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Mark Goulston M.D., F.A.P.A.

Mirror Neuron Receptor Deficit (MNRD) - An Idea Whose Time Has Come

"Mirror, mirror on the wall..."

Hell hath no fury as a narcissist
whose mirror is not telling them what they want to hear.

(excerpted from “Just Listen” Discover the Secret to Getting Through to Absolutely Anyone).

You cringe when a coworker gets a paper cut and cheer when a movie hero gets the girl. That’s because for an instant, it’s just as if these events are happening to you—and, in a way, they are.

Years ago, scientists studying specific nerve cells in macaque monkeys’ prefrontal cortexes found that the cells fired when the monkeys threw a ball or ate a banana. But here’s the surprise: these same cells fired when the monkeys watched another monkey performing these acts. In other words, when Monkey #1 watched Monkey #2 toss a ball, the brain of the first monkey reacted just as if it had tossed the ball itself.

Scientists initially nicknamed these cells “monkey see, monkey do” neurons. Later they changed the name to mirror neurons, because these cells allow monkeys to mirror another being’s actions in their own minds.

The new name is more accurate, because we’re finding that humans, just like macaques, have neurons that act as mirrors. In fact, studies suggest that these remarkable cells may form the basis for human empathy. That’s because, in effect, they transport us into another person’s mind, briefly making us feel what the person is feeling. In a 2007 article titled, “The Neurology of Self-Awareness” in Edge, V. S. Ramachandran, a pioneer in mirror neuron research, commented, “I call these ‘empathy neurons’ or ‘Dalai Lama neurons’ for they are dissolving the barrier between self and others.”

In short, these cells may prove to be one way nature causes us to care about other people. But look at mirror neurons from another angle, and new questions emerge. Why is it that we often tear up when someone is kind to us? Why is it that we get a warm feeling when someone understands us? Why is it that a simple caring “Are you okay?” can so move us?

My theory, which my clinical findings support, is that we constantly mirror the world, conforming to its needs, trying to win its love and approval. And each time we mirror the world, it creates a little reciprocal hunger to be mirrored back. If that hunger isn’t filled, we develop a condition I have given the name “Mirror Neuron Receptor Deficit” (MNRD).

Mirror Neuron Receptor Deficit, Narcissism and Neurosis

The concept of Mirror Neuron Receptor Deficit (MNRD) may partially explain the emotional experience, thinking and behavior responses in narcissism and neurosis.

Narcissists constantly need to be mirrored and have others conform to their emotional and psychological needs. They frustrate and become irritated easily and when they are already in a state of MNRD and someone dares to not cater to them, their frustration can quickly turn into what we call “narcissistic rage.” This is what happened with the Evil Queen in Snow White. Already experiencing a MNRD (or else why would she have needed to ask for reassurance), she needed some stroking of her ego when she approached the Magic Mirror. And when in that state of mind she wasn’t “mirrored,” but instead was told that she was no longer “the fairest of them all” the insult added to her narcissistic injury was too much and caused her to fly into rageful retaliation.

On the other hand, when neurotics experience MNRD, they feel anxious and/or depressed. If at that point they are not mirrored by someone and to make matters worse, experience a further lack of mirroring through an uncaring act by someone else, they usually don’t fly into a rage. Instead they usually feel more anxious and/or depressed and will often withdraw or seek comfort with food, alcohol, drugs, shopping and/or sex (through hooking up, prostitutes and/or masturbation).

Mirror Neuron Receptor Deficit and Implications for Psychotherapy

There is a well known quote first made famous by President Theodore Roosevelt and more recently by John Maxwell , respected leadership expert, speaker, and author that, “People don’t care how much you know, until they know how much you care.” I would add to that the notion that, “Sometimes people aren’t able to care about what you want them to do, until they feel cared about by you.” The reason for that is that when people feel unmirrored and uncared for and are experiencing a MNRD, they are in a state of emotional deprivation. While in that state of mind, their focus is often distracted by trying to correct that deprivation rather than focusing on what they need to get done for the good of their company or organization.

Alternatively, when you are in a state of MNRD and you are accurately mirrored, you feel temporarily complete. That usually crosses over into feeling grateful and often the desire to reciprocate... and with some resistant patients, the desire to cooperate and take steps towards getting well.

Here’s an example from my own practice that illustrates the surprising power of reducing someone's MRND. It involves Jack, a highly intelligent paranoid patient I saw several years ago. Before coming to me, Jack had seen four other psychiatrists.

“Before we start talking,” Jack said right off the bat, “I need to tell you that the people living above me keep making noise all night long and it’s driving me crazy.” He said this with a wry grin that seemed odd at the time.

“That must be exasperating to you,” I responded empathetically.

Smiling mischievously as if he’d caught me in a trap, Jack added: “Oh, I neglected to tell you that I live on the top floor of my apartment building and there’s no access to the roof.” Then he looked at me with a smirk reminiscent of a comic looking to get a rise out of an audience.

I said, “Tell me more,” and he continued to explain his paranoid delusion in more delusional detail.

I thought to myself: “Hmm. I could say ‘so what?’ and trigger a confrontation. I could repeat ‘tell me more,’ and have him go into even detail about his paranoid delusion. I could say ‘I’m sure that the sound appears quite real to you, but a part of you knows it isn’t’ . . . but that’s probably what the other four psychiatrists said.”

Then I asked myself, “What’s more important to me? To be a calm, objective professional giving him yet another of the reality checks that he’s already received from my profession? Or to try to help him, even if it means letting go of reality?”

I decided on the latter. And with that conclusion, I let go of what I knew to be the objective truth, stepped completely into what he believed to be the truth and said with full sincerity: “Jack, I believe you.”

With that, he looked at me and paused for a moment. Then, startling me, he started crying, making the sound of a starving feral cat out in the night. I thought I’d opened up a real can of worms and questioned my judgment, but I just let him cry. As the minutes went by, his crying lessened, sounding less animal and more human. Finally, he stopped, blotting his eyes with his sleeve and wiping his nose with a tissue. Then he looked at me again, seeming ten pounds lighter as if he’d just relieved himself of a tremendous burden, and offered me a wide, knowing grin, “It does sound crazy, doesn’t it?”

We smiled together at the insight he’d just gained, and he took his first step toward getting better.

What happened to allow Jack to begin to give up his craziness? He felt mirrored by me. In his experience, the world required him to mirror and agree with it, whether it was a doctor saying, “You need this medication,” or a psychiatrist saying, “You realize that these are delusions, don’t you?” In that scenario, the world was always sane and right, and Jack was always insane and wrong. And “insane and wrong” is a heck of a lonely place to be.

My accurate mirroring helped Jack to feel less alone. As he felt less alone, he was able to feel some relief. And as he felt that relief, he was mentally able to relax. As a result, he felt grateful and, with that gratitude, came a willingness to open his mind to me and to work with me rather than fight me.

Mirror Neuron Receptor Deficit goes to the Movies

In today’s world, it’s easy to imagine that deficit growing into a deep ache. Many of the people I work with—from CEOs and managers to unhappy spouses to clinically depressed patients—feel that they give their best, only to be met day after day with apathy, hostility, or (possibly worst of all) no response at all. In my belief, this deficit explains why we feel so emotionally touched, disarmed and even overwhelmed when someone acknowledges either our pain or our triumphs.

Understanding MNRD and mirroring those who are experiencing it has tremendous application to leadership, sales, marketing, family and intimate relationships. Many of the "tear jerker" scenes in movies are caused when a rift between two individuals with severe MNRD, suddenly connect with each other. As we watch that happen we experience the protagonists going from conflicted to connected to each feeling complete. The tears we feel at those moments are the vicarious experience of the MNRD being corrected in both of the characters on the screen.

You might recognize some of the following (you might also want to get out your handkerchiefs):

I think that leadership guru and my mentor, Warren Bennis , summed it up best, “When you deeply listen and get where people are coming from, and then care about them when you’re there, they’re more likely to let you take them where you want them to go.”*

* from the dedication in: “Just Listen” Discover the Secret to Getting Through to Absolutely Anyone(AMACOM, $24.95).