HOW I FOUND MY RHYTHM WHEN THE MUSIC STOPPED

At a time in everyone’s life, we come to find ourselves in a situation where the music stops, and we must go on.  The unfortunate truth about life is that the unexpected will happen. Some of us learn from it, some of us change because of it and some of us find our life’s calling because of it. The latter was the case for me.  After our dad picked us up from middle school, we spent that afternoon like we had every afternoon that month. We went to the oncology unit at the hospital, where my brother was admitted.

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THE MAN IN A BLUE SARONG

I remember him. I remember the man in the dark blue sarong the same way I remember the lines on back of my own hand. He was hunched over next to a column on a dirty platform at a railway station in Calcutta, India in the middle of the harsh summer sun. His hands were withered, his fingers and toes looked like tiny nubs, and he was completely malnourished and alone. He had opaque blue eyes, as if fog had taken place of his irises and pupils.

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PATIENT “OWNERSHIP”

I studied insects in college; my favorite insects were the bees (I found them diligent and so helpful to humankind).  One of my favorite classes was about medical diseases caused by insects. My professors noticed my interest in the medical side of things and connected me with a professor who did clinical research. Our work focused on a clinical trial for children with intractable epilepsy and exposed me early on to patient care and patients.

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Any strategic or organizational change required by a leader or manager, and then secondarily required by employees/staff or those under a leader or manager, uses the same type of cognitive dynamics. In our own profession, surgeons are probably the best examples of this. After years of residency and fellowship training with surgical procedures, these become so well fixed and ingrained that the basal ganglia are running the show. If a surgeon attempts to change any hardwired habit or surgical technique with new learning, it requires much effort, which usually is in the form of demands on the cerebral attentional network. This leads surgeons to an uncomfortable feeling, and they do what they can to avoid changes to their routines. The same is true of leaders.


Human brains have evolved a particularly strong capacity to detect what neuroscientists call “errors.” This is a perceived difference between the person's expectations and actuality.(3)  These error signals are generated by a part of the brain called the orbitofrontal cortex. In detecting error signals, the amygdalae are also activated. Error detection signals can push people to become highly emotional or to act more impulsive as they attempt to adjust, and animal instincts take over. This may be destructive to leadership or to the social cognitive functions of people being managed. Attempts to change routine behaviors sends out strong messages in the brain that "something is not right".


Researchers are now expanding neuroscience research into social cognitive neuroscience and leadership.(4)  Neuroscientists are seeking to understand various aspects of leader decision making, such as boldness or risk-taking behavior, the tendency to “freeze with fear” when faced with important decisions, and how these may involve linkages between the cortex and thalamus with the limbic areas of the brain, specifically the amygdalae. The amygdalae appear to be a principle node in the neural network pertaining to emotions and reasoning. Further research is examining shared or distributed aspects of leadership. It is questioned whether a form of neuro-synchronicity is evident in groups in which a high degree of shared leadership is present. If this can be proved, what are the common or complimentary aspects of brain structures that exist in groups in which there is a high degree of shared leadership or shared strategic vision?


These forms of leadership research have set off alarm bells among certain scientific groups with regard to the possible ethical implications of neuroscientific studies to identify and develop effective leaders.(5)  Lindebaum believes that neuroscience will influence leadership research considerably in years to come, but this begs significant ethical questions. He has asked that neuroethicists be involved in leadership and neuroscience management research as a matter of priority, and this approach should be extended to teaching these issues within MBA programs. He further warns that as neuroscientific methods move from the laboratory and enter the real world, they simultaneously leave a relatively controlled environment of ethical protocols, rules, and IRB guidelines that apply to academic researchers. He believes that once leadership neuroscience research goes from academia to boardrooms, hospitals, or factories, these prior constraining forces may not be present. Using scientific methods and principles to identify and develop high performance leaders at work is an ethically and extremely sensitive issue. Lindebaum further points out that effective inspirational leaders can now be reliably identified by neuroimaging techniques, such as fMRI. He calls these the neurological brain profiles of the individual. He is concerned that those with “deficient” leadership profiles can be sorted out or even "cured", according to the claims of some researchers.(4)  He makes a call to action, because of the tendency for technological advances to evolve considerably swifter than our ethical understanding of the consequences for individuals and societies at large.(5)


References


1. Rosenbloom MH, Freudenreich O, Price BH. Comportment. In Arciniegas DB, Anderson CA, Filly CM, eds. Behavioral Neurology and     Neuropsychiatry. Cambridge, UK: Cambridge University Press; 2013: 250-265.


2. Rock D, Schwartz J. The neuroscience of leadership. Strategy and Business. 2006; 43: 70-79.


3. Rolls ET. On the brain and emotion. Behavioral Brain Science. 2000; 23: 177- 234


4. Waldman DA, Balthazard PA, Peterson SJ. Social cognitive neuroscience and leadership. The Leadership Quarterly. 2011; 22: 1092-1106.


5. Lindebaum D. Pathologizing the healthy but ineffective: some ethical reflections on using neuroscience in leadership research. Journal of     Management Inquiry. 2013; 20: 1-11.  

There has been a flurry of activity in the last decade regarding neuroscience and leadership. From a brain standpoint, much of leadership is based upon the cerebral functions underlying social cognition. Social cognition has evolved to contextualize the matters and outcomes under consideration, the effects of any decisions made on others, and to guide considerations of what others might or might not think. These cognitive functions are expected to lead to sound reasoning and rational judgment. From a behavioral neurological or neuropsychiatric standpoint, leadership includes domains of “comportment.” These are the complex mental processes that include insight, judgment, self-awareness, empathy, and social adaptation. Comportment does not include cognitive functions such as memory, language, planning, set-shifting, and attention.(1)


Good leadership often requires changes that are painful to individuals. Organizational change is unexpectedly difficult, because it provokes sensations of physiological discomfort. The challenge for the leader is to deal with the resistance to change, even when it is in the organization's or person’s best interest. Jeffrey Schwartz, M.D., a psychiatrist at UCLA, and David Rock, an academic at New York University School of Continuing Professional Studies, have outlined simple explanations for normal human resistance to change.(2)  Working memory is the brain’s information holding area, and it is frequently engaged when people encounter something new. When a leader, or an employee, is asked to make a change in action or thought, the benefits of the

BY ROBERT P. GRANACHER JR., MD, MBA

change are compared to the action or thought that one already uses. A +/- valence is determined by lateral prefrontal, medial temporal and orbitofrontal regions. It is working memory that takes in the new information and matches it against the old. This, in turn, activates the prefrontal cortex of the brain, an energy-intensive area.


On the other hand, the basal ganglia are activated by routine, familiar activity. In other words, activity continuing with the same behaviors and actions, or continuing with the same mode of thinking. The basal ganglia are very deep midline structures and sit above the brainstem. They are particularly involved in neural circuits that respond to the formation of longstanding habits. They require much less energy to function than working memory, and much less blood flow. The basal ganglia seamlessly link simple behaviors from brain modules that have already been shaped by extensive training and experience (e.g., management or surgical training). They can function exceedingly well without conscious thought. Since they work automatically without requiring conscious thought, this frees up the information processing resources of the prefrontal cortex. The basal ganglia operate analogous to an automatic transmission, shifting among patterns of deeply held thoughts and actions.  

ROBERT P. GRANACHER, JR., MD, MBA

Robert P. Granacher, Jr., MD, MBA practices clinical and forensic neuropsychiaty in Lexington and Mt. Vernon, KY. He is a noted scientific author and past president of the Kentucky Psychiatric Medical Association. He is currently president-elect of the Lexington Medical Society and Clinical Professor of Psychiatry at the University of Kentucky College of Medicine.