Let’s Look at How the Brain Really Works
By Mary Sykes Wylie
Brain science may be all the rage among psychotherapists, but that doesn’t mean most psychotherapists actually know much about it. And yet, who hasn’t fallen prey to the seductions of what might be called the new phrenology—the assignment of emotional or relational problems in clients to particular brain regions or functions, often with implausible, if not laughable, results?
In the world of pop neuroscience, it all seems fairly simple. The left hemisphere is the seat of logic and analysis, and the right hemisphere is where the brain stores intuition and artistic creativity. Fear and anger lurk in the amygdala like brother ogres brooding in a deep cave, memory lives in the hippocampus, and empathy comes from mirror neurons that somehow “see” and “get” the signals other people send. Low serotonin “causes” depression, while dopamine is a pleasure chemical, and oxytocin is the brain’s own love potion.
But, in reality, the brain isn’t just a storehouse full of discrete modules and chemicals with complicated names, each precipitating a particular function, feeling, or process. Just about every mental function, from doing a simple arithmetic problem to experiencing transcendent feelings of love or spirituality, results from external stimuli and a vast range of neural activities and connections, drawing on many brain regions interacting with each other—systems within systems. In fact, most mental functions involve many regions of the brain performing a variety of functions that don’t necessarily predict or correlate with the specific behaviors or feelings to which they’re supposedly attached.
Much, much harder than playing phrenologist is actually grasping something of the unimaginably complex, fully dynamic brain processes that shape our mental and physical lives. The problem is, of course, that most people can feel their eyes glazing over and their own brains going offline when threatened with serious neuroscience, and yet, if therapists are ever going to bring genuine insights—not just soundbites—from neuroscience into the practice of therapy, they need a much more nuanced and sophisticated understanding of how the brain actually works.
How can they acquire this knowledge without becoming brain scientists themselves? Even more pressing, what real-life practical therapeutic implications, if any, can truly be drawn from neuroscience? To the rescue come two brain experts who are very good teachers, and who not only elucidate—each from a unique perspective—dynamic brain processes, but demonstrate with remarkable clarity what they mean for the daily practice of psychotherapy.
Norman Doidge, psychiatrist, training psychoanalyst, and neuroscience researcher (as well as poet and award-winning essayist), has spent the last 14 years exploring how to integrate recent discoveries in brain science, particularly neuroplasticity, into psychotherapeutic practice. He’s the author of The Brain That Changes Itself, a New York Times bestseller that describes the brain’s astonishing capacity for change, even in people seriously disabled from conditions like strokes, brain injuries, cerebral palsy, and learning disorders, not to mention entrenched depression, anxiety, and crippling character traits. In contrast, in what Doidge calls the plastic paradox, brain plasticity doesn’t always work out for the best. Says Doidge, “if you do something that’s good for you, the circuitry will fire faster, stronger, and more clearly. Over time, it’ll take up more cortical real estate and become your default circuitry. But it’s also true that if you do something that’s bad for you, the same thing happens.... The plastic paradox accounts for both our flexibility when we choose to do something for the first time as well as our symptomatic rigidity.” Probably nobody in neurobiology and psychotherapy has made a stronger case for the truth of the old adage “use it or lose it,” or argued more convincingly for routinely considering the power of plasticity in day-to-day psychotherapy.
Stephen Porges, a professor in the Department of Psychiatry and the director of the Brain-Body Center in the College of Medicine at the University of Illinois at Chicago, is a leading expert in developmental psychophysiology and developmental behavioral neuroscience. In his groundbreaking book The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation, he explores the evolution of the neurobiological system underlying our automatic emotional responses to other people and our unconscious ability to detect threats in the environment. What this means for psychotherapy is that hard scientific evidence now exists for what most therapists instinctively know: successful therapy depends utterly on establishing safe, caring, mutually trustworthy, stable relationships with clients.
Norman Doidge on The Use-It-Or-Lose-It Brain
You’ve written about people with extreme cognitive or psychological problems who, against all odds, managed to recover much of their functioning through what you call neuroplastic breakthroughs. Can you give an example of what these kinds of people taught you about the brain?
Norman Doidge: One person who taught me an enormous amount is a psychologist named Barbara Arrowsmith, who was born with a devastating array of learning disorders, including dyslexia. She had great difficulty processing concepts, an inability to sense where her body was in space, and difficulties in the Broca’s area of the brain that made her sound at times like someone who’d had a stroke. One of her problems was that she couldn’t perform any mental function that required her to understand the relationship among symbols. For instance, she couldn’t understand prepositions because prepositions use language symbols to describe relationships: the cup is on the table; the middle finger is between the thumb and the pinky. She had trouble understanding many mathematical concepts because they also involved understanding symbolic relationships. And she couldn’t read an analog clock because she couldn’t tell the relationship between the minute and the hour hands, which are symbols too.
Despite a traumatic childhood, she managed to get through college because of her remarkable memory and extraordinary determination. To keep up, she’d sometimes read the same passage in a textbook 20 or 30 times. As a graduate student in psychology—she got into the program because of her extraordinary memory and ability to observe—she heard about some lab research with rats and mice whose brain functioning had been shown to improve dramatically after receiving special cognitive stimulation in environments with various kinds of rat toys. After learning about that study, she had an epiphany and decided that she should be able to improve her own brain function through cognitive exercises. Since one of her most obvious problems was reading a wristwatch, she got pictures made of how the hands looked at different times. She started off simply with just an hour hand, then added a minute hand, and made hundreds of these cards. Then she got one of her friends to hold up a card with the answer on the back, and she had to guess it right before she went on to the next card. Then she added seconds, then weeks and months and years. She kept doing this despite the fact that it was mentally exhausting. Eventually, she was able to tell the exact time using five and six-handed clocks and also began to be able to understand numbers and logic and calculation.
After this experience, she set up a school to help other people with learning disabilities. After sending some of my clients to her school and seeing them get better, I got more interested in studying different kinds of learning disorders and working with people who’d had strokes. In the process, I learned more and more about the brain’s remarkable plasticity.
The basic principle of neuroplasticity is the idea that brain tissue, in some respects, works like muscle tissue: once it gets stimulated through exertion, it develops itself. The corollary is that if you don’t stimulate a certain part of the brain, that cortical real estate is taken over by other functions. In other words, we have a use-it-or-lose-it brain.
One practical application of this knowledge is exemplified in the work of a psychologist named Edward Taub, who discovered the principle of learned nonuse. So if I have a stroke and can’t use my left hand, I’ll stop trying to use it during the typical six weeks of brain swelling following the stroke. During this time, the feedback mechanism of the brain is basically saying, “The left hand doesn’t work. Stop trying to use it. Use your right hand more.” But if the person focuses too soon on doing things with the right hand, the left hand isn’t given the opportunity to recover. So Taub found that by preventing people from using their right hand and by forcing them to do even babylike motions with the left hand, the result was far more increased functioning in their left hand. In fact, when people who’ve gone through Taub’s therapy get scanned afterward, it’s found that other brain areas have taken over for the area that was originally damaged in the stroke.