Monday, May 19, 2008

HMS Conference

Dan Siegel, a child psychiatrist who specializes in parent-child attachment and its neurobiological orgins spoke at the Boston conference I attended this past weekend. I will try to post some comments on the conference (and blocks of quotes) but for now, a teaser from the article Mindsight: Dan Siegel offers therapists a new vision of the brain:

[Siegel] focused, for example, on the clinical implications of the fact that the right and left hemispheres work in dramatically different ways. By then it was commonly understood that the left brain is associated with logic, cause-effect reasoning, verbal processing, and linear thinking, while the right is associated with nonlinear, holistic (big-picture) thinking, intense emotion, body sense, social awareness, and nonverbal communication.

What Siegel became interested in was that a coherent narrative about the past requires both hemispheres to be fully online: the right holds the images, themes, and sense of personal self existing across time, while the left holds the drive to make logical meaning and put words to these wordless feeling states and perceptions. Right away, this seemed to explain the difficulties many people had in creating coherent narrative: if the two sides of the brain weren't working together, the story would either be chaotic and confused-overwhelming feeling, overwhelmed thought-or superficially logical but lacking the emotional oomph of a good, coherent autobiographical story.

He decided to try out the theory that integrating brain function could be beneficial therapeutically with clients who had an impoverished sense of their own past and couldn't really feel or express emotion: "I'd worked out a hypothesis that this type of patient might respond to therapy that explicitly stimulated the development of the right hemisphere." And it worked. A lot of the patients, who usually intellectualized their way through talk therapy, responded very well to guided imagery, sensate-body focusing, and practice in using and picking up on nonverbal cues.

Simply telling patients what might be going on in their brains, he discovered, could also be both deeply comforting and therapeutic. He explained to patients with PTSD the difference between implicit and explicit memory and the function of the hippocampus, and they felt less crazy. "You're telling me I'm not nuts," said one greatly relieved patient, who thought she was going insane because of the flashbacks and intrusive images that hounded her. As she put it, "It's just that the bad things that happened to me got fragmented in my mind and were never put together into my regular memory by my hippowhatsis."

Soon, he was spiking his therapy with brief, neurobiological vignettes that helped clients understand why they were so prone to sudden rages, or had such rotten love lives, or felt so anxious all the time. Siegel became adept at explaining the role of the unbridled amygdala, the self-calming talents of the neocortex, the heroically integrative properties of the orbitofrontal cortex, the amazing system of mirror neurons that allows us to pick up and feel the feelings and intentions of others-the remarkable capacity for "mindsight."

He even started keeping a chalkboard in his office to draw rough sketches of the brain and its parts, which helped ground discussions of subjective mental experience in the world of physical reality. "Unlike most psychological concepts, the brain is a three-dimensional object that you can hold in your hand," he says. "It's also a visual entity, and we're very visual creatures-a lot of our cortical real estate is devoted to vision. So when I sketch the brain on the board, people can really 'see' it."

His patients loved it. Far from making them feel that their lives were completely determined by physiological processes beyond their control, they felt empowered. They discovered that their negative feelings weren't them, but originated from one part of their brains, which could be controlled by another part, actually altered by what they think.

"Connections in the brain shape the way you think, but the flip side is true, too," says Siegel. "The way you think can change your brain. Neural firing changes neural connections-if you pay attention." We often have the idea that we have no power to control our own attention. Not so. "You can harness the power of your mind," says Siegel. "You can sit in your prefrontal cortex, where self-regulation is mediated, and simply notice, just notice, the mental processes emanating from different neural circuits of the brain-without locking onto them."

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