Is Schizophrenia a Network Disorder? Researchers Weigh in …

This is just a brief note that Dialogues in Clinical Neuroscience 2013; 15(3)focuses on Static and Dynamic Imaging: Clinical and Therapeutic Implications. The issue includes an overview by Olaf Sporns, author of Networks of the Brain(MIT, 2010) and Discovering the Human Connectome (MIT, 2012).

In particular, three papers might be of particular interest to this community on (1) schizophrenia and effective connectivity (Birnbaum, Weinberger); (2) schizophrenia and and abnormal brain network hubs (Rubinov, Bullmore), and (3) the default mode network and psychosis (Buckner). Abstracts for the three papers and links are pasted below. NB: Olaf Sporns was recently interviewed in Brain Science Podcast re the connectome (link to audio file).

Functional neuroimaging and schizophrenia: A view towards effective connectivity modeling and polygenic risk

Rebecca Birnbaum, MD ; Daniel R. Weinberger, MD

We review critical trends in imaging genetics as applied to schizophrenia research, and then discuss some future directions of the field. A plethora of imaging genetics studies have investigated the impact of genetic variation on brain function, since the paradigm of a neuroimaging intermediate phenotype for schizophrenia first emerged. It was initially posited that the effects of schizophrenia susceptibility genes would be more penetrant at the level of biologically based neuroimaging intermediate phenotypes than at the level of a complex and phenotypically heterogeneous psychiatric syndrome. The results of many studies support this assumption, most of which show single genetic variants to be associated with changes in activity of localized brain regions, as determined by select cognitive controlled tasks. From these basic studies, functional neuroimaging analysis of intermediate phenotypes has progressed to more complex and realistic models of brain dysfunction, incorporating models of functional and effective connectivity, including the modalities of psycho-physiological interaction, dynamic causal modeling, and graph theory metrics. The genetic association approaches applied to imaging genetics have also progressed to more sophisticated multivariate effects, including incorporation of two-way and three-way epistatic interactions, and most recently polygenic risk models. Imaging genetics is a unique and powerful strategy for understanding the neural mechanisms of genetic risk for complex CNS disorders at the human brain level.

Schizophrenia and abnormal brain network hubs

Mikail Rubinov, MBBS, PhD; Ed. Bullmore, MBBS, PhD, FRCPsych, FMedSci

Schizophrenia is a heterogeneous psychiatric disorder of unknown cause or characteristic pathology. Clinical neuroscientists increasingly postulate that schizophrenia is a disorder of brain network organization. In this article we discuss the conceptual framework of this dysconnection hypothesis, describe the predominant methodological paradigm for testing this hypothesis, and review recent evidence for disruption of central/hub brain regions, as a promising example of this hypothesis. We summarize studies of brain hubs in large-scale structural and functional brain networks and find strong evidence for network abnormalities of prefrontal hubs, and moderate evidence for network abnormalities of limbic, temporal, and parietal hubs. Future studies are needed to differentiate network dysfunction from previously observed gray- and white-matter abnormalities of these hubs, and to link endogenous network dysfunction phenotypes with perceptual, behavioral, and cognitive clinical phenotypes of schizophrenia.

The brain’s default network: Origins and implications for the study of psychosis

Randy L. Buckner, PhD

The brains default network is a set of regions that is spontaneouslyactive during passive moments. The network isalso active during directed tasks that require participantsto remember past events or imagine upcoming events.One hypothesis is that the network facilitates constructionof mental models (simulations) that can be used adaptivelyin many contexts. Extensive research has consideredwhether disruption of the default network may contributeto disease. While an intriguing possibility, a specificchallenge to this notion is the fact that it is difficult toaccurately measure the default network in patients whereconfounds of head motion and compliance are prominent.Nonetheless, some intriguing recent findings suggestthat dysfunctional interactions between front-oparietalcontrol systems and the default network contributeto psychosis. Psychosis may be a network disturbance thatmanifests as disordered thought, partly because it disruptsthe fragile balance between the default network andcompeting brain systems.

A Very Brief Introduction: Resting-State Brain Connectivity

Some of the speakers at our forthcoming winter workshopon psychosis for CBD/CBDMH affiliated faculty and students will be talking about, or have an active research interest in the brain’s resting state activity, including Steve Lopez and Mary Helen Immordino-Yang, Georg Northoff, and Suparna Choudhury.

I thought I’d post two videos (a very short, fun intro submitted as part of an SFN competition in 2011) and a 2013 talk by Thomas Liu (Director, Center for Functional MRI; Professor, Departments of Radiology and Bioengineering, UCSD).

“A Brief Introduction to the Default Mode Network”

 

 

“Resting-State Activity and the Human Connectome”

Lessons from Ten Years of Mixed Methods Graduate Training at UCLA

Screen Shot 2013-12-18 at 6.06.58 PMIn May 2012 I attended the 10th reunion of the the FPR-UCLA CenterforCulture, Brain, andDevelopment, whichwas founded in 2002 to foster interdisciplinary research and training at the graduate and postdoctoral level at the intersection of culture, social environment, and human brain development. The meeting included CBD alumni and current trainees as well as CBD faculty, including MirellaDapretto (Neuroscience), PatriciaGreenfield (Developmental Psychology), JohnSchumann (Applied Linguistics), and TomWeisner(Anthropology). Below is a repost of a summary I wrote after the meeting.

Meeting Summary

Eighteen creative young social scientists shared experiences and insights, as well as the latest data and observations from ongoing research projects involving mixed methods. Particularly notable over the course of two days was the frequency with which CBDers described how the program has contributed to both a broader and deeper grasp of research topics and issues and a concrete set of skills (in, e.g., qualitative ethnographic research, quantitative/statistical analysis, measuring biomarkers, and performing imaging studies) that has enhanced their understanding and opened doors to participating in collaborative interdisciplinary projects in a variety of research settings around the world.

But the group also discussed the realities of interdisciplinary research the complexity of integrating levels of analysis (particularly brain research) and the technologies involved, difficulties publishing interdisciplinary work or obtaining funding for research projects, and current job market prospects for interdisciplinary academics. The meeting ended with a resolution to create more space and opportunities for past and present trainees to both advance and promote their work to others as well as to communicate with and support one another given that boundaries between disciplines like psychology, anthropology, and neuroscience are likely to recede even further over the next decade.

The CBD program has not only benefited students in terms of exposing them to interdisciplinary research training, but also UCLA faculty, said MirellaDapretto, CBD director, in her opening remarks. I can say that I would not have collaborated with some of my colleagues here at UCLA had it not been for the students who brought CBD faculty together, as well as the opportunity of attending CBD events and teaching the interdisciplinary seminar. CBD has offered its trainees many unique benefits, she continued, including mentoring by faculty members from different disciplines, the gift of time in terms of not having to TA every single quarter, and research awards, which have allowed students to travel to different field sites, to perform imaging studies, and to conduct many kinds of quantitative and qualitative research. None of this would have been possible, Dr. Dapretto ended, without the vision ofFPR founder, UCLA anthropologist, and documentary filmmakerRobertLemelson.

PatriciaGreenfieldalso extended a warm welcome to the former and current trainees who represent all five of our participating PHD programs anthropology, neuroscience, applied linguistics, education, and developmental and clinical psychology. Students working with an interdisciplinary team of mentors have created not one paradigm but many creative paradigms for investigating multiple intersections of culture, brain, and human development. She said that because of CBD weve had psychology students going into the field in Mexico, Burma, and Korea. Weve had anthropology students doing child development research, weve had applied linguistics and education students doing neuroscience research; and neuroscience students doing cross-cultural and developmental research. Without CBD and FPR this would never have happened. CBD alums are all over the world, she continued, from Paris, Singapore, Jerusalem and Germany to Michigan, Berkeley, Hawaii, Carnegie Mellon, Delaware, UCLA, USC, and the Cal State system.

Dr. Greenfield described CBDers as leading the way in developing new research and new theoretical paradigms along with fellow students and alumni of similar programs at Emory University (biocultural anthropologist Ryan Brown and neuroanthropologist Daniel Lende are alumni), University of Michigan’s Center for Culture, Mind, and Brain(several CBDers have attended Shinobu Kitayama’s Summer Institute in Cultural Neuroscience)and McGill University’s Division of Social and Transcultural Psychiatry, where social neuroscientist Suparna Choudhuryof McGill, who is co-founder of an interdisciplinary project on cultural neuroscience, was a postdoc.

After a brief introduction by FPR board member Steve Lopez, human development psychologist and affective neuroscientist MaryHelenImmordinoYang of USC gave a stimulating keynote presentation (Embodied brains, social minds: Neurobiological correlates of emotion experience in Beijing and Los Angeles) that exemplified the kind of mixed-methods, cross-cultural comparative and experience-near research that is being nourished by the FPR and the CBD programs. The data included physiological correlates, imaging studies, and interviews that are sensitive to contextual effects and personal experiences, all related to the processing of emotions. Then, from mid-morning to mid-afternoon, CBD alumni and students gave brief (8 minute) overviews of their work and, frequently, some overall perceptions of the training program.

The themes of of work by current grad students and alums included caregiving practices, language, and social and emotional development from a cross-cultural comparative perspective that brought several different strands of research together.

For example, former CBD postdoc MonikaAbels (now a postdoctoral researcher atMaxPlanckInstituteforOrnithology)described her research on culture and nonverbal communication between infants and caregivers in India and Germany, including the relationship between socioeconomic status and social communication, using a variety of methods observations, videos, interviews, questionnaires, as well as early social communication scales.

Others work focused on atypical development. KristenGillespieLynch (College of Staten Island), explored the relationship between deficits in early responsiveness to social stimuli like joint attention and autism. In addition she studied the relationship (and tensions) between two emerging cultures of autism: one centered around the medical model, the other around the neurodiversity movement.

CBD alum/cultural developmental psychologist AdrianaManago, who accepted a tenure-track position at Western Washington University, described her mixed method research on gender and sexual socialization, for example, how cultural changes have shifted gender and sexual development in the US and Chiapas, Mexico.

The last session of the day featured two documentary films by psychological anthropologist RobertLemelson, who has amassed an extraordinarily rich body of ethnographic film work on culture, development, and mental illness that focuses on the same individuals and families living with psychological trauma, psychotic disorder, depressive illness, grief, and gender-based and political violence over the course of several years.

The first film, Ngaben: Emotion and Restraint in a Balinese Heart, which was shot in three days, captures the dark currents of a sons grief and feelings of regret that underlie his participation in a colorful and festive ngaben, or Balinese cremation ceremony, which is being conducted in his fathers honor. The second film, Standing on the Edge of a Thorn, follows a family in rural Indonesia over ten years (mostly from the perspective of the couples young daughter), as they struggle with poverty, mental illness, and severe social stigma stemming from the couples unmarried status and the wifes participation in the sex trade. The films provided a basis for a wonderful discussion, which ranged from the technical and ethical aspects of ethnographic filmmaking to morality, suffering, and the importance of recognizing the full complexity of persons and the porous boundaries between persons outside laboratory settings.

Lessons Learned

The group reconvened Saturday morning for a panel on interdisciplinary research and professional development. CBD and UCLA have led the way in terms of institutionalizing a method of doing interdisciplinary research compared to other universities, according to David Frederick and other CBD alums. The program has the advantage of teaching students mixed methods, a skill set that Tom Weisner predicted will be in much demand during the next decade. It also gives trainees a birds eye view of a particular research topic or theme. CBD additionally offers trainees the possibility of interacting with a wide mix of students and faculty and creating projects they otherwise could not have undertaken. Another advantage Steve Lopez pointed out is that the novel insights which emerge from this kind of experimentally rigorous, interdisciplinary research frequently serve to advance knowledge or otherwise benefit the home discipline, in which case disciplinaryinterdisciplinary research may be best viewed as a continuum, he added. And in fact some of the most compelling work we heard about the day before illustrated how different factors that emerge at different levels of analysis interrelate.

But the group also discussed some common predicaments that seem to revolve around the fact that quite frequently different disciplines (or subdisciplines) aren’t mutually intelligible. (But as, Tom Weisner wrote in a post for Anthropology News, the lingua franca is understanding each other’s methods and research designs rigorous training at the graduate level in mixed methods can achieve fluency in a second and even third language.) Many agreed that while it is possible to publish interdisciplinary studies in mainstream journals (as long as you understand the concerns of a particular discipline and position your paper accordingly) it is much harder to get funding, particularly from the government and particularly given the difficulty of operationalizing culture for grant submissions. (Tom Weisner suggested coming up with two, three, or four features that should be included in any attempt to invoke culture as part of a mental health study rather than one all-purpose definition.)

Overall, the consensus appeared to be that trainees should be able to leave CBD and related programs with (1) a well honed set of skills (as Dr. Dapretto observed, its important to make interdisciplinarity a glaring strength on CVs); (2) a good knowledge of or even relationship with other centers doing cross-cultural research (making this even more of a collective process); (3) a good understanding of where this research can be published, including developing relationships with journal editors, colleagues who serve on editorial boards, and colleagues to suggest as reviewers. (As DonFavareau noted, until interdisciplinarity gets a foothold in publishing, young researchers in particular will be at a disadvantage by pursuing it. On the other hand, as Tom Weisner noted, editors in particular are under pressure to increase impact factors, and frequently the most downloaded papers are those that have a broader constituency); and finally (4) a solid funding strategy (again, this requires ongoing efforts to educate funding agencies about the benefits of interdisciplinary research).

An immediate outlet for this group is the newly launched open access BrainandBehaviorjournal, which is published by Wiley Open Access (CBD alum KristinMcNealy is managing editor). As one of the participants remarked, the journal, which is open to empirical and theoretical articles linking brain and behavior to cultural and social environment, is (like CBD) clearly the wave of the future.

References

Yoshikawa, H., Weisner, T.S., Kalil, A., Way, N. (2008). Mixing Qualitative and Quantitative Research in Developmental Science: Uses and Methodological Choices. Developmental Psychology 44(2): 344354.


DSM-5 and Culture: A Significant Advance

[A]llforms of distress are locally shaped, including the DSM disorders.

DSM-5 (APA, 2013, p. 758)

The fifth edition of theDiagnostic and Statistical Manual of Mental Disorders(DSM-5; APA, 2013) was finally presented on May18that the American Psychiatric Associations annual meeting in San Francisco. Much ink has been spilled in the media about the ten-year process leading up to last month’sunveiling. But there has been virtually no mention of the fact the DSM-5 is avast improvementin its treatment of culture.It reflectsa much more inclusive description of the range of psychopathology across the globe, not just the particular constructs or exemplars most commonly encountered in the US, Western Europe, and Canada. I think the cultural component of DSM-5 has the makings of a model on which subsequent versions of the manual should be based.

What follows is a summary of a few talks that were given at theannual meeting of the Society for the Study of Psychiatry and Cultureon May 35 in Toronto outlining the changes.

According to cultural psychiatristRoberto Lewis-Fernndez(Columbia University), including information on cultural concepts of distress in DSM-5 will enhance the validity and clinical usefulness of diagnostic practice” across the board. Lewis-Fernndez began his talk by briefly describing the limitations of DSM-IV-TR, which listed twenty-fiveculture-bound syndromes” in an appendix. The use of the term culture-bound made these conditions appear highly localized and confined, a cabinet of curiosities. The list was also heterogeneous, Lewis-Fernndez continued, some syndromes, includingnervios, seemed to represent specific situational predicaments, or variations in the way people express their distress, rather than coherent collections of symptoms. Other expressions, such asataque de nervios, are syndromic, but do not always represent psychopathology. Still others (likeshenjing shuairuoor neurasthenia) appeared to be a cover term for several common, but seemingly unrelated, human ailments (e.g., fatigue, dizziness, headache, GI problems, sexual dysfunction, excitability); another group of conditions simply defied DSM categorization, such asmal de ojo(evil eye).

Under the direction of Kimberly Yonkers and Lewis-Fernndez, chair and co-chair respectively of theGender and Cross-Cultural Issues Study Group,DSM-5 is a vast improvement. The new volume is divided into three sections Section 1: Introduction (DSM-5 Basics);Section II: Diagnostic Criteria and Codes;Section III: Emerging Measures and Models and anAppendix, which includes a Glossary of Cultural Concepts of Distress. Section III includes a chapter on cultural formulation, featuring an updated version of the outline introduced in DSM-IV as well as an approach to assessment, using the Cultural Formulation Interview (CFI). The chapter also includes a section discussing Cultural Concepts of Distress (pp. 758759).

As Lewis-Fernndez explained, the notion of culture-bound syndromes has been replaced by three concepts: (1)cultural syndromes: clusters of symptoms and attributions that tend to co-occur among individuals in specific cultural groups, communities, or contexts . . . that are recognized locally as coherent patterns of experience (p. 758); (2)cultural idioms of distress: ways of expressing distress that may not involve specific symptoms or syndromes, but that provide collective, shared ways of experiencing and talking about personal or social concerns (p. 758); and (3)cultural explanations of distress or perceived causes: labels, attributions, or features of an explanatory model that indicate culturally recognized meaning or etiology for symptoms, illness, or distress (p. 758).

Lewis-Fernndez used depression as an example of a cultural concept. For western clinicians, major depressive disorder (MDD) can be considered a syndrome, or cluster of symptoms that appear to hang together. But depression can also be considered an idiom of distress, in the sense that westerners commonly talk of feeling depressed in everyday life. Finally, the label depression can imbue a set of behaviors with a particular meaning. No single concept maps onto a specific psychiatric disorder, and, conversely, no single psychiatric disorder (e.g., MDD) maps onto a cultural concept (e.g.,nervios). In all, the glossary lists nine of the best-studied concepts of distress around the world ataque de nervios(attack of nerves),dhatsyndrome (semen loss),khyl cap(wind attack),kufingisisa(thinking too much),maladi moun(lit. human caused illness),nervios(nerves),shenjing shuairuo(re-glossed as weakness of the nervous system),susto(fright), andtaijin kyofusho(interpersonal fear disorder).

In practice, according to Lewis-Fernndez, each illness has to be assessed in its own right and both the practitioners expertise and epistemological assumptions and the individuals understanding of the illness should apply. That is, the clinician must not only draw from diagnostic experience, available categories of illness, and the various dimensions along which aspects of the illness may range, but also recognize and try to understand each individuals anomalous experience. Furthermore, he said that nosology has to be constantly evolving due to cultural variation over time in the way that psychopathological experiences are constructed. But the information provided throughout DSM-5, and particularly in the cultural formulation chapter should help practitioners avoid misdiagnosis, obtain clinically useful information, improve clinical rapport and therapeutic efficacy, guide research, and clarify cultural epidemiology.

Lewis-Fernndez sketched the structure of the Cultural Formulation Interview (CFI), which is also included in Section III. The CFI is a semi-structured interview composed of 16 questions that focuses on individual experience and social context (the objective is to assess cultural factors using a person-centered approach). The text is divided into two columns, with questions on the right and instructions on the left. Two versions are available, one for the individual and one for an informant, such as a family member or caregiver. (The interviews are available online atpsychiatry.org/dsm5.) There are also 12 Supplementary Modules to the CFI, which provide additional questions to flesh out domains assessed briefly in the 16-item CFI (e.g., cultural identity) as well as questions that can be used during the cultural assessment of particular groups, such as children and adolescents, older adults, immigrants and refugees, and caregivers.

Lewis-Fernndez also described how the glossary works usingataque de nerviosas an example. Briefly,ataqueis a syndrome characterized by intense emotional upset, including acute anxiety, anger, or grief; screaming and shouting uncontrollably; attacks of crying; trembling; heat in the chest rising into the head; and becoming verbally and physically aggressive, or otherwise feeling out of control (p. 833). (Ataque,like depression, also qualifies as an idiom of distress and an explanation.) The entry in the glossary cross-references related conditions in other cultural contexts and in the main text of DSM-5 (e.g., panic disorder). Conversely, a section in the entry under panic disorder in Section II of the volume (Culture-Related Diagnostic Issues, pp. 211212) describesataqueand refers the reader to the glossary. In this way, clinicians are alerted to culture-related features of DSM prototypes in the main text and in more detail in the glossary. The cross-referencing, absent in DSM-IV, should enhance the ability of the clinician to diagnose syndromes in an appropriate cultural context.

In closing, Lewis-Fernndez said that further research must continue to improve the international applicability of DSM by exploring the range of cultural variation (such as the nine examples provided in the glossary) and making revisions. The objective is that DSM-5 and subsequent versionsreflect a more inclusive description of the range of psychopathology across the globe, not just the particular constructs or exemplars most commonly encountered in the US, Western Europe, and Canada.

In the next talk, psychiatrist-anthropologistDevon Hinton(Harvard Medical School) discussed the glossary in more detail, usingkhyl cup(wind attack) as an example. He began by saying that the purpose of the thick, more detailed descriptions in the glossary is to increase the effectiveness of assessment by encouraging greater consideration of cultural concepts of distress and their role in understanding how something akin to, e.g., panic disorder might be expressed, understood, and treated in particular settings. For instance, he continued, work onkhylindicates that an episode can generate catastrophic cognitions about panic attack symptoms that create pernicious feedback loops, which have to be addressed. (Similarly, the dissociation frequently experienced during an initialataquemay lead to more dissociative episodes in response to stress.) The entries in the glossary are not just distractions but key parts of local ontologies that need to be evaluated. In other words, thinking through the three concepts or dimensions (cultural syndrome, cultural idiom of distress, and cultural explanation) is clinically useful for a rich diagnosis (Parnas & Gallagher, forthcoming).

Akhylattack is a syndrome found among Cambodians. Symptoms include palpitations, dizziness, shortness of breath, and neck soreness, the triggers for which might be worry, fright, standing up, riding in a car, or going into a crowded area. The attack also includes catastrophic cognitions related to the symptoms that create pernicious loops (fear of the symptoms amplifies the symptoms and consequently the fear). The point, according to Hinton, is thatkhylattacks are not just labels; more generally, cultural syndromes are key ways in which realities (the body, social worlds) are experienced, and they profoundly shape how anxiety and other disorders play out in particular contexts.

It is important to note that these attacks include other co-occurring symptoms that you dont usually see in Americans with panic attacks, or we dont ask about at least, such as soreness of the joints, neck soreness, tinnitus, and also headache and a feeling of being out of energy. In part this is because, according to the Cambodian understanding of the physiology underlying an attack,khyl(a windlike substance that flows along with blood throughout the body) is suddenly flowing up toward the heart, lungs, and neck. The lack of downward flow ofkhyland blood causes hands and feet to grow cold, and possibly stroke; and as thekhyland blood flow upward, they may potentially stop the heart or burst the neck vessels before thekhylexits from ears or eyes (which causes the related tinnitus or blurry vision). Akhylattack can be mild, moderate, or severe. Degree of severity is determined during the course of treatment, typically coining (the streaks can range from light red to a more serious dark purple). The coining is also a way to remove blockages and restore the flow ofkhyland blood; it can create a warming effect, which is considered curative because it meanskhylis travelling out through the streaks left by the edge of the coin on the skin.

Hintons final point was that every symptom that clinicians might associate with an anxiety attack is read according to the local ethnophysiology ofkhyl. As one example, fear ofkhyloverload makes Cambodians hyper-vigilant to any sensation they may feel on standing, especially if they havent slept at night or havent been eating well, he added, so you can see how these panic cycles can happen.

******

One comment at the close of the session by cultural psychiatristLaurence Kirmayerparticularly resonates: The DSM-5s cultural revisions challenge “the fundamental logic of psychiatric nosology” i.e., “describing problems located inside peoples heads” which is at odds not only with the fact thatwhen we start talking about languages and suffering . . . we are embedded in social networks and interpersonal relations and local worlds, but with new work in social and cultural neuroscience and social genomics that illuminates how social factors, like childhood adversity, social isolation, migration, and stigma, affect mental health and illness.

The cultural aspect of DSM-5 signifies a richer diagnosis for people “living under the description of” a psychiatric disorder, in the words of Emily Martin. And, as Roberto Lewis-Fernndez and Devon Hintons work onataque de nerviosandkhylhas shown, identifying the right cluster has major implications in terms of helping to elucidate the complex interactions of mechanisms physiological, psychological, and social and their various feedback loops.

Waking, Dreaming, Being: The FPR Interviews Philospher Evan Thompson

The FPR interviews philosopher Evan Thompson (University of Toronto) for the Foundation for Psychocultural Research about his new book in progress, Waking, Dreaming, Being: New Light on the Self and Consciousness from Neuroscience and Mediation.

Thompson

Photo by Raphaele Demandre. Dharamsala, India. October 2004.

Evan Thompson, Professor of Philosophy at the University of Toronto, works in the areas of cognitive science, philosophy of mind, phenomenology, and comparative philosophy. He is the co-author (with Francisco Varela and Eleanor Rosch) of the groundbreaking book, The Embodied Mind: Cognitive Science and Human Experience, (MIT Press, 1991), one of the first books to explore systematically the relationship between Buddhist philosophy and cognitive science, and to argue for the “embodied” approach in cognitive science. Thompson is also the author of Colour Vision: a Study in Cognitive Science and the Philosophy of Perception (Routledge, 1995) and Mind in Life: Biology, Phenomenology, and the Sciences of Mind (Belknap Press, 2007), and co-editor, with Philip David Zelazo and Morris Moscovitch, of the Cambridge Handbook of Consciousness (Cambridge University Press, 2007).

KAF: You are interested in the central problem of whether consciousness is a primary phenomenon not wholly dependent on the brain and cant be reduced or understood as anything else. And in your new book, you call for acknowledging the contribution of these traditions to understanding the mind. On the other hand, you point out that science has contributed to knowledge of evolution and brain development. Please say more about your position on how we can get these two approaches to collaborate in our understanding of the mind and whether or not it transcends the brain.

ET: Im interested in the nature of the mind. On the one hand, we have contemplative traditions with expertise in examining first-hand the nature of the mind from within, where from within means through direct experience in a rigorous way that involves training attention, emotion, and awareness so that basic characteristics of the mind manifest in a clear way. On the other hand, we have our scientific tradition. Historically, the scientific tradition emerged in a way that excluded the mindthe mind was treated as subjective, and science was interested in things that are objective and public. So if you look at the rise of physics, for example, we have a bracketing off of subjective experience. But in the 20th century that method was turned back on the mind through experimental psychology. Today we can record whats going on in the brain. Through neuroscience, due to new tools like brain scans and electrophysiological recordings, we try to see whats going on in brain while someone is having a visual experience, or while sleeping, or dreaming. We try to investigate the mind through the brain. Im interested in how these two ways of understanding the mind relate to each other and can be brought into a productive interaction. This comes down to the problem of consciousness because when we look at brain recordings when someones falling asleep, is asleep, or dreaming, what we have are measures of the brain that have some relationship to consciousness, to the persons experience. On the other hand, what were looking at in the meditative traditions is the mind or consciousness through direct experience. So the deep question that the encounter of these traditions raises is: What is the nature of consciousness? The traditional position of many contemplative traditions is that consciousness is primary, in the sense that its where we start from, where all our evidence comes from, and is what we always have to relate back to. So there is no way to meaningfully talk about getting outside of consciousness to see how it measures up to something else, because were always working within consciousness. From a scientific perspective, however, were looking at biological processes. Its not as if consciousness is observable apart from a brain and a body. So our touchstone is always incarnate, embodied. We have these two inseparable aspects of consciousnessthe experiential and the embodied. And so the question arises: is the biological primary or is the experiential primary?We need to think about a new way of doing the science of the mind, the science of consciousness. This new way integrates biology and psychology with phenomenology and works directly with first-person experience in a laboratory setting.

KAF: What do you think?

ET: What I want to do in my new book, which is a work in progress called Waking, Dreaming, Being: New Light on the Self and Consciousness from Neuroscience and Meditation, is show that we cant prioritize one over the other. We have to have a non-dualistic perspective.

On the one hand, from the scientific side we have to recognize that were always working within experience. Scientists perform measurements that relate back to their own experience as observers and they communicate what they observer to other scientists. This takes place within social experience. So theres no way to get outside of experience there.

On the other hand, from the contemplative perspective, experience is primary, but its always embodied. In meditation, you put the body in a particular posture and orient it in certain ways. Youre also in a communicative context with other individuals, such as your teacher or the practice community. So its misguided to think we can prioritize one over the otherthe experience or the embodiment, We need a non-dualistic perspective that doesnt valorize one over the other.

But that leads to the concrete question, especially if youre a scientist, how do we work with that perspective concretely? What do we actually do? We need to think about a new way of doing the science of the mind, the science of consciousness. This new way integrates biology and psychology with phenomenology and works directly with first-person experience in a laboratory setting.

KAF: Can you give an example?

ET: One way in a neuroimaging experiment, for example, is to investigate attention or awareness with individuals who have trained their minds in meditation. The working hypothesis is that trained meditators can make reports about their experience that are quite refined and precise compared to the reports we get from inexperienced undergrads. I have in mind experiments where someone is in a brain scanner and we ask them to report about some aspect or quality of their perception or emotion. With more detailed and refined first-person reports we can enrich the information available about experience and how it relates to the brain.

Heres another example. In the last five years theres been a renewal of interest in mind wandering or spontaneous cognition, as psychologists call it. This goes back to William James. The mind flows in a stream of consciousness, to use James metaphor. Mind wandering reflects self-organizing activity that you miss when you put someone in a controlled experiential situation and give them a task. When left to its own devices the brain spontaneously generates images, thoughts, plans for the future. So neuroscientists have been putting people in scanners and their minds are allowed to wander. And then the scientists probe the subjects, asking them, when your mind was wandering at a certain moment, were you aware or not aware that it was wandering? The hypothesis is that a person who practices certain kinds of meditation would be faster at noticing when thoughts arising and be able to describe them more precisely, such as being able to say what intention or feeling was behind the thought, whether the thought lead to another one, whether there was an immediate awareness of the thought arising, or whether it was noticed later, and so on. Highly trained meditators can make these reports because meditation trains attention and awareness of the mind itself. Thats not to devalue the importance of working with people who dont have meditative training; in fact, its very important to compare them and to control for other factors like age, culture, and gender.

KAF: So someone would be in an fMRI machine spacing out and if a neuroscientists saw more flow of blood in a particular part of their brain at a certain moment they would ask what they was thinking about and see if that changed blood flow?

ET: Youd be in scanner and have a repetitive task to do, like whenever you see a letter instead of a number, you press or withhold pressing a button. It doesnt demand too much attention so your mind naturally wanders. Then the scientists randomly ask, Were you on task or off? and if off task, Were you aware or not for being off task? Then they compare the blood flow in various brain areas immediately prior to someone saying they were off task and aware, or off task and unaware. Kalina Christoff at the University of British Columbia is doing this mind wandering work and Im collaborating with her on studies with meditators.

Heres another example: youre in the scanner and you see a red bar graph like a mercury thermometer and the red level goes up or down depending on what your brain is doing. You can try to make it go up or down through various mental procedures. If youre trained in meditation, you might have greater flexibility to make the bar move.

KAF: What are some applications for this ability?

ET: The management of chronic pain. We know that some aspects of pain are sensory and some aspects have to do with whether you respond to this sensory aspect adversely or with acceptance. Brain areas that have to do with judgmental response to pain are affected by meditation training. So you can combine meditation training and neuro-feedback about these regions to try to help such patients learn mental pain management skills.

KAF: In your book you use phrases like examining the brain from within, first-person exploration, and meditative insight. What do you mean by them?

ET: I use the word insight in a precise way that comes from Buddhist philosophy and mediation. It means the ability to discern whats happening precisely in your experience from moment to moment. Its different from focusing your attention on one thing continuously without distraction. It requires stability of attention, but the point of insight is not simply to stabilize your attention but to hold your mind quiet and unwavering so that you can discern fluctuations like the arising of a feeling or thought, or the way that feeling leads to memory. Or the way a pain sensation biases you towards an aversive reaction so that you can work with that bias and loosen it so that you can deal with that pain more adequately. So the Buddhist practice of insight targets that discerning capacity of the mind; its what enables us to see things as they are instead of through all our habitual filters.

In the context of working on the neuroscience of consciousness, the hypothesis would be that people with training in meditative insight can provide more nuanced information about consciousness than others who dont have that kind of training. One example I find particularly fascinating is work on dreaming. In the last couple of years, its been recognized that lucid dreaming (knowing youre dreaming when youre dreaming) is a robust, valid state of consciousness thats different from ordinary dreaming and from being awake. Some neuroimaging pilot studies have been done on lucid dreaming. Meditative traditions in Indian and Tibetan Buddhism work with lucid dreaming as a state of consciousness that can be used to train the mind and work with negative emotions, which are so strong in dreams. I hypothesize that those with meditative training would make good participants in experiments on lucid dreaming because they can inhabit this state in a robust and stable way and report on it by making certain kinds of eye movements while dreaming.

KAF: Meditators can report on their eye movements?

ET: The way this works is when you’re in a dream and you know youre dreaming, and your dream ego looks left and right and so on, that shows up as regular eye movements in the REM stage, when the eyes start out moving irregularly. If you have a pre-established code for what these regular eye movements mean, you can use that as way of making reports, and as a marker of when the dream became a lucid dream. The dreamer can report on some quality of the dream. You could ask the dreamer to jump up and down 10 times in the dream and signal when they begin and finish. Then you can compare that to jumping up and down when theyre awake. Why is that interesting? It tells you about the time course of motor activity in the brain and the subjective sense of time in the dream state compared to the time it would take to make those movements in the waking stating.

KAF: It enables us to compare brain activity to whats going on in the mind during a lucid dream.

Yes.

KAF: Lets go on to religion and science. You object, in your book, to the bifurcation we see today between religious extremism and the scientific materialist tradition because they dont recognize the contemplative traditions. Whats the best way to get them to recognize the contemplative tradition and use it so that we may survive together?

ET: We have to create a scientific culture that recognizes the value of contemplative experience, and we have to create a culture of wisdom or spirituality that recognizes the value of science. We have to hold the two together. If we cant or dont, we will slide into one or other extremethe resurgence of anti-scientific religious fundamentalism based on outmoded belief systems that are not valid and sustainable, or sustainable only in violent, terrible ways, or a scientific reductionism that doesnt recognize the value of contemplative traditions, including the way that religious traditions have been the home where contemplative traditions have developed and flourished.

To be fair, many elements in religious history have been antagonistic to mysticism and contemplative experience, so its not as if reductionistic scientific trends are the only problem for contemplative traditions.

We have to move beyond this situation if we’re going to be a wholesome and healthy culture. The way I see forward is to working within both science and contemplative traditions to create a science that recognizes the importance and value of these traditions, while also transforming these traditions with scientific knowledge. I see this as potentially leading to a new post-religious or secular spirituality. I mean secular in the sense of a place where many different traditions can meet and hold something in common for the common good.

KAF: It’s interesting that your way out of this is that scientific culture should modify itself rather than the religious extremists. Why is that?

ET: Religious extremists should modify themselves. Its important to challenge religious extremisms in a multitude of ways including from within the religious traditions themselves. I dont mean to exclude that. But my strategy in this book is to show how science can be enriched and to point to different ways of thinking about science and religion from what we see in authors like Daniel Dennett or Richard Dawkins, Christopher Hitchens, and Sam Harris. Sam Harris is actually a bit different, in that he ends his book, The End of Faith, by talking about consciousness and meditative experience. Its important for him that this be something that’s seen as valid. Hitchens sometimes says similar things, so theres diversity among these authors and their positions. But the critical dismissal of religion most associated with Dawkins takes religion at its absolute worst, but has no discussion of how religion is not the same as theism, or how religious traditions have been the home for contemplative experience and how that kind of experience is a source of wisdom and insight relevant to science.

KAF: Is it more important to bridge the gap now than ever before?

ET: Its more important than ever because these extremisms are stronger than ever before. Religious extremisms are particularly troubling and its very important to transform religious traditions in a why that maintains and enriches whats best, which are the contemplative traditions and the social ethics informed by them, while leaving behind regressive and outmoded belief systems. Thats never been more important than now in world history. In the case of science, its very important that we have a deep inner appreciation of the mind and ways of working with it in a wholesome manner because this is a culture that suffers from a variety of ailments like ADHD that we treat try to treat with exclusively pharmaceuticals means. Our population is also an aging one that needs to deal with sickness and death. Our culture also inculcates certain habits of attention in children through video games and texting. I dont mean to criticize these technologies in and of themselves, but theyre unhealthy when not placed in a richer, wider context of wholesome attentional functioning and mental wellbeing.To create a rich science of the mind thats adequate to the complexities of mind, we need a more precise language for talking about the mind, especially at an experientialIndian and Tibetan traditions … havevery systematic, precise descriptions of mental processes from the perspective of experience.

KAF: When you were talking about reporting states of mind, I wondered about having to overcome the language barrier, that is, the difficulty of describing them and interpreting how theyre reported.

ET: First, to create a rich science of the mind thats adequate to the complexities of mind, we need a more precise language for talking about the mind, especially at an experiential level. In western philosophy this was of concern to William James and philosophers in the phenomenological tradition, like Maurice Merleau-Ponty and Edmund Husserl. In Indian and Tibetan traditions we have very systematic, precise descriptions of mental processes from the perspective of experience. These are arguably very helpful to recent developments in western science. For example, neuroscience and psychology have recently challenged the idea that theres a sharp separation between thinking and feeling, or between reason and passion, or cognition and emotion. If you try to map these distinctions onto the brain, they make no sense. There is no area of the brain that is a thinking area vs a feeling area. If any area can be described as a cognitive area, its also a crucial area for emotion. Interestingly, Indian and Tibetan Buddhist traditions have very detailed taxonomies of mental phenomena, but no sharp distinction between cognition and emotion. Things are taxonomized in a different wayaccording to whether theyre wholesome states of mind, like compassion, or unwholesome states like envy or hatred. Attention is neither wholesome nor unwholesome in itself. These taxonomies have to do with looking at the mind so it can be trained and shaped in wholesome ways. Within that framework, some things we would call cognition are in some places and some things wed call emotion are in other places, but theres no distinction between cognition and emotion. This kind of taxonomy can be a useful and refreshing perspective for western science. Im not saying we can take it and impose it on the brain. Thats too nave. But it could provide a shift, a different way of looking at how the mind works. That could be and has been very inspiring for neuroscientists like Richie Davidson, whos done a lot of work on the neuroscience of meditation.

Second, when working with foreign cultural and linguistic traditions, for example long-term Tibetan Buddhist practitioners, immediately a complicated dialog has to take place in order to do psychological or neuroscientific investigations into how their meditative practices might affect the brain and its structure and functioning. We need to understand what these practitioners are talking about when they describe their experiences. That understanding requires second-person perspective in a laboratory where we work with someone who is skilled in mediating between western science and the Tibetan language and meditative philosophical perspective. To do this kind of experimental research on meditation, you need a multi-talented team. So we get a different kind of neuroimaging labone with people who have an array of skills in meditation, Tibetan language, philosophy, and neuroscience. Were creating a much richer field of knowledge than what happens when we just run studies on American undergraduate students. Its not as if this field is just there, waiting to be put into action; we have to create it.

KAF: Are there a few such labs now in the US?

ET: There are a number of teams in Europe, the US, and Canada. Richie Davidson has spearheaded a lot of this research. He has published major scientific studies and has a big lab devoted to this kind of research at the University of Wisconsin, Madison. There are others in various places. Amishi Jha at Miami University works on mindfulness training and its impact on attention. Kalina Christoff , who I already mentioned, is working on meditation and mind wandering. Adam Anderson at my university, the University of Toronto, uses mindfulness based stress reduction, which is a clinical secular adaptation of yoga and Buddhist meditation, to investigate emotion and how we experience the self. Tanya Singer in Leipzig at the Max Planck Institute is working on empathy and compassion and meditation. Within neuroscience its a small group of people compared to the majority.

Within clinical psychology there many people examining mindfulness based stress reduction and mindfullness-based cognitive therapy. There are a number of groups in the US, Canada, England, and Europe. This kind of research is much more widespread than the neuroscience research on meditation.

KAF: Cultural neuroscientist Shinobu Kitayama believes that studying the brain with fMRIs and EEGs will make it possible to see how culture might be transformed into a biological process. He believes the brain is very malleable and designed to incorporate cultural information. Your work is very cross-cultural too. So do you think Western and Eastern minds may be wired differently, so that each may implement contemplative or meditative traditions differently?

ET: I wouldn’t say it that way. West and East are very general categories. West includes North American, Europe, and South America, and East encompasses Japan, China and Korea and India.

KAF: OK. But you know what Im getting at. Might an Indian do mediation differently than a New Yorker like me?

ET: We dont know because we dont have enough studies and evidence that speak directly to that. But given the kind of work being done in cultural neuroscience and at the interface with anthropology, we have very good reason to believe that culture strongly shapes how the brain and the body develop. Connecting this work to meditation is speculative because we dont have evidence that speaks directly to the way culturally different practices or styles of meditation affect the brain. But its reasonable to think that the way attention is trained or the way different cultures support habits of attention might be reflected in the way brain systems for attention are structured and organized. Its reasonable to believe this. One caveat is that many people think everyone in Asia meditates. But in many Asian cultures, the majority of Buddhists dont meditate, though they participate in social practices that have a meditative dimension. And those who do meditation dont learn to meditate as young children. Most Asian cultures dont start training in mediation until adolescencemaybe 15, 16 or 17. You may be trained in other things, such as memorizing texts if youre a young monk, which indirectly train attention. So all of this is to say we really need much more research that relates the culture to the meditative practices to the brain systems, and this research hasnt been done. But cultural neuroscience has a great perspective for looking at the kind of research that needs to be done here.

KAF: Do you think the contemplative traditions can enhance neuroplasticity and how flexible the mind and brain may be? Has this been shown?

ET: We do have some evidence from Richie Davidsons lab. He looked at how attention is changed as a result of intensive insight or Vipassana meditation practice. He tested visual attention along with EEG measures that are well-known and well-understood markers of attentional processing. He ran attentional tests on individuals before they went on an intensive three-month retreat and after the retreat, and compared their performance also to non-mediators. He found that three months of Vipassana meditation significantly improves the function of attention and that this is reflected in EEG brainwaves associated with attention. There are other studies that show there are pretty significant changes to attention as a result of meditation. They tell us that, yes, intensive mediation practice leads to significant changes in attention and that these changes are reflected in brain functioning.

KAF: Ill just be devils advocate for a moment. The contemplatives that you describe who have observed their own process of dying, have had the luxury, it seems to me, of dying during peaceful times or circumstances. I wonder if you think this tradition would help when someone is dying in an emergency or a time of war?

ET: Thats a really great question. One centerpiece of the contemplative traditions is practicing to increase awareness of death and mortality and to try to create a wholesome frame of mind that can meet death when it happens. We do have anecdotal reports of Tibetans whove been tortured and imprisoned who say that what got them through the torture and helped them survive was their ability to recognize that the torturer was also a sufferer, in the sense that the torturer was committing an act that was destructive to his own mind, ordered by someone else, and who was ignorantly perpetuating his own suffering. Not necessarily in the same way as the person tortured, obviously. But that he was in a predicament, that he was unhappy and in a condition of suffering.

This ability to feel compassion for someone who is severely mistreating you suggests that these monks may be exceptional individuals. This also relates to scientists who are interested in why some people who suffer severe trauma, such as these monks, dont develop PTSD, and what mediation might or might not have to do with this kind of resilience. In any case, this kind of resilience suggests to me that the ability to deal with death in variety of situations as a dying person or caregiver could be significantly improved by having contemplative ways to face suffering.

The crucial point here is that we are a culture that refuses to face the reality of dying, that flees from it, that does everything it can to hide it, and creates horrific hospital environments in which to end ones days. A scientific culture that has a contemplative mindset and allows itself to recognize the reality of death, and works with that contemplative perspective to create situations more socially harmonious and beneficial to the dying and those dealing with the dying, is something we desperately need.

The crucial point here is that we are a culture that refuses to face the reality of dying, that flees from it, that does everything it can to hide it, and creates horrific hospital environments in which to end ones days. A scientific culture that has a contemplative mindset and allows itself to recognize the reality of death, and works with that contemplative perspective to create situations more socially harmonious and beneficial to the dying and those dealing with the dying, is something we desperately need. There are people already working with this in hospice care. Joan Halifax, Roshi, a Buddhist teacher in Santa Fe, NM, has a contemplative training program called Being with Dying to help clinicians be more effective with end-of-life care. Thats where I see real value of the contemplative perspective on death.

KAF: You write that attention is unstable and that meta-awareness is hard. I think its getting more unstable with people multitaskingkids listening to iTunes while playing video games and doing homework these and other technologies on in the background. I worry that they spread attention thin, whereas video games are one-pointed concentration, to use your phrase. So how can we get kids who grew up with these technologies to be contemplative? What if they dont want to be?

ET: That connects to work people are trying to do with mindfulness and education. What may be the most important is to develop mindfulness training methods or programs that arent religious but secularize and can be used in public school settings. Mindfulness methods with no religious content and acceptable to those you come from one religion or another, or no religion.

KAF: Is there an attempt to do this with religion?

ET: Within religion there are contemplative movements within Christianity and Judaism in religious schools. I dont know about Islam.

KAF: You’d like to see it secularized?

ET: Id like to both see secular and non-secular. Both are essential. I also think its urgent to restructure schools in a way that doesnt simply import these mindfulness methods into the schools and leave everything else unchanged. They need to be integrated with other ways of restructuring curricula so that theyre integrated in a meaningful way.

Im a child of the 70s. I was raised around yoga and meditation. Some of it was funny and was the silliness of the times but other aspects of it were very important and had lasting value for me. I learned a very simple breath-centering mantra when I was around seven years old. It was crucial for me to have the sense that there was a place to go mentally to center myself in order to deal with the difficulties you face when youre a kid. Thats a human birth right. We all have that ability and we should all be a given some training that gives us that ability just as were trained to learn the multiplication tables and play basketball. That would be really important. Kids who want to resist it will and thats not worth directly fighting. Its more important to make this available. Kids fight things at different developmental stages and its important for kids to fight certain things so thats part of life and not troubling to me. But if all we have are texting and video games and iPods and things like that to capture our attention, then were unbalanced. Its not that we should get rid of those things and they wont go away anyway. Its that they should be situated in broader, richer context.

KAF: The New York Times recently ran two stories about meditation and Yoga coming back. Look Whos Meditating Now, was in the Fashion and Style section. Theres a celebrity and it references celebrity faddism with the Kabala. It mentions that the squash team at Trinity College begins its meets by mediating together. The other story, Agent Pursues a Cut of the Yoga Boom, was a local piece. But there was a meeting in December and there were some statistics about how meditation may reduce hypertension and diabetes. Can you comment on whether theres fashion here or whether the contemplative tradition can get diluted.

ET: On the one hand, anything that improves quality of life is great. On the other hand, its a dilution of the real point and purpose of contemplative traditions to assimilate them into the American self-help agenda. The self-help agenda is about a self that is very egotistically conceived and the meditative traditions are about breaking that down and creating a sense of compassion and connectedness and empathy for other suffering beingsnot just humans but also animals. There is an element of fashion and faddism. A self-help agenda can assimilate something new thats driven by marketing. Im dont think thats of particularly deep, lasting value.

KAF: Whom do you most want to reach with your new book?

ET: My hope is to reach a wide audience of scientists, clinicians, and philosophersprofessionals and clinicians who have an interest in nature of mind and consciousness and want to know how meditation and neuroscience are creating a new, richer picture of the human mind and consciousness. I especially like the idea of reaching graduate and undergraduate students because theyre the future of knowledge. To inspire them with this vision, that would be a great accomplishment.