Steven Johnson
Date Published: 

A Book Review by: Paul Harris, OD

Johnson’s writing style is very engaging.  As I read the book it felt as if we were sitting at a cozy table in a coffee shop and the Latte’s were coming one after another and Johnson was excitedly relating his stories.  Although there is a lot of neurology in this book, it is delivered via exciting stories that help to make his points real, in a conversational way. 

The book is divided into six sections, none of which have traditional titles, for example: “Your Attention, Please”, or “Survival of the Ticklish”, or “Scan Thyself”.  In the first section, “Mind Sight”, he begins by talking about his experience with some biofeedback monitoring equipment that was monitoring his adrenaline levels.  He and the therapist had just shared a joke.  He states, “Making a joke had triggered a surge of adrenaline in me.  Or was it the reverse?  Perhaps the rise in adrenaline was me mentally revving the engines before launching my joke into the environment.  Whatever the causal chain, my joke-telling and my adrenaline levels were locked in some kind of chemical embrace.” (page 2)  Throughout the book Johnson gives us insight into how he is put together and how this is revealed to him step by step by all the things he willingly tries.

Early attempts to understand how the brain works attempted to assign particular functions to particular locations in the brain.  However, this simplistic view has been fairly well torn down over the years.  “Your brain is filled with a lively cast of characters sharing space inside your cranium, and while it’s interesting to find out their exact addresses, that information is ultimately unsatisfying.  Call it the ‘neuromap fallacy.’  If neuroscience turns out to be mostly good at telling us the location of the ‘food craving center,’ or the ‘jealousy center,’ then it will be of limited relevance to ordinary people seeking a new kind of self-awareness – because learning where jealousy lives in your head doesn’t make you understand the emotion any more clearly.” (page 15).  Recall seeing so many presentations with the new colored fMRI’s or PET scans showing brightly lit areas during this activity or that activity.  This may just be a passing phase in our coming to terms with what a brain is and how we use it.

In chapter 1, “Mind Sight”, Johnson discusses how we model the way others think and how central this is to who we are and what makes us human.  “One of the human brain’s greatest evolutionary achievements is its ability to model the mental events occurring in other brains.” (page  20) “We construct working hypotheses about what’s going on in other people’s heads almost as readily as we convert oxygen into carbon dioxide.”  He points out that this is necessary for language to have developed at all.  “For language to evolve, humans needed a viable theory about the minds of other people – otherwise, they’d just be talking to themselves.” (page 23)

Evidence of this mind-modeling comes from work with monkeys in the 1990’s.  What was found were neurons that were labeled “mirror neurons”, neurons that fire both when a monkey performs a particular task and when they see another monkey do the same or very similar task.  This suggests, “that the brain is designed to draw analogies between our own mental and physical states and those of other individuals.”  Getting very clinical for a moment he discusses how problems analogous to these cells may be occurring in autistics.  Autistics may suffer from a kind of mind-blindness, which prevents them from building hypotheses about others’ internal monologues. 

Johnson brings vision into this “other mind” hypothesis.  “Eyes are essential to building what brain scientists call a ‘theory of other minds’.”  “In their first year, most children will become adept at something called ‘gaze monitoring’: they see you looking off toward the corner of the room; they turn and look in that direction; then they check back to make sure the two of you are looking at the same thing.” (page 30) “Gaze monitoring is a kind of psychological physics: people have minds; people’s minds perceive different things; part of that perception happens through the eyes; if you want to know what someone’s thinking, look at his eyes.”  “So just as some animals evolved nervous systems that were adapted for sudden movement or sonar, our brains grew increasingly sophisticated at modeling the behavior of other brains.”  (page 32)

He returns to how this relates to autism.  “Autistics are mind-reading impaired; they lack social intelligence, particularly the ability to make on-the-fly assessments of other people’s inner thoughts.  Autistic people do have to go to school to read facial expressions – learning to intuit another person’s mood is at least as challenging for them as learning to read is for the rest of us.”  “One of the early predictors of autism in toddlers is an inability to perform gaze monitoring.”  Interestingly, I have found myself now trying to work in a manner in which to observe this in my work with young children. 

In his chapter 2, “The Sum of My Fears”, he discusses the role of thalamic connections in the auditory system, which are very similar to some of the things we see in the visual system, which come to the fore in stroke victims or head injury cases.  Learning in the auditory process was dependent on the thalamic connections, which were found to have a branch out to the amygdala.  Some patients, whose connections to their auditory cortex were severed or with a non-functioning auditory cortex, would continue to show fear to a sound in spite of not being able to “hear” the sound.  This reminds me very much of blind sight in the visual process, where visual information is still getting to other parts of the brain, but because the loops between the lateral geniculate and the primary visual cortex in both directions have been disrupted, conscious awareness of what is being seen is not functioning.

I began chapter 3, “Your Attention, Please”, with rapt attention as he jumped right into the topic of neurofeedback.  I have a patient who has been involved in neurofeedback for a number of years who has wanted me to try some of these devices to see to what degree they might shorten the length of a vision therapy program.  As well, one of our colleagues has been very involved in using neurofeedback favorably in his optometric practice.  Johnson describes a session in detail and he learned a few things about his own ability to concentrate.  One of the key things he learned, which the research is showing, is that there is no one thing “attention”.  Attention has various elements and controls and mastering control in one area does not mean that the person has achieved universal control of attention.  “We’ve found from our tests that some people can focus intently while they listen whereas others can’t. One of our clinicians was testing adults, and was working with a man you tested off the charts when he was reading but couldn’t listen worth a damn.”  Johnson was a very good listener during his testing. 

Johnson attended a meeting of those doing neurofeedback and he said, “The New Age component had me eyeing the exits on a number of occasions, but there was also an infectious enthusiasm to the group, in both their belief in the technology itself and their belief that they could use it to enhance their brains.”  Johnson discussed several examples of how neurofeedback was used with athletes in different sports to help them achieve getting in the “zone” or to recapture the mind set of performing at the top of their game.  One injured diver was able to continue practice in his mind during his recovery by using the device and returned to a higher level of competition soon after his physical recovery, when normally many months of working back into competitive shape would have been necessary.  With golfers one neurofeedback clinician discussed how he has the golfer work to inhibit all frequencies of the mind, causing an almost blanking out of the minds inner speech, allowing the athlete to letting muscle memory do its thing.

Johnson summarized the keys of neurofeedback in the following, “Neurofeedback is mostly just a mirror.  How we choose to change ourselves based on what we see in the reflection is up to us.”  This reminds me very much of my view on vision therapy.  Each of the activities or procedures is a means to an end, not an end unto itself.  We do the activities to provide our patients the opportunity to have the necessary meaningful experiences to acquire new skills and abilities, not to become masters of the procedures or activities.

Attention is broken into many separate pieces by Johnson that can be assessed by the Comprehensive Attention Battery (CAB), which was developed by John Rodenbough, a North Carolina-based psychologist.  At the basic level one must sustain attention on a task to encode the sensory data that is coming in.  This helps to get the data into a useable form into working memory.  Next comes the attention skills of “focus and execute”.  This is where you are going through a complex series of things that you have habituated, focusing first on this and executing it, and then focusing on that and executing that, and on and on, each step of your normal routine.  Much of this occurs below a level of consciousness until something out of the ordinary pops up.  On top of all of this is “supervisory attention control.”  This is how we extract on-the-fly assessments of relevance out of a flurry of competing signals. 

“The attention system works as a kind of assembly line: higher-level functions are built on top of the lower-level function.  So if you have problems encoding, you’ll almost certainly have problems with supervisory attention.  When people notice attention impairments, they’re usually detecting problems with the focus/execute or the supervisory levels, but the original source of the problem may well be farther down the chain, or it might be localized to a particular sensory channel.” (page  93)  Wow, what a mouthful, but what a beautiful mouthful!  What Johnson has caught here is the essence of what may be going on in the great debate about ADD and ADHD and why so many of these kids are getting medicated and why we feel it is so unnecessary.  What the parents and teachers are seeing are the higher level attention problems.  We see the lack of control in the visual system of visual attention and know that until that is fixed of course the other stuff will also be a problem.  Rather than using a top down approach of fixing symptoms with drugs we take a bottom up approach, working on the sensory attention issues and then working to integrate that into an overall control of attention that would then obviate the need for stimulant medications.

Johnson ends the section on attention with the following, “You could use the technology (neurofeedback) to take the edges off or you could use it to make the edges sharper.  You could attempt to improve focus, or you could learn how to make things a little blurrier.  And maybe more important, you could use the technology to help you select the appropriate state on command.”  What Johnson is getting to here is that in just about anything it’s not achieving a particular level that is the goal.  The goal is to have a wider range through which that process can be used and to have the control to use it just the way it needs to be at that moment.  In vision it is not about having great attention all the time.  It is about using attention as needed and then letting it fall back to a “blurry” steady state, allowing resources to be used in other ways, rather than always being locked in on any detail that happens to present itself. 

In chapter 4, “Survival of the Ticklish”, Johnson explores some gender differences.  He discusses the fight-flight responses typically talked about in stress situation, and assigns these primarily to males.  Females he says, approach these types of situations more with a different set of options, that he has termed; tend-and-befriend.  The maternal instincts to protect her young do not permit too much fighting, so women tend to seek social support in stressful situations more often than men. 

In this section Johnson gets into some aspects of what emotions are for.  By developing love and positive feelings, he states it helps prepare humans for taking care of their young.  “The glue that keeps those bonds strong is the feelings of pleasure and reward and satisfaction that our brains concoct for us when we enter into loving relationships.” 

Johnson spends much of this section of the book talking about the social nature of laughter.  He talks about how important facial expressions are and how laughter is actually healthy for us.  He summarizes this section with the following, “As far as brain chemistry goes, there are two strategies available: you can load up on adrenaline and fight-or-flight, or you can cool down with oxytocin and tend-and-befriend.” 

I found the rest of the book interesting.  For many just getting into functional neurology, this section may be more interesting but Johnson was going back over areas where I had already done extensive reading.  His views are very similar to my own, which of course, I found quite comforting.  I highly recommend this book and look forward to discussing it with you.

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