Untangling the Mind

Why We Behave the Way We Do

David Theodore George, Lisa Berger

• Publisher: HarperOne
• Year: 2013
• Print ISBN:
  9780062127778
• eBook ISBN:
  9780062127785
• Topic: Psychology
• Subtopic: Emotions in Psychology
• Index: Psychology

Free yourself from emotional turmoileven when that turmoil is caused by others!

We have a much greater understanding of human behavior now than we did just a few decades ago. Yet even with this greater understanding of the human mind, why we do what we do can sometimes seem like a mystery. People are often left with unsettling questions about their own (or others') behavior.

We ask ourselves, Why did I make a spectacle of myself? Why am I so stressed? Why am I constantly so negative?

In his years as a clinician, Dr. Ted George has been struck by how much easier it is for people to say they have a physical illness than it is to admit they feel out of control with an emotion—be it anger, fear, or depression. With a physical issue, you have the source of the problem in concrete terms, such as in a lab report, but with an emotional issue, it can be much harder to define what's gone wrong. Untangling the Mind helps make sense of what's happening—and why. With knowledge of how the brain translates sensory signals into emotions, you will increase your understanding of your own—and others'—behaviors. As you learn about your psychological and neurological makeup, you will begin to see new possibilities for optimism, motivation, and well-being.

We can control our behavior and our feelings, no matter how much they may have ruled us in the past, and Dr. George helps us know how. Once you understand the deeply rooted instincts that activate your emotions, you can live more peacefully, behave in ways that are more in keeping with the person you'd like to be, and enjoy your life more fully. And you'll be better able to remain unaffected by the drama of other people's emotional storms.

Part I
Why Emotions Spin Out of Control

1
Patient Zero

A Patient Under Siege

I greeted Henry Wilson in the waiting area and escorted him to my office. It’s an intimate room furnished with soft throw pillows on a well-worn couch, a couple of floral upholstered easy chairs, and a wood-paneled ceiling. I gestured to a seat and took my usual place in a chair across from him. I scanned over this new person—middle-aged, well-groomed in a charcoal suit, dress shoes, and a serious look.

We exchanged brief pleasantries, a few comments about the weather, and then got down to business.

“How can I help you, Henry? What can I do for you?” I leaned forward, making steady eye contact. I knew what my body language said about my attitude would set the course for our time together. I tried not to look too eager, although that was what I felt—an avid curiosity to hear his story and devise a way to help. My practice was relatively new, and every patient was a compelling challenge.

“I’ve been on depression medication, and it’s not working very well. My wife thinks my thoughts are disorganized and jumbled.”

“What do you think?” I asked.

“She’s somewhat right. I do have a problem concentrating and don’t sleep well. And, as she is quick to point out, I’m no good at planning things. She also says I’ve got a negative outlook. I don’t know. Maybe that’s the depression,” he said.

He did look haggard, probably from lack of sleep.

He took a deep breath. “I have to confess, you are not the first psychiatrist I’ve seen. In fact, you’re the fourth. And each one prescribed medication, and nothing has worked. I’ve been told I’m treatment resistant. Maybe I am, I don’t know. But it’s caveat emptor with me. I’m not an easy case, and I’ll understand if you’d rather not see me.” He sat back, as if waiting for me to accept his verdict.

“You’re here now, so why don’t we talk and you tell me later whether you want to continue.” I paused, then plunged ahead. “You said your wife thinks you have a negative outlook. Can you tell me more about that? Why does she think that?”

Henry Wilson began by talking about their seventeen-year-old daughter, who was at a tough-love boarding school in Utah because of repeated episodes of cutting, lying, and drunk driving. He and his wife fought over the decision to send her there because it was costly and far away. It was now time to pay her tuition, and Henry said he couldn’t afford it anymore but strongly believed she needed some kind of correctional environment. He and his wife were revisiting all the old arguments.

“The kid has problems. Okay, call me negative. We go round and round, and by now I’m just fed up with the whole thing. Helen thinks I’m the problem. I’ve given up trying to explain things to her. We really can’t afford that school. She knows that—I was let go last month because business is so slow. And the boss and I didn’t get along. I’m job hunting now, but it’s not easy. She is right about one thing—we don’t talk anymore. We just take swipes at each other.”

“It sounds like you’ve got a full plate. Losing your job must have been a blow. Did you have any inkling that that was going to happen?” I asked.

He shrugged. “Yes and no. I did blow up at my boss the month before. He’s a micromanager. You know the type, always double-checking, saying I wasn’t paying attention to details, said clients were complaining about my style. Whatever that meant. When he got that way, I either pushed back or just made myself scarce, and left. That probably wasn’t the best way to handle it.”

“You mean leave work?” I asked.

“I’d go to the tavern around the corner, big watering hole for lobbyists. I’d maybe bump into someone I know, we’d have a couple of drinks, and I’d feel better. Until I got home. Helen hated it when I’d have a couple after work. She’d really lay into me, accuse me of being a drunk, which I’m not, and then keep on about how I needed help.”

“What would you do then?” I probed.

“I’d lose it. Couldn’t help myself. Rip into her like she was a Thanksgiving turkey. She knows what gets to me and doesn’t hesitate to say things that set me off. So I lash back. I was just defending myself. In the end, I’d go into the TV room and not come out for the night. I’d sleep on the couch.”

Henry paused, his eyes searching my face for a reaction. If he expected to see disapproval, he was disappointed. I had heard versions of this and was concerned about his behavior. It did not take much to send him off the rails, and I wondered why.

“Overwhelming emotions can be frightening,” I said. “How do you feel when your wife gets on you?”

“Like I’m under siege. I’ve got no control over the situation but can’t get away. Trapped, I guess.”

Henry and I devoted much of that first session to his explosive temper and how it was rippling through his life. We especially examined the progression of emotions he went through, the mood swings that began with aggravation and sometimes ended in avoidance behavior that looked like depression. His range of emotions fascinated me, especially the anger. It seemed the most predominant emotion, yet it somehow was consistent with his other emotions. He was one of the first patients in my fledgling practice who had a constellation of problems that I felt were somehow related. There was a puzzle here I needed to solve, and I sensed that the first piece was Henry’s rage.

Why Do People Behave the Way They Do?

I’ve treated hundreds of patients like Henry Wilson. I’m also a researcher, conducting studies at the edge of psychiatric science. Throughout my career, I’ve been absorbed with the question, why do people behave the way they do? Anger that trips into rage or violence. Fear that paralyzes someone. Depression that shuts down a life. The dead affect of a predator or stalker. Why does one person end a mild disagreement with a brutal punch while another person responds with a groveling apology or weeping? Why do they decide to act one way and not another? I’ve been focused on trying to understand how normal emotions get hijacked and become twisted and destructive.

Of course people are driven by a complicated mixture of genetics, environment, upbringing, and biology. Every shrink knows this. But what is it about our nervous system that differs from person to person? This is where I’ve been looking for answers or, more precisely, for models to explain these behaviors—biological templates that would explain what happens in our brain when certain emotions are triggered. This model would be like a switch or universal remote control—push the green button and the power always comes on, push the yellow button to mute the sound. It would provide an accurate, predictable explanation for an array of intense emotions and behaviors.

Henry presented me with pieces of a puzzle, and anger was the most predominant piece. To successfully treat him, I needed more than insight into what he was experiencing. What was happening neurologically to set him off? The better I understood his emotions and behavior, the more effective his treatment would be. It was like the adage that you feed a man not by giving him a fish but by teaching him how to fish. I could not just give Henry a drug because it would only temporarily alleviate his emotions. Medication and support would ease the immediate symptoms but not address the reasons for them. My goal was to give him the tools to manage his emotions over the long term. To do that, I had to figure out what was going on in his brain.

Now, after years of clinical research and legions of patients led by Henry Wilson, I have formulated a model for understanding extreme emotions and destructive behavior. Before I get into that, let me explain how I got here.

Surprised by Psychiatry

I did not begin my professional life intending to become a psychiatrist. In medical school, I was on track to go into internal medicine and barely noticed the few students who spent their residency not drawing blood or putting in central lines but talking to people. My heroes in medical school were the revered surgeons and internists who dealt with life-and-death issues every day. Then a friend suggested I apply for a rotation at Duke University to study with a preeminent doctor who happened to be a psychiatrist. Enticed by the man’s reputation, I called him. I don’t remember exactly what he said except for one question: “Are you any good?”

That intimidated yet intrigued me. Doubts are regular fare for medical students, and at the time, my plate was fuller than most. I worried constantly about whether I was choosing the right treatment or requesting the right test or knew enough to make an accurate diagnosis. The man’s question was like asking a Navy Seal if he could parachute behind enemy lines, a challenge for me to plunge forward and prove I was both determined and tough enough to take on something completely foreign. My answer must have been the right one because he offered me a small stipend and an opportunity to study with one of the best.

Psychiatry came alive for me during that time. Patient stories took on personalities, and their histories became dramas. My initial misplaced skepticism about the benefits of psychiatry—what was the point when patients never got truly well?—was washed away by the realization that every illness has a natural course and an end stage regardless of whether the disease is in the mind or the body. But at that time, psychiatry from my vantage point was lodged at the bottom of the totem pole of specialties. It seemed that psychiatric residents received few patient referrals, and when they came, it was late in the day after all the other specialists had done their work. They were usually sent to some outer, dingy office to do an interview. Psychiatry was to medicine as voodoo was to healing. This presented both an obstacle and a challenge. Psychiatry would be difficult, but the field was wide open for discovery.

After getting my medical degree and completing residencies in internal medicine and psychiatry, I wrestled with what kind of psychiatrist to become. A full-time private practice seemed limited. I wanted broader psychiatric horizons, fields beyond treating one patient at a time. I cast about for room to run, an area where I could tackle mysteries and perhaps make a difference for many people. I wanted discovery and impact, not adulation and attention. It’s probably natural that research excited me.

The Allure of Research

I began my career at the National Institutes of Health in Bethesda, Maryland, in a laboratory studying addiction. Around the same time, I opened a small private practice. Over the years, my patients’ stories kindled ideas and theories that could be applied to many other people. Their struggles sparked in me a search for answers that I hoped would alter the way physicians and researchers thought about emotions and behavior. My motivation to help my patients dovetailed with my desire to uncover a behavioral model to guide my thinking.

Fortunately, my research into a neurological model for intense emotions didn’t require redefining neuroscience. Human biology is full of models that explain physiological and neurological reactions. When you touch a hot burner in the kitchen, cut yourself with a knife, or spill bleach on yourself, your hand will become red, swollen, and painful. Every time, no matter when or where the accident happens, the body reacts this way. This is the model for inflammation.

As I pursued my research into a possible neurological model, I realized that I already had a vital piece of the puzzle. I realized that I had encountered it serendipitously during a medical school lecture describing the transection of a live cat’s brain done by Philip Bard in 1928.1 Bard was a physiologist at Harvard Medical School and a protégé of Walter Cannon, the father of the fight-or-flight response concept. Seeking to trace the source of anger in the brain, Bard had transected different sections of a cat’s brain to see how the animal responded. Bard’s findings were remarkable—when he transected the high midbrain, the cat responded with a fight reaction. The cat instantly arched its back, puffed up its lungs, hissed, and bared its teeth. It looked like the Halloween cat with its body enlarged by inflated lungs and fur on end. It was a classic example of defensive rage. But when Bard transected the lower midbrain, the cat did not react.

Normally, the Halloween-cat response is a natural behavior to a threat. As I learned from his experiment, all the physical actions needed for defense—an arched back and enlarged lungs to look as menacing as possible and teeth bared, ready to tear into anything—appeared to arise from the high midbrain region. By severing the connection with the cortex, which is the advanced part of the brain controlling thought, intention, and action, Bard produced an automatic reaction in the cat. He generated an emotionally charged reaction in the cat—defensive rage. There was no reason for its defensive rage other than severing the connection between the cortex and the midbrain.

Bard’s findings were the foundation for the model that would explain defensive rage. What fascinated me about the animal’s defensive rage was that it was uncontrollable and had no external or obvious explanation. Rage came from the midbrain. A severing of the connection between the cortex and the midbrain had generated a dramatic emotional behavior. And the cat would react this way every time this part of its brain was disturbed. It was impossible for it to learn that the threat was nonexistent and stop acting this way. When its cortex was disconnected at the high midbrain level, the cat readied for a fight.

The Face of Domestic Violence

Henry Wilson returned to my office the following week. As soon as he sat down, he sighed loudly and began talking. “This was a bad week. Helen and I . . .” he halted, perhaps searching for a starting point. “Thursday night I came home from an interview, and it was a little late. I had stopped for a drink. About seven. Not real late. The house was dark; Helen was gone. No food in the kitchen, lights off, not even a note. I thought maybe she had left me. I really do love her,” he declared, looking squarely at me as if to punctuate his feelings.

I nodded and waited for him to continue. I had a feeling that Henry was tottering on a thin ledge.

“So I called her cell, and when she answered I was relieved. Meant she hadn’t left me or anything. But then I got really angry. She said she was at the store, carpet shopping, and there was food in the fridge. I flipped out. How could she do that to me? Just leave me like that? She never tells me anything,” he bemoaned. Then he added, almost as an afterthought, “I feel like hell. It’s like my skin’s crawling. I’m always agitated, always angry.”

After hanging up with his wife, Henry started drinking and consumed almost a fifth of vodka.

“What happened when your wife came home? Did you talk?” I asked.

Henry shook his head. He was tremb...

Table of contents

• Dedication
• Contents
• Introduction
• Part I: Why Emotions Spin Out of Control
• Part II: Losing It: Extreme Behavior
• Part III: Seeking Healthy Emotions
• Acknowledgments
• Notes
• Index
• About the Authors
• Credits
• Copyright
• About the Publisher