FREDRIC SCHIFFER, M.D.



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OF TWO MINDS
THE REVOLUTIONARY SCIENCE OF DUAL-BRAIN PSYCHOLOGY

by Fredric Schiffer
 
 

Chapter 1: Introduction

She is in despair. Her life is a shambles. She can't think straight, and the anxiety she feels seems to bury her. She has spent two weeks in bed, and there she cries most of the time. She doesn't know what has overtaken her. Nothing -- not her business failure, not the divorce she sought, not her new relationship -- seems even vaguely proportional to her distress.

My first contact with Carol was through her brother, who urged me over the phone to hospitalize her. "She's flipped out," he told me. I asked him to bring her over to my office instead.
 
 

Carol seemed to hide beneath her straggly hair, partially covering her naturally pretty dark eyes, now red from crying. She was handsome in spite of her condition. She was no longer crying, and she was cooperative and trying to be pleasant. Carol was in touch with reality. She clearly saw her distress but had no clue about what suddenly brought this great, escalating turmoil into her life several weeks ago. Her life for the past thirty years certainly had been troubled at times, but never before had she been in quite so much distress.

I liked Carol, and I think I had a good sense of the despair she had been experiencing. We seemed to make a good emotional connection. As we discussed her distress, I pushed her to try to see when she had felt this way before, and she discovered to her surprise that as a child she had experienced similar periods of distress.

I asked her to describe her family life in her childhood, and it became clear to us as she spoke that frequently she felt emotionally abandoned and betrayed by her parents. There was clearly a connection between her early distress and that perception of estrangement.

I wanted to see if her present despair might somehow parallel that of her childhood. She began to understand that about a month earlier, when her divorce became final and her business failed outright, she started to feel abandoned and unsupported emotionally. And just as she had as a child, Carol blamed herself, certain she was somehow bad, defective, or at the very least at fault, to warrant the perceived abandonment. Carol's present-day despair seemed related to the anxiety of feeling abandoned and metaphorically left to suffer a painful psychological death, compounded by the pain of believing she was so repugnant as a person as to deserve such treatment and its terrible consequences.

Carol was fighting constantly with her new boyfriend, a man she loved dearly and who loved her in return. She was continually accusing him of not loving her, and her behavior was becoming unbearable for him. She was effectively pushing him away, which only intensified her sense of abandonment. Remarkably, Carol was able to see and appreciate all this.

At this point, I said, "But I think there's another part of you that knows that Mike loves you."

"Yes, I know that."

At that point I explained my hypothesis because I didn't feel I could wait a few years for her to come to it in her own time. I wanted to bring some clarity and structure into the session right then. I told Carol that there was a part of her personality that was immature, troubled, and panicking, and it had been taking control of her life. I explained that she might also have another part of her personality, one more mature and grounded, but it was being pushed aside now. Carol told me that she could actually feel that struggle within; she had periods when she felt calm and in control, but then even those times were disrupted by overwhelming feelings of anxiety.

"I am going to talk with your troubled-sided personality," I told her. "I can see that this part of you is extremely frightened and upset. I know you [her troubled side] don't yet understand why you are so distressed, but I and your more mature side will help you to understand yourself. Right now, I want you to stop attacking Carol. I want you to let your mature side lead; otherwise your life will continue crashing off course." My tone was caring, firm, forceful.

To Carol's surprise, her symptoms suddenly abated, leaving her calm and in control. Although I didn't expect this remission to last more than a few minutes, its occurrence set out the blueprint for what was to follow in our work together. We interpreted her response as her troubled mind's listening and deciding to cooperate. It was in essence, I believed, her troubled mind's nonverbal response to what I had said.

I explained to Carol that I believe we have two minds, much as Steve Martin and Lily Tomlin are comically portrayed as living and struggling together within the head of one person in All of Me. In my view, Carol had a mature part that knew she was essentially safe and well regarded in spite of the business failure -- more of an insult to her pride than her pocketbook -- and in spite of the divorce she struggled so hard to achieve. But Carol had another mind that knew she was utterly alone and on the verge of a long-awaited destruction. She acknowledged that she had been living in that mind for the past month. Finally, I shared my idea that in life, these two parts of our mind can struggle or cooperate, and that apparently in the past month, her immature part had assumed a dominant role in her personality. In time Carol and I would explore why this switch occurred at this turn in her life, but for now I just wanted to offer a diagram for what had been happening to her and, from that map, a direction back to mental stability.

I next asked Carol to try on a pair of plastic safety glasses taped over the front so that she could see only out of the extreme right side of her right eye. She looked at me skeptically, as if I might need help myself. I simply asked her what she was experiencing. In a moment she said, with some surprise, that the glasses made her feel calmer and safer. I gave her a second pair almost identical to the first, and I asked her to try them on. The second pair limited her vision to the left side of her left eye. She told me almost immediately that she felt trapped and distressed. Her symptoms were recurring. I asked her to switch again to the first pair, and within seconds she was calmed by that pair.

With this strange exercise, which I will explain in great detail as we proceed, I wanted to help Carol see that the idea of an immature personality's taking over the control of her life was more than a metaphor, more than a vague hypothesis; it was a demonstrable, concrete phenomenon. When I suggested that we talk to the immature part of her from then on, Carol knew from her experience that we were not waxing poetic.

I began teaching Carol how to strengthen her mature mind and how to notice her troubled side -- how to listen to it, how to talk with it, how to get it to cooperate, how to get it to feel better. By the end of her fifty-minute session, her despair was gone. We had begun a therapeutic relationship, and she left with a new understanding and techniques for taking advantage of that insight. Carol wouldn't need hospitalization after all. Although I knew that her troubled side would reassert itself and that this respite would be brief, we had accomplished something dramatic and would be able to return to what we did.
 

Over the next month, the course of therapy was turbulent as Carol's immature side showed its strength and determination in fits and starts. But steadily we made progress, and after six weeks, she began, for the first time in several months, to feel almost completely like her old self again. By that time Carol could readily feel what she called "my troubled side," and she had become quite skilled at listening to her, disciplining her, and helping her with her fears. Eventually she easily related to this newly discovered troubled part of her, and she found that her relationship to this aspect of her own self was much like her relationships with other people. She responded to it, and it responded in turn. Over this time, we helped her troubled side feel safer and more a part of her life in a cooperative, constructive way. She improved significantly over the next three months and then dramatically over the following three. By that time she had achieved an emotional stability and balance because the mature part of her personality had firmly established its leadership.

Of Two Minds

From even my early days as a psychiatric resident at McLean Hospital, I noticed that my patients often seemed to have a kind of double personality: on the one hand, very mature and stable, but on the other hand, more irrational, overly emotional, and impulsive. This impression became more complex but clearer as I worked over the next twenty years with patients in private practice. I could see how these different aspects of my patients interacted, with one part often struggling with or sabotaging the other. The troubled part seemed stuck in a traumatic past, and I had begun to see that the object of treatment was to help this distressed part learn that it was more valuable and safer than troubling past experiences had led it to believe. The relationship and the complex interaction between our two minds is the focus of this book: How to recognize them, communicate with them, and, most important, improve their relationship. We will also explore the physical basis for the two minds.

Split-Brain Studies

My clinical impressions led me to reread and reassess the literature on the famous split-brain studies of the 1960s because I had the feeling that the scientists that conducted them had also encountered two minds in one person. The split-brain surgery, a commissurotomy, consisted of cutting the corpus callosum, the large nerve bundle connecting the left and right cerebral hemispheres. It had been performed on patients desperately suffering from epilepsy not relieved by conventional treatments, because it was reasoned that the operation could prevent the spread of a seizure from one hemisphere to the other. The doctors hoped that limiting the spread of the seizures might reduce the epilepsy generally. The results showed that not only were the seizures decreased, but also the patients did not seem adversely affected by the radical surgery. As I will discuss more fully in the next chapter, these operations became famous not as much because of their therapeutic benefits as more because of the subsequent studies performed on the patients after they recovered from the surgery. These studies enabled scientists to investigate the properties of each separated hemisphere, the left and the right brain.

I was, of course, very much aware of the popular belief that there are left- and right-sided personality types with the "left-sided" person being very logical and unemotional and the "right-sided" person perceived as very poetic or impulsive. But I knew also that these ideas were generally held in disregard by neuroscientists.

As I reviewed the entire split-brain literature, I realized that the most striking and dependable finding from the studies was generally underappreciated by scientists as well as laypeople. This most important idea, which I discuss in detail in the next chapter, is that in split-brain patients, there exist two intact, reasonably intelligent, autonomous minds. After these patients had their corpus callosum cut, they each manifested two separate minds. They became, in effect, two people inhabiting one body. In the next chapter, I present extensive evidence and clarification of this incredible statement, but briefly here are some dramatic examples (elaborated on later) to illustrate my point quickly:

Each of these is an example of the "post-commissurotomy syndrome," which many split-brain patients manifest for a short time following the surgery. In this syndrome, the left hand, connected to the right brain, acts autonomously and purposefully -- but often in opposition to the intentions and actions of the left brain.

My Notions Versus the Popular Notions from the Split-Brain Studies

Although there are similarities between my idea about two minds in each of us and the popular assumption of left- (logical) and right- (poetic) sided personalities, my notion had more to do with maturity versus immaturity. I first expected the immature personality to reside in the right brain, for there is not a long leap from the popular idea of a creative, emotional right brain and my idea of an overly emotional, neurotic side. Similarly, the popular concept of a logical, orderly left brain didn't seem too distant from my idea of a mature side. Yet as I came to understand the dynamics of the two minds, it became increasingly clear that the mature mind might easily be the poetic and artistic one, and the troubled side might tend to be extremely orderly and logical.

The popular notion did not suggest two actual, distinct minds, but rather that some people were more logical and less emotional, like typical computer wizards, and that others were more creative and spontaneous, like typical artists. The popular notion does imply that these personality types might bear a relation to the left and right brains, with one hemisphere -- either left or right -- tending to have a more important role in shaping the individual's integrated personality. Neuroscientists call this popular notion "hemisphericity," but its scientific validity has not been established. Nor is it disproved. Scientists generally believe that the popular notions about hemisphericity have far overreached the scientific evidence for them. And so while it is obvious that some people are more logical and less emotional, and others the opposite, this categorization has not been well enough studied to determine clearly whether it relates to the hemispheres of the brain.

Although the split-brain findings didn't suggest that one hemisphere was more mature or more emotional than the other, two main, dependable findings from the split-brain studies demanded further investigation. The first was the amazing discovery that two autonomous minds resided in each split-brain patient. The second was that only the left side could speak; the right brain is mute. (The location of speech in the left hemisphere was known prior to the initial split-brain studies, but that fact became more graphic in the split-brain patients.) It appeared that while the left side was superior at most language tasks, the right side excelled at spatial tasks, but whether one side was more intelligent, logical, or mature was difficult to assess. The detailed nature of right mind was not well studied because the right brain, being " mute," was difficult to study psychologically. Recently I collaborated with the California group that did the original split-brain research. Our new studies, described in the next chapter, were designed specifically to explore the psychological nature of the left and right brains in split-brain patients.

Two Personalities?

I wondered how the two personalities I observed in my patients related to the two minds revealed by the split-brain operations. Was what I was observing as a clinical psychological phenomenon supported by the compelling data from these neurosurgical patients? Was what began for me as a clinical metaphor an actual reality? Are there really two minds in my patients? Do these two minds relate to the two cerebral hemispheres in a manner consistent with the observations to come from the split-brain studies? How do these two minds reconcile with classic Freudian theory of the conscious and unconscious minds and to the superego, ego, and id? Do all people have two minds? Is there a relationship between traumatic experiences and the troubled mind's worldview? If these two minds exist, might not both be mature or both immature in some people?

With these and many more questions in mind, I embarked on a deeper review of the literature and a series of neuroscientific and psychological studies, often in collaboration with some of the finest neuroscientists of our age. In this book, I present our results as well as their implications for psychological theory and treatment.

Testing a hypothesis is not limited to collecting and interpreting laboratory data. It extends also to how well it can successfully explain a wide range of clinical observations and to how much its therapeutic methods accomplish. In conducting our research, we attempted to interrelate as much as possible the consulting room and the scientific laboratory.

n and Out of the Lab

In 1990, I approached Dr. Martin Teicher, a highly regarded neuroscientist who had always maintained an interest in novel ideas. I told him of my hypotheses and suggested a protocol that could begin to test my ideas scientifically. Dr. Teicher gave his assent and offered me the use of his laboratory for conducting electroencephalograms (EEGs). I invited patients with a history of trauma to come to the laboratory, where I asked them to recall a neutral memory, such as something routine that they did the week before, and a traumatic memory, which I helped elicit in a brief psychiatric interview. What Teicher and I found was that in most of the patients, their left brains were more active during the neutral memory, and their right brains were more active during their recall of their traumas. The data suggested that traumatic memories might be more often lodged in the right hemisphere. I speculated that each hemisphere had a recollection of the trauma, but the mind in the right hemisphere was more sensitive to it.

In November 1995, I made a completely unexpected discovery that was to advance my ideas and my clinical skills -- and drastically alter my hypothesis that it was always the right brain that was more troubled by past traumas.

Dr. Werner Wittling and his associate neuroscientists from Eichstart, Germany, had developed a technique to show films to one half of the brain at a time in a group of healthy, intact subjects. The German experiment seemed to confirm what a group of scientists working in the United States had already learned: films shown to the right brain often elicited a stronger emotional and physical response than when shown to the left brain. It is commonly known that if something is shown to the extreme left or the extreme right of a person, the image tends to go first to the opposite side of the brain. The German group used an expensive and complicated method for isolating one side of the brain. It was too costly and complex for my tastes and budget, but it inspired me to begin using my hands to block out parts of my vision -- to see if I felt a little differently when looking out of one side. I imagined I felt some difference, but concluded my brief experience unconvinced.

That afternoon I asked my first patient, Larry, a research assistant at MIT, to hold one hand over his right eye and the other over all but the outside half of his left eye. I was completely surprised when he became a bit agitated and said, "Oh, my God!"

"What's that?" I had no idea what he meant.

"I have all of my anxiety back."

Some months earlier, Larry had entered treatment for profound anxiety stemming from childhood mistreatment. By this time, his symptoms had been substantially relieved.

"Try the other side [right side of the right eye]," I retorted.

"That's better!" he immediately responded, to the relief of both of us.

I asked him to go back and forth, and he repeatedly felt his symptoms when he looked to the left side of his left eye, and he had the complete relief of his symptoms when he looked out of the right half of his right eye. We were both amazed.

I asked all of my patients that day to do the same thing, and the first five all had similar dramatic responses. One patient, a Vietnam veteran, whom I had diagnosed with a severe posttraumatic stress disorder, looked out of one side and developed an expression of intense apprehension as he looked at a large plant in my office. "It looks like the jungle," he said with some alarm. I asked him to look out the other side, and he said, "No, it's a nice-looking plant."

Over the past two years, I have studied this phenomenon extensively, in the laboratory with volunteers and in my office with my patients. To simplify the technique, I taped the front of plastic safety goggles so that they blocked vision in all but the extreme side of the left or right eye.

When I began, I expected that all the troubled views would be associated with the right brain, because that hemisphere had been found more active during episodes of negative emotion. I couldn't understand why Werner Wittling's group in Germany had found in a later study that a second group of subjects, patients suffering from psychosomatic complaints, had more distress in their left brains. However, several of my own therapy patients experienced increased anxiety while looking to the right side, which we believed stimulated their left brains. My unexpected findings in my patients were consistent with Wittling's unexpected findings in his psychosomatic patients. The goggles' effects and later effectiveness in psychotherapy not only supported my long-held hypothesis that we are essentially of two minds, but also confirmed Wittling's reports that emotional distress can be associated with the left hemisphere as easily as with the right.

The New Dual-Brain Science

Dual-brain science is a new field engaged in exploring scientifically the role of the left and right brains (and their relationship) in psychological functioning. Until just a few years ago, it was unfashionable to turn to brain studies for an understanding of emotions. Most of the scientific interest in the split-brain studies focused on cognition. My approach to neuroscience has been grounded in psychology. I have sought to resolve any antagonism that often exists between a biological approach that sees complex psychological syndromes as simply brain or chemical malfunctions, devoid of personal meaning, and a psychological approach that has not been able to relate to the vast amount of information now being generated by technological advances in neuroscience. Indeed, for much of the past decade, I and other scientists have attempted to ally the discrete fields of neuroscience, psychopharmacology, and clinical psychology, to initiate a new understanding of behavior, and to lead to more effective ways of improving psychological balance. I will present compelling evidence from the scientific literature and from my own studies that I believe proves a relationship between the two cerebral hemispheres and the two distinct personalities. I will show that dual-brain science has the power to explain the whole range of symptoms that we humans suffer, from anxiety to psychosis.
 

Dual-Brain Therapy

The lessons from dual-brain science provide me with the theoretical framework to learn how to access and work with the troubled hemisphere to correct its archaic, destructive ideas and emotions. Dual-brain therapy incorporates aspects of the traditional psychotherapy that I have practiced for over twenty years, as well as strategies from cognitive therapy. Like traditional psychotherapy, it emphasizes empathy and a psychodynamic understanding. And like cognitive therapy, it attempts to help patients correct misperceptions and negative ideas they have about themselves. My new techniques diverge from and surpass these popular therapies because they are better informed by recent advances in brain science and grounded in the idea that we can have two distinct parts to our personality, which allows the therapy to become more active and more concrete. The advance of dual-brain therapy over traditional therapies derives from its demonstration of the troubled side as an interior, complex person. This realization greatly clarifies and simplifies the therapeutic tasks.

One major goal of dual-brain therapy is the care, nurturance, and education of the mind of the more troubled hemisphere. The troubled side is often like a traumatized person who hasn't been able to move beyond the trauma, even when removed from it, because he continues to expect retraumatization. The traumas can range from the obvious and apparent to the most subtle and inapparent. Initially this mind may have withdrawn from the world around it, making it even more difficult for it to learn that the world may have changed for the better since the traumas. This is especially true for childhood traumas, which are often externally removed with the passage of time and the physical and mental maturity that comes with development. Yet, insidiously, trauma can remain covertly present because the mind on the troubled side fails to notice or trust the improvement. Dual-brain therapy entails a reaching out to the mind of the troubled hemisphere, attempting through patience, persistence, and a loving, mature, and informed attitude to teach it that it no longer has to fear abuse or protect itself with the archaic defenses that have become the source of new pain and problems.

Both right- and left-handed patients respond to dual-brain therapy as well as to the lateralizing glasses. In my studies I found no significant differences between right- and left-handers in regard to the intensity or the side of their emotional responses to the glasses, and I have observed no differences in their clinical responses to therapy.

Some Definitions

Throughout the book we will explore the relation between psychology and neuroscience. The language and vocabulary of neuroscience, although complex, can be defined with some precision. To understand thoroughly the physics of magnetic resonance imaging (MRI) requires a sophisticated grasp of theoretical physics, higher mathematics, and computer science, but we all understand that if the doctor orders us to have an MRI, we will have a series of pictures similar to X-rays taken of the insides of us.

When we cross over to psychology, concepts become more difficult to define precisely. Think about the word "mind," for example. We know that we have one, but few experts have been able to define it to everyone's satisfaction. According to Webster's Dictionary, it is "the element or complex of elements in an individual that feels, perceives, thinks, wills, and especially reasons." Our certainty may evaporate when we begin to wonder about the element or complex of elements that does the feeling and perceiving. Still, even if we can't be absolutely explicit, I will state the definition of mind that I use in this book: that part of a person which experiences, thinks, and decides.

But what about the self? How does it differ from the mind? To me, the two terms essentially refer to the same thing except perhaps "self" might imply more of a life history and the added dimension of a human quality. And what of the term "personality"? Webster's defines this as "the totality of an individual's behavioral and emotional character traits, attitudes, or habits." Walter Mischel's textbook, entitled, Introduction to Personality, states on the first page: "Most thoughtful people have asked the question, 'What is personality?' but few agree on an answer. The term 'personality' has many definitions, but no single meaning is accepted universally."

These three terms -- "mind," "self," "personality" -- might tend to differ in their temporal implications. If we speak of Joe's "mind," we might be thinking of his mind in a moment of time. We might say his mind was alert or confused. If we speak of his "self," we refer to a lifelong quality, closely related to his personal identity. When we refer to Joe's personality, we are identifying his psychological characteristics, which may change over time. We wouldn't be surprised if Joe manifests changes in his personality over time but we wouldn't expect Joe's self to change. It isn't my intention to stick rigidly to these imprecise meanings. For our purposes, the terms "mind," "self," and "personality" have more or less the same meaning: a part of an individual that has a unique set of memories, motivations, and behaviors.

Compared to the next task, attempting to define mind, self, and personality may seem easy. What does it mean to assert that a person has two minds, two personalities, or especially two selves? Surely Joe hasn't been cloned or twinned. He's one person with one mind and one self. (We wouldn't be too troubled if he had changes in his personality, especially over time.) When I speak of two minds in one person, I mean that in each person there are two parts side by side, each with its unique (though possibly similar) set of memories, motivations, and behaviors.

This may seem unreasonable and unforgivable on my part. The philosopher Daniel Dennett tells us that we get one self "to a customer." And Nobel laureate and eminent neuroscientist Sir John Eccles and psychologist Daniel Robinson write, "Each soul [self] is a Divine creation, which is 'attached' to the growing fetus at some time between conception and birth. It is the certainty of the inner core of unique individuality that necessitates the 'Divine creation.' We submit that no other explanation is tenable."

But philosopher Jennifer Radden in her book, Divided Minds and Successive Selves: Ethical Issues in Disorders of Identity and Personality, argues that a person can clearly have two selves especially in exceptional conditions, such as recurrent psychosis or multiple personality disorders, which she asserts have implications for ordinary people. Radden clarifies what would be required for a person to have two selves in one body. She suggests that each self would have to have a separate, distinguishable pattern of motivation and behavior. They may also have different physical and emotional styles, temperaments, and moral dispositions. Radden suggests that at times, "each [self] exhibits well-rounded and roundly contrary personalities," and that at other times the differences can be more subtle. For instance, Radden quotes a beautiful description by William James of men who are constantly struggling with destructive impulses as an example of more subtle divisions in the self "Their spirit wears with their flesh, they wish for incompatibles, wayward impulses interrupt their most deliberate plans, and their lives are one long drama of repentance and of effort to repair misdemeanors and mistakes."

Following Radden's definitions, I will present evidence and then argue that ordinary people generally have two selves in one body. In the next chapter, "A New Look at Split-Brain Studies," I will show how split-brain and other neuroscientific research compellingly demonstrate that two separate minds can exist in one person. In Chapter 3, "Looking Right (and Looking Left)," I describe in detail my discovery and research into the effects of the glasses, limiting vision to one side or the other. These findings give graphic evidence from my patients that ordinary people may frequently manifest two distinct personalities, each related to either the left or right hemisphere.

The fourth chapter, "Dual-Brain Psychology," discusses how understanding the many different possible relationships between the two minds, revealed by the research described in the earlier chapters, leads to a much clearer understanding of human psychology. For instance, the two minds can cooperate with each other in a deep, synergistic relationship that fosters creativity and maturity, or they can sabotage each other, leading to a plethora of psychological and psychosomatic problems. Psychological problems often result from injuries to the left or right mind and from the internal struggles and imbalances that such injuries initiate. Many psychological insults of both childhood and adulthood can injure one hemisphere more than the other. Such damage will often enhance or corrupt the power of the troubled side and can often leave the more mature side underdeveloped, which can lead to a destructive struggle between the two minds and to psychological problems.

Chapters 5 through 10 show what the ideas and techniques of dual-brain science really mean for specific areas of human distress: anxiety, depression, posttraumatic stress disorder, psychosis, cocaine abuse, and stress-induced cardiac problems. Each chapter discusses past theoretical explanations and shows how they are improved with the dual-brain approach. Each chapter presents stories of patients that illustrate how they struggled to understand and deal with their problems.

In Chapter 11, "Dual-Brain Therapy to Discover and Assist Your Troubled Mind," I describe how you might improve the relationship between your two minds, how to discover and assist a troubled side to mature further or heal. I explain how a healthy left and right mind with a respectful, cooperative relationship between them can lead you to a life of greater meaning, creativity, productivity, and fulfillment. Only when the relationships within yourself are in harmony are you best able to sustain a healthy relationship with another person. Throughout this book I present cases to illustrate my ideas and my work. I have altered identifying information about each patient so that their anonymity will be maintained, but the essential facts of each case are accurate. All the transcripts presented are unaltered except for some minor editing for clarity.
 

Copyright © 1998 by Fredric Schiffer

Copyright (c) 1996,1997,1998,1999 by Simon & Schuster, Inc.
All rights reserved, including the right of reproduction in whole or in part in any form.


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