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by Louis Cozolino
W.W. Norton, 2010
Review by Rob Harle on Nov 9th 2010
This book at over four hundred and fifty pages kept me captivated from the first to the last page. Considering the subject matter, the technical aspects of neuroscience, and the complexity of psychotherapeutic processes this is astonishing. Cozolino is a brilliant writer and wonderful story teller. It is one thing to be a neuroscientist and a successful, practising psychotherapist but to be able to write about the combination of these disciplines in an informative and entertaining way is over and above the call of duty. This is probably why the first edition of this book published in 2002 was a best seller.
This edition, which is part of the Norton Series on Interpersonal Neurobiology, has new chapters, completely updated information concerning the latest findings of neuroscience, especially the concept of brain plasticity, and the importance of this to psychotherapy. It is arranged in six parts together with an excellent Bibliography and Index.
Part 1 -- Neuroscience and Psychotherapy: An Overview looks at the integration of neuroscience and psychotherapy with a slant towards the recent history of the two modalities.
Part 2 -- How the Brain Works: The Legacy of Evolution looks briefly at how our brains work, how evolution has modified them, and how they have adapted over time. As Cozolino says, this description is necessarily brief as it would take “...tens of thousands of pages to do justice to what is known about its structure and function” (p. 55)
Part 3 -- The Organization of Experience and the Healthy Brain tackles the prickly subject of consciousness and reality, and how we construct our realities and how psychotherapy helps sort out “false” realities from healthy realities.
Part 4 -- The Social Brain. This chapter deals with Cozolino's second major thesis (the first is the importance of brain plasticity) that the human brain is a social organ. The importance of brains interacting with each other, from day one, cannot be overestimated according to Cozolino. He gives numerous case scenarios of social deprivation, especially in laboratory controlled experiments with rats, where both brain physiology/anatomy is measured and resultant behaviour is observed. What hit me like a sledge hammer in this section was the extreme importance of the first six months (at minimum) of a child's relationship with its mother.
Part 5 -- The Disorganization of Experience as the title suggests discusses what happens to brains and lives when things go wrong. It explains for example how the amygdala part of brain, which is fully formed at birth, hijacks other areas and brings on fear when none is warranted. This is a legacy of our evolution and as the cerebral cortex has expanded dramatically together with its imaginative power, “...we have become capable of being anxious about situations we will never experience”. (p. 240) Many common health problems are discussed with a fair amount of space given to Post Traumatic Stress Disorder. This is not because PTSD is the new “fashionable” psychological problem, commonly associated with combat, auto accidents and so on, but because PTSD is implicated in all sorts of situations from child abuse to serious illnesses, in fact anywhere trauma has been experienced over and above the normal day to day levels of living.
Part 6 -- The Reorganization of Experience discusses psychotherapy in relation to specific case studies. What changes occur and where in the brain when a psychotherapist uses various techniques. How permanent these changes may be, and ways of increasing the permanency of such changes are also discussed.
These brief section descriptions are really only guidelines for the book's structure. Cozolino moves effortlessly from complex deep brain neuroanatomy, to evolutionary influences on the brain, to different psychotherapeutic modalities, to personal anecdotes, to (at times) quite moving case histories.
A question which many readers probably would like to ask is, Why does a psychotherapist need to know anything about neuroscience? Does knowing for example, “A component of the integration of top-down, cortical, and limbic processing occurs in the communication between the ompfc and the dlpfc. The bias of these regions toward the right and left hemispheres respectively allows them to also support the integration of the left and right cerebral cortices”. (p. 127) make one a better psychotherapist? Cozolino would argue most definitely and outlines these reasons in the section, Why Neuroscience Matters to Psychotherapists. (pp. 356-358) Just one example from this section will suffice. “On a practical level, adding a neuroscientific perspective to our clinical thinking allows us to talk with clients about the shortcomings of our brains instead of the problems with theirs. The truth appears to be that many human struggles, from phobias to obesity, are consequences of brain evolution and not deficiencies of character” (p.356)
This book is primarily intended for student or practicing psychotherapists. Regardless of the level of neuroscience a psychotherapist wishes to add to their expertise I cannot recommend this book highly enough. The book also will be a valuable addition to the bookshelves of neuroscientists themselves, clinicians, policy makers and especially public mental health workers.
© 2010 Rob Harle
Rob Harle is an artist and writer, especially concerned with the nature of consciousness and high-body technologies. His current work explores the nature of the transition from human to posthuman, a phenomenon he calls the technoMetamorphosis of humanity. He has academic training in philosophy of mind, comparative religious studies, art and psychotherapy. Rob is an active member of the Leonardo Review Panel. For full biography and examples of art and writing work please visit his web site: http://www.robharle.com