How mindfulness changes the structure of your brain

What does mindfulness actually do to your brain? I decided to start off with the most concrete examples. Literally, those who meditate and those who don’t have different looking (and measurably functioning) brains, a bit like the people who go to the gym tend to look different to who don’t.

It’s understood at this point that it leads to structural change. In short, it changes the connections between different neurons (brain cells). It strengthens the pathways that are helpful to mindfulness and weakens ones that interfere with it. This is also known as neuroplasticity: the changing of neurons, to put it literally. This is a bit too high level for some people so I wanted to delve a little deeper.

Functional magnetic resonance imaging, fMRI, studies are of questionable significance, but then again, everything is. Many scientists hypothesised whether there is a change in the connectivity between default mode network (DMN) regions.

A DMN is basically a collection of parts of the brain that like to be in sync with each other when we are at rest. These parts are especially active when we’re not involved in a goal-directed task, e.g. when we are day dreaming. Sometimes the DMN gets shut off when we are actually doing something goal-directed. It can be hard to imagine what a brain network is without naming a specific part of the brain. The difficulty with naming it… Is evident when you try. But we shall try. What has been conventionally included in the DMN is as follows: posterior cingulate cortex, precuneus, medial prefrontal cortex, angular gyrus, dorsomedial prefrontal cortex… The list goes on. It is mostly a variety of cortical regions. Interestingly, it overlaps with parts of the limbic system at the hippocampus.

So what fMRI studies found was that those who practice meditation had weaker functional connections between certain DMN regions – especially those associated with emotional judgement. On the flipside, meditators had stronger links in other regions (specifically the dorsomedial prefrontal cortex and right inferior parietal lobule). It is difficult to articulate what exactly this means in practical terms, but it’s real – whatever it is. You can read more about these studies here and here.

Mindfulness is associated with greater attention related activity in the anterior dysgranular insula regions. This suggests that mindfulness is linked to being able to find better context for internal sensations given one’s the surroundings. In other words, it helps to answer the question – why do I feel a this way in these circumstances? (See study)  On a related note, another study suggested that this ellusive non-reactivity that we are all after is inversely related with insula activation. Mindfulness could reduce vulnerability to depression by reducing automatic emotional responding via the insula.

A different type of MRI, so called diffusion tensor imaging, or DW-MRI, has also been used to study those who practice meditation.

Interestingly, those who practice mindfulness have greater cortical thickness in the anterior regions of the brain: the medial prefrontal cortex, superior frontal cortex, temporal pole and the middle and interior temporal cortices. On the flipside, there was reduced cortical thickness in the posterior regions of the brain including the postcentral cortex, inferior parietal cortex, middle occipital cortex and posterior cingulate cortex. These and other findings indicate that those that take part in meditation over long periods have structurally different brains in terms of both gray and white matter. You can read more here: Lazar et alTang et al, Holzel et al, Luders et al,  Kang et al.

how mindfulness changes the structure of your brain

Image from Meditation experience is associated with increased cortical thickness showing the cortical regions that are thicker in meditators. Numbered regions: (1) insula, (2) Brodmann area (BA) 9/10, (3) somatosensory cortex, (4) auditory cortex.

Loving-kindness meditation has been linked to increased gray matter volume in the right angular and posterior parahippocampal gyri. The right angular gyrus has been linked to empathy, anxiety and mood.

Even if fMRI is just a mirage, DW-MRI seems to back up the findings of changing structure. It is fascinating to think that we can actively structurally change our brains.

Besides the different types of MRI, changes have been shown on EEG (it’s like an ECG/EKG for the brain).  More importantly, those who do mindfulness tend to behave differently – as shown by their differing test scores in various tasks – I shall describe this another time.

What happens to the kids who did well in school

Following on from my recent thoughts of what schooling does to our brain, I wanted to reflect on what happened to my friends who showed themselves to be remarkably intelligent in school. I have a circle of friends made up of people with IQs at least over 140 (sounds rough, I know, but thankfully it’s not limited to that). Seriously though, it’s interesting to reflect what had happened to my most intelligent friends over the 10 years that have passed since leaving school.They all did incredibly well in their exams. They all come from different countries and backgrounds: some come from well off families, which cannot be said of others.

I have observed a few different paths:

  • Join the biggest fanciest company I can find. Think Goldman, McKinsey, Google – and I don’t mean the HR department of those companies. Everybody left after a year. Why? I’ve gathered my people couldn’t tolerate the lethal combination of short-sightedness and narcissism that’s characteristic of middle management in these companies. It will take years and years of repetitive boring back breaking work – measured by the hour, not by output, before you actually get to make any interesting decisions.
  • Join the company that will take me with least resistance. We’re talking about less fancy firms – the big four, European investment banks, non-backbreaking medical jobs in fancy universities/hospitals or intense jobs in less famous ones. Interestingly, this has an almost 100% retention rate. I think these people are risk averse and comply with expectations set by their culture. They are capable of doing the same thing over and over and are able to see the greater context. They believe their labour now will lead to massive payoffs later – kind of the way it did 50 years ago. They often talk about how this job they have now gives them experience. Experience for what? I used to think there was some kind of substance behind this statement. However, now I think of it as a way of saying: what I am doing now isn’t a waste of time no matter how you look at it. A few of these people have even dipped their toes into entrepreneurship or trading – but they don’t seem to have any faith in their ability to succeed unless they are under the wing of a big company.
  • Do a Ph.D./advanced degree in the fanciest place that will take me and proceed the academic route. Think Oxford, Cambridge, Stanford. Here, I’ve observed a 50/50 completion/dropout rate. Those that dropped out went with start ups – with varying degrees of success. Those that continued the academic route are exceptional scientists. One is lazy af. He’s there for the good life. The other is the most industrious person I have ever come near. Madonna ain’t got nothing on her. This girl, let’s call her Anna, has gone after every degree, exam, medal and trinket she could. She is also unhealthily thin – to the point of bone brittleness – and always has been. I’ve wondered about her: what motivates her? Is it the pure validation and vanity of medals and awards? Is it that she is simply playing to her strengths? I don’t think she is: she went into medicine after doing a science degree. This was no backdoor entry: I mean a first class honours top of the class from a university everybody knows. She didn’t want to do medicine when she was 18. My own view is that she would have much interest in patients – she’s not mad into vulnerabilities and feelings. In fact, she first got into law – and switched to science on a whim.She did mention money though. I recall a conversation between the two of us and a veteran academic before either of us were in college. Her questions revolved around trends. Clearly, she had no direction. I think what drove her is neither validation nor a thought out plan. It was the desire for safety and certainty: law and medicine will always provide you with a reasonably paying job; a trend will always bring you in the right direction. This is another example of a situation where directionlessness has played havoc with a person. Is she happy now? I have no idea. I know that the guy who pursued academics because it ticks the box of having a job and brings in some income is indeed happy. What Anna lacks in direction, this guy lacks in ambition. Both are doing pretty well for themselves on paper though.
  • Doing something odd. I know a guy who started a science degree in a mediocre college, dropped out, started the same science degree in a very fancy college and went into finance after graduating. It’s not exactly a untrod path. The black swan who has managed to make billions in his twenties dropped out of an Ivy League college and was one of the founders of a tech start up. A number of friends have gone through a variety of things: medicine, startups and management consulting. All of these people tend to have excellent relationships with their parents: nothing promised, no regrets. There is an understanding there that the child doesn’t owe their parents the obligation of following a certain path past a certain point. The point seems to be after graduating and making some kind of money. These people tend to have a higher risk tolerance and put less value on conventional markers of success.
what happens to intelligent kids after they leave school
A black swan

Of note, none of them have children of their own at this point. Many of them have travelled a lot and even permanently immigrated, mostly to the United States.

All in all, I think all these superbly intelligent people have fallen into different categories driven by what they value most. In terms of their values the most important spectrum seems to be their appetite for risk. Is there success here? It all depends on how you define it. They are all doing well financially. They are all reasonably happy, it seems. There’s no one size fits all recipe for success here. They only one I can suggest is play to your strengths and go all in.

What schooling and culture does to our heads

All in all you’re just another brick in the wall.

The school system has conditioned us a certain way. Often this sort of criticism comes from people who did poorly in school. At best, it comes from self-made billionaires who weren’t academic or were dyslexic.

I never got anything other than the top possible grade in any state exam I sat (and I sat them in 2 countries). So while anyone could be open-minded on the issue, I feel my lack of a chip on the shoulder or any other incentive to diss formal education adds a little more credibility. What I have noticed is:

  • School doesn’t reward strengths as strongly as it punishes weaknesses. This makes us very aware of our weaknesses and gets us to associate weakness with pain. It tells us to direct our efforts towards our weaknesses, not our strengths. This is probably a bad thing because we can always pair up with someone who can compensate for our weaknesses. We cannot, however, make up for the chances we lost to further our strengths.
  • It asks us to follow instructions. Following instructions isn’t a skill rewarded in real life, unless you have just come from IKEA. Seriously though, maybe there was a time when one could get hired and be told what to do and paid well for it – but even I have missed that boat. Anybody currently in school is certainly not going to have that luxury.
  • It asks us to not make mistakes. While life appears to work on the mistake-learn-do better cycle, schools teach that mistakes are final failures and should be avoided at all costs. Rather than teaching people to pick themselves up and consider what they would do differently next time, school teaches people not to try. Fear of rejection, abandonment and judgement is everything within a school.
  • It teaches us to be compliant. What do I mean by that? You need to learn things you know you will never use in order to get a gold star on your homework. That’s compliance. That’s what employers want. This is a tough one to call as it is specific to a person. Compliance doesn’t necessarily encourage innovation, to put it politely, but it probably builds better teams. Further, if you aren’t a compliant agreeable person by nature, school probably isn’t going to make you so (unlike the previous points, this actually attacks a character trait).
  • It teaches us to revere authority. Authority is king in school. A teacher’s word is pretty much final. On the one hand, this translates pretty well onto how employers deal with their employees. On the other hand, it stops us from thinking outside the box. I can’t count the number of times I consciously remember debating something with kids – when I was a kid – and the final line coming from my opponent being: my mammy says so, so that’s the way it is. Schools only make this horrible addiction to certainty worse.

what society and schooling does to our brain

So now that we’ve been through this machine, how do we deal with it? How do we unlearn the nasty habits and build new and better ones?

  • Focus on our strengths. Screw the weaknesses. The rest of the world is there to constantly point at our weaknesses. We have to be the advocates for our strengths. I tend to be able to notice things from more angles that other people and be open minded. Hence, I am writing this.
  • Decide what we’re after. Yeah, sure, sounds easy. It’s so hard in reality. Different people have different values. Our values will determine what we want in life. Maybe you are one of the lucky ones and your values correspond exactly to what the values you learnt in school. It certainly pays to contemplate what our values are.

We have a very strong desire to be consistent. We hate being wrong, so it’s painful to deconstruct our values. It’s not just an ego thing – we are wired that way. It’s how the placebo effect works. Our brain will make up the difference between the physiological and the perceived through specific chemistry. This is the reason I love mindfulness so much: it helps to disconnect all those false pathways and expose what’s really going on.

Having an understanding of two cultures (the West and Russia), I have always been fascinated how people feel that the values of the place that they just happened to be born in are their very own personal deeply held values. I think one has to actually dig pretty deep to understand what they believe now and what they want to believe.

There’s a conundrum I’ve always struggled with. Ok, so you’ve stripped off the BS. You are ready to find out what you’re actually about. So you ask yourself the question: who am I?.. Only to hear silence in response – what does that mean?!

I think I have the answer to that.

It means you have finally become open-minded. You have finally recognised, on a visceral level, that your values aren’t imposed on you. It is what you make them. There isn’t a ready-made answer. We don’t all come with either an iOs or a Windows operating system. We decide what our own operating system is going to be. So if you are struggling to understand who you are: you are probably asking the wrong question. You are what you ask yourself to be. We are what we pretend to be. We are what we repeatedly do. That’s not me who said that, that K.Vonnegut and Aristotle. Choice is a really fundamental ability, a power even, that is often overlooked.

What’s it all for if…

I often say on my blog for secondary school students that it’s all about balance. I feel wishy washy about it when I say it, so I wanted to tell this story to explain.

I recall spending some time with a dear friend of mine. She is a hugely successful physician now in one of the world’s top universities. This is way back when we were about 19 – in the throes of medical student life.

mindfulness-how-to-find-balance

My friend, let’s call her Angela, is a particularly classy lady. She grew up in one of the finest neighbourhoods in a nice Irish city, educated privately, fancy extracurricular activities, the whole thing. She’s a gunner though, that girl. Being wealthy doesn’t automatically make you soft, and she’s the perfect example of that.

We were probably the only 19 year olds in Marks & Spencer’s buying things like dark chocolate and fresh linguini while our college classmates were out drinking 2 for 1 cocktails or Dutch Gold and eating frozen pizza. We spent our afternoons watching Gray’s Anatomy, The Other Boleyn Girl, Marie Antoinette, Coco Before Chanel, Gilmore Girls… And studying (her way more than me). You get the gist.

I never judge people for indulging. It would never occur to me to begrudge someone their luxuries or criticise them for being wasteful. So when I remarked on the fact that she has expensive taste, she was relaxed about it and said: If you can’t eat properly, what’s it all for?

This throwaway remark got etched on my brain. What’s it all for if you can’t be with your family? What’s it all for if you can’t sit and meditate for 10 minutes? What’s it all for if you can’t enjoy yourself for even a little part of the day? I don’t think she meant it that existentially. The way I took it was more in the stoic philosophy sense: live every day like it’s your last. As a true medical student workaholic fanatic, who was ready to give up everything for success, I never thought that living each day like it’s your last is about more than just achieving. I think if you work really hard, weirdly, sometimes it is easy to lose respect for yourself in a certain way. You become your own slave, the executive of your dreams, but not the person who actually gets to live them. That’s what I mean by balance.

Sporadic rewards

There’s an interesting psychological phenomenon observed in dolphins. Dolphins a particularly high ratio of brain size to body size. As humans, we are behind them. Generally, intelligence correlates to this metric, hence the claim that dolphins could be more intelligent than humans.

meditation techniques and accessories

When a dolphin does a trick you like – you positively reinforce it by giving him a treat. Rinse and repeat. A bit of operant conditioning never hurt anybody. However, to be clever about it, the trainer then gives the dolphin a treat only when the dolphin jumps especially well – let’s say higher, through a hoop, whatever. The trainer creates an understanding in the dolphin’s head that he must not just jump but give it all he’s got. The way this works best is when the trainer only rewards the dolphin sporadically. The dolphin isn’t quite confident he will always get the reward. This creates the infamous gambling-like anticipation. Does this remind you of anything? I think it is quite reminiscent of how managers assign promotions.

Bain & Co summarised the conventional thoughts on behaviour modification here. They got the basics down, but they preach that behaviour are modified best when the rewards are likely, immediate and positive. I guess likely doesn’t mean certain. The science behind this relates to how dopamine is released in response to anticipation, not reward. If the reward is uncertain – that causes more dopamine, hence the effect.

In short, if you want someone to always give it their best, be a tad sporadic with your rewards.

The value of work

As someone who really gave it everything when it came to studying or working and not necessarily seeing it as having given me what I wanted, I ran the risk of learning helplessness. Somewhere within me there is a belief that work is a double edged sword. Work is only useful when the direction is right (no physics puns intended). In all honesty though, it really is a vector. I have seen so many people expending so much energy getting nowhere fast. Ray Dalio says that you should only work on the things you really want.

mindfulness-belief-modification

As a true millennial, I didn’t know what I wanted for a long time. Something is telling me that in another 5 years, looking back on this note, I will think: Ha, I though I knew, but I didn’t really. In any case, I have a better idea now than I did five years ago. I recognise what my priorities are. It’s family first and everything else after that.

The learnt helplessness comes in where you finally get the freedom to start again and work on what you really want, but you wonder – is there any point? What if I am wrong again? There’s also a feeling of being spent – having worked so hard in the past, you’re not sure you’ve got the energy anymore. Of course, these beliefs aren’t helpful and luckily they are entirely changeable. I guess I wouldn’t have even ever come close to being aware of them had it not been for mindfulness. The truth is that work is useful when it is in the right direction. Time is going to go by so I may as well put in the work and make a bet on what I believe in. There’s no certainty and no promises, but it is better to always have a direction and therefore a chance at a legacy. The spent thing is nonsense too – you only get stronger from exercising mental muscles through study and work. Past experiences can equally serve as references for one’s ability to succeed regardless of the complexity of the task. After all, there’s always a choice.

What mindfulness teaches you

I had a really hard time trying to do mindfulness last night. It took me a good 30 minutes to even get into my first proper breath that I could focus on. This is unusual for me. At this point I’ve been a pretty decent meditator for about 1.5 years.

What was it? Procrastination. Why? Falling asleep and meditating is effort. It takes effort to not go down 10 million rabbit holes. Saying no is more difficult than it may initially seem. However, it is completely necessary. Focus is the mother of execution. The only way to execute is by focusing on one thing at a time. It’s unitasking. Even if it seems like you are multitasking: you are only ever doing one thing at any given time – just switching more often than you think. Multitasking is a form of hiding: if you fail, you had “so much going on.” Whereas if you are working on just one thing – you can’t really run and hide from it, it is staring you in the face.

The other thing that mindfulness teaches you is that it’s not how many times you fail, it’s all about getting back up on your feet. It doesn’t matter how many times your mind wanders. Every single time you bring it back – you got back up on your feet. The neural pathway that is responsible for bringing you back has just gotten that little bit stronger. It’s like a biceps curl for your focusing muscles.

Does it only do focus? No. It also gives breadth somehow. There’s a technique called noting. So when a memory comes in: you say memory. A plan, an idea, a fantasy, an itch, a dart of pain, a noise and so on. Identifying things helps to deal with them.

Once I was able to get past the initial wall of procrastination and actually went and did it, straight away – I got an amazing reward. I saw the sky as cloudy and then my mind just shifted to the other side of the clouds – where is was sunny and still. Maybe this was just a really small hypnagogic hallucination, but it gave me an insight. Cognitively, it is such an obvious thing: we all know that things have different meanings depending on what side you look at them. To really feel it, to really internalise the meaning of this is something much deeper.

Asking better questions

The American election is everywhere. I hate thinking about politics. It’s wrong to hate it because it is important. Whether you have an interest in politics or not, it has an interest in you. So it’s important to know what you think. This insanely funny cartoon is from The New Yorker:
asking-better-questions
“I had a dream that this election never ends and I never have to go back to worrying about my own problems.”

The kind of questions that seeing Clinton and Trump debating stimulates are all nasty. Who is lying? Who is lying more? How can we trust this person to be a president?
Asking these questions has me thinking in circles. A much better set of questions would be:
1. What future do we want for the world?
2. Who can help us achieve this future?
3. Do we have an election system that allows us to achieve this future?

The answer to the first question is muddled. The western world seems quite divided. With cracks in the EU and a painful election in the US, nobody is clear on what they want. The other two questions are simply worrying.

Doctors and social media

This post came out recommending things that doctors should and shouldn’t do on social media.

So the article sites these 5 things you should never post as a doctor on social media:
1. Inaccurate Medical Information
2. Anything that Violates Patient Confidentiality
3. Your Personal Information
4. Opinions on Controversial Issues
5. Complaints or Rants

doctors-and-social-media

Point 1 is universal. It has to do with due diligence and integrity, not with being a doctor. Point 2 – about patient confidentiality – is sacred. 100% agreed.

My questions is:
Must a doctor always continue to be a doctor on social media?

A doctor isn’t a public figure – with a few notable exceptions. Doctors don’t have a responsibility to treat every interaction with another human being (including virtual interactions) like they are consultations with a doctor. Anybody who perceives it that way is misguided. The same way you don’t expect a lawyer who sat down beside you in a coffee shop to give you bulletproof advice or a professional investor sat next to you on an airplane to tell you the next big stock – you shouldn’t expect a doctor to remain a doctor in non-medical situations.

The rules above are coming from a place of fear. While the above is probably meant as a recipe for an easier life, it seems to put constricting expectations on doctors that will ultimately harm them and their patients.

As it stands, doctors aren’t outspoken enough about problems they face. They are the last to complain, the last to go on strike, the last to give their opinions on how their own system could be improved. What if they talk about their problems? Is it going to get controversial? Hell, yeah!

A propagation of fearful attitudes called for by the author of the linked article couldn’t possibly alleviate the global healthcare problems that we are all facing. Yes, information should be accurate and useless rants are… useless. However, given the extent to which doctors like to follow rules verbatim, it seems that the above rules (“don’t speak unless spoken to”) wouldn’t serve them well in the long run.

The overflowing cup

I heard this Asian parable today. A student wanted to learn from a master. He already considered himself a good student and quite intelligent. The master sat him down for tea. The master started pouring him tea. He filled the cup, but did not stop. The tea was spilling and running down the students legs. Eventually, baffled, the students exclaimed – what are you doing?! The master explained: you cannot fill a cup if it already full.

mindfulness-reassessing-beliefs

Asian culture is so interesting. Modern day Asia and the US value achievement. Modern day Europe and history book Asia value savouring and contemplation. The culture of letting go that is so central to the teachings of Asian religions and meditative practices seems counter-intuitive at first. Will you learn if you let go? Are you giving up? What is the difference between letting go and giving up?

It’s not like we are as finite as a cup. However, the most accessed memories are references are probably quite a small portion of everything we know. I think that above all it is letting go of stuff that’s not relevant any more. There’s learning and then there’s going around in filtered – not tinted – filtered glasses. Past experiences create distorting filters that add meanings to things that aren’t necessarily there. Staying in touch with reality is our biggest job. It is the one thing that allows people to figure out how to make their dreams come true: you need to always be aware of the ever-changing direction of the wind so that you can adjust the sails in order to get to where you need to be. You also need have a map, however. You need to learn to predict the weather – as much as it is possible.

The trick is to constantly reassess what should be in your cup. Beliefs shouldn’t just be formed by your own experiences, but constantly change with incoming information. An awareness of outside data is important, but an awareness of your own internal software is equally as important – that’s what mindfulness is for. It’s not just garbage in – garbage out. It is good data in – garbage out if the software is garbage. Every day is an iteration in testing both perception and our inner workings.