Part 5 – Nature Plus Nurture: Mind in Context
By Dr. Dana Leigh Lyons, DOM, AP
This is Part 5 in an Alchemist’s Notebook blog series exploring places of resonance, merger and synergy between neuroplasticity and Taoist-inspired Chinese Medicine practice.
Three focal points frame the series: Change, Relationship and Process.
For an introduction and overview, see Part 1 – Parallels & Possibilities. For the three installments on Change, see Part 2 – On the Edge: Introducing Neuroplasticity, Part 3 – On the Path: Introducing Taoism and Part 4 – Past Meets Present: Plasticity in Practice.
Today, we bring you the first installment on our second focal point: Relationship.
Neuroplastic shifts are not exceptions, observable only in cases of significant pathology or prodigy. Rather, they represent the ordinary, everyday nature of our minds.
These shifts emerge within an interconnected body-mind system as well as through interaction of that system with the outside world. The mind then, is not only embodied; it is relational.
Neuronal connections are responsive, flexible and dynamic. Reflecting one of neuroplasticity’s key tenets, they operate on a “use it or lose it” basis (1).
The cerebral cortex, for instance, is constantly adjusting its maps to fit the tasks it encounters, and the “maps of normal body parts change every few weeks” (Doidge 47, 61).
When it comes to brain map “border zones,” measurable movement is even faster. At these sites of interface, brain areas “can expand quickly, within minutes, to respond to our moment-to-moment needs” (Doidge 276).
These needs—and the changes they engender—are intimately tied to environmental stimuli. As early as 1949, Canadian psychologist Donald Hebb posited that experience could alter neural structure and thus function, and pioneering neuroplasticity researcher Michael Merzenich later showed that simultaneously activating distinct neurons strengthened connections between them (Doidge 63).
In other words, environment and experience impact neural firing patterns, and “neurons that fire together wire together” (Doidge 63).
In revealing how environment and experience shape our brains, neuroplasticity research aligns with the science of epigenetics.
Bruce Lipton, a stem cell biologist by training, provides a synopsis of this emergent field in The Biology of Belief: Unleashing the Power of Consciousness, Matter and Miracles.
Epigenetics (literally, “control above genetics”) arose from evidence that environmental factors can alter genes without changing their DNA blueprints (2). Here, “environmental factors” encompass all non-inherited influences, including aspects of the external environment as well as internal states, thoughts and emotions.
The relationship between these factors and our genetic makeup can be understood in terms of a gene’s two basic functions.
Its “template function” allows for gene replication so that genetic copies are passed down through generations. This function represents the predetermined side of the nature-versus-nurture equation in the sense that we cannot influence it directly, through our actions and thoughts (Doidge 220).
Meanwhile, the “transcription function” involves transcribing information from the gene about how to generate new proteins. Although each of our cells contains all our genes, transcription only occurs when a gene is turned on, or “expressed”; the protein created as a result modifies cell form and function.
Epigeneticists have shown that our environment, experience, actions and even thoughts influence whether a gene is expressed and whether transcription takes place (3).
And Nobel-Prize-winning physician, psychiatrist and scientist Eric Kandel has demonstrated the role learning plays in this process. Studies by Kandel and colleagues showed that “when we learn our minds also affect which genes in our neurons are transcribed,” allowing us to “shape our genes, which in turn shape our brain’s microscopic anatomy” (Doidge 220).
Taking this further, epigeneticists assert that modifications arising from environmentally (and mental-emotionally) influenced gene expression “can be passed on to future generations as surely as DNA blueprints” (Lipton 37).
An emergent sub-field, known as behavioral epigenetics, is producing growing evidence that experiences not only alter our genes, but alter them in ways that “stick.”
The experiences of our parents and grandparents thus play a role in shaping our genetic makeup (and through that, our preferences, tendencies, strengths and weaknesses).
So, for example, “traumatic experiences in our past, or in our recent ancestors’ past, leave molecular scars adhering to our DNA” (4). The same mechanism applies to “positive” experiences and resulting imprints, such as those left by maternal nurturance.
Crucially, these new findings do not point to inevitable outcomes. Rather, they underscore our capacity to change ourselves as well as generations to come.
As Dan Hurley writes: “The genome has long been known as the blueprint of life, but the epigenome is life’s Etch A Sketch: Shake it hard enough, and you can wipe clean the family curse” (5).
And as science editor and writer Jonah Lehrer eloquently summarizes in Proust Was a Neuroscientist (6):
“What makes us human, and what makes each of us his or her own human, is not simply the genes that we have buried in our base pairs, but how our cells, in dialog with our environment, feed back into our DNA, changing the way we read ourselves. Life is a dialectic… Our human DNA is defined by its multiplicity of possible meanings; it is a code that requires context.”
This interplay between genes and environment shapes the brain throughout our lives.
Emphasizing its role in childhood, physician and addictions expert Gabor Maté maintains: “The three environmental conditions absolutely essential to optimal human brain development are nutrition, physical security and consistent emotional nurturing” (6).
And at any age, existing in a “socially and cognitively enriched environment” is conducive to neural health and regeneration (7).
Animal studies have shown that living in stimulating settings or engaging in regular mental training increases brain weight by 5 percent in the cerebral cortex (and up to 9 percent in targeted brain areas), with neurons increasing in size, blood supply, number of branches and number of connections (Doidge 43).
As Doidge notes, these effects on brain structure have been observed in “all types of animals tested to date,” while post-mortem exams on humans have shown that education increases neural branches and thus brain volume and thickness (Doidge 43).
Such studies demonstrate that the brain is not a passive recipient of environmental influences (any more than it is of genetic code). Rather, it is an active participant. It takes form and re-forms in response to interactions of the whole body-mind within an environmental and genetic context.
And as “self-conscious” beings able to observe and influence how we respond to environmental stimuli, we “co-create” our “destiny” (Lipton 104).
This interface and interaction is the stuff of experience, and experience shapes a plastic brain. As we act in the world and are acted upon, “pre-existing but little used connections” and pathways can “become unmasked and start carrying traffic” (Begley 109).
In this way, the merger of genes and environment engenders and continuously adjusts body-mind patterns.
Manifestations include subtle shifts as well as dramatic transformations in cognitive abilities, emotional tendencies, motor skills, sensory sensitivity, and conscious or subconscious habits and routines.
Configuring Brain Space
The neuroplasticity of an embodied, relational brain offers promise in the form of expanded possibilities and potential.
It means that through learning—and unlearning—we can literally change our minds.
In the process, we alter our physical brains (and bodies) as well as our experience of the world.
And yet, this inherent malleability is not inherently welcome.
Lipton underscores potentially unwanted ramifications of the relational brain’s “ability to ‘learn’ perceptions,” such as when unwanted “programs” of the subconscious mind result in “limiting behaviors” (or limiting beliefs) (Lipton 104).
Doidge, in turn, points to a “plastic paradox,” whereby “the same neuroplastic properties that allow us to change our brains and produce more flexible behaviors can also allow us to produce more rigid ones” (Doidge 242).
Because the brain operates in accordance with the principles of “use it or lose it” and “neurons that fire together wire together,” neural circuits have a tendency “to become self-sustaining” (Doidge 242).
Repetition in behavior or thought lends itself to rigidity, stagnation and inertia.
Once again, this “plastic paradox” is embodied and relational, as illustrated by the neuroplastic effects of depression, emotional stress and childhood trauma.
All three stem (at least partially) from experience and environment, existing at the interface between self and world.
All three also stimulate release of glucocorticoids, our so-called stress hormones, which in turn destroy cells in the brain’s hippocampus and cause memory loss (Begley 70; Doidge 241).
In other words, mental-emotional pathology—which usually unfolds in relationship—causes a plastic brain to “lose essential cortical real estate” (Doidge 241).
Meanwhile, feelings of well-being arising from emotional nurturance engender the opposite effect.
In the words of psychiatrist Daniel Siegel, a founding member of the Center for Culture, Brain and Development (University of California – Los Angles): “Human connections create neuronal connections” (8).
Efforts to circumvent plasticity’s perils and understand its capacity to beget both flexibility and rigidity draw on the science of learning and unlearning.
Equally essential aspects of neuroplasticity, learning and unlearning each involve a chemical process at the neuronal level (Doidge 117). With learning, the process of “long-term potentiation” strengthens connections between neurons. With unlearning, the process of “long-term depression” weakens them.
Walter Freeman, a neuroscience professor at the University of California – Berkeley, maintains that these mechanisms are rooted relationship. His theory on the neuromodulator oxytocin illustrates this premise (Doidge 121).
Oxytocin (together with vasopressin) is considered one of two main “sociability hormones” (Begley 179). It is released when we fall in love, start parenting children, have an orgasm or experience comforting physical contact. Because it strengthens bonding and feelings of attachment, it is sometimes called “the cuddling or the commitment neuromodulator” (9).
But Freeman contends oxytocin also precipitates “massive unlearning and neuronal reorganization” (Doidge 119). He posits that it “melts down existing neuronal connections that underlie existing attachments, so new attachments can be formed” (Doidge 120).
Unlearning, initiated in interpersonal context, thus creates space for new learning—and new relationships—to emerge.
Oxytocin is just one part of this story. Another lead role in embodied, relational plasticity goes to the neurotransmitter dopamine, “one of the brain’s ‘feel good’ chemicals” (10).
Dopamine release reinforces neuronal connections associated with reward- and pleasure-inducing behaviors.
Anything that triggers a massive dopamine surge—mania, falling in love or taking cocaine, for instance—activates pleasure centers in brain’s limbic system and also lowers their firing threshold, causing heightened sensitivity to pleasure from any source and diminished sensitivity to displeasure or pain (Doidge 113).
Doidge calls this effect “globalization” and says it makes falling in love “a powerful catalyst for plastic change” (Doidge 114).
It promotes learning by strengthening neuronal connections associated with dopamine release. And, on account of the competitive nature of neuronal firing patterns, it also facilitates unlearning behaviors not involved in the dopamine spike.
The range of potential outcomes attests to neuroplasticity’s promises and pitfalls. Reconfigured brain space may manifest desirable shifts in body-mind patterns or, alternatively, addiction to harmful substances, behaviors or emotional states.
Oxytocin and dopamine are but two neurochemicals involved in shaping an always-changing brain. Here, they serve to illustrate the embodied, transactional nature of learning and unlearning—processes at the core of neuroplasticity and the “plastic paradox.”
Within a clinical setting, these characteristics of neuroplasticity guide efforts to effect therapeutic shifts.
The patient-practitioner interface is an important aspect of this picture.
Because gene expression occurs in response to environment and experience—and because learning and unlearning occur in relationship—this interface offers a powerful arena of influence.
And when it comes to optimizing influence and outcomes, neuroscientists have shown that patient and practitioner perception plays a paramount part.
As epigeneticists and pioneering neuroscientist Candace Pert have demonstrated, perception is not just “in the mind.” Exerting a very real, very physical influence, it creates changes in matter and function throughout the human system.
In so doing, it affects the brain’s capacity to either support or impede the innate wisdom of the body-mind and its tendency to move toward balance. Lipton thus contends that doctors “should not dismiss the power of the mind as something inferior to the power of chemicals and the scalpel” (Lipton 108).
Indeed, he asserts: “when doctors wearing a white coat deliver a treatment decisively, patients may believe the treatment works—and so it does, whether it is a real drug or just a sugar pill” (Lipton 109).
Rather than dismiss or downplay this outcome, Lipton advocates its research-based cultivation. He insists: “If medical researchers could figure out how to leverage the placebo effect, they would hand doctors an efficient, energy-based, side effect-free tool to treat disease” (Lipton 108).
Physician Ted Kaptchuk, conducting such research at Harvard Medical School, maintains that the “ritual of medicine,” including “the environmental cues and the behavior of an authority figure,” causes “catalytic” changes in neurochemistry (11).
And because the mind is embodied, these changes result in system-wide shifts.
Research has demonstrated that perceptions and emotions exert powerful effects on the autonomic nervous system (and thus the functions it controls, such as respiration, circulation and digestion).
It has shown an equally significant impact on voluntary muscle regulation.
In one prominent study on Parkinson’s disease, for example, patients receiving a placebo experienced outcomes comparable to those taking a drug that mimics dopamine (which declines in Parkinson’s, resulting in diminished muscle control) (12). Their brains released as much dopamine as those on the active drug, and they showed similar improvements in voluntary muscle coordination.
In another example, a recent study using brain imaging found that subjects’ expectation that pain medication would be effective doubled the impact of the administered drug, while expectation that it would be ineffective reduced its impact (13).
More than “just” affecting subjective symptoms, expectations elicited measurable responses in brain areas associated with pain. Expectation of pain alleviation was accompanied by increased activity in the anterior cingulate cortex (part of the brain involved in reward anticipation and rational cognitive functions) and the striatum (part of the brain involved in balance and movement).
Meanwhile, expectation of pain aggravation was accompanied by increased activity in the hippocampus, mid-cingulate cortex and medial prefrontal cortex (parts of the brain involved in mediating mood and anxiety).
Underscoring this capacity of thoughts, as “the mind’s energy,” to “directly influence how the physical brain controls the body’s physiology,” Lipton renames the placebo effect the “belief effect” (Lipton 95).
Crucially, these “thoughts” need not be conscious.
Indeed, “neuroscience has now established that the conscious mind runs the show, at best, only about 5 percent of the time”; meanwhile, the subconscious mind patterns “95 percent or more of our life experiences” (Lipton 98).
And once again, our subconscious mind takes shape in relationship.
Lipton goes so far as to state: “Our lives are essentially a printout of our subconscious programs, behaviors that were fundamentally acquired from others.” Evincing plasticity’s paradoxical potential, these programes are often “limiting and disempowering” yet “can be quickly rewritten.” (Lipton 98)
Physician Jerome Groopman explores the biology behind this phenomenon and its impact on recovery and well-being in The Anatomy of Hope: How People Prevail in the Face of Illness.
Early in his career, as a medical student and young practitioner, Groopman dismissed “the fairy-tale claims of hope.” Later, after 30 years of practice and research in hematology and oncology and after suffering a failed spinal surgery, he came to view it “as important as any medication…or any procedure.” (Groopman xvi)
Summarizing the changes hope can evoke in an embodied, neuroplastic mind, Groopman writes:
“Belief and expectation—the key elements of hope—can block pain by releasing the brain’s endorphins and enkephalins, mimicking the effects of morphine. In some cases, hope can also have important effects on fundamental physiological processes like respiration, circulation, and motor function. During the course of an illness, then, hope can be imagined as a domino effect, a chain reaction in which each link makes improvement more likely. It changes us profoundly in spirit and body.” (Groopman xvi-xvii)
Pain offers one example of how this works.
The brain and spinal cord contain “on cells” that convey pain signals and “off cells” that block them (Groopman 169). Opiate drugs, such as morphine, inhibit the “on cells,” leaving the “off cells” free to counter pain.
As Groopman notes, belief and expectation trigger the brain’s release of its own opiate-like chemicals: endorphins and enkephalins. They may also inhibit release of central nervous system chemicals that “amplify” pain, including substance P and cholecystokinin (Groopman 173).
Like Lipton and Kaptchuk, Groopman underscores the role of relationship in this process.
Because neuronal networks involved in “the very complex feeling we know as hope” are part of a plastic, embodied, relational mind, “events in our lives modify them” (Groopman 190).
The practitioner’s “words” and “gestures” can thus influence a patient’s “synaptic connections” and their system-wide effects, potentially boosting therapeutic prospects (Groopman 190).
Crucially, the power to leverage the “belief effect” hinges not only on patient perceptions, but also on those of the practitioner.
Lipton relates the account of a young physician, Albert Mason, who in 1952 cured a 15-year-old boy’s “warts” using hypnosis (Lipton 93). An inexperienced doctor, he did not recognize that the boy’s “warts” were actually due to congenital ichthyosis—a lethal disease causing thickened, scaly skin. Only later did Mason learn he had cured an “incurable” disease. And yet, when news of his success brought scores of patients seeking cure, he was unable to replicate the results—a failure he ascribes to his own shift in expectations. Once Mason knew he was treating an “incurable” disease, “he couldn’t replicate his cocky attitude as a young physician treating a bad case of warts” (Lipton 94). Simply “acting” optimistic did not change his beliefs about the prognosis and did not produce successful results.
The point here is not that perception is a panacea for disease or (necessarily) the determining factor in recovery.
But in a plastic, embodied mind, it is one important element.
And the conscious and subconscious beliefs of both parties influence its role in therapeutic relationship.
In our next installment on Relationship, we will explore Taoist perspectives on “pre- and post-heaven” influences and interfacing with others and our world. Looking at concepts such as qi as well as principles for guiding and shaping transformation, we will then investigate implications for the patient-practitioner relationship.
1. Norman Doidge, The Brain that Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science (Penguin Books, 2007), 61. Citations of Doidge here are from this work.
2. Bruce H. Lipton, The Biology of Belief: Unleashing the Power of Consciousness, Matter and Miracles (Elite Books, 2005), 37. Citations of Lipton here are from this work.
3. See, for example: Thomas Lewis, Fari Amini and Richard Lannon, A General Theory of Love (Vintage Books, 2000), 152; Lipton, 37.
4. Dan Hurley, “Grandma’s Experiences Leave a Mark on Your Genes,” Discover Magazine (June 11, 2013); available online at: http://discovermagazine.com/2013/may/13-grandmas-experiences-leave-epigenetic-mark-on-your-genes#.Ux3lf_SwL-Q
6. Jonah Lehrer, Proust Was a Neuroscientist (Houghton Mifflin, 2007), 44-45. Lehrer has also worked in Kandel’s lab; in Proust Was a Neuroscientist, he explores how 19th- and 20th-century artists and visionaries intuited truths about the mind that were subsequently “discovered” by neuroscientists.
7. Gabor Maté, In the Realm of the Hungry Ghosts: Close Encounters with Addiction (Vintage Canada, 2009), 185.
6. Sharon Begley, Train Your Mind, Change Your Brain: How a New Science Reveals Our Extraordinary Potential to Transform Ourselves (Foreword by the Dalai Lama) (Ballantine Books, 2007), 57. Citations of Begley here are from this work.
8. Daniel Siegel qtd. in Maté, 185.
9. John B. Arden, Rewire Your Brain: Think Your Way to a Better Life (John Wiley & Sons, 2010), 163
10. Maté, 143.
11. Jerome Groopman, The Anatomy of Hope: How People Prevail in the Face of Illness (Random House, 2004), 174. Citations of Groopman here are from this work.
12. Ibid, 181.
13. Ulrike Bingel, et al. “The Effect of Treatment Expectation on Drug Efficacy: Imaging the Analgesic Benefit of the Opioid Remifentanil,” in Science Translational Medicine 3 (16 Feb. 2011), 70.