Eric Kandel has become a household name in some circles since his
sharing of the Nobel Prize in 2000. He is on the second psychiatrist in history
to have done so, and also the only American of that discipline to have done so.

Specifically for anyone who desires to read the book
and doesn’t know what he got the prize for for, well, you probably aren’t going
to enjoy the book anyway, as it may be outside of your field: however, for the
sake of clarity, Kandel and his collaborators across the years refined their
way of thinking about mind and brain, and illuminated for posterity the complex
process of long term potentiation. 
Simply put, we tickle the connections of neural networks to lay down
passing memory, but major changes in the way the cell arranges its chemistry
and expresses its DNA are required to enable to-be-remembered material to be
stored and recalled later.  This is not
exact, rather like recalling chocolate cake by finding the items of the recipe
that made it.

For those who are already keen on Kandel and the other 10 Nobel Prize
winners at Columbia, following the pathway he took to create and prove his
award winning theories is a journey of devotion to science. 

This book is made up of eight previously presented works that Kandel
believes exemplify the crucial aspects of his work and epistemology. They are
thematically presented, rather than following their chronology. This is done to
allow the reader to follow the journey, rather than the recipe of his arrival
at the clarification of LTP and its role in laying down information within the
neuronal pathways of the hippocampus and related structures.

Before each essay Kandel has invited commentary from various experts,
thus this is the added value, not a simple rehashing, but rehashing with
retrospective analysis.

The first essay, "Psychotherapy and the single synapse" leads
Judith Rapoport to write of this 1979 work that we still have a long way to go
in reconciling the relationship between Psychiatry and Biology, with more
psychiatrists than ever practicing without neuroscience training.  The article highlights this duality.

The second essay attracts comment from Thomas Insel.  In the article, "A new intellectual
framework for psychiatry", Kandel attempts once again, this time in 1998,
to address the duality, to reconcile the interactions between cognition and
behavior, and the brain’s processes. 
This search for a neuroepistemology, biological pluralism or systems
biology leads Insel to comment that the scientific excitement generated has not
yet filtered down well enough into clinical practice by refining diagnosis or
informing treatment, and worse, it has so far been ignored by those who
formulate training programs.  One of the
notable exceptions occurs in fact in Adelaide, South Australia, where the SA
Psychiatry Training Committee has introduced neuroscience into its curriculum,
and even medical students can rotate through neuroscience blocks carried out on
closed wards at the local state psychiatric unit.  However, this is not without protest from some postgraduates,
leading some to comment that if one wants to leave medicine, one becomes a
psychiatrist.  Recently too, there is
tension between evidence based medicine and the moral imperative of engaging on
a more humane and human level with patients possessed of mental illness.  Despite the years between the two first
essays, Kandel is making his point early: revise and review what one considers
the baseline reality for study in psychiatry, how brain produces mind.  Even within this simple concept, there is
controversy, with Bill Blessing and other neuroscientists arguing that the
brain is not entirely contained within the skull, and what we consider mind, or
brain, is composed across wider referential points, such as the endocrine and
blood systems.

Otherwise Psychiatry runs the risk of making a fool of itself as Othmer
et al pointed out some years ago in a Psychiatric Clinics of America article:
Here, the three Othmers warn of fat ankle syndrome.  Simply posed, a client wakes to find pedal oedema investing her
ankles.  She goes to a doctor and he
looks beyond her ankles and seeks out her blood, her cardiac status, her iron
levels and so on.  Had she turned left
instead of right and gone into the psychiatrist’s rooms, she would have
received the diagnosis of fat ankle syndrome: this is the danger of failing to
deal with the mind brain dilemma, rather than the mind body duality loved by
Descartes and refuted by Damasio.

The attention of a Nobel Prize winner tells you this is not trivial or
inconsequential for the profession, and yet very little of this literature or
of this debate enters the training of registrars in psychiatry.

Continuing in this way is the essay "Biology and the future of
psychoanalysis" with commentary by Arnold Cooper.  Theoretical pluralism again dominates as the
subject matter.  Attempts to adjudicate
the superiority of one or the other viewpoint by detailed reporting of
analyst-patient interactions have failed. 
Predictably, Kandel’s views in articles such as this 1999 one have
raised vigorous support, and equal opposition. The problem posed here again is
for psychiatrists to find a way to absorb the findings of neuroscience into the
theories of psychoanalysis, which are concerned with much less precisely
defined areas of the mind.  Yet, of
course, if one reads Freud’s dissections of the brain one sees precisely that
he saw the one in terms of the other, and also, it was Freud himself who said
that one day we would find that all the processes of the mind were indeed
organic.  Simple, but contentious.  Within the references here, we find Kandel
looked at the works of Mark Solms, who deals with this issue often, and
translated Freud’s dissections of the brain into English/

Donald Klein speaks before the next essay "From metapsychology to
molecular biology" together with Joseph Le Doux who speaks of anxiety and
Aplysia, playing with the name of the worm from which Kandel derived his
theories, and on which he proved his case. 
In 1983, Kandel writes that until that time the cell-biological
mechanisms of mentation had eluded analysis. 
Kandel uses anxiety as a platform, much as Othmer et al were later to do,
and points out how body and brain combine to produce mind and anxiety, even in
animals, as a learned response.  Even
the humble Aplysia shows aspects of anticipatory and chronic anxiety, reducing
this to cell-biological mechanisms, and sending Aplysia into a sprint away from
danger, well, locomotive avoidance anyway. 
Again, this lead Kandel into the idea that stimuli could change the way
DNA is expressed, the way genes are expressed at a molecular level, and this of
course is one of the mechanisms underlying LTP.

Eric Nestler comments on "Neurobiology and molecular biology"
which Kandel also produced in 1983. Here, he takes the molecular argument for a
neuroepistemolgy of mental illness forward. Or otherwise, is such reductionism
too limiting, should we find we come to a mechanistic understanding of complex
behavior under normal and pathological conditions.

Steven Hyman, the ex-head of the NIMH takes on "Neural
Science" which Kandel produced in 2000, nearly 20 years beyond the
previous two.  He is quick to point out,
on reading Kandel that far too many contemporary psychiatrists act as if
Descartes was right in his dualism. 
Nevertheless, he wryly notes that we cannot understand an entire
organism from the activities of its tiny bits, as the gestalt provides the
challenge, more so than the constituent parts. 
Kandel produced the article, which examines a century of progress, with
Albright, Jessell and Posner, all of whose names should be familiar, if you
recognize Kandel, anyway.  This is a
walk through history in the eyes of these luminaries, and it makes superb
reading.  Ramon y Cajal’s sketch of the
hippocampus is still in my overheads today, with its annotations of the CA
fields, the subiculum, the whole gyrus, perfect in its rendering.  Yet, can we distinguish between the feeling
of thirst and the resultant search for water, as Bill Blessing at Flinder’s
University puts it?  This mammoth
chapter covers 132 pages, a book in itself, and defies comment, even by one such
as Hyman.

It is then Charles Zorumski’s opportunity to comment on the article
"The molecular biology of memory storage" which gets to the heart of
the Nobel matter and is adapted from Kandel’s address to the Nobel
Foundation.  After 50 years at work at
the bench, Kandel was able to address what he called the dialogue between gene
and synapse.  This epitomizes the work
of this genius researcher, who was able to show definitively that we can
dissect out tiny processes within tiny animals in order to understand much more
gross behaviour in large primate mammals.

One is now talking of the biology of brain, which Kandel began to
illuminate in his search for a neuroepistemology.

John Oldham addresses "Genes, brains and self-understanding"
which Kandel wrote or at least revealed in 2001. This is the onset of his work
in enhancing biology’s aspirations for a new humanism.  Kandel’s aspirations comprise what he calls
Kandel’s Laws.

The first, is that producing knowledge and training young students is
vital to progress.  Teaching there is
thus rewarding (second law).  Patient
care is our most important responsibility (three).  The book closes with Kandel’s afterword, his revisiting of his
first essay in the book.

Compelling here in this last chapter is the realization that alive in a
man such as Kandel is his belief, rare in a biologist, that psychotherapy is as
important as neuro-imaging and psychopharmacology.  Not for Kandel is the pompous view still taken by many of my
colleagues that psychologists are the handmaidens of psychiatry, and both
ineffective and unnecessary.  Australia
is happily embarking on reducing psychologists to generic allied health titles,
and supporting four- year degrees as sufficient, so that unlike the doctoral
programs of other countries, we can provide ever more mediocre therapy to ever
increasing numbers, rather than provide excellent and informed care to the
patients. If only Kandel’s laws were propagated down under.

Sad too is the realization for many of us who train psychiatrists and
medical students that the two major areas they need to be proficient in, namely
psychopharmacology and neuroscience, comprise only a small portion of their
training.  Perhaps this unhappy
situation explains why so many state hospitals cannot recruit specialists, or
nurses with expertise in mental health.

For what Kandel’s journey informs us is that this is the last frontier
for medicine, with all the excitement of a dynamic neuroscience available if we
only observe Kandel’s Laws.  I note
however that recent books reviewed on this website speak of the failure of
universities to deliver substance in their courses in mental health, to deliver
clinically useful training, rather then the dry between groups evidence based
science that teaches nothing of the moral engagement of Kandel’s third law.

This is the gift of Kandel: he can easily navigate from molecules to
humanity, from evidence based to moral encounter, and sadly, this appears to be
rare.

It’s a book filled with eight essays of stunning revelation and
scientific brilliance, a balanced view of worm’s gills and mankind’s
misery.  One could expect nothing less
from this man, who brings glory and hope to a dismally disliked profession,
parodied and mocked in the media, comfort to one of the few medical professions
that dies at the hands of its patients. 
He sees systems within systems in biology, and that is no small task,
confounding Descartes and Damasio alike. 
It should be required reading for everyone, everywhere, if they have
just the capacity to read it through, and the courage to engage both moral and
scientific issues in human suffering.

If there is a weakness, it is that the commentaries are weak, pale by
comparison with the writing that follows each: I believe they could have risen
to the challenge and done better with what they read.

 

© 2005 Roy Sugarman

 

Roy Sugarman, Ph.D., Conjoint Senior Lecturer in Psychiatry, University
of New South Wales, Australia

Categories: Philosophical, Psychology, Psychoanalysis