Chapter 8

Consciousness and Reality

People are accustomed to look at the heavens and to wonder what happens there. It would be better if they would look within themselves…

—Kotzker Rebbe

At the heart of psychotherapy are two interwoven processes; the first is the way in which our brains and minds construct reality, while the second is our ability to modify these constructions to support mental health and well-being. In other words, why are we so vulnerable to constructing distorted realities, and how can we learn to counterbalance these distortions? People come to therapy because one or more aspects of their lives are not how they would like them to be. Most often our clients know what they should be doing differently but cannot bring themselves to make changes. They come in with a feeling that something within them is holding them back. The answers to their questions can usually be found in the architecture of the hidden layers of neural processing—those networks within the brain that construct our reality, guide our experience, and shape our identity.

Prior to my training as a clinical psychologist, I spent many years studying the beliefs and practices of Eastern religions. One of the first things I discovered was that Buddhism is less akin to Western religious traditions than to the analytic introspection of William James or the selfanalysis of Sigmund Freud. At the core of Buddhist teachings is the belief that the experience of world and self are illusions (Maya) and that our minds and senses fool us into attributing significance to things that are, in themselves, devoid of meaning. In other words, “reality” is a construction of the mind which we take to be an external truth. So, at the heart of both dynamic psychotherapy and Buddhism is the fundamental belief that our conscious experience is a creative fiction subject to distortion.

Although controversial, the way in which the brain generates consciousness, including its many distortions, may have been subject to the pressures of natural selection. That is, our creative fictions may be sculpted to enhance survival rather than to maximize perceptual accuracy. While the way in which our brains construct consciousness and reality may have some survival advantages, we turn our focus here to those aspects which impair our relationships and limit self-insight. You will soon see that the take-home message from psychoanalysis, Buddhism, and neuroscience is to be a skeptical consumer of the offerings of your mind.

Beware of Maya

We don’t see things as they are; we see things as we are.

—Anaïs Nin

Let’s begin by taking a look at some of the illusions of consciousness through which we construct reality. The first is that our conscious awareness comes together at some specific location within our heads and is presented to us on a screen. This Cartesian theater—an homage to Descartes’s articulation of mind–body dualism—creates the subjective illusion of self as a nonphysical spirit inhabiting the body as opposed to being one with it (Dennett, 1991). This spirit, some religions believe, can leave the body upon death, go to heaven, or occupy a new body in the next life.

A second illusion is that our experience occurs in the present moment and that conscious thought and decision making precede feelings and actions. In fact, our brains react to internal and external stimuli in as little as 50 milliseconds, yet it takes more than 500 milliseconds for conscious awareness to occur. During this half-second, hidden layers of neural processing shape and organize these stimuli, trigger related networks, and select an appropriate presentation for conscious awareness (Panksepp, 1998). Although we tend to think of our brains as processing information from the environment, the vast majority of the input to the cerebral cortex comes from what is already inside the brain. And because our senses are shaped by experience, they are also silent contributors to the construction of reality (Gibson, 1966).

The projection onto the screen of our Cartesian theater is actually generated within the hidden layers of our neural architecture prior to conscious awareness. This leads us to assume that the world of our experience and the objective world are one and the same. We also tend to believe that we have all the necessary information we need to make choices. In truth, we often have little or no access to the information or logic upon which we base our decisions. In addition, we possess a powerful reflex to confabulate in the absence of knowledge (Bechara, Damasio, Tranel, & Damasio, 1997; Lewicki, Hill, & Czyzewska 1992). What we call intuition is likely the result of rapid and unconscious processing that can be so surprising to us that it is often attributed to occult knowledge or psychic powers.

A third illusion, which relies on the first two, is that our thoughts and behaviors are under conscious control (Bargh & Chartrand, 1999; Langer, 1978). This hubris leads us to consistently overestimate the authority we have over an outcome, while underestimating the role of chance, unconscious influences, and outside forces (Taylor & Brown, 1988). So although we may feel as if we are at the wheel of our lives, it might be more accurate to say that most of us are trying to steer our lives with the rearview mirror.

The illusions of the Cartesian theatre, living in the present moment, and being in total control of our actions can be successfully exposed on cognitive and neurological grounds. Yet the ubiquity of many perceptual and cognitive distortions in everyday human interaction, provides convincing evidence for the existence of nonconscious processing (Levy, 1997). And unlike bothersome psychological symptoms, these illusions and distortions are invisibly woven into the warp and woof of our perception, memory, and character (Reich, 1945).

By definition, hidden layers of neural processing cannot be directly observed. Like black holes, we are made aware of their existence by their effects upon the visible world. Hidden layers can make the same situation a source of pleasure or dread, acceptance or rejection, pride or shame. They will highlight some aspects of experience while diminishing others, orient us to certain aspects of the environment, and completely block awareness of others. Our hidden layers translate past experience into an anticipated future, converting past trauma into a self-fulfilling prophecy of future suffering (Brothers, 1997; Freyd, 1987; Ingvar, 1985). This carryover of past learning into the present where it may be irrelevant or destructive is certainly one of the contemporary human brain’s major design flaws.

Perceptual Biases and Self-Deception

The most erroneous stories are those we think we know best—and therefore never scrutinize or question.

—Stephen Jay Gould

The consistency of many perceptual and cognitive biases across individuals reflects our shared neural organization and functioning. Some of these biases are the result of natural limits to our perspective and judgment, while others may have evolved to help us cope with living in an uncertain and dangerous world. Although many of our perceptual biases appear to serve us, they can also lead to the kinds of problems that often become the focus of psychotherapy.

Social psychologists have identified a number of consistent errors in human judgment that can be especially damaging to relationships among individuals, groups, and nations. Our tendency to explain the behavior of others based on aspects of their character, while explaining our own behaviors as a result of external factors, is referred to as the fundamental attribution error (Heider, 1958). In other words, others flunk tests because they are not smart enough or are too lazy to study; we fail because the test wasn’t fair or because the professor wasn’t very good. An extension of this attributional bias leads to a phenomenon called blaming the victim, where individuals victimized by crime or poverty are believed to have done something to create their misfortune (Ryan, 1971).

While individual perspectives are limited and incomplete, this does not stop us from assuming that we possess the true view of the world. This egocentric bias leads us to reflexively believe that anyone who sees the world differently from ourselves is misguided or dull-witted. Unfortunately, it also leads mortal enemies to both believe that God is on their side. While an egocentric bias is reflexive and self-evident, maintaining a balanced perspective requires sustained mindful effort.

Another bias organized within our hidden layers is called belief perseverance—the tendency to attend to facts supportive of existing beliefs while ignoring others (Lord, Ross, & Lepper, 1979). The hidden layers are conservative, holding onto thoughts, feelings, and behaviors that have been associated with past survival (Janoff-Bulman, 1992). Thus, we scan for examples that prove preexisting beliefs and ignore ones which contradict them. This tendency is likely driven by the tenacity of fear memories stored within the amygdala and our desire to avoid the possibility of danger in the unknown. This may explain why prejudices continue to persist in the face of conflicting evidence.

One reason that our abilities of self-deception may have been selected during evolution is because they aid in the deception of others. The more we believe our own deceptions, the less likely we are to give away our real thoughts and intentions via nonverbal signals. In fact, it requires considerable more brain power to lie than to tell the truth, and even more to convince others that we are being honest with them when we are lying (Ganis et al., 2003). Good poker players raise the skill of social deception to an art by keeping a poker face while learning the “tells” of their opponents. Actions and beliefs that are the opposite of our true desires can be quite effective in deceiving others. It has also been noted that “people are remarkably reluctant to consider impure motives in a loud moralist” (Nesse & Lloyd, 1992, p. 611) despite the repeated and well-publicized downfall of one moral crusader after another. In fact, the best con artists are often so convincing that their victims refuse to accept that they have been cheated at all.

The distortions of the psychodynamic unconscious—reflected in defense mechanisms such as reaction formation, denial, humor, and intellectualization—are thought to keep thoughts and feelings out of conscious awareness to help us regulate negative emotions. Defense mechanisms may enhance survival by reducing shame, minimizing anxiety, and decreasing awareness of depressing and demoralizing realities. Some defenses also support social cooperation and lead us to either overlook or put a positive spin on the bad behavior of family and friends. Freud recognized that we can see the workings of defense mechanisms and other aspects of the unconscious in the way that we organize and understand ambiguous stimuli. In a condition of reduced external structure, our hidden layers organize the world, make predictions, and highlight certain thoughts and feelings while ignoring others. You may remember that Freud referred to this phenomenon as the projective hypothesis.

Therapists employ the projective hypothesis to explore the architecture of their clients’ unconscious. Some try to remain as neutral as possible to allow clients to project feelings and thoughts onto them in a process referred to as transference. In a similar manner, projective tests like the Rorschach present ambiguous stimuli to evoke idiosyncratic perceptions of the material. Finally, because of their uninhibited nature, Freud was impressed with the value of dreams in providing us with insight into hidden layers, calling them “the royal road to the unconscious.”

Most forms of psychotherapy attempt to shine the light of conscious awareness on belief perseverance and attribution biases, and undermine the conservative nature of the hidden layers. Others engage in a deep exploration of the dynamic unconscious, defenses, and primitive emotional states. By encouraging clients to be open to new ideas, explore the connections within their hidden layers, and take responsibility for positive change, we challenge them to reorganize the neural networks of their hidden layers.

Searching for the Still Point

Men are disturbed not by things, but by the view which they take of them.

—Epictetus

By now it is clear that our brains are in the business of constructing rather than conveying reality. This perspective is in sharp contrast to the modern Western notion of the brain as a combination camera, tape recorder, and computer. If our electronic equipment really did function like our brains, we would replace them at the first opportunity. But I’m sure you would agree that, imperfect as they are, we would take our brains over a machine any day. Few of us would want to sacrifice feelings of love, inspiration, and passion for the sake of accuracy or efficiency.

Once we wake up to how our brains work, what do we do? How can we overcome or at least cope with our distortions, impulses, and unconscious drives in constructive and healthy ways? Fortunately, our brains contain structures and networks that allow us to counteract some of the more problematic workings of our hidden neural layers. Let’s begin an exploration of the evolution of consciousness with ice cream.

I’m a person who has been on a diet all my life with limited success. I could do well all day—eat properly and exercise—but at night, I would seem to have no self-control. I would go into each day feeling bad about the night before and vow to do better, only to fail again. Years into therapy I mentioned this in a session and was given the following suggestion: “Pay attention to your thoughts, feelings, and fantasies during the transition from doing well to your loss of control.” It turned out that, depending on the day, I felt exhausted, stressed, lonely, or dissatisfied with one thing or another on these evenings. When my therapist asked what I did with these negative and painful feelings, I was stumped. I didn’t remember doing anything with them—they seemed to just dissolve. As I struggled to make sense of this process, I recalled a vivid memory.

I was a young boy of 5 or 6 standing in my grandmother’s kitchen and had just expressed being upset about something. I could feel my unhappiness expressed in the muscles of my face and recall my grandmother’s face mirroring mine. Without saying a word she pivoted around, opened the freezer, took out a large box of Neapolitan ice cream (chocolate, vanilla, and strawberry in three neat rows), tore off the cardboard tab holding the lid closed, buried a spoon in the ice cream, and handed me the entire box. Also without a word I went to the sofa, lay down, put the quart of ice cream on my chest and began eating. In fact there were no words at all. There was no memory of discussing how I felt. Whatever bad feelings I may have been having quickly dissolved in a haze of glucose.

The similarity of this memory to my experience in my adult life was striking. My hidden layers had learned a pattern—feel tired, sad, stressed, or disappointed; get lots of calories; watch TV; and the feelings pass. These early memories were encoded in hidden layers and guided my behavior when triggered by similar states of mind. Being the first grandchild in an extended family that had experienced a great deal of sadness and loss, I realize in retrospect that no one could cope with my sadness. I was the hope for a better future where there would be no pain. Having no language with which to process my feelings, I could only deal with them through actions. As long as I continued to act this process out without awareness of what was happening, it continued in a stereotyped manner much like a posttraumatic flashback.

What is it that allows us to become self-aware, generate explanations, and modify long-standing ways of being? How do we expand conscious awareness in ways that allow us to change? Obviously, something has to change in the way our brains process information when we benefit from psychotherapy. Let’s explore two central regions involved in awareness and change—the prefrontal and parietal cortices.

Because behavior is easily observable, neurologists have traditionally focused on the manifest results of brain injury such as deficits in language, motor behavior, and memory. At the same time, there has been significant confusion and misunderstanding when it comes to changes in subjective experience. I have worked with many clients who perform within normative ranges on objective tests of memory and intellect, but complain that their inner worlds are no longer the same. Some use the metaphor of a house and say that some rooms are no longer accessible to them. Others have described blackboards they could use to work out problems that have been lost. These subtle and elusive aspects of human experience have received little attention from neurologists. What is even more difficult for clients is to perform well on objective tests of memory and problem solving, and be told that they have fully recovered, when in fact they know better. Their use of three-dimensional metaphors like houses and blackboards to describe inner experience may be telling. Is the house as an archetype for the self (as Carl Jung suggested) more than myth?

How does the brain achieve conscious awareness? Where is the seat of consciousness? The answer to both of these questions is that we don’t yet know. At this point, we must be satisfied with discovering pieces of this complex puzzle of consciousness that will be assembled sometime in the future. Because executive problems often arise after damage to the prefrontal areas, it is generally assumed that consciousness and self-awareness reside within these regions, but the key to understanding consciousness extends beyond the frontal lobes. We can be somewhat confident that consciousness emerges from the coordination of many processes throughout the brain and that the prefrontal lobes are major players. I would suggest that another major contributor to our conscious experience is our parietal lobes. Let me explain why.

The Parietal Lobes

The soul never thinks without a mental picture.

—Aristotle

You may remember that the parietal lobes evolved from the hippocampus which, in lower mammals and humans, organizes an internal three-dimensional map of the external environment (Joseph, 1996; O’Keefe & Nadel, 1978). This is especially useful in navigating a habitat for foraging, storing, and retrieving food. The hippocampi of mother rats actually increase in size when they have babies, in preparation for having more mouths to feed. The hippocampi of cab drivers in London are larger than those of other Londoners, because of their need for a detailed inner map of a large and complicated city (Maguire, Woollett, & Spiers, 2006). It seems that the parietal lobes developed a parallel capacity for constructing and navigating a map of internal, imaginal space.

Curiously, some studies of primate brain evolution suggest that expansion of the parietal and not the frontal lobes is most characteristic of the transition to the human brain (von Bonin, 1963). Could the fact that we don’t think of the parietal lobes as a component of the executive brain reflect a cultural bias of equating individuals with their external behavior rather than the quality of their inner experiences? The parietal lobes’ interconnections with the rest of the cortex allowed for the integration of working visual memory, attentional capacities, and bodily awareness necessary for these imaginal abilities. This suggests that our self-awareness was likely built in a stepwise manner during evolution through a series of overlapping “maps”—first of the physical environment, then of self in environment, and later of self as environment. Thus, the growth of imaginal abilities allowed us to create an increasingly sophisticated inner topography.

The lower parts of the parietal lobes develop through the first decade of life in parallel with our increasing abilities in reading, calculations, working memory, and three-dimensional manipulation (Joseph, 1996; Klingberg, Forssberg, & Westerberg, 2002; Luna, 2004). Cells in these inferior parietal regions respond to hand position, eye movement, words, motivational relevance, body position, and many other components of the integration of physical experience in space. Left parietal damage disrupts mathematical abilities while damage to the right parietal lobe results in disturbances of body image and the neglect of the left side of the body. Despite these florid and debilitating symptoms, patients are either oblivious to or deny the significance of their deficits, which suggests that the parietal lobes serve an executive role in the organization of self-awareness. Damage to the parietal lobes disrupts the experience of location, self-organization, and identity—in other words, who and where we are (see Table 8.1).

TABLE 8.1

Manifestations of Parietal Compromise

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Left Parietal Compromise Results In

Gerstmann syndrome, which includes the following symptoms:

Right-left confusion

Digital agnosia (inability to name the fingers on both hands)

Agraphia (inability to write)

Acalculia (inability to calculate)¹

The symptoms of Gerstmann syndrome are linked through a unitary deficit in spatial orientation of body—sides, fingers, and numbers²

Right Parietal Compromise Results in Deficits Of

Mental imagery and movement representations³

Visual-spatial awareness⁴

Visual-spatial problem solving⁵

Temporal awareness and temporal order⁶

Spatial perception⁷

Somatosensory experience⁸

Detecting apparent motion⁹

The analysis of sound movement¹⁰

Spatial-temporal abnormalities¹¹

Contralateral neglect of the body and external space¹²

Denial of hemiparalysis and neglect¹³

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The posterior parietal regions weave together sensory information about our physical environment with networks of organized motoric actions and intentions which (along with the frontal lobes) create goal-directed action plans (Anderson, Snyder, Bradley, & Xing, 1997; Colby & Goldberg, 1999; Medendorp, Goltz, Crawford, & Vilis, 2005). In combination with episodic and working memory, this would provide a work space for decision making about whether or not to perform an action—should I eat the ice cream or is something else going on that I should pay attention to? Utilizing these abilities, a frontal-parietal network could support the integration of perception and action over time (Quintana & Fuster, 1999).

Parietal activation occurs during a wide variety of cognitive tasks, suggesting that high-level association areas involved in the coordination of sensory and motor processing underlie what we experience as abstract (nonphysical) processes (Culham & Kanwisher, 2001; Jonides et al., 1998). It is likely that evolution has used these core visual-spatial networks to serve as an infrastructure for language and higher cognitive processes (Klingberg et al., 2002; Piazza et al., 2004; Simon et al., 2002). The parietal lobes participate in our conscious awareness of visual experience, voluntary actions, and a sense of agency during actions (Chaminade & Decety, 2002; Decety et al., 2002; Rees, Kreiman, Koch, 2002; Sirigu et al., 2003). The multimodal representation of space in the posterior parietal areas integrates our goal-directed behavior and attention with higher cognitive functions (Andersen et al., 1997; Bonda et al., 1996; Corbetta & Shulman, 2002; Culham & Kanwisher, 2001).

Like the frontal lobes, areas of the parietal lobes become activated by novelty and appear to be involved in coding intentions and calculating the probability of success (Platt & Glimcher, 1999; Snyder, Batista, & Andersen, 1997; Walsh, Ashbridge, & Cowey, 1998). These findings point to the fact that the parietal lobes are far more than sensory-motor association areas, but are involved in the deployment of attention, understanding the environment, and constructing the experience of self (see Table 8.2).

The medial parietal area can be conceptualized as the central structure for self-representation, self-monitoring, and a state of resting consciousness (Lou et al., 2004). Damage at the junction of the parietal and temporal lobes correlates with out-of-body experiences and a variety of other disturbances of identity and self (Blanke & Arzy, 2005). There is also evidence to suggest that the parietal lobes participate in the creation of internal representations of the actions of others within us (Shmuelof & Zohary, 2006). In other words, we internalize others by creating representations of them in our imaginations. This allows us to both learn from others and carry them with us when they are absent. These inner objects, as described in psychoanalysis, likely serve as the infrastructure of the construction and maintenance of our experience of self (Macrae et al., 2004; Tanji & Hoshi, 2001).

 

TABLE 8.2 Functions of the Parietal Lobes

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Hemisphere	Function
Right	Analysis of sound movement1
	General comparison of amounts2
	Attention3
	Self-face recognition4
Left	Verbal manipulation of numbers5
	Mathematics6
	Multiplication7
	Motor attention8

 

Bilateral Findings

Visual-spatial work space⁹

 

Visual-spatial problem solving¹⁰

Visual motion¹¹

Construction of a sensory-motor representation of the internal world in relation to the body¹²

Internal representation of the state of the body¹³

Verbal working memory¹⁴

Retrieval from episodic memory¹⁵

Sequence and ordering of information in working memory¹⁶

Controlling attention to salient event and maintaining attention across time¹⁷

Preparation for pointing to an object¹⁸

Grasping¹⁹

Movement of three-dimensional objects²⁰

 

A sense of “numerosity” defined as nonsymbolic approximations of quantities (l)²¹

Processing of abstract knowledge²²

Perspective taking (r)²³ Processing of social information (r)²⁴

Taking a third-person perspective (r)²⁵

 

(l) left hemisphere (r) right hemisphere

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Some sort of frontal-parietal network appears to be essential to our experience of self. Neural fibers connecting the middle portions of these two areas appear to serve a general integrative function of linking right and left hemispheres, limbic and cortical structures, as well as anterior and posterior regions of the cortex (Lou et al., 2004). Frontal-parietal networks work together to analyze the context and location of specific variables, work to interrupt ongoing behavior, and direct attention to new targets (Corbetta & Shulman, 2002; Peers et al., 2005). Frontal-parietal circuits are also involved in the sustained focus and updating of information in working memory (Edin et al., 2007; Sauseng et al., 2005). They may together give rise to a global work space or central representation allowing for conscious working memory and self-reflection (Baars, 2002; Cornette, Dupont, Salmon, & Orban, 2001; Taylor, 2001).

The frontal-parietal network may be primarily responsible for the construction of the experience of self (Lou, Nowak, & Kajer, 2005). A properly functioning frontal-parietal network allows for the successful negotiation of our moment-to-moment survival and the ability to turn our attention to inner experience. A compromised or poorly developed prefrontal cortex can ensnare us in “a noisy and temporally constrained state, locking the patient into the immediate space and time with little ability to escape” (Knight & Grabowecky, 1995, p. 1368). Without the ability to reflect on and sometimes cancel reflexive motor and emotional responses, there is little freedom (Schall, 2001). A similar phenomenon can occur with anxiety, as in obsessive-compulsive disorder. When the medial frontal lobes are incapable of adequate affect regulation, victims become “stuck” to the environment or “stimulus bound” and unable to override reflexive reactions (Brown et al., 1994).

Constructing a Self

I never came to any of my discoveries through the process of rational thinking.

—Albert Einstein

Creating a quiet internal world allows for private thought, self-reflection, and traveling through time via episodic memory. Quiet moments can then serve as the grounds for mentalization, creativity, and consolidating the self (Winnicott, 1958). Victims of frontal brain injury lose this ability and are constantly distracted by sensory and emotional experience, are unable to maintain focus, and suffer deficits of imagination. These individuals become trapped in time, unable to disengage from the constant stream of sensations, emotions, and demands of their inner and outer worlds. Although they retain consciousness, for them, attention, concentration, affect regulation, and motivation become problematic, while higher level metacognitive processes become impossible.

Winnicott (1962) suggested that the ego and one’s sense of self consolidate during the periods of quiescence when children feel safe and calm in the presence of their parents. Good-enough parenting scaffolds the child, allowing him or her to go “inside” and rest in imagination and the experience of self (Stern, 1985). This may serve as an important mechanism of the transmission of neural organization from parent to child. It is rare to find a child who is able to be still and centered and feel safe in the presence of chaotic adults. We believe that early caretaking builds and shapes the cortex and its relationships with the limbic system, which supports emotional regulation, imagination, and coping skills. To this we now must add the development of the parietal lobes in the construction of internal space.

As a child I had an imaginary retreat. I would close my eyes and picture the back of my grandmother’s closet, always piled high with shoe boxes. Behind these boxes was a hidden door just large enough for me (but not an adult) to squeeze through. Once through the door, there was a flight of stairs leading up to a large room resembling a medieval laboratory, the kind with a resident sorcerer. This was a safe place for me—quiet and private—where I could imagine other worlds, reflect on life, and fantasize about the future. The evolution and expansion of the parietal lobes were likely essential to the emergence of this kind of imaginal self.

One study has shown that when experienced meditators engage in meditation, the frontal lobes become less active while the parietal lobes become more active, reflective perhaps of a shift from outer to inner attention (Newberg et al., 2001). Other studies have shown a shift to left hemisphere activation and stronger immune response with meditation (Davidson, Kabat-Zinn, et al., 2003). Interestingly, inferior regions of the right parietal lobe become activated when we witness others being still. This may explain how meditating on inanimate objects or statues of a tranquil Buddha may help us feel centered within ourselves (Federspiel et al., 2005). This may also be a part of internalizing calm parents as a model for self-reflection.

Johnson (1987) asserts that the experience of our bodies provides the internal basis for meaning and reasoning with our sense of numbers, quantity, and space growing out of bodily experience. The brain’s ability to take our physical experience and use it metaphorically is the basis of imagination. For example, jumping down a slide may serve as a sensory-motor metaphor for falling in love. The child’s experience of emerging from under the covers into the light of day provides a metaphor for religious enlightenment later in life. The balance provided by the vestibular system may be the model for psychological and emotional stability, and ultimately for leading a more balanced life (Frick, 1982). Physical metaphors provide a contextual grounding in time and space that helps us grasp our experience and may serve as an infrastructure of higher cognitive processes.

Albert Einstein, who did poorly in math during his formal education, went on to solve some of the universe’s most complex mysteries. He intuited relationships between time, matter, and energy, which contributed to the development of atomic energy and brought us a step closer to understanding the workings of the universe. I remember my seventh grade math teacher praising us with the phrase “Little Einstein.” As you can imagine, many neuroscientists were interested in having a look at Einstein’s brain to see if and how it differed from yours and mine. In comparison to 91 other brains, Einstein’s was different only in the size of the inferior parietal lobe (Witelson, Kigar, & Harvey, 1999). A subsequent examination of the same region revealed lower ratios of neurons to glial cells when compared to other areas of Einstein’s brain as well as to the brains of other people (Diamond et al., 1966; Diamond, Scheibel, Murphy, & Harvey, 1985). It is highly likely that this enhanced neural-glial relationship enhanced neuronal activity and led to superior visual-spatial abilities (Nedergaard et al., 2003; Oberheim et al., 2006; Taber & Hurley, 2008).

These neuroanatomical findings are especially interesting in light of Einstein’s reported use of mental imagery to solve complex conceptual problems. Einstein described translating numerical equations into images that he would manipulate in imagination, come up with solutions, and translate back into equations. This ability to conceptualize and manipulate three-dimensional objects in imagination appears to separate us from other primates and may be a uniquely human evolutionary accomplishment (Orban et al., 2006; Vanduffel et al., 2002). Based on his description of his problem-solving strategies and the findings concerning his brain, it is possible that Einstein’s unusual parietal lobes may have been central to his genius.

Einstein’s difficulty in navigating the simple demands of day-to-day life was notorious, making him the archetypical absent-minded professor. Interestingly, one study has shown that the volumes of the frontal and parietal lobes demonstrate significant negative correlation (Allen, Damasio, & Grabowski, 2002). Being absent-minded may have been the price he paid for an overdeveloped parietal lobe. Research suggests that inner imaginal space enhances the possibility for creative problem solving, empathy, and compassion. Perhaps this is one of the reasons that Einstein turned his attention to world peace and other humanitarian concerns later in life.

The Executive Brain in Psychotherapy

All of our final decisions are made in a state of mind that is not going to last.

—Marcel Proust

As stated earlier, the brain is an organ of adaptation, a process that continues for as long as we live. Given their role as high-level association areas sculpted by ongoing experience, the frontal and parietal lobes likely retain a great degree of neural plasticity. This plasticity and their joint roles in the synthesis of physical, social, and emotional information make these regions primary targets of psychotherapy. In line with this, psychotherapy requires that we step away from reflexive behavior and the immediate demands of the environment to reflect upon our experiences in sophisticated ways. Acting in instead of acting out provides us with the interpersonal and intrapsychic space to try on new truths. Consider my client, Sandy, who found herself trapped in a mysterious cycle of changing attitudes and moods.

Sandy came to therapy in her mid-40s with the usual concerns about relationships, family, and career. Although her mood was generally upbeat and positive, she occasionally came to sessions feeling irritable, deflated, and hopeless, leading me to think that she might be suffering from bipolar disorder. When I mentioned her fluctuating moods, she was distressed that they were noticeable to others. She told me that she had discounted their importance because they didn’t seem to relate to events in her life, “just hormones I guess.”

Once Sandy began to focus her attention on these moods, she reaffirmed that they seemed to come out of nowhere and disappear just as mysteriously. When she was down, she felt like a fraud, and planned to quit her job and leave her husband. “When I feel this way,” she said, “I just lose the will to live.” On further reflection she realized that these mood states had been part of her life for as long as she could remember—recalling instances as far back as elementary school.

We monitored and discussed her experiences through a number of mood cycles and engaged in considerable speculation about their origin. Her father was prone to moodiness and she had a maternal aunt who had a “nervous breakdown” decades earlier, which made us consider a genetic inheritance or modeling behaviors that she saw as a child. Sandy struggled to find thoughts, feelings, or events in her life that would precipitate them and discovered that they did not coincide with anything related to her work, family, menstrual cycle, exercise, or diet. All serious medical conditions were ruled out, her only physical complaint being her allergies and frequent sinus infections. On the outside chance there was some relationship between her use of antihistamines and her mood changes, we created a mood chart that included her use of medication.

Although we did not find any connection between mood and medication, it did turn out that she consistently lost her will to live a day or two before suffering a sinus infection. Her mood would then improve shortly after the onset of her respiratory symptoms and headaches. Once we made this connection, we waited for the next dip in mood to see if it would again be followed by a sinus infection. Sure enough, the same pattern emerged. Although we still did not know what affected her mood, the timing did suggest that it was related to the cycle of her allergies and sinus infections. Up to this point, our work together depended upon Sandy’s ability to reflect on her experiences, analyze her reactions to situations, and think about her thinking. Now it was time to develop Sandy’s memory for the future, and create some experiments focused on alternative plans and actions.

We decided to anticipate her next dip in mood with a new plan. We agreed that she would stop evaluating her life on days that she lost her will to live. She was not allowed to think about leaving her husband or her job, or assess her worth as a person. Instead, the mood dip would be a cue for her to go to the health food store, buy vitamin C and zinc tablets, and rearrange her schedule to reduce stress. She also made an appointment with a new allergist. In essence, her assignment was to remember the future in the present. Sandy had to remain mindful of the possibility that what she experienced as negative emotions was really a result of biological changes related to a physical illness and not a collapse of character or impending global catastrophe. We worked on developing a safe internal place for her to retreat to at these times, where she could soothe and comfort herself and focus on healing.

Over time, the association between sinus infections and mood changes held up—we had created a new narrative with far more explanatory power than the one it replaced. For some unknown reason, Sandy’s biochemistry reacted to infection with a sharp drop in mood, most likely related to drops in serotonin and dopamine. The psychological depression experienced as a result of these changes led her to reinterpret, in a negative way, the value of all aspects of her existence. How she dealt with these feelings was neither pleasant nor adaptive. By being mindful of this process and using her frontal and parietal executive functions to associate experiences with new meanings, she was able to engage in different behaviors and create a better outcome. We had converted what usually led to an existential crisis into a trigger for enhanced self-awareness, self-care, and medical management.

Sandy needed to learn how to pay attention to her feelings, reflect on them with past experiences in mind, and follow a new plan of action contrary to old reflexive patterns. These important frontal functions allowed Sandy to escape from automatic and detrimental behaviors. She was able to modify stimulus-response connections by escaping the present moment both in therapy and then in her day-to-day life, first imagining and then executing a new scenario. As Sandy learned to understand the functioning and fluctuations of her brain, she was able to utilize executive functions and an imaginal self to gain insight, perspective, and change dysfunctional patterns of behavior.

Summary

The exploration of human consciousness is a vast new frontier for neuroscience where there may always be more questions than answers. We know consciousness exists; we just have no idea of how it emerges from the functioning of the brain. An inherent challenge to this exploration will always be the conflict of interest involved when something is studying itself with all the bias and distortion that interferes with objective observation. There is no easy way around this.