George David Theodore - Untangling the Mind: Why We Behave the Way We Do

To W. P. W. Wilson, M.D., professor emeritus at Duke University, who taught me my love of psychiatry.

To my patients who afforded me the privilege of walking alongside them.

To my family who shared lifes ups and downs with unconditional love.

Contents

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 patients 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 cant 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 cant 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 dont 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 Im afraid Im 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 meI 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 psychiatrists default response. Tell me more, I said.

Paul didnt 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 didnt 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 peoples aggressive feelings into possibly acting them out.

That was many years ago and ever since that conversation, Ive 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 victims healthy fears morph into post-traumatic stress disorder (PTSD)?

The emotions I encounter in my practice are not unusual. Theyre universal, human reactions; what makes them pathological are not the emotions themselves but the circumstances under which they flare up. Patients lose it when theres no rational reasonno 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 thema sight, sound, smell, thought, or memorystirs 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 behaviorthey fuel it. By examining the relationship between tumultuous emotions and magnified responses, you get an idea of what sets them off, whos 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 why s, what s, and how s of emotions.