Four Ways to Click: Rewire Your Brain for Stronger, More Rewarding Relationships (2015)

Chapter 2

THE FOUR NEURAL PATHWAYS FOR HEALTHY RELATIONSHIPS

Aculture telling you that you need to separate from others and be independent above all else is selling you an ancient script. Not one that’s based on the brain as it is, but the brain as it was.

Years ago, when my children were young, they were given a kit for raising a frog from a tadpole. With much positive anticipation, we set up the frog habitat in the kitchen and ordered a tadpole we dubbed Uncle Milty. Uncle Milty’s home was just beside the breakfast preparation area. Each morning, as I made breakfast for my kids, we would peek into the small container of water to see if Uncle Milty had sprouted his frog legs yet. Weeks went by. Milty’s head and torso grew bigger and bigger, but . . . no legs. In our household, we talk a lot about the importance of relationships for good health and development, so it was natural for everyone to speculate: was it possible that Milty was not becoming a frog because he was alone in his habitat? Like human babies who fail to thrive because they are not held, was Milty failing to grow legs because he didn’t have another amphibian to cuddle with? Without relationships, would he remain an immature, unsatisfied tadpole? No. Our family was trying to analyze Milty as if he had a human brain. But he didn’t. He had a reptile brain.

Reptiles and amphibians have brains that, basically, haven’t evolved in about five hundred million years. The reptile brain doesn’t need relationships. It doesn’t require connection with others for physical development. The reptile brain is all about bare-knuckled survival, about breathing, eating, reproducing, fighting, and hotfooting it away from anything that might want to eat it. Uncle Milty never did develop legs (the poor guy couldn’t hotfoot away from anything), but he was probably the victim of a genetic mutation, not loneliness—because the reptile brain doesn’t get lonely. It doesn’t care about anyone else. It doesn’t need anyone else. It’s the very model of separation and rugged independence.

We humans still possess the primitive reptile brain; it’s what we call our brain stem. But the brain stem is just one structure within a human brain that has evolved far beyond the reptile brain to be much larger, more complicated, and more advanced. The human brain is different from the reptile brain in a zillion ways, but the one I’m most concerned with here is that, over millennia, the human brain has evolved away from reptilian independence. For example, reptiles don’t have neural equipment that causes them to feel pain if they are left out of a social group . . . but you and I do. Reptiles don’t possess a nerve that uses signals from welcoming facial expressions to modulate stress . . . but you and I do. Reptiles don’t need to know that other reptiles really “get” them . . . but we do. Reptiles don’t get a surge of a motivating neurochemicals when they’re in the company of others. . . . but . . . you get the picture.

Uncle Milty didn’t need or want friends to be a fully developed frog, but our brains are different. To us, healthy connection is central. The old reptile script of surviving on your own, of not needing others to help you develop and grow, is life threatening to mammals. It is life threatening to you. Fortunately, it is possible to write a new script, one that’s more in tune with the reality of our human brains. Humans have developed a deep need to connect with others, and we’re constantly learning more about the neurobiology that underpins our need for good relationships. This chapter will describe some of that neurobiology.

No single area of the brain exclusively regulates relationships; this is a function that appears to be integrated across many parts of the human nervous system. Although there’s always a danger of oversimplification when it comes to describing neurobiology, I find it helpful to think about our human brain’s need for connection in terms of the four major neural C.A.R.E. pathways I described in the last chapter. When you are in healthy relationships with others, your brain sends messages that help you feel:

Calm (this pathway is governed by the smart vagus nerve)

Accepted (ruled by the dorsal anterior cingulate cortex, or dACC)

Resonant (the mirroring system)

Energetic (the dopamine reward system)

The health and strength of these pathways are influenced by early childhood relationships, and then these pathways are reshaped continually throughout our lives, again in the context of our relationships. That’s right: our relationships sculpt our brains. The quality of our relationships helps determine our ability to feel motivated, to remain coolheaded in a crisis, and to perceive other people’s social signals with accuracy. This is exciting news; it means that even if our C.A.R.E. pathways aren’t working very well, we can learn to leverage the power of relationships to heal and change them. And we can think differently about how we raise the next generation, so that our children and grandchildren possess fully functioning systems for connectedness.

C Is for Calm: The Smart Vagus

I’ll begin with a story about Brooke, a client of mine. I’m betting that her story will sound familiar. Maybe you’ve lived it.

After a stretch of unemployment, Brooke was delighted to land a job just before the winter holidays. But she was anguished, too, because her new employer was throwing her annual holiday party on the Friday of Brooke’s first week of work. As the week progressed, Brooke was increasingly torn between the desire to make a good impression on her coworkers and her dread of socializing in a large, unfamiliar group. She imagined awkward conversations with colleagues she barely knew; the humiliating feeling of her sweaty hand in another’s dry palm; the uncomfortable but liberating moment when a conversation partner declares that it is time to mingle with other people. Brooke resigned herself to an evening of stress and faking it for the sake of her career. Her only hope for escape was a sudden natural disaster or an open bar serving very large glasses of white wine.

The night of the party, Brooke entered the hotel lobby and immediately felt like an outsider. Everywhere she turned, small groups of people huddled together, talking. A few of the people seemed to be looking in her direction and smirking. Get over yourself, Brooke thought, no one is laughing at you. But she stood off to the side for nearly thirty minutes, sipping her wine and looking around in vain for a face that appeared even a little bit friendly.

Rescue arrived in the form of her coworker Pete, who greeted Brooke warmly and wished her happy holidays. Almost immediately, Brooke began to relax. She and Pete had met a few days earlier at an office lunch meeting. During a break in the meeting, she discovered they shared a similar sense of humor and an unusual hobby: fly-fishing. At the party, they picked up where they had left off at the meeting, swapping stories about streams that were off the beaten track and debating the best fly for catching a striped bass. The rest of the party went smoothly. Pete brought two of their colleagues into the discussion and Brooke introduced herself to a few more. Maybe it was the wine, Brooke remarked to herself, but the group seemed to become much friendlier and more open as the night went on.

It wasn’t the wine. (Brooke had drunk very little.) Thanks to complex forces in Brooke’s life, a pathway in her nervous system was unable to accurately read and respond to the people she saw when she entered the party. Instead of seeing welcoming faces, she saw mockery. Even when she tried to talk herself into seeing things differently (Get over yourself, Brooke; no one is laughing at you), she was nearly overpowered by a feeling of jeopardy, a feeling that no one wanted her around. But as she talked with her new friend Pete, that pathway in her nervous system, the smart vagus, started to do its job. Not only could Brooke relax, she was better able to transmit and receive social cues. She could show friendliness. She could see it on the faces of others.

The human central nervous system is the control center for the electrical activity that drives your thoughts and actions. It contains an essential subsystem: the autonomic (think automatic) nervous system, which is designed to help you quickly respond to threats or stress. The autonomic nervous system is at work 24/7, humming along below the level of your conscious awareness. It runs throughout your entire body, innervating muscles, organ systems, and glands. We used to think that our autonomic nervous system was a lot like Uncle Milty’s, with only two major parts:

The sympathetic nervous system, which is responsible for the famous fight-or-flight response.

The parasympathetic nervous system, which leads to the freeze response.

In other words, scientists believed that when you feel surprised or threatened, your body automatically responds in one of two ways: either your sympathetic nervous system revs up, providing you with the energy and focus needed to fight or flee; or your parasympathetic nervous system activates, slowing your body processes down so that you freeze and play dead. According to most introductory biology and psychology courses, whether you fight, flee, or freeze is largely dependent on the extent of the threat and on your ability to man up to it. If the threat seems potentially survivable and you are large and strong, you face the threat head-on. If you face that same threat but are small and weak, it is better to turn and run as fast as you can. Those are the choices in the sympathetic nervous system’s fight-or-flight response. In the face of a severe, life-threatening situation, you might do what the baby rabbit I found on my porch last spring did. The bunny, which had been dropped there by one of my cats as a special “gift” to me, looked dead. But it was actually in the midst of a full-blown freeze response, in which the parasympathetic nervous system exerts a slowing down or calming effect. The body and brain begin to shut down; they literally go numb. Ideally, this reaction causes the predator to lose interest and turn away, but if the predator keeps attacking, the freeze response creates protection from the tremendous pain and stress. This is where the expression “playing dead” comes from, but the freeze reaction is anything but play and is not under conscious control. This shutting down of bodily functions is so effective that one-quarter of the animals playing dead actually die. (Fortunately, when I separated the bunny from its predators for a few hours, the parasympathetic stimulation stopped and the bunny hopped away.) Obviously, this potentially lethal response is the last line of defense for any animal, including humans.

These reactions of the sympathetic and parasympathetic nervous systems, collectively named the “fight, flight, or freeze” responses, have been socially and scientifically accepted as the truth of how human beings respond to stress since they were identified by physiologist Walter Cannon in the early 1900s. But times are changing. Researchers are taking another look at the stress response in humans, and they are showing that “fight, flight, or freeze” is an incomplete list of the body’s menu of options.

One of those researchers is Stephen Porges, the director emeritus of the Brain-Body Center of the College of Medicine at the University of Illinois–Chicago. His paradigm-breaking studies are what first identified a third branch of the autonomic nervous system: the smart vagus. The smart vagus is an evolutionarily newer pathway than the sympathetic or parasympathetic nervous systems. While amphibians, reptiles, and fish have the older responses, only mammals have a smart vagus in addition to the first two.

From an evolutionary perspective, the appearance of the smart vagus went hand in hand with the appearance of mammals and their increased social complexity and interdependence. Until the evolution of mammals, the world was populated by creatures that are less dependent on one another for survival. For them, the sympathetic fight-or-flight response and the parasympathetic freeze response are adequate to help them cope with the world. Have you ever wondered why turtles lay piles of eggs and fish release large clumps of roe? The primary reason for producing a large number of offspring is to increase the odds that any one of them will survive to reproduce. Young turtles, fish, and many other nonmammalian creatures have no psychological or physical need to be cuddled and fed by a parent; they leave the nest to fend for themselves immediately after birth. They are born with a complete set of instincts for hunting, eating, and hiding. They’ve got everything they need to survive in their habitats . . . except size. Unfortunately, in their turtle-eat-fish world, size matters. A lot. The only hope for the ultimate survival of these premammalian species is to mass-produce young and to hope that a few escape predation and survive into adulthood to reproduce. Though it has worked for millennia, it is not a particularly efficient system for the propagation of a species.

Mammals are different. Our reproduction efforts are more efficient, in the sense that we produce fewer children, and those children have better odds of survival. One of the hallmarks of this system is a mammal baby’s dependence on others for growth and development. A baby not only needs food and water, but also cuddling, cooing, and other stimulating contact with adults in order to grow and thrive. While turtles, fish, and frogs are born with instincts to manage the world on their own, mammals are born with a complete set of instincts to reach out to others. If you watch a newborn baby closely, you can see some of these instincts at work. The rooting reflex keeps an infant’s neck and mouth turned toward the mother, searching for a breast for comfort and food; the Moro reflex causes an infant’s arms to reach out, as if in a hug, when they are being put down. These instincts are vitally important, because a newborn mammal is not able to survive on his own without the help of a parent or older group member to care for him.

It appears that as mammals evolved and life on Earth became more socially complex, there was a need—or perhaps the opportunity—to use social connections as a way to moderate stress. Thus you and I have a smart vagus, a nerve that arises from the tenth cranial nerve at the base of the skull and heads north, where it links with some of the muscles of facial expression, speech, swallowing, and hearing. (Yes, hearing involves muscles—tiny ones—in your inner ear.) When you get input from other people’s faces and voices telling you that these people are safe, the smart vagus sends a message to the sympathetic and parasympathetic nervous systems, telling them to turn off. In effect, the smart vagus says, “I’m with friends and everything is going to be okay. You don’t need to fight, flee, or freeze right now.” The smart vagus is one reason we feel less stress when we’re around people we trust.

When you feel safe, the smart vagus also lets your muscles do the motor work that’s necessary for engaging with the people around you. Your eyelids and eyebrows lift, so that your face becomes more open. The muscles of your inner ear tense, preparing you to hear the conversation. Without thinking about it, you look directly into the eyes of the people you’re talking with. Your expression is animated, accurately reflecting your emotional response to the situation. This is a nerve that works to sustain social relationships, letting you send and receive emotional information that brings you closer to others and helps you feel calmer. Now that’s smart.

In an ideal relational world, your autonomic nervous system automatically reads the environment and responds by activating the smart vagus when you are safe, the sympathetic nervous system when you are in danger, and the parasympathetic nervous system when your life is being threatened. But when your smart vagus isn’t working well, you’re less able to accurately interpret other people’s intentions. Without the smart vagus doing its job, you can’t see or hear other people as well, and you’re at risk of misinterpreting their expressions. You don’t make eye contact as easily, and your own facial expression becomes flatter, which increases the chances that you’ll be seen as hostile or uncaring. Imagine how other people respond to your face when it looks closed off or angry.

If the smart vagus feels that other people are unsafe, it automatically shuts down.

It stops sending inhibitory messages to the sympathetic and parasympathetic nervous systems, allowing them to let loose with a stress response. If you’re actually in danger, those stress responses are useful. But if you are around safe people whom your nervous system has misread as unsafe, imagine how problematic the feelings of the fight-or-flight response become. You get the familiar feelings of stress: elevated heart rate, sweaty palms, dry mouth, and fuzzy brain. You might not actually hit someone, but you may start an argument. Or you might perform the social equivalent of flight. (Have you ever zoned out during an uncomfortable conversation?) A parasympathetic freeze response is usually reserved for seriously life-threatening events, but in rare cases people who have experienced significant trauma at the hands of others can experience a partial shutdown in social situations. This goes way beyond a case of jitters; these folks literally can’t speak or move.

In the case of Brooke, her smart vagus was off duty and her sympathetic nervous system was up and running as she entered the office party. Few people relish the idea of going to a cocktail party where they don’t know a soul, but Brooke suffered from more than garden-variety butterflies. Brooke had a genetic tendency toward an overreactive stress response. In fact, both her mother and her mother’s mother were anxious worriers who often preferred small, intimate groups to large crowds. These adults, however, were also capable of showing Brooke love and support. Both of these forces—anxiety and love—informed the way Brooke’s autonomic nervous system responded to interpersonal interactions. She didn’t have what neuroscientists call good vagal tone. Her smart vagus didn’t always work as well as it should have, making it harder for her to navigate social situations. She tended to feel threatened by people she didn’t know well, even when their intentions were friendly or neutral. And so, after spending a week in dread of the event, and without a friend’s comforting presence, she was unable to read the smiling faces of the people around her as welcoming. To Brooke, those faces looked mocking and unreceptive. Her smart vagus, unable to sense that the environment was safe, failed to send a calming message to the sympathetic nervous system. Brooke didn’t actually flee the party, but she did hide on the sidelines.

Brooke was unable to accurately read the expressions of strangers, but fortunately for her, her smart vagus wasn’t completely broken. It was still able to respond to the presence of a friend. When Pete arrived and wished Brooke happy holidays, the vibrations from his kind, familiar voice traveled through space into her ear, moving the minuscule muscles that stimulated her smart vagus nerve. Almost immediately, she felt a wave of relief. Without thinking, her eyes scanned his smiling face and she responded with a delighted grin. As the muscles around her mouth and eyes tightened, they, too, stimulated her smart vagus. Instantaneously, the smart vagus sent an inhibitory message to both her sympathetic and parasympathetic nervous systems. She no longer had the urge to flee. She was safely in a conversation with Pete about fly-fishing. Not coincidentally, the other partygoers started to look friendlier—and she looked more receptive to them.

All in all, Brooke’s social anxiety was fairly moderate. A friendly interaction could interrupt its loop. There are people who have it much worse. These are people with seriously poor vagal tone, sometimes because of genetic misfortune, but more often because their nervous system was shaped by an environment that was chronically threatening.

The human nervous system is shaped from infancy. A baby’s life is full of routine stressors—hunger, sleepiness, wet diapers, sudden noises—that signal discomfort or danger and stimulate her sympathetic nervous system. Ideally, when a baby cries in distress, her caregivers respond supportively. They change her diaper, offer milk, or hold the baby tightly and rock her from side to side. This attuned adult–child relationship causes the baby’s brain to release neurochemicals, like serotonin and endogenous opioids, that lessen the feeling of the threat. The baby’s fear is soothed. Not only does the baby learn to associate her caregiver with safety, the experience helps her smart vagus become better connected with the parts of her brain that recognize safe faces, safe smells, safe noises, and so on. The multiple senses associated with a healthy relationship are eventually coded into the baby’s nervous system. The regulatory pathway between the smart vagus and the sympathetic nervous system grows stronger and stronger. The result: human connection can now modulate the baby’s stress response. The sympathetic and parasympathetic nervous systems can be soothed, or completely turned off, when the baby is in the presence of caring family and friends. The baby’s sympathetic and parasympathetic nervous systems learn not to fire unless there is a real threat. The baby grows up with the ability to accurately distinguish between danger and safety, and she wants to seek out healthy human relationships.

This process of strengthening the smart vagus is one that continues throughout a child’s life, into adulthood. If you have a terrible week at work, you may realize that you’ll feel better if you have dinner with a friend Friday night. At the restaurant, you share the trials of the week, and your friend is appalled on your behalf. Your friend shares her own hard news: her mother has been diagnosed with a chronic illness. You cry together and laugh together, and at the end of the evening, you part ways. Not only do you feel better, the stimulation to your smart vagus has given it a fine tuning. Every time you share and receive comfort, your smart vagus becomes faster and more efficient at sending its chemical signals.

But what happens when the smart vagus develops within chaotic, disconnected, frightening circumstances? When a baby is repeatedly exposed to distress and is not soothed, her sympathetic nervous system is constantly stimulated. Her smart vagus doesn’t learn to associate human relationships with comfort and safety. Her brain doesn’t learn that there are times when the stress response can be turned off. She grows up hyperalert to danger, unable to relax even when she is safe, unable to enjoy other people even when their intentions are kind.

Infancy is the most significant time for brain development, but believe me: in a chronically dangerous environment, the smart vagus of an older child or adult will suffer.

If you are in constant danger because of a scary home situation, a violent neighborhood, or a war, your brain has a rational response—stay on high alert. Your sympathetic nervous system will flip to the On position, and depending on the intensity and consistency of the threat, it may more or less stay there. Your heart will race; your lungs will expand to take in more oxygen; and the blood vessels in your arms and limbs will dilate so more blood can flow through them. This way, you’ll be prepared to fight or flee whenever the danger presents itself. If things are really bad, your parasympathetic nervous system might be preparing to bring on a freeze. But your body’s nervous system is designed to respond to threats in short spurts, not twenty-four hours a day. Under extreme, chronic stress your body begins to break down. There’s a greater risk of heart disease, illness, insomnia, depression . . . the list goes on. In fact, cortisol, the very chemical your body unleashes to counter the stress response, will damage brain cells needed for memory when it’s released for too long.

The near-constant activation of the stress response is like exercise for your fight, flight, or freeze pathways. They become stronger and faster. At the same time, your smart vagus doesn’t get the opportunity for a good workout. Eventually it will lose its good tone and become weak—leaving you with a loud and hypersensitive set of stress responses that perceives other people as basically dangerous and unkind, no matter what the reality. That’s a tragedy, because we are built to use safe relationships as a way of reducing stress. Without this ability, we may look more independent, but in reality we are weaker and sicker. Happily, there are plenty of ways to improve the tone of your smart vagus. Later in the book, I’ll describe these methods in detail.

A Is for Accepted: The Dorsal Anterior Cingulate Cortex

In 2003, three scientists at UCLA invited a series of volunteers to participate in an online game of catch called Cyberball.1 The volunteer would arrive at the lab and, from inside a functional MRI scanner, begin playing the game. Things would start amicably enough, with the volunteer and researchers tossing the “ball” back and forth. So far, so good. But as things went on, the volunteer was gradually excluded from the game. No one explained to the volunteer why he or she wasn’t receiving the ball anymore. No one even acknowledged that anything odd was going on. Eventually, the subject was completely left out as the other players tossed the ball among themselves.

Compared to other forms of social exclusion, like being beaten up on a playground or being snubbed because you look different from everyone else, getting inexplicably dropped from a game of Cyberball is pretty tame. But the researchers, Naomi Eisenberger and Matthew Lieberman, discovered that even this mild degree of social exclusion activated a specific part of the brain, the dorsal anterior cingulate cortex.

The dorsal anterior cingulate cortex, or dACC, is a small strip of the brain deep in the frontal cortex and part of a complex alarm system that—until this experiment—was primarily known for picking up the distress of physical pain. Walk into the corner of the kitchen table? The dACC activates. Catch your fingers in a drawer? That’s your dACC, howling Make this horrible feeling stop.

So it was a surprise when the dACC lit up in response, not to being kicked or pinched, but to being left out. Remember, the volunteers weren’t experiencing any physical harm. They were simply being excluded. The more emotionally distressed the volunteer was by the exclusion, the more activated the dACC became. The study’s conclusion: to our brains, the pain of social rejection is the same as the pain from a physical injury or illness. That our major alarm system fires as a result of both physical pain and social pain is a measure of how important it is for us to be included—and how damaging it is to feel left out.

In our tough, hypercompetitive, gut-it-out culture, it is standard practice for some therapists to treat the pain of rejection or loneliness by encouraging the patient to become more emotionally independent. But when health professionals hear about this study that links social pain with physical pain, they tend to rethink this strategy. That’s because the helping professions know to take physical pain seriously. Chronic physical pain is known to have significant medical consequences: it engages the stress response and causes depression, anxiety, and physical health problems. Imagine a person in extreme physical pain who visits an emergency room for help. Doctors might disagree about the best course of action, but most would try to treat both the pain itself as well as the underlying cause. No true medical professional would ever dream of dismissing this person’s distress by saying, “We’re going to reparent you so that you’re less needy.” After Cyberball, it seems incredibly cruel to do the same to someone who is suffering from social pain. Instead, it makes more sense to honor the pain and to help the person make healthy connections—because belonging to a group is, for all of us, more than one of life’s fun perks. It’s a biological requirement.

To understand why the dACC lights up when we’re left out, let’s look a little more closely at what we know about physical pain. In an interesting job share, your nerves register pain’s noxious physical sensation, while your dACC registers how distressed you are by that sensation. The dACC is like a fire alarm that goes off when it senses smoke, warning you to get out of a burning house—except that this alarm goes off when you feel pain, telling you that you’ve got to do something about an injury. Without this alarm, you might not care enough to stop your hike through the woods and notice that your ankle hurts. Without that information, you might not see the blood that’s gushing from a cut, and then you wouldn’t know to stanch the flowing blood or to clean the wound. In other words, suffering from the sensation of pain gives you information that helps you preserve your physical well-being and even your life. On rare occasions, when a person has severe chronic pain whose underlying cause cannot be cured, a neurosurgeon may perform a cingulotomy, which is the surgical removal of the portion of the dACC associated with the distress of pain. What is so remarkable about this surgery is that afterward, the person still feels the physical sensation of pain but no longer feels bothered by it. Having a cingulotomy is like disconnecting your wailing smoke detector: you still have pain, but without the distress alarm, you might not have the impetus to seek out the source of the pain and stop it.

The fact that this same area of the dACC also registers the stress of social disconnection was revelatory to scientists, but I imagine our cave-people ancestors would find this discovery a no-brainer. Feeling distress from social pain was a way to alert them to the terribly risky condition of being alone. In a group, they could share information about food sources or team up to fight a mammoth. Alone, they were at high risk of starvation or being gored. And consider the experiment performed in the 1950s by the American psychologist Harry Harlow, who presented baby monkeys with two mother surrogates: a bare wire surrogate that provided food, or a surrogate that did not offer food but was covered with a soft cloth. The monkeys preferred the soft surrogate. For primates—and that includes you and me—there is a powerful internal drive toward physical closeness, and it’s more powerful than our drive for food. That biological need for connection is expressed, partly, in the behavior of the dACC.

When we respect our need for connection, we know to pay attention to the distress call of the dACC. When we feel isolated or excluded, we should be able to say, “This feels awful. I need to do something about this!”—and then apply our energies to the problem. We can reach out to dependable friends. Where necessary, we can mend relational rifts or reconnect after long, sometimes awkward separations. We can let our discomfort propel us to figure out why we’re not included in the group, and then either change our behavior or change the company we seek.

But when we adhere to the idea that it’s healthier to be separate and independent, we have a different reaction to the brain’s distress signal. Instead of listening to it, we try to suppress it. We say, “I’m an idiot for feeling this way! I’m a grown person; I shouldn’t need anyone!” or “I’ll just grin and bear it.” This is like hearing your smoke detector go off and saying, “Well, I guess I just have to get used to that horrible sound.” You ignore the cause of the alarm. Meanwhile, your house smolders.

I worry about what’s happening to our brains in a world that does not put a priority on connection. As humans, we are blessed and cursed with the ability to form abstract thoughts and an enormous capacity to remember past events. These two characteristics of the human brain can enhance our enjoyment of life. You use these capacities when you conjure up a fantasy about the date you are about to go on; or when you imagine an afternoon laughing by the pool with your best friends; or when you anticipate a loving reunion with your family after a long business trip away from home. Of course, you never really know how any interaction with another person will go. Essentially, you’re making stuff up all the time, based on your past experiences.

The problem comes when you live in a culture that doesn’t support healthy relationships or teach people how to make strong connections. Anyone who has a history of repeated social exclusion will use those painful experiences as a template for imagining the future. You expect more exclusion, and you will probably interpret your social encounters according to this expectation. The more you’re left out, the more the experience of being left out is knitted into your neural pathways. Instead of anticipating happy reunions and pleasant social events, you tend to assume that you’ll be rejected. And when this is the case, your dACC is almost always at least a little bit activated. This is especially problematic when people experience rejection and abuse in childhood, a time when their brains are creating their initial pathways for relationship. They live with an alarm system that is constantly ringing. The nerve pathway that is supposed to help them stay connected becomes a nerve pathway that keeps them frightened and apart.

One of my favorite movies, Good Will Hunting, illustrates how past relationships can create an overactive dACC. The lead character, Will, was born and raised in gritty South Boston (back before the townies moved there and spruced it up). Will is an Einstein-level math genius working as a janitor in the hallowed halls of MIT during the day and hanging out with his townie buddies in the evening. He meets a Harvard girl, Skylar, at a local bar, and charms her with his intellect, humor, and good looks. As their relationship gets more intimate, Skylar tries to deepen their commitment—and Will flips out. He rages at her, yelling while revealing his childhood history of neglect and abuse. (I’ll go out on a limb here and suggest that screaming is rarely an effective way to communicate vulnerability.) At the peak of his outburst, Will lifts up his shirt and reveals a long red scar on his torso where one of his foster parents had stabbed him. It’s clear that by exposing the physical evidence of his deepest wounds, Will is not inviting Skylar to be closer to him; he’s aggressively trying to scare her away for good. He caps the scene by telling Skylar that he doesn’t love her and storming out of the room.

You might know someone like Will; you might even be someone like Will. His relational template—which can also be called his controlling image, because of the way it significantly controls his adult life—was formed early and reinforced repeatedly by severe beatings, frequent abandonment, neglect, and poverty. For all of us, early environments are the shapers of our young neural pathways, including the distress meter, the dACC. For Will, and for many other survivors of severe abuse or neglect, the dACC has linked intimacy with the threat of abandonment and physical pain. This is the brain’s equivalent of a DEFCON 1 scenario. In response, your ability to think gets tossed like nonessential personnel while your brain unleashes its most potent weapon: a cascade of terror and survival instincts. When that happens, a person trying to get closer is indistinguishable from a person moving in for the kill.

Traumatized people are not the only ones with overactive dACCs. Milder experiences with rejection also have lingering effects. Even if you had an ideally loving childhood and rejection-free adolescence, you’re still living in a culture that measures success by how little you need other people and by whether you’ve battled your way to the top. Sure, we know that we’re supposed to be nice to other people, and that everyone matters. But we still socialize around hierarchy and stratification. Children very early on learn their ABCs—but they also pick up from the adults around them that it’s vital to sort the smartest from the dumbest and the fastest from the slowest, to know which kids are shipped from the inner city to the suburbs for a better education and which kids can walk to the same school from their very large house. In our culture, extreme competitiveness is at the core of child rearing and brain building. I’m not disparaging normal, healthy competition here. (Put me on a basketball court, and I will take you down . . . but then we’ll go out afterward for cake.) I’m talking about the kind of competition that is really judgmental, the kind that becomes the basis for deciding who is worthy of love and acceptance, the kind that has everyone worrying that it’s only a matter of time before they’re voted off the island.

In a competitive, judgmental, unaccepting environment, everyone’s relational templates are distorted, and everyone’s dACC is reactive to some degree. You can see the proof in the adults who have an exaggerated need to control the in-crowd at work or social activities. These people may act like they are kings or queens of the hill, but the harder they try to make sure they are “in” by leaving others out, the more anxious they become about being pushed out of the “in” group. If these folks weren’t so afraid of candor, they would tell you that being on the bottom of the pile is so excruciating that they will avoid it at all costs—but being alone at the top is pretty destructive, too.

At the other extreme is the person who moves seamlessly into the outsider role, with no expectation of being welcome or included in any group. The first kind of person carries the weight of rage; the other carries the weight of shame. Both emotions go hand in hand with feeling unworthy of inclusion in the larger human community. And both are the cause and result of social exclusion—and an overactive dACC.

R Is for Resonant: The Mirroring System

Resonance is the deep nonverbal connection between our bodies and brains that allows our hands to feel warm when another person rubs his together, or to sense a friend’s sorrow even before she tells you about it. It’s the sense of “getting” another person, of instinctively knowing him. The neural basis for resonance is what Rizzolatti and his team first stumbled on to when they discovered that a monkey’s brain internally mimicked the action of a researcher lifting his arm.

The mirroring system that creates resonance is the third C.A.R.E. pathway, and its story becomes even more fantastic when you consider the role it plays in understanding what another person is saying. The next time you have ten minutes, a clean pencil, and a nearby friend, try this experiment. It was designed by Paula Niedenthal, of the Niedenthal Emotions Laboratory at the University of Wisconsin–Madison, to highlight the important role of the mirroring system in understanding each other.2

Sit comfortably across from each other and think of a detailed, emotional story. The first listener should place a pencil or pen horizontally in his mouth and keep it there while the speaker tells his story. Once the story is told, switch roles.

Did either of you notice a difference in listening while the pen engaged the muscles of your mouth? I use this exercise with workshop participants, and I hear a similar set of responses every time. The first few comments usually focus on how ridiculous and distracted the speakers felt as they tried to communicate with someone who has a pen in his mouth. When pushed to think about the content of what they heard when they were listeners, the reaction is usually unanimous—it is more difficult to understand what is being said when the muscles in your face are busy holding the pen. For most of us, this is a strange and unexpected response. After all, the pen was not stuck in your ears. What in the world is going on here?

Stephen Wilson was a research student at UCLA when he began studying the connection between speaking and listening, using functional brain imaging to see the brain in action. He discovered that the exact same part of the brain was activated when his research subjects were listening as when they were speaking.3 In another study looking at the overlap between speaking and listening, the German neurologist Ingo Meister used another new technique called transcranial magnetic stimulation to effectively turn off the speech center of a person’s brain. He found that when the motor neurons controlling speech are turned off, people have difficulty understanding what they are hearing.4 Apparently, when in conversation, internally mirroring the other person’s speech is essential to understanding it.

So what happens when your face is really paralyzed? Let’s say rather than placing a pencil in your mouth to disable your ability to make expressions, you have a condition that prohibits you from moving the muscles of your face. People born with Moebius syndrome, a rare disorder that affects the cranial nerves, present researchers with an opportunity to explore this question in real life. People with Moebius syndrome live with a frozen face and are found to have a more difficult time communicating their emotions to other people. Given how much we count on facial expressions in showing our feelings to others, this is no big shock. What has been surprising to researchers is that Moebius syndrome also makes it more difficult to read other people’s emotions. Just as holding a pencil between your teeth keeps your brain from mimicking another person’s speech, paralysis of the facial muscles prevents people with Moebius syndrome from internally copying other people. Because this mimicking is key to understanding what a person is hearing, victims of this disorder have a much more difficult time understanding other people. People who get Botox treatments for facial wrinkles also have a harder time reading others.5 Because injections of Botox temporarily paralyze the muscles, they aren’t able to perform internal mimicking in the same the way they are used to.

Your brain mirrors far more than other people’s movements. After the Rizzolatti monkey study, a number of studies showed that the mirroring system works on a profound level. If you see another person experiencing pain, your brain mimics the experience. When you watch another person smile or frown, both of your brains will activate in the same regions as that person’s, although your brain activity won’t be as intense. Your mirror system activates even when another person simply gives a hint that he is about to do something. If, say, you’re in line at Starbucks and the man in front of you begins to move his arm, you may simply “know” that he is about to point to a slice of lemon cake—even though he’s not actually pointing yet—and that’s because your brain is copying the experience and using that information to read his actions and emotions, and anticipate what he might do. And other people are doing the same with you.

The mirroring system appears to be a crucial element in the complex act of empathy. Once your mirror system registers information about what another person is doing or the feeling she is expressing, that information passes through the insula, a small strip of tissue that lies deep within the brain and helps attach content to feeling states. The mirroring experience becomes a feeling you have in connection with another person’s feeling.

Of course, there’s a limit. We don’t copy every action we witness in another person, or feel every single thing that everyone else around us is feeling. That would be exhausting and paralyzing. A world of unfiltered emotions would be a nightmare! Fortunately, for most of us, biology has, again, saved the day by creating a super mirroring system as an integral part of the grand design to read others.

The super mirroring system acts like the brakes on an idling car. These days, cars with automatic transmissions have a baseline level of movement when you pull up to a stoplight. If all you do is take your foot off the gas, the car moves forward. If you want to keep the car from moving, you have to put your foot on the brake. Likewise, the classical mirroring system is constantly picking up the feelings and actions of people around you—and sometimes you need to put a brake on that activity and keep yourself in a more neutral state. That’s when the super mirroring system steps in. Thanks to the super mirroring system, if you see someone crying, you do not necessarily break out in sobs; if you see someone reaching for the coffee shop pastry, your arm does not have to reach out, too.

Marco Iacoboni, the UCLA psychiatrist and author, believes that the super mirroring system has a regulatory, inhibitory impact on our classical mirroring system so that we do not physically act out every action or feeling we see in others. In collaboration with Itzhak Fried, a researcher whose studies of epilepsy involved placing electrodes on individual brain cells, Iacoboni is beginning to map the super mirroring system in the frontal lobe of the brain. Whether or not you actually enact a movement or simply know that another has made the same movement is dependent on how the two systems—the classical mirroring system and super mirroring system—interact. The classical mirroring system fires both when you move your arm and when you watch someone across the room move his arm. The inhibitory, super mirroring system is more active when you watch someone move his arm, however, and less active when you are moving your arm.

My experience with a client, Jessica, shows how both systems work together to bring about an empathic response. Jessica texted me the night before her therapy appointment to tell me that her boyfriend of one year, the man she thought she would marry—the man everyone thought she would marry—had broken up with her. Ray had been unusually distant for about two weeks, but Jessica figured that with the holidays coming up and with his family in town, he was simply busy and less available. She tried to reassure herself that things would be back to normal once the New Year started. They met up for what Jessica thought would be an ordinary dinner, and he broke up with her on the spot. The text read simply: Ray just broke up with me. I am devastated!

When I saw her in my waiting room the next morning, my mirroring system was immediately activated. As my eyes registered her red, sad-looking eyes and the downward turn of her mouth, neurons in my prefrontal cortex were stimulated so that internally my own state mimicked her misery. Nerve cells in my somatosensory cortex re-created the state of having itchy, puffy, crying-all-night eyes. As my insula relayed the information to my own visceral system, I felt a tightening in my stomach and a heaviness in my chest. This empathetic experience of Jessica’s pain happened in an instant.

Fortunately, my super mirroring system (a therapist’s best friend) was also activated, enabling me to have a taste of what my client was feeling—but just a taste. As Jessica sat and wept, head in her hands, I felt a tear well up in my own eye, but I never got close to sobbing myself. This ability to modulate is crucial to maintaining healthy connections. Think about it. If we were all simply mimicking everything all the time, there would be a single feeling that traveled through humanity in a gigantic wave. Thankfully, that doesn’t happen.

When the mirroring system fires in empathic response, it is not an exact duplicate of another person’s experience, nor is it a complete merger of feelings. Jessica’s sadness, however, was strong enough and clear enough for us to be joined through an empathic connection. Just as a fish knows how to turn in unison with the rest of its school, Jessica and I instinctively knew how to move closer together in this magical, mutual moment. It’s not just emotional; it’s biological, down to our nerve cells. Physically, emotionally, and neurologically, we were in sync. It was a reminder to both of us that, as human beings, we are never alone in the world.

Unfortunately, the separation-individuation model of human development doesn’t leave a lot of space for thinking about the mirroring system and warm, connected closeness. It was not too long ago that mental health providers were taught that empathy did not belong in the therapy hour. The idea was that empathy was a contagion that would distort the real work of therapy—which was, supposedly, helping a person identify mental blocks preventing him from “standing on his own two feet.” Now many therapists identify empathy as the most important ingredient in a healthy healing relationship. But you still see the old attitude in the idea that we’re not supposed to need other people to share in our happiness or heartache, or that healthy individuals should be able to avoid “catching” other people’s feelings. You certainly see it in our competitive day-to-day environment, in which we tend to view other people as adversaries, not potential friends, and everyone is under near-constant stress. In our ideal of success, you are admired for your ability to do what is necessary without considering the impact on others. To unwind from the tension, people play violent video games or watch violent television shows.

This environment actively undermines the natural physiology of connection. In a competitive, visually violent world, you’re exposed to so much pain that the only way to thrive is to ignore the signals that your mirroring system sends you about other people’s feelings, actions, and intentions. It’s true that mirroring activities happen involuntarily, but it’s possible to consciously reject the signals that other people send you. Over time, it’s even possible to develop the capacity to dissociate from your own body, which is a bigger version of paralyzing your facial muscles by holding a pencil in your mouth—it makes it harder for you to decode the feelings of others. When you are disconnected from your body, you also miss out on the sensations that signal your own feeling states. Years ago, I treated a woman who had been physically abused as a child. Over the years, she learned to decouple her bodily messages from her thoughts, as a way to protect herself from feeling pain. She had so effectively ignored her basic body signals for so long, however, that as an adult, she had no idea what it felt like to be hungry. That slight ache you feel in the sternum when you wake up in the morning? You and I know this to be hunger—but my client barely registered the feeling. When she did notice the feeling, she thought it was a stomachache. As a result, she rarely ate in the mornings, and the rest of the day she barely ate enough to keep herself going. She had to relearn how to focus on her body in order to understand messages that she should have read instinctively.

Whenever an uncomfortable empathic message—like pain—comes through, you can choose to withdraw from it. Do this often enough, and your mirroring system takes a hit. Because the mirroring system is made of nerve cells throughout your brain, especially in the areas that govern action, sensation, and feeling, the system can thrive only when it’s used repeatedly. As you’ll see in the next chapter, complex neural pathways are made stronger by being “wired together”—by being stimulated over and over. It’s this wiring together of different brain regions that forms the 3-dimensional experience of another person’s world. It makes the information you get clearer and more complex, which means that the empathic response you feel is more likely to be in tune with what the person is actually feeling. Without frequent stimulation, the pathways between the neurons become weaker and less able to carry signals. Our complex mirror nerve system needs to be stimulated in order for us to maintain this gift of reading each other.

Is it inevitable that we will lose our ability to communicate and read one another as we interact increasingly through technology? I don’t think so, but it is necessary to educate children and adults about the essential role of the mirroring system in our human interactions and teach them how to keep this part of their nervous systems robust. As I sit typing this chapter in Panera, I see and hear groups engaged in good old-fashioned conversation. Elderly men and women are gathered at a large table, laughing, talking, drinking coffee, eating muffins—and stimulating their mirroring system. Another group of coworkers is discussing a work project, two of them huddled over their computers. They are typing ideas, talking, laughing, drinking coffee—and stimulating their mirroring systems. My kids are now at school. In a typical day, they might be working in small groups in science lab and learning how to divvy up tasks and to cooperate in writing a report; sitting at lunch acting goofy with their friends; or asking teachers for help—in all these interactions, they are stimulating their mirroring systems. These human interactions are as ubiquitous as Apple products these days. What shapes us is not so much the devices we use, but the culture in which the device is placed. If, as a society, we value human connection as the center of our lives, and if we understand the need to stimulate our mirroring systems to maintain our ability to read others and to cooperate in groups, then the electronic world will follow.

E Is for Energetic: The Dopamine Reward System

On the fourth relational pathway, we meet up with dopamine, a neurotransmitter that makes our lives feel more gratifying. Like many of our neurotransmitters, dopamine plays a different role in our brains and bodies depending on which neural pathway it is traveling. The dopamine pathway that is most directly connected to relationships is the one that is involved in our brain’s reward system. This pathway, known as the mesolimbic pathway, starts in the brain stem. It then sends projections to the amygdala, which is involved in feelings and emotions, and travels through the thalamus, which acts like a kind of relay station. The mesolimbic pathway ends in the orbitomedial prefrontal cortex, where some of the decision-making process takes place. The pathway then loops back to the brain stem and modulates the production of dopamine.

When dopamine is stimulated in this pathway, you feel good. Remember Jean Baker Miller’s description of growth-fostering relationships as “zestful”? Dopamine gives you that zest; it can feel like a shot of warm, glowing, motivating energy. This is a system whose purpose is to reward healthy, growth-promoting activities—like eating well, having sex, and being in a good relationship—with a supply of dopamine that makes us feel great. The resulting feelings of elation make us want to participate in more of those healthy activities. It encourages the human population to do what’s good for us.

It’s a brilliant setup, but only when it works the way it’s supposed to. In an ideal world, you’re born with a brain that pairs human contact and dopamine. And then, in your first months and years, your early relationships are so rewarding and healthy that your dopamine system learns to connect relationships even more tightly with feeling good. In one study, the more dopamine receptors in the striatum (part of the forebrain), the better your social status and social support.6 More dopamine, more interconnection.

But what happens to this pathway when a baby or child does not experience snuggly, supportive relationships? What happens to children who are raised to be fiercely “independent” above all else? To children raised to believe that counting on others throughout life makes them weak and vulnerable? In these children, relationships become disconnected from the dopamine reward system. Seen from the brain’s perspective, this is a logical protective step: if relationships are threatening or seen as unhealthy, they should not be paired up with a rewarding boost of dopamine. These children become adults who simply don’t get much pleasure from relationships. Instead of becoming energized by friendships—even good ones—they are drained and depleted by the interaction.

When the dopamine system is disconnected from healthy relationships, the brain looks for other ways to feel good—so it seeks out other ways to stimulate the dopamine system. Those “other ways” are familiar to all of us: overeating, drug and alcohol abuse, compulsive sex, shopping, risk-taking activities, gambling.

This is why you may have heard either dopamine or the mesolimbic pathway getting a bad rap. Recently it’s been discovered that all drugs of addiction—and in fact all addictions, whether or not they’re drug-based—stimulate the mesolimbic pathway and release dopamine. The more this pathway is repeatedly stimulated by a particular drug or activity, the more robust the addiction gets.

It’s important to understand how a pathway that’s meant in part to encourage healthy human connection can get hijacked to create drug addictions. Addictive drugs, such as cocaine, heroin, and marijuana, have a two-pronged attack on the central nervous system. A drug’s first action on the body is unique to that drug. Cocaine produces its euphoria and grandiosity by stimulating the release of a large amount of the naturally occurring neurotransmitter norepinephrine. Heroin, on the other hand, works by imitating the effects of the body’s naturally occurring opioids.

While the initial high a drug causes is compelling, it is the second action of addictive drugs, the stimulation of the dopamine reward system, that ultimately leads to addiction. With repeated use of a drug, the body adapts by either producing less dopamine or down-regulating its receptors. When this happens, you get less of a “hit,” or reward, from the drug. Over time, tolerance develops so you need more of the drug to produce the same high. This double whammy of an altered mental state and stimulation of the dopamine reward system serves as the perfect storm for addiction.

Substance abuse may be the most well-known addiction, but it certainly is not alone. In reality, any activity done so repetitively that it gets in the way of other meaningful activities in life is an addiction. In a perversion of the dopamine pathway’s original purpose, your brain learns to pair dopamine with activities that are incredibly unhealthy. When the powerful chemistry of addiction sets in, humans are no different from rats in a lab that obsessively press a lever to receive stimulants even as they are starving to death. Producing dopamine trumps all other life-sustaining activities.

The science of addiction is specific and devastating. But in a way, we all seek out dopamine. We all live from one dopamine hit to another, and it’s natural for us to want to feel good. What matters is the source of the dopamine. It can be as life affirming as drinking water or cuddling a newborn baby—or it can be as destructive as a drug addiction. But every single one of us craves dopamine. It is simply the nature of human physiology and the behavior of the dopamine reward system.

When we are under pressure to be highly separate, intensely independent individuals, we are at risk for cutting ourselves off from one of the primary healthy sources of dopamine. But it is possible to rewire your brain so that it can get more pleasure out of relationships—to crave human contact instead of unhealthy substitutes. The key, as Louis Cozolino writes in The Neuroscience of Human Relationships, is to understand that “healing involves reconnecting our dopamine reward system to relationships.”7 With practice and an understanding of how the dopamine system works, you can teach your brain to stop searching for dopamine in all the wrong places—and that the easiest way to feel better is to reach out to another safe human being.

• • •

The science is clear. Social disconnection stimulates our brain’s pain pathways and our stress response systems, making it more likely we’ll seek out unhealthy sources of dopamine. We also miss out on the richness of human experience, of the empathic connections that are intricately tied to the depth and breadth of feeling and emotion.

But there is plenty that you can do to nourish your neurological pathways for connection. If they are damaged, you can start to heal them. If they are neglected, you can cultivate them. And if they are stressed, you can soothe them. In the next chapter, I’ll describe the science that is teaching us how to change our brains for the better.