Untangling the Mind: Why We Behave the Way We Do

By David Theodore George and Lisa Berger

Free yourself from emotional turmoileven when that turmoil is caused by others!

We have a much greater understanding of human behavior now than we did just a few decades ago. Yet even with this greater understanding of the human mind, why we do what we do can sometimes seem like a mystery. People are often left with unsettling questions about their own (or others') behavior.

We ask ourselves, Why did I make a spectacle of myself? Why am I so stressed? Why am I constantly so negative?

In his years as a clinician, Dr. Ted George has been struck by how much easier it is for people to say they have a physical illness than it is to admit they feel out of control with an emotion—be it anger, fear, or depression. With a physical issue, you have the source of the problem in concrete terms, such as in a lab report, but with an emotional issue, it can be much harder to define what's gone wrong. Untangling the Mind helps make sense of what's happening—and why. With knowledge of how the brain translates sensory signals into emotions, you will increase your understanding of your own—and others'—behaviors. As you learn about your psychological and neurological makeup, you will begin to see new possibilities for optimism, motivation, and well-being.

We can control our behavior and our feelings, no matter how much they may have ruled us in the past, and Dr. George helps us know how. Once you understand the deeply rooted instincts that activate your emotions, you can live more peacefully, behave in ways that are more in keeping with the person you'd like to be, and enjoy your life more fully. And you'll be better able to remain unaffected by the drama of other people's emotional storms.

• Language: English
• Publisher: Open Road Integrated Media
• Release date: May 7, 2013
• ISBN: 9780062127785

David Theodore George

Ted George, M.D., board-certified in psychiatry and internal medicine, is an associate clinical director at the National Institutes of Health in Bethesda, Maryland, and a clinical professor of psychiatry at George Washington University School of Medicine. Dr. George has presented before numerous professional groups, such as the American Psychiatric Association, American Neuropsychiatric Association, and the American College of Neuropsychopharmacology.

Book preview

Introduction

Unsettling Questions

I am a psychiatrist and a neuroscientist. My specialty is treating people with emotional disorders and researching the neurological reasons for extreme emotions and destructive behaviors. My patients range from people with active, successful lives to individuals who have to be hospitalized. Nevertheless, each of them is troubled by strong emotions that frequently spin out of control. They are beset by anger, fear, depression, or trauma. Like countless individuals who are not seeing a psychiatrist, my patients struggle with these emotions because they do not understand them and are not able to contain the behaviors they spark.

When I began my practice almost thirty years ago, I thought my job was to diagnose what was wrong with patients and offer treatments that would make them feel better. It made sense at the time. Yet as I began listening to patients, I soon realized that I was seeing only part of the picture. Focusing purely on diagnosis and treatment was like trying to solve a complicated math problem by learning how to use a calculator. These were tools used in the healing process but were incomplete because of a missing vital third element: understanding what was happening in each patient’s brain.

I remember giving a talk to a group of people at a community outreach gathering. I was one of a number of speakers talking about depression and treatments, and I was the last speaker on the program. After speaking for about thirty minutes, I answered questions. As the people were leaving the hall, I heard snatches of conversations that suggested disappointment with all the presentations. The gist of their reaction was frustration because we did not answer their basic questions. People wanted to know why they were depressed and why treatment was often not successful.

Only years later, after many hours of listening to patients, did I truly understand what that audience and my patients wanted: informative, relevant answers to unsettling questions. They wanted to know: Why am I the way I am? Why do I behave this way? Why can’t I get better? They were frustrated because, for most of them, psychiatry had so far provided lists of symptoms and an assortment of drugs but little understanding. They had no idea where their symptoms came from, what the symptoms meant to their lives and why treatment was not working for them. I shared their mystification, especially in those early years. When I first began practicing, there was much about therapy and psychiatry that I did not know. Every day patients posed questions I could not answer.

A middle-aged woman who had been depressed for years asked, Why do I always dwell on negative things?

An older man on the brink of divorce asked, Why can’t I control my temper?

A college student feeling overwhelmed by stress and who had become a binge drinker asked, How do I stop drinking?

A man who had accidentally killed a pedestrian asked, How do I get rid of this guilt?

A successful businessman with a drug addiction asked, Why do I always feel inadequate?

A teenager who was cutting herself asked, Why don’t I feel anything?

Answers to their questions have been slow to come. Finding them is why I decided to divide my career between treatment and research. My patients’ mystification about what was causing their strong emotions led me to pose a question that became the centerpiece of my research: What produces an emotion? As an extension of that, I wondered if it was possible for someone to feel an emotion for no reason. For instance, some patients said they felt angry despite not being able to identify any conflict behind it. Time and again they said that they just woke up angry and had no idea why they felt that way. And the emotion was so strong that it dictated their life. What was the difference between a legitimate emotion and a pathological one? Was there a neurological explanation, maybe a malfunction, for why my patients’ lives were being hijacked by their seismic emotions?

A Panic Attack Leads Down an Unfamiliar Path

My education into the mysteries of emotional distress began unexpectedly. I was conducting a study of people who experience panic attacks, attempting to pry apart the diverging symptoms of alcohol dependence, withdrawal, and panic disorder. I was interviewing each of the participants before they enrolled in the study, reassuring them that their participation was entirely voluntary. All routine stuff. Except for Paul. After we had talked about the procedure and chatted briefly about his background, I was almost at the door when his voice stopped me.

Doc, sometimes I’m afraid I’m going to lose control and hit my son. What do I do? he asked.

I halted. No patient had ever asked a question like that. He sounded genuinely distressed, his tone pleading for a meaningful answer. This was completely new for me—I knew next to nothing about emotions associated with violence. I wanted to be helpful but had no basis for reassuring him that such disturbing thoughts would pass. In the moment, all I could do was fall back to the psychiatrist’s default response. Tell me more, I said.

Paul didn’t add much more information other than that he felt fear and unease at home and had a sense that he could quickly lose control with his family. I had no answers for him, only bland reassurances, and exited quickly. But his anguish stayed with me long after. I resolved to learn more about the neurological origins of this intersection between panic and aggressive urges. What made Paul feel as if he had no control over these emotions? Was it something in his past or in his brain that kindled his aggressive thoughts? The questions captivated me, and not just as a scientist.

As a physician trained to treat patients beset by crippling emotions, I wanted to be able to offer help. I didn’t even understand what he had been going through. The more I thought about him, the more absorbed I became in probing the neurological underpinnings of emotions that could instantly push people’s aggressive feelings into possibly acting them out.

That was many years ago and ever since that conversation, I’ve been searching for a neurological explanation to better understand behavior. Why does anger trip into rage and even violence in one person but not another? Why are some people overcome by fear even though there is no apparent danger? How does depression become so overpowering that it shuts down a life? What are the emotions that turn someone into a predator or a stalker? When do an abuse victim’s healthy fears morph into post-traumatic stress disorder (PTSD)?

The emotions I encounter in my practice are not unusual. They’re universal, human reactions; what makes them pathological are not the emotions themselves but the circumstances under which they flare up. Patients lose it when there’s no rational reason—no immediate trauma, no life-and-death crisis. Their emotions are extreme, yet their daily lives and relationships often appear stable. This makes it even harder for them to understand what is happening. Something around them—a sight, sound, smell, thought, or memory—stirs their emotions to the point that their reaction is totally out of proportion to the circumstances.

Magnified Emotions

This book looks at emotions and behaviors that are out of proportion to a situation. Emotions are not the same as behavior—they fuel it. By examining the relationship between tumultuous emotions and magnified responses, you get an idea of what sets them off, who’s most vulnerable, why they spin out of control, and what you can do to understand and contain them. My hope is to begin to untangle and answer the vexing questions about the whys, whats, and hows of emotions.

My search has helped me construct a neurological model that ties together extreme emotions with behavior, pathways, and clinical characteristics. This explanation centers on the notion that everyone possesses a neurological switch deep in the brain that can be flipped at the right time, and the wrong time. I hope to share with you my understanding and insight into how this switch works and what’s going on in people’s brains. As you read, I will walk you through my findings, which are illustrated by stories of individual patients. Ultimately, I hope to answer questions about your own emotional life or that of someone you know.

I also offer this caveat: I don’t know everything. Far from it. Psychiatry is a daunting and humbling profession, and every day I encounter patients who continue to challenge me. My thoughts and ideas are constantly evolving, taking on new perspectives and more knowledge. Nothing is written in stone.

The book covers a wide swath of emotional landscape, yet it contains a handful of recurring themes. There is a neurological reason for emotions that seem inexplicable. These emotions arise because neurons are activated not as a single structure but as part of a process that is wired into a neurological platform. This platform encompasses not only multiple structures but also pathways and neurochemistry.

Another theme is that the purpose of human emotion is survival. Scratch the surface of any emotional state and you will find a behavior that has its roots in survival. At the heart of our survival instinct is the fight-or-flight response. This term has become part of our popular vocabulary. However, most people have only a general idea of what it means. Few realize how fight or flight is manifested in everyday behavior and how it can rule daily routines.

Finally, years of doing therapy and research have convinced me that the extreme emotions I encounter among patients are universal. While patients provide the most dramatic evidence of how and why people lose it both emotionally and in their actions, no one is immune. All people are vulnerable to having their emotions neurologically hijacked, and awareness of this is essential to learning to control them.

Many books have been written about emotion, including a small cluster about the neurological workings of emotion. But little has been written on the integration of emotional behavior and neurological pathways. The brain’s machinery is hard to penetrate, and only with the advent of positron-emission tomography (PET) and functional magnetic resonance imaging (fMRI) has science been able to see what goes on inside the brain when someone feels a particular emotion. Until now, the bulk of the research has been done with animals and then extrapolated to humans. But I have had the unique experience of not only treating thousands of people derailed by out-of-control emotions but also being able to combine what I’ve distilled from them with years of research, both mine and that of other scientists. While studies involving chimps, cats, and mice have helped guide my investigations, my findings are drawn from complicated, passionate people. I hope this book will help people understand and navigate the origins of their troubling and often painful emotions.

Part I, Why Emotions Spin Out of Control, begins with how I came to focus on extreme emotional disorders, survival instincts, feeling threatened, and fears that underlie emotional lives. I also try to demystify the brain’s inner workings by describing how it translates sensory signals into emotions. Part II, Losing It: Extreme Behavior, uses stories of individuals to show the inner workings of specific emotional disorders. I not only show how they derail lives but also tease apart the emotions and behaviors so you can see them in a new light. Part III, Seeking Healthy Emotions, shows how demystifying the workings of the mind helps explain different treatments. At the same time, I offer a cautionary explanation, emphasizing that knowledge and understanding are not enough to contain people’s emotional fires. It also requires taking personal responsibility.

You are going to read about patients, although their identities have been obscured for privacy and confidentiality reasons. Nevertheless, the stories represent real people, and their struggles have much to teach all of us not only about their disorders but also about their courage and fortitude in confronting them.

One last thing. Despite all the neurological realties and evidence of hardwiring for our errant emotions, I believe that in most cases, treatment works. It begins with giving patients a voice—hearing their deepest, most distressing secrets and not judging but accepting who they are. By learning about themselves, not only their psychological undercurrents but also their neurological makeup, they can shift their fears about their troubled emotions and move from the dark places of bewilderment, inner loneliness, and despair to hope. With this, they can feel the freeing effects of personal honesty and the satisfaction of taking responsibility.

Part Image

Part I

Why Emotions Spin Out of Control

1

Patient Zero

A Patient Under Siege

I greeted Henry Wilson in the waiting area and escorted him to my office. It’s an intimate room furnished with soft throw pillows on a well-worn couch, a couple of floral upholstered easy chairs, and a wood-paneled ceiling. I gestured to a seat and took my usual place in a chair across from him. I scanned over this new person—middle-aged, well-groomed in a charcoal suit, dress shoes, and a serious look.

We exchanged brief pleasantries, a few comments about the weather, and then got down to business.

How can I help you, Henry? What can I do for you? I leaned forward, making steady eye contact. I knew what my body language said about my attitude would set the course for our time together. I tried not to look too eager, although that was what I felt—an avid curiosity to hear his story and devise a way to help. My practice was relatively new, and every patient was a compelling challenge.

I’ve been on depression medication, and it’s not working very well. My wife thinks my thoughts are disorganized and jumbled.

What do you think? I asked.

She’s somewhat right. I do have a problem concentrating and don’t sleep well. And, as she is quick to point out, I’m no good at planning things. She also says I’ve got a negative outlook. I don’t know. Maybe that’s the depression, he said.

He did look haggard, probably from lack of sleep.

He took a deep breath. I have to confess, you are not the first psychiatrist I’ve seen. In fact, you’re the fourth. And each one prescribed medication, and nothing has worked. I’ve been told I’m treatment resistant. Maybe I am, I don’t know. But it’s caveat emptor with me. I’m not an easy case, and I’ll understand if you’d rather not see me. He sat back, as if waiting for me to accept his verdict.

You’re here now, so why don’t we talk and you tell me later whether you want to continue. I paused, then plunged ahead. You said your wife thinks you have a negative outlook. Can you tell me more about that? Why does she think that?

Henry Wilson began by talking about their seventeen-year-old daughter, who was at a tough-love boarding school in Utah because of repeated episodes of cutting, lying, and drunk driving. He and his wife fought over the decision to send her there because it was costly and far away. It was now time to pay her tuition, and Henry said he couldn’t afford it anymore but strongly believed she needed some kind of correctional environment. He and his wife were revisiting all the old arguments.

The kid has problems. Okay, call me negative. We go round and round, and by now I’m just fed up with the whole thing. Helen thinks I’m the problem. I’ve given up trying to explain things to her. We really can’t afford that school. She knows that—I was let go last month because business is so slow. And the boss and I didn’t get along. I’m job hunting now, but it’s not easy. She is right about one thing—we don’t talk anymore. We just take swipes at each other.

It sounds like you’ve got a full plate. Losing your job must have been a blow. Did you have any inkling that that was going to happen? I asked.

He shrugged. Yes and no. I did blow up at my boss the month before. He’s a micromanager. You know the type, always double-checking, saying I wasn’t paying attention to details, said clients were complaining about my style. Whatever that meant. When he got that way, I either pushed back or just made myself scarce, and left. That probably wasn’t the best way to handle it.

You mean leave work? I asked.

I’d go to the tavern around the corner, big watering hole for lobbyists. I’d maybe bump into someone I know, we’d have a couple of drinks, and I’d feel better. Until I got home. Helen hated it when I’d have a couple after work. She’d really lay into me, accuse me of being a drunk, which I’m not, and then keep on about how I needed help.

What would you do then? I probed.

I’d lose it. Couldn’t help myself. Rip into her like she was a Thanksgiving turkey. She knows what gets to me and doesn’t hesitate to say things that set me off. So I lash back. I was just defending myself. In the end, I’d go into the TV room and not come out for the night. I’d sleep on the couch.

Henry paused, his eyes searching my face for a reaction. If he expected to see disapproval, he was disappointed. I had heard versions of this and was concerned about his behavior. It did not take much to send him off the rails, and I wondered why.

Overwhelming emotions can be frightening, I said. How do you feel when your wife gets on you?

Like I’m under siege. I’ve got no control over the situation but can’t get away. Trapped, I guess.

Henry and I devoted much of that first session to his explosive temper and how it was rippling through his life. We especially examined the progression of emotions he went through, the mood swings that began with aggravation and sometimes ended in avoidance behavior that looked like depression. His range of emotions fascinated me, especially the anger. It seemed the most predominant emotion, yet it somehow was consistent with his other emotions. He was one of the first patients in my fledgling practice who had a constellation of problems that I felt were somehow related. There was a puzzle here I needed to solve, and I sensed that the first piece was Henry’s rage.

Why Do People Behave the Way They Do?

I’ve treated hundreds of patients like Henry Wilson. I’m also a researcher, conducting studies at the edge of psychiatric science. Throughout my career, I’ve been absorbed with the question, why do people behave the way they do? Anger that trips into rage or violence. Fear that paralyzes someone. Depression that shuts down a life. The dead affect of a predator or stalker. Why does one person end a mild disagreement with a brutal punch while another person responds with a groveling apology or weeping? Why do they decide to act one way and not another? I’ve been focused on trying to understand how normal emotions get hijacked and become twisted and destructive.

Of course people are driven by a complicated mixture of genetics, environment, upbringing, and biology. Every shrink knows this. But what is it about our nervous system that differs from person to person? This is where I’ve been looking for answers or, more precisely, for models to explain these behaviors—biological templates that would explain what happens in our brain when certain emotions are triggered. This model would be like a switch or universal remote control—push the green button and the power always comes on, push the yellow button to mute the sound. It would provide an accurate, predictable explanation for an array of intense emotions and behaviors.

Henry presented me with pieces of a puzzle, and anger was the most predominant piece. To successfully treat him, I needed more than insight into what he was experiencing. What was happening neurologically to set him off? The better I understood his emotions and behavior, the more effective his treatment would be. It was like the adage that you feed a man not by giving him a fish but by teaching him how to fish. I could not just give Henry a drug because it would only temporarily alleviate his emotions. Medication and support would ease the immediate symptoms but not address the reasons for them. My goal was to give him the tools to manage his emotions over the long term. To do that, I had to figure out what was going on in his brain.

Now, after years of clinical research and legions of patients led by Henry Wilson, I have formulated a model for understanding extreme emotions and destructive behavior. Before I get into that, let me explain how I got here.

Surprised by Psychiatry

I did not begin my professional life intending to become a psychiatrist. In medical school, I was on track to go into internal medicine and barely noticed the few students who spent their residency not drawing blood or putting in central lines but talking to people. My heroes in medical school were the revered surgeons and internists who dealt with life-and-death issues every day. Then a friend suggested I apply for a rotation at Duke University to study with a preeminent doctor who happened to be a psychiatrist. Enticed by the man’s reputation, I called him. I don’t remember exactly what he said except for one question: Are you any good?

That intimidated yet intrigued me. Doubts are regular fare for medical students, and at the time, my plate was fuller than most. I worried constantly about whether I was choosing the right treatment or requesting the right test or knew enough to make an accurate diagnosis. The man’s question was like asking a Navy Seal if he could parachute behind enemy lines, a challenge for me to plunge forward and prove I was both determined and tough enough to take on something completely foreign. My answer must have been the right one because he offered me a small stipend and an opportunity to study with one of the best.

Psychiatry came alive for me during that time. Patient stories took on personalities, and their histories became dramas. My initial misplaced skepticism about the benefits of psychiatry—what was the point when patients never got truly well?—was washed away by the realization that every illness has a natural course and an end stage regardless of whether the disease is in the mind or the body. But at that time, psychiatry from my vantage point was lodged at the bottom of the totem pole of specialties. It seemed that psychiatric residents received few patient referrals, and when they came, it was late in the day after all the other specialists had done their work. They were usually sent to some outer, dingy office to do an interview. Psychiatry was to medicine as voodoo was to healing. This presented both an obstacle and a challenge. Psychiatry would be difficult, but the field was wide open for discovery.

After getting my medical degree and completing residencies in internal medicine and psychiatry, I wrestled with what kind of psychiatrist to become. A full-time private practice seemed limited. I wanted broader psychiatric horizons, fields beyond treating one patient at a time. I cast about for room to run, an area where I could tackle mysteries and perhaps make a difference for many people. I wanted discovery and impact, not adulation and attention. It’s probably natural that research excited me.

The Allure of Research

I began my career at the National Institutes of Health in Bethesda, Maryland, in a laboratory studying addiction. Around the same time, I opened a small private practice. Over the years, my patients’ stories kindled ideas and theories that could be applied to many other people. Their struggles sparked in me a search for answers that I hoped would alter the way physicians and researchers thought about emotions and behavior. My motivation to help my patients dovetailed with my desire to uncover a behavioral model to guide my thinking.

Fortunately, my research into a neurological model for intense emotions didn’t require redefining neuroscience. Human biology is full of models that explain physiological and neurological reactions. When you touch a hot burner in the kitchen, cut yourself with a knife, or spill bleach on yourself, your hand will become red, swollen, and painful. Every time, no matter when or where the accident happens, the body reacts this way. This is the model for inflammation.

As I pursued my research into a possible neurological model, I realized that I already had a vital piece of the puzzle. I realized that I had encountered it serendipitously during a medical school lecture describing the transection of a live cat’s brain done by Philip Bard in 1928.¹ Bard was a physiologist at Harvard Medical School and a protégé of Walter Cannon, the father of