Research & Action Report Spring/Summer 2007

The Stone Theory Group developed Relational-Cultural Theory (RCT) in the 1970s and the Jean Baker Miller Training Institute has been teaching and applying these ideas for over ten years. Why is it that so much research on the brain is coming out just now?

AB:  It’s partly about the technology. Twenty years ago we could take snapshots of the brain but now we are able to scan the brain in action. Using SPECT* scans we can record functioning brains responding in different situations. It’s like getting an MRI when your brain is doing something.

What is the science telling us about the brain and relationships?

JJ:  Some of the forerunners in this research—Allan Shore, Daniel Siegel, Shelley Taylor, Daniel Amen— have now really determined, without a doubt, that our brains are hardwired to connect: that we have mirror neurons that fire in response to the firing of another person’s neurons; that we actually have parts of the brain that atrophy in isolation. We know from Eisenberg and Lieberman’s work, for instance, that the centers of the brain that are activated when there’s physical pain are the very same centers of the brain that light up when there is social pain, pain of exclusion specifically. We now know that we need connection to grow, and that isolation actually damages our neurobiology. So all of these ideas we had back in the ’70s are really being documented currently by these scientists.

AB:  Over the last three to five years, the information has been pouring in about the brain. And within that body of literature there’s been a subset of work on the centrality of relationships. For example, the book, “The Neuroscience of Human Relationships” by Louis Cozolino that came out in 2006 offers a great overview. It puts the neurobiology in relational context; it’s really well done.

Another concept that has come out over the last seven to eights years is this idea of neuroplasticity. It used to be that we talked about the brain as being very static—that it atrophies, that over the course of a lifetime we are basically killing off brain cells. What research has shown is that this is not the case. There is a lot of ability for the brain to adapt and change over time. And probably the most exciting news is that there are areas of the brain that can actually generate new neurons, particularly the Hippocampus, which is the primary memory storage area. 

Are there differences in the way the brain responds for people of different cultures, ages, or gender?

AB:  Some of this new literature stemmed from attachment theory, like Daniel Stern’s early work on the mother-infant attachment. Babies are born with an immature orbital frontal cortex—that area of the brain that’s necessary for social relationships. In fact, we know now that this part of the brain develops to its full capacity in healthy relationships, by the washing of the dopamine, the endorphins, the serotonin. If the child has been in a good care-taking relationship or exposed to minimal stress, then it develops this ever-increasing ability to adapt, to change, to be flexible, and to be related. Every healthy baby is born with that potential. When you think about that, early intervention should begin as soon as the baby is born and it needs to focus on psycho-education, on how a healthy child grows up and develops.

From a gender perspective, there’s a group of neuro-affiliative hormones that help us connect and bond. For women, the estrogen level is high and it works well with oxytocin, which is a calming feel-good hormone that the brain produces when we are stressed; it is also produced when mothers breastfeed. For men, their stress is driven more by testosterone which counteracts the effect of oxytocin. Testosterone is a very reactive hormone. It fluctuates throughout the day and over the course of a lifetime. One research finding that may reflect this is that when a man and a woman are in conflict or stressed, the woman is likely to be more physiologically aroused than the man; it may seem almost like his affect is cut off. This doesn’t necessarily reflect how much he values the relationship. But if we can start thinking neurochemically about the way people’s brains and bodies work, then we can learn how to interact across differences and find mutuality in our relationships.

JJ:  Shelley Taylor and her graduate students noted that all the earlier research on stress was done on males and the findings were that if you were stressed you fight or you flee. This “fight or flight” response to stress was a very widely accepted psychological “truth”. When she replicated the studies using females, she found that when stressed, women would reach out for connection, to gain and provide comfort, to soothe, to calm. She called it the “tend and befriend” response and she suggested the production of oxytocin contributed to this response. This was very important data. It also shows how wrong our understanding of “human” behavior can be when we generalize from studies on only one segment of the population, in this case males.

To my knowledge the research has not yet paid attention to integrating work on diversity and cultural differences with neurobiology. From our point of view, this is a major omission. The only way that this research has been used to further our understanding of  forces like marginalization and oppression is to show that social exclusion really impacts people—that it has a real, detrimental impact on people’s physiology and wellbeing and ultimately on the larger community.

How does this change the way psychiatry is practiced?

AB:  Daniel Amen has a classic comment, that there’s no other field of medicine where we would do so much treatment without actually looking closely at the organ or system we are studying, that we rely so much on history alone. My job as a psychopharmacologist is to evaluate people and make the best recommendation given the history that I hear. I then try to prescribe the treatment, including  therapy, medication, meditation, or some combination. But as most psychiatrists know, there is a small group of people that do not respond to our current treatments. If you look at the statistics for most treatment protocols, they generally work 60-70% of the time. 

I’ve referred a handful of patients for SPECT scans who hadn’t been responding in a usual way to treatment. After a very detailed psychiatric history, medical history, and head-trauma history, a SPECT scan  is taken to see  how the brain is functioning. The clients that I’ve sent for SPECT scans had experienced significant trauma, both emotional and physical, and they weren’t getting better enough. With one of my patients, for example, this comprehensive evaluation showed more temporal lobe activity that I hadn’t considered. This changed my recommended treatment and made a difference in this patient’s quality of life. Utilizing this research and new technology can lead to answers, offers validation, and can be added as another piece of the entire clinical picture.

JJ:  I think that this information makes a tremendous difference in terms of how clinicians understand their clients and the process of change. It’s very important for clinicians to accurately understand the behavior and the suffering of the clients who they’re working with—who have suffered chronic childhood abuse or trauma, for instance—to know the way their brains work and the ways in which their neurobiology has been altered. And it’s very important to the clients to help them understand some of their inexplicable reactions. That’s very important information because it helps us to stop blaming the client and to understand the brain chemistry which we may be able to help rebalance.

And clearly there is something very healing about the relationship in therapy. We now have data that shows that the brain re-regulates as a result of two people sitting in a room talking, responding to one another with facial signals, body posture responses, and  empathy—that attuned “being with” the other person. This actually changes the way the brain works. And interestingly there is change in both brains—the mutuality we’ve talked about! It is very important for therapists to begin to appreciate the power of empathic responsiveness in facilitating change.

What does it mean for the way we teach psychology or human development?

AB:  Dean Ornish, a cardiologist, wrote an important book documenting all the studies that have been done through the years on the health risks of isolation. That body of literature is so robust that if you ever bottled that effectiveness in a pill it would be jumping off the shelves. Yet we—the clinicians and the health professionals—don’t use this information. It should be health education 101. The importance of this knowledge—it’s for families, it’s for practitioners, it’s for educators, it’s for everyone. This is not a mental health issue; this is a health issue, period. Human beings thrive in connection.

JJ:   When we shift our understanding-- whether it’s in therapy or in an organization—from a paradigm that says we function best as separate individuals to a recognition that we are people who need to feel connected in order to bring forward our most creative thoughts and processes, we are making a fundamental and huge shift. Jean Baker Miller suggested “This changes everything”(also the title of Chris Robb’s book about relational psychology).This change is real, it’s important, and it’s needed in an increasingly individualistic and fragmented world.. Through the training programs JBMTI offers to practitioners, educators, and business professionals, we’re clearly outlining a proven theory, we’re reframing situations in terms of connection, we’re validating what many people know in their hearts: we grow in relationship not in isolation. The work of JBMT is very cutting edge and it has implications for many fields.

This research really does offer significant validation for RCT and the work of JBMTI.

JJ:  When we were talking about RCT back in the late ’70s early ’80s, we were seen as very radical and a lot of these ideas were seen as far from scientific truth. In the realm of therapy, for instance, we were seen as “dangerous” because we were suggesting that it was important for the therapist to be present and responsive in the therapy session rather than more distant, remote, and/or inaccessible; for some that was seen as potentially damaging to clients. There was a lot of bias that said it was better to be separate; it was better to be opaque if you were a therapist. Yet we now know the brain needs empathic responsiveness to grow. There are many, many people who will only believe something if we have the data of “hard science”, if we have objective neurobiology-research to substantiate our theories. That’s one of reasons that the new neurobiology is so exciting for us. It so completely validates what we have been suggesting for years! And in many ways it offers a very optimistic picture of human possibility.

How do you see this work growing?

AB:  I think we need to help boys grow to be healthy and happy men. One thing about boys is that it’s clear that their brains are lateralized, meaning that there is less connection between one side and the other. This is about helping them to have good relationships, not about making little boys little girls. There are very concrete physiological differences related to the testosterone and its effects on brain development, which does lead to the stereotypical pattern of enhanced spatial relations. We do not want to pigeonhole boys as either being disconnected or “lesser connected”.  It’s not a reasonable expectation to have boys connect as girls do any more than it was in the ’70s to expect women to behave like men. How do you honor the differences, not exploit them or make them bigger than they need to be, and then start to figure out how to come together in relationships? I think this is one of the central things. There isn’t a right way or a wrong way. When you start thinking about billions of neurons and the many ways they can be put together; you realize how every single person is so different and so complex.

JJ:   The dominant US culture is directed toward individualism, standing alone, autonomy, separation; so the culture is actually asking people to go against their basic neurobiology which is about connection not separation. This cannot be good for the individual or the larger community. What is exciting to me about this is that it really means that we have to adjust our thinking about people and about groups. For instance, since we now know that social pain activates the same areas of the brain as physical pain, we really need to take seriously the pain of racism, sexism, and other forms of marginalization. Social pain has an effect on these individuals and groups; it negatively impacts their functioning and their organic integrity. When people complain of social pain, they’re often seen as “whiners,” or complainers or as not being strong enough. Instead of this silencing and shaming response, let’s respect their real pain and work to alter the social conditions that create it. The link to working for social justice rather than just “fixing” the individual feels so clear in RCT.  That’s one thing that feels really important:  growing this work has implications not just for personal development but for understanding social pain and social justice.

Because people at the margin have the courage to speak a new kind of truth or a new reality, change often starts at the margin and works its way to the center. In most of the Western world, hard empirical science still resides at the center. Currently I would say we are seeing a convergence of these ideas about the importance of connection, coming from the more mainstream academic study of the brain, the clinical realms and the developmental laboratories. We at JBMTI certainly were discussing these ideas long ago but we’re not the only ones who’ve been interested in the importance of relationships. What especially characterizes the work of JBMTI is our emphasis on mutuality and social justice.

JBMTI is very concerned with the ways in which “power-over” models create social and personal pain. Shaming, humiliations—those actions disconnect and disempower people. We pay attention to the destructive consequences of power imbalances. We believe that social justice is a relevant concern, whether in re-thinking power and marginalization in organizations or in helping people to re-regulate brain chemistry. We are working toward equitable, just relationships in a world where human dignity is respected. I think that was Jean Baker Miller’s vision and that is the vision that we are carrying forward.

Amy Banks is the director of the Practitioner Program at the Jean Baker Miller Training Institute. She is an instructor of psychiatry at Harvard Medical School and previously the medical director for mental health at The Fenway Community Mental Health Center in Boston, MA. She is co-editor of The Complete Guide to Mental Health for Women and author of the paper, Post-Traumatic Stress Disorder: Relationships and Brain Chemistry. The Complete Guide to Mental Health for Women and author of the paper, Post-Traumatic Stress Disorder: Relationships and Brain Chemistry.

Judith Jordan, is director of the Jean Baker Miller Training Institute (JBMTI). She is a founding scholar of the Stone Center where she worked with Jean Baker Miller, Irene Stiver, and Jan Surrey on the development of what has come to be known as Relational-Cultural Theory. Jordan co-authored the book Women's Growth in Connection and edited Women's Growth in Diversity and The Complexity of Connection.

Banks and Jordan presented related work at the JBMTI 2007 Spring Professional Seminar, “The Brain Connection: Building Resilient Relationships and Flexible Brains” held in April in Dedham, MA.

*[Single Photon Emission Computed Tomography]