I recently finished reading Joseph LeDoux’s wonderful book Anxious: Using the Brain to Understand and Treat Fear and Anxiety. LeDoux has written numerous books and articles on fear over many decades now, with an accessible that makes neuroanatomy and neuroscience easy to understand. LeDoux studies the brain, but readers of this site would want to know that he is dubious about drugs being the answer to ameliorating anxiety or fear. He raises questions regarding which domains of behavior belong to the brain and which domains belong to mind.
A little background on Joe LeDoux is appropriate for those who have not followed his work.
Split Brain Research
Under his doctoral mentor Michael Gazzaniga, LeDoux worked with split-brain patients. Persons with intractable epilepsy sometimes have axons connecting the two sides of cortex severed, so that seizure activity can no longer spread from one side of the brain to the other. For most functions of daily life these patients are fine. However, the fact that the right brain does not know what the left is doing leads to some interesting phenomena. In fact, language – that is the ability to comment on what one is doing – is housed in the left side of the brain in most of us. Information from the right field of vision goes to the left brain where it can be commented on. Information from the left field of vision goes to the right side of the brain, where it can be acted upon but not commented on. It is possible to set up screens so that visual information only goes to one side of the cortex.
Numerous experiments have been conducted in which stimuli presented to the right brain induces an action and then the left side of the brain is asked “why did you do this?” LeDoux and Gazzaniga reflect on the fact that no one is ever puzzled by the question. Rather, the left brain comes up with some plausible explanation for the motivation driving the behavior which, apparently, people believe. Of course, LeDoux knows that the left brain’s explanation is not correct, because LeDoux knows what the right brain saw.
For Gazzaniga and LeDoux these findings raise the question of whether anyone ever really knows why he/she did anything. People, for Gazzaniga and LeDoux, are effectively almost in the position of being observers of their own behavior – just as another person observes our behavior and guesses at our motivation. In some cases, we can only guess at why we did what did, in the same manner that others might guess about the motivation driving behavior.
It should be noted that Gazzaniga and LeDoux were not the first psychologists to discover this. Gazzaniga and LeDoux basically confirmed what social psychologists Nisbett and Wilson came up with years prior to their work: under particular circumstances, none of us can definitely know why we behave as we do. We can only piece together some plausible explanation based on observation of what we have done in the context of particular environmental contingencies that we have consciously processed.
More About LeDoux and Fear Conditioning
After establishing an independent career in the 1980s, LeDoux embarked on the study of where in the brain fear conditioning occurs. (“Fear conditioning” refers to the response an organism forms in response to otherwise neutral environmental stimuli when they come to be associated with harmful stimuli.) LeDoux identified those neurons in the amygdala associated with information about the co-occurrence of a light (the conditioned – or neutral – stimulus) with shock (the unconditioned – or harmful – stimulus). He then identified the parts of the brain to which the amygdala sends the output. Given a danger-associated stimulus, the output from the amygdala increases cortisol levels in the blood (the stress hormone), induces an increase in heart rate and respiration, and the animal freezes. (Think: deer in headlights. For the anatomical details, the reader should consult LeDoux’s book.)
Emotion Entails a Conceptual Narrative
What will interest visitors to this web site is that LeDoux argues that the animal’s freezing, the increase in blood pressure, and the rise in stress hormones is not anxiety. LeDoux characterizes freezing, an increase in stress hormones, and increased heart rates, as hard-wired defensive programs. When under attack, we all have hard-wired “defensive programs” which will be elicited. According to LeDoux, these defensive programs are not emotion. Emotions in general and, in particular here, anxiety, are characterized by subjective self-report. Self-report of emotions (feelings) are concepts: stories that people tell themselves. To state it alternatively; when deciding how you feel you are constructing a narrative that integrates physical sensations and your concept of yourself responding to your environment. Thus, self-reports of emotion are, in part, a statement about one’s self-concept.
This of course returns us to the old debate between William James and Walter Cannon in the early 1900s. Walter Cannon argued that “I’m scared, so I run from the bear.” William James argued “I see myself running from the bear, so I decide I’m scared.” In fact, a lot of data support William James’ position. Emotions are as much a product of self-observation as they are of awareness of internal events. If people are induced to behave consistent with a particular emotion or their facial expressions are manipulated by the experimenter to be consistent with a particular emotional expression, their self-report of emotion is greatly enhanced. When discussing these rather novel ideas with my students, I always ask the mothers in the class, “who did your two-year old look at after falling down to decide whether he/she should cry?” Most little kids look to see whether mom is horrified before they decide if they’re hurt.
The idea that emotions are constructs raises issues about self-reports of depression. In an earlier post, I presented the data supporting the case that depression involves systemic inflammation and inflammatory hormones in the brain. Since a virus or bacteria will induce a physical state equivalent to one induced by stressful circumstances, it’s equally valid for persons with systemic inflammation to decide they are depressed as to decide they harbor a virus. The question is; which explanation enables a faster recovery.
Caveats Regarding Trauma-Informed Psychotherapy
Assuming that self-report of emotion entails a conceptual narrative carries implications for talk therapy. Currently, trauma-informed care, and screening for trauma, is in vogue. A problem with this approach is the implication that if I have experienced a trauma, I should be traumatized. “Traumatized” is a concept. It’s a narrative incorporating the concept of who the person is in relationship to an event.
Unfortunately, it’s not a narrative of resilience. Just as psychiatrists look at physical manifestations (e.g., low threshold for a startle reflex) and decide it’s evidence of a brain disease (PTSD), are those who screen for experience of traumatic events in the past making the analogous mistake of finding evidence of an unfortunate event in the past (my mother was very shaming) and deciding that the client is “traumatized”? Saying that my diseased brain caused my current distress, or my past caused my current distress, leaves no room for personal choice. Could we instead be screening for evidence of strength in the client and helping them to find a narrative of resilience? (“Yea, mom was shaming, but that was about her and not about me. I’ll write my own narrative.”)
With the emphasis on trauma-informed care these days, I’m wondering if anyone remembers the last time we collectively went down that path. In the 1980s, everyone was searching for repressed memories of child sexual abuse. If a child was shy, many therapists asked who might have abused them. Therapists frequently defined themselves as doing a good job, when a client came up with another memory. Competent women who recalled their traumatic pasts would be hospitalized for extended periods of time with the diagnosis of borderline personality or multiple personality disorder. Treatment consisted of processing the memories. This all ended rather abruptly when a prominent psychiatrist lost his license and insurance companies began prosecuting for insurance fraud, a felony offense. The history of this trauma-centered approach is recounted in Mistakes Were Made But Not by Me, by Carol Tavris and Elliot Aronson. (Yea, talk therapy can do a lot of damage too.)
Are “How” Questions More Important Than “Why” Questions?
My social work students all want to explore why a client comes in with a particular problem. Perhaps it’s human nature to ask “why?” Those of us with a physiology bent ask about diagnosis, and evidence of heredity. The social science people ask “what happened to you?” These days some of us might ask about diet (see my last post). What I try to impress on my students is that in any particular case, we will actually never know “why.” There are just too many potential causes. In line with the late Jay Haley’s suggestion “define the problem in such a way that you can solve it,” perhaps the more important question is “how do we get from where we are now, to where we want to be?” Oftentimes, how one got there has little to do with how one moves on.
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Donovan, L. (December 8, 1999). Controversial psychiatrist suspended: recovered memory case spurs state move. Chicago Tribune
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.