There are many collaborative contributors to the growing perspective of cross-disciplinary thinking about the mind and mental health whose empirical research, clinical interventions, and community approaches have shaped its formation, the framework of Interpersonal Neurobiology (IPNB). Now with over eighty textbooks in the Norton Professional series on Interpersonal Neurobiology, this framework offers a wide array of disciplines a unique and useful approach to helping the mind grow and thrive. This article will be written in the first person, through the voice of each of its co-authors—and in these direct entries, we will identify this as in the first-person, singular as either Chloe or as DanFootnote 1 or in the first-person plural, “we.” We invite you, whatever your own background, to consider these ideas and how they might fit—or not—with your professional work and perhaps even personal life. While the Archives of Psychiatry is an academic journal and in this setting the first-person terms of me, you, or we are not often used, it seems that a shift in that usual approach is appropriate as we discuss the nature of the mind itself, the source of our experience of self, identity, and belonging. In this paper, we invite you to explore an overview of this framework of IPNB and how it is potentially relevant to the various disciplines of mental health, including psychiatry, psychology, social work, nursing, and masters level therapists focusing on individuals, couples, families, groups, and communities. As we’ll come to see, while IPNB is not a form of therapy, it informs any form of intervention to promote health by offering a framework for understanding the mind and human development across the lifespan.

One of my (Dan’s) teachers was Edwin Shneidman, Ph.D., a leader in the prevention of suicide who had founded the American Association of Suicidology. A fundamental idea of this pioneer in suicidology and thanatology was that the pain in the psyche—what Professor Shneidman called “psychache”—was a way of naming the experience that he viewed as a fundamental cause of suicide and suicidal ideation. Dr. Shneidman and I similarly shared the view that the field of mental health seemed to be inadvertently reducing individuals to diagnostic categories rather than seeing individuals and their relational worlds. In 1978 when I was a medical student with my first exposure to the working drafts of the Diagnostic and Statistical Manual of Mental Disorders, the DSM that was about to be published in its third edition by the American Psychiatric Association, I heard that the important step of finding a common vocabulary to communicate about mental illness was paramount. Despite this need for consistency in nomenclature and accuracy in formulation, such a classification system unfortunately may often make the mental health clinician vulnerable to missing the unique features of the persons in their care.

But what are these unique features? If the focus was on the mind, what was this “thing” in our lives, this mind, that was actually experiencing such a range of symptoms and signs revealing at a minimum mental suffering, or, at an extreme, a mental dysfunction so pervasive we might classify it as a disorder? Though I ended up dropping out of medical school in 1980 due to a lack of focus on the mind in medicine, I ultimately came back with a term inside of me, “mindsight,” that would remind me that the mind and its expressions of feelings, thoughts, and meaning, was not only real, but really important. Later studies would show that a capacity to sense the inner state of the person in the clinical setting may be a key feature of therapeutic efficacy [20]. Even primary care physicians who take a moment to identify the internal experience of their patients have improved clinical outcomes, such as enhanced patient immune function and recovery from the common cold a day sooner than control groups who were not offered such empathic comments [22]. Why would sensing the mind—having and showing mindsight—be such a potent component of clinical care? And could this capacity to sense the mind’s inner, subjective nature be related to the specific question about suicide, the psychache that is the pain in the psyche? To address these questions, it seemed that having some clear notions of what psyche and mind might actually be, what truly comprised our mental lives, would be a useful place to begin the journey of the field of mental health.

The mind and psyche of psychiatry, psychology, and psychological well-being

What exactly is meant by the term, “psyche”? The standard dictionary definition [17] , of this term is the soul, the spirit, the intellect, and the mind. Yet the reality of our various disciplines in the broad field of mental health, ones that often use the prefix, “psyche”—as psychiatrists, psychologists, and those in the psychological fields of psychiatric nursing and social work as well as many other mental health professionals who work as psychotherapists—is that we use the terms “mind” and “psyche” without having been offered a clear definition of what these actually mean. When this first became clear and I, Dan, was being given the opportunity as an educator to meet with hundreds and sometimes thousands of mental health practitioners from around the world, I’d ask them two simple questions about their formal training: “Were you ever offered a definition—not descriptions alone—of what the mind is?”; and, “were you ever offered a definition of mental health?” The result of this survey of one hundred thousand professionals in a wide range of disciplines in the field of mental health were remarkably similar around the globe: two to five percent said “yes” to each question. Taken at face value, what this suggests is that over ninety-five percent of mental health professionals have never been told what the mental or the health means of their professional work in the mental health field.

My own training would put me in the “no” category for each question. We do have many descriptions of the mind’s activities, including the processes of emotions, memories, attention, and thought. The closest to a “definition” that is sometimes offered is the saying, “the mind is what the brain does.” This perspective was enunciated by Hippocrates over two thousand years ago (see The Sacred Disease) and repeated by William James one over one hundred years ago (see The Principles of Psychology). For me, Dan, as a young trainee, back in the early 1980s after I had returned to medical school, entered pediatrics, and then began my psychiatry training, the idea that came from medicine that the mind was just the brain seemed to be a limited part of a much larger story. The brain in our head has a lot to do with our mental life and must have something to do with the psychache that Ed Shneidman was speaking about as a core cause of suicide. But what more might be involved in the mind that experienced so much pain that it would choose to end its own existence? What actually is this psyche, what is this mind, that has an “ache” that could lead individuals to end their lives?

In our various professions that are a part of the field of mental health, we have the opportunity to find a common ground, or what E.O. Wilson [32] might call, “consilience” across a range of independent disciplines that come to similar findings. One of the fascinating implications of these exploratory survey findings is that if the field of mental health does not define the “mental” part of its name, how can it say what the “health” is referencing? In this paper, we begin with the important experience of human suffering and the subjective sensation of psychache and its relationship to suicidal behavior. We will then take a step back and ask the broad question, what is this psyche, this mind, that is experiencing an ache, a suffering so severe that the impulse to end one’s life arises? In short, what is the mind and what is a healthy mind?

A lack of definition of the mind for the field of mental health

Throughout my (Chloe) training in the second and now third decade of this new millennium, mental health was defined as the absence of mental illness. This limited description reinforces the notion that the sole focus of clinicians is to eliminate the symptoms of disorders. While there are undoubtedly benefits to reducing symptoms, this one-dimensional approach leaves many important questions unanswered: What are the core unmet needs underlying the symptoms? Is the elimination of symptoms the full scope of healing and the goal of clinical intervention? What are the natural resources of the mind and how can they be accessed? These questions are difficult to address if the “mind” and “mental health” remain terms without definition, or at most, simply abstract concepts. If we want to be equipped to reduce the symptoms of mental pain, to facilitate growth and cultivate well-being, we need to have a deeper understanding of what we are talking about when we refer to the mind.

When we communicate with one another with language, we use linguistic terms to convey symbols with meaning—with words. We are beginning with the common term, mind. And we will use other terms, such as “self”, “identity” and “belonging” that each reveal fundamental aspects of our mental lives. As we introduce each of these words in this academic paper, we will try to be as direct and foundational as possible in defining what we mean by the term. Rather than making a citation for every statement, a deeper dive into these ideas and their scientific basis along with the hundreds of research papers supporting their specific details can be found in a number of texts by Dan, including [26,27,28].

Let’s start here with a common word, “individual.” We might agree that there's a skin encasement around many organs and organ systems that form our body, and that this body is an entity—a thing with boundaries and features—that is the homebase for what we are naming as the individual. Much of the focus in research and clinical interventions in the field of mental health in the last one hundred years has focused on the psychological and neurological processes of the individual as the basis for the mental suffering of those with psychiatric disorders. By neurological, we mean the structure and function of the nervous system including its complex neural interconnections in the brain. By psychological, what is meant are the experiences of thoughts, emotions, memories, meaning, beliefs, attitudes, intentions, and the initiation of action. Some might use the common terms, cognitive, emotional, and behavioral—and there are divisions of clinical intervention, for example, that are named for the specific focus they use, such as cognitive-behavioral therapy or CBT. Groups of individuals can also be the setting of clinical intervention, and even individuals in a family or in a relationship. And in each of these approaches, there is a unit of experience that can be demarcated as the individual human body.

If we were then to assume that those psychological experiences—of emotion, thought, and memory, for example—are simply the output of neurological processes in the head, or even more broadly, in the whole body, then we would locate the psyche only inside the individual. We might even concur with the thousands of year view from medicine that mind is what brain does. While this was the commonly held view at the time I, Dan, was in training, when I was learning to be a psychotherapist, and then when I became an attachment researcher studying parent–child relationships, it seemed to me that whatever this “mind” was, it was more than simply brain activity alone. The mind seemed to be fully embodied, not just up in the head. And there was a relational aspect to mind that was even beyond the individual’s skin-encased body.

In researching attachment, the experience of an infant was directly shaped by communication with parents. The experience of something we could call a “sense of self”—a sense of what a center of experience felt like—was both inside that individual and between that person and others around them. This inner and relational experience of self-raised some provocative questions in my own mind as both a researcher and clinician, as well as an educator and new parent. If the experience we name as self was constructed by the mind, could the mind be both inside the individual and relational? If self and the mind it emerged from were in these “two places”, did this mean that the individual body was only part of the self? What could be both within and between?

Seeking consilience: individual, mind and self

In a range of scientific endeavors to explore self-experience, three features are often highlighted: Sensory subjective experience, Perspective or point of view, and Agency or being a center of initiating action (See IntraConnected). These can be readily recalled with the acronym, SPA, the SPA of self-experience. Are these SPA features of self-limited to the individual body? Is the subjective sense we have simply reduceable to “what the brain does?” Here is a story that exemplifies these questions.

When I, Dan, was in college, I worked on a suicide prevention phone service, long before I was to meet Professor Shneidman. On that service, I had the feeling—as the person on the receiving end of the phone line speaking with someone who was thinking of killing themselves—that meaning in their lives, the meaning of life and also the meaning of the words I said, made all the difference in whether they would end their life on that phone call or have a sense of hope and possibility and choose, at least for that moment, to stay alive another day. The meaning of how our relationship unfolded in the communication we shared on that call was literally a matter of life and death. What this meant was that how I focused on the inner life of the caller and then connected in a way that was supportive in our communication would directly influence the inner mental experience of that person. It mattered how we connected in a way that would shape meaning in the individual’s life. All of this—the inner meaning and the meaning of interpersonal connection—seemed far more than what was happening in the brain alone.

So “meaning” is something that seemed to me, as a college student, to really “matter”. In English we have the interesting double meaning of “matter” in that it matters and indicates that something is significant; and that matter has substance as something you could hold in your hand and is a real situation, such as a “matter of life and death.” So, we have the intriguing meanings of something that has weight to it, it has significance and substance—it is “substantial”. The overlap of a life that matters, one with meaning and significance, and the lack of these elements of life in suicidal ideation and action, and perhaps found in impediments to mental health in general, can relate to the individual and their place both in life and in the setting of the culture in which the individual lives. This relational context—how a person is situated in their connections with other individuals—seems more than just their “setting” but rather an essential feature that matters in their experience of self, their identity, and their sense of belonging. Self we’ve defined with its SPA features of subjectivity, perspective, and agency. Identity can be viewed as those characteristics used to define the self, to identify who we are. Belonging can be described as the experience of being a part of something, to be accepted for one’s unique features while also being a member of something larger than the individual alone. Self, identity, and belonging seem to be three aspects of our mental lives beyond the individual body.

It is these relational factors that seemed to make the experience of being a self, with the subjective sense of being alive, the perspective on life and the world, and the experience of agency with its empowerment and integrity, that were essential for the mental well-being of the individual. When the self is fractured, the psyche aches. Our modern culture, especially prominent in the United States with its extreme emphasis on individuality [18], focuses on the separateness of people. And in this cultural setting, levels of suicide, and the despair of psychache, are high. Following the viral COVID-19 pandemic, suicide levels, along with the incidence of anxiety, depression, loneliness, and addiction, have risen dramatically—especially in youth [7]. But if these are each an example of impediments to mental health, if these are examples of mental suffering, what actually is this mind that is not healthy, this mind that is aching? Is this solely something arising inside the body of the individual because of its isolation? Or, might the self that is suffering be embedded in a much larger system than that of the body alone?

From a cognitive science vantage point, four E’s are used to describe our mental experience of information processing: Embodied, Enacted, Extended (beyond the body), and Embedded (in our social worlds) [19]. And from this perspective, we do not limit information processing to the individual alone. Even your experience of reading this paper, and our experience of writing it, are examples of extended information processing. We share information with one another as individuals.

After finishing my clinical training in adult and then child and adolescent psychiatry, I, Dan, did a research training fellowship through the National Institute of Mental Health studying parent–child relationships and how these interpersonal connections shaped emotions, memory, and narrative. The central role of emotions in our mental life, the ways our past experiences continue to impact us in the present and shape our future within memory processes, and how we find meaning in life through the narrative efforts to make sense of experience each reveal how relationships shape our minds. This was just before and then at the beginning of the Decade of the Brain, as our ability to peer beneath the skull into the neural networks and mechanisms associated with our mental lives was exponentially expanding. Turning to brain studies was now possible, for example, to explore how trauma might specifically impact the encoding, storage, and retrieval of memory in both its implicit and explicit forms. We could even examine the neural networks in the cortical regions involved in the processing of autobiographical narratives—the stories we tell about what we have experienced and who we are. There was clearly a direct association between neural and mental processes as we had known for thousands of years only now the details were becoming possible to envision in useful ways. But if emotions, memory, and narrative are examples of what we experience as “mind”—what actually was this process so fundamental to our well-being? Was the term, mind, simply a placeholder for “brain activity?” And if so, might we simply drop the term, mind, and speak of neural activity instead? Would you mind if we did that and speak, instead, of “would you brain if we did that?” Even if mind was dependent upon that embodied neural activity, at least in part, could it be that what we mean by mind is not the same as the brain?

After that fellowship, the opportunity to run the training program at UCLA in child and adolescent psychiatry also afforded the chance, as the Decade of the Brain, the 1990’s, was unfolding, to invite forty scientists to gather together to address the simple question: “what is the relationship between mind and brain?” The brain was straightforward for the group to define—a complex neural network up in the head, connecting to the whole body. But when it came time to define the mind, short of saying that it is “brain activity,” there were no definitions, only descriptions offered by the academicians. For an anthropologist or sociologist in the room, mind was a social process. For the psychologist or neuroscientist at the meeting, mind was an internal process of the nervous system—the brain up in the head and its neural network activity. The tension in the room was uncomfortable and intense; there seemed little reason to meet again after that first discordant gathering. But after being urged to try one more time, the individuals in the group chose to come again. What would you offer as a definition of the mind that might be a common ground for those who saw mind as social and for those who saw it as neural?

In brief, the challenge of the “what” that could be both inside the individual and between the individual and the surrounding world, in relationships with people and with nature, was to imagine what the “stuff” might be that could serve as the basis of mind. What is it that could be both inner and inter? Identifying the essence of neural firing, one finds energy flow within neural networks in the form of electrical energy as ions flow in and out of membranes and of chemical energy in the form of neurotransmitters and receptors. Identifying the essence of relationships, one finds the sharing of energy and information flow between individuals and between an individual and the environment. It seemed clear that one way of viewing the common ground of the neural view and relational view of mind was energy flow. Inner and inter reveal the spatial location of what might be the common “stuff” of the mind: energy flow.

If you see or hear the word, “hello,” this is the energy of light or of sound waves in a specific pattern with symbolic meaning—it is a formation of energy that is “information.” And so, we can say that energy can be in a pure form—like a sunset’s rainbow of color—and we can say “sunset” and we then have a symbolic term, a word, that is representing, it is “re-presenting” or presenting again, the pure form of energy. Some physicists see the fundamental aspect of the universe as energy; others view the universe as comprised of information. To find that common ground, the consilience, we can simply use the term, “energy and information” to be inclusive. In our everyday experience, though, we may more directly sense that information emerges from energy. Because these change, we call this unfolding, “flow.” Energy and information flow, we are suggesting, is the fundamental stuff of the mind—and this flow can be both inner and inter.

A systems view

In the 1980’s, systems studies revealed that the mathematics of complex systems identified a process known as “emergence” in which the interaction of elements of a system gives rise to something larger than the elements themselves. Could it be that “mind” was an emergent process arising from energy flow that was both within and between? In this line of reasoning, neither skull nor skin were impermeable barriers that impeded the flow of energy and information.

One particular emergent process is known as “self-organization.” A system that is capable of being chaotic, open to influences from outside of “itself”, and non-linear, meaning a small input at one time can lead to large and difficult to predict outcomes, is considered a “complex system.” These are systems that adapt and learn, their component elements have interdependent, multidirectional influences on each other, and they have the emergent property of regulating their own unfolding called self-organization. While this may seem counterintuitive in that there is no orchestral director, no guide, no planner of the system’s flow, self-organization governs how a complex system emerges over time. By balancing the differentiation of elements and their linkage, self-organization is optimized, and the system achieves a flowing state toward “maximal complexity.” Within mathematics and the study of probability, one can explore the science of systems and discover how this linkage of differentiated parts is the most probable to arise if nothing impedes its innate emergence. It has been helpful to name this balance of parts being different and parts being linked without losing their differences with a commonplace term, “integration.” Integration is how a complex system achieves optimal functioning—it adapts and learns by way of the intricate interdependent connections among differentiated parts.

While coming from the field of mathematics, systems science can be applied to molecules, bodily systems including the brain, families, communities, and our global ecological biosphere. For me, Dan, this mathematical perspective on systems seemed like it might be both relevant and important in attempting to understand the mind.

The complex system emergent property of self-organization can be imagined visually like a river in which the central flow of integration has the features of being flexible, adaptive, coherent, energized, and stable [26]. In English, this forms a useful acronym, FACES. This FACES set of features describes the harmony of an integrative flow. The two banks outside of this central integrative flow of harmony are chaos on one side, rigidity on the other.

The observation that each of the various mental disorders and its list of symptoms in the ICD-10 or the DSM-V might be re-envisioned as examples of chaos, rigidity, or both, suggested that perhaps the mind, in part, might be defined as: “The emergent, self-organizing, embodied and relational process that regulates the inner and inter flow of energy and information”.

A mind that facilitates integration would be a healthy mind; one that blocks integration by impeding differentiation, linkage, or both, would be an example of an unhealthy mind—or at least a mental state that was leading to mental suffering in the form of chaos and rigidity. The FACES flow and the linkage of differentiated parts that create it results in the experience of harmony. It is this view that leads to the suggestion that integration creates the harmony of health.

The mind also includes other features that may be emergent properties of embodied and relational energy flow. These include subjective experience, the felt texture of life; consciousness, our capacity to be aware; and information processing, how we shape energy flow into symbolic meaning:

These four facets of mind—subjective experience, consciousness, information processing, and self-organization—enable us to see what an ache in the mind might involve and why it might lead to suicidal behavior and despair. Energy and information flow that is not integrative leads to chaos and rigidity. These we can now conceptualize as the fundamental aspects of mental suffering, including that of psychache. How do these arise? From this broad proposal, mental suffering arises from impediments to integration. This blockage of mental health would be revealed as chaos, rigidity, or both. When we are not experiencing integration’s balance in differentiation and linkage, then chaos and rigidity emerge—we can become stuck on the banks of suffering outside the central flow of integration, the harmony of mental health and resilience.

The mind and psychache

Imagine a situation in which someone calls in to a suicide prevention service and says, “I see no future, I'm in so much pain, I have no feeling of connection to anything, I don't belong anywhere—I see no reason to live.” Now imagine if you are the responder for the service. What would you say? Imagine if, as a trained mental health professional versed in ideas about neurotransmitters and depression, you were to say to them, “I can sense that your serotonin levels are so low in your brain, likely in your prefrontal cortex and your anterior cingulate, that you have a chemical imbalance.” If you were to say only that, even if it were accurate, what do you think might happen? Is this statement connecting with the felt sense, what is sometimes called the “subjective” or “first-person” experience of this distressed individual? Even if it were describing the neural processes underlying those subjective sensations of despair, would the person “feel felt,” a phrase one of my, Dan’s, first patients used to describe what she felt was the attuned connection with her therapist that was the healing component of therapy?

You may sense that this neurochemical statement by itself would be missing an opportunity to attune to the individual human being on the other end of that phone line. Such attunement, such focus of attention on the inner life of another person—or of ourselves for internal attunement—would have given them a feeling of connection and hope, they would not feel alone or that they had nowhere or no one with whom they had the feeling of belonging, and they would be less likely to end their lives. And so even if the brain state involved low serotonin levels, naming this fact is not the same as tuning in with your attention to the subjectively sensed experience of mental pain. At a minimum, one reason we cannot replace the term “mind” with the terms “brain” or “brain activity” is that our subjective sense of being alive is simply not the same as the electrochemical energy flow of the nervous system.

When we use the term, “subjective”, we in no way view this as less than something that is “objective”—it simply is the inner felt sense of being alive that can only be known directly by the “subject”—the individual feeling the experience of being alive. Subjective experience is one facet of mind, and one component of the self. In this way, the subjective sense, along with one’s experience of perspective and agency, form what we’ve seen can be named as the SPA of self-experience. The term, “sense of self” is sometimes used to denote this feeling that there is a coherence, a wholeness, to being alive. It is this sense of self that is troubled in the experience of psychache. Though neurochemical status may shape each of the features of our minds, including the SPA of our individual sense of self, they are not the same as how we come to feel whole as a self, how our sensation, perspective, and agency give us a sense of belonging and well-being. In other words, the individual sense of “me” is not the whole story of who we are—who we are is also a relational “we.” In spatial terms, the me is inner; and the we is inter. Inner and inter are each an aspect of the system of energy flow we are saying is the system of mind.

A second facet of mind, consciousness, is how we know we have that pain. This is how we are aware of our inner sense of self. Whatever neural processes underlie the flow of sensation, that create our state of mind, and that shape our experience of being aware—the knowing and the knowns of consciousness are not the same as these neural processes. In this fundamental way, our subjective experience and the consciousness that enables us to know that this sensation of being alive cannot be reduced to just brain firing, even if they are internally dependent on them. In other words, mind processes are not the same as brain processes, even if they are dependent upon them, wholly or even in part, for their emergence in our mental lives.

Emergence, energy, and information

Emergence is something we experience every day, and in the science of complex systems, we see that the arising of something from the interaction of its components that is larger than these fundamental parts is an inherent feature of how these types of systems work. A complex system, one defined as having those three features of being open, capable of chaos, and non-linear, has emergence with which something greater than the individual parts is arising. In IPNB, we propose that the mind in all its facets may be emergent processes of embodied and relational energy flow. What this means is that both internal processes, such as our state of physiology and neural firing, as well as communication within our relationships, such as your experience of reading this paper, involve energy flow. Energy is not meta-physical or some non-scientific concept; energy is a core foundation of the physical world. When energy flow has symbolic value, when the energy formation stands for something other than itself, we’ve seen that we call that formation of energy, “information.”

This brings us naturally to our third facet of mind, information processing, which may also be an emergent property of energy flow that's happening in a complex system that includes, but may not be limited to, the brain up in our head. When the formation of energy flow symbolizes something, when it “re-presents” something other than itself that is information. Information processing reveals how even a representation is itself a verb-like unfolding—information naturally involves the emergence of even more information as it is “processed” by the emergence of ever more complex representational processes. A breeze on your cheek, can be considered pure energy flow as it exists before we name it, “breeze.” But once you name it the breeze on my cheek, then it becomes information. And once we have that information, other aspects of representations associated with breeze, from ongoing experience, predictions for the future, or memory from the past, will be like a river flowing—that is information processing.

We can get as close to pure energy flow in these bodies we live in with sensation. That can be called a “bottom-up” experience in that we have a beginner’s mind, as best we can, to simply experience here-and-now sensory flow of energy, initiated by external or internal sensory processes. Once we take the next step of perceiving something, we are filtering what we perceive by what we’ve learned in the past—a kind of “top-down” filter that shapes our experience of reality, how we construct our view of the world. Perception is a top-down construction of information processing.

If we simply stay with these first three facets of mind, there’s nothing about them that helps us define what a healthy mind might actually be. These are useful ways of proposing that energy flow has an emergence to it and that this property of complex systems may be how these mental processes of subjectivity, consciousness, and information processing arise, how they emerge. But what would healthy subjectivity, or consciousness, or information processing be?

Mind as a self-organizing emergent process

When we look into the mathematics of complex systems, we find that these have an emergent property known as “self-organization.” This is a somewhat counter-intuitive way in which assemblies of components that are open, chaos-capable, and non-linear—that make up complex systems—have an innate emergent process that regulates its own becoming as it unfolds over time. Self-organization shapes the state of a complex system, moment-by-moment. By observing that many symptoms of mental disorders could be re-conceptualized as chaos or rigidity, the possibility that the mathematics of complex systems might offer helpful insights into the nature of the mind and mental health became apparent. Mathematics offered a potential way to make sense of the chaos and rigidity that seemed to characterize mental suffering.

This lead to the fourth facet of mind being envisioned and then defined this way:

“An emergent, self-organizing, embodied and relational process that regulates the flow of energy and information.”

Offering this working definition of a facet of the mind to that forty-member group back in the Decade of the Brain enabled us to find common ground and then to go on to meet for four and half years exploring the connections between mind and brain. It was within the collaboration of that multidisciplinary group that the notion of Interpersonal Neurobiology as a framework for understanding the mind and mental health was born.

This definition was useful in helping find consilience across many disparate ways of knowing by locating mind as an emergent embodied and relational process. This aspect of this proposal for a definition of the mind means that our mental lives emerge from beyond simply the brain in the head and involve the whole of the body; and mind also emerges within our relationships with people and the whole of the planet. This is a systems view of mind. A unanimous vote supporting this working definition arose from the academic group, enabling a diverse set of forty scientists to find a common ground of which they were previously unaware. Energy flow is not limited by skull nor skin, and so the mental lives we lead could be seen to involve cultural processes in our societies, communication patterns in our families, and physiological and neural processes in our bodies.

The importance of a systems view of mind when it comes to growth and change in therapy was exemplified when I, Chloe, began working with kids who had neurodevelopmental differences. I found it was paramount to understand their brain structure and functioning, as the neurological underpinnings of any given challenge with emotional regulation, sensory processing, motor planning or social communication would inform how to support the needs of each individual child. Central to positive therapeutic change was activating neuroplastic processes in the brain to stimulate learning and growth. But how exactly do such changes in the brain occur? In my experience, the pathway to integrative transformation in the brain was always facilitated through the embodied and relational facets of the mind. This happened in the context of shared experiences via an attuned and trusting connection, where I could sense the inner experience of the child and they could sense my being with them, moment to moment, as we navigated problem solving in the physical and social environment together. Any attempt to singularly control the process rather than join in its unfolding invariably blocked progress, so the therapeutic process required an openness and flexibility to the flow of energy and information between us.

Understanding the mind as a self-organizing emergent process allows us to ask a simple question: how does self-organization become optimized? Mathematics has an answer. When components of complex systems differentiate and then link, optimal self-organization emerges. A key to understanding this process is that in the linkage—as facets of the system interconnect—their differentiation is not lost. In this way, optimal self-organization does not arise with blending or making the system homogenous; instead, there is a balance of differentiation and linkage. In mathematics this combination of differentiation and linkage has no term, and so in IPNB it became important to have a way of naming this process, and the common-language word we use is integration.

Integration as health

Integration, which in IPNB we define as a combination of the linkage and differentiation of parts or facets of a system, is how mathematics views the way a complex system optimizes its self-organization. In other fields, this term may be used for linkage alone (as in neuroscience using “segregation” for differentiation and “integration” for linkage) or as addition in which differentiation is lost with the joining function (as in calculus). From the mathematics of complex systems, optimal self-organization is how the system becomes flexible, adaptive, coherent, which means resilient over time, energized and stable, meaning it's reliable, not that it's rigid. This combination of characteristics can be remembered with the acronym, FACES, which describes the quality of harmony. Unusual to imagine, but might the mathematical principles of complex systems be applied to understanding the mind? If so, then could mental health—and possibly health in general—be arising with the optimal self-organization that comes from integration?

As described above, this FACES flow of harmony can be visualized as the flow of a river, the central flow as that FACES emergence of being flexible, adaptive, coherent, energized, stable. Outside of this integrative harmony on one bank is chaos, and the other bank is rigidity.

If one examines the Diagnostic and Statistical Manual, for example, it’s possible to reframe the symptoms of each syndrome as either chaos or rigidity. The proposal back from 1992 and published in The Developing Mind in 1999 was that perhaps mental un-health—what is called “mental disorder”—is an example of impaired integration in which there is a blocking of differentiation, or linkage, or both. The outcome of such impediments to integration is chaos, rigidity or both. And since that time, each study of individuals with major mental disorders reveals neural structure and function of the brain with impaired integration [26]. For example, individuals with a range of conditions, such as those with schizophrenia, manic-depressive illness, autism spectrum disorder, and post-traumatic stress disorder have impaired functional and structural integration as revealed especially in the integrative regions of the prefrontal cortex, hippocampus, corpus callosum, and the interconnections of the connectome [14, 23, 30]. Of note is that regardless of etiology, whether primarily experiential or what might be considered “innate” or not caused by experience, the finding remains that mental suffering associated with a psychiatric condition appears to have impediments to neural integration, and even to be associated with challenges to relational integration as well. Relational integration emerges as individuals are honored for their differences and connections are established with respectful, compassionate communication.

A study by [29], revealed the corollary, that the most robust predictor of well-being across a wide array of measures is how interconnected the connectome is. The “connectome” is a term for the ways the many differentiated regions of the brain are linked, and so a shorthand for the term “degree of interconnectedness of the connectome” is, more simply, how integrated the brain is. Other studies have also shown that certain ways of training the mind can also lead to the neuroplastic changes associated with well-being—and they make the brain’s differentiated areas more linked. This reveals how what we do with the mind can integrate the structure and function of the brain. What are these practices? When the mind’s attention is trained to be focused, when its capacity to open awareness is strengthened, and when the mind’s intention is set in a direction of kindness, these positive changes emerge. This can be called “three-pillar mind training” [31] and include practices that teach an individual to focus attention, open awareness and build kind intention.

Mental suffering as chaos or rigidity

If someone is experiencing chaos and rigidity, we can see this as the underlying mechanism of the mental suffering of psychache. This perspective from the consilient view of IPNB enables us to offer a definition of both the mind and of mental health that can help mental health practitioners from our wide range of disciplines to have a common understanding of what we mean by mental suffering and psychiatric dysfunction. This view of mind as both embodied and relational enables us to see that there is no need for a battle between neural views and relational views—each “location of mind” may contribute to the psychache dominated by chaos and rigidity. Chaos can be experienced as intrusive thoughts, waves of intense and dysregulated emotions beyond a “window of tolerance” [26] in which integrative flow is possible, and distressing memories. Rigidity can emerge as a shutting down of an emotional sense of vitality, unrelenting ruminations, compulsive and repetitive behaviors, and disconnection from other people and the accompanying experience of not belonging.

One of the pathways to intervention, whether it is in the acute setting of a suicide prevention service, a psychiatric emergency room, or an outpatient office, is to provide a sense of connection by the mental health practitioner’s PART: Their presence, attunement, resonance, and the trust that ensues from these being a part of the communication. In its essence, a therapeutic intervention and connection combine the way each individual in the therapeutic relationship is differentiated from the other and while also becoming linked within compassionate communication. Presence is the open awareness that engenders a receptive relational state, what Steven Porges calls the “social engagement system” [21]. Attunement we’ve seen is the focusing of attention on the inner subjective experience, not merely on the externally visible behaviors. Resonance is feeling the other person’s feelings, without identifying their feelings as your own. And trust is that open state of feeling that the kind intentions and the availability of the other person are reliably present. When we play the PART we need to be integrative clinicians, we enable the relational connection to stimulate the internal integration needed for optimal inner regulation.

The benefit of clearly defined language for principles of the mind and the therapeutic alliance has important practical implications. As a play therapy trainee, I, Chloe, needed to explain to parents and teachers how the process of play and emotional attunement were essential for facilitating growth in the embodied and relational mind. These caring adults were accustomed to structured interventions with tangible methods and metrics, as opposed to the emergent, relational process of play therapy. Like many other forms of integrative therapy, much of the work was happening on levels of processing that were not immediately evident to an outside observer. As such, some parents worried this approach seemed trivial or too good to be true to address the complex social, academic, and emotional challenges that their children faced. To gain their trust and collaboration, it was essential that I had language to explain how this process worked and the central role of attunement and presence in cultivating integration.

But being present is not always easy when we face the chaos and rigidity of the minds of others. Keeping integration in mind as not the excessive over-identification with another’s mental suffering but rather the integration that requires both linkage and the necessary differentiation is a helpful starting place. If we over-identify, we lose differentiation; if we overly distance ourselves, we lose connection. Therapy is a fine art of integration in which both differentiation and linkage are highlighted. Having a regular practice that trains the mind to retain this integrative capacity to balance differentiation and linkage is an important resource tool for anyone working on the frontlines of clinical care. Studies reveal [31] that when individuals build the three pillars of focused attention, open awareness, and kind intention, they are able to reduce stress, improve immune function, enhance cardiovascular function, and even reduce bodily inflammation by altering the epigenetic molecules, the non-DNA molecules that sit on top of the genes that regulate the inflammatory response. What one does to train one’s mind in these ways can also optimize the levels of an enzyme called telomerase that repairs and maintains the ends of the chromosomes. And so, with each of these, and especially the latter, molecular mechanisms of well-being, what we do with our mind actually slows the aging process [2]. And, amazingly, three-pillar mind practice has also been shown to enable the structure and function of the brain to become more integrative in the areas we’ve discussed earlier: the corpus callosum that links the differentiated left and right side of the brain, the prefrontal cortex that links the lower areas in the body with the subcortical areas that are often called the brainstem and the limbic areas with the cortex and even with the social world; the hippocampus that grows connections across various differentiated memory systems; and the connectome becomes more interconnected. Yes, an integrated brain corresponds to our experience of well-being. It may not be a surprise then to learn of the important studies on mindfulness training, that include the first two if not all three of these pillars, as a source of preventing burnout in primary care physicians [15]. So why not include this as the basic resource tool for every clinician?

Integrating consciousness

There is a multi-layered practice that includes all three of these pillars in it. It's called the Wheel of Awareness, and it is possible to learn this and dive deeply into its personal and professional applications [25, 27]. This practice “integrates consciousness” by differentiating its basic components and then linking them to one another. The metaphor of a wheel is useful for imagining the knowns of consciousness on the rim and the knowing of being aware in the wheel’s central hub. A singular metaphoric spoke of attention can then, in imagination, be moved from point to point on the rim. In an advanced step, the spoke is bent back to aim attention directly into awareness itself to invite the experience of being aware of awareness, or simply resting in open awareness without an object of attention.

While this is one example of a practice that includes all three pillars—focusing attention, opening awareness, and building kind intention—the Wheel of Awareness is also an experiential immersion in what a receptive state of mind feels like, and is thus a direct invitation for cultivating an open state of mind we can simply call presence. Research across modalities of psychotherapy suggest that the availability of the clinician to be in an open and receptive state, to be empathic with the patient and ask for and respond non-defensively to feedback, is the best predictor of therapeutic outcome [20]. Finding a practice that suits the individual clinician and then weaving that into a consistent state created during the session can become a trait of the individual which can be very empowering [