Making decisions in clinical practice isn’t easy; frequently we are expected to make high-risk, intellectually demanding decisions in the presence of considerable complexity, with inadequate evidence and within very limited timespans.
This is not the way our brains are comfortable working and exposes us to a very brain-unfriendly working environment that can have serious consequences. In this article we will take a look at our brains in a different way and explore the opportunities this gives us to think and do things differently.
The majority of our ideas about the brain link back to hundreds if not thousands of years of research that has been based on the physical structure of the brain (Figure 1) and an interpretation of function from just that. Many of these assumptions are wrong.
Profoundly different
It is now only a little over 15 years ago that functional MRIs (fMRI) became available. Where we are familiar with MRI’s ability to image the brain structure, the fMRI allows us to watch, in real time, the functioning of the brain (Figure 2) and this is opening a new and profoundly different vision of our most important asset.
The brain is a remarkable computing device which, whilst it weighs barely 1/60th of the average person’s bodyweight, can consume up to 25% of daily calorie intake, a reflection of just how much is going on in there.
To keep it simple, we are going to take a functional look at the brain and separate it into just two parts: the “Little Brain” and the “Big Brain”: together they make up that 1.3kg of firm jelly in your head that contains 100 billion neurones and is the most sophisticated computing device in the known universe.
Seat of conscious thought
The Little Brain is the pre-frontal cortex (PFC), a thin layer of cells little more than 5mm thick that covers an area on the front of the brain: it is the seat of conscious thought and exerts the conscious or executive control over everything that we do.
The Big Brain is all the rest; it has a myriad of functions which are either fully or partially automatic. For Roald Dahl fans, we will call it the Big Friendly Giant (BFG) in that many of its functions are protective.
To put things into perspective, if we were able to build a metre cubed supercomputer capable of the processing abilities of the PFC, then the relative size of the BFB would be something a little larger than the solar system. This size differential is important in that, culturally, we attribute great importance to the functions of the PFC and often are unintentionally blind to the BFG.
To develop our model further, we are going to use the analogy of a theatre and use this to represent our brains in a rather different, functional, sense.
At the centre of the theatre is the stage, of central importance but of small size. This represents our PFC, the centre for conscious thought and that which allows us control of our activities. The role of the self might be likened to that of stage director exerting executive control over what goes on the stage but not necessarily able to control events.
The rest of the theatre represents the remainder of the brain which comes complete with a highly interactive audience.
No multi-tasking
Despite the sophistication of the PFC it is still young in evolutionary terms and has several limits to its capabilities. The stage is defined and limited in size, capable of accommodating only three or four ideas (actors) at any one time: as the number of actors increases, the coordination/quality of thinking deteriorates.
It is not capable of multi-tasking despite what we might tell ourselves and it can be easily overwhelmed by the BFG via fear, emotions or a multitude of automatic functions.
Emotions and the complex default programmes of the BFG sit as members of our interactive audience ready to jump onto the stage at a moment’s notice and influence us in ways that we are unable to predict and control.
Also within this audience are cast members over which we can exert executive control to at least some degree and improve our lot.
Memories provide us with the foundations for our future actions. By reflecting accurately on the past, we can build sounder ideas for the future, improving the likelihood of success. Memory acquisition should not be random or passive but rather active and critical, providing as sharp an image of the world as possible.
Personal constructs
Our “personal constructs” are how we see the world: some are genetic and not subject to change, some are culturally or situationally created. Others are subject to considerable conscious control and being critical/taking responsibility for the accuracy of these can elevate performance considerably..
We each have an almost innumerable range of constructs, each occupying a seat in our theatre but instantly available to be called to the stage.
Our habits of thinking and doing provide the expertise scripts that we play out on our stage every day. They allow rapid action by moving the processing from the PFC to the BFG which can manage many such tasks as and when required. Working to ensure the development of good habits and diminishing bad is a central requirement of executive control.
As expertise increases, awareness decreases, meaning that we can become very good at doing what we no longer require and even more, can become attached to the habit in an unhealthy way.
Breaking down
Even our fundamental ways of thinking need to be considered. We have been trained in the scientific method but when dealing with complex systems this tends to break down and systems thinking becomes more relevant as it focuses on the relationships within the system rather than the individual parts.
Whilst this is becoming increasingly necessary, the BFG dislikes systems thinking as it threatens our conventional sense of identity, self, autonomy and certitude.
Whilst our stage may be small with only four actors available at a time, we can still put on one hell of a show!
- If you would like to learn more about the relevance of neuroscience to your work, apply for one of five free 1-2-1 “Working smarter not harder” package(s) before 30th November. Each package includes a 1-2-1 session and e-mail support for one month – value: £250 (plus VAT).
To apply email chris.whipp@vetlearning.co.uk.
