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From Dynamic Lesions to Brain Imaging of Behavioral Lesions: Alloying the Gold of Psychoanalysis with the Copper of Suggestion

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From Dynamic Lesions to Brain Imaging of Behavioral Lesions: Alloying the Gold of Psychoanalysis with the Copper of Suggestion Neuropsychoanalysis, 2010, 12 (1) 5 From Dynamic Lesions to Brain Imaging of Behavioral Lesions: Alloying the Gold of Psychoanalysis with the Copper of Suggestion Amir Raz (Montreal) & Joanna B. Wolfson (New York) Contemporary studies in the cognitive neuroscience of attention and suggestion shed new light on psychoanalytic concepts of yore. Findings from neuroimaging studies, for example, seem to revive the notion of dynamic lesions—focal brain changes undetectable by anatomical scrutiny. With technologies such as brain imaging and reversible brain lesion, some findings from modern biological psychiatry seem to converge with nineteenth-century psychiatry, reminiscent of the old masters. In particular, suggestion has been shown to modulate specific neural activity in the human brain. Here we show that “behavioral lesions”—the influence that words exert on focal brain activity—may constitute the twenty-first-century appellation of “dynamic lesions.” While recent research results involving suggestion seem to partially support Freudian notions, correlating psychoanalysis with its brain substrates remains difficult. We elucidate the incipient role of cognitive neuroscience, including the relative merits and inherent limitations of imaging the living human brain, in explaining psychoanalytic concepts. Keywords: fMRI; genetics; hypnosis; neuroscience; ontology; suggestion “It is very probable, too, that the large-scale application of Indeed, these psychological constructs draw on over- our therapy will compel us to alloy the pure gold of analysis lapping brain circuitry, functional neuroanatomy, neuro- freely with the copper of direct suggestion . .” modulators, and cellular structure (Fernandez-Duque Sigmund Freud, Fifth International Psycho-Analytical & Posner, 2001; Posner & Fan, 2004; Raz, 2006; Raz, Congress, Budapest (Freud, 1919 [1918], pp. 167–168) Lamar, Buhle, Kane, & Peterson, 2007). Thus, the rela- tionship between attention and suggestion has been es- Alongside the established science of attention, the tablished theoretically as well as experimentally (Raz, unfolding science of suggestion is gradually reframing 2004, 2005a, 2005b, 2006, 2007, 2008a; Raz & Buhle, core psychodynamic ideas. Suggestion and attention 2006; Raz, Lamar, et al., 2007). are pivotal themes in cognitive science (Raz & Buhle, Multiple accounts corroborate the involvement of 2006). They reify the links between brain and behavior psychological parameters, including suggestion and and bind psychology to the techniques of neuroscience expectation, in the modulation of biological processes (Posner & Rothbart, 2007a). Experimental findings (Harrington, 2008). The literature is fraught, however, show that suggestion and attention influence cognition, with uncritical accounts of suggestion. In one cancer affect, thought, and action (Posner & Rothbart, 2005, patient, for example, suggestion seemed to trigger dra- 2007b). In addition, studies involving imaging of the matic tumor shrinkage and miraculous remission, while living human brain and genetics begin to unlock the a subsequent suggestion led to abrupt death (Klopfer, neural underpinnings of and the mechanisms underly- 1957). Beyond anecdotes, many compelling assays ing the influence of suggestion on behavior (Posner, demonstrate the power of suggestion (Brown, 1985; Rothbart, & Sheese, 2007; Raz, 2008a). The bulk of Gauld, 1992). Believing that they were ingesting al- the evidence supports the idea that attention and sug- cohol, for example, participants in psychology experi- gestion form overlapping organ systems (Raz, 2005a). ments displayed the symptoms of alcohol intoxication Amir Raz: McGill University and the Lady Davis Institute for Medical Research, Departments of Psychiatry, Neurology & Neurosurgery, and Psychology, Jewish General Hospital and the McConnell Brain Imaging Centre of the Montreal Neurological Institute, Montreal, Quebec, Canada; Joanna B. Wolfson: Department of Psychology, Fairleigh Dickinson University, Teaneck, NJ, U.S.A. Correspondence to: Amir Raz, McGill University & Jewish General Hospital, Lady Davis Institute for Medical Research, Institute of Community & Family Psychiatry, 4333 Cote Ste Catherine Rd, Montreal, Quebec H3T 1E4, Canada (email: [email protected]). © 2010 The International Neuropsychoanalysis Society • http://www.neuropsa.org 6 Amir Raz & Joanna B. Wolfson even when drinking nonalcoholic beverages (Marlatt & ganic brain changes (Chertok, 1977). Observing hyste- Rohsenow, 1981). Treated as if they were hypervigilant ria, Charcot postulated that temporary neural changes pilots, Harvard undergraduates outperformed “regu- correspond with patient symptomatology. According lar” Harvard control students on visual acuity tasks, to Charcot, for example, a portion of the right hemi- including a “routine eye check-up” (Langer, 1989). sphere was responsible for hysteric paralysis of the left Although follow-up research demonstrated that visual arm (Koehler, 2003). Although unable to find a focal acuity hardly improved, students in the experimen- brain abnormality to account for his patients’ symp- tal condition were better than controls at identifying toms (Goetz & Bonduelle, 1995), Charcot considered small targets on a screen (Raz, Marinoff, Landzberg, & dynamic or “functional” lesions to be the underly- Guyton, 2004; Raz, Marinoff, Zephrani, Schweizer, & ing cause. Thus, the emerging dynamic lesion model Posner, 2004; Raz, Zephrani, Schweizer, & Marinoff, linked organic disorders with unexplainable somatic 2004). In another study, researchers found that by re- symptoms (i.e., today’s psychogenic disorders). peatedly suggesting to adults that they had become ill Reminiscent of dynamic lesions, the recent technol- from eating particular foods in childhood, participants ogy of transcranial magnetic stimulation (TMS) pro- consequently avoided those foods (Bernstein, Laney, duces transient changes in brain function. TMS delivers Morris, & Loftus, 2005). Taken together, such studies a short burst of a powerful magnetic field to a specific provide a sampling of the diverse influence that sugges- brain area, inducing a temporary brain “lesion” that is tion can wield on physical and mental experience. reversible in nature and leaves no anatomical traces Recent findings elucidate early psychodynamic (Bohning et al., 1998). Brain researchers uncover more ideas regarding the power of suggestion. The French complex lesion-like behaviors using variations of this neurologist Jean-Martin Charcot coined the term “dy- methodology including repetitive TMS, which induces namic lesions”—anatomically unobservable neuro- longer-lasting, yet temporary, changes (George, 2003). physiologic alterations that produce a marked change As we show throughout this piece, despite differences, in behavior—to explain what was occurring in hysteria intriguing overlaps bind TMS-induced dysfunction to (Charcot, 1889). Thereafter, Freud theorized that cer- Charcot’s age-old concept of dynamic lesions. tain behaviors are the result of bodily changes that Increasingly ubiquitous, functional magnetic reso- take place in response to language (Freud, 1893). Most nance imaging (fMRI) is a noninvasive brain-mea- scholars agree that by “language” Freud was likely surement technology, which opens a window into the referring to abstractions that go beyond mere words neurological underpinnings of behavior. By examining (Makari, 2008). We propose that one central formu- the influence of words on the workings of the mind, lation—suggestion—carries a powerful psychological fMRI can disentangle the behavioral lesions that spe- influence that affects individuals via their subjective cific suggestions can invoke (Raz & Shapiro, 2002; beliefs and experiences. Shapiro, 2004). As a case in point, using hypnotic Recontextualizing psychoanalysis through the lens suggestion as an experimental intervention, one of us of cognitive neuroscience, we sketch herein how mod- has conducted multiple imaging studies showing that ern findings rekindle the old flame of dynamic lesions. specific suggestions correlate with focal brain changes We demonstrate how recent research findings from (Raz, 2004; Raz & Buhle, 2006; Raz, Fan, & Posner, studies of suggestion are congruent with at least some 2005). For example, suggestion has been shown to in- psychodynamic concepts. The conceptual reduction of fluence neural processing in the domains of color vision psychoanalysis to brain mechanisms is appealing, albeit (Kosslyn, Thompson, Costantini-Ferrando, Alpert, & unlikely. We outline the shortcomings and relative vir- Spiegel, 2000), audition (Szechtman, Woody, Bowers, tues of such a reductionist account. Finally, we submit & Nahmias, 1998), pain (Kong, Kaptchuk, Polich, that the field of neuropsychoanalysis may benefit from Kirsch, & Gollub, 2007; Rainville, et al., 1999), and adopting an abstemious outlook regarding the prospects word-reading (Raz, Moreno-Iniguez, Martin, & Zhu, of brain imaging, while we argue that Charcot’s and 2007; Raz, Shapiro, Fan, & Posner, 2002; Raz et al., especially Freud’s grasp of suggestion may benefit from 2005). the modern designation of behavioral lesions. Suggestion reduces conflict From dynamic to behavioral lesions The classic Stroop task serves as a clear example of The concept of dynamic lesions has been helpful in the top-down effect of words on brain functioning. In explaining how psychological stressors may propel or- this paradigm, participants identify the ink color of From Dynamic Lesions to Brain Imaging of Behavioral
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