How the Body knows its Mind
CHAPTER 1 The Laughter Club THE PHYSICAL NATURE OF EMOTION
It is estimated that one in fifteen American adults, about 21 million, is living with major depression.1
Most of us feel down in the dumps from time to time, but depression is a never-ending feeling of sadness that affects how you think, how you feel, and how you behave. For people living with a major depressive disorder, everything is gray and life seems bleak, not worth living.
Despite recent headway made in understanding the inner workings of the brain, there is still no treatment for depression that works for everyone. Psychotherapy and drugs like Prozac have helped millions of people stave off depression, but these modalities haven’t worked for millions more. The sad fact is that some individuals’ depression is resistant to treatment.
Yet consider for a moment that almost all available treatments for depression (whether therapy or medication) target what’s going on inside the head. What if there were a way to alleviate depression that went beyond the cortex and altered the body? It might seem odd to focus on the body as an antidote for a disorder
seemingly rooted in the mind, but striking new scientific evidence suggests that our body has a powerful influence on our psychological state.
Take the case of Laura, an intelligent, driven twenty-two-year-old. Laura had just graduated from a prestigious Ivy League university and taken her first job at a top public relations firm in Manhattan when her fiancé, Brian, was involved in a car accident and died. Laura was devastated.
Brian and Laura had been high school sweethearts. He was her third kiss and her first love. Even though they had gone off to college on different sides of the country, the two had managed to stay connected as a couple. Brian was her family, the “one,” but suddenly, in the midst of planning their late summer wedding and only three short weeks after they had moved into their first apartment together, Brian was gone.
In the several months after Brian’s unexpected death, Laura tried to put her life back together. She rented a new apartment in order to get a change of scenery and even went out on a few blind dates her concerned friends had set up for her. But her heart just wasn’t in it. While her friends were busy planning their lives, Laura spent her days contemplating the bleakness of life. She constantly broke down in tears and often had trouble getting out of bed, especially on weekends and holidays when she wasn’t expected to be anywhere in particular. Her physical energy and her ability to concentrate all but disappeared, and she became increasingly isolated from friends and family. She was noticeably different. As Elizabeth Wurtzel wrote about her own depression in Prozac Nation, that’s how depression hits: gradually, then suddenly. Laura woke up one morning afraid of what might happen that day, scared to live her life. Everything seemed dark, and she could not think of anything that would make her happy. At some
point her mother suggested that she see a psychiatrist, who, not surprisingly, diagnosed Laura with a major depressive disorder.
Laura initially began taking Prozac and going to weekly psychotherapy sessions. At first the drug’s effects were almost miraculously positive. Laura couldn’t believe how much better she felt. She was more energetic and motivated at work, started seeing her friends, and became interested in life again. Over time, however, she had to take higher and higher doses of Prozac to beat her depression, until the drug seemed to stop working completely. Laura’s doctor started her on another medication, but again Laura’s depression failed to lift. After a few years she gave up on both drugs and therapy. She was stuck. Then she heard that Botox had been found to help ease depression.
Depressed individuals can often be recognized by their facial expression: a frown with a furrowed brow and downturned mouth. Kurt Cavanaugh, a cosmetic surgeon, immediately picks up on this when patients like Laura walk into his office. On a cool fall day, almost two years to the day after her fiancé had been killed, Laura went to Cavanaugh for Botox treatments.
The active ingredient in Botox is a neurotoxin that paralyzes the muscles into which it’s injected. When people get Botox for their frown lines, not only do the frown lines disappear, but their ability to produce unhappy or sour expressions goes away too. Physicians believe that preventing the outward expression of negative emotions helps alter the inner experience of negativity. In other words, certain body movements (or lack thereof) help to change the mind’s experience of emotions. On several instances Cavanaugh had casually noted that the moods of his Botox patients after treatments seemed less negative than those of his patients who didn’t use Botox. Of course, such differences could easily be due to increased feelings of attractiveness after treatment.
In Hollywood the immense pressure to stay youthful drives actors to use Botox repeatedly. But too much Botox can immobilize your face and your internal feelings. This is bad news for an actor, who needs to convey emotion, but maybe not for someone like Laura with major depression. The media has reported that Nicole Kidman, for example, has had a Botox-induced frozen face; this appeared to be in evidence when she accepted an Academy Award for her performance in The Hours. She was clearly crying, yet nothing on her face seemed to be moving. Actors’ emotional expressions make their performances more believable to their audience and also help them internally experience their character’s feelings. The eighteenth-century German philosopher Gotthold Lessing wrote, “I believe that when the actor properly imitates all the external signs and indicators and all the bodily alterations which experience taught him are expressions of a particular [inner] state, the resulting sense impressions will automatically induce a state in his soul that properly accords with his own movements, posture, and vocal tone.”2
Botox can be bad for actors’ ability to emote convincingly, yet it can help depressed individuals to quell their internal feelings of sadness by blocking its physical expression.
It may seem odd to think that the expressions we produce outwardly can affect our internal state. After all, we tend to assume that it’s the mind that controls the body, not the other way around. But there are direct connections running from the body to the mind. For example, when people are asked to hold a golf tee between their eyebrows in such a way that they have to furrow their brow, they report being in a bad mood.3
People also judge stories, pictures, and cartoons to be less funny when they are asked to hold a pencil between pursed lips so that their face makes a frown. The opposite is also true: when you hold a pencil in
your teeth so that you are smiling, you feel happier. And it’s not just facial expressions that send feedback to our brain about our feelings and emotions. When you sit in a slumped position (as opposed to straight, with shoulders back), you don’t feel as good about your accomplishments, such as how you just performed on a test or in a presentation. Simply assuming a happy or sad bodily posture, a confident or anxious mien, conveys to our brain what emotional state we are in.
Our facial expressions also affect how we react to stress. Smiling while submerging your hand in ice water for several minutes lessens stress and leads to a quicker recovery from the painful incident than if you don’t smile.4
There really is something to the old adage “Grin and bear it.” Of course, there is also a catch: this smile technique works best if you don’t know you are doing it—if you form an unconscious smile rather than smile intentionally. In the latter case, the brain seems to catch on and doesn’t interpret the bodily expression as happiness. But even faking a smile is better than nothing, because our neural circuitry doesn’t always make a clear distinction between what is fake and what is real. Even if you “smile while your heart is breaking,” as the ballad suggests, at some level your brain can’t help but interpret your smiling as a sign that everything is okay.
A relatively new type of yoga known as Laughter Yoga, or Hasyayoga (hasya means “laughter” in Sanskrit), combines laughter with rhythmic breathing. Laughter clubs, where people can engage in this playful activity, have formed from India to Chicago. What starts as forced laughter at some point turns spontaneous and contagious. Laughter not only provides physiological benefits (an abdominal muscle workout and increased lung capacity) but psychological benefits too. Laughter lifts our spirits precisely because our body has a direct line to our mind, telling us how to feel.
In the movie Mary Poppins, Uncle Albert (played by Ed Wynn) floats up to the ceiling of his study because he is filled with uncontrollable laughter, singing a song entitled “I Love to Laugh.” Uncle Albert’s levitation obviously involved some movie fakery, but there is something real in the power of laughter to lighten our moods. A laughing body is an inhospitable host to negativity and stress. There is now even a World Laughter Day—the first Sunday in May, in case you are interested in taking part.
What if your body can’t take part in these emotional experiences? This actually happens to the unlucky people born with a rare neurological disorder known as Moebius syndrome. Moebius syndrome prevents people from moving their facial muscles; they can’t smile, frown, grimace, or even blink their eyes. It’s like “living a life of the mind,” one patient said. “I . . . think happy or I think sad, not . . . actually feeling happy or feeling sad.”5
Folks with Moebius syndrome, unable to shape their face into a particular expression, have trouble expressing themselves to others and difficulty experiencing emotions themselves.
To treat Laura’s depression, Cavanaugh reasoned that using Botox to prevent frowning might serve as an artificial Moebius syndrome and at least impede negative emotions. The Botox injections he settled on would work on her glabellar frown lines, the wrinkles that occur above the nose and between the eyes and express emotions such as sadness, anger, and distress. Before giving her the injections, however, Cavanaugh asked Laura to complete a common psychological test for evaluating depression, the Beck Depression Inventory,6
which gauges the severity of symptoms of depression, such as hopelessness and irritability. People taking the test are asked to pick the statements that most closely resemble how they have felt during the previous two weeks. There are twenty-one questions; here is a sample:7
0 I do not feel unhappy.
1 I feel unhappy.
2 I am unhappy.
3 I am so unhappy that I can’t stand it.
CHANGES IN ACTIVITY LEVEL
0 I have not experienced any change in activity level.
1 I am somewhat less active than usual.
2 I am a lot less active than usual.
3 I am not active most of the day.
A score of 13 or less signifies that the person is experiencing normal ups and downs (picking mostly 0’s and 1’s). A score of 29 or more indicates a severe depressive state. Laura scored 42.
In the procedure that followed, which took only a few minutes, Cavanaugh injected Botox into several sites between Laura’s eyes and on her forehead. All you have to do is scrunch up your forehead to furrow your brow to see which areas he targeted.
Two months after her Botox treatment, Laura’s depression had lifted completely. Given that there was no major change in her life, Cavanaugh’s best guess was that her improvement in mood was due to the Botox.
Botox works by blocking the movement of acetylcholine, a neurotransmitter, from the nerves to the muscles. Acetylcholine helps carry signals from the brain to the muscles, letting the muscles know when to tense up. When the flow of acetylcholine is blocked, or at least significantly reduced, the muscle is no longer being told to contract, and so it relaxes. That’s why the wrinkled areas into which Botox is injected smooth out and soften: they’re not getting the message to tighten. After a while the acetylcholine
does get back through. (A normal course of Botox typically lasts between four and six months.) The muscles once again begin to contract and the wrinkles reappear. That’s the bad news. The good news is that the wrinkles usually become less prominent after Botox because the muscles have been “trained” to be in a more relaxed state. Perhaps this explains why, when Laura returned to Cavanaugh for a second treatment, her frown lines weren’t as pronounced (nor her depressive symptoms as extreme) as on her initial visit. Because Botox can permanently retrain the muscles, the need for further treatment is gradually reduced.
Botox is also approved by the Food and Drug Administration to treat chronic migraines; injections every twelve weeks or so into the head or neck help dull future headaches.8
Even excessive underarm sweating can be fought with Botox injections to the armpits.9
Both migraines and sweating have physical as well as emotional triggers. Laura’s story suggests that Botox can alleviate depression and improve mental health too, though it’s important to point out that Laura knew why she was getting Botox and anticipated that it would help her, just as the Prozac helped initially. But the Botox has kept her depression from returning, so it is unlikely that Laura’s changes in mood were simply due to her hopes and expectations about the treatment.
Laura’s experience wasn’t a fluke. A few years ago a group of psychologists in the United Kingdom tracked down people who had recently had cosmetic treatments. They were particularly interested in comparing the moods of people who had had Botox injections for frown lines (at the same facial sites where Laura had received treatment) with the moods of those who had received other treatments, such as Botox for crow’s feet around the eyes, chemical peels, or lip fillers like Restylane. The researchers reasoned that, if not being able to frown makes people happier,
then folks who got injections for frown lines should have elevated moods compared to those who got other cosmetic treatments. That is exactly what they found. Limiting negative facial expressions seems to affect mood for the better.10
Yet another example of the effectiveness of Botox to change the mind comes from the psychologist David Havas, who specializes in the effects of emotions on how we think and feel. Havas and his colleagues Art Glenberg and Richard Davidson offered first-time Botox users receiving treatment for frown lines a $50 credit toward their treatment if they took part in an experiment before and after the procedure. At both points, the volunteer patients simply had to read a series of sentences depicting positive and negative scenarios:
“You spring up the stairs to your lover’s apartment.” (happy)
“You open your email in-box on your birthday to find no new emails.” (sad)
“Reeling from the fight with that stubborn bigot, you slam the car door.” (angry)
Unbeknownst to the volunteers, the researchers measured how long it took them to read the different sentences. Generally it takes longer to read about unfamiliar events than familiar ones, and it also takes longer to read things you don’t understand. Reading time thus ends up reflecting how well the information resonates with your own experience—how well you are able to, say, empathize with the emotions you are reading about.
The researchers found that it took the patients roughly the same amount of time to read the happy sentences before and after the Botox treatment. However, they were much slower at reading the sad or angry sentences after the treatment as compared to
before. Botox didn’t alter comprehension across the board, but it increased the time it took to read and comprehend negative information. According to Havas and his colleagues, this is because Botox prevents people from outwardly and inwardly experiencing the negative situations they are reading about. That’s why Botox treatments that prevent people from frowning help to alleviate depression: when you can’t form negative facial expressions, you don’t feel sad or unhappy thoughts the same way you did before.11
How exactly does this facial feedback work? One theory is that, when we read or even think about an emotional event, we mentally relive how we have felt in a similar situation in the past. Put another way, when we see, hear, read, or even think about something bad, we “embody” the experience ourselves. These reactions aren’t just in the brain; they extend to our facial expressions and posture. The way we hold our body, in turn, sends signals to the brain about how we feel. That’s why when we read a sad story or watch a sad movie, we tend to show evidence of our feelings on our face. But when we aren’t able to embody the experience—when there is no feedback from our face to change our mind—emotional processing is hindered. A link in the chain needed for making meaning out of emotional information is missing. For depressed folks who tend to spend a good deal of their time frowning, an inability to furrow their brow to the degree they normally would helps put them in a better mood.
A prolonged inability to form negative facial expressions—a frown or a furrowed brow—actually seems to change how the brain registers negative emotions. People who have had Botox to remove frown lines show reduced activity in neural centers involved in emotion processing. Brain areas such as the amygdala, an almond-shaped region deep inside the brain where negative feelings originate, are less active in people who are asked to mimic
angry facial expressions after Botox as compared to before.12
Not being able to make a sad or angry face for a period of several weeks changes how the brain registers negative emotional experiences, watering them down, making them less severe.
A recent study conducted in Germany and Switzerland further confirms the ability of Botox to alleviate depressive symptoms. Men and women with an ongoing major depressive disorder were recruited from local psychiatric clinics to get a series of injections in their face (between and just above the eyebrows) over a sixteen-week period. Volunteers knew they might receive injections of either Botox or a placebo, but they didn’t know which one. The power of the study comes from the fact that it was double-blind, which means that neither the doctors giving the injections nor the patients themselves knew if they were getting the real Botox injections or a saline solution. The syringes that contained the Botox and the placebo were indistinguishable. But the results were striking. Signs of depression, such as sadness, hopelessness, and feelings of guilt, decreased by an average of 47 percent six weeks after the first treatment for those who actually received the Botox, and the positive benefits remained for the length of the trial. Those in the placebo group didn’t show the same marked improvement; their depression held fairly steady across the course of the study.13
“Refuse to express a passion, and it dies,” wrote the father of modern-day psychology, William James, in 1890.14
A century later scientists have found support for James’s statement in Botox, a drug made popular for its ability to smooth wrinkles.
Facial expressions do not merely express our internal states; they actually affect how emotions are registered in the brain. Charles Darwin was among the first to recognize this body-mind connection. He wrote in The Expression of Emotion in Man and Animals,
“The free expression by outward signs of an emotion intensifies it. On the other hand, the repression, as far as this is possible, of all outward signs softens our emotions. He who gives way to violent gestures will increase his rage; he who does not control the signs of fear will experience fear in a greater degree.”15
The New Science of Embodied Cognition
Darwin argued that the connection of mental states to movement is literally what emotion is (as in the word emotion itself), but other philosophers, including René Descartes, thought differently. Descartes claimed that there was a great divide between the mind and the body, that the mind was made up of an entirely different substance than the body. This dualist viewpoint—that our body is irrelevant to understanding how we think, learn, know, and feel—is still widely accepted today. Even many recent brain science books completely overlook the formative role that our body plays in shaping our mind.
The influence of our movements on our thinking and reasoning is only beginning to be measured and appreciated. In the past few years the science of embodied cognition, which is in line with Darwin’s teachings, has demonstrated how the workings of our mind are entangled with our physical sensations. It sheds new light on the powerful influence that our body has on our mind, and the minds of others. It is providing surprising insights into how our movements influence our decisions and choices, from whom to date to what products to buy. The research on embodied cognition is also changing how we think about how to learn and perform best at school and on the job.
Our mind arises from interactions between our brain, body, and experiences, especially emotional experiences. It’s not just that we need the body to show emotions—emotion itself can be traced back to the body. That’s why holding a pencil between your teeth in a way that forces you to form a smile puts you in a good mood. It’s also why Botox that gets rid of frown lines between the eyes lessens depression. The configuration of your facial muscles sends signals to your brain about how you should feel.
Thinking about the striking connection between body and mind has special significance for me. My career as a cognitive scientist has been heavily influenced by the idea that there is a great divide between the mental and the physical, which has dominated psychology and Western thought for a couple of centuries. This separation of mind and body has been likened to the distinction between the software and the hardware of a computer. I no longer accept the idea that we are simply a set of software programs running on our body hardware because, unlike hardware, our body does influence our mind. As a cognitive scientist, I’m using all the tools available to me to find out how our thinking is shaped by the body, to understand the mind in a larger context, and to find the keys to how we can function at our best.
Accepting the body’s influence on the mind helps us make sense of some surprising connections between the physical and the psychological. Take pain as an example. Some of the same brain areas that register physical pain, as when you burn your hand on a hot stove or stub your toe, also log the psychological pain of being rejected by a lover. Because the same neural hardware can serve as a gauge of both mental and physical pain, it makes sense that people who are sensitive to one type of pain (rejection, for example) tend to have more physical complaints.
People who experience the psychological pain of depression also tend to experience a higher rate of physical ailments than those who are mentally healthy.16
Body pains also affect our interpretation of psychological pain. Fibromyalgia, characterized by chronic pain and body fatigue, has been linked to loneliness.17
Likewise, people with chronic pain disorders have a greater tendency to have an “insecure” attachment style, characterized by fear of loneliness and rejection.18
Enhanced sensitivity to physical pain goes hand in hand with enhanced sensitivity to social pain. Our body has a direct line to our brain and exerts a powerful influence on our mental health and well-being.
Striking new research that my colleagues and I have conducted in my Human Performance Laboratory at the University of Chicago has found evidence of the mind’s dependence on the body. For instance, we have discovered that feeling anxiety about doing math is grounded in some of the same folds of brain tissue that register physical pain.19
My colleagues and I have peered inside the brains of people as they wait to take a math test and discovered that, for those who fear the subject, anticipating doing math looks a lot like being pricked with a needle or burning one’s hand on a hot stove. Our mental fears have a lot in common with our physical pains.
It’s a standard view that we scientists always conduct a little bit of “me-search” in what we do, and I absolutely want to explore the mind-body connections I have experienced firsthand. As an example, a few months ago I went to pick up my two-year-old daughter, Sarah, from preschool. I immediately noticed she wasn’t her happy self, and my maternal alarm signal went off when she asked for some medicine. Was she sick? I checked her forehead, but she didn’t feel overly warm, so I asked her what was wrong.
Did her tummy hurt, or maybe she had a sore throat? But neither seemed to be the case. After some more questioning, and a short conversation with one of Sarah’s teachers, I got to the bottom of things. Apparently one of the boys in her class had taken a toy from her that she really wanted to play with. He was so mean about not sharing that Sarah had started to cry. Sarah remembered that she took Tylenol when she had a fever and didn’t feel well and that taking the medicine usually made her feel better. It was a short leap for her to the idea that the Tylenol would make her feel emotionally better too.
I got to wondering whether Sarah’s line of thinking might have some merit, especially since my team had recently discovered that, in the brain, being mentally anxious (say, about doing math) looks a lot like experiencing physical pain. Sure enough, I found research by the husband-and-wife team of Naomi Eisenberger and Matthew Lieberman at UCLA that a daily dose of Tylenol diminishes the hurt feelings that often accompany being socially teased, spurned, or rejected—or getting a toy taken away.20
Tylenol reduces the sensitivity of the neural circuits involved in pain, so it has the power to lessen both social and physical pain. I wondered if this might work for math-anxious folks too, and, in future research, intend to find out.
Our thinking extends beyond the cortex. My new goal, as both a researcher and a layperson, is to find out just how far this new science of embodied cognition can take us in finding the ingredients we need to function at our best.