Review by Robert M Ellis

Every so often during the last few years, I have come across a new book by a new thinker that seems to add substantially to my understanding of Middle Way Philosophy. When that happens I encounter not just a sense of excitement at learning something new, but also a sense of confirmation, as I find that another thinker has independently reached conclusions similar to my own. Past experiences of this kind have included reading Iain McGilchrist’s ‘The Master and his Emissary’ as well as Nassim Nicholas Taleb’s ‘Antifragile’ and I have had a very similar experience with this book. ‘Mindsight’, an accessible distillation of a lifetime’s work in psychotherapy and the brain, is a rich, rewarding, insightful and deeply compassionate book.

‘Mindsight’ is Siegel’s coined term for what we might otherwise call awareness: that bigger perspective that allows us to recognise an unhelpful flow of energy in our minds and divert it into more helpful channels. The phrase ‘awareness is revolutionary’, which I have sometimes heard used by Buddhists, springs to mind to reflect the role that Siegel gives to mindsight. However, to my mind a more significant role is given in this book to the concept of integration, which Siegel describes as “the key mechanism beneath both the absence of illness and the presence of well-being”. We integrate through the application of mindsight but mindsight in its turn depends on the development of integration. Siegel has regularly used meditative techniques to help a range of disintegrated patients develop mindsight, thus beginning to address problems of inner conflict that up to that point had proved intractable.

What is most new and important about Siegel’s approach is the rigorously scientific account of integration he gives, both in terms of brain processes and in terms of our experience. Integration is impeded by rigid patterns of thought which connect our conceptualising prefrontal cortex (especially the left-brain language centres) to the amygdala and the ‘old’ or ‘reptilian’ brain with its fight-flight-freeze responses. Those rigid patterns prevent us from adapting to new circumstances and tend to reinforce themselves. However, if we can both soothe the old brain responses and provide enough space for reflection (or ‘mindsight’) in the prefrontal cortex, we can (thanks to the amazing plasticity of the human brain) change those patterns at any point in our lives. Siegel offers new evidence of the importance of working both at a meditative level (to soothe our reptilian reactivity) and at a cognitive level (to make use of our distinctively human capacities to widen our understanding of things). The organs of integration particularly seem to be the middle prefrontal cortex, which widens our awareness, and the hippocampus, which  enables us to form synthetic overviews in time and space.

But this book is not just a technical account of how our brains work. It is also a set of inspiring stories of the processes of integration Siegel has gone through with his patients. One of the most amazing for showing whole-life neuroplasticity is that of Stuart, a ninety-two year old man who managed to make significant progress with integrating the over-dominance of his left hemisphere. Then there are Denise and Peter, a couple who also illustrate the social impact of individual integration, as the integrative development of each heals their relationship. A depressed teenager, a female maths teacher who has cut off her feelings from the neck down, a sufferer of post-traumatic stress from the Vietnam War, an investment banker who sabotages all his intimate relationships, and a twelve-year old who fears that sharks may emerge from the toilet – all are helped through a combination of mindfulness training soothing their reactions and increasing awareness of the wider context of their assumptions, even when their problems may go back to insecure attachment to parents during childhood. On the evidence Siegel offers here, psychotherapy has become far more effective, firstly through understanding of the brain, and secondly through the adoption of meditation techniques from religious traditions.

My most frequent complaint about the writings of psychologists is their constraint by the medical model. Siegel makes it clear that he is not only interested in curing people of psychological problems, but also in the positive psychology model of human development. Nevertheless, all his examples focus on the curing of problems, which may be seen as somewhat undermining this positive psychology perspective. Like every psychologist I have ever read, too, he uses implicit moral language about integration from time to time but explicitly only focuses on a health model. There is no attempt to tackle any of the philosophical issues raised by integration as an ethical model, or of rigidity of belief as a maladaptation. In many ways there is thus rather a limited account of integration here. Nevertheless, within its own traditionally psychological terms, this book is the best treatment of integration I have come across.

One of Siegel’s biggest contributions is his analysis of eight domains of integration. These are so helpful that I may well incorporate them into my own work. These eight domains are as follows:

• Integration of consciousness: the stabilisation of immediate attention
• Horizontal integration: the integration of left and right hemispheres
• Vertical integration: integration of the cortex (“head”) with limbic and brain-stem areas that make us aware of bodily states and emotions
• Memory integration: the making explicit of memories that are implicit or unconscious
• Narrative integration: the development of a coherent narrative of our lives
• State integration: bringing together the varying mental states, or even multiple personalities, we may have at different times
• Interpersonal integration: integration between people

Siegel sees all these forms of integration as themselves ultimately integrated, and proposes the term ‘transpiration’ for integration across these domains. In other words, this list does not offer distinct processes that could be tackled in complete isolation from each other, but rather he is here offering an analysis of different aspects of the same process.

In my own writings I have already identified these different aspects in different ways, talking about two levels of integration (individual and socio-political) and three types of integration (desire, meaning and belief). Siegel’s recognition of interpersonal integration obviously corresponds to the socio-political level, however, I would suggest that his other seven categories cut across my three types and divide them up in different ways. I have always recognised that integration involved both a more immediate access of awareness (‘mindsight’) and a longer-term process, and that this process involved the bringing together of processes over time that would otherwise have been separated. If I have given more emphasis to horizontal (or hemispheric) integration than Siegel does, it is because I see the other forms of integration as all requiring that hemispheric element. Because the left hemisphere is unable to experience the flow of time (as opposed to discontinuous sequence), it requires the right (presumably the right hippocampus) to co-ordinate awareness over time and to integrate memories that might otherwise be kept absolutely separate. It also appears to be the rigidity of left-hemisphere representation that prevents us from integrating bodily experiences and emotions when these are in conflict with that rigid representation. I would thus argue that we can make a strong case for horizontal integration as being the keystone on which all Siegel’s other types depend. However, that doesn’t prevent each of the types being interdependent with the others. Whilst getting in touch with repressed memories through the hippocampus may be in some ways distinguishable from immediate body awareness, in the end the consolidation of integration of each kind depends on our ability to develop a wider awareness of the context of our representations.

Siegel usefully notes that integration is in turn dependent on prior differentiation. You obviously cannot integrate what has not been separated first. In a complex system such as the human brain, different elements have developed to perform specialised functions. However, the effectiveness of the brain as a whole depends on how well these different specialised functions work together, and if, for example, one function becomes over-dominant, the system becomes less adaptive. The system as a whole needs to be both sufficiently stable to work effectively and sufficiently flexible to adapt to new circumstances beyond it – in other words, to find a state of balance, otherwise known as homeostasis.

The nearest Siegel gets to explicitly discussing the Middle Way is where he writes “It is the middle way between chaos and rigidity… that maximise both complexity and vitality. This is the essence of integration”. His example for this is that of a choir which needs to harmonise rather than either singing in completely unrelated ways or merely singing a single undifferentiated note. Here Siegel’s perception of the extremes to be avoided by the middle way he is discussing is one based on the states created by those extremes rather than of the beliefs that give rise to them, so to me he seems here to be talking about the effects of the Middle Way or its absence rather than the Middle Way as we experience navigating it. The rigidity of individual beliefs (whether explicit or implicit) may indeed lead to chaos as well as undifferentiated order, as it may be used either to impose social conformity or for individuals to react chaotically against it. We can also get into rootless chaotic states as individuals, but the process preventing that chaotic state settling into a more adequate ordered one is still nevertheless one of rigidity, as our representations of the favoured state repress and exclude challenges of a kind that may help us to settle into a more stable arrangement. For example, in the life of a drug addict chaos may seem to be the most obvious indicator of a desperately unintegrated state of mind, but that chaos is created by the rigidity of belief in the drug-experience as relieving all problems, with the accompanying exclusion of wider awareness.

Siegel thus does not seem to differentiate adequately between an ultimate homeostatic state and a consistent alignment towards that state. Being as unbalanced as we are, it is unlikely that we will ever achieve a completely integrated state, whether you imagine that completely integrated state as a state of health or as something ‘positive’ beyond mere health. It is the orientation towards that state, starting from wherever we start, that constitutes the Middle Way, rather than the state of homeostasis itself, and I would argue that it is the Middle Way that is the morally important element in the situation. Nevertheless, Siegel gives us lots of inspiring examples of people going through that moral process in which they gradually recognise the limitations of the view of the world they have habituated, and gradually emerge from it into something more adequate.

In Siegel’s final case study, of a twelve-year old girl with deluded fears and obsessive-compulsive rituals of tapping and counting to deal with them, Siegel movingly illustrates the incremental nature of the solution for this girl. She did not conquer her fears, but rather respectfully negotiated with them, calling them ‘Sam’ and addressing them in a way that showed she understood and respected their good intentions for keeping her safe, even though she also firmly insisted on her own agenda. Initially tapping fourteen times, she managed to gradually reduce the compulsion from fourteen times to ten, then to eight and so on down to one, then gradually reducing the frequency of single taps until they disappeared altogether. As Siegel writes, “whether you’re twelve or ninety-two, you’re probably not going to win a battle against a brain-circuit that’s at least one hundred million years old. In an integrative approach, the winning strategy is respect and collaboration”.

So, overall, though I would have liked Siegel to recognise and explore more of the massive wider implications of the integration model he uses, I would still greatly recommend this wonderful book. It will help you to recognise and understand integration as a very concrete process which is part of all our experiences because it is an aspect of the operation of our brains. It will also present you with a range of stories which all offer hope. Starting from wherever you start, whether you are twelve or ninety-two, there is always hope, and rigidity need not prevail.