Clinical director Marilyn Marks along with clinicians Nick Luchetti, Mary Tibbetts, and Kermit Cole compiled the following questions to inform our readers of Dan’s important work.
Windhorse: In your book Mindsight, you define mindsight as “a process that enables us to monitor and modify the flow of energy and information… sensing this flow within ourselves and within others through our relationships.” Also as “a very special lens that gives us the capacity to perceive the mind with greater clarity than ever before”. Is mindsight another word for mindfulness, and if not, what is the distinction between the two?
Dan: Mindfulness has been defined in many ways: As a form of being conscientious (as be mindful of what you eat), as an approach to learning that promotes creativity by avoiding premature closure of categories (in the work in mindful education of Ellen Langer), and in the ancient contemplative practices—such as yoga, tai’ chi’, quiqong, and mindfulness meditation in the Buddhist tradition—that promote what Jon Kabat-Zinn has described as paying attention, on purpose and non-judgmentally, to moment-to-moment experience. Mindsight is a term I created to approach the ways we see the internal world because my own professors in medical school seemed to focus only on the physical aspect of human reality—bodies, symptoms, diseases— rather than on the internal subjective, mental side of life. Over time, I found the drive to integrate a wide range of sciences into one framework to understand human development, lead to a view of a triangle of wellbeing that could sense energy and information flow within our brain (the extended nervous system), share in our relationships, and regulated by the mind. Mindsight is the ability to sense and shape this flow across each of these three aspects of human experience—brain, relationships, and mind—and move our lives toward integration. Integration is the linkage of differentiated aspects of a system whether that is a person, a couple, a family, a community, a society, or the planet itself. Integration creates harmony; lack of integration leads to chaos and/or rigidity. In these ways, mindsight embraces the power of mindfulness to promote what is called “integration of consciousness” in which we differentiate awareness from that which we are aware of. But mindsight moves us into new domains of integration beyond mindfulness, weaving a deep understanding of the brain and relationships into an approach to see our mental lives with more clarity and depth and move them more effectively toward health and well-being.
Windhorse: How has learning about mindfulness practice changed your relationship to your life and work?
Dan: Learning about mindfulness has been an important source of connection for me across the personal, clinical, and academic aspects of my life. Academically, it has been wonderful to weave the contemporary research on this ancient contemplative practice into our interpersonal neurobiology perspective that embraces all ways of seeking truth into a common synthesis of knowledge. Mindfulness researchers have worked hard with ingenious studies that support the notion that integration is at the heart of health and that intentional mental practice can transform the brain’s function and structure toward wellbeing. Clinically, I have found the formal practices of mindfulness training in meditation and yoga, tai’ chi’ and quiqong, to be helpful for my patients. And personally, I have not only found groups of like-minded people and made new friends in the world of mindfulness that have greatly enriched my life, but “coming out of the closet” as a mind-focused person in a profession that often has lost its mind has been of great value to me in this journey.
Windhorse: It seems that you discuss “the self” in ways that are similar to post-modern philosophers such as Derrida, Levinas, or Michel Henry, who have much to say that is relevant to psychology and psychotherapy. Can you tell us how they might have influenced you in your work? I would also wonder if Martin Buber’s influence on the interpersonal approach to psychotherapy has impacted you?
Dan: I am not trained in philosophy, though I love to think about issues of how we know what we know. So I can say that, unfortunately, I have no familiarity with any of these authors but am interested in learning about their perspectives. Trained as both a scientist and a clinician, working at the boundaries between the objective and the subjective, I have tried my best to stick very closely to carefully amassed research data and actual, lived experience. Ideas that emerge from these two very grounded but distinct ways of knowing have served as our source of conceptual framework building. That effort to bridge these two worlds of the objective and subjective and to keep up with the explosion of research in the various fields has kept me quite busy and quite full in terms of finding the “consilience” across their perspectives. Consilience, the effort to find parallel findings across independent ways of knowing, is the fundamental approach to creating the field of interpersonal neurobiology in which I work.
Windhorse: You also write about “interpersonal neurobiology.” Can you describe it briefly and its implications for your work?
Dan: At the beginning of the Decade of the Brain, the 1990’s, I was seeking ways to understand the link between mind and brain and I invited forty scientists to address this topic. We met for four years, exploring the insight from their various disciplines that ranged from anthropology to neurobiology, sociology to linguistics. In the course of that effort, it became clear that while the brain could be easily defined as a collection of neurons, embedded in the skull but a part of an extended nervous system distributed throughout the entire body, no one had a common description of the mind. And while people might say things like “the mind is just the activity of the brain” or “the mind is the what links people together in groups across generations”, there was no consensus on what “mind” is. And so, in an effort to keep the group going, as its facilitator I felt the need to come up with some working definition of the mind that could enable us to communicate respectfully and effectively with one another. The definition that ultimately I offered to the group—of which there was one hundred percent agreement—is this: “The mind can be defined as an embodied and relational process that regulates the flow of energy and information.” This was essentially the beginning of the field of Interpersonal Neurobiology—the effort to find the consilient view across a wide range of sciences, and now all ways of knowing from contemplative practices and the arts to clinical experience and religion—that now has its own professional library, training programs, and organizations. The essence of Interpersonal Neurobiology is that we use mindsight to promote integration that we view as the heart of health and well-being. Chaos and rigidity are present when integration is impaired; promoting the linkage of differentiated elements of a system leads to integration and the movement toward harmony. Being flexible, adaptive, coherent, energized, and stable are the fundamental features of an integrated state. While Interpersonal Neurobiology is not a form of therapy, it does inform how to understand our lives and human development and therefore is used to organize an approach to psychotherapy, education, family functioning, and organizational processes.
Windhorse: While reading Mindsight, I was impressed with the balanced interweaving of accessible scientific information, case histories, user-friendly tools for enhancing mindsight, and vignettes from your own personal experience. I have begun incorporating some of the concepts and tools in my work with clients, and find them appreciative of the hand model of the brain, the notion of implicit and explicit memory, the “wheel of awareness”, and the mindfulness exercises. Do you believe that these body-oriented components of healing are essential elements to integrate into traditional “talk therapy”, and why?
Dan: Thanks for your thoughtful reflections on the book, Mindsight. My wife reminds me that while the book has been in development for five years, it is really a lifetime’s work and so it is deeply moving to hear you say the ideas, stories, and practices are helpful. That makes all the energy and vulnerability of putting something new down on paper worthwhile. As I discuss in the book, the flow of energy and information is what we use to shape our lives. And words are only one “top-down” aspect of that flow, helpful yes, but limiting if we believe words have the “final say” on what is real! And so the stories in the book attempt to illustrate, with real life example from my own life or from clinical experiences as a therapist, how we can use integration of energy and information flow beneath, before, and beyond words to create health in our lives. Being body-oriented is one aspect of this non-worded approach, but this is just one part of the ways we can free the mind itself by focusing our attention on energy and information flow patterns. This is why the book is organized around mindsight—the learnable skill that can help people literally transform their lives by changing the very structure of their brains and the patterns of communication in their relationships. I will be very grateful if the stories make these empowering and scientifically grounded ideas accessible to the reader.
Windhorse: In your book you tell the story of Jonathon, a young man diagnosed with bipolar disorder, who experienced swings from depression and suicidal thoughts to manic symptoms and emotional dysregulation. Could you tell us how the combination of psychotherapy, mindfulness, healthy diet, and aerobic exercise alleviated his symptoms and precluded the need for psychotropic medications?
Dan: Offering stories of real clinical cases is a powerful way of illustrating ideas. Naturally, many people with serious psychiatric conditions may need a combination of approaches, including various psychotherapeutic interventions that can harness the power of the mind to change the brain as well as psychiatric medications. But the crucial point in Jonathon’s story is that, while “traditional” psychiatric treatment might only move to medications for someone diagnosed (by three board certified psychiatrists, including me) with bipolar disorder, we should also consider the science of neuroplasticity in creating our treatment strategies. Neuroplasticity is how the brain’s structure changes in response to experience. We now know that the focus of attention—the mind—can change the specific activity in the brain and therefore ultimately change the structure of the brain in those activated regions: Neurons that fire together, wire together. Knowing this, I wanted to offer this young adolescent patient, relatively new with his symptoms of dysregulation, the opportunity to see if we could use his mind to change his brain. I knew from writing the book, The Mindful Brain, that studies suggested that mindfulness practice might promote the growth of integrative fibers of the prefrontal cortex—ones that might be crucial in changing Jonathon’s brain from dysregulated to regulated. These prefrontal fibers send inhibitory axons down to the lower limbic areas—such as the amygdala—can calm those regions down when they become excessively irritated. Subsequent studies from Yale have actually shown that these prefrontal to amygdala inhibitory fibers are actually too few in number in those with bipolar disorder. So the idea was to use mindfulness practice to create a state of mindful awareness that would then, with repetition, become a trait of regulation and equanimity in Jonathon’s life. The harnessing of neuroplasticity was our goal, so I also offered Jonathon the strategies of aerobic exercise, sleep hygiene, good diet, and the close, careful focus of attention during mindfulness practice and journal writing reflections. This does not always work— people need to be up for this intense practice and diligent in their focus—but in Jonathon’s case it seems we could inspire him to rewire his brain. Years later now, he is still symptom free and doing great!
Windhorse: As I read Mindsight, I felt moved by the compassion that emanates from the pages of the book, and also by your statement that “Curiosity, openness, and acceptance are in many ways the fundamental ingredients of love”. Moment by moment, albeit imperfectly, clients and staff attempt to cultivate these states of being at Windhorse, and to return to them when we stray. As a scientist, physician, and board-certified psychiatrist, are you, in essence, offering us the psychoneurobiological basis for the healing potential of love?
Dan: Beautifully said. I hope so, and I hope by trying to carefully articulate the science of our inner life in this work, we’ll illuminate the mind, the brain, and our relationships so that we can have more love, kindness and compassion toward ourselves and toward others in this fragile and wonderful world in which we live.