On 'Throwing Around Diagnoses'

Published on 9.25.2023 at garyborjesson.substack.com

We all do this, we all throw around diagnoses. - Comedian Marc Maron

Imagine you’re at a party and a guy tells you he used to be “a little borderline”—shorthand for reactive and emotionally unstable. Now imagine you saw a person across from you cringe upon hearing this. Why did they cringe? Should you cringe?

Something like this happened to the comedian Marc Maron. After his podcast episode featuring a conversation with fellow comedian Maria Bamford, a listener wrote that they were concerned to hear Maron say that when he was younger he was “a little borderline”. Maron graciously took the listener’s concerns seriously enough to air them on episode 1467.

So, what’s wrong with Maron saying, “When I was younger I was a little borderline”? Why were he and Bamford cautioned for speaking causally, even jokingly, about their mental-health issues? What assumption made the listener feel they had the authority to advise Maron and his listeners against using diagnostic language thus?

There are several issues at play here, including matters of free speech, but I won't be wading into those (shark-infested) waters here. Instead, I want to explore the assumption about mental illness that motivates the listener’s concern, and look at why it’s false.

The assumption came out in the listener’s claim that a personality disorder is “something intrinsic to your being”. Practically speaking, this means that if you’re diagnosed with a personality disorder you’re largely stuck with it. But while personality disorders can be difficult to treat, this is not because they are intrinsic to the person’s being. As I pointed out in my last note, on diagnosis and human experience, being emotionally unstable and behaving narcissistically are human experiences. This is why Maron is speaking accurately when he says he used to be “a little borderline.” What distinguishes people diagnosed with personality disorders is the severity and duration of their experience, not its uniqueness. The listener may have been misled by the DSM’s categorical system of classification into thinking that personality disorders are like being pregnant, either you have it in you—it’s “intrinsic”—or you don’t. In fact, these experiences lie on a continuum.

Before looking at the deeper reason why personality disorders are not intrinsic, let’s first unfold what the listener thought followed from their assumption. If a personality disorder is intrinsic, the reasoning goes, then to speak of it as something you could have a “little bit” of, or as a phase you could go through, is to speak falsely. It risks giving “false hope” to those so diagnosed: they might imagine change is more possible than in fact it is. They might end up feeling ashamed they aren’t able to change. The listener also worried that speaking as Maron and Bamford had risked “diminishing” how seriously people take such diagnoses. Presumably the worry is that people might think of personality disorders the way we used to think about addiction—as coming down to a matter of willpower. In that case failing to overcome a personality disorder could be viewed as a moral failing—as if someone just didn’t try hard enough to change.

To the contrary, the observation made in “About Addiction” applies here: the cause and treatment of most mental disorders has such a strong developmental and interpersonal component that it makes little sense to blame or shame the individual for their problem. This expresses the deeper reason why personality disorders are not intrinsic. Like most disorders, they are not intrinsic to us, and there is no evidence they are “in the genes”. Rather they emerge from a complex interplay between nature and nurture, between the individual and their environment. This rules out viewing it as intrinsic, either in origin or with regard to treatment.

That said, some, if not many, clinicians share the listener’s assumption. But this says more about the time it takes for current research to trickle into mainstream thinking.¹ The fact that we’re only beginning to appreciate the extrinsic factors informing mental illness is part of why we’ve been so bad at treating mental health problems, including addiction and personality disorders. We’ve been looking in the wrong place. Treatment is more effective (though not easier) when we view mental health in the context of the interpersonal field through which it exists.

So, there’s no good reason to cringe when Maron and Bamford (or any of us) use diagnostic language to help describe their experience. Assuming that, like Maron, we’re sensitive and aren’t seeking to push buttons, the language offers us a shortcut, a useful map to the territory of human suffering. I am also assuming here that it’s reasonable to expect that adults not take personally what’s not meant personally. Taking responsibility for our feelings means recognizing that being triggered by others doesn’t necessarily mean they’ve said anything wrong. That’s a lot to ask in our current hypersensitive culture, but it’s part of being a grownup, and of living in a society committed to tolerating free speech.

1. Again, Dr. Gabor Maté’s most recent book, The Myth of Normal, exhaustively documents the critical role developmental and interpersonal factors play in mental health.

Thrown, Never Asked

Posted October 2nd, 2023 at garyborjesson.substack.com

Until we make the unconscious conscious, it will direct our lives, and we will call it our fate. -Carl Jung

As many who’ve been in therapy know, it’s common to become aware of the depths of our ignorance when exploring our family. As a patient, I was alternately dismayed and relieved to discover how distorted were my stories about my family, and therefore myself. Now, as a therapist, I frequently witness patients having similar revelations.

Among the most beneficial (and unsettling) insights psychotherapy offers us learning that we’re not who we think we are. Psychotherapy becomes philosophical when it embraces the Socratic point that the first step toward self-knowledge and wisdom is becoming aware of our ignorance.

So far in these weekly reflections on How We Help I have emphasized two truths that are easy to neglect. First, that we exist through a field that dramatically affects who we become and how we experience ourselves. Second, that we’re largely unconscious of this field—especially in the west. This leads us to overemphasize the self and under-rate the role of others in who we are and why we’re suffering. So, I’ve begun these notes on the theory and practice of alliances by bringing our attention to the others, to connection, the interpersonal field, co-regulation, interdependence, and the role these play in addiction and mental health generally.

I should say why I prefer “interpersonal field” to “interpersonal biology” or “interpersonal neurobiology”. The latter invite the reductive view that our psychic experience will be understood by biology or neurobiology alone. The notion of field gives us more space for understanding. Borrowing from the example of physics, which recognizes that the particle and field are co-emergent phenomena, the human psyche is like a particle, neither reducible to the interpersonal field from which it emerges, nor independent of it. This way of thinking suggests an answer to the old debate whether ‘history makes the man’ or ‘the man makes history’; it’s both.

Back now to our two truths—that we’re profoundly affected by our environing conditions, and that we’re largely unconscious of them. These facts have been well known to philosophers since ancient times. Before I mention some examples, let me say why I think even the most practically minded ally should care. Philosophy offers us a larger, more integrated perspective, and insights that are less perishable than our usual fare. Just as it’s easier to see the particle than the field, and easier to diagnose the individual pathology than to see the interpersonal field through which it emerges; so also it’s easier to let current theories and novel practices distract us from the larger principles and processes that can help put what we’re doing in perspective.

In addition to orienting us, the philosophical perspective promises to be inspiring, reassuring, and steadying. Or so I’ve found it! To see how the challenges we currently face have been thematized by some of humanity’s greatest thinkers reminds us we’re not alone, and that there’s help.

Plato’s Socrates goes deep into the territory, for example in the famous allegory of the cave. There’s a fascinating analogy between Socrates’ depiction of the soul’s journey of education and the journey undertaken in psychotherapy. For starters, both are concerned with the defenses and psychodrama that come up on the way to flourishing. Plato wrote dialogues, not treatises, partly to remind us that the circumstances (or field) are key to understanding how knowledge and wisdom emerge in human life—when they do. More recently, Heidegger wrote of our being thrown. By this he means that we wake up already surrounded by a world, thrown into circumstances and contexts not of our making, and into a family and culture we did not choose! I’m reminded of Laurie Anderson’s song, “Born, Never Asked”—a great reminder of our thrownness.

Circling back to where we began, it seems to me wonderfully revealing that the first step toward knowing ourselves better, and taking better care of ourselves, should be a step not inward but outward! A step toward recognizing how much others have made us who we are. Socrates often promoted this by showing his interlocutors that what they call their truthsusually turn out to be a set of unexamined beliefs and opinions unconsciously adopted from family and culture. The Buddha taught us how to recognize the emptiness of our prevailing thoughts and stories. Likewise, therapy may help us recognize how partial and distorted are the stories we’ve been telling about ourselves (and others).

Recognizing our thrownness is the first step toward becoming truly ourselves. Before we can own our lives, we need to become aware of how we’ve been owned—how deep an adjustment we made to the world before we were old enough to be conscious of doing so. While that insight has contributed to my dismay at times, it’s also a relief to learn that my problems are not entirely of my own making. And now that I know, I’m more free.

Diagnosis and Human Experience

I am human, and I think nothing human is alien to me. - Terence

Years ago, I was having lunch with a friend who was a graduate student in psychology. He’d been studying the DSM (Diagnostic and Statistical Manual of Mental Disorders) and learning that he was a good fit for many disorders. Darkly amused, he said, “So now at least I can name exactly what kind of mess I am.”

First published in 1952, and now in its 5th edition, the DSM makes an impressive contribution to the catalog of patterns known to cause suffering. Even if you’ve never read it, its terms and categories suffuse our ways of talking about mental illness. At its best, the DSM is phenomenological, which means it describes the appearance of basic psychic patterns. That’s why my friend could see a little of himself in so many of its descriptions. He was using the DSM as a kind of map to the territory of his lived experience.

Unfortunately, the DSM suffers from some disorders of its own. Some it works to address, others remain largely unnoticed by its authors and the medical establishment they represent. Let’s look at a couple difficulties it seeks to address. They offer us a way to start thinking about where diagnosis fits in human experience.

The first difficulty is that the DSM sometimes pathologizes perfectly healthy psyches; the second concerns its categorical method of classification. To understand the first, we keep in mind that to describe is not the same as to judge. To describe the sun as appearing to move across the sky is not to assert that the sun actually moves across the sky (which it doesn’t). Likewise, to observe someone appears “emotionally unstable” or “anxious” is not to assert there is any disorder or illness. Description is one thing, judgment another. Calling something a “disorder” is a judgment, and usually carries negative connotations. After all, if something weren’t wrong, we wouldn’t follow a diagnosis by proposing treatment.

Sometimes these judgments wrongly pathologize healthy ways of being human, simply because they are not the norm, or go against cultural norms. That’s why until 1987 homosexuality was associated with a mental disorder by the DSM. A more recent example of trying to avoid the stigma associated with diagnosis is the movement to rebrand “disorders” like autism and ADHD as “differences” that fall on a continuum of “neurodiversity”. In effect, the movement wants us to describe without judging.

Of course, the DSM would be practically useless if it didn’t hazard judgments about what constitutes dysfunctional and thus disordered psychic patterns. To a large extent, these judgments reflect a cultural consensus; that’s why homosexuality could be named a disorder—until the culture changed, and it wasn’t. In addition, the categorical system for judging whether someone has a disorder simplifies the work of diagnosis. It also provides a common set of terms for communicating about, researching, and treating mental illness.

A page from DSM-5

But though it strives for objectivity, the DSM can’t avoid prejudice and bias. It is after all a human artifact produced by the psychiatric community, and reflects the wisdom, ignorance, and biases of that community. One takeaway is that, as helpful as the DSM can be, it’s a good idea to be skeptical whenever it departs from mere description and starts making judgments or offering explanations. We also do well to be skeptical of the medical establishment’s attempts to explain the causes and treatment of psychic “disorders”. (Dr. Gabor Maté’s most recent book, The Myth of Normal, documents how mainstream medicine has yet to integrate current research regarding the causes and treatment of psychic suffering.)

As for the second difficulty, the problems with the DSM’s categorical system stem in part from its virtues. By providing a clear set of criteria for diagnosing a disorder, it makes diagnosis easier. At the same time, it fosters the illusion that mental illnesses are things that you either “have” or don’t have, the way you do or don’t have Covid. Thus it gives the false impression that the criteria are less arbitrary than in fact they are, and that our psyches are less dynamic than in fact they are. This has real-world consequences, for example, leading some diagnosed with personality disorders to assume they are stuck with that pattern.

Aware that there are problems, the most recent edition of the DSM includes an alternative system for classifying personality disorders. Broadly speaking, this “dimensional” system better acknowledges the complex and dynamic character of psychic experience—including that our experience usually falls on a continuum rather than fitting neatly into categories. It makes room, say, for being a little borderline, without being diagnosed with a personality disorder.

This is a long way of saying that my friend was speaking truly when he noted that he appeared to have a little of this, a little of that—and in some places a lot more of this or that. We can relate to different diagnostic patterns, even in their subclinical presentations, because these represent regions of human experience. It’s not the experience of addiction or depression or anxiety or emotional instability, or whatever, that makes it diagnosable; rather it’s the intensity and duration of the experience. After all, since we are human, nothing human is truly alien to us. It’s just about where we fall on the continuum.

About Addiction

Posted September 11th, 2023 at garyborjesson.substack.com

What is addiction, really? It is a sign, a signal, a symptom of distress. It is a language that tells us about a plight that must be understood. - Alice Miller

If only we acted according to what is best for us. How much easier our lives would be! There’d hardly be a need for therapy. Awakening, enlightenment, an actualized life— whatever name we give to flourishing—would be a matter of educating ourselves. Once we realized we were drinking or eating too much, misusing our devices and media, or otherwise developing an addiction, we’d just dial back our behavior to the optimal range.

But as everyone knows, even when we seem to know what’s best for us, we often don’t do it. Addiction is an example of acting contrary to our best interests, and one to which we can all relate. It is well defined as any behavior we engage in compulsively, despite its negative consequences. A show of hands, please?

Of course, some of us have an easier time regulating compulsive behavior than others. And most of us have an easier time regulating some of our behaviors than others. It may be easy to say no to a second drink, but harder to say no to a second dessert, to scrolling on Instagram, to gaming, to working obsessively, and so on. Addiction looms whenever our compulsion has harmful consequences.

Not so long ago, addiction was seen primarily as a failure of willpower. It’s true that this describes that strange moment when—despite knowing better—we opt for what is worse. Yet, it begs the question of why our willpower failed. It also misleads us into thinking that the root of the problem lies in the individual. A major advance in understanding and treating addiction has come from identifying its link with adverse early childhood experiences.

Like most forms of psychological suffering, addiction has a large social aspect. If you happen to have been reading these notes, you won’t be surprised. As part of thinking about how we can help others, I’ve pointed to how we live in an interdependent, deeply social world; and how the power of self-regulation develops from early experiences of limbic resonance and co-regulation. In such a world, it’s no surprise that individuals suffering from serious addictions also suffered childhood abuse and neglect. As Gabor Maté writes, “The question is never ‘Why the addiction?’ but ‘Why the pain?’ The research literature is unequivocal: most hard-core substance abusers come from abusive homes."1

Now we can see that the “failure of willpower” points to larger familial, communal, and sociopolitical failings. A more accurate motto, currently being adopted, is that “addiction is a disease of isolation whose cure is connection.” Attachment theory and interpersonal neurobiology are providing a powerful, empirically based framework for understanding the origin of addiction, and its “cure”. This is not to say that as individuals we don’t bear responsibility for our behavior. Nor is to deny that genes and neurobiology play a part in susceptibility to addiction. But it is to say that these factors are not as central as many think.

If only it were an individual and biological problem—a matter of moral fiber, willpower, genes, and neurochemistry. Then we’d have the quicker cheaper fixes we (and the insurance industry) understandably crave: medications, medical treatment, focused short-term therapies (that actually delivered the results they promise). Whereas in fact, there are rarely quick fixes, and the help of others is needed. But the good news is that now more than ever we know what’s needed, and we know it usually works. Unfortunately it’s not cheap or quick, and it’s not (just) an inside job.

Most psychotherapists recognize that psychoeducation and technique, by themselves, won’t heal serious addiction. (This is why the intervention I described with my patient was not a key part of her therapy.) Psychotherapy exists because insight and information won’t save us from suffering, much less from doing what we know harms us! What does seem to help are trusted, reliably attuned connections, made over time. To a surprising degree, as we shall see, the “cure” is connection itself.

1 In the Realm of Hungry Ghosts: Close Encounters with Addiction. Vintage, 2009.

Disabling the Media

Posted September 4th, 2023 at garyborjesson.substack.com

The unexamined life is not worth living. - Socrates

In last week’s note I described an intervention with a patient whose media use was fueling her anxiety and depression. Because we have a good alliance, I chose to be playful but provocative. I told her that the world she views through the lens of media is not in fact the world at all, but a for-profit manipulation of it designed to capture and exploit her attention. I described how the negative emotions she feels are by design, since these better capture her attention.

Now I’ll share the final point I made: When under the influence of our devices and media, our thoughts and feelings are not as much our own as we believe. I asked her to imagine she lived in a simulation, but didn’t know it. As far as she knew, she was just living her life, doing as she chooses, thinking her thoughts, feeling her feelings. Whereas in fact she’s being set-up to think, feel, and behave in predictable ways. It could be an alien teenager is using their game controller to put her (their avatar) in certain situations, like endless doom scrolling or binging Netflix. Or it may just be that the simulation’s algorithms are tailoring her experience to fit the programmers’ needs. “That’s pretty creepy”, she half smiled.

It’s not that the feelings are being put in us, exactly. Rather, it’s that when we’re put in specific situations, we humans respond in depressingly predictable ways. Of course, this was already old news, even in the Buddha’s and Socrates’ time. In our time, we’ve just learned more about the specific ways we get fooled. In Thinking Fast and Slow,research psychologist Daniel Kahneman details how “your actions and emotions can be primed by events of which you are not aware.”1

For example, if you are reminded of money or if you have much money, you become more “selfish….reluctant to be involved with others, to depend on others, or to accept demands from others.” In another experiment, teenage subjects who had been primed by seeing words like “age” and “old” (without any context that suggested old age) left the building walking more slowly—since that’s how old people behave. (I love that this is called the “Florida effect”.)

The subjects in such experiments have no awareness they’ve been primed to think or feel or behave as they do. Even after being informed by the researchers, they insist they haven’t been thus influenced. So too, my patient initially denied that her mood was as effected by media as in fact it was. Who wants to believe they’re being gamed? That unknown forces are shaping how we think and feel?

Turning to what she can do about it, I suggested she could learn more about how media works. She could start with the documentary The Social Dilemma, which shows how we think we’re the end-users, but in fact we’re the product: Our attention is a commodity, bought and sold. (Yes, I’m aware of the irony that I was recommending she watch something. So was she!) For a deeper dive and a bracing read, there is Adam Alter’s book Irresistible: The Rise of Addictive Technology and the Business of Keeping Us Hooked.

I finished by saying, playfully, “I’m going to tell you one more thing you already know”: the best practice is to use media intentionally and moderately. And don’t use devices at all for a couple hours before bedtime—if you want to sleep well and be in a better mood. If she didn’t believe all this, she could run her own experiments. She could go cold turkey from all news and social media. Or, more realistically, she could restrict her use in the recommended ways, and see what she notices.

Taking a step back, we can see how our predicament with devices and media reflects a more general human predicament: We suffer from ignorance. As Socrates noted, our suffering is compounded when we are unaware of our ignorance—and thus unable to remedy it. (The Buddha made much the same point, as did Freud, among many others.) Sure, it’s embarrassing and even humiliating to recognize how suggestible we are, and how easily deluded, but it’s worth knowing. Especially if you believe, with Socrates, that the examining life is more worth living.

1Daniel Kahneman (2011). Thinking Fast and Slow. New York: Farrar, Straus and Giroux. See pp. 51-62.

Disabling Media

Posted August 28th, 2023 at garyborjesson.substack.com

In a recent session, a young woman was telling me she’d been feeling down and hadn’t been sleeping well. When I asked what was on her mind, she named some familiar culprits: climate change, the destruction and smoke from wildfires, the erosion of democracy and the rise of fascism. Slumped on the couch, she said, “And that’s just the beginning. The world feels hopeless.”

Before I say what happened next, let me assure you that I obscure identifying characteristics of any patients, students, friends, or family mentioned here. I hope that drawing on my professional and personal experience helps bring to life the very human concerns we’re exploring. I expect most people will relate to the examples. In this case, of course, there’s zero danger of singling out my patient. For I could as easily be speaking about myself, a family member, a friend, even, possibly, about you. We’re all swimming in the same waters.

As I listened, I was showing I understood what she was thinking and feeling. For again, we’re more open to help when we trust that the other person knows where we’re coming from—that their attention is directed to our specific situation. Another way of saying this is, I don’t treat anxiety or depression or addiction, but I do work with people who suffer from these.

Given what was on her mind, I asked the obvious question: what media was she consuming, and when and where she was consuming it? I’ve learned it’s useful to get into the weeds, so we walked hour-by-hour through a typical day. She was on her iPhone periodically throughout the day, and “for an hour or two” each night before bed, “unwinding” with Instagram, TikTok, Apple News, and the New York Times. As she said “unwinding” she smiled bitterly. Picking up on that smile, I playfully said, “I think it’s time for an intervention. Are you willing to go over a few things you probably already know? I’ll offer you the reminders I give myself.”

I say “reminders” because most of them are as self-evident as the nose on our face, and as easy to overlook. My patient’s smile showed she knew about the connection between her use of media and her suffering, and that she had somehow been overlooking it until that moment. What makes electronic media insidious is that it’s easy to fall into a trance and neglect what’s actually happening.

David Foster Wallace offers an apt reflection that applies here. He begins a commencement speech titled “This is water” with the following parable: “Two young fish are swimming along, and they happen to meet an older fish who nods to them and says, ‘Morning boys, how’s the water?’ The two young fish swim on a ways, then one of them looks at the other and goes, ‘What the hell is water?’” For water, read media.

My intervention was meant to remind us both of the media waters we’re swimming in, and how her experience of anxiety and hopelessness was largely being manufactured—programmed—by that media. This leads to the first reminder, which was that in fact she is not getting an actual view of the world. Thus it cannot be the actual state of the world that’s depressing her. Instead, her attention is being targeted, captured, held, and exploited by algorithms designed to generate profit. She was seeing a disfigured simulacrum of the world, programmed by the media for its benefit, not hers. She was seeing through their screen, darkly.

The second reminder was that her felt experience is indeed being intentionally darkened. Why? Because it is a feature of our brains that negative emotions more reliably capture our attention than positive ones. This negativity bias is exploited by media, which profits from capturing our attention. That’s why most news is bad news. The water we’re swimming in is murky and bloody, because if it bleeds it leads.

Now imagine an alternate reality where media more accurately captured our actual world. For every story about the war in Ukraine, there would be a dozen stories of countries quietly enjoying mutually beneficial relations. There would of course be countless stories about beautiful children being born to overjoyed parents.

The Onion gets it!

There’d be stories about innovations helping solve social, health, and ecological problems. Naturally there’d be stories on the joy puppies and kittens bring. I like to imagine that the leading story would frequently be about how different people are enjoying gloriously uneventful days: raising children, doing good work, enjoying time with their partners and friends, making art, making love, making food, running in the woods with their dog, getting a good night’s sleep, and waking refreshed.

In the next note, I’ll wrap up the intervention and offer a few tips for navigating the waters.

Independence vs. Interdependence

The universe refuses the vows of the celibate. Preparing them instead with songs for marriage. Everything it knows was born of the great embrace. -David Whyte, from The Statue of Shiva.

I worked with a man who got irritated whenever the conversation turned to his wife and children. He had made it obvious (to me anyway) that he was overwhelmed, and that his life was unmanageable. So I said, “I wonder what it would be like to let your wife know how stressed you’re feeling, and how unsustainable the current arrangement is.” Bristling, he replied, “Look. I don’t think that’s the issue. I’m here to work on myself. Once I have myself sorted out, I’ll be able to fix my relationships.”

Becoming aware of how much resistance we have to asking for help is a common experience in therapy, including my own. For some of us, it can feel unbearably vulnerable, a proclamation of weakness.

Yet this story—that we’ll “fix” our relationships by fixing ourselves—is too simple. It falsely assumes that we don’t depend on others. It also doesn’t do justice to our partners, children, friends, and other allies, since it implies their roles in our lives don’t matter as much as in fact they do.

In this note I offer a revision to the larger cultural story of individualism that drives many of us to the lonely place where my patient found himself, where all help has to be self-help. The gist of the revised story is that we live in an interdependentuniverse. This means we depend on others to survive and flourish. And by “others”, I mean not just other humans, but our microbiomes, families, communities, institutions, ecosystems, the earth, the sun, galactic clusters, and so on.

If we knew this in our bones, our default mindset wouldn’t be, ‘First I fix myself, then everything else will fall into place.’ Nor, by the way, would it be, ‘First everyone else needs to fix themselves, then I’ll be okay.’ Both stories are untenable and equally isolating: It’s as lonely being the neurotic who shoulders burdens that belong to others, as it is being the narcissist who projects onto others burdens they ought to be shouldering.

If we knew the interdependent story in our bones, we might wake up in the morning and ask ourselves not, How am I? but, How are we this morning?” For the answer, we might scan our body, then call to mind our microbiome, our partners, friends, family, group affiliations, etc. Wholly alive to our interdependence, we might end our morning check-in with our selves as Buddhists end their loving-kindness practice, “May all beings be well, happy, and peaceful.” In a world where everything is connected, it makes sense that what’s good for others is likely to be good for us.

I know, the whole story is more complicated. There is of course a place for independence and competition and fighting. As Hegel might observe, these too are crucial moments of the whole process. But in the West we’re hardly in danger of neglecting these moments. Our predominant story has been of a competitive, dog-eat-dog world. In such a world, cooperating is at best a strategy, a moment in the larger zero-sum game that continually sorts the winners from the losers. With this as our default story, it’s no wonder we associate needing something—or feeling that something is needed of us—with vulnerability and weakness.

But if we let the interdependent story sink in, we begin to see our own need, and the need of others, in a different light. Our need is not a sign that something needs to be fixed, but a mark of our interdependent nature. In case we hadn't already noticed, research is showing that human development passes from dependence to independence, but doesn’t end there. It ends in interdependence. In earlier notes, on the interpersonal field and co-regulation, we saw how our limbic system invites (and needs) engagement with others. In future posts, we’ll dig further into the evidence.

Reviewing the science of limbic regulation, the authors of A General Theory of Love write, “People can’t be stable on their own—not should or shouldn’t be, but can’t be. This prospect is disconcerting to many, especially in a society that prizes individuality as ours does.”¹ The World Health Organization offers a more bureaucratic formulation of the same story: “Mental health is produced socially; the presence or absence of mental health is above all a social indicator and therefore requires social, as well as individual, solutions.”²

1. A General Theory of Love, Thomas Lewis, MD, Fair Amini, MD, and Richard Lannon, MD. New York: Random House, 2000; p. 86.

2. WHO, 2011. Quoted in Lost Connections, Johann Hari. New York: Bloomsbury USA; p. 256.

How Co-Regulation Works

One way we help each other is by coming together—in friendship, love, and other partnerships, in families, groups, and communities. A felt sense of connection and belonging is good for us.

One powerful effect of coming together is what psychologists call “co-regulation.” This has been defined as the "continuous unfolding of individual action that is susceptible to being continuously modified by the continuously changing actions of the partner.”1 (Though not an elegant definition, you can detect in it the presence of the interpersonal field.)

How does co-regulation work? Imagine a child is having a meltdown or that an adult is having a panic attack. You could probably help them if they followed your instructions for how to breathe and where to direct their attention. But it’s hard to follow instructions when flooded by emotion. So, how do you help?

Begin by noticing what’s happening in the field. In other words, start by attuning to their experience and demonstrating your attunement. If you perceive that their posture is rigid and their breathing fast and ragged, demonstrate this by bringing your own posture and breathing closer to theirs. You might speak to what they are experiencing, but more important than what you say is how you embody it. If their speech is tight, pressured, urgent, so is yours as you say: “Oh, you’re feeling overwhelmed. It’s all too much. It’s scary when it’s so hard to catch your breath…”

But wait! Why amplify signals of distress when your aim is to help them calm down? In fact, whether you actually start here will depend on the particular situation—including your relationship with the person. But wherever you start, the guiding principle is the same: If you want to help someone, start by attuning to them and demonstrating that you’re attuned—that you recognize how they’re feeling. Otherwise, it’s like your friend cheerfully telling you to relax when you’re the one who sees the mountain lion coming up fast behind her. You know better than to trust her calm assurances!

By attuning, you’re establishing a limbic resonance between your nervous systems. Resonating with their sympathetic vibrations, as it were, you’re ready to start shifting toward more parasympathetic vibrations: You slow your breathing, sit back, uncross your legs, relax your face, drop the volume and tempo of your speech, make your tone and words more reassuring: “What a relief that’s over. It’s quiet and safe here. We have time to figure out what happened. I’m here, so you can relax. You can take longer and slower breaths, yes, like that.” In effect, your regulated nervous system becomes a beacon of safety drawing them into co-regulation.

Good-enough parents do this with their children as a matter of course, first attuning and empathizing with the situation that led to the meltdown, then inviting the child to hold onto their regulated nervous system, much as the child might hold their hand for comfort.

What we’re doing here is leveraging a core function of our socially minded mammalian limbic systems, which is to sense signals from the external world, and to infer from these signals what emotions are fitting. If there’s a mountain lion out there, be afraid. If you’re freaking out, but others around you are acting as if it’s safe, you can (probably) relax. Similarly, when a deer senses my presence, I can observe its awareness ripple through the local field of the herd, so that in a second they’ve all lifted their heads from grazing to look for the source of the sensed danger. I’m watching the herd co-regulate.

Co-regulation as I’ve described it doesn’t always work. Studies suggest it is less likely to work if the person doesn’t know you or trust you. Organic differences may also play a part. It has been found that children with autism spectrum disorder (ASD) are less likely to engage in contagious yawning, among other social communications.2 It makes sense that individuals facing challenges to communicating, verbally and nonverbally, would be less susceptible to social “contagions” and thus more isolated in the self. (“Autism” comes from the Greekautos, meaning “self”.)

Whatever the cause, diminished access to the social, interpersonal field makes it harder to experience the calming, belonging effects of co-regulation. This in turn leads to a more isolated, and often more dysregulated, self. Our society’s mental-health crisis has many causes, but the most significant is social isolation, what’s being called the “epidemic of loneliness”. I’m reminded of the tagline of an ad for Meals on Wheels, an organization that helps “homebound seniors know they’re not alone”:

1 Butler, E. A., & Randall, A. K. (2013). Emotional Coregulation in Close Relationships. Emotion Review, 5(2), 202–210. https://doi.org/10.1177/1754073912451630

2 Neilands P, Claessens S, RenI, Hassall R, Bastos APM, Taylor AH. 2020. Contagious yawning is not a signal of empathy: no evidence of familiarity, gender or prosociality biases in dogs.Proc. R. Soc. B287:20192236.http://dx.doi.org/10.1098/rspb.2019.2236.