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How to Improve Motivation & Overcome Procrastination | Dr. Masud Husain

Andrew Huberman · 25,500 words · 116 min read

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Masud Husain

0:00Almost every drug of addiction, whether

0:02we go from nicotine to alcohol to heroin

0:05to cocaine to amphetamine, almost every

0:08drug of addiction hijacks that dopamine

0:11system we were talking about. We find

0:13when that circuitry is not working that

0:15you can get profound loss of motivation,

0:18apathy. When that circuitry is on

0:21overdrive because it's been hijacked by

0:23these drugs, you get states of hyper

0:25motivation. So, of course, this is going

0:28to be overly simplistic to think

0:30dopamine levels are the only factor that

0:35affect our motivation, but it certainly

0:38turns out to be a very important factor

0:40in graduating the level of motivation we

0:43have to seek particular outcomes.

0:46>> Welcome to the Huberman Lab podcast,

0:48where we discuss [music] science and

0:50science-based tools for everyday life.

0:54>> [music]

0:55>> I'm Andrew Huberman and I'm a professor

0:57of neurobiology and opthalmology at

1:00Stanford School of Medicine. My guest

1:02today is Dr. Massud Hussein who is a

1:04neurologist and neuroscientist at Oxford

1:06making key discoveries about the

1:08relationship between motivation and

1:09pleasure. Today we discuss what really

1:11determines our level of drive and

1:13determination to do everything from

1:16getting up to go to school or work to

1:18pursuing long hard challenges that last

1:20many years. We start off by talking

1:22about the opposite of motivation, which

1:24of course is apathy. And as you'll

1:26learn, perhaps surprisingly, apathy is

1:29separate from one's desire for

1:31something. We also discuss something

1:32very useful, which is how you can change

1:34your own perception of your own effort

1:36level. Today's discussion really gets to

1:39the heart of motivation and

1:40procrastination and how anyone, healthy

1:43or otherwise, can leverage that

1:44understanding to their benefit. As

1:46you'll soon hear, Dr. from Massud

1:48Hussein is a remarkable scientist,

1:50neurologist, and communicator. Indeed,

1:52he's the author of a spectacular book.

1:54I've read it. It's entitled Our Brain,

1:56Ourselves, and it's a terrific read if

1:58you want to learn more about how your

2:00brain works, how it can change over

2:02time, and how it makes you who you are.

2:04Before we begin, I'd like to emphasize

2:06that this podcast is separate from my

2:08teaching and research roles at Stanford.

2:10It is, however, part of my desire and

2:11effort to bring zero cost to consumer

2:13information about science and science

2:15related tools to the general public. In

2:17keeping with that theme, today's episode

2:19does include sponsors. And now for my

2:21discussion with Dr. Massud Hussein.

Apathy, Motivation

2:24>> Dr. Massud Hussein, welcome. Thank you

2:26for having me. You've worked on a huge

2:30variety of topics. Alzheimer's,

2:32attention, apathy. We're definitely

2:35going to talk about apathy. Spatial

2:37neglect, which I'm guessing most of our

2:40audience probably doesn't know exactly

2:42what that is. I'd like to start with the

2:44one that sounds like a bit of a downer,

2:46but as a window into understanding

2:49motivation and these states of

2:51excitement that most of us would like to

2:53be in, but let's talk about and really

2:55define through your lens what is apathy?

2:59How does the brain bring about this

3:01thing that we call apathy? And is apathy

3:03just a lack of motivation? Yeah, I mean

3:06these are big questions and I think the

3:08way we've approached them is somewhat

3:11serendipitous in the sense that you

3:13[snorts] know 15 years ago I wasn't

3:15studying apathy or motivation like many

3:18people I might think someone's lazy or

3:21they're highly motivated but that's a

3:23sort of psychological state it's a

3:24personality and it was only about 15

3:26years ago I started beginning to be

3:28aware that there may be a an important

3:31biology underlying motivation and when

3:34that biology goes wrong, it can lead to

3:38loss of motivation and even pathological

3:40apathy. And the way this happened was

3:43completely out of the blue. Uh I was

3:45then working in London at the National

3:47Hospital for Neurology in Queens Square

3:50at UCL. And we received a letter from a

3:54doctor describing a guy in his 30s. And

3:58this guy had been a highly productive

4:00person. He was in finance. He was also

4:03really liked socially, had a wide

4:05network of friends. But suddenly he had

4:08become completely different from being

4:11highly motivated. He went to I'm not

4:14interested. I can't be bothered. And

4:16that was both at work as well as with

4:19his friends. So people began to think

4:21this is something really different in

4:23this guy David. What's happening? They

4:26wondered if he had become depressed.

4:29That's why he wasn't really functioning.

4:31and he went to see his doctor who

4:32started him on an anti-depressant but it

4:34made no difference. He was still the

4:37same. So he lost his job. He got fired

4:40because he had lost motivation and he

4:44was so apathetic that he couldn't be

4:47bothered to get social security benefit.

4:49So his friends said, "Okay, come and

4:50stay with us." And they regretted it

4:53almost immediately because David did

4:56nothing. He just sat there in a chair

4:59all day long waiting for his friends to

5:02come back, do the cooking, clean. They

5:06needed to prompt him to have a shower

5:08because he literally just sat there. His

5:11level of motivation was almost zero.

5:14When we got to see him, and it was

5:15difficult because he'd never come to his

5:17appointments. We I had to phone him up

5:19to say, "Look, I am going to be here

5:21tomorrow.

5:23Please come." and he grudgingly said,

5:26"Okay, I'll I'll try and make it." And

5:28he was, of course, late. Um, he came and

5:31there was this very sad guy. He, you

5:34know, he was disheveled, really not

5:36looking after himself, stains on his

5:39shirt. But the one thing he wasn't was

5:41unhappy. He was absolutely happy about

5:44life, right? Which was the perplexing

5:46thing. He'd lost his job. He'd lost his

5:49apartment because he wasn't paying the

5:50rent. Couldn't be bothered to get social

5:52security. But there he was really happy

5:55about what was happening in life,

5:56looking forward to something that he

5:59didn't know what, but he was still

6:01looking forward to good things in life.

6:02So when I asked him, why aren't you

6:04doing anything when you're at home? What

6:06would you what would you normally do? I

6:09would listen to some music. So why

6:11aren't you listening to music? Because

6:13it would take me some time to put my

6:15music system together. How long would it

6:17take? 5 minutes. So this was really sort

6:21of revelatory for me. The effort of

6:23putting the cables together for his

6:26music system. Taking out the

6:27loudspeakers was too much in terms of

6:31the pleasure he could obtain from

6:34listening to music. It turned out that

6:36David had a very unusual neurological

6:40problem. His MRI brain scans revealed

6:42that he had two tiny little strokes in

6:44the basil ganglia. These are deep nuclei

6:46in the brain which are evolutionally

6:48wellconserved. They go back to the

6:51earliest vertebrate that we still have

6:53the lampay 360 million years old. And

6:56the key thing that we've discovered from

6:57the neurohysiology of the lampay is the

7:00basil ganglia are important in linking

7:03motivation signals to action. Some

7:06people call it motivation to act. So in

7:08an organism like the lamprey, motivation

7:11signals might be hunger or sex that lead

7:14to action to fulfill those goals. In

7:18David, these strokes in the vententral

7:22stratum, what what's called the nucleus

7:24encumbent in in animals led to no

7:27motivation signals leading to action.

7:30Nothing happened. But if you prompted

7:32him, go take a shower, come on, he would

7:34do it. But of his own valition, he

7:38wasn't motivated to act. And that was

7:41really something that was extraordinary

7:43for us because here was a man who had

7:46been highly motivated and that

7:48motivation had been extinguished by

7:49these two tiny little strokes which

7:51didn't affect him physically but

7:54affected his behavior. And the studies

7:57that we performed with David to try and

7:59understand this led us to the concept

8:01that we might be able to deconstruct

8:03this nebulous thing called motivation.

8:06>> May I ask a question? It's fascinating.

Rewards, Apathy & Motivation; Dopamine

8:09Um, and I'm sure everyone including

8:11myself is also wondering what became of

8:13David. But before you tell us, was it

8:15the case that he would feel overwhelmed?

8:17Like I want to listen to music, but that

8:20five minutes feels like a huge effort.

8:23That's a long effort. Or was it the case

8:25that he didn't really want it either?

8:28Because the way you've described these

8:29lesions is a is a severing of the

8:32wanting from the engagement in the

8:34process to have. Yeah.

8:35>> But of course, as you and I know, neural

8:37circuits are never that simple.

8:38>> No, of course not. Yeah. And he never

8:41expressed it unless we asked him. But he

8:44would say that it's too much effort to

8:47put this system together. So [snorts]

8:49even if he was asked, "What would you

8:51like to do?" He might say, "I'd like to

8:53listen to music." Why aren't you doing

8:55it? Because it's too much effort to do

8:59it. Right? And that became a real

9:01insight into how our brains work when we

9:04make decisions about is this potential

9:07action worth the effort in terms of the

9:10reward that will arise from it. Because

9:14[clears throat]

9:14it turns out that if we look at apathy

9:17across many different neurological

9:19disorders, one common trait that we

9:22found when we ask people is this

9:25particular option worth the reward if it

9:28was requiring this much physical effort.

9:31We find that everyone is willing to work

9:33for high rewards.

9:35But the difference between motivated

9:37people and apathetic people is at the

9:40level of the low rewards. Apathetic

9:43people are more inclined to say, "Nah, I

9:46don't think this is worth the effort, so

9:48I won't do that option." That's a really

9:50interesting signature that we found when

9:52people make that decisions. But in

9:53someone extreme like David, almost

9:56nothing incentivized him to put in

9:59effort to act unless he was prompted to

10:01do so. But going back to what happened

10:03to him, one of the things we've learned

10:05from the neuroscience of the basil

10:07ganglia and motivation to act is that

10:09dopamine is a key neurotransmitter, a

10:12key chemical in the brain which is

10:14important in the neural circuitry. And

10:16that's when we thought okay is there

10:19anything we can do for this guy to

10:21improve his motivation. So initially we

10:24tried Leodopa L-dopa which is the drug

10:26that Oliver Saxs describes in Awakenings

10:29and many people have seen the film and

10:31it's used a lot in Parkinson's disease

10:34for treatment. We slowly ramped up that

10:37drug but seemed to make absolutely no

10:40difference behaviorally to David or on

10:43our tests of reward sensitivity. We we

10:46developed some ways of measuring that.

10:49So we were about to give up and then I

10:51suddenly thought look let's use the

10:53other drug that we use for the dopamine

10:55system and that class of drugs acts

10:59directly on dopamine D2 and D3 receptors

11:03rather than being a precursor to making

11:05dopamine in the brain like leodopa and

11:08this drug rapinroll

11:10latches onto dopamine receptors directly

11:13and stimulates the dopamine circuitry.

11:16So we slowly ramped up this drug

11:19thinking is it going to be any different

11:21or not? But 3 months after we started

11:24this medication, he came back, David

11:27came back to see us and I did not

11:29recognize this guy in the waiting room

11:31because first of all, he'd had a shower,

11:34he'd had a haircut, he was wearing a

11:36suit, he had a new job, and most

11:39impressively, he had a new girlfriend

11:42because in the state he'd been in, he

11:45was seeing nobody. but he'd obviously

11:47been motivated to get out there and, you

11:50know, see if he could find a new

11:51partner. I was absolutely delighted for

11:55him, but so astonished that we could go

11:58in a human biological

12:01system where someone has tiny lesions in

12:05the bas ganglia and has their motivation

12:07[clears throat] extinguished. We could

12:09go from that to recovering motivation by

12:12using a drug that we already have that

12:15affects the dopamine circuitry. And of

12:17course, David is really rare. This kind

12:20of bilateral in both sides of the basil

12:23ganglia being affected tiny little

12:25strokes. This this is extremely rare.

12:27It's reported and it leads to

12:29pathological apathy. But it turns out

12:32that apathy is really common across

12:35neurological disorders. And the way we

12:37thought about it is if a pathological

12:40process whether it's a stroke or whether

12:44it's Alzheimer's disease or whether it's

12:47Parkinson's disease or even some

12:49inflammatory disorder affecting the

12:51nervous system like multiple scerosis.

12:54If that pathological process is

12:57affecting this circuitry it can lead to

13:01loss of motivation. And that's what

13:03we're really interested in is to think

13:04about the circuits that are affected and

13:06also trying to deconstruct motivation in

13:09terms of [clears throat] what's actually

13:11going on in the brain. What does this

13:12circuit really doing for us that leads

13:15to this behavior we call motivated

13:18behavior?

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15:43like to drill into motivated behavior

Types of Apathy; Goal Prioritization: Effort vs Rewards

15:45and the dopamine system. And thank you

15:47for sharing what became of David because

15:49uh always nice when medicine can deliver

15:52a a victory story.

15:54>> Absolutely. Yeah.

15:55>> Because as some people may recall that

15:58L-dopa for the treatment of Parkinson's

16:00had these transient improvements that

16:03sometimes can be dismaying for people,

16:05right? People get better and then they

16:06get worse again. And I'm sure there's

16:09additional progress being made there. We

16:10still need to do an episode all about

16:11Parkinson's, but we'll reserve that for

16:13another time.

16:14>> In thinking about motivation

16:17and the fact that there's really one

16:19system for most types of motivation,

16:22this is kind of what the David story

16:23suggests, right? That these basil

16:25ganglia, nuclei, nucleus encumbent are

16:28underlying all sorts of motivations to

16:30listen to music, to shower, to find a

16:32romantic partner, to work, to take care

16:34of oneself as opposed to distributed

16:36networks for motivation. Yeah,

16:38>> that's interesting in its own right, I

16:40think. But many people are probably

16:42familiar with feeling really motivated

16:44to do certain things but not others.

16:46Even if there isn't a pain point

16:47associated with doing, I don't know,

16:49maybe somebody likes arithmetic but they

16:51don't like literature or vice versa.

16:53Putting aside individual variation based

16:55on family history, psychology, traumatic

16:58experiences, is it true that certain

16:59people by virtue of the way that their

17:01dopamine system is kind of tuned up like

17:03how willing these neurons are to fire or

17:06not fire in different circumstances are

17:08just motivated people. I mean, you see

17:10this sometimes like

17:12>> you know, I've had two different

17:13bulldogs. The first one is like let's go

17:14and it's like and you have to really

17:16[clears throat] coax them along. The

17:17other one, let's go, okay, and just go.

17:19Some people are like this. Hey, like

17:20let's go. They pop up, they go. other

17:23people more reluctant, but I think most

17:25of us are somewhere in between. So,

17:28clinically and outside of the clinic, do

17:31you think that some people's

17:33dopamineergic neurons are just more

17:35willing to fire in response to everyday

17:37activities, novel activities, and the

17:39super exciting stuff? And I have a very

17:41specific reason for asking this, but

17:42I'll I'll keep it quiet for now because

17:45I really want to understand is there a

17:47continuum of motivation? And if so, can

17:50it exist both between individuals and

17:52within individuals?

17:53>> So, taking your first question, it turns

17:56out that this circuitry we're talking

17:58about, it's called the misolyic

18:00circuitry that links the basil ganglia

18:03to the frontal loes, is almost like a

18:05final common pathway for motivation

18:07signals to engage with the action

18:10systems of the brain. So, it could be

18:13hunger, it could be thirst, it could be

18:14sex. These are primary motivation

18:16signals that many animals have. But as

18:20you said, there are other motivating

18:22signals that we may also want to engage

18:25with. We may have other goals, whether

18:27it's arithmetic or to learn a new

18:29language or to go out into the park,

18:31whatever it is. Now how those different

18:34types of motivation signals are weighted

18:37or valued within our brains to engage or

18:41not engage this circuitry to lead to

18:44action is actually a very very

18:46interesting area. So one thing that

18:48we've learned is even apathy might be in

18:52different domains. The research in this

18:54area started with behavioral apathy.

18:56What we can measure is someone inert or

18:59are they active doing something? Then

19:01other kinds of work suggested there

19:03might also be social apathy. You know we

19:06might know colleagues who seem to be

19:08very very motivated to work but they

19:10don't want to engage with other people

19:12or do things like go to a party or

19:14something like that. They may also be

19:16emotional apathy. So there are people

19:19who seem to have very blunted responses

19:22to things that you and I might either

19:24find, you know, something that we want

19:26to congratulate people for or feel sad

19:29about if they had an issue. These people

19:31seem to not have that kind of range of

19:35motivational responses. And some people

19:37argued that there's also cognitive

19:39apathy. So whereas someone might be

19:42apathetic to do something physical, they

19:44might not necessarily be apathetic for

19:47doing something cognitive, being curious

19:49about the world, reading the newspaper,

19:51finding out what's going on in the

19:52world. And there may be dissociations.

19:55So someone could be socially apathetic,

19:58but you know, cognitively very highly

20:01motivated. So how does that happen? How

20:03do these different domains vary if

20:06there's one final con system? And of

20:09course this is where we have to think

20:10about the fact that brain circuits are

20:12complicated. And the kinds of signals

20:15that are being developed for behavior,

20:18cognition, social interaction or emotion

20:21are being formulated in different parts

20:24of the brain even though they might

20:26funnel through this basil ganglia system

20:29to engage the action systems in the

20:31frontal lobe. And even more granular if

20:35we want to get to that, you know,

20:36whether you want to learn a new language

20:38or you want to do arithmetic or go to

20:40the park or whatever it is, how do you

20:43weight these different motivation

20:45signals? So, one way we've thought about

20:47this is, you know, let's imagine today

20:50it's a beautiful day out there. What are

20:53the things you could do? And I'm sure

20:54Andrew, you could give me 20 things you

20:56could do, but you can't do them all at

20:58once. So somehow you have to prioritize

21:02what's the thing that you value most.

21:05And the way we conceive of this is a

21:07sort of a neuroeconomic decision-m where

21:10you look at those 20 things and you go

21:12okay how rewarding do I think each of

21:14these things are and then you also think

21:17well how effortful is that going to be

21:19and it could be physical effort it could

21:22be cognitive effort social effort

21:24emotional effort whatever it is and out

21:26of that kind of system where you do a

21:28calculation

21:30you will find the thing for you that you

21:32will value most given the level of

21:35effort required and that's what emerges

21:38as your motivated behavior at that time.

21:43>> Do you think people do that computation

21:46consciously?

21:47>> I don't think they have to do it. We

21:48could do it consciously, right? If I

21:50>> because I don't wake up I look at my

21:51schedule and I have to do this, this,

21:53and this. I actually schedule my

21:54workouts. I schedule time with others

21:56and things, but it's sort of the the

21:59constellation of things in my life. I'm

22:01not doing a very conscious waiting of

22:03this versus that. Although occasionally

22:05when there's a conflict in scheduling, I

22:06have to select this is more valuable to

22:08me than that. But it's not something

22:10that I generally sit back and think and

22:13I probably should. We probably all

22:15should sit back and think, okay, what is

22:16the best use of my time? Effort, reward,

22:19payoff, but we we sort of just go about

22:21life.

22:22>> Yeah. And I think what you're really

22:23getting me towards discussing is the

22:26fact that each behavior has a kind of

22:29activation

22:30hill that we have to cross to think,

22:33yeah, I could start this. So for some

22:36people, let's say learning a new

22:38language is a mountain. That's a huge

22:40kind of effort to put in. Whereas for

22:43other people, it's barely a mount. You

22:45know, I I don't think of that as a big

22:47burden, a big activation hill that I've

22:49got to cross before I get there. So

22:51there's the activation barrier before I

22:55even think of starting. And these things

22:57are not necessarily consciously being

23:00considered. It's just you have these

23:01biases because you've got experiences.

23:03The fact, hey, I wasn't that good at

23:05learning Spanish. Do I really want to

23:07spend a lot of energy in learning

23:09French? Those biases add up and affect

23:12the way you do that calculation. We were

23:15talking about reward versus effort. And

23:18essentially

23:20that's a very important way I think that

23:22we make a decision. Much of that could

23:24be subconscious.

23:25>> I'll tell two brief anecdotes if if I

Motivation, Apathy, Tool: Activation Energy & Overthinking

23:27may to set the texture for the next uh

23:29question.

23:31>> Years ago I was at a PhD thesis at

23:33Stanford, a student, I'll just name her

23:35because she did a wonderful job in her

23:37thesis. Her name was Lauren Casease. She

23:39was not my student. I attended because

23:41she was working on neural regeneration

23:42and she had screened an enormous number

23:44of molecules for their ability to

23:46inhibit or promote neural regeneration.

23:49Super important problem as you and I

23:50both know that still hasn't been solved.

23:52Yeah.

23:52>> And it was really striking how many

23:54molecules she had evaluated. And I'll

23:56never forget her advisor's introduction.

23:59He said one of the best things about

24:01Lauren

24:02>> is that she has very low activation

24:05energy. Meaning there's the opportunity

24:07to do an experiment. she'd get up and do

24:09the experiment and say, "Ah, that was an

24:11interesting molecule. Move to the next

24:12one." And it occurred to me then that

24:14having low activation energy, provided

24:16the thing that you do doesn't get you

24:18injured or killed, is really a

24:20spectacular thing in life because you

24:23just get a lot more life out of days

24:24lived. So, you kind of wonder about the

24:26Lauren cases of the world. Are these the

24:28people where somebody says, "Hey, you

24:29know, uh, we need to do this thing like

24:32like take out the recycle and it's a ton

24:34with the roommate something back when,

24:35you know, and it's like, okay, I'll do

24:37that later." There's so much energy lost

24:40in the deliberation in the feeling like

24:43the effort reward trade-off. You don't

24:45want to waste your time doing things,

24:46but you also don't want to waste your

24:47time thinking about whether or not

24:48you're wasting your time. So let me take

24:50you up on that because after seeing

24:53David we thought about exactly this

24:55problem and we got a bunch of Oxford

24:57students and believe it or not at Oxford

25:00just like Stanford I'm sure there's a

25:02whole range of motivation amongst the

25:04students there are people who are highly

25:06motivated the Laurens and then there are

25:08people who are actually surprisingly

25:10apathetic they might be very smart

25:13people but they have high activation

25:15energy levels they need to cross that

25:18barrier to do something and we put them

25:20into the MRI scanner and we looked at

25:23their brain activity when they were

25:25given these choices. Is this option with

25:28this much reward worth this much

25:30physical effort? You just say yes or no.

25:32Would you do it or not? We could then

25:34look across this neuroeconomic space by

25:37parametrically

25:39changing the level of reward that we're

25:41offering and parametrically changing the

25:43level of effort. And it turned out just

25:45as we'd found in patients, the apathetic

25:47students were all willing to work for

25:49high rewards, but they weren't willing

25:51to work for low rewards. Interesting.

25:54>> Now in the brain, what we find is that

25:56the vententral parts of the basil

25:59ganglia, vententral stratum nucleus

26:01encumbent is active as well as the parts

26:04medial frontal areas, frontal lobe areas

26:07in these healthy students when they're

26:10simply making the decision. is this

26:12option worth the reward for this much

26:15effort? So they're not doing anything.

26:17They're just thinking about it. And we

26:19thought great, this is really fantastic

26:22because now we have convergence from the

26:24stroke patient that we saw with the

26:26basil ganglia lesions who lost

26:28motivation and now we can see that

26:31healthy individuals when they're having

26:32to make this decision show activation in

26:35the same area that was lost in David as

26:37well as the frontal loes. But the

26:39paradox here was that we found greater

26:43activity in those regions in the

26:46students who were apathetic

26:49compared to the students who are

26:50motivated. And we were not expecting

26:52that. We thought if you lack motivation,

26:54your brain activity when you're being

26:56asked to do this would just be lower. So

26:58the way we have resolved this problem is

27:01to think actually this is showing us

27:03something very important. It's showing

27:06us that apathetic people use more brain

27:09energy when they're making this

27:11decision. They have a bigger activation

27:14energy barrier to overcome because when

27:18they're making that decision, the brain

27:20is consuming more energy. It's consuming

27:22more glucose when it's doing that. Now,

27:24of course, in the scanner, in this sort

27:26of experimental situation,

27:28everyone's willing to do the task.

27:30They're making those decisions. But

27:32imagine these people at home if you're

27:35confronted with, "Oh my goodness, I'm

27:37going to have to work hard just to

27:39decide whether I should do this option

27:41or not. Maybe I would just won't do it."

27:43And that's, I think, a really important

27:46insight into what you might do to

27:51energize motivation in people who might

27:53be apathetic because it's showing us

27:56that that activation barrier that I was

27:58talking about in a way exists in the

28:00brain. Physiologically you can show that

28:03these people are working harder to make

28:05the same decision compared to motivated

28:08people.

28:09>> Fascinating experiment by the way. So

28:11elegant in its simplicity, but the

28:13paradoxical piece of more activity in

28:16these dopamineergic circuits in the

28:18apathetic folks tells me, and correct me

28:20if I'm wrong, that there's a cost to

28:22thinking about the effort required plus

28:24the cost of the actual effort required

28:27that compounds and puts some people out

28:30of the game.

28:31>> Exactly. So, you know, the Lauren, the

28:34the student you were talking about, has

28:35low activation energy. She obviously

28:37doesn't need to burn a lot of brain fuel

28:40in terms of thinking I I can do this.

28:42I'm going to do it. And you know she

28:43reminds me of something that happened to

28:45me when I was a PhD student. I was in

28:48Oxford and we would sit around having

28:50tea thinking about great studies we

28:52could do. nothing really happened and

28:55then I came to be a posttock at MIT and

28:58was surrounded by these highly motivated

29:00people and I can remember we disc had

29:03the same kind of discussion and then one

29:05of them would go yeah well let's do that

29:07tonight and I'd go tonight and that was

29:10the level of difference it just blew my

29:14mind that there were people who could

29:16just go right let's do it

29:18[clears throat]

29:18>> and I think that's been a real lesson

29:19for me that you can achieve things if

29:22you if you think in this way.

Tools to Increase Motivation: Incentives, Subdivide Tasks, Planning

29:24>> Well, the other anecdote, I'll keep this

29:26brief, is a is a slightly humorous one,

29:27but it's designed to illustrate a point,

29:29which is I try not to spend too much

29:31time on social media unless I'm actively

29:33learning on there because I do find

29:34things that are really interesting and

29:36educate me sometimes just for

29:37entertainment. But there's a a post I

29:39came across um it's a little parody skit

29:42where uh a woman walks into the room and

29:44her uh husband or boyfriend is playing a

29:46video game and she says, "Hey, do you

29:48mind um hanging up those pictures that

29:50are in the hall? They've been there for

29:51a few days." He's like, "Yeah, yeah,

29:52yeah, yeah." And she walks out. She like

29:54shakes her head and she has an idea. She

29:56walks back in and she says, "Hey, do you

29:58mind showing me how to hang those

30:00pictures in the hallway? I'd love to

30:02learn how." And he's like, "Boom." And

30:04it like, you know, he launches into, you

30:06know, so she's tapped into a component

30:07of his motivational circuitry where the

30:09opportunity to to teach clear literally

30:11gets him around this uh this activation

30:14energy thing like all of a sudden the

30:15activation energy required to do the

30:17same thing just drops to zero. And it's

30:19a very good example because you know one

30:21thing you got to think about is how can

30:23you change that barrier for people.

30:26Either you make the effort less. Let's

30:28say you got a part task to do. You could

30:31break it down into subcomponents so the

30:32activation level doesn't seem quite so

30:34formidable. Or you could change the

30:36incentive. And this is what happened in

30:38your example, right? The incentives

30:41change because now the guy is thinking

30:43ah now the the reward here is to show

30:47her how I do this. That's the thing I

30:49will get the pleasure from, the reward

30:51from. Right? So I think that's the other

30:55insight we got is how do you change

30:57people's motivation in a practical way?

31:00Well, you have to think if this is

31:01really happening in the brain that

31:02you're making decisions about whether

31:04this reward is worth the effort. You can

31:07either increase the reward or change it

31:09in some way in terms of something that's

31:11meaningful for the person or you change

31:15the effort required to accomplish maybe

31:18part of the task or perhaps start you

31:21know just initiate the task and often

31:23starting can be a huge motivational

31:26pull. You know, this gets to um some uh

31:30sticky territory around the actual

31:34versus the perceived utility of lots of

31:37things that are on the internet

31:38including in the health and dare I say

31:40wellness space which is the following.

31:42There's this idea that if you do for

31:45instance a hard run or a hard workout

31:47that you are teaching yourself how to do

31:49hard things that can translate to doing

31:51hard things in other domains. So as

31:54psychologists, neuroscientists, we talk

31:55clinicians, we talk about the domain

31:57specificity, but that's just nerdy speak

31:58for like does one thing translate to

32:00another circumstance. Are you teaching

32:01yourself an algorithm of I did a hard

32:03thing this morning, you know, I did the

32:05cold shower I don't like. I did the

32:06workout I may or may not have wanted to

32:08do, but so now I'm more empowered or and

32:12I've thought about this quite a bit or

32:14do we have a finite amount of energy and

32:16the most rational approach is to is to

32:18think okay what's actually going to

32:20provide me the most benefit today? Like,

32:22can we really get momentum and

32:24understanding of our underlying

32:26motivational circuitries? Or is it the

32:28case that we're diluting ourselves? I'm

32:30not attempting to undercut a lot of

32:32content I've done previously, but I've

32:33had plenty of um hard workouts and then

32:36gotten to the other thing I needed to do

32:37and went like, I don't want to do this.

32:39I'm tired from that workout this

32:40morning. [laughter and clears throat]

32:41But we are also familiar with the fact

32:43that if something really intriguing or

32:45exciting to us is presented to us,

32:47suddenly it's like we're a different

32:49human being. It's a complete state

32:50change. So, I'm I'm curious. I'm not

32:52asking you to editorialize about the

32:54health and wellness space, but more

32:56globally, can we teach ourselves to

32:59lower our activation energy in a way

33:02that can serve us well across the board?

33:04I think we can because it turns out

33:06obviously some of these things that

33:08people use psychologically to improve

33:11their motivation can be framed in

33:13exactly the way I put it to you that the

33:16what we're doing here is trying to

33:18either increase the reward or change the

33:20nature of the incentive you know if it's

33:22something novel and salient that you

33:24think ah this is really interesting it's

33:26rewarding for me or we reduce the effort

33:29so just using these simp this simple

33:32principle might be enough for someone to

33:34think about how to do it. You know,

33:36planning out your day or week in advance

33:40for some people makes life better

33:42because every time they're having to

33:44make a decision on the fly if they're

33:46just doing it without planning it out

33:48means that the it's costing, right?

33:51Every decision has a cost in terms as

33:53we've seen the brain having to put in

33:56invest fuel to make that decision. So if

34:00you're having to do that every time you

34:02make a decision, that can seem very

34:04burdensome. Whereas if you did it once

34:08in a big way where you planned it out

34:10for the day or the week, maybe the costs

34:13in terms of the activation energy

34:15required for the brain is much lower for

34:18you if you do that. So it's a simple

34:20thing to do. Dividing up a task, let's

34:23say you're given a project by your

34:25manager, it's going to take you three

34:27months to accomplish from it. seems

34:29absolutely formidable because you have

34:31no idea of where to start. What if you

34:34could break it down into smaller tasks

34:37which bring down that mountain the

34:39activation energy required to get that

34:42small thing done. Let's say first of all

34:44let's research one area of this and get

34:47a handle on that and if we get that done

34:50this is a sort of if then kind of

34:52construct if we get that done we can

34:54then move on to a second piece of work.

34:57It would also help if your manager said,

34:59"Well done for getting that bit done."

35:00Right? That's that's also a motivation

35:02pull to think, "Yeah, actually I don't

35:05need to get the whole piece done to get

35:07the reward of somebody identified that

35:11as a positive thing to have done." I

Subjective Effort, Mental Framing; Learning & Motivation

35:13would love to see an experiment done

35:15where the perception of one's effort to

35:18do something can be separated from the

35:20actual effort and really get to the meat

35:23of whether overthinking or even thinking

35:26at all about the effort takes us away

35:29from having more quote unquote

35:31motivation or even better performance.

35:33And I haven't had time to think this

35:34through, but as you were describing

35:36David and his transformation and this

35:38experiment on the undergraduates

35:40of valuing different outcomes, I wonder

35:43if you could put somebody on a

35:45stationary bike and put them in a

35:47virtual environment

35:48>> and measure the effort required to climb

35:51a hill and you could adjust the

35:53difficulty,

35:54>> but you change the perception of how

35:56steep that hill is, right? If we could

35:58translate that to the real world like to

36:00to learn something to learn how to tango

36:03for instance you know I have Argentine

36:05relatives it'd be nice to learn how to

36:06tango that's pretty cool skill right

36:08there's a lot required you had to go to

36:09the class you got to drive there find

36:10the teacher you if you're the one who's

36:12supposed to lead then it's like

36:14especially embarrassing if you can't do

36:16it so there

36:16>> sounds like you've already started

36:17>> yeah started this process but that's

36:20very different than the actual work

36:23involved in doing it which in most cases

36:25turns out to be much lower than the

36:26perceived effort Yeah.

36:28>> So is there a way to tease these things

36:29apart?

36:30>> I think not in exactly the way you

36:32suggested about the treadmill and the

36:34and changing the perception of the

36:36gradient, let's say, that's coming. But

36:38that wouldn't that be interesting

36:39because what we then get is subjective

36:42value of effort versus the real effort

36:45the physiological effort whatever it is

36:48you know oxygen consumption the glucose

36:51required the lactic acid that's building

36:53up all of those parameters and seeing

36:56how that diverges but I bet you we would

36:58find that there's a huge variation in

37:02subjective valuation

37:03>> and it could go either way it could

37:05>> we have a good friend Ken Ry out who's

37:06like a very famous within the

37:09marathoning community like endurance

37:11athlete and he does this mind game on

37:13his opponents when he runs and he wins

37:15races in the Gobi Desert at like age 50

37:18plus he'll run up next to his

37:19competitors an actual event and he'll

37:22take his earbuds out and he'll say I

37:25don't know what it is I never get tired

37:27and then he wins

37:29>> and these are guys that he couldn't

37:30catch up to

37:31>> barely until then and he dominates them

37:33so there's a psychological thing

37:35happening in both of them right and I

37:37think he does as much for himself as he

37:38does for them. And many competitive

37:40athletes have talked about when they see

37:42a great competitor starting to fail, how

37:45it gives them this sense that they have

37:47like a booster pack. Y

37:49>> and it's not the nicest example because

37:51I'm not big on motivating through

37:53competition, per se, but it says

37:56something about our perceived effort of

37:58our own, whether or not we're overcoming

38:00the challenge. And if we see someone

38:02else falling into a psychological trap

38:04like that, presumably it allows us to

38:07access the inverse of that psychological

38:08trap. It's like we get a boost.

38:10>> Yeah. And I think what you've said is

38:12within the individual, you can change

38:15your subject evaluation of the same

38:17effort you're running on the Gobi

38:18Desert, right? It's the same effort

38:20you've been putting in for miles and

38:22miles. And suddenly you have

38:24subjectively valued this thing as less

38:27effort

38:28>> and you're going to now, you know, get

38:30the booster.

38:31>> Wild, right?

38:32>> Well,

38:32>> it shouldn't work in terms of the the

38:34the laws of physics and chemistry and

38:36biology. The hill is the hill.

38:38>> Yeah.

38:38>> And of course, it speaks to the brain's

38:40critical role. It suggests that there's

38:42a cost all along that you weren't

38:45acknowledging, right? like you're

38:46removing some additional effort as

38:48opposed to like getting more

38:50>> energy from you know from the sky.

38:53>> Yeah. You're not going to get that. So

38:54it is also the way you framed it for

38:56yourself right the activation energy

38:59required to do this to get that little

39:02bit more uh from this. So I think you

39:05know this simple principle actually

39:06takes us quite a long way.

39:07>> You had a book that was tremendously

39:10successful. We'll put a link to it in

39:12the show notes captions. And it was

39:13tremendously successful because it's an

39:15awesome book. Tons of learning there.

39:17Super interesting. First book of its

39:18kind in a long while to really educate

39:21people on the brain and its workings.

39:23There have been others, but yours really

39:25did spectacularly well for its content,

39:27but you also won a big award for this,

39:29right? Do you ever think about that in

39:31terms of how hitting the pinnacle of

39:33something impacts our perception of the

39:36next effort and the next potential

39:37outcome? I mean, we think of this as

39:38quote unquote reward prediction error,

39:41but this has broad implications for

39:44whether constant scrolling on social

39:46media is actually adjusting dopamine

39:48circuits in a way that makes rewards in

39:50the real world less enticing, or whether

39:52success in one domain truly leads to

39:56confidence and success and lower

39:58activation energy in another domain, or

40:00whether or not it puts a certain

40:02pressure on us because, you know, the

40:04rewards might not feel as great. I'm not

40:05trying to undercut any of your own

40:07relationship to this book, but what is

40:09the relationship between prior rewards

40:11or failures, memory and motivation?

40:14>> So, we've talked about this calculation

40:16about reward and effort. We've gone into

40:18that in some detail. Once the behavior

40:21is initiated, it's not just initiation,

40:24it's also persevering to make sure we

40:26get to the end. And then at the end, if

40:30we get to the outcome of what we wanted

40:31to achieve, we can have a hedonic

40:34pleasureful experience. That's what we

40:37wanted. Or we could have an aversive

40:39response. You know, we put all this

40:41effort in and actually it turned out it

40:43was an apt terrible decision. And we've

40:45all made those, right?

40:46>> Oh, yeah. [laughter]

40:48>> Not me. I understand. Oh, of course.

40:50Yeah.

40:50>> And the outcome, you know, whether it's

40:53a great pleasureful hedonic response or

40:57whether it turned out to be absolutely

40:58awful and very aversive obviously is

41:00graded. But that graded outcome

41:04is important for learning. What

41:06neuroscientists call reinforcement

41:08learning. And that learning comes back

41:10to affect the way we make that decision

41:13I was talking about. Which of the 20

41:15things I could do today do I prioritize?

41:18Because if it turned out that I

41:19prioritized one which turned out to be

41:21absolutely awful, next time it's coming

41:24up in my menu of things I could do, I am

41:26going to devalue that. So my subjective

41:31evaluation of that particular choice

41:34would be much lower. The learning

41:36mechanism is really important for

41:39choices in the future. You were talking

41:40about how previous experiences affect

41:44your motivation to do things. Well, my

41:46motivation to do that terrible thing is

41:48really going to be low next time it

41:50comes up. So, I might pick something

41:52completely new, perhaps something which

41:54gives me something novel and salient

41:56that I haven't experienced before. It

41:58might turn out to be a bad thing, but I

41:59don't know. I'm going to give it a go.

42:01So, I think learning is a really

42:04important mechanism in motivation. And

42:06of course, guess what? The evidence

42:09suggests that dopamine is not only

42:10important in in terms of this decision-

42:13making about whether this is worth the

42:15effort or not. It's also very important

42:17in the human brain and in animal brains

42:20for learning from previous actions.

42:23I'd like to take a quick break and

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Perseverance, Failure; Finding Your Passion, Depression vs Apathy

44:58approach would be to have a lot of

45:01generalizability about the process of

45:04overcoming activation energy and just

45:06getting into action toward a goal.

45:08>> Like if you do the hard workout that

45:10morning or maybe you write a certain

45:11passage, let's take it out of exercise.

45:13exercise always. It's kind of a cliche

45:15example by now. You know, you're trying

45:16to learn violin or you're trying to

45:18learn a language and it's hard, but you

45:19do a little bit of that before going to

45:21work that it does set you up to be able

45:24to engage in effortful things throughout

45:27the day. Some things you like to do,

45:28some things you don't want to do. Okay,

45:30let's let's assume that one could

45:31achieve that. But in terms of failures,

45:34you want a ton of domain specificity

45:36because if the person says, you know

45:38what, I'm going to go after this

45:40athletic goal or cognitive goal or

45:43scholastic goal and they fail.

45:46>> If they attach the effort process and

45:49not the specific goal to their memory in

45:53some broad way, then it could be I try

45:55things and I fail. Things being like

45:58everything, right? And that's how you

46:00described David. So I'm struck by the

46:03potential for an asymmetry in the way

46:06that this reward motivation circuitry

46:08works. On the one hand, it's very

46:10generic. On the other hand, we have a

46:12lot of ability to say, well, I'm put in

46:15a ton of work, and I'm talking about

46:16myself now, to try and learn a musical

46:18instrument as a kid. Total failure. Dogs

46:20howled, parents cringed, everyone

46:23cringed. I was happy to put it away.

46:25>> But I've put effort towards other

46:26things, and it's worked out fabulously.

46:29It's good to know that it wasn't just

46:30effort.

46:31>> Yeah.

46:31>> Right. But if you don't obey punishment

46:34and failure, you're also setting

46:36yourself up for a very hard life. No one

46:38wants to be the person with low

46:39activation energy who's kind of an idiot

46:42because they're always trying things and

46:43they never work out. That's I think what

46:46keeps a lot of people in the chair, so

46:48to speak, wondering if they should put

46:49effort towards this or that. And that's

46:51why they, dare I say, watch too many

46:55videos about motivation. Right? you want

46:57to watch the right ones. But you know,

47:00you get the point.

47:01>> Yeah. So, this is generic in the sense

47:04that this pathway we've been talking

47:06about is a, if you like, a final common

47:09pathway where all of these signals

47:11converge. So, in David, it took out this

47:14final common pathway. The strokes took

47:16out the final common pathway and

47:17therefore we saw no motivation signal

47:20really was prompting him in any way of

47:23his own accord valitionally to do

47:25something. Now the other point you make

47:27about the fact that you don't want this

47:29to be something that generalizes to all

47:32kinds of decision-m otherwise you'd

47:34think you're a failure if every time you

47:36did something and it didn't work you'd

47:38say oh I generalized to everything so it

47:41doesn't seem to be like that and we can

47:42understand that if it's if this is the

47:44final common pathway there the signals

47:47for decisions about playing violin

47:49learning a new language whatever it is

47:51are being computed elsewhere in the

47:53brain to engage this system. This is

47:56just the final common pathway to get you

47:58that vigorous energy over the activation

48:01energy barrier to initiate the action.

48:04And then of course, you're not going to

48:06be any good at the violin or salsa

48:07dancing or tango if you don't persevere.

48:11You have to persevere. And that's the

48:12other really important part of

48:15motivation. You know, we know a lot of

48:16people who start things and then we also

48:18know the non-competers, the people who

48:20are always so energetic but actually

48:23don't finish, right? So, it's almost as

48:26important to be able to finish and

48:28complete as initiate actions. Perhaps it

48:32should be required learning to do some

48:34things that you're very passionate

48:36about, but intentionally do things that

48:40you maybe even loathe just a little bit

48:42even if provided they're not damaging to

48:45sell for others or something because

48:47there's a real value in just what I call

48:49chop wood carry water where you just

48:52>> and I have this mode sometimes where I

48:54just really don't want to do something

48:55and I say like all right chop wood carry

48:57water I'm doing it just to do it and you

49:00finish and you feel pretty good about

49:02the effort and the thing you're kind of

49:04like h all right got it done I'm just

49:05glad to have it done but to be a

49:07functional human being generally you

49:10need both and and I'm asking this on

49:11behalf of many many questions I get

49:13about motivation or how do you find your

49:15passion and I always say well you find

49:17your passion by getting good at effort

49:18in things that you're not passionate

49:20about so that when you eventually find

49:21your passion you can just get there much

49:23faster you can't just sit around waiting

49:25to be passionate

49:26>> and that's sort of what David was doing

49:28and it wasn't pulling him forward for

49:30it. Exactly. No, that's right. And uh

49:32you know, obviously there are different

49:33ways of getting your passion, but as you

49:35say, if you're just waiting for it to

49:36happen, it may not happen. The other

49:39thing that was important about what we

49:40were just speaking about is if you do

49:43for some reason generalize maladaptively

49:46to thinking this didn't work and I tried

49:49this, this didn't work, and I tried this

49:50and I'm really bad at this. That can

49:52lead not only to loss of motivation, but

49:55what we might call clinical depression.

49:58Because one of the things that happens

49:59in depression is you think you're not

50:01good at anything. Even though you know

50:04that might be an unreliable objective

50:07measure of your performance. Everything

50:09you do seems bad. It hadn't been a

50:12terrible outcome. And one of the areas

50:14that we're really getting into is trying

50:17to work out the difference between

50:20depression and apathy. And it turns out

50:23it's quite complicated. But there are

50:25some people who have pure apathy, no

50:27depression like David. And there are

50:29other people who can be depressed, they

50:31can be sad, they can be hopeless about

50:32the future, but they don't necessarily

50:35lose motivation. They can have pure

50:36depression. And to make life really

50:39complicated, there are people who would

50:40fulfill the criteria for both apathy and

50:43depression. They fit in the overlap

50:46between those two syndromes. And trying

50:48to understand the biology of what

50:50separates depression from loss of

50:53motivation as we see in apathy is is one

50:55of the important areas of research at

50:57the moment.

Self-Concept, Ambition; Life Satisfaction

50:58>> None of us want to be the person who

51:00just doesn't motivate to do anything.

51:03None of us want to be the person who

51:04motivates to do everything. And none of

51:08us want to be the person who invests

51:09lots and lots of time and energy in lots

51:12of things and underneath it all doesn't

51:14really want the things they're going

51:15after. This sort of the tapestry of the

51:18internet self-help motivation. And

51:20there's so much I really have to say

51:22this. I've wanted to say this for a long

51:24time and it's the appropriate time. I

51:25think there's so much BS about oh is

51:29something pulling you forward or are you

51:31pushing yourself to it? You should do

51:32things out of love. No, you should do

51:33things to serve others. both wonderful

51:37in in principle and practice, but

51:40there's this idea and I think it's a

51:42false idea that there's some specific

51:44thing working on behalf of others,

51:47knowing what the purpose of what you're

51:49doing that that is somehow going to

51:50unlock this circuitry.

51:52>> What I'm realizing today is the

51:53circuitry is the same. The learning

51:55about what engages that circuitry

51:58>> is based on our historical understanding

52:00and probably the messages that we hear

52:02in our family, etc. This is a worthwhile

52:04pursuit. It's hard. keep going. Trust

52:06me, it's going to work out in the end,

52:08even if it doesn't work out the way you

52:09think. Exactly. Those are very valuable

52:11messages to hear. But my question is

52:13this.

52:14>> For any of us, we've also seen the

52:18person who is very very excited to try

52:21everything. Every idea is something that

52:23they take action on and they seem

52:25resilient to the fact that it never

52:27really goes anywhere. It's almost like

52:28their self-concept is divorced from the

52:31outcomes. Other people have it in the

52:33opposite direction where like you said

52:36they're trying things, they're getting a

52:38reasonable amount of success certainly

52:40against the backdrop of averages, but

52:42maybe they have one big failure or a

52:44couple and then suddenly their whole

52:46self-perception is altered.

52:47>> Where does self-perception come into all

52:49of this? Like one's beliefs about

52:52themselves.

52:53>> Yeah. and their ability to do hard

52:55things both for reward and just for the

52:58sake of getting good at hard work seems

53:01like an immensely valuable feature of

53:03the human psyche and I don't think we

53:05have a name for that but like the

53:07self-concept piece yeah

53:09>> in my mind is really important

53:10>> I don't [clears throat] think we have a

53:11mechanistic explanation for the

53:13differences you've just suggested you

53:15know psychologically we could think

53:17there are many reasons for that some

53:18people don't have high ambitions they're

53:20happy to sit at the 50% level maybe 51%

53:2452% in terms of where they sit in the

53:26population and other people are not

53:28happy with that. That's not what they

53:29were brought up in this world to do.

53:31They want to be at the top 2% if

53:34possible at the 1%. I don't think we

53:35have at the moment a good idea of the

53:38neuroscience that distinguishes between

53:41those two types of individuals

53:43>> of ambition.

53:44>> Of ambition. Yeah.

53:45>> Yeah. I don't know why I'm obsessing

53:46about this at the moment. I feel like a

53:48lot of the pain of the world is about

53:50people trying to understand what they

53:52should strive for. A friend long ago,

53:55she said to me something. She goes,

53:56"Flo, don't fight." And I was like,

53:58"What do you mean?" She's like,

53:59"Everything with you was like this like

54:00intense pursuit." And I said, "But I'm

54:02in I'm in love with the things I'm

54:04doing." And she said, "Well, it's just a

54:06lot." I thought, and then I realized

54:09like, oh, yeah, she really flows through

54:10life. She's accomplished, but it's just

54:12kind of in flow. Like there isn't this

54:14push energy. And you know in Eastern

54:17medicine and philosophy they talk about

54:19like it gets interesting right at the

54:21level of neuro anatomy they talk about

54:22sort of like whether or not you're

54:23pushing yourself from the back of your

54:25body versus being pulled from the front.

54:27I mean it's mystical and vague to

54:29somebody like me trained in western

54:31science but I think they're on to

54:32something

54:33>> like whether or not you're expending

54:34extra energy kind of forcing yourself to

54:38do things. Yeah.

54:38>> In your undergraduate students your

54:40patients

54:41>> I'm assuming you see the full range.

54:44>> I do. Yeah.

54:45>> If you were to editorialize a little

54:47bit, what do you think is the the key to

54:49both satisfaction from work,

54:51satisfaction, realistic satisfaction

54:54from outcomes and and kind of uh peace

54:57like a good life?

54:58>> Well, it's interesting, isn't it?

54:59Because there and there is some research

55:00on this. you know, the Harvard U study

55:03of aging looked at these people, these

55:06men who I think were in their late teens

55:11um and followed them up uh to their 60s

55:14and 70s. And my recollection of that

55:17data is really interesting that there

55:19are some people who lived a kind of

55:21average life and they had a average

55:25family, they had average income, they

55:28had an average house. And then there

55:31were other people who really looked like

55:34they were going to soar and something

55:38happened to those people along the way.

55:40They didn't saw, they they fell. And

55:42then finally there was another group who

55:44actually did saw and were right up here.

55:47But when they looked at the happiness

55:49levels of these people, it was the

55:51average person who actually would

55:55self-report the highest levels of

55:57happiness. So ambition doesn't

55:59necessarily equate with happiness, which

56:02I think many people would agree with

56:04with that. But on the other hand, it

56:07seems to be such an important thing for

56:10humans, right? For so many humans, it's

56:12not sufficient just to be at the 50%. We

56:15really want to propel ourselves, whether

56:17we're pushed or pulled, whatever it is.

56:19We want to get there. So, it would be a

56:21great area of research, wouldn't it? To

56:23find out how ambition is encoded in the

56:26brain and how does it work, you know,

56:28because there's also the question of

56:30realistic ambition. So, if someone had

56:32told me when I was younger, don't be

56:34stupid, be realistic. You're never going

56:37to get to Oxford as an undergraduate.

56:40And you're never going to have a career

56:42where you're going to be doing clinical

56:46neurology as a clinically qualified

56:48person doing neuroscience research,

56:52editing a journal, writing a book.

56:54That's not going to happen. If I had

56:56thought in those ways, it probably

56:58wouldn't have happened. I just didn't

57:00think that we should have these

57:01boundaries to what you can do.

57:02>> Yeah. The early messaging is key.

57:04>> I think it is. Yeah.

57:06>> Yeah. I'm the son of a scientist and I

57:07was born and raised in Silicon Valley

57:09and I realize only now that it

57:11completely shaped my brain in terms of

57:14like you want to do something you go try

57:16it and there's a good chance you can

57:18succeed and I mean even friends that

57:20went the way of athletics if they didn't

57:22succeed there they started companies

57:24that succeeded and and some crashed and

57:26burned mind you in all these domains in

57:27academia too we see it right ambition

57:30doesn't protect against disease or poor

57:33judgment in a lot of times either But it

57:36is fascinating and and maybe our species

57:39needs a distribution of kind of

57:40motivational circuitries in the way you

57:42describe certainly developing new

57:44technologies that transform medicine.

57:47Yeah,

57:47>> someone needs to do that. They can't be

57:49happy with just the scalpel and the

57:51current surgical mask and the current

57:53questionnaire that you ask patients in

57:55psychiatry. I mean, we need tool

57:57builders and that takes a vision of

57:59something that doesn't exist or kind of

58:01sense that there's something else.

58:03>> Absolutely. And so, you know, God bless

58:05the the people that do that, but also

58:08>> it's nice to have members of society

58:09that are just happy living their lives

58:11because otherwise, what else is all that

58:12technology [laughter] for, right?

58:14>> Yeah. No, I'm not making any judgments

58:16here. I'm just saying it's a really

58:18intriguing thing if you could get any

58:21kind of handle on what what makes this

58:23happen, this range of ambition. I didn't

Psychedelics, Anhedonia & Changing Self

58:25think we were going to discuss

58:26psychedelics and we don't have to if if

58:28if you don't want to. But these days

58:30there's growing interest in what are

58:32essentially and let's talk about classic

58:34psychedelics. Let's forget MDMA is not a

58:36psychedelic folks. It's an impathogen.

58:38Ketamine is not a psychedelic. It's a

58:40dissociative anesthetic. So people lump

58:41these things together and we'll move

58:43ibain and LSD and the those are

58:46different in the realm of psychedelics.

58:48Psilocybin is one that's increasingly

58:50being used in clinical trials and

58:52>> it's not a cure all but many people who

58:54do who are in these clinical trials come

58:57through talking about a kind of a more

58:59connected sense of self to the world and

59:02you know it seems to um take the edge

59:05off of the hyper ambitious miserable

59:07person.

59:07>> That's my observation anyway. And it

59:10also seems to take some people with

59:13major depression to a place of like oh I

59:15actually could change. I could get a

59:18different outcome which is

59:19[clears throat] simply plasticity.

59:20>> Yeah.

59:20>> So what is your thought about our

59:22ability to radically change our

59:25self-perception right

59:27>> in terms of our ability to do things in

59:30the world accomplish things in the world

59:31because that's really what getting over

59:32depression is about. It's about

59:34imagining a different outcome for

59:36oneself.

59:36>> Yeah. It's a very important question and

59:38I'm not an expert on psychedelics but I

59:40think there is some emerging research on

59:42the effect of psychedelics on what is

59:45called anhidonia lack of pleasure that

59:47you could get from something. So you

59:49know we talked about changing effort but

59:51it could be that one variable that

59:53happens in people with low mood is that

59:57they devalue the reward. Everything

1:00:01seems bland. It doesn't seem pleasureful

1:00:04anymore. So psychedelics seem to have an

1:00:07effect on the self. That principle is

1:00:09really interesting because the kind of

1:00:11patients that I study, the kind of

1:00:13patients that I describe in the book are

1:00:15people in whom there was a change in the

1:00:17self. There was a change in the way they

1:00:21portrayed themselves to the world, their

1:00:24social identity, but also in their

1:00:26personal identity. And this is a really

1:00:28big area. I mean, what what makes the

1:00:30self? But the key thing here is that the

1:00:33self can change. The self is not set in

1:00:35stone. We talked about psychedelics, but

1:00:38even even simple things like if you have

1:00:41too much thyroxine, thyroid hormone

1:00:43floating around in your body and you're

1:00:45in hypothyroid state, people might be

1:00:48surprised to hear that that can cause

1:00:49not only irritability but cognitive

1:00:52impacts on your processing. It can also

1:00:55be the same. You know, sometimes if you

1:00:57have lack thyroxine, if you're hypo

1:01:00thyroid, your cognitive functions may go

1:01:04so low that sometimes people wonder if

1:01:06you're developing dementia. It can be

1:01:07that bad. Now, most people wouldn't

1:01:09think thyroxine, why would that affect

1:01:11the self? It's a hormone that affects

1:01:13metabolism, for example. But of course,

1:01:15thyroxine also affects neurons. And I'm

1:01:18just using this as an example to show

1:01:20that something that seems as simple as

1:01:23having too much or too less of a

1:01:25particular hormone that we all need can

1:01:26alter the self. The way that the self is

1:01:30in people with brain disorders from

1:01:33stroke, from Alzheimer's disease, from

1:01:34Parkinson's disease, from traumatic

1:01:37brain injury, the self can change

1:01:39remarkably. And what I try to illustrate

1:01:43in the book is that you can have one

1:01:45domain of cognitive function affected.

1:01:48It could be memory. It could be

1:01:50perception. It could be attention. It

1:01:52could be your understanding of concepts.

1:01:54It could you be your representation of

1:01:56your body or the way you control your

1:01:58behavior. Someone may become very

1:02:00impulsive. Each of those domains in and

1:02:03of themselves contribute to our

1:02:06perception of the self. I mean Marvin

1:02:08Minsky, one of the pioneers of AI,

1:02:10called this the society of mind. You

1:02:12know the self emerges from the interplay

1:02:16and the activity of this society of

1:02:19mind. If we take one of the modules out

1:02:23of that society, memory, attention,

1:02:26language, whatever it is, the self is

1:02:29changed. It's not that you've deleted

1:02:31the self. The self has changed and it's

1:02:34observable. You know, someone's personal

1:02:36identity can change, their social

1:02:38identity can change. So, I think the key

1:02:41point here is the self is not immutable.

1:02:44It's something that can change. People

1:02:46might think my personality is this way.

1:02:48It can never change. Well, your

1:02:49personality is the product of your

1:02:53society of mind. The cognitive processes

1:02:55that are going on all the time, of which

1:02:58we are consciously aware of only a

1:03:00fraction under the hood. 95% of the

1:03:03stuff is going on without us consciously

1:03:06being aware of these processes.

1:03:08>> It seems and I'm not trying to play

Personal & Social Identity, Tools: Curiosity, Purpose & Dementia Risk

1:03:10psychologist here that fulfilling roles

1:03:13in our [clears throat] daily lives is an

1:03:15important part of our self-concept. You

1:03:17know, I'm a student, I'm a teacher, I'm

1:03:19a husband, I'm a wife, I'm a whatever it

1:03:22happens to be feeds back heavily on our

1:03:24notions of self. Yeah.

1:03:25>> Are we fulfilling this role well or less

1:03:27well? But there's another piece and I

1:03:30know this exists more in Eastern

1:03:32philosophy and I am not versed in that

1:03:34where we wake up each day and we know

1:03:36who we are. We don't forget who we are.

1:03:39>> We're carrying our prior life experience

1:03:41to that day. And I love the idea that we

1:03:43can change ourselves at the level of

1:03:47like optimism or anything. To me, that's

1:03:50like the apex of neuroplasticity.

1:03:52>> But of course, we want to hold on to

1:03:54something consistent. We don't want to

1:03:55wake up and not know where we are or who

1:03:57we are. That's super scary, too.

1:03:59>> So, is it the case that when we take on

1:04:02a new role that we are fundamentally

1:04:05changing? And it also seems that unless

1:04:08we're very young, most people don't add

1:04:12new roles over time. I mean, they might

1:04:14become a parent or a grandparent, have

1:04:16some friends, but you sort of have a

1:04:18limited number of roles in life. And so,

1:04:20it seems like doing new things could

1:04:23actually change the self. And that

1:04:25[snorts] seems exciting. And I think

1:04:27it's not a depressing thought to me that

1:04:30many [clears throat] people probably

1:04:31would like to change themselves somewhat

1:04:33or a lot. They want to feel like a

1:04:35different person,

1:04:36>> but not so different that they lose

1:04:38touch with the prior person so they can

1:04:39look at the the Is that is that

1:04:41catching?

1:04:42>> Yeah, I understand where you're coming

1:04:43from. So on the one hand, of course, our

1:04:46ideas of who we are, ourselves rely on

1:04:50our embodied self. We occupy a body.

1:04:52>> Mhm.

1:04:53>> My body, the one I occupy, is different

1:04:55from yours. And so we have different

1:04:58physical identities in that respect. But

1:05:00we also have different perspectives,

1:05:03experiences, and those experiences give

1:05:07us our firsterson experiences. You know,

1:05:09if I put my hand in the fire, I'm the

1:05:11one who's going to feel the pain. If I

1:05:13pick up this cup, I have agency of what

1:05:16I do. Those are my first person

1:05:17experiences. and the physical identity

1:05:20in terms of both the body that I occupy

1:05:24and the first person experiences that I

1:05:26have stretch back over time and

1:05:29therefore I have more confidence that

1:05:31this is me.

1:05:32>> Mhm.

1:05:32>> I've occupied this body. It's grown up.

1:05:34It's also aging and I've had these

1:05:37experiences that make me me. I've made

1:05:39these choices. I made these decisions. I

1:05:41had these memories. That's what

1:05:43contributes to my personal identity. And

1:05:46the other bit you mentioned was really

1:05:49relates to social identity, my roles.

1:05:51When someone asks you, who are you? Tell

1:05:53me a little bit about yourself. It's

1:05:55inevitable that we'd say, well, I I grew

1:05:57up in San Francisco in the Bay Bay Area.

1:06:00I did this. I went to as an

1:06:02undergraduate to here. I had these

1:06:04experiences. If you're religious, you

1:06:06might say this is my faith. If you

1:06:09follow a particular sporting team, you

1:06:11might say, "I'm a big fan of this

1:06:13particular team." If you were influenced

1:06:16by some very important people in your

1:06:18field, you might say, I am part of that

1:06:22school of thinking in this way that

1:06:25defines your social identity and that's

1:06:28a really important part of who you are.

1:06:30So there's the personal identity, the

1:06:32body, the first person experiences and

1:06:35there's a social identity. And again,

1:06:36social identity over time is is very

1:06:39very important to change from these

1:06:43things which we have grown up with these

1:06:46identities is possible. As we've said,

1:06:49it's possible through something hormonal

1:06:52like changes in thyroxine. It's possible

1:06:54through brain disorders. But these

1:06:56principles suggest that it's possible

1:06:58through what we do.

1:07:00>> And interestingly, I think there is an

1:07:02evidence base for this. So, as we grow

1:07:04older, for example, as you're coming to

1:07:07retirement, your

1:07:10network of friends, your social

1:07:12connections often shrinks. People may

1:07:15have moved away. You're going to no

1:07:18longer have the colleagues that you

1:07:19interacted with because you're going to

1:07:21retire. Your family is now old. your

1:07:24children have moved away, the network is

1:07:26shrinking. But it turns out that the

1:07:28data show across many studies that

1:07:31people who keep relationships increase

1:07:34or maintain the number of social

1:07:37relationships they have, they have a far

1:07:40less risk of developing dementia than

1:07:42those who don't. If we correct for all

1:07:44other confounding factors, people who

1:07:47have a sense of curiosity, who are

1:07:50open-minded, want to engage in something

1:07:52new, perhaps a new hobby, a new pursuit,

1:07:55whatever it is, they also have a far

1:07:58lower risk of developing dementia. And

1:08:01you mentioned this term sense of

1:08:03purpose. So, you know, that's used or

1:08:05misused in various ways in different

1:08:07places. But if we take sense of purpose

1:08:10as thinking you know I get up in the

1:08:11morning with a sense of I need to do

1:08:14this I have a purpose in life those

1:08:16people who say that are also more

1:08:19resilient to cognitive decline over time

1:08:23>> which is a remarkable thing.

1:08:24>> It's incredible. Yeah.

1:08:25>> And it makes me wonder if the key to

1:08:28evolving the self is about verbs not

1:08:34labels.

1:08:34>> Mhm. which sounds like a very California

1:08:36newagy like let's be about verbs not

1:08:39labels but I mean it because if you're a

1:08:41scientist like people will say like I'm

1:08:43a scientist okay so you get a degree in

1:08:46science awesome as an undergraduate

1:08:48somebody does that means they learned a

1:08:49lot of science but if you're a doctor a

1:08:52physician you're a physician and a

1:08:54scientist and many other things too

1:08:57it's really about the things that you

1:08:58did and do in those roles that really

1:09:02shape your brain just having a PhD D I

1:09:05can promise you doesn't do anything for

1:09:07you and no one really cares after a

1:09:08short while. But the things you learn,

1:09:11the failures, the the your strivings,

1:09:14your successes, like those really shape

1:09:16your self-concept. Goes back to what we

1:09:18were talking about before about they

1:09:19shape our thinking about what we could

1:09:21do or potentially not do if we were to

1:09:24strive, which raises a very specific

1:09:26question. What does David now think

1:09:29about apathetic David? And what does

1:09:33David now think about David before he

1:09:36became apathetic? His memory of self is

1:09:38as interesting to me as the

1:09:40transformation. Although the

1:09:42transformation is clinically like

1:09:43remarkable and awesome and I just want

1:09:45to tip my hat to it again. I mean you

1:09:47saved a life basically. It's so cool and

1:09:49physicians do this. This is my

1:09:51admiration for physicians. But what does

1:09:53he think? Is he like, "Oh yeah, I was in

1:09:55a state, you know, I need more dopamine.

1:09:57I take this drug. I have more dopamine

1:09:58and now I'm good." And how has that

1:10:00evolved over time? No, I think after he

1:10:03improved, he certainly looked back on

1:10:07the situation he was in and could not

1:10:09believe that he couldn't create that

1:10:12effort that

1:10:13>> disbelief.

1:10:14>> Yeah.

1:10:14>> Like a disconnect like how could that

1:10:16>> how could I not have done that because

1:10:18all he had to do is put the cables

1:10:20together to, you know, listen to music,

1:10:22right? It's such a simple thing. He

1:10:24didn't have to do a huge amount. But

1:10:26this is like somebody who has a skill

1:10:28telling somebody else like, "Hey, you

1:10:29just like dunked the basketball and

1:10:31you're like, [laughter] "Yeah, but

1:10:33>> but if it's you telling yourself, how

1:10:36can how can I how could I be like that?"

1:10:39>> Because obviously he has memories of

1:10:41what he used to be like before those

1:10:44strokes hit him that he was this highly

1:10:46productive, very socially engaged

1:10:48person. So, I guess you can see it

1:10:52afterwards, but at the time you you

1:10:56can't necessarily have you don't

1:10:58necessarily have the inside. It's

1:10:59interesting this week I was reading that

1:11:01um Carly Simon uh was speaking about the

1:11:04fact she's developed Parkinson's

1:11:06disease, but she mentioned that one of

1:11:07the biggest problems is her apathy. She

1:11:10can't believe that she's become

1:11:11apathetic. Now, she obviously has

1:11:14insight into the problem that she's

1:11:16developed apathy, but nevertheless can't

1:11:20necessarily change that because, you

1:11:23know, there's if circuits that affect

1:11:25motivation are not firing as they should

1:11:29be. No matter what you think, you're not

1:11:32necessarily going to be able to change

1:11:33things.

1:11:34>> Yeah. That's like if anyone has ever had

1:11:36transranial magnetic stimulation, it

1:11:38it's like they can inhibit your ability

1:11:40to move a finger and it's like you can

1:11:43>> will that finger to move with everything

1:11:45you've got

1:11:46>> and it doesn't move and then they take

1:11:48the coil off your head and it just you

1:11:50can tap your finger. It's it's a

1:11:51remarkable thing to feel that it's

1:11:54painful in in a psychological way. Very

1:11:56painful. We've all heard of mania. I'm

Addiction, Dopamine; Social Media & Dopamine “Hits”?

1:11:59not an expert in mania, but seems that

1:12:02when people are manic, they have tons of

1:12:04energy, tons of motivation. Yeah. To do

1:12:07everything, everything is a good idea.

1:12:10>> And it's mostly about them, you know.

1:12:12Same if you see people on

1:12:14methamphetamines, it's not a very

1:12:15empathic state. It's not about like what

1:12:18can I do for society with all this extra

1:12:19energy. It's a very me state. You see

1:12:22this cocaine, empetamines, manic states.

1:12:25It's every idea is a great one and

1:12:26there's billions of ideas. So much so

1:12:29that people are doing trivial things

1:12:31thinking it's interesting or even

1:12:33damaging themselves or others. Are all

1:12:35of those hyperdopamineergic states?

1:12:38>> Is it just this motivational circuitry

1:12:40just gasp pedal to the floor?

1:12:42>> And what does it tell us about

1:12:44motivational states? Because I do think

1:12:45the extremes are are interesting. So, I

1:12:47don't know much about mania, but it

1:12:49turns out um when I was having to prov

1:12:53present a lecture on motivational

1:12:55disorders, I thought I would dip in to

1:12:57the neuroscience of addiction. I'm not

1:12:59an addiction expert. And to my surprise,

1:13:02almost every drug of addiction, whether

1:13:04we go from nicotine to alcohol to heroin

1:13:07to cocaine to amphetamine, almost every

1:13:10drug of addiction hijacks that dopamine

1:13:14system. when we were talking about this

1:13:16circuitry that goes from the basil

1:13:18ganglia to the frontal loes and I don't

1:13:21think that's a coincidence that we find

1:13:24when that circuitry is not working as in

1:13:26David that you can get profound loss of

1:13:29motivation apathy when that circuitry is

1:13:32on overdrive because it's been hijacked

1:13:35by these drugs you get states of hyper

1:13:37motivation so of course this is going to

1:13:40be overly simplistic to think dopamine

1:13:43levels

1:13:44are the only factor that affect our

1:13:47motivation. But it certainly turns out

1:13:50to be a very important factor in the

1:13:53sort of graduating the level of

1:13:55motivation we have to seek particular

1:13:58outcomes. And of course in the drug

1:14:00addiction literature that's really

1:14:01become what do you find

1:14:05incentively salient

1:14:07to act in order to try and get that

1:14:11outcome. But it's the same circuitry.

1:14:13And isn't that an amazing thing that

1:14:15neuroscience has stumbled on? People who

1:14:18study apathy like me would not

1:14:20necessarily study the addiction

1:14:22literature. But when you do, you find

1:14:24that there's absolute convergence

1:14:26between this circuitry on the one hand

1:14:29being hypoactive and leading to apathy,

1:14:32on the other hand being hyperactive and

1:14:35leading to addictive states. There's a

1:14:38lot that's been said about, you know,

1:14:40are we constantly getting dopamine hits

1:14:42with online behavior? And there's, you

1:14:45know, platforms are incentivized to keep

1:14:46us scrolling. This is certainly true.

1:14:49>> It seems almost compulsive

1:14:51>> more than it feels rewarding. I mean,

1:14:54it's a interesting thing to observe

1:14:55oneself engaging in a behavior where the

1:14:58reward is gone. The subjective sense of

1:15:00the reward is gone, but we proceverate.

1:15:02>> There are two things here. One is yes, I

1:15:05agree with you that this sort of

1:15:06behavior, doom scrolling, etc. occurs,

1:15:09but I think the evidence that there are

1:15:10dopamine hits when you're doing this

1:15:13isn't really very strong.

1:15:14>> I agree and I'm grateful that you said

1:15:16that because people say, "I'm doing this

1:15:18for dopamine. I'm doing this for

1:15:19dopamine."

1:15:20>> Certain platforms and certain content

1:15:22does take us into drama and high

1:15:24arousal.

1:15:25>> I don't know if there's dopamine

1:15:26associated with it. We could explore

1:15:28that perhaps. It's an area I'm very

1:15:30interested in. But a lot of it is sort

1:15:33of,

1:15:34>> if I may, mindless numbing out type

1:15:36behavior. It doesn't feel good. It

1:15:39doesn't feel bad.

1:15:40>> People do often report that when they

1:15:42put the thing away, they're like, "Oh my

1:15:43god, I wasted some more time." But

1:15:45they're not really so down in the trough

1:15:46that they don't do it again.

1:15:48>> So, there must be something somewhere in

1:15:49between. I agree. I don't think of it as

1:15:52like dopamine hits. It's something else.

1:15:54>> It can be something else. But the second

1:15:56point that you're making here is you may

1:15:59not actually like it what you're doing.

1:16:01You may even be aware that you don't

1:16:02like it. And of course in drug addiction

1:16:04that's also sometimes a paradox that

1:16:06addicts seek this thing they want but

1:16:09they don't necessarily like it. They

1:16:11don't necessarily get pleasure from it

1:16:13if they consume it. And of course there

1:16:15is this dissociation in the neuroscience

1:16:19literature between wanting the

1:16:22motivation to go and try and find that

1:16:25rewarding outcome versus liking the

1:16:28hedonic pleasure from getting it. And

1:16:30the evidence suggests that wanting

1:16:33pursuit of a goal is mediated or

1:16:37modulated at least by dopamine whereas

1:16:39actually the liking the pleasure you

1:16:42might get from an outcome is not that

1:16:45seems to be related to uh opioid

1:16:48neurotransmitters in the brain. I think

1:16:50there's quite a lot of nice work by Kent

1:16:52Buridge and his colleagues on this in

1:16:54rodent models but the principles still

1:16:56apply. There can be a dissociation

1:16:58between wanting to do something and

1:17:00actually liking it.

1:17:01>> You're the first person to say that, you

1:17:03know, online scrolling probably doesn't

1:17:05lead to a ton of dopamine release. It

1:17:07seems the experiment should be done.

1:17:09It's not hard to get people to scroll

1:17:11while in a scanner, look at nucleus, and

1:17:14adjust the content. So there was an old

1:17:16experiment and it was done with a PET

1:17:18scanner many years ago in the

1:17:20Hammersmith Hospital in in London when

1:17:22the original scanning experiments were

1:17:24being done. And they used uh a dopamine

1:17:29receptor liant, something that will

1:17:32light up when this dopamine receptor

1:17:36drug attaches to dopamine receptors. And

1:17:40in an indirect way, you can work out how

1:17:42much binding of dopamine receptors is

1:17:45occurring endogenously with this with

1:17:48this technique. And they found that when

1:17:50someone was playing a video game, there

1:17:52was evidence that there was certainly

1:17:54more dopamine release in the vententral

1:17:56stratum in the basil ganglia. But the

1:17:58pausing out, the sort of deconstructing

1:18:01whether that dopamine release is due to

1:18:04the motivation you're getting when

1:18:06you're playing that game versus the

1:18:08liking that you're getting, the pleasure

1:18:10you're getting is not so

1:18:12straightforward, especially with pet,

1:18:14you know, which doesn't have the sort of

1:18:15temporal resolution of doing this. So in

1:18:18some ways it sounds straightforward to

1:18:20do the experiment but actually the

1:18:22subjective experience of liking and

1:18:25pleasure you're getting has to be

1:18:28temporarily dissociated

1:18:30>> from the motivation to act. Uh and

1:18:33that's not so straightforward.

1:18:35>> I'd like to take a quick break and

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Dopamine, Parkinson’s Disease; Other Roles of Dopamine

1:20:13I think of dopamine, of course, being

1:20:16involved in movement,

1:20:18>> which is why when it's depleted, yeah,

1:20:20>> people get Parkinson's or Parkinsonian

1:20:22like symptoms.

1:20:23>> But also, it seems that dopamine in an

1:20:26indirect or a direct way is involved in

1:20:29thought movement. Like, it's involved in

1:20:31moving thoughts and ideas forward, which

1:20:33is sort of a piece of motivation. Yeah,

1:20:36>> it's not the whole thing, but and so in

1:20:39these hyperdopamineergic states like

1:20:41people take empetamines or they're

1:20:43manic. It's like everything is about the

1:20:44future. It's from now forward. I don't

1:20:46know if people reflect on the past at

1:20:48all in those states, but

1:20:49>> yeah,

1:20:50>> having seen never I've never tried

1:20:52methamphetamine. I've never fortunately

1:20:54I don't have mania, but it seems like

1:20:55people are all about what could happen

1:20:56next. Yeah,

1:20:57>> that's where they get themselves into

1:20:58trouble is it's kind of a fire hose of

1:21:00that stuff.

1:21:01>> Social media is an interesting one

1:21:03because you're constantly updating the

1:21:04stimulus. You're giving likes, you might

1:21:08be receiving likes, you can make

1:21:10comments. And so if you think about it,

1:21:11it's like the perfect video game that

1:21:14goes in a infinite loop.

1:21:17>> You just keep going and going and going

1:21:19and you're never going anywhere.

1:21:21>> But all the proper bells and whistles

1:21:23are getting tapped on. At least when I

1:21:24go to Vegas, which I do from time to

1:21:26time. Yeah.

1:21:27>> I like gambling a little bit. M like you

1:21:30could walk out with some or a lot more

1:21:33money or you could lose some or a lot of

1:21:35money.

1:21:36>> I generally break even or win a little

1:21:38bit like most people cuz I'm tempered in

1:21:40it. But at least there's a potential

1:21:42outcome you can take elsewhere,

1:21:44>> right? So I think about this all the

1:21:46time like what video game are you

1:21:48playing on social media? Not as a

1:21:50creator but as a consumer.

1:21:52>> What game are you playing?

1:21:53>> I mean what video game are we playing in

1:21:55reality in this?

1:21:56>> That's the big one. Yeah. Well, you're

1:21:58from Oxford. I'm from California.

1:21:59[laughter] So, you asked the big

1:22:00questions.

1:22:02>> No, but just coming back to some of the

1:22:03points you made. Dopamine depletion

1:22:06>> of course can lead to Parkinson's

1:22:07disease. But interestingly, a lot of

1:22:09researchers are thinking, is it really

1:22:11just action or is it motivation to

1:22:14action? So, you know, the classical

1:22:16thing they describe is if a Parkinson's

1:22:19patient is in a house and they've just

1:22:21realized it's burning, they will be able

1:22:22to run out of that house.

1:22:24>> Is that right?

1:22:24>> Yeah. So that's what they will say is

1:22:26that the motivation signal has suddenly

1:22:28ramped up to a level where it engages

1:22:32the action system. So it's a different

1:22:33way of framing why is there a reduction

1:22:37of action? Why is there bradicynesia, a

1:22:40slowing of movement in people with

1:22:42Parkinson's disease? That's really

1:22:44interesting. It doesn't just have to be

1:22:45about motor control. It could be the

1:22:47motivation to act just as we said with

1:22:50David, right? Because the Parkinson's

1:22:52pathology affects the basil ganglia.

1:22:55Basil ganglia is important for action,

1:22:57but it also has these motivation signals

1:22:59that link those motivations like there's

1:23:03a burning house here. I've got to run

1:23:04out to action to the outcome. And the

1:23:07second piece you mentioned, I think

1:23:09brings up the other question. Dopamine

1:23:11in the human brain isn't all about

1:23:14motivation to action. There's dopamine

1:23:16in other parts of the brain. We know

1:23:19from some really classical work by

1:23:21Patricia Goldman Rakit, for example,

1:23:23that dopamine is important for working

1:23:25memory, short-term memory. It's

1:23:26important for holding memories in mind.

1:23:29And it's probably very important for

1:23:31executive function, the kinds of things

1:23:34that we might think of as either

1:23:36initiating action or stopping it,

1:23:38inhibiting it. You know, stopping our

1:23:41impulsive thoughts from getting out. You

1:23:43know, we might think someone is

1:23:45addressed inappropriately, but you and I

1:23:46wouldn't say that to them. But someone

1:23:48who might have a change in their

1:23:50dopamine system affecting let's say the

1:23:52frontal lobe can somehow lose that

1:23:55control and become disinhibited.

1:23:58So initiation of action, stopping

1:24:00action, possibly switching from one goal

1:24:02to another and also those higher order

1:24:05things, you know, planning ahead, being

1:24:07able to think about planning ahead.

1:24:10Dopamine might also be important for

1:24:11those aspects of executive control. So I

1:24:14wouldn't want your audience to think all

1:24:15that dopamine does is this motivation to

1:24:18action. There's a lot of evidence it

1:24:19does other stuff.

1:24:20>> The Parkinson's person in the burning

1:24:24home is a remarkable result.

1:24:27>> Remarkable result

1:24:29>> completely changes the conceptual

1:24:32framework around Parkinson's and what it

1:24:34is at a circuit level. We've also done

1:24:36some more I guess constrained

1:24:40experimental studies, research studies

1:24:42in Parkinson's disease where my

1:24:44colleague Sanjay Manahar and I were

1:24:46looking at eye movements. And eye

1:24:48movements are very ballistic. They're

1:24:49they're pre-programmed. You know, they

1:24:51have a particular velocity. And what

1:24:53we've managed to show is if you increase

1:24:56the incentive, the reward you get if you

1:24:59make a rapid eye movement, you can find

1:25:01that the velocity of eye movements in

1:25:04Parkinson's disease can increase just as

1:25:07it can increase in you and me. But if

1:25:09you add dopamine to to a patient with

1:25:14Parkinson's disease, that velocity

1:25:16increases even further. you've increased

1:25:19the vigor of a simple thing like an eye

1:25:22movement. So that goes along with this

1:25:24idea that it's not just inaction,

1:25:28you need incentives for action and

1:25:31dopamine is important for those

1:25:33incentives. In some sense, the the

1:25:36person with mild Parkinson's, while we

1:25:38wouldn't wish this on anybody,

1:25:40>> um, is hyperrational, like they're not

1:25:43going to initiate action unless it's

1:25:46there's really a potential payoff. I

1:25:48mean, many people have an excess of

1:25:50energy, so they can afford to like move

1:25:52about and do all sorts of things and

1:25:54pick things up and put them down and a

1:25:56lot of wasted energy out there. I'm not

1:25:58saying that people should give

1:25:59themselves Parkinson's by any stretch,

1:26:01but

1:26:02there does seem to be a kind of built-in

1:26:05feature slashflaw of this dopamineergic

1:26:08system that it's so subject to learning.

1:26:12>> So, prior experience can really bias us

1:26:14towards or away from things. That's good

1:26:17and bad, right? But also, you know, that

1:26:21the person with Parkinson's, just the

1:26:23mere fact that they need an elevated

1:26:25motivation to hit some threshold for

1:26:27action, I think it reveals a lot about

1:26:29people without Parkinson's. Like, we're

1:26:31we're wasting a lot of energy all day

1:26:33long.

1:26:33>> You might say it'd be efficient just to

1:26:35do nothing. Maybe David was very

1:26:37efficient. You know, he didn't do

1:26:38anything.

1:26:39>> His roommates definitely took care of a

1:26:41lot. It sounds like it's not it's not

1:26:43functional for an adult to be like that

1:26:44after a while, but society sort of

1:26:46operates on this. Yeah,

1:26:48>> there's largely been made some room for

1:26:50people who are just not going to

1:26:52contribute and other people who

1:26:53overcontribute and then it's a

1:26:55distribution

1:26:56>> and sort of what allows us to to

1:26:58function

Life Purpose, Culture; Reflection, Weighing Decisions

1:26:59>> at risk of going into really um high

1:27:01high level territory here. You said

1:27:03something you said you know what game

1:27:05are we playing here after all?

1:27:07>> It's an important one I think to ask. We

1:27:08don't want to go down that rabbit hole

1:27:10too often or too deeply because we can

1:27:12get lost. We have our roles to carry out

1:27:14in life after all. But I think about

1:27:16this a lot. You know, I do think the

1:27:19first third to half of one's life,

1:27:22assuming people live somewhere between

1:27:2370 and 100 years of age, is about

1:27:28learning all these contingencies,

1:27:30developing social skills, what works,

1:27:32what doesn't work, hopefully avoiding

1:27:33traumas, but if you have some,

1:27:35eventually overcoming those, seeing that

1:27:37not everything has to end that way in

1:27:38that domain. And you know, and then you

1:27:40hit the middle of your life and you do a

1:27:42few more rounds of learning and

1:27:44extending oneself and building oneself

1:27:47and family and culture and but then

1:27:50there does seem to be something that

1:27:51happens to all humans is they they start

1:27:54reflecting a little or a lot

1:27:56>> like what game are we playing here? Were

1:27:58we just leveraged by all these

1:28:00evolutionarily constrained circuits and

1:28:02drives

1:28:03>> or is there something that we're

1:28:06>> supposed to focus on or aspire to? And

1:28:08then I think most people just shove it.

1:28:10It's just way too much to think about.

1:28:11It's really heavy to think like maybe

1:28:14there is really no purpose in this. And

1:28:16then it's also fun and and can really

1:28:19lift you up to things like oh this is

1:28:20cool. Like this this game we call life

1:28:22is actually a really amazing gift.

1:28:25>> Yeah.

1:28:25>> Which is sort of where I live these

1:28:27days. Like

1:28:28>> think I'm so grateful my parents made me

1:28:30like that alone. Like I have no gripes

1:28:32about anything else anymore because they

1:28:34made me like I'm here. So many people

1:28:36didn't make it here. It's it's a great

1:28:38place to start. Yeah. You know, one's

1:28:40day and then you have to go do stuff.

1:28:42So, how do you conceptualize like what

1:28:44we're going after and and for each of

1:28:47us, I think it is important to step back

1:28:48and ask these highle questions,

1:28:50especially after age about 35, 40

1:28:53because the early part you really are

1:28:54just trying to acquire the skills to

1:28:56navigate life.

1:28:57>> Yeah. I think your background makes a

1:28:58huge difference and as you were speaking

1:29:00I was thinking of course this also

1:29:03speaks to culture, right? The culture in

1:29:05which you grew up also defines some of

1:29:08the goals, the aspirations, the

1:29:10ambitions you have. It could be the

1:29:11larger culture growing up in the United

1:29:14States versus growing up in the culture

1:29:17of your family as well. Those are

1:29:19obviously important aspects. So when you

1:29:23are growing up, I think a lot of it is

1:29:25dominated by the environment. You call

1:29:28them contingencies, the culture in which

1:29:30you're growing up. But in a way, of

1:29:32course, as we're growing up, we are also

1:29:35contributing to that culture. You know,

1:29:38if we have kids, we are also

1:29:40transmitting this information. And

1:29:42perhaps the one of the most important

1:29:44things that people do between

1:29:46generations is transmit the culture, the

1:29:49culture, the local culture of the home,

1:29:51the domestic home, the wider culture in

1:29:54terms of the values shared by the tribe

1:29:56you happen to be a member of. All of

1:30:00those things shape what we do. And

1:30:02perhaps a generation ago, even a

1:30:04generation or two ago, people didn't

1:30:06have the luxury of reflecting back on

1:30:10what on earth are we doing this for.

1:30:11They were surviving. They were just

1:30:13surviving. And of course, there are many

1:30:14people in the world today who are also

1:30:16surviving. They're going, you know, what

1:30:17are you on about? You know, I just have

1:30:19to survive. This is not a game of

1:30:21anything else. We've got to a point as

1:30:23humans though where we have the luxury

1:30:26some of us that we can have time to even

1:30:30consider what this is all about. And one

1:30:33of those things I think is where our

1:30:35culture is going. That's really

1:30:36important. It's a very big question in

1:30:38the US at the moment in terms of what is

1:30:41the culture? What are the values we

1:30:43consider to be part of the tribe? How

1:30:46big is the tribe actually? How many

1:30:47tribes are there? That's so important, I

1:30:50think, in influencing my answer to that

1:30:52question is thinking, yeah, what game

1:30:55are we playing? Well, we're playing a

1:30:56game that's been played for centuries

1:30:59and generations, and that has led to

1:31:02human culture as we know it, highly

1:31:04successful in so many ways, but also

1:31:07capable of dysfunctional activity as we

1:31:11know. as a physician. Um I'm sure there

1:31:13are many reasons you go to work each

1:31:15day, but just you personally if if

1:31:17you're willing, uh where does your mind

1:31:20go when you reflect on your career,

1:31:22past, present, and future? Do you think

1:31:24about making a specific type or size of

1:31:28contribution? Like what's deeply

1:31:29satisfying for you? I've got to the

1:31:32point where if [snorts] I have to make

1:31:34decisions or choices about things to do,

1:31:38I am going to make what I would call my

1:31:40deathbed decision here. I want to think

1:31:44that when I am passing away on my

1:31:47deathbed, I can look back on this

1:31:49decision and think that was a valuable

1:31:52thing to do for me. I take pride in it.

1:31:55I did something useful. It could be for

1:31:56me. It could be for my family. It could

1:31:58be for somebody else. But I can look

1:32:00back on that and think that was worth

1:32:01it. So if someone gives me an option of

1:32:04doing something that I would say no that

1:32:07really would not be something I would be

1:32:08proud of or value

1:32:10in any way esteem, I just say no. So the

1:32:13juice for me is do only the things if

1:32:16you can if you have that option do only

1:32:19the things that you think will be

1:32:22valuable in time to come. That's I think

1:32:25I've got to that point where I can think

1:32:27like that. And obviously there are some

1:32:29things we just cannot avoid. What did

1:32:31you call it? Wood. Wood. What was your

1:32:33>> Oh, chop wood. Carry water.

1:32:34>> Chop wood. Chop wood. Carry water.

1:32:36>> Yeah, that's a friend of mine who came

1:32:38from a blueco collar background and now

1:32:40he's an academic and a clinician. And he

1:32:43just said, you know, there's some things

1:32:44just like you just when you grow up on a

1:32:47in a farmish community. He wasn't like

1:32:49farm per se, but you know, it's like

1:32:51rural community. You know, there's

1:32:52certain times a year where you just chop

1:32:54wood, carry water. It's no fun. like you

1:32:57don't necessarily want to do it but the

1:32:59pleasure at the end of the day is in

1:33:01having chopped a lot of wood and carried

1:33:03a lot of water.

1:33:04>> Yeah. And sometimes as you said you got

1:33:06to do that

1:33:07>> to make the other things happen. So I

1:33:08understand that. I'm just giving you the

1:33:10extreme view. So for me the juice is try

1:33:14and focus such that you do the stuff you

1:33:16you really think is valuable. That's

1:33:19really important to me. I understand

1:33:20that that may not be an option for many

1:33:22people. Well, I think almost everybody,

1:33:25not everyone, but almost everybody has

1:33:26the option to read book A or book B,

1:33:29listen to podcast A or B or episode A or

1:33:32B. And and I don't think we put quite as

1:33:34much thought into the decision-m around

1:33:36those these days. I try and do more of

1:33:38it. And um I [clears throat] appreciate

1:33:39your answer because

1:33:41>> I think for people who hear

1:33:43conversations with folks like you who

1:33:45are very accomplished, they assume that

1:33:48they're just sort of on a locomotive of

1:33:50achievement. work, achieve, work,

1:33:52achieve, and you had all this. Right.

1:33:54Exactly. But I know based on the short

1:33:57time we've had the opportunity to

1:33:58interact and the way you answer your

1:34:00questions

1:34:02>> that you think carefully about what to

1:34:04work on next because it's a huge

1:34:06investment to work on a David versus you

1:34:09could work on anything. You're a

1:34:10neurologist. You could quit neurology

1:34:12probably and just write. You could do

1:34:13any number of different things. So as

1:34:15you have more skills and more agency

1:34:17that the choice-making process becomes

1:34:18increasingly important, not less. Y

Internal & External Attention

1:34:21>> I'd like to talk a bit about your work

1:34:24on the way we sometimes can get

1:34:27dissociated from our environment but not

1:34:29necessarily dissociative disorders

1:34:32>> but [laughter] if we could do a little

1:34:33experiment with the audience you know I

1:34:35think everyone is familiar with the idea

1:34:37of closing their eyes and being inside

1:34:38of themselves then opening their eyes

1:34:41and still feeling yourself but also

1:34:43sensing the outside world

1:34:45>> and then moving through the world in a

1:34:47way where you're they're kind of going

1:34:48back and forth quickly you're sort of

1:34:50out there, but in here, out there. Of

1:34:52course, we're always in here. It's all

1:34:53an ab an abstract construction in our

1:34:55brain,

1:34:56>> but you've studied patients where

1:34:58they're not seeing big swaths of the

1:35:00outside world. Maybe you could explain

1:35:02what that's called and what it is and

1:35:04how it changes their perception of

1:35:06experience on the inside because this is

1:35:08something that I hope I'll never truly

1:35:11understand. Although, maybe you have an

1:35:12experiment where I can shut down some

1:35:14stuff and do it. But this is a really

1:35:16important aspect of being a human that

1:35:19we've never discussed on this podcast

1:35:20and hardly anyone talks about. We can go

1:35:22in here, we can be out there, but

1:35:24usually we're somewhere in between. How

1:35:25does all this stuff work?

1:35:26>> So the way many people would think about

1:35:28this is either internal attention or

1:35:31external attention. I mean attention is

1:35:33just a term we use and most of the

1:35:36audience will be very familiar with the

1:35:37idea of attention to things in the

1:35:39outside world. Why do we have a system

1:35:42for attention? And the way that many

1:35:44neuroscientists would put this is that

1:35:46the brain has limited capacity, right?

1:35:49It doesn't have capacity to process all

1:35:51the information in the outside world.

1:35:54It's coming at us in our eyes. It's

1:35:56coming at us in our ears. It's coming at

1:35:58us in our touch receptors in our skin.

1:36:03So if we were to upload all that

1:36:06information which is coming at a

1:36:08millisecond basis, it would be storing

1:36:11terabytes of information every minute or

1:36:14so. We don't have that capacity. Nor

1:36:17should we because we don't want to have

1:36:19neural space devoted to stuff that isn't

1:36:22important. Do you remember Google

1:36:24glasses? They were supposed to record

1:36:26everything that you saw through the day.

1:36:29They weren't successful when they came

1:36:31out because most people realize that

1:36:33actually most of the things that are

1:36:34happening during the day are boring.

1:36:36They're not very interesting. They

1:36:38shouldn't be things we pay attention to.

1:36:42So the first point is the brain has

1:36:44limited capacity. So some process has to

1:36:47be there to select the stuff that is

1:36:50important for you. And that process we

1:36:52call attention. And how does that work?

1:36:56Right? One way that many people think

1:36:58that works for the external deployment

1:37:01of attention is that items are competing

1:37:05for the selection of processing. That

1:37:07sounds a bit of a nebulous thing, but

1:37:09imagine you're walking down the street

1:37:11and suddenly you see a bit of a building

1:37:13is falling off and coming towards you.

1:37:15That grabs your attention. And

1:37:18neuroscientists call that, you know,

1:37:20bottomup attention, right? It's a

1:37:22sensory stimulus that's really

1:37:24important. It's grabbed your attention.

1:37:25You got to move.

1:37:27But you can also have goal directed top-

1:37:30down attention. You go to a busy railway

1:37:33station, you're going to meet a friend

1:37:34and she said, "I'm going to be wearing a

1:37:36red dress." So you can filter out

1:37:39everything else apart from all the

1:37:41people who are wearing something red and

1:37:44that gets you to a faster state of

1:37:46finding the person you're going to meet.

1:37:48So we've got bottom up attention, we've

1:37:50got top down goal- directed attention.

1:37:53But where do we normally deploy this? I

1:37:55mean, so if there's something very

1:37:56important bottom up, like a bit of a

1:37:58building falling towards you, that will

1:38:00grab your attention because the system

1:38:02is designed, our systems are designed to

1:38:06devote all the resources that we have to

1:38:08that very important threat. Now, in

1:38:11terms of goal directed attention, that

1:38:14might also in include internal thoughts.

1:38:17So if I'm in a lecture and I'm listening

1:38:20to somebody, I may fade in and out of

1:38:24attending externally

1:38:26and then I might be captured by internal

1:38:30thoughts. I might be thinking, yeah, I

1:38:33should have really made some plans for

1:38:35this evening because I haven't really

1:38:36done that. How can I what can I do this

1:38:38evening? Right? Should I make a booking

1:38:39for a restaurant or something like that?

1:38:41I should have done that earlier. I'm now

1:38:43thinking my attention is captured by

1:38:46these internal thoughts. So one way that

1:38:49we have tried to understand this stuff

1:38:52is that items are competing for our

1:38:55attention. Either external items or

1:38:57internal thoughts are competing for

1:39:00where we are focusing our resources. So

1:39:02attention is really just a way of

1:39:06explaining the fact that we're devoting

1:39:08our brain resources to this particular

1:39:12location in space or this thought. So

1:39:17closing your eyes thinking internally is

1:39:20really just an extreme form of putting

1:39:23all your resources into a particular

1:39:25thought. But that happens as I said even

1:39:27with your eyes open you can be

1:39:30distracted by this thought in your head

1:39:33even though your eyes are open and there

1:39:34are things going at them because in this

1:39:37competition for selection at that moment

1:39:40that thought has captured your neural

1:39:43processing and that's happening because

1:39:45the brain has limited capacity. Things

1:39:48are competing for selection

1:39:50because of that limited capacity. So you

1:39:52can only focus your processing on a

1:39:56small number of items at a time, perhaps

1:39:58even just one.

Internal Chatter, Distraction; Working Memory, Stimulants, Nicotine

1:39:59>> I think if you pulled most people, they

1:40:02would say that they experience too much

1:40:05inner what's been called chatter. We had

1:40:08Ethan Cross on the podcast. He's a

1:40:10psychologist at University of Michigan

1:40:11and he wrote a book about chatter. And

1:40:14people would love to turn off their

1:40:17thoughts because most of what people

1:40:20report as their inner chatter is not

1:40:23pleasant. It's not necessarily

1:40:25unpleasant. It's not like you're a

1:40:27terrible person. You're what are you

1:40:28doing with yourself? Or it's just it's a

1:40:30nuisance. I do think that some of the

1:40:32more effective people I've known in life

1:40:35have low activation energy and they seem

1:40:38to think, make a decision. Once they

1:40:42make the decision and there could be

1:40:44some contemplative time first to be

1:40:45fair. They make a decision and then they

1:40:48are able to be fully engaged in the

1:40:50thing and they're able to turn down the

1:40:53volume on their inner landscape. Their

1:40:57attention drifts out. Maybe it's in

1:41:00themselves only in so far as it's

1:41:03required to do the thing really well. I

1:41:05actually think this might be the flow

1:41:06state

1:41:07>> is you know dare I say flow is a whole

1:41:10thing as you know and it gets

1:41:12bastardized a lot and I don't want to do

1:41:14that but

1:41:16>> there's a real cost an energetic cost to

1:41:20being in a conversation and being

1:41:21somewhat in one's head except if you're

1:41:24me only as required to you know think

1:41:26about where we could go next this kind

1:41:28of thing it's it's just not helpful to

1:41:30be in one's head very often unless

1:41:32you're contemplating or making decisions

1:41:34It's great to just like turn that stuff

1:41:36off. I think most people would feel that

1:41:38way.

1:41:38>> It must vary an an awful lot, I think,

1:41:40cuz we're usually so attentive to

1:41:44external cues, events, right? Whether

1:41:47it's an appointment, something coming in

1:41:49email, text, or conversation, whatever.

1:41:52Sometimes we also do need that space. I

1:41:55think that there's an a hypothesis we

1:41:57could wager would be that one of the

1:42:00things that's [snorts] so enticing about

1:42:03um high arousal

1:42:05media or social media

1:42:07>> is that it takes people out of their

1:42:09heads.

1:42:10>> Y

1:42:10>> I'm just throwing this out there for

1:42:11sake of discussion. Maybe it's not about

1:42:14what they're seeing as much as what

1:42:15they're not having to think about.

1:42:17>> Mhm.

1:42:18>> Like [clears throat] I know a lot of

1:42:18people that listen to audiobooks. I have

1:42:20a friend, she tells me that she has to

1:42:22be really careful that she doesn't like

1:42:23listen to certain types of audio books.

1:42:25She'll just

1:42:27>> use that as a way to detach from a bunch

1:42:29of other stuff that she just doesn't

1:42:31want to think about.

1:42:32>> Right. Okay.

1:42:33>> There's a whole market for distraction

1:42:34and numbing and and arousal and um

1:42:38thinking in a structured way internally

1:42:40is not easy.

1:42:41>> I was about to say it's hard, right?

1:42:42It's hard.

1:42:43>> So, it's like this thing we were talking

1:42:45about, making a decision can be hard for

1:42:47some people. thinking through a problem

1:42:51and the potential solutions. I mean, you

1:42:53know, there are some people who love it.

1:42:56They love the permutations. Here's the

1:42:58problem. How many ways could I solve it?

1:43:01And they'll go down one route and think,

1:43:03you know, branching tree. Ah, yeah. If

1:43:05you go down this route, you could do A,

1:43:06B, or C. On the other hand, if you go

1:43:08down this route, you could do D, E, and

1:43:09F. And they love that. They love the

1:43:12fact that there are these permutations.

1:43:14Whereas for me, I'd rather narrow it

1:43:16down very quickly and go down this is my

1:43:19favorite route and okay, there are one

1:43:21or two choices to be made here. So there

1:43:23are different styles of thinking in your

1:43:25head, you know, and maybe for some

1:43:28people who don't necessarily love the

1:43:30permutations, but end up thinking there

1:43:32are so many permutations. That's a big

1:43:34thing to do. There's there are too many

1:43:36choices here. So I'd rather just listen

1:43:38to the, you know, the audio book.

1:43:40>> I have a colleague at Stanford. I'm sure

1:43:42you've heard of him, Carl Daiserov,

1:43:44psychiatrist, developer, co-developer

1:43:47with several others of optogenetics. And

1:43:49when he came on the podcast, he was

1:43:50actually our first guest.

1:43:51>> He said that he spends time every night

1:43:54after his then young kids went to sleep.

1:43:56And now still he'll spend an hour or two

1:43:59just forcing himself to think in

1:44:01complete sentences.

1:44:03>> That's no small task.

1:44:05>> What discipline,

1:44:06>> right? I think most of us who like to

1:44:09think and think about permutations will

1:44:11often write and do flowcharts because

1:44:13it's it's a little bit out there. It's a

1:44:16little easier than structuring

1:44:17everything in here.

1:44:19>> Well, you have to have such a great

1:44:20working memory system if you've got it

1:44:22all in here. And as we know, the more

1:44:25you put into that working memory system,

1:44:27the bigger the burden, right? Capacity

1:44:29limits mean that you can't hold, most of

1:44:31us can't hold lots and lots of

1:44:34permutations. We may be limited. And

1:44:36maybe that's what I'm expressing in

1:44:37myself is I I like to keep it really

1:44:39focused and have two or three

1:44:41alternatives in my working memory

1:44:43system. Whereas if you're confronted

1:44:45with 15 20 possible solutions, that's

1:44:49quite a hard thing for the working

1:44:50memory system to hold on to. And our our

1:44:52own work in memory has suggested the

1:44:54quality of the information you have for

1:44:56for the stuff you hold is diluted. the

1:45:00more you add into the working memory

1:45:03system, the quality with which you

1:45:05remember each bit of information is

1:45:07reduced. So there is also a cost from

1:45:10holding everything in mind. I don't know

1:45:12if these studies still hold, but my last

1:45:14read of the studies on working memory

1:45:15and dopamine suggested that some people

1:45:18have a low, others medium, and others

1:45:22quote unquote high level of baseline

1:45:24dopamine. This is a tricky term and our

1:45:26science colleagues they're going to go

1:45:27ahead and you know might roll their eyes

1:45:29a little bit at the way I'm describing

1:45:30it but for sake of discussion low medium

1:45:32or high baseline dopamine and that if

1:45:34you give somebody a drug to increase the

1:45:37amount of dopamine in their system and

1:45:40they are in the low or medium baseline

1:45:42group they experience a boost in working

1:45:45memory their ability to keep thoughts

1:45:46online for short periods of time make

1:45:48use of that information. But that

1:45:49somebody who's already sealinged out,

1:45:51yeah, on dopamine doesn't afford them a

1:45:54benefit, maybe even degrades their their

1:45:57ability. I find those studies

1:45:58fascinating, especially given the fact

1:46:00that so many people take stimulants.

1:46:02>> Yeah.

1:46:02>> You know, whereas a few years ago there

1:46:04were some people taking Adderall, Rolin,

1:46:07and most every 90% of adults drink

1:46:09caffeine worldwide. I mean, it's

1:46:11incredible. Now, nicotine is everywhere.

1:46:16oral nicotine use in women, men, young

1:46:19people, and dopamine is a big part of

1:46:22the nicotine story. I mean,

1:46:24acetylcholine as well.

1:46:25>> Yeah.

1:46:26>> So, these people who are now addicted to

1:46:28nicotine, I don't care what people say.

1:46:30It's a you're not necessarily robbing

1:46:32people to get money for your pouches of

1:46:34nicotine, but tell them to stop and then

1:46:37it's like, I'm not gonna stop. They go

1:46:38from one pouch to three to eight

1:46:40>> to a canister every couple of days or

1:46:42even day. This is like

1:46:44>> happening. I'm not judging it, but

1:46:46chances are they're not getting a

1:46:48cognitive benefit, right? That they're

1:46:50just able to hang in there with their

1:46:52normal baseline.

1:46:53>> My reading of that literature, the

1:46:55psychopharmarmacology literature in

1:46:57terms of cognitive enhancement is

1:46:59absolutely what you said. If you start

1:47:01from a low baseline of performance, you

1:47:03might get some positive boost. It's

1:47:06quite small, but you might get it. But

1:47:08if you are actually quite a high

1:47:09performer, then you risk getting worse.

1:47:14with this is called the inverse U-shaped

1:47:17curve. I don't mean and so I tell the

1:47:19students that I teach, you know, about

1:47:21this sort of stuff, you're probably not

1:47:24going to be in that low baseline state

1:47:26given where you you're here at this

1:47:29university. Uh so just think twice about

1:47:31taking some stimulant that you want to

1:47:34get a better grade because actually the

1:47:36evidence would be that you might get

1:47:37worse from doing it. So yeah, you have

1:47:40to be very careful with this. There seem

1:47:42to be real individual differences which

1:47:45depend on our intrinsic

1:47:47uh chemistry, neurochemistry. The

1:47:50history of nicotine is fascinating. It's

1:47:52almost as if ever since humans

1:47:54discovered it, they find some way to get

1:47:56it into their system. And once they

1:47:58figure out that that way is really bad

1:47:59for them, like it can kill them from

1:48:01lung cancer. Takes a couple of years and

1:48:03they figure out another way. And then

1:48:05it's almost like humans love to eat and

1:48:08consume plant alkaloids. Like they just

1:48:10have to do it. They just got to feel

1:48:12different than their their natural

1:48:14chemistry will allow them to.

1:48:15>> I mean, this is our culture, right?

1:48:17That's what's happened over years. I

1:48:19mean, as you say, if we look back, let's

1:48:22say in South America, the cultures of

1:48:24how people use stimulants in various

1:48:27ways that goes back, you know, thousands

1:48:29of years. It's not something new. So,

1:48:31this is what our brains are used to in

1:48:33terms of stimulation in some way. and

1:48:35many of the drugs of addiction okay not

1:48:37the not the more modern things but have

1:48:40that propensity have been around because

1:48:43the culture has allowed that to happen

1:48:45in some way. So this is really important

1:48:47I think in terms of how our

1:48:49neurochemistry sort of interfaces with

1:48:52our cultures. I have to imagine that

ADHD, Diagnosis; Attention & Motivation

1:48:55given you work on attention and you work

1:48:57on motivation and apathy that you get a

1:48:59lot of emails from parents or even kids

1:49:02and young people about ADHD

1:49:04>> and many people think that they have

1:49:07attentional issues. Do you think there

1:49:09are a lot of people that don't

1:49:10necessarily have attentional issues?

1:49:12They just haven't figured out how to

1:49:14stop and think and make a decision about

1:49:15what to do next. I'm not trying to be

1:49:17disparaging here. I think that as each

1:49:19of the psychiatric disorders has become

1:49:23kind of more in the public discussion

1:49:26like people will say OCD they'll say oh

1:49:28on the spectrum they'll say

1:49:30>> you know I have ADHD and these are real

1:49:32clinical issues but I think

1:49:35>> there's kind of a feedback where people

1:49:37start to notice their lack of attention

1:49:40maybe I have ADHD maybe I should take

1:49:42stimulants you know do you get a lot of

1:49:43questions about ADHD and do you think

1:49:46it's a real thing for for many adults,

1:49:48for many kids, or do you think there's

1:49:50kind of a perception that we have an

1:49:52issue that we don't necessarily have?

1:49:53It's just lack of good old discipline.

1:49:55>> I do get a lot of questions. I think it

1:49:57is a real issue for some people.

1:49:59Interestingly, you know, the number of

1:50:00people who remain with the diagnosis of

1:50:03ADHD into adulthood if they had it as

1:50:06children can reduce actually the numbers

1:50:09reduce in terms of people who continue

1:50:11to have adulthood. So, that's

1:50:12interesting that there is some

1:50:13plasticity in the brain. But I also

1:50:15think that this is not mutually

1:50:17incompatible with the view that there's

1:50:19also overdiagnosis. And I think we need

1:50:22very careful ways of making diagnosis

1:50:26because the conventional way is you take

1:50:30a history from a person about what the

1:50:32problem is. You may then do some degree

1:50:35of cognitive testing and that degree of

1:50:38cognitive testing varies enormously

1:50:40between different specialists.

1:50:42And then you have to decide where is

1:50:45normality. Essentially that's what

1:50:47you're asking cuz you and I also get

1:50:49attention lapses from time to time. We

1:50:51also don't always perform well. Uh we

1:50:54have difficulty in sustaining attention.

1:50:56So where do we put that marker of

1:50:59normality? It will always be a

1:51:01continuum. Right? So we're going to have

1:51:03to place this marker in terms of

1:51:05diagnosis at some point. And often that

1:51:09might be a point where you think it's

1:51:11actually having a detrimental functional

1:51:14effect on somebody's performance whether

1:51:17it's scholastic or whether it's in

1:51:19social ways or whatever it is. And then

1:51:21it becomes more difficult because you

1:51:22know you that's that's a much more

1:51:24subjective thing to decide. You've got

1:51:26your cognitive test but now you have to

1:51:29make a decision about whether this is

1:51:31subjectively something that's having an

1:51:34impact on their everyday lives.

1:51:36That might be one of the places where

1:51:39some of the fuzziness in diagnosis

1:51:42comes.

1:51:43>> Long ago, we had a guest on the podcast

1:51:45who's an expert in ADHD who shared that

1:51:48kids and adults with ADHD actually can

1:51:50focus quite intensely on things they

1:51:52really

1:51:53>> enjoy and are curious about.

1:51:55>> Reminds me of the Parkinson's patient

1:51:57running out of the house.

1:51:59And it raises the question of whether we

1:52:01should train to have better levels of

1:52:04attention, longer duration attention by

1:52:08doing boring stuff

1:52:10>> as opposed to trying to find the thing

1:52:12that hooks us all the time. That too,

1:52:14but maybe we should do more chop wood,

1:52:16carry water stuff. [laughter] You know,

1:52:18>> you know, in the Second World War, there

1:52:20were these studies in Britain uh for

1:52:23radar operators because they would look

1:52:25at this screen. It's a very boring

1:52:26screen and they're looking out for

1:52:29German fighter planes or bombers coming

1:52:32over the channel. Most of the time there

1:52:34isn't anything, but they could have

1:52:36false positives. They could push the

1:52:37button because they think they saw a

1:52:40blip or they might drift off, which was

1:52:43more the worry is that they were

1:52:45drifting off. Their sustained attention

1:52:47was drifting off and therefore they

1:52:49would miss a really important event on

1:52:52their radar screens. And it turns out

1:52:55that there is something we call a

1:52:56vigilance decrement. Over time, if

1:52:59you're doing something boring and dull,

1:53:01healthy brains, you will find a

1:53:04reduction in your ability to detect

1:53:06these boring, very infrequent events.

1:53:09You can measure it. And one of the

1:53:10problems that's been found in ADHD is

1:53:13there can be a difficulty in sustaining

1:53:15attention over time.

1:53:17Not necessarily because they miss

1:53:19things, but also the variability in

1:53:21response is something that's become a

1:53:24signature of people with ADHD. They're

1:53:27far more variable than people who are

1:53:29not giving that diagnosis if we believe

1:53:31the diagnosis was made correctly at that

1:53:33time. And I think that's telling us

1:53:35something really important about this

1:53:37because that variability might reduce if

1:53:40the motivation to do this was better. So

1:53:45you mentioned intrinsic motivation in

1:53:47the sense that if they're doing

1:53:48something they're really interested in,

1:53:49they might be more focused in in order

1:53:51to do that. And the neuroscience, I'm

1:53:54not a specialist in ADHD, but the

1:53:55neuroscience that I have read about

1:53:57suggests that it's not only the parietal

1:54:01and frontal regions of the brain which

1:54:02are important in deploying attention to

1:54:05the external world. There may also be

1:54:09dysfunction in the basil ganglia in

1:54:11people with ADHD.

1:54:13that's been referred to in some ways as

1:54:15being involved in working memory, but it

1:54:17can also probably be involved in

1:54:18motivation. So, we're bringing these

1:54:20themes together here that attention

1:54:22might also be related to motivation

1:54:25because you're more likely to pay

1:54:27attention to something that you think is

1:54:30intrinsically rewarding to you. Maybe we

1:54:33could drill just a little bit further

Goal Planning & Perseverance

1:54:34into the nucleus encumbent and this

1:54:36basil ganglia circuitry because I think

1:54:39most everyone is familiar with the fact

1:54:41that some goals are very short-term. I'm

1:54:44going to make a cup of coffee. I'm going

1:54:45to drink the coffee. Some are long-term.

1:54:47I always say, you know, if nothing else,

1:54:49you know, get a PhD because you'll teach

1:54:52yourself that you can work on things for

1:54:53long periods of time, sustain a lot of

1:54:55effort and uncertainty and it

1:54:57>> provided you complete it and I trust you

1:54:59will, you get something at the end and

1:55:01say there you have this ability to say,

1:55:04well, I can do hard things, uncertain

1:55:06things over four to six years.

1:55:08>> I mean, that's not alone a reason to do

1:55:10it. Hopefully, you're interested in what

1:55:12you're doing. It really helps. But do

1:55:14you think there are ways that this

1:55:17circuitry learns different time

1:55:19contingencies that it must, right? I

1:55:22mean, if the same circuitry is involved

1:55:24in motivating to make a cup of coffee

1:55:25because it feels worth it to me to get

1:55:27the caffeine and the taste that's

1:55:29responsible for

1:55:31trudging through something over several

1:55:33years, an endeavor or relationship of

1:55:36any kind. And it's the same circuitry

1:55:39that suggests there's a really robust

1:55:42and dynamic dial on on how it integrates

1:55:46time, right? I mean I mean it's a

1:55:48totally different game. In one case it's

1:55:50like a slot machine

1:55:52>> that has a high probability of success

1:55:54like making the coffee, right? It's

1:55:55almost every time you actually get the

1:55:57coffee. And in the other one it's like

1:56:00we're talking years. So the same

1:56:02neurons, they're clocking over vastly

1:56:05different time scales. How does that

1:56:07work?

1:56:08>> So I think most of the studies that have

1:56:09been done are over very short time

1:56:11scales. They're what you're talking

1:56:13about, you know, the slot machine type

1:56:14of study. We've also done some studies

1:56:16recently looking at perseverance, but

1:56:19again, they're not over years that we

1:56:22normally have to think about when we're

1:56:23making long-term goals. I don't think

1:56:26it's necessarily

1:56:28timekeeping in the basil ganglia that's

1:56:30the issue here. I think these are much

1:56:33higher level goals and plans that you

1:56:36might think are being constructed in the

1:56:39cortex, particularly the frontal cortex.

1:56:40You know, we talked about executive

1:56:41control and planning. Planning has not

1:56:43been studied in great detail except for

1:56:45some relatively simple problem solving

1:56:47tasks that patients are given to do

1:56:50which usually can be done within a few

1:56:52minutes. But this [clears throat]

1:56:54extended

1:56:55long-term

1:56:57planning and perseverance, I don't think

1:57:00that's something that the basil gang do.

1:57:02Those networks are there from the

1:57:05lamprey, right, to solve

1:57:07>> getting my motivation signal to action.

1:57:10But this extended motivation to do

1:57:13something over years for a a long-term

1:57:16goal, I think must be something which is

1:57:19different from what's going on just in

1:57:21the basil ganglia. And of course then it

1:57:23also brings into this issue about what's

1:57:25called temporal discounting. So if I say

1:57:28to someone you will get this great

1:57:31rewarding outcome but you have to

1:57:33persevere for one year or I say to them

1:57:37you'll get this sort of mediocre outcome

1:57:39and you'll get it within a week. People

1:57:42will differ in which ones they'll

1:57:43choose.

1:57:44>> What are the current data on that? Does

1:57:45it divide in some sort of like two

1:57:47marshmallow experiment kind of way?

1:57:49[laughter] Still, you know,

1:57:50>> the marshmallow experiments have

1:57:52obviously become very controversial in

1:57:54terms of

1:57:54>> I heard they were debunked. Then someone

1:57:55came on the podcast who works on these

1:57:57and said the debunk was debunked.

1:57:58>> Yeah, I'm not an expert on those

1:58:00studies, but I think the key thing I'm

1:58:02just trying to explain is that also

1:58:04people differ in their levels of how

1:58:07they will discount the reward that

1:58:10they're willing to take

1:58:13>> with time.

1:58:14>> And that varies enormously between

1:58:16people. So, what is it that allows

1:58:19someone to say, "I'm going to wait for

1:58:20the bigger reward after a year rather

1:58:23than take this mediocre reward in a

1:58:25week." I don't think we've we've really

1:58:28got the neuroscience of that. Now, it's

1:58:30tempting to say that to pursue long-term

1:58:32goals, you know, you want to break it up

1:58:34into short-term goals and

1:58:36>> but I always think about these

1:58:38asymmetries like if you if we said that

1:58:40we said, okay, you know, you have a

1:58:41five-year goal and in order to get

1:58:43there, you're going to use the same

1:58:44reward circuitry and motivation

1:58:45circuitry, but you're really going to

1:58:47pay attention to the small wins along

1:58:49the way, the incremental wins.

1:58:51>> The risk is that you also pay attention

1:58:52to the failures along the way, right?

1:58:54Because in the end, it's binary. you

1:58:56either get the thing or you don't in

1:58:58most cases certainly with a degree.

1:59:00>> But with wins and losses, they're graded

1:59:03as we say, you know, like they're not

1:59:05zero or one, they're 0 to 10. And it's

1:59:08very subjective. And so I feel like

1:59:10perseverance for me has a lot to do with

1:59:13making the pain

1:59:16a shorter experience than the win. Like

1:59:18like carrying forward our wins and our

1:59:21memories of being motivated. Like if we

1:59:23kind of allow those to seep into our

1:59:26self-concept a little bit more, then

1:59:28it's sort of like, oh yeah, you can do

1:59:29hard things, but it's it's a little bit

1:59:30of self-d delusion, but it's a

1:59:32functional self-d delusion, right?

1:59:33>> Of course. Of course.

1:59:34>> You know, I don't know how one could get

1:59:35a medical degree without engaging in

1:59:37some amount of functional self-d

1:59:39delusion.

1:59:40>> Yeah. I mean, it's tough.

1:59:42>> Yeah. [laughter] You've worked on, as I

Alzheimer’s Disease, Dementia, Apathy, Tools: Dementia Risk Factors

1:59:44mentioned earlier, a huge number of

1:59:46issues. I don't expect us to go into all

1:59:47of them today, but I know many people

1:59:49are interested in Alzheimer's disease

1:59:51>> and uh the loss of memory due to aging.

1:59:53What in your mind are some of the more

1:59:55interesting findings of past, present,

1:59:57and maybe anything that you did in

1:59:59particular that changed your notions of

2:00:02memory and and Alzheimer's?

2:00:04>> I think one of the most interesting

2:00:06things that much of the audience would

2:00:09not be aware of is Alzheimer's disease

2:00:11does not necessarily equal dementia.

2:00:14people can have Alzheimer's disease and

2:00:16not get dementia. So, we found this out

2:00:19from post-mortem studies. People have

2:00:22been followed as they age. Uh they've

2:00:25donated their brains and it turns out

2:00:27that perhaps 20 to 30% of these

2:00:30individuals who never had dementia have

2:00:33Alzheimer pathology. What do we mean by

2:00:35that? We mean that when we look down

2:00:37under the microscope, you can see the

2:00:39signature of Alzheimer's disease. You

2:00:42can see plaques which are made up of

2:00:45this protein amaloid which has been

2:00:47deposited in the brain. You can see

2:00:50tangles which are made out of this

2:00:52protein towel. And you can see that also

2:00:55perhaps some of the neurons have uh

2:00:58suffered. They've died in these brains

2:01:01and yet the person never developed

2:01:04dementia. So the first point I think is

2:01:07really important is Alzheimer's disease

2:01:10can increase in the brain as we age but

2:01:13it doesn't necessarily have to lead to

2:01:15dementia which is a really important

2:01:17point. So what's the difference between

2:01:19the people who can

2:01:22cope with this burden of pathology in

2:01:24their brain and remain cognitively

2:01:28relatively intact? Why do they have this

2:01:31cognitive resilience? And a lot of

2:01:34people are investing

2:01:37uh funds to try and work out what's the

2:01:39difference between these people. Of

2:01:40course, there might be biological

2:01:42differences and lifestyle differences.

2:01:43It could be, you know, the people who

2:01:46can be resilient are the ones who've had

2:01:49a routine of physical exercise. They

2:01:51made sure their blood pressure never got

2:01:53too high. They've made sure that, you

2:01:55know, they don't have pre-diabetes or

2:01:58diabetes or they check for it. Their

2:01:59cholesterol is under control. They're

2:02:00not drinking too much alcohol. they're

2:02:02not smoking. All of those things can be

2:02:05important. But it turns out that

2:02:06actually there are other factors that

2:02:08can be just as important. You know, we

2:02:11talked a little bit about these. Those

2:02:13include that having that sense of

2:02:15purpose, making sure that you have a

2:02:18network of people, that you're socially

2:02:20connected as your age, and also

2:02:23remaining curious, open to new ideas.

2:02:26Those factors turn out to be almost as

2:02:29important as some of the physical things

2:02:30we do. And we're just scratching the

2:02:33surface of trying to understand how

2:02:36those factors affect the biology. How is

2:02:38it that having a sense of purpose

2:02:41makes a difference to how you cope with

2:02:45this burden of pathology in your brain?

2:02:47But in a way, that's a really

2:02:50interesting optimistic thing to learn

2:02:52about Alzheimer's disease that it

2:02:54doesn't necessarily always lead to

2:02:56dementia. And by the way, I should also

2:02:57just explain for the audience that

2:02:59although Alzheimer's disease is the

2:03:01leading cause of dementia, there are

2:03:03many many causes of dementia. So again,

2:03:05Alzheimer's disease is not the only

2:03:07thing that can cause dementia. In terms

2:03:11of our own work, one of the things that

2:03:14we've really tried to do is extend the

2:03:16kind of work we were talking about with

2:03:18loss of motivation and apathy [snorts]

2:03:21into people who develop Alzheimer's

2:03:24disease. And in fact, perhaps even

2:03:26before we're aware they've developed

2:03:28[snorts] it. A lot of studies in the

2:03:30last few years have shown that if we

2:03:32just study healthy aging people, they

2:03:36don't have dementia, they don't have any

2:03:38diagnosis of a neurological disorder.

2:03:40What we find is that those individuals

2:03:43who score highly on just self-reported

2:03:47questionnaires for motivation, if they

2:03:50score highly for apathy, they have twice

2:03:53the risk of developing Alzheimer's

2:03:56disease than people who don't.

2:03:59And the conclusion that is emerging is

2:04:03that Alzheimer's disease is not

2:04:05necessarily just about cognitive

2:04:07impairment. It can also lead to

2:04:09behavioral changes long before you

2:04:14develop any sign of cognitive

2:04:15impairment. And one of those behavioral

2:04:17changes happens to be apathy, loss of

2:04:20motivation. So if you can pick that up

2:04:23at an early stage, could you potentially

2:04:26do something about it? Because the

2:04:29evidence suggests that these pathologies

2:04:31in Alzheimer's disease, the amaloid and

2:04:33the tow that's being laid down in the

2:04:35brain, that can be more than 10 years,

2:04:40perhaps more than 15 years before

2:04:42somebody presents to a doctor with

2:04:44cognitive complaints. So we've got this

2:04:46huge window maybe 10 to 15 years before

2:04:50someone comes along and has a diagnosis

2:04:53of Alzheimer's disease. So if we could

2:04:56detect this at the earliest stages maybe

2:05:00the drug therapies that have developed

2:05:02and shown very small changes the

2:05:04monoconal antibodies that mop up amaloid

2:05:07have shown that even in established

2:05:09early Alzheimer's disease they can make

2:05:10a small difference to the trajectory of

2:05:12the illness. Maybe those monoconal

2:05:16antibodies could make a difference if

2:05:17you could do something 15 years before

2:05:21someone develops Alzheimer's disease if

2:05:23we could detect it in the brains. So I

2:05:25guess these are perhaps some of the most

2:05:27interesting things that I think um I've

2:05:30been stimulated by in the last few

2:05:32years.

2:05:33>> I wasn't aware that one could have

2:05:35plaques and tangles so-called

2:05:37Alzheimer's characteristic signs of

2:05:39Alzheimer's and yet not have dementia.

2:05:42Sounds like certain people by virtue of

2:05:43having sense of purpose engaging in the

2:05:45world and who knows maybe even the

2:05:47reflection back onto who they are sense

2:05:49of self being reinforced I'm making up

2:05:51that portion of the story but I like the

2:05:53idea uh no basis for it but uh no direct

2:05:57data for it rather are resilient to

2:05:59their own internal landscape. It's an

2:06:01interesting way of thinking about

2:06:02neurodeenerative disease because we

2:06:04think about exercise, crossword puzzle,

2:06:06social connection, Mediterranean diet

2:06:09and all these things, you know, and good

2:06:10cardiovascular health in general

2:06:12buffering us against the uh pressures of

2:06:15the outside world. But the idea that our

2:06:18thoughts, our self-concept, our emotions

2:06:21could buffer us against our internal

2:06:23neural landscape,

2:06:25that's pretty exciting because that's

2:06:27something that, as you mentioned, if you

2:06:29could start early enough

2:06:30>> Yeah. Well, it would benefit us anyway.

2:06:33Why wouldn't we do it? Of course.

2:06:34>> Right. It's just good for us across the

2:06:36board.

2:06:37>> What's the harm in doing that?

2:06:38>> Right.

2:06:38>> Yeah. But that is an exciting new

2:06:40development. Uh but of course that has

2:06:42all sorts of implications. Um

2:06:45would you tell someone they have

2:06:47Alzheimer pathology in their brain when

2:06:50they weren't going to develop dementia?

2:06:53>> You're spoiling spoiling the party here,

2:06:54right?

Neurodegenerative Disease & Emerging Treatments

2:06:55>> That's a tough one. You know, these days

2:06:57there's a lot of interest in whole body

2:06:59MRI. friend of mine who's a neurosurgeon

2:07:01says that he gets people in his clinic

2:07:03all the time who spotted things in a you

2:07:07know they paid to go get their own MRI

2:07:10and it saved their life but he gets a

2:07:13lot of calls from people that are

2:07:14concerned about white spots on the brain

2:07:16or growths in the brain that are

2:07:18basically of no concern clinically and

2:07:21it's a tough call and there's a

2:07:23financial piece where some people can

2:07:24afford to do this and some people can't

2:07:26and so it's become a point of contention

2:07:28but

2:07:29>> this This is how we used to talk about

2:07:30genetic data in the late 80s, early 90s.

2:07:33I remember the discussion like, would

2:07:34you want your genome?

2:07:36>> And some people say, well, if I'm going

2:07:37to get Huntington's, well, wait, no,

2:07:39maybe I wouldn't want to know. And other

2:07:41people say, oh, I would absolutely want

2:07:42to know. It's it's a very complicated

2:07:44issue.

2:07:45>> Yeah. And you need informed choice. So,

2:07:46you need to have enough information

2:07:48before you make that choice. And of

2:07:49course, as you said, maybe some people

2:07:51are financially able to do this sort of

2:07:53stuff and others aren't. So, it has huge

2:07:55implications going forward. But again,

2:07:58you know, there's so much excitement in

2:08:01brain diseases that we we couldn't

2:08:04potentially think about treating years

2:08:05ago. For example, the landscape in

2:08:08multiple sclerosis. When I was a junior

2:08:10neurologist, all we had was steroids,

2:08:12corticosteroids to give to people who

2:08:14had relapses of multiple scerosis. Now,

2:08:18there are a huge range of immune

2:08:21therapies for multiple scerosis, which

2:08:23has transformed the lives of people with

2:08:25that diagnosis. and the disability in

2:08:28that condition. You can't be a general

2:08:30neurologist in you know looking after

2:08:32multiple sclerosis patients. You have to

2:08:33be a real hypers specialist because

2:08:36there are so many therapeutic

2:08:38possibilities and for neurodeenerative

2:08:40diseases it's a tough call as well but

2:08:44so much has happened in a condition

2:08:45which was thought pretty untreatable 30

2:08:48years ago apart from giving steroids. So

2:08:50I think this is an area that's become

2:08:52really exciting. it's a good time to

2:08:53become a neurologist if anyone's

2:08:56thinking about it. Whereas maybe a few

2:08:57years back I had a more depressing view

2:08:59of neurology. It sounds like things are

2:09:01really on the upswing in terms of tools

2:09:03and approaches for treatment. Again, 30

2:09:06years ago, deep brain stimulation for

2:09:08Parkinson's disease was just being

2:09:10introduced. And I used to think what are

2:09:12these guys doing? They're putting these

2:09:14patients through this terrible surgery.

2:09:16There's risks of infection, hemorrhage,

2:09:18all these kind of things. Now I look

2:09:20back and I think you have to take those

2:09:22pioneering steps, take the risks because

2:09:24there are patients with Parkinson's

2:09:26disease who have had their lives

2:09:28transformed by this sort of radical

2:09:31treatment where you have deep brain

2:09:32stimulation of the basil ganglia. I mean

2:09:35that's an incredible achievement and so

2:09:38if you could have that why can't you

2:09:39have deep brain stimulation in other

2:09:42neurodeenerative diseases provided you

2:09:44found the targets for that stimulation

2:09:46well and why can't you have focal

2:09:49neuropharmacological

2:09:52uh treatment which would mean that you

2:09:53wouldn't necessarily get any of the

2:09:55toxic side effects or or unwanted side

2:09:58effects of drugs that you might give

2:10:01systemically or introvenously in some

2:10:04I I think these things are coming.

2:10:06>> I think so, too. I'm excited about

2:10:07intersectional methods like giving a

2:10:10drug that potentially could increase

2:10:11dopamine everywhere, but you give

2:10:13another compound that directs it

2:10:15specifically to the components of the

2:10:18brain that you're interested in and so

2:10:19you relieve side effects. That that

2:10:20stuff is being done in animal models and

2:10:22we're not quite there. I feel like we're

2:10:24getting there.

2:10:25>> That's right. and and some of my

2:10:26colleagues in Oxford and elsewhere in

2:10:28the world are, you know, using focused

2:10:29ultrasound to open up the bloodb brain

2:10:32barrier, the zip that covers the brain

2:10:34so that it's focally opened up at the

2:10:38location you want to deliver the drug.

2:10:39>> Oh, that's cool.

2:10:40>> I mean, that's, you know,

2:10:41>> very cool.

2:10:42>> Fantastic if you can achieve it.

2:10:43>> I'm excited and encouraged by these MS

2:10:46results. Um, we have a colleague here

2:10:49that has MS and, um, we haven't done an

2:10:52episode about it yet. uh we need to but

2:10:54that's super encouraging. Super

2:10:56encouraging.

2:10:57>> It really is transformative in that

2:10:58field.

Can You Train Attention?, Tool: Reduce Distraction

2:10:59>> You've been very generous with your

2:11:00time. Before we uh wrap up, can I just

2:11:02ask you a few more questions?

2:11:03>> Of course.

2:11:04>> Okay. Um people will wonder if there's

2:11:06anything they can do to increase their

2:11:08attention or ability to stay focused in

2:11:11stuff that isn't super engaging for

2:11:13them. Is that a is that a skill? the

2:11:16studies that have been done there have

2:11:18really focused on things like playing

2:11:22video games or stuff like that and you

2:11:24can improve on those sort of tasks but

2:11:27what you mentioned before this doesn't

2:11:29necessarily generalize to other types of

2:11:32activity so it seems to be very task

2:11:34specific domain specific in in that way

2:11:37hyperdomain specific so training your

2:11:40attention I'm not sure there is such uh

2:11:45such great literature which I would

2:11:47think you I could point you to this has

2:11:49been also tried in people with stroke

2:11:51and who lose attention like the neglect

2:11:53syndrome and again things improve on the

2:11:55task but they don't necessarily

2:11:57generalize to other tasks can we train

2:12:00to not get distracted so the inverse of

2:12:04that this is might seem like a crazy

2:12:06example but in the world of mouse

2:12:07genetics I learned a long time ago that

2:12:09it takes many generations to evolve a

2:12:12trait but it doesn't take very many

2:12:14generations to devolve all of a trait.

2:12:16So, you can just breed some mice, breed

2:12:17some mice, pretty soon you'll get

2:12:18interesting mutations um that you can

2:12:21study and you can find the role of

2:12:22particular genes, put them back in. But

2:12:24if you go and you try and say, "Oh, you

2:12:26know, we're going to like breed mice for

2:12:27a while until we get an interesting

2:12:28outlier and then we're going to study

2:12:30that outlier." You're going to you're

2:12:31going to be an old old human before you

2:12:34even get something that might be

2:12:35interesting. And that's [clears throat]

2:12:36a for me was a very informative example

2:12:38because in the realm of attention maybe

2:12:41we can't get better but maybe we're

2:12:42doing a lot of things in our daily life

2:12:43that are degrading our attention and we

2:12:45just rescue a little bit of that and

2:12:46we're like oh I'm actually much better

2:12:49at focusing than I thought.

2:12:50>> Yeah. So I think although there might

2:12:52not be a great deal of evidence that you

2:12:54can intrinsically train your attention

2:12:55to do better generally

2:12:58what you could do is to cut out things

2:13:00that are distracting for you. I mean you

2:13:02know these are simple things that people

2:13:03will be very familiar with. Make sure

2:13:05you don't get notifications. That's a

2:13:07really important thing that many people

2:13:09don't do, right? Or keep your email open

2:13:11while you're doing something else. Make

2:13:13sure that there isn't some sort of

2:13:15distracting noise wherever you're doing

2:13:17this. So, you could do things in your

2:13:20environment to cut down distracting

2:13:22stimuli that will capture your

2:13:24attention.

2:13:25>> I sometimes wonder if there's both a

2:13:27pleasure and a pain in giving something

2:13:29our full attention. M I now look at the

2:13:32world as okay what's effective in

2:13:33grabbing people's attention and

2:13:35distracting them what's effective in

2:13:36grabbing people's attention and engaging

2:13:38them okay well drama arousal and numbing

2:13:43out are very effective at grabbing

2:13:44people's attention but I think I and

2:13:46others have experienced this thing I

2:13:49know I have perhaps others where when

2:13:52you try hard to really focus on

2:13:54something it's a pleasure once you get

2:13:56through it and you get someplace but

2:13:58there's a kind of a pain to it also

2:14:00[snorts]

2:14:00And so perhaps the attention economy

2:14:02isn't so much about grabbing people's

2:14:04attention. It's about distributing it

2:14:06over a certain array of things where

2:14:08they can potentially make money. I think

2:14:10about this a lot lately and I think wait

2:14:12what I'm getting back when I'm

2:14:14>> getting much better getting so focused

2:14:16cuz I have a pretty laser focus when I

2:14:17want to. I learn a lot of it in here.

2:14:19I'm not thinking about anything else.

2:14:21But were my mind to flip to something I

2:14:23can grab it right back. Is my attention

2:14:26and focus getting better or are we just

2:14:28not allowing ourselves to get pulled

2:14:29into the array of other things? This has

2:14:32been a pleasure I should say. But as you

2:14:34say, hard work is hard work. Focus is

2:14:37hard work and hard work involves a bit

2:14:38of friction. Does this make sense?

2:14:40>> Yeah. And and I I think it goes back to

2:14:43that conversation we were having about

2:14:45economy of what you do. You know, is it

2:14:48better to be inert? Is it better to

2:14:50allow your attention to just focus on

2:14:52one thing or is it better to allow it to

2:14:56be deployed widely to be captured by

2:14:59different things? So there might be an

2:15:01economical benefit for the brain

2:15:04>> and for Andrew to just devote resources

2:15:09to a few things rather than to many

2:15:12things. So reduce the choices.

2:15:13>> I don't normally ask these sorts of

Enrichment, Art

2:15:15questions, but I feel compelled to ask

2:15:16and feel free to say pass. Uh what do

2:15:19you do for um enrichment? Uh I don't

2:15:22like the word fun. For enrichment uh

2:15:25when you're not thinking about the brain

2:15:26or or engaging with, you know, family

2:15:28and that sort of thing. Like what what

2:15:29do you like to do to stimulate your mind

2:15:31if it's not work or or family?

2:15:33>> Yeah, I really like drawing. I like art.

2:15:36>> That's something I get a lot of pleasure

2:15:37from. I mean, I I do physical things,

2:15:39too. I'll go to the gym as well, but but

2:15:41the thing I really like I wish I had

2:15:43more time for

2:15:44>> is art and painting. If I could do that,

2:15:47I'd be I would love it. But I know I'd

2:15:50have to devote a lot of resources and

2:15:52time to do that properly to do it. Well,

2:15:54>> what do you draw? Is it neural related?

2:15:56Is it by

2:15:56>> I drew the figures, for example, in the

2:15:58book. I really enjoyed that doing that.

2:16:00But I can, you know, I can draw anything

2:16:02else that I fancy. It could be a still

2:16:04life, whatever it is. But but I don't

2:16:07take a huge amount of time, but I get a

2:16:08lot of pleasure from doing it.

2:16:09>> And you have thoughts about other things

2:16:11while you do it, ideas and that

2:16:12>> and that will come. But there is a just

2:16:14an intrinsic pleasure from disengaging

2:16:16from everything else and just you know

2:16:18even if you spend half an hour on

2:16:21something like this which doesn't

2:16:23necessarily have value to anybody else.

2:16:26It's just for you. It's something you're

2:16:28doing and maybe improving your skill in

2:16:31this. So maybe that's what I what you

2:16:33might call enriching.

2:16:34>> No, it certainly is. Uh as someone who

2:16:36likes to draw, I can relate. But no

2:16:38matter what people enjoy doing, I hope

2:16:41uh they heard your answer clearly. I I

2:16:43knew there was a reason I asked, which

2:16:44is interesting people always have a lot

2:16:48of interests. This is like kind of

2:16:50obvious when you hear it, but it's like

2:16:52interesting people have a lot of

2:16:53interests and they they pursue them even

2:16:55if they're not trying to, you know, have

2:16:56their work in the Guggenheim or

2:16:58something. Although you probably will

2:16:59knowing you, you Oxford types, you know.

2:17:01Thank you, Dr. Massud Hussein. I

2:17:04appreciate you very much for the work

2:17:06you do. Your patients certainly

2:17:08appreciate you for the science you're

2:17:09doing in addition to the clinical work,

2:17:11for the fact that you write books, that

2:17:13you go on podcasts, and that you share

2:17:17information that is interesting and

2:17:18relevant to everybody because this is

2:17:20after all the the human experience.

2:17:22Sometimes pathologies and overcoming

2:17:24them, but always the reflections on the

2:17:26quote unquote normal everyday human

2:17:28experience is what's so relevant to

2:17:30everybody. I've thoroughly enjoyed this

2:17:32conversation. and hopefully we can

2:17:34encourage you to come back across the

2:17:35pond to talk to us again in a few years

2:17:37because you're moving at a rapid rate

2:17:38and it's going to be hard to keep up

2:17:40with your discoveries, but please do.

2:17:41>> Thanks for a really stimulating

2:17:43conversation. Thank you.

Zero-Cost Support, YouTube, Spotify & Apple Follow, Reviews & Feedback, Sponsors, Protocols Book, Social Media, Neural Network Newsletter

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