Brain Cartography

This is one in a series of short discussions of the myriad ways our society in general, and the mental health field in particular, fail to understand the veteran culture. That there is a such a thing as a “Veteran Culture” as something unique is itself a hotly contested when not summarily dismissed concept.

One of the most common complaints of those seeking, thinking of seeking, or deciding not to seek mental health therapy is thoughts and emotions that are out of control. The reasons between the doing and not doing of therapy generally fall into two camps, the “it’s my thoughts out of control, not emotions” for the latter, and “I can’t sleep, concentrate or stop the thoughts unless I’m busy and distracted, and even that isn’t working so well anymore” for the two former positions. To say that doing something about what is going on between your ears before it becomes necessary, to keep your job or your family, to be able to sleep, or just function without desperation driving your life, is obvious.

One of the hurdles to overcome, both for the seekers and the refusers, is understanding what actually happens in therapy.  I’ve written before about my orientation and spiel being very direct and transparent, both because of the effectiveness of the approach and the comfort that can be taken from defining the unknown. Still, what about the mechanics of therapy? How does that even work? Are we going to talk about my mommy potty training me too soon or not loving me enough?

The short answer to both those questions is no. Unless you wet my couch.

My primary technique falls under the general umbrella of Cognitive Behavioral Therapy, the gold standard of protocols. The reverence for this orientation is slightly biased due to it being the most empirically studied. Comparing CBT to other modalities that do not have as easily quantifiable research objectives is unfair, and does not mean other orientations and techniques do not work. Recognizing this bias does not, however, invalidate the underpinnings of CBT itself.

The simplest, most direct explanation of how CBT works is part of my initial conversation with clients. Granted, it is not a purely scientific description, and is a gross oversimplification. The explanation works, not for its strict biological, neurologically accurate depiction but more for its metaphoric accessibility for both clinicians and clients.

Cognitive Behavioral Therapy recognizes four distinct domains, our thoughts, emotions, behavior, and somatic experiences. While each can be recognized and addressed separately, the various entry points to this four component description of human experience is what has given rise to the numerous derivatives of CBT. Basic CBT as it is practiced in talk therapy starts with thoughts.

Thoughts are regarded as things, as events that happen in the brain, of neural connections firing. The more frequent the thought, the more robust the neural connection. Thoughts create our emotions, literally and experientially. Emotions cause behaviors, which in turn create sensations in the body, which create perceptions – thoughts. Most importantly, this is not a one-way, sequential experience, meaning each of these four components of our existence impact each of the others.

The basic premise of CBT is to intervene in the thoughts to create change in the experience of all the other components. New thoughts, or even just questioning existing ones, weaken the connections supporting unhelpful cognitions while encouraging the creation of new neural links. This is the justification for stating that talk therapy literally rewires our brains. Understanding we have this much power over a part of our biology normally considered something that can only be impacted via chemicals or surgery can be a watershed moment.

Imagine a primeval forest. Animals (our survival instincts) find the path of least resistance and create a trail, which is then used by hunter-gatherers (our mammalian brain), which eventually becomes a cart-path (our human brain), a road and then perhaps a superhighway.

Roads become obsolete over time. Sometimes a road was not constructed wide or strong enough to sustain increased traffic, or perhaps a natural disaster so changed the landscape rebuilding in that spot is not feasible. Sometimes, the destination to which the road once led is no longer there such as when a landslide, earthquake or flood changes the topography. What happens to a road, even a highway, that is no longer used for even the most mundane of reasons? It becomes overgrown and eventually nature reclaims its own, making it all but indistinguishable from the surrounding fields or forest.

Traveling down those near-forgotten byways then becomes an intentional choice, perhaps born of nostalgia, or maybe as a courageous act of adventure. Part of that exploration is recognizing why the now disused or no longer useful road was originally created. Exploring the road map of your brain through the use of CBT is akin to taking a trek with a guide whose map shows a safer, more comfortable, and more direct route than you have previously traveled.

Your guide also helps uncover historical points of interest, structures in which you once sought shelter and weathered storms, pointing out the crumbling foundations which make staying there now dangerous. Each of those waypoints served a purpose, had a function at the time it was created. In one way or another those now familiar, haunted sites supported the survival of the person and facilitated the ongoing journey that is life.

When we are experiencing racing thoughts, bouts of anxiety, crippling depression or memories from which we cannot escape, I liken the road map created in the brain as having been drawn by an epileptic cartographer in the throes of a gran mal seizure. And, written in a foreign language. CBT is the phenobarbital, mapmaker, and translator you commission and direct.

If you are struggling, reach out to a buddy or call 988 and press 1 if you want to identify as a veteran. If you are not struggling, reach out and be the buddy to someone else.

Category: Mental Health