How the Body Knows Its Mind_The Surprising Power of the Physical Environment to Influence How You Think and Feel Read online

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

  UNHAPPINESS

  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 he
r 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 men
tal 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.