The Brain in Love Part 4

Androgens/Testosterone Androgens, of which testosterone is the primary one, are s.e.x hormones produced primarily by a male's t.e.s.t.i.c.l.es, but they are also produced in small amounts by the female's ovaries and the adrenal glands. Androgens help trigger the development of the t.e.s.t.i.c.l.es and p.e.n.i.s in the male fetus. They jump-start the process of p.u.b.erty and influence the male secondary s.e.x characteristics, the development of facial, body, and pubic hair; deepening of the voice; and muscle development. After p.u.b.erty, testosterone plays a role in the s.e.x drive. Deficiencies of testosterone may cause a drop in s.e.xual desire, and excessive testosterone may heighten s.e.xual interest in both s.e.xes. In men, too little testosterone may cause difficulty obtaining or maintaining erections. As we age, testosterone levels begin to decrease; as many as five million men suffer from abnormally low testosterone levels (a condition known as hypogonadism).

Unfortunately, most men never seek treatment either because they just think it is a normal part of aging or they are embarra.s.sed to admit that they have a problem. Very often it is the female partner or wife who encourages her husband or boyfriend to seek help. This was the case with William, a fifty-six-year-old male who came to my office on the advice of his wife who had noticed a decrease in his s.e.xual desire and approaches when he was typically a highly s.e.xual partner. He noted that he still liked to cuddle with his wife and loved her dearly, but was rarely having erections upon awakening (a normal event in healthy males) and was not having as many spontaneous erections when feeling aroused. He also described a decreased interest in s.e.x and felt less motivation and interest in other parts of his life as well. Both his blood and saliva tests revealed very low levels of testosterone; prescribing AndroGel (a testosterone gel applied to the shoulders once daily) restored his levels to normal, and his s.e.xual interest and erectile function returned.

In women during their reproductive years, testosterone surges just before ovulation, in the middle of the menstrual cycle, lead many to a higher level of desire when they are most fertile. Some physicians believe that birth control pills may possibly be the cause of a decreased libido in many women because of how they interfere with ovulation to prevent pregnancy through the manipulation of levels of testosterone and estrogen. Low testosterone levels have also been a.s.sociated with Alzheimer's disease and other memory problems, heart disease, and lowered bone density. If you have a low libido and memory problems, it is critical to have your testosterone levels checked.

Estrogens Estrogens are the s.e.x hormones produced primarily by a female's ovaries that stimulate the growth of a girl's s.e.x organs, as well as her b.r.e.a.s.t.s and pubic hair, known as secondary s.e.x characteristics. Estrogens also regulate the functioning of the menstrual cycle. Estrogens are important in maintaining the condition of the v.a.g.i.n.al lining and its elasticity, and in producing v.a.g.i.n.al lubrication. They also help preserve the texture and function of a woman's b.r.e.a.s.t.s. Considering when women with deficient desire are given estrogen and testosterone separately, the increase in desire is not as dramatic as when they are given the two hormones together, estrogen is thought to play a synergistic role with testosterone in increasing l.u.s.tful desire.

In women and men, estrogen is also produced in the brain; though the contribution of estrogen to male s.e.xual behavior has not been completely established yet, researchers are speculating that estrogen may also be very important for s.e.xual appet.i.te in men. An unusually high level, however, may reduce s.e.xual interest, cause erectile difficulties, produce some breast enlargement, and result in the loss of body hair in some men. Unfortunately all of us are being exposed daily to a large amount of "xenestrogens," chemicals in the environment such as pesticides, which look like estrogen and bind to those receptors in the body. Also, inorganic chicken and beef may be injected with multiple hormones including estrogens to plump them up for the slaughterhouse. If you have the choice, it is better to select organic chicken and beef.

Nitric Oxide Nitric oxide is a chemical released by the genitals when you are "turned on" that causes blood vessels to dilate and increases blood flow especially to the p.e.n.i.s. Drugs like v.i.a.g.r.a and Cialis work by stimulating the release of nitric oxide. Though these medications can work very well for some men, results of the studies that have been done thus far on women have not been compelling. Also, because these medications affect blood vessels, caution must be taken in giving them to individuals with blood pressure problems or heart disease.

Pheromones Have you ever noticed how you have been attracted to the way someone of the opposite s.e.x smells while another's scent may completely repel you? Pheromones, scented hormones secreted by sweat glands primarily in the armpits, are thought to attract the opposite s.e.x. In 1991, a research group from Harvard University proved the existence of this "sixth sense," or human vameronasal system. How these hormones work is not clearly understood yet, but they are thought to influence how humans mate, bond, and take care of their offspring. Women in college dorms, or who spend a lot of time together, develop synchronized menstrual cycles and pheromones are thought to be responsible for this phenomenon. In primitive times, scent was one of the first methods of communication, and it is still an important part of how humans relate and who they will want s.e.xually. According to neurologist Alan Hirsch, smell also has a tremendous impact on attraction. "If you smell good, we want you closer; if you smell bad, we want you to go away. When you think about the s.e.xual organ, you really should be speaking of the nose." He goes on to say that we talk about love at first sight, when we really should be speaking of love at first sniff, because there's a direct connection between the olfactory bulb at the top of the nose and the septal nucleus of the brain, the erection center. s.e.xual arousal is also a.s.sociated with engorgement of the erectile tissue in the nose. Dr. Hirsch has treated patients who have smell and taste disorders, and found that almost a quarter of people who lost their sense of smell develop s.e.xual dysfunction. Measuring penile blood flow with what looks like a small blood pressure cuff, he found that s.e.xual arousal in men was enhanced by the smells of lavender and pumpkin pie. Doughnuts, licorice, and cinnamon were also on the top of the list. (I will discuss this topic in more depth in Lesson Nine, which covers aphrodisiacs.) Infatuation Chemicals-

"I Can't Get You Out Of My Head"

(Epinephrine, Norepinephrine, Dopamine,

Serotonin, and Phenylethylamine)

Mother Nature formulated a very powerful concoction when she created the potion of chemicals involved with infatuation. The biology is smart because if it weren't for this forceful surge of chemicals, the inhibitory centers in the brain (primarily the amygdala), which warn us of potential danger or heartache, would prevail and people would never meet, mate, and procreate. Some have described the infatuation stage as an "altered state of consciousness" or akin to being "intoxicated" or "under the influence." People in this phase tend to sacrifice sleep, stay up late for hours talking with their lover on the phone, send abundant e-mails daily, and engage in behaviors that they wouldn't typically do, such as skydiving when they are afraid of heights or eating sushi when the thought of raw fish has always made them gag.

Romantic love and infatuation are not so much of an emotion as they are motivational drives. They are part of the brain's reward system. These feelings intensify to compel lovers to seek mating partners. The brain links these drives to all kinds of specific emotions, depending on how the relationship is going. All the while, our PFC is a.s.sembling information, putting the pieces of data into patterns, coming up with strategies, and monitoring progress toward "life's greatest prize." The chemicals that stimulate the motivation and drive system in the brain are the neurotransmitters epinephrine, norepinephrine, dopamine, serotonin, and phenylethylamine (PEA). These neurotransmitters play a role in the initial phase of attraction as well but it is really in the second phase of infatuation where their release becomes more active and predominant. Neurotransmitters are chemicals that help regulate the electrical signals between nerve cells in the brain. The brain is constantly seeking to keep itself balanced through increasing or decreasing amounts of these substances, some of which excite the body, for example when you see your new love from a distance and your heart starts to pound uncontrollably, and some of which calm the system and allow you to enjoy the moment, "smell the roses," and have the "warm, fuzzy" feelings a.s.sociated with a new relationship.

Epinephrine and Norepinephrine Epinephrine and norepinephrine, produced in the adrenal glands, spinal cord, and brain, are considered excitatory neurotransmitters because they cause that "adrenaline rush" feeling when the heart beats faster, blood pressure goes up, and the body is prepared to take action either in the face of a threat or in the presence of a positive stimuli such as a potential love partner. The feeling of zest and excitement comes from these chemicals as they help to facilitate both s.e.xual arousal and o.r.g.a.s.m. High levels of these chemicals are a.s.sociated with anxiety, and low levels with depression. Chronic stress, low levels of the s.e.x hormones estrogen, testosterone, and progesterone, a sedentary lifestyle, poor diet, and genetics can all lead to low levels of epinephrine and norepinephrine, creating interference with "the laws of attraction." Certain medications, such as stimulants or supplements like the amino acid tyrosine, can help to increase levels of these chemicals in those who have a deficiency. Medications and forms of therapy including hypnosis and biofeedback are also used to decrease these levels when they get too high, such as when individuals refrain from asking someone who they find attractive out on a date because they are afraid they will get overly anxious, their palms and face will get sweaty, or they will fumble over their words.

Dopamine The most important and well-studied neurotransmitter a.s.sociated with infatuation is dopamine. Produced in the central part of the brain, dopamine is a.s.sociated with pleasure, motivation, and concentration. It has been shown to work in the reward centers of the brain. Proper amounts are a.s.sociated with healthy motivation and s.e.xual drive. Individuals feel "s.e.xy" when they have enough of this chemical. A study by Dr. Helen Fisher published in 2002 helps explain the activity of dopamine in the brain when people are falling in love. She and a team of experts recruited forty subjects who had just fallen in love-twenty who stayed in love, the other half who had recently split up. She put each of these people into an MRI tube with a photo of a sweetheart and one of an acquaintance. Each subject looked at the sweetheart photo for thirty seconds, then-after a distraction task-at the acquaintance photo for another thirty seconds. They switched back and forth for twelve minutes. The result was a picture of the brain in love. There was increased activity in the right ventral-tegmental area. This is the part of the brain where dopamine cells project into other areas of the brain, including the basal ganglia, part of the brain's system for reward and motivation. The sweetheart photos, but not the acquaintance photos, caused this to happen. In addition, several parts of the prefrontal cortex that are highly wired in the dopamine pathways were used, while the amygdala in the temporal lobes, a.s.sociated with fear, was temporarily put out of commission.

While high levels of dopamine are a.s.sociated with attraction, low levels are a.s.sociated with certain types of depression, attention-deficit/hyperactivity disorder (ADHD), and excitement-seeking or high-risk-taking behavior. Both cocaine and stimulant medications, such as methylphenidate (Ritalin), have been shown to enhance its production. Bupropion (Wellbutrin) is an antidepressant that enhances dopamine availability to the brain as well as enhances s.e.xual function. Also, certain amino acid supplements like tyrosine can be used to increase dopamine levels and potentially s.e.xual function as well. I have seen both women and men benefit from Wellbutrin and/or amino acid supplementation either when s.e.xual function has been diminished from low levels of dopamine or when substances like SSRI medications have suppressed s.e.xual interest.

Serotonin Serotonin is known as the "feel good" neurotransmitter and is produced in the midbrain and brain stem. Satisfaction with a partner and the positive feelings after an o.r.g.a.s.m are to a large degree controlled by serotonin. Normal serotonin levels help people have healthy moods and motivation. Serotonin is involved with mood regulation and emotional flexibility. Low serotonin levels have been a.s.sociated with depression, anxiety, obsessive-compulsive disorder, impulsivity, and excessive activity in the brain's anterior cingulate gyrus (ACG). Low levels have also been a.s.sociated with new love. Unfortunately, this makes lovers vulnerable to high anxiety levels and moodiness, common in the initial stages of a relationship. When serotonin levels are low and the ACG works too hard, people tend to get stuck on certain thoughts or behaviors. Remember the last time you fell in love. All you could think about was your new love, and no matter how busy you were, you could always find time for her. Your moods were up when you thought about her and then down when she didn't answer her cell phone the first time you called. You felt more reckless and your friends wondered about your judgment. Lowered levels of serotonin make you vulnerable to depression if the relationship ends prematurely.

In my clinical practice, I spend most of my time scanning the brains of people who need help. As part of my research, I scan many healthy people as well. Several years ago, one of my friends was scanned as part of our healthy-brain study. Several months later he fell madly in love. One day he dropped by my office to tell me about his new love. I could hear in his voice that he was so taken with his new woman that I did a repeat scan on him just to see his brain in love. The second scan showed significant increased activity in the anterior cingulate gyrus and basal ganglia, indicating his brain was literally obsessed with the woman; probably a measure of his serotonin levels would have revealed low levels at that time.

High serotonin levels can also be a problem and are a.s.sociated with lowered motivation. Medications that enhance serotonin, such as selective serotonin reuptake inhibitors (SSRIs) like Prozac and Lexapro are notorious for decreasing s.e.xual drive and function in part because recipients of these medications can lose interest if there is too much serotonin circulating in the brain, but also because these medications can decrease sensation in the genital areas, making it harder to achieve o.r.g.a.s.m.

Dopamine and serotonin tend to counterbalance each other in the brain. When dopamine levels are high, such as in new love, people tend to be motivated and driven toward dating behaviors that bring people closer together. Higher levels of dopamine cause lower levels of serotonin, which have been a.s.sociated with obsessive thinking, hence the feeling of falling in love. When serotonin levels are high, people tend to have lowered motivation and an almost "I don't care" att.i.tude.

Phenylethylamine Phenylethylamine (PEA), an adrenalinelike substance, the chemical found in chocolate, speeds up the flow of information between nerve cells and is triggered in the process of attraction to help us pay attention to the love feelings. PEA is known as the "love molecule" because it is what initiates the flood of chemicals into the brain along with norepinephrine and dopamine to create the feelings of euphoria and infatuation when we are highly attracted to someone.

Commitment Chemicals-"I Love You"

(Oxytocin and Vasopressin)

For those of us who have had the wonderful experience of falling in love and being infatuated with someone, we also know that this amazing high and trancelike bliss does not last forever. We either progress into deeper love and commitment or make the decision to break apart and detach. Neuroscientists have determined that after a period of anywhere from six months to two years, the brain downshifts its response and the production of stimulating chemicals and levels of neurotransmitters like PEA start to drop off. It is the body's innate wisdom to turn down the volume because it cannot maintain the l.u.s.t-crazed state forever or people would eventually collapse with exhaustion. Several of my colleagues who do family and couples therapy note that a lot of unnecessary divorces and relationship breakups can occur during this time because people mistake the lack of intensity and euphoria as a sign that they have fallen out of love. Also because individuals may feel a withdrawal from the chemicals of infatuation, they may look for other s.e.x partners, alcohol, or other substances to try to re-create the high. Understanding this phenomenon in advance can really help partners antic.i.p.ate this phase and help them move into the next phase of trust and commitment where true love really begins. Once you find an attractive partner, how does your brain decide if you want to keep him or her? Commitment is usually harder for men than women. Even though our goals are the same (continuity of the species, pleasure, and connection), women are more oriented to raising children. There is not one human society where men are primary caretakers for kids. Men and women are wired differently. Women have a larger limbic or emotional brain. It doesn't mean that men are not essential in childrearing or that they won't help. They just have different roles. Unless women have experienced emotional trauma, they are usually more ready to settle down and start a family. Men are often frightened by the responsibilities involved in raising children and being faithful to one woman, which is easier for men who have lower testosterone levels. An American study of over four thousand men found that husbands with high testosterone levels were 43 percent more likely to get divorced and 38 percent more likely to have extramarital affairs than men with lower levels. They were also 50 percent less likely to get married at all. Men with the least amounts of testosterone were more likely to get married and to stay married, maybe because low testosterone levels make men calmer, less aggressive, less intense, and more cooperative. The desire to commit to someone is strongly linked to two other hormones of emotional bonding, oxytocin and vasopressin.

Oxytocin Oxytocin is released by the pituitary gland and acts on the ovaries and testes to regulate reproduction. Researchers suspect that this hormone is important for forming close social bonds. The levels of this chemical rise when couples watch romantic movies, hug, or hold hands. Prairie voles, when injected with oxytocin, pair much faster than normally. Blocking oxytocin prevents them from bonding in a normal way. This is similar in humans, because couples bond to certain characteristics in each other. This is why you are attracted to the same type of man or woman repeatedly. In general, levels of oxytocin are lower in men, except after an o.r.g.a.s.m, where they are raised more than 500 percent. This may explain why men feel very sleepy after an o.r.g.a.s.m. This is the same hormone released in babies during breast-feeding, which makes them sleepy as well.

Oxytocin is also related to the feelings of closeness and being "in love" when you have regular s.e.x for several reasons. First, the skin is sensitized by oxytocin, encouraging affection and touching behavior. Then, oxytocin levels rise during subsequent touching and eventually even with the antic.i.p.ation of being touched. Oxytocin increases during s.e.xual activity, peaks at o.r.g.a.s.m, and stays elevated for a period of time after intercourse. This may also be why men are more likely to talk and feel emotionally connected after s.e.x. In addition, there is an amnesic effect created by oxytocin during s.e.x and o.r.g.a.s.m that blocks negative memories people have about each other for a period of time. The same amnesic effect occurs from the release of oxytocin during childbirth, while a mother is nursing to help her forget the labor pain, and during long, stressful nights spent with a newborn so that she can bond to her baby with positive feelings and love.

Higher oxytocin levels are also a.s.sociated with an increased feeling of trust. In a landmark study by Michael Kosfeld and colleagues from Switzerland published in the journal Nature, intranasal oxytocin was found to increase trust. Men who inhale a nasal spray spiked with oxytocin give more money to partners in a risky investment game than do men who sniff a spray containing a placebo. This substance fosters the trust needed for friendship, love, families, economic transactions, and political networks. According to the study's authors, "Oxytocin specifically affects an individual's willingness to accept social risks arising through interpersonal interactions." The scientists studied oxytocin's influence on male college students playing an investment game. Each of fifty-eight men was paid $64 to partic.i.p.ate in the experiment. The volunteers were paired up, and one man in each pair was randomly a.s.signed to play the role of an investor and the other to play the role of a trustee. Each partic.i.p.ant received twelve tokens, valued at thirty-two cents each and redeemable at the end of the experiment. The investors decided how many tokens to cede to the trustees. Both partic.i.p.ants, sitting face to face, knew that the experimenters would quadruple that investment. The trustee then determined whether to keep the entire, enhanced pot or give some portion of the proceeds-whatever amount seemed fair-to the investor. Among the investors who had inhaled oxytocin, about half gave all their tokens to the trustees, and most of the rest contributed a majority of their tokens. In contrast, only one-fifth of the investors who had inhaled a placebo spray forked over all their tokens, and another one-third parted with a majority of their tokens. Oxytocin influenced only the investors. Trustees returned comparable amounts of money after inhaling either spray. The trustee responses were generous when the investors offered most of their tokens and were stingy when the investment was small. The influence of oxytocin was limited to social situations. The oxytocin influence is "a remarkable finding," says neuroscientist Antonio Damasio of the University of Iowa College of Medicine in Iowa City in an editorial published with the research report. Damasio had previously argued that the hormone acts somewhat as a love potion. "It adds trust to the mix, for there is no love without trust," he says.

Bonding chemicals can also enhance fertility. Increases in oxytocin have enhanced fertility in some studies in animals. In humans, increased oxytocin levels are a.s.sociated with decreased stress levels and increased trust, both of which are likely to enhance conception.

Vasopressin Other clues to male commitment come from new research on the hormone vasopressin. This chemical is involved in regulating s.e.xual persistence, a.s.sertiveness, dominance, and territorial markings. Not surprisingly, it is found in higher levels in the male brain. Why do some men constantly live with the discomfort of a wandering eye, while others remain content with fidelity? The difference may have to do with vasopressin, which has been found in male voles (little rodents) to make the difference between stay-at-home dads and one-night-stand artists, for example. The voles with a certain brain distribution of vasopressin were monogamous, while others with a different pattern were not.

High levels of oxytocin and vasopressin may interfere with dopamine and norepinephrine pathways, which may explain why attachment grows as mad, pa.s.sionate love fades. The antidote may be doing novel things together to goose the two love neurotransmitters. Elevated testosterone can suppress oxytocin and vasopressin. There is good evidence that men with higher testosterone levels tend to marry less often, be more abusive in their marriage, and divorce more regularly. The reverse can also be true. If a man holds a baby, levels of testosterone go down, perhaps in part because of oxytocin and vasopressin going up.

The trust, bonding, and persistence created by oxytocin and vasopressin are critical for a partnership to succeed. However, the release of these hormones is not enough by itself to keep two people compatible s.e.xually and romantically. It is at this time when it is critical for partners to communicate their desires and needs to each other both in the bedroom and outside of the bedroom, to listen attentively and be mutually supportive of the bond that has formed from attraction to commitment. If you haven't seen it yet, see the movie March of the Penguins for one of the best demonstrations of true commitment.

Detachment Chemicals: Why It Hurts

(Serotonin and Endorphins)

When Shawna and Nick broke up, he was a mess. He couldn't stop thinking about her, hearing her voice in his head, feeling her touch on his body, and smelling her scent in his clothes. After being together for five years, everything reminded him of Shawna, from songs to pictures to movies to waking up and going to bed. She had been wrapped up in most of the thoughts of his day. A part of him was okay with her going away, in fact, even glad. They could never get on the same page in the relationship, and they had broken up several times before. Nick had the sense that she would not always be there for him and that she would go away if things got tough. Yet despite the deep ambivalence in the relationship, he was still a mess when she left. He couldn't sleep, he felt constantly anxious and unbalanced, and he even had panic attacks when the longing for Shawna overwhelmed him.

What happens in the brain when you lose someone you love? Why do we hurt, long, even obsess about the other person? When we love someone, they come to live in the emotional or limbic centers of our brains. He or she actually occupies nerve-cell pathways and physically lives in the neurons and synapses of the brain. When we lose someone, either through death, divorce, moves, or breakups, our brain starts to get confused and disoriented. Since the person lives in the neuronal connections, we expect to see her, hear her, feel her, and touch her. When we cannot hold her or talk to her as we usually do, the brain centers where she lives becomes inflamed looking for her. Overactivity in the limbic brain has been a.s.sociated with depression and low serotonin levels, which is why we have trouble sleeping, feel obsessed, lose our appet.i.tes, want to isolate ourselves, and lose the joy we have about life. A deficit in endorphins, which modulate pain and pleasure pathways in the brain, also occurs, which may be responsible for the physical pain we feel during a breakup.

Getting a Loved One out of Your Head and the Fishhooks out of Your Heart In Dean Koontz's novel Velocity, the killer uses fishhooks to torture Billy Wilens, a good-natured bartender who finds himself in a random storm of murder and mayhem. The killer, a twisted psychopathic performer, renders Billy unconscious and plants three fishhooks deep in his forehead. The fishhooks were extremely painful to extricate, requiring alcohol and painkillers, and they left deep scars.

When a loved one leaves us, or even when we are the ones who instigate a breakup, many of us feel like Billy Wilens. We have deep wounds, like fishhooks, that leave lasting scars. Many of us use alcohol or any sort of painkillers (such as drugs, s.e.x, or excessive work) to medicate the pain. I have firsthand knowledge of what it takes to survive the painful loss of a love. I have left relationships and I have been left. Being left is definitely harder.

On one occasion after being left, it felt as though I had many fishhooks in my mind and my heart that were painfully pulled whenever I remembered any good thing my lost lover had done for or with me. Pictures, songs, friends, cars, names (she had a common name), cities, pillows, and restaurants all reminded me of her. I was a neurochemical mess for nearly six months. I even scanned myself in the middle of the process to see what grief looked like in my brain. It showed excessive anterior cingulate gyrus activity (not normal for me), which was partially why I felt so sad and obsessed.

From my own experience and work with patients who have lost loved ones, here are five tips to survive and eventually thrive through the loss of a love.

1. Above all, stay healthy. At first, we just want to medicate the pain. We eat or drink too much, stop exercising, wallow, and isolate ourselves. Stop that behavior immediately. Watch what you eat, exercise more, not less (exercise has been found to be as effective as the antidepressant Zoloft for depression), and spend time with your friends. Make sure you get enough sleep. During my breakup, sleep was very hard for me. The supplement kava kava was helpful on a short-term basis.

2. Do not idealize the other person. Whenever we just focus on someone's good qualities, the pain increases; when we focus on his or her bad qualities, the pain decreases as we are glad to be rid of them. Spend time to write out the bad times and your ex's bad points. Whenever we lose someone we love, there is a tendency to exclusively remember the wonderful things about her. Idealizing people impairs the grieving process and makes us hurt more. Be balanced. You do not have to vilify them, but be honest about their bad qualities and focus on them to help soothe the pain. One helpful technique I found during the loss of a painful love was to make up a mnemonic that helped me remember her bad qualities. That way, when the fishhook memories pulled painfully at my heart, I could immediately remember, and silently repeat to my self, why I was glad she was gone. For example, if her name was Hanna, you could use the letters of her name to label the bad or irritating qualities: Hanna could stand for ...

Hairy lip Argumentative Never able to say she was sorry No memorable s.e.x Ambivalent about our relationship You may need these memory skills in the midst of grief to remember why you are happy someone is gone.

3. Cry, then hide the pictures. In the beginning of the breakup, take some time to allow yourself to feel the pain. Crying can be a wonderful release of the built-up tension in your limbic brain. But after a good cry, eliminate the constant triggers to your nervous system. Go through the house, your computer, and workplace and collect the pictures and gifts, then hide them somewhere. Hide them initially, rather than burning them, because you never know what will happen in the future. If you get back together, you will feel terrible about having burnt them. Time will tell. A few months down the line you will make better decisions about whether or not you want to keep some of the things that represent your relationship. But, in the short term, get them out of sight.

4. Love must be tough. When you act weak, needy, or demanding during a breakup, you literally push the other person away. You are no longer attractive or appealing. You seem and act as a victim. Being well is not only the best revenge; it is the best way to be well.

5. Do "The Work." Byron Katie has written a wonderful, wise book t.i.tled Loving What Is. In the book, written with her husband, Stephen Mitch.e.l.l, she discusses the power of asking yourself four questions and doing a turnaround. During my breakup it was the single most helpful technique to get my usually happy, healthy self back. I learned that I suffer whenever I do not accept what is. When I fight against reality, I am out of my mind. Katie teaches you to understand the thoughts that cause the suffering, such as "I miss her," and ask four questions and a turnaround.

Question #1: Is it true? You bet. I miss her terribly.

Question #2: Is it absolutely true? Not absolutely. I do not miss our ambivalence, her resentment, and her disappointment.

Question #3: How do you feel when you have the thought "I miss her"? Miserable, remorseful, stupid, ashamed-which means my thoughts were what was torturing me, not her.

Question #4: Who would I be without the thought "I miss her"? I would be my usual happy self.

Katie says to then turn the thought around-I miss her becomes "I miss me." I miss my normal, happy, sound-sleeping, wake-up-singing, healthy, driven, successful self.

These four questions and the turnaround can literally change your life. I have seen it work for many of my patients as well.

Lesson #3: The dance of relationships is both chemically and environmentally driven. Understanding the ingredients of the dance can help you be more effective both when the music starts and stops.

RULES FOR HIM, RULES FOR HER.

Navigating Gender Differences in the Brain "The genetic differences between the s.e.xes are hundreds of times more significant than the differences between the races. You can't look at an fMRI of someone and say, 'That's an African-American brain, or a Caucasian brain.' But you can differentiate between a male and female brain."

-STEVEN B. JOHNSON When Nicole threatened to leave Christopher, she said that their communication was like "a square peg in a round hole." They came to see me on the advice of a friend. Christopher was completely confused during their first session. He had no idea what she meant. Nicole said that she was tired of him not listening to her, always wanting to fix her, and not being present for her when she needed him. Bewildered, Chris argued that he loved her, spent hours listening to her, and just wanted to be helpful to her. I watched in pain as this couple played out a common gender war. I had once been victim of the same drama myself. When the love relationship I discussed in the last chapter ended, the woman used the same phrase as Nicole, "square peg in a round hole." Hearing it again, I felt a sharp pain sting my heart.

Male-female communication styles are radically different, brain-based, and hardwired. Many people think these differences are culturally defined, yet they appear very stable across almost all cultures studied and have their roots in the brain. Men and women evolved different brains over millions of years, because of necessity. Men chased down food for their families and provided protection. Women cared for the young and old, and provided a nurturing environment. Because of these different roles, the s.e.xes evolved to process information differently, think in radically different ways, expect different things, and have different perceptions, beliefs, and behaviors. In the last forty years, as the gender roles in our society have been blurred, both males and females have become more and more confused as to what is normal behavior. We expect our partners to be able to read our minds and think as we think. Unfortunately, we are just not wired that way.

Knowing about the differences between men and women will help you be more effective in interacting with the opposite s.e.x and help you navigate relationships without feeling hurt or rejected. In this chapter I will look at how male and female brains develop, the differences between the left and right hemispheres (which gives us clues to male-female differences), the differences in language and intuition, and the answers to commonly asked questions. I will also give males and females eight rules each for effectively dealing with each other's brains.

Different from Conception The moment of conception determines gender. Males get an X chromosome from the mother and a Y chromosome from the father (XY), while females get X chromosomes from both Mom and Dad (XX). Inheriting a Y chromosome triggers two bursts of hormones, mostly testosterone, that change the brain and body. The first burst early in the womb differentiates the boy's brain from the girl's. From early in infancy, girl brains are more interested in smiling, communicating, people, and security; while boy brains are more interested in objects, actions, and compet.i.tion. With higher levels of testosterone, the male areas of the brain are more developed, including the parietal lobes responsible for sense of direction, visualizing objects in three dimensions (good for catching a football), and mathematics. Without testosterone, the language centers of the brain are more developed, which is why girls like to talk and boys like to play catch. In addition, testosterone beefs up the area of the brain that is interested in s.e.x. This area is twice as large in men as women. He really is more interested in s.e.x.

The second burst of testosterone during p.u.b.erty starts to turn a boy into a man. He now has twenty times the level of testosterone as most girls, his t.e.s.t.i.c.l.es descend, his voice deepens, his body becomes hairier, he has more well defined muscles, and he begins to grow like a beanstalk. His mind becomes highly focused on girls.

Since the female brain is exposed to little testosterone, her s.e.xual development is very different. Her brain sends a message to the ovaries that it is time for the body to change. The ovaries begin to make much higher levels of estrogen and other hormones that cause the body to change in shape and size. They get the body ready for reproduction. Her b.r.e.a.s.t.s begin to grow, the nipples get larger and darker, curves begin to form as fat is deposited in the b.r.e.a.s.t.s and hips, and hip bones widen, which makes the waist look smaller. Her moods may begin to shift, she becomes much more interested in her appearance, and boys become the primary topic of discussion.

Two Minds in One Brain: Left Versus Right The brain is divided into two sides or hemispheres, left and right, connected by three nerve fiber bundles. The largest nerve bundle is called the corpus collosum. Each hemisphere specializes in certain functions (although there is considerable overlap). We call one hemisphere dominant, usually the left side, because it is responsible for handedness and language, and the other side non-dominant, usually the right side, because it houses other functions that are not as obvious. The left hemisphere is dominant in almost all right-handed people and about half of left-handed people. For this discussion I'll refer to the left hemisphere as the dominant hemisphere and the right hemisphere as the nondominant.

The left hemisphere has received bad press through the years-being thought of as the uptight, materialistic, controlling, unfeeling, and unemotional side of the brain. In fact, the left hemisphere is likely responsible for human success. It is a.n.a.lytical, logical, precise, detail oriented, and capable of conceiving and executing plans. The left hemisphere has more gray matter, which means a greater density of nerve-cell bodies. The left hemisphere is communicative and time sensitive, breaks down complicated patterns into component parts, and is heavily involved with planning. It is the happy, cheerful, more optimistic side of the brain. When there is good activity in the left-frontal lobe, people tend to be joyful and approach their lives with a positive zest for life. When the left hemisphere is hurt, people are often depressed, negative, and irritable. Sixty percent of people who have a left-frontal lobe stroke will develop a major depression within a year. A consistent brain-imaging finding in major depression is low activity in the left-front side of the brain.

The right hemisphere sees the big picture, or gestalt of situations. It allows us to see the forest, while the left hemisphere is responsible for the trees. The right hemisphere tends to be dreamier and more artistic. It helps us recognize familiar faces and is responsible for hunches and intuition. It also sees patterns at a glance. The right hemisphere has more white matter. Its neurons are connected from farther distances, which help it to draw on several different brain regions at a time. This allows the right hemisphere to come up with broad, multifaceted but vague concepts. The right side of the brain also allows people to know when problems are present and when they should be taken seriously. Unlike the left side, when the right hemisphere is hurt, people are often unduly happy, jocular, and in denial of any problems. People with right-sided strokes may develop "anosagnosia," failure to recognize disabling conditions. In the face of adversity, people with right-hemisphere damage may appear unconcerned or even optimistic. The right hemisphere tends to be more negative, fearful, anxious, mournful, and pessimistic. In looking at the differences between the left and right hemispheres, it is as though there are two individuals in one skull.

There are several practical applications of left-versus-right-hemisphere research, such as where to stand in a conversation, or what side of your partner's neck to kiss during lovemaking. Due to how our brain processes information, if you stand to someone's right side, you are processed more prominently in the left side of his brain, the happier side of the brain. If you stand to someone's left, you are processed more in the right side of his brain, the more anxious and negative side of the brain. Some research indicates that salespeople do significantly better when standing to someone's right. When you ask someone to marry you, interview for a job, try to make a sale, or preach from the pulpit, stand to the audience's right side, so that you are processed more in the happier left side of the brain; you may have a better chance of getting what you want. In a similar way, if you kiss someone on the right side of the body, she likely processes the kiss more intensely on the left side of her brain, the happier side of the brain, and she is more likely to want you to continue. If you kiss her on the left side of the neck, she processes the kiss more intensely on the right side and may feel more bugged or irritated by the kiss. Pay attention to the reactions of others, depending on where you stand and how you touch them. It may help.

Gender Brain Differences Several of the gender differences in the brain correlate with the left-right hemisphere differences. It has been reported that men have more total brain cell numbers, even when corrected for their increased total body weight. It has been estimated that men have 4 percent more neurons than women do. When I state this fact in lectures, many women groan and complain. I then tell them about a time when I was on the Carolyn Davidson radio show in Dallas, when she asked me, "Tell me Dr. Amen, why do men need one hundred grams more brain tissue to get the same things done as women?" It has been estimated that women have a greater number of cellular connections than men.

The corpus collosum, a large fiber band that connects the hemispheres, has been found in some studies to be larger in women, allowing greater access to both sides of the brain. Men tend to be more left sided in their approach to life, while women tend to use both sides more often then men. This is very important in helping us understand the differences between men and women. In language, men tend to be totally left sided, more detail oriented, and more directly to the point. Women, more often than not, use both sides, and tend to be more fluent, which may be why they have more to say. When husbands and wives get into arguments, their brain hemisphere activation styles often make problems worse. Because women use more words, men often become overwhelmed in disagreements and say insensitive things like "What's the point?" or "Specifically, what do you want?" These statements infuriate women and make communication even more of a struggle. They know the point, they just have more to say about it with the extra input from the right side.

The female hormone estrogen encourages brain cells to develop more connections within the brain and between the two hemispheres. Because of these extra connections, women are better at mult.i.tasking. They can talk on the phone while watching TV, cooking dinner, and checking their e-mail. Men, on the other hand, are more compartmentalized and do best when they do only one thing at time. When a man stops his car to read a map, he asks everyone else to be quiet and turns down the radio. This allows him to focus. His wife usually doesn't understand, as her brain can do, and actually enjoys doing, many things at a time.

Left-sided strokes, which affect the language area, tend to affect men more than women because many women have language on both sides of the brain. In one brain-imaging study, when asked to judge whether nonsense words rhymed, men used only the left side of the brain, where more than half of the women used both sides. In another study done at the University of Indiana, when listening to a novel being read, men used the left side of the brain, where women typically used both sides.

The limbic system, or emotional brain, tends to be larger in women. The limbic system is the emotional bonding center of the brain. Therefore, it is no accident that women in overwhelming numbers are the primary caretakers for children. Likewise, women are primary caretakers for the elderly; 70 percent of elderly people who need care get it from a woman. The larger limbic size makes bonding easier for women. Women tend to have more friends in life, they go to church more often than men, and they pray (bonding with G.o.d) more than men. Women have a larger nesting instinct than men. They have a greater biological need to have their houses in order. When a couple moves, it is generally the woman who feels unsettled until everything is put away. Women are usually primary caretakers for the home and take on the bulk of housework. With the larger limbic size comes a greater incidence of depression. After p.u.b.erty, females are three times more likely to develop depression than males. Women attempt to kill themselves three times more often than men. Yet men, due to lack of bonding and use of more violent means, kill themselves three times more often than women.

In another brain study, the inferior parietal lobe was found to be larger in men, especially on the left side. This part of the brain estimates time, judges speed, visualizes objects in 3-D (such as catching a football thrown toward you), and solves math problems. Our direction sense is influenced by this part of the brain. Men are usually better at directions. Women, because of their greater access to the right hemisphere, are better at knowing when they are lost. Women are also better at knowing when problems are present. Psychiatrists see three times the number of women as men. Not because women have more problems, but because women are more aware that a problem exists and more willing to seek help. Women, more often than men, call marital therapists for help with a troubled marriage, and they bring their children to the child psychiatrist much more than fathers do. Seventy-five percent of the time, divorces are filed by women.

Recent research has shown that men may have a tendency to be more unrealistically optimistic. Unrealistic optimism is the belief that good things are more likely to happen to them than other people. If this way of thinking dominates a person's thoughts about life, it can have both positive and negative consequences. On the positive side, it is a.s.sociated with better mental health as people are more hopeful and optimistic even in the most difficult times. However, this can prevent people from taking preventive measures for a negative outcome.

Sensory Skills Women are better at reading facial expressions and noticing the feelings of others. Like most mammals, they are equipped with more sensitive sensory equipment. In a study by Barbara and Allan Pease, authors of Why Men Don't Listen and Women Can't Read Maps, they found that women were dramatically better at reading emotions than men. At a maternity hospital they collected a selection of ten-second clips of crying babies and asked the mothers to watch the clips with the sound turned down. This way the mother only had the visual information. Most mothers could quickly identify a range of emotions from hunger and pain to gas and tiredness. When the fathers took the same test, their performance was awful, less than 10 percent of fathers recognizing more than two emotions. Grandmothers also faired much better than the fathers, while grandfathers often did not recognize their own grandchildren. On the other hand men have shown greater blood pressure reactivity to s.e.xually arousing pictures than did women.

Women also have better peripheral vision than men, which is why they catch their guys looking at attractive women, but hardly ever get caught when they look at hot guys. As hunters, guys have better long-distance tunnel vision. Men are also more adept at driving at night.

From birth, girls are dramatically more sensitive to touch, and as an adult, a woman's skin is at least ten times more sensitive than a man's. Women like and need to be touched more than men. In one study, a woman is four to six times more likely to touch another woman in a social situation than a man would another man. A woman's senses of taste and smell are also more sensitive than a man's. Men score higher on salty and bitter tastes, while women score higher on sweet and sugary tastes, which explains why there are more female chocoholics. Not only is a woman's sense of smell better than the average male, during times of ovulation she is better at picking up male pheromones that cannot be detected consciously. The superior sensory equipment of women allows them to pick up body language, thus dishonesty, much more than men.

She Is Thinking, Thinking, Thinking Neuropsychologist Ruben Gur of the University of Pennsylvania used brain scans to show that when a man's brain is in a resting state, at least 70 percent of his brain is shut down. On the other hand, when women were resting, at least 90 percent of their brain was active, confirming that women are always thinking, thinking, thinking. The man wants the remote control and a little peace and quiet; she wants to talk.

In another study, when asked to think of nothing, men's brains were more active in the more primitive physical activity centers of the brain (cerebellum), women's brain were more active in the emotional and bonding centers of the brain (limbic system). Left to themselves, men will think about s.e.x, their golf swing, or their jump shot; women will think about their spouse, children, or parents. One common complaint from women is that they do not feel connected to their partners. Men would do well to initiate conversations about children and parents.

As part of a national talk show on the differences between male and female brains that I did with gender expert Michael Gurian, author of the wonderfully insightful book What Could He Be Thinking?, I performed brain scans on Jennifer and Brad. They had the typical couple complaints. She wanted more time, talking, and attention. She wanted Brad to help around the house and be more present with the children. He wanted more peace, quiet, and s.e.x. He wanted to be left alone for a half hour when he got home from work. Their struggles were clearly affecting their marriage. The brain scans showed clear differences. Jennifer's scan, as Ruben Gur's research would suggest, showed much higher levels of activity. Brad's scan had significantly lower levels of activity. Jennifer's worries and overthinking in the relationship were a product of a much more active brain, while Brad's need for rest came from his sleepy brain. A great couple activity to help balance both these states is physical exercise. For men, exercise wakes up the brain, while for women exercise enhances brain serotonin levels and calms the overactivity.

s.e.x Is Like Shooting Free Throws When I counsel couples, I often say that s.e.x is like shooting free throws, hitting a golf ball, learning how to throw a football or a curveball, or hitting a winning tennis serve. Men like sports a.n.a.logies; women want their mates to pay attention. When boys learn to shoot free throws, or become skilled in any other sport, they practice over and over and over again. They repeatedly work on their technique. They spend hours at the free-throw line, figuring out what to do to improve their stats. Successful athletes have great coaches and they listen to them. They spend years perfecting their techniques and are not crushed by failure; rather they use it as an opportunity to learn. They film their performances to see how they can improve on technique and outcome.

For optimal satisfaction in the bedroom, women would do best to act like a good coach, recognizing that it may take your man some time to perfect his technique. Like a good coach, offer encouragement, praise, and advice. Meet him for practice on a regular basis and make it a fun experience that both of you want to revisit again and again.

Unfortunately, many women have trouble asking for what they want s.e.xually. They may tell their man once or twice, often hesitantly, but then never again bring up their wants and desires. Many women I have counseled believe that if a man doesn't get it right the first time around, he probably doesn't really love, care, or want to please her. Training your lover to please you s.e.xually is an important goal for your overall health. This is especially true for women, as their longevity is a.s.sociated with pleasure, not frequency. Men are often slow to pick up the needs of their partner. They do not have the same access to reading social cues as women, so need more direct communication. Men are not born knowing how to please their partners; they need to be taught, over and over, like shooting free throws. They need good coaches who help them with technique and form. And you need to be satisfied; your life may depend on it.

The same principle applies to men. Ask what pleases your partner, listen, and practice. Tell her what you like, encourage her to talk about what she likes. Talk about what you do together that makes you think about her during the day when you are apart.