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The Developing Mind

A Teleseminar Session withDan Siegel, MD

and Ruth Buczynski, PhD

The National Institute for the Clinical Application of Behavioral Medicine

http://www.nicabm.com

The National Institute for the Clinical Application of Behavioral Medicinewww.nicabm.com

The Developing Mind 2

A complete transcript of a Teleseminar Session featuring Dan Siegel, MD and conducted by Dr. Ruth Buczynski, PhD of NICABM

The Developing Mind

Contents

The Role of Interpersonal Neurobiology in the Developing Brain . . . . . . . . . . . . 4

Childhood Experience and the Development of the Brain . . . . . . . . . . . . . . . . . 5

Relationships, Mental Processes, and the Brain . . . . . . . . . . . . . . . . . . . . . . . . 6

What Parents and Practitioners Need to Know About the Development of a Child’s Brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

The Power of Touch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Abusive Relationships and the Developing Brain . . . . . . . . . . . . . . . . . . . . . . 12

The Biochemistry of Humiliation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

How Neuroplasticity Can Be Utilized to “Re-Develop” the Brain . . . . . . . . . . . . 16

Six Features that Promote Neuroplasticity. . . . . . . . . . . . . . . . . . . . . . . . . . . 17

How Practitioners Can Utilize Mindsight to Influence Interpersonal Neurobiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20



Dr. Buczynski: Hello everyone. Welcome back. This is Dr. Ruth Buczynski. I’m the president of the National Institute for the Clinical Application of Behavioral Medicine and a licensed psychologist here in Connecticut. I want to welcome you back to this series on The New Brain Science. This is our second week and reports are in about last week. It was an historic event. As far as I know, it was the largest practitioner global teleseminar series. According to Google analytics, there were 4,113 listeners on that call and they represented 60 different countries, Washington D.C., and all 50 of our states here in the United States.

And let me just report in a little bit on the details. So, just choosing a few of the countries and next week I’ll choose a few other ones. From Canada, there were 580 listeners. From Germany, there were 38. From El Salvador there were six. From Kazakhstan, there were two. From China, there were two and from Qatar there was one listener. I just want to say to everyone, we are so glad that you were part of that call last week and we’re very glad to welcome you back this week.

We are practitioners representing all kinds of professions. We are physicians, nurses, psychologists and social workers. We are marriage and family counselors. We are mental health counselors and rehab counselors. We are chiropractors, physician assistants, occupational therapists, and physical therapists. We are stress management consultants, coaches, and energy therapists. We are clergy. There are a lot of lay people on this call, as well. And if you are a lay person and not a practitioner, I just want you to know that you are welcome and we’re glad you’re here.

We have an exciting call tonight. My guest is my friend Dan Siegel. He is a physician and a psychiatrist. He received his medical training at Harvard University. He is now based in UCLA, which if you’re out of the country, that’s in California. He is on the faculty of the Center for Culture, Brain, and Development. And he’s the co-director of the Mindful Awareness Research Center.

So Dan, thanks for being part of our call.

Dr. Siegel: My pleasure Ruth. And thank you for having me.

Dr. Buczynski: I didn’t mention, and I do want to. Dan has written many, many books. And two of them that I’ll mention are The Developing Mind, which he wrote about how relationships in the brain interact to shape who we are, and Mindsight: The New Science of Personal Transformation.

He’s also written books for therapists that basically talk about the mindful brain and so forth.

And Dan I’m always excited to have a call with you because we get into such interesting things, and you are such a curious person. So let’s jump right in.I want to start this call with the role of interpersonal neurobiology in the developing brain. So focusing on the developing brain, you looked at that, it’s almost been ten years now, and I’m sure that’s changed a bit since you looked at it when you wrote your book.

What are we learning that’s exciting and interesting to you about how infant and toddler, child brains develop?

The Developing Mind

with Dan Siegel, MD and Ruth Buczynski, PhD



The Role of Interpersonal Neurobiology in the Developing Brain

Dr. Siegel: That’s a great question Ruth. First of all, let me thank you again for having me as a part of your series and for the opportunity to share with everyone the idea that the way we relate to one another starting in early childhood with our caregivers, our parents and others, and even later on with the clinicians who take care of us, with our teachers, and our friends are not just something we do. They’re not just a part of our lives. They actually shape who we become.

And of course in the last 12 years since The Developing Mind was published, those dozen years have really accelerated the pace of technology and that offers us the chance to do scientific studies of the brain and to see how that contributes to healthy development.

We can look at how mental processes like emotions, thoughts, intuitions, memories and even attitudes and awareness are a part of our mental life, to see inside. And how in fact, those processes flow together with mental life interacting directly with brain processes.

The third entity, the influence of relationships, has really emerged even more than the way it seemed to be back in the 90’s when I wrote The Developing Mind, now we have even stronger support for this approach. Relationships are a huge, huge influence on the development of the nervous system.

So the field of social neuroscience has really blossomed. Affective neuroscience has joined the ranks with cognitive neuroscience. So those are really exciting areas.

The field I work in is called interpersonal neurobiology, distinct from social neuroscience. Interpersonal neurobiology is basically a field where we try to bring in all disciplines of science as well as any other human effort to understand truth, whether it’s music and art or poetry or even contemplative practice in religion. We really invite everyone to come into a supportive collective conversation to say what is human reality?

What is the reality of our human lives? And how can we draw on the wisdom of all these different ways of knowing, whether they’re artistic, scientific, or contemplative, so that we can have a picture of, if you will, the whole elephant, not just pieces of the elephant that one discipline studies or another part that another discipline studies, but rather the whole elephant view.

“...the way we relate to one another starting in early childhood with our caregivers, our parents...our teachers, our friends are not just something we do...They actually shape who we become.”

“We can look at how mental processes like emotions, thoughts, intuitions, memories and even attitudes and awareness are a part of our mental life...And how in fact, those processes flow together with mental life interacting directly with brain processes.”

“...how can we draw on the wisdom of all these different ways of knowing, whether they’re artistic, scientific, or contemplative, so that we can have a picture of, if you will, the whole elephant, not just pieces of the elephant.”



We call that consilience, based on E. O. Wilson’s work, which means finding the principles that are shared across independent disciplines. So interpersonal neurobiology is that world, and I invite you Ruth and everyone else to come join us whether it’s online or in person.

We have annual meetings and all sorts of fun stuff. So everyone, whether you’re a psychiatric nurse, working in a medical clinic, working with people in physical rehab and

physical aspects of medicine, psychology, psychiatry, social work, occupational health, or educational programming. Anyone interested in helping develop well-being has something they can contribute and also benefit from within the field of interpersonal neurobiology.

This summer 15 interns worked on the revision of The Developing Mind, a dozen years after interpersonal neurobiology was first proposed. And I’m happy to report that their task was to try to prove that the book The Developing Mind was wrong.

They scoured the scientific literature, which has become huge in the12 years since the book was first published to try to find evidence that the hypotheses in the book were not supported or not correct or just outright wrong.

And what actually happened is that easily over 98% of that book, the data and the proposals have been supported by subsequent research. So the basic premises, which I can tell you about later, have been supported.

And science, like the study of the new field epigenetics, the way our experience changes the regulation of our gene expression, continues to support the idea that relationships shape the development of the brain.

Dr. Buczynski: And everyone we’ll be having a call devoted exclusively to epigenetics toward the end of the series. So I’m glad you brought that up Dan.

Now when you wrote that book just over 10 years ago, it was pretty much a hypothesis then, the idea that the relationships that a child experiences were actually affecting the way that child’s brain developed and the structure of that child’s brain. That was a fairly bold hypothesis at the time, wouldn’t you say?

Childhood Experience and the Development of the Brain

Dr. Siegel: Yes. It was supported by the science, but not proven really. My own training in biochemistry was basically biological studies as an undergraduate and my training in medicine included neuroscience with Dave Hubel at Harvard. While I was in school there, he got the Nobel Prize for showing that experience shapes the way a kitten’s nervous system unfolds.

One of the main points of Hubel’s and Wiesel’s study, which won the Nobel Prize, was there was a limited window of opportunity for helping people. Now we know that this is much more flexible than

“...consilience, based on E. O. Wilson’s work, means finding the principles that are shared across independent disciplines.”

“...science, like the study of the new field epigenetics, the way our experience changes the regulation of our gene expression, continues to support the idea that relationships shape the development of the brain.”



back in 1980, so that’s changed a lot. We now know the brain continues to respond to experience throughout the lifespan. In fact in the Mindsight book, I have the case of a 92-year-old that we talk about.

So that’s changed. But what that really taught me is that experience does change the structure of the brain. I wasn’t making that up. That’s been known for a long time.

Is there a way of hypothesizing how that might happen? In my point of view, I wasn’t going out on that much of a limb, because my teacher David Hubel got the Nobel Prize for showing that.

So it wasn’t so big a deal for saying the stimuli that is entered into a nervous system—in this case he was working with visual stimuli with young cats—the visual stimuli that enters the nervous system shapes the way that nervous system develops. That we’ve known.

Then in the late ‘80s, I was very frustrated with where the field of mental health was going, because it was so reductionistic. If you had a psychiatric problem or ended up with a mental health illness, it was your brain that was the problem.

Or if you had a diagnosis of cancer or an MI heart attack whoever was taking care of you, a nurse, a physician, a physical therapist, thought if someone’s having trouble, there’s something wrong with their brain. And therefore they needed a pill.

That just seemed to me to be too simplistic, too reductionistic a view, and yet there were a lot of forces wanting fast treatments and other political and economic reasons why that view started to hold sway. And with training in science and also working as a clinician, it just seemed to me that was scientifically wrong, even if it was being put into clinical practice.

Relationships, Mental Processes, and the Brain

So in my own world, I really wanted to get training in what I felt was at the heart of health -- relationships. I got trained as an attachment researcher starting in the late 80’s and then just as that was happening; it was the beginning of the decade of the brain, the 1990’s.

New technology allowed us to look into the healthy living brain. So I wanted to combine those discoveries that were just coming out 20 years ago with my own training as a biologist and as an attachment researcher studying relationships.

I think it was a natural evolution of my own thinking to try in the early 90’s to make basic statements like; how do relationships, mental processes, and the brain relate to each other? What’s the connection? What are the interactions among those three things?

“I was very frustrated with where the field of mental health was going, because it was so reductionistic...yet there were a lot of forces wanting fast treatments and other political and economic reasons why that view started to hold sway.”

“We now know the brain continues to respond to experience throughout the lifespan.”



There was also a push to make sure you only thought of the mind as an outcome of brain activity. But as an attachment researcher, I knew that relationships shaped the mind, not just brain activity. So I felt that those statements were excessively reductionistic.

It didn’t make me friends among my neuroscience colleagues. I just felt like the mind was something more than just brain activity. Even as recently as a few days ago, when I said that at a meeting of retired professors at UCLA, a young professor who happened to be in the room got up and said,

“You’re going to kill science with those outrageously wrong statements that the mind is not just the activity of the brain.”

So that was a politically incorrect thing to be doing, but I felt that if you really read the science deeply, you could show a connection among those three entities—relationships, mind, and embodied brain, or the whole nervous system distributed throughout the whole body, which we’ll just call brain for short.

They were three aspects of one reality and if you saw energy and information flow as a reality, we’re looking at relationship, like now between you and me, Ruth. Also between you and me and everyone else on the call, we’re sharing energy and information right now, and as that moves, it’s going through a mechanism in our bodies. Let’s just call that brain, but it’s through the whole body, not just the thing in the skull. So you have the embodied brain if you want to call it that.

And then you have the mind. I ran a group in 1991 or 1992. I gathered a bunch of scientists I had met when I was a research fellow, and our question was what’s the connection between mind and brain? They couldn’t really define the mind but they could describe the brain. That was pretty easy.

So I came up with a definition of mind about 20 years ago that has been really useful. That one aspect of the mind is of course our consciousness and our subjective experience. But another aspect of the mind, a core feature of the mind can be seen as this embodied and relational, self-organizational emergent process that regulates the flow of energy and information.

And with that definition the group could go on meeting for about 4 ½ years, where 40 scientists from over a dozen different disciplines of science could actually communicate in a respectful way with each other.

And in doing that, what I learned 20 years ago was that you really need to rely on different disciplines to paint a picture of the whole elephant. And it was during that time I started writing The Developing Mind.

It just seemed to me working full-time as a therapist and part-time as an academic and part-time as a teacher that the most useful thing I could do for my patients, my clients was to be really honest and not just taken by what the fad of the day was, this approach or that approach, but see the deeper reality about mind, brain, and relationships.

“But another aspect of the mind, a core feature of the mind can be seen as this embodied and relational, self-organizational emergent process that regulates the flow of energy and information.”

“There was also a push to make sure you only thought of the mind as an outcome of brain activity. But as an attachment researcher, I knew that relationships shaped the mind, not just brain activity.”



And that ultimately led to the publication of The Developing Mind, and saying, let’s all work together. Let’s collaborate whatever we call it. Maybe we can call it interpersonal neurobiology, which means everything from the social, what happens in our society and the interpersonal world to what happens at the molecular level, like our synapses.

What’s the synaptic and social hug we can give all these different disciplines. I named it interpersonal neurobiology, but it’s not a branch of neuroscience, and it’s certainly not the same as social neuroscience. It’s more this consilient interdisciplinary home where clinicians, teachers, parents, people working in contemplation of religion, the arts, everyone can find a home in this field.

So The Developing Mind was the flagship book that made that hypotheses based on science, not totally proven by science, but it made the hypotheses in a way that was founded on over a dozen different disciplines of science. My students this summer asked me, are you really surprised that 98% of the book held up to be true, that we only had to modify the other 2%, and that we added over two thousand new scientific references to support the findings. I said I’m really pleased. I’m relieved. But because

the book was based on the overlapping but independent findings from over a dozen different disciplines of science, it would have been kind of shocking in a way if twelve scientists were wrong.

Dr. Buczynski: Let’s bring this to the practical level, and let’s say you’re a pediatrician or a school counselor or maybe you’re on this call and you’re a mom, what should you be keeping in mind? What should that pediatrician be coaching or counseling the parent to keep in mind when they’re thinking about how their relationship with their child affects the development of the child’s brain?

What Parents and Practitioners Need to Know About the Development of a Child’s Brain

Dr. Siegel: The first thing to say from a very practical point of view if you’re a parent or a clinician is the relationship you have with your child in a parent’s case or your patient in a clinician’s case is all about how you’re sharing the focus of attention with that other person. Which means how you communicate both with the words you say and your non verbal communication, which includes your eye contact, your facial expressions, your tone of voice, your posture, your gestures, the timing of what you say, and the intensity of what you say.

We bring nonverbal factors which have a dominance in the right hemisphere of the brain both being sent by you and received by the other. We have verbal communication, the text of what we say, not just the

“So The Developing Mind was the flagship book that made...hypotheses based on science, not totally proven by science, but...made...in a way that was founded on over a dozen different disciplines of science.”

“It seemed to me working full-time as a therapist...that the most useful thing I could do for my patients...was to be really honest and not just taken by what the fad of the day was...but see the deeper reality about mind, brain, and relationships.”



context, but the text, the actual words, the syntax, the definition of the words we say. The actual things we say in words are also really important. That has a dominance on the left side.

At a minimum what I would say is when you think about your connection with your child for a parent or your patient for a clinician—and I hope it’s okay, I’ll just say the word patient, rather than saying patient or child all the time.

Dr. Buczynski: It’s fine.

Dr. Siegel: And I wish we could just have another third word that we could all agree on.

Dr. Buczynski: And certainly let’s not fight about it.

Dr. Siegel: I’ve actually seen a wonderful book called Mindfulness in Psychotherapy where psychologists who write and edit the book say we’re going to use the word patient, because patient really means a student. And in many ways we see the role of a clinician as a guide or a teacher while client means someone who is inferior. This is the work of Christopher Germer who wrote that in his introduction.

Dr. Buczynski: Right and Ron Siegel, I think.

Dr. Siegel: Ron Siegel and Trudy Goodman are in there too. Fabulous book. But anyway, when I read that from psychologists, maybe a lot of psychologists don’t believe that, but it made me feel more comfortable using the word patient because that’s what they decided to do. But I in no way mean to say patient is better than client. It’s just easier to say.

Embedded in that little teeny parenthetic discussion, the essence of it is you bring an attitude of respect and collaboration with your child and with your patient-client that is felt deeply by the other person. So a relationship is the sharing and whatever you’re dealing with.

Let’s say a person has had a heart attack or is facing cancer, the relationship that you bring can totally transform how that clinical interaction unfolds. To that point you may know the study that shows if a primary care clinician approaches a patient even with a common cold with empathy; “How are you feeling? What’s this like for you? This must be hard?” Versus, “What are the symptoms? Here, take this medicine.”

The person who had the empathic 15 minute visit will actually get over their cold a day faster and have an improved immune response just from that encounter.

So empathy which is all about a relationship being in resonance shows that when we focus on the subjective inner life of the other whether it’s the child for a parent or a patient in a clinical case, it promotes health. So the first thing to say is your relationship really matters. It affects the physiology of the body.

“...the word patient...really means a student. And in many ways we see the role of a clinician as a guide or a teacher.”

“The first thing to say from a very practical point of view...is the relationship you have with your child...or your patient...is all about how you’re sharing the focus of attention with that other person.”



And that’s just not a hypothesis. It was a hypothesis 12 years ago. Now we show it actually improves the immune system. It improves the cardiovascular system. There are some studies that imply, we don’t have the data yet, that parenting can be important even epigenetically helping your genes be expressed properly.

Relationships are not just convenient niceties. They’re the substrate of the reality in which we grow. This energy information sharing, which is what a relationship can be defined as, is really important. So that’s the first thing to say.

The next thing to say is that a healthy relationship, a healthy brain and healthy mind too, can be defined. In our work, interpersonal neurobiology, we actually define health as integration. And integration is a word that means the linkage of differentiated parts.

Let me give you a practical example for a clinical case. When a person comes in with a common cold, differentiation means you want to know about their unique, specialized, inner subjective experience. What’s that like? You’re honoring the differences. You’re exploring the differences. How does it feel to miss work?

This might only take 30 seconds, but it honors the differences rather than showing the people, you’re just one of 500 people with a common cold. Here’s what I need you to do, drink fluid, good bye, see you in a week. That’s where you’re not differentiating the person.

The linkage comes from your interest in their unique subjective inner life. So that example of an empathic clinician can be understood through the lens of integration and that’s why integrative communication promotes integration in the nervous system.

And to put it really quite simply, integration of the nervous system means different parts of the brain, let’s say the left side and the right side, the higher parts, the lower parts, when they can differentiate and then link together, they can coordinate and balance the movement of energy and information through the nervous system. And when they do that, the system achieves optimal regulation.

Integration is actually the heart of healthy regulation. Now once you realize that integrative communication promotes integrative healthy regulation in the body, you get the whole picture. The book Tina Bryson and I just wrote, A Whole Brain Child, really demonstrates for parents, how to take your relationship and inspire your kids to rewire their brains towards integration.

“The next thing to say is that a healthy relationship, a healthy brain and healthy mind too, can be defined...we actually define health as integration. And integration is a word that means the linkage of differentiated parts.”

“So empathy which is all about a relationship being in resonance shows that when we focus on the subjective inner life of the other...it promotes health.”

“The person who had the empathic 15 minute visit will actually get over their cold a day faster and have an improved immune response just from that encounter.”



These relational integrative communications, empathic ways of tuning in, can be honed so that you actually promote integration in the child’s brain, and what’s exciting about this, is it gives parents the opportunity to really deeply see how they can use their relationships to promote health in the child’s nervous system and whole body. The regulatory function controlling all of this is the mind, so how to create a healthy integrated mind.

Dr. Buczynski: How much does touch affect any of this?

The Power of Touch

Dr. Siegel: Well, we’re born to be touched and to make connections, the release of oxytocin, just the subjective feeling of connection and well-being. Touch is vitally important, from a biological point of view.

Michael Meaney from McGill in Canada has shown that for rats. For example, the amount of touch that rats receives as pups will shape the structure of their brain and also shape the unfolding of the molecules that control gene expression, which basically are the epigenetic regulators of gene expression. They’re little molecules, histones and methyl groups on the chromosome.

So they aren’t the sequence of DNA, the nucleotides that are like the letters in the alphabet. These are more like the librarians in a library that allow you to check out a book or not. When a gene is in the double helix DNA folded up and just sitting there, it’s not expressed, it actually has no impact. It is like a book sitting on a shelf in the library where the librarian doesn’t let it out.

With the regulatory molecules distributed around the nucleotide, they determine when and how and which genes will be allowed to unfold out of their double helix configurations. Single-stranded RNA’s may float out of the nucleus and get translated into proteins. Gene expression ultimately leads to protein production, which allows in the brain terms, the connections among neurons to be changed.

We now know about touch, which we were only guessing years ago, and now we know with unbelievable clarity. Michael Meaney and others have done some really mind boggling research to show in this case that the way a rat mother licks and grooms and touches her rat pups will change the epigenetic control in the nuclei of the neurons in the brain that help regulate stress response.

Touch then is necessary for gene expression to allow the healthy growth of the part of the nervous system that helps you deal with stress. Studies

“Touch is vitally important, from a biological point of view.”

“Integration is actually the heart of healthy regulation...These relational integrative communications, empathic ways of tuning in, can be honed so that you actually promote integration in the child’s brain...”

“Touch then is necessary for gene expression to allow the healthy growth of the part of the nervous system that helps you deal with stress. Studies have shown what happens if you aren’t touched enough in rat terms, we can only imagine the extension to human beings.”



have shown what happens if you aren’t touched enough in rat terms, we can only imagine the extension to human beings; we haven’t done the studies yet.

Although Meaney did one study on the opposite, on abuse, and showed that the result of neglect and abuse leads to abnormal epigenetic changes in the parts of the brain that regulate the stress response.

Dr. Buczynski: You know I was thinking if it is true that the relationship very much affects how the structure of the brain develops, then the corollary is true too. A poor, ineffective, or what you brought up just now, an abusive relationship also would be affecting how the brain and the mind develop.

Abusive Relationships and the Developing Brain

Dr. Siegel: Totally. Since The Developing Mind came out which proposed the view that abuse would lead to impaired integration in the brain, the linkage of differentiated parts as carried out by certain areas, the pre-frontal region, the hippocampus, the corpus callosum, those are major circuits in the brain that link widely separated areas in the brain together. If you’re an integrated circuit, you help regulate the brain.

Hence The Developing Mind proposed that in 1999. It was just a hypothesis based on inferences. Since then Martin Teicher has actually shown that abuse and neglect impair the growth and destroy integrative fibers in the brain, in the pre-frontal, hippocampus, and corpus callosum.

So a sad truth, but what we now know from science, it is the sad reality that in fact, just as you’re saying Ruth, neglect and abuse lead to a damaging, whether it’s impaired growth or actual destruction, that we have to clarify, of integrative fibers in the brain. And of course the general hypothesis from The Developing Mind is that integration is health.

Integration in relationships that is empathic promotes the growth of integrative fibers in our mental life that is coherent, fluid, flexible and full of vitality. And in an abused child that doesn’t happen.

Dr. Buczynski: Which doesn’t mean that a parent has to schedule every waking moment of their child’s life. They don’t have to necessarily take their kid from gymnastics to soccer to violin to every possible thing they could do.

Dr. Siegel: No, quite the opposite in fact. You’ve got to give a child some downtime so they can literally have time to have an inner experience. I call it internal education. Though I understand the well-intended concern of wanting kids to be active, having downtime, an inner time, is really important to do.

And look, here’s the great news. So much comes from intention. So that if we can reassure parents, as you’re saying, that they don’t have to worry about every synapse they have to get hooked up.

“Martin Teicher has actually shown that abuse and neglect impair the growth and destroy integrative fibers in the brain, in the pre-frontal, and hippocampus, corpus callosum.”

“...neglect and abuse lead to a damaging, whether it’s impaired growth or actual destruction, of integrative fibers in the brain.”



There’s a natural intention you can bring and there’s a natural push toward integration. This is the fun thing about this perspective. Integration is the natural push of a system. And so in a way as the parent or even as a clinician, our job is to create the intention and the setting in which integration can manifest and push itself.

I’ve mentioned in some of my books that with abuse and neglect or our own leftover issues, or if I have some unresolved trauma in myself or unresolved complicated relationship issues with my own parents, they will come out in my interaction with my child or even in my interactions with my patients.

In Parenting from the Inside Out, what Mary Hartzell and I tried to do is take the lessons of The Developing Mind, which basically say as an adult you can make sense of your life, and when you do that, you’re integrating your brain and making it possible to have an integrated relationship with your child, or if you’re a clinician, with your patient.

The fun thing about that is we’re in a position now, with this welcoming view of interpersonal neurobiology, inviting everybody into the tent, so to speak, into a common conversation that we have across the globe online and that we have conceptually and all this stuff we share in meetings.

Interpersonal neurobiology offers a way where the different aspects of clinical practice find a common home. This is true whether you’re in physical health, nursing, a physician, physical therapy, doing massage work, you’re a body worker of other sorts or you’re working in the educational field with occupational therapy, educational therapy, and dance or movement therapy or in more direct psychotherapy settings, a social worker or psychologist.

This is a common home for us to find a definition of mind, which amazingly only 2 to 5 percent of mental health practitioners have ever been given.

Dr. Buczynski: I want us to move along; because there is some other material that’s also fascinating that I want to get to, but before we do, I’d just like to spend a little bit of time talking about how humiliation is so toxic to the developing brain. I want to get into the biochemistry of humiliation.

“...as an adult you can make sense of your life, and when you do that, you’re integrating your brain and making it possible to have an integrated relationship...”

“Integration in relationships that is empathic promotes the growth of integrative fibers in our mental life that is coherent, fluid, flexible and full of vitality. And in an abused child that doesn’t happen.”

“Interpersonal neurobiology offers a way where the different aspects of clinical practice find a common home...”



The Biochemistry of Humiliation

Dr. Siegel: Unfortunately as a parent, you see kids on a playground being humiliated. Bullying is kind of a common term for being humiliated. Just now in the White House is a whole discussion on bullying.

We know that bullying as a form of humiliation is a profound assault on a person’s sense of self. I’ve got to say even in my own practice of medicine, when I was trained as a medical student I saw the students being humiliated by their professors and I don’t want to say it was intentional.

I saw some of the patients being humiliated and I saw their vulnerability. One way of describing or defining humiliation is to be vulnerable and to receive an intentional act of harming that assaults a person’s sense of integrity and well-being.

Dr. Buczynski: So what happens in the brain when the person experiences humiliation?

Dr. Siegel: In the brain, there are a couple of layers. Let’s start with the first less severe layer, but I say less severe meaning it’s a step on the path to humiliation.

Let’s talk about shame. In shame what we see is when someone has an activated nervous system, you can be excited about sharing something, you can be hurt and wanting to get comfort from someone, and if you see a patient that would be the case.

When an attuned, focused response of caring, either sharing the joy or sharing the pain is not offered, the brain goes from a heightened state likely of the sympathetic branch.

The brain has an autonomic nervous system, which has a number of branches.

But the two we’ll focus on are the parasympathetic branch, which is itself very complex. We’ll just call it the brake for simplicity’s sake.

The other is the sympathetic branch. When you need help, your sympathetic accelerator is activated. I’m really hurting. Come connect with me. I’m a patient. I’m a child. Whichever.

Or I’m really excited. I just got a part in the school play, and you don’t attune to me. That can create a sudden slamming on of the brake. The biology of shame is this activated sympathetic system that Alan Shore and a number of authors talked about, which is followed by a crashing on of the brake. So in terms of the physiology of shame, which is what it’s thought to be, a high sympathetic tone and sudden abrupt parasympathetic tone because of the lack of attunement. That’s how the relational piece induces a state of shame.

“Bullying is kind of a common term for being humiliated...We know that bullying as a form of humiliation is a profound assault on a person’s sense of self.”

“The biology of shame is this activated sympathetic system...which is followed by a crashing on of the brake...a high sympathetic tone and sudden abrupt parasympathetic tone because of the lack of attunement.”



Now if that state of shame, which of course happens in bullying all the time, is followed by an intentional act of anger or rage directed toward the individual then the humiliation deepens the shame, the heightened profile.

What is then created inside the system is the possibility of literally a toxic state of release of cortisol, where there’s so much stress from this feeling of helplessness and now active derogation of the person, active destructive intent of the other person. This is hard wired through the system called the mirror neuron system to detect people’s intention.

So it’s one thing when someone is just distracted and this is the opportunity to feel shame. It is another when another person has the intention to harm. It creates a toxic state, I believe where you’re absorbing through your mirror neuron system that intention of anger and destruction. The cortisol released can literally in terms of the biochemistry, not only temporarily suspend all sorts of function like in the hippocampus, but it can actually be neurotoxic, it can kill synaptic connections. It can destroy them and even ultimately destroy neurons if that humiliation is maintained.

So part of abuse and even neglect, part of the mechanism of it, the biology of this humiliating experience, I believe is mediated through the shame state which I’ve just described and cortisol response which when it continues through elevated states is neurotoxic.

And that sears in through what is called neuromemory into this implicit sense of self, feeling of not only turning away of the eyes, so you have no direct eye gaze, a heaviness in the chest, sometimes a nauseous feeling in the belly, those physiological equivalents of shame, but ultimately a cognitive belief that the self is defective.

And in humiliation sometimes people absorb that anger. You can call it identifying with the aggressor if you want. But sometimes when humiliation is added with shame, it’s not just this caving in, but there’s a rage component, an infantile rage that can be enacted as an adult if that humiliation and shame are never dealt with within the structure of implicit memory.

So you may not even feel like I’m remembering being humiliated. You’re just attacking another person because you have such low self worth. But I think it’s why bullying is so toxic. I take care of adults now who are still reeling from being bullied when they were 7-8 years of age.

Dr. Buczynski: I remember I had so many patients who were younger brothers and they had stories about how their older brother tortured and tormented them and how it still affected them today.

“The cortisol released can literally in terms of the biochemistry...be neurotoxic, it can kill synaptic connections. It can destroy them and even ultimately destroy neurons if that humiliation is maintained.”

“So it’s one thing when someone is just distracted and this is the opportunity to feel shame. When another person has the intention to harm, it creates a toxic state...”

“...bullying is so toxic. I take care of adults now who are still reeling from being bullied when they were 7-8 years of age.”



I think we could certainly talk about that so much more, but I’d like to move on to how neuroplasticity can be utilized to redevelop the brain. And I’d like briefly to talk about a story you told in your book. It was Jonathan, who I believe was a high school student. Can you just briefly tell us his story?

How Neuroplasticity Can Be Utilized to “Re-Develop” the Brain

Dr. Siegel: Sure. And it’s nice. I’m actually in my office now and I’m looking over to the chair where he would always sit.

Jonathan came with a not uncommon problem. Obviously the details are changed to protect his identity. He was around sixteen years old, a teenager struggling in high school.

He was struggling and unfortunately his moods were going up and down a lot, and sometimes he would feel so desperate with the depression and the lack of feeling of hope, even in the setting where he hadn’t been humiliated or shamed or suffered abuse or neglect that I really was concerned he had a primary perhaps genetically related mood disorder, whether it was depression or possibly had a feeling of cycling. So I was concerned it was a first manifestation of bi-polar disorder, manic depressive illness.

I wanted another opinion because it’s a serious condition and also one that often requires medication, so I sent him to another board-certified child and adolescent psychiatrist. And there was concurrence in the diagnosis. I talked to the parents about starting medication. And they said let’s get a third opinion.

So we got a third board-certified child and adolescent psychiatrist to give his opinion. Now there were three of us, and we were all concerned. You can never know for sure, but our concern was highly likely that he had the first manifestations of a mood disorder, probably bi-polar, because of certain issues in the family.

The parents really didn’t want to start the medication for reasons involving the side effects, which are really pretty serious. And they were nervous about that. And they asked is there anything else that can be done?

At the time, I was working on this book called The Mindful Brain and really trying to understand how the focus of attention within mindfulness practice, developing mindful awareness might in fact be able to induce the brain to grow integrative fibers.

The hypothesis that was emerging in my own mind was that mindful awareness was more than just a focus of attention. It was more than even just emotion regulation, both of which are really important. It was a way of integrating your whole brain and changing your relationship with yourself.

“Jonathan came with a not uncommon problem...He was around sixteen years old, a teenager struggling in high school.”

“The hypothesis that was emerging in my own mind was that mindful awareness was more than just a focus of attention. It was more than even just emotion regulation...It was a way of integrating your whole brain and changing your relationship with yourself.”



Six Features that Promote Neuroplasticity

So I told them I didn’t know if it would work and that Jonathan had some serious issues like suicidal thoughts, and that I was very concerned about how risky this was. But if they really wanted to give it a try, I thought that if he could use all these features that promoted neuroplasticity we could try the team to make it work.

What would that be besides the exercises I teach? It meant he needed to get good sleep. He needed to do aerobic exercise. He needed to take healthy sources of omega-3’s that would help the membranes of his neurons maintain themselves and be able to grow new neurons and new connections.

He needed to develop a novel way of thinking. Novelty is really important. He needed to have relationships with his family, with his friends, with me. And we needed to teach him how to have the close paying of attention.

He needed those six things, so just to repeat them. You want to get people to get good sleep, good nutrition including omega-3’s, aerobic exercise, relationships, novelty; new things stimulate the growth of the brain and the close paying of attention. The close paying of attention seems to activate a part of the brain called the nucleus basalis just above the brain stem that creates acetylcholine which supports the expression of genes and the growth of new synaptic connections and maybe even new neurons from neural stem cells.

What I said was, this is laying the groundwork for neuroplasticity but now we don’t want just the brain to grow. We want to make a hypothesis about which areas of the brain we want to grow.

And for a clinician, the focus of attention is like a scalpel is to a surgeon. The focus of attention drives energy and information flow through the nervous system. And the general saying is neurons which fire together wire together.

You can use attention to stimulate neuronal activation and growth, which we call SNAG; S-stimulate, N-neuronal, A- activation, and G- growth. So we want to SNAG the brain toward integration.

And I believed in putting the book together, you can read my thoughts about it, that mindful awareness was a way of growing integrative fibers in various areas of the brain including the pre-frontal region.

In fact there was just a study that came out showing even after 8 weeks of mindfulness-based rest reduction work with Jon Kabat-Zinn, people do develop these regulatory circuits in the brain. Even after 8 weeks they’re thicker.

We know that now, but when I was writing this book, it was a hypothesis with supportive evidence, but I said to the family, let’s give it a try.

“It meant he needed to get good sleep. He needed to do aerobic exercise...to take healthy sources of omega-3’s...to develop a novel way of thinking...to have relationships...And to have the close paying of attention.”

“The close paying of attention seems to activate a part of the brain called the nucleus basalis...which supports the expression of genes and the growth of new synaptic connections and maybe even new neurons.”



So with Jonathan, I drew a picture of the brain, and you could say this is hypnotic suggestion. Whatever. If I can be that powerful to suggest to people that they’re going to grow parts of their brain and they grow, fine. I’ll take it.

So I drew a picture of the brain, I said when you focus attention in this way, and I outline the steps in the book, focusing on the breath, get distracted, bring it back to the breath.

And then we did this thing called the wheel of awareness. In fact, you can get both of those on my website www.drdansiegel.com for free and you can do the things that Jonathan did.

You need to do this regularly, every day, a daily practice. I want you to do it every day like you brush your teeth. If you do this daily mindfulness practice, we’re going to get your brain to grow the very circuits that seem like they’re inadequate.

Now since that time, Hillary Bloomberg came out with studies that showed in bi-polar disorder there are insufficient, integrative fibers from a part of the pre-frontal cortex, the ventral lateral pre-frontal, especially on the right side, that come down to the amygdale. These are neurons that differentiate the areas, so we call them integrative neurons, and they secrete inhibitory peptides like GABA.

What we now know from her work at Yale is that people with bi-polar disorder have insufficient inhibitory integrative fibers from the pre-frontal cortex to the amygdale. This is exactly what I said to Jonathan in this office.

You’re going to grow these fibers that secrete GABA. And he and other patients have said, it’s a way of secreting GABA-goo. Like it’s going to soothe this irritated amygdale.

With that as our shared belief, and now it is an n of 1, it’s only one subject.

We can’t say this is the magic bullet for bipolar disorder, but it worked.

And after three months, he had a significant reduction in his symptoms. After 6 months, there was a massive reduction in his symptoms. And now it is 5-6 years later and he’s symptom-free without any medication.

Now other patients don’t have this great response. Luckily David Miklowitz at UCLA is going to do a number of studies using, because of his own work at Oxford, mindfulness in the treatment of bi-polar disorder.

The subjects of one of the studies are women who have bi-polar disorder and want to get pregnant. They can’t take lithium or other medications because they hurt the baby in the womb. What do they

“You can use attention to stimulate neuronal activation and growth, which we call SNAG; S-stimulate, N-neuronal, A- activation, and G- growth. So we want to SNAG the brain toward integration.”

“...a study that came out showing even after 8 weeks of mindfulness-based rest reduction work with Jon Kabat-Zinn, people do develop these regulatory circuits in the brain. Even after 8 weeks they’re thicker.”



do? The study very importantly is going to take this notion that mindful awareness practice can grow the regulatory circuits of the brain that are deficient in bi-polar disorder. He’s going to actually do a controlled study of that.

He’s at UCLA, fantastic guy, fantastic researcher. Here’s the idea Ruth. Now we’re at the stage in science where we say, even if you have a genetically created vulnerability, like bi-polar, if it is genetic − and it probably is − that doesn’t mean you can’t use an experience like the focus of attention to get the structure of the vulnerable parts of your brain to change.

We’re now in this whole new approach, able to say the relationship you develop with a person helps guide their attention in this very specific way. And the reason why in the Mindsight book I gave such detailed case studies, every chapter is one case, is I wanted general people to see, but also therapists to see, how you would use your relationship to inspire people to rewire their brains toward integration.

Every case in that book is an example of how you use the focus of attention to find areas of the brain that are not integrated and try to grow the circuits of the brain to change that. Now with this controlled study, we’ll be able to see, if it is just the clinician’s conviction that makes it work?

So could I have given Jonathan a purple popsicle and say eat this purple popsicle every day and he would have gotten better. Maybe. Maybe I’m just an incredible person who should be selling Brooklyn Bridges or something. But I don’t think so.

I think it’s the actual relationship yes, attunement caring absolutely, but I think it’s the specific practice. And we’ll see with the specific double-blind control studies they do at UCLA if they show that it is the mindfulness piece. Is that really what it is, or is it just exercise? We have to tease this apart, I know.

I’m not claiming this is absolutely the way to go. What I’m trying to do is use my opportunity as a clinician and a scientist and a theoretician to say, hey, let’s open our eyes to new approaches that might really help people.

Dr. Buczynski: It’s an excellent direction for practitioners to take.

I’d like to ask you Dan to tell us one more story. This one fascinated me. It’s the story of Stuart. And am I right, he was 92 years old?

Dr. Siegel: At the time he was with me, he’s much older now, but then he was 92.

Dr. Buczynski: Could you share that?

“Now we’re at the stage in science where we say, even if you have a genetically created vulnerability, like bi-polar...That doesn’t mean you can’t use an experience like the focus of attention to get the structure of your vulnerable parts of your brain to change.”

“What we now know from [Hillary Bloomberg’s] work at Yale is that people with bi-polar disorder have insufficient inhibitory integrative fibers from the pre-frontal cortex to the amygdale.”



How Practitioners Can Utilize Mindsight to Influence Interpersonal Neurobiology

Dr. Siegel: Again, I’m in the office, so I’m getting eerie thinking about John and Stuart. When a 92-year-old walks into your office for the first time ever to see a therapist because his son brings him, as a person of course, you’re going wow! Can I really help someone at 92? So I had my real concerns that I didn’t want to waste his time.

And he was a lawyer and really was hard on me, thinking this is stupid, try to help a 92-year-old guy. But what amazed me, the details of the case are all there, is when you develop a relationship with someone and in that attuned connection filled with a sense of possibility and hopefulness and caring, you can invite someone to reflect even on 92 years of life.

In Stuart’s case where the impaired integration was caused by, I believe, the way his family life was, it didn’t really nurture the development of one side of his brain, and I talk about the reasoning of that in The Developing Mind. I talk about the science, not just about what to do about it.

And I said to Stuart, your sense of losing yourself in your books now. The presenting problem was his wife got sick and he became more socially withdrawn. His son thought he was depressed. I didn’t think he was depressed. I thought he was just using his adaptation of his childhood in a more intense way, so that rather than confronting the vulnerability of his wife of 65 years, what her illness brought up in him, this unbelievable sense of vulnerability which he wasn’t prepared to sit with. Instead he just withdrew into his law books and people thought he was depressed. But I didn’t think he was depressed. I thought he was using his adaptation.

So I said to him, I don’t think you’re depressed. I don’t really know if you want to do anything, but my impression from the evaluation we’ve just done is you’ve been living with half a brain your whole life. And that’s fine.

You’ve done great. You have children and grandchildren and this whole social network you’re in. You’ve done a wonderful job in your profession. I don’t know if you want to do anything, but if you want to try to live with a whole brain, I might be able to help you. And he said, we’ll give it 2-3 sessions.

So we went on a journey together. And I talk about the steps. And the idea is this—if a part of your brain is underdeveloped, not destroyed, but underdeveloped, it can be changed. And even if it’s destroyed maybe you can sometimes get around it like an abuse. I want to make sure to say that.

Even if Marty Teicher’s studies are true, which I think they are, it doesn’t mean you can’t as an adult or an older child when you’re away from the abusive situation grow either new fibers or repair the ones that have been damaged. Neuroplasticity as you’ll see in Stuart’s case exists throughout the lifespan. So I’m

“Can I really help someone at 92? So I had my real concerns that I didn’t want to waste his time.”

“I didn’t think he was depressed. I thought he was just using his adaptation of his childhood in a more intense way...he just withdrew into his law books and people thought he was depressed.”



very hopeful about people who have been abused that we can actually get in there with these new ways of focusing attention within a relational setting to grow the integrated fibers and repair.

The fantastic book The Master and His Emissary, by Ian McGilchrist supports the idea of right brain and left brain differences. So you might think I’m overstating the case of right brain, left brain differences, but just read that book and say, wow! How do I apply it, and that’s what we do in the Mindsight book and The Developing Mind.

So in Stuart’s case it was more an emotional desert he grew up in. So I said, here’s what the right hemisphere allows you to experience as a way of being. It’s not so much what it does as the way you are in awareness and in your sense of being, connectedness to others.

So I outlined that the right hemisphere is more about context. The left is more about text. The right is more about the inner life of oneself and others. The left is more about the exterior aspect of the mechanical way things work, the rules, and the syntax.

So with that as a basic backdrop, I said, I just get a feeling from being with you and the history I’ve gotten from you and your relatives that you have a really well developed left side but not a well developed right.

He said is that why when people say how do you feel I have no idea what they mean by that question. This isn’t uncommon. It’s a common response if someone’s super avoidant attached as a kid and dismissively attached as an adult, which Stuart was. And these are attachment terms, but this is basically how I do the assessment.

So we began a journey to say let’s take the right hemisphere, let’s ask the left hemisphere to step aside for a moment, and let’s do some work stimulating neuronal activation and growth in the left hemisphere. Let’s differentiate the right from the left by working on the fact that the right hemisphere has a whole map of the body which Stuart was not in touch with.

Because the body is more directly in touch with the right hemisphere than the left hemisphere, emotions are more directly experienced in the right. This is why Stuart had no idea what it meant when someone said how do you feel?

The left hemisphere didn’t know what to do with that. He couldn’t go to the body to say, my heart is pounding, my stomach is churning, I’m breathing fast. He had no registration of the whole body in his brain, which doesn’t exist in the left. The whole body is only represented on the right. It’s amazing.

“Neuroplasticity as you’ll see in Stuart’s case exists throughout the lifespan. So I’m very hopeful about people who have been abused that we can actually get in there with these new ways of focusing attention within a relational setting to grow the integrated fibers and repair.”

“...the right hemisphere is more about context. The left is more about text. The right is more about the inner life of oneself and others. The left is more about the exterior aspect of the mechanical way things work, the rules, and the syntax.”



Autobiographical memory is primarily in the right hemisphere. Stuart’s was very thin. He really didn’t have a rich vital sense of himself or himself with others. Stress response. Stuart could only retreat into the linguistic in terms packets of information and logic and linearity of the left where he wasn’t vulnerable, he wasn’t dealing with uncertainty.

The left hemisphere loves to be certain, it likes to make lists, and likes to know the literal meaning of things, which was Stuart’s forte as a lawyer. So I had to convince his left hemisphere that it was okay and not a threat to the left to develop the right.

And I did that by talking about the way he walked. If you only have one foot, you hop through life, but if you have a left and right foot, you can stroll through life and maybe you can even dance. So the right foot is not a threat to the left. It just adds a complementary part of your path through life.

He got that. So we just did these SNAGING things and over the course of 3 to 5 months, you could see that these things were changing.

There was this quiescent period where nothing much was happening, and then I remember the timing, in 4-6 months, something really started to change. And I remember once in the office, and I talk about this in the book, he brought up something about a ski trip and I knew his brother had lost a leg in a ski trip and I can’t remember now what exactly Stuart said.

But his grandson was going on a trip and Stuart seemed worried about it. And I said to him something about you’re remembering this thing you said from before. He said no, that’s not it. I said, is that not a left over issue from your relationship with your brother? And he said no, I don’t think so.

I said, what do you think it is? And he looks at me, and the feeling in the room is totally different. He said, I can’t believe you remember who I am. And it was this moment of connection with him that didn’t exist before.

And from that time onward the feeling in the room was like I had a whole person with me. And his wife was so startled, she called me up and said, Dan, what’s going on? Have you given Stuart a brain transplant?

There was this natural unfolding. Once you allow these areas to be differentiated and honored, they can naturally find a linkage often. And that’s what happened with Stuart. Empathy became something he did. With the right hemisphere focused on his interior, it also naturally began to focus on the interior of other people, me, his wife, his friends, and that presence you have when you’re interested in the interior world of other people is a totally different way of being on the planet.

And now I get these beautiful cards from Stuart every winter. The last one he wrote said, Dan, you cannot believe how much fun I’m having. Thank you. And this is the vitality of integration.

Dr. Buczynski: That’s neat.

“Autobiographical memory is primarily in the right hemisphere. Stuart’s was very thin. He really didn’t have a rich vital sense of himself or himself with others.”

“The left hemisphere loves to be certain, it likes to make lists, and likes to know the literal meaning of things...”



Dr. Siegel: It’s not rocket science. It may be brain science. But it’s something we can offer everyone.

Dr. Buczynski: I’m so sorry that we’re out of time. This has been fascinating and just so moving to hear this story. We’ve talked about many ways that people might apply this, practitioners and lay people in their lives and practices.

Everyone, I am about to send you an email. In that email, I’m going to send you a link to that comment board. I want you to go that comment board and tell us how you’re going to use what you learned tonight. This is really important. This is our community board where we exchange ideas and where we take this dialogue further. So go to the comment board and talk about how you’re going to use what we talked about tonight.

When you do, put in your first and your last name, your city and state or your country, and your profession. And then share with us your thoughts.

And also everyone, thanks for taking the time to be on this call. I’ll be sending you a link to Dan’s book. The Developing Mind will be coming out later, and so I think what I’ll do is send you the link to Mindsight and you can check that out. I’ll send you the link to Amazon for that book.

Dan, thanks for your work. You just have bravely pioneered and taken your hypotheses, put them out there for people to criticize, for people to research, for people to develop double blind studies and prove you wrong if that were to turn out to be the case. That takes a brave person.

Dr. Siegel: Well thank you Ruth.

Dr. Buczynski: A pioneer.

Dr. Siegel: Thank you for this opportunity to be here. We welcome everyone on the online community we have too where people can go deeply into clinical approaches, assessments, and treatment. We need to be a global community exploring each other and the new ways of helping people.

Dr. Buczynski: Yes. Thank you. Now, next week we’ll continue discussing these powerful ideas with Rick Hanson. We’re going to be looking at how to rewire the brain. Rick and I will be specifically focusing on how to encourage self-directed neuroplasticity. We’ll see you next week. Goodnight all!

“Once you allow these areas to be differentiated and honored, they can naturally find a linkage...With the right hemisphere focused on his interior, it also naturally began to focus on the interior of other people, me, his wife, his friends...”



References:

Germer, C.K., Siegel, R.D., & Fulton, P.R. (2005). Mindfulness and Psychotherapy. New York, NY: The Guilford Press; 1 edition

Hubel, D.H., & Wiesel, T.N. (2004). Brain and Visual Perception: The Story of a 25-year Collaboration. Oxford, NY: Oxford University Press.

McGilchrist, I. (2010). The Master and His Emissary: The Divided Brain and the Making of the Western World. Yale University Press; Reprint edition.

Wilson, E.O. (1999). Consilience: The Unity of Knowledge . New York, NY: Vintage



About The Speaker:

Daniel J. Siegel, MD, is an internationally acclaimed author, award-winning educator, and child psychiatrist. He is currently a clinical professor of psychiatry at the UCLA School of Medicine where he also serves as a co-investigator at the Center for Culture, Brain, and Development and co-director of the Mindful Awareness Research Center. He is also the Executive Director of the Mindsight Institute, an educational center devoted to promoting insight, compassion, and empathy in individuals, families, institutions and communities. He lives in Los Angeles with his wife and two children.

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