MINDSIGHT, OUR SEVENTH SENSE, an introduction. Change your brain and your life – Daniel J. Siegel MD.

Mindsight, the brain’s capacity for both insight and empathy.

How can we be receptive to the mind’s riches and not just reactive to its reflexes? How can we direct our thoughts and feelings rather than be driven by them?

And how can we know the minds of others, so that we truly understand “where they are coming from” and can respond more effectively and compassionately?

Mindsight is a kind of focused attention that allows us to see the internal workings of our own minds, making it possible to see what is inside, to accept it, and in the accepting to let it go, and finally, to transform it.

When we develop the skill of mindsight, we actually change the physical structure of our brain. How we focus our attention shapes the structure of the brain.

Mindsight has the potential to free us from patterns of mind that are getting in the way of living our lives to the fullest.

Mindsight, our ability to look within and perceive the mind, to reflect on our experience, is every bit as essential to our wellbeing as our six senses. Mindsight is our seventh sense.

What is Mindsight?

“Mindsight” is a term coined by Dr. Dan Siegel to describe our human capacity to perceive the mind of the self and others. It is a powerful lens through which we can understand our inner lives with more clarity, integrate the brain, and enhance our relationships with others. Mindsight is a kind of focused attention that allows us to see the internal workings of our own minds. It helps us get ourselves off of the autopilot of ingrained behaviors and habitual responses. It lets us “name and tame” the emotions we are experiencing, rather than being overwhelmed by them.

“I am sad” vs. “I feel sad”

Mindsight is the difference between saying “I am sad” and ”I feel sad.” Similar as those two statements may seem, they are profoundly different. “I am sad” is a kind of limited selfdefinition. “I feel sad” suggests the ability to recognize and acknowledge a feeling, without being consumed by it. The focusing skills that are part of mindsight make it possible to see what is inside, to accept it, and in the accepting to let it go, and finally, to transform it.

Mindsight: A Skill that Can Change Your Brain

Mindsight is a learnable skill. It is the basic skill that underlies what we mean when we speak of having emotional and social intelligence. When we develop the skill of mindsight, we actually change the physical structure of the brain. This revelation is based on one of the most exciting scientific discoveries of the last twenty years: How we focus our attention shapes the structure of the brain. Neuroscience has also definitively shown that we can grow these new connections throughout our lives, not just in childhood.

What’s Interpersonal Neurobiology?

Interpersonal neurobiology, a term coined by Dr. Siegel in The Developing Mind, 1999, is an interdisciplinary field which seeks to understand the mind and mental health. This field is based on science but is not constrained by science. What this means is that we attempt to construct a picture of the ”whole elephant” of human reality. We build on the research of different disciplines to reveal the details of individual components, while also assembling these pieces to create a coherent view of the whole.

The Mindsight Institute

Through the Mindsight Institute, Dr. Siegel offers a scientificaliy-based way of understanding human development. The Mindsight Institute serves as the organization from which interpersonal neurobiology first developed and it continues to be a key source for learning in this area. The Mindsight Institute links science, clinical practice, education, the arts, and contemplation, serving as an educational hub from which these various domains of knowing and practice can enrich their individual efforts. Through the Mindsight Institute’s online program, people from six continents participate weekly in our global conversation about the ways to create more health and compassion in the world.

Mindsight Institute

Daniel J. Siegel, MD, is a clinical professor of psychiatry at the UCLA School of Medicine, co-director of the UCLA Mindful Awareness Research Center, and executive director of the Mindsight Institute. A graduate of Harvard Medical School, he is the author of the internationally acclaimed professional texts The Mindful Brain and The Developing Mind, and the co-author of Parenting from the Inside Out.

The groundbreaking bestseller on how your capacity for insight and empathy allows you to make positive changes in your brain and in your life.

Daniel J. Siegel, widely recognised as a pioneer in the field of mental health, coined the term ‘mindsight’ to describe the innovative integration of brain science with the practice of psychotherapy. Combining the latest research findings with case studies from his practice, he demonstrates how mindsight can be applied to alleviate a range of psychological and interpersonal problems from anxiety disorders to ingrained patterns of behaviour.

With warmth and humour, Dr Siegel shows us how to observe the working of our minds, allowing us to understand why we think, feel, and act the way we do; and how, by following the proper steps, we can literally change the wiring and architecture of our brains.

Both practical and profound, Mindsight offers exciting new proof that we have the ability at any stage of our lives to transform our thinking, our wellbeing, and our relationships.

Mindsight, change your brain and your life

Daniel J. Siegel MD

FOREWORD by Daniel Goleman

The great leaps forward in psychology have come from original insights that suddenly clarify our experience from a fresh angle, revealing hidden patterns of connection. Freud’s theory of the unconscious and Darwin’s model of evolution continue to help us understand the findings from current research on human behavior and some of the mysteries of our daily lives. Daniel Siegel’s theory of Mindsight, the brain’s capacity for both insight and empathy, offers a similar “Aha!” He makes sense for us out of the cluttered confusions of our sometimes maddening and messy emotions.

Our ability to know our own minds as well as to sense the inner world of others may be the singular human talent, the key to nurturing healthy minds and hearts. I’ve explored this terrain in my own work on emotional and social intelligence. Self-awareness and empathy are (along with seIf-mastery and social skills) domains of human ability essential for success in life. Excellence in these capacities helps people flourish in relationships, family life, and marriage, as well as in work and leadership.

Of these four key life skills, self-awareness lays the foundation for the rest. If we lack the capacity to monitor our emotions, for example, we will be poorly suited to manage or learn from them. Tuned out of a range of our own experience, we will find it all the harder to attune to that same range in others. Effective interactions depend on the smooth integration of selfawareness, mastery, and empathy. Or so I’ve argued. Dr. Siegel casts the discussion in a fresh light, putting these dynamics in terms of mindsight, and marshals compelling evidence for its crucial role in our lives.

A gifted and sensitive clinician, as well as a master synthesizer of research findings from neuroscience and child development, Dr. Siegel gives us a map forward. Over the years he has continually broken new ground in his writing on the brain, psychotherapy, and childrearing; his seminars for professionals are immensely popular.

The brain, he reminds us, is a social organ. Mindsight is the core concept in “interpersonal neurobiology,” a field Dr. Siegel has pioneered. This two-person view of what goes on in the brain lets us understand how our daily interactions matter neurologically, shaping neural circuits. Every parent helps sculpt the growing brain of a child; the ingredients of a healthy mind include an attuned, empathetic parent, one with mindsight. Such parenting fosters this same crucial ability in a child.

Mindsight plays an integrative role in the triangle connecting relationships, mind, and brain. As energy and information flow among these elements of human experience, patterns emerge that shape all three (and the brain here includes its extensions via the nervous system throughout the body). This vision is holistic in the true sense of the word, inclusive of our whole being. With mindsight we can better know and manage this vital flow of being.

Dr. Siegel’s biographical details are impressive. Harvard-trained and a clinical professor of psychiatry at UCLA and co-director of the Mindful Awareness Research Center there, he also founded and directs the Mindsight Institute. But far more impressive is his actual being, a mindful, attuned, and nurturing presence that is nourishing in itself. Dr. Siegel embodies what he teaches.

For professionals who want to delve into this new science, I recommend Dr. Siegel’s 1999 text on interpersonal neurobiology, The Developing Mind: Toward a Neurobiology of Interpersonal Experience. For parents, his book with Mary Hartzell is invaluable: Parenting from the Inside Out: How a Deeper Self-Understanding Can Help You Raise Children Who Thrive. But for anyone who seeks a more rewarding life, the book you hold in your hands has compelling and practical answers.

Daniel Goleman

INTRODUCTION

Diving into the Sea Inside

Within each of us there is an internal mental world that I have come to think of as the sea inside, that is a wonderfully rich place, filled with thoughts and feelings, memories and dreams, hopes and wishes. Of course it can also be a turbulent place, where we experience the dark side of all those wonderful feelings and thoughts, fears, sorrows, dreads, regrets, nightmares. When this inner sea seems to crash in on us, threatening to drag us down below to the dark depths, it can make us feel as if we are drowning.

Who among us has not at one time or another felt overwhelmed by the sensations from within our own minds? Sometimes these feelings are just a passing thing, a bad day at work, a fight with someone we love, an attack of nerves about a test we have to take or a presentation we have to give, or just an inexplicable case of the blues for a day or two.

But sometimes they seem to be something much more intractable, so much part of the very essence of who we are that it may not even occur to us that we can change them. This is where the skill that I have called “mindsight” comes in, for mindsight, once mastered, is a truly transformational tool. Mindsight has the potential to free us from patterns of mind that are getting in the way of living our lives to the fullest.

WHAT IS MINDSIGHT?

Mindsight is a kind of focused attention that allows us to see the internal workings of our own minds. It helps us to be aware of our mental processes without being swept away by them, enables us to get ourselves off the autopilot of ingrained behaviors and habitual responses, and moves us beyond the reactive emotional loops we all have a tendency to get trapped in. It lets us “name and tame” the emotions we are experiencing, rather than being overwhelmed by them. Consider the difference between saying “I am sad” and “I feel sad.” Similar as those two statements may seem, there is actually a profound difference between them. “I am sad” is a kind of seIf-definition, and a very limiting one. “I feel sad” suggests the ability to recognize and acknowledge a feeling, without being consumed by it. The focusing skills that are part of mindsight make it possible to see what is inside, to accept it, and in the accepting to let it go, and, finally, to transform it.

You can also think of mindsight as a very special lens that gives us the capacity to perceive the mind with greater clarity than ever before. This lens is something that virtually everyone can develop, and once we have it we can dive deeply into the mental sea inside, exploring our own inner lives and those of others. A uniquely human ability, mindsight allows us to examine closely, in detail and in depth, the processes by which we think, feel, and behave. And it allows us to reshape and redirect our inner experiences so that we have more freedom of choice in our everyday actions, more power to create the future, to become the author of our own story. Another way to put it is that mindsight is the basic skill that underlies everything we mean when we speak of having social and emotional intelligence.

Interestingly enough, we now know from the findings of neuroscience that the mental and emotional changes we can create through cultivation of the skill of mindsight are transformational at the very physical level of the brain. By developing the ability to focus our attention on our internal world, we are picking up a “scalpel” we can use to resculpt our neural pathways, stimulating the growth of areas of the brain that are crucial to mental health. I will talk a lot about this in the chapters that follow because I believe that a basic understanding of how the brain works helps people see how much potential there is for change.

But change never just happens. It’s something we have to work at. Though the ability to navigate the inner sea of our minds, to have mindsight, is our birthright, and some of us, for reasons that will become clear later, have a lot more of it than others, it does not come automatically, any more than being born with muscles makes us athletes. The scientific reality is that we need certain experiences to develop this essential human capacity. I like to say that parents and other caregivers offer us our first swimming lessons in that inner sea, and if we’ve been fortunate enough to have nurturing relationships early in life, we’ve developed the basics of mindsight on which we can build. But even if such early support was lacking, there are specific activities and experiences that can nurture mindsight throughout the lifespan. As you will see, mindsight is a form of expertise that can be honed in each of us, whatever our early history.

When I first began to explore the nature of the mind professionally, there was no term in our everyday language that captured the way we perceive our thoughts, feelings, sensations, memories, beliefs, attitudes, hopes, dreams, and fantasies. Of course, these activities of the mind fill our day-to-day lives, we don’t need to learn a skill in order to experience them. But how do we actually develop the ability to perceive a thought, not just have one, and to know it as an activity of our minds so that we are not taken over by it? How can we be receptive to the mind’s riches and not just reactive to its reflexes? How can we direct our thoughts and feelings rather than be driven by them?

And how can we know the minds of others, so that we truly understand “where they are coming from” and can respond more effectively and compassionately? When I was a young psychiatrist, there weren’t many readily accessible scientific or even clinical terms to describe the whole of this ability. To be able to help my patients, I coined the term mindsight so that together we could discuss this important ability that allows us to see and shape the inner workings of our own minds.

Our first five senses allow us to perceive the outside world, to hear a bird’s song or a snake’s warning rattle, to make our way down a busy street or smell the warming earth of spring. What has been called our sixth sense allows us to perceive our internal bodily states, the quickly beating heart that signals fear or excitement, the sensation of butterflies in our stomach, the pain that demands our attention.

Mindsight, our ability to look within and perceive the mind, to reflect on our experience, is every bit as essential to our wellbeing. Mindsight is our seventh sense.

As I hope to show you in this book, this essential skill can help us build social and emotional brainpower, move our lives from disorder to well-being, and create satisfying relationships filled with connection and compassion. Business and government leaders have told me that understanding how the mind functions in groups has helped them be more effective and enabled their organizations to become more productive. Clinicians in medicine and mental health have said that mindsight has changed the way they approach their patients, and that putting the mind at the heart of their healing work has helped them create novel and useful interventions. Teachers introduced to mindsight have learned to “teach with the brain in mind” and are reaching and teaching their students in deeper and more lasting ways.

In our individual lives, mindsight offers us the opportunity to explore the subjective essence of who we are, to create a life of deeper meaning with a richer and more understandable internal world. With mindsight we are better able to balance our emotions, achieving an internal equilibrium that enables us to cope with the small and large stresses of our lives. Through our ability to focus attention, mindsight also helps the body and brain achieve homeostasis, the internal balance, coordination, and adaptiveness that forms the core of health. Finally, mindsight can improve our relationships with our friends, colleagues, spouses, and children, and even the relationship we have with our own selves.

A NEW APPROACH TO WELLBEING

Everything that follows rests on three fundamental principles.

The first is that mindsight can be cultivated through very practical steps. This means that creating wellbeing in our mental life, in our close relationships, and even in our bodies, is a learnable skill. Each chapter of this book explores these skills, from basic to advanced, for navigating the sea inside.

Second, as mentioned above, when we develop the skill of mindsight, we actually change the physical structure of the brain. Developing the lens that enables us to see the mind more clearly stimulates the brain to grow important new connections. This revelation is based on one of the most exciting scientific discoveries of the last twenty years: How we focus our attention shapes the structure of the brain. Neuroscience supports the idea that developing the reflective skills of mindsight activates the very circuits that create resilience and wellbeing and that underlie empathy and compassion as well. Neuroscience has also definitively shown that we can grow these new connections throughout our lives, not just in childhood. The short Minding the Brain sections interspersed throughout part 1 are a traveler’s guide to this new territory.

The third principle is at the heart of my work as a psychotherapist, educator, and scientist. Wellbeing emerges when we create connections in our lives, when we learn to use mindsight to help the brain achieve and maintain integration, a process by which separate elements are linked together into a working whole.

I know this may sound both unfamiliar and abstract at first, but I hope you’ll soon find that it is a natural and useful way of thinking about our lives. For example, integration is at the heart of how we connect to one another in healthy ways, honoring one another’s differences while keeping our lines of communication wide open. Linking separate entities to one another, integration, is also important for releasing the creativity that emerges when the left and right sides of the brain are functioning together.

Integration enables us to be flexible and free; the lack of such connections promotes a life that is either rigid or chaotic, stuck and dull on the one hand or explosive and unpredictable on the other. With the connecting freedom of integration comes a sense of vitality and the ease of wellbeing. Without integration we can become imprisoned in behavioral ruts, anxiety and depression, greed, obsession, and addiction.

By acquiring mindsight skills, we can alter the way the mind functions and move our lives toward integration, away from these extremes of chaos or rigidity. With mindsight we are able to focus our mind in ways that literally integrate the brain and move it toward resilience and health.

MINDSIGHT MISUNDERSTOOD

It’s wonderful to receive an email from an audience member or patient who says, “My whole view of reality has changed.” But not everyone new to mindsight gets it right away. Some people are concerned that it’s just another way to become more self-absorbed, a form of navel-gazing, of becoming preoccupied with “reflection” instead of living fully. Perhaps you’ve also read some of the recent research (or the ancient wisdom) that tells us that happiness depends on “getting out of yourself.” Does mindsight turn us away from this greater good?

While it is true that being selfobsessed decreases happiness, mindsight actually frees you to become less self-absorbed, not more. When we are not taken over by our thoughts and feelings, we can become clearer in our own internal world as well as more receptive to the inner world of another. Scientific studies support this idea, revealing that individuals with more mindsight skills show more interest and empathy toward others. Research has also clearly shown that mindsight supports not only internal and interpersonal wellbeing but also greater effectiveness and achievement in school and work.

Another quite poignant concern about mindsight came up one day when I was talking with a group of teachers. “How can you ask us to have children reflect on their own minds?” one teacher said to me. “Isn’t that opening a Pandora’s box?” Recall that when Pandora’s box was opened, all the troubles of humanity flew out. Is this how we imagine our inner lives or the inner lives of our children? In my own experience, a great transformation begins when we look at our minds with curiosity and respect rather than fear and avoidance. Inviting our thoughts and feelings into awareness allows us to learn from them rather than be driven by them. We can calm them without ignoring them; we can hear their wisdom without being terrified by their screaming voices. And as you will see in some of the stories in this book, even surprisingly young children can develop the ability to pause and make choices about how to act when they are more aware of their impulses.

HOW DO WE CULTIVATE MINDSIGHT?

Mindsight is not an all-or-nothing ability, something you either have or don’t have. As a form of expertise, mindsight can be developed when we put in effort, time, and practice.

Most people come into the world with the brain potential to develop mindsight, but the neural circuits that underlie it need experiences to develop properly. For some, such as those with autism and related neurological conditions, the neural circuits of mindsight may not develop well even with the best caregiving. In most children, however, the ability to see the mind develops through everyday interactions with others, especially through attentive communication with parents and caregivers. When adults are in tune with a child, when they reflect back to the child an accurate picture of his internal world, he comes to sense his own mind with clarity. This is the foundation of mindsight. Neuroscientists are now identifying the circuits of the brain that participate in this intimate dance and exploring how a caregiver’s attunement to the child’s internal world stimulates the development of those neural circuits.

If parents are unresponsive, distant, or confusing in their responses, however, their lack of attunement means that they cannot reflect back to the child an accurate picture of the child’s inner world. In this case, research suggests, the child’s mindsight lens may become cloudy or distorted. The child may then be able to see only part of the sea inside, or see it dimly. Or the child may develop a lens that sees well but is fragile, easily disrupted by stress and intense emotions.

The good news is that whatever our early history, it is never too late to stimulate the growth of the neural fibers that enable mindsight to flourish. You’ll soon meet a ninety-two-year-old man who was able to overcome a painful and twisted childhood to emerge a mindsight maven. Here we see living evidence for another exciting discovery of modern neuroscience: that the brain never stops growing in response to experience. And this is true for people with happy childhoods, too. Even if we had positive relationships with our caregivers and parents early on-and even if we write books on the subject, we can continue as long as we live to keep developing our vital seventh sense and promoting the connections and integration that are at the heart of wellbeing.

We’ll begin our journey in part 1 by exploring situations in which the vital skills of mindsight are absent. These stories reveal how seeing the mind clearly and being able to alter how it functions are essential elements in the path toward wellbeing. Part 1 is the more theoretical section of the book, where I explain the basic concepts, give readers an introduction to brain science, and offer working definitions of the mind and mental health. Since I know that my readers will come from a wide variety of backgrounds and interests, I realize that some of you may want to skim or even skip much of that material in order to move directly to part 2.

In part 2, we’ll dive deeply into stories from my practice that illustrate the steps involved in developing the skills of mindsight. This is the section of the book in which I share the knowledge and practical skills that will help people understand how to shape their own minds toward health. At the very end of the book is an appendix outlining the fundamental concepts and a set of endnotes with the scientific resources supporting these ideas.

Our exploration of mindsight begins with the story of a family that changed my own life and my entire approach to psychotherapy. Looking for ways to help them inspired me to search for new answers to some painful questions about what happens when mindsight is lost. It also led to my search for the techniques that can enable us to reclaim and recreate mindsight in ourselves, our children, and our communities. I hope you’ll join me on this journey into the inner sea. Within those depths awaits a vast world of possibility.

PART I

THE PATH TO WELLBEING: MINDSIGHT ILLUMINATED

1. A BROKEN BRAIN, A LOST SOUL The Triangle of WellBeing

Barbara’s family might never have come for therapy if seven year old Leanne hadn’t stopped talking in school. Leanne was Barbara’s middle child, between Amy, who was fourteen, and Tommy, who was three. They had all taken it hard when their mother was in a near fatal car accident. But it wasn’t until Barbara returned home from the hospital and rehabilitation center that Leanne became “selectively mute.” Now she refused to speak with anyone outside the family, including me.

In our first weekly therapy sessions, we spent our time in silence, playing some games, doing pantomimes with puppets, drawing, and just being together. Leanne wore her dark hair in a single jumbled ponytail, and her sad brown eyes would quickly dart away whenever I looked directly at her. Our sessions felt stuck, her sadness unchanging, the games we played repetitive. But then one day when we were playing catch, the ball rolled to the side of the couch and Leanne discovered my video player and screen. She said nothing, but the sudden alertness of her expression told me her mind had clicked on to something.

The following week Leanne brought in a videotape, walked over to the video machine, and put it into the slot. I turned on the player and her smile lit up the room as we watched her mother gently lift a younger Leanne up into the air, again and again, and then pull her into a huge, enfolding hug, the two of them shaking with laughter from head to toe. Leanne’s father, Ben, had captured on film the dance of communication between parent and child that is the hallmark of love: We connect with each other through a give-and-take of signals that link us from the inside out. This is the joy filled way in which we come to share each other’s minds.

Next the pair swirled around on the lawn, kicking the brilliant yellow and burnt-orange leaves of autumn. The mother-daughter duet approached the camera, pursed lips blowing kisses into the lens, and then burst out in laughter. Five-year-old Leanne shouted, “Happy birthday, Daddy!” at the top of her lungs, and you could see the camera shake as her father laughed along with the ladies in his life. In the background Leanne’s baby brother, Tommy, was napping in his stroller, snuggled under a blanket and surrounded by plush toys. Leanne’s older sister, Amy, was off to the side engrossed in a book.

“That’s how my mom used to be when we lived in Boston,” Leanne said suddenly, the smile dropping from her face. It was the first time she had spoken directly to me, but it felt more like I was overhearing her talk to herself. Why had Leanne stopped talking?

It had been two years since that birthday celebration, eighteen months since the family moved to Los Angeles, and twelve months since Barbara suffered a severe brain injury in her accident, a head-on collision. Barbara had not been wearing her seat belt that evening as she drove their old Mustang to the local store to get some milk for the kids. When the drunk driver plowed into her, her forehead was forced into the steering wheel. She had been in a coma for weeks following the accident.

After she came out of the coma, Barbara had changed in dramatic ways. On the videotape I saw the warm, connected, and caring person that Barbara had been. But now, Ben told me, she “was just not the same Barbara anymore.” Her physical body had come home, but Barbara herself, as they had known her, was gone.

During Leanne’s next visit I asked for some time alone with her parents. It was clear that what had been a close relationship between Barbara and Ben was now profoundly stressed and distant. Ben was patient and kind with Barbara and seemed to care for her deeply, but I could sense his despair. Barbara just stared off as we talked, made little eye contact with either of us, and seemed to lack interest in the conversation. The damage to her forehead had been repaired by plastic surgery, and although she had been left with motor skills that were somewhat slow and clumsy, she actually looked quite similar, in outward appearance, to her image on the videotape. Yet something huge had changed inside.

Wondering how she experienced her new way of being, I asked Barbara what she thought the difference was. I will never forget her reply: “

Well, I guess if you had to put it into words, I suppose I’d say that I’ve lost my soul.”

Ben and I sat there, stunned. After a while, I gathered myself enough to ask Barbara what losing her soul felt like.

“I don’t know if I can say any more than that,” she said flatly. “It feels fine, I guess. No different. I mean, just the way things are. Just empty. Things are fine.”

We moved on to practical issues about care for the children, and the session ended.

A DAMAGED BRAIN

It wasn’t clear yet how much Barbara could or would recover. Given that only a year had passed since the accident, much neural repair was still possible. After an injury, the brain can regain some of its function and even grow new neurons and create new neural connections, but with extensive damage it may be difficult to retrieve the complex abilities and personality traits that were dependent on the now destroyed neural structures.

Neuroplasticity is the term used to describe this capacity for creating new neural connections and growing new neurons in response to experience. Neuroplasticity is not just available to us in youth: We now know that it can occur throughout the lifespan. Efforts at rehabilitation for Barbara would need to harness the power of neuroplasticity to grow the new connections that might be able to reestablish old mental functions. But we’d have to wait awhile for the healing effects of time and rehabilitation to see how much neurological recovery would be possible.

My immediate task was to help Leanne and her family understand how someone could be alive and look the same yet have become so radically different in the way her mind functioned. Ben had told me earlier that he did not know how to help the children deal with how Barbara had changed; he said that he could barely understand it himself. He was on double duty, working, managing the kids’ schedules, and making up for what Barbara could no longer do. This was a mother who had delighted in making homemade Halloween costumes and Valentine’s Day cupcakes. Now she spent most of the day watching TV or wandering around the neighborhood. She could walk to the grocery store, but even with a list she would often come home empty-handed. Amy and Leanne didn’t mind so much that she cooked a few simple meals over and over again. But they were upset when she forgot their special requests, things they’d told her they liked or needed for school. It was as if nothing they said to her really registered.

As our therapy sessions continued, Barbara usually sat quietly, even when she was alone with me, although her speech was intact. Occasionally she’d suddenly become agitated at an innocent comment from Ben, or yell if Tommy fidgeted or Leanne twirled her ponytail around her finger. She might even erupt after a silence, as if some internal process was driving her. But most of the time her expression seemed frozen, more like emptiness than depression, more vacuous than sad. She seemed aloof and unconcerned, and I noticed that she never spontaneously touched either her husband or her children. Once, when three-year-old Tommy climbed onto her lap, she briefly put her hand on his leg as if repeating some earlier pattern of behavior, but the warmth had gone out of the gesture.

When I saw the children without their mother, they let me know how they felt. “She just doesn’t care about us like she used to,” Leanne said. “And she doesn’t ever ask us anything about ourselves,” Amy added with sadness and irritation. “She’s just plain selfish. She doesn’t want to talk to anyone anymore.” Tommy remained silent. He sat close to his father with a drawn look on his face.

Loss of someone we love cannot be adequately expressed with words. Grappling with loss, struggling with disconnection and despair, fills us with a sense of anguish and actual pain. Indeed, the parts of our brain that process physical pain overlap with the neural centers that record social ruptures and rejection. Loss rips us apart.

Grief allows you to let go of something you’ve lost only when you begin to accept what you now have in its place. As our mind clings to the familiar, to our established expectations, we can become trapped in feelings of disappointment, confusion, and anger that create our own internal worlds of suffering. But what were Ben and the kids actually letting go of? Could Barbara regain her connected way of being? How could the family learn to live with a person whose body was still alive, but whose personality and “souI”, at least as they had known her, were gone?

“YOU-MAPS” AND “ME-MAPS”

Nothing in my formal training, whether in medical school, pediatrics, or psychiatry, had prepared me for the situation I now faced in my treatment room. I’d had courses on brain anatomy and on brain and behavior, but when I was seeing Barbara’s family, in the early 1990s, relatively little was known about how to bring our knowledge of such subjects into the clinical practice of psychotherapy. Looking for some way to explain Barbara to her family, I trekked to the medical library and reviewed the recent clinical and scientific literature that dealt with the regions of the brain damaged by her accident.

Scans of Barbara’s brain revealed substantial trauma to the area just behind her forehead; the lesions followed the upper curve of the steering wheel. This area, I discovered, facilitates very important functions of our personality. It also links widely separated brain regions to one another, it is a profoundly integrative region of the brain.

The area behind the forehead is a part of the frontal lobe of the cerebral cortex, the outermost section of the brain. The frontal lobe is associated with most of our complex thinking and planning. Activity in this part of the brain fires neurons in patterns that enable us to form neural representations, “maps” of various aspects of our world. The maps resulting from these clusters of neuronal activity serve to create an image in our minds. For example, when we take in the light reflected from a bird sitting in a tree, our eyes send signals back into our brain, and the neurons there fire in certain patterns that permit us to have the visual picture of the bird.

Somehow, in ways still to be discovered, the physical property of neurons firing helps to create our subjective experience, the thoughts, feelings, and associations evoked by seeing that bird, for example. The sight of the bird may cause us to feel certain emotions, to hear or remember its song, and even to associate that song with ideas such as nature, hope, freedom, and peace. The more abstract and symbolic the representation, the higher in the nervous system it is created, and the more forward in the cortex.

The prefrontal cortex, the most damaged part of the frontal lobe of Barbara’s brain, makes complex representations that permit us to create concepts in the present, think of experiences in the past, and plan and make images about the future. The prefrontal cortex is also responsible for the neural representations that enable us to make images of the mind itself. I call these representations of our mental world “mindsight maps.” And I have identified several kinds of mindsight maps made by our brains.

The brain makes what I call a “me-map” that gives us insight into ourselves, and a “you-map” for insight into others. We also seem to create “we-maps,” representations of our relationships. Without such maps, we are unable to perceive the mind within ourselves or others. Without a me-map, for example, we can become swept up in our thoughts or flooded by our feelings. Without a you-map, we see only others’ behaviors, the physical aspect of reality, without sensing the subjective core, the inner mental sea of others. It is the you-map that permits us to have empathy. In essence, the injury to Barbara’s brain had created a world without mindsight. She had feelings and thoughts, but she could not represent them to herself as activities of her mind. Even when she said she’d “lost her soul,” her statement had a bland, factual quality, more like a scientific observation than a deeply felt expression of personal identity. (I was puzzled by that disconnect between observation and emotion until I learned from later studies that the parts of our brain that create maps of the mind are distinct from those that enable us to observe and comment on self-traits such as shyness or anxiety or, in Barbara’s case, the lack of a quality she called “soul.”)

In the years since I took Barbara’s brain scans to the library, much more has been discovered about the interlinked functions of the prefrontal cortex. For example, the side of this region is crucial for how we pay attention; it enables us to put things in the “front of our mind” and hold them in awareness. The middle portion of the prefrontal area, the part damaged in Barbara, coordinates an astonishing number of essential skills, including regulating the body, attuning to others, balancing emotions, being flexible in our responses, soothing fear, and creating empathy, insight, moral awareness, and intuition. These were the skills Barbara was no longer able to recruit in her interactions with her family.

I will be referring to, and expanding on, this list of nine middle prefrontal functions throughout our discussion of mindsight. But even at first glance, you can see that these functions are essential ingredients for wellbeing, ranging from bodily processes such as regulating our hearts to social functions such as empathy and moral reasoning.

After Barbara emerged from her coma, her impairments had seemed to settle into a new personality. Some of her habits, such as what she liked to eat and how she brushed her teeth, remained the same. There was nothing significantly changed in how her brain mapped out these basic behavioral functions. But the ways in which she thought, felt, behaved, and interacted with others were profoundly altered. This affected every detail of daily life, right down to Leanne’s crooked ponytail. Barbara still had the behavioral moves necessary to fix her daughter’s hair, but she no longer cared enough to get it right.

Above all, Barbara seemed to have lost the very map-making ability that would enable her to honor the reality and importance of her own or others’ subjective inner lives. Her mindsight maps were no longer forming amid the now jumbled middle prefrontal circuitry upon which they depended for their creation. This middle prefrontal trauma had also disrupted the communication between Barbara and her family, she could neither send nor receive the connecting signals enabling her to join minds with the people she had loved most.

Ben summed up the change: “She is gone. The person we live with is just not Barbara.”

A TRIANGLE OF WELLBEING: MIND, BRAIN, AND RELATIONSHIPS

The videotape of Ben’s birthday had revealed a vibrant dance of communication between Barbara and Leanne. But now there was no dance, no music keeping the rhythm of two minds flowing into a sense of a “we.” Such joining happens when we attune to the internal shifts in another person, as they attune to us, and our two worlds become linked as one. Through facial expressions and tones of voice, gestures and postures, some so fleeting they can be captured only on a slowed-down recording, we come to “resonate” with one another. The whole we create together is truly larger than our individual identities. We feel this resonance as a palpable sense of connection and aliveness. This is what happens when our minds meet.

A patient of mine once described this vital connection as “feeling felt” by another person: We sense that our internal world is shared, that our mind is inside the other. But Leanne no longer “felt felt” by her mom.

The way Barbara behaved with her family reminded me of a classic research tool used to study infant-parent communication and attachment. Called the “still-face” experiment, it is painful both to participate in and to watch.

A mother is asked to sit with her four-month-old infant facing her and when signaled, to stop interacting with her child. This “still” phase in which no verbal or nonverbal signals are to be shared with the child is profoundly distressing. For up to three minutes, the child attempts to engage the now nonresponsive parent in a bid for connection. At first the child usually amps up her signals, increasing smiles, coos, eye contact. But after a period of continuing nonresponse, she becomes agitated and distressed, her organized bids for connection melting into signs of anguish and outrage. She may then attempt to soothe herself by placing her hand in her mouth or pulling at her clothes. Sometimes researchers or parents call off the experiment at this time, but sometimes it goes on until the infant withdraws, giving up in a kind of despondent collapse that looks like melancholic depression. These stages of protest, self-soothing, and despair reveal how much the child depends upon the attuned responses of a parent to keep her own internal world in equilibrium.

We come into the world wired to make connections with one another, and the subsequent neural shaping of our brain, the very foundation of our sense of self, is built upon these intimate exchanges between the infant and her caregivers. In the early years this interpersonal regulation is essential for survival, but throughout our lives we continue to need such connections for a sense of vitality and well-being.

. . .

from

Mindsight, change your brain and your life

by Daniel J. Siegel MD

get it at Amazon.com

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