Beginning with the question: “What happens when our minds feel as though they’ve been hijacked by something we cannot control?” p6, this book presents a mechanism to understand emotional and mental illness ranging from anxiety and depression to addiction and schizophrenia. Underlying is the idea that all of these experiences have a common underpinning. The DSM provides labels to symptoms, but does not suggest any underlying explanation, though psychiatry is currently itself captured by the notion that mental illness is due to imbalances in neurochemistry (see for example, Shrinks: the untold story of psychiatry by Lieberman).
“We have the DSM-V, which we use to diagnose and classify hundreds of mental disorders. And yet the biology is suggesting that these disorders are related. It’s no longer that schizophrenia is completely different from depression-it looks very much as if there’s this spectrum that’s interrelated rather than separate neurotransmitter system diseases. And the drugs, wonderful as they may be, are not so precisely targeted as is often claimed. We see one drug working for a variety of problems-or not working. It seems to be often largely a matter of individual response. There is also the growing evidence of the huge placebo effect in psychoactive drugs, which is , or ought to be, humbling.” (quoting Bunney, p16). Later Kessler warns: “For the past thirty-five years, psychiatry has based its diagnostic categories on patients’ symptoms. Over time, the name attached to a given cluster of symptoms has become accepted as explanations as the cause of the patient’s suffering. Consequently, these labels , such as ‘bipolar disorder’ and ‘depression’, have been accepted as explanations rather than descriptions. Unfortunately, such confusion has deflected attention away from the crucial link between psychological pain and brain function” p119
Advances in neuroimaging is changing our understanding of how the brain responds to external and internal stimuli, “But while we can view the brain with much greater accuracy, our emotional lives cannot be reduced to a single neurobiological function or theory.” P35
“Capture arises from a vast and complex circuitry in the brain…Every time we experience something new, a neural pattern…is created in response. Over time, those neural patterns become associated with anything that evokes that experience. p36-37 Hebb’s rule: neurons that fire together wire together. The nervous system responds to both external and internal triggers, so even our thoughts and feelings can evoke or reinforce previously laid down circuits. Top down circuits play a role in decision making and most parts of the brain are involved in this processing. Bottom up processing is involuntary and automatic and serve to reorient our attention. “There is a close interaction to attention…and working memory, which allows us to use that information…When we pay attention to something, it is more likely to remain in memory. Conversely, if something remains in our working memory, there is a greater chance we will pay attention to it.” P40 “Whatever we are paying attention to at a given moment(whether it’s an external stimulus, such as food, or an internal stimulus, such as self-doubt or regret) initially resides in working memory. Over time, unless a competing goal redirects our attention, our response eventually becomes so instinctive that our brains no longer mobilize to create a new or different reaction. Our response becomes automatic-and when our response is discordant with our conscious intentions, we begin to feel as if we’re losing control. This loss of control is a key feature of capture.”…”A good deal of new learning is implicit, meaning it is so subtle as to be imperceptible to the conscious mind.” [this is what underlies the ‘hidden curriculum’ in medicine]. “This is how we come to develop patterns of behavior and emotional response without ever being aware of their taking hold.”p41
Neural stimuli may have salience, meaning they stand out from other features in the environment due to their ability to stimulate the nervous system. They can become associated with other stimuli that may be relatively neutral, but subsequently the two (or more) become associated with one another. “The areas of the brain that register salience are the same areas, or connected to the areas, that register physiological changes, such as increases in heart rate and skin temperature.”p42 There is salience in bright colors, shape, motion and novelty (think here of the way that video games capture attention, which oddly, isn’t discussed in this book, but given its effects on young brains, especially young males has great implications for society). There is also salience in powerful desires, goals, attitudes toward adversity or opportunity and major life events. The valence of salient stimulus refers to whether the emotional content is positive or negative.
Capture, as described in this book, is the same as attractor behavior in the science of complex adaptive systems.
The greatest part of the book is given over to many case examples including well known figures: David Foster Wallace; Tennesee Williams; William James; John Belushi; Sylvia Plath; Virginia Woolf; Ernest Hemingway, as well as many anonymous individuals. These chapters illustrate the extremes to which capture can lead, but I often felt that the link to the elements of the concept of capture could have been made more explicit. Nevertheless, these sections of the book are well written and very interesting.
Kessler also discusses that capture doesn’t only lead to mental distress. It is also is part of positive activity including artistic endeavors, scientific work, spiritual development etc. Where problems arise is when it becomes so strong that we become rigid in our responses and then trapped.
Does this new way of looking at mental distress lend itself to therapeutic approaches? Kessler addresses the role of meditation and mindfulness in making ourselves aware of the tendencies toward capture in our lives. There is an interesting interview with a psychotherapist that (Danielle Roeske) who cautions that complete permanent freedom from capture is not realistic. It is more acceptable as a way of thinking how we grow and develop as individuals. “…when people go through a transformation of how they experience themselves, it’s not uncommon for their sense of their history to be rewritten as well.”p263 This is the basis of narrative based therapy. She also goes on: “Gathering the courage to change is perhaps one of the more difficulty parts of transformation, as it requires a deliberate leap into the unknown…To say that such an act requires a gesture of faith seems to put the care before the horse. Faith is what follows after the new experience has been had, while is the quality that comes before it.” P263. This reminds me of Needleman’s point that perhaps the most important role of the clinician is to provide hope to the patient (see The Way of the Physician).
Kessler finishes the book by once again, referring to the stories we tell of our own lives; the salient features that we put together to construct a narrative. Capture helps us make sense of an otherwise chaotic world, and there is no freedom from it completely. There is, however, within our reach, a more modest form of autonomy. “By becoming aware of the ways in which we deploy our attention, we may even develop a beneficial flexibility of mind, one that allows us simultaneously to tell varied, sometimes even contradictory stories.”
“We can influence this process not by accepting a static diagnosis, such as ‘anxiety’ or ‘depression’, but by actively changing what occupies our attention.” P267
“The power to will, however, is not enough to sustain change. The challenge is to draw strength from something other than mere self-discipline-or condemnation. Lasting change occurs when we let go of such isolating pressures and allow ourselves to feel support and connection instead of preoccupation with the self. This transformation of the self often occurs through sacrifice, service, love, belief in a cause or membership in a community”p267
The book has extensive end notes and references and these contain a number of long essays that are very useful. Putting these at the end make reading the text easier while providing a wonderful resource for more reading.