Andreas Killen

If transcranial magnetic stimulation, or TMS, emerges with good results from several studies being conducted by Lisanby and others around the country, the little paddle Lisanby wields could represent a breakthrough in the treatment of depression and other intractable conditions. TMS could be “the neuropsychiatric tool of the 21st century,” one physician says. But as even the most ardent proponents of TMS admit, that’s a big if.

Electromagnetism has been harnessed in everything from kitchen appliances to the space shuttle. It has also been employed — unsuccessfully — at different periods in medicine’s colorful and at times dark past. In 18th century, pre-revolutionary France, the craze for all things scientific led to the discovery of so-called animal magnetism and launched the fad of mesmerism, a kind of hypnotherapy. Invalids of every description flocked to healers with mesmeric tubs or linked hands with each other to form human electrical circuits. In the late 19th century, medical fascination with invisible energies resurfaced in experiments with magnetotherapy. Jean-Martin Charcot, the eminent nerve doctor, staged public demonstrations in which he claimed to move hysterical symptoms across the surface of the patient’s body with the aid of a magnetic coil. However bizarre, these experiments did have the virtue of fueling interest in hypnosis, and led indirectly to Sigmund Freud’s discovery of the talking cure.

In the 1930s, electricity was harnessed in a brutal form in shock treatment, which induced seizures in patients. Electroconvulsive or electroshock therapy, as it was known, became a staple of the psychiatric arsenal for decades before falling out of favor — only to be revived in recent decades, in a safer form, to treat depression. In the meantime, popular interest in magnetism seems once again to have peaked, albeit in contradictory ways — ranging from self-proclaimed magnetic healers to technology critics who warn of the ill effects of the force fields emanating from cellphones and electric power lines.

It is against this backdrop of dubious science and medical dead ends that researchers have staked their claim for TMS. Despite the treatment’s unorthodox appearance, its proponents are not exactly tilting at windmills. TMS has become one of the hottest fields in psychiatric medicine, part of the revolutionary change in the field brought about by new insights into the functioning of the brain.

The basic science behind TMS is simple. Magnetic fields, unlike electrical current, pass easily through the human skull, without being deflected by bone. Researchers can thus wield magnetism with greater precision and in much smaller doses than electrical current. Instead of being zapped into a convulsive state, the patient’s brain is mildly “tickled.” Exactly what happens inside the brain is only imperfectly understood, but the magnetic field seems to induce electrical current in areas of the brain — particularly the left and right prefrontal cortices — that are associated with mood disorders. Mysteriously, the current can stimulate or disrupt cortical activity depending on which side of the brain gets zapped. Stimulating the right side causes happiness, while stimulating the left causes sadness, says Mark George, one of Lisanby’s colleagues.

While researchers are still attempting to show how and with which patients TMS works, they are encouraged by the fact that it seems to have few side effects beyond mild headache. That sets it apart from electroshock therapy, which more than 50,000 people receive each year and which works by inducing seizures. While a seizure may shake a patient out of depression, it can also produce amnesia and tangled thoughts.

The discovery of TMS’s curative powers represents an outgrowth of two decades of research dedicated to pinpointing the relations between brain function and brain location. At Lisanby’s Magnetic Stimulation Lab, TMS is used in combination with techniques like magnetic resonance imaging and positron emission tomography to map brain function by creating temporary brain lesions and matching the physical changes to behavioral ones.

The therapeutic potential of TMS rests on a central insight of the new brain science: “plasticity,” the idea that the brain has the capacity to reorganize itself in response to new stimuli, or to lost or impaired functions. “I was taught,” Lisanby tells me, “that once you lose a neuron in the brain, that’s it.” But many recent studies have shown that neurons can regenerate. The discovery that the brain is a far more malleable organ than was once supposed has opened all sorts of new therapeutic vistas where once there had seemed to be only darkness. The premise behind TMS is that a small jolt can essentially “reset” the brain by stimulating its capacity for reorganization. These jolts can change the function of neurotransmitters, stimulate new synaptic connections or recruit new areas of the brain to compensate for lost functions.

If a depressed state of mind equates with sluggish brain circuitry, so the thinking goes, then injecting a small dose of energy into it could bring the circuits flickering back to life. A session with the paddle may be just what doctors of the future order.

That said, transcranial magnetic stimulation has far to go before it can be offered as a safe, effective treatment for psychiatric ills. Studies in the mid-1990s showed great promise but haven’t been easily replicated, causing proponents to back away from some of their more sweeping claims about the treatment’s benefits. Current research focuses on trying to pinpoint TMS’s effects with greater precision. Lisanby has just completed a study examining the effects of combining TMS with the antidepressant drug Zoloft. Zoloft typically takes up to six weeks to take effect, while TMS is faster acting but provides only short-term results. The purpose of the study, whose results are currently being analyzed, is to see whether TMS can be used to kick-start Zoloft’s therapeutic effects.

Other researchers are trying to set the parameters for the use of TMS, examining how much electricity should be sent through the coil, the optimal duration of the dose and where on the head the coil should be placed. Dr. Alvaro Pascuale-Leone, a neurologist and director of the TMS lab at Boston’s Beth Israel Hospital, is finishing a three-year, National Institutes of Health-sponsored study focused on tailoring TMS to the needs of individual patients, an advantage TMS may end up having over pills. More than 50 percent of Pascuale-Leone’s patients have responded with better than 50 percent improvement on the Hamilton Scale, a measure of depression. In the world of severe, treatment-resistant depression, those are great numbers. In the March 25 issue of the Lancet, investigators at Yale School of Medicine reported that TMS had reduced auditory hallucinations suffered by a majority of schizophrenics participating in a study there. Some of the patients became symptom-free, according to the researchers.

The search for better treatments has also led some researchers to consider using TMS in quite different ways than originally intended. One method involves using magnetism at frequencies high enough to induce seizure. The effects of the method, known as magnetic seizure therapy, are believed to be milder and more easily controllable than those of electroshock therapy. But some researchers are wary of using TMS to induce any seizures at all — the avoidance of potentially damaging seizures being a prime reason for using TMS in the first place. “All of us in this field worry about seizures,” says Pascuale-Leone. To be sure, he says, shock therapy has its place, and many of its ill effects have been eliminated through improvements in anesthesia and electrode placement. Still, Pascuale-Leone believes, seizure therapy is overkill: “If you think of depression as a fly on the wall, then ECT [electroconvulsive therapy] can be compared to a bazooka and TMS to a BB gun.”

Skeptics, on the other hand, doubt that TMS can work at all unless it causes seizures. Max Fink, a physician at Long Island Jewish Medical Center and a senior figure in shock therapy research, believes TMS can be attributed to the placebo effect. In his field, it is axiomatic that treatment does not occur without seizure. Fink believes TMS proponents have yet to show it works.

TMS researchers acknowledge it will be difficult to convince skeptics, especially given the superficial resemblance of TMS to the faddish magnetotherapy. (In fact, explains George, who studies TMS at the Medical University of South Carolina, “most if not all of the biological effects of TMS are due to the induced electrical currents and not the magnetic fields, which, although powerful, are very brief.”)

Should the public be optimistic or skeptical about TMS? Though early studies of the procedure generated a great deal of excitement, a recent paper coauthored by Lisanby and George ends cautiously, saying that it’s too early to know whether we are at the threshold of a new era of noninvasive, nonchemical treatment. Still, Pascuale-Leone is convinced that once researchers figure out the best way to use TMS, it “will have a role in the neuropsychiatric armamentarium.”

The day may yet come when people slip off at lunch for a quick burst of electromagnetism to get their brain current flowing in the right direction. In the meantime, it seems prudent to heed the words of the anonymous 19th century skeptic who said, “Beware of an optimist wielding a stimulating coil.”

But in the strange turn-of-the-century limbo we now occupy — marked by awesome economic prosperity, mind-boggling advances in science and medicine and a temporary respite from global ideological conflicts — happiness has moved from the margins of public discourse back to the center. A new generation of thinkers and researchers has appeared, seemingly determined to reclaim the subject of happiness from the pop psychologists and spiritual guides who’ve milked it for so long. Earlier this year, the American Psychological Association devoted a special millennial issue of its journal, the American Psychologist, to the subject of happiness. And Martin Seligman, former APA president, has spent the past year building a field known as positive psychology — which explicitly distinguishes itself from the inexorable negativity that has characterized the shrinking profession.

“Happiness is now receiving some long-overdue attention,” says Mark Kingwell, a philosopher at the University of Toronto. “Many thinkers lost track of the idea that happiness is a deep category, a non-obvious and frequently counterintuitive topic. They thought, as many people do, that they knew all about it.”

In his new book “In Pursuit of Happiness: Better Living From Plato to Prozac,” Kingwell chronicles his experiences visiting a “happy camp” (a spiritual retreat in Connecticut), taking Prozac and checking out an exhibition devoted to better living. He also compares competing philosophical notions of the good life, from Plato to the utilitarians, the late 18th century school of thought that preached that society must strive for the “greatest happiness for the greatest number.”

Enshrined in the political documents of that utilitarianist era (including the Declaration of Independence’s “Life, liberty, and the pursuit of happiness”), this “greatest happiness” principle has been central to the history of the modern world. Unfortunately, according to Kingwell, it also created a debased version of happiness, wherein happiness is a technical problem to be solved by public policymakers.

Kingwell’s special bugaboo is Prozac. He doesn’t blame people for turning to happy pills — confronted as they are by what he calls “consumerism, psychopharmacology and therapeutic fetishism.” But he does criticize psychiatrists for pathologizing unhappiness, thereby subtly ratcheting up the social pressure to be happy. In the end, he comes down firmly on the side of Aristotle’s notion of happiness — an austere idea that you’re only as happy as you are virtuous.

While Kingwell’s book skewers the quick-fix, buy-it-now happiness of our Prozac culture, it nevertheless leaves the impression that philosophy has broken little new ground on the subject since the time of Plato. Unfortunately, Kingwell ignores a whole tradition of modern writing about happiness that differs substantially from the utilitarian school. This tradition, which runs from Saint-Juste to the situationists, with detours through Stendhal and Baudelaire, takes happiness seriously as a political claim. For these writers, happiness was an idea that needed to be liberated from the aristocracy and made available to all of humanity.

“We don’t want happiness in the next world,” declared Saint-Juste in a speech given in 1793, at the height of the French Revolution. “We want it next Monday!” His is still one of the most impassioned of modern demands for happiness; he was demanding the kinds of liberties and equalities that common Western citizens had never before been given. At a time when the ideals of personal health and good living have become an anemic substitute for genuine political change, this strain of thought is still oddly relevant.

But where philosophy has fallen short, social scientists and psychologists have leapt into the fray, generating reams of research devoted to the subject. Among some of the more intriguing findings are those that reveal happiness’s illusive relationship to our self-knowledge. One study reports that 90 percent of people describe themselves as happier than the average person. This study leaves us to wonder just who this rare average person might be, especially considering the results of another survey finding that one in seven people born in the mid-1970s say they’ve had a major episode of depression at some point in their lives.

One of the most controversial and important finds revealed that beyond a certain minimum standard of living, greater prosperity does not in and of itself assure greater happiness. This explains the fact that the GNP is closely related to happiness in developing countries, but not in developed countries.

The discovery that affluence produces rapidly diminishing returns on happiness is often described as counterintuitive, a testament to the deeply entrenched belief that higher standards of living will result in greater felicity. Though this hardly counts as shocking news, it does perhaps explain why, when the belief fails, the temptation to take happy pills becomes overpowering. It also explains the psychology behind the bewildered, slightly shellshocked expressions on the faces of Solondz’s characters in his film “Happiness”: They assume they should be happy, but they’re not; feeling vaguely swindled, they hurl themselves into a series of increasingly desperate efforts at self-gratification, mostly involving queasiness-inducing acts of masturbation.

One problem that has dogged the happiness investigators is the difficulty of measuring it. On the face of it, happiness seems an inherently subjective matter. But is it? The editors of the Journal of Happiness Studies, which began pusblishing this year, think not. Drawing on empirical research about subjective well-being, they argue that happiness can be accurately predicted based on the objective livability of the society, as well as the individuals’ personal (read: genetic) profile. Covering everything from sociological surveys to neuropsychological studies, the journal includes articles on subjects like “Happiness in Russia” and “The Biology of Happiness.”

According to its editor, sociologist Ruut Veenhoven of the Erasmus University in Rotterdam, Amsterdam, happiness research methods have reached the point where they “can separate the chaff from the wheat among the many theories of happiness.” Veenhoven is also creating an extensive world database of happiness, made up of the results of hundreds of surveys asking people how happy they are.

What’s the purpose of this kind of data? Veenhoven hopes it will be used to influence social policy and broaden measures of livability. Alongside traditional measures of the GNP, ever more elaborate quality-of-life indexes factor in average life span, education, affordable healthcare, infant mortality rates, crime statistics and pollution. The result is a kind of happiness index intended to guide policymakers.

An even more radical way of tracking happiness comes from an unusual source. Recently on “60 Minutes,” the small mountain nation of Bhutan, which neighbors Tibet and is predominately Buddhist, was held up as an example of a nation that measures its output in terms of “Gross National Happiness” — a term referring to progress in the area of ethics, compassion and charity. The story was picked up by American pundits perplexed by the apparent gap between wealth and happiness in the United States. Resulting editorials touted a distinctly Aristotelian-sounding version of virtue-based happiness, while holding out the hope that a connection between wealth and virtue (in the form of charitable giving) might yet be discovered.

Why the sudden interest in happiness? Is it a symptom of sunnier times? The result of greater knowledge? Not likely, says Kingwell. “There’s still a lot of confusion about happiness,” he says. “People may be more interested in the idea of happiness because they are even more deluded than usual about the prospect of ‘solving the problem’ of being happy.”

Has our culture made any lasting contribution to human happiness, beyond Prozac, beyond the drug ecstasy, beyond Frappuccinos? Hard to say. There remains the possibility that happiness may be simply a matter of synaptic wiring. Recent research in the field of affective neuroscience has indeed shown that people who describe themselves as happy have more activity in their left prefrontal cortices, while depressed people have more active right prefrontal lobes.

The promise of new drugs will continue to fuel our fantasies of happiness for years to come. And future generations will no doubt continue to fork their money over to the “entrepreneurs of public happiness,” as Baudelaire called them. As for happiness studies, if it seems unlikely that the secrets to that elusive sweet bird of happiness lie buried within a mountain of statistical information, maybe I’m just being pessimistic, complacent in my unhappiness. Or maybe it’s because I believe, as the French poet Apollinaire put it: “Now and then it’s good to pause in our pursuit of happiness and just be happy.”

People have long assumed that the fate of civilization hangs on proper potty training. In his new book, James C. Whorton suggests civilization has also flourished because of toilet troubles — specifically, clogged bowels.

“Inner Hygiene” explores the unhappy modern preoccupation with irregularity and the remedies and devices that have been developed for this affliction. One of the many virtues of the book is that it shows, to some extent inadvertently, that civilization may be more compatible with failed potty lessons than Giuliani would have us believe.

Sure, we all grow up learning that “a movement a day keeps the doctor away.” But does that mean that freedom from anxiety about pooping is a prerequisite of civilized society? Far from it. As Whorton reminds us, some of the most creative thinkers of the modern era were afflicted by bowel trouble, perhaps even inspired by it. Martin Luther’s spiritual meltdown was famously precipitated by intestinal crisis. Later bowel-beclogged notables included John Locke and Ben Franklin, who both rhapsodized on the subject of regularity.

For centuries, the desperate and often humiliating quest for regularity has pushed human ingenuity to remarkable heights of invention, contrivance and rhetoric. In treating this quest as a serious subject, Whorton, a professor in the department of medical history and ethics at the University of Washington in Seattle, follows other recent scholars who have discovered fascinating histories behind modern attitudes toward bodily functions. He performs a valuable service in reminding us that civilization as we know it is unthinkable without bowel trouble and the entrepreneurial spirit it has called forth. Moreover, he does so with elegance and wit.

Source of so much misery, the blocked bowel has also fueled some of the most compelling modern visions of happiness. Visions of an existence free of straining, of an almost virginally pure and obedient intestinal tract, have animated the writings of innumerable scatologists and copromaniacs. Bowel afflictions have been transmuted into pure gold, in works like Rabelais’ “Gargantua and Pantagruel.”

But Whorton’s main subjects are the medical quacks, dreamers and men of dubious science who have unleashed on the modern world myriad patent medicines and contrivances designed to deliver their desperate patients from the torments of intestinal intransigence. The real story of this book lies in the endless stream of purgatives, enemas, irrigation devices, flavored laxatives, rectal dilators, chewing techniques, graham crackers and Kellogg’s All-Bran, which people have lavished on themselves in the quest for intestinal bliss.

From the Reformation on, Whorton tells us, Western society has been haunted by the specter of constipation, and worked energetically to rid itself of the ailment. Medical specialists and philosophers theorized endlessly about the causes, and inevitably came to focus on the pathogenic role of civilization itself: the rich diets, the sedentary lifestyles, the upright toilet seating and, most damaging, the curse of being too busy to answer nature’s call.

Whorton is full of eloquent sympathy for the tortured souls for whom a successful b.m. became the main event in a life of squeezing and suffering. There is both tragedy and comedy in the stories he recounts.

One 17th century anonymous poet was so alarmed by the violent purgative-induced expulsion he experienced that he wondered: “Will all my body runne out here?” At least he survived to tell the tale. We can only stand in awe of the intestinally impaired Frenchman who died in 1809 and was found to have 60 pounds of “pudding-like material” inside.

Such natural wonders had their unnatural counterparts: Witness the case of a French apothecary called to examine a severely constipated officer in the local regiment. Frustrated in his efforts to administer an enema, the unsuspecting healer peered into his patient’s rectum, and there discovered an eye peering back at him. The explanation for this “anus mirabilis”? The patient had accidentally swallowed his artificial eye; he, too, died soon after.

Against such tribulations, doctors laid down the need for regularity as an absolute law of intestinal care. Regularity was a highly serious business, as well as a deeply moral one — one of the building blocks of a civilized order, though some critics wondered whether the obsession with regularity itself bred constipation. Health manuals raged against dietary sins: rich foods, heavy gravies and cream-clotted pastries. Victorian moralizing was succeeded by 20th century science, though as Whorton’s book makes clear, the new war on constipation was waged with greater fervor than ever.

One early 20th century crusader was London surgeon William Arbuthnot Lane. Lifelong study of intestinal clogging convinced Lane that the problem lay in the design of the colon itself. His drastic solution: to re-engineer the body’s defective “drainage system.” Thus ensued one of the more unpleasant episodes in this history, with Lane and countless other doctors carrying out thousands of “short-circuit operations” on their mostly female patients. These procedures were designed to accelerate transit time in the bowel by surgically removing parts of the colon and its nasty little kinks.

Lane’s methods of disembowelment were met with horror by many doctors. (“No organ of the body is so misunderstood, so slandered, and maltreated as the colon,” lamented one.) The surgery eventually was replaced by a seemingly more benign, yet ultimately far more insidious, array of techniques for intestinal management.

The 1920s and ’30s were the golden age of the laxative industry. Aggressive laxative manufacturers sold their products by: 1) making constipation seem “inescapable and terrifying” and 2) making their peppermint- and chocolate-flavored cure palatable, even fun. Victorian strictures gave way to modern permissiveness: If dietary discipline failed, Ex-Lax absolved the self of its sins against the bowel. Marketing drugs as candy, the purgation industry created a generation of Americans enslaved to the consequences of laxative overuse. The ironic result: constipation, and, even worse, the fear of constipation — what Whorton calls “bowel neurosis.”

In recent decades, the dietary-fiber hypothesis has been the reigning shibboleth, linking all manner of diseases to the low fiber content of the typical Western diet. The belief that earlier, less civilized societies experienced more generous movements because they ate more fiber resulted in the modern embrace of psyllium husk. But the release of medical studies earlier this year showing that high fiber does not help fight colon cancer has threatened to plunge intestinal science back into the darkness from which it only recently emerged.

The colon may be the darkest of the continents civilization has encountered; a final place of resistance to culture. But, implies Whorton, one need not see the relation between civilization and shit strictly in terms of enmity. In fact it is very likely that the perception that shit is, well, shit, has contributed to the fear of constipation, and therefore to constipation itself.

The notion that civilization is threatened by either pathological retention or expulsion is anachronistic. The real question is not whether civilization causes constipation, but where would we be without it? Whorton’s answer: much impoverished in spirit, word and deed.

Will “freedom of the bowels,” that “most precious and essential of all the freedoms,” as one of Whorton’s sufferers puts it, ever be more than a chimera? Whorton’s book provides little hope. The best he offers is the advice of a wise physician, who urged his patients “to follow the example of the dog rather than the cat, and never look behind them.”

What strikes me in retrospect was my father’s absolute conviction that dreams have meaning. The skeptics aside, for much of this century my father has been in good company. The man he had to thank, of course, was Sigmund Freud.

This year marks the centennial anniversary of Freud’s epoch-making “The Interpretation of Dreams.” (The actual date of publication was November 1899, but Freudian myth has postdated it to 1900.) In commemoration, scholarly works and a new translation of Freud’s magnum opus have been published. Universities, institutes and museums have held conferences to probe Freud’s legacy. These events have reignited the debate around dreaming that has burbled among science, psychology and popular opinion for the past century.

The arrival of Freud’s dream book in central European bookstores launched psychoanalysis upon an unsuspecting world and turned most of us, even the deniers among us, into dream interpreters. “In a sense Freud has himself programmed the way we dream or, at least, the way we remember our dreams and infuse them with meaning,” says Avital Ronell, a professor of German literature at New York University.

But will we continue to be hung up on dreams in the next century? Or will we simply tire of the hard work of dream analysis? With all the sleep-suppressing pharmaceuticals we ingest nowadays — both legal and illegal — will there even be dreams left to interpret in the future?

At the forefront of the so-called Freud wars of recent decades is the question of whether dreams have meaning. Neuroscientist Allan Hobson of Harvard first leveled the charge that dreams are simply random neuronal events in the 1970s. He has continued arguing this point ever since, though his position has undergone modifications.

“Most psychoanalytic dream theory is obsolete,” Hobson tells me in the hearty voice of someone who enjoys a good scientific quarrel. “The idea that Freud’s dream theory is alive and well and only needs a little jiggering is absurd.”

It’s not that he believes dreams are meaningless. Hobson records his own dreams and discusses his patients’ dreams with them. But where Freud dethroned the conscious self, Hobson would like to restore it to its rightful place.

“Dreams are loaded with meaning,” he says. “It’s just obvious meaning, not repressed or censored. You don’t need to go around decoding them; the deep motives are right on the surface.”

Other researchers have launched a counterattack. While their findings are not conclusive, they point to a growing body of empirical evidence suggesting that dreams are meaningful in ways not accounted for by Hobson.

“If you show a man a circumcision film before he goes to sleep, he will dream about it,” says Steven Ellman, a professor of psychology at the City University of New York, a psychoanalyst and a sleep and dream researcher. “That,” he adds dryly, “is not random neuronal firing.”

Ellman’s research on REM (rapid eye movement) sleep suggests that dreaming is not just epiphenomenal but a form of unconscious processing — that it works through emotionally laden content not immediately accessible to the conscious mind. Other researchers have used neuro-imaging techniques to demonstrate that REM sleep activates regions of the brain associated with memory and feeling.

As a psychoanalyst, Ellman sees dreams as a point of entry into a patient’s inner world. At the same time, he does not feel that dreams represent, as Freud put it, the royal road to the unconscious. In the place of dreams, the idea of transference (the relationship between patient and analyst) has become the primary means of unlocking the unconscious.

Echoing the adage that Freudian patients have Freudian dreams while Jungian patients have Jungian dreams, he says: “When you focus too much on dreams, you distort the analysis. Patients give the analyst what they believe he or she wants.”

Other psychiatrists agree that the status of the dream in psychoanalysis has been subtly downgraded. In part, this reflects the economic realities of managed care. Less money means fewer sessions and more emphasis on psychopharmaceuticals — many of which, including antidepressants, suppress REM sleep. The upshot is not just less time and money to devote to dream analysis but fewer dreams to analyze.

George Makari, a psychoanalyst and director of the Institute for the History of Psychiatry at Weill Medical College of Cornell University, still feels that Freud’s ideas offer the most comprehensive model for understanding our inner life. Yet he’s cautious about the reliability of dream work.

“This is the movie you directed, whether you like it or not, and pursuing dreams in this manner can make for startling encounters with oneself. But,” he adds, “the interpretation of dreams can only usefully occur with a great deal of context.”

Popular belief in the validity of dream interpretation — whether Freudian, Jungian, “Eastern” or otherwise — seems stronger than ever. A glance at any bookstore psychology section reveals a plethora of books on dream analysis, glossaries, dictionaries and guides to dream symbolism. On the Ask the Dream Doctor Web site, one can submit one’s dreams for instant interpretation (at $20 a pop) and read the “Teen Dream of the Week.” On the Dream Lover Inc. site one is told, “All dreams are good dreams!” The International Institute for Dream Research is amassing a “dreambank” from visitor submissions.

Clearly the way we think about dreams has changed over the past 100 years. But have dreams themselves been altered by changes in sexual consciousness or the mass media? Has the sheer glut of interpretations domesticated our dreams, robbed them of their strangeness?

Makari doubts it. Sure, the content of our dreams has changed over time, like the content of delusions — which have shifted from 17th-century witches to late 20th-century surveillance systems. “Does this suggest the mechanism of delusion formation has changed?” Makari asks. “I think not. So, too, for dreams.”

Michael Moskowitz, a psychoanalyst and founder of Other Books, a bookstore and publishing house devoted to psychoanalysis, thinks the meaning of dreams is less obvious now. Once, he recalls, it was common to hear people say, “That’s an obviously Oedipal dream” or “That’s obviously anal.”

Yet the primal conflicts expressed in dreams are ultimately just as powerful as ever, Moskowitz believes. In other words, it’s just as horrifying now as it was 100 years ago to dream about killing one’s father or having sex with one’s mother. Thus there is a disincentive to dreaming — one heavily tapped into by the modern psychopharmaceutical industry. The Prozac nation doesn’t dream as much the Freudian nation, and that may be part of the attraction of drugs.

Where, finally, has all this talk about dreams gotten us? Has it brought us closer to insight into our selves and our inner demons? Or has it made us, simply, connoisseurs of dreams — and, for the more squeamish among us, eternally condemned to listen to others speak in the voice of their innermost narcissistic being, without even receiving an analyst’s fee for our troubles?

From a distance of 15-plus years and several thousand miles, my father’s faith in the meaningfulness of dreams now seems one of his more endearing qualities. It was futile to contradict him, as I once tried to do. Nowadays, I try to remember my dreams. But the morning ritual — the divulging of those dreams — is one I don’t miss. I’m pretty sure that Freud himself would have blushed to find himself a guest at my family’s breakfast table.

Weine’s anecdote hints at this combustible and compelling mixture of tragedy, politics and media that has given rise to the field of trauma studies, which has become one of the hottest — some would say, most overheated — fields in academe. In what seems a perfect marriage of public policy and academic theory, recent years have seen the convergence of a panoply of scientific and intellectual investigations around this subject. The aftermath of trauma is being researched in laboratories and analyzed by historians, literary critics and experts in media, law and psychiatry. Meanwhile, the effects of trauma proliferate in war-torn countries, clinics and courtrooms, as well as on Web sites documenting post-traumatic stress disorder among victims who range from survivors of ethnic cleansing to law enforcement officers.

It’s no accident that Clinton was the intended audience for these stories. In addition to being the leader of the most powerful country in the world, he’s probably done more than anyone since Sigmund Freud to make it acceptable to talk about psychic pain. Does the advent of trauma studies, as its advocates claim, mean the subject is simply receiving the long-overdue attention it deserves? Or does it mean, as others suggest, the triumph of victim culture; the saturation of public discourse with shocking stories?

There is no simple definition of trauma. Researchers claim to be targeting its underlying neurophysiology by linking trauma with shrinkage of brain tissue. Psychologists regard it as neither depression nor mental illness, but rather as an assortment of symptoms including nightmares, flashbacks, depression, amnesia, thoughts of suicide and states of disassociation that plague survivors of psychologically shattering events.

Charles Figley, head of the Psycho-Social Stress Laboratory at Florida State University and editor of the electronic journal Traumatology, explains that “our society has become more toxic and thus we react to events vicariously. This is due in part to the fact that our lives are more fraught with anxiety.” Taking a more jaundiced view, others have proposed that ours is a “trauma culture” on the verge of drowning in a surfeit of tragic tales.

In the New York Review of Books, Ian Buruma takes a more skeptical view by suggesting that the current proliferation of Holocaust museums, memorials and memoirs feeds a ghoulish cult of vicarious traumatization. The most extreme example is Binjamin Wilkomirski, the Swiss writer whose Holocaust complex resulted in a “memoir” that used memories supposedly recovered under hypnosis to help reinvent himself as that most privileged of victims: the concentration camp survivor.

As psychoanalyst Ghislaine Boulanger explains, trauma has a cyclical history connected with times of extreme violence or social upheaval, such as the Holocaust, the Vietnam War and the feminist movement. Initially applied to Vietnam veterans, post-traumatic stress disorder was included in the criteria for insurance reimbursement for the first time in 1980 and later incorporated into studies on domestic and sexual abuse. But by the end of the 1980s, advocates of recovered memory were lumped with alien abduction and satanic ritual abuse theorists. This uninvited alliance was an embarrassment to the field.

The “ethnic cleansing” of the past decade may have placed trauma on the contemporary radar screen. In the 1980s, reports of torture or genocide in places like Chile or Sri Lanka failed to capture world attention, but more recently, events in Rwanda, Bosnia and Kosovo have generated a wave of protest. In the United States, clinics for torture survivors have become a cottage industry, and the field of trauma studies has acquired all the trappings of a discipline: academic programs, certifying boards, journals, electronic newsletters and international conferences.

New York University’s International Trauma Studies Program is one example of trauma’s new cachet as an academic subject — evidence, according to its director, Jack Saul, that “trauma is here to stay.” The program, now in its second year, provides specialized training for mental health professionals who work with trauma survivors. It tries to broaden the framework of training for all those who deal with trauma survivors and refugees. Saul stresses that professionals must abandon their neutrality and advocate for patients by educating them about their human rights.

Another feature of this training concerns the secondary effects of constant exposure to trauma. “Vicarious traumatization” refers to the fact that dealing with disasters is emotionally draining. A significant percentage of those who do so suffer from burnout and symptoms of PTSD. Aside from high turnover rates, “vicarious trauma” creates more serious problems, such as “re-traumatizing” the client. It’s not uncommon for immigration lawyers to vent by becoming sadistic and treating their clients as liars or malingerers.

Police departments have recognized the phenomenon as a factor in police brutality. Web sites maintained by Vietnam veterans and ex-police officers routinely invoke books like “Copshock,” which makes the alarming claim that 20 to 30 percent of law enforcement officers working in urban areas will develop post-traumatic stress disorder. The exculpatory potential of such claims was illustrated by the father of Justin Volpe, the officer who sodomized Abner Louima in 1997. Volpe’s father pleaded stress-related disorder in defense of his son, who claimed he couldn’t remember what happened. (Volpe is serving 30 years after pleading guilty to violating Louima’s civil rights.)

It’s no wonder that one issue at the center of trauma studies is the relation between trauma and the stories told about it in courts, the media and art. Weine, the Illinois professor, cautions that questions about the quality of testimony cannot be ignored, given the legal and political issues at stake, and evidence of the ease with which these stories can be manipulated, whether by therapists with their own agenda, or by radical ethno-nationalists solely interested in settling old scores. Trauma is increasingly vulnerable to counterfeiting and misrepresentation. As Steven Reisner, a psychoanalyst who teaches at NYU’s trauma studies program, puts it, trauma sells, and people are rushing to cash in before its currency becomes devalued.

If the challenge for trauma experts lies in evaluating patients’ stories, this task seems to be growing more and more difficult. How, for instance, does it complicate our notions of trauma that police officers are now claiming the status of trauma victims, or that the Kosovars have turned out to be every bit as brutal as the Serbs? Reisner predicts that the current trauma activism in Kosovo will end badly. The desire for clarity simply won’t hold up; recognition of Kosovar crimes will overburden the narrative of bad Serbian and good Kosovar.

Reisner strikes a more positive note in tracing the value of trauma to a shift in the political landscape. “What’s different today,” he says, “is that the voice of human rights as a moral compass has become clearer.” Public discussion of torture in Chile, for instance, is no longer so easily obscured by anti-communism. But if the tendency on the right is to downplay human rights abuses, the left has been no less guilty of its own myopia. In its desire to set the historical record straight, it sometimes naively accepts stories that prove false upon closer scrutiny.

Many trauma scholars invoke the possibility that the Clinton years made suffering a topical and valid course of study. According to Ernie Duff, director of a community outreach center in Queens, N.Y., refugee mental health was once considered a soft service with low budgetary priority, but it has gained credence under the Clinton administration. Five years ago, says Janet Chassman, head of New York state’s Department of Mental Health Trauma Initiative, no one wanted to hear about the aftermath of suffering. Now it’s everywhere, which she attributes to the policies of the Clinton administration. For example, in New York City, two-thirds of patients with serious mental illness have now been diagnosed with trauma histories.

Will the preoccupation with trauma die with the Clinton administration? Some people may hope so. Listening to disclosures from Clinton, Monica Lewinsky, Henry Hyde and Newt Gingrich may be hazardous to public health: Like vicarious traumatization, it can induce exhaustion and nausea.

It’s easy to make fun of psychoanalysts and their earnest enthusiasm for hidden and not-so-hidden meanings. For Freud, as everyone knows, the unconscious had a way of breaking through the surface of consciousness in slips of the tongue, double-entendres, cigar jokes and so forth. At the time he came up with this notion, it seemed radical, but in our current, post-repressive society there’s something quaintly Victorian about it. Who is shocked by unintended meanings nowadays?

In the ’70s, a group of neuroscientists led by Roger Sperry conducted research on split-brain patients that suggested a simpler way of understanding the scenario described above. Working with patients whose two brain hemispheres had lost the ability to communicate with one another, this research demonstrated that the emotional meaning of the stimulus “mom” (“You bitch”) can reside in a part of the brain completely separate from the perceptual awareness of “mom” (“Mother, please pass the salt”). Like Freud’s binary theory of consciousness and unconsciousness, this neurological discovery suggested there were indeed two channels of human experience … but it has also thrown the Fruedian worldview into question.

Since then, researchers in the field of cognitive neuroscience have continued recasting psychoanalytic ideas in anatomical terms. Slowly but surely these researchers are forcing their way into the stronghold of the Freudian worldview: the unconscious. What’s at stake in this is nothing less than a revolution in the way we understand our emotions and psychological defense systems.

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I’m peering into a refrigerator whose shelves are lined with tubes containing rats’ brains. These brains are about the size of macadamia nuts, their surfaces wrinkled and whitish, each with a large crevice running across the top dividing it into two halves. They occupy a corner in the laboratory of Joseph LeDoux, professor of neural science at New York University.

These brains contain the raw material for LeDoux’s research into the neurophysiology of emotion. LeDoux is especially interested in one particular brain structure, the amygdala. This modest-looking, kidney-bean-shaped structure, roughly a couple of millimeters in diameter, is one of the newest frontiers in brain research, though it belongs to the oldest part of the brain

With his reddish goatee and piercing eyes, LeDoux could pass for a psychoanalyst himself. When I ask how he identifies himself, he laughs and shifts uncomfortably in his chair before responding: “I’m a behavioral neuroscientist with a psychological orientation.” As this statement reveals, LeDoux wants to speak to different audiences, including experts in the neural sciences, behavioral psychologists and orthodox Freudians, as well as the general public. Originally from Louisiana, he participated in the aforementioned research on split-brain patients in the 1970s before becoming interested in the field of emotions, long a blind spot in the cognitive neurosciences. His pioneering work in this field was described in his 1997 book “The Emotional Brain.” He’s now a celebrity, with a recent article in the New York Times Magazine highlighting his contributions to the new field.

The particular emotion that interests LeDoux is fear. It is our most primitive emotion, and the one most closely identified with the amygdala, the least evolved structure in our brains. This makes it easy to reproduce and study in animals, through techniques of fear-conditioning. LeDoux explains to me that when we encounter something dangerous, such as a snake or a bear, the danger-stimulus is conveyed first to our amygdala, which initiates the proper sequence of responses: sweaty palms, adrenalin, pounding heart, flight. These are all automatic responses (as are about 90 percent of our responses). We don’t need to be conscious of them; if we were our brains would rapidly be overwhelmed. It’s a secondary set of networks activated by the amygdala that produces the conscious feelings we know as “fear.” The awareness of fear only comes after the response, a paradox William James first noted in the 19th century.

James’ notion that civilization had freed us from the grip of fears that dominated the lives of our primitive ancestors has an anotomical correlative in the new neurological findings. The cortex, a more recently evolved brain structure, offers a distinct, more self-conscious line of defense against fear. Whereas it takes only 12 milliseconds for an auditory stimulus to reach the amygdala, it takes up to three times as long to reach the cortex. This is a significant lapse of time, one that allows certain conscious mechanisms to be activated and to impose control over our reactions. For obvious reasons, this is an advantage in the modern world, where fears may erupt but need more sophisticated responses than a club to the head.

In people suffering from fear disorders such as phobias, however, the neural links between cortex and amygdala seem to break down chronically, plunging the individual back into a world of archaic fears. In this state, the amygdala has essentially taken over the mind, like a parasite or an evil troll. Unfortunately, as LeDoux puts it, “Fear learning is forever.” Once fears are learned they cannot be unlearned. Phobias are especially difficult to cure, but we all carry inside us fears we don’t want. It’s estimated that more 20 million Americans suffer from some form of anxiety disorder, including panic, social phobia, post-traumatic stress disorder, obsessive-compulsive disorder and generalized anxiety.

Next page | Can my amygdala explain my failure in psychotherapy?

A couple of weeks after my meeting with LeDoux, I go to Washington for the weekend. On the train down I skim back issues of “Shadow of the Bat,” a spinoff of the original Batman comic book series. In them, a mad scientist called Jonathan Crane (aka “Scarecrow”) experiments on people’s fear reactions, turning them, with the help of Pavlovian fear-conditioning methods, into puppets ready to carry out his scheme to take over the city of Gotham. By releasing fear-gas in the city, he intends to turn its inhabitants into a population of wildly hallucinating, panic-stricken people ready to worship him as the “God of Fear.” It’s an entertaining read, reminding me a bit of the paranoid scenarios Rudy Giuliani likes to peddle to the citizens of New York City.

It also reminds me of the reasons for my interest in LeDoux’s work. Having just ended six years of psychotherapy, I’m intrigued by his theories for a number of reasons. The central conflict between my therapist and me concerned my resistance to her efforts to get me to verbalize my feelings. We talked about dreams, but my abysmal failure to free associate, my doubts about the existence of my unconscious, weighed heavily on me. I invented emotions just to cut short the awkward silences that ensued when she’d ask me, for the millionth time, “Do you remember how you felt when your mother insisted that your whole family sleep in one bed in that B&B in Ireland?” I felt like a failure as a patient and wished for a simpler explanation of my “blocked” relation to my feelings.

In this respect, the notion of the amygdala has a lot to recommend it. It provides a simple, tidy model of the brain’s primitive, reptilian core, very different from the old Freudian unconscious, which has a certain messy, amorphous quality. Unlike the idea of amygdala, the idea of the unconscious also provides a social theory about how humans interact. It oozes over its boundaries, showing up like an uninvited guest at the dinner table or in more programmed ways in comic books. It helps explain who we are culturally as well as psychically.

While in Washington I check out the Freud exhibit at the Library of Congress. I’m particularly interested in Freud’s favorite images of the unconscious: a print of an excavation site in Rome; a popular child’s toy called the mystic writing-pad (waxy paper from which written words were erased while traces were left in the soft tablet underneath); a small, exquisite statue of Athena, goddess of wisdom and warfare. It’s obvious why Freud treasured this last piece. It speaks to one of his strongest beliefs, if one that, later in life, he seems to have harbored doubts about: that self-knowledge frees us from the grip of archaic impulses.

Freud’s “talking cure”, as he conceived of it, released patients from their traumatic memories, creating insight and awareness where previously there had only been darkness. But Freud’s work rests on certain postulates now widely under attack. Does psychoanalysis still have anything to teach us about the obstinate irrationality of our minds? Can it truly help us gain insight into our feelings? Are we better off looking elsewhere?

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Back in New York, I ask LeDoux about his views on Freud. “My work is quite compatible with Freud’s,” he claims. Both drugs and the talking cure, he suggests, are equally valid ways of “rewiring the brain.” On the other hand, LeDoux feels that Freud’s concepts of repression and the unconscious don’t stand up to scientific scrutiny. Unconscious processes do dominate mental life, though not for the reasons Freud believed: “They’re unconscious not because they’re repressed, but simply because they’re not conscious.” Consciousness — that 10 percent slice of the psychic pie — is, in a word, “un-unconsciousness.”

LeDoux’s model places powerful biological forces at the center of mental life. Indeed, his book makes it sound as though consciousness is little more than an appendage to these forces. It’s somewhat incongruous, therefore, that he frequently illustrates his views with references — as though this were unusual — to the problems of the “neurotic” who suffers from “poor insight” into his feelings; to the poor soul who has a difficult time verbalizing his emotions, or who finds himself in a condition of emotional arousal without knowing why. These references seem ironic, given the powerful role he ascribes to the amygdala. A further incongruity comes in the closing pages of his book when he optimistically depicts a future of greater cortical control over amygdala-driven behavior. Hints of what this might mean come when he cites research suggesting that using drugs to block the production of adrenalin might help prevent the creation of traumatic memories among soldiers.

The therapeutic implications of LeDoux’s work have already been explored by David Goldman, a Manhattan psychiatrist. Told that I’m writing an article for Salon, he enthusiastically endorses it as the “magazine of cortically active-amygdala-modifying progressives.” Goldman has recommended LeDoux’s book to some of his patients. Learning about the amygdala seems to help them objectify their anxieties and fears. By clueing patients in to the automatic nature of much of their mental life, it allows them to think about their problems in physical terms rather than as products of a runaway mind. Paradoxically, this discovery seems to ease their sense of hopelessness and guilt. “It helps them to think of automatic behavior in a more relative way,” he explains. This is the first step toward insight.

All this makes sense to me. By physicalizing our mental life, LeDoux’s work lifts some of the stigma of personal responsibility often associated with debilitating fears. Yet I can’t help wondering about another aspect of LeDoux’s work: its appeal to my desire for easier, simpler explanations. The danger of a certain reductivism seems to lurk within his model, especially insofar as it provides support for the new psycho-pharmaceutical contract between us and our feelings: We let medication take care of the dirty work, meanwhile cultivating that 10 percent of the mind accessible to consciousness.

Moreover, how realistic are the possibilities he envisions? It’s nice to think of a world in which amygdala-driven behavior is controlled. But in a book otherwise dedicated to a hard-nosed view of the ineradicable forces dominating mental life, LeDoux’s optimism seems like a false note, a sop to human vanity. If Freud has taught us nothing else, it’s that our mental life is stubbornly irrational. The evidence of this is all around us, in the fear-gas scenarios of “Shadow of the Bat” and in the increasingly whacked out rhetoric of New York’s mayor, to cite just two examples.

William James, that great 19th century spokesman for the civilizing process, probably never envisioned the possibilities of “Shadow of the Bat.” This is where Freud comes in. For there can be no doubt about it, fear has become a strange thing in our modern world, severed from any simple evolutionary narrative. If evolution has freed most of us from an existence filled with real danger, it’s delivered us into a world in which primitive impulses are kept on permanent overdrive by the fear-programming of mass culture or by fear-mongering politicians. We may well have more fears than we know what to do with, and medication may indeed help to control fear on an individual level. But fear proliferates in the cultural and political landscape; it’s become ubiquitous, with entire industries devoted both to controlling it and to therapeutically detonating it.

Strangely, while I went to LeDoux looking for some sort of reassurance that my alienation from my feelings was not at all a sign of failure but rather perfectly normal, I now find myself worrying about what is lost and what gained in the paradigm shift from the unconscious to the amygdala. Ultimately, the price seems to be a kind of flattened mental landscape, in which fear is either the pathology of maladapted individuals or a condition that civilized society subjects to increasingly precise forms of prediction, control and exploitation. In either case, there seems to me to be little ground for optimism. On the other hand, I have to admit that I still like the idea of a pill that would make it possible for me to ask my mother for the salt without fear of interruption from my unconscious.