Jane on the Brain

Austen was well aware that subconscious emotions and desires can influence us without our knowledge long before Freud revolutionized mental health with this observation. Austen also understood psychotherapy’s other major insight: Given the right circumstances, people can change profoundly, that our ways of being in the world aren’t written in stone—or its equivalent in our day and age, the genetic code. The warp and weft of Austen’s novels consists in portraying people who change for the better, psychologically and morally, although of course psychological and moral changes can go for the worse in real life and in Austen’s novels (think of the fallen Eliza in Sense and Sensibility, or even of Mr. Bennet, whose cynicism appears to ensue from his unhappiness in marriage)*

In her novels, Austen shows, and as many theories in current psychotherapy maintain, that insight is key to personal transformation. For instance, in Pride and Prejudice (let’s stay with that novel a bit longer), insight plays a huge role in the profound changes experienced by both Darcy and Elizabeth. Elizabeth comes to understand that her judgment is not always objective, and that she isn’t above being influenced by her feelings. She realizes that she was ignorant of this all-too-human susceptibility, and that she therefore failed to interrogate her judgment or her motives. She’ll be wiser in the future.

Even greater changes happen for Darcy. When we meet Darcy at Pemberley several months after Elizabeth’s harsh rejection, we see that he has a different way of looking at himself and his place in the world. He’s welcoming rather than haughty, and he enjoys the company of Elizabeth’s aunt and uncle even though they’re in trade, well below him in status. He has obviously spent some time questioning the validity both of his automatic judgments and his customary behavior. He’s a different man.

But as psychotherapy—and Austen—also tell us, insight isn’t sufficient to bring about these kinds of changes. Knowledge alone rarely changes mind, brain, heart, or behavior. Darcy makes this clear in his account of his psychological and moral awakening. He tells Elizabeth that as a child, he’d been taught to know what good behavior meant (insight), but that the emotional lessons he learned contradicted such knowledge: “I have been a selfish being all my life, in practice, though not in principle. As a child I was taught what was right, but I was not taught to correct my temper. I was given good principles, but left to follow them in pride and conceit.” [my italics] Knowledge without the punch of emotion lacks conviction or power; emotional lessons win out over cognitive ones every time.

More specifically, the emotions that spur us to change are embedded in our connections with other people. According to Dr. Judith Herman, a pioneer in the study of trauma, healing “can take place only in the context of relationships.”† Sociality provides the occasion for growth and change in nonpathological contexts as well. Darcy’s knowledge of right and wrong remained abstract until his relationship with Elizabeth sparked a psychological and moral transformation: He continues, to Elizabeth, “You showed me how insufficient were all my pretensions to please a woman worthy of being pleased.” Because he loves Elizabeth, Darcy is motivated to examine his behavior in the past, including both his proposal, which was condescending and insulting, and his habitual approach to most other people, also condescending and insulting. That is to say, disappointed love gives him the desire to examine his behavior in light of his principles, and so to realize the discrepancy between the two. More important, Darcy acquires the will to change, not necessarily to marry Elizabeth—he thinks that’s a lost cause—but rather because he realizes that changing his ways might allow him to please “a woman worthy of being pleased.”

Similarly, on reading Darcy’s letter, Elizabeth understands that she’s been mistaken about Darcy and Wickham. This causes her to question her habitual rush to judgment. Elizabeth becomes less susceptible to prejudice because doing so matters.

Insight and relationship are the two main factors that help people to change, and this is seen in Austen’s novels, in real life, and in therapy. Nevertheless, just as the existence of the subconscious was accepted by academic psychology only when empirical evidence grounded in the study of the brain became available, so the claim that psychotherapy works by inducing substantial changes in cognition, feeling, and behavior required some “hard” scientific proof, preferably brain based, if psychotherapy were to be allowed to join the respectable world of evidence-based knowledge. Eric Kandel, winner of the Nobel Prize in Physiology and Medicine in 1990, provided such proof. His extraordinary research showed that learning and experience really do change the brain. The first part of the chapter tells of his findings. With this basic knowledge as a foundation, we can jump from the microscopic world of neurons to the mind-brain to view such changes in a therapeutic mode, as Marianne of Sense and Sensibility heals from her debilitating bout of depression.

OF SNAILS AND PEOPLE

The goal of psychotherapy is to effect positive changes for people, to help them, at the very least, to heal from mental affliction, and at best, to find a path to well-being and contentment. And it has worked. People have been helped by therapy for over a century, although it was only in the last quarter of the twentieth century that psychologists began to collect empirical evidence to measure such improvement. One popular research tool is the Likert scale, which asks people to assess their feelings using a spectrum of possible responses: For instance, “On a scale of one to ten, how depressed do you feel?” Assessments can be made at several times during a course of therapy to see if treatment is making a difference. Or people can be asked to rate the treatment itself. You’re probably familiar with Likert scales from visits to the doctor; they’re widely used to assess pain.

It was only possible to use measures such as the Likert scale when the intellectual climate of the age had shifted and the field of academic psychology began to take people’s reports of their own experience seriously. A type of research called “exploratory” or “qualitative” research, which relies on what people have to say about their experience, on narratives rather than numbers, complements the information gleaned from quantitative evidence, such as the Likert scale and other statistical methods for evaluating various practices. Of course, people have been reporting the benefits of psychotherapy from the get-go, but the difference is that what they have to say is now being taken seriously by researchers.

Even so, such evidence, whether it’s quantitative or qualitative, refers to the mind, not the brain. This focus has always been suspect in certain quarters of hard-core neuroscience. People, no matter how astute they are about their mental state, will never provide the impartial proof we see when we chart the activity of the brain. In addition, although we can measure levels of stress through charting blood pressure, the level of stress hormones and triglycerides in the blood, skin temperature (conductance), and other biological indicators, evidence coming from the body rather than the brain doesn’t provide irrefutable, direct evidence of the brain per se.

Eric Kandel dedicated his career to the quest for such evidence, to providing neurological proof for the tenets of psychotherapy. As a young man, Kandel had planned to become a psychoanalyst. But he began to wonder where in the brain the id, the ego, and the superego—the three divisions of the psyche established by Freud—were located. One of his mentors, Harry Grundfest, told him that the answer to this question was well beyond the grasp of current biology and that in order to understand these psychological categories in terms of anatomy, we had first to understand how nerve cells work. To understand the mind, we have to understand the brain, one neuron at a time.

Kandel thought this was well worth doing and decided to pursue a career in medical research. Freud’s trajectory had been just the opposite. Beginning as a neurologist, Freud realized that he couldn’t account for, nor influence, the mind by confining himself to the study of the brain. And so he invented a science of the mind, psychoanalysis. Freud, Kandel, and Grundfest were all ahead of their respective times in realizing that we need to know about both mind and brain because an adequate understanding of either depends on seeing how they relate to one another. Today this is beyond question, a fundamental principle of the mind-brain sciences.

Although inspired by Freud, Kandel didn’t direct his research to finding Freud’s three divisions of the mind. Rather, he addressed the essential principle of all psychotherapy, that therapy is a form of learning that changes a person’s habitual ways of responding—emotionally, cognitively, and behaviorally. Kandel reasoned that the first step in proving that learning changes the brain would involve demonstrating that the brain is transformed physiologically as a result of experience.

Kandel couldn’t attempt his proof using the human brain, nor the brains of other mammals, reptiles, or vertebrates, for in these animals the neurons are too numerous and small, and the connections among them too complex, to be able to trace the impact of experience on a single neuron or group of neurons. He worked with the giant snail, Aplysia, which has about 20,000 neurons, some of them visible to the naked eye. Compare this to the roughly eighty-four billion microscopic neurons in the human brain.

You wouldn’t think that Austen or her characters or you, for that matter, would have any reason to be interested in a giant snail, unless, of course, you decided to read Sense and Sensibility and Sea Monsters, one of the many novels belonging to Austen’s afterlife. This one is part of a series that considers the challenges posed by various kinds of monsters, rather than the more pedestrian and difficult challenges we encounter in our dealings with other people. But actually, the Aplysia can tell us more about ourselves than we might care to admit.

Kandel was able to use the Aplysia to discover principles of neuron function in all animals with nervous systems, including humans, because evolution is remarkably conservative and builds on what’s already there. The most primitive part of our brains, the brainstem, looks very much like a reptile’s brain. This means that neurons work in essentially similar ways in every animal that possesses them. It also means that we share much of our genetic material with “lower” animals, even monstrous snails. Later, influenced by LeDoux’s work, Kandel also conducted research on learning and memory with mice. But his dramatic early discoveries focused on the Aplysia.

By the time Kandel began this research, some important basic facts were known about neurons: The neuron is the building block of all nervous systems, however advanced or primitive. Neurons send signals to one another through chemical transmission that is converted to an electrical charge within the sending cell (this is the “firing” or “action potential” of the neuron). Firing in turn causes the cell to release chemicals that cross the synapse, the small space between neurons, to an adjacent neuron (or muscle or gland) in the circuit. The receiving cell (or body part) responds according to the content of the chemical message it receives from the sending cell. Neurotransmitters can be excitatory, instructing another neuron to fire (or a part of the body to react), or inhibitory, sending a message to inhibit reaction. But this foundational knowledge didn’t begin to explain some of the higher functions of the brain, such as learning and memory, at the cellular level, in biological, physiological terms.

Kandel began his studies of this difficult topic by focusing on the gill withdrawal reflex of the Aplysia. When the skin of the Aplysia is touched, it naturally withdraws its gill to protect this crucial part of its body. To begin with, Kandel tracked the actual neuronal circuit between sensory and motor neurons that caused this reflex. While the mechanics of neuronal circuits had been theorized (as described above) no one had previously mapped an actual circuit, matching it to the behavior it enables. This was an extraordinary achievement since the neural mechanics of a specific behavior were now known.

Kandel could now build on this knowledge to explore the mechanisms involved in learning. He had to work with very simple kinds of learning, since the Aplysia is a very simple kind of creature. No insights about self-deception or denial for the Aplysia! But just as this animal’s body appears to be vastly different from ours yet possesses the fundamental building blocks of human cognition, so human learning has its analogues with the learning this creature is capable of. An Aplysia can’t be taught to consciously recognize its prejudices and amend its behavior, but it possesses the basic mechanism underlying all learning, the ability to form habitual ways of responding and, just as important, to change such habits as a result of experience. Kandel worked with three kinds of simple learning—habituation, sensitization, and conditioning—to observe what cellular changes took place as the animal mastered its tasks.

All animals habituate to nonthreatening stimuli that remain constant, which means that they get used to things and stop responding, or respond much less strongly. That’s why you might notice a certain smell upon entering a place, but soon cease to be aware of it. Your nose doesn’t physically stop smelling it, but your brain no longer responds or interprets those cues to the same degree. Or, you might become startled on hearing a particular loud sound for the first time, but if you hear it repeatedly (such as when there’s construction going on outside your office), you soon take it in stride as background noise, perhaps even failing to register it. When the Aplysia’s skin was touched repeatedly, its gill reflex became weaker; that is to say, the snail withdrew its gill to a lesser extent and more stimulation was needed to elicit a response.

Kandel next worked with sensitization, the opposite of habituation. This was done by applying a shock to the animal’s tail or head, which made the gill reflex stronger, occurring more readily and with less stimulation. Watch how after a scare you remain “jumpy” for a while. When Darcy insulted Elizabeth at the ball, he made her more sensitive to perceiving his negative qualities. Just as the Aplysia withdrew its gill reflex more readily to protect itself, so Elizabeth was “sensitized” to picking up on information that would confirm her negative opinion of Darcy. Like the gill-withdrawal reflex, this too was a protective gesture; by attributing Darcy’s negative perception of her to his own bad character, she didn’t have to admit that his remark had hurt, or that he might have been right in thinking she was “not handsome enough.” Of course, as it turned out, there were other explanations than the alternatives “Darcy is a terrible person” or “I’m not attractive,” but most reflexive automatic behavior is almost as thoughtless as a gill-withdrawal reflex.

On a related note, I love how the word sensitize, from the same root as sense and sensibility, bridges physical, cognitive, and emotional experience, the latter two pertaining to Elizabeth and not Aplysias. Again, usage points to essential features of the human mind-brain, in this case indicating the commonality between the simple defense mechanisms of our evolutionary forbears, many of whom likely resembled the Aplysia, and our own responses. Darcy’s comment at the ball was also a shock, another word that bridges mental and physical divides.

The third kind of lesson for the Aplysia involved classical conditioning, the most famous instance being that of Pavlov’s dogs.‡ This is the pattern of classical conditioning: An unconditioned stimulus (such as food) is paired with a conditioned stimulus (such as a bell) so that the subject, be it dog, snail, or human, learns to produce the unconditioned stimulus response when the conditioned stimulus alone occurs. Kandel was able to condition the Aplysia to withdraw its gill when its siphon (connected to the gill) was lightly touched by repeatedly following such a touch with a shock. Eventually, the Aplysia had a strong withdrawal response, akin to the negative impact of a shock, when its siphon was touched.

We might say that Darcy was conditioned to be distant and disdainful by one too many experiences of balls like the one at Meryton. Annoying people who make Darcy feel like the door prize in the marriage contest (the unconditioned stimulus) are paired with a type of event (a ball), so that even before a ball starts, Darcy’s in a bad mood. However, I would qualify this with my characterization of this behavior as conditioning, as well as my examples of habituation and sensitization in humans, by noting that conscious and subconscious thought of a much higher order than simple association also goes into producing Darcy’s bad mood and Elizabeth’s sensitivity, or lack thereof. The “conditioning” for both these characters depends on complicated input, both cognitive and emotional, conscious and subconscious, that takes place in many areas throughout the brain.

By observing neurons during these lessons with the Aplysia, Kandel saw that at the cellular level, learning involves changes in synaptic strength, how readily a neuron will send an electrical impulse across a specific synapse, the small space separating one neuron from another. Electrical signals must cross this space for a neuron to activate, and so for us to respond. Synaptic strength in turn depends on the amount of neurotransmitter that’s required to elicit a response in the receiving cell, the one to which the electrical impulse is being sent. Sensitization means that less neurotransmitter is required to elicit a response from the receiving cell than was formerly required. In this case we say that the synaptic connection has strengthened. Conditioning also involves sensitization, but with the intermediary of the conditioned stimulus (bell, light touch, Meryton ball).

Conversely, with habituation, more neurotransmitter is needed to evoke a response, and so the synaptic connection has weakened. Moreover, the duration of these effects, how long the Aplysia holds on to its learning, depends on the length of time of its “training.” Kandel found that the longer the training, that is, the greater the number of times the experiment was conducted, the longer the Aplysia’s behavior continued. Here was support for Hebb’s theorem: Neurons that fire together wire together.

This information was crucial. Kandel’s experiments proved that learning takes place initially not by altering the number or kinds of neurons in the nervous system, but by altering the strength of their synaptic connections. Of course in animals with complex centralized nervous systems, a given response will also depend on the sum of signals that both stimulate and inhibit that response, as well as the strength of each individual signal.

The idea that learning depends on synaptic strength was already endorsed by many scientists, but it was by no means accepted by all. Here now was definitive proof that learning, and hence memory, are altered as a result of alterations in the strength of synaptic connections. No new circuitry was required. This contributed support for the idea of neuroplasticity; even in brains that were fully mature, substantial change was possible. Elizabeth and Darcy experience significant changes of mind-brain as adults.

Up to this point, Kandel’s research concerned short-term learning and memory. Short-term memories last seconds, minutes, or hours, but long-term memories last days, years, or a lifetime. The changes wrought by psychotherapy, as well as most other kinds of learning, are forms of long-term memory. And so, momentous as his discoveries were, Kandel extended his research to the more complicated issue of how long-term memories are made at the cellular level.

It was known already from observation that for short-term memories to turn into long-term memories, something needed to happen that took some time. If, say, Darcy had a fall from a horse and suffered a concussion, he might forget the events immediately preceding the accident, such as leaving his house and starting his ride. The rather common type of memory loss suggests that a blow to the head can interfere with the consolidation of information, the process of turning short-term memories into long-term memories.

An important clue about what might be happening in cases like this was suggested by Louis Flexner, who discovered that drugs that disrupt the synthesis of new proteins in the brain also disrupt the acquisition of long-term memories. This suggested that protein synthesis was needed for long-term memory. Protein synthesis is also how genes work. They produce proteins that act as chemical messengers, telling the body what to do.

Still working with the Aplysia, Kandel confirmed Flexner’s results while also making another amazing discovery: Learning can actually cause the growth of new synapses. His previous experiments had shown that in the case of sensitization or habituation of relatively short duration, synaptic strength changes for synapses that already exist. Kandel also confirmed that dormant synapses can begin to activate. In this subsequent phase of experimentation he discovered that long-term sensitization can actually cause a neuron to grow new terminals, new pouches that secrete neurochemicals, and so increase synaptic transmission by increasing not only the percentage of active synapses but the actual number of synapses. Today, we also know that mature adult human brains can even grow new neurons. This was deemed impossible until a short time ago.

Kandel’s work demonstrated that learning does change the brain. The difference in synaptic strength that occurs in short-term learning and memory is often the first step of a series of changes that ultimately alter the landscape of brain areas. Short-term memory involves functional changes in the brain’s activity, but long-term memory involves anatomical changes to the brain. And what’s surprising—and this applies to simple animals such as the Aplysia as well as to complex animals like humans—these changes take place using the same chemicals and signaling systems that the body uses to make other kinds of changes. All our biological processes, including the physiological substrate of our thoughts and memories, use the same basic elements.

Subsequent research has confirmed Kandel’s findings. For example, two studies conducted in the 1990s, in the wake of Kandel’s research, used brain imaging to show that new growth occurred alongside learning in higher animals as well as in simple animals such as the Aplysia. Michael Merzenich trained monkeys to get food pellets by touching a rotating disk with their three middle fingers. After several months, the cortical area in charge of these fingers had expanded. Thomas Ebert and colleagues in Germany compared images of violinists’ and cellists’ brains with images of the brains of people who didn’t play an instrument. He found that the area of the somatosensory cortex in charge of the fingers of the left hand—the active hand for these musicians—was up to five times larger than this area in nonmusicians. Areas in charge of the right hand were similar in all groups. There is even evidence that antidepressants encourage neurogenesis in adults in various areas. Among the most important of these is the hippocampus (responsible for memories), which we’ve long known loses cells and volume as a result of chronic depression.

Kandel published some of his findings about changes in synaptic strength in an article entitled “Psychotherapy and the Single Synapse: The Impact of Psychiatric Thought on Neurobiologic Research.” His title indicated that he had begun the important work of providing physical, empirical evidence for psychotherapeutic theory, and just as important, that he had never lost faith in the value of psychotherapy. To find the ego, id, and superego, or whatever other names we give to our mechanisms of thought and feeling, Kandel knew you have to start with neurons, as his mentor had advised. And so he studied the Aplysia in order to begin to validate the insights of psychotherapy. The Aplysia is like a small detail of a very large painting, one tiny part of the picture of the kinds of activity we find throughout the human mind-brain, but which nevertheless yields important information about the whole. Kandel traveled a path opposite to Freud’s, from psychology to neurology, while never losing sight of the need for a synthesis of the two.

Without this awareness, he might have positioned his work differently; the discovery that learning changes the physical properties of the brain is huge, certainly worthy of a Nobel Prize, but it doesn’t have to be linked to psychotherapy. But Kandel deliberately referenced psychotherapy, signposting the direction that he thought the mind-brain sciences ought to take. He publicly championed the value of “the talking cure” during an era when its views were discarded by universities and other official research institutions. He courageously bridged the disciplinary divide between the hard sciences and psychotherapy, remaining a champion of the latter throughout his career. For such vision, steadfastness, and courage, Kandel is as remarkable as his discoveries.

In his very readable autobiography, Kandel observes that psychoanalysis has contributed to our understanding of the mind, leading to ideas that are almost universally accepted today. These include the existence of different types of subconscious processes, as well as the complexities of psychological phenomena such as motivation; denial; and transference, the influence of past experiences and relationships on current functioning. It’s not surprising that this visionary scientist, who never lost sight of the human aspect of his research, also recognized the value of literature, and spoke of its inspirational power in his own life:

Until the end of the nineteenth century, the only approaches to the mysteries of the human mind were introspective philosophical inquiries . . . or the insights of great novelists, such as Jane Austen, Charles Dickens, Fyodor Dostoevsky, and Leo Tolstoy. Those are the readings that inspired my first years at Harvard.§

Jane is there with the best of them.

MARIANNE IN THERAPY

Changes in the behavior of snails result from physical events and are registered as neurological (anatomical) changes. Changes in patterns of response for humans also involve neurology. If a person’s mind (and so their behavior) is going to change, the brain has to change as well, there’s no doubt about this. But for humans, a lot of other factors are involved, and we tend to lose sight of this. The human brain is still worshipped as the core of the self. Ninety-five percent of mind-brain scientists will tell you that the brain is equivalent to the mind, and that the mind arises from the activity of the brain, while ignoring the significance of Siegel’s emphasis on social connection as a crucial part of mind.

Nevertheless, people tend to change through relationships, one of the key insights of psychotherapy. No one shows this better than Austen. Her characters change their behavior, they change their feelings, they change their minds, and they change their lives, but always in the course of engaging with people who matter to them. Austen’s novels are all about the transformative power of social connection.

In a broad sense, such changes can be defined as therapeutic. Psychotherapy has always been about changing the way a person perceives and reacts to events and people. It’s about changing the core of one’s emotional and cognitive habits, and as a result, learning to create a different reality than the one that motivated a person to seek therapy in the first place. Many of Austen’s main characters experience such therapeutic change, becoming better or more satisfied people in one way or another. We see this with Elizabeth and Darcy, who become less judgmental, and in so doing, find happiness.

But Sense and Sensibility stands out as the most “therapeutic” of Austen’s novels, portraying personal development in the context of psychological healing. When Marianne’s suitor Willoughby abandons her, she becomes clinically depressed; we can actually diagnose her using DSM-5, the diagnostic bible of the mental health profession in the U.S. She eventually recovers through her connection with her sister, Elinor, a relationship with many therapeutic aspects.

Of course, Elinor is Marianne’s sister, not her therapist—there were no therapists in Austen’s day. There weren’t even alienists yet, the nineteenth-century term for this newly minted occupation. But the relationship between the sisters takes on the characteristics of what’s called a “therapeutic alliance,” a positive relationship between therapist and client with the express goal of helping the client to heal and achieve a sense of well-being.

A strong therapeutic alliance has been proved to be the crucial element in successful therapies, even those that differ significantly from one another in terms of technique and theory.¶ Psychotherapy was founded on the knowledge that others are instrumental in shaping our minds, and that our most significant transformations in mental states and behavior happen through connections with other people. This is true throughout our lifetimes; from the very beginning, our mind-brains are linked to those of the people who care for us, dependent on them for their very development. Psychotherapy works by means of our drive to connect with others in order to achieve its fundamental goal: Psychotherapy has always been about changing the way a person perceives and reacts to events and people. It’s about changing the core of one’s emotional and cognitive habits, and as a result, learning to create a different reality than the one that motivated a person to seek therapy in the first place, to help people lead happier lives.

Elinor begins to relate to Marianne in therapeutic mode the moment Willoughby’s treachery becomes too obvious to ignore. After spending most of the previous two months with Marianne, and appearing to be entirely devoted to her, Willoughby suddenly takes his leave from the Dashwood family, saying that he won’t be able to return. Marianne writes to him, but he doesn’t answer her letters. (They shouldn’t be corresponding since they’re not engaged, but Marianne disregards this rule.) When Willoughby arrives in London, where Marianne has also traveled and eagerly awaits him, he visits when he knows she’s sure to be out, leaving his calling card; he wouldn’t have done even this much were it not for the dictates of decorum. Marianne spends day after day on tenterhooks, waiting for Willoughby to seek her out, wondering why he hasn’t done so.

When Marianne finally sees Willoughby at a ball, he openly snubs her, which adds humiliation to her sorrow. Marianne is so overwhelmed that Elinor must restrain her from making a spectacle of herself by very publicly demanding an explanation for what is so clear to Elinor and everyone else: Willoughby has jilted her. Just prior to the ball, Marianne had written to Willoughby, desperate to understand his strange behavior. He eventually responds with what might be the cruelest letter in the nineteenth-century novel, a letter that coldly suggests that their relationship had been no more than a casual and distant friendship. This is the final blow. At this point, Marianne begins her downward spiral into depression.

Marianne becomes withdrawn and dysfunctional, virtually oblivious to her surroundings. When she regains sufficient calm to be able to leave her room, she goes through the motions of living on automatic pilot, truly engaging with very little around her. The only reality she fully experiences is the stubborn presence of emotional pain.

Depression can begin in this way as a chaotic response to an overwhelming event, or it can be purely organic, a feature of a person’s mind-brain rather than a reaction to a particular experience. Most depressions involve a combination of organic and environmental-psychological factors. While Marianne’s crisis is clearly a response to the dramatic end to her relationship with Willoughby, she might have had a tendency to depression because she’s not naturally a good self-regulator. She’s much more thin-skinned and reactive than Elinor, a characteristic she’s deliberately cultivated rather than sought to curb.

Indeed, what Austen blames Marianne for is her refusal to make an effort—it is not for being depressed or inherently thin-skinned. We know today that depression can be so totally incapacitating that it renders a person incapable of doing anything to help himself, but this wasn’t known in Austen’s day. And so Austen interprets Marianne’s lack of effort as a moral failing rather than a psychological affliction. However, readers in our own time can view Austen’s judgment as one of those strange but not unusual moments when an author’s intention doesn’t necessarily prevail in her writing. However judgmental Austen might have been about Marianne, and however much she wanted to punish her character and teach her readers the value of behaving well and staying motivated, she portrays the course of Marianne’s depression with a clinical accuracy that garners our sympathy.

I suspect that this might have been true for Austen’s first readers as well as for us, despite their lack of knowledge about psychology. In a highly appreciative review of Austen’s work, the novelist Sir Walter Scott takes Austen to task for her negative opinion of Marianne’s romance, viewing this heroine as far less culpable than Austen likely intended: “Who is it, that in his youth has felt a virtuous attachment, however romantic or however unfortunate, but can trace back to its influence much that his character may possess of what is honourable, dignified, and disinterested? . . . [They] are neither less wise nor less worthy members of society for having felt, for a time, the influence of a passion which has been well qualified as the ‘tenderest, noblest and best.’” In writing her novel, Austen’s wisdom about human nature exceeded her conscious morality.

Even if Austen blames Marianne more than we and Scott do, she clearly shows that Marianne is suffering and debilitated and that Elinor provides a healing relationship and environment for her sister. Elinor offers a “safe space,” as it’s called by therapists. When Marianne is at her lowest, Elinor protects her from well-meant offers of help and from the predatory voyeurs who thrive on gossip about the suffering of others. She provides the peace and quiet, the “holding environment” (another therapeutic term), so necessary for the processing of difficult emotions and experiences.

Elinor’s quiet strength and anticipation of Marianne’s needs further convey empathy, a crucial aspect of the therapeutic alliance. Empathy includes both cognitive understanding and emotional resonance, being in sync in terms of emotional state. Resonance alone is often comforting because it sends the message that our feelings are recognized; most of us need this kind of validation. Empathy amplifies this point, extending fellowship in cognitive as well as emotional terms, conveying that someone else can take our perspective; this too is tremendously validating. In short, empathy sends the message that our problems are real and that we don’t have to face them alone. Even good times are made better when shared with people we care about who “empathize” with our happiness. It’s a feature of our humanity to want to know that we’re recognized in the minds and hearts of others.

Elinor’s empathy informs her care of Marianne throughout the course of the depression. Here’s one instance of Elinor’s behavior that shows her understanding and affirmation of Marianne’s pain. This is shortly after Marianne has received Willoughby’s letter, ending their relationship:

Elinor . . . returned to Marianne, whom she found attempting to rise from the bed, and whom she reached just in time to prevent her from falling on the floor, faint and giddy from a long want of proper rest and food . . . A glass of wine, which Elinor procured for her directly, made her more comfortable, and she was at last able to express some sense of her kindness, by saying, “Poor Elinor! how unhappy I make you!”

The glass of wine, given in the privacy of the sisters’ room, speaks of Elinor’s concern and understanding. And Marianne’s observation that Elinor is unhappy on her behalf shows that she recognizes the significance of this interaction, that it’s registered as empathy. Marianne knows that Elinor understands and resonates with her own unhappiness.

The therapeutic safe space provides the time and opportunity for Marianne to go through her ordeal in peace and eventually resolve her crisis. This involves dwelling on her sorrow, at least to begin with. Although Austen might have disapproved of Marianne’s stasis, she shows that it’s an important part of the process of recovery. Psychologists Paul Andrews and J. Anderson Thomson, Jr. argue that the “persistent rumination,” the obsessive focus that accompanies many depressions (certainly Marianne’s), has an important purpose; it allows for the “slow, sustained processing” that’s essential to solving major problems.

Rumination and depression can continue for a long time. But ideally, a person gradually begins to emerge, and she can begin to process the experiences that sparked the depression. This means being able to put her story into a narrative with a beginning, a middle, and an end. And it means recalling not only events, but also the emotions that accompanied them. If the experience can be placed within a finite narrative that encompasses events and feelings, it becomes possible to move on and heal. This is equally important for healing from trauma, a secondary aspect of Marianne’s condition. With severe depression and trauma, upsetting events feel timeless; Marianne experiences the pain of her rejection as if it will be her emotional reality forever. Narratives provide closure.

Telling the story to an empathetic, supportive, and objective person works magic much of the time. In terms of the brain, telling the full story in this context to someone who can help us make sense of events, enables neural integration, what psychiatrist Daniel Siegel calls “the free flow of energy and information throughout the brain.” The more “integrated” our brains are, the more that different areas communicate with one another so that the brain functions as a whole, the more options we have for responding in the best way possible. To put this in terms of dynamic systems theory, integration allows us to increase complexity, and so to be able to respond flexibly and thoughtfully to situations. Hence the healing that often accompanies something as seemingly simple as talking to someone, and how valuable it can be to have someone you know is empathetic, who doesn’t necessarily give advice but simply listens.

We can think of many maladaptive reactions, responses that are inappropriate or detract from our well-being, as failures of neural integration—the result of parts of the brain not working together either because they’re inaccessible to, or in conflict with, one another. A word that describes this segmentation is dissociation. Depression, trauma, denial, and many other conditions involve dissociation, and the result is that dysregulated emotional responses take over. Cognitive inputs that might modify such negative reactions are off-line. This state of affairs also characterizes automatic responses such as losing your temper or being excessively anxious, which also exemplify dysregulated emotion.

Much of the work of psychotherapy involves increasing neural integration in the brain through work done with the mind, and in some forms of therapy, the body as well. To overwrite bad patterns, whether they’re all-encompassing, as in depression and trauma; somewhat incapacitating, as in denial; or they constitute habitual, automatic ways of responding, such as Marianne’s tendency to react before thinking (a characteristic we see well before her encounter with Willoughby at the ball), improvement means the integration of emotion with cognition. Higher cortical cognitive areas can provide crucial information that makes a difference to how we respond, and they’re also connected with regulatory areas, especially the OFC, that can send the safety message that will stop negative stress responses.

Neural integration is an aspect of the success of all therapies that improve mental health and well-being. “Telling the story,” as we do in most therapies, facilitates neural integration because it demands that emotional and cognitive, right and left, lower and higher areas of the brain work together. Even when parts of the story are inaccessible to consciousness, as with memories from infancy or early childhood, clues as to what must have happened can be found in later events, or even in the nature of the client’s responses in the present day, so that the story can be told. By “telling the story,” the client ideally reshapes it, so that she eventually tells a narrative of healing and resilience rather than of injury and hopelessness. If you asked Marianne to tell her life’s story while she was depressed, her response (if she would deign to talk to you in the first place) would differ greatly from her narrative of events after she’s become Mrs. Brandon.

However, the whole story must be told in order for narratives to be therapeutic, and this means telling of events and feelings in the past, along with commentary by the present-day self—again including feelings—who looks back at past events. An outline of the facts from a detached, impassive, dissociated narrator will not have the therapeutic value of integrating various parts of our brains and selves. And it means telling the story to someone who can empathize and help to reduce our distress.

I believe that the demands of narrative account for one reason reading novels is so gratifying—they involve our whole minds and brains. This feeling of being completely absorbed and present during an activity is known as “flow,” and it pertains to all sorts of activities in addition to reading Austen and other all-consuming novelists. Flow days are glory days for writers! Flow is the essence of mindfulness and meditation.

Marianne eventually tells her story to Elinor in terms that show that she has been processing her experience in ways that have helped to heal, to make her mind whole again. She demonstrates that her thinking self (cognition) has begun to influence her reactive, feeling self. As you know, reason cannot suppress or resolve Marianne’s turbulent feelings, but it can give her access to other, more productive feelings. She tells Elinor, “My illness has made me think. It has given me leisure and calmness for serious recollection. Long before I was enough recovered to talk, I was perfectly able to reflect.” Although Marianne doesn’t tell her story during a fifty-minute hour, Elinor’s knowledge of her situation and calm presence provide a therapeutic environment in a less structured manner. As in therapy, Marianne first endures, and then begins to process her experience.

Marianne’s story is not the one readers might be inclined to tell about her; like Elizabeth in Pride and Prejudice, she’s far too hard on herself, accepting total responsibility for a situation that’s only partly her fault: “I considered the past; I saw in my behaviour since the beginning of our acquaintance with him [Willoughby] last autumn, nothing but a series of imprudence towards myself, and want of kindness to others.” Marianne doesn’t consider the involuntary nature of her distress, or the huge part that Willoughby played in events. But what’s crucial to her healing is that she tells the story in the right way, recognizing her emotions in the past and present. She’s thinking about events rather than moving through them. She no longer inhabits a timeless no-man’s-land of emotional pain.

ARE YOU MY MOTHER?

Therapy further provides a venue for practicing healthy relationships through transference, one of psychotherapy’s most famous concepts. Transference basically means relating to someone in the present as you did to someone in the past. For instance, a client who distrusted authority figures might initially distrust the therapist. Transference allows a client to “redo” relationships, forming different patterns of response. At the neurological level, new and better habitual neural patterns, attractor states, overwrite older maladaptive ones.

Marianne’s transference involves “revising” her relationship with her mother. We don’t have a narrative of Marianne’s childhood, but Mrs. Dashwood’s behavior in the present indicates patterns that likely prevailed in the past. I’m inferring past events from present ones, but this is what often goes on in psychotherapy. It is widely accepted today that transference involves the kind of corrective attachment experience that enables a client to create new patterns of relating, as well as altering negative patterns of thought and feeling.

Children need emotional resonance from parents. Resonance means attuning to emotions, being on the same wavelength, as we say. This is crucial to developing social intelligence, including the capacity for emotional regulation (this is the topic of a future chapter). Parental attunement signals both validation and support, saying that you have a right to your feelings and that you’re not alone with them.

But for resonance to be effective, it has to be true attunement, not emotional contagion. When a therapist resonates with a client’s feelings, she shows the client that she understands such feelings viscerally, in the gut and not just cognitively. But she must maintain the distinction between understanding a feeling and experiencing it firsthand. Entering fully into another’s feelings without critical distance ceases to be resonance and becomes emotional contagion. A therapist who’s overwhelmed by a patient’s distress fails to maintain boundaries. This doesn’t help anyone.

A therapist must also maintain cognitive distance, taking the perspective of the client while maintaining her own point of view. She does this in terms of thoughts as well as feelings, and at this point, resonance becomes empathy, full-blown perspective taking. Failure to do this, assimilating another person’s point of view cognitively as well as emotionally, is known as introjection. It’s useless, and quite often harmful.

In order to comfort children, parents and caregivers also need to maintain boundaries, to resonate and take the child’s perspective rather than introjecting the child’s experience and feeling it as their own. Older children need empathy as well as resonance; they need to know that the caregiver understands what they’re thinking and feeling, as well as attuning to emotions. As we’ve seen, Elinor takes Marianne’s perspective both cognitively and emotionally. She resonates with Marianne’s distress without taking it on as her own. Marianne understands this, that her sister intuits the pain she’s in without being overwhelmed by it. Elinor similarly understands Marianne’s thoughts—her sense of disbelief and betrayal—without feeling personally wronged.

We see the failure to take Marianne’s perspective in a well-regulated and helpful way with Mrs. Dashwood, who tends to respond with contagion and introjection rather than empathy. This is especially true in her relationship with Marianne, the daughter who is most like her. (Readers have long noticed that Marianne and Mrs. Dashwood are alike, that they tend to have similar responses to experience.) This means that Mrs. Dashwood enters into Marianne’s feelings and viewpoint wholeheartedly, that she doesn’t maintain the distance needed for conveying empathy. Notably, this applies to her response to Marianne’s relationship with Willoughby.

After Willoughby’s hasty and uncomfortable visit to the Dashwoods to say that he’s leaving Devonshire (where they live), Mrs. Dashwood retires in private for a while, returning with the signs of her emotion obvious: “Mrs. Dashwood felt too much for speech, and instantly quitted the parlour to give way in solitude to the concern and alarm which this sudden departure occasioned . . . In about half an hour . . . [she] returned, and . . . her eyes were red.” Certainly, Mrs. Dashwood is fond of Willoughby, and it would be appropriate for her to be disconcerted on Marianne’s behalf, but her behavior clearly shows that she’s almost as overwhelmed as Marianne herself, and thus not in a position to help her distraught daughter.

In contrast, Elinor, who’s also fond of Willoughby and worried about her sister, keeps her distance and responds with thought as well as feeling—tempered feeling, appropriate to the situation. Elinor wonders why Willoughby has gone so suddenly, and with no intention of returning, as he’s made clear. Elinor detects warning signs, things that don’t make sense if Willoughby is sincere and on the level. She doesn’t know how to explain Willoughby’s strange behavior, but she believes that “suspicion of something unpleasant is the inevitable consequence of such alteration as we have just witnessed in him.”

Mrs. Dashwood criticizes Elinor for such thoughts, arguing that Willoughby might have reasons for secrecy about his relationship with Marianne, which she’s certain is an engagement. She doesn’t suspect Willoughby of betrayal, nor have concerns about his devotion. Mrs. Dashwood dismisses Elinor’s doubts and vehemently defends Willoughby against all of Elinor’s accurate suspicions:

Oh! Elinor, how incomprehensible are your feelings! You had rather take evil upon credit than good. You had rather look out for misery for Marianne, and guilt for poor Willoughby, than an apology for the latter. You are resolved to think him blameable, because he took leave of us with less affection than his usual behaviour has shewn. And is no allowance to be made for inadvertence, or for spirits depressed by recent disappointment? Are no probabilities to be accepted, merely because they are not certainties? Is nothing due to the man whom we have all so much reason to love, and no reason in the world to think ill of?

This is Marianne’s perspective as well. She might be upset at Willoughby’s departure, but she doesn’t suspect him of treachery. Even after his villainy is clear to all, she still believes that he’s behaving oddly because someone must have maligned her to him. Only the letter makes her see the light. Like Marianne, Mrs. Dashwood defends Willoughby until his behavior is clearly indefensible.

In short, Mrs. Dashwood takes Marianne’s viewpoint and experiences all of Marianne’s emotions uncritically. She grieves, trusts, and hopes almost as intensely as Marianne. She shares her daughter’s thoughts and feelings—catches them, if you will—instead of empathizing with them.

The effect of this is to make things worse rather than to provide comfort. After Willoughby leaves, Mrs. Dashwood enables Marianne’s theatrical if genuine devastation, failing to set limits or encourage her to calm down. Not only does Mrs. Dashwood neglect her duty to inspire a more peaceful frame of mind for her daughter, but she actually encourages Marianne’s distress by her full and uncritical participation in Marianne’s feelings. Emotional contagion has this dysregulatory effect, for when people catch one another’s emotions, this often leads to a spiral of intensifying feelings. Conversely, when someone empathizes but remains calm—is emotionally involved rather than emotionally overwhelmed—this induces a natural regulatory effect.

Empathy becomes Elinor’s job. She understands her sister’s feelings but maintains a critical distance, keeping both her own and Marianne’s perspectives in view. She does what Mrs. Dashwood ought to have done, and actually takes on a maternal role. It’s not accidental that Mrs. Dashwood is absent during Marianne’s crisis in London. This makes it clear that Elinor is functioning as the stand-in for Mrs. Dashwood, psychologically as well as pragmatically. Elinor is older than Marianne by a few years, which also facilitates the transference. And indeed Marianne herself regresses to a child-like state of being during her depression, unable to get her own food, or interact with others, or follow the social rules expected of all but the very young.

The transference magnifies the healing effects of Elinor’s empathy. As Elinor cares for Marianne, this patient/daughter/sister begins to experience the regulatory influence so missing from her real parent. By being in the care of a mother figure who calms her down rather than works her up, Marianne acquires the lessons in emotional regulation she missed as a child. Elinor’s calming influence helps to teach Marianne to deal with her destructive emotions; the same is true of the relationship between therapist and client, and it should be the dynamic between caregiver and child. Much of this influence happens subliminally. An increased capacity for regulation is instilled simply by being with someone who remains calm, available, and empathetic in the face of one’s own turbulent emotions. Elinor helps Marianne just by being herself.

A similar process occurs in therapy. Brain as well as mind is crucial in this respect. When the client is sad, or stressed, or withdrawn, the therapist resonates with this mood but then offers an alternative to the downward spiral by remaining tranquil and regulated. The client subliminally perceives this regulatory force by picking up on social signals, right brain to right brain, and then begins to respond by regulating her own emotions. Emotional resonance, or mood matching, right brain to right brain, gradually and subliminally teaches emotional regulation by inducing the client to habitually regulate rather than escalate strong negative feelings. This is also how we regulate one another outside the therapeutic relationship, and how caregivers regulate the emotions of babies and children.

This might sound mystical but it’s scientifically sound. We read emotional signals with our right brains, and we are, as a species, very susceptible to catching one another’s emotions. Just as Marianne “caught” her mother’s dysregulated feelings (and vice versa), so Marianne absorbs Elinor’s serenity. Such influence forms different habits of response and of relating to others at the level of mind, new attractor patterns in terms of the brain.

In a more overt manner, Elinor helps Marianne by suggesting alternative ways of thinking, feeling, and behaving. Therapists also do this, although not until the therapeutic alliance has been firmly established, and always by offering insights and sometimes suggestions—not orders. Elinor’s comments are also indirect; she doesn’t comment on Marianne’s situation verbally, but her own behavior in a situation that’s parallel models an alternative. She too has been abandoned by the man she loves, and although this isn’t as obvious as it is in Marianne’s case since Elinor keeps the secret of Edward’s engagement for several months, Marianne knows at the very least that Elinor’s beloved has not been behaving as a faithful suitor should.

When the engagement does become known, Marianne at first attributes Elinor’s self-command to a lack of feeling. Elinor quickly corrects her sister, recounting the horrific ordeal of losing Edward, without even the comfort of being able to confide in anyone. She concludes, “If you can think me capable of ever feeling—surely you may suppose that I have suffered now.” Marianne is instantly contrite: “How barbarous I have been to you!—you, who have been my only comfort, who have borne with me in all my misery, who have seemed to be only suffering for me! Is this my gratitude? Is this the only return I can make you? Because your merit cries out upon myself, I have been trying to do it away.”

But guilt isn’t the only effect of this knowledge; when Marianne begins to emerge from her depression, she has Elinor’s example in mind. Rather than dwelling on her own misery, she determines to channel her energy differently: “As for Willoughby—to say that I shall soon or that I shall ever forget him, would be idle. His remembrance can be overcome by no change of circumstances or opinions. But it shall be regulated, it shall be checked by religion, by reason, by constant employment.” This is Elinor’s mode, and Marianne has obviously taken the example to heart. Marianne begins to view herself as more than the sum of a broken relationship.

Elinor also models a technique seen in one of the most popular forms of therapy today: cognitive behavioral therapy (CBT).# CBT involves training people to consciously replace negative thoughts with positive ones rather than focusing on the processing of experience, thought, and feeling as happens in more traditional (psychodynamic) talk therapy. Reason alone won’t bring changes in habitual responses; you can’t talk yourself out of a depression. But you can practice positive replacement thoughts, talking back to your own negativity with the goal of inducing different, more positive feelings.

This is the theory behind CBT, which provides training in replacing negative thoughts that bring destructive emotions and behavior in their wake, with positive and corrective statements. Of course, reframing, viewing one’s situation differently, is an aspect of all successful psychotherapy. But CBT aims to achieve this goal by imposing such well-being through cognitive channels, rather than encouraging its development emotionally, as is the way with most talk therapy. It works “top down” rather than “bottom up.”

Elinor teaches CBT by modeling such self-talk, recasting her situation in ways that make the best of a bad deal. She predicts that Edward will marry Lucy, and that she herself will meet another appropriate suitor because “after all that is bewitching in the idea of a single and constant attachment, and all that can be said of one’s happiness depending entirely on any particular person, it is not meant—it is not fit—it is not possible that it should be so.” We see Eleanor talking herself into this constructive attitude after she tells Marianne about Edward’s secret engagement. She’s reassuring Marianne, but her statements serve to convince herself as well:

I would not have you suffer on my account; for I assure you I no longer suffer materially myself. I have many things to support me. I am not conscious of having provoked the disappointment by any imprudence of my own [ouch to Marianne!], I have borne it as much as possible without spreading it farther. I acquit Edward of all essential misconduct. I wish him very happy; and I am so sure of his always doing his duty that though now he may harbour some regret, in the end he must become so. Lucy does not want sense, and that is the foundation on which every thing good may be built.

Like a lot of people who engage in CBT scripts, Elinor says all this in an attempt to believe it. I leave it to Austen’s readers to determine how successful she is! (Incidentally, such techniques of self-talk have trickled down to a general public today in much the same way as awareness of psychoanalytic categories did in the last century. (I find it fascinating to watch this kind of positive self-talk in action on Facebook, as people publicly talk themselves into better modes of thought and feeling.)

CBT is one of many new methods in the rapidly evolving world of psychotherapy. Many new therapies differ radically from traditional talk therapy (psychodynamic therapy), which relies heavily on insight in addition to the therapeutic alliance and other mechanisms. CBT claims to be able to bypass the need for insight altogether.

Some of these newer therapies that have proved highly successful involve the body as much as speech, or even primarily the body. Take Eye Movement Desensitization and Reprocessing (EMDR), which uses eye movements or tapping, and is believed to help people heal from trauma by integrating right- and left-brain experiences. Traumatic memories, involving such reactions as panic and fear, are thought to be stored primarily in the circuits of right-brain areas. As noted, processing them so that their power is curbed means integrating them with left-brain activity. It is believed that EMDR takes a shortcut to neural integration by having a client look right and left (or to do the same with tapping), while remembering and speaking about the traumatic event; this appears to help integrate parts of the experience, such as cognitive (left-brain input) and emotional (right-brain input), that had been dissociated.

That such a mechanical process can work transformations within the mind is a potent reminder of the physicality of all our thought processes, and of what it means to have a mind-brain. Recall that Siegel defines the mind as consisting of our brains, bodies, and relationships—our interactions with other minds. The mind is neurological, physiological, and relational. These are the three elements that interact to create the dynamic system that constitutes our minds.

They’re also the three elements involved in any effective therapy. While talk therapy might not be as obviously physiological as more body-focused therapies, responses during sessions are registered in the body as well as the brain; this is automatic. All psychotherapies involve changing our bodily and neurological responses (brain and body) by using the therapeutic alliance (relationship).

Another example of a promising therapy that addresses all the aspects of mind is Accelerated Experiential Dynamic Psychotherapy (AEDP). This works largely by putting a person in touch with “core affects,” the essence of how they really feel, thereby connecting the cognitive observing self with the feeling reactive self, including bodily reactions, in the context of an empathetic therapeutic relationship. This facilitates health and change, even when it forces a confrontation with negative feelings. Progress occurs in leaps and bounds rather than baby steps.

Psychotherapy shows that changing your mind in substantial ways involves addressing all the mind’s different facets. This happens in everyday life as well, often through the magic of our loving connections with others (the relationship aspect of mind). When Elinor finds Marianne in her room, debilitated with grief, she brings her sister a glass of wine, not the treatment of choice for our puritanical, anti-substance era, but often an effective stimulant. She tends to her sister’s weakened physical condition (her body), and her depression (brain, the neurological processing of physiological, cognitive, and emotional signals), showing her love through her attention and care (relationship). Elinor comforts Marianne in many other instances as well, never flagging in her careful attention and care.

But even though new techniques such as CBT and EMDR have been successful, and many other newer kinds of therapy that differ from traditional talk therapy appear promising, they nevertheless all rely on the strength of the therapeutic relationship. Bessel van der Kolk, a leading expert in the treatment of trauma, stresses that relationships are crucial to the healing process. He particularly criticizes the use of CBT without an emphasis on the therapeutic alliance by pointing out that cognition alone is inadequate to treating conditions like trauma or depression. Without a strong therapeutic alliance, many people fail to believe a word of their chosen mantras.

The therapeutic relationship can help a depressed or traumatized person to stay connected to at least one other person, providing an escape from the often relentless solitude and misery of these conditions. It might enable a person to endure until her condition improves. Even at her very worst, Marianne still cares deeply for Elinor and can rouse herself to express this care, as we see at a social gathering, when Marianne is at the nadir of her depression. Elinor’s sister-in-law Fanny Dashwood compliments Elinor’s artwork. Then fearing she’s been too kind (Fanny isn’t a kind person), she compares it to another young lady’s paintings, on which she lavishes much greater praise. Marianne is indignant: “. . . such ill-timed praise of another, at Elinor’s expense . . . provoked her immediately to say with warmth, ‘This is admiration of a very particular kind!—what is Miss Morton to us?—who knows or cares, for her?—it is Elinor of whom we think and speak.”

This is the first sign of interest in anyone that Marianne has expressed for many weeks. It suggests that her love for her family, especially for Elinor, will provide her with a way back to health by reminding her that she can care for others besides Willoughby, and that there are better ways of loving than the desperate hunger she feels for him.

Marianne nearly dies from the aftereffects of a relationship, which led her to stop caring about her health and even her life. Her reawakening to the many other important connections in her life, especially her connection to Elinor, rescues her from her depression and reconnects her with the living. She begins to process and integrate feelings that had been overwhelming. She thinks—thinks hard—rather than merely reacting. She gains insight about herself and what’s happened, weaving her experiences into a narrative that looks to the past and the future. In the words of Daniel Siegel, she moves from being “the passive victim of trauma to the active author of the ongoing story of . . . her life.** At the nuts-and-bolts level of the brain, this process brings analytical left-brain, cortical processes to bear on right-brain, subcortical emotional processes, creating new neural pathways that allow for greater cognitive and emotional flexibility. Marianne is able to come to this empowering resolution of a bad experience largely because of Elinor’s love and protection. Elinor provides the therapeutic environment—the empathy, safety, transference, and constructive thought—that enables Marianne to heal.

* Austen actually refers to just such a change as is implied in Mr. Bennet with Mr. Palmer, a minor character in Sense and Sensibility.

† Judith Herman, M.D., Trauma and Recovery: The Aftermath of Violence—From Domestic Abuse to Political Terror (New York: Basic Books, 2015), 133.

‡ Classical conditioning was discovered by Russian psychologist Ivan Pavlov in the 1890s.

§ Eric. R. Kandel, In Search of Memory: The Emergence of a New Science of Mind (New York: W. W. Norton & Company, 2006), 40.

¶ The importance of the therapeutic relationship is widely accepted. On this point, see Paul L. Wachtel, Therapeutic Communication: Knowing What to Say When (New York: The Guilford Press, 2011), 104–105.

# Beth Lau analyzes Sense and Sensibility in terms of CBT in “Optimism and Pessimism: Approaching Sense and Sensibility Through Cognitive Therapy,” Persuasions: The Jane Austen Journal 33 (2011), 40–52.

** Siegel, Developing Mind, 53.