As a neurobiologist who was never formally associated with psychoanalysis, I have always had great respect for those who write, teach, and practice or utilize the discipline. From the start of my interest in psychiatry to the present day, I have been encouraged, mentored, and influenced by psychoanalysts at a personal level and such facilitation has continued in my research and administrative roles, as well as in friendships.
When I was about 16 and told my parents I was interested in psychiatry, my father, a litigator whose avocation was the history of science and ideas, arranged for me to meet one of his friends, a psychoanalyst who practiced in Los Angeles. That gentleman took me to a lovely small French restaurant in Beverly Hills—my first experience with both psychiatry and such a restaurant. Quite dramatic on both counts. He described his palpable enjoyment and satisfaction being in the profession. Even then I knew my personal interests were in biological areas and he encouraged that approach as well. It was a perfect evening.
After completing Pomona College in three years, I spent a year at UCLA working as a research assistant for James Olds, a social psychologist who, in a remarkable burst of creative experimentation, discovered the neurobiological reward system of the brain in the early 1950s. His work is now recognized as one of the great discoveries in neurobiology of the past half century.
As one of his earliest assistants, I implanted electrodes into the brains of animals that would receive small doses of electricity in a Skinner box setup. By applying such stimuli to areas of the brain, he delineated the reward system. Animals would press the bar hundreds or thousands of times throughout the 24-hour cycle for the reward, which took precedence over essentially all functions. My first publication was an abstract on the 24-hour cycle. His work is now known to be relevant for many forms of normal behavior as well as aspects of mental illness and substance abuse. Had Olds not died at an early age, he might well have received the Nobel Prize. He realized the implications of his work for psychodynamic concepts and would talk about his ideas as he paced about his small laboratory while I implanted the electrodes in a room in the UCLA animal facility.
Editors Note:
At the 2014 National Meeting ten honorary members were welcomed to APsaA. The remarks they gave were both enlightening and entertaining. Four of the seven present sent the text of their remarks. Edited versions have been published in this issue of TAP, beginning on this page and continuing on pages 16-19.
Those granted honorary membership in 2013 include
Jack Barchas, M.D., Beatrice Beebe, Ph.D.,
Jeffrey Berman, Ph.D., Erik Hesse, Ph.D.,
Frank Lachmann, Ph.D.,
Mary Main, Ph.D., Allan Schore, Ph.D.,
Jonathan Shay, M.D., Ph.D.,
Robert Stolorow, Ph.D., and
Estrela Welldon, M.D.
Jack D. Barchas, M.D., is Barklie McKee Henry Professor and chairman of the Department of Psychiatry at Weill Cornell Medical College and psychiatrist-in-chief of Weill Cornell Medical Center of New York-Presbyterian Hospital, including the Payne Whitney Clinic in Manhattan and Westchester.
Leaving Olds to attend Yale Medical School, I had an idea that formed the core of my future work and my life in research: If behavior is important in subsequent mental life—a viewpoint central to psychodynamic approaches and all the multiple ideas of treatment that have evolved from psychodynamics—then behavior must change neurochemistry and neurotransmitters. That behavior can influence brain chemistry mechanisms that in turn can change subsequent behavior now seems obvious; 50 years ago it had not been directly demonstrated. I resolved to study that process at Yale.
Had Olds not died at an early age, he might well have received the Nobel Prize.
While other students were involved in orientation the first week of medical school, I met with almost every person at Yale who worked in what we now call neuroscience. In the great psychiatry department there, then headed by Fritz Redlich, there was only one person doing biological research, Daniel X. Freedman, a young instructor trying to do research but without a laboratory; he borrowed some of the facilities of a pharmacology professor for bioassays of neurotransmitters. Freedman was destined to become one of the great figures as a mentor and administrator of the last half of the 20th century in psychiatry. Freedman, a psychoanalyst who had been analyzed twice and was deeply committed to clinical practice, was an outstanding educator, gifted editor of the Archives of General Psychiatry, and author with Redlich of a superb one-volume text of psychiatry. He was also a warm and loving mentor.
Freedman liked my ideas, including the goal of using newly developed biochemical assays instead of the less reliable and variable bioassays, such as clam hearts, for the neurotransmitters, serotonin and norepinephrine. We knew we could only measure the concentrations of the substances and that the changes could be small but important, thus the need for more sensitive assays. The Department of Psychiatry at Yale, later to become a great power in neurobiology, did not have a pH meter and could not afford to purchase one. We tried without proper equipment to set up the assays.
I was sent to try to convince the Department of Biochemistry to lend us such an instrument—quite beautiful in their maple boxes. Biochemistry had a closet full of such instruments. The department chair refused to lend us a pH meter. He said in effect, “Nothing will happen in neurochemistry for 100 years, if you want to study biochemistry, study the liver.” More discouraging was his response to what I wanted to do with the instrument: “Biochemistry is strong, biochemistry is the locomotive, behavior is weak, like the wind. The wind does not change the locomotive.” We tried our best using European pH paper; it did not work.
Then another event occurred that was both exhilarating and discouraging. Using a clam heart assay for serotonin, Freedman had the first evidence that a hallucinogen, LSD, could change brain serotonin. It was a finding with implications for psychosis. He was scheduled to give his first lecture to the Department of Psychiatry. The room was packed. People were standing or sitting on the floor. His presentation, dramatic and clearly important, was to lead to major work and hundreds of papers in the decades to follow. The first question was from a powerful leader in the department, Professor Theodore Lidtz, who asked in a hostile tone: “Where is this work justified in the work of Freud?” Freedman answered strongly with a thorough knowledge of Freud's writing. He concluded by saying: “If Freud were alive, he would spend his days with me working on topics such as brain serotonin and LSD and his evenings talking with his patients and writing ideas in psychoanalysis.”
It was clear that the “wars in psychiatry” were heated. Nevertheless, during the clinical years on the Yale psychiatry service, I constantly saw the excellence of the analytic perspective as evidenced, for example, by watching a clinician quietly listening to a person with schizophrenia and establishing real contact with that individual.
(I had seen some aspects of the “wars” in my first psychiatry course at Yale, with a young instructor who was to become a major power in American psychiatry, Thomas Detre. When I asked if there could be any biological aspects to the severe psychiatric illnesses, he stated absolutely not. Years later he completely changed his mind and basically took the position that we should all be neurologists. I disagreed with him the first time and disagreed with him the second time.)
After the difficulty trying to move the project ahead and seeing the problems that Freedman was having, I elected to take a year out of medical school and work with Aaron Lerner, the discoverer of melatonin. Through that and subsequent work, I provided evidence that melatonin is a hormone and impacts sleep.
Later, with Freedman, I returned to stress research. I even picked an internship at the University of Chicago where I could (with difficulty) continue the stress studies, sending the brains to him from a then small O'Hare airport late at night on dry ice for chemical assays.
We were ultimately to find that indeed stress does differentially impact neurotransmitters, changing serotonin and norepinephrine in opposite ways—the first such demonstration proving that the wind does impact the locomotive! Today that and similar findings with other neuroregulators is a factoid of neurobiology, confirmed and extended by hundreds of papers rarely referring to our first demonstration, but still highly satisfying. In later years, my research group at Stanford provided the first demonstration of changes in endorphins in the brain in rats with stress
and changes in the blood of runners, and worked out many fundamental mechanisms of stress responses.
From my perspective, much of my work and that of my colleagues, even our work demonstrating for the first time genetic controls on the formation of key neurotransmitters, was quietly inspired out of a belief that it tied into theories of psychodynamics and the interplay of mind and brain—that perspective seemed to me to also be the way Freedman saw our work. Freedman sometimes said his work on LSD, our work on stress, and his work on autism were his major scientific contributions.
After two years working on peptides and enzymology in a superb National Heart Institute biochemistry laboratory, I started to search for a residency in psychiatry. There were few persons who we would now call neurobiologists interested in psychiatry, and few places interested in their training. Alfred Stanton at Harvard was one. Another was Milton Rosenbaum at Einstein. Highly encouraging, he graciously offered me a position but advised me to go someplace where my interests would be understood.
All roads led to David Hamburg at Stanford, my other great mentor and the person who has had the most impact on me professionally for 50 years, along with Betty Hamburg, in her own right, a great figure in American psychiatry. David was trained as a psychiatrist and psychoanalyst but has crossed more disciplines with understanding and more situations with powerful impacts than any person I have ever known. He and Betty were pioneers in the study of human coping mechanisms. He also facilitated work in anthropology and primatology and was involved in studies of aggression, including his current work on genocide, in which he is acknowledged as the world leader in the study of its prevention. It is a project he worked on for over 10 years in the faculty office closest to mine at Weill Cornell after retiring from the presidency of the Carnegie Corporation. What started as a mentorship became an emotional hybrid equivalent to the closest of friends-family.
David encouraged my interaction and training experiences with serious psychoanalysts, such as William Weber, formerly of New York, Norman Graff, and Maurice Grossman—all of whom I came to revere. Grossman was so serious that some residents were afraid to have him as a supervisor. I found him demanding and incredibly interesting. He would often stop our supervision sessions about 10 minutes early to discuss one or another question. He would ask me, for example, to summarize what we knew about serotonin.
While some of my friends in what we now call neurobiology have complained about how they were treated decades ago during the wars of psychiatry, I have always had the opposite feeling—welcomed, helped, aided, and encouraged. Those three psychoanalysts made a profound impact. Interestingly, Fritz Redlich, who had moved from the chairmanship of psychiatry to become the dean at Yale, visited the Stanford department and noted that it was remarkable as a place that had the full range of intellectual areas but enjoyed the various approaches without conflicts so common elsewhere. That was the culture David Hamburg and a true representation of his values. Later, Hamburg led a group of leading psychiatrists, most from the analytic tradition, in a landmark study for the National Research Council, Psychiatry as a Behavioral Science. It called for broad inclusion of areas of knowledge into psychiatry.
Another aspect of my connection to psychoanalysts came with the illness of my late wife, Patricia, now viewed as a founder of what is today called social neuroscience, whom I had met and fallen in love with the first hour of the first day I was at Pomona College. She put me through medical school and I put her through a doctorate in sociology that led to her being a faculty member in sociology and psychiatry at Stanford. She had extensive interaction with psychoanalysts through the Yale child psychiatry program as she became the senior teacher at the Ribicoff Center for profoundly ill children. Most of the supervision was by Yale psychoanalysts, and she read a great deal of literature in that field.
When she developed severe headaches in her early forties, she saw many physicians. The two neurologists she saw were convinced her symptoms must be psychological and that she should see a psychiatrist or psychoanalyst. She decided on Norm Graff, a Menninger-trained psychoanalyst of broad intelligence, wide interests, good humor, and marvelous sense. He decided she was one of the healthiest individuals he had ever encountered, said she had a physical problem (which turned out to be a large brain astrocytoma) and followed her episodically for the next 15 years of her life when there were transitions or surgeries. Despite the difficulties, he noted that through the course of her illness she never became depressed. I was proud of my profession and appreciative of wise psychoanalysts.
Although I had been at Stanford for 25 years, I rarely looked at other positions even when approached. The nature of my wife's illness meant that an offer to become dean for neuroscience at UCLA would be interesting and give me far more time to be with her than other positions.
As I tracked what was happening in American psychiatry, I had become concerned that there was a new form of the wars in psychiatry. Now psychoanalytic approaches were the ones largely being ignored and marginalized, just the opposite of what had happened decades before.
Then came the request from Cornell to consider their position. Bob Michels, the great chair of the department who brought it to its modern form, had become dean. I fantasized that the Cornell community had made a list of neuroscientists and tried to decide who on the list would be sympathetic to what had been developed at Cornell, which included psychoanalytic approaches and much more. My wife, Pat, was bedridden and headed toward what would be a long state of altered consciousness, but she wanted me to look at the position and to accept it if offered. She loved New York and she liked the idea of the department.
I made a very fast trip and was totally enchanted by a place that covered much wider areas than most people realized and had a spirit of collegiality, an interest in ideas, a reputation for excellence in its clinical and educational activities, and was a center of outstanding scholarship, with extraordinary full-time and voluntary faculty.
While some of my friends in neurobiology had taken chairmanships and then enforced massive changes, I did not feel that was appropriate for Cornell. Indeed, when offered the position, I felt it was more like a trusteeship for me to preserve and protect its best aspects and build some additional foci that might interact. With Philip Wilner, the exceptional executive vice-chair of the department, it has been possible to undertake such a plan. We have a developmental focus from childhood through geriatrics, a remarkable array of specialized clinical programs and research, and initiatives in many other subjects such as history and social policy. Analysts are involved in all aspects, but so too are persons with quite different interests working together in a cooperative manner.
We have tried to facilitate scholarship in many areas for the department. In terms of psychoanalysis, that has included support for projects such as that of Bob Michels as a coauthor of the new classic edition of the volume on interviewing; Otto Kernberg and his colleagues dealing with psychodynamic treatment and biological aspects of borderline personality disorder; George Makari and his brilliant text on the intellectual history of psychoanalysis; John Barnhill in his able writing on diagnosis and various approaches in psychiatry; Betsy Auchincloss with her coediting of the fascinating dictionary of psychoanalysis; Milt Viederman with a project on interviewing patients in consultation liaison using psychodynamic approaches, and Barbara Milrod with her pioneering projects on anxiety. A number of these projects and volumes have received national and international acclaim. We are proud to have been able to facilitate them as we are of projects in other areas of psychiatry.
Some of our earliest efforts were aided by psychoanalysts, including William Frosch and the late Arnold Cooper, as well as the late Sam Perry, a psychoanalyst who was the vice chair for research in the department and had a magical ability to encourage multiple areas. Later, David Silbersweig, now chair of psychiatry at the Brigham, became the vice chair for research and, while not an analyst, was pleased to be helping those projects and even had a joint project with Otto Kernberg.
Another significant direction was made possible by the Sackler family with the establishment of the Sackler Institute for Developmental Psychobiology, through the wonderful philanthropy of Mortimer Sackler, a psychiatrist interested in both biology and psychoanalysis. Ilene Sackler, one of his daughters and a voluntary faculty member, was particularly interested in the project to which the entire family has contributed. In this case there was also major input from others, all psychoanalysts. Bob Michels was a force for the project, which was also inspired by the late, beloved Dan Stern. Ted Shapiro helped with the development of the project. An individual who made a major difference was the late Ethel Person, who served on the founding board and was an important advisor to me, encouraging the combination of psychodynamic approaches and biology. The institute was first headed by Michael Posner, the pioneering developer of cognitive neuroscience, and is now headed by B.J. Casey, considered one of the best developmental psychobiologists of her generation in the world.
I must admit that one other effort on behalf of psychoanalysis did not work out as I had hoped. When I came to New York 20 years ago, I believed there would be an advantage to a merger of some of the analytic institutes. Toward that end, I met with the leadership of several institutes—all agreed it might be a good idea someday, but “not now.”
Interestingly, while we do have analysts on our staff, most faculty members are not analysts. The difference is that many places now have almost no full-time faculty with such a background—we do. Some have none. A friend told me that at his nationally ranked institution he is happy if his residents have memorized DSM and a textbook of psychopharmacology That combination would not be satisfactory at Weill Cornell. We want our residents to be able to think about what is in their patients' heads, how their worlds are constructed. We do not expect our residents to become analysts—some do, most do not. Believing that it is helpful to better understand themselves and that they are part of the instrument of treatment, I urge residents to have personal therapy, a practice common years ago, less so now. I found such therapy helpful both personally and professionally. And I have always been impressed by the wisdom and advice persons with psychodynamic experience can bring to the discussion of issues on any subject, from patients to the arts.
Aaron Beck, the great cognitive behavioral therapist, once told me that when young psychologists ask him for advice about places to take an internship, he often suggests they consider Payne Whitney. They will say, isn't it just psychoanalysis in its orientation? He tells them it is actually everything—you can do various forms of psychotherapy, or have interests in completely different areas, but the key is to do whatever you do with excellence. I think that describes Weill Cornell quite well. As Francis Lee, a brilliant neurobiologist, now vice chair for research, said when he chose to come here for a faculty position when he was one of the, if not the, hottest prospect of his year on a national basis, “I like the tapestry of the place.” So do I. We are a large clinical program but a smaller research program with few silos, so there are strong natural pressures for people to work together and that encourages collaboration and intellectual interaction, a feature that is relatively rare and is prized by the faculty.
Years ago, one of my mentors, Maurice Grossman, told me, “Someday it (referring to the combination of psychodynamic medicine and biology) will all come together.” I believe we are entering that phase. The result will be good for a renewed understanding of behavior and treatment for patients with a wide range of problems. We will truly be able to have individualized therapy that will take into account factors of which we now have only a faint glimpse. Biology in its various forms will be important, but so, too, will be behavior.