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The Neuropsychotherapist 

issue lApril-June 2013 

"e can promote compassion, integration, and kindness." So says my guest. Dr. Dan 
Siegel, discussing his latest book Mindsight and the organization he has founded. 
The Mindsight Institute. Daniel J. Siegel, MD, received his medical degree from 
Harvard University and completed his post-graduate medical education at UCLA 
with training in pediatrics and child, adolescent, and adult psychiatry. He served 
as the National Institute of Mental Health Research Fellow at UCLA studying family interactions with an 
emphasis on how attachment experiences influence emotions, behavior, autobiographical memory and 

Dr. Siegel is currently a clinical professor of psychiatry at the UCLA School of Medicine where he is also 
on the faculty of the Center for Culture, Brain, and Development and the Co-Director of the Mindful Aware- 
ness Research Center at UCLA. An award-winning educator, he is a Distinguished Fellow of the American 
Psychiatric Association and recipient of several other honorary fellowships. Dr. Siegel is also the Executive 
Director of the Mindsight Institute, an educational organization that focuses on how the development of 
mindsight in individuals, families and communities can be enhanced by examining the interface of human 
relationships and basic biological processes. His psychotherapy practice includes children, adolescents, 
adults, couples, and families. 

Dr. Siegel has published extensively for the professional audience. He is the co-editor of a handbook 
of psychiatry and the author of numerous articles, chapters, and the internationally acclaimed text. The 
Developing Mind: Toward a Neurobiology of Interpersonal Experience. This book introduces the ideas of in- 
terpersonal neurobiology and has been of interest to and utilized by a number of organizations, including 
the U.S. Department of Justice, The Vatican's Pontifical Council for the Family, Microsoft and Google, early 
intervention programs and a range of clinical and research departments worldwide. He has been invited to 
lecture for the King ofThailand, Pope John Paul II, and His Holiness the Dalai Lama. 

Dr. Siegel serves as the Founding Editor for the Norton Professional Series on Interpersonal Neurobiol- 
ogy, which also includes more than 20 textbooks. His book with Mary Hartzell, Parenting from the Inside 
Out: How a Deeper Self-Understanding Can Help You Raise Children Who Thrive, expresses the application 
of this newly emerging view of the mind, the brain, and human relationships. His professional book. The 
Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being, explores the nature of mindful 
awareness as a process that harnesses the social circuitry of the brain as it promotes mental, physical, and 
relational health. His book Mindsight: The New Science of PersonalTransformation offers the general reader 
an in-depth exploration of the power of the mind to integrate the brain and promote well-being. His latest 
professional text. The MindfulTherapist, explores the application of these ideas for the clinician's own devel- 
opment of mindsight and neural integration. 

Dr. Dave: I am really happy 
to have this opportunity to meet 
with you and to discuss your 
work. As I was reading your lat- 
est book, Mindsight, / appreci- 
ated reading about some of your 
personal struggles as a young 
medical student at Harvard. You 
actually dropped out of medi- 
cal school for a time because of 
what you felt was missing in the 
curriculum at that time. Tell us a 
bit about what led to that disaf- 
fection and what you did during 
those intervening years before 
returning to Harvard Med. 

Dr. Siegel: Well, I had been 
a biochemistry major in college 
and also very interested in oth- 
er things, like people, basically. 
And I had worked on a suicide 
prevention service and was on a 
dance team, and things like that. I 
thought medical school would be 
a great opportunity to blend the 
real passion I had about people 
with my background in science. 
And the science was very useful, 
of course, for learning the techni- 
cal aspects of medicine, but when 
I was a young student in my first 
and second year, unfortunately I 

encountered [some] professors 
who had this really unfortunate 
trait, in which they treated peo- 
ple as if they were bags of chemi- 
cals rather than having a center 
of subjective mental life— a core 
aspect of the essence of their hu- 
manity. Instead they were treated 
Just like they were a bunch of en- 
zymes in need of surgery or medi- 
cal prescriptions or whatever. 

I was very young when I started 
school and I think my youth, and 
also my idealism. Just made it so I 
tried my best to do what I thought 
you were supposed to do, which 


The Neuropsychotherapist 23 

is to learn from your teachers. But the more 
and more I learned from these particular 
people who didn't see the mind — a word I 
coined as mindsight— they seemed to lack 
this thing called mindsight; to see the mind. 

I got very depressed and disillusioned with 
the whole experience and ultimately came 
to the Dean of Students after one particu- 
larly horrendous interaction with a supervi- 
sor during a final physical examination re- 
view. It's a long story, but the bottom line 
was how very painful it was to see the way 
he treated the patient; not in a very kind 
or empathic way. So I went to the Dean of 
Students and I just basically said, "I can't go 
on anymore. I'm dropping out." While in my 
mind I was dropping out, she insisted that I 
just take a leave of absence, which I thought 
would be a leave forever. 

I ended up spending a little under a 
year actually. I loved dancing in college, so 
I thought of becoming a dancer and a cho- 
reographer. I pursued that for a while and 
then when I decided that wasn't going to be 
my calling for all sorts of reasons I travelled 
across Canada to become a salmon fisher- 
man, and that didn't exactly work out for all 
sorts of reasons too. I came back and worked 
in Los Angeles as a sound technician for a 
film crew who were filming the performing 
arts at Royce Hall, UCLA. During that time 
I had surgery, and John Lennon was unfor- 
tunately assassinated. I woke up out of the 
anesthesia and heard this news report that 
Lennon was killed and I couldn't believe it. 
In my mind, it was like, "why in the world 
would a person kill John Lennon?" And it 
kind of opened my mind to other things 
that had been cooking during that time off 
of travel and dance and stuff: what is the 
mind? What is in the mind of this murderer 
that would get him to take such an incred- 
ibly benign and contributing member of our 
society and kill him intentionally? 

So that really opened up my own aware- 
ness of the idea that you could try to figure 
out what was going on in people's minds 
and try to help those minds get better. 
And through a series of different things I 
ultimately decided to go back to school 
because it was actually faster for me to be- 
come a psychiatrist than to become a psy- 
chologist because I was halfway done with 
medical school. So I went back to Harvard 
armed with this year off and the convic- 

tion that the mind was real. I could then use 
mindsight in my own inner world to — this 
is back in 1981 — say, "Look, some people 
don't see the mind. They are my anti-role 
models, and if they're my professors, I have 
to not be like that." 

And then I saw with my medical pa- 
tients, when I saw their minds, when I could 
really relate to their feelings and ask them 
what they're thinking, what they remem- 
bered, what had meaning for them, the sto- 
ries that emerged and the feelings that ac- 
companied them seemed to help them get 

Ironically, I finished medical school, 
went into pediatrics, went into psychiatry, 
went into child psychiatry, went into re- 
search psychiatry, become a scientist study- 
ing narratives and emotion regulation and 
ultimately I started teaching about that kind 
of stuff and coming up with new ideas about 
it. But years later, it was maybe 25 years af- 
terthe day I decided to drop out of school, in 
the very room that I decided, a place called 
the Ether Dome — I was back there giving a 
lecture, invited to give the opening keynote 
address to Harvard on the importance of 
stories and emotion in the development of 

What a triumph! 

It was unbelievable. My son was there. It 
was just incredible. 

To come full circle like that must have 
been so gratifying? 

It was. 

Now mindsight is a new term that you 
introduced into our therapeutic vocabu- 
lary. What do you mean by mindsight? 

Well, originally the word mindsight back 
in 1980-81 was just a little private term I 
made up, describing how you see the mind. 
And then as I went through my training at 
medical school, it helped me remain sane, 
basically. And then when I became a psychia- 
try trainee I saw that there's something very 
special about knowing how we as clinicians 
see the inner, subjective world of another 
person, the mental life of another person, 
to see inside. But when we teach them — our 

The Neuropsychotherapist 

issue lApril-June 2013 

clients, our patients— how to 
develop the skill of seeing the 
mind, perceiving the mental 
world, they can then start to 
work with that inner life in a 
very different way. So mind- 
sight, then, became more than 
just insight into yourself or 
empathy for another person. 

Those are very, very impor- 
tant, but it became also, how 
do you shape your own inter- 
nal world, or help another per- 
son shape their internal world 
toward health? So now mind- 
sight is a term that means 
how you perceive the inner 
world and then move that world towards 
something I call integration, which we can 
talk about. Integration is basically a process 
where you link different elements to one 
another, and in the world I work in we con- 
sider integration as health. So mindsight al- 
lows you not only to see the inner world of 
yourself or others, it helps move that world 
in yourself or others toward wellbeing be- 
cause it promotes integration. 

Mindsight sounds a lot like mindfulness. 
Is there a difference? 

Yes. The two words that people always 
ask me about— and it's a very important 
question— one is mindfulness and the other 
is something called mentalization. I'll start 
with the mentalization part. 

Mentalization is a term [coined by] 
Peter Fonagy and Mary Target and Howard 
and Miriam Steele; these are fabulous re- 
searchers in London. In the '90s and in the 
last decade, the 2000s, they studied the way 
parents see the inner mental life of a child. 
And when parents reflect on that inner life 
forthemselves — something called reflective 
function fortheir child — they're basically us- 
ing mentalization; they're seeing things in 
mental terms. 

So mindsight of course embraces 
those fantastic studies on mentalization 
and sees that seeing the mind is at the core 
of something called "secure attachment." 
It's really good for developing resilience 
and thriving, really. Mindsight overlaps with 
that, but it's not the same — I'll explore that 
in a moment. Mindfulness, the next word. 



THINGS - What is the mind? What is in 


is something that's been around for thou- 
sands of years. It's been in the East, in the 
West, also used in contemporary practices, 
in religion, in contemplative traditions. So in 
Buddhism, for example, and Hinduism, and 
the Islamic faith, and Judaism, and Christi- 
anity, in Lakota tradition, in all sorts of tradi- 
tions, there's an effort to encourage mem- 
bers of that culture to focus on the present 
moment, to not be swept up by Judgments 
and expectations, and to then use this abil- 
ity to focus your mind, your attention, on 
the present moment sensory experience so 
that you're not suffering. So it allows you 
to distinguish, for example, between self- 
created suffering and inevitable pain in life. 
So suffering might be seen as coming from 
saying, "Oh! I shouldn't have hit my knee! I 
shouldn't have hit my knee! What a clumsy 
guy I am. I'm so clumsy! Look how I've done 
that to myself. Oh, I'm so bad! I'm so bad." 
All that negative talk would create suffer- 
ing, when instead I'vejust bumped my knee. 

Mindfulness, just as a little example 
there, has you pay attention to the present 
moment, as Jon Kabat-Zinn has beautifully 
described it: in a purposeful way without 
being swept up by judgments. Other people 
describe it as imbued with a feeling of kind- 
ness, an attitude of compassion toward the 
self and others. And that's mindfulness. 

Now mindsight, this term I made up 
before I even knew there was a term called 
mindfulness, embraces all those fantastic 
practices of mindfulness, but it's not the 
same, because mindsight is the way we 
monitor energy and information flow in our 
relationships. So like we are sharing right 
now between you and I, the way we're shar- 


The Neuropsychotherapist 



ing with people who might listen to this in- 
terview — that's a relationship, the sharing of 
energy and information flow. Then there's 
the embodied part. There's the mechanism 
of energy and information flow that extends 
from your toes to your nose. It's basically a 
neural mechanism and you can learn to be- 
come sensitive so you perceive or monitor 
this flow. And then basically whether the 
flow is happening in your body — the em- 
bodied brain, I call it — or in your relation- 
ships (the sharing is the relationships and 
the mechanism is the embodied part), you 
can then use the focus on energy and infor- 
mation flow to move that flow towards inte- 
gration. This is something that's not talked 
about in the mindfulness world, it's not 
talked about in mentalization. You can look 
at mindsightthis way: if you took a triangle 
and said there's relationships — one point of 
the triangle; there's the brain— the second 
point; and there's an emergent property 
that we call the mind — the third point on 
the triangle.. Basically what we are saying is 
that mindsight is the ability to perceive en- 
ergy and information flow in your subjective 
mental life, in the sharing of relationships, 
in the mechanism of the body, and then 
move that flow toward integration. And so 
that's how mindsight is distinct from mind- 
fulness, which it embraces, and mentaliza- 
tion, which it also embraces but it takes it 
into the realm of health and integration in 
body and in relationships. 

/ was interested to read that you called 
together a conference of peers, and that 
you experienced some frustration looking 
for a definition of “mind" because nobody 
had a good one, and you ended coming up 
with your own, which you've alluded to 
here, and I'll quote: “The human mind is a 
relational and embodied process that regu- 
lates the flow of energy and information." 
One of the things I especially appreciated 
is your emphasis on the whole body, that 
the mind is not just in the brain that's in the 
skull, but that the brain is in some sense 

distributed throughout the body. 

Exactly. So here's what happened. The 
thing that I brought together was actually 
a think tank of forty scientists, and it was 
at UCLA back in 1992, the beginning of the 
decade of the brain. Ourtask was tojust ask 
the question, "What is the connection be- 
tween the brain and the mind?" These were 
anthropologists, sociologists, linguistics 
people, these were people from neurosci- 
ence, one neurosurgeon was in the room, 
psychology, all sorts of groups were there 
— forty people from over a dozen different 
disciplines of science. We could all agree on 
what the word brain meant. No one knows 
exactly how the brain works, but we knew 
it was composed of basic cells distributed 
throughout the whole body, but many of 
them in a spider web-like set of connections 
in the skull itself. We were learning lots of 
new, exciting things back then in the be- 
ginning of the decade of the brain because 
technology had allowed us to look beneath 
the previously opaque skull and see what 
the functioning of this stuff was, looking 
at the skull part of the brain. I use the word 
brain to mean the embodied nervous sys- 
tem, but brain is a lot easier to say. 

So here we were, ready to turn to 
the mind, and these scientists could not find 
any common ground on what to say about 
what that word meant! And this was really, 
really frustrating, and the group was basi- 
cally going to implode and disappear. So I 
took myself for a walk, as the person who in- 
vited everyone into the group, and the next 
time when the group got together I offered 
a definition, the one you quoted. Basically 
that one part of the mind — not the whole 
mind (because of course the mind is con- 
sciousness and subjective experience and 
beauty and love and poetry and everything 
is a part of mental life like that) — can be de- 
fined as the way energy and information 
flow is regulated. So we say it's a relational 
and an embodied process that regulates 
the flow of energy and information. Now 

The Neuropsychotherapist 

issue lApril-June 2013 

when you say it like that you need to under- 
stand that at that moment, saying it to this 
group, every single one of the 40 scientists 
said, "Yes, this is a place we can begin our 
discussion. This fits with everything I do." 
Anthropologists would say, "Yes, I study the 
way energy and information flow is shared 
in relationships across generations. That's 
what culture is! So that's fine with me." A 
neuroscientist said, "Yeah, I put a person in 
a scanner, I have energy flow (let's say from 
a picture) and the moment it has meaning 
(information) I see what parts of the brain 
are activated. I'm looking for energy and in- 
formation flow in the brain itself. And that's 
fine with me." So the group with 100% con- 
sensus went on to meet for four and a half 

Oh, that's great! 

Yeah. Four and a half years, and you 
know the exciting thing was we could go 
deeply with that working definition. Now, 
just so we're on the same page about this, 
what this means isthatthe process says that 
the mind — this core aspect of the mind — is 
a verb, it's not a noun, and from a scien- 
tific point of view we use the concept of an 
emergent property. The emergent property 
is something you see by elements of a sys- 
tem interacting with each 
other, give rise to a pro- 
cess called an emergent 
property, and that's what 
I'm suggesting the mind is 
and the group found that 
very useful. 

I've asked psycho- 
therapists from every dis- 
cipline of psychotherapy 
you can imagine — social 
work, nursing, psychol- 
ogy, psychiatry, all of us 
in mental health, "How 
many of you have ever 
had even one lecture, besides the one I 
gave, that defined the mind?" 2-5% say yes. 
It's always the same; way over 95% say, "I've 
never been given even one lecture that de- 
fines the mind." 

So what people have told me, and I 
don't know if it's true, but they say, "Look, 
you're proposing a revolution in the field of 
mental health." And I say, "I don't think it's 

a revolution, I Just think it's a natural evolu- 
tion — that we've had a field of mental health 
that didn't define the mental, and now it's 
natural to Just define it together. A working 
definition." When you say it's relational and 
embodied, it honors the power of relation- 
ships, and of course that makes people nerv- 
ous because then they don't own their mind. 
Of course anyone in a relationship knows 
you don't, it's dependent on everyone else 
in the relationship. And then the embodied 
part means every psychotherapist needs to 
know about the nervous system, brain sci- 
ence and biology, which of course makes 
them nervous, but that's what it means to 
be a professional. We need to know about 
relationships and the embodied brain also. 

When you say it's a regulatory pro- 
cess— here's the exciting thing— it means 
you have to monitor something, like when 
you're watching where you're driving a car, 
and modify that thing. And so the thing is 
energy and information flow, energy being 
the capacity to do stuff is how a physicist 
defines it. Information is a swirl of energy 
that has symbolic meaning, like these words 
we're using with each other, and so when 
you realize that, you have to monitor and 
modify energy and information flow in your 
relationships and in your body, and then we 
put in the thing which we can talk about 

1 1 * 

The mind is a relational 



next if you want, Dave, that we're talking 
about integration. We don't Just say, "Hey, 
regulate yourself." We're actually saying we 
can define mental health, or any other kind 
of health probably but let's Just stick with 
mental health — mental health is integra- 
tion, and integration is the linkage of differ- 
entiated parts. Amazingly, when you're not 
integrated you go to chaos or rigidity. 


The Neuropsychotherapist 


The first thing to 

THEN they’re 


Now when I first came across this 
and looked forthe science, it blew my mind. 

I went to a mathematics book because I 
could find no science that said why chaos 
and rigidity would be the patterns I was 
seeing in my patients in psychotherapy. 
So I found this book on the mathematics 
of complex systems that said when a sys- 
tem is not linking differentiated parts and 
maximizing complexity (like a choir singing 
harmony), when they're not in this harmo- 
nious flow, this flexible adaptive, they go 
to either chaos or rigidity. I opened up the 
Diagnostic and Statistical Manual of Men- 
tal Disorders to any page and every single 
symptom of every syndrome in that book 
(which has no conceptual framework), was 
an example of chaos, rigidity, or both, and 
I thought, "Oh, my God! This is a book de- 
signed not to have a framework," but now 
it can finally have a framework that not just 
says impaired integra- 
tion leads to any of the 
psychiatric syndromes; 
now we know it's being 
supported by new data 
coming out by all sorts 
of people, to show that 
developmental trauma 
or schizophrenia or au- 
tism or bipolar disorder 
shows evidence of im- 
paired neural integra- 
tion, where the parts of 
the brain that link dif- 
ferentiated parts aren't 
working well together. 
You can also show 
that integration can 
be promoted through 
psychotherapy— and 
it works. People go 
from chaos or rigidity 
into more harmonious 
states of being, which 
we call wellbeing. So 
the framework has em- 
bedded in it a definition 
of health, a pathway to 
understand how inte- 
gration is health, im- 
pairments lead to cha- 
os or rigidity, and a plan 
for what you can do 
about it. So that's kind 

of where we're at in this field, this mindsight 

You spell out functional areas of inte- 
gration, so can you take us through the 
highlights of integration? 

Well, what happened to me back in the 
'90s, when all this was emerging in my own 
explorations, was first of all an importance 
to stay really close to science. So everything 
I'm saying has a scientific foundation that 
comes from many different disciplines in 
science. You won't see it written anywhere 
in one place, but the process is to look for 
the common principles across separate dis- 
ciplines, and that's something Wilson calls 

The first thing to say is that these 
ideas are built from science and then they're 
applied in everyday life in parenting and in 
psychotherapy and in schools, in education- 
al settings, so that there is a practical ben- 
efit to these scientific and conceptual ideas. 

People would ask me for a practical guide, 
and I would say, "Look, this approach, which 
I call interpersonal neural biology, is about 
health, but it is a form of therapy. It informs 
therapy, sure, but it's really a way of bring- 
ing together all the different disciplines of 
science and now contemplative practice, 
religion, art, music, dance — all these dif- 
ferent ways of exploring the truth of being 
human and being alive. They're all welcome 
into this conversation. When they said "get 
practical," then I had to really try to formu- 
late what I was doing in my private therapy 
suite. When I started teaching students the 
more organized approach to it— these do- 
mains you're talking about— I started teach- 
ing students and they started applying, for 
example, in integrating consciousness. So 
you say, "What's that?" Well that's finding 
ways to differentiate awareness from that 
which you are aware of and then linking 
those. "What other kind of integration?" 
Well, there's something called bilateral in- 
tegration: the difference between the left 
hemisphere and the right. There's a beauti- 
ful book called The Master and his Emissary 
by lain McGilchrist that explores these dif- 
ferences between left and right. What we've 
been doing is exploring how you integrate. 
To honor the differences, promote the dif- 
ferences, then cultivate connection. Here's 

28 The Neuropsychotherapist 

issue 1 April-June 2013 

the thing: integration is not the same as 
blending. It's not like a smoothie, it's more 
like a fruit salad; you maintain your indi- 
vidual identities so that the whole is greater 
than the sum of the parts. 

So that's the key of integration. 
There's bilateral integration, then there's 
vertical integration that is honoring these 
deep, deep processes in the body itself: the 
muscles, the intestines, the heart, the brain- 
stem, the sub cortical areas also like the lim- 
bic area — and how you bring those up into 
cortically-mediated forms of awareness. 
Then there's memory integration where 
you literally see how different elements of 
synaptic shadows from past experiences 
are embedded in forms of memories, called 
implicit memory, and you can literally pull 
them together; take the differentiated ele- 
ments and link them together in something 
called explicit memory. You can see how 
trauma is, in large part, an impediment to 
memory integration. 

If you have an integrated memory, then 
the nextform of integration is narrative inte- 
gration. We are narrative creatures and you 
need to have a way where you find mean- 
ing by connecting the past, present, and fu- 
ture. Now this connection of past, present, 
and future is really the fundamental core 
of narrative. Narrative integration allows 
you to become not just a passive historian 
of what's happened to you, but actually the 
active constructor of your own life story. You 
can be your own novelist. 

Then there's state integration, which 
is the brains' capability of being in different 
states. Like one state in me wants to be in 
solitude because I love Just getting into the 
present moment and going inward. Another 
part of me loves to be social. Well, with one 
body, how do I take these two states and 
give them both what they need? So that's 
just a simple example. State integration is 
honoring differences, promoting linkages; 
not becoming the same. I don't say, "Oh, 
I've gotta chose one or the other!" No. I 
hold onto the opposites within awareness 
and I intentionally find harmony by bringing 
them together. 

That sounds very Jungian in a way- 
holding of the opposites is an essential Jun- 
gian concept. 

Well, it's so beautiful when I hearthat be- 
cause what we're looking for is consilience. 
The sages and wise elders, all of whose 
shoulders we stand upon, if this works then 
this framework should meet the criteria for 
Jungian analysis, and psychoanalysis from 
a Freudian point of view, cognitive behav- 
ior work, EMDR work, narrative therapy, 
work therapy, group therapy; it should fit 
with contemplative practice. It turns out — it 

I can't tell you how exciting it is. I'm of- 
ten asked to give addresses to each of these 
groups, including the religious groups, and 
what people find is that it's consilient with 
their approach. So what I say is that inter- 
personal neural biology, this mindset ap- 
proach, is really a place for all of us to come 
together and collaborate, to try to bring 
more kindness into the world. 

The next kind of integration, inter- 
personal integration, is all about that. How 
do you honour differences and promote 
linkages? — which is basically kindness. Inte- 
gration is kindness. 

/ have really been sensing this coming 
together. That some kind of "coming to- 
gether" has been happening and we can 
all get under the same tent. It really does 
build on a lot of threads of thought, and 
approaches that I have been articulating; 
ideas like mindfulness, the various func- 
tions of the brain, gaining a better under- 
standing of the brain and so on, and the 
role of memory— all of that. It's beautiful. 
One of the things / love about your book, 
too, is that you ground many of these ide- 
as in case histories. Early in the book you 
relate a case history of Barbara, who suf- 
fered from headaches. Perhaps you could 
take us through that, because it effectively 
sets up many of the theoretical points that 
you make. 

Sure. Barbara suffered from a car ac- 
cident, and unfortunately she had terrible 
damage to the part of her brain just behind 
theforehead, in the arc of the steering wheel 
because she unfortunately didn't wear her 
safety belt. What happened in taking care of 
her family was the family was falling apart 
after this brain damage. Her neurosurgeon 
lent me her scans and I took her scans to the 
library and I looked up the parts of the brain 


The Neuropsychotherapist 

that had been damaged and pursued a sci- 
entific review of what we knew at that time 
(it was a long, long time ago) from the sci- 
ence of the brain that could help us under- 
stand what areas were damaged and what 
the science would tell us about what those 
areas were responsible for. So ultimately a 
list of nine functions that emerged from this 
area behind the forehead came out, and I 
could help the family, the children and her 
husband, understand why Barbara was not 
Barbara anymore. Even though she looked 
similar, because she had plastic surgery, 
the brain surgery had removed all sorts of 
things. She got better from a physical point 
of view, but not from a mental point of view. 
This area of the brain is one of the most 
integrative regions; that is, it's part of the 
cortex that links the cortex to areas below 
it: the limbic area, the brain stem, the body 
proper. It even makes maps of the firing of 
other nervous systems, called empathy, and 
these are mindsight maps of the self. I call 
them me-maps, or mindsight maps of some- 
one else are called a you-map, and even a 
mindsight map that makes an internal rep- 
resentation of a sense of "we", I call those 
mindsight we-maps. Barbara didn't have 
any of those maps anymore. The whole 
family collapsed. 

These maps we make in our cortical 
regions, these pre-frontal areas, are neces- 
sary for us to have social and emotional intel- 
ligence. They're necessary for other people 
to feel felt by us. All these ways that Barbara 
used to be, unfortunately, sadly, she could 
no longer create because those areas of her 
brain, the integrative areas, couldn't pull all 
that stuff together. So the family was able 
to go through a grieving process when they 
could understand the truth. That insight, 
about the importance of knowing about in- 
tegration in the brain and its role in creat- 
ing wellbeing in our families, really started 
me on a journey to honor relationships — I 
was being trained as a relationship scien- 
tist — and to also look at narrative, because 
we make meaning out of these experiences. 
And this is what the kids and husband had 
to do to make meaning out of their loss. 

So I wanted to put together some 
kind of view that tied relationships, narra- 
tive, psychotherapy, the brain, and inte- 
gration, all into one perspective. Barbara... 
while her situation was so painful, the family 

did recover in a very deep and powerful way 
and could do the necessary healing. The les- 
sons learned were profoundly important for 
understanding the importance of integra- 
tion in our relational and mental and neural 

Thanks for taking us through that. 
We now know that there is this recipro- 
cal integration between the brain and 
our thoughts, that the brain shapes our 
thoughts but our thoughts can also shape 
our brain. So what do you see as the deeper 
implications of this neuro-plasticity? 

Oh, it's huge, Dave! I mean, here's the 
power of it. The simplistic model that was 
running around a while ago was that the 
brain runs the show. Like they'll say, "The 
mind is just the activity of the brain, or the 
side effect of brain activity or whatever." 
But what we now know is that the brain is 
constantly changing. Your mind, your men- 
tal life, the process that regulates the flow 
of energy and information in your relation- 
ships and your body, including the stuff up 
in your skull, the way you focus energy and 
information flow, which is basically how you 
pay attention, drives your pattern of think- 
ing; you can alter how you feel and it specifi- 
cally activates the firing of certain circuits of 
neurons. When you make your neurons fire 
by the energy of your mind and the focus 
of that flow, you can actually get the brain 
to change not only its firing in the moment, 
but you can rewire it so that it changes its 
synaptic connections. You can grow new 
neurons, you can alter the myelin sheath 
that's laid down connecting neurons in a cir- 
cuit so that the effect of flow is 3000 times 
more potent! And now we're learning — not 
only synapse formation, neuron formation 
from new neurons from stem cells in the 
brain, myelin formation — about the cutting 
edge area of epigenesis. You can actually 
change the regulation of gene expression, 
and molecules called epigenetic molecules. 
The preliminary data is coming in that, for 
example, if you use mindfulness meditation, 
which is using the focus of your attention in 
a very specific way to pay attention to pre- 
sent moment experience and letting go of 
judgments, when you're taught how to do 
that you can actually reduce the destruction 
of the part of the chromosome called telom- 

The Neuropsychotherapist 

issue lApril-June 2013 



eres. When the telomere destruction is re- 
duced, you actually, conceptually, theoreti- 
cally, are extending your life span — we have 
these ends of chromosomes, and when you 
use them all up your body is ready to die— if 
you can slow down that telomere turnover 
by increasing something called telomerase 
through mindfulness meditation. 

We now know the focus of your mind — 
that's all mindfulness meditation is, focusing 
your mind in particular ways; it's very pow- 
erful — can change not only the connections 
in the brain, but even epigenetic control of 
gene expression. So we're at this incredibly 
exciting time to empower ourselves to de- 
velop our mind with mental training to pro- 
mote wellbeing; in body, in relationships, in 
mental life, in ways we could only dream of 
before; and now we have the mechanisms 
that are just being illuminated to support 
these important steps toward health. 

Now another factor, mirror neurons, 
plays a key role in the interpersonal aspect 
of your interpersonal neural biology. Take 
us through the role of mirror neurons in em- 
pathy and emotional contagion. 

Well, like anything in science you can say 
"up" and a bunch of people would say, "No, 

it's down." We need to Just start by saying 
that mirror neurons are extremely excit- 
ing. I think they are an incredible discov- 
ery by some researchers in Italy, Rizzolatti 
and Gallese and others. They were discov- 
ered and proven to be in human beings by 
Marco lacoboni and Itzahak Fried here at 
UCLA, through neurosurgery they were do- 
ing. There are a lot of contributors to this 
field, but you need to know, some scientists 
don't believe they exist. I happen to believe 
in them because I've read the research and I 
really think it's fantastic. Basically what this 
is, and there's a long history to it but I'll Just 
cut to the chase, are neurons that constant- 
ly scan the movements of other beings, liv- 
ing creatures, and try to detect predictable 
patterns. When these mirror neurons detect 
a predictable pattern, they have a process 
called the sensory implication of motor ac- 
tion, and what that means is that, Dave, if 
I see you moving your hand toward a glass 
of water and lifting the glass toward your 
mouth, I'm going to start predicting that 
you're going to drink water. Now my mirror 
neurons predicting your actions work with 
an area called the superior temporal cortex 
to create a map of your intentional state. 
So the first step that these mirror neurons 
do is that they are looking for predictable 


The Neuropsychotherapist 



sequences. The next thing they do is they 
make a neural map of another being's in- 
tention, which is a mental state. So now I've 
mapped out your intention, and then I can 
do two things with that mapping of your in- 

The first thing I do is I drive that informa- 
tion down into my subcortical areas; these 
are all cortical regions — superior temporal 
cortex... mirror neurons are in the parietal 
area and the anterior area, as well as the 
cortical lobe as well as other areas besides 
these frontal and parietal regions— and I 
drive it down into my limbic area, and prob- 
ably downward to my brain stem, and make 
my body resonate with you. So I might start 
feeling thirsty, for example. We call this "in- 
ternal simulation". 

The second thing I'm doing is get- 
ting ready for behavioral imitation; that is, 
my hand may try to find a glass, or it may 
even happen automatically, and I find a 
glass and I start drinking when you're drink- 
ing. Just like when someone yawns and you 
yawn, or someone crosses their legs and 
you cross your legs. These are behavioral 
imitations, and there's also internal simu- 
lation. So the mirror neurons allow for be- 
havioral imitation, and through the insula 
they go downwards — the sub-cortical area 
is rising back up through the insula to the 
prefrontal areas, especially the right inte- 
rior insula... a twig of it goes over to the right 
anterior cingulate— I just call this whole set 
of prefrontal areas the resonance circuits. So 
you can resonate with another person. I can 
resonate with you and I'll feel thirsty. Or if 
you're in pain, I could feel your pain. Or if 
you're Joyful, I could feel Joyful. 

This isthe modern conceptualization 
of the neurobiology of empathy and com- 
passion; that we move from internal simula- 
tion, then, in these middle pre-frontal areas, 
that that patient Barbara unfortunately had 
severely damaged, and not only map out 
our internal sub-cortical state in something 
called interoception, but then you take inter- 
oception in these middle pre-frontal areas 
and you make a map of what's going on in 
your own mental life. Like, "Oh, I'm feeling 
sad," and then you take it a next step over 
in an adjacent area of the middle pre-fron- 
tal region and you say, "I wonder if Dave is 
sad?" And so we draw on interoceptive abil- 
ity — the ability to perceive inward — and we 

then imagine what we ourselves are feeling 
with insight, and then we project really that 
insight into ourselves onto what we imagine 
is going on in someone else, which we can 
call empathy. That's kind of the pathway, 
and this is how mirror neurons fit into the 
whole exciting discovery about the nature 
of our relationships with each other. 

Is there any final thought that you'd like 
to leave us with? 

I think if we do this together, then the 
sky's the limit on what we can achieve. I 
know the world's in a very painful place for 
lots and lots of people all around the planet, 
but people can now, with all this new sci- 
entific understanding and this framework 
for understanding what wellbeing is, be 
empowered to promote integration and 
promote compassion and kindness. This is 
something we can do. We can help affect 
global change issues, which is an area I work 
in. We can work with people in communities 
that are really struggling to bring this kind 
of resilience from the inside out. And doing 
this together, I think we can do incredible 
things. So, I want to welcome everyone into 
the mindsight community and I look for- 
ward to meeting people in person. 

Dr. Dan Siegel, thanks for being my 
guest today. 

Dave, thank you. It's really been a pleas- 
ure; a great interview. Thank you. 

Van Nuys, D. (2013). Interview with Dr. Daniel 
Siegel. The Neuropsychotherapist, 1, 22-32 10. 12744/tnpt( 1)022-032 

This interview is an 
adaptation from the 
Shrink Rap Radio show 
#255, "Mindsight with 
Dr. Daniel Siegel", as in- 
terviewed by David Van 
Nuys, Ph.D., aka "Dr. 
Dave". The interview 
was originally transcribed by Erika Steeves 
before editing for this publication. 

Further interviews and transcriptions can 
be found at 

The Neuropsychotherapist 

issue lApril-June 2013 



The International Journal of Neuropsychotherapy (IJNPT) is an open-access, online journal that con- 
siders manuscripts on all aspects of integrative biopsychosocial issues related to psychotherapy. IJNPT 
aims to explore the neurological and other biological underpinnings of mental states and disorders to 
advance the therapeutic practice of psychotherapy. 

Our mission is to provide researchers, educators and clinicians with the best research from around 
the world to raise awareness of the neuropsychotherapy perspective on mental health interventions. 
for more information on submitting articles, letters and research notes. 

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The Neuropsychotherapist