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The social brain
Winn: So it is all on a range of normal?
Ratey: I'd say it's just a range. I think we are challenged to say what is normal any more. I'm certainly not one who has ever been accused of being politically correct and I rebel against those kinds of things.
Winn: Can we look at some of the effects that differences in the ventromedial cortex cause?
Ratey: Yes, a lot of interesting work has been done, mainly by the distinguished neurologist Antonio Damasio but also others, looking at this key area. The ventromedial cortex is a section of the frontal lobes and it is responsible for the emotion that colours our decision making processes, especially in the personal-social realm.
Contrary to the popular notion that decision making requires a cool head, it is feelings that point us in the right direction, and help us make moral, personal, predictive and planning decisions. This particular area is crucial not only for knowing, understanding and controlling our own emotional experience but also knowing that other people have their own emotional experience.
In one of Damasio's famous cases, a man called Elliot had part of the tissue from the ventromedial cortex removed because it was damaged by a tumour. Whereas Elliot had been a capable businessman and caring husband before, he was very different afterwards. He moved and spoke as he had before, but he started to make bad work and personal decisions. He lost his job because he couldn't prioritise his work, instead getting hooked on insignificant detail which might occupy him for an entire day, such as whether to sort a stack of documents by date or name. He then set up partnerships with con men and lost all his money, and then divorced his wife to marry a prostitute, whom he later divorced as well.
Tests showed he had perfectly normal intellect but a dearth of emotional reactions. Since then Damasio has identified 12 other patients with similar brain damage and a resultant lack of emotion and poor social judgement, leading to appalling social decision making.
Winn: You mention quite a few areas of the brain in connection with social effects and there isn't room to explore them all here. But I would like to ask you about the role of a region called the anterior cingulate gyrus. This is in the centre of the brain and is, among other things, concerned with free will.
Disturbances in this area, which can be caused by epilepsy, surgery, chemical imbalance and so on, can have social/emotional effects as diverse as apathy, impulsiveness, disinhibition, psychosis and obsessive compulsive behaviour. It seems to be implicated in Tourette syndrome, where people often develop marked physical tics and come out with torrents of foul language — a strange set of symptoms which make remarkable sense to me now, when looked at from this viewpoint. Has the Tourette's connection been known about for some time, or is it recent?
Ratey: It's recent. It certainly makes sense that the cingulate is an important way station in our emotional life. It's connected to what we call the obsessive compulsive disorder (OCD) circuit. There's a reverberating circuit effect and so a thought or action just keeps going and going and going. The cingulate is involved in a lot of different pathologies, and so it should be, because it controls output and input from our bodies' sympathetic nervous system. It's the command centre for action and excitement. If you have damage on both sides of the cingulate, then you are not going to initiate much.
Winn: But many of the sort of things we've been discussing can be altered by training or practice, I think you say.
Ratey: Oh, I think so. Some of my people who have these differences, if you give them the right scripts, they can learn how to do it.
Winn: Can you give me an example?
Ratey: Okay, well, let's go to an extreme. In some of the autism centres in the United States, one of the big training methods is to develop social practice sessions early on. The kids are taught not just to ask, "How are you?" in a contact with someone they know, but to ask a second question, which focuses on remembering something about that person and asking something personal like, "How did it go for you yesterday, at the test?" or whatever. That can be done through training. A study showed that just doing that really increased children's socialisation.
It is the same thing with my engineers or my computer people. It is enormously helpful just getting them to modify the way they talk on the phone or to realise that, when they meet people, they don't have to just talk and talk and talk, which some of them do and which then chases everybody away. Getting focused solely on answering another person's question about themselves, instead of asking their own questions, ruins a lot of social interactions. Just by changing the script, or rather, by giving them a script, one can see a big change.
Winn: And does it then become second nature to them to behave that way?
Ratey: Exactly. They get the practice. My people, when I see them in their 20s, are absolutely brilliant in their fields but they don't know the first thing about social relationships because they haven't had any practice in any.
By the time they get to their teens, they are really social phobics. They have terrific anxiety in any social situation because they have been such a failure at them.
Winn: Getting people to practise these sorts of things are what many therapists have been doing, regardless of knowing about whether there are differences in the brain which explain the development of the behaviour in the first place. So how does knowing what is going on in the brain help us?
Ratey: It helps us to be aware of what's going on and get in earlier. Say a child of four or five, just starting school, is having a difficult time socially. If you begin to look at what the problem is and deconstruct it, then your prescription of the remedy is going to be much better informed.
Winn: Whereas they tend to be written off as ...
Ratey: ... as kids who don't want to get involved, who really like being off by themselves, when that is not the case at all for many of these children. They really do want to be involved with others, but they just don't know how to do it. Even these kids who don't know how to share, and don't particularly want to share, they really feel the pangs and they want to have friends, but don't know why they can't.
Sometimes it's as easy as just giving an instruction — it's as simple as that, sometimes — and people's lives could be so different. I recently saw a guy who was in some kind of support group where the leader asked a question, and in reply he just talked and talked and talked and wouldn't let her respond. She called him on it, and instead of feeling hurt, he said, "Oh, my god, thank you." So a lot of the time, it is just a matter of bringing these things to light.
© Human Givens Limited, Denise Winn and John Ratey (2001)
This article first appeared in Volume 8, No, 1 (2001) of the Human Givens journal.
JOHN RATEY is associate clinical professor of psychiatry at Harvard Medical School. He is co-author of Driven to Distraction, Answers to Distraction and Shadow Syndromes and his latest book is, A User's Guide to the Brain.
DENISE WINN is the editor of the Human Givens Journal.
> More information on the human givens approach can be found in the following book by Joe Griffin and Ivan Tyrrell
> You can find out more about the issues raised in this article on the following Human Givens College events:
From stress to psychosis: How to prevent people having breakdowns (one-day course)