Full transcript
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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44:53Seems to me that the most advantageous
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
2:17:45>> Thank you for joining me for today's
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