The Siren Song of Oversimplification
Just about any significant mental function relies on the dynamic interworking of multiple neural assemblies and processes involving many different brain areas. Nonetheless, it’s easy to be seduced by the magic of brain terminology to play 21st-century phrenologist. Consider these common assertions about which pocket or bump in the brain controls which human function: emotion comes from the limbic system; the insula is the seat of self-awareness; fear is in the amygdala; the right hemisphere holds the sense of a personal self existing across time; empathy is about mirror neurons; and so on.
There’s a place for handy simplifications, but sometimes it’s too much of a good thing. Take empathy, for example. For all the attention given to mirror neurons, it’s still controversial whether they even exist in the human brain. Parts of our perceptual-motor networks do activate both when we perform an action and when we see someone else doing the same action, but this internal sense of the other person’s movements is just one aspect of tuning into him or her. The other major components of empathy are emotional resonance—supported by the insula—and “theory of mind,” involving the prefrontal cortex. Based on these neural systems, we “get” the actions, emotions, and thoughts of other people. Mirroring the actions of others is just one of three aspects of understanding them—and usually the least important in both everyday relationships and in psychotherapy. Yet the appealing metaphor of mirror neurons has dominated discussions of empathy for a decade.
Besides overlocalizing function, the tendency toward oversimplification also shows up in catchy yet exaggerated language that drastically distorts the way the brain really works. Take the popular meme that there’s an inherently female brain and male brain. Yes, some statistically significant differences have been found between the average adult female and male brains. But much, if not most, of these differences aren’t innate; rather, they’re acquired as a result of the different socialization of girls and boys, women and men. Further, the differences among female brains and among male brains are much greater than the differences between the average female and male brain. And in most of the fundamental functions of the brain—reasoning, memory, perception, motor planning, and consciousness itself—women and men are similar.
Perhaps the ultimate oversimplification is to reduce mind to matter alone. This little sleight-of-hand conveniently sidesteps the so-called—and unsolved—“hard problem” in brain science: how intangible experiences, such as a memory of childhood or a feeling of compassion, emerge out of tangible neural structures and processes. One time, a client of mine felt sad after not getting a promotion at work, and I said without thinking, “Oh, that’s a drop in dopamine.” Sounds good, right? But no one actually knows how slumping dopamine becomes the feeling of disappointment.
Even worse, neural reductionism puts our clients—and society as a whole—on a slippery slope of declining moral responsibility. I once worked with a middle-aged man and his aging mother, who started arguing about some money she’d given him. Things got heated, and he started swearing at her viciously while she froze in her chair. After I got him to slow down and stop yelling, I asked him about what had just happened, which left his mother reeling and me shaken. He shrugged unapologetically and said, “That was my lizard brain, it just took over.” Hmm. On the one hand, the notion of a lizard brain gave him language for his feeling of being overwhelmed by an internal force beyond his control, and that was helpful. But on the other hand, it gave him a convenient excuse for blowing up at his mother, along with the get-out-of-jail free card that he “couldn’t help it”—a powerful formula, since it came wrapped in the mantle of science. What’s the logical extension of reducing depression to low serotonin, addiction to insufficient dopamine receptors, and angry outbursts to the lizard brain within us all? Men who say that emotional conversation is beyond them due to their male brains? Teenagers who say they can’t do their homework because their brains don’t produce enough acetylcholine? (Of course, the teen who wants to blame this neurotransmitter will need to learn how to pronounce it.)
False Claims of Authority
You’ve probably heard this one already: (Q) How many therapists does it take to change a light bulb? (A) Only one. But the light bulb has to want to change.
The joke is silly and a little tired by now, but also insightful. Therapy-outcome studies show that a person’s motivation is a major factor in whether he or she gets better, and just talking about the brain can be a powerful motivator. Skeptics who’ve been court-, spouse-, or parent-ordered into therapy are more inclined to pay attention when you translate the immaterial mind into the material meat of the brain. In the past, when I touted the benefits of relaxation training for anxiety, I could almost see the thought balloon over the client’s head: “Yada, yada, long slow breaths, fluffy white clouds, whatever.” But these days, I tell a client how the sympathetic (fight or flight) and parasympathetic (rest and digest) wings of the autonomic nervous system interact with each other like the two ends of a seesaw: when one goes up, the other goes down. So raising parasympathetic activation through relaxation lowers alarm signals in the brain, thus reducing anxiety. When I explain it this way, I see the client’s eyes snap into focus; my “prescription” is now as concrete as a bottle of Xanax. Reframing psychological problems as neurophysiological conditions normalizes and destigmatizes them, making it easier for clients to deal with them squarely. It’s as if they believe that the brain is both more real and more respectable than the mind.
During the hard work of therapy, with its ups and downs and pains and sometimes stagnant spells, clients are encouraged when they realize that their efforts are leaving lasting traces in the tissues of their brains. And it’s not just clients who get motivated by neuroscience. The new studies showing how mindfulness training, meditation, and psychotherapy can change the brain are heartening for therapists, too, who may sometimes feel that Freud was right when he characterized ours as an impossible profession. Further, as a practical matter, neural evidence for the benefits of psychotherapy could help motivate policymakers and insurance companies to give it more support.
Nevertheless, even a well-meaning use of neural terminology to help motivate clients can go too far, replacing psycho-babble with brain-babble. When talking about the brain, it’s tempting to mix in dollops of glib sciency-sounding explanations as a way to impress others and claim authority. (Mea culpa.) Given that psychotherapists and psychologists have historically had lower status than physicians and “hard scientists,” murmuring expertly about the brain is a powerful way to raise your prestige with clients, colleagues, the media, and (I admit it) your own parents. But in reaching for authority, we run the risk of actually losing it by resorting to neurological accounts that add little or no real value to therapy.
After I’ve said things like “Oh, that’s your amygdala firing off,” I’ve had clients reply, “So what?! How does knowing that help me?” Merely replacing familiar psychological language (“You felt anxious”) with fancy neural terminology (“Your amygdala was activated”) does little good by itself. Plus, it can implicitly communicate a kind of insecurity about your ability to analyze a client’s problems in mental terms and then offer mental solutions—and since this is the fundamental province of psychotherapy, too much brain talk can lead to doubt, in both our profession and the mind altogether.