In Leslie Sabbagh's revealing article on brain development in adolescents, “The Teen Brain, Hard at Work,” psychologist Robert Epstein's passionate objection to data suggesting differences in teenage and adult brains seems puzzling and misplaced. I have worked for the past 15 years with children who come from immigrant homes with tightly knit family units, where social interaction is closely monitored and limited, as well as with children from more open-ended family structures, where preteens and teens are allowed greater autonomy in regard to peer relations.

The stress that both groups of students experience in highly pressurized academic environments appears to be the same. Research such as that featured in the article suggests that it is vital to “de-stress” learning environments for all school-age children while they are developing greater “endogenous control.” Educators might also be more empathetic toward students if they knew that their students' brain capacities are still in significant transition.

Jason Ablin
Director of Studies
Milken Community High School
Los Angeles

The teen brain article stated that MRIs showed a distinct difference between teen brains and adult brains. Yet a critic mentioned that teens in certain other societies act differently from American teens and that environment can change the brain. It would be interesting to do a study that compares MRIs of teens in different societies with American teens.

Cynthia Creary
Lewiston, Mich.


Katrina Firlik's “Should We Operate?” was an eye-opener. As a fourth-year medical student aspiring to become a surgeon, I found Firlik to be a true inspiration. Thank you, Katrina Firlik, for showing us that neurosurgery is not just about dealing with the brain but also about dealing with the minds of terrified patients—and for showing us that a career in neurosurgery is possible, even for students like me who are women.

Kavita Gundur

As a surgeon who has counseled cancer patients for 30 years and who, like Firlik, has also trained and worked at Yale University, I appreciated her comments. We doctors are informed but not educated during our training because we are trained to treat disease and not the patient's experience. We are tourists, whereas patients are the natives, each living a unique experience even when their diagnosis is the same.

My life changed when a patient told me, “I feel better when I am in the office with you, but I can't take you home with me. So I need to know how to live between office visits.” That's when I began support groups and the patients trained me. I learned a great deal from being a patient, too. Spending time in a hospital bed should be a part of medical training.

The easiest way to find a good doctor is to ask him or her if he or she has ever been criticized by patients, nurses or family members. If the answer is yes, you have a good doctor. A good M.D. is one who is learning from the natives and his or her own mistakes and who is capable of apologizing and not acting like a Medical Deity who is never truly “wrong.” No one wastes time criticizing or providing feedback to someone who always has an excuse and is never at fault. For me, “M.D.” also stood for “My Disease,” and thinking about it that way has taught me a great deal.

Last, but not least, I use drawings by my patients and doctors to see what the experience of the operating room or the practice of medicine means to them. Patients will draw the operating room as heaven or hell, depending on how they feel about the experience—and it alters their recovery.

Bernie Siegel
Woodbridge, Conn.


In “Feeling Faint,” Rolf R. Diehl suggests that fainting at the mere sight of blood may result from the caudal midline medulla's attempt to invoke the vasovagal mechanism, after stimulation from a signal originating in the limbic system. I'd like to suggest an alternative explanation based on neuronal mirroring. Perhaps on seeing blood on another individual, the subject's so-called mirror neurons fire to activate the relevant motor neurons, which in turn stimulate the medulla's action.

Stephane Joseph Savanah
via e-mail


Regarding “Rise of the Modern Mind,” by Cameron McPherson Smith: I have an unanswered question underlying both Merlin W. Donald's theory of evolving levels of cognition and new states of consciousness and Steven Mithen's theory of increasing fluidity and cross-referencing between the linguistic, social, technical and natural-history modules of intelligence. Why was the need to connect with and help others by communicating and sharing personal observations so strong in our earliest ancestors? In chimps, this need does not extend to adults who are non-kin, and it ends when their offspring reach independent adulthood. Lacking an explanation for the development in our evolutionary past of this seminal need, cognitive anthropology fails to lay the foundation for the uniquely human emotional dimension of our complexly interwoven neurological mind/body processes, leaving a gaping hole in our self-understanding.

Marilyn Kramer
Wausau, Wis.


I write about an error in the article “Picture This,” by Thomas Grueter [February/March 2006]. It described my work as follows: “Many people, however, see mental imagery better with their eyes open than when they are shut. This was the finding of psychologist Stuart J. McKelvie of Bishop's University in Quebec, when he subjected the results of a large number of experiments on image representation to a meta-analysis.”

In my review of the research literature on vividness of visual imagery (Vividness of Visual Imagery: Measurement, Nature, Function and Dynamics, Brandon House, 1995), I did note (page 20) that imagery may be less vivid with eyes open than closed because visual perceptual input may interfere with visual imagery; however, my combination of the results of five comparisons from four studies showed that the overall mean difference in imagery vividness under these two conditions was not significantly different.

This conclusion was reinforced by the results of another study (page 210), in which 20 out of 26 groups showed no difference in the two conditions. So it is certainly not the case that I found that mental imagery is generally better with eyes open than shut.

Stuart J. McKelvie
Bishop's University
Sherbrooke, Quebec

ERRATA On page 1 the credit should have read “COVER IMAGE BY KENN BROWN.”

On page 50 the credit for the illustration should have read “SIGANIM Gehirn & Geist.