Notes on Kandel, Age of Insight

Van Swieten formed what is now known as the First Vienna School of Medicine, a school that began to transform Viennese medicine from the practice of therapeutic quackery based on humanist philosophy and the teachings of Hippocrates and Galen into a practice based on natural science.

This development had two roots. First, as noted, every patient who died in the Vienna General Hospital was autopsied under the supervision of a single, highly trained person, the head pathologist.

During a career spanning over thirty years, he and his associates carried out some sixty thousand autopsies,

The process gave rise to a new understanding of the clinical-pathological correlation that has characterized modern medicine ever since.

contrary to the teachings of Galen, clinical symptoms arise from disorders of individual organs: symptoms are the cries of suffering organs. To understand disease, one must first find where in the body the disease originates.

Skoda became not only a skilled listener to the heart’s sounds, but also a remarkable interpreter of their anatomical and pathological significance, setting the standard for current medical practice.

In fact several of the founders of academic medicine in the United States—William Osler, William Halsted, and Harvey Cushing—studied medicine in Vienna before assuming their leadership roles.

disease, Rokitansky and Skoda also provided the scientific basis for the concept of the disease process, the idea that each disease has a natural history and progresses through a series of steps from its onset to its termination.

“The phenomena are a visible expression of that which is hidden.”

both fields appear repeatedly in the background ornamentation of Klimt’s paintings. In fact, his radical portrayals of the nude female figure are seen by the art historian Emily Braun as reflecting a naturalistic, post-Darwinian perspective: “After Darwin, the body in painting stands nakedly for itself: a biological species subject to the same procreative laws as every other organism.”

His linking of psychology and brain biology led him to a second idea that is central to the biology of mind: the brain—and particularly its outer covering, the cerebral cortex—does not function as a single organ; therefore, different mental functions can be localized to different regions.

Broca and Wernicke each conducted postmortem examinations of the brains of people with speech defects and found that specific disorders of language are associated with damage to specific regions of the brain. Thus, language can indeed be localized. The understanding of language is located

in the back of the cortex (in the left posterior superior temporal gyrus), the expression of language is located in the front of the cortex (in the left posterior frontal lobe), and the two sites are connected by a bundle of nerve fibers.

damage to the hypothalamus produces stress that can cause what we now call “stress ulcers” in the stomach. Subsequent work by other scientists showed that the hypothalamus controls the pituitary gland and the autonomic nervous system and therefore plays a central role in mediating sexual, aggressive, and defensive behavior and in controlling hunger, thirst, and other homeostatic functions.

Encouraged by Brücke to study the nervous system, Freud completed one study of the lamprey, a simple vertebrate animal, and another study of the crayfish, a simple invertebrate animal. He found that the cells of the invertebrate nervous system

are not fundamentally different from those of the vertebrate nervous system.

During this period, Freud made several contributions to research on the neuroanatomy of the medulla oblongata (the part of the nervous system that contains the centers for breathing and heart rhythms), and carried out several important clinical neurological studies on cerebral palsy and aphasias.

We cannot do without men with the courage to think new things before they can prove them.

He therefore concluded that his patients’ reports were based not on real events but were “only phantasies which my patients had made up or which I myself had perhaps forced on them.” 11 This led him to alter his seduction theory. He now saw the traumatic seduction experienced by the patient not as an actual physical act, but as an imagined physical experience with the patient’s parent, a fantasy that he concluded was universal.

Rather, he saw the decision as a necessary and, he hoped, temporary separation that would allow time for both the psychology of mind and the biology of the brain to mature before any ultimate unification of the two was attempted—a radical idea at that time.

“We must recollect that all of our provisional ideas in psychology will presumably one day be based on an organic substructure,” 14 he wrote. In his book Beyond the Pleasure Principle, written in 1920, he continued:

The deficiencies in our description would probably vanish if we were already in a position to replace the psychological terms with physiological or chemical ones.…

We may expect [physiology and chemistry] to give the most surprising information and we cannot guess what answers it will return in a few dozen

years of questions we have to put to it. They may be of a kind that will blow away the whole of our artificial structure of hypotheses.

His determination was based on the remarkable insight that unlike many neurological disorders, psychiatric disorders—and psychopathology in general—are extensions and distortions of normal mental processes.

cognitive psychology,

The term “cognition” refers to all processes by which a sensory stimulus is transformed, reduced, elaborated, stored, recovered and used. It is concerned with these processes even when they operate in the absence of relevant stimulation, as in images and hallucinations.… Given such sweeping definition it is apparent that cognition is involved in everything a human being might possibly do, that every psychological phenomenon is a cognitive phenomenon. 16

The subjective experience which appears in consciousness during sleep and which, after waking, is referred to by the sleeper as a dream is only the end result of unconscious mental activity during sleep which, by its nature or its intensity, threatens to interfere with sleep itself. Instead of waking, the sleeper dreams. We call the conscious experience during sleep, which the sleeper may or may not recall after waking, the manifest dream. Its various elements are referred to as the manifest dream content. The unconscious thoughts and wishes which threaten to waken the sleeper we call the latent dream content. The unconscious mental operations by which the latent dream content is transformed into the manifest dream we call the dream work. 8

Freud also continues an earlier line of thought—namely, that to understand a person’s present, one must turn inward and understand that person’s earliest experiences in childhood, both real and imagined.

First, mental processes operate primarily unconsciously; conscious thought and emotion are the exception rather than the rule.

Second, no aspect of mental activity is simply noise in the machinery of the brain. Mental events do not occur by chance, but adhere to scientific laws.

Third, and critical to unlocking the secrets of the human unconscious, Freud

argued that irrationality per se is not abnormal: it is the universal language of the

Fourth, normal and abnormal mental function lie on a continuum. Every neurotic symptom, no matter how strange it may seem to the patient, is not strange to the unconscious mind, because it is related to earlier mental processes.

What proved to be Freud’s most original and influential idea is that mental activity adheres to scientific laws.

The superego is the unconscious moral agency, the embodiment of our aspirations.

the implicit unconscious. The implicit unconscious, which we now realize is a much larger part of our unconscious mental life than Freud thought, is not concerned with instinctual drives or conflicts. Instead, it is concerned with habits and perceptual and motor skills, which involve procedural (implicit) memory. Even though it is not repressed, the implicit unconscious is never accessible to consciousness.

Freud used the term unconscious in a broader sense—the preconscious unconscious—

access to it by an effort of attention.

unconscious much of the time; it becomes conscious only as sensory percepts—words, images, and emotions.

consciousness is Darwinian: it allows us to experience thought, emotion, and the states of pleasure and pain that are essential for the propagation of the species.

book Darwin points out that emotions are part of a primitive, virtually universal approach-avoidance system designed to seek out pleasure and decrease exposure to pain.

The patients in his five major case studies—Dora, Little Hans, the Rat Man, Schreber, the Wolf Man—have become characters as indelible in the canon of modern literature as those of Dostoevsky.

Die Träumenden Knaben

The ventral tegmental area of the midbrain also contains neurons that release dopamine, a chemical that serves to command attention and anticipate reward.

Computers are better than the human brain at processing and manipulating large amounts of data, but they lack the hypothesis-testing, creative, and inferential capabilities of our visual system.