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  • Localization and Its Discontents: A Genealogy of Psychoanalysis and the Neuro Disciplines by Katja Guenther
  • Susan Lamb
Katja Guenther. Localization and Its Discontents: A Genealogy of Psychoanalysis and the Neuro Disciplines. Chicago: University of Chicago Press, 2016. 310 pp. Ill. $35.00 (978-0-226-28820-8).

In this insightful new monograph Katja Guenther challenges the “two cultures” narrative in the origin stories of modern psychiatry and neurology—that sometimes short-sighted historiographical trope that attributes the development of these medical disciplines in the last 150 years primarily to incompatible allegiances to studying body or mind, to using scientific versus humanistic methods. Guenther argues, rather, that the transformative contributions of Theodor Meynert, Carl Wernicke, Sigmund Freud, Otfrid Foerster, Paul Schilder, and Wilder Penfield all emerged from a “common neuropsychiatric heritage” (p. 6) rooted in fundamental contradictions between the “localizing” and “connective” paradigms applied, then and now, to investigations of higher brain function.

Guenther examines the work of these six key figures as each grappled with the relationship between localization (direct correspondence between symptoms [End Page 735] and lesions in specific brain areas) and connectivity, as demonstrated by reflex physiology in the mid-nineteenth century. Chapter 1 shows how Meynert, in the morgue of his Vienna institute, bolstered his neuroanatomical investigations by applying the connective principle of sensory-motor physiology, the reflex—reconceptualized by him in terms of association psychology—to explain why parts of the brain might control specific functions, such as language. Guenther exposes the “self-corrosive tendencies” (p. 36) of what became Meynert’s hegemonic model: that localization fragmented the brain, whereas connectivity unified it. The remaining chapters deal with how their distinctive attempts to address this problem—not problems of mind-body duality—conditioned the research trajectories of the others.

Chapter 2 shows how Wernicke’s research program was transformed by applying Meynert’s hybrid model clinically, in the lecture theater of his Breslau clinic, where Wernicke used the reflex to interpret psychiatric patients’ verbal responses as reflex movements stimulated by specific exam questions. These investigations weakened Wernicke’s confidence in localization and contributed to the clinical turn in German psychiatry at century’s end. Chapters 3 and 5 examine the significance of the Meynert-Wernicke model for psychoanalysis. In his early work on aphasia, Freud emphasized connectivity by universalizing its associative properties. Psychoanalysis was a continuation of these ideas, Guenther argues, and the product of Freud’s efforts to develop “a thoroughgoing physiology of association” (p. 81). Schilder, a German protégé of Freud’s in the United States, broke with the traditional model by treating motor and sensory arcs independently. His resulting “body image” concept (p. 143) was based on the notion of a self-transparent mind, which controverted that of the Freudian unconscious and caused Schilder’s split with psychoanalysis. Chapters 4 and 6 analyze the emergence of neurology and neurosurgery from these same intellectual resources. Foerster was a booster for neurology’s independence from the neuropsychiatry institutionalized by Meynert and Wernicke. In the 1920s and 30s, he accumulated new “institutional capital” (p. 123) in the exercise hall, where he developed effective physical therapies for numerous neurological diseases. Relationships between lesions and symptoms were indirect, Foerster reasoned, and the “plasticity” of the nervous system (p. 97) could be exploited therapeutically by manipulating patients’ sensory experiences. The models of Foerster and Freud are intellectual relatives, Guenther suggests, because both challenged localization by ascribing higher functions primarily to connectivity. The final chapter unfolds in the Montreal operating room of Wilder Penfield. Much as Schilder had reconfigured his mentor’s psychoanalytic concepts, Penfield transformed the neurosurgical techniques he had learned from Foerster by treating sensory and motor arcs separately. He used this experimental division to investigate the effects of electrical stimulation on the sensory cortex, asking surgical patients to describe their experiences as he stimulated various brain areas. These experiments reenergized the localization project in the twentieth century, and exemplified for many the supremacy of brain research over personality studies. Guenther suggests, however, that his failure to locate the higher integrating system that converted sensation into perception (i.e., the “mind”) indicates [End Page 736] that Penfield shared “the frustrations and discontents with localization” (p...

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