Crossing the Mind-Brain Barrier: Neuroimages of Emotion

CNS News. June 2003, pages 47-48. (Published with permission)

Even if it could be made to work as you suggest, we cannot imagine a significant market for such an expensive apparatus which would do nothing but make a radiographic cross-section of a head ...

So went the response from an X-ray equipment manufacturer that Bill Oldendorf, MD, contacted in search of marketing support for a new machine built in his basement and patented in 1963.Tired of performing invasive and inconclusive studies on his patients at the University of Minnesota Hospital, Dr. Oldendorf believed his machine could build on existing techniques to produce pioneering images of the human brain. Later, Sir Godfrey Hounsfield would acknowledge Dr.Oldendorf’s ideas in the Nobel Prize– winning work that led to the invention of the X-ray CT scanner in 1979.

The Rise of Neuroimaging

The next two decades saw an explosion of neuroimaging advances that afforded researchers unprecedented opportunities to look deep into the brains of their subjects. Taken together, the fine-grained images made available by techniques such as electroencephalography, magnetic resonance imaging (MRI), positron emission tomography (PET), single photon emission computed tomography (SPECT), functional MRI (FMRI), anatomic MRI, magnetoencephalography and magnetic resonance spectroscopy (MRS) give researchers the ability to measure brain receptor pharmacology, chemistry and neurotransmitter function, as well as map brain regions and characterize structure. “The field of imaging has exploded in the last decade because the machines have been refined,” explained Maggie Zellner, MA, a psychoanalytic psychotherapist and doctoral candidate in neuropsychology at the Graduate Center of the City University of New York. Depicting regional cerebral blood flow with FMRI and PET, researchers can “identify which regions are most active at a given moment, not just by imaging the structures, but looking at what is happening in the brain when a person is doing, looking at or perceiving something.”

This idea of pinpointing the mechanisms behind internal responses to the external world is not new to the field of psychoanalysis. Practitioners in this discipline have been looking at human motivation for more than a hundred years—just from a different portal. Neuropsychoanalysis, though, is “a relatively new approach. It really has not been possible to try and link those two endeavors until recently, in part because the sensitivity in resolution in imaging technology was insufficient,” said Robert Scharf, MD, a New York City psychoanalyst, assistant clinical professor of psychiatry at Columbia University College of Physicians and Surgeons and chair of the Neuroimaging of Psychoanalytic Treatments Study Group in the neuropsychiatry program at the New York Psychoanalytic Institute and Society.“It functionally shows the human brain in real time.”

In this way, discussions of regional blood flow, glucose metabolism and activation in the hippocampus, amygdala or striatum are now common parts of the research jargon—language a neurologist named Sigmund Freud could only dream about.

Starting at the Beginning

Limited to Victorian-era tools, Freud described emotional processing in terms of aggression and libido— unconscious drives that guided human behavior and were especially visible, although in disguised ways, in dreams.This theory was nearly debunked in the 1960s with the discovery that rapid eye movement (REM) sleep—the phase during which dreams most often occur—is controlled by the pons, an elementary brain stem area involved in largely automatic processes, rather than the storage of deep-seated wishes and desires, as Freud had imagined.

A paradigm shift occurred when PET and FMRI images gave researchers a different picture of dreaming brains.Allen Braun,MD,of the National Institute on Deafness and Other Communication Disorders, discovered that the limbic and paralimbic areas, which are concerned with emotion and motivation, were activated during dreaming. In addition, while the primary visual cortex is deactivated, regions that conduct higher-level visual processing were active, explaining why we seem to “see” while dreaming.

Later, Mark Solms, PhD, of St. Bartholomew’s and the Royal London School of Medicine, found that individuals with damage to the pons could not achieve REM sleep but could still dream, while individuals with damage to motivation centers in the forebrain were able to achieve REM but ceased dreaming. Dreams are produced by the forebrain’s motivational, emotional, memory and perceptual systems, he wrote (Behav Brain Sci 2000;23:843-850). “It is, in short, the ‘wishing system.’ ... Nothing that we know about in the brain comes closer to being the neurophysiological equivalent to what Freud described as the libidinal wish or libidinal drive.”

A thought leader in neurobiology, Jaak Panksepp, PhD, a neurobiologist at Bowling Green University in Ohio, then wrote about the modern idea of the drives that motivate human action:rage,panic,separation distress, lust and seeking (a variation on libido). Like the others, his seeking drive involves the limbic system but specifically arises from the mesolimbic dopamine circuitry which begins in the ventral tegmental area in the midbrain, so it would appear that Dr.Panksepp discovered through neuroimaging what Freud had discovered through analysis.

“This instinctual drive is a classical Freudian concept, and now the evidence supports that,”Ms. Zellner confirmed.“The bottom line is that it really does seem that most of the findings on dreams do confirm and correlate with Freud’s theory that dreams are generated by wishes.There was not enough known about the brain for him to speculate which parts of the brain were involved, and it turns out that drives seem to be important in dream functioning.” So seemingly un- Freudian neuroimaging data have brought the dream discussion full circle and laid the groundwork for a new discipline: neuropsychoanalysis.

Unlikely Partners

Neuropsychoanalysis is the blending of two seemingly at-odds schools of thought and is increasingly able to link the physiological and emotional data collected from patients.The trend was discussed at the 2003 winter meeting of the American Psychoanalytic Association in New York City, at which Ms. Zellner, Dr. Scharf and Mortimer Ostow,MD, presented research and perspectives during a session on ways neuroimaging and psychoanalytic psychotherapy can work together to facilitate a better understanding of depression.

“Neuropsychoanalysis is growing rapidly. It started 13 years ago at the New York Psychoanalytic Institute, by Dr. Arnold Pfeffer, who invited neuroscientists like Dr. Solms and Dr. Panksepp” to discuss ways the specialties can inform one another, Dr. Scharf said. Study groups and other research entities from Austria to Japan formed. Now there is an annual international meeting and a five-year-old journal. “It is an exciting movement,”Dr. Scharf noted.

Some in the field would rather the new ideas not converge as another academic silo.“Not only has psychoanalysis been too isolated, even neurology and psychology have had quite divergent activities.”Ms.Zellner noted. For example, “depression has psychodynamic aspects, neurochemical aspects, neurodynamic aspects. We need to look at it from all points of view.… We are all missing something.” Finding out what happened to a person in early childhood to potentially make them more susceptible to later depression is different from finding out which neurotransmitters seem to be in deficit, but obtaining a full picture is increasingly possible if the approaches work together.“Unless you look at all of it together, you will never understand what is going on.” —Jennifer Kulpa CNS NEWS