Is Freud Really Dead?

Question: Is Freud dead?

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Dr. Katherine Shear: Oh, that's a hard question. I would have to say in my case personally, I don't think a lot about this, I have to say. But I'm quite sure that there – Freud was an incredible observer. He was a very, very good observer and what he wrote about, the clinical phenomenon, were very insightful. And also things like his ideas about the concept of transference – how people basically bring to a new relationship the expectations and predictions they have gleaned from other earlier relationships, especially attachment relationships. That's my background. And I'm sure it still informs what I do.

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Question: Will one-on-one therapy always be part of psychiatry?

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Dr. Katherine Shear: Yes, I think. I absolutely think and very much hope, but I mean, I think it's an essential part of healing people and we know this, regardless of what other ways we develop and whether they be neurobiological methods. And now we're talking not only about psychopharmacology but a lot of other kinds of brain stimulation, for example, and even some kinds of very focused neurosurgeries seem to be things that have promise for certain people in certain situations. So I do very much see psychiatry developing in the direction of neuroscience and neurobiology. I think we've made some great leaps in that direction and I think we will and we should continue to work in that area.

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At the same time, one of the things about psychotherapies is that the more focused psychotherapies actually are better able to target specific behavioral syndromes than any kind of somatic treatment that we have so far. So I definitely think that there's a role for very focused kind of technical interpersonal interventions that are, so to say, psychological interventions. I don't think that will ever go away. But I think we're learning more and more about those kinds of interventions and again, specific techniques. Like there's a very interesting recent report of using training in attention in attentional processes in some anxiety disorders and social phobia and generalized anxiety – probably for any of the anxiety disorders. Because one of the things that you do when you have an anxiety disorder is you over-focus on certain kinds of cues like we were talking about with panic. You know, if you're a socially anxious person, you're going to do that with social cues. You're going to be overly sensitive to social cues. And you can train people apparently away from that by training their attention. And so that's one kind of thing I see happening in the future. But for many of the – I would say virtually all of the conditions we treat – there's always going to be some way in which the person who has the problem will need to kind of get close to – really close – to very distressing emotions and thoughts. And to do that, I think you really need to feel safe. And to feel safe in any treatment, you need another person. You need a person who can be there for you. So I think that will always be there.

Recorded on November 3, 2009
Interviewed by Austin Allen

According to Columbia grief therapist Dr. Katherine Shear, we shouldn't mourn his passing from relevance just yet.

Yale scientists restore brain function to 32 clinically dead pigs

Researchers hope the technology will further our understanding of the brain, but lawmakers may not be ready for the ethical challenges.

Still from John Stephenson's 1999 rendition of Animal Farm.
Surprising Science
  • Researchers at the Yale School of Medicine successfully restored some functions to pig brains that had been dead for hours.
  • They hope the technology will advance our understanding of the brain, potentially developing new treatments for debilitating diseases and disorders.
  • The research raises many ethical questions and puts to the test our current understanding of death.

The image of an undead brain coming back to live again is the stuff of science fiction. Not just any science fiction, specifically B-grade sci fi. What instantly springs to mind is the black-and-white horrors of films like Fiend Without a Face. Bad acting. Plastic monstrosities. Visible strings. And a spinal cord that, for some reason, is also a tentacle?

But like any good science fiction, it's only a matter of time before some manner of it seeps into our reality. This week's Nature published the findings of researchers who managed to restore function to pigs' brains that were clinically dead. At least, what we once thought of as dead.

What's dead may never die, it seems

The researchers did not hail from House Greyjoy — "What is dead may never die" — but came largely from the Yale School of Medicine. They connected 32 pig brains to a system called BrainEx. BrainEx is an artificial perfusion system — that is, a system that takes over the functions normally regulated by the organ. Think a dialysis machine for the mind. The pigs had been killed four hours earlier at a U.S. Department of Agriculture slaughterhouse; their brains completely removed from the skulls.

BrainEx pumped an experiment solution into the brain that essentially mimic blood flow. It brought oxygen and nutrients to the tissues, giving brain cells the resources to begin many normal functions. The cells began consuming and metabolizing sugars. The brains' immune systems kicked in. Neuron samples could carry an electrical signal. Some brain cells even responded to drugs.

The researchers have managed to keep some brains alive for up to 36 hours, and currently do not know if BrainEx can have sustained the brains longer. "It is conceivable we are just preventing the inevitable, and the brain won't be able to recover," said Nenad Sestan, Yale neuroscientist and the lead researcher.

As a control, other brains received either a fake solution or no solution at all. None revived brain activity and deteriorated as normal.

The researchers hope the technology can enhance our ability to study the brain and its cellular functions. One of the main avenues of such studies would be brain disorders and diseases. This could point the way to developing new of treatments for the likes of brain injuries, Alzheimer's, Huntington's, and neurodegenerative conditions.

"This is an extraordinary and very promising breakthrough for neuroscience. It immediately offers a much better model for studying the human brain, which is extraordinarily important, given the vast amount of human suffering from diseases of the mind [and] brain," Nita Farahany, the bioethicists at the Duke University School of Law who wrote the study's commentary, told National Geographic.

An ethical gray matter

Before anyone gets an Island of Dr. Moreau vibe, it's worth noting that the brains did not approach neural activity anywhere near consciousness.

The BrainEx solution contained chemicals that prevented neurons from firing. To be extra cautious, the researchers also monitored the brains for any such activity and were prepared to administer an anesthetic should they have seen signs of consciousness.

Even so, the research signals a massive debate to come regarding medical ethics and our definition of death.

Most countries define death, clinically speaking, as the irreversible loss of brain or circulatory function. This definition was already at odds with some folk- and value-centric understandings, but where do we go if it becomes possible to reverse clinical death with artificial perfusion?

"This is wild," Jonathan Moreno, a bioethicist at the University of Pennsylvania, told the New York Times. "If ever there was an issue that merited big public deliberation on the ethics of science and medicine, this is one."

One possible consequence involves organ donations. Some European countries require emergency responders to use a process that preserves organs when they cannot resuscitate a person. They continue to pump blood throughout the body, but use a "thoracic aortic occlusion balloon" to prevent that blood from reaching the brain.

The system is already controversial because it raises concerns about what caused the patient's death. But what happens when brain death becomes readily reversible? Stuart Younger, a bioethicist at Case Western Reserve University, told Nature that if BrainEx were to become widely available, it could shrink the pool of eligible donors.

"There's a potential conflict here between the interests of potential donors — who might not even be donors — and people who are waiting for organs," he said.

It will be a while before such experiments go anywhere near human subjects. A more immediate ethical question relates to how such experiments harm animal subjects.

Ethical review boards evaluate research protocols and can reject any that causes undue pain, suffering, or distress. Since dead animals feel no pain, suffer no trauma, they are typically approved as subjects. But how do such boards make a judgement regarding the suffering of a "cellularly active" brain? The distress of a partially alive brain?

The dilemma is unprecedented.

Setting new boundaries

Another science fiction story that comes to mind when discussing this story is, of course, Frankenstein. As Farahany told National Geographic: "It is definitely has [sic] a good science-fiction element to it, and it is restoring cellular function where we previously thought impossible. But to have Frankenstein, you need some degree of consciousness, some 'there' there. [The researchers] did not recover any form of consciousness in this study, and it is still unclear if we ever could. But we are one step closer to that possibility."

She's right. The researchers undertook their research for the betterment of humanity, and we may one day reap some unimaginable medical benefits from it. The ethical questions, however, remain as unsettling as the stories they remind us of.

Dubai to build the world’s largest concentrated solar power plant

Can you make solar power work when the sun goes down? You can, and Dubai is about to run a city that way.

Photo credit: MARWAN NAAMANI / AFP / Getty Images
Technology & Innovation
  • A new concentrated solar plant is under construction in Dubai.
  • When it opens next year, it will be the largest plant of its kind on Earth.
  • Concentrated solar power solves the problem of how to store electricity in ways that solar pannels cannot.
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19th-century medicine: Milk was used as a blood substitute for transfusions

Believe it or not, for a few decades, giving people "milk transfusions" was all the rage.

Photo credit: Robert Bye on Unsplash
Surprising Science
  • Prior to the discovery of blood types in 1901, giving people blood transfusions was a risky procedure.
  • In order to get around the need to transfuse others with blood, some doctors resorted to using a blood substitute: Milk.
  • It went pretty much how you would expect it to.
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