Your Unique and Beautiful Brain

• 

Recently, I visited with a young man who has been my patient for twelve years. Throughout those years, his life has been narrowed by obsessions and compulsions. They dictated how he crossed doorways, in a literal sense, and limited his ability to cross the thresholds of life, in a figurative sense. As ordinary actions were extraordinarily difficult, so too were the healthy developmental transitions of life.

As we spoke, I recalled the life of John Forbes Nash, Jr., whose story was told in the 2001 cinematic film, A Beautiful Mind. Russell Crowe portrayed Nash as both a victim and a victor. Nash was a brilliant mathematician whose life was overtaken for decades by hallucinations and delusional thinking. The film ends with Nash receiving the Nobel Prize.

.

Late in his life, Nash spoke of learning to question the authority of those psychotic thoughts. In an interview, he stated, "I think it is possible for a person to emerge from schizophrenia by rejecting the delusional thinking." He described learning, in essence, to ignore the hallucinations and delusions rather than succumb to their intrusions into his mind.

As my patient and I spoke, a thought occurred to me: are not all minds beautiful?

Over the many years of my practice, I have felt increasingly constrained by the limitations of the psychiatric diagnoses available to me. The Diagnostic and Statistical Manual of the American Psychiatric Association is the common language of research and patient care in mental health. In his 2002 book, DSM: A History of Psychiatry's Bible, Allan V. Horowitz wrote, " In short, the DSM is fundamentally a social document that both influences and reflects the changing internal and external dynamics surrounding psychiatry."

Psychiatric diagnoses are conceptualized to improve reliability in research and communication among researchers and clinicians. The psychiatric disorders are both scientific and socio-political constructs. They are at once useful and flawed. They do not come close to capturing the lived complexity that shapes the human brain to be the human mind.

We know that the human brain contains approximately 100 billion neurons, supported by ten times as many modulating cells, called glial cells. Together, they form a trillion internal connections, called synapses. Communication occurs instantaneously through dozens of neurotransmitters, which act as signaling systems. The scale of complexity is difficult to grasp.

Each brain is changed moment to moment by its internal and external environment. We experience our complex and ever-changing brains as our minds.

How do I try to understand your unique and beautiful mind? Each morning in my home study, over a cup of coffee or two, I read the histories of my patients for that day. With narratives increasingly composed and synthesized by artificial intelligence, I imagine each person's life, with its goals, challenges, failures, and successes. I ask myself, "How could I be of help today? "

As I look over the notes from months and years past, I necessarily consider diagnoses. More importantly, I consider life stories - stories shaped by biology, family, friendship, mentorship, and culture. All contribute to the formation of a unique and beautiful brain into a unique and beautiful mind.

I am humbled each day by the opportunity to share in the life of your unique and beautiful mind.