Nobel-Prize Winner To Speak at Annual Meeting
Eric R. Kandel, M.D.: The future of psychiatry lies in the context of modern biology.
“Eric Kandel’s work provided a significant part of the impetus behind my selection of the theme of ‘Mind Meets Brain’ for this meeting,” said APA President Daniel B. Borenstein, M.D. “It is exciting that neuroscience work by psychiatrists and others is increasingly able to demonstrate the neurophysiologic and neurobiologic underpinnings to psychiatric illness and successful treatments, including psychotherapy,” Borenstein told Psychiatric News.
The 2001 Marmor Award Lectureship, honoring an individual whose work significantly advances the biopsychosocial model, is the latest in a long list of honors for Kandel, university professor at Columbia University and senior investigator at the Howard Hughes Medical Institute. The list includes the National Medal of Science, Albert Lasker Basic Medical Research Award, Wolf Prize in Biology and Medicine, a 1989 Distinguished Service Award from APA, and membership in the National Academy of Sciences.
Capping the list last October was the award of the 2000 Nobel Prize in Medicine and Physiology, which he shared with Paul Greengard, Ph.D., of Rockefeller University and Arvid Carlsen, M.D., of the University of Goteborg in Sweden (Psychiatric News, November 3, 2000).
Troubling Words
It has been Kandel’s prolific and unusually to the point writing that has, on occasion, surrounded him with controversy. A few years ago Kandel penned two articles for the American Journal of Psychiatry regarding a “new intellectual framework” for psychiatry.
The first article, which appeared in the April 1998 issue, detailed Kandel’s thoughts about the future of psychiatry, outlining a new way of thinking about the relationship of the mind to the brain. Kandel strongly believed, as he does today, that the future of psychiatry lay in the context of modern biology.
Kandel said his purpose was twofold. First, the new framework was designed to emphasize that the professional training of future psychiatrists would need to include a greater knowledge of the structure and functioning of the brain, he said. Second, he hoped to illustrate that the unique place psychiatry occupies within academic medicine is well suited to studying the interactions between social and biological determinants. But psychiatry, he said, must first have a full understanding of the biological components of behavior.
“I did not intend to say anything controversial,” Kandel told Psychiatric News. “I wasn’t interested in sticking my head out there, but in saying something from my perspective that was pretty obvious but needed saying. No one else was quite saying it in a coherent fashion.”
The article sparked the largest number of letters to the editor AJP ever received. The response, mostly from the psychoanalytic community, was fierce. Many letters decried Kandel’s dismissing of analytic theory in favor of biologically based thinking and behavior. One letter even boldly said, “Of course psychoanalytic theory is not biologically based; analysis has no need of biology.”
Kandel wrote a second article, which appeared in April 1999, that revisited the new intellectual framework and dealt directly with the interaction of biology and psychoanalysis.
Kandel has said that he believes the analytic community misunderstood what he was saying. “They simply did not understand where I was coming from. I have a strong investment in psychoanalysis—I am in admiration of psychoanalytic thinking.”
However, Kandel believes that the analytic field became “fixated” and never progressed beyond an early stage. The only point that he was making, he said, was that the analytic field needed to come closer to the biological basis of behavior to provide proof of its utility.
“It hasn’t developed a kind of scientific base that would be necessary to sustain its growth,” he told Psychiatric News. He is encouraged, however, by early reports from studies, such as the Stockholm Outcome of Psychoanalysis and Psychotherapy Project (STOPPP), which are attempting to provide blinded, randomized data that support the effectiveness of analysis and psychotherapy (Psychiatric News, February 2).
Igniting such a controversy was “OK,” he said. “It helps to stimulate, to create diversity. It’s part of the richness and depth of the science.”
A Misquoted Marriage
More recently Kandel was again promoting, he said, “the richness and depth of the science” through an editorial he wrote with W. Maxwell Cowen, M.D., a neurologist and senior investigator at the Howard Hughes Medical Institute in Bethesda, Md. The editorial, “Prospects for Neurology and Psychiatry,” appeared in the February 7 Journal of the American Medical Association.
Cowen and Kandel wrote that the most promising advances in neurological and psychiatric diseases will require “advances in neuroscience for their elucidation, prevention, and treatment.” The pair outlined what they believe are the most significant neuroscience advances of the past 20 years, noting they have come from the application of molecular genetics and molecular cell biology to the nervous system. Prospects for solving complex, presumably polygenic, disorders such as schizophrenia, bipolar disorder, and borderline personality disorder, they stated, would depend on input from those fields.
“So rich will this harvest [from molecular genetics] be,” Kandel wrote, “that it is not too rash to state that it will completely transform both clinical disciplines and put them on the sound scientific foundation that has long been their principal, if often unstated, goal.”
Kandel and Cowen suggested that the future will see a “clinical neuroscience with the unification of psychiatry and neurology.” They said, “We therefore believe that with further growth, neuroscience will most likely serve to bring neurology and psychiatry even closer together.”
Many took the article, as well as misleading quotes in popular-press accounts following its publication, to mean that there would be a “marriage” of the two specialties into one clinical field. Kandel said the “marriage” reference attributed to him at a press conference announcing the publication of the JAMA issue was “a bit of a misquote.”
“I don’t think,” Kandel told Psychiatric News, “that neurology and psychiatry should become one discipline—I think that they should be closer together. What I would like to see is common training for neurologists and psychiatrists for the first year.”
The idea, he said, is that both specialties are concerned with diseases of the brain so they need to start together. Then psychiatry should concentrate on patients with mental disorders, he explained, and neurology should see patients with nonmental disorders.
“I don’t think there should be one neuropsychiatry, but [the two fields] share many problems, and common training would be helpful as a first step.”
The 21st-Century Couch
So, does Kandel think that the analyst’s couch is obsolete?
“No, absolutely not,” he said. “Therapy has the potential, just as learning and memory do, to alter the brain’s functions at the gene level. And I think that the methods of evaluating the outcomes, such as new imaging techniques, will provide indications of just that.
“I think I am just a shoemaker—my specialty is the neurobiology of learning and memory. These other exercises are evidence of early senility,” Kandel suggested, “and I would not devote a lot of energy to them.”
All jokes aside, said Kandel, he does take these questions seriously and continues to be devoted to the original field in which he was educated and completed his residency. “But, you know,” he said with a laugh, “I am not on a campaign to transform psychiatry!”
Kandel will present the APA Marmor Award Lecture on Monday, May 7, at 9 a.m. The location will be listed in the annual meeting program. The articles “A New Intellectual Framework for Psychiatry” and “Biology and the Future of Psychoanalysis” are available online at http://ajp.psychiatryonline.org by searching under “Kandel.” “Prospects for Neurology and Psychiatry” by Cowen and Kandel is available online at www.jama.com. ▪
