The Mind and The Brain - Jeffrey M. Schwartz & Sharon Begley

A groundbreaking work of science that confirms, for the first time, the independent existence of the mind–and demonstrates the possibilities for human control over the workings of the brain.

Conventional science has long held the position that 'the mind' is merely an illusion, a side effect of electrochemical activity in the physical brain. Now in paperback, Dr Jeffrey Schwartz and Sharon Begley's groundbreaking work, The Mind and the Brain, argues exactly the opposite: that the mind has a life of its own.Dr Schwartz, a leading researcher in brain dysfunctions, and Wall Street Journal science columnist Sharon Begley demonstrate that the human mind is an independent entity that can shape and control the functioning of the physical brain. Their work has its basis in our emerging understanding of adult neuroplasticity–the brain's ability to be rewired not just in childhood, but throughout life, a trait only recently established by neuroscientists.

Through decades of work treating patients with obsessive–compulsive disorder (OCD), Schwartz made an extraordinary finding: while following the therapy he developed, his patients were effecting significant and lasting changes in their own neural pathways. It was a scientific first: by actively focusing their attention away from negative behaviors and toward more positive ones, Schwartz's patients were using their minds to reshape their brains–and discovering a thrilling new dimension to the concept of neuroplasticity.

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Ailén said:

It reminds me of how, when we notice a program in ourselves (or more often, are given a mirror about it), we start being able to observe it, and know it's intrusive/our false personality, etc., but can't do anything at first. In the case of OCD, focusing on what it would be like to master that mechanical part of the self has shown to produce actual physical changes in the brain, AS IF the behavioral change had already occured. Then, it takes focus and attention, but the behavior CAN be changed. The patients learn to get less and less identified with the programmed reactions/thoughts, predator, etc., and little by little they manage to modify it or a least stop it from ruling their actions. Sounds familiar?

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Ennio said:

The idea that we can re-wire ourselves physiologically - via self-awareness, and accompanied by behavioral change - really gets my attention (so to say!). Not that it is a new idea here, but the fact that 'science' seems to be catching up to all the metaphysical understandings we have come to know makes me interested in understanding things from this other perspective.

Greatly looking forward to reading it. Thanks for mentioning it, Ailén.

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anothermagyar said:

I comprehend better the cognitive science books.

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Laura said:

So it seems that, overall, as a network, we have been putting together a True Way Forward for the spiritually evolving human. It may not be THE way for everyone, but I guess that depends on the individual's AIMS and capacities. And Aims may depend on capacities for their formulation.

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Ennio said:

This reminds me of just how synergistic all of the 'ways' here are. Everything that's done here has some effect or relationship to everything else in some form or another. To neglect one area is, in some way, neglecting all areas because of how interconnected things are, in other words. Taking this just a little step further, what I've been thinking about lately is that everyone that's doing something here has some effect upon, or relationship to, everyone else in some form or another. A larger pattern of understanding and behavior and action is then enabled - the more we are able as individuals to engage in the different 'ways' and processes that are shared here.

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anothermagyar said:

Thank you to share this!

I'm looking forward to read it, I have to admit the psychological books,

like Wilson's for me more readable I can relate to it.

Although I didn't read everything from Gurdieff or Mouravieff it is an ongoing project,

I comprehend better the cognitive science books.

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The obsessions that besiege the patient seemed quite clearly to be caused by pathological, mechanical brain processes—mechanical in the sense that we can, with reasonable confidence, trace their origins and the brain pathways involved in their transmission. OCD’s clear and discrete presentation of symptoms, and reasonably well-understood pathophysiology, suggested that the brain side of the equation could, with enough effort, be nailed down.

As for the mind side, although the cardinal symptom of obsessive-compulsive disorder is the persistent, exhausting intrusion of an unwanted thought and an unwanted urge to act on that thought, the disease is also marked by something else: what is known as an ego-dystonic character. When someone with the disease experiences a typical OCD thought, some part of his mind knows quite clearly that his hands are not really dirty, for instance, or that the door is not really unlocked (especially since he has gone back and checked it four times already). Some part of his mind (even if, in serious cases, it is only a small part) is standing outside and apart from the OCD symptoms, observing and reflecting insightfully on their sheer bizarreness. The disease’s intrinsic pathology is, in effect, replicating an aspect of meditation, affording the patient an impartial, detached perspective on his own thoughts. As far as I knew, the impartial spectator in the mind of an OCD patient—overwhelmed by the biochemical imbalances in the brain that the disease causes—remained only that, a mere spectator and not an actor, noting the symptoms that were laying siege to the patient’s mind but powerless to intercede. The insistent thoughts and images of OCD, after all, are experienced passively: the patient’s volition plays no role in their appearance.

But perhaps, I thought, the impartial spectator needn’t remain a bystander. Perhaps it would be possible to use mindfulness training to empower the impartial spectator to become more than merely an effete observer. Maybe, just maybe, patients could learn a practical, self-directed approach to treatment that would give them the power to strengthen and utilize the healthy parts of their brain in order to resist their compulsions and quiet the anxieties and fears caused by their obsessions. And then, despite the painful intrusions into consciousness caused by the faulty brain mechanisms, the patient could exercise the power to make a choice about whether the next idea the brain attends to will be “I am going to work in the garden now,” rather than “I am going to wash my hands again.” Although the passive stream of the contents of consciousness may well be determined by brain mechanism, the mental and emotional response to that stream may not be. The OCD patient, in other words, may have the capacity to focus attention in a way that is not fixed or predestined by the (pathological) brain state.

[...]

In what came to be called the Four Steps regimen of cognitive-behavioral therapy for OCD, patients gain insight into the true nature and origin of the bothersome OCD thoughts and urges. They Relabel their obsessions and compulsions as false signals, symptoms of a disease. They Reattribute those thoughts and urges to pathological brain circuitry (“This thought reflects a malfunction of my brain, not a real need to wash my hands yet again”). They Refocus, turning their attention away from the pathological thoughts and urges onto a constructive behavior. And, finally, they Revalue the OCD obsessions and compulsions, realizing that they have no intrinsic value, and no inherent power. If patients could systematically learn to reassess the significance of their OCD feelings and respond differently to them through sustained mindful awareness, I reasoned, they might, over time, substantially change the activity of the brain regions that underlie OCD. Their mind, that is, might change their brain.

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There, I propose that the time has come for science to confront the serious implications of the fact that directed, willed mental activity can clearly and systematically alter brain function; that the exertion of willful effort generates a physical force that has the power to change how the brain works and even its physical structure. The result is directed neuroplasticity. The cause is what I call directed mental force.

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...the materialist-determinist model of the brain has profound implications for notions like moral responsibility and personal freedom. The interpretation of mind that dominates neuroscience is inimical to both. For if we truly believe, when the day is done, that our mind and all that term entails—the choices we make, the reactions we have, the emotions we feel—are nothing but the expression of a machine governed by the rules of classical physics and chemistry, and that our behavior follows ineluctably from the workings of our neurons, then we’re forced to conclude that the subjective sense of freedom is a “user illusion.” Our sense that we are free to make moral decisions is a cruel joke, and society’s insistence that individuals (with exceptions for the very young and the mentally ill) be held responsible for their actions is no more firmly rooted in reason than a sand castle is rooted in the beach. In stark contrast to the current paradigm, however, the emerging research on neuroplasticity, attention, and the causal efficacy of will supports the opposite view—one that demands the recognition of moral responsibility.

And it does something more. The implications of directed neuroplasticity combined with quantum physics cast new light on the question of humankind’s place, and role, in nature. At its core, the new physics combined with the emerging neuroscience suggests that the natural world evolves through an interplay between two causal processes. The first includes the physical processes we are all familiar with—electricity streaming, gravity pulling. The second includes the contents of our consciousness, including volition. The importance of this second process cannot be overstated, for it allows human thoughts to make a difference in the evolution of physical events.

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As soon as the thought that your hands are dirty seizes your attention, I counseled them, use mindfulness to enhance awareness of the fact that you do not truly think your hands need washing; rather, tell yourself that you are merely experiencing the onslaught of an obsessive thought. The patient would start saying to herself, That’s not an urge to wash; that’s a bothersome thought and an unpleasant feeling caused by a brain wiring problem. Or, if the compulsion to check a door lock intruded, the patient was to regard it as the result of a nasty compulsive urge, and not of any real need to check the lock. The feeling of doubt, I told patients repeatedly, is a false message, due to a jammed transmission in the brain. To enhance the recognition that the thoughts and urges are symptoms of OCD, I taught patients to make real-time mental notes, in effect creating a running stream of mindful commentary on what they were experiencing. This enabled them to keep a rational perspective on the intrusive thoughts and urges and not get caught up in automatic compulsive responses and thus a destructive run of compulsive rituals.

By refusing to accept obsessive thoughts and compulsive urges at face value, and instead recognizing that they are inherently false and misleading, the patients took the first step toward recovery. Done regularly, Relabeling stops the unpleasant feelings of OCD from being unpleasant in the same way: understanding their true nature gives a feeling of control, even of freedom. By Relabeling their thoughts and urges as manifestations of a medical disorder, patients make a purposeful cognitive shift away from self-identification with the experience intruding into the stream of consciousness.

The week after patients started relabeling their symptoms as manifestations of pathological brain processes, they reported that they were getting better, that the disease was no longer controlling them, and that they felt they could do something about it. I knew I was on the right track. By this time, the PET data had clearly shown that the orbital frontal cortex of OCD patients is hypermetabolic. One day, just a few months after starting the group, I happened to be carrying around some plain black-and-white PET scans. One patient asked me, “Doc, can you just tell me why the damn thing keeps bothering me—why it doesn’t go away?” I looked at him. “You want to know why it doesn’t go away?” I asked. “I’ll show you why it doesn’t go away. You see this dark spot in the brain on this scan? That is why: it means this region of the brain is hugely overactive in people with OCD. That’s why the bad feeling doesn’t go away.”

It was as if a lightbulb went off in his head—indeed in all the patients’ heads. At that moment what was to become the second of the Four Steps, Reattribute, was born. Whenever a patient told me an obsession was bothering her, I responded, This is why: I printed slides of color PET scans and showed patients the neuroanatomical basis of their symptoms. This is why you feel you have to wash, or check, or count, I said, photographic evidence in hand. This reattribution of OCD feelings to a brain glitch was the breakthrough that pushed us beyond simple Relabeling. Cognitive techniques that merely teach the patient to recognize OCD symptoms as false and distorted—something called cognitive restructuring—do not make much of a dent in OCD. Relabeling was essentially just a form of cognitive restructuring. Reattributing went further: having Relabeled an intrusive thought or insistent urge as a symptom of OCD, the patient then attributes it to aberrant messages generated by a brain disease and thus fortifies the awareness that it is not his true “self.” By first making mental notes of the arrival of an OCD obsession, and immediately attributing it to faulty brain wiring, I hoped, patients could resist that false message. “The brain’s gonna do what the brain’s gonna do,” I told them, “but you don’t have to let it push you around.”

[...] I began using Relabeling and Reattributing via mindfulness as a core part of their treatment. Accentuating Relabeling by Reattributing the condition to a rogue neurological circuit deepens patients’ cognitive insight into the true nature of their symptoms, which in turn strengthens their belief that the thoughts and urges of OCD are separate from their will and their self. By Reattributing their symptoms to a brain glitch, the patients recognize that an obsessive thought is, in a sense, not “real” but, rather, mental noise, a barrage of false signals. This improves patients’ ability not to take the OCD thoughts at face value. Reattributing is particularly effective at directing the patient’s attention away from demoralizing and stressful attempts to squash the bothersome OCD feeling by engaging in compulsive behaviors. Realizing that brain biochemistry is responsible for the intensity and intrusiveness of the symptoms helps patients realize that their habitual frantic attempts to wash (or count or check) away the symptoms are futile.

Relabeling and Reattributing reinforce each other. Together, they put the difficult experience of an OCD symptom into a workable context: Relabeling clarifies what is happening, and Reattributing affirms why it’s happening, with the result that patients more accurately assess their pathological thoughts and urges. The accentuation of Relabeling by Reattributing also tends to amplify mindfulness. Through mindfulness, the patient distances himself (that is, his locus of conscious awareness) from his OCD (an intrusive experience entirely determined by material forces). This puts mental space between his will and the unwanted urges that would otherwise overpower the will.

Besides Relabeling and Reattributing their OCD symptoms, I realized, patients needed to turn their attention to something else, performing an activity other than the one being urged on them by their stuck-in-gear brain. It seemed a good idea to make it a systematic part of the treatment, akin to the practice of methodically directing attention “back to the breath” when the mind wanders during meditation. So I gave it a name: Refocusing. It evolved to become the core step of the whole therapy, because this is where patients actually implement the willful change of behavior. The essence of applying mindful awareness during a bout of OCD is thus to recognize obsessive thoughts and urges as soon as they arise and willfully Refocus attention onto some adaptive behavior.

Directed mental focusing of attention becomes the mind’s key action during treatment. The goal of this step is not to banish or obliterate the thought, but rather to initiate an adaptive behavior unrelated to the disturbing feeling even while the feeling is very much present. Refocusing on such a behavior, and thus resisting the false message to carry out the OCD compulsion, requires significant willpower, for the feeling that something must be washed or checked is still very much a part of the inner experience. Although the patient has Relabeled and Reattributed the obsessions and compulsions to brain pathology, the anxiety and dread still feel frighteningly real. Early in treatment, I therefore suggested to patients that they Refocus on a pleasant, familiar “good habit” kind of behavior. This is when biological reasoning became crucial: I specifically wanted patients to substitute a “good” circuit for a “bad” one. The diversion can be almost anything, although patients began telling me that physical activity—gardening, needlepoint, shooting baskets, playing computer or video games, cooking, walking—was especially effective. That is not to say it was easy. To the contrary: Refocusing attention away from the intrusive thought rather than waiting passively for the feeling to go away is the hardest aspect of treatment, requiring will and courage.

Soon after I explained the Refocus step to one patient, Jeremy, he began carrying around a small notebook in which he wrote ways to Refocus whenever a compulsive urge arose. On its cover, he had written “caudate nucleus.” In what he called his “refocus diary,” Jeremy told me, he recorded how he prevented himself from responding to an OCD urge and which alternative behavior he used. The diary, it turned out, not only increases a patient’s repertoire of Refocus behaviors, but also boosts confidence by highlighting achievements: see, yesterday when I had a seemingly irresistible urge to count cans I did some needlepoint instead. Many patients were helped by selecting one Refocus task daily as the “play of the day,” to remember and review as a form of positive feedback and self-empowerment. Over the course of treatment, patients slowly developed the sense that they could control their response to the OCD intrusions and that well-directed effort really does make a difference.

Early on, I developed a “fifteen-minute rule.” The patient had to use an “active delay” of at least fifteen minutes before performing any compulsive act. Setting a finite length of time to resist giving in seems to help patients [...]. The fifteen minutes should not be just a passive waiting period, however. Rather, it must be a period of mindful adaptive activity intended to activate new brain circuitry, with the goal of pursuing the alternative activity for a minimum of another fifteen minutes. This seems to be the length of time generally needed for most patients’ OCD urges to diminish noticeably. When a patient’s mind is invaded by obsessive thoughts, even brief periods of Refocusing help, for they demonstrate that it is not essential to squelch intrusive thoughts entirely in order to engage in healthier behaviors.

Refocusing also alleviates the overwhelming sense of being “stuck in gear.” This is where Relabeling and Reattributing come in: both help keep patients’ minds clear about who they are and what the disease process is. This mental clarity has tremendous therapeutic power, for it keeps the Refocusing process moving forward. It also reinforces the insight that active will is separable from passive brain processes—an awareness that forms the core of the quantum perspective on the mind-brain interface, as we shall explore later.

At the neurological level, the rationale for Refocusing is straightforward. Our PET scans had shown that the orbital frontal cortex, the caudate nucleus, and the thalamus operate in lockstep in the brain of an OCD sufferer. This brain lock in the OCD circuit is undoubtedly the source of a persistent error-detection signal that makes the patient feel that something is dreadfully wrong. By actively changing behaviors, Refocusing changes which brain circuits become activated, and thus also changes the gating through the striatum. The striatum has two output pathways, as noted earlier: direct and indirect. The direct pathway tends to activate the thalamus, increasing cortical activity. The indirect pathway inhibits cortical activity. Refocusing, I hoped, would change the balance of gating through the striatum so that the indirect, inhibitory pathway would become more traveled, and the direct, excitatory pathway would lose traffic. The result would be to damp down activity in this OCD circuit.

When patients changed the focus of their attention, in other words, the brain might change, too. I thought that if I could somehow induce the patient to initiate virtually any adaptive behavior other than whatever the compulsion was, this process would activate neuronal circuitry different from the pathways that were pathologically overactive. Then I could exploit the brain’s tendency to pick up on repetitive behaviors and make them automatic—that is, to form new habits. Ideally, this alternative behavior would be one the patient already knows so well that it is almost automatic. When patients change their focus from “I have to wash again” to “I’m going to garden,” I suspected, the circuit in the brain that underlies gardening becomes activated. If done regularly, that would produce a habitual association: the urge to wash would be followed automatically by the impulse to go work in the garden. I therefore began encouraging patients to plan sequences of Refocusing behaviors that they could call on, in order to make them as automatic as possible. Refocusing is the step that, more than any other, produces changes in the brain.

[...]

Like Relabeling, Reattributing, and Refocusing, Revaluing was intended to enhance patients’ use of mindful awareness [...]. I therefore began teaching Revaluing by reference to what Buddhist philosophy calls wise (as opposed to unwise) attention. Wise attention means seeing matters as they really are or, literally, “in accordance with the truth.” In the case of OCD, wise attention means quickly recognizing the disturbing thoughts as senseless, as false, as errant brain signals not even worth the gray matter they rode in on, let alone worth acting on. By refusing to take the symptoms at face value, patients come to view them “as toxic waste from my brain,” as the man with chapped hands put it.

In both my individual and my group practice, I was getting encouraging results with the Four Steps by the early 1990s. With continued self-treatment—for I always intended that patients be able to follow the treatment regimen on their own—the intensity of their OCD symptoms kept falling. As it did, the patients found they needed to expend less effort to dismiss OCD symptoms through Relabeling, and less effort to Refocus on another behavior.

Some of the OCD patients, especially those willing to be treated without drugs, were recruited into the brain imaging study that Lew Baxter and I were starting, with the goal of measuring whether the positive behavioral changes we were seeing in patients were accompanied by brain changes. Our UCLA group therefore performed PET scans on eighteen drug-free OCD patients before and after they underwent ten weeks of the Four Steps, with individual sessions once or twice a week in addition to regular group attendance. The patients who signed on exhibited moderate to quite severe symptoms. What they all had in common was a willingness to be PET-scanned twice and to try a largely self-directed, drug-free treatment. Twelve of the patients improved significantly during the ten-week study period. In these, PET scans after treatment showed significantly diminished metabolic activity in both the right and the left caudate, with the right-side decrease particularly striking. (See Figure 3.) There was also a significant decrease in the abnormally high, and pathological, correlations among activities in the caudate, the orbital frontal cortex, and the thalamus in the right hemisphere. No longer were these structures functioning in lockstep. The interpretation was clear: therapy had altered the metabolism of the OCD circuit. Our patients’ brain lock had been broken.

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By refusing to accept obsessive thoughts and compulsive urges at face value, and instead recognizing that they are inherently false and misleading, the patients took the first step toward recovery. Done regularly, Relabeling stops the unpleasant feelings of OCD from being unpleasant in the same way: understanding their true nature gives a feeling of control, even of freedom. By Relabeling their thoughts and urges as manifestations of a medical disorder, patients make a purposeful cognitive shift away from self-identification with the experience intruding into the stream of consciousness.

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Ailén said:

Soon after I explained the Refocus step to one patient, Jeremy, he began carrying around a small notebook in which he wrote ways to Refocus whenever a compulsive urge arose. On its cover, he had written “caudate nucleus.”

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Laura said:

This is a marvelous description of self-observing and seeing that "there are two of you" even if it is situated in a context of OCD:

By refusing to accept obsessive thoughts and compulsive urges at face value, and instead recognizing that they are inherently false and misleading, the patients took the first step toward recovery. Done regularly, Relabeling stops the unpleasant feelings of OCD from being unpleasant in the same way: understanding their true nature gives a feeling of control, even of freedom. By Relabeling their thoughts and urges as manifestations of a medical disorder, patients make a purposeful cognitive shift away from self-identification with the experience intruding into the stream of consciousness.

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astrozombie said:

Here is a free link to the book:
{removed}

ADMIN NOTE:
Astrozombie, we do not encourage giving links to pirated copies of copyrighted works that deprive the authors of well-earned compensation. Only in some cases, when a book is very, very difficult to get, do we at all countenance private sharing and even then, we expect the recipients to give something back to the author in the way of a review on amazon at least.

I understand completely . This, however, was a preview link from the publisher.

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Ailén said:

It reminds me of how, when we notice a program in ourselves (or more often, are given a mirror about it), we start being able to observe it, and know it's intrusive/our false personality, etc., but can't do anything at first. In the case of OCD, focusing on what it would be like to master that mechanical part of the self has shown to produce actual physical changes in the brain, AS IF the behavioral change had already occured. Then, it takes focus and attention, but the behavior CAN be changed. The patients learn to get less and less identified with the programmed reactions/thoughts, predator, etc., and little by little they manage to modify it or a least stop it from ruling their actions. Sounds familiar?

Click to expand...