Katja Guenther, Localization and its Discontents: A Genealogy of Psychoanalysis and the Neuro Disciplines (Chicago: Chicago University Press 2015) 310 pp. $35.00 PDF, Hb. ISBN: 9780226288208
Investigating the relationship between psychoanalysis and neurology, Localization and its Discontents takes the reader back to the nineteenth-century German-speaking world by providing a historical approach to the link between two seemingly conflicting fields of science. Guenther successfully demonstrates that the intellectual roots of both disciplines can be found in neuropsychiatry that was dominant in Europe at the time. While neurology relied on technologies to examine, track and model the nervous system, psychoanalysis focused on verbal communication in therapeutic processes concerning the mind. Both disciplines, however, radically transformed our understanding of the function of the brain, making immense contributions to humankind's scientific advancement in equal measures. This book sets out to consider the significance of the common history and shared attributes of psychoanalysis and neurology, governed by their mutual engagement with the principles of localisation (that is, the project of locating and analyse physiological changes in the brain) and connectivity (the identification of combinative principles related to the study of how different nervous elements function together).
Localization and its Discontents contains six main chapters that undertake an in-depth analysis of the nineteenth-century circumstances of scientific and clinical work. The period's obsession with localisation derived from a general enthusiasm for somatic explanations and medicine. As contemporary scientist Wilhelm Griesinger claimed, '[m]ental disease is brain disease' (4). In mainstream somatic psychiatry, scientists located mental faculties in particular centres of the brain with a connectivist model of brain function. The most observed connective principle at the time was the reflex - spontaneous and immediate movements in response to stimuli - because it enabled practitioners to engage with their patients' nervous system. Interestingly, albeit unsurprisingly, Freud's early participation in analysing pathological anatomy and reflexes played a pivotal role in the emergence of psychoanalysis later on.
Each chapter in the book introduces the reader to prominent scientists who, challenging one another's ideas, pushed the boundaries of medical discovery. Chapter One discusses the work of the neuropsychiatrist Theodor Meynert, who reshaped reflex physiology. Although the reflex had previously been restricted to spinal action, Meynert managed to apply it to the idea of brain-centred localisation, which he achieved by revising the reflex model to make it suitable for describing higher brain functions. He argued that in the neural pathway that controls a reflex action, there is indeed an 'association system' between the sensory arc and the motor arc, providing an explanation for the complexity of brain function. Chapter Two looks into the clinical work of Carl Wernicke, an influential member of the contemporary group of neuropathologists. He rejected the idea that certain brain centres were responsible for certain functions only, postulating rather that nervous disease was the complex interaction of several different nervous elements. He laid emphasis on the role of the whole reflex arc, highlighting links connecting sensory and motor arcs (a view which the early Freud supported too).
Chapters Three and Four shift the focus to the influence of Sigmund Freud and Otfrid Foerster, who refigured the relationship between reflex and localisation. Freud challenged the localisationist paradigm by radicalising the associative factors of Meynert's theory of connectivism. He reconsidered the cause of mental diseases, drawing attention to psychological trauma instead of physical reasons, and he invented talk therapy in place of reflex testing. Similarly, Foerster rejected the pathological anatomical model and grew increasingly wary of the assumptions of the localisation tradition. Foerster separated the mutual connection between lesion and function (that had formed the basis of Meynert's pathological anatomy) and he proved how sensory damage could have motor consequences. As a result, Foerster reconceptualised nervous disease, Freud made a breakthrough in the field of mental health research, and thus the two new disciplines of neurology and psychoanalysis materialised.
Chapter Five continues to reflect on Freudian psychoanalysis and its development, which saw the formerly groundbreaking idea of connective principles discarded. This part of the book charts the professional development of the psychoanalyst Paul Schilder, who moved away from the theories of Wernicke and the early Freud by treating sensory arcs and motor arcs discretely. The kind of reflex testing that he promoted allowed him to rely on his patients' reports of sensory experiences which, by extension, encouraged him to acknowledge the self-transparency of the subject in his psychoanalytic work (through which he also demonstrated his opposition to Freud's theory of the unconscious). Chapter Six foregrounds one further scientific transformation that took place in the late nineteenth and early twentieth centuries. Wilder Penfield, an American-Canadian neurosurgeon (who conducted studies in Germany as well) developed unique methods and techniques in brain surgery, which still form an integral part of medicine even today. In addition to devoting a lot of research to mental and emotional processes, he was the first to map the functions of sensory and motor cortices of the brain, demonstrating their connections to various parts of the body. Penfield was also a pioneer in the treatment of epilepsy by surgery.
Localization and its Discontents reframes the history of psychoanalysis and the neuro disciplines, revealing that the correlation between them is much deeper than hitherto thought. The chapters are easy to follow, the translation of original German phrases is provided in a consistent manner, and the author's careful organisation of the book enables the reader to perceive a meaningful sequence in the order of different sections.
Teodora Domotor, University of Surrey