FOREWORD
Want to have more joy and contentment in your life? All the scientific studies of happiness, longevity, and mental and medical health point to one factor: the strength of your relationships with others. In Four Ways to Click, psychiatrist Amy Banks, M.D., provides an innovative and user-friendly summary of the extensive research on the neuroscience of relationships and offers readers practical ways to use this knowledge to retrain their brains for healthier, more rewarding relationships. What’s in this for you? Simply put, you can intentionally transform your life by improving how you connect with others. Relationships are not simply the “icing on the cake” for a life well lived. Relationships are the cake.
After decades of studying how culture shapes our relationships as well as working as a psychiatrist in clinical practice, Amy Banks has brilliantly created what she calls the C.A.R.E. system, which can help improve the four ways we “click” with one another: how calm we feel around others, are accepted by others, resonate with the inner states of others, and are energized by these connections. Using the C.A.R.E. system as it is described in this book, readers can target the neural pathways that need fine-tuning so that the quality of their relationships increases. With an understanding of how our brains truly work we can intentionally change how we live our lives!
I love this book! It is beautifully written, engaging, and inspiring.
Want more happiness? Want to live longer? Want to be healthier in mind and body? Then learning these four ways to click into more meaningful and rewarding relationships is your passport to achieving these goals. Let Amy Banks be your guide to a better life of love and laughter. Enjoy!
—DANIEL J. SIEGEL, M.D.
Chapter 1
BOUNDARIES ARE OVERRATED
A New Way of Looking at Relationships
Boundaries are overrated.
If you want healthier, more mature relationships; if you want to stop repeating old patterns that cause you pain; if you are tired of feeling emotionally disconnected from the people you spend your time with; if you want to grow your inner life, you can begin by questioning the idea that there is a clear, crisp line between you and the people you interact with most frequently.
People who talk a lot about boundaries tend to make statements like these:
“It shouldn’t matter what other people do and say to you, not if you have a strong sense of self.”
“How do parents know they’ve been successful? When their children no longer need them.”
“Best friends and true romance are for the young. As you get older, you naturally grow apart from other people.”
“You shouldn’t need other people to complete you.”
“You wouldn’t have so many problems if you would just stand on your own two feet.”
The message is clear: it’s not “healthy” to need other people—and whatever you do, don’t let yourself be infected by other peoples’ feelings, thoughts, and emotions. The statements above are intended to have an emotional effect on you. You may notice that they sound just a teensy bit judgmental and shaming. I know they make me uncomfortable; when I read them, I feel like I’m standing in a harsh white spotlight with someone pointing a finger at me, intoning You’re pretty messed up, missy, and it’s all your fault.
The ideal of complete psychological independence is one that was very big with mental health professionals in much of the twentieth century, and it still has our culture by the throat. So even if those statements about boundaries carry a sting, they also probably sound familiar to you, or even self-evident. Obvious!
So I couldn’t possibly be suggesting that they’re untrue. I couldn’t possibly say that it can be good to be dependent, or that our mental health is unavoidably affected by the people we share our lives with, or that we achieve emotional growth when we are profoundly connected to others instead of when we are apart from them.
That’s exactly what I’m saying.
This book is going to show you a different way of thinking about your emotional needs and what it means to be a healthy, mature adult. A new field of scientific study, one I call relational neuroscience, has shown us that there is hardwiring throughout our brains and bodies designed to help us engage in satisfying emotional connection with others. This hardwiring includes four primary neural pathways that are featured in this book. Relational neuroscience has also shown that when we are cut off from others, these neural pathways suffer. The result is a neurological cascade that can result in chronic irritability and anger, depression, addiction, and chronic physical illness. We are just not as healthy when we try to stand on our own, and that’s because the human brain is built to operate within a network of caring human relationships. How do we reach our personal and professional potential? By being warmly, safely connected to partners, friends, coworkers, and family. Only then do our neural pathways get the stimulation they need to make our brains calmer, more tolerant, more resonant, and more productive.
The good news for those of us whose relationships don’t always feel so warm or safe: it is possible to heal and strengthen those four neural pathways that are weakened when you don’t have strong connections. Relationships and your brain form a virtuous circle, so by strengthening your neural pathways for connection, you will also make it easier to build the healthy relationships that are essential for your psychological and physical health.
For many people, the news about the importance of relationships began with a 1998 study at the University of Parma in Italy, a study that proved how deeply connected we are to one another, right down to our neurons.
Your Feelings, My Brain
It was one of those lucky scientific mistakes, an unexpected observation that could have easily gone unnoticed if it hadn’t been for an astute researcher. When Giacomo Rizzolatti, a neurophysicist at the University of Parma, and his research team began their now-famous experiment, they were not intending to explore how human beings interact. In fact, they were not even studying people. The Italian researchers were mapping a small area, known as F5, in the brains of the macaque monkey. At this point in neurological research, it was already well known that the F5 neurons fire when a monkey reaches his arm and hand away from his body to grasp an object.
One routine day in the lab, a researcher observed something unprecedented. The researcher was standing in the line of sight of a monkey whose F5 cells had been implanted with micro-sized electrodes. As the researcher reached out to grasp an object, the electrodes placed on the monkey’s F5 area activated.
Remember: it was known that the F5 neurons activate when a monkey moves his arm to grasp something.
Then think about this: the monkey was not moving his arm; he was simply watching as the researcher’s arm moved.
This seemed impossible. At the time of this observation, scientists believed that the nerve cells for action were separate and distinct from the nerve cells for sensory observations. Sensory neurons picked up information from the outside world; motor neurons were devoted to acting. So when the F5 area, known for its link to physical action, lit up in the brain of a monkey who was only watching action in someone else, it was a clear violation of this known divide. It was as if the brain of the monkey and the brain of the researcher were somehow synchronized. Even more unsettling, it was as if their brains overlapped, as if the researcher’s physical movement existed inside the monkey.1
As Rizzolatti and other neuroscientists pursued this odd observation, they found that human brains also demonstrate this mirroring effect. In other words, you understand me by performing an act of internal mimicry—by letting some of my actions and feelings into your head. Ask a friend to briskly rub her hands together as you watch. Chances are that as her hands become warm from the friction, your hands will start to feel warm, too. In the aftermath of the monkey experiment, it was hypothesized that our brains contain mirror neurons, nerve cells that are dedicated to the task of imitating others. Most scientists no longer feel that specific mirror neurons exist; instead, there is a brainwide mirroring system whose tasks are shared by a number of regions and pathways. The imitating effect—the reason your hands warm up when your friend rubs hers together—happens because neural circuits throughout your brain are copying what you hear and see. Nerves in your frontal and prefrontal cortex (the same ones that are activated when you plan to rub your own hands together and then execute that plan) begin to fire. At the same time, neurons in your somatosensory cortex, which is the area of the brain responsible for bodily sensations, activate and send you messages of friction and warmth. Deep inside your brain, your hands are rubbing themselves together—even if your hands don’t actually move.
Actually, the process goes far beyond the mere reflection of another person’s actions. Your mirroring system is made up of neurons that can “see” or “hear” what someone else is doing. The system then recruits neurons from other areas of the brain to provide you with input not just about sensations and actions but about emotions, too. This input lets you have a comprehensive, detailed imitation of what the other person is experiencing. That’s why you can almost instantly pick up on the emotion of another person. If you watch as I rub my hands together, your brain might read the excitement on my face as I demonstrate how the mirroring system works—and you may feel some of that excitement. If you’ve ever “caught” a smile that you spotted on the face of a complete stranger, or if the silent tension of your partner has caused your own heart to race, you’ve experienced the effects of the mirroring system. This emotional contagion is caused by a neural pathway that can, in effect, take in another person’s feelings and replicate them squarely inside you.
When I ask groups of people to try the hand-rubbing experiment, there are usually two sets of reactions. Some people are amazed, as if they’ve just watched themselves pull a rabbit out of a hat. Their neurological connection with others feels like magic. But other people immediately say, “This is creepy!”
I get it. When you’ve been taught all your life that your mind is its own little castle, one that’s surrounded by a thick, high wall that’s designed to keep your thoughts and feelings in and everyone else’s out, it can be unsettling to learn about the power of the mirroring system. And in fact, the discovery of our mirroring ability challenges some traditional assumptions about how our brains and bodies are wired. Vittorio Gallese, a neurophysiologist in the Parma lab, described the role of the mirroring system in human interactions this way: “The neural mechanism is involuntary, with it we don’t have to think about what other people are doing or feeling, we simply know.”2 Marco Iacoboni, a professor of psychiatry at UCLA, takes it one step further in his book Mirroring People. He says that the mirroring system helps us in “understanding our existential condition and our involvement with others. [It shows] that we are not alone, but are biologically wired and evolutionarily designed to be deeply interconnected with one another.”3
When you and I interact, an impression of the interaction is left on my nervous system. I literally carry my contact with you around inside me, as a neuronal imprint. The next time you hear someone say, “Don’t let other people affect how you feel,” remember the mirroring system. Because we don’t really have a choice. For good or for bad, other people affect us, and we are not as separate from one another as psychologists once thought.
Maturity Has a New Meaning
When I say that boundaries are overrated, I don’t mean that there are absolutely no boundaries, or that all of humanity is just one big, undifferentiated, brownish-beige lump. Nor am I suggesting that anyone give up her or his own distinct personality for the sake of fitting in with a cozy, companionable group. No therapist I know believes that it’s healthy to abandon your beliefs, preferences, and quirks for the sake of a smoothly running—and bland—larger whole.
For decades, in fact, psychology moved in the other direction, in the belief that the only path to human growth was traveled via emotional separation. According to separation-individuation theory, which was most energetically advanced by Margaret Mahler in the 1970s, we all begin our work of separation in the first six or seven months of life, when we start to realize that our caregiver is a person distinct from ourselves. Separation-individuation theory holds that the rest of life is a variation on this discovery. In the practicing stage of human development, we supposedly practice separation by crawling or toddling away from our mothers and then returning to their arms. In the object constancy stage, we develop the capacity to hold an abstract image of Mom in our minds, meaning that we are secure enough to venture farther and farther away from her, thus developing our independence. As school-aged children, we become more aggressive in an attempt to move forward with our individual desires. In adolescence, we move further away from our parents by developing a sexual identity and pairing off with our peers. Adulthood? It’s a constant process of refining our ability to stand on our own, soothe our own distress, and solve our own problems. With each stage, the boundary between the self and other people grows stronger, more solid. Separation-individuation theory has been written about in thousands of books and dissertations, but here’s a micro-summary: in order to grow, we must step farther and farther away from others. The fully mature person may enjoy other people but doesn’t really need them. He is defined by the firm boundaries between himself and other people, and within those boundaries he is a self-sufficient being.
Even before the mirroring system came on the scene, and before relational neuroscience began to turn up additional evidence for the biological basis of human connectedness, some in the field wondered whether the separation model had gone too far. In the 1970s, a forward-looking group of Boston mental health experts—psychiatrist Jean Baker Miller and psychologists Judith V. Jordan, Irene Stiver, and Janet Surrey—noticed that their patients weren’t suffering from poor boundaries. They weren’t suffering from a lack of personal independence from others. What they suffered from was a lack of healthy human connection. As Judith Jordan notes, “The Separate Self model has wrongly suggested that we are intrinsically motivated to build firmer boundaries, gain power over other people in order to establish safety, and compete with others for scarce resources. Mutuality helps us see that human beings thrive in relationships in which both people are growing and contributing to good connection.”4
When you look at relationships this way, it’s possible to take the stages of development according to separation-individuation theory and cast them in a warmer light. When an infant crawls away from her mother, she’s not trying to separate from humanity. Instead, the baby is expanding her relational world; she’s moving toward more connections, toward the big world and the people who populate that world, before scooting back to enjoy her relationship with her mother. A toddler who learns object constancy isn’t building the ability to get away from Mom; by developing a mental image of her mother, she’s able to carry Mom with her wherever she goes. She’s learning a skill necessary for sustaining relationships over distance and time. As school-aged children interact with their peers and make mistakes, they learn how to manage relationships. Teenagers expand their relational worlds even further; they negotiate sexual relationships, and they have to learn how to become part of a group without succumbing to peer pressure. This reinterpretation of developmental growth has an overarching theme: human beings don’t mature by separating. Instead, they grow toward a greater and greater relational complexity. This approach to human development has a name: relational-cultural theory, or RCT. As a young psychiatrist, I found that RCT was more effective than any other theory, including separation-individuation, in helping people heal and helping them grow. I’ve spent twenty years applying RCT to the problems of my patients and the disconnected world they—and we—live in.
Separation theory and RCT have a few ideas in common: to be healthy, you have to know who you are; what your feelings and thoughts are; that other people have thoughts and feelings, too; and you have to be able to differentiate yourself within a relationship. But in separation theory, you’re learning all this in order to eventually walk away. You can still forge bonds and be part of a community if you want to, but your role as an adult has to be earned by your ability to tough things out on your own. This is a psychology that emphasizes a defensive stance, because you’re always defining and protecting your boundaries. You’re wary of being invaded by other people’s emotions and problems. In fact, this is how Freud saw the condition of being alive: “For the living organism protection against stimuli is almost a more important task than reception of stimuli.”5 It’s sad, isn’t it? In separation theory, there is always a wall between you and other people.
In RCT, there are no walls between people. Good relationships are the rich soil in which people grow and bloom. A good relationship with your parents helps you feel safe enough to approach other people and make a connection with them. A good relationship with your peers helps you try out who you are, practice your skills of empathy, and learn communication. As your skills for relationship grow, so does your desire for more relationship.
Relational-cultural theory doesn’t imagine people as defined by boundaries; it sees relationships as more like a magician’s linking rings. The rings are a set, but they are not stuck in a rigid configuration. They can move far apart and they can move closer together. And they can—this is the magic part—temporarily interconnect and overlap, just as they do when you watch someone rub his hands together and feel the warmth in your own. Or when you sometimes feel like you’re in another person’s skin, finishing their sentences or feeling their sadness. There’s flexibility and movement in this definition of relationship. You come together, experiencing each other; and then you move away again so that you can absorb what you’ve learned. Relationships are a dynamic process of experiencing, learning, and integrating your knowledge so that you are able to see both yourself and the other person more deeply and more clearly.
Jean Baker Miller liked to talk about “growth-fostering relationships,” a wonderfully descriptive term that suggests just the right idea: relationships aren’t an end in themselves. Although a relationship can be a safe harbor, it is never just that. It also helps you grow. A good relationship helps you and the other person develop clarity about yourselves; promotes your self-worth; makes you more productive at your work; and it gives you an appetite for more relationships. In Baker Miller’s language, a growth-fostering relationship brings more “zest” to everything you do. When you’re in a growth-fostering relationship, you’re not being belittled or silenced, and you’re not hiding from the things that bother you. A growth-fostering relationship is the opposite of having to put up walls and fortify the battlements. Instead, you are constantly reaching out to others and stretching toward greater maturity.
So for years before the mirroring study, I was using Relational-Cultural Theory, or RCT, to help my patients. Instead of giving struggling young people the standard advice to “separate from your parents and stop depending on them for emotional support,” we looked for ways they could stay connected to their families of origin while building their adult lives. Instead of telling people with explosive anger or chronic irresponsibility that they had to learn to self-regulate, we picked their relationships that felt the most durable—and worked on new emotional skills in an atmosphere that made it safer and easier to take risks. Sometimes I saw patients who were barely hanging on, whose relational worlds were limited to one or two abusive connections. In these cases, we worked together to find ways to detach from unhealthy relationships and—gently, slowly—grow relationships that held more potential for acceptance and warmth. From these starting points, we’d continue the work that would allow them to grow, expand, connect, heal, and move forward. I grew, too, refusing to maintain a cool distance in the therapy room. Whereas a separation-individuation therapist would see it as her job to help her patients stand on their own, I forged real relationships with my clients. I shared my own worries and feelings and expanded my emotional repertoire. Within the relationship, the patient grew—and so did I. That’s how RCT works. As one client said, “Relational therapy differed from my previous therapy, which was about me as an individual with no real connection to the therapist. In relational therapy, we worked together. The therapist went out of her way to make an emotional bond with me. I saw and felt her concern and caring.”
Healthy Relationships = Healthy Body
From a clinical perspective—my private laboratory—this approach was working. I wasn’t alone, either; my colleagues at the Jean Baker Miller Training Institute at the Wellesley Centers for Women were doing the same thing, with similar good results. Patients who came to us as chronic “hard cases”—the kind who are transferred from therapist to therapist and never seem to improve—blossomed. They became more able to derive gratification from real give-and-take relationships. Stressed-out people became calmer; the rejected became more trusting; the abusive developed empathy; and people who had emotionally flatlined became more energetic.
On a case-by-case basis, we had enough proof for our approach to keep going. Every day we saw people developing through and toward relationships, instead of away from them. But we also were bolstered by the stunning evidence about the health benefits of relationships. This evidence could fill an entire book—and in his book Love and Survival: The Scientific Basis for the Healing Power of Intimacy, the trailblazing cardiologist Dean Ornish does amass hundreds of pages of studies and thinking about the subject. Here are just a few of the highlights:
Let these studies sink in for a moment. Better cardiovascular health. Fewer cases of cancer. Better health in midlife. And 340 percent fewer premature deaths from all causes. Here was clear evidence that the perception of having healthy human connection is critical not just for emotional health but physical health as well. When I was a child, the government was worried about curious kids who were drinking household chemicals and accidentally poisoning themselves. To address the problem, they distributed acid-green stickers decorated with the face of Mr. Yuk, who displayed a theatrically sick expression. Parents placed these stickers on dangerous chemicals throughout the house to send a clear warning message to their children who were too young to read. I’ve often thought we need a similarly strong message for adults about the poison of disconnection. Why don’t medical waiting rooms offer pamphlets marked with a skull and crossbones, with the words Social isolation can kill you in stark letters underneath? The evidence for the claim is certainly there. Maybe a clear message like that would temper our compulsive need to stand on our own two feet.
The C.A.R.E. Plan
At the time Jean Baker Miller and her colleagues at Wellesley were forming their theories about human development, there was no technology available to see what was happening in the brain when it was either isolated or connected. Like everyone else at the time, the group had to work from their external observations. But then, in the 1990s, technology made brain study more possible. With advanced scanning technologies that allowed scientists to see the brain functioning in real time, and with discoveries such as learning that the brain can grow new cells even in old age, new findings about brain activity and new fields of research emerged. By the year 2000, neuroscientists were eagerly studying the brain’s activity within the context of relationships. What they’ve found since then has taken relational-cultural therapy’s work and extended it. The new science is completely upending the old ideas about separation and individuation.
Relational neuroscience has been showing that people cannot reach their full potential unless they are in healthy connection with others. Take the mirroring system. It needs relational input to stay in shape. So you need to really “see” other people (in the emotional sense that you understand and honor their feelings) and be “seen” in order to keep the mirroring system functioning well; without that input, it’s harder to perceive other people accurately and to feel close to them. There are other neural pathways, too, that are nurtured when we are in good relationships. Other systems use the input from healthy relationships to help tell our brains to turn off the stress response, to think clearly, and to feel pleasure without resorting to damaging or addictive behavior. (The next chapter describes the scientific findings in more detail.)
It’s important to stay humbled by the knowledge of how much we still don’t know about the brain and relationships. As always, we can only work with the best knowledge available. But the knowledge we do have has provided me with a way of talking to my patients about how relationships are vehicles for our growth and our healing. It helps people really “get” why relationships are so crucial to feeling happier, to managing their stress, to feeling less angry, to stop eating or shopping or drinking compulsively, or to make other changes. It’s also provided the framework for a plan that blends relational psychology and neuroscience to help patients make those changes.
Remember when I said that good relationships help people feel calmer, more tolerant, more resonant, and more productive? Each of these four benefits of a healthy relationship is directly related to a specific neural pathway. These pathways help you feel:
Calm. A feeling of calm is regulated in part by a pathway of the autonomic nervous system called the smart vagus. When you’re feeling stressed, your primitive brain wants to kick in—and when the primitive brain is in charge, it tends to make decisions that are bad news for relationships. When you have strong relationships, the smart vagus can modulate the stress response and keep the primitive brain from taking over. You’re healthier, can think more clearly, and you’re more likely to solve problems through creative thinking instead of exploding in anger or running away. But when you’re isolated from other people, your smart vagus can suffer from what neuroscientists call poor tone. This means that your primitive brain is more likely to call the shots. In the short term, this leads to relationship problems. Over time, you can expect chronic stress, illness, depression, and big-time irritability.
Accepted. A sense of belonging flows from a well-functioning dorsal anterior cingulate cortex, or dACC. The role of the dorsal anterior cingulate cortex is featured in SPOT, or social pain overlap theory, in which scientists show that being left out hurts—physically. Unfortunately, a person who suffers frequent exclusion can develop a dorsal anterior cingulate cortex that is highly reactive to social pain, leaving him or her to sense rejection even when other people are welcoming. Have you ever known someone who snaps at you when you say something mild and friendly like, “Hey, you look a little tired today. Are you all right?” Then you know someone who may be suffering from an overactive dorsal anterior cingulate cortex.
Resonant. Resonance with other people—the feeling among friends who “get” each other—is facilitated by the mirroring system. As I’ve described, other people’s experiences are imprinted onto our nervous system in a very literal way. When your mirroring pathways are weak, it’s hard to read other people or even to send out signals that allow other people to accurately read you.
Energetic. Energy is a benefit of the relational brain’s dopamine reward system. In the beginning—whenever that was—human beings were created with a clever, life-enhancing mechanism that exists to this day. When we’re engaged in healthy, growth-promoting activities, we are rewarded with a hit of dopamine that sweeps through the body’s reward circuitry, producing a wave of euphoria and energy. Dopamine’s feel-good effects are the carrot on the stick for healthy behavior: water, healthy nutrition, sex, and human relationships all stimulate dopamine. It was such a simple and ingenious plan . . . until casinos, malls, and opium dens came along. Sigh. When people don’t get enough pleasure from healthy relationships, they may turn to less healthy sources like addictive shopping, drugs, or compulsive sex to get their dopamine hits. And when they do this enough, they can rewire their brains so that the dopamine pathways are no longer connected to relationships. Even when they’re in a good relationship, some people just can’t get real enjoyment from it.
Calm. Accepted. Resonant. Energetic.
Each of these four pathways is a feedback loop. Supply the loop with good relationships, and most of the time, the pathway will become stronger. Strengthen the pathway, and your relationships become more rewarding. There are plenty of places in each loop to step in and boost the entire system.
This book describes what I call the C.A.R.E. program, named after the four benefits of a healthy relationship. The C.A.R.E. program is the book version of work I’ve been doing with clients for fifteen years. It can help heal some of the neural damage that isolation or chronic emotional disconnection can cause. It can also help you form healthy, thriving connections—whether you need a new perspective on one particularly sticky relationship or whether you describe yourself as “just not good with people” and want a major relational overhaul. This program has also helped successfully address the symptoms that extend past the immediate pain of disconnection, including addictions, stress, anxiety, anger problems, and more.
FOREWORD
Want to have more joy and contentment in your life? All the scientific studies of happiness, longevity, and mental and medical health point to one factor: the strength of your relationships with others. In Four Ways to Click, psychiatrist Amy Banks, M.D., provides an innovative and user-friendly summary of the extensive research on the neuroscience of relationships and offers readers practical ways to use this knowledge to retrain their brains for healthier, more rewarding relationships. What’s in this for you? Simply put, you can intentionally transform your life by improving how you connect with others. Relationships are not simply the “icing on the cake” for a life well lived. Relationships are the cake.
After decades of studying how culture shapes our relationships as well as working as a psychiatrist in clinical practice, Amy Banks has brilliantly created what she calls the C.A.R.E. system, which can help improve the four ways we “click” with one another: how calm we feel around others, are accepted by others, resonate with the inner states of others, and are energized by these connections. Using the C.A.R.E. system as it is described in this book, readers can target the neural pathways that need fine-tuning so that the quality of their relationships increases. With an understanding of how our brains truly work we can intentionally change how we live our lives!
I love this book! It is beautifully written, engaging, and inspiring.
Want more happiness? Want to live longer? Want to be healthier in mind and body? Then learning these four ways to click into more meaningful and rewarding relationships is your passport to achieving these goals. Let Amy Banks be your guide to a better life of love and laughter. Enjoy!
—DANIEL J. SIEGEL, M.D.
Chapter 1
BOUNDARIES ARE OVERRATED
A New Way of Looking at Relationships
Boundaries are overrated.
If you want healthier, more mature relationships; if you want to stop repeating old patterns that cause you pain; if you are tired of feeling emotionally disconnected from the people you spend your time with; if you want to grow your inner life, you can begin by questioning the idea that there is a clear, crisp line between you and the people you interact with most frequently.
People who talk a lot about boundaries tend to make statements like these:
“It shouldn’t matter what other people do and say to you, not if you have a strong sense of self.”
“How do parents know they’ve been successful? When their children no longer need them.”
“Best friends and true romance are for the young. As you get older, you naturally grow apart from other people.”
“You shouldn’t need other people to complete you.”
“You wouldn’t have so many problems if you would just stand on your own two feet.”
The message is clear: it’s not “healthy” to need other people—and whatever you do, don’t let yourself be infected by other peoples’ feelings, thoughts, and emotions. The statements above are intended to have an emotional effect on you. You may notice that they sound just a teensy bit judgmental and shaming. I know they make me uncomfortable; when I read them, I feel like I’m standing in a harsh white spotlight with someone pointing a finger at me, intoning You’re pretty messed up, missy, and it’s all your fault.
The ideal of complete psychological independence is one that was very big with mental health professionals in much of the twentieth century, and it still has our culture by the throat. So even if those statements about boundaries carry a sting, they also probably sound familiar to you, or even self-evident. Obvious!
So I couldn’t possibly be suggesting that they’re untrue. I couldn’t possibly say that it can be good to be dependent, or that our mental health is unavoidably affected by the people we share our lives with, or that we achieve emotional growth when we are profoundly connected to others instead of when we are apart from them.
That’s exactly what I’m saying.
This book is going to show you a different way of thinking about your emotional needs and what it means to be a healthy, mature adult. A new field of scientific study, one I call relational neuroscience, has shown us that there is hardwiring throughout our brains and bodies designed to help us engage in satisfying emotional connection with others. This hardwiring includes four primary neural pathways that are featured in this book. Relational neuroscience has also shown that when we are cut off from others, these neural pathways suffer. The result is a neurological cascade that can result in chronic irritability and anger, depression, addiction, and chronic physical illness. We are just not as healthy when we try to stand on our own, and that’s because the human brain is built to operate within a network of caring human relationships. How do we reach our personal and professional potential? By being warmly, safely connected to partners, friends, coworkers, and family. Only then do our neural pathways get the stimulation they need to make our brains calmer, more tolerant, more resonant, and more productive.
The good news for those of us whose relationships don’t always feel so warm or safe: it is possible to heal and strengthen those four neural pathways that are weakened when you don’t have strong connections. Relationships and your brain form a virtuous circle, so by strengthening your neural pathways for connection, you will also make it easier to build the healthy relationships that are essential for your psychological and physical health.
For many people, the news about the importance of relationships began with a 1998 study at the University of Parma in Italy, a study that proved how deeply connected we are to one another, right down to our neurons.
Your Feelings, My Brain
It was one of those lucky scientific mistakes, an unexpected observation that could have easily gone unnoticed if it hadn’t been for an astute researcher. When Giacomo Rizzolatti, a neurophysicist at the University of Parma, and his research team began their now-famous experiment, they were not intending to explore how human beings interact. In fact, they were not even studying people. The Italian researchers were mapping a small area, known as F5, in the brains of the macaque monkey. At this point in neurological research, it was already well known that the F5 neurons fire when a monkey reaches his arm and hand away from his body to grasp an object.
One routine day in the lab, a researcher observed something unprecedented. The researcher was standing in the line of sight of a monkey whose F5 cells had been implanted with micro-sized electrodes. As the researcher reached out to grasp an object, the electrodes placed on the monkey’s F5 area activated.
Remember: it was known that the F5 neurons activate when a monkey moves his arm to grasp something.
Then think about this: the monkey was not moving his arm; he was simply watching as the researcher’s arm moved.
This seemed impossible. At the time of this observation, scientists believed that the nerve cells for action were separate and distinct from the nerve cells for sensory observations. Sensory neurons picked up information from the outside world; motor neurons were devoted to acting. So when the F5 area, known for its link to physical action, lit up in the brain of a monkey who was only watching action in someone else, it was a clear violation of this known divide. It was as if the brain of the monkey and the brain of the researcher were somehow synchronized. Even more unsettling, it was as if their brains overlapped, as if the researcher’s physical movement existed inside the monkey.1
As Rizzolatti and other neuroscientists pursued this odd observation, they found that human brains also demonstrate this mirroring effect. In other words, you understand me by performing an act of internal mimicry—by letting some of my actions and feelings into your head. Ask a friend to briskly rub her hands together as you watch. Chances are that as her hands become warm from the friction, your hands will start to feel warm, too. In the aftermath of the monkey experiment, it was hypothesized that our brains contain mirror neurons, nerve cells that are dedicated to the task of imitating others. Most scientists no longer feel that specific mirror neurons exist; instead, there is a brainwide mirroring system whose tasks are shared by a number of regions and pathways. The imitating effect—the reason your hands warm up when your friend rubs hers together—happens because neural circuits throughout your brain are copying what you hear and see. Nerves in your frontal and prefrontal cortex (the same ones that are activated when you plan to rub your own hands together and then execute that plan) begin to fire. At the same time, neurons in your somatosensory cortex, which is the area of the brain responsible for bodily sensations, activate and send you messages of friction and warmth. Deep inside your brain, your hands are rubbing themselves together—even if your hands don’t actually move.
Actually, the process goes far beyond the mere reflection of another person’s actions. Your mirroring system is made up of neurons that can “see” or “hear” what someone else is doing. The system then recruits neurons from other areas of the brain to provide you with input not just about sensations and actions but about emotions, too. This input lets you have a comprehensive, detailed imitation of what the other person is experiencing. That’s why you can almost instantly pick up on the emotion of another person. If you watch as I rub my hands together, your brain might read the excitement on my face as I demonstrate how the mirroring system works—and you may feel some of that excitement. If you’ve ever “caught” a smile that you spotted on the face of a complete stranger, or if the silent tension of your partner has caused your own heart to race, you’ve experienced the effects of the mirroring system. This emotional contagion is caused by a neural pathway that can, in effect, take in another person’s feelings and replicate them squarely inside you.
When I ask groups of people to try the hand-rubbing experiment, there are usually two sets of reactions. Some people are amazed, as if they’ve just watched themselves pull a rabbit out of a hat. Their neurological connection with others feels like magic. But other people immediately say, “This is creepy!”
I get it. When you’ve been taught all your life that your mind is its own little castle, one that’s surrounded by a thick, high wall that’s designed to keep your thoughts and feelings in and everyone else’s out, it can be unsettling to learn about the power of the mirroring system. And in fact, the discovery of our mirroring ability challenges some traditional assumptions about how our brains and bodies are wired. Vittorio Gallese, a neurophysiologist in the Parma lab, described the role of the mirroring system in human interactions this way: “The neural mechanism is involuntary, with it we don’t have to think about what other people are doing or feeling, we simply know.”2 Marco Iacoboni, a professor of psychiatry at UCLA, takes it one step further in his book Mirroring People. He says that the mirroring system helps us in “understanding our existential condition and our involvement with others. [It shows] that we are not alone, but are biologically wired and evolutionarily designed to be deeply interconnected with one another.”3
When you and I interact, an impression of the interaction is left on my nervous system. I literally carry my contact with you around inside me, as a neuronal imprint. The next time you hear someone say, “Don’t let other people affect how you feel,” remember the mirroring system. Because we don’t really have a choice. For good or for bad, other people affect us, and we are not as separate from one another as psychologists once thought.
Maturity Has a New Meaning
When I say that boundaries are overrated, I don’t mean that there are absolutely no boundaries, or that all of humanity is just one big, undifferentiated, brownish-beige lump. Nor am I suggesting that anyone give up her or his own distinct personality for the sake of fitting in with a cozy, companionable group. No therapist I know believes that it’s healthy to abandon your beliefs, preferences, and quirks for the sake of a smoothly running—and bland—larger whole.
For decades, in fact, psychology moved in the other direction, in the belief that the only path to human growth was traveled via emotional separation. According to separation-individuation theory, which was most energetically advanced by Margaret Mahler in the 1970s, we all begin our work of separation in the first six or seven months of life, when we start to realize that our caregiver is a person distinct from ourselves. Separation-individuation theory holds that the rest of life is a variation on this discovery. In the practicing stage of human development, we supposedly practice separation by crawling or toddling away from our mothers and then returning to their arms. In the object constancy stage, we develop the capacity to hold an abstract image of Mom in our minds, meaning that we are secure enough to venture farther and farther away from her, thus developing our independence. As school-aged children, we become more aggressive in an attempt to move forward with our individual desires. In adolescence, we move further away from our parents by developing a sexual identity and pairing off with our peers. Adulthood? It’s a constant process of refining our ability to stand on our own, soothe our own distress, and solve our own problems. With each stage, the boundary between the self and other people grows stronger, more solid. Separation-individuation theory has been written about in thousands of books and dissertations, but here’s a micro-summary: in order to grow, we must step farther and farther away from others. The fully mature person may enjoy other people but doesn’t really need them. He is defined by the firm boundaries between himself and other people, and within those boundaries he is a self-sufficient being.
Even before the mirroring system came on the scene, and before relational neuroscience began to turn up additional evidence for the biological basis of human connectedness, some in the field wondered whether the separation model had gone too far. In the 1970s, a forward-looking group of Boston mental health experts—psychiatrist Jean Baker Miller and psychologists Judith V. Jordan, Irene Stiver, and Janet Surrey—noticed that their patients weren’t suffering from poor boundaries. They weren’t suffering from a lack of personal independence from others. What they suffered from was a lack of healthy human connection. As Judith Jordan notes, “The Separate Self model has wrongly suggested that we are intrinsically motivated to build firmer boundaries, gain power over other people in order to establish safety, and compete with others for scarce resources. Mutuality helps us see that human beings thrive in relationships in which both people are growing and contributing to good connection.”4
When you look at relationships this way, it’s possible to take the stages of development according to separation-individuation theory and cast them in a warmer light. When an infant crawls away from her mother, she’s not trying to separate from humanity. Instead, the baby is expanding her relational world; she’s moving toward more connections, toward the big world and the people who populate that world, before scooting back to enjoy her relationship with her mother. A toddler who learns object constancy isn’t building the ability to get away from Mom; by developing a mental image of her mother, she’s able to carry Mom with her wherever she goes. She’s learning a skill necessary for sustaining relationships over distance and time. As school-aged children interact with their peers and make mistakes, they learn how to manage relationships. Teenagers expand their relational worlds even further; they negotiate sexual relationships, and they have to learn how to become part of a group without succumbing to peer pressure. This reinterpretation of developmental growth has an overarching theme: human beings don’t mature by separating. Instead, they grow toward a greater and greater relational complexity. This approach to human development has a name: relational-cultural theory, or RCT. As a young psychiatrist, I found that RCT was more effective than any other theory, including separation-individuation, in helping people heal and helping them grow. I’ve spent twenty years applying RCT to the problems of my patients and the disconnected world they—and we—live in.
Separation theory and RCT have a few ideas in common: to be healthy, you have to know who you are; what your feelings and thoughts are; that other people have thoughts and feelings, too; and you have to be able to differentiate yourself within a relationship. But in separation theory, you’re learning all this in order to eventually walk away. You can still forge bonds and be part of a community if you want to, but your role as an adult has to be earned by your ability to tough things out on your own. This is a psychology that emphasizes a defensive stance, because you’re always defining and protecting your boundaries. You’re wary of being invaded by other people’s emotions and problems. In fact, this is how Freud saw the condition of being alive: “For the living organism protection against stimuli is almost a more important task than reception of stimuli.”5 It’s sad, isn’t it? In separation theory, there is always a wall between you and other people.
In RCT, there are no walls between people. Good relationships are the rich soil in which people grow and bloom. A good relationship with your parents helps you feel safe enough to approach other people and make a connection with them. A good relationship with your peers helps you try out who you are, practice your skills of empathy, and learn communication. As your skills for relationship grow, so does your desire for more relationship.
Relational-cultural theory doesn’t imagine people as defined by boundaries; it sees relationships as more like a magician’s linking rings. The rings are a set, but they are not stuck in a rigid configuration. They can move far apart and they can move closer together. And they can—this is the magic part—temporarily interconnect and overlap, just as they do when you watch someone rub his hands together and feel the warmth in your own. Or when you sometimes feel like you’re in another person’s skin, finishing their sentences or feeling their sadness. There’s flexibility and movement in this definition of relationship. You come together, experiencing each other; and then you move away again so that you can absorb what you’ve learned. Relationships are a dynamic process of experiencing, learning, and integrating your knowledge so that you are able to see both yourself and the other person more deeply and more clearly.
Jean Baker Miller liked to talk about “growth-fostering relationships,” a wonderfully descriptive term that suggests just the right idea: relationships aren’t an end in themselves. Although a relationship can be a safe harbor, it is never just that. It also helps you grow. A good relationship helps you and the other person develop clarity about yourselves; promotes your self-worth; makes you more productive at your work; and it gives you an appetite for more relationships. In Baker Miller’s language, a growth-fostering relationship brings more “zest” to everything you do. When you’re in a growth-fostering relationship, you’re not being belittled or silenced, and you’re not hiding from the things that bother you. A growth-fostering relationship is the opposite of having to put up walls and fortify the battlements. Instead, you are constantly reaching out to others and stretching toward greater maturity.
So for years before the mirroring study, I was using Relational-Cultural Theory, or RCT, to help my patients. Instead of giving struggling young people the standard advice to “separate from your parents and stop depending on them for emotional support,” we looked for ways they could stay connected to their families of origin while building their adult lives. Instead of telling people with explosive anger or chronic irresponsibility that they had to learn to self-regulate, we picked their relationships that felt the most durable—and worked on new emotional skills in an atmosphere that made it safer and easier to take risks. Sometimes I saw patients who were barely hanging on, whose relational worlds were limited to one or two abusive connections. In these cases, we worked together to find ways to detach from unhealthy relationships and—gently, slowly—grow relationships that held more potential for acceptance and warmth. From these starting points, we’d continue the work that would allow them to grow, expand, connect, heal, and move forward. I grew, too, refusing to maintain a cool distance in the therapy room. Whereas a separation-individuation therapist would see it as her job to help her patients stand on their own, I forged real relationships with my clients. I shared my own worries and feelings and expanded my emotional repertoire. Within the relationship, the patient grew—and so did I. That’s how RCT works. As one client said, “Relational therapy differed from my previous therapy, which was about me as an individual with no real connection to the therapist. In relational therapy, we worked together. The therapist went out of her way to make an emotional bond with me. I saw and felt her concern and caring.”
Healthy Relationships = Healthy Body
From a clinical perspective—my private laboratory—this approach was working. I wasn’t alone, either; my colleagues at the Jean Baker Miller Training Institute at the Wellesley Centers for Women were doing the same thing, with similar good results. Patients who came to us as chronic “hard cases”—the kind who are transferred from therapist to therapist and never seem to improve—blossomed. They became more able to derive gratification from real give-and-take relationships. Stressed-out people became calmer; the rejected became more trusting; the abusive developed empathy; and people who had emotionally flatlined became more energetic.
On a case-by-case basis, we had enough proof for our approach to keep going. Every day we saw people developing through and toward relationships, instead of away from them. But we also were bolstered by the stunning evidence about the health benefits of relationships. This evidence could fill an entire book—and in his book Love and Survival: The Scientific Basis for the Healing Power of Intimacy, the trailblazing cardiologist Dean Ornish does amass hundreds of pages of studies and thinking about the subject. Here are just a few of the highlights:
Let these studies sink in for a moment. Better cardiovascular health. Fewer cases of cancer. Better health in midlife. And 340 percent fewer premature deaths from all causes. Here was clear evidence that the perception of having healthy human connection is critical not just for emotional health but physical health as well. When I was a child, the government was worried about curious kids who were drinking household chemicals and accidentally poisoning themselves. To address the problem, they distributed acid-green stickers decorated with the face of Mr. Yuk, who displayed a theatrically sick expression. Parents placed these stickers on dangerous chemicals throughout the house to send a clear warning message to their children who were too young to read. I’ve often thought we need a similarly strong message for adults about the poison of disconnection. Why don’t medical waiting rooms offer pamphlets marked with a skull and crossbones, with the words Social isolation can kill you in stark letters underneath? The evidence for the claim is certainly there. Maybe a clear message like that would temper our compulsive need to stand on our own two feet.
The C.A.R.E. Plan
At the time Jean Baker Miller and her colleagues at Wellesley were forming their theories about human development, there was no technology available to see what was happening in the brain when it was either isolated or connected. Like everyone else at the time, the group had to work from their external observations. But then, in the 1990s, technology made brain study more possible. With advanced scanning technologies that allowed scientists to see the brain functioning in real time, and with discoveries such as learning that the brain can grow new cells even in old age, new findings about brain activity and new fields of research emerged. By the year 2000, neuroscientists were eagerly studying the brain’s activity within the context of relationships. What they’ve found since then has taken relational-cultural therapy’s work and extended it. The new science is completely upending the old ideas about separation and individuation.
Relational neuroscience has been showing that people cannot reach their full potential unless they are in healthy connection with others. Take the mirroring system. It needs relational input to stay in shape. So you need to really “see” other people (in the emotional sense that you understand and honor their feelings) and be “seen” in order to keep the mirroring system functioning well; without that input, it’s harder to perceive other people accurately and to feel close to them. There are other neural pathways, too, that are nurtured when we are in good relationships. Other systems use the input from healthy relationships to help tell our brains to turn off the stress response, to think clearly, and to feel pleasure without resorting to damaging or addictive behavior. (The next chapter describes the scientific findings in more detail.)
It’s important to stay humbled by the knowledge of how much we still don’t know about the brain and relationships. As always, we can only work with the best knowledge available. But the knowledge we do have has provided me with a way of talking to my patients about how relationships are vehicles for our growth and our healing. It helps people really “get” why relationships are so crucial to feeling happier, to managing their stress, to feeling less angry, to stop eating or shopping or drinking compulsively, or to make other changes. It’s also provided the framework for a plan that blends relational psychology and neuroscience to help patients make those changes.
Remember when I said that good relationships help people feel calmer, more tolerant, more resonant, and more productive? Each of these four benefits of a healthy relationship is directly related to a specific neural pathway. These pathways help you feel:
Calm. A feeling of calm is regulated in part by a pathway of the autonomic nervous system called the smart vagus. When you’re feeling stressed, your primitive brain wants to kick in—and when the primitive brain is in charge, it tends to make decisions that are bad news for relationships. When you have strong relationships, the smart vagus can modulate the stress response and keep the primitive brain from taking over. You’re healthier, can think more clearly, and you’re more likely to solve problems through creative thinking instead of exploding in anger or running away. But when you’re isolated from other people, your smart vagus can suffer from what neuroscientists call poor tone. This means that your primitive brain is more likely to call the shots. In the short term, this leads to relationship problems. Over time, you can expect chronic stress, illness, depression, and big-time irritability.
Accepted. A sense of belonging flows from a well-functioning dorsal anterior cingulate cortex, or dACC. The role of the dorsal anterior cingulate cortex is featured in SPOT, or social pain overlap theory, in which scientists show that being left out hurts—physically. Unfortunately, a person who suffers frequent exclusion can develop a dorsal anterior cingulate cortex that is highly reactive to social pain, leaving him or her to sense rejection even when other people are welcoming. Have you ever known someone who snaps at you when you say something mild and friendly like, “Hey, you look a little tired today. Are you all right?” Then you know someone who may be suffering from an overactive dorsal anterior cingulate cortex.
Resonant. Resonance with other people—the feeling among friends who “get” each other—is facilitated by the mirroring system. As I’ve described, other people’s experiences are imprinted onto our nervous system in a very literal way. When your mirroring pathways are weak, it’s hard to read other people or even to send out signals that allow other people to accurately read you.
Energetic. Energy is a benefit of the relational brain’s dopamine reward system. In the beginning—whenever that was—human beings were created with a clever, life-enhancing mechanism that exists to this day. When we’re engaged in healthy, growth-promoting activities, we are rewarded with a hit of dopamine that sweeps through the body’s reward circuitry, producing a wave of euphoria and energy. Dopamine’s feel-good effects are the carrot on the stick for healthy behavior: water, healthy nutrition, sex, and human relationships all stimulate dopamine. It was such a simple and ingenious plan . . . until casinos, malls, and opium dens came along. Sigh. When people don’t get enough pleasure from healthy relationships, they may turn to less healthy sources like addictive shopping, drugs, or compulsive sex to get their dopamine hits. And when they do this enough, they can rewire their brains so that the dopamine pathways are no longer connected to relationships. Even when they’re in a good relationship, some people just can’t get real enjoyment from it.
Calm. Accepted. Resonant. Energetic.
Each of these four pathways is a feedback loop. Supply the loop with good relationships, and most of the time, the pathway will become stronger. Strengthen the pathway, and your relationships become more rewarding. There are plenty of places in each loop to step in and boost the entire system.
This book describes what I call the C.A.R.E. program, named after the four benefits of a healthy relationship. The C.A.R.E. program is the book version of work I’ve been doing with clients for fifteen years. It can help heal some of the neural damage that isolation or chronic emotional disconnection can cause. It can also help you form healthy, thriving connections—whether you need a new perspective on one particularly sticky relationship or whether you describe yourself as “just not good with people” and want a major relational overhaul. This program has also helped successfully address the symptoms that extend past the immediate pain of disconnection, including addictions, stress, anxiety, anger problems, and more.
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