All posts by John pullyblank

M. Jackson Group Update – October 2014 – Soldiers Wary of Treatment

M. Jackson Group Update – October 2014 –  Soldiers Wary of Treatment

This month’s article again comes from the listserv of Ken Pope. What is described here is what we often see in clients who are first responders or otherwise on the front lines of health and mental health care. Unfortunately, their fears can be reinforced by the way in which they are treated by colleagues and supervisors.  The article is as follows:

The Canadian Broadcasting Corporation released an article: “Soldiers’ mental health survey reveals fear of career stigma; Military watchdog efforts to reduce stigma and barriers working but more needs to be done” by Kristen Everson.

Here are some excerpts:

[begin excerpts]

One-third of Canada’s soldiers worry that seeking mental health services would harm their career, according to newly released data from the Canadian Forces Mental Health Survey.

The military’s ombudsman says the numbers suggest the message that it is OK to seek help is getting through to some soldiers — but more needs to be done.

The raw data reveals 34 per cent of soldiers agree or strongly agree that seeking mental health services would harm their military career.

Forty-seven per cent disagreed or strongly disagreed, and 19 per cent didn’t feel strongly either way.

The survey was developed by Statistics Canada with the Department of National Defence. About 6,700 regular force members and 1,500 reservists were interviewed from April to August in 2013.

Participants were selected based on a random sample of the total population of full-time Canadian Forces members.


The numbers given to CBC News are a snapshot of a larger survey to be released next month, and include only responses from regular force members.

National Defence launched the survey to look for possible barriers to Canadian Forces members getting care.

A rash of suicides in late 2013 and early 2014 thrust mental illness and mental health support in Canada’s military into the spotlight.

This survey was conducted before those incidents, but during a time when Canada’s mission in Afghanistan was ending and concern about mental health support was on the rise.


Canada’s military ombudsman called the preliminary data “disconcerting.”


Members were also asked whether they would prefer to seek mental health services on their own. Forty per cent agreed or strongly agreed, 38 per cent disagreed or strongly disagreed and 21 per cent did not feel strongly either way.

One official suggested this may lead the military to design tools to allow members to seek help online.


Johanna Quinney, spokeswoman for the minister of defence, said the health and well-being of soldiers remains a top priority for the government.

“Whether wounds are physical or mental, members who are battling illness or injury now have greater access to specialized care than ever before. We personally encourage all those in need to reach out, get help and benefit from these services,” she said in a statement.

[end excerpts]

The article is online at:

Ken Pope


“[T]he good we secure for ourselves is precarious and uncertain, is floating in mid-air, until it is secured for all of us and incorporated into our common life.”
–Jane Addams (1860-1935), founder of U.S. social work profession, women’s suffrage leader, and recipient of the Nobel Peace Prize


M. Jackson Group Update – September 2014 – Hours of Sleep

M. Jackson Group Update – September 2014 –  Hours of Sleep

This month’s article comes from my favorite source, the listserv of Ken Pope. Since I never convinced myself to get 8 hours of sleep, I particularly liked this article.

The *Wall Street Journal* includes an article: “Why Seven Hours of Sleep Might Be Better Than Eight; Sleep experts close in on the optimal night’s sleep” by Sumathi Reddy.

Here are some excerpts:

[begin excerpts]

It’s the holy grail of questions: how many hours of sleep should we ideally get per night?

We’ve heard the magic number eight, but experts are working to come up with a more refined, evidence-based number.


Several sleep studies have found that seven hours is the optimal amount of sleep–not eight, as was long believed–when it comes to certain cognitive and health markers, although many doctors question that conclusion.

Other recent research has shown that skimping on a full night’s sleep, even by 20 minutes, impairs performance and memory the next day.

And getting too much sleep–not just too little of it–is associated with health problems including diabetes, obesity and cardiovascular disease and with higher rates of death, studies show.

“The lowest mortality and morbidity is with seven hours,” said Shawn Youngstedt, a professor in the College of Nursing and Health Innovation at Arizona State University Phoenix.

“Eight hours or more has consistently been shown to be hazardous,” says Dr. Youngstedt, who researches the effects of oversleeping.

The Centers for Disease Control and Prevention is helping to fund a panel of medical specialists and researchers to review the scientific literature on sleep and develop new recommendations, probably by 2015.

Daniel F. Kripke, an emeritus professor of psychiatry at the University of California San Diego, tracked over a six-year period data on 1.1 million people who participated in a large cancer study.

People who reported they slept 6.5 to 7.4 hours had a lower mortality rate than those with shorter or longer sleep. The study, published in the Archives of General Psychiatry in 2002, controlled for 32 health factors, including medications.

In another study, published in the journal Sleep Medicine in 2011, Dr. Kripke found further evidence that the optimal amount of sleep might be less than the traditional eight hours.

The researchers recorded the sleep activity of about 450 elderly women using devices on their wrist for a week.

Some 10 years later the researchers found that those who slept fewer than five hours or more than 6.5 hours had a higher mortality.

Other experts caution against studies showing ill effects from too much sleep.


“The problem with these studies is that they give you good information about association but not causation,” said Timothy Morgenthaler, president of the American Academy of Sleep Medicine, which represents sleep doctors and researchers, and a professor of medicine at the Mayo Clinic Center for Sleep Medicine.

Dr. Morgenthaler advises patients to aim for seven to eight hours of sleep a night and to evaluate how they feel.

Sleep needs also vary between individuals, largely due to cultural and genetic differences, he said.

Getting the right amount of sleep is important in being alert the next day, and several recent studies have found an association between getting seven hours of sleep and optimal cognitive performance.

A study in the journal Frontiers in Human Neuroscience last year used data from users of the cognitive-training website Lumosity.

Researchers looked at the self-reported sleeping habits of about 160,000 users who took spatial-memory and matching tests and about 127,000 users who took an arithmetic test.

They found that cognitive performance increased as people got more sleep, reaching a peak at seven hours before starting to decline.

After seven hours, “increasing sleep was not any more beneficial,” said Murali Doraiswamy, a professor of psychiatry at Duke University Medical Center in Durham, N.C., who co-authored the study with scientists from Lumos Labs Inc., which owns Lumosity.

He said the study replicated earlier research, including a look at memory loss.

“If you think about all the causes of memory loss, sleep is probably one of the most easily modifiable factors,” he said.

Most research has focused on the effects of getting too little sleep, including cognitive and health declines and weight gain.

David Dinges, a sleep scientist at the University of Pennsylvania’s Perelman School of Medicine who has studied sleep deprivation, said repeatedly getting just 20 or 30 minutes less than the minimum recommendation of seven hours can slow cognitive speed and increase attention lapses.

Experts say people should be able to figure out their optimal amount of sleep in a trial of three days to a week, ideally while on vacation.

Don’t use an alarm clock.

Go to sleep when you get tired.

Avoid too much caffeine or alcohol.

And stay off electronic devices a couple of hours before going to bed.

During the trial, track your sleep with a diary or a device that records your actual sleep time.

If you feel refreshed and awake during the day, you’ve probably discovered your optimal sleep time.

The new sleep guidelines will be drawn up by a panel of experts being assembled by the American Academy of Sleep Medicine, the Sleep Research Society, an organization for sleep researchers, and the CDC. The recommendations are meant to reflect evidence that has emerged from scientific studies and are expected to take into account issues such as gender and age, says Dr. Morgenthaler, the academy president.

Another group, the National Sleep Foundation, a nonprofit research and advocacy group, also has assembled an expert panel that expects to release updated recommendations for sleep times in January.


Most current guidelines say school-age children should get at least 10 hours of sleep a night, and teenagers, nine to 10.


A study in the current issue of Journal of Clinical Sleep Medicine seemed to confirm that. Five healthy adults were placed in what the researchers called Stone Age-like conditions in Germany for more than two months–without electricity, clocks or running water.

Participants fell asleep about two hours earlier and got on average 1.5 hours more sleep than was estimated in their normal lives, the study said.

Their average amount of sleep per night: 7.2 hours.

[end excerpts]

The article is online at:

Ken Pope


“The most erroneous stories are those we think we know best–and therefore never scrutinize or question.’
–Stephen Jay Gould, Harvard Professor of Zoology & Geology (1941-2002)

Take care,





John Pullyblank, Ph.D., R.Psych.


Managing Partner

M. Jackson Group Update – August 2014 – Cognitive Rehabilitation Reprise

M. Jackson Group Update – August 2014 –  Cognitive Rehabilitation Reprise

In looking at past postings, I found a couple discussing the April, 2005 Vocational Outcomes in Traumatic Brain Injury conference, and particularly a Pre-Conference Workshop by Dr. Catherine Mateer and (now Dr.) Claire Sira on Cognitive and Emotional Consequences of Brain Injury:  Intervention Strategies for Vocational Rehabilitation. What particularly drew me to re-posting this is how it laid out the key practical issues in working with TBI in a way that continues to be relevant at present. I have combined 2 previous postings.

During the initial portion of this talk, Dr. Mateer examined the research on various predictors of return to work following a traumatic brain injury.  These predictors included:

Client age. Findings show poorer vocational outcomes for individuals aged 7 or younger, or after age 40.  Older clients are less likely to return to work due to reduced adaptability, as well as the unwillingness of employers to employ a person with deficits and a reduced working life.

Speed of return to work. Findings show that the highest rates of return to work occur between 1 and 6 months post-injury, although it is likely that this finding correlates with severity of injury, medical and emotional complications, and so forth. Clients who return to work within 2 years are more likely to be working at follow-up.

Severity of injury (coma duration, amnesia). Interestingly, but perhaps not surprising for those who work with clients with TBI, findings in this regard are mixed. Some research does show decreasing return to work with more severe injuries, while other research does not.  Severity may be more related to survival following injury and neuropsychological deficits, than the concrete outcome of return to work. Most of us can think of clients who had “mild” injuries that have left them very impaired, while others with more “severe” injuries go on to accomplish more than we might have expected. The relationship of our usual measures of severity to outcome is not clear cut or reliable.

Duration of acute rehabilitation. Again, the findings are mixed here, but a longer stay in hospital may be associated with a poorer employment outcome. This may be due in part to complications due to other injuries that further erode employability.

Post-acute emotional adjustment. Emotional reaction to injury is as powerful a predictor with TBI as it is with other disabilities. Clients who are depressed, anxious/helpless, and have PTSD are less likely to return to work. While clients who show less effective coping and higher levels of hopelessness are less likely to be employed, it is often not clear whether this led to lack of work, or was a result of it. Sometimes, in my experience, it seems to be both.

Awareness and acceptance of deficits.  Willingness to change and accept guidance from others following TBI is positively related to return to work.  Conversely, poor awareness/insight regarding deficits may reduce the likelihood of return to work.

Functional status.  In looking at the research, the presenters noted that physical, cognitive, and emotional status is best assessed at discharge from initial rehabilitation.  It is this level of functioning that is more reliable in predicting return to work than are severity of injury indices.

Neuropsychological factors.  It is noted that global intelligence, attention, memory, and language skills all predict return to work at a moderate level.  Importantly, executive functioning (concept formation, divided and selective attention, mental flexibility, mental programming, planning) is the most reliable predictor of return to work.

Preinjury psychological adjustment.  Research and practice consistently shows that preinjury substance abuse reduces the likelihood of return to work.

Preinjury work status.  Clients with higher preinjury qualifications are more likely to return to work, partially as they have had stable work prior to the injury.  The most disadvantaged group in this regard is those 40 years of age and older who have no pre-existing qualifications.

Educational attainment.  Education is not consistently a reliable factor in predicting return to work, although in some studies, having completed High School is associated with a higher likelihood of return to work.

Litigation and insurance status.  The findings in this regard, as in other areas of disability, are mixed.  There are some findings that say that clients involved in litigation are less likely to return to work, and other findings that indicate that clients seeing or receiving compensation take longer to return to work.  However, there is other literature showing that compensation/litigation makes very little difference.  In my opinion, this issue is likely to be more about the specifics of the groups being examined in the particular studies, and less about the issue of compensation per se.

It can be helpful to get a feel for employment issues by looking at predictors and outcomes.  However, it is often unclear how these kinds of findings inform our work with particular individuals who represent a sometimes confusing combination of many factors, and whose presentation can change over time.  I conceptualize research findings as often showing us almost a sociological view of what groups of people with disabilities look like as a culture, or as they proceed into and out of rehabilitation.  Again, that is relevant, but if I am working with 41 year old Susan with a particular profile of abilities and impairments, rehabilitation rapidly becomes about individual differences and creativity of intervention, rather than general research findings or predictors.

The most common cognitive and behavioural difficulties following brain injury include the following:

  • Poor memory – This can adversely affect retention particularly of new work skills, requiring reminder systems and multiple presentations.
  • Concentration difficulties – Problems with sustained attention, and particularly divided attention may direct us to quieter work environments and less complex information where the client does not have to grasp everything with only one pass.
  • Irritability/impatience/anger – Some TBI’s result in irritability due to some combination of changes in the brain and the frustration of disability (see below), the latter of which is more easily addressed.
  • Fatigue – In my experience, while we take care to assess the cognitive sequelae, the uncompromising consequences of fatigue may not be fully appreciated. For many clients, part-time education/work may be necessary in order for them to have other aspects to their life.
  • Slowness in thinking and moving – A general slowing may again result in the need for multiple passes at information, as well as work environments where speed is not a critical issue.
  • Problems with initiating (i.e., “getting going) – Clients may want to do things and make promises, but find themselves having a hard time getting going.  Cuing systems and schedules may help.

In terms of the most common emotional consequences of brain injury, traumatic brain injury survivors may become:

  • Depressed – across disabilities, including TBI, there is the recurring finding of 50% of individuals experiencing depression.  In the case of TBI, this may be delayed pending increased insight into their limitations.
  • Socially withdrawn – It is common to hear clients talk about being overwhelmed by the information in social settings, tiring of answering questions about their TBI, and not wanting to socialize if they cannot keep up with others.
  • Anxious
  • Angry

While some of these emotional consequences may have “organic” causes, in other words may be the direct result of damage to the brain, they are also described by Dr. Mateer, “as a reaction to the disruption in their lives, their losses, and the chronic frustration associated with acquired disabilities.”

Given both the research literature and what we know as clinicians, issues to consider in vocational rehabilitation following traumatic brain injury include:

  • Actual vs. stated motivation for return to work – Motivation is a single word masking a very complex web of issues. TBI survivors may have vague or even fanciful ideas that they may not have the tools or energy to pursue. Others show a tenacity that is remarkable and exceed all expectations.
  • Client’s cognitive abilities – These need to be assessed on an individual basis and may evolve to some degree over time.
  • Client’s emotional functioning – As above.
  • Client’s physical deficits/limitations – Vocational rehabilitation following TBI can be very complex, with cognitive limitations compounded by physical limitations, and generalized factors such as pain adversely affecting cognitive, emotional, and physical functioning.
  • Client’s general medical stability – Clients may passionately wish to proceed with their rehabilitation, but there may be pending medical issues that stall rehabilitation.  Waiting for maximum medical improvement, including maximum cognitive and emotional improvement, can be a very problematic time if there are no rehabilitation interventions in place.
  • Presence or absence of neurological symptoms or seizures
  • Family support and interactions – There is a huge literature on the family’s response to TBI. Some do everything they can to structure and support the client’s rehabilitation, while others blame their symptoms on them and expect full and complete recovery of the persons role responsibilities. A rehabilitation plan that includes the family is essential.
  • Self-esteem and self-concept – Naturally, all individuals vary in these domains, but some will be more resilient to the changes brought on by TBI than others. Some will react to a severe injury by making a new plan to the best of their ability, while others will respond to a milder impairment by focusing on how they are permanently “broken.”
  • Client’s work ethic – This and the following 3 issues relate to the fact that a TBI does not occur in a vacuum. For those who have always been keen workers, we may even find ourselves almost trying to hold them back, while their residual skill set may be quite broad. For those who bounced around from job to job, a TBI is unlikely to improve their situation and they may have trouble with the structure and multiple helpers they encounter in their rehabilitation.
  • Client’s work history
  • Preinjury work characteristics
  • Current and preinjury personality factors – There are a host of issues here. Generally speaking, existing personality attributes may be exaggerated by a TBI, while others may change, with the individual becoming notably different to their family. Changes in the direction of passivity, indecisiveness, or brittle anger are not uncommon.
  • Adjustment to disability – This is a recurring theme here. Again, while some adapt, others fight their changes, while others have limited insight as to their limitations or try to simply ignore them.
  • Transferable skills – As you probably know, this refers to skills that can still be applied following the onset of a disability. For clients who had a limited skill set prior to the accident, and now have their ability for new learning compromised, rehabilitation can be very difficult. Others, may have a broad range of skills and associate preserved knowledge, but may require a specific work environment with specific accommodations.
  • Employment index of client’s area – The combination of TBI and physical injuries in a rural setting can be very challenging, whereas urban centres may have a broader range of post-injury options to consider.
  • Employee prejudices of brain injury – Deciding what to tell co-workers and how to manage their response is a significant issue in vocational rehabilitation with TBI. I generally advise to manage this, rather than to send the client back and hope for the best, but this has to be determined on a case by case basis. In one case I was involved in, it eventually became clear that the employees were embarrassed that a former high level manager would be among them and this became an issue to deal with.
  • Litigation – I personally feel that too much is made of the impact of litigation on individuals’ participation in their rehabilitation. Having said that, litigation can seem to put things on hold, produce an array of competing commitments, and put everything into the optic of figuring out just how “damaged” or not the client is, rather than the more desirable goal of attaining the best rehabilitation outcomes possible.

Take care,



M. Jackson Group Update – July 2014 – The Creative Brain

For July, this is another fascinating article from Dr. Ken Pope’s listserv. There is a link at the bottom to take you to the online article.

*The Atlantic* includes an extended article: “Secrets of the Creative Brain; A leading neuroscientist who has spent decades studying creativity shares her research on where genius comes from, whether it is dependent on high IQ–and why it is so often accompanied by mental illness” by Nancy Andreasen.

Here are some excerpts:

[begin excerpts]

As a psychiatrist and neuroscientist who studies creativity, I’ve had the pleasure of working with many gifted and high-profile subjects over the years, but Kurt Vonnegut–dear, funny, eccentric, lovable, tormented Kurt Vonnegut–will always be one of my favorites.

Kurt was a faculty member at the Iowa Writers’ Workshop in the 1960s, and participated in the first big study I did as a member of the university’s psychiatry department.

I was examining the anecdotal link between creativity and mental illness, and Kurt was an excellent case study.

He was intermittently depressed, but that was only the beginning.

His mother had suffered from depression and committed suicide on Mother’s Day, when Kurt was 21 and home on military leave during World War II.

His son, Mark, was originally diagnosed with schizophrenia but may actually have bipolar disorder.

(Mark, who is a practicing physician, recounts his experiences in two books, The Eden Express and Just Like Someone Without Mental Illness Only More So, in which he reveals that many family members struggled with psychiatric problems. “My mother, my cousins, and my sisters weren’t doing so great,” he writes. “We had eating disorders, co-dependency, outstanding warrants, drug and alcohol problems, dating and employment problems, and other ‘issues.’ “)

While mental illness clearly runs in the Vonnegut family, so, I found, does creativity.

Kurt’s father was a gifted architect, and his older brother Bernard was a talented physical chemist and inventor who possessed 28 patents.

Mark is a writer, and both of Kurt’s daughters are visual artists.


For many of my subjects from that first study–all writers associated with the Iowa Writers’ Workshop–mental illness and creativity went hand in hand.


Compared with many of history’s creative luminaries, Vonnegut, who died of natural causes, got off relatively easy.

Among those who ended up losing their battles with mental illness through suicide are Virginia Woolf, Ernest Hemingway, Vincent van Gogh, John Berryman, Hart Crane, Mark Rothko, Diane Arbus, Anne Sexton, and Arshile Gorky.

My interest in this pattern is rooted in my dual identities as a scientist and a literary scholar.

In an early parallel with Sylvia Plath, a writer I admired, I studied literature at Radcliffe and then went to Oxford on a Fulbright scholarship; she studied literature at Smith and attended Cambridge on a Fulbright.

Then our paths diverged, and she joined the tragic list above.

My curiosity about our different outcomes has shaped my career.

I earned a doctorate in literature in 1963 and joined the faculty of the University of Iowa to teach Renaissance literature.

At the time, I was the first woman the university’s English department had ever hired into a tenure-track position, and so I was careful to publish under the gender-neutral name of N. J. C. Andreasen.

Not long after this, a book I’d written about the poet John Donne was accepted for publication by Princeton University Press.

Instead of feeling elated, I felt almost ashamed and self-indulgent.

Who would this book help?

What if I channeled the effort and energy I’d invested in it into a career that might save people’s lives?

Within a month, I made the decision to become a research scientist, perhaps a medical doctor.

I entered the University of Iowa’s medical school, in a class that included only five other women, and began working with patients suffering from schizophrenia and mood disorders.

I was drawn to psychiatry because at its core is the most interesting and complex organ in the human body: the brain.

I have spent much of my career focusing on the neuroscience of mental illness, but in recent decades I’ve also focused on what we might call the science of genius, trying to discern what combination of elements tends to produce particularly creative brains.

What, in short, is the essence of creativity?

Over the course of my life, I’ve kept coming back to two more-specific questions: What differences in nature and nurture can explain why some people suffer from mental illness and some do not?

And why are so many of the world’s most creative minds among the most afflicted?


As research methodology improved over time, the idea that genius might be hereditary gained support.


But despite the implications of the title Genetic Studies of Genius, the Termites’ high IQs did not predict high levels of creative achievement later in life. Only a few made significant creative contributions to society; none appear to have demonstrated extremely high creativity levels of the sort recognized by major awards, such as the Nobel Prize.

(Interestingly, William Shockley, who was a 12-year-old Palo Alto resident in 1922, somehow failed to make the cut for the study, even though he would go on to share a Nobel Prize in physics for the invention of the transistor.)

Thirty percent of the men and 33 percent of the women did not even graduate from college

A surprising number of subjects pursued humble occupations, such as semiskilled trades or clerical positions.

As the study evolved over the years, the term gifted was substituted for genius.

Although many people continue to equate intelligence with genius, a crucial conclusion from Terman’s study is that having a high IQ is not equivalent to being highly creative.

Subsequent studies by other researchers have reinforced Terman’s conclusions, leading to what’s known as the threshold theory, which holds that above a certain level, intelligence doesn’t have much effect on creativity: most creative people are pretty smart, but they don’t have to be that smart, at least as measured by conventional intelligence tests.


A neuroimaging study I conducted in 1995 using positron-emission tomography, or PET, scanning turned out to be unexpectedly useful in advancing my own understanding of association cortices and their role in the creative process.

This PET study was designed to examine the brain’s different memory systems, which the great Canadian psychologist Endel Tulving identified.

One system, episodic memory, is autobiographical–it consists of information linked to an individual’s personal experiences.

It is called “episodic” because it consists of time-linked sequential information, such as the events that occurred on a person’s wedding day.

My team and I compared this with another system, that of semantic memory, which is a repository of general information and is not personal or time-linked. In this study, we divided episodic memory into two subtypes. We examined focused episodic memory by asking subjects to recall a specific event that had occurred in the past and to describe it with their eyes closed. And we examined a condition that we called random episodic silent thought, or REST: we asked subjects to lie quietly with their eyes closed, to relax, and to think about whatever came to mind. In essence, they would be engaged in “free association,” letting their minds wander. The acronym REST was intentionally ironic; we suspected that the association regions of the brain would actually be wildly active during this state.

When eureka moments occur, they tend to be precipitated by long periods of preparation and incubation, and to strike when the mind is relaxed.
This suspicion was based on what we had learned about free association from the psychoanalytic approach to understanding the mind. In the hands of Freud and other psychoanalysts, free association–spontaneously saying whatever comes to mind without censorship–became a window into understanding unconscious processes. Based on my interviews with the creative subjects in my workshop study, and from additional conversations with artists, I knew that such unconscious processes are an important component of creativity. For example, Neil Simon told me: “I don’t write consciously–it is as if the muse sits on my shoulder” and “I slip into a state that is apart from reality.” (Examples from history suggest the same thing. Samuel Taylor Coleridge once described how he composed an entire 300-line poem about Kubla Khan while in an opiate-induced, dreamlike state, and began writing it down when he awoke; he said he then lost most of it when he got interrupted and called away on an errand–thus the finished poem he published was but a fragment of what originally came to him in his dreamlike state.)

Based on all this, I surmised that observing which parts of the brain are most active during free association would give us clues about the neural basis of creativity. And what did we find? Sure enough, the association cortices were wildly active during REST.

I realized that I obviously couldn’t capture the entire creative process–instead, I could home in on the parts of the brain that make creativity possible. Once I arrived at this idea, the design for the imaging studies was obvious: I needed to compare the brains of highly creative people with those of control subjects as they engaged in tasks that activated their association cortices.

This time around, I wanted to examine a more diverse sample of creativity, from the sciences as well as the arts. My motivations were partly selfish–I wanted the chance to discuss the creative process with people who might think and work differently, and I thought I could probably learn a lot by listening to just a few people from specific scientific fields. After all, each would be an individual jewel–a fascinating study on his or her own. Now that I’m about halfway through the study, I can say that this is exactly what has happened. My individual jewels so far include, among others, the filmmaker George Lucas, the mathematician and Fields Medalist William Thurston, the Pulitzer Prize-winning novelist Jane Smiley, and six Nobel laureates from the fields of chemistry, physics, and physiology or medicine. Because winners of major awards are typically older, and because I wanted to include some younger people, I’ve also recruited winners of the National Institutes of Health Pioneer Award and other prizes in the arts.


We begin the actual study with an MRI scan, during which subjects perform three different tasks, in addition to REST: word association, picture association, and pattern recognition. Each experimental task alternates with a control task; during word association, for example, subjects are shown words on a screen and asked to either think of the first word that comes to mind (the experimental task) or silently repeat the word they see (the control task). Speaking disrupts the scanning process, so subjects silently indicate when they have completed a task by pressing a button on a keypad.

Playing word games inside a thumping, screeching hollow tube seems like a far cry from the kind of meandering, spontaneous discovery process that we tend to associate with creativity. It is, however, as close as one can come to a proxy for that experience, apart from REST. You cannot force creativity to happen–every creative person can attest to that. But the essence of creativity is making connections and solving puzzles. The design of these MRI tasks permits us to visualize what is happening in the creative brain when it’s doing those things.

As I hypothesized, the creative people have shown stronger activations in their association cortices during all four tasks than the controls have. (See the images on page 74.) This pattern has held true for both the artists and the scientists, suggesting that similar brain processes may underlie a broad spectrum of creative expression. Common stereotypes about “right brained” versus “left brained” people notwithstanding, this parallel makes sense. Many creative people are polymaths, people with broad interests in many fields–a common trait among my study subjects.

After the brain scans, I settle in with subjects for an in-depth interview. Preparing for these interviews can be fun (rewatching all of George Lucas’s films, for example, or reading Jane Smiley’s collected works) as well as challenging (toughing through mathematics papers by William Thurston). I begin by asking subjects about their life history–where they grew up, where they went to school, what activities they enjoyed. I ask about their parents–their education, occupation, and parenting style–and about how the family got along. I learn about brothers, sisters, and children, and get a sense for who else in a subject’s family is or has been creative and how creativity may have been nurtured at home. We talk about how the subjects managed the challenges of growing up, any early interests and hobbies (particularly those related to the creative activities they pursue as adults), dating patterns, life in college and graduate school, marriages, and child-rearing. I ask them to describe a typical day at work and to think through how they have achieved such a high level of creativity. (One thing I’ve learned from this line of questioning is that creative people work much harder than the average person–and usually that’s because they love their work.)

One of the most personal and sometimes painful parts of the interview is when I ask about mental illness in subjects’ families as well as in their own lives. They’ve told me about such childhood experiences as having a mother commit suicide or watching ugly outbreaks of violence between two alcoholic parents, and the pain and scars that these experiences have inflicted. (Two of the 13 creative subjects in my current study have lost a parent to suicide–a rate many times that of the general U.S. population.) Talking with those subjects who have suffered from a mental illness themselves, I hear about how it has affected their work and how they have learned to cope.


As in the first study, I’ve also found that creativity tends to run in families, and to take diverse forms. In this arena, nurture clearly plays a strong role. Half the subjects come from very high-achieving backgrounds, with at least one parent who has a doctoral degree. The majority grew up in an environment where learning and education were highly valued.


One possible contributory factor is a personality style shared by many of my creative subjects. These subjects are adventuresome and exploratory. They take risks. Particularly in science, the best work tends to occur in new frontiers.

(As a popular saying among scientists goes: “When you work at the cutting edge, you are likely to bleed.”)

They have to confront doubt and rejection. And yet they have to persist in spite of that, because they believe strongly in the value of what they do. This can lead to psychic pain, which may manifest itself as depression or anxiety, or lead people to attempt to reduce their discomfort by turning to pain relievers such as alcohol.

I’ve been struck by how many of these people refer to their most creative ideas as “obvious.” Since these ideas are almost always the opposite of obvious to other people, creative luminaries can face doubt and resistance when advocating for them. As one artist told me, “The funny thing about [one’s own] talent is that you are blind to it. You just can’t see what it is when you have it … When you have talent and see things in a particular way, you are amazed that other people can’t see it.” Persisting in the face of doubt or rejection, for artists or for scientists, can be a lonely path–one that may also partially explain why some of these people experience mental illness.

One interesting paradox that has emerged during conversations with subjects about their creative processes is that, though many of them suffer from mood and anxiety disorders, they associate their gifts with strong feelings of joy and excitement. “Doing good science is simply the most pleasurable thing anyone can do,” one scientist told me. “It is like having good sex. It excites you all over and makes you feel as if you are all-powerful and complete.” This is reminiscent of what creative geniuses throughout history have said. For instance, here’s Tchaikovsky, the composer, writing in the mid-19th century:

It would be vain to try to put into words that immeasurable sense of bliss which comes over me directly a new idea awakens in me and begins to assume a different form. I forget everything and behave like a madman. Everything within me starts pulsing and quivering; hardly have I begun the sketch ere one thought follows another.

Another of my subjects, a neuroscientist and an inventor, told me, “There is no greater joy that I have in my life than having an idea that’s a good idea. At that moment it pops into my head, it is so deeply satisfying and rewarding … My nucleus accumbens is probably going nuts when it happens.” (The nucleus accumbens, at the core of the brain’s reward system, is activated by pleasure, whether it comes from eating good food or receiving money or taking euphoria-inducing drugs.)

As for how these ideas emerge, almost all of my subjects confirmed that when eureka moments occur, they tend to be precipitated by long periods of preparation and incubation, and to strike when the mind is relaxed–during that state we called REST. “A lot of it happens when you are doing one thing and you’re not thinking about what your mind is doing,” one of the artists in my study told me. “I’m either watching television, I’m reading a book, and I make a connection … It may have nothing to do with what I am doing, but somehow or other you see something or hear something or do something, and it pops that connection together.”

Many subjects mentioned lighting on ideas while showering, driving, or exercising. One described a more unusual regimen involving an afternoon nap: “It’s during this nap that I get a lot of my work done. I find that when the ideas come to me, they come as I’m falling asleep, they come as I’m waking up, they come if I’m sitting in the tub. I don’t normally take baths … but sometimes I’ll just go in there and have a think.”

Some of the other most common findings my studies have suggested include:

Many creative people are autodidacts. They like to teach themselves, rather than be spoon-fed information or knowledge in standard educational settings. Famously, three Silicon Valley creative geniuses have been college dropouts: Bill Gates, Steve Jobs, and Mark Zuckerberg. Steve Jobs–for many, the archetype of the creative person–popularized the motto “Think different.” Because their thinking is different, my subjects often express the idea that standard ways of learning and teaching are not always helpful and may even be distracting, and that they prefer to learn on their own. Many of my subjects taught themselves to read before even starting school, and many have read widely throughout their lives. For example, in his article “On Proof and Progress in Mathematics,” Bill Thurston wrote:

My mathematical education was rather independent and idiosyncratic, where for a number of years I learned things on my own, developing personal mental models for how to think about mathematics. This has often been a big advantage for me in thinking about mathematics, because it’s easy to pick up later the standard mental models shared by groups of mathematicians.
This observation has important implications for the education of creatively gifted children. They need to be allowed and even encouraged to “think different.” (Several subjects described to me how they would get in trouble in school for pointing out when their teachers said things that they knew to be wrong, such as when a second-grade teacher explained to one of my subjects that light and sound are both waves and travel at the same speed. The teacher did not appreciate being corrected.)

Many creative people are polymaths, as historic geniuses including Michelangelo and Leonardo da Vinci were. George Lucas was awarded not only the National Medal of Arts in 2012 but also the National Medal of Technology in 2004. Lucas’s interests include anthropology, history, sociology, neuroscience, digital technology, architecture, and interior design. Another polymath, one of the scientists, described his love of literature:

I love words, and I love the rhythms and sounds of words … [As a young child] I very rapidly built up a huge storehouse of … Shakespearean sonnets, soliloquies, poems across the whole spectrum … When I got to college, I was open to many possible careers. I actually took a creative-writing course early. I strongly considered being a novelist or a writer or a poet, because I love words that much … [But for] the academics, it’s not so much about the beauty of the words. So I found that dissatisfying, and I took some biology courses, some quantum courses. I really clicked with biology. It seemed like a complex system that was tractable, beautiful, important. And so I chose biochemistry.
The arts and the sciences are seen as separate tracks, and students are encouraged to specialize in one or the other. If we wish to nurture creative students, this may be a serious error.

Creative people tend to be very persistent, even when confronted with skepticism or rejection. Asked what it takes to be a successful scientist, one replied:

Perseverance … In order to have that freedom to find things out, you have to have perseverance … The grant doesn’t get funded, and the next day you get up, and you put the next foot in front, and you keep putting your foot in front … I still take things personally. I don’t get a grant, and … I’m upset for days. And then I sit down and I write the grant again.
Do creative people simply have more ideas, and therefore differ from average people only in a quantitative way, or are they also qualitatively different? One subject, a neuroscientist and an inventor, addressed this question in an interesting way, conceptualizing the matter in terms of kites and strings:


In A Beautiful Mind, her biography of the mathematician John Nash, Sylvia Nasar describes a visit Nash received from a fellow mathematician while institutionalized at McLean Hospital. “How could you, a mathematician, a man devoted to reason and logical truth,” the colleague asked, “believe that extraterrestrials are sending you messages? How could you believe that you are being recruited by aliens from outer space to save the world?” To which Nash replied: “Because the ideas I had about supernatural beings came to me the same way that my mathematical ideas did. So I took them seriously.”

Some people see things others cannot, and they are right, and we call them creative geniuses. Some people see things others cannot, and they are wrong, and we call them mentally ill. And some people, like John Nash, are both.

[end excerpts]

The article is online at:

Ken Pope


“The purpose of art is to lay bare the questions that have been hidden by the answers.”
–James Baldwin (1924-1987)

Take care,


M. Jackson Group Update – June 2014 – Thinking Quick and Locking In

This month’s article is excerpted from a talk I gave on this topic, a portion of which was extracted from the following book.

Don’t Believe Everything You Think (Kida, Thomas. (2006).  Don’t Believe Everything You Think:  The 6 Basic Mistakes We Make in Thinking.  New York: Prometheus Books.

This book describes 6 basic mistakes that we make in thinking.  This book comes from the Skeptics Society tradition of looking at what prevents us from critical thinking.  Let’s take a brief look at these mistakes.

  • The first is that we tend to prefer stories and anecdotes to statistics or formal proof.  The example of this I recall from graduate school is the person who is picking a car.  While they may have data to tell them a certain car is very reliable, they are more likely to be swayed by a neighbour who tells them about a isolated bad experience with that car.  This is part of the “thinking quick” portion of this talk’s title, we like to get the broad sense of something and are much less inclined to evaluate the factual basis of the stories.  Weapons of mass destruction anyone?
  • The second is that we tend to seek to confirm, rather than to question our ideas.  This is part of the “locking in” that we do in making judgements.  We are prone to looking at and better remembering information that confirms our beliefs and potentially not even seeing information that disconfirms them.  The final impression we may be left with is that the evidence for our belief is simply overwhelming.  The alternative, pondering whether we have missed the point and need to re-tool is not an easy thing.  After the invasion of Iraq it was found that the evidence that had been carefully selected to support going to war was mostly incorrect.  This is a situation where a confirming strategy lead to dire consequences.  We can also see it with those who believe in psychics or unusual health interventions, they tend to remember the hits and forget the misses.  In fact, we are generally prone to remember the times we’re successful, and forget the times we fail.  Failures that are remembered may then tend to be reinterpreted in a way that supports our belief.  This is what the Harvard psychologist Eileen Langer calls the:  “Heads I win, tails its chance” phenomenon.
  • The third mistake is that we rarely appreciate the role of chance and coincidence in shaping events.  We are prone to looking for meaning and causality in everything, which is generally good, but sometimes things just happen.  What I like to say to my clients, and is discussed in this book, is that if you flip a coin several thousand times, a run of 20 heads, for example, is still random.  You can see this kind of misplaced sense of causality in athletes wearing “lucky” clothes, and people putting their life savings into slot machines believing that they have warmed them up.  I had a client who had worked in casinos for many years who described a common phenomenon of people who actually win, but are then unable to step away from the tables at that point, and then as one would expect given the role of chance, end up losing. Gaming feeds off human nature.
  • The fourth mistake is that we sometimes misperceive the world around us.  It has been said that the saying should not be “I’ll believe it when I see it,” but rather, “I see it because I believe it.”  People who believe in ghosts or aliens are more likely to see them.  An example in the book was a radio personality staying that he had seen V-shaped vessels in the sky, resulting in many calls of sightings.  He had actually made it up.  We can see this in the social realm when, for example, we expect bad behaviour from someone and chastise them even though they turn out to behave quite well.
  • The fifth mistake is that we tend to oversimplify our thinking.  We are inundated with information all the time and our body takes care of us by paring things down.  Sometimes we do that in our decision-making too when we assume that because someone has some similar attributes to others we know, that they will behave in the same way.  This is seen in stereotypes, and other situations where we judge solely on the basis of information that readily comes to mind.
  • Finally, the sixth mistake discussed in this book is that we tend to have faulty memories.  Many assume wrongly that memory should work perfectly.  One other little nugget I have used with some clients is that about 7 billion people in the world think that they have a memory problem.  Some do, of course, many do not.  Not only do we selectively store information away, we can be selective in retrieving it.  Remembering is not actually going to a shelf to get the very same book that we put away, but rather a process of reconstructing the memory, or actually rewriting the book to a degree.  With time, there is more and more creative writing going on.  So, if I form a quick impression of you and lock that in, I may not notice, store away, or recall information that goes against that impression.

In essence critical thinking does not come naturally to us, we are uncomfortable with the uncertainty required as part of a search for truths, and we tend to be quick to believe things on the basis of incomplete or inappropriate evidence.  What we need to do is think about reasons why our particular judgements could be wrong.  Considering the alternatives is one of the most effective methods we have to counter many of our problematic judgment biases, but this takes practice.

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Take care,