Ashley Ford, MD

Mind: A Journey to the Heart of Being Human

 is a thought-provoking book that offers a comprehensive, powerful definition of the “mind,” as an “emergent, self-organizing, embodied, and relational process that regulates the flow of energy and information.” Notably, a comprehensive, complex, and dynamic definition that is felt to be missing from a wide range of fields, including medicine, psychology, and even philosophy.

Throughout the book, Siegel explores the how, what, when, where, and why of who we are-all the while emphasizing and explaining the mind’s capability and how to characterize it. He invites the reader to join him on a journey using imagery, personal experience, science, and concepts of time as he works toward the goal of adequately ensuring understanding of the “mind” and “integration,” which could allow for better understanding of how to facilitate well-being.

This book provides an invaluable opportunity for readers to explore and reflect on their own experiences and their impact not only on professional lives and practice, but on personal lives as well. What follows is a Q&A . . . the exchange is between Ashley Ford, MD, and Daniel J. Siegel, MD. -Howard Forman, MD

 The mind is often studied and discussed, but you note that an actual definition is missing from a wide range of fields that deal with the mind, including from clinical practice and education to scientific research and philosophy. How do you define mind in your book 

 By linking a wide range of disciplines together, we offer this definition of one aspect of the mind as the emergent, self-organizing, embodied, and relational process that regulates the flow of energy and information. This view enables us to see energy and information flow as the fundamental element of a system from which the mind arises.

Where is this system? This flow occurs both within the body, including its brain, as well as in the sharing of energy and information between an individual and others and the environment in which the person lives.

What kind of system is this? The characteristics of this system include that it is open, capable of being chaotic, and non-linear, meaning that small inputs lead to large and difficult to predict results. Complex systems have emergent properties that arise from the interaction of the elements of the system; one of those processes is self-organization. And so the proposal is that one aspect of mind is this embodied and relational process that emerges from, and then regulates, energy and information flow within an individual (the embodied aspect) and between the individual and the world around (the relational aspect).

 How might understanding and exploration of the mind enhance someone’s personal life and assist in creating a healthier mind?

 This definition of the mind as a self-organizing process enables us to ask the question, what is optimal self-organization? The mathematics of complex systems-those that have these emergent self-organizing processes-reveals that when aspects of the system are differentiated and linked, when they are “integrated,” they move in a way that is flexible, adaptive, coherent (hold well over time or are resilient), energized, and stable (FACES). This flow comes when a complex system is integrating-when it links differentiated elements to each other.

When integration is blocked, chaos and/or rigidity arise. Amazingly, each symptom of every described syndrome can be viewed as chaos or rigidity. And so far, research on individuals with a range of psychiatric disorders has revealed impaired integration in the brain. The Human Connectome project has shown that the best predictor of a wide range of measures of well-being is how interconnected the connectome is-that is, how integrated the brain is.

 How would a better understanding of the mind improve the effectiveness of physicians and mental health providers?

 By offering a definition of the mind, we can see how the mind is both within us and between us, within the body and the brain, and within the relational connections we have with one another and the world around us. Our work as clinicians is greatly aided with this definition. It allows us to work with our relationships and our embodied brains in trying to move an individual’s life toward more integration in a range of domains-from how we connect with one another with respect, to how we link different aspects of our brain to each other.

A person-specific domain assessment can lead to treatments that are strategically planned to address a patient’s forms of blocked integration.

For example, studies have shown that physicians who offer an empathic comment, one that recognizes the differentiated internal subjective experience of the patient, have a clinical response in which the patient has a more robust immune response and can recover from a common cold a day sooner. That is an example of how an integrated relationship promotes health in the body.

 Can you discuss integration and how the emergence of impaired integration through chaos and rigidity has helped you understand patients with mental illness rather than categorizing them into a DSM grouping that might limit the understanding of who they are (p 198).

 Seeing the unique aspects of an individual is a challenge in any clinical encounter. By defining the mind as a self-organizing process, we can see that chaos or rigidity would be the result of a system that is not integrated. In this way, chaos or rigidity can be assessed in a person’s life to illuminate how some domain of integration may be impaired for this individual. This person-specific domain assessment can lead to treatments that are strategically planned to address this individual’s forms of blocked integration.

This model provides a way to view the broad spectrum of life’s challenges and helps the clinician see each individual as unique; to have treatments that do more than simply reduce symptoms, but also move the person to states of well-being. Instead of being clinicians who aim only to reduce symptoms, this framework enables us to define the mind and mental health and aim treatment toward well-being by promoting integration. This allows us to truly be mental health professionals as we promote health directly.

 Can you discuss the Wheel of Awareness Practice and how we can use it to “distinguish knowing of consciousness and the known”?

 With this model of the centrality of integration in health, energy, and information flow in seeing the essence of mind, I combined the research that suggested that consciousness was needed for change with the exciting findings of neuroplasticity to try to “integrate consciousness.”

Integration is the linkage of differentiated aspects of a system. With consciousness, we can distinguish the sense of knowing, of a receptive awareness, from that which is known. For example, you may have the sense of being aware of the word 

. There is your receptive awareness, or knowing, and there is the 

 itself, the known of the experience. In the Wheel of Awareness (which actually began around a table shaped like a wheel), the hub represents the knowing, the rim the known, and the spoke of the wheel the process of attention. With a systematic movement of the spoke around the rim, the practice enables 4 segments of the rim to be experienced: the first 5 senses; the interior senses of the body’s muscles, bones, and organs; mental activities like thoughts, feelings, and memories; and our relational connections. In an advanced step, the spoke is bent around and the experience of awareness of awareness is offered.

Doing the wheel enables individuals to learn about their mind as well as create more clarity and regulation of the mind through this process of integrating consciousness. The findings thus far have supported the notion that such a practice strengthens the mind by improving the 2 aspects of mind as a regulatory process: monitoring and modulation. With the Wheel practice, the focus of attention is stabilized so that energy and information flow is sensed with more depth and detail; and the individual also learns directly how to modulate that flow toward integration.

 As health care professionals, many of us have dealt with the “mind-blind” professor or a person who has discouraged us or made us question our decision to enter the mental health field. How might this book encourage future health professionals to enter the field of mental health? And how can we use “mindsight” to teach others about mental illness?

 Mindsight describes how we “see the mind” through insight, empathy, and integration. When we are mind blind, we do not sense the internal mental experience of ourselves or others, and we therefore cannot intentionally create integration.

My hope is that this book will make the mind something that is “real” in our scientific and clinical worlds. Insight and empathy are essential skills for the clinician to have that enable the mind of the self and others to be sensed and respected. The book offers some personal reflections and hard-earned scientific discoveries into the nature of mind and of mental health that can benefit anyone interested in how to professionally help the mind grow toward well-being.

 In your book, you discuss how those with a history of long-term trauma, abuse, and neglect have an impairment in the development of their mind and in the integration of their brain. How can this be repaired with therapy?

 Psychotherapy in its various forms may be all about harnessing the power of the therapeutic relationship to inspire people to rewire their brains toward integration. What this means is that where attention goes, neural firing flows, and neural connection grows. When therapists learn about the science behind the notion that integration is the basis of health, they are empowered to see the relational and the embodied nature of mind itself, and how this self-organizing process moves the individual, family, or even society toward well-being with the process of integration.

Trauma is an assault on integration relationally that creates compromises to integration in the brain. Therapy is an integrative relationship, one that can harness the power of relationships to grow the neural integration needed for healthy regulation to develop.

 Why did you choose to write this book as a narrative, using imagery, and providing your own subjective experience to portray your message?

 I made the decision to synthesize both story and science with the notion that mind itself is a deeply subjective experience and also an objectively observable process, and so the experience of reading the book reflects these distinct ways of exploring the mind and mental health. Readers are invited to explore their own experiences of mind, of chaos and rigidity, and of how to bring more integration into their personal and professional lives.

 You remark that if we think of the mind as relational, as integrated identity, people will understand that “we” is just as important as you or I. How will the acceptance of “we” improve our connections with others?

 Data reveal that in studies of longevity, happiness, and mental and medical health, the primary shared factor is supportive social networks-relational connections to others. That’s the “we” of our lives. We also know that getting good sleep, exercising, being grateful, and being present in life as it unfolds in our subjective experience also promote well-being-improving our immune system’s functioning, raising levels of the enzyme telomerase that repairs and maintains the ends of our chromosomes, and optimizing epigenetic regulation to help prevent inflammation. That’s the “me” of our lives.

To integrate our identity, we can embrace these differentiated sources of identity and then link them: Me plus We equals MWe. That’s an integrated identity that science would suggest is the way we can bring more well-being into our individual and collective lives.

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How might a better understanding of the mind enhance someone’s life and optimize a clinical encounter?

Author | Ashley Ford, MD

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Being Human: An Interview With Daniel J. Siegel, MD