By John J. Ratey, Vintage, January 8, 2002, 978-0375701078

This has to be the best book I’ve read on the brain, ever. John Ratey explains in layman’s terms the latest research on the brain and are behavior comes directly from the brain’s biology.

The Four Theatres is a model for “analyzing human experience”. This is not a literal framework, but a way of thinking about patients’ brains. The four theaters are “perception captures incoming stimuli; attention, consciousness, and cognition filter and process these perceptions; the brain functions then work with this information and affect how subsequent information is perceived and processed; the final result is behavior and, ultimately, identity.”

The Four Theatres aside, the book explains the brain as we understand it today in great detail. While you may not agree with his model, you’ll get an education on how the brain metabolizes stimuli (my words).

[k84] The brain is nothing like the personal computers it has designed, for it does not process information and construct images by manipulating strings of digits such as ones and zeros. Instead,

[k97] Our troubled world, too, is becoming too complex for logical argumentation, and may have to change its thinking: real trust, when emotions are running high, is based on analogy, not calculation. Meanwhile,

[k143] The accepted wisdom has always been that the key to success in life is to know yourself, and this still remains one of the most basic truths of philosophy, psychology, and religion. To know ourselves, we must become good self-observers, and it is for this reason, more than any other, that we must learn about the object that drives our logic, imagination, and passion. Biological determinism,

[k163] It’s not surprising that language about the brain is complex, for the brain is the most complex object in the universe. There are a hundred billion neurons in a single human brain, and roughly ten times as many other cells that have noncomputational roles.

[k190] The brain is so complex, and so plastic, that it is virtually impossible, except in the broadest fashion, to predict how a given factor will influence its state.

[k194] Darwinism.” These networks of synapses, Edelman argues, are more than a vast communicative infrastructure; each network in the brain is striving against the others for feedback from the outside world.

[k224] Likewise, blaming yourself for the physiological shortcomings of your brain, whatever they may be, is misdirected energy, energy better spent in changing your habits and lifestyle to live the most productive life you can.

[k355] Brain structure is not predetermined and fixed. We can alter the ongoing development of our brains and thus our capabilities. This is not always beneficial, however, as sometimes in the brain’s attempt to adapt, the rewiring can make things worse.

[k384] The first weeks and months are a time of furious cell production and overproduction, with 250,000 neuroblasts, or primitive nerve cells, being created every minute.

[k405] The two main types of cells, neurons and glia, make up the brain, which is pretty much complete by the eighth month of pregnancy. At this point there are twice as many neurons as in the adult brain. As the brain ages,

[k430] A period of cell death during the later stages of pregnancy wipes out almost half the neurons in the brain, which are probably phagocytized, or eaten up, by the support cells of the brain and the molecules recycled locally. There is a drop from about 200 billion neurons to 100 billion. This widespread cell death is normal, for it eliminates the wrong and weak connections that could inhibit efficient and proper brain function. This is a classic example of the incredible resourcefulness of evolution, which makes us highly adaptable creatures. It also points to the fact that even at the very beginning of development the brain is a social organ: where there is no connection, there is no life.

[k519] “Neurons that fire together wire together” means that the more we repeat the same actions and thoughts–from practicing a tennis serve to memorizing multiplication tables–the more we encourage the formation of certain connections and the more fixed the neural circuits in the brain for that activity become. “Use it or lose it” is the corollary: if you don’t exercise brain circuits, the connections will not be adaptive and will slowly weaken and could be lost.

[k538] A mere 50,000 genes for the brain are not nearly enough to account for the 100 trillion synaptic connections that are made there. Genes set boundaries for human behavior, but within these boundaries there is immense room for variation determined by experience, personal choice, and even chance.

[k555] Studies of identical twins separated at birth are often used to test the debate between nature and nurture. While these can be valuable, this test is hamstrung from the start for several reasons, one of which is that differences in the position of each twin in relation to the placenta may bring with them differences in blood supply, hormonal levels, and other factors that are not intrinsic to the genes of the twins. Whether a twin is a “front child” or a “back child,” a “spleen child” or a “liver child,” makes a difference.

[k578] Genes and the environment work together to shape our brains, and we can manage them both if we want to. It may be harder for people with certain genes or surroundings, but “harder” is a long way from predetermination.

LEARNING TO CHANGE THE NEURAL PATHWAYS that control the basic functions we need to survive–heartbeat, temperature control, breathing–are already connected at birth, but many more pathways are determined by the greatest environmental factor in our lives: learning. Although the brain’s flexibility may decrease with age, it remains plastic throughout life, restructuring itself according to what it learns. The brains of children three to ten years old consume twice as much of the blood nutrient glucose as those of adults, in part because their brains are less efficient and are in the business of forming a vast number of connections. Studies also show that children who exercise regularly do better in school. New research indicates that adult exercise juices the brain with more glucose too, which may promote an increase in neural connections.

[k606] The drug Prozac can be helpful in breaking these kinds of deadlocks. We always have the ability to remodel our brains. To change the wiring in one skill, you must engage in some activity that is unfamiliar, novel to you but related to that skill, because simply repeating the same activity only maintains already established connections. To bolster his creative circuitry, Albert Einstein played the violin. Winston Churchill painted landscapes. You can try puzzles to strengthen connections involved with spatial skills, writing to boost the language area, or debating to help your reasoning networks. Interacting with other intelligent and interesting people is one of the best ways to keep expanding your networks–in the brain and in society.

[k625] There is stronger evidence, however, that children who listen to and play music at ages younger than eight do better on spatial reasoning tests. For example, the California team studied a class of three-year-olds. Half the class attended piano or singing lessons for eight months. Their scores on puzzles, tests of spatial reasoning, and drawing of geometric figures shot up to 80 percent higher than those of their classmates who did not attend music lessons. The musical children gradually became faster and more accurate at spatial reasoning over the school year and boosted their spatial intelligence. The theory is that as music is structured in space and time, practicing it will strengthen circuits that help the brain think and reason in space and time, important for math. If the effect of sustained practice during childhood is permanent, the improved ability will help children in complex math and engineering problems when they grow up. It is theorized that the music triggers neural firing patterns over large regions of the cortex that are also used for spatial reasoning.

[k1039] An excess of mental noise in the brain can make it difficult to perceive what’s going on, overloading other circuits of attention, memory, learning, cognition, emotional stability, or any other brain function. The system goes into information overload. If random neuronal firings are too fast and furious, incoming stimuli might fail to activate and assemble the neurons into properly synchronized behavior. This, in turn, could result in the incorrect processing of a stimulus, and neurons would misfire accordingly. This is what can happen when highly anxious people take tests. The heightened anxiety drives up the mental noise, so much so that such people may literally see less of their environment, as though the brain space usually open for perception is busy with the internal noise.

[k1046] Our brains are not infinite. They run out of space, run out of gas, as it were. If the brain is busy trying to filter uncomfortable and frustrating noise, worries, or other concerns, there is less “brain stuff” available for perceiving.

[k1428] It is easy to understand how the many processing difficulties of autism can lead to social isolation. If one has an aversion to being touched by another human being, if clothes feel like steel wool, and if sensory information comes too fast and furiously for one to process, a perfectly natural reaction is to avoid the overwhelming stimuli in any way possible. Sadly, this social isolation, which begins in early childhood when the brain is developing, sets up behaviors that can last a lifetime.

[k1575] Like all of us, some dyslexics learn to tolerate this inability to fit auditory information into models by becoming more inventive in deciphering the sounds around them, perhaps by asking probing questions all the time that help make sense of what is being said and heard.

[k1678] To add to this complexity, recent physiological findings suggest that all this processing takes place along several independent, parallel pathways. One system processes information about shape, one about color, and one about movement, location, and spatial organization. If you look up and see a clock, the image of its face and the action of its sweeping second hand are being processed independently, despite how unified the image appears. It may seem bizarre to think of vision as functionally subdivided. But how otherwise could a person who has perfect focus and tracking of moving objects be color-blind? Some “blind” people who cannot see colors or objects can still see movement.

[k1784] With research in hand, I finally came to understand that my mother has an exceptional parvo, slow-processing system; like most artists, she expresses an enhanced perception of color. She also expresses a mildly deficient magno, fast-processing system. I also became aware that her brain “compensated” for its deficiency; and finally, I put to rest the notion that perhaps my mother had a slightly abnormal brain.

[k1794] My research assistant had not only found an underlying cause for her mother’s reading difficulty, she had also hit upon a central conclusion about perception, and indeed all brain function. Each brain is different, and each is more efficient at certain kinds of processing than others. For most people, their plastic brain attempts to reorganize to compensate for its deficiencies the best it can. The more we learn about how this occurs, the more we will be able to help the brain retrain itself.

[k1889] If the brain were simply reflexive, it would never be able to plan a future action. The brain is a powerful prediction machine, continuously making elaborate mental maps of the world that are reliable enough to enable us to predict what lies ahead, both in space and in time. All animals that move must have some predictive power–at the very least a simple image of what they are moving into and a sense of how they are moving into it.

[k1926] Scientists have identified four distinct components within the attention system, which together create the brain’s overall ability to monitor the environment: arousal, motor orientation, novelty detection and reward, and executive organization. At the lowest level of monitoring, the brainstem maintains our vigilance–our general degree of arousal. At the next level, the brain’s motor centers allow us to physically reorient our bodies so that we can immediately redirect our senses to possible new villains or food sources. Then, the limbic system accomplishes both novelty detection and reward. Finally, the cortex–especially the frontal lobes–commands action and reaction and integrates our attention with short- and long-term goals.

[k1971] A key area of action is this little group of cells, the nucleus accumbens. Monkeys with lesions in this region are unable to sustain attention, which hinders them in performing tasks that are not rewarded immediately, therefore affecting motivation. ADHD can be thought of as an addiction to the present. Patients are often impulsive, lacking in inhibitions, and quick to act because they are hooked on immediate feedback. They tend to prioritize tasks according to which offers the most immediate gratification. As a result, they tend to not interrupt current activities in order to rehearse skills or evaluate the consequences of their actions.

[k2014] Since the 1930s, studies have linked the anterior cingulate gyrus to attention, emotion, memory, somatic and autonomic motor responses, motivation, and even responses to painful stimuli. One of the keys to its widespread power is that it can regulate its own dopamine levels, which enhance the reactivity of neural networks. It also has extensive neural connections to regions throughout the brain, helping it regulate other regions involved in attention. The complex system of arousal, emotion, and motivation feeding the attention system seems to be coordinated through the anterior cingulate gyrus.

THE PRIMARY EMOTIONAL signal the anterior cingulate gyrus receives comes from the amygdala, at the core of the limbic system, which influences attention by assigning emotional significance to incoming information. Even before a sensory perception has reached the frontal lobes, where it enters conscious awareness and undergoes fine categorization, the amygdala has already branded it with a raw emotional valence somewhere along a continuum from mildly interesting to “oh my God!” It activates the body and the rest of the brain in response to how significant it deems the stimulus to be to survival. If the stimulus seems threatening,

[k2025] The amygdala provides a preconscious bias of intensity to every stimulus you come into contact with, even before you actually pay attention to it. It can, and does, operate outside consciousness.

[k2057] One of these, the D2R2 receptor gene, which codes for the D-2 receptors on the postsynaptic site for dopamine that is mainly concentrated in the area of the limbic system, has an allele, or alternative gene, that has been linked repeatedly with a variety of psychiatric conditions such as alcoholism, ADHD, cocaine abuse, nicotine addiction (better known as smoking), compulsive gambling, and other addictions. These findings remain, but a number of studies now show that there is a relationship–this is an association, not a causal connection–between the D2 receptors and problems reward and attention.

It is believed that an abnormally low density of D2 receptors in the nucleus accumbens reduces an individual’s ability to experience pleasure. This diminished capacity would almost inevitably drive that individual to seek external forms of self-gratification. During the course of a life, such strategies could settle into pathological patterns of reward-seeking, from substance abuse to sexual conquest to problem gambling. This has led Dr. Kenneth Blum of the University of Texas and others to define a new syndrome called the “reward deficiency syndrome.” Recognizing that a reward you are receiving is “enough” is in part a function of memory, and sustaining attention is the primary gate-way to the encoding of memories. Dopamine is central to both attention and reward. What’s more, substances such as nicotine, cocaine, chocolate, marijuana, carbohydrates, and alcohol increase the level of dopamine in this area of deficiency, so searching for and ingesting these substances may be in part an attempt to compensate for individual differences in dopamine levels. These levels may also be increased rapidly by engaging in high-risk behaviors, or by constantly confronting novel and challenging situations. Putting yourself at prolonged risk, say,

[k2072] The D2R2 allele, although present in only 20 to 25 percent of the American population, was found to be present in 70 percent of severe alcoholics dying from cirrhosis of the liver. These findings, presented to the public in 1990, stirred up a flurry of debate in the media, which immediately jumped to the conclusion that the “alcoholism gene” had been discovered.

[k2095] Most often, ADHD individuals are deficient in the motivational sensations of pleasure or pain, and as a result they struggle to sustain the drive required to complete important but tedious tasks that only reward after a long period of time, such as doing well in school to eventually take on college or a career.

[k2149] WHETHER IT FUNCTIONS smoothly or not, the ultimate purpose of our attention system is to help our brains tune in to the world, including our own minds. Tuning in opens the door to that most fascinating aspect of our lives: consciousness. People love to debate consciousness. Considering that we don’t know what it is or how it works, the fervor with which it is debated can be embarrassingly presumptuous.

[k2250] CONSCIOUSNESS One of the most appealing explanations of consciousness is the proposal that the recurrent network set up between the thalamus and the cortex is the neurology of consciousness. The thalamus is connected to the cortex by the intralaminar nuclei, which project long axons to all areas of the cerebral hemispheres. These areas in turn send back projections to the same intralaminar nuclei, and when this circuit is humming with a steady oscillation, consciousness may result.

[k2410] The next frontier in the quest to explain consciousness is the hard question of subjective experience. We all know what a subjective experience is, but it’s hard even to explain what we experience. The most central subjective experience we have is “what it is like to be me from the inside.” Examining consciousness from the inside reveals a whole new set of “data” to be explained–the qualitative aspects of our experiences, or, for short, qualia. The term qualia is currently in vogue in the field of philosophy of the mind. Qualia are the phenomenological properties of experience; the “what it is like” of consciousness that are elements that can only be known from one subjective standpoint. For example, you cannot experience another person’s pain. You can infer what the other person is going through, but there is no direct transfer of the experience. Other examples of qualia might be, for instance, deja vu, a chilling dive into a cold river, or the smell of burnt rubber.

I do not understand altruismm in this context. Altruism is a quality like anything else.

[k2423] As we attend more and are more conscious about what is going on around us, we have more freedom, while at the same time we are more bound to the reality of the world. We can think of an increasing consciousness as an expanding playground for creativity, where we can learn in new ways how the world is put together. Altruism and consciousness are the steps that we’re walking through that will define us more in the future.

[k2453] Motor function is as crucial to some forms of cognition as it is to physical movement. It is equally crucial to behavior, because behavior is the acting out of movements prescribed by cognition. If we can better understand movement, we can better understand thoughts, words, and deeds.

[k2473] Nature is a frugal tinkerer.

[k2518] The typical OCDer is a perfectionist who is interminably searching for error. He or she explodes with worry and gets caught in a never-ending do-loop of concern and rumination. Did I make the right move?

[k2547] Cases like T.J.’s stunned practicing psychiatrists, virtually all of whom had been schooled in the classic Freudian view that OCD somehow stemmed from a disturbance in toilet training. Acute-onset cases like T.J.’s totally upset the traditional psychodynamic, interpretative framework for the disease, even the updated, biologically aware versions that put some blame on an imbalance of serotonin. These children were virtually “catching” OCD, or at least tics, the way a person catches a cold. There was nothing social about it. MRI scans revealed that in these children the caudate nucleus, the area implicated in OCD, had swollen to as much as 24 percent larger than normal. What’s more, the degree of swelling directly correlated with the severity of the OCD symptoms. Researchers surmised that the antibodies created to attack the strep bacteria were attacking the caudate neurons of the children’s brains.

[k2572] A lot of brain function is, essentially, movement.

[k2584] Movement is fundamental to the very existence of a brain. Interestingly, only an organism that moves from place to place requires a brain. Plants enhance their chances for photosynthesis by turning their leaves to face the sun, but this is done through the growth of cells, not by changing their position. A tiny marine creature known as the sea squirt swims about like a tadpole. It has a brain and a nerve cord to control its movements. However, when it matures, it attaches itself permanently to a rock. From that moment on, the brain and the nerve cord are gradually absorbed and digested. The sea squirt consumes its own brain because it is not needed anymore.

[k2671] We therefore have to be very wary when we are presented with a nice, neat map of the brain. For six decades investigators have created brain maps that reflect the “latest” research. The maps have evolved from well-defined point-to-point grids to messy configurations showing complex overlapping areas. The phrenologist and the geographer live within us: we want to know where and how. But this is just not the way the brain is organized.

[k2887] What’s even more fascinating is that the motor control of movements related to emotion is not in the same location as the control for a voluntary movement of the same kind. For example, when a stroke destroys the motor cortex in the brain’s left hemisphere, the patient experiences paralysis on the right side of the face. When asked to smile the patient cannot move the right side of his mouth. However, when the same patient is told a joke and laughs spontaneously, the smile is normal; both sides of the mouth move as they should. The cortex cannot exercise its usual control over the muscles, but the muscles still respond to the more automatic and implicitly learned responses that are located on the first floor–the basal ganglia.

[k2911] Our motor programs continually reorganize into sequences of motor movements that reflect what we learn each time, to lead to well-thought-out and successful performance. We are always modifying and learning through movement.

[k2942] Our physical movements can directly influence our ability to learn, think, and remember. It has been shown that certain physical activi-ties that have a strong mental component, such as soccer or tennis, enhance social, behavioral, and academic abilities. Although the reasons are not completely understood, many reports indicate that this is so. Evidence is mounting that each person’s capacity to master new and remember old information is improved by biological changes in the brain brought on by physical activity. Certain kinds of exercise can produce chemical alterations that give us stronger, healthier, and happier brains.

[k2969] Studies suggest that challenge and feedback are necessary to maximize learning. The brain is exquisitely designed to operate on feedback, both internal and external. The substantia nigra,

[k3003] What am I talking about? False memories. We all have them. Despite our great certainty about what we have and have not experienced, the fact is that given a few bogus details and a little prodding, about a quarter of adults can be convinced that they remember childhood adventures they never had. Our memories are much more malleable and fallible than we like to think.

[k3153] This process, however, is not standardized. Motivation can affect how encoded a memory becomes. Michael Merzenich did much of the early work in showing that when there is a reward, the pieces of a memory are more strongly bonded. He placed a slowly spinning wheel beside monkeys’ cages, which the monkeys could touch with their fingertips, and monitored the region of their brains responsible for the fingers. The cells responsible for feeling the wheel and remembering the sensation were mapped. Merzenich then added a learning task; when the monkeys could recognize a designated pattern of spinning and press a buzzer, they were given a food reward. They soon became experts at recognizing the right pattern, and literally within hours the nerve cells responsible for the task multiplied as the monkeys’ discriminatory powers increased. Neighboring neurons were recruited to help perceive and then remember the perception. The adding of a reward led to having many more neurons code the memories. The monkeys were motivated to remember the event. The adage that reward is part of learning is backed up by real neuronal proof.

[k3178] More evidence comes from the evolutionary ladder. In the one mammal that does not experience REM sleep, the spiny anteater, the prefrontal cortex–the major center of learning and behavior–is so disproportionately large relative to the animal’s body mass that memories are encoded at the moment an event is first experienced. Higher mammals, lacking this massive reservoir, were perhaps forced to develop and reserve REM sleep as a time for solidifying memories; recall the study showing that the exact neuronal firing patterns present when rats explored a maze were repeated precisely when the rats were in REM sleep.

[k3246] Problems with working memory are crucial to the many symptoms of ADHD. Those of us blessed with proper working memory can predict the consequences of our actions: we have memory of the future. People with ADHD lack this gift. Planning overwhelms them, and they “forget to remember” and “forget to remember that they will exist in the future” and so on until everything falls into an unproductive infinite regress. Further, they lack an ability to screen out extraneous stimuli.

[k3585] Cognitive changes assumed to accompany aging are seriously misunderstood. Many people, for example, confuse normal age-associated memory changes with the severe clinical condition of Alzheimer’s disease, a form of senile dementia. Statistics show that no more than 10 to 15 percent of people from age sixty-five to one hundred show symptoms of clinically diagnosed senile dementia, yet thanks to prompting–or perhaps priming–by the popular press, a great majority of the aging population would swear to having the disease. Some memory loss is common as people get older, and it differs significantly from dementia. In normal aging, individuals may have a “tip-of-the-tongue” memory loss for words that haven’t been used in a while. That’s why Grandma, having a “senior moment,” may confuse her grandchildren’s names when they first come to visit after having not seen them for several months. With Alzheimer’s, people lose the names for common objects they run into every day, like glasses or ovens.

[k3948] Sadness probably evolved to emphasize and underscore losses of all kinds; it takes us off-line so that we can regroup and reevaluate. It may even cause us enough “pain” that we are motivated to change. In the brain,

[k3986] Depression affects 3 to 5 percent of the population at any given time, and about 20 percent of people will experience major depression in their lifetimes. Even children only five or six years old can experience symptoms clinically similar to adult depression. Depression is less genetically based than any other mental illness, and is the one most dependent on environmental factors.

[k4135] A disorder of the motivation system is apathy, which can have a neurological basis or accompany another medical disorder. Apathy can be particularly difficult to treat because the behavior may be seen by the patient’s family as moral weakness or be misinterpreted by a therapist as passive-aggressive behavior.

[k4140] High doses of dopamine are usually needed to help patients suffering from apathy. In one study, seven out of eight patients who became depressed following liver transplants and were given methylphenidate, or Ritalin, a drug that elevates dopamine levels, showed improved motivation in pursuing their rehabilitation regimens and less social withdrawal and apathy than they exhibited before taking the drug. For apathy patients, drugs are not the final cure. They also need assistance in practicing techniques to help themselves. Education of the family is an important job for the therapist, too. Treatment of apathy raises some complex human rights issues, because these patients may be competent enough to make some decisions but not others. They are also prone to anxiety, which must be relieved so that they will consider options and get involved with life again. Treating apathy is also important in depressed patients. Drugs can be used to bring about rapid improvement at an early stage. Since depressed patients are often convinced that nothing can be done for them, they may not adhere to the treatment plan, and become uncooperative and neglectful. Rapid countering of this resigned apathy is an essential aspect of treatment.

[k4181] As we evolved and our social groups got bigger and more complex, we needed to delay and react more deliberately or chaos would have reigned. Language may have evolved as a delay mechanism.

[k4186] It is the moment of delay that is so crucial to planned action. Owing to language, we don’t have to act immediately on emotional impulses determined by our immediate surroundings.

[k4648] Electrical stimulation studies on the conscious brain have helped define the reading areas. They overlap with naming sites, but aren’t always in the same area, and exact locations vary from one individual to another, as is the case for naming sites for oral language. Other tests show that people with high verbal IQs have reading sites in the superior temporal gyrus and naming sites in the middle temporal gyrus. Ironically, the reverse pattern is found in people with weaker verbal skills. William Calvin of the University of Washington proposes one explanation: We learn to name before we learn to read. If we are genetically less efficient at this task, the greater neural area in the superior temporal gyrus is necessary for success. So when we begin to learn the complex task of reading when we start school, the superior temporal gyrus is already dedicated to naming sites, so reading sites form in the less optimal middle temporal gyrus.

[k4669] Whether schools should teach reading by phonics versus whole language has become a hot, almost political debate, but brain research provides a simple answer: they should use both. The whole-language trend assumes that reading is a natural, genetically programmed part of language development, and that children will pick it up as easily as speaking. However, as noted, since writing has only existed for 5,000 years and literacy has only been widespread for a few centuries, it is highly unlikely that the human brain has evolved structures specifically for reading and writing in this time. It is our ability to learn through experience that allows us to achieve reading, but only with explicit instruction.

[k4796] The process of writing may provide an even greater delaying function, allowing for even more organization of ideas before action. So many of us claim that we can organize our thoughts better and learn new tasks more easily if we sit down and write them out on a piece of paper. Perhaps journal writing would be a useful rehabilitation tool to train our brains to slow down, think, and vocalize before acting on emotion or acting out in a social situation–the subject of our next chapter.

[k4899] The more I see the pieces put together, the more I am convinced that there is indeed a social brain. The pieces have long been identified, but we do not think of them as constituting a holistic function.

[k4903] This simple declaration may seem heretical to some.

[k4907] If we can understand how the social brain works, we can begin to find ways to treat people whose behavior crosses the limits tolerated by our social society. More important, we might find a way to give otherwise isolated and anguished people the ability to make friends, get along with co-workers, and form intimate relationships. Even though we typically think of these emotional, psychological, or moral capacities as learned, the existence of a social brain indicates that our social skills also have a partly biological basis.

[k4922] Our highest human virtue is our connection with other humans, and social activity is basic to our health and happiness. Our brains are preprogrammed to look for other humans from the moment of birth, and continuing social interaction with parents and peers is essential for normal development throughout life.

[k4957] The lesson is that practice can make perfect. Some schools are realizing this, and are beginning to put class time aside, even if it’s as little as 15 minutes a week, to help children learn how to be friends, how to recognize and talk about different feelings, how to handle anger or pain, and how to express what they like and dislike. Teachers will act out situations–

[k4963] Modern society has canonized successful social relationships as the ultimate in psychological adaptation, and much of psychology and psychoanalysis is based on this premise. But there is a definite neurological component to this exalted function, and the possibility of correcting the brain’s social neurology has been largely ignored.

[k5033] Often it is easier for an individual to participate in an exchange relationship than to do everything for himself. Once you open a door for yourself, it requires only a bit of extra effort to continue to hold it for the person behind you. This little effort is rewarded with a lessening of your own burden when someone else holds a door open for you. This economic principle, which surfaces as little politenesses, helps make civilized society possible.

[k5200] This motor activity then helps her calm down. Alternatively, as the woman’s anxiety heightens, someone may approach her who has a friendly expression and a quieting tone of voice and give her a reassuring touch on the arm. This raises the woman’s serotonin level, which dampens the network, tells the cortex to quiet down and the amygdala to reduce its vigilance for there is no longer a threat.

[k5581] This view leads to a radically different but simple model for analyzing human experience, which delves far below the emotional surface of feelings while recognizing that emotion conditions the entire process. The model consists of four “theaters” of exploration, which flow and feed back into one another: perception captures incoming stimuli; attention, consciousness, and cognition filter and process these perceptions; the brain functions then work with this information and affect how subsequent information is perceived and processed; the final result is behavior and, ultimately, identity. By logically investigating each theater, clinicians–and people themselves–can find the fundamental cause of difficulties and design lasting cures.

THE TRADITIONAL EFFORT to uncover the hidden trauma supposedly responsible for suffering is largely being replaced today by searches for neurotransmitter imbalances, aberrant genes, and altered brain functions. Where we once spoke of superego, ego, and id, we now speak of serotonin, gene sequences, and neural networks in various brain regions. Nevertheless, mental health practitioners continue trying to treat affect directly, as if it were the illness itself, rather than attempting to investigate the ways in which it might be a consequence of a patient’s underlying disorders. Furthermore, they continue to insist on a Pasteurian notion of illness: one pathogen, one antigen, one cure. The pressing desire to provide immediate relief also leaves many doctors and patients addicted to the search for a convenient, comforting diagnostic label and a hot new drug to cure the affliction. The hunt for a single villainous gene for each behavioral problem is just as intoxicating, and the media have fostered unwarranted hopes among the general public, which now plainly expects miracle cures for suffering. This trend is unfortunate and distressing.

[k5602] Although psychiatry has finally achieved recognition as a medical science, drug therapy is still a crude and primitive tool for treating an organ we are only beginning to understand. Which faculties and sources of satisfaction should a psychiatric patient expect to surrender for the sake of therapeutic convenience?

[k5625] Feelings may be the cause of distress, but they also cover up the problem. Furthermore, in light of the paucity of our understanding of the brain, it seems more productive for clinicians to replace confidence in diagnostic categories with curiosity and a knowing humanity.

Even if emotions are largely the cause of a problem, those emotions are created by the physical firing of neurons in the brain. Furthermore, even if an emotional trauma is the root cause of a problem, that trauma reorganizes the brain’s circuits–a biological result that can be turned around.

[k5670] My hope is that with the metaphorical framework of the four theaters we can begin to base modern mental health care on a more holistic method of healing. By starting upstream and working their way down, psychiatrists stand a better chance of identifying the true etiologies of the disorders they seek to treat and of engineering the environment in such a way that patients’ internal shortcomings are met with self-forgiveness and effective steps to correct their problems.

The First Theater–Perception THE BRAIN DOES NOT mechanically store the information that it acquires. It is changed forever each and every time it interacts with the world. Each time, it becomes the information. Perception is the gateway through which we receive information from our five senses and from our internal awareness. Perception is the beginning of all experience.

[k5684] A lifetime of misperceptions leaves many patients ashamed of their limitations and fearful of repeating failures. Perception is the starting point for diagnosis, because mental life develops primarily in response to the information that the brain apprehends. The Second Theater–Attention, Consciousness, and Cognition WHEN WE ATTEND to a perception, we become conscious of it, and then we think about it or react to it. The second theater encompasses a person’s conscious experience of the world. It is how a person represents the world to himself or herself, from moment to moment, and how he or she interprets events within it. Upstream problems in perception

The quality of one’s inner awareness can deteriorate as poorly formed perceptions fail to provide the structural basis for well-coordinated attention shifts, and as ill-formed cognitive networks lead to confused internal representations of the world. This leaves the brain trapped in a state of constant “noise” and starved for accurate information.

[k5696] The Third Theater–Brain Function THE THIRD THEATER comprises the primary functions of the brain, movement, memory, emotion, language, and the social brain, all of them affected by differences between the brain’s hemispheres. These processes directly influence the moment-by-moment experience of life, yet adapt relatively slowly.

[k5702] Brain functions lie downstream from the first two theaters in our model because they emerge and develop in response to whatever kinds of experiences enter consciousness from perception. A second theater filled with mental noise can distort functions in the third in numerous ways, including ADHD, OCD, autism, anxiety disorders, and others.

[k5722] The Fourth Theater–Identity and Behavior THE FOURTH THEATER constitutes the “output” of the brain: one’s decisions, behavior, and historical sense of self. It is the sum total of neurological and psychological traits that, at any given moment, constitute who a person has become. This theater is, in a sense, the space occupied by the life narrative that individuals tell themselves–and their care-givers. It is also where modern psychiatry has spent most of its time, for it is where we confront early traumas, lowered self-esteem, fantasies, phobias, behavioral troubles, broken marriages, character disorders, and personality. A patient’s quest for accurate self-knowledge begins in the fourth theater. The obvious problem, of course, is that a life of long-compromising influences flowing in from upstream alters one’s own self-observation, self-esteem, sense of self, and memory.

[k5890] The possibilities for change are bounded only by our imagination, our willingness to assess our brains accurately through self-reflection, and our commitment to do some hard work.

He gets grandiose at times.

[k5907] Not so. The brilliantly simple evidence from exciting new areas of physical and social science–complexity theory and tipping points–shows how powerful such universal factors can be in affecting the brain-body system.

[k5966] Several studies show that older men who have stayed in shape do better on mental tests than those who have not; indeed, they do just as well as men thirty to forty years younger. Aging brains may also decline in function owing to lower levels of dopamine crossing the synapses. Physical exercise elevates these dopamine levels.

[k5984] Hatha-yoga has been found to decrease excitability, aggressiveness, and somatic complaints and to enhance emotional and life satisfaction.

[k6235] Any activity that gives us a sense of purpose and accomplishment, that makes us feel glad to be alive, can help us care for and feed our brain. Many people put off doing what they love, or what they know they need to do for themselves, until later in life, trying to get the world’s demands out of the way first. What a grave mistake! It is far better to make sure that part of our lives is consumed with activities that we can put all our hearts, minds, energies, and joys into at once.

[k6242] Remember one important point: In pursuing your passion, the actual doing is what matters, not any measure of success. A diet of constant, stimulating activity is the best prescription for our troubles. It keeps the brain in a state of constant change, flow, confirmation, and anticipation, thereby reducing the noise, fragility, self-doubt, and stagnation with which we all have to contend.