Psychotherapists who facilitate behavior change tend to forget they are working with the brain. Do they forget or not know? While every new thought does not produce a corresponding change in the brain, enduring changes in thoughts and behavior are now understood to result in changes to the brain itself. Psychiatrists impact the brain more directly with psychopharmacology, but we all work in one field.
I am not a neuroscientist. In my training as a psychologist, I gained limited knowledge of the field. Most behavioral healthcare executives also lack this expertise. Yet many patients in their treatment programs take psychotropic medications. Many are told their problems are rooted in the brain. Should these patient realities dictate that program executives gain more knowledge about the brain?
Executives have more pressing concerns, but they should know something about how the brain operates. They should have enough knowledge to not encourage the dualisms of mind-body and nature-nurture. More importantly, they should realize everyone holds a naïve biological model of the brain and its functioning. Are these models valid? Do mistaken beliefs have consequences for patients?
I think of patients who bemoan that their brain is broken. They experience evidence of this every day. Do we inadvertently support such beliefs with pharmacological treatments? How does therapy fit in? Do patients believe that behavior change has an impact on the brain? Should we teach patients that biological and behavioral solutions both result in a positive effect on the brain?
The plasticity of the brain
While a neuroscientist might identify several essential facts about the brain, I nominate brain plasticity for the top of that list. It is a well-validated aspect of brain functioning that we should elevate into common understanding. The popular science literature on this is large, but the Stanford neuroscientist, David Eagleman, has several books and a PBS series, “The Brain,” to his credit.
Plasticity means that the brain is malleable and ever-changing. Eagleman suggests we replace the term plasticity with one he uses for the title of his 2020 book, “Livewired.” He notes that a malleable piece of plastic is fixed after its molding. Yet the brain continues to respond to both physical and psychological experiences. The brain continues to remold throughout life. It is dynamic and adaptable, or livewired.
This responsiveness to experience is critical in brain development. Genetic mapping identified about 20,000 genes in humans. Yet genetic coding is not a fixed hardwiring of the brain. It is not a detailed blueprint at birth. Instead, it is the foundation for continued development. Eagleman notes we are “remarkably unfinished” at birth, and interaction with the world completes our unique development.
While the brain is not fully mature for about 25 years, maturity is not the end of change. The adult brain still changes based on experience. He notes that “neuronal networks require interaction with the world for their proper development.” Our subjective experience is “reflected in the brain’s structure.” Brains can be negatively impacted in many ways, but they are powerfully adaptive.
Mental and physical healing
Two major implications emerge from this understanding of an ever-changing, livewired brain. Recovery from damage or dysfunction is often possible, and it may occur either through direct changes in brain functioning or through changes in experience. In other words, we can use strategies for directly impacting the brain or we can promote enduring behavioral changes that will in turn modify the brain.
This may not change much of what we do today. We use medicine and psychotherapy to help people rebuild. These efforts may change mind, brain, or both. Yet we must judge the results behaviorally at this stage of brain diagnostics. Neuroscience reinforces the importance of behavior change and the reality that we should not give up on “broken brains.” We have lots of evidence for this latter point.
People are leading high functioning lives today who once suffered from disorders like schizophrenia and addiction. They benefited from various professional services, along with critical help from friends and peers. A few probably had little hope for them at the height of their suffering. Neuroscience tells us to have hope in the remarkable plasticity of the brain, not just in the recovery process we can see.
This message is an important one for our industry leaders to carry. It is not a technical message for scientists to own. The behavioral healthcare field should embrace a focus on behavior change, but it should never forget that this focus rests on the reality of brain functioning. We may still have much to learn about the brain, but we should celebrate it as the biological core of behavioral healthcare.
The current reality of healthcare delivery is that psychiatrists work largely in isolation. Aside from practical problems with this, it reinforces a perception that psychiatry is a separate domain of the brain. Patients need to know we are all on the same team but have different assignments. Neuroscience illuminates that we all work with the brain in one way or another. Executives should remind us often.
Ed Jones, PhD, is senior vice president for the Institute for Health and Productivity Management.