The future of thinking differently

An exclusive extract from Gail Saltz's forthcoming book 'The Power of Different: The Link Between Disorder and Genius'.

‘It’s not so categorical as: this is normal, this is abnormal.’

– Thomas Insel, former director of the National Institute of Mental Health and the Human Connectome Project

Thomas Insel is a psychiatrist, neuroscientist and former director of the National Institute of Mental Health, the organisation spearheading the Human Connectome Project, President Obama’s brain-mapping initiative. The project’s researchers are cur­rently scanning the brains of twelve hundred healthy people between the ages of twenty-one and thirty-five, including three hundred pairs of twins, to examine both their structural and functional wiring – as Insel describes it, ‘how brains look when they’re at rest and how they look when they’re engaged in a given activity’. 

One of their most striking findings so far is the wide variation found even among healthy brains. While cells in the heart or kidneys perform set and easily determined functions that don’t vary from human to human, the healthy human brain is not nearly so invariable. Not only can we not always successfully ascribe particular functions to particular parts of the brain, we can’t even say that brains function the same from person to per­son. This means that while medicine has been quite naturally focused on illness in the brain – looking for what might be structurally or chemically wrong with the brain with depression or schizophrenia, for example, and how to treat it – we have been operating with little or no sense of how the normal brain operates. This is akin to evaluating heart disease without knowing what a healthy heart looks like. 

Insel and the group he led while he oversaw the Human Connectome Project are just beginning to understand the delicate and mysterious in­terplay between biology and experience. ‘What we know is that experience drives connectivity in the brain. And that’s what we call plasticity. So that when you learn to play the piano or you learn to play the violin or you learn a new language, it changes brain wiring in a fundamental way, enough that you can see it in a brain scan. What is less clear is whether something about the wiring that you’re born with and which we all have also drives you towards certain kinds of experiences.’

Insel’s son is an excellent example of this interplay. Now an adult, Insel’s son was diagnosed with dyslexia as a child. In fact, his dyslexia was so severe that he needed to be in special schools starting at the age of seven. At these schools, educators realised ‘they could bang away for eight hours in a day the difference between a B and a D, and at the end of the day he still couldn’t see it. His brain could not process that. So that was inherent, right? No matter how much experience he was going to get on B versus D, that was never going to happen. It was like putting a blind person in front of a book and telling him to read it. He couldn’t see it, and he wasn’t wired in a way that allowed that.’ 

At the same time, ‘there were plenty of things that he could do really easily. In fact, there were things that probably came more easily to him than to anybody else around. He had this amazing auditory memory. We didn’t know that he was dyslexic for a long time because he could hear people read something to him and he would remember it, could recite it back, and he’d just fake it. So it wasn’t until he had to start reading in class without anybody reading it to him first that we realised he had a problem. So does somebody whose brain doesn’t allow them to distin­guish a B from a D, do they at the same time have wiring that makes it easier to do something else like memorise a poem that they hear or memorise music?’ Since the brain doesn’t work like the heart, we can’t yet point to an exact cluster of cells or pathway and say, Yes, see, that’s it right there, that’s the link between letter recognition and auditory sensitivity. But certainly in the case of Insel’s son and many of the other individuals who shared their stories for this book, the answer to Insel’s question is an arguable yes.

CREATIVITY AND THE U-SHAPED CURVE

If we accept that for some individuals with brain differences, there is a connection between deficit and asset, the next obvious question is why some are able to utilise their gifts and others are not. Studies, empirical evidence and the examples provided throughout this book show that people suffering at the extreme end of what clinicians and researchers call the inverted U-shaped curve of mental illness are not able to utilise whatever gifts might accompany their brain differences. However, those with brain differences who can function well with treatment – whether talk therapy, CBT or pharmaceutical intervention – can exhibit extraordinary creativity. These are the people in whom divergent thinking crosses over with creative thinking – with the result being greater qualitative as well as quantitative output. In an article published in Frontiers in Psychology in 2015, Rex Jung and a team from the University of Mexico performed a study of 246 people, putting them through a battery of tests for divergent thinking and creative thinking. In this case, Jung and his colleagues de­fined divergent thinking as the production of many uses or meanings for a common object or single image. They found that a higher number on the divergent thinking scale correlated with creativity. This, they argue, supports the ‘equal-odds rule’, meaning that the more ideas you have – also known as ‘higher ideational output’ – the more likely you are to be creative. On the inverted U-shaped curve, these are individuals whose brain differences allow them to produce many thoughts that aren’t just original – they’re also usable. 

Robert Bilder and Kendra Knudsen at the University of California, Los Angeles, explain the inverted U-shaped curve phenomenon in another article in Frontiers in Psychology, in which they observe that the most creative individuals are not the most well or the most ill. The most creative are often mildly ill. These are the individuals who can be diagnosed with all sorts of brain differences – like depression or bipolar disorder – who are simultaneously well treated and flexible enough to move back and forth between convergent and divergent thinking. Examples of this kind of flex­ibility can be found in a forty-year longitudinal study conducted by Swedish researchers and published in the Journal of Psychiatric Research. These researchers found that being an author ‘was specifically associated with increased likelihood of schizophrenia, bipolar disorder, unipolar de­pression, anxiety disorders, substance abuse and suicide.’ Clearly the authors who suffered from these brain differences were functioning at a level high enough to enable them to produce publishable work. More­over, these same researchers found much higher representation in scientific and artistic fields among those whose first-degree relatives had diagnosed mental illness. This suggests some genetic linkage between these brain differences and the drive and ability to be creative. That is, the kind of creativity that produces novels, musical scores, entrepreneurial ideas and scientific theories requires the ability to flip back and forth between organised and messy thinking. In the words of Bilder and Knudsen, the creative brain needs to balance at ‘the edge of chaos’.

This genetic linkage between creativity and brain differences goes to the centre of a question that has long baffled us: Despite how devastating mental illness can be, why has it not evolved out of the species, and even more to the point, why does it continue to be so remarkably prevalent? The most recent available National Institute of Health statistics estimate that 18.6 per cent of all US adults currently have a diagnosable mental illness. Given the stigma associated with mental illness, and therefore the hesitation to seek treatment, the actual statistic is likely much higher. In any case, people with diagnosable brain differences are not outliers, no matter how much we as our society might behave as if they were.

One theory for why brain differences are so common among human beings as a species is described by David Dobbs in his article ‘The Science of Success’ in The Atlantic. Dobbs summarises the work of child psy­chiatrist Tom Boyce, who coined a ‘dandelion and orchid’ theory of human behaviour. Boyce’s research suggests that, neurologically speaking, there are two sorts of people – ‘dandelions’, who flourish in any environ­ment, and ‘orchids’, who have much narrower requirements. While orchids are much more difficult to grow, when they thrive, they do so beautifully and with far more extraordinary results. Think of the examples cited in this book – people such as Matt Savage, who, when given the right audi­tory therapy and exposure to music, was able to become a musical prodigy. Without that early intervention, he might have continued to be unable to tolerate music at all. 

Our species can’t survive with only dandelions or orchids. In Dobbs’s words, ‘The behavioural diversity provided by these two different types of temperaments . . . supplies precisely what a smart, strong species needs if it is to spread across and dominate a changing world. The many dandeli­ons in a population provide an underlying stability. The less-numerous orchids, meanwhile, may falter in some environments but can excel in those that suit them. And even when they lead troubled early lives, some of the resulting heightened responses to adversity that can be problematic in everyday life – increased novelty-seeking, restlessness of attention, ele­vated risk-taking or aggression – can prove advantageous in certain challenging situations: wars, tribal or modern; social strife of many kinds; and migrations to new environments. Together, the steady dandelions and the mercurial orchids offer an adaptive flexibility that neither can pro­vide alone. Together, they open a path to otherwise unreachable individual and collective achievements.’

THE FUTURE OF TREATING BRAIN DIFFERENCES

In their article ‘Brain Disorders? Precisely’, in Science magazine, Thomas R. Insel and Bruce N. Cuthbert write, ‘Mental and substance abuse disorders constitute the leading source of years lost to disability from all medical causes.’ This cost to productivity is astounding. The cost to human life is tragic. ‘The World Health Organisation estimates over eight hundred thousand suicides each year globally, nearly all of which are a consequence of a mental disorder.’

Clearly, we need to do a better job diagnosing and treating mental dis­orders. Insel’s former colleagues at the Human Connectome Project are actively looking for more effective ways to do that – starting with the words they use to talk about mental illness. As Insel and Cuthbert write, ‘syndromes once considered exclusively as “mental” are being reconsid­ered as “brain” disorders – or, to be more precise, as syndromes of disrupted neural, cognitive and behavioural systems.’ In other words, we are moving to a more biological understanding of the brain and behaviours that result from the workings of the brain.

Insel is concerned that the way we currently describe behaviour and experience that may result from brain differences is inexact. And he looks forward to that changing. ‘When someone comes in with a hopelessness and a sense of dread and what we now would label as “depression”, we’d like to be able to ask what that really means in terms of what’s going on in their brain, what’s going on biologically, what’s going on cognitively for them? There are probably many different ways of having the symptoms. And they may require different treatments, because we know that if you take people who meet the criteria for depression, that some people respond really well to medication and some respond to therapy and some require ECT [electroconvulsive therapy].’ Currently, ‘we can’t know who’s going to respond to what. So the hope is that [in the future] using other tech­niques, just like we’ve done in cardiology, we listen to the symptoms. We take a really careful history. We do a good physical diagnosis. And then we have some sort of laboratory test or something else that tells us what is this person’s most likely cause. And that determines the intervention.’

The future of treating brain differences, according to Insel and Cuth­bert, is about ‘precision’. Once we better understand the workings of the variations among healthy brains, we can then determine the sources of deleterious brain differences in people with brain disorders. These treat­ments range from what sounds genuinely cutting edge, such as deep brain stimulation, to cognitive behavioural therapy. The learning curve for this will be very steep. We currently understand very little about the natural variation even in healthy brains. But now that we know where we’re look­ing, and resources – financial as well as intellectual – are being applied to the task, we’re beginning to progress at a faster pace than ever before.

Harold Koplewicz, founder and director of the Child Mind Institute, is undertaking a study of the functioning of children’s brains even larger than the Human Connectome Project’s scanning of adult brains. Using MRI and other technology that didn’t exist even a decade ago, their ulti­mate goal is to observe the resting brains of ten thousand children and young adults between the ages of five and twenty-one, while looking for ‘patterns of connection’. One significant difference between the Child Mind Institute’s study and the Human Connectome Project is that Kople­wicz is looking primarily at children and young adults with diagnosed brain differences. Each study participant receives an EEG and functional MRI as well as psychological testing by licensed clinicians, a stress test and an evaluation of nutritional status and genetic history. The result will be the largest repository of data on the developing brains of children with mental illness and learning disabilities.

The sheer number of scans being performed by Koplewicz and his team enables them to draw conclusions that weren’t possible before now. For example, ‘we [now] know that as a group, there’s a certain pattern of connection in kids with ADHD [attention deficit hyperactivity disorder] versus a group of kids who have ADD [attention deficit disorder without hyperactivity].’ Given the largeness of the sample, it’s Koplewicz’s hope that eventually they will be able to see different patterns of connection among children who present with subtle differences and yet share a diag­nosis, or alternatively, who share symptoms but different diagnoses. So, for example, they might be able to see how the child with ADHD who also has social anxiety differs from the child with autism spectrum disorder who is also stressed by engagement with strangers. Already they’ve deter­mined differences in how the dyslexic brain reads text, even once treated. ‘When you look at a dyslexic reader they underactivate the left side of their brain. Then when you remediate them with a multisensory approach, they activate both sides of the brain,’ the way someone would read a second language. ‘And so they’re not reading the way you and I would read. We’ve taught them to use another part of their brain.’ 

Time will tell what else Koplewicz and his team discover, but for the time being he is a strong believer that there are two factors that distinguish high-performing people with brain differences from those who perform less well: IQ and environment. And of these two, he considers environ­ment the most important. ‘I love the epigenetics of this, and I think that’s the difference between one dyslexic and another. You know, IQ is certainly part of it, but it’s the environment that put crayons and pastels in [cele­brated artist] Chuck Close’s hands even though he [grew up dyslexic and in impoverished circumstances].’

HOW PEOPLE WITH BRAIN DIFFERENCES CAN FLOURISH 

As Tom Insel noted, the most extraordinary finding so far in the Human Connectome Project is that there is a massive amount of variation among human brains – even those considered typical. ‘We are moving to a more dimensional approach trying to understand certain domains of func­tioning and thinking about how people are arrayed across these do­mains in a dimensional way. It’s not so categorical as: this is normal, this is abnormal.’

Perhaps the very phrase brain difference is a redundancy. All of us have differently functioning brains, and therefore, what produces creativity of all types may also vary wildly. It’s up to us as individuals, clinicians, re­searchers, educators, parents – and as a society – to find and support the creative spark.

Whether we are considered mentally healthy or we have a diagnosed brain difference, the key to a positive identity is to find a way to feel pro­ductive. As important as it is to identify and treat weakness, it’s equally important to identify and encourage strength – particularly in the early years when our brains are at their most plastic.

Imagine how different the experience of a child with dyslexia might be if, rather than focusing on their inability to read at the same pace as their peers, we sought out what they might be exceedingly good at? Imagine how much less the stigma of a learning disability might be if a child’s iden­tity could be geared towards a particular strength that could be cultivated? In a school setting, the educator might sit down with the child at an early stage and say, ‘Look, this is difficult for you. We’re going to try to help you figure out work-arounds for this. But at the same time you have this incredible strength. And here are ways in which you can pursue that.’ In­stead, too often, parents feel crushed by diagnoses that feel dooming, and children feel broken because they don’t fit the mould.

Scott Barry Kaufman, scientific director of the Imagination Institute in the Positive Psychology Center at the University of Pennsylvania, is par­ticularly critical of the formulaic approach to educating children. ‘I don’t think we need these standardised hoops. I don’t think we’re offering a lot of value. I mean, what do we want to say? Do we just want good students or good learners? Or do we want creators? I think we’ve really left behind the creators. I’m a big fan of project-based learning. And perhaps if a parent does feel as though their child is being neglected by the school system, [I would suggest they ask,] “Is it okay if he does a project that incorporates more of what he does love?” And if they say, “No” to that – then say, “Is there some way that we can pair him up with a mentor or someone within this field so that he can work on a meaningful project?”’ In fact, Kaufman works with an organisation called the Future Project that helps match students and mentors in just that way. ‘To me that would be a great way forward,’ he says emphatically.

Kaufman envisions a move away from being good at everything – as students in our test-heavy educational environment are currently expected to be – and towards one that focuses on developing expertise. ‘The more you are solely or obsessively focused on learning a particular domain of knowledge, obviously the expertise is going to be acquired. [That] can be very conducive to creative achievements, because you’re constantly think­ing about problems. You’re very detail oriented and focused. And it’s that intense focus that you see in most great creators.’

Scott Barry Kaufman’s vision, although rooted in brain science, is still only a hopeful future. Our current educational system is focused on having children spend the majority of their time on what doesn’t work for them, rather than what does. This is why we drill the child with dyslexia to read with the same fluency as the non-dyslexic child. This is why we press children with autism spectrum disorder to engage with subjects and situ­ations that they find distasteful and uninspiring. This isn’t to say that we shouldn’t want all capable children to function well in the larger world. But that doesn’t mean they should all function in the same way. That ex­pectation of sameness is why the school years can be such a torture for so many children with brain differences. 

With the help of involved caregivers and understanding educators, our children can make it through the torturous years of lower education and spread their wings when allowed to focus on what they love. For other children and young adults, though – who lack resources at home and perhaps even an accurate diagnosis – success lies on the other side of an impassable brick wall. This is a loss to all of us.

There are alternatives to building that wall. 

Intro

• Seek evaluation and diagnosis – early intervention can make all the difference in overcoming and remediating symptoms.

• Lead with strengths – talk to children about their abilities and how they might hone them.

• Avoid drilling weaknesses – use the 80-20 approach: 80 per cent of time spent on strengths and 20 per cent on weaknesses.

• Encourage and allow more play time and provide more oppor­tunities for children to immerse in their particular passions.

• Enlist the help of educators – speak to teachers about children’s strengths and ask for help in allowing children to show and develop them.

For ourselves we can:

• Consider neuropsychological testing to find our particular areas of strength.

• Find and devote ourselves to the right combination of self-care and treatment – from exercise and proper nutrition to talk ther­apy and prescribed medication.

• Seek out work options that play to our strengths and consult a career counsellor to help identify opportunities.

As a society we can:

• Appreciate the enormous potential of those with brain differences. Examples are all around us.

• Stop shaming those who are in the struggle, and banish words such as crazy and nuts from our speech.

• Talk about brain illnesses openly, as we would any other illness.

• Encourage an emphasis on creativity and expertise versus testing in our schools.

• Foster the pursuit of strengths in hiring and workplaces.

• Apply research funding to gaining a better understanding of brain illness – commensurate with its prevalence and impact.

Based on my twenty-three years of treating patients, extensive analysis of the geniuses of the last several hundred years, and discussions with my expert colleagues across the fields of medicine and the most cutting-edge neurological sciences, I am convinced that there is something special about the brains of those struggling with mental illness that also yields some of the most astounding and beautiful achievements. I think this is an enor­mously positive and encouraging message for the nearly 50 per cent of people who will develop at least one mental illness during their lifetime. As so many of the accomplished people I’ve interviewed for this book have illustrated, a high-functioning brain is not the same thing as a tidy brain. A great deal of brilliance and creativity is sparked in brains that might be described as a bit messy.

The ability to find the unique strengths in our messy brains is what separates those of us who achieve from those of us who are held back by our differences. Sometimes what’s holding us back is the society around us. The stigma of mental illness is deeply damaging and defeating. People with mental illness are often seen strictly through the lens of their deficits and weaknesses rather than their gifts and strengths. In fact, these gifts and strengths are why brain differences have persisted in our genetic make-up: such differences can confer an evolutionary advantage.

As a result of our current wholly negative take on mental health problems, most parents delay taking their children for evaluation and treatment, which serves not only to delay and amplify the weaknesses children experience, but also to hinder identifying their strengths. The same is true for adults. The stigma associated with acknowledging to yourself that you have a mental health issue delays your getting treat­ment to prevent the associated suffering, and can overshadow the unique abilities that are a byproduct of your brain’s wiring.

What does this mean for you, your family and your children? The people who fare best are those that get early treatment, thereby preventing illness from overtaking their strengths. Educate yourself on the signs and symptoms of mental illness and learning disability. When a problem starts to interfere with your or your child’s ability to function well, get an evalu­ation and follow through on a treatment plan.

As recommended by Kevin Pelphrey, director of the Child Neurosci­ence Laboratory at the Yale School of Medicine, most of our and our children’s time should be spent on discovering, engaging with and honing our particular strengths. Much less time should be spent on treating our relative weaknesses – he recommends an eighty-twenty split of time. On a case-by-case basis, prior to settling into such a split, psychiatric treatment (medication and/or therapy) might be needed. Once symptoms have been regulated to some extent, occupational therapy, or tutoring in a specific skill set such as executive function, might be recommended. Spend time exposing yourself and your children to opportunities to find what lights their fire and where their strengths arise. Astrophysicist and author Neil DeGrasse Tyson, who has taught children and adults of all abilities and interest levels to love science, told me that one of the most important things his parents did for him as a child was exposing him to a wide range of fields and disciplines such as art, music, dance and science – everything and anything that could engage his interest and his aptitudes. He didn’t always desire to attend every event, but it was this exposure that he found allowed him to stumble on his passion for astronomy and stirred his mind to think creatively. In his opinion, this diverse exposure is important for all children. In my opinion, this is especially so for children with brain differences.

Whether you are struggling with illness yourself or your child is, remember that treatment does not diminish your strengths. Treatment allows you to make the best use of those strengths, to employ them unen­cumbered by the disruptive nature of the symptoms that hamper your functioning. Had Vincent van Gogh been treated, he would still have been a profoundly brilliant painter, but he likely would have lived a longer life with far less suffering. Without the unique wiring of his brain, though, it is unlikely we would ever have seen such a starry, starry night. Anthro­pologist Emily Martin and legal scholar Elyn Saks could not perform at the exceptional level they do if it weren’t for judiciously prescribed medications to treat their bipolar disorder and schizophrenia (respectively). And yet even while medicated they are able to draw on the richness of experi­ence and divergent thinking that their brain differences afford them.

Accepting and embracing our differences is the way forward – for all of us, diagnosed or undiagnosed, parent, clinician, educator or child. We can choose this way forward, or we can turn away from it. We already know the cost of the path we’ve been on, both to our families and our com­munities. The better way is to launch ourselves forward with all the passion, creativity, grit and determination that so many people with brain differences exhibit so inspiringly in their daily lives.

I have been changed by the stories of adversity and the finding of po­tential the many people in this book were willing to be vulnerable enough to share with me. What amazes me most is the children who in many ways have more of an ability than adults to seek out their spark and run with it. All of the children I spoke to felt they would never give up their ‘disabil­ity’ because intuitively they know it is part and parcel of their spark. They inspired me with their capacity for self-reflection and their striving to make meaning of their struggles and strengths.

I have been struck by the enormous discrepancy between how cele­brated the geniuses I’ve studied and spoken about have been and continue to be and how terribly they have suffered in their actual lives. The suffer­ing came not only from their illnesses, but very much because they felt rejected by others for being different. As a result they were isolated and lonely, often devoid of real and loving relationships and contentment in their lives. They changed our worlds for the better with their art, their music, their scientific discoveries – but their own worlds remained bleak because they were devoid of the warmth and comfort of acceptance by others. Lacking in the kind of understanding we can grasp today, society shunned many of them. And while their spark enabled them to create history-altering innovations, this societal rejection caused them to emo­tionally wither and experience great misery. The origin of the tortured artist evolves not just from the effects of illness, but from the effects of our reactions to illness and difference.

My hope is that by understanding brain differences and the package of wiring that produces suffering but also unique strengths, we can all ap­preciate and accept the person who contains that package. Every brain and every life holds potential. Squashing that potential by dismissing those out­side some standard mould is not only cruel on an individual level, it is a sad waste on a societal level. Armed with the knowledge of how to treat and manage the differences that cause suffering and knowing how to best mine the potential that accompanies those differences, we can not only increase the genius output of many but also enhance the quality of life for many millions.

My multi-year journey spent researching this book began with ques­tions and observations that sprouted from my personal and professional lives. My fascination with the origins of genius started long ago growing up with a younger brother who endlessly questioned everything and anything. His dogged curiosity and pursuit of answers as a kid made me wonder what was up in that mind of his. Why was he always asking ‘Why?’ And why did he always remain tenacious in his pursuit of the answers to his questions to such an extreme? Why did he break open his toys to see how they worked, even though they would then be broken for good? Why were our minds similar and yet different? It seemed to me that his passion for understanding was clearly always a standard or two of deviation off the curve. It fascinated me, and it still does. When as kids we looked up at the night sky, he wondered how it could be that the light we were viewing from the stars was actually light given off millions of years ago from a star that perhaps no longer even existed. He never gave up looking for answers. In 2011, he received the Nobel Prize in physics at age forty-one, becoming one of the youngest recipients ever, for his discoveries about the accelerating universe and dark energy. I grew up with a genius and then went on to make a career in studying and helping people with brain differences. In my many years of practice I have treated a number of extraordinary people who suffered mightily yet found the power in their differences, and their particular spark of genius. Like my brother, I have been driven by curiosity. So often, I witnessed this coexistence of unique ability side by side with disability. We are just starting to unlock the mys­teries of the brain. Only by doggedly asking ‘why?’ will we discover our own potential for strength in the face of weakness.

- A Clinical Associate Professor of Psychiatry at The New York Presbyterian Hospital/Weill-Cornell School of Medicine, Dr Gail Saltz is a psychoanalyst, columnist, bestselling author, television commentator, and contributing editor for Health magazine. Her book 'The Power of Different' will be published by Little, Brown Book Group (on the Constable imprint) in March 2017. This extract is reproduced with kind permission.

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