No matter what your individual experience has been since the new millenium dawned, it’s relatively safe to say that things certainly haven’t been boring. Events of uncommon scale and scope have permeated, punctuated and often punctured our lives, and the health and human services sector has seen its own share of instability, conflict, pressures and the distinct shadow of more change to come. 2012 comes along with no clear sign of the Mayan apocalypse just yet, but who knows.
What’s more telling is what we can learn about ourselves when previously unforeseen forces overtake our collective consciousness, and nothing provides insight into consciousness quite like a disputed theory of what goes on inside our skulls. Neuroscientist Paul MacLean’s triune brain model provides a window through which to view the ever-changing world around us and our role within it.
MacLean asserted that the brain didn’t so much grow in size as it built additions onto the original house of the smaller reptilian/primitive brain that claims fame for the flight-or-fight response and scarcity/survival mechanisms. First, the limbic/caring brain wrapped around it and brought us the capacity for emotions, bonding, and feelings linked to behaviors. Then the large neocortex/thinking brain was added that included the toys of language, logic, operational thinking, foresight and planning.
MacLean has caught flak for his work, and yet it feels both sensible and explanatory (more on feeling later). He generally gets credit for identifying the limbic system of the brain, but much of the rest of his work has received more criticism than praise. We’ll side with early 20th century statistician George E.P. Box’s quip that “essentially all models are wrong, but some are useful” and say that the notion of three brains fighting for dominance pretty well provides insight into behaviors being played out in front of us.
Take the financial crises of the world. They wouldn’t be possible without dominant neocortex thinking to create complex instruments concealing high risk assets. Likewise, without the reptilian brain’s scarcity reaction any number of people at all levels of market participation might have stayed on the sidelines. Instead lots of people jumped in feet first and financial crises bloomed like mushroom clouds in Iceland, Greece, Ireland and the U.S., to name a few.
Or take health care. One could suggest that a similar brain playbook was followed by engaging reptilian instincts and neocortex wizardry. In this case, the last 50 years have been focused on the reptillian/survival concept of ‘wars’ (on cancer, heart disease and now obesity, among others). In response, neocortex-driven scientific minds have developed compelling breakthroughs, demand for which is driven by the survival instincts of each increasing patient population in a continuously snowballing cycle of growth.
Except that at some point, unchecked growth creates imbalance. Bubbles form and, historically speaking, they burst, unless we can find our way back to balance first.
What’s been missing in both cases is the limbic/caring brain. Trapped as it is in MacLean’s model between the other two brains, it seems to have been subjugated, it’s role out of balance in comparison.
With worldwide financial systems nearly running off the rails, Michael Lewis concluded in his book on the subject that the people involved first required a culture change in order to figure a way out of the financial mess. If they could not accomplish that, he reported, then outside elements would force it upon them. In other words, we can either change our own minds, or they will be changed for us.
There are signs that people are in the process of such a change, rethinking what matters and perhaps re-engaging their caring minds in the process. You could see it when Bruce Springsteen released a song last month titled “We Take Care of Our Own” and it quickly became a political and cultural rorshrach test. You could see it two weeks ago when the world watched Clint Eastwood stride across 111 million television sets declaring it was halftime in America and that our second half comeback of pulling together and helping each other win was about to begin.
Health care must embrace this conversation shift that engages all three brains in balance. Too much is at stake for it not to: individual health, population health and economic stability for starters. Within the industry of health care itself, far too many bubbles are increasing in size and threatening to burst. A system built around adherence to the tenet of “do no harm,” has been harming itself by the diminution of caring within the caring profession.
The contributions of our uniquely evolved brains make us distinctly human, so it makes sense (neocortex), and feels right (limbic) that this will be a key to moving forward (survival). It is an opportune time to debate the meaning of taking care of our own, and of working through what our second half comeback gameplan will be. In short, it’s time to make sure all three of MacLean’s brains are working in concert when we approach the task of improving health and improving lives through recognition that nobody wins unless everybody wins.
Models can be useful when you work through them and learn something about yourself in the process. As Robert Frost once said “the best way out is always through.”