Well, to say that some things are coming to a head is probably an understatement; dad's coordination and balance have gone completely to sh*t, to the point where doctors have advised that it's probably not the best idea for him to be living at home. I know right now, frankly, Cheryl is numb over the thought of that, but I wouldn't blame her, either, if she had mixed feelings about it. There's only so much any of us is capable of. Be that as it may, I did find this in the course of literature review for class: okay, it's primarily for my own purposes, but it was very interesting to me. If it seems a little hairy, read on anyway, if you like, it's still very useful information.

The educational process called psychotherapy offers a
model for brain repair through learning.
Brain Self-Repair in Psychotherapy:
Implications for Education
Colin A. Ross
This chapter is based on my twenty-five years of clinical experience as a psychotherapist and twenty-five years as an educator. I propose that the kind of brain “repair” possible through therapeutic intervention holds similar promise for certain kinds of educational experience. Recent advances in technology, which make it possible to look inside the brain in ways not heretofore dreamed of, are beginning to confirm these empirical findings. My goal is to explain the lessons I have learned from psychotherapy about the role of learning in brain repair. Psychotherapy appears to initiate and carry out a program of brain self-repair; in essence, it enables the brain to repair and replace neurons damaged by psychological trauma. The repair involves creation of countless dendritic connections, which are functional, purposeful, and adaptive. In my view, psychotherapy, education, and brain self-repair are different facets of a single, complex, unified process.
Psychological Trauma and Brain Self-Repair
Twenty-seven years ago, I diagnosed my first case of multiple personality disorder, in 1979 (Ross, 1984), when I was a third-year medical student. For the past twenty-six years, I have been treating adult survivors of severe, chronic childhood trauma with a combination of medication and psychotherapy. During this time, I have had to unlearn much of what I was
taught about the relationship between psychiatry and psychotherapy. 1994, 1995, 1997, 2000a, 2000b, 2004; Ross and Halpern, in preparation; Ross and Pam, 1995). Psychotherapy was considered similar to handholding and therefore could not affect the brain as drugs do. Only psychiatry could really treat and heal the brain. Psychotherapy, with its creation of a trusting relationship, attention to emotions, and quest for reflection and insight, was deemed ineffective (Arehart-Treichel, 2001). Twenty-five years ago, when I was in medical school, and later, during my psychiatric residency, it was an undisputed scientific fact that the brain could not repair itself. At the time, we were taught that all it could do in response to injury was create scartissue; once a neuron was lost, it was gone forever.
The Emergence of a Paradigm Shift
According to Cartesian dualism, body and soul are separate; events in the soul (in Greek, psyche) cannot cause events in the body. Cartesian dualism became the foundation of biological reductionism, which in turn is still largely the foundation of biological psychiatry. From a bioreductionist perspective, mind is an epiphenomenon of the brain, and all causality in serious mental illness runs in one direction: from abnormal genes to abnormal brain function to abnormal mental state. On the basis of this assumption, if the biological machinery were completely understood then all treatment interventions would be at the level of genes and brain biology (Gabbard, 2000). The reductionism that dominates biological psychiatry does not hold up on scrutiny. Given the view of the brain afforded us by brain imaging, we now know that the psyche, or mind, can change the brain. To put it another way, the reflective process that leads to insight has been shown to affect— and ultimately change—patterns in the brain (Liggan and Kay, 1999). Virtually all psychiatrists claim adherence to a biopsychosocial model of mental illness, but in my experience this does not accord with operational reality. At the levels of sociology, economics of academia, grant funding, promotions, prestige, and clinical practice, biological psychiatry pays only trivial attention to the psychosocial. My trauma model theory (Ross, 2000b, 2004) suggests that we are undergoing a paradigm shift concerning the relationship among mind and brain, body, and spirit. Medical advances of the last twenty-five years now demonstrate conclusively that severe psychological stress (“trauma”) has certain predictable effects on normal mammalian physiology. As one example, stress causes an elevated level of cortisol in the blood, which in turn affects gating mechanisms in neurons in a part of the brain called the hippocampus. The gates open up and toxic metabolites and molecules enter the hippocampal neurons, causing cell damage and even cell death. The biochemical details of these effects are currently being worked out in basic science labs. We have learned that the brain can in fact repair and even replace damaged or dead neurons. This ability of the brain to repair itself is especially evident in the hippocampus. Selective serotonin reuptake inhibitor antidepressants appear to provide a nonspecific stimulus to neuronal repair in the hippocampus. According to my trauma model, severe mental illness can result from a biologically normal response to toxic—that is, traumatic—input from the environment but can also be repaired by input from the environment. Brain biology “causes” the mind, in the sense that the chemical, neurological, and anatomical workings of the brain create that which we understand as mind; but the workings of the mind can also modify and—in the sense of creating new, more effective responses to current situations—repair the biological hardware of the brain. Given this reciprocity, psychoanalytical psychotherapy can help the brain, and medication can help the mind. Rather than separate Cartesian spheres, with the mind reduced to an epiphenomenon, we have two spheres interacting through countless feedback loops and mechanisms, just as the genome and the environment interact in a complex bidirectional fashion.
Education—from the root educare, to draw out—is a major component of psychotherapy for psychological trauma. Individuals in successful therapy learn reflective skills and develop insight into their inner world. They use autobiographical memory and challenge their old belief systems while restructuring and evolving the “self.” It is interesting that transformative learning (Mezirow and Associates, 1990, 1991, 2000) discusses these same techniques, such as challenging assumptions, critical reflection, and restructuring belief systems. According to Daloz (1986, 1999), these techniques need to be implemented within a caring environment. We now know from brain imaging that these techniques of psychotherapy change and repair the brain. In fact, according to Gabbard (2000), psychotherapy, together with neuroscience, will develop even more specific modes of psychotherapy in order to “target specific sites of brain functioning” (p. 118). Since evidence supports the contention that some therapeutic techniques change and repair the brain, and since these techniques have corollaries in particular approaches to education, it now appears that education of a kind that emulates certain aspects of psychotherapy can repair and modify the biology of the brain (see Perry’s Chapter Three in this volume).
Implications of Brain Self-Repair for Education
Experience shows, and we know scientifically, that a child’s brain learns to carry out increasingly complex functions as the child matures. The brain of a ten-year-old can carry out conceptual operations such as understanding the conservation of volume, whereas the “same” brain could not do so seven years previously. It therefore follows that the brain is not actually the same; it has grown, developed, and more effectively organized itself. At the level of neurons, dendrites, and synapses, the ten-year-old’s brain is different from its configuration seven years earlier.
One might compare the root system of a tree that is three years old to the root system of the same tree seven years later. A great deal of structure exists at ten years that did not exist at three. This is easy to see at a macroscopic level with a tree, but there is equally real, concrete, and biologically meaningful growth in the human brain at the microscopic level. We also know that a child’s brain has an amazing degree of plasticity. For instance, it is possible to remove a large portion of a child’s brain surgically due to cancer, yet the child can adapt, rewire, and reorganize and be cognitively normal as an adolescent. Until fairly recently, we believed that for all practical purposes brain plasticity falls to zero by early adulthood. Now we are in the process of discovering that this is not true. These two factors, brain plasticity and self-repair, suggest that education in the broadest sense—as provided by family, peers, the culture—is essential for the brain to grow and organize. The biology is no longer inevitable gene expression driven unidirectionally by the DNA. Rather, genes for brain growth and development are turned on and off by the environment in a complex, rich set of feedback loops. Causality in brain development involves a dance between two partners, DNA and the environment. Learning can therefore either foster healthy, rich brain development or retard it. The same applies to certain types of learning in the educational system. Certain inputs are actively toxic to the brain, such as childhood physical and sexual abuse, neglect, and family violence. However, plasticity is a general property of the child’s brain, and with the proper attention children’s brains can be repaired. Given our new understanding of plasticity in the adult’s brain and the significant number of adults who come to us with stress-related problems that hinder cognitive functioning, how can we give them reparative attention? On the basis of the changes demonstrated in the
therapeutic environment, it appears that an educational system that strives toward similar engagement of higher brain functions might accomplish this task. Educational strategies that engage and develop higher brain functions include narrative, reflection, and provision of a safe or “holding” environment (See Taylor’s Chapter Nine in this volume).
Conclusion
My twenty-five years of clinical practice suggest that certain aspects of education— those that correspond to tools used in psychotherapy (creating a trusting environment, narrative, reflection, and insight)—are interventions capable of repairing damaged adult brains. The interesting question then becomes: If a traumatized brain can be repaired through this process, then what about the average brain? Can it, because of greater plasticity and more capacity to connect with the regions that control self-reflection, insight, and critical thinking, become an even more developed brain than was heretofore thought possible? Perhaps educators can collaborate with neuroscientists to explore which aspects of the educational process are most effective in lighting up the portions of the brain that lead to higher-order thinking. Indeed a new initiative, recently funded by the National Science Foundation, appears to be working in this
direction. The Center for Cognitive and Educational Neuroscience at Dartmouth College will use a multidisciplinary team that includes researchers from cognitive neuroscience, psychology, and education to explore how the brain learns. The NSF plans on giving more monies to major universities to fund centers for the science of learning (National Science Foundation, 2005).
References
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2001, 36(13), 33–36.
Daloz, L. Effective Teaching and Mentoring. San Francisco: Jossey-Bass, 1986.
Daloz, L. Mentor: Guiding the Journey of Adult Learners. San Francisco: Jossey-Bass, 1999.
Fonagy, P. “Psychotherapy Meets Neuroscience: A More Focused Future for Psychotherapy
Research.” Psychiatric Bulletin, 2004, 28, 357–359.
Gabbard, G. O. “A Neurobiologically Informed Perspective on Psychotherapy.” British
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Liggan, D. Y., and Kay, J. “Some Neurobiological Aspects of Psychotherapy: A Review.”
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National Science Foundation. “National Science Foundation Funds Center at Dartmouth.”
Press release PR-05–01.http://www.nsf.gov/news/news_summ.jsp?cntn_
id=100812. Retrieved Dec. 1, 2005.
Ross, C. A. “Diagnosis of Multiple Personality Disorder During Hypnosis: A Case Report.”
International Journal of Clinical and Experimental Hypnosis, 1984, 32, 222–235.
Ross, C. A. The Osiris Complex: Case Studies in Multiple Personality Disorder. Toronto:
University of Toronto Press, 1994.
Ross, C. A. Satanic Ritual Abuse: Principles of Treatment. Toronto: University of Toronto
Press, 1995.
Ross, C. A. Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of
Multiple Personality (2nd ed.). New York: Wiley, 1997.
Ross, C. A. Bluebird: Deliberate Creation of Multiple Personality by Psychiatrists. Richardson,
Tex.: Manitou Communications, 2000a.
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Ross, C. A. Schizophrenia: Innovations in Diagnosis and Treatment. New York: Haworth
Press, 2004.
Ross, C. A., and Halpern, N. Talking to the Voices: Treatment Techniques for Trauma and
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Ross, C. A., and Pam, A. Pseudoscience in Biological Psychiatry: Blaming the Body. New
York: Wiley, 1995.
COLIN A. ROSS is president of the Colin A. Ross Institute for Psychological
Trauma.