hardly eliminate it. Instead, psychiatry will synthesize with molecular biology into what he describes as "the new science of the mind."
Dr Kandel - an avid lover of fine art, classical music, and opera - resides in the Riverdale section of the Bronx with his wife of 50 years, Denise. As a girl in Nazi-occupied France, Denise hid in a convent without knowing the whereabouts of her parents. Denise is a professor in the Department of Psychiatry and School of Public Health at Columbia and a pioneer in the epidemiology of drug use in adolescents. They have two children and a number of grandchildren.
Writes Dr Kandel in his Nobel autobiography:
"In retrospect it seems a very long way for me from Vienna to Stockholm. My timely departure from Vienna made for a remarkably fortunate life in the United States. The freedom that I have experienced in America and in its academic institutions made Stockholm possible for me, as it has for many others."