Friday, October 24, 2014

DAN ZAHAVI - Is the Self a Social Construct?


Dan Zahavi is a Danish philosopher and currently Professor of Philosophy at University of Copenhagen. Zahavi writes on phenomenology (especially the philosophy of Edmund Husserl) and philosophy of mind. He has written extensively on topics such as self, self-consciousness, intersubjectivity and social cognition. He is co-editor of the journal Phenomenology and the Cognitive Sciences.

Zahavi is the author of several books, including Self-Awareness and Alterity: A Phenomenological Investigation (1999), Husserl's Phenomenology (Cultural Memory in the Present) (2003), and the classic Subjectivity and Selfhood: Investigating the First-Person Perspective (2005). You can read selected papers here.

Is the self a social construct?

University of Copenhagen, Denmark


There is a long tradition in philosophy for claiming that selfhood is socially constructed and self-experience intersubjectively mediated. On many accounts, we consequently have to distinguish between being conscious or sentient and being a self. The requirements that must be met in order to qualify for the latter are higher. My aim in the following is to challenge this form of social constructivism by arguing that an account of self which disregards the fundamental structures and features of our experiential life is a non-starter, and that a correct description and account of the experiential dimension must do justice to the first-person perspective and to the primitive form of self-referentiality, mineness or for-me-ness that it entails. I then consider and discuss various objections to this account, in particularly the view that an endorsement of such a minimal notion of self commits one to an outdated form of Cartesianism. In the final part of the paper, I argue that the self is so multifaceted a phenomenon that various complementary accounts must be integrated if we are to do justice to its complexity.

Author's Copy: Forthcoming in Inquiry

There is a long tradition in philosophy for claiming that selfhood is socially constructed and self-experience intersubjectively mediated. It is a view that has had many different voices. According to a widespread reading, Hegel argued that subjectivity is something that can only be achieved within a social context, within a community of minds, and that it has its ground in an intersubjective process of recognition rather than in some immediate form of self-familiarity. In the late 19th and early 20th Century related views were defended in the US by Royce and Mead. According to Royce, “Self-conscious functions are all of them, in their finite, human and primary aspect, social functions, due to habits of social intercourse”(Royce 1898, 196). Mead argued that the self is not something that exists first and then enters into relationship with others, rather it is better characterized as an eddy in the social current (Mead 1962, 182), and he explicitly defined self-consciousness as being a question of becoming “an object to one’s self in virtue of one’s social relations to other individuals”(Mead 1962, 172). Partly playing on the etymological roots of the term “subject”–one is always subject to or of something – Foucault has more recently claimed that individuals acquire their sense of autonomy inside contexts of domination and subordination. Forming subjects and subjecting them to authority were in his view two sides of the same coin. As he wrote at one point, “the subject that is constituted as a subject –that is ‘subjected’ – is one who obeys”(Foucault 1976, 112). On this reading, subjectivity and individuality are not rooted in some free and spontaneous interiority. Rather, we are dealing with categories produced in a system of social organization. By forcing us to think about ourselves in terms that might support moral categories such as guilt and responsibility, the system will be better able to control and manage us. An example found in Althusser illustrates this idea well. When a policeman calls out to someone in the street, “the hailed individual will turn round.”And as Althusser then continues, “By this mere one-hundred-and-eighty-degree physical conversion, he becomes a subject”(Althusser 1971, 174).

Without denying that there are significant differences between these various proposals, I think it is fair to say that they are all united in their rejection of the idea that subjectivity and selfhood – and for reasons that will become apparent in the following, I will be using both notions interchangeably –are something innate, automatic and spontaneous. On many accounts, we consequently have to distinguish between being conscious or sentient, and being a self. The requirements that must be met in order to qualify for the latter are higher. More precisely, being a self is an achievement rather than a given, and therefore also something that one can fail at. Selves are not born, but arise in a process of social experience and interchange. Indeed many would consider the self a construction, something more a matter of politics and culture, than of science and nature.

My aim in the following is not to dispute that there are important insights to be found in such claims. However, insofar as they are presented as accounts of the self tout court, rather than as accounts of certain dimensions or aspects of self, I find all of them unpersuasive. I think there is a basic yet crucial aspect of self that they all fail to consider let alone explain. To put it differently, I am opposed to the claim that the self is nothing but a social construct and in the following I will argue against this kind of social reductionism by outlining a more basic experiential notion of self that I consider a necessary precondition for any socially constructed self. This more basic notion is one with a venerable ancestry. It has been defended by various figures in the phenomenological tradition.
Read the whole article.

What Schizophrenia Can Teach Us About Ourselves

This is a pretty good article on schizophrenia from PBS's Nova Next blog. However, they adhere to the standard "biological disease" model of schizophrenia, which is a partial truth, and one that prevents many researchers from looking into the interpersonal antecedents of schizophrenia.

I especially appreciate, however, the take on hearing voices presented in the article. They mention Intervoice, a mostly European organization that holds voice hallucinations to be a natural and non-frightening phenomenon.

I feel it's important to make another point here - a lot of people with PTSD hear voices and how we, as therapists, deal with that is much different (in my opinion) than how we handle the voices in schizophrenia, or even dissociative identity disorder. The voices are qualitatively different in PTSD.

What Schizophrenia Can Teach Us About Ourselves

By Allison Eck on Wed, 22 Oct 2014

“I don’t believe in anything. That’s my cardinal rule. I do it for my mental health. If I believe in God, then I start talking to God and God starts talking to me. As soon as I start believing in something, then it talks to me. So, I don’t believe in anything.”

Sara, whose name we changed to protect her identity, was diagnosed with schizophrenia at age 19 during her senior year at New York University. She had not experienced any trauma as a child—no abuse, no bouts of depression, nothing that would raise any red flags. She led a more or less happy life. But in high school she experimented with drugs, and upon travelling abroad around the same time, she experienced intense culture shock.

This series of events may have been Sara’s personalized recipe for mental illness, cooked up with all the flavors of her unique position in life, her temperament, and her family’s history. Her mind became a prison; she felt as though people were constantly laughing at her. She could no longer distinguish fantasy from reality. She assumed she wouldn’t go back to school.

“I thought that my life was over, that I would never be able to do anything,” she says. “Because that’s what the doctors told me.”

Then she began to hear voices.

The Schizophrenic Brain

Schizophrenia is a disease that afflicts almost all walks of life. Because it can be so debilitating, scientists have been feverishly searching for its genetic basis. In July, researchers affiliated with the Psychiatric Genomics Consortium compared the genomes of nearly 37,000 people with schizophrenia to the genomes of more than 113,000 people without the disease. In the end, they identified 108 locations where the DNA sequence in schizophrenic people tends to differ. The finding was a major advance in the field of psychiatric genomics, one that could ultimately help scientists understand who is susceptible and why.

Still, the biological markers aren’t always clear—often, a patient’s genes for schizophrenia can lay dormant until certain circumstances trigger their expression, making a diagnosis based on DNA alone less than clear-cut. And with no blood test or brain scan available to detect schizophrenia’s symptoms elsewhere in the body, diagnosis is based almost entirely on what the patient reports.

Treatment of mental illness is nested in confusion, too. Many therapists approach their practice from a different medical perspective than a cognitive psychologist or a geneticist. And while a geneticist might have access to the most current research, she isn’t going to have direct daily contact with a patient’s behavioral nuances like a psychiatrist. What’s going on in the lab, in other words, is often divorced from what’s being implemented “on the couch.”

But it doesn’t have to be that way.

Some scientists are arguing that our new understanding of a particular network in the brain is allowing neuroscientists, psychologists, and psychiatrists—even artists and writers—to understand each other in ways that wouldn’t have made sense ten years ago. Called the default mode network, or DMN, it’s a set of brain regions that are typically suppressed when a person is engaged in an external task (playing a sport, working on a budget), but activated during a so-called “resting state” (sitting quietly, day-dreaming).

“It’s an extremely important platform for any kind of thought that is disengaged from the ‘here-and-now,’" says Mary Helen Immordino-Yang, assistant professor of psychology at the University of Southern California’s Brain and Creativity Institute. That includes processing other people’s stories, reflecting on our own lives, planning for the future, or making important decisions. Immordino-Yang says the default mode network is “metabolically expensive.” In other words, when your head is lost in the clouds, your brain is hard at work.

The default mode network, which is hyperactive in schizophrenic people, plays an important role in self-reflection, identity, and mind-wandering.

Though not the only “resting state” network that’s active when we’re staring off into space, the DMN is unusual in that it is reliable and identifiable, making it easy for scientists to study. Like a web of taut ropes overlaying and intersecting one another, the regions of the DMN—which include the medial prefrontal cortex and the posterior cingulate, both of which are involved in self-awareness, self-reflection, and so on—light up in concert, despite any distance separating them.

When neurologist Marcus Raichle and his colleagues discovered the DMN in 2001, it took the scientific community by surprise. How could rest and self-reflection excite the same brain regions in us all? Why are those regions so intimately correlated? Wouldn’t a brain scan vary more from person to person depending on the content of an individual’s thoughts? It turned out that the DMN has nothing to do with content and everything to do with context. This network is functioning all the time—focusing on a task merely tempers and subdues it.

“This is first time we’ve found a neural system that actually reveals your inner self,” says Susan Whitfield-Gabrieli, a research scientist at MIT. In 2009, she and her colleagues found that in schizophrenic people, the DMN operates on overdrive. When clinically diagnosed patients enter an fMRI scanner and are asked to perform various tasks, the dial on their DMN doesn’t turn down like it should. And when the patients are at rest, their DMN is hyper-connected, buzzing with surplus energy. What’s more, they lack the ability to toggle out of the DMN, this highly self-referential state of being. “They’re actually stuck in their default mode network,” Whitfield-Gabrieli says.

So how does a schizophrenic person get unstuck? That’s a question hundreds of experts from diverse backgrounds are trying to answer.

Coping with Voices

One lens through which experts are studying schizophrenia is anthropology. If the default mode network is related to identity and self-reflection—and if schizophrenia, in turn, is associated with the default mode network—then considering culture may help us understand how psychosis manifests itself globally. After all, how you experience your inner world depends partly on where you live and how you’ve grown up. The same is true of mental illness. “When immigrant groups move to a new cultural group, they take on the mental illness liabilities of the culture where they are,” Immordino-Yang says. Because 60 to 80% of people diagnosed with schizophrenia hear voices, a good indicator of how a given culture views the disease might be how its people cope with its most well known but most misunderstood facets: auditory verbal hallucinations.

“Americans hate their voices. Their voices mean schizophrenia to them,” says Tanya Luhrmann, an anthropologist at Stanford University. By contrast, people in India and Africa don’t typically label their illnesses or their voices, she revealed in a study published in the British Journal of Psychiatry. “It’s not that they don’t recognize that they’re struggling,” she says. “But they talk about their experience as having much more of a natural role.” For example, they may think of their auditory hallucinations as benevolent or spiritual—like a friend or even the voice of God.

People not diagnosed with a mental illness, too, hear voices. In some cases, what they experience may be something that would be classified as a hallucination if reported by a clinically psychotic person. “If you ask someone, ‘have you ever heard a voice when you’re alone?’ the rate is somewhere between 15 to 80% depending on how you ask the question,” Luhrmann says. If you couple it with an example of what might be considered an auditory verbal hallucination, the percentage of people who say “yes” goes up.

Testimonies from people who experience varying kinds of auditory hallucinations support the idea that voice-hearing is complex and culturally-dependent. Their range of experiences is vast. Some say they hear audible, crystalline voices that emanate from inside their heads. Others report cacophonous screeches and bangs coming from outside their bodies. Still others sense murmurs and whispers that crawl over from the next room. Finally, some people describe a phenomenon similar to what cognitive psychologists call “inner speech,” the wordless soup of dialogue that you “hear” when deep in thought. For some, inner speech is acoustically more intense than it is for others. For example, they might say their mental landscape is made up of “loud thoughts” or “soundless voices.”

For Sara, the voices she heard began as disembodied, made-up personalities. Then, after about a year of taking a handful of different medications to varying degrees of success, her voices became solely associated with real people and their private thoughts. Sara is now 33—and though she’s been well enough to go without medication for 11 years, she still hears this latter type of voice.

“If I hear somebody psychically communicating with me—which I don’t believe in; I’m a complete atheist—then the sound will come from above their head or behind their hair…even from inside their stomach. It’s somewhere besides their actual mouth,” she says. “It’s not as loud as their real voice. It’s softer, but I don’t think the tone and quality of the voice is compromised.”

The reason why Sara can talk about her voices so intelligently is because she’s cultivated a relationship with them, in a sense. Though she tries not to engage too much with them, she’s learned to understand her voices and even use them to her advantage. If she’s bored, they’re sometimes entertaining. Occasionally she even asks them questions.

“Sometimes I’m worried about what people think of me,” she says. “And so I ask them [what they think of me] in the air above their head, and I hear their voice say it.”

Sara enjoys and even values some of her auditory hallucinations now, which is atypical of most American psychotic and post-psychotic patients. But that’s not the case everywhere. A simple internet search in her early 20s led Sara to Intervoice, a network established in the U.K. and now widely recognized in 29 (mostly European) countries. The organization’s central tenet is that hearing voices is a meaningful human experience and not necessarily a sign of mental illness. Members set up support groups where people can meet and talk about their experiences without fear of stigma.

Still, Intervoice has not caught on in the U.S. like it has in the U.K. and elsewhere. “There are real differences in the way Americans and Europeans think about voices,” Luhrmann says. In Europe, people are generally more comfortable with the ambiguity between psychosis and religion, and there’s more interest in applying humanities research to medicine.

For Sara, the idea that people could handle and live with their voices made the difference. “I decided I was going to be one of those people,” she says. “Just a small glimmer of hope was all I needed.”

Angela Woods, a medical humanities researcher at Durham University in the U.K., is leading a team of experts in a project called “Hearing the Voice,” which works closely with the broader Intervoice network. It aims to dispel some of the myths about voice-hearing and to see how cognitive neuroscientists can work with writers, artists, clinicians, theologians, and even philosophers to grasp the full spectrum of schizophrenia itself.

A "Voice Walk" in a U.K. cemetery earlier this year encouraged voice-hearers to tell their stories.

“We wanted to call for a more nuanced, richer account of what it is like to hear voices,” Woods says. An initial step in their research involved sending surveys to 158 people from around the world in an attempt to better understand what the experience is like. The team has hosted a number of different events to raise public awareness of schizophrenia and its many shades, including a “VoiceWalk” in a U.K. cemetery to bring people’s voice-hearing stories to the fore and an event at the Durham Book Festival to promote a better understanding of how writers cope with disparate inner voices—their characters, their muse, their narrators, and so on.

Another way people can learn to cope with their voices is by bringing them into the lab. Whitfield-Gabrieli, in collaboration with Margaret Niznikiewicz of Harvard University, is training patients to regulate their auditory hallucinations by consciously controlling activation in their auditory cortex. Participants attempt to push their cortex activation levels up and down, without receiving any auditory stimuli other than the background noise of the fMRI scanner. Meanwhile, they receive visual feedback from the fMRI on their progress. Whitfield-Gabrieli says the hope is that patients can learn to mitigate their voices by focusing on what’s going on in their own brain.

“Teaching people with psychosis to use their imagination to handle their voices is a promising tool,” Luhrmann says. As a society, we can encourage positive relationships with auditory hallucinations by helping patients—schizophrenic or not—better understand them. That means allowing people to tag their voices as “me” or “not me,” give the voices names, recognize what they’re saying and why, and discover what personal significance, if any, a particular voice might have.

Whatever the auditory input may be, Luhrmann says people can have positive or negative experiences depending on the attitude they adopt. “People attend to different pieces of that good-bad spectrum depending on the way their culture invites them to attend,” she says.

While there’s no evidence yet that a learning-based method will work, Whitfield-Gabrieli has reason to believe it’s possible. Research has linked increased DMN activity to the phenomenon of voice-hearing. While scientists still aren’t entirely certain how or why people hear voices, they think that auditory hallucinations may be a misattributed form of inner speech. A hyperactive DMN agitates the auditory cortex, resulting in what could be a fundamental confusion between what the brain “hears” inside itself and what it actually hears as a result of real, external stimuli. Many factors, though—including social isolation—contribute to the health of a person’s brain. Imagination can help with the healing process and reclaim a functioning relationship between the self, the auditory cortex, and inner speech.

Woods’ and Luhrmann’s work—as well as their colleagues’—dovetails with a study published about a month ago in the American Journal of Psychiatry, which concluded that the term “schizophrenia” actually encompasses eight genetically distinct disorders, not just one. The assertion, whether or not it holds up, suggests that mental well being comes in a variety of different “packages” depending on your genetic makeup. That goes for clinically diagnosed patients as well as healthy individuals.

“We should be wary of seeing a schizophrenic person as someone with a kind of deficiency,” Woods says. Rather, it may be just another part of what it means to be human. A person might simply process language differently or ruminate on social interactions for too long. His or her inner speech might be more fragmented or circuitous. Individual differences in DMN activity account for the diverse ways the human mind freely wanders.

Searching for Answers

The default mode network may sound like a gold mine to psychiatrists and neuroscientists alike. The reality, though, is somewhat more complicated. Brain imaging, while promising, has yet to definitively solve major mental health issues like schizophrenia, depression, anxiety, and bipolar disorder.

Daniel Margulies of the Max Planck Institute for Human Cognitive and Brain Sciences argues that even if our scientific understanding of the DMN evolves, its weight in the science world has “opened up a way of talking about the relationship between the self and these disorders.” The default mode network (and its relationship to voice-hearing), he says, can provide a gateway to understanding the full range of how people comprehend themselves—even if anomalies in the network aren’t proven to be a direct cause of schizophrenia.

That may be what matters most, since schizophrenia is not necessarily about neurons or synapses. It’s about the people it affects.

“Technology is giving us important information, but not the final answers,” says David Farb, professor and chair of the Department of Pharmacology and Experimental Therapeutics at the Boston University School of Medicine. He advocates an approach that views diseases and disorders as “vast and complex chimeras of symptoms that can be mixed and matched.” For example, depression may share symptoms with other disorders, like severe anxiety. It’s also possible, he says, that a person may develop an anxiety disorder as they grow increasingly self-conscious of their schizophrenia, for example. In that case, Farb says that schizophrenia may be made even more complex by “an expression of learned helplessness.”

By acquiring as much genetic and neurological information about a patient as possible, we may be able to intervene at an earlier stage and prevent schizophrenia before it develops. Whitfield-Gabrieli and Larry Seidman of Harvard University are studying at-risk people in Shanghai to find brain markers that predict whether or not someone will become schizophrenic. Interestingly, they’ve noticed a skew toward more female than male schizophrenic patients in China; in the U.S, schizophrenia is a predominantly male disorder, again pointing to the cultural element.

And that is what’s so striking to the U.K. researchers associated with Hearing the Voice. We shouldn’t assume that nature (rather than nurture) is the primary culprit when it comes to schizophrenia, they say. “If the default mode network is somehow connected with mind-wandering, self-referential cognition, you can’t simply use objective measures,” says Felicity Callard, another Durham University researcher involved in the project. “You have to get at what people think is going on in their own heads.” In other words, to find a cure, we might have to put ourselves in other peoples’ shoes.

“We should direct energy and funding and resources into exploring people’s lives—not just their chemistry, their neuroanatomy, or their genes,” Woods says. PSTD, for example, is a legitimate response to a traumatic event. Likewise, schizophrenia is a legitimate response to a lifetime of accumulated events, thoughts, interactions, and engrained beliefs. “We need to be able to ask, ‘What happened to you?’ That’s not ruling genetics out, but it’s taking things from another angle.”

Farb suspects the answer might be simpler than that. Drugs that target genes regulating DMN connectivity or surgery that modifies key points of DMN activity, for example, could resolve schizophrenic symptoms. He acknowledges, though, that there may be other factors at play. Schizophrenia—like PTSD or chronic pain—may have a cumulative effect on the brain that’s hard to anticipate. “While we may be able to correct the original deficit, we may still be left with others because they are a consequence of all of those years spent living with the disorder,” he says. “It’s really complicated to get a cure.”

As a patient, Sara believes that the process needs to be individualized. Doctors should ask patients questions about their experiences and how they want to go about getting better. Woods agrees. “The more we treat schizophrenia as a mysterious entity that we’re going to pin down in a piece of DNA,” she says, “the more we’ll miss the complicated, multifaceted aspects of existence that go into making someone have an experience of psychosis.”

“And if people don’t feel as though they’re able to tell stories about their experiences, then it’s hard to see that a cure would be particularly welcome, rich, or meaningful.”

Tell us what you think on Twitter #novanext, Facebook, or email.

Photo Credits: © Frederic Cirou/PhotoAlto/Corbis, Angela Woods

Allison Eck

Allison Eck is a production assistant for NOVA Online.

Other posts from this contributor

The Restorative Power of Nature for Dealing with Psycho-Physiological Stress

The healing powers of nature can be very profound. The experience of calm, peace, or awe (subjective) no doubt contributes to the neurochemical changes in the brain (objective) that reduce anxiety and depression, as well as helping us cope better with stress.

Full Citation:
Berto, R. (2014, Oct 21). The Role of Nature in Coping with Psycho-Physiological Stress: A Literature Review on Restorativeness. Behavioral Sciences; 4(4), 394-409; doi:10.3390/bs4040394

The Role of Nature in Coping with Psycho-Physiological Stress: A Literature Review on Restorativeness

(This article belongs to the Special Issue Advances in Environmental Psychology)

Physical settings can play a role in coping with stress; in particular experimental research has found strong evidence between exposure to natural environments and recovery from physiological stress and mental fatigue, giving support to both Stress Recovery Theory and Attention Restoration Theory. In fact, exposure to natural environments protects people against the impact of environmental stressors and offer physiological, emotional and attention restoration more so than urban environments. Natural places that allow the renewal of personal adaptive resources to meet the demands of everyday life are called restorative environments. Natural environments elicit greater calming responses than urban environments, and in relation to their vision there is a general reduction of physiological symptoms of stress. Exposure to natural scenes mediates the negative effects of stress reducing the negative mood state and above all enhancing positive emotions. Moreover, one can recover the decrease of cognitive performance associated with stress, especially reflected in attention tasks, through the salutary effect of viewing nature. Giving the many benefits of contact with nature, plans for urban environments should attend to restorativeness.

This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Introduction

This brief review attempts to draw greater attention to the role of the physical environment in stress recovery and psychological restoration processes. As people interact daily with physical settings, the physical environment can heighten stress or help people cope with it. “Stress” can be defined as the condition that results when person-environment transactions lead the individual to perceive a discrepancy (whether real or not) between the demands of a situation and the biological, psychological or social resources of the individual [1]. The negative effects of stress can be measured in various ways inside and out of the laboratory and these measures fall into three categories: those that rely on (1) neuro-physiological or bodily changes in the individual experiencing stress, (2) performance or behavioral changes and (3) self-report by individuals. The present paper updates and reviews the literature from each area, discussed separately.

In Psychology, most theoretical accounts of stress effects invoke some variation of the inverted U-hypothesis relating arousal to performance [2], with both high and low levels of arousal causing reduced performance. However, other theories account for effects of stress on cognition, specifically on attention allocation, with stress overloading attentional capacity for the deployment of attention itself and other resources [1]. Except for social support (operationalized primarily in terms of family, socio-cultural and economic conditions), Health Psychology has directed attention away from environmental factors that can be coping resources, whereas research and theories in Environmental Psychology point also to certain kind of environments that have the capacity to facilitate recovery of depleted resources. Environmental conditions are antecedent factors in stress-related mechanisms interceding between environment and health: they might operate as an environmental stressor, straining human adaptive capacities, or as a coping strategy, re-establishing some balance between environmental demands and personal resources. People rarely respond to stressful conditions passively, instead they use coping strategies. The physical environment can damage or ameliorate coping resources, thus heightening or reducing stress themselves. 

2. The Mechanisms and Theoretical Approaches Underlying the Phenomenon

Experimental research has found evidence that restoration from stress and from mental fatigue relates to exposure to nature [3,4]. Natural environments protect people against the impact of environmental stressors and offer physiological, emotional and attention restoration more so than do urban environments. Natural places that allow a shift towards more positively-toned emotional states, positive changes in physiological activity levels, and in behavior and cognitive functioning are called restorative environments [5,6]. For pragmatic and theoretical reasons [7] nature scenes dominated by green vegetation have been the most frequently studied among restorative environments, with a relatively high success rate [8]. Exposure to nature is a coping strategy, which has positive effects on both arousal/activation level and cognitive overload. Arousal theories [9,10] imply that recuperation from excessive arousal should occur more rapidly in settings having low levels of arousal. Since natural settings tend to have lower levels of arousal properties, such as complexity, intensity and movement than urban environments [11], they should have comparatively restorative influences on stress. The alternative overload perspectives provide a different explanation of why recuperation following a stressor may be more rapid when external stimulation is comparatively low. High complexity and other increasing-stimulation properties typical of urban settings, place taxing processing demands [12] and elicit more sustained attention than nature settings; accordingly restoration from cognitive overload is hampered.

Research on restorative environments has developed within two complementary theoretical positions: the Stress Recovery Theory (SRT) [13] and the Attention Restoration Theory (ART) [6]; the former is a psycho-evolutionary theory, while the latter a psycho-functionalist. The evolutionary perspective contends that because humans evolved over a long period in natural environments, people are to some extent physiologically and perhaps psychologically adapted to natural, as opposed to urban settings [4]. To functionalist, humans have an unlearned predisposition to pay attention and respond positively to natural content (e.g., vegetation, water) and to configurations characteristic of settings that were favorable to survival during evolution [5,13,14,15]. Although in both theories natural environments are more restorative than urban or artificial environments, they differ in what drives individuals toward a restorative place: In SRT it is physiological stress, whereas in ART it is mental fatigue. These theories complement one another, in that the elevated physiological arousal and negative affect characteristic of stress (SRT) can occur in absence of mental fatigue. Conversely elevated arousal or negative affect do not always accompany attentional fatigue (ART); attentional fatigue can be considered a stress aftereffect and treated as a condition that increases vulnerability to stress [3,4,6,12,16].

Research related to these two theories agrees on two findings: (1) Environmental preference is affected by people’s need to get restoration [17,18,19,20,21,22]; (2) Environments perceived as natural tend to be more restorative than environments perceived to be urban or artificial e.g., [3,23,24,25,26,27,28]. In fact, research shows restoration related to environmental preference, but the direction of the effect remains unclear; however the positive linear correlation between the perception of place restorative qualities and environmental preference may suggest that the general preference for natural environment can be explained by individual conviction that “psycho-physiological” restoration occurs easier in natural environments. In practice people prefer natural environments because those places allow maintaining or enhancing psycho-physiological wellbeing.

Mental fatigue gives higher preference for the natural over the urban environment [22]. Nature is especially conducive to our involuntary attention engagement; on the contrary built content captures attention dramatically, requiring attention to be overcome [6,8,24]. In the ART this attention-drawing quality of natural settings is referred to as “soft fascination” [6]. When nature captures people’s attention, the executive system that regulates directed attention gets to rest, pessimistic thoughts are blocked, and negative emotions are replaced by positive ones [29]. In addition to fascination, nature is characterized also by other properties called restorative factors, which work together with fascination. Actually, the renewal of a depleted capacity also occurs with a physical and/or psychological “being-away” from demands on directed attention, a sense of “extent”, i.e., being in a large enough world where “coherence” and “scope” are perceived in the environment, and “compatibility” between one’s inclinations and the environmental demands, for more details see [6,21,23].

The research does not claim that the restorative experience can occur only in natural environments, nor does it state that all urban environments lack restorative qualities [30,31]. For example, some natural environments would not likely be restorative because they are perceived as dangerous [32,33], and some urban environments, such historical environments [18], museums [34], or monasteries [35], can sustain restoration because they have to some extent restorative qualities, are easily approachable and so compatible with the little free time of the majority of the inhabitants of the city [36,37]. Accordingly the involuntary attentive process might be activated also by the vision of urban environments [31], but only if environmental information is fascinating, i.e., doesn’t overload the attentive system [38], as nature does. ART claims that fascination is a restorative characteristic of an environment related to information processing, therefore suitable urban-artificial solutions can sometime fill the gap due to the lack of nature [30,31,39]. 

3. The Direct and Indirect Effects of Natural Environments

Central to the recovery from psycho-physiological stress are positive changes in emotional states. Exposure to natural environments produce positive mood chances, actually exposure to natural stimuli can mediate the negative effect of stress reducing the negative mood state and at the same time enhancing positive emotions. In particular, natural settings have restorative influences on three affective dimensions: positive affects, anger/aggression, and fear [4,40,41]. Moreover, people report more positive emotions (such as friendliness) and fewer negative emotions (such as sadness) when viewing urban scenes with trees than when viewing the same scenes with inanimate objects [42]. In contrast, exposure to environments lacking of natural elements can produce anxiety, anger, frustration and sadness [43,44]. The association between environment and emotions leads people to assess natural environment on the opportunity they offer to regulate mood, in practice preference for natural environments arises from the favourable effects on mood of such environments [45].

The positive emotional states elicited by viewing natural stimuli are part of the mechanism underlying the landmark Ulrich’s [46] finding that hospital patients had more favorable recovery (shorter post-operative hospital stays, lower scores post-surgical complications, fewer negative comments in nurses’ notes, fewer strong analgesic intake) if their windows overlooked trees rather than a brick building wall. Exposure to nature can reduce anxiety, improve pain control and patients’ satisfaction with the procedure [47,48]. One study found that the exposure to natural environments (pleasant stimuli) effectively distracted patients from stressful or painful conditions [47]. Another study found that heart-rates and self-reports of emotional state of patients in dental clinics improved with exposure to natural environments [49]; patients felt calmer on days when a mural depicting a natural scene was on the wall then on days when the wall was blank. To this end, Diette et al. [47] recommended the routine clinical use of nature sights and sounds of sights. The use of nature scenes was shown to be an effective tool for “distraction”, i.e., patient’s attention is focused on a pleasant stimulus and away from a stressful or painful condition. Research in prisons has shown that prisoners whose cell windows offered views of farmland and trees had lower frequencies of stress symptoms such as digestive illness and headaches, and fewer sick calls than prisoners whose cell windows offered views of the prison courtyard [50,51].

The negative effects of psycho-physiological stress can also manifest with significant decreases of cognitive performance. However, people can recover cognitive efficiency simply taking advantage of the beneficial effect deriving from exposure to nature. For example, children playing in highly natural school playgrounds showed fewer attention and concentration problems, and improved cognitive and physical functioning than children playing in less natural school playgrounds, for a review [52]. At workplace, a view of natural elements was found to buffer the negative impact of job stress, intention to quit and it had a positive effect on general wellbeing and cognitive functioning [53,54]. The most significant understanding of nature’s salutary effect on cognition comes through studies of attention. Research has shown that natural settings might have restorative effects that include increased performance on task requiring attention and cognitive processing [5,23,55,56,57]. Cognitive restoration following visual exposure to the natural environment, as reflected in improved performance on attentional tasks, has been established in a variety of experimental studies involving either the use of videos [17] or actual field trips [3,58,59], or image slideshows of natural scenes [23,55]. Kaplan’s ART [6] gives a convincing explanation of what makes up the so-called “psychological restoration.” The theory originated when it was noticed that people preferred scenes depicting natural than urban environments, and exposure to natural environments had a profound restorative effect on the ability to focus, in practice people’s attention was easily and almost effortlessly held. The tenets of this theory state that a person can engage two types of attention: involuntary and voluntary, for more details see [60]. The former is a rather effortless form of attention, in contrast the latter, otherwise called directed attention, requires a good deal of focus and effort that leads inevitably to mental fatigue. The mental fatigue state increases the probability that an individual experiences the stress response due to the cognitive overload, and the concomitant reduction of the cognitive resources necessary to address daily requests. Mental/attentional fatigue manifests itself in negative emotions, irritability, impulsiveness, impatience, reduced tolerance for frustration, insensitivity to interpersonal cues, decrease altruistic behaviors, reduced performance, increased likelihood of taking risks [58,61,62,63,64], generally speaking in reduced competence and/or decreased effectiveness in functioning [58,63]. In practice, the inability to renew the attentional capacity aggravates the mental fatigue state and can also damage mood, work performance and interpersonal relationships.

Nature may not only have direct effects on stress recovery and mental fatigue restoration, but it may also have indirect effects by serving as a buffer against the health impacts of stressful events [65]. Many people seek out nature in time for stress. Unfortunately due to increasing urbanization, modern people’s homes have become more removed from green environments [65]. Restricted access to green spaces may increase people’s vulnerability to the impact of stressful life events and environmental stressors affecting physical and psychological wellbeing. Higher accessibility to park/forest-like area correlates with higher happiness, lower stress, anger, depression and tension, improved mood and concentration [17]. In particular, the amount of green space within a radius of 1–3 km relates to perceived general health [66].

Thus, urban green besides making our cities more appealing, gives relief from stressful life, and an opportunity to recover cognitive resources and restore the optimal level of physiological activation [5,13,44,67]. This can have positive effects on sense of control, privacy, encouraging personal relationships and physical exercise, and offering natural fascinating distractions that promotes positive emotions and mood. Loss of control and the lack of privacy can aggravate the stress condition and threaten individual’s capacity to cope with stressful situations [68]. Exposure to nature offers the opportunity to display control through a “temporary being-away” or “temporary escape” from reality. Estrangement from habits/routines means to go away from the source of stress. ]Regarding social support. Outdoor spaces and gardens can promote social relationships and enhance the sense of community. Mental health services engage nature-related programs (horticulture, gardening) to provide opportunities that enhance multiple aspects of health and wellbeing, increase constructive interpersonal relationships that enhance social inclusion, and support the destigmatization of mental illnesses [69,70]. Participants benefit from the increase of positive emotions, expand healthy relationships with peers and staff, improve physical activity, have greater involvement in familiarity within the community and exhibit skills that enable acceptance in the community and the perception of being part of the community [71]. Active participation in nature has additionally been found to reduce mental distress, enhance self-confidence and improve physical health of the participants [72].

The recognition of nature’s health benefits has brought to broader discussion on public health and also inspired practical applications. In particular psychologists have begun to study whether technology can salvage some of nature’s healthful properties [73]. Although virtual nature may not replace actual nature, people who are not able to go outside can benefit from exposure to virtual nature [74]. When real nature is not at hand, surrogate (artificial plants, potted plants) or simulation (pictures of nature, films, slides) of nature are accepted at work, in hospitals or institutions providing restorative effects such as improved affect and decreased physiological stress [17,75]. In particular, the immersion in a virtual computer-generated nature setting has been found to be a valid therapeutic aid in treatment of anxiety disorders and an effective tool in stress management and relaxation [76,77]. Virtual settings are enriched with a variety of positive visual and auditory stimulation that affect self-efficacy and mood; the virtual reality (VR) scenario-experience is vivid and real and induces a high sense of “presence” that affects relaxation and the emotional response. 

4. How to Measure the Effects of Natural Environments

4.1. Physiological Effects

Though their concern was not to compare the effects of natural vs. urban settings, back in 1963 Wadeson et al. [78] found evidence that exposure to natural environments had a direct influence on urine and blood levels of cortisol, a stress-related hormone. More recently, literature has shown that independently from the type of exposure: plants, poster, slides, video, VR settings or views of natural environments/stimuli, people experience a general reduction of symptoms related to psycho-physiological stress. Natural environments elicit greater calming physiological and psychological responses than urban environments. The SRT [13] proposes exactly that perceiving particular qualities and contents in a place can support recovery from physiological stress. Using a paradigm in which stressed individuals were exposed to simulations of either natural or urban environments, Ulrich encompassed the range of restorative effects of the natural environments on human beings [4,13,46,79]. Research showed different rates of recovery from stress depending upon the type of environmental exposure. Physiological measures of stress (e.g., electromyography, skin conductance response, pulse transit time, cardiac response, partial thromboplastin time) indicated that recovery was quicker and more complete in the natural environment exposure conditions, even when recovery was measured over a 10-minute period only [79]. In the initial minutes of recovery the parasympathetic component response was recorded to the natural environments, whereas there was no evidence of the parasympathetic involvement in response to the urban settings. The parasympathetic system, often called “relax and renew,” is the branch of the Autonomic Nervous System (ANS) responsible for recuperating and returning to a balanced state (homeostasis) after experiencing a stressful situation; it reacts to return the body to a state of equilibrium by slowing down heart rate, dilating blood vessels, activating digestion, and storing energy. In contrast, the sympathetic system, the other branch of the ANS, activates in response to stressors; it is also known as the “fight or flight” response [80], because its activation is central in the taxing mobilization involved in responding to unexpected stressful events.

The relaxing effect of nature is supported by electroencephalogram (EEG) data as well. EEG measures are sensitive to conditions such as fatigue and sleep deprivation. If so, perhaps neuro-physiological measures, such as the EEG or functional magnetic resonance imaging (fMRI), might be used to differentiate stress states of the organism from normal or restored states. Unstressed subjects who viewed slides of natural landscapes and urban scenes [79], or single natural elements such as plants with flowers and pots without plants [81], or who were seated in an outdoor setting watching greenery or a concrete block fence [82] had greater brain electrical activity in the alpha frequency range. High alpha amplitude is associated with lower level of physiological arousal as well as feeling of wakeful relaxation [79]. Generally, feeling of anxiety are related to high arousal and accordingly to low alpha amplitude. All these results suggest that subjects are less aroused physiologically and more relaxed but wakeful, during exposure to natural stimuli. EEG studies identify tranquility as an outcome of viewing natural settings [83]. Recently, Korean researchers used the fMRI to investigate brain activation patterns in participants viewing nature vs. urban scenes [84]. The urban scenes showed enhanced activity in the amygdala, which is linked to impulsivity, anxiety and increased stress. By contrast, the natural scenes promoted activity in the anterior cingulate and the insula – where increased activity is associated with heightened empathy and altruistic behavior. 
4.2. Behavioral Effects
A logical extension of attention restoration theory is that people deprived of nature will display behaviors caused by weary minds: inhibition is essential to delay and reflection, lacking this capability an individual behaves in a less adaptive and appropriate fashion [6]. Moreover, without the patience and endurance necessary to carry out difficult or unpleasant tasks, performance becomes more oriented to the short term. In fact, directed attention fatigue not only leads to the inability to focus, but it has also several unfortunate consequences, including performance errors, inability to plan, social incivility and irritability [6]. Taylor, Kuo and Sullivan [85] found also a relationship between exposure to nature and self-control; in studying a group of girls living in the same housing complex, the researchers found that those with greener views scored higher than those deprived of nature on several tasks related to discipline, higher concentration, inhibited impulsivity and ability to delay gratification. Regarding social behavior, which also depends upon inhibition, it becomes less appropriate and there is also a greater inclination to be impulsive, to take unnecessary risks, and to act in an impatient and hasty manner. Kuo and Sullivan [86] reported significantly lower levels of aggression and violence in residents with apartments near nature than in those who looked onto barren lands; the researchers suggested that if fatigued attention is related to irritability, and irritability leads to impulsivity and aggression, then perhaps people deprived of nature’s restorative qualities would be overly aggressive. In general, exposure to nature enhances sense of attachment, social life, mental and physical health, quality of life and the occurrence of activities and events that enhance wellbeing. In particular, green vegetation in neighborhood common spaces correlates with stronger ties, higher sense of safety and adjustment [87], less aggressive behavior, and fewer property and violent crimes reported to the police than areas without greenery [86].

Views of nature affect driving as well. Comparing the physiological responses of subjects who watched a video driving through nature with those who watched a drive through more built-up environments, Parsons et al. [88] found that the nature-group displayed lower levels of stress and recovered more quickly from the stress they experienced. Views of dense vegetation (vs. sparse and mixed) enhance in fact drivers’ ability to tolerate frustration [89]. 
4.3. Self-Report Measures

Quantifiable measures of restoration are the key to understand how restorative mechanisms work, and research on the buffering effects of nature among stressed or mentally fatigued individuals has mostly relied on physiological and cognitive measures as outcome variables. However, together with physiological, behavioral and performance measurements there are also self-report measures aimed to assess the restorative value of real places/pictures, i.e., the degree of perceived restorativeness of a setting. To this aim, the majority of the studies have used the Perceived Restorativeness Scale (PRS). The scale based on the ART, which appeared in 1997 [25,26], aimed to measure the presence of the four theoretical restorative factors (being-away, fascination, extent, compatibility) in the environment. From then on, the PRS has been widely used not only to compare the restorative value of natural and urban settings, but also to measure perceived restorativeness of outdoor activities [90,91], vacation destination [92], zoo and small public parks [93,94,95], and it has appeared with different names, e.g., Restorative Outcome Scale [96], Revised Perceived Restorativeness Scale [97], Perceived Restorative Characteristics Questionnaire [94], PRS-short version [23], but questions about the scale validity/reliability remain.

Since the PRS appearance researchers have differed on the number of items making up the scale and on its factorial structure [97,98]. However, research has confirmed, through the PRS, both the positive correlation between environmental preference and perceived restorativeness, and the lack of correlation between familiarity on perceived restorativeness [21,99]. Furthermore, research using the PRS found that the higher restorative value of natural versus urban or artificial settings did not differ with gender or age [100]. Primary school children can discriminate the restorative value of environments varying in their degree of naturalness [101], and assess natural environment more restorative than school environments and playground [102].

Regarding the PRS factorial structure, Pasini et al. [103] have shed light on the psychometric characteristics of the scale. After a detailed understanding of the meaning of PRS individual items with the method of cognitive interviews, which is the proper starting point for the development of a self-rating scale, Pasini et al. [103] ended up in an 11-item. Using Confirmatory Factor Analysis to compare five models based on previously published research and underlying theory, the researchers found that a four-factor model that mirrored the four factors of ART, had the best fit to the data. The resulting 11-item PRS was also invariant across nationality and gender.

The PRS-11 is less concerned with people’s environmental preference. Instead, it addresses the perceived “cognitive” supportiveness of the environment in relation to individual’s psychological wellbeing. It assesses aspects of purposive behaviors to avoid mental fatigue, and the cognitive fit between person and environment is indicative of a “no-mental fatigue” state in relation to the environment, and not only of how an environment is restorative. For this reason the PRS-11 can help researchers and community planners who can both rely on a valid, reliable, brief and easy to comprehend instrument. In fact, for people interested in people’s wellbeing, it is the subjective fit which is essential, i.e., the perceived supportiveness of the environment in connection with the personal goal to recover from mental fatigue.

The PRS-11 assumes that people’s subjective appraisal of their environments provides a reasonable, straightforward index of the quality of their psychological restoration experiences in those settings. However the complex psycho-physiological pathways of stress make measurement via one single measure insufficient. Moreover the issue of which type of measure (behavioral, self-report or neuro-physiological) is the better or more appropriate measure of stress effects is far from settled. Stress impacts physical and mental health and a number of inter-personal differences have been found to impact on the ways we experience and interact with green space, they are gender [104], age [105], culture/ethnicity [106], interests/expertise [107] and it is a matter of fact that different “extraneous” variables are associated with restorative experiences in favorite settings [96]. Nevertheless, the relationship between perceived restorativeness and stress measures has not been firmly established. To this end, considering the different kinds of measures (self-report, physiological, behavioral, task performance) a multi-method multi trait study (MMMTS) would allow assessing the adequacy, namely if the PRS-11 fits with other measures of stress or recovery. However, the conceptual formulation of the trait “perceived cognitive supportiveness/perceived restorativeness” implicitly includes the proposition that this trait can be meaningfully differentiated by other traits. 

5. Conclusions

Given the many benefits from contact with nature, plans for urban settings should consider the human need for restoration. For this, research must offer practical guidelines for the accessibility and quality of urban green areas. A well-designed urban landscape can contribute to creating a less stressful day [108] and to providing an opportunity for physical, cognitive and emotional restoration [36]. Thus, research can help integrate natural elements and structural features into built environments [109] in order to plan urban environments that are “cognitive sustainable” and restorative from mental fatigue and the stresses of urban life [30,110].

Empirical evidence on the stress reduction from exposure to natural settings agrees with both SRT and ART. However, the findings are unclear about whether active or passive involvement with nature is preferable for restorative benefits, and whether restorative outcomes (both physiological and cognitive) vary with the length of exposure to natural stimuli. According to adaptation level theory [111,112] people adapt (or get accustomed) to their environments. If that applies to exposure to natural environments, then people surrounded by nature might require a higher dose (a sort of threshold) to recover from stress and mental fatigue than would people surrounded by buildings. On the other hand, their long-term exposure may inoculate them from stress. Research could also consider effects related to different kinds and form of nature, as well as individual and cultural differences in the perception of restorativeness and the restoration process.

Another important issue concerns the relation between biophilic design and psychological wellbeing, i.e., whether the presence of natural features (such as curvilinear forms, gradations of colors, blending of textures) and elements (water, plants) in buildings can have real benefits on human emotional wellbeing, stress reduction, cognitive efficiency, learning and healing processes.

Research on restorative environments has included both field and laboratory studies using primarily the transversal design, or to a lesser extent the pre-post design [113]. These studies miss a longer-term question. Successful coping strategies can mask the negative effects of a stressor. Studies have not determined whether long-term exposure to nature helps one adapt to or recover from stress/mental fatigue. To answer that question, we need longitudinal studies. 


I wish to express special thanks to Jack Nasar, Editor of this special issue, for his patience and invaluable assistance in the arrangement of this manuscript. I gratefully acknowledge the anonymous reviewers for their valuable comments.

Conflicts of Interest

The author declares no conflict of interest.

References at the Behavioral Sciences site

Thursday, October 23, 2014

From Neuroscience's Perspective: Our Brains in Love and The Harmful Effects of Loneliness

This two-part interview with neuroscientists John and Stephanie Cacioppo (conducted by Marin Gazzaniga, daughter of Michael Gazzaniga, the well-known and highly respected neuroscientist) comes from Cafe, a cool online magazine. In the interview they discuss how the brain changes when it's in love, as well as the very negative impact of loneliness on the brain.

[For what it's worth, the image above came up on a search for "loneliness," but to me it feels like peace - but then, I am an introvert.]

Our Brains in Love: From Neuroscience's Perspective

What does a neuroscientist who studies loneliness have in common with a Ph.D. who studies love? For one, they share the same home, office and last name. In Part One of this two-part interview, John and Stephanie Cacioppo discuss how love helps you read minds, and whether you can experience desire without love.

What Qualifies Me to Talk Neuroscience?

I don’t claim to be a science writer; most have advanced degrees in their areas of expertise. But my father, Michael S. Gazzaniga, is well known in his field—one of the founders of cognitive neuroscience, and a pioneer in the theory of left and right hemisphere function. I grew up visiting his labs, and I have a basic comfort level with the vocabulary and methodology of neuroscience. One of the perks of being his daughter is that I can convince some of the world's leading neuroscientists to talk to me about their work. They will be patient with my simplistic questions—because some of them used to babysit me. 

He Wrote the Book on Loneliness; She Looks for Love in the Brain

My first call was to John and Stephanie Cacioppo. I met Stephanie when she was doing her post-doctorate work with Scott Grafton at the SAGE Center for the Study of the Mind at the University of California, Santa Barbara (which is run by my father). She helped me with a plot point in a play I was writing, in which my main character is in an fMRI scanner and a certain area of her brain lights up, which suggests she is in love. My question for Stephanie was: Is this possible? Is there a love area of the brain? Could our brains know we are in love before we do?  The answer was a qualified "yes."

Now, years later, Stephanie has fallen in love and married one of the founders of Social Neuroscience, John Cacioppo. Apparently their brains lit up when they met at a conference. They are a rom-com "meet cute." He wrote the book on loneliness. Literally. And she studies love.

© Stephanie Cacioppo
They spoke to me from their home office, sharing the phone, answering each others’ questions, and praising each others’ work. If they weren’t the researchers, they could be subjects for Stephanie’s studies on love relationships.

How Love Makes You a Mind Reader

MG: Stephanie, can you briefly describe your recent research?

SC: I try to better understand the role of the mirror neuron system in social interactions, and how social interactions, specifically with significant others, can be beneficial and detrimental to our mental and physical health.

(A side note: Mirror neurons were first discovered in monkeys, and later in humans. They are brain cells that are activated when you perform an action, and when you observe others doing the same action—hence the "mirror" name. The exact function of the neurons is still debated, but many believe they are associated with empathy.)

MG: Can you give an example?

SC: I’m interested in how a bond with your spouse, for instance, can make you think better, faster and make you healthier. In terms of thinking faster, one model I’m using is that of embodied cognition. How your social connection with your spouse can help you understand his intention very quickly, even before he’s finished his action. Is that clear?

MG: Can you give me an example of an experiment you do to look at that?

SC: Typically, we ask participants to watch different agents (a stranger, a friend, a family member, a beloved spouse) perform different actions (grasp a cup of coffee, hold a gun, toss a tennis ball in the air) with different intentions (meaningful, harmless, kind, etc.), and we ask the participants to guess what the agents’ intentions are, before they complete the actions. The participants are in an fMRI and we measure their brain activity while they do these tasks. Research suggests the more you feel "in tune" or "bonded" with someone, the faster you can anticipate their intentions. 

MG: What have you found about how love relationships impact this ability to predict behavior?

SC: When it comes to couples, theories of simulation and embodied cognition are in line with a model that is well-known in relationship science: The model of self-expansion. This model suggests that you fall in love with someone to expand yourself or to include the other’s attributes to make you a better person. Altogether, these theories suggest that the more in tune/in love you are with someone, the more time you spend with that someone, the more motor familiarity with them you acquire (unconsciously or not), the more your brain can encode their actions, the more your brain can then re-activate their actions by simple observation of the first step of a movement, and the faster you can understand their actions. In other words, the more you have a joint representation of yourself and the other person, the faster your mirror neuron system will be activated and the faster you can understand him or her.

MG: So somehow with our significant others we become more in tune with the motor processing cues. So, I can tell my husband is reaching for his car keys, say, rather than the mail, before he picks them up.

SC: Yes. And it doesn’t need to be conscious. That’s the beauty of it. It is largely a spontaneous and automatic process.

The Difference between Love and Desire

(At this point, John interrupts.)

JC: Tell her about the—

SC: Go ahead.

JC: (laughs) Steph’s work is brilliant. She’s looked at all of the fMRI studies of love and sexual desire and finds some overlapping brain regions but clearly some very different regions of the brain involved, as well. Importantly, love or desire isn’t represented as a spot in the brain. Each is the result of the collaboration of a set of neural regions operating on perhaps the same input to produce different inferences about and responses to that person. For instance, one distinction is in the insula – a long narrow nucleus on both sides of your head. There’s a front part (anterior) and a back part (posterior), and the distinctions within the insula are that the anterior regions are associated with more abstract representations and thought, and more temporal flexibility (for example, future orientation, mental time travel), whereas the posterior regions are associated with the present sensory, visceral and motoric inputs one is experiencing. This functional organization (concrete representations and operations in the back, abstract representations and operations in the front) is pretty typical of the brain generally.

MG: Uh huh. (At this point I felt my own brain getting a little overloaded.)

JC: What Stephanie found in the fMRI studies is that the back part of the insula, the posterior insula, is associated with desire whereas the front is associated with love. Now from that, Steph has developed a model of love and desire where both can actually occur together but, of course, need not do so. When both are active, the person is more likely to not only love someone but also desire that person.

Can You Love Someone but Not Desire Him? Or Vice Versa?

JC: Imaging research is correlational, though. It tells you these areas are associated, but it doesn’t tell you what they are doing. So the insula is an area of the brain where it’s hard to find lesion patients; because it’s not a richly vascularized region, strokes that compromised just a single part of the insula are uncommon.

(An aside: John spoke earlier about the need to study the "hole in the brain." That means looking for patients with a lesion (injury) to a specific part of the brain in order to learn more about what that area actually does—to see if the damaged area disrupts the behavior. In other words, if your anterior insula is damaged, do you lose the ability to love?)

JC: Steph found such a patient in South America. The front of the insula was damaged. She tested that patient for tasks she has used in her behavioral and neuroimaging research on love and desire. And she also tested other South American men to make sure that it wasn’t a cultural difference. The South American men were like the US men in how they responded to the tasks. Importantly, she also found that the patient whose anterior insula was damaged had trouble with tasks when it involved making judgments about love, but not when it involved making judgments about desire (photos they were looking at). That’s brilliant work showing it’s not just correlational. There’s something causal about what the anterior insula contributes to love. Stephanie is still looking for a patient with a lesion in the posterior insula. But her combination of neuroimaging and lesion research illustrates the kind of rigor that characterizes her research. I just love her mind.

SC: And I love his mind!

MG: I’m curious, what kind of task do you come up with that distinguishes between love and desire?

SC: So we have different tasks. One of them is to present images of single individuals, fully clothed, and we use the same exact stimuli for the love and the desire task. But the instruction is different. For the same set of pictures, the participants are being asked if the person is love material. And in another block, we present the same pictures in different order and ask if they could feel sexual desire for them. And the participants are asked to press keys to tell us their response and we analyze their brain activity based on their behavioral response rather than on the category of the stimuli. During previous studies, researchers have tended to categorize the stimuli ahead of time as being desirable or loveable. But someone who is desirable for you may not be for me. So we thought that it was very important to analyze the brain activity based on the participant's response rather than the experimenters' categorization.

How a Doctor of Love Can Help

MG: You mentioned that one of the lessons you learned from Scott Grafton and my father was to always ask the question, "And so what?" What is the "so what" of your research on love?

SC: People wonder why you need a Ph.D. to study love. A lot of people have a lot to say about this topic and they all think they know what love is and why we fall in love, and actually they don’t. We need to understand the brain in love, scientifically. And to bring the psychological model and biologic sciences to this field.  By breaking down love with different scientific and mathematical approaches we can really try to reconstruct it and better understand it in healthy couples and patients who have neuropsychiatric issues with love relationships. We can try to treat jealousy, people with obsessive-compulsive disorders—stalking—autism, patients who have social disorders and difficulty relating to others. By bringing science into this so-called soft science we can help patients in their early life.

NEXT….In Part Two of this series, John explains the brain science of loneliness.
 photo: S. Cacioppo. Modified from NeuroImage, 2008; Vol. 43, no. 2

* * * * *

The Harmful Effects of Loneliness

In Part 1 of this interview, married neuroscientists John and Stephanie Cacioppo discussed her research on love. Here, John explains his research and some paradoxical behaviors of the lonely.

MG: You are one of the founders of social neuroscience. Can you explain what that is?

JC:  The premise of social neuroscience is complementary to cognitive neuroscience – but distinct. In cognitive neuroscience you look at the brain as if it were a computer. The metaphor stimulates a number of questions. For instance, language is viewed as a way of representing information in the brain. So you ask: What is that representational system? Where is the encoding and decoding? What types of storage and memory systems exist? In social neuroscience, the appropriate metaphor is the cell phone. Brains are viewed as mobile, broadband-connected computing devices. This metaphor raises different questions, such as: Where’s the wifi card? What’s the communication protocol? Language is seen as one of the ways these devices are linked, rather than a way to represent information within the device. Neither cognitive nor social neuroscience is "correct." They are distinct and complementary perspectives on the human brain. 

Why we need grandchildren to survive

MG: So what is the focus of your work?

JC: I’ve been interested in a combination of social and biological perspectives on the human brain for years now. What struck me as interesting about social in the first place was that social species, by definition, create super-organismal structures. These structures evolved hand in hand with neural, hormonal, cellular, and genetic mechanisms because they promote behavior that foster survival, reproduction, and care for offspring sufficiently that they reproduce. For mammals, whose offspring are dependent on parental care, it’s not your ability to reproduce that determines your genetic legacy but your ability to have grandchildren. If you reproduce a great deal but in conditions where there is no care for those offspring, then they perish during infancy, leaving you with no genetic legacy. So one interesting question is, What are the biological mechanisms that help us survive as a social species? The way I’ve been investigating this question for the past twenty years is to determine what happens when an individual is absent social connections. 

MG: Loneliness.

JC: Yes. So you see it’s actually a complement to what Stephanie studies. 

MG: She studies love - how people create deep connections - and you study what happens when they feel isolated.

JC: Yes, the reason I took that approach is very straightforward. If I want to understand what a gene does, I create an animal model where I can compare the responses from an animal that has that gene and an animal that does not. If I want to understand what the orbital frontal cortex does, I look at Phineas Gage before and after his orbital frontal cortex was obliterated. It’s not that I’m interested in the hole in Gage’s brain; I’m interested in what happens before and after that hole existed. Similarly, if I want to know what the effects of meaningful social connections are, I can compare individuals who feel socially connected with those who feel absent meaningful social connections – that is, individuals who feel lonely.

What Robin Williams knew about loneliness

JC: We’ve been doing experiments and longitudinal research on loneliness to determine the effects of loneliness on behavior, brain function, autonomic and neuroendocrine activity, sleep, and gene function. Fairly quickly we found that it isn’t the objective presence or absence of people, it’s whether you feel isolated. The brain is the key organ for forming, monitoring, maintaining, repairing, and replacing salutary connections with others, so the presence of others in many cases is less important than whether one feels connected or isolated. Stephanie gave me a quote from Robin Williams, from 2009. He captured this point better than many scientists: "I used to think the worst thing in life was to end up all alone. It’s not. The worst thing in life is to end up with people that make you feel all alone."

We’ve found that chronic loneliness is associated with early morbidity and mortality as well as a number of psychological disorders. For instance, our longitudinal and experimental research suggests that loneliness increases depressive symptoms. Loneliness also leads to heightened sympathetic tonus of the vasculature.

MG:  What does that mean?

JC:  Loneliness can lead to higher blood pressure. It also disrupts sleep due to an increased number of micro-awakenings over the course of the night. These effects are independent of the amount of sleep, or whether or not you’re actually sleeping with someone. We’ve seen this effect in studies of undergraduates and in the Hutterites (a communal population), and we’ve seen loneliness predict less salubrious sleep longitudinally. If you feel lonely tonight, you are likely to have more micro-awakenings across the course of the night. 

MG: Why is that?

JC: We have an evolutionary theory to account for these findings. If it’s dangerous to fend off wild beasts all day with a stick, imagine how dangerous it is to lay that stick down at night and sleep when predators are out and you don’t have a safe social surround. Going to sleep feeling isolated puts the brain into a state of alert for threats to promote self-preservation. The disruption of sleep has been seen in an experimentally isolated social animal, as well. 

MG: How do you determine the difference between someone who is feeling lonely vs. not feeling lonely? Is it just self-reported?

JC: We have a couple different ways. We have a monkey model and we are developing a rodent model of loneliness. In both of these models, we focus on the behavior of the animals to define loneliness. When working with people, however, we typically use a set of questions to measure loneliness. We don’t ask, "Do you feel lonely?" because men, in particular, tend to under-report. But there are other questions we can ask that relate to loneliness. If you ask, "Do you feel lonely?" there’s a bit of defensiveness that is aroused. But if you ask, "Do you feel socially isolated?" "Do you have others in whom you confide?" Then you start to get a more accurate picture of the extent to which they feel socially connected or isolated. 

Why loneliness can make you negative

JC: You know what the Stroop test is, right?

MG: Uh…I know the name. But…remind me?

JC: Stroop developed a test in which you show people the names of colors, but they appear in an incongruent color or ink, such as the word "blue" printed in red.

MG: Yes, yes.

JC: In the Stroop task, you ask a participant to identify what color the ink is. To people’s surprise, this is a difficult task because, whether they want to or not, people automatically read the words. Because you’ve read "blue" but it’s written in red, it takes you longer to say "red." And in fact often you make an error and say, "blue."

MG: Right.

JC: The Stroop task illustrates how information can be processed by the brain even when we did not intend to do so and are unaware of having done so. We used a version of this task to investigate how individuals who felt lonely or non-lonely preattentively (automatically) processed positive and negative social and nonsocial information. We presented social and nonsocial words in different colors and instructed participants to identify the color of ink in which the word was presented.

MG: What’s a social or nonsocial word?

JC: A negative nonsocial word is "vomit." A negative social word is "reject." As you can see, both are very negative words. What we found is that the lonelier you feel, the longer it takes to name the color of the negative social words. 

MG: Huh.

John can tell I’m not completely following…

JC: That’s evidence that if you feel lonely, your brain is especially paying attention to negative social stimuli because we did not find this interference effect when we contrasted positive social and positive nonsocial words. 

So, the idea is, you aren’t just being a Negative Nancy, you are actually on the lookout for things—or more specifically, people—that could hurt you because there’s no one around you feel would protect you.

How depression may actually be a way to connect

JC: Whether a fish or a herd animal on the social perimeter, the attack of another member is not only sad but also a threat to your survival. So the brain is more likely to focus on self-preservation than on the welfare of others. In fish, for example, an attack increases the tendency for each of the fish to swim to the middle (as far from the social perimeter as possible). We see similar behavior in herd animals. And we see something similar in the brains of humans. In brain imaging studies we have also found that the lonelier you are, the less brain activation found in the temporal parietal junction when viewing a negative social scene—for example, a photo of someone being hurt. Activation of the temporal parietal junction occurs when you take the perspective of another person, empathize with that person, or think about what they are thinking or experiencing. The fact that loneliness is related to less activation of this brain region is interpretable in terms of the lonely brain emphasizing self-preservation rather than concern for others.

The interesting part of this story is that people do not have conscious access to what their brain is doing. You don’t know your brain is in self-preservation mode because the brain was selected to do this long before humans walked the earth. The absence of accurate insight into what our brains are doing increases the likelihood that lonely individuals engage in self-protective—but paradoxically self-defeating—behavior. They are motivated to reconnect, but they engage in defensive, sometimes downright prickly behavior. When you feel lonely, you are more likely to be negative and disagreeable. Although this seems dysfunctional, it actually can promote survival in a potentially hostile social environment while an individual seeks to reconnect. We actually think that the depressive postures, vocalizations, and behavior that result from loneliness is adaptive—specifically, they may be ways to connect at a distance. I don’t have to push my way back into the group. I can sit there and cry, and look very sad, and if there are others in the setting who are willing to reconnect they are more likely to do so. If you’ve ever put your child in "time-out," you know what a strong force the child’s sadness can exert on you. These depressive behaviors, then, may have the positive effect of being a safe way to reconnect when you’ve been socially isolated. 

The paradox of loneliness

JC: I didn’t even mention all of the biologic effects that have been seen in human and animal studies. The lonelier you feel at the end of a day, the greater rise in cortisol we see the next morning. We see a change in gene expression, one of the most robust being increased inflammatory responses. In animal studies, an animal who is isolated from others and subjected to an experimental stroke shows three times greater brain cell death than normally housed animals who are subjected to the same experimental stroke. The differences in cell death appear to be due to differences in neuro-inflammation. Although there is more to do, these findings appear to be fitting together to tell an interesting story of how loneliness can lead to earlier dementia and earlier mortality through a variety of specific biologic processes which, from an evolutionary perspective, occur to increase your likelihood of short-term survival when you find yourself on the social perimeter.

Final Pop Quiz

Stephanie has rejoined the conversation, and I decide to let them go with an easy question. 

MG: If you weren’t neuroscientists what would you be?

Long pause. 

JC: Probably a mathematician.

MG: So not so far afield.

SC: Same. A physician.

JC: Steph likes to help. I don’t. I like taking things apart.

MG: Sounds like you’re doing exactly like what you want to be doing.