Avenge Charcot!

Were the statement to appear on a true-false test, most people would mark “Sigmund Freud advocated a theory of the subconscious” with a “T” and feel some confidence when doing so. The red mark correcting it would come as a shock. In fact, Freud seldom used the term “subconscious.” When he did, it was usually to dismiss it as imprecise vernacular, of no use in developing a scientific understanding the mind. Instead, he insisted on the need for a concept of “the unconscious,” which he was in the position to elucidate on the basis of his own techniques.

Not quite trusting my own recollection on this point, I did a search for “subconscious” in two different digital editions of Freud’s collected works in translation. In one of them, he sounds almost testy. (The public disregarded his wishes and insisted on equating the subconscious and the unconscious.) But he sounds a bit less stern in one passage, when he recalls the great neurologist Jean-Martin Charcot coining it in the days when he was Charcot’s student in Paris.

With Yves Agid’s Subconsciousness: Automatic Behavior and the Brain (Columbia University Press), we find an effort to upgrade the term and relaunch it as a viable concept. The author is professor emeritus of neurology and cell biology at the Pitié-Salpêtrière University Hospital, the very institution where Freud heard Charcot lecture. Agid takes a few shots at the founder of psychoanalysis for taking psychology down a dead end. Some kind of Oedipal drama seems underway—with Freud overthrowing the authority of Charcot, only to be challenged in turn by someone from a later generation.

With its informal tone and doodle-like cartoons—not to mention what must be the shortest bibliography to appear in a university press book published in the current century—Subconsciousness is clearly meant for a general audience without much interest in nuances of terminology. Agid takes as his point of departure some distinctions that are just about self-explanatory, then introduces the reader to the perspective coming from his decades of clinical and laboratory work.

His emphasis is less on cognitive features like language or memory than on movement, understood as “the synthesis of our emotions, intellect and physical condition.” And from that vantage point, the difference between consciousness and subconsciousness lies in the contrast between deliberate and automatic activity. Driving in an unfamiliar place requires a good deal of focused attention and decision making, and very likely the processing of data from both the environment and a map. All of this comes under the heading of consciousness. By contrast, driving to the same destination following the same route a number of times will soon become a habit requiring little concentration at all, most of the time.

Agid distinguishes a third category, “metaconsciousness,” in which, he writes, “I become the object, the witness, of my own thinking.” You miss an exit and think, “Stop daydreaming! Pay attention. I’m late enough as it is.”

While definite contrasts exist between consciousness and its sub- and meta- auxiliaries, we shift between them constantly. To put it another way, life consists of a variety of activities carried on at one level or another, as necessary at the moment. The author further breaks up subconsciousness into types based on whether or not it “takes over” from a conscious activity or involves memory. By no means is Agid’s subconsciousness an inferior kind of consciousness. The larger share of a gifted musician’s or athlete’s performance is a matter of subconscious movement, executed with precision the onlooker cannot quite imagine.

The typology is less interesting than how Agid then grounds it in what is now known about how the brain functions. Reducing the map to a very crude sketch, we could say that the consciousness and metaconsciousness are largely based in the frontal cortex: “the brain’s effector that produces behavior, that translates into motor activities based on information received by the posterior cortex, known as the sensory cortex, and receives information from all five senses.” Subconsciously performable actions seem to be rooted in the basal ganglia, at the center of the brain: structures that developed much earlier in evolution than the much larger cerebral cortex.

The basal ganglia have been the focus of Agid’s research, and the importance of their interaction with the rest the brain becomes especially clear in light of various ailments that can affect it. “These small balls stuffed with neurons (a few hundred thousand) receive messages from the cerebral cortex (20 billion neurons),” he writes, “which results in a spectacular compression of cortical information toward the basal ganglia (a ratio of almost 1,000:1!).” Their components link up “motor, cognitive and emotional circuits” while remaining “under the control of the cerebral cortex, so that in the case of a new situation, the cortex can disengage itself from the basal ganglia to adapt the individual to a new situation, whereas the basal ganglia continue to ensure the automatic adaptation of the individual to the environment.”

Such is the norm in a healthy brain. With Alzheimer’s disease, for example, “the patient has intellectual disorders (memory, language, perceptions) resulting from dysfunction of different areas in the cerebral cortex, while automatic behaviors (walking, eating, exhibiting elementary courtesy) that depend on the proper functioning of the basal ganglia remain unaffected until well into disease progression.” In terms of Agid’s categories of consciousness and their relationship to movement, metaconsciousness (the capacity to reflect upon how accurate or appropriate thoughts are for action) goes first, and then “the boundary of ‘conscious’ exploration itself narrows: the local neighborhood, the building, the apartment, the bedroom, the armchair, the bed—with all the ensuing psychological and social consequences.”

By contrast, the Parkinson’s patient can maintain the cognitive functions performed by the cerebral cortex, but “automatic behaviors such as walking, brushing teeth, and writing are altered due to the dysfunction of the basal ganglia.”

In one of several sidebars to the main text, Agid poses a question: “What will be the future of psychiatry, which is still largely based on the doctrine of psychoanalysis?” The reader acquainted with American conditions has to guess that this is a French thing: a byproduct, perhaps, of the considerably greater role psychoanalysts have had there over the past few decades while waning in the United States. Here, pharmaceutical ingenuity has long since become the front line of mental health treatment. Here, someone in a psychiatric residency is less likely to be studying Freud than their younger sibling with an English major.

And in any case, the disorders that Freud developed his ideas to address are quite different from anything Agid discusses in Subconsciousness. Not even the most gung-ho orthodox Freudian on any continent would claim that an Alzheimer’s patient is going to benefit from psychoanalytic treatment.

A cure for such suffering, if it ever comes, will probably be the result of the sort of biomedical research that Agid has spent his life doing. He can’t be faulted for celebrating that approach. But to frame it as a battle against the dead hand of Freud seems, at this late date, like beating down an open door barely on its hinges.