This is where we find the 'output' of the brain: decisions, behaviour and the historical sense of one's self. It is the sum total of all our neurological and psychological traits that at any given moment make up who a person has become. It is the space occupied by the life-narrative that individuals tell themselves - and their care-givers.
It is also where modern psychiatry has spent most of its time, for it is where we confront early traumas, lowered self-esteem, fantasies, phobias, behavioural troubles, broken marriages, character disorders, and personality. A patient's quest for accurate self-knowledge begins in the fourth theatre. The obvious problem, of course, is that a life of long-compromising influences flowing in from upstream alters one's own self-observation, self-esteem, sense of self and memory.
Problems in the fourth theatre are the ones most readily apparent to ourselves and to others, so not only are they the ones most likely to motivate people to seek treatment, they are often the sole focus of investigation and treatment. Many clinicians never look at or through other theatres of the brain. Personality is not a cause of problems; it is rather the expression of good and bad influences from the other theatres.
When a patient asks "what is wrong with me?" it is essential that the clinician suspend the desire to seize upon a diagnosis based on behaviour. The patient wants to be rid of the behaviour or the feeling state of the disease. It is painful. The clinician wants to help relieve the pain. So both get locked onto fixing the behaviour and feelings, and become trapped in a region of vague speculation, while the river of upstream influences keeps flooding in, unexamined and unaltered.
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