All the different kinds of mind reading – does it exist?

The ability to read minds is a superpower often portrayed in many forms of popular media. The idea of being able to understand our peers, down to the most minute detail, is both seductive and a credence to our innate desire to understand one another. It is our perception, of the understanding of others’ minds, that we use to shape our views of the world. Mount Rushmore, in the United States, for example, only holds meaning because of our collected understanding of the grandeur of the monument, and an appreciation of what/who we gaze upon.

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All humans sort of read minds – it’s called intuition. Based on the feelings, actions and behaviours of another person, someone with well practiced intuition can often tell when something is wrong, or when someone is excited. Believe it or not, these functions are encoded directly into our brain, in an area called the posterior superior temporal sulcus, an area dedicated to recognizing facial expression. The ability “read ones feelings” is so integral to our survival as a social species in fact, that many animals exhibit this level of intuition, dogs being the most obvious example. Have you ever had your pet dog come and comfort you on a difficult day? Ever have your German Shepherd start barking at a stranger when you start to look alarmed and panicked? Ultimately, this phenomenon comes from a profound ability to react to subtle nonverbal communication, like facial expression and body position, on a seconds’ notice.

People have different degrees of intuition. For some people, they are able to “read a room” without ever having met anyone in it. For others, they have a difficult time guessing a loved ones’ thoughts, despite their best effort. There are likely genetic and environmental reasons for this, although they are not well-defined.

Someone practicing as a psychic shows a high level of human intuition and understanding of the human experience, for example. By reading your face, body language, reaction to their readings, and with a little context, they are often able to provide spookily relevant advice to you about, for example, the death of a loved one.

Anxiety and mind reading

A psychic is a great example of a person using an innate ability to their advantage for their profession. Not always, however, does strong intuition on the feelings of others provide us an advantage. Many people with an anxious disposition find themselves hyper-aware of situations, and consequently, it can become overwhelming. Seeing a young group of teenagers for example might set off the anxious persons “spidey sense” and prevent them from walking by the group, whereas someone else may find themselves less preoccupied by this group of people.

An anxious person may also find themselves taking too much responsibility for keeping the flow or a party, group, or conversation comfortable, because they are more sensitive to the various social cues sent out by the attendees. An anxious person would be the first to recognize when Tim was getting bored or when Siobhan is feeling uncomfortable. They might be the first to recognize when dad has had too much, or when the hostess is getting tired. Obviously, having some degree of this behaviour shows high social intelligence. If you find yourself being unable to enjoy your own birthday party for the same reason, it might fall under the umbrella of a disorder.

Cognitive mind reading and depression

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“Everyone hates me.”

“My friends think I’m boring.”

“I know everyone is looking at the weight I put on when I go to work.”

“I give a bad first impression.”

“They all think my clothes is lame.”

One of the most common forms of pathological mind reading, is cognitive mind reading. See the examples above. We have all, probably, had a thought at least something like that at some point in the past. We might even be having those thoughts now.

The above examples represent cognitive mind reading, a phenomenon common to many forms of depression. Cognitive mind reading involves someone often making a negative assumption about someone’s thoughts, as it relates to themselves, out of keeping with reality. “Everyone hates me,” for example. Everyone does not hate you. Most people on the street don’t know you! These thoughts are actually a reflection of a depressive process.

When you become depressed, you put on some “gray-coloured glasses.” What this means is you often view things in a more negative light. The skies are grayer, video games are less fun. And seem esteem deflates. The social intuition discussed at the beginning of this post is no exception. When you’re depressed, this part pf your brain becomes hijacked, and all of a sudden, you may find yourself thinking that the world is thinking a lot more negative of you, even though it isn’t. In reality, those negative mind reading assumptions (where you believe that all of the negative things you worry people are saying about you are true) are a reflection of your brain being depressed. When you’re depressed, your brain colours everything gray. It sucks!

But it’s not all doom and gloom. Cognitive mind reading is one of the most common forms of cognitive distortions seen in depression, and physicians and therapists are well positioned to help you handle this. One of the first steps to this is understanding what cognitive mind reading is, why it’s happening, and importantly, that it’s very common in situations like your own. You’re not going crazy.

And not everybody hates your jacket.

Thought reading

While cognitive mind reading is extraordinarily common, with many depressed and non-depressed people experiencing some degree of this on any given day, thought reading is relatively rare.

Thought reading is a delusion, and is actually one of the more classic features of a

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psychotic (not psychic) illness called schizophrenia. When someone is experiencing thought reading, they literally believe that they are privy to the thoughts of others. I can literally hear your thoughts. This can be differentiated from cognitive mind reading in a few different ways.

  • Someone with thought reading may (though not necessarily) literally hear the thoughts as a form of auditory hallucination.
  • When you ask someone with cognitive mind reading to explain how they know “Yousef hates me,” they will usually give a lot of evidence, as if building an overwhelming court case. “Look at the way he did this… look at this behaviour… and I just know he does because this… he hugged me last and it seemed uncomfortable…” Someone experiencing thought reading will often reply, “I can hear their thoughts.”
  • The clinical picture is wildly different in both (though there are of course borderline cases). Thought reading is accompanied by psychosis. Cognitive mind reading is accompanied by anxiety and depression.

An important note here is that cognitive mind reading usually upsets the person and causes them problems. Thought reading has a variety of much more extreme reactions attached to it.

A twenty two year old male presents to the unit acutely psychotic and paranoid. During the course of the admission, he is very aggressive, and damages much of the furniture on the wards in a psychotically driven rage. When he’s better treated, you speak to him, and he discussed that he read the thoughts of the female nurses, and they all thought he was disgusting, which angered him.

A thirty year old male tells you about the microchip he had implanted so he can now read minds. He plans to kick some ass on the stock market with this new information. You diagnose him with a grandiose delusion.

If you are worried you have some form of mind reading, it’s most likely some degree of cognitive mind reading. If you’re concerned, see your doctor. They might help!

Dr. Travis Barron is a resident physician in Toronto, Canada.

Narratives and Post-traumatic stress

“I was walking down the road… I don’t know why the light didn’t go off… there it was, the screeching… and Amanda, she didn’t know what was happening…”

“That sounds upsetting. Let’s take a step back, and go back to the beginning. Which road were you walking down?”

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Trauma affects us in many ways. But what is trauma? There is no simple answer to that question. The reality is what may be traumatic to one person may not be traumatic to the next. Trauma cares about context. About who we are. About our past experiences. And importantly, trauma cares about how we react to it, and what we have the opportunity to do after a traumatic event.

The dialogue above might seem a little disjointed and confusing. Don’t worry, that was intentional! This is an example of poor narrative cohesion, a feature commonly seen in post-traumatic stress.

During a traumatic event, our senses are often overwhelmed and over-stimulated. Everything seems to happen so fast and take forever at the same time. In many ways, a traumatic event “shocks” the brain. Our memories of a traumatic event may seem sped-up, disjointed, or contain blanks. They can seem chaotic. As we think and reflect on a traumatic event, we piece together a cohesive narrative that makes sense to us, almost like a story.

This isn’t always as easy as it sounds. Traumatic memories are exactly that – traumatic! They’re not pleasant and can even be painful to think about. People may actively avoid thinking about a traumatic memory, or may avoid talking about it with friends, even if it’s all they can think about. This can contribute to the development of poor narrative cohesion, as seen in the dialogue above. Without the chance to think, talk, and reflect with our peers, we don’t fully get the chance to piece the story together for ourselves. It isn’t unusual that the first time someone has spoke about a trauma has been with me in my office, and it isn’t uncommon for their story to be disjointed at first.

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Discussing traumatic events with someone isn’t only important to string together your story. Speaking to someone about  trauma plays an important role in the prevention and treatment of post-traumatic stress disorder.

Whenever we recall a memory, that memory is overwritten and re-coded by our memory of the memory – wait, what? To simplify it, if we have a memory of an apple, and we remember the apple as being a little more red than it actually was, our memory would now be re-written as a little more red (and distorted!) than previous.

This phenomenon is why over time you might take a new perspective on a vacation you thought was bad, or change your thoughts on a movie. In post-traumatic stress, it allows us to continually expose ourselves to the traumatic memory, and re-code it into something more pragmatic and tolerable. This is why narrative therapy, a form of therapy which gives individuals an opportunity to explore their own experiences, and form them into a story that they can use to better understand themselves and their own story, is a key feature of any trauma-focused therapy.

I recently came across this article from HuffPost Canada that talks about a particular legal barrier some therapists may face in Canada if they wish to provide treatment to a Canadian juror. Apparently in Canada, section 649 of the Criminal Code prohibits jurors from discussing elements of their cases with anyone, including therapists, despite them being committed to confidentiality with their patients. As a physician, I wouldn’t have even thought about this legal scenario and I can promise you it wasn’t taught in medical school. That’s probably because it’s absolutely absurd.

Do you think it’s fair to vulnerable jurors at risk for PTSD that they cannot seek counselling?

Editor’s note: Narrative therapy is an important element of trauma-focused therapy but not the first element. Most trauma therapies first focus on building skills to manage distress before delving into traumatic memories. This can be important to prevent psychological distress from accessing memories that may be at first very difficult to recollect.

Dr. Travis Barron is a resident physician in Toronto, Canada.

Depression-Go-Round

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I’m not feeling great today, maybe I should skip the party…

“Hey, Jen! Are you coming?”

“No, I think I’m going to stay in.”

Later that night, you find yourself thinking, I’m such a failure, I’m so useless, I couldn’t even get to the party… And I’m not any kind of company right now…

When you have depression, it is absolutely exhausting. A big part of that is because it seems like this sick, endless loop. Like you’ve been cursed to listen to your least favourite song on repeat for the remainder of eternity.

People with depression often become progressively withdrawn over the course of their illness. Often times, people with depression will skip events because they feel like they are incapable of having fun. They may worry about ruining others’ evenings. In the immediacy, this strategy seems like the only tolerable option. In the long-term, social withdrawal, caused by depression, also exacerbates depression, which in turn leads to further avoidance.

These cycles of thinking and behaviour are well recognized in the field of psychiatry, and we utilize our understanding of this phenomenon to guide our treatments.

In broad strokes, psychiatric illnesses have two main modalities of treatment – medication and therapy based. They often work best in conjunction with each other. Today, I’ll be discussing cyclical behaviours and the role of cognitive behavioural therapy in the treatment of depression.

Cognitive behavioural therapy (CBT) is a manualized, evidence-based treatment for anxiety and depression. What does manualized mean? Don’t think of a guy on his couch discussing his relationship with his mother; that would be an open-ended psychotherapy, such as psychodynamic therapy. CBT is very specific, with worksheets, homework, and goals that are worked on by you and your therapist over a course of 2-4 months.

tfbCBT relies on a principle – that our thoughts, feelings, and behaviours are all related and that they inform each other. And this relationship is a two way street, Your thoughts inform your actions, and your actions inform your thoughts. Your feelings inform your actions and behaviours, and vice versa. I could go on.

In CBT, you and your therapist will work together to address all three of these elements simultaneously. Thought records and your time with your therapist are used to explore thoughts and feelings, and to understand how behaviours may have an impact on how you feel. Remember the cycle of depression and social avoidance.

tfbtOver time, you and your therapist hope to achieve cognitive restructuring – literally a change in the way you think. Instead of thinking, “I’m too tired for that party,” you might find yourself thinking, “I’m tired and I should go to the party for at least a few minutes – it will probably be fun.” Cognitive restructuring takes time, and considerable investment. It can be considered the “top down approach,” because it focuses on thoughts/the brain/the “top.”

A big – and underappreciated – aspect of CBT is behavioural activation, or the “bottom up approach.” When you’re depressed, and have been withdrawn for some time, it literally becomes difficult to have a positive thought. It also becomes easier to have negative thoughts, and you lose enjoyment in things you had previously found enjoyable. This isn’t just partying and socializing, but also things like laundry, and brushing your teeth, things that previously resulted in satisfaction but now seem insurmountable.

tfbbBehavioural activation acknowledges this disconnect and works to encourage people to do things anyway, despite the sense that no enjoyment or satisfaction will be wrought. Behavioural activation “kick starts” our brain, and gives us the ability to feel positive about things again. This can in turn make the cognitive restructuring arm of CBT a little easier, and before you know it, the cycle is working in the opposite direction, and improving your mood.

When I work on behavioural activation with patients, we often start with simple things such as brushing your teeth, or making your bed in the morning. We escalate the therapy progressively, and before you know it, the most out of reach goals are within the patients grasp.

I know when I started my residency, therapy seemed like a bit of an enigma. Now, I have a bit of an understanding, and it has empowered me. I hope I have been able to empower you!

 

Dr. Travis Barron is a resident physician in Toronto, Canada.