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The nature of communication in the talking cure.

Posted on January 12, 2014 at 6:36 PM Comments comments (106)

Mark Solms is the director of the Arnold Pfeffer Center for Neuro-Psychoanalysis at the New York Psychoanalytic Institute; a lecturer at the University College Londons Department of Psychology; a consultant in neuropsychology at the Anna Freud Center in London; and an honorary lecturer in the Academic Department of Neurosurgery at St. Bartholomews and the Royal London School of Medicine. Over the last 15 years, Dr. Solms has been the driving force in establishing the new field of neuro-psychoanalysis, which brings together the fields of neuroscience and psychoanalysis.

What is the nature of communication between the analyst and the patient 

Defining psychoanalysis as "the talking cure" is somewhat misleading, a misnomer. We have the mystical-sounding phrase from Freud about the communication from the unconscious of the patient to the unconscious of the analyst. We speak of empathic attunement and projective identification as a form of communication between patient and analyst, which is reflected in the countertransference. The nature of communication in the analytic room somehow fails to be conveyed in the words that are transcribed down from a recording of the analytic session. Something goes on inside of the patient and the analyst in parallel with the talking which cannot be readily captured. 

The building blocks of the meaning-making process. 

The most rudimentary form of a conscious thing that stands for something occurs within ourselves about ourselves, to ourselves. Communication is communication of meaning. The best theory that we are working with revolves around the notion that consciousness originates in structures within the very deep core of our brain stems. These structures which project very widely to the forebrain, are representing aspects of the state of ones self, the subjective state, the visceral bodily state. This state of self is meaningfully being represented as a feeling of consciousness which either feels good or bad. Action tendencies are intrinsically interwoven to these feeling states. Pleasurable feelings are associated with approach behaviours, they motivate approach behaviours. 

Negative/painful feelings are associated with avoidance behaviours. These raw feeling states originate in the periaqueductal gray (PAG). Even in such elementary forms of consciousness, something is conveyed but not necessarily intentionally. We see that in herd-contagion behaviour. 

The approach mechanism is essentially a seeking mechanism. It has to do with detecting needs that can only be met in the outside world. It is almost an implicit predictive mechanism: "Unless I go looking for food, I am not going to survive". The feeling that comes with it is mildly optimistic, mildly curious - "something good is going to happen and I want to be there kind of feeling". Freud defined emotions as "mnemic residues of biological situations of universal significance". The universality of significance makes us all know what it means when we see it. Basic emotion systems link our core consciousness to the outside world and those around us. Emotions are a perceptual modality, they are a medium of consciousness just as vision, smell, hearing are a medium of consciousness.  

When another animal (human) feels something and another sees it, hears it, smell it (there are all sorts of ways in which the state of an animal is conveyed) then one knows what the other animal is feeling. These are things which we can't afford to learn, they are "mnemic residues" - we just know what it means, although we may not be able to demonstrate. Empathic knowing When I see that experience it activates the same system in me. I know what it is because it is activated in me. Mirror-neurons allow a higher level elaboration of this basic system. Mirror-neurons were accidentally discovered in a research lab in Italy. When a monkey with a brain activity recording device on its brain observes another monkey eating a banana, the same areas in the brain of the observing monkey are activated. There is a mirroring of the motor-neuron activity in the acting monkey, which is activated in the brain of the perceiving monkey. 

The prefrontal cortex allows for a suppression of the basic emotional systems, inhibiting the action tendencies associated with them. They enable us to not have to act on the feeling, to create virtual scenarios, to represent the relation between things. A 'non-doing' kind of thinking evolves - a highly abstracted, symbolic thinking removed from the emotional core. It is our 'pride and joy' but the price is that it alienates us from our feelings. We develop this curious inability to know what is driving our own actions. 

In therapy the analyst is taught to listen with his "third ear", with an evenly suspended attention. The analyst does not listen to the words, because they only convey part of the story - she picks something up, she feel something, which is akin to a biological situation with universal significance. This way we recognise the patient's emotional configuration, and we use the words to convey our understanding. The talking cure is not about the talking - the talking is about feelings. 

Brain affective systems

Posted on January 12, 2014 at 5:30 PM Comments comments (110)
Jaak Panksepp Ph.D: "Ancestral Memories: Brain Affective Systems, Ancient Emotional Vocalizations, and the Sources of Our Communicative Urges." Over the last 35 years, Dr. Panksepp has almost singlehandedly created the field of affective neuroscience. His book, Affective Neuroscience: The Foundation of Human and Animal Emotions, is the definitive textbook for the field. He is the Baily Endowed Chair of Animal Well-Being Science at Washington State University, an Emeritus Professor in the Department of Psychology at Bowling Green State University, and the author of A Textbook of Biological Psychiatry.

Compassion Based CBT workshop with Prof Paul Gilbert

Posted on January 9, 2014 at 12:09 PM Comments comments (0)
This is a workshop delivered by Prof Paul Gilbert at Palo Alto University in 2013 about the scientific premise and technique of Compassion Focused Therapy. 


Overview of Compassion Focused Therapy and the process of change with compassion. 

CFT is a psychological model, although it uses elements of CBT, humanistic and psychodynamic therapies. CFT started with Prof Gilbert's interest in patients who were struggling with standard therapies (diagnosis of Borderline Personality Disorder). These patients were focused on shame and self-criticism, which is linked to poor outcomes. He wanted to understand evolutionary mechanisms which maintained emotional problems. 

Cognitive Behaviour Therapy traditionally focuses on replacing on unhelpful thoughts and behaviour with helpful thoughts and behaviour. However some clients say they see the logic of the alternative thoughts but do not feel reassured or helped at the emotional level. They also say: "I know I am not to blame but I still feel to blame"

We need to feel congruent emotion in order for our thoughts to be meaningful to us. Emotions "tag" meaning onto experiences. In order to be reassured by the thought "I am loveable", this needs to be linked with the experience of 'being loveable'. Many patients who come from traumatic backgrounds have few memories of being loveable or soothed and thus may struggle to feel reassured and safe by alternative thoughts. 

Compassion focused therapy targets the activation of the soothing system so that it can be more readily accessed and used to help regulate threat-based emotions of anger, fear, disgust and shame. 

Evolutionary model of psychopathology 

We are an emergent species in the 'flow of life' so our brains, with their mechanisms for motives, emotions and competencies are products of evolution, designed to function in certain ways. 

Anxiety disorders are related to how cognitions trigger innate defences - fight, flight, demobilisation (Marks, 1987) or danger modes (Beck, 1996)

Depressions are related to evolved mechanisms for coping with defeats and loss (Beck, 1987; Gilbert, 1992)

Personality disorders are related to the under or over development of innate strategies (e.g. cooperation vs. competition) (Beck, Freeman et al. 1990; Gilbert, 1987)

The social circumstances of our lives, over which we have no control, have major implications for the kinds of minds we have, the way our genes become expressed, the kids of brains we end up with, the kind of person we become, the values we endorsed and the lives we live. 

How new psychologies emerged in the world
500 mil years ago - Reptilian psychology (territory, fear, aggression, sex, hunting)
120 mil years ago - Mammalian psychology (capacity for caring, group, alliance building, play, status)
2 mil years ago - Human psychology emerged (capacity for symbolic thought and self-identity, theory of mind, meta-cognition)
1 mil years ago - Human capacity for extended caring (looking after the old or the sick) 

Why we have complex brains and minds that are difficult to understand and regulate

The Old Brain: Emotions (anger, anxiety, sadness, joy, lust); Behaviours (fight, flight, withdraw, engage) Relationships (sex, status, attachment, tribalism)
New Brain: Imagination, fantasise, look back and forward, collating and integrating vast amounts of information from different modalities- sensory emotional, plan, ruminate. 
Social Brain: Need for affection and care 

The brain has a number of built-in biases. Biased learning (fear of snakes, heights). Biases can be implicit or explicit. We tend to be self-focused, kin-focused and exhibit in-group preferences. 

We have a capacity to become aware of being awareness. Mindfulness is the capacity to observe one's mind and it naturally calms us down. Compassion comes is a motivating system rooted in the caring system. Compassion has to be understood as an interaction - it depends also on the other being responsive to being cared for. 

The mind is primarily a social signalling system (See Tronick's 'still face' experiment, Joseph Campos experiment on the role of non-verbal communication guiding behaviour in babies) 

Humans have fundamentally have a desire to be helpful( Warneken and Tomasello experiments in compassion in babies). 

Evolutionary functional analysis 

There are three types of emotions, which act as motivators: 
-those that focus on threat and self-preservation
-those that focus on doing and achieving 
-those that focus on contentment and feeling safe. 

The threat system is the dominant system in your brain. It is designed to over-rule and switch off everything else. Attention becomes narrow-focused, scans for threats, moves towards thinking about what could go wrong. In anger and anxiety the body feelings overlap. Borderline patients are not able to distinguish between tension and anxiety. 

Transforming the mind changes the brain

Posted on February 7, 2013 at 7:45 PM Comments comments (102)
Richard Davidson lecture on the impact of mental training on the neural circuits of emotion and attention. Watch here. (min. 5.08)

Circuits of emotion
Sensory information travels from the sensory organs, through relay centres (sensory thalamus) to the cortex. Once the relevance of this information is processed (is it safe or dangerous), this is transmitted to the the visceral organs (heart and the lungs) and to the muscles in our face and body. If we perceive a threatening stimulus (i.e) a predator, our heart beats faster and hour lungs work harder, etc. The information about the state of the viscera and the body then travels back to the brain. It is only when the brain detects the changes in our body that the experience of emotion arises. This is an influential view espoused by William James in the "Principles of psychology". The fact that our perception of emotion is reliant of information from the body was proven through an experiment in which people who had botox injected in their forehead (in muscles associated with the expression of sadness) were tested before and after. The test showed that the lack of signal feedback from these muscles to the brain changed the emotional response of the person (they experienced less sadness).

James Papez was the first to describe a model of the circuit in the brain associated with emotion. His model included the hippocampus, the hypothalamus, the anterior thalamus and the cingulate gyrus.This was the first time that it was suggested that emotion is processed in parts of the brain that lie below the cortex. Later on, studies on patients with lesions to the prefrontal cortex showed that the cortex (the medial prefrontal part) is actually involved in emotional processing.

In the modern understanding, the capacity to regulate our emotions is associated with the prefrontal cortex. No other species can voluntarily regulate their emotions in the way humans do. 

Emotion as a process is distributed throughout a circuit and different areas of the brain interact to create emotion (i.e. the limbic system and the prefrontal cortex. However there is no single site in the brain about which we can say: that is where emotion resides. There are circuits in the brain for positive emotions and circuits that process negative emotion.

Stress changes the structure of the brain, particularly the hippocampus, amygdala and orbito-frontal cortex. When an animal is chronically stressed the nervous cells in the hippocampus shrink shrink (fewer dendrites), whereas cells in the amygdala apear to have more ramifications. (Davidson & McEwan, Nature neuroscience, 2012) 

Networks in the brain important for attention 
Attention has different atributes and some can be distinguished in terms of circuits in the brain. There are three types of attention: alerting, orienting and executive control. Alerting occurs for instance when there is a big loud noise. Something happens in the environment and our attention is pulled towards it. Orienting is the capacity to direct your attention mentally to different senses. Executive control is about resisting distractions and directing our mind to focus on one thing and inhibit the distractive influences that come from somewhere else. There are parts of the brain involved with these attention functions that overlap with emotion. This is not surprising because it is emotionally relevant information in our environment that captures our attention. We do not become alerted to neutral stimuli.

The impact of contemplative training on networks important in attention
Children who have attention deficit hyperactivity disorder are very variable in how they pay attention. In a study in which participants practiced Vipassana meditation for three months, it was shown that this practice greatly helped reduce this variability of attention (Lutz et al. 2009, Neuroscience). 

Affective neuroscience: Pro-social behaviour

Posted on January 11, 2013 at 5:07 PM Comments comments (106)
Stephen W. Porges is one of the world's leading experts in the autonomic nervous system, and author of a book titled "Polyvagal Theory - Neurophysiological foundations of emotions, attachment, communication and self-regulation". The book is basically a collection of articles published during a career spanning 40 years. 

Telluride conference on compassion 
I first learned about his work a couple of months ago when I watched the YouTube posted footage of the Compassion science conference organised by CCARE Stanford in Telluride, Colorado, in July 2012. Watching him deliver his presentation, Mr. Porges impressed me as an anxious, vulnerable man who self-admitted to feeling a bit lost as he couldn't see the faces of his audience and said he found it difficult without being able to gauge the feedback from facial expressions. The organisars duly turned on the lights and offered him a glass of water and he saluted this act of "pro-social behaviour". 

Porges' theory combines observations on comparative anatomy about the development of the nervous system from fish to reptiles to mammals, with the study of the nervous system of newborns, insights from psychiatric conditions in which pro-social behaviour is impaired (autism, depression). Porges states that his scope is both scientific and humanistic - in that he wants to promote better, more humane care practices amongst clinicians, that honour the healing power of human relationships. 

Autonomic nervous system
Porges focuses on a part of the Autonomic Nervous System - the para-sympathetic nervous system (PNS), which traditionally was believed has an antagonistic relationship with the sympathetic system (SNS). The PNS consists of cranial nerves that have efferent (taking information to the body and internal organs) and afferent branches (that bring information from the body and the internal organs). 

The vagus nerve
The thenth cranial nerve (X), also called the vagus nerve is of particular interest. This nerve has two pathways - an unmyelinated one, which originates in the dorsal motor nucleux (DMNX) and a myelinated one, which originates in the nucleus ambiguus (NA). Myelinated nerves transmit information much faster. The myelinated vagus is a mammal "invention". Reptiles do not have it. What reptiles do have, is an unmyelinated vagus. The role of this nerve is to massively slow the heart's pacemaker - an important part of death-feigning. For mammals it is extremely dangerous to resort to death-feigning as a strategy to escape danger. A massive slow-down in breathing and heart-beat can cause cause serious damage to the mammalian oxygen-hungry brain and body. So mammals also have a myelinated vagus nerve, which makes sure that the unmyelinated nerve does not stop the heart.

Myelinated vagus, a mammal invention
What is interesting about the vagus nerve is that it's branches do not only innervate the heart, but also the facial muscles, the larynx, the pharynx and the inner ear muscles. This means in effect that engaging in pro-social behaviour - communicating with our face and voice, listening also has the effect of maintaining our heart beat within the normal range and preventing us from going into a state of mobilization (sympathetic activation characterized by flight, fight or freeze behaviour) or immobilization - death feigning). Basically it's like a neural brake that stops us  from "literally bouncing off the walls" (Porges, p.31) 

Hierarchy of behavioural responses
Vagal tone is highest when we are in a non-threatening situation. If we detect danger in the environment, then vagal tone withdraws and the body is now under the influence of the sympathetic nervous system, which gears it through hormones such as norepinephrine (noradrenaline) and cortizol to send all available energy into the muscles in order to fight or freeze, or run away. A state of mobilization is incompatible with pro-social behaviour. Traumatized clients which are easily triggered to feel angry or scared may not be available to be contacted through conversation and reasoning. 

Misreading the environment
What is interesting is that not only does the environment affect our internal state, our internal state also "colours" the way we interpret our environment. Traumatized individuals who are constantly in a state of agitation, are also more likely to "misread" cues from the environment and interpret them as dangerous. This is why working with clients diagnosed with borderline personality disorder is so difficult. No matter how benign and benevolent the therapist believes she is, the client easily mis-reads and mis-interprets her actions. The transactional analysis cathexis school calls this phenomenon "re-framing" (Schiff). Reframing, far from being a conscious process seems more likely that is "wired" into bodily responses which were geared to deal with harmful, dangerous environments. 

If the situation is interpreted to be imminently life-threatening and the emotional response triggered is one of terror, then the unmyelinated vagus takes over and slows the heart right down. The result is immobilization (fainting, dissociative state). In transactional analysis language, client becoming immobilized is an indication that they are cathecting a severely traumatic Child ego-state. 

Porges basically says that in any given situation we will employ the evolutionarily newest neural systems - those involved in pro-social behaviours. If this strategy fails then the sympathetic system will activate to promote flight, fight or freezing and if that fails as well, we will go into immobilization (fainting, dissociation). 

Other important researchers
If I had a criticism of Porges is that like any researcher absorbed by his area of focus he tends to downplay the importance of other neural areas involved in the process. He barely mentions the work of Damasio, LeDeux, Richardson and Sapolsky. Damasio talks about the importance of the medial-prefrontal cortex in self-control. LeDeux talks about the way in which "news" of possible danger hit the amygdala before the prefrontal cortex through a "fast and dirty way", which means that we react before we've had time to assess what it is that we are reacting to. Richardson focuses amongst other things on the insula, involved in representing bodily states and Sapolsky is an expert in stress and the sympathetic activation and its effects on the hippocampus. 

Implications for practice
I think Porges' theory supports humanistic practices such as person centred and body-based psychotherapy as facial expressiveness, a positive warm presence and caring attitude which are valued in these types of therapies are also proven to promote states of calm and healing. I think that this theory challenges traditional psychoanalytic approaches such as neutral stance and non-disclosure which I think can trigger mobilization in already traumatized individuals. It also challenges health professionals in general - doctors and nurses, who traditionally are more concerned with performing the tasks and operations needed to maintain and promote bodily function and are less concerned with how they relate to their patients and the potentially harmful impact of their distant stance.  

Research into the brain of a psychopath

Posted on November 26, 2012 at 11:58 AM Comments comments (97)
BBC News Health online article by Matthew Taylor: Psychopaths: Born evil or with a diseased brain?

The article presents the work of neuroscientist Dr Kent Kiehl of the University of New Mexico who travels across prisons in the USA scanning the brains of people with custodial sentences for serious offences such as rape or murder. He sees psychopaths not as evil, but as people who suffer from a disorder of brain function. 

A proposal to classify happiness as a psychiatric disorder

Posted on November 21, 2012 at 5:09 AM Comments comments (2)
Here's a very funny also strangely spooky scientific satire by Richard Bentall, who makes a tongue-in-cheek proposal that happiness be classified as a psychiatric disorder. Or at least I think it is tongue-in-cheek. He might be serious. (Read it here)

Bentall's argument is seductive, wildly entertaining but also strangely spooky because it shows how seemingly impecable logical sequencing of arguments can nevertheless lead to an absurd conclusion. It simply turns all arguments for considering aspects of mental life symptoms of psychiatric disorders on their head. 

Bentall is obviously having a justified dig at the proliferation of psychiatric disorders, and whether there's anything there at all to prevent all human emotions being conceived as abnormal. Bentall proves that one certainly can rake up the arguments to do so and how useful to the task are conceptually vague concepts such as "normality" and "function". 

Death and the doctor

Posted on November 19, 2012 at 4:52 PM Comments comments (1)
After hearing dr. Elaine Kasket on Digital Human I became interested in her research on the many facets of how we experience death and mourn. I found two articles Death and the Doctor published by Dr. Kasket in the Journal of Existential Analysis (2006). These are extracts from her doctoral thesis. (Death and the Doctor I and II) I was excited to find this research because it links in with my current interest into how the death of a client through suicide is affecting mental health clinicians such as psychotherapists, counsellors psychiatrists and clinical psychologists. 

Ultimate rescuer
Dr. Kasket is reflecting on the status of the physician in relation to the modern experience of dying.  She says: “With the modern decline of religion and elevation of science and technology, the fight against death is a war, with the charge led by the physician. Society and patients cast physicians in a highly pressurized role that is both potentially rewarding and potentially awkward” (p. 137) The doctor thus  becomes the "ultimate rescuer" (Yalom, 1980), a role both imposed and eagerly accepted by the physician, who may himself be motivated to enter the medical field by a personal need to overcome his death anxiety. 

"Be strong" as a professional norm
Dr. Kasket reviews the existing literature on how doctors' responses to their patients and their suffering or demise is subtly shaped by their training and work culture. Physicians supervise their own emotional response by considering informal professional norms and client expectations.
 
“When emotional expression is discouraged and not allowed space, when faculty members do not ask about students’ affective responses, when it is explicitly stated that too much emotional involvement will interfere with good patient care, and when hard work and academic pressures are so strong as to cause emotional blunting, medical students get the message that negative emotions and their management are a private matter and their own “problem”, to be dealt with by themselves and not part of their professional development” (p. 140)

Physicians are expected to maintain “affective neutrality” – a highly valued aspect of professional identity, associated with power, knowledge and being above challenge. The underlying assumption seems to be that an effective physician does not become emotionally involved with patients. 

Strategies against the experience of emotional pain
Defense mechanisms such as intellectualisation, use of scientific technical language, thinking about the patient as a "case",  black humour and  suppression of feelings are learned and employed, leading to blunted emotional awareness and a reduced capacity to communicate effectively. 
 
Other emotion management strategies employed by doctors are: deflecting attention from personal feelings, blaming the patient, making the patient responsible for the doctor’s feelings, projecting. Some doctors may choose specializations where they believe they are less likely to be confronted by death – such as psychiatry, cosmetic surgery, pathology.

Dr. Kasket conducted a qualitative research into the experience of eight doctors and found that they are impacted deeply by the death of their patients and become frequently experience grief and a radical re-assessment of their professional capacity. 
 
“The dying patient challenges physician’s carefully constructed and reinforced view of themselves that they are experts, who know what is wrong and who know what needs to be done to cure the patient. Not being able to effect that cure can lead to identity confusion, feelings of personal failure and self-esteem crises. (…) After a death, physicians are left doubting themselves: Did they do something wrong? Could something more have been done to prevent the death? Is their grief reaction abnormal? Will it interfere with their work?” (p.144)
 
Physicians who lose clients become uncertain about diagnosis and about treatment. Terror of making a mistake that could result in death, which could provoke a crisis of identity and have important consequences legally and professionally.
 
Common coping strategies include: seeking support socially, self-talk, avoidance and wishful thinking. Negative strategies: lashing out, blaming self and others, taking alcohol or drags, intellectualisation, avoidance, crying. They may not be able to take time to reflect or have a private emotional moment. Other behaviours: heroic attempts to sustain life, resuscitation at any cost, unnecessary tests for a patient who is dying, over-prescribing medication.

Zero degrees of empathy

Posted on November 7, 2012 at 8:03 AM Comments comments (99)
Empathy. It is considered an essential skill and a core condition (Rogers) in psychotherapy and counselling. It is the ability to put oneself in another person's shoes, to experience the world as they are experiencing it. In essence when we are being empathic we are recreating in our own mind and body a map of another person's mind, we are resonating with their pain and experiencing it as our own. 

A while ago I read a book by Simon Baron-Cohen "Zero degrees of empathy". Baron-Cohen asked the question "why does evil exist?" and wanted to find a scientific answer rather than a religious one. Baron-Cohen is an expert in autism, a condition which is characterised by a person's reduced ability to pick up and interpret another person's facial and bodily expressions in order to understand what they are feeling. This causes a considerable amount of strain socially. People are unable to gauge whether what they are doing is appropriate to the situation at hand. For instance, they might tell you a story about a subject that they are passionate about and fail to notice that you are drifting off, getting bored and would like them to stop. People with autism feel lost in social situation. They find it difficult and confusing - a minefield. They notice that people frequently get irritated and fed-up and this is scary because they don't understand what they've done wrong. 

People with high-functioning autism (Asperger's) can be helped to manage social situations by being taught about non-verbal communication and the significance of social cues. It's a little bit like learning to colour by numbers. 

There is another category of individuals tthat display zero-empathy. Baron-Cohen suggests that in this category are people on the high-end of spectrum of personality disorders such as borderline personality disorder (BDP), narcissistic personality disorder and antisocial personality disorder. 

Amongst other traits, patients diagnosed with BDP show an inability to connect with the pain caused to others through their self-harming acts and suicidal threats. They do not understand or experience the turmoil and the extreme fear that the other person is overwhelmed with. 

Clients with narcissistic structures are unaware of the other having any needs. They fill up the space with their discourse and tend to put others down. 

Antisocial personality disorder (psychopathy) is a condition rarely encountered in the therapy room. Psychopaths who are also violent and break the law tend to end up in prison. Those who don't break the law may be highly successful professionals. Cambridge trained psychology researcher dr. Kevin Dutton is fascinated by psychopaths. He has interviewed many of these individuals. 

Dutton has a certain admiration for psychopaths. He has found that some psychopathic traits (charm, ruthlessness, low empathy, focus, low stress response under pressure), if  coupled in an individual with high intelligence and low predisposition to violence may be highly useful in certain professions such as surgery, law and the arm and facilitate a high degree of achievement in these areas. (Psychopath in your family is a short film uploaded on his website www.wisdomofpsychopaths.com. I also found this documentary: I am fishead that proposes the thesis that corporate leaders are psychopaths)

The psychopath can accurately create a map of another's mind. He (because it tends to be a man) is extremely good at gauging what the other may be experiencing or thinking. However, the psychopath fails to experience another person's pain and are themselves emotionally under-aroused. Functioning MRI brain scans show that in psychopaths the amygdala (the structure of the brain that gets activated when we experience negative emotion and fear) is under-activated. 

In other words psychopaths cannot display the kind of "hot" empathy that translates into compassion and moral restrain. They are very good at thinking on their feet, focused, driven and because they brain/body rarely triggers the stress response, their verbal and manual performance remains highly accurate even in the most daunting situations. 

Why is that? Stress response translates partly into the release of a steroid hormone - cortisol. This hormone triggers bodily reactions that are biased towards facilitating a motor reaction such as running really fast. Prolonged exposure to glucocorticoids however has negative effects on the hippocampus (the part of the brain involved in the retrieval of autobiographical memory). We have all experienced stressful situations in which we feel tongue tied and cannot remember facts that we do know. Cortisol is to blame. In fact, cortisol not only interferes with the functioning of the hippocampus but can also contribute to premature cell death at this site. Prof. Dr. Robert Sapolsky from Stanford University has proved that stress has a negative effect on memory and the hippocampus. (The audio of his talk Stress and memory Forget it! is uploaded on youtube. Ignore the picture of the cat.)

Psychopaths have no such concerns. They are able to withstand extremely stressful situations without their nervous system being overwhelmed and without their body swimming with adrenaline or cortisol. 

Unsurprisingly, it turns out that what all people with zero-degree of empathy have in common is that they are not so good at relationships. The inability to hold someone else's mind in your mind, to respond with compassion is not conducive to being able to form a strong bond with another human being. 

The good news is that we are getting better and better at identifying low-empathy in children and that there are ways to train people in empathy. 

And to end, I found this brilliant short animated history of empathy by Jeremy Rifkin. It is called "The empathic civilisation". Rifkin argues traces the evolution of the empathic brain and argues that our ability to extend empathy to others with whom we don't share the same culture and religion, as well as to other species is essential to our survival on this planet. 

The body influences the mind.

Posted on October 22, 2012 at 6:38 AM Comments comments (144)
Social psychologist Amy Coddy from Harvard University has investigated whether when it comes to displaying body language associated with confidence "faking it" really does make a difference. 

Coddy has asked research subjects to spend two minutes in a "low power" pose (hunched back,  lowered head, arms folded) or a "high-power pose" (spreading out, taking space, arms extended). She found that this had an effect on the levels of stress cortisol in the body. "Low-power pose" participants reporting feeling under-confident and anxious. Those that spent two minutes in a "world is my oyster" pose had a hormonal profile that showed low cortisol levels and felt more relaxed and self-assured. 

Bodily expressions (postures, facial mimicry) affect our state of mind, just as our state of mind affects how we use our body

Coddy, goes on to give a personal account on how "faking it" or persisting acting out her role with confidence in spite of her deeply felt sense that "I shouldn't be here" did over time become who she was. Coddy had a severe brain injury when she was 19 and was told that as a result her IQ had suffered and she wouldn't be able to continue to a college education.