Transcript
[0:00] Almost every drug of addiction, whether
[0:02] we go from nicotine to alcohol to heroin
[0:05] to cocaine to amphetamine, almost every
[0:08] drug of addiction hijacks that dopamine
[0:12] system we were talking about. We find
[0:14] when that circuitry is not working that
[0:16] you can get profound loss of motivation,
[0:19] apathy. When that circuitry is on
[0:21] overdrive because it's been hijacked by
[0:23] these drugs, you get states of hyper
[0:26] motivation. So, of course, this is going
[0:28] to be overly simplistic to think
[0:31] dopamine levels are the only factor that
[0:35] affect our motivation, but it certainly
[0:38] turns out to be a very important factor
[0:41] in graduating the level of motivation we
[0:44] have to seek particular outcomes.
[0:47] >> Welcome to the Huberman Lab podcast,
[0:49] where we discuss [music] science and
[0:50] science-based tools for everyday life.
[0:54] >> [music]
[0:56] >> I'm Andrew Huberman and I'm a professor
[0:58] of neurobiology and opthalmology at
[1:00] Stanford School of Medicine. My guest
[1:02] today is Dr. Massud Hussein who is a
[1:04] neurologist and neuroscientist at Oxford
[1:07] making key discoveries about the
[1:08] relationship between motivation and
[1:10] pleasure. Today we discuss what really
[1:12] determines our level of drive and
[1:14] determination to do everything from
[1:16] getting up to go to school or work to
[1:18] pursuing long hard challenges that last
[1:20] many years. We start off by talking
[1:23] about the opposite of motivation, which
[1:24] of course is apathy. And as you'll
[1:26] learn, perhaps surprisingly, apathy is
[1:29] separate from one's desire for
[1:31] something. We also discuss something
[1:33] very useful, which is how you can change
[1:35] your own perception of your own effort
[1:37] level. Today's discussion really gets to
[1:39] the heart of motivation and
[1:41] procrastination and how anyone, healthy
[1:43] or otherwise, can leverage that
[1:45] understanding to their benefit. As
[1:47] you'll soon hear, Dr. from Massud
[1:48] Hussein is a remarkable scientist,
[1:50] neurologist, and communicator. Indeed,
[1:52] he's the author of a spectacular book.
[1:54] I've read it. It's entitled Our Brain,
[1:57] Ourselves, and it's a terrific read if
[1:59] you want to learn more about how your
[2:00] brain works, how it can change over
[2:02] time, and how it makes you who you are.
[2:05] Before we begin, I'd like to emphasize
[2:06] that this podcast is separate from my
[2:08] teaching and research roles at Stanford.
[2:10] It is, however, part of my desire and
[2:12] effort to bring zero cost to consumer
[2:13] information about science and science
[2:15] related tools to the general public. In
[2:17] keeping with that theme, today's episode
[2:19] does include sponsors. And now for my
[2:22] discussion with Dr. Massud Hussein.
[2:24] >> Dr. Massud Hussein, welcome. Thank you
[2:27] for having me. You've worked on a huge
[2:30] variety of topics. Alzheimer's,
[2:33] attention, apathy. We're definitely
[2:35] going to talk about apathy. Spatial
[2:38] neglect, which I'm guessing most of our
[2:40] audience probably doesn't know exactly
[2:42] what that is. I'd like to start with the
[2:45] one that sounds like a bit of a downer,
[2:47] but as a window into understanding
[2:49] motivation and these states of
[2:52] excitement that most of us would like to
[2:53] be in, but let's talk about and really
[2:56] define through your lens what is apathy?
[2:59] How does the brain bring about this
[3:01] thing that we call apathy? And is apathy
[3:03] just a lack of motivation? Yeah, I mean
[3:06] these are big questions and I think the
[3:08] way we've approached them is somewhat
[3:11] serendipitous in the sense that you
[3:13] [snorts] know 15 years ago I wasn't
[3:15] studying apathy or motivation like many
[3:19] people I might think someone's lazy or
[3:21] they're highly motivated but that's a
[3:23] sort of psychological state it's a
[3:25] personality and it was only about 15
[3:27] years ago I started beginning to be
[3:29] aware that there may be a an important
[3:31] biology underlying motivation and when
[3:35] that biology goes wrong, it can lead to
[3:38] loss of motivation and even pathological
[3:41] apathy. And the way this happened was
[3:44] completely out of the blue. Uh I was
[3:46] then working in London at the National
[3:48] Hospital for Neurology in Queens Square
[3:50] at UCL. And we received a letter from a
[3:54] doctor describing a guy in his 30s. And
[3:58] this guy had been a highly productive
[4:00] person. He was in finance. He was also
[4:03] really liked socially, had a wide
[4:05] network of friends. But suddenly he had
[4:09] become completely different from being
[4:11] highly motivated. He went to I'm not
[4:14] interested. I can't be bothered. And
[4:17] that was both at work as well as with
[4:19] his friends. So people began to think
[4:21] this is something really different in
[4:23] this guy David. What's happening? They
[4:26] wondered if he had become depressed.
[4:29] That's why he wasn't really functioning.
[4:31] and he went to see his doctor who
[4:32] started him on an anti-depressant but it
[4:35] made no difference. He was still the
[4:38] same. So he lost his job. He got fired
[4:40] because he had lost motivation and he
[4:44] was so apathetic that he couldn't be
[4:47] bothered to get social security benefit.
[4:49] So his friends said, "Okay, come and
[4:51] stay with us." And they regretted it
[4:53] almost immediately because David did
[4:56] nothing. He just sat there in a chair
[4:59] all day long waiting for his friends to
[5:02] come back, do the cooking, clean. They
[5:07] needed to prompt him to have a shower
[5:08] because he literally just sat there. His
[5:11] level of motivation was almost zero.
[5:14] When we got to see him, and it was
[5:16] difficult because he'd never come to his
[5:17] appointments. We I had to phone him up
[5:20] to say, "Look, I am going to be here
[5:22] tomorrow.
[5:23] Please come." and he grudgingly said,
[5:26] "Okay, I'll I'll try and make it." And
[5:28] he was, of course, late. Um, he came and
[5:31] there was this very sad guy. He, you
[5:35] know, he was disheveled, really not
[5:37] looking after himself, stains on his
[5:39] shirt. But the one thing he wasn't was
[5:42] unhappy. He was absolutely happy about
[5:44] life, right? Which was the perplexing
[5:47] thing. He'd lost his job. He'd lost his
[5:49] apartment because he wasn't paying the
[5:50] rent. Couldn't be bothered to get social
[5:52] security. But there he was really happy
[5:55] about what was happening in life,
[5:57] looking forward to something that he
[6:00] didn't know what, but he was still
[6:01] looking forward to good things in life.
[6:03] So when I asked him, why aren't you
[6:04] doing anything when you're at home? What
[6:06] would you what would you normally do? I
[6:09] would listen to some music. So why
[6:12] aren't you listening to music? Because
[6:14] it would take me some time to put my
[6:16] music system together. How long would it
[6:18] take? 5 minutes. So this was really sort
[6:21] of revelatory for me. The effort of
[6:24] putting the cables together for his
[6:26] music system. Taking out the
[6:28] loudspeakers was too much in terms of
[6:31] the pleasure he could obtain from
[6:34] listening to music. It turned out that
[6:37] David had a very unusual neurological
[6:40] problem. His MRI brain scans revealed
[6:42] that he had two tiny little strokes in
[6:44] the basil ganglia. These are deep nuclei
[6:46] in the brain which are evolutionally
[6:49] wellconserved. They go back to the
[6:52] earliest vertebrate that we still have
[6:54] the lampay 360 million years old. And
[6:56] the key thing that we've discovered from
[6:58] the neurohysiology of the lampay is the
[7:01] basil ganglia are important in linking
[7:03] motivation signals to action. Some
[7:06] people call it motivation to act. So in
[7:09] an organism like the lamprey, motivation
[7:11] signals might be hunger or sex that lead
[7:15] to action to fulfill those goals. In
[7:19] David, these strokes in the vententral
[7:22] stratum, what what's called the nucleus
[7:24] encumbent in in animals led to no
[7:28] motivation signals leading to action.
[7:30] Nothing happened. But if you prompted
[7:33] him, go take a shower, come on, he would
[7:35] do it. But of his own valition, he
[7:38] wasn't motivated to act. And that was
[7:42] really something that was extraordinary
[7:44] for us because here was a man who had
[7:46] been highly motivated and that
[7:48] motivation had been extinguished by
[7:50] these two tiny little strokes which
[7:52] didn't affect him physically but
[7:54] affected his behavior. And the studies
[7:57] that we performed with David to try and
[7:59] understand this led us to the concept
[8:01] that we might be able to deconstruct
[8:03] this nebulous thing called motivation.
[8:07] >> May I ask a question? It's fascinating.
[8:10] Um, and I'm sure everyone including
[8:11] myself is also wondering what became of
[8:13] David. But before you tell us, was it
[8:15] the case that he would feel overwhelmed?
[8:17] Like I want to listen to music, but that
[8:20] five minutes feels like a huge effort.
[8:23] That's a long effort. Or was it the case
[8:25] that he didn't really want it either?
[8:29] Because the way you've described these
[8:30] lesions is a is a severing of the
[8:32] wanting from the engagement in the
[8:34] process to have. Yeah.
[8:36] >> But of course, as you and I know, neural
[8:37] circuits are never that simple.
[8:39] >> No, of course not. Yeah. And he never
[8:41] expressed it unless we asked him. But he
[8:44] would say that it's too much effort to
[8:47] put this system together. So [snorts]
[8:49] even if he was asked, "What would you
[8:52] like to do?" He might say, "I'd like to
[8:54] listen to music." Why aren't you doing
[8:56] it? Because it's too much effort to do
[8:59] it. Right? And that became a real
[9:02] insight into how our brains work when we
[9:05] make decisions about is this potential
[9:07] action worth the effort in terms of the
[9:11] reward that will arise from it. Because
[9:14] [clears throat]
[9:15] it turns out that if we look at apathy
[9:18] across many different neurological
[9:20] disorders, one common trait that we
[9:22] found when we ask people is this
[9:25] particular option worth the reward if it
[9:28] was requiring this much physical effort.
[9:32] We find that everyone is willing to work
[9:34] for high rewards.
[9:36] But the difference between motivated
[9:38] people and apathetic people is at the
[9:41] level of the low rewards. Apathetic
[9:43] people are more inclined to say, "Nah, I
[9:46] don't think this is worth the effort, so
[9:48] I won't do that option." That's a really
[9:50] interesting signature that we found when
[9:52] people make that decisions. But in
[9:54] someone extreme like David, almost
[9:56] nothing incentivized him to put in
[9:59] effort to act unless he was prompted to
[10:02] do so. But going back to what happened
[10:04] to him, one of the things we've learned
[10:05] from the neuroscience of the basil
[10:07] ganglia and motivation to act is that
[10:10] dopamine is a key neurotransmitter, a
[10:13] key chemical in the brain which is
[10:15] important in the neural circuitry. And
[10:17] that's when we thought okay is there
[10:19] anything we can do for this guy to
[10:21] improve his motivation. So initially we
[10:24] tried Leodopa L-dopa which is the drug
[10:27] that Oliver Saxs describes in Awakenings
[10:30] and many people have seen the film and
[10:32] it's used a lot in Parkinson's disease
[10:34] for treatment. We slowly ramped up that
[10:37] drug but seemed to make absolutely no
[10:41] difference behaviorally to David or on
[10:44] our tests of reward sensitivity. We we
[10:47] developed some ways of measuring that.
[10:49] So we were about to give up and then I
[10:52] suddenly thought look let's use the
[10:54] other drug that we use for the dopamine
[10:56] system and that class of drugs acts
[11:00] directly on dopamine D2 and D3 receptors
[11:03] rather than being a precursor to making
[11:06] dopamine in the brain like leodopa and
[11:09] this drug rapinroll
[11:11] latches onto dopamine receptors directly
[11:14] and stimulates the dopamine circuitry.
[11:17] So we slowly ramped up this drug
[11:20] thinking is it going to be any different
[11:21] or not? But 3 months after we started
[11:25] this medication, he came back, David
[11:28] came back to see us and I did not
[11:30] recognize this guy in the waiting room
[11:32] because first of all, he'd had a shower,
[11:34] he'd had a haircut, he was wearing a
[11:36] suit, he had a new job, and most
[11:40] impressively, he had a new girlfriend
[11:42] because in the state he'd been in, he
[11:45] was seeing nobody. but he'd obviously
[11:47] been motivated to get out there and, you
[11:50] know, see if he could find a new
[11:52] partner. I was absolutely delighted for
[11:55] him, but so astonished that we could go
[11:59] in a human biological
[12:02] system where someone has tiny lesions in
[12:06] the bas ganglia and has their motivation
[12:08] [clears throat] extinguished. We could
[12:09] go from that to recovering motivation by
[12:13] using a drug that we already have that
[12:15] affects the dopamine circuitry. And of
[12:18] course, David is really rare. This kind
[12:20] of bilateral in both sides of the basil
[12:23] ganglia being affected tiny little
[12:26] strokes. This this is extremely rare.
[12:28] It's reported and it leads to
[12:30] pathological apathy. But it turns out
[12:32] that apathy is really common across
[12:35] neurological disorders. And the way we
[12:38] thought about it is if a pathological
[12:41] process whether it's a stroke or whether
[12:44] it's Alzheimer's disease or whether it's
[12:47] Parkinson's disease or even some
[12:50] inflammatory disorder affecting the
[12:51] nervous system like multiple scerosis.
[12:54] If that pathological process is
[12:57] affecting this circuitry it can lead to
[13:01] loss of motivation. And that's what
[13:03] we're really interested in is to think
[13:04] about the circuits that are affected and
[13:07] also trying to deconstruct motivation in
[13:10] terms of [clears throat] what's actually
[13:11] going on in the brain. What does this
[13:13] circuit really doing for us that leads
[13:15] to this behavior we call motivated
[13:18] behavior?
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[15:44] like to drill into motivated behavior
[15:46] and the dopamine system. And thank you
[15:48] for sharing what became of David because
[15:50] uh always nice when medicine can deliver
[15:52] a a victory story.
[15:54] >> Absolutely. Yeah.
[15:55] >> Because as some people may recall that
[15:58] L-dopa for the treatment of Parkinson's
[16:01] had these transient improvements that
[16:03] sometimes can be dismaying for people,
[16:05] right? People get better and then they
[16:07] get worse again. And I'm sure there's
[16:09] additional progress being made there. We
[16:11] still need to do an episode all about
[16:12] Parkinson's, but we'll reserve that for
[16:14] another time.
[16:15] >> In thinking about motivation
[16:17] and the fact that there's really one
[16:20] system for most types of motivation,
[16:22] this is kind of what the David story
[16:24] suggests, right? That these basil
[16:26] ganglia, nuclei, nucleus encumbent are
[16:28] underlying all sorts of motivations to
[16:30] listen to music, to shower, to find a
[16:32] romantic partner, to work, to take care
[16:34] of oneself as opposed to distributed
[16:36] networks for motivation. Yeah,
[16:38] >> that's interesting in its own right, I
[16:40] think. But many people are probably
[16:42] familiar with feeling really motivated
[16:44] to do certain things but not others.
[16:46] Even if there isn't a pain point
[16:48] associated with doing, I don't know,
[16:50] maybe somebody likes arithmetic but they
[16:51] don't like literature or vice versa.
[16:54] Putting aside individual variation based
[16:56] on family history, psychology, traumatic
[16:58] experiences, is it true that certain
[17:00] people by virtue of the way that their
[17:01] dopamine system is kind of tuned up like
[17:04] how willing these neurons are to fire or
[17:06] not fire in different circumstances are
[17:08] just motivated people. I mean, you see
[17:11] this sometimes like
[17:12] >> you know, I've had two different
[17:13] bulldogs. The first one is like let's go
[17:15] and it's like and you have to really
[17:16] [clears throat] coax them along. The
[17:17] other one, let's go, okay, and just go.
[17:19] Some people are like this. Hey, like
[17:21] let's go. They pop up, they go. other
[17:23] people more reluctant, but I think most
[17:26] of us are somewhere in between. So,
[17:28] clinically and outside of the clinic, do
[17:31] you think that some people's
[17:33] dopamineergic neurons are just more
[17:35] willing to fire in response to everyday
[17:38] activities, novel activities, and the
[17:40] super exciting stuff? And I have a very
[17:42] specific reason for asking this, but
[17:43] I'll I'll keep it quiet for now because
[17:45] I really want to understand is there a
[17:47] continuum of motivation? And if so, can
[17:50] it exist both between individuals and
[17:52] within individuals?
[17:53] >> So, taking your first question, it turns
[17:56] out that this circuitry we're talking
[17:59] about, it's called the misolyic
[18:00] circuitry that links the basil ganglia
[18:03] to the frontal loes, is almost like a
[18:05] final common pathway for motivation
[18:07] signals to engage with the action
[18:10] systems of the brain. So, it could be
[18:13] hunger, it could be thirst, it could be
[18:15] sex. These are primary motivation
[18:17] signals that many animals have. But as
[18:20] you said, there are other motivating
[18:22] signals that we may also want to engage
[18:25] with. We may have other goals, whether
[18:28] it's arithmetic or to learn a new
[18:29] language or to go out into the park,
[18:31] whatever it is. Now how those different
[18:34] types of motivation signals are weighted
[18:37] or valued within our brains to engage or
[18:41] not engage this circuitry to lead to
[18:44] action is actually a very very
[18:46] interesting area. So one thing that
[18:48] we've learned is even apathy might be in
[18:53] different domains. The research in this
[18:55] area started with behavioral apathy.
[18:56] What we can measure is someone inert or
[18:59] are they active doing something? Then
[19:02] other kinds of work suggested there
[19:03] might also be social apathy. You know we
[19:06] might know colleagues who seem to be
[19:09] very very motivated to work but they
[19:10] don't want to engage with other people
[19:13] or do things like go to a party or
[19:15] something like that. They may also be
[19:17] emotional apathy. So there are people
[19:19] who seem to have very blunted responses
[19:22] to things that you and I might either
[19:24] find, you know, something that we want
[19:26] to congratulate people for or feel sad
[19:29] about if they had an issue. These people
[19:32] seem to not have that kind of range of
[19:35] motivational responses. And some people
[19:38] argued that there's also cognitive
[19:39] apathy. So whereas someone might be
[19:42] apathetic to do something physical, they
[19:45] might not necessarily be apathetic for
[19:48] doing something cognitive, being curious
[19:50] about the world, reading the newspaper,
[19:52] finding out what's going on in the
[19:53] world. And there may be dissociations.
[19:55] So someone could be socially apathetic,
[19:58] but you know, cognitively very highly
[20:01] motivated. So how does that happen? How
[20:04] do these different domains vary if
[20:07] there's one final con system? And of
[20:09] course this is where we have to think
[20:10] about the fact that brain circuits are
[20:12] complicated. And the kinds of signals
[20:15] that are being developed for behavior,
[20:18] cognition, social interaction or emotion
[20:22] are being formulated in different parts
[20:24] of the brain even though they might
[20:27] funnel through this basil ganglia system
[20:29] to engage the action systems in the
[20:32] frontal lobe. And even more granular if
[20:35] we want to get to that, you know,
[20:36] whether you want to learn a new language
[20:39] or you want to do arithmetic or go to
[20:41] the park or whatever it is, how do you
[20:43] weight these different motivation
[20:45] signals? So, one way we've thought about
[20:48] this is, you know, let's imagine today
[20:51] it's a beautiful day out there. What are
[20:53] the things you could do? And I'm sure
[20:55] Andrew, you could give me 20 things you
[20:57] could do, but you can't do them all at
[20:58] once. So somehow you have to prioritize
[21:02] what's the thing that you value most.
[21:05] And the way we conceive of this is a
[21:07] sort of a neuroeconomic decision-m where
[21:11] you look at those 20 things and you go
[21:13] okay how rewarding do I think each of
[21:15] these things are and then you also think
[21:17] well how effortful is that going to be
[21:20] and it could be physical effort it could
[21:22] be cognitive effort social effort
[21:24] emotional effort whatever it is and out
[21:26] of that kind of system where you do a
[21:29] calculation
[21:30] you will find the thing for you that you
[21:33] will value most given the level of
[21:35] effort required and that's what emerges
[21:39] as your motivated behavior at that time.
[21:43] >> Do you think people do that computation
[21:47] consciously?
[21:48] >> I don't think they have to do it. We
[21:49] could do it consciously, right? If I
[21:50] >> because I don't wake up I look at my
[21:52] schedule and I have to do this, this,
[21:53] and this. I actually schedule my
[21:54] workouts. I schedule time with others
[21:57] and things, but it's sort of the the
[22:00] constellation of things in my life. I'm
[22:02] not doing a very conscious waiting of
[22:04] this versus that. Although occasionally
[22:05] when there's a conflict in scheduling, I
[22:07] have to select this is more valuable to
[22:09] me than that. But it's not something
[22:10] that I generally sit back and think and
[22:13] I probably should. We probably all
[22:15] should sit back and think, okay, what is
[22:17] the best use of my time? Effort, reward,
[22:20] payoff, but we we sort of just go about
[22:22] life.
[22:22] >> Yeah. And I think what you're really
[22:24] getting me towards discussing is the
[22:26] fact that each behavior has a kind of
[22:29] activation
[22:31] hill that we have to cross to think,
[22:34] yeah, I could start this. So for some
[22:36] people, let's say learning a new
[22:38] language is a mountain. That's a huge
[22:41] kind of effort to put in. Whereas for
[22:43] other people, it's barely a mount. You
[22:45] know, I I don't think of that as a big
[22:47] burden, a big activation hill that I've
[22:49] got to cross before I get there. So
[22:52] there's the activation barrier before I
[22:55] even think of starting. And these things
[22:58] are not necessarily consciously being
[23:00] considered. It's just you have these
[23:02] biases because you've got experiences.
[23:04] The fact, hey, I wasn't that good at
[23:06] learning Spanish. Do I really want to
[23:07] spend a lot of energy in learning
[23:09] French? Those biases add up and affect
[23:13] the way you do that calculation. We were
[23:15] talking about reward versus effort. And
[23:18] essentially
[23:20] that's a very important way I think that
[23:22] we make a decision. Much of that could
[23:24] be subconscious.
[23:25] >> I'll tell two brief anecdotes if if I
[23:28] may to set the texture for the next uh
[23:30] question.
[23:31] >> Years ago I was at a PhD thesis at
[23:34] Stanford, a student, I'll just name her
[23:36] because she did a wonderful job in her
[23:37] thesis. Her name was Lauren Casease. She
[23:39] was not my student. I attended because
[23:41] she was working on neural regeneration
[23:43] and she had screened an enormous number
[23:45] of molecules for their ability to
[23:47] inhibit or promote neural regeneration.
[23:49] Super important problem as you and I
[23:51] both know that still hasn't been solved.
[23:53] Yeah.
[23:53] >> And it was really striking how many
[23:55] molecules she had evaluated. And I'll
[23:57] never forget her advisor's introduction.
[23:59] He said one of the best things about
[24:02] Lauren
[24:03] >> is that she has very low activation
[24:05] energy. Meaning there's the opportunity
[24:08] to do an experiment. she'd get up and do
[24:09] the experiment and say, "Ah, that was an
[24:11] interesting molecule. Move to the next
[24:13] one." And it occurred to me then that
[24:15] having low activation energy, provided
[24:17] the thing that you do doesn't get you
[24:18] injured or killed, is really a
[24:20] spectacular thing in life because you
[24:23] just get a lot more life out of days
[24:25] lived. So, you kind of wonder about the
[24:27] Lauren cases of the world. Are these the
[24:29] people where somebody says, "Hey, you
[24:30] know, uh, we need to do this thing like
[24:32] like take out the recycle and it's a ton
[24:34] with the roommate something back when,
[24:36] you know, and it's like, okay, I'll do
[24:38] that later." There's so much energy lost
[24:41] in the deliberation in the feeling like
[24:43] the effort reward trade-off. You don't
[24:45] want to waste your time doing things,
[24:46] but you also don't want to waste your
[24:48] time thinking about whether or not
[24:49] you're wasting your time. So let me take
[24:51] you up on that because after seeing
[24:53] David we thought about exactly this
[24:55] problem and we got a bunch of Oxford
[24:58] students and believe it or not at Oxford
[25:00] just like Stanford I'm sure there's a
[25:03] whole range of motivation amongst the
[25:05] students there are people who are highly
[25:06] motivated the Laurens and then there are
[25:09] people who are actually surprisingly
[25:11] apathetic they might be very smart
[25:13] people but they have high activation
[25:16] energy levels they need to cross that
[25:18] barrier to do something and we put them
[25:20] into the MRI scanner and we looked at
[25:24] their brain activity when they were
[25:26] given these choices. Is this option with
[25:28] this much reward worth this much
[25:31] physical effort? You just say yes or no.
[25:32] Would you do it or not? We could then
[25:34] look across this neuroeconomic space by
[25:37] parametrically
[25:39] changing the level of reward that we're
[25:41] offering and parametrically changing the
[25:43] level of effort. And it turned out just
[25:45] as we'd found in patients, the apathetic
[25:48] students were all willing to work for
[25:50] high rewards, but they weren't willing
[25:52] to work for low rewards. Interesting.
[25:54] >> Now in the brain, what we find is that
[25:57] the vententral parts of the basil
[25:59] ganglia, vententral stratum nucleus
[26:01] encumbent is active as well as the parts
[26:05] medial frontal areas, frontal lobe areas
[26:08] in these healthy students when they're
[26:10] simply making the decision. is this
[26:13] option worth the reward for this much
[26:15] effort? So they're not doing anything.
[26:18] They're just thinking about it. And we
[26:20] thought great, this is really fantastic
[26:22] because now we have convergence from the
[26:25] stroke patient that we saw with the
[26:26] basil ganglia lesions who lost
[26:29] motivation and now we can see that
[26:31] healthy individuals when they're having
[26:33] to make this decision show activation in
[26:35] the same area that was lost in David as
[26:37] well as the frontal loes. But the
[26:40] paradox here was that we found greater
[26:43] activity in those regions in the
[26:46] students who were apathetic
[26:49] compared to the students who are
[26:51] motivated. And we were not expecting
[26:52] that. We thought if you lack motivation,
[26:55] your brain activity when you're being
[26:56] asked to do this would just be lower. So
[26:59] the way we have resolved this problem is
[27:02] to think actually this is showing us
[27:04] something very important. It's showing
[27:06] us that apathetic people use more brain
[27:09] energy when they're making this
[27:12] decision. They have a bigger activation
[27:15] energy barrier to overcome because when
[27:18] they're making that decision, the brain
[27:20] is consuming more energy. It's consuming
[27:22] more glucose when it's doing that. Now,
[27:24] of course, in the scanner, in this sort
[27:27] of experimental situation,
[27:29] everyone's willing to do the task.
[27:31] They're making those decisions. But
[27:33] imagine these people at home if you're
[27:36] confronted with, "Oh my goodness, I'm
[27:38] going to have to work hard just to
[27:40] decide whether I should do this option
[27:42] or not. Maybe I would just won't do it."
[27:44] And that's, I think, a really important
[27:46] insight into what you might do to
[27:51] energize motivation in people who might
[27:54] be apathetic because it's showing us
[27:56] that that activation barrier that I was
[27:59] talking about in a way exists in the
[28:01] brain. Physiologically you can show that
[28:04] these people are working harder to make
[28:06] the same decision compared to motivated
[28:08] people.
[28:09] >> Fascinating experiment by the way. So
[28:12] elegant in its simplicity, but the
[28:14] paradoxical piece of more activity in
[28:16] these dopamineergic circuits in the
[28:18] apathetic folks tells me, and correct me
[28:20] if I'm wrong, that there's a cost to
[28:22] thinking about the effort required plus
[28:25] the cost of the actual effort required
[28:28] that compounds and puts some people out
[28:30] of the game.
[28:31] >> Exactly. So, you know, the Lauren, the
[28:34] the student you were talking about, has
[28:36] low activation energy. She obviously
[28:38] doesn't need to burn a lot of brain fuel
[28:40] in terms of thinking I I can do this.
[28:42] I'm going to do it. And you know she
[28:44] reminds me of something that happened to
[28:45] me when I was a PhD student. I was in
[28:48] Oxford and we would sit around having
[28:50] tea thinking about great studies we
[28:52] could do. nothing really happened and
[28:55] then I came to be a posttock at MIT and
[28:58] was surrounded by these highly motivated
[29:01] people and I can remember we disc had
[29:03] the same kind of discussion and then one
[29:06] of them would go yeah well let's do that
[29:08] tonight and I'd go tonight and that was
[29:11] the level of difference it just blew my
[29:14] mind that there were people who could
[29:16] just go right let's do it
[29:18] [clears throat]
[29:18] >> and I think that's been a real lesson
[29:20] for me that you can achieve things if
[29:22] you if you think in this way.
[29:24] >> Well, the other anecdote, I'll keep this
[29:26] brief, is a is a slightly humorous one,
[29:28] but it's designed to illustrate a point,
[29:30] which is I try not to spend too much
[29:31] time on social media unless I'm actively
[29:33] learning on there because I do find
[29:35] things that are really interesting and
[29:36] educate me sometimes just for
[29:38] entertainment. But there's a a post I
[29:40] came across um it's a little parody skit
[29:42] where uh a woman walks into the room and
[29:45] her uh husband or boyfriend is playing a
[29:47] video game and she says, "Hey, do you
[29:48] mind um hanging up those pictures that
[29:50] are in the hall? They've been there for
[29:51] a few days." He's like, "Yeah, yeah,
[29:52] yeah, yeah." And she walks out. She like
[29:55] shakes her head and she has an idea. She
[29:56] walks back in and she says, "Hey, do you
[29:58] mind showing me how to hang those
[30:00] pictures in the hallway? I'd love to
[30:02] learn how." And he's like, "Boom." And
[30:05] it like, you know, he launches into, you
[30:06] know, so she's tapped into a component
[30:08] of his motivational circuitry where the
[30:10] opportunity to to teach clear literally
[30:12] gets him around this uh this activation
[30:14] energy thing like all of a sudden the
[30:16] activation energy required to do the
[30:17] same thing just drops to zero. And it's
[30:20] a very good example because you know one
[30:22] thing you got to think about is how can
[30:24] you change that barrier for people.
[30:27] Either you make the effort less. Let's
[30:29] say you got a part task to do. You could
[30:31] break it down into subcomponents so the
[30:33] activation level doesn't seem quite so
[30:35] formidable. Or you could change the
[30:37] incentive. And this is what happened in
[30:39] your example, right? The incentives
[30:41] change because now the guy is thinking
[30:44] ah now the the reward here is to show
[30:47] her how I do this. That's the thing I
[30:49] will get the pleasure from, the reward
[30:52] from. Right? So I think that's the other
[30:55] insight we got is how do you change
[30:58] people's motivation in a practical way?
[31:00] Well, you have to think if this is
[31:02] really happening in the brain that
[31:03] you're making decisions about whether
[31:05] this reward is worth the effort. You can
[31:07] either increase the reward or change it
[31:10] in some way in terms of something that's
[31:12] meaningful for the person or you change
[31:15] the effort required to accomplish maybe
[31:19] part of the task or perhaps start you
[31:22] know just initiate the task and often
[31:24] starting can be a huge motivational
[31:27] pull. You know, this gets to um some uh
[31:31] sticky territory around the actual
[31:34] versus the perceived utility of lots of
[31:37] things that are on the internet
[31:39] including in the health and dare I say
[31:41] wellness space which is the following.
[31:43] There's this idea that if you do for
[31:45] instance a hard run or a hard workout
[31:48] that you are teaching yourself how to do
[31:50] hard things that can translate to doing
[31:52] hard things in other domains. So as
[31:54] psychologists, neuroscientists, we talk
[31:56] clinicians, we talk about the domain
[31:57] specificity, but that's just nerdy speak
[31:59] for like does one thing translate to
[32:01] another circumstance. Are you teaching
[32:02] yourself an algorithm of I did a hard
[32:04] thing this morning, you know, I did the
[32:05] cold shower I don't like. I did the
[32:07] workout I may or may not have wanted to
[32:09] do, but so now I'm more empowered or and
[32:12] I've thought about this quite a bit or
[32:15] do we have a finite amount of energy and
[32:17] the most rational approach is to is to
[32:19] think okay what's actually going to
[32:21] provide me the most benefit today? Like,
[32:22] can we really get momentum and
[32:24] understanding of our underlying
[32:26] motivational circuitries? Or is it the
[32:29] case that we're diluting ourselves? I'm
[32:31] not attempting to undercut a lot of
[32:32] content I've done previously, but I've
[32:34] had plenty of um hard workouts and then
[32:36] gotten to the other thing I needed to do
[32:38] and went like, I don't want to do this.
[32:39] I'm tired from that workout this
[32:41] morning. [laughter and clears throat]
[32:42] But we are also familiar with the fact
[32:44] that if something really intriguing or
[32:46] exciting to us is presented to us,
[32:47] suddenly it's like we're a different
[32:49] human being. It's a complete state
[32:51] change. So, I'm I'm curious. I'm not
[32:53] asking you to editorialize about the
[32:54] health and wellness space, but more
[32:57] globally, can we teach ourselves to
[32:59] lower our activation energy in a way
[33:02] that can serve us well across the board?
[33:04] I think we can because it turns out
[33:06] obviously some of these things that
[33:08] people use psychologically to improve
[33:11] their motivation can be framed in
[33:14] exactly the way I put it to you that the
[33:16] what we're doing here is trying to
[33:18] either increase the reward or change the
[33:21] nature of the incentive you know if it's
[33:22] something novel and salient that you
[33:25] think ah this is really interesting it's
[33:27] rewarding for me or we reduce the effort
[33:30] so just using these simp this simple
[33:32] principle might be enough for someone to
[33:35] think about how to do it. You know,
[33:37] planning out your day or week in advance
[33:40] for some people makes life better
[33:43] because every time they're having to
[33:44] make a decision on the fly if they're
[33:46] just doing it without planning it out
[33:49] means that the it's costing, right?
[33:52] Every decision has a cost in terms as
[33:54] we've seen the brain having to put in
[33:57] invest fuel to make that decision. So if
[34:01] you're having to do that every time you
[34:03] make a decision, that can seem very
[34:05] burdensome. Whereas if you did it once
[34:08] in a big way where you planned it out
[34:10] for the day or the week, maybe the costs
[34:13] in terms of the activation energy
[34:16] required for the brain is much lower for
[34:19] you if you do that. So it's a simple
[34:20] thing to do. Dividing up a task, let's
[34:24] say you're given a project by your
[34:25] manager, it's going to take you three
[34:28] months to accomplish from it. seems
[34:30] absolutely formidable because you have
[34:31] no idea of where to start. What if you
[34:34] could break it down into smaller tasks
[34:38] which bring down that mountain the
[34:40] activation energy required to get that
[34:42] small thing done. Let's say first of all
[34:44] let's research one area of this and get
[34:47] a handle on that and if we get that done
[34:50] this is a sort of if then kind of
[34:53] construct if we get that done we can
[34:55] then move on to a second piece of work.
[34:57] It would also help if your manager said,
[34:59] "Well done for getting that bit done."
[35:01] Right? That's that's also a motivation
[35:03] pull to think, "Yeah, actually I don't
[35:05] need to get the whole piece done to get
[35:08] the reward of somebody identified that
[35:11] as a positive thing to have done." I
[35:14] would love to see an experiment done
[35:16] where the perception of one's effort to
[35:18] do something can be separated from the
[35:20] actual effort and really get to the meat
[35:23] of whether overthinking or even thinking
[35:27] at all about the effort takes us away
[35:29] from having more quote unquote
[35:31] motivation or even better performance.
[35:34] And I haven't had time to think this
[35:35] through, but as you were describing
[35:36] David and his transformation and this
[35:38] experiment on the undergraduates
[35:41] of valuing different outcomes, I wonder
[35:43] if you could put somebody on a
[35:45] stationary bike and put them in a
[35:47] virtual environment
[35:48] >> and measure the effort required to climb
[35:51] a hill and you could adjust the
[35:53] difficulty,
[35:54] >> but you change the perception of how
[35:56] steep that hill is, right? If we could
[35:59] translate that to the real world like to
[36:01] to learn something to learn how to tango
[36:03] for instance you know I have Argentine
[36:05] relatives it'd be nice to learn how to
[36:06] tango that's pretty cool skill right
[36:08] there's a lot required you had to go to
[36:10] the class you got to drive there find
[36:11] the teacher you if you're the one who's
[36:13] supposed to lead then it's like
[36:14] especially embarrassing if you can't do
[36:16] it so there
[36:17] >> sounds like you've already started
[36:18] >> yeah started this process but that's
[36:21] very different than the actual work
[36:23] involved in doing it which in most cases
[36:25] turns out to be much lower than the
[36:27] perceived effort Yeah.
[36:28] >> So is there a way to tease these things
[36:30] apart?
[36:30] >> I think not in exactly the way you
[36:32] suggested about the treadmill and the
[36:34] and changing the perception of the
[36:37] gradient, let's say, that's coming. But
[36:39] that wouldn't that be interesting
[36:40] because what we then get is subjective
[36:43] value of effort versus the real effort
[36:46] the physiological effort whatever it is
[36:48] you know oxygen consumption the glucose
[36:51] required the lactic acid that's building
[36:54] up all of those parameters and seeing
[36:56] how that diverges but I bet you we would
[36:59] find that there's a huge variation in
[37:02] subjective valuation
[37:04] >> and it could go either way it could
[37:05] >> we have a good friend Ken Ry out who's
[37:07] like a very famous within the
[37:09] marathoning community like endurance
[37:11] athlete and he does this mind game on
[37:14] his opponents when he runs and he wins
[37:16] races in the Gobi Desert at like age 50
[37:18] plus he'll run up next to his
[37:20] competitors an actual event and he'll
[37:23] take his earbuds out and he'll say I
[37:25] don't know what it is I never get tired
[37:28] and then he wins
[37:29] >> and these are guys that he couldn't
[37:30] catch up to
[37:32] >> barely until then and he dominates them
[37:34] so there's a psychological thing
[37:35] happening in both of them right and I
[37:37] think he does as much for himself as he
[37:39] does for them. And many competitive
[37:41] athletes have talked about when they see
[37:43] a great competitor starting to fail, how
[37:45] it gives them this sense that they have
[37:48] like a booster pack. Y
[37:50] >> and it's not the nicest example because
[37:52] I'm not big on motivating through
[37:54] competition, per se, but it says
[37:56] something about our perceived effort of
[37:59] our own, whether or not we're overcoming
[38:00] the challenge. And if we see someone
[38:02] else falling into a psychological trap
[38:05] like that, presumably it allows us to
[38:07] access the inverse of that psychological
[38:09] trap. It's like we get a boost.
[38:10] >> Yeah. And I think what you've said is
[38:12] within the individual, you can change
[38:15] your subject evaluation of the same
[38:17] effort you're running on the Gobi
[38:19] Desert, right? It's the same effort
[38:21] you've been putting in for miles and
[38:22] miles. And suddenly you have
[38:24] subjectively valued this thing as less
[38:27] effort
[38:28] >> and you're going to now, you know, get
[38:30] the booster.
[38:31] >> Wild, right?
[38:32] >> Well,
[38:33] >> it shouldn't work in terms of the the
[38:34] the laws of physics and chemistry and
[38:36] biology. The hill is the hill.
[38:39] >> Yeah.
[38:39] >> And of course, it speaks to the brain's
[38:41] critical role. It suggests that there's
[38:43] a cost all along that you weren't
[38:45] acknowledging, right? like you're
[38:47] removing some additional effort as
[38:49] opposed to like getting more
[38:51] >> energy from you know from the sky.
[38:53] >> Yeah. You're not going to get that. So
[38:54] it is also the way you framed it for
[38:57] yourself right the activation energy
[39:00] required to do this to get that little
[39:02] bit more uh from this. So I think you
[39:05] know this simple principle actually
[39:06] takes us quite a long way.
[39:08] >> You had a book that was tremendously
[39:11] successful. We'll put a link to it in
[39:12] the show notes captions. And it was
[39:14] tremendously successful because it's an
[39:16] awesome book. Tons of learning there.
[39:17] Super interesting. First book of its
[39:19] kind in a long while to really educate
[39:22] people on the brain and its workings.
[39:23] There have been others, but yours really
[39:25] did spectacularly well for its content,
[39:27] but you also won a big award for this,
[39:29] right? Do you ever think about that in
[39:31] terms of how hitting the pinnacle of
[39:34] something impacts our perception of the
[39:36] next effort and the next potential
[39:38] outcome? I mean, we think of this as
[39:39] quote unquote reward prediction error,
[39:41] but this has broad implications for
[39:44] whether constant scrolling on social
[39:46] media is actually adjusting dopamine
[39:48] circuits in a way that makes rewards in
[39:51] the real world less enticing, or whether
[39:53] success in one domain truly leads to
[39:56] confidence and success and lower
[39:58] activation energy in another domain, or
[40:01] whether or not it puts a certain
[40:02] pressure on us because, you know, the
[40:04] rewards might not feel as great. I'm not
[40:06] trying to undercut any of your own
[40:07] relationship to this book, but what is
[40:09] the relationship between prior rewards
[40:12] or failures, memory and motivation?
[40:15] >> So, we've talked about this calculation
[40:17] about reward and effort. We've gone into
[40:19] that in some detail. Once the behavior
[40:21] is initiated, it's not just initiation,
[40:24] it's also persevering to make sure we
[40:27] get to the end. And then at the end, if
[40:30] we get to the outcome of what we wanted
[40:32] to achieve, we can have a hedonic
[40:34] pleasureful experience. That's what we
[40:37] wanted. Or we could have an aversive
[40:39] response. You know, we put all this
[40:41] effort in and actually it turned out it
[40:43] was an apt terrible decision. And we've
[40:46] all made those, right?
[40:46] >> Oh, yeah. [laughter]
[40:48] >> Not me. I understand. Oh, of course.
[40:50] Yeah.
[40:51] >> And the outcome, you know, whether it's
[40:54] a great pleasureful hedonic response or
[40:57] whether it turned out to be absolutely
[40:59] awful and very aversive obviously is
[41:01] graded. But that graded outcome
[41:05] is important for learning. What
[41:07] neuroscientists call reinforcement
[41:08] learning. And that learning comes back
[41:11] to affect the way we make that decision
[41:14] I was talking about. Which of the 20
[41:16] things I could do today do I prioritize?
[41:18] Because if it turned out that I
[41:20] prioritized one which turned out to be
[41:22] absolutely awful, next time it's coming
[41:25] up in my menu of things I could do, I am
[41:27] going to devalue that. So my subjective
[41:31] evaluation of that particular choice
[41:34] would be much lower. The learning
[41:36] mechanism is really important for
[41:39] choices in the future. You were talking
[41:41] about how previous experiences affect
[41:44] your motivation to do things. Well, my
[41:47] motivation to do that terrible thing is
[41:49] really going to be low next time it
[41:51] comes up. So, I might pick something
[41:52] completely new, perhaps something which
[41:54] gives me something novel and salient
[41:56] that I haven't experienced before. It
[41:58] might turn out to be a bad thing, but I
[42:00] don't know. I'm going to give it a go.
[42:01] So, I think learning is a really
[42:04] important mechanism in motivation. And
[42:07] of course, guess what? The evidence
[42:09] suggests that dopamine is not only
[42:11] important in in terms of this decision-
[42:14] making about whether this is worth the
[42:15] effort or not. It's also very important
[42:18] in the human brain and in animal brains
[42:20] for learning from previous actions.
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[44:54] Seems to me that the most advantageous
[44:58] approach would be to have a lot of
[45:01] generalizability about the process of
[45:04] overcoming activation energy and just
[45:06] getting into action toward a goal.
[45:08] >> Like if you do the hard workout that
[45:10] morning or maybe you write a certain
[45:11] passage, let's take it out of exercise.
[45:14] exercise always. It's kind of a cliche
[45:15] example by now. You know, you're trying
[45:17] to learn violin or you're trying to
[45:18] learn a language and it's hard, but you
[45:20] do a little bit of that before going to
[45:21] work that it does set you up to be able
[45:24] to engage in effortful things throughout
[45:27] the day. Some things you like to do,
[45:29] some things you don't want to do. Okay,
[45:30] let's let's assume that one could
[45:32] achieve that. But in terms of failures,
[45:34] you want a ton of domain specificity
[45:36] because if the person says, you know
[45:38] what, I'm going to go after this
[45:41] athletic goal or cognitive goal or
[45:44] scholastic goal and they fail.
[45:47] >> If they attach the effort process and
[45:49] not the specific goal to their memory in
[45:53] some broad way, then it could be I try
[45:56] things and I fail. Things being like
[45:58] everything, right? And that's how you
[46:00] described David. So I'm struck by the
[46:04] potential for an asymmetry in the way
[46:06] that this reward motivation circuitry
[46:09] works. On the one hand, it's very
[46:11] generic. On the other hand, we have a
[46:13] lot of ability to say, well, I'm put in
[46:15] a ton of work, and I'm talking about
[46:17] myself now, to try and learn a musical
[46:18] instrument as a kid. Total failure. Dogs
[46:21] howled, parents cringed, everyone
[46:23] cringed. I was happy to put it away.
[46:25] >> But I've put effort towards other
[46:27] things, and it's worked out fabulously.
[46:29] It's good to know that it wasn't just
[46:31] effort.
[46:31] >> Yeah.
[46:32] >> Right. But if you don't obey punishment
[46:34] and failure, you're also setting
[46:36] yourself up for a very hard life. No one
[46:38] wants to be the person with low
[46:40] activation energy who's kind of an idiot
[46:42] because they're always trying things and
[46:44] they never work out. That's I think what
[46:46] keeps a lot of people in the chair, so
[46:48] to speak, wondering if they should put
[46:50] effort towards this or that. And that's
[46:52] why they, dare I say, watch too many
[46:55] videos about motivation. Right? you want
[46:58] to watch the right ones. But you know,
[47:00] you get the point.
[47:01] >> Yeah. So, this is generic in the sense
[47:04] that this pathway we've been talking
[47:06] about is a, if you like, a final common
[47:09] pathway where all of these signals
[47:11] converge. So, in David, it took out this
[47:14] final common pathway. The strokes took
[47:16] out the final common pathway and
[47:18] therefore we saw no motivation signal
[47:20] really was prompting him in any way of
[47:23] his own accord valitionally to do
[47:25] something. Now the other point you make
[47:27] about the fact that you don't want this
[47:29] to be something that generalizes to all
[47:33] kinds of decision-m otherwise you'd
[47:35] think you're a failure if every time you
[47:37] did something and it didn't work you'd
[47:38] say oh I generalized to everything so it
[47:41] doesn't seem to be like that and we can
[47:43] understand that if it's if this is the
[47:44] final common pathway there the signals
[47:48] for decisions about playing violin
[47:50] learning a new language whatever it is
[47:52] are being computed elsewhere in the
[47:53] brain to engage this system. This is
[47:56] just the final common pathway to get you
[47:59] that vigorous energy over the activation
[48:01] energy barrier to initiate the action.
[48:04] And then of course, you're not going to
[48:06] be any good at the violin or salsa
[48:08] dancing or tango if you don't persevere.
[48:11] You have to persevere. And that's the
[48:13] other really important part of
[48:15] motivation. You know, we know a lot of
[48:17] people who start things and then we also
[48:19] know the non-competers, the people who
[48:21] are always so energetic but actually
[48:23] don't finish, right? So, it's almost as
[48:26] important to be able to finish and
[48:28] complete as initiate actions. Perhaps it
[48:32] should be required learning to do some
[48:35] things that you're very passionate
[48:37] about, but intentionally do things that
[48:40] you maybe even loathe just a little bit
[48:43] even if provided they're not damaging to
[48:46] sell for others or something because
[48:48] there's a real value in just what I call
[48:50] chop wood carry water where you just
[48:52] >> and I have this mode sometimes where I
[48:54] just really don't want to do something
[48:56] and I say like all right chop wood carry
[48:58] water I'm doing it just to do it and you
[49:00] finish and you feel pretty good about
[49:02] the effort and the thing you're kind of
[49:04] like h all right got it done I'm just
[49:06] glad to have it done but to be a
[49:08] functional human being generally you
[49:10] need both and and I'm asking this on
[49:12] behalf of many many questions I get
[49:14] about motivation or how do you find your
[49:16] passion and I always say well you find
[49:17] your passion by getting good at effort
[49:19] in things that you're not passionate
[49:20] about so that when you eventually find
[49:22] your passion you can just get there much
[49:24] faster you can't just sit around waiting
[49:26] to be passionate
[49:27] >> and that's sort of what David was doing
[49:29] and it wasn't pulling him forward for
[49:30] it. Exactly. No, that's right. And uh
[49:32] you know, obviously there are different
[49:34] ways of getting your passion, but as you
[49:35] say, if you're just waiting for it to
[49:37] happen, it may not happen. The other
[49:39] thing that was important about what we
[49:41] were just speaking about is if you do
[49:43] for some reason generalize maladaptively
[49:46] to thinking this didn't work and I tried
[49:49] this, this didn't work, and I tried this
[49:51] and I'm really bad at this. That can
[49:53] lead not only to loss of motivation, but
[49:56] what we might call clinical depression.
[49:58] Because one of the things that happens
[50:00] in depression is you think you're not
[50:02] good at anything. Even though you know
[50:04] that might be an unreliable objective
[50:07] measure of your performance. Everything
[50:10] you do seems bad. It hadn't been a
[50:12] terrible outcome. And one of the areas
[50:15] that we're really getting into is trying
[50:17] to work out the difference between
[50:21] depression and apathy. And it turns out
[50:23] it's quite complicated. But there are
[50:25] some people who have pure apathy, no
[50:27] depression like David. And there are
[50:29] other people who can be depressed, they
[50:31] can be sad, they can be hopeless about
[50:33] the future, but they don't necessarily
[50:35] lose motivation. They can have pure
[50:37] depression. And to make life really
[50:39] complicated, there are people who would
[50:41] fulfill the criteria for both apathy and
[50:44] depression. They fit in the overlap
[50:46] between those two syndromes. And trying
[50:49] to understand the biology of what
[50:51] separates depression from loss of
[50:54] motivation as we see in apathy is is one
[50:56] of the important areas of research at
[50:58] the moment.
[50:58] >> None of us want to be the person who
[51:01] just doesn't motivate to do anything.
[51:04] None of us want to be the person who
[51:05] motivates to do everything. And none of
[51:08] us want to be the person who invests
[51:10] lots and lots of time and energy in lots
[51:12] of things and underneath it all doesn't
[51:14] really want the things they're going
[51:15] after. This sort of the tapestry of the
[51:18] internet self-help motivation. And
[51:21] there's so much I really have to say
[51:23] this. I've wanted to say this for a long
[51:24] time and it's the appropriate time. I
[51:26] think there's so much BS about oh is
[51:30] something pulling you forward or are you
[51:31] pushing yourself to it? You should do
[51:33] things out of love. No, you should do
[51:34] things to serve others. both wonderful
[51:38] in in principle and practice, but
[51:40] there's this idea and I think it's a
[51:42] false idea that there's some specific
[51:45] thing working on behalf of others,
[51:48] knowing what the purpose of what you're
[51:49] doing that that is somehow going to
[51:51] unlock this circuitry.
[51:52] >> What I'm realizing today is the
[51:54] circuitry is the same. The learning
[51:55] about what engages that circuitry
[51:58] >> is based on our historical understanding
[52:00] and probably the messages that we hear
[52:02] in our family, etc. This is a worthwhile
[52:04] pursuit. It's hard. keep going. Trust
[52:06] me, it's going to work out in the end,
[52:08] even if it doesn't work out the way you
[52:10] think. Exactly. Those are very valuable
[52:12] messages to hear. But my question is
[52:14] this.
[52:15] >> For any of us, we've also seen the
[52:19] person who is very very excited to try
[52:22] everything. Every idea is something that
[52:23] they take action on and they seem
[52:25] resilient to the fact that it never
[52:27] really goes anywhere. It's almost like
[52:29] their self-concept is divorced from the
[52:32] outcomes. Other people have it in the
[52:34] opposite direction where like you said
[52:37] they're trying things, they're getting a
[52:38] reasonable amount of success certainly
[52:40] against the backdrop of averages, but
[52:43] maybe they have one big failure or a
[52:44] couple and then suddenly their whole
[52:46] self-perception is altered.
[52:48] >> Where does self-perception come into all
[52:50] of this? Like one's beliefs about
[52:52] themselves.
[52:53] >> Yeah. and their ability to do hard
[52:55] things both for reward and just for the
[52:59] sake of getting good at hard work seems
[53:02] like an immensely valuable feature of
[53:04] the human psyche and I don't think we
[53:05] have a name for that but like the
[53:07] self-concept piece yeah
[53:09] >> in my mind is really important
[53:11] >> I don't [clears throat] think we have a
[53:12] mechanistic explanation for the
[53:14] differences you've just suggested you
[53:16] know psychologically we could think
[53:17] there are many reasons for that some
[53:19] people don't have high ambitions they're
[53:21] happy to sit at the 50% level maybe 51%
[53:24] 52% in terms of where they sit in the
[53:27] population and other people are not
[53:28] happy with that. That's not what they
[53:30] were brought up in this world to do.
[53:32] They want to be at the top 2% if
[53:34] possible at the 1%. I don't think we
[53:36] have at the moment a good idea of the
[53:39] neuroscience that distinguishes between
[53:41] those two types of individuals
[53:43] >> of ambition.
[53:44] >> Of ambition. Yeah.
[53:45] >> Yeah. I don't know why I'm obsessing
[53:47] about this at the moment. I feel like a
[53:48] lot of the pain of the world is about
[53:51] people trying to understand what they
[53:53] should strive for. A friend long ago,
[53:55] she 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
[54:01] intense pursuit." And I said, "But I'm
[54:02] in I'm in love with the things I'm
[54:04] doing." And she said, "Well, it's just a
[54:06] lot." I thought, and then I realized
[54:09] like, oh, yeah, she really flows through
[54:11] life. She's accomplished, but it's just
[54:13] kind of in flow. Like there isn't this
[54:14] push energy. And you know in Eastern
[54:17] medicine and philosophy they talk about
[54:19] like it gets interesting right at the
[54:21] level of neuro anatomy they talk about
[54:22] sort of like whether or not you're
[54:24] pushing yourself from the back of your
[54:26] body versus being pulled from the front.
[54:28] I mean it's mystical and vague to
[54:30] somebody like me trained in western
[54:31] science but I think they're on to
[54:33] something
[54:33] >> like whether or not you're expending
[54:35] extra energy kind of forcing yourself to
[54:38] do things. Yeah.
[54:39] >> In your undergraduate students your
[54:41] patients
[54:42] >> I'm assuming you see the full range.
[54:44] >> I do. Yeah.
[54:46] >> If you were to editorialize a little
[54:48] bit, what do you think is the the key to
[54:50] both satisfaction from work,
[54:52] satisfaction, realistic satisfaction
[54:54] from outcomes and and kind of uh peace
[54:57] like a good life?
[54:58] >> Well, it's interesting, isn't it?
[54:59] Because there and there is some research
[55:01] on this. you know, the Harvard U study
[55:03] of aging looked at these people, these
[55:06] men who I think were in their late teens
[55:11] um and followed them up uh to their 60s
[55:15] and 70s. And my recollection of that
[55:17] data is really interesting that there
[55:19] are some people who lived a kind of
[55:22] average life and they had a average
[55:26] family, they had average income, they
[55:29] had an average house. And then there
[55:31] were other people who really looked like
[55:35] they were going to soar and something
[55:38] happened to those people along the way.
[55:40] They didn't saw, they they fell. And
[55:42] then finally there was another group who
[55:44] actually did saw and were right up here.
[55:48] But when they looked at the happiness
[55:50] levels of these people, it was the
[55:52] average person who actually would
[55:55] self-report the highest levels of
[55:57] happiness. So ambition doesn't
[56:00] necessarily equate with happiness, which
[56:03] I think many people would agree with
[56:04] with that. But on the other hand, it
[56:08] seems to be such an important thing for
[56:10] humans, right? For so many humans, it's
[56:13] not sufficient just to be at the 50%. We
[56:15] really want to propel ourselves, whether
[56:17] we're pushed or pulled, whatever it is.
[56:20] We want to get there. So, it would be a
[56:22] great area of research, wouldn't it? To
[56:24] find out how ambition is encoded in the
[56:27] brain and how does it work, you know,
[56:29] because there's also the question of
[56:30] realistic ambition. So, if someone had
[56:33] told me when I was younger, don't be
[56:35] stupid, be realistic. You're never going
[56:37] to get to Oxford as an undergraduate.
[56:41] And you're never going to have a career
[56:42] where you're going to be doing clinical
[56:46] neurology as a clinically qualified
[56:49] person doing neuroscience research,
[56:52] editing a journal, writing a book.
[56:55] That's not going to happen. If I had
[56:57] thought in those ways, it probably
[56:59] wouldn't have happened. I just didn't
[57:00] think that we should have these
[57:01] boundaries to what you can do.
[57:03] >> Yeah. The early messaging is key.
[57:05] >> I think it is. Yeah.
[57:06] >> Yeah. I'm the son of a scientist and I
[57:08] was born and raised in Silicon Valley
[57:09] and I realize only now that it
[57:12] completely shaped my brain in terms of
[57:15] like you want to do something you go try
[57:17] it and there's a good chance you can
[57:19] succeed and I mean even friends that
[57:21] went the way of athletics if they didn't
[57:23] succeed there they started companies
[57:24] that succeeded and and some crashed and
[57:26] burned mind you in all these domains in
[57:28] academia too we see it right ambition
[57:30] doesn't protect against disease or poor
[57:33] judgment in a lot of times either But it
[57:36] is fascinating and and maybe our species
[57:39] needs a distribution of kind of
[57:41] motivational circuitries in the way you
[57:43] describe certainly developing new
[57:45] technologies that transform medicine.
[57:47] Yeah,
[57:47] >> someone needs to do that. They can't be
[57:49] happy with just the scalpel and the
[57:51] current surgical mask and the current
[57:54] questionnaire that you ask patients in
[57:56] psychiatry. I mean, we need tool
[57:58] builders and that takes a vision of
[57:59] something that doesn't exist or kind of
[58:02] sense that there's something else.
[58:03] >> Absolutely. And so, you know, God bless
[58:06] the the people that do that, but also
[58:08] >> it's nice to have members of society
[58:10] that are just happy living their lives
[58:11] because otherwise, what else is all that
[58:13] technology [laughter] for, right?
[58:15] >> Yeah. No, I'm not making any judgments
[58:16] here. I'm just saying it's a really
[58:19] intriguing thing if you could get any
[58:21] kind of handle on what what makes this
[58:23] happen, this range of ambition. I didn't
[58:26] think we were going to discuss
[58:27] psychedelics and we don't have to if if
[58:28] if you don't want to. But these days
[58:30] there's growing interest in what are
[58:33] essentially and let's talk about classic
[58:34] psychedelics. Let's forget MDMA is not a
[58:36] psychedelic folks. It's an impathogen.
[58:38] Ketamine is not a psychedelic. It's a
[58:40] dissociative anesthetic. So people lump
[58:42] these things together and we'll move
[58:43] ibain and LSD and the those are
[58:47] different in the realm of psychedelics.
[58:48] Psilocybin is one that's increasingly
[58:50] being used in clinical trials and
[58:52] >> it's not a cure all but many people who
[58:54] do who are in these clinical trials come
[58:57] through talking about a kind of a more
[59:00] connected sense of self to the world and
[59:03] you know it seems to um take the edge
[59:05] off of the hyper ambitious miserable
[59:07] person.
[59:08] >> That's my observation anyway. And it
[59:10] also seems to take some people with
[59:13] major depression to a place of like oh I
[59:16] actually could change. I could get a
[59:18] different outcome which is
[59:19] [clears throat] simply plasticity.
[59:20] >> Yeah.
[59:21] >> So what is your thought about our
[59:23] ability to radically change our
[59:26] self-perception right
[59:27] >> in terms of our ability to do things in
[59:30] the world accomplish things in the world
[59:32] because that's really what getting over
[59:33] depression is about. It's about
[59:35] imagining a different outcome for
[59:36] oneself.
[59:37] >> Yeah. It's a very important question and
[59:38] I'm not an expert on psychedelics but I
[59:41] think there is some emerging research on
[59:43] the effect of psychedelics on what is
[59:45] called anhidonia lack of pleasure that
[59:48] you could get from something. So you
[59:50] know we talked about changing effort but
[59:51] it could be that one variable that
[59:54] happens in people with low mood is that
[59:58] they devalue the reward. Everything
[1:00:02] seems bland. It doesn't seem pleasureful
[1:00:04] anymore. So psychedelics seem to have an
[1:00:08] effect on the self. That principle is
[1:00:10] really interesting because the kind of
[1:00:12] patients that I study, the kind of
[1:00:13] patients that I describe in the book are
[1:00:16] people in whom there was a change in the
[1:00:18] self. There was a change in the way they
[1:00:22] portrayed themselves to the world, their
[1:00:24] social identity, but also in their
[1:00:26] personal identity. And this is a really
[1:00:28] big area. I mean, what what makes the
[1:00:30] self? But the key thing here is that the
[1:00:33] self can change. The self is not set in
[1:00:36] stone. We talked about psychedelics, but
[1:00:39] even even simple things like if you have
[1:00:41] too much thyroxine, thyroid hormone
[1:00:43] floating around in your body and you're
[1:00:45] in hypothyroid state, people might be
[1:00:48] surprised to hear that that can cause
[1:00:50] not only irritability but cognitive
[1:00:52] impacts on your processing. It can also
[1:00:55] be the same. You know, sometimes if you
[1:00:58] have lack thyroxine, if you're hypo
[1:01:01] thyroid, your cognitive functions may go
[1:01:04] so low that sometimes people wonder if
[1:01:06] you're developing dementia. It can be
[1:01:08] that bad. Now, most people wouldn't
[1:01:09] think thyroxine, why would that affect
[1:01:11] the self? It's a hormone that affects
[1:01:13] metabolism, for example. But of course,
[1:01:15] thyroxine also affects neurons. And I'm
[1:01:18] just using this as an example to show
[1:01:20] that something that seems as simple as
[1:01:23] having too much or too less of a
[1:01:25] particular hormone that we all need can
[1:01:27] alter the self. The way that the self is
[1:01:30] in people with brain disorders from
[1:01:33] stroke, from Alzheimer's disease, from
[1:01:35] Parkinson's disease, from traumatic
[1:01:37] brain injury, the self can change
[1:01:40] remarkably. And what I try to illustrate
[1:01:43] in the book is that you can have one
[1:01:46] domain of cognitive function affected.
[1:01:48] It could be memory. It could be
[1:01:50] perception. It could be attention. It
[1:01:52] could be your understanding of concepts.
[1:01:54] It could you be your representation of
[1:01:56] your body or the way you control your
[1:01:58] behavior. Someone may become very
[1:02:00] impulsive. Each of those domains in and
[1:02:03] of themselves contribute to our
[1:02:06] perception of the self. I mean Marvin
[1:02:08] Minsky, one of the pioneers of AI,
[1:02:11] called this the society of mind. You
[1:02:12] know the self emerges from the interplay
[1:02:16] and the activity of this society of
[1:02:20] mind. If we take one of the modules out
[1:02:23] of that society, memory, attention,
[1:02:27] language, whatever it is, the self is
[1:02:29] changed. It's not that you've deleted
[1:02:32] the self. The self has changed and it's
[1:02:35] observable. You know, someone's personal
[1:02:37] identity can change, their social
[1:02:39] identity can change. So, I think the key
[1:02:41] point here is the self is not immutable.
[1:02:45] It's something that can change. People
[1:02:46] might think my personality is this way.
[1:02:48] It can never change. Well, your
[1:02:50] personality is the product of your
[1:02:53] society of mind. The cognitive processes
[1:02:56] that are going on all the time, of which
[1:02:58] we are consciously aware of only a
[1:03:01] fraction under the hood. 95% of the
[1:03:03] stuff is going on without us consciously
[1:03:06] being aware of these processes.
[1:03:09] >> It seems and I'm not trying to play
[1:03:10] psychologist here that fulfilling roles
[1:03:14] in our [clears throat] daily lives is an
[1:03:16] important part of our self-concept. You
[1:03:18] know, I'm a student, I'm a teacher, I'm
[1:03:20] a husband, I'm a wife, I'm a whatever it
[1:03:22] happens to be feeds back heavily on our
[1:03:25] notions of self. Yeah.
[1:03:26] >> Are we fulfilling this role well or less
[1:03:28] well? But there's another piece and I
[1:03:30] know this exists more in Eastern
[1:03:32] philosophy and I am not versed in that
[1:03:34] where we wake up each day and we know
[1:03:37] who we are. We don't forget who we are.
[1:03:40] >> We're carrying our prior life experience
[1:03:41] to that day. And I love the idea that we
[1:03:44] can change ourselves at the level of
[1:03:47] like optimism or anything. To me, that's
[1:03:50] like the apex of neuroplasticity.
[1:03:53] >> But of course, we want to hold on to
[1:03:55] something consistent. We don't want to
[1:03:56] wake up and not know where we are or who
[1:03:58] we are. That's super scary, too.
[1:04:00] >> So, is it the case that when we take on
[1:04:02] a new role that we are fundamentally
[1:04:06] changing? And it also seems that unless
[1:04:09] we're very young, most people don't add
[1:04:12] new roles over time. I mean, they might
[1:04:15] become a parent or a grandparent, have
[1:04:17] some friends, but you sort of have a
[1:04:19] limited number of roles in life. And so,
[1:04:21] it seems like doing new things could
[1:04:24] actually change the self. And that
[1:04:26] [snorts] seems exciting. And I think
[1:04:28] it's not a depressing thought to me that
[1:04:30] many [clears throat] people probably
[1:04:31] would like to change themselves somewhat
[1:04:34] or a lot. They want to feel like a
[1:04:36] different person,
[1:04:37] >> but not so different that they lose
[1:04:38] touch with the prior person so they can
[1:04:40] look at the the Is that is that
[1:04:42] catching?
[1:04:42] >> Yeah, I understand where you're coming
[1:04:44] from. So on the one hand, of course, our
[1:04:46] ideas of who we are, ourselves rely on
[1:04:50] our embodied self. We occupy a body.
[1:04:53] >> Mhm.
[1:04:53] >> My body, the one I occupy, is different
[1:04:56] from yours. And so we have different
[1:04:58] physical identities in that respect. But
[1:05:01] we also have different perspectives,
[1:05:04] experiences, and those experiences give
[1:05:07] us our firsterson experiences. You know,
[1:05:10] if I put my hand in the fire, I'm the
[1:05:12] one who's going to feel the pain. If I
[1:05:13] pick up this cup, I have agency of what
[1:05:16] I do. Those are my first person
[1:05:18] experiences. and the physical identity
[1:05:21] in terms of both the body that I occupy
[1:05:24] and the first person experiences that I
[1:05:26] have stretch back over time and
[1:05:30] therefore I have more confidence that
[1:05:31] this is me.
[1:05:32] >> Mhm.
[1:05:33] >> I've occupied this body. It's grown up.
[1:05:35] It's also aging and I've had these
[1:05:38] experiences that make me me. I've made
[1:05:40] these choices. I made these decisions. I
[1:05:42] had these memories. That's what
[1:05:44] contributes to my personal identity. And
[1:05:47] the other bit you mentioned was really
[1:05:49] relates to social identity, my roles.
[1:05:51] When someone asks you, who are you? Tell
[1:05:54] me a little bit about yourself. It's
[1:05:56] inevitable that we'd say, well, I I grew
[1:05:58] up in San Francisco in the Bay Bay Area.
[1:06:00] I did this. I went to as an
[1:06:02] undergraduate to here. I had these
[1:06:05] experiences. If you're religious, you
[1:06:07] might say this is my faith. If you
[1:06:09] follow a particular sporting team, you
[1:06:12] might say, "I'm a big fan of this
[1:06:14] particular team." If you were influenced
[1:06:17] by some very important people in your
[1:06:19] field, you might say, I am part of that
[1:06:23] school of thinking in this way that
[1:06:25] defines your social identity and that's
[1:06:28] a really important part of who you are.
[1:06:30] So there's the personal identity, the
[1:06:33] body, the first person experiences and
[1:06:35] there's a social identity. And again,
[1:06:37] social identity over time is is very
[1:06:39] very important to change from these
[1:06:44] things which we have grown up with these
[1:06:47] identities is possible. As we've said,
[1:06:49] it's possible through something hormonal
[1:06:52] like changes in thyroxine. It's possible
[1:06:54] through brain disorders. But these
[1:06:57] principles suggest that it's possible
[1:06:59] through what we do.
[1:07:00] >> And interestingly, I think there is an
[1:07:02] evidence base for this. So, as we grow
[1:07:05] older, for example, as you're coming to
[1:07:07] retirement, your
[1:07:11] network of friends, your social
[1:07:13] connections often shrinks. People may
[1:07:16] have moved away. You're going to no
[1:07:18] longer have the colleagues that you
[1:07:20] interacted with because you're going to
[1:07:22] retire. Your family is now old. your
[1:07:24] children have moved away, the network is
[1:07:26] shrinking. But it turns out that the
[1:07:28] data show across many studies that
[1:07:31] people who keep relationships increase
[1:07:35] or maintain the number of social
[1:07:37] relationships they have, they have a far
[1:07:40] less risk of developing dementia than
[1:07:43] those who don't. If we correct for all
[1:07:45] other confounding factors, people who
[1:07:48] have a sense of curiosity, who are
[1:07:50] open-minded, want to engage in something
[1:07:53] new, perhaps a new hobby, a new pursuit,
[1:07:55] whatever it is, they also have a far
[1:07:59] lower risk of developing dementia. And
[1:08:01] you mentioned this term sense of
[1:08:03] purpose. So, you know, that's used or
[1:08:06] misused in various ways in different
[1:08:08] places. But if we take sense of purpose
[1:08:10] as thinking you know I get up in the
[1:08:12] morning with a sense of I need to do
[1:08:14] this I have a purpose in life those
[1:08:17] people who say that are also more
[1:08:20] resilient to cognitive decline over time
[1:08:23] >> which is a remarkable thing.
[1:08:25] >> It's incredible. Yeah.
[1:08:26] >> And it makes me wonder if the key to
[1:08:29] evolving the self is about verbs not
[1:08:34] labels.
[1:08:35] >> Mhm. which sounds like a very California
[1:08:37] newagy like let's be about verbs not
[1:08:39] labels but I mean it because if you're a
[1:08:42] scientist like people will say like I'm
[1:08:44] a scientist okay so you get a degree in
[1:08:46] science awesome as an undergraduate
[1:08:48] somebody does that means they learned a
[1:08:50] lot of science but if you're a doctor a
[1:08:53] physician you're a physician and a
[1:08:54] scientist and many other things too
[1:08:57] it's really about the things that you
[1:08:59] did and do in those roles that really
[1:09:03] shape your brain just having a PhD D I
[1:09:05] can promise you doesn't do anything for
[1:09:07] you and no one really cares after a
[1:09:09] short while. But the things you learn,
[1:09:11] the failures, the the your strivings,
[1:09:14] your successes, like those really shape
[1:09:16] your self-concept. Goes back to what we
[1:09:18] were talking about before about they
[1:09:19] shape our thinking about what we could
[1:09:22] do or potentially not do if we were to
[1:09:25] strive, which raises a very specific
[1:09:27] question. What does David now think
[1:09:30] about apathetic David? And what does
[1:09:33] David now think about David before he
[1:09:36] became apathetic? His memory of self is
[1:09:39] as interesting to me as the
[1:09:41] transformation. Although the
[1:09:42] transformation is clinically like
[1:09:44] remarkable and awesome and I just want
[1:09:46] to tip my hat to it again. I mean you
[1:09:47] saved a life basically. It's so cool and
[1:09:50] physicians do this. This is my
[1:09:51] admiration for physicians. But what does
[1:09:53] he think? Is he like, "Oh yeah, I was in
[1:09:55] a state, you know, I need more dopamine.
[1:09:57] I take this drug. I have more dopamine
[1:09:59] and now I'm good." And how has that
[1:10:00] evolved over time? No, I think after he
[1:10:03] improved, he certainly looked back on
[1:10:07] the situation he was in and could not
[1:10:10] believe that he couldn't create that
[1:10:12] effort that
[1:10:13] >> disbelief.
[1:10:14] >> Yeah.
[1:10:14] >> Like a disconnect like how could that
[1:10:17] >> how could I not have done that because
[1:10:19] all he had to do is put the cables
[1:10:20] together to, you know, listen to music,
[1:10:22] right? It's such a simple thing. He
[1:10:25] didn't have to do a huge amount. But
[1:10:26] this is like somebody who has a skill
[1:10:28] telling somebody else like, "Hey, you
[1:10:30] just like dunked the basketball and
[1:10:32] you're like, [laughter] "Yeah, but
[1:10:34] >> but if it's you telling yourself, how
[1:10:36] can how can I how could I be like that?"
[1:10:39] >> Because obviously he has memories of
[1:10:42] what he used to be like before those
[1:10:45] strokes hit him that he was this highly
[1:10:46] productive, very socially engaged
[1:10:48] person. So, I guess you can see it
[1:10:52] afterwards, but at the time you you
[1:10:56] can't necessarily have you don't
[1:10:58] necessarily have the inside. It's
[1:10:59] interesting this week I was reading that
[1:11:02] um Carly Simon uh was speaking about the
[1:11:05] fact she's developed Parkinson's
[1:11:06] disease, but she mentioned that one of
[1:11:08] the biggest problems is her apathy. She
[1:11:10] can't believe that she's become
[1:11:12] apathetic. Now, she obviously has
[1:11:14] insight into the problem that she's
[1:11:17] developed apathy, but nevertheless can't
[1:11:20] necessarily change that because, you
[1:11:23] know, there's if circuits that affect
[1:11:26] motivation are not firing as they should
[1:11:30] be. No matter what you think, you're not
[1:11:32] necessarily going to be able to change
[1:11:34] things.
[1:11:34] >> Yeah. That's like if anyone has ever had
[1:11:36] transranial magnetic stimulation, it
[1:11:38] it's like they can inhibit your ability
[1:11:40] to move a finger and it's like you can
[1:11:43] >> will that finger to move with everything
[1:11:45] you've got
[1:11:47] >> and it doesn't move and then they take
[1:11:48] the coil off your head and it just you
[1:11:50] can tap your finger. It's it's a
[1:11:52] remarkable thing to feel that it's
[1:11:54] painful in in a psychological way. Very
[1:11:57] painful. We've all heard of mania. I'm
[1:12:00] not an expert in mania, but seems that
[1:12:03] when people are manic, they have tons of
[1:12:05] energy, tons of motivation. Yeah. To do
[1:12:07] everything, everything is a good idea.
[1:12:10] >> And it's mostly about them, you know.
[1:12:13] Same if you see people on
[1:12:14] methamphetamines, it's not a very
[1:12:16] empathic state. It's not about like what
[1:12:18] can I do for society with all this extra
[1:12:20] energy. It's a very me state. You see
[1:12:22] this cocaine, empetamines, manic states.
[1:12:25] It's every idea is a great one and
[1:12:27] there's billions of ideas. So much so
[1:12:29] that people are doing trivial things
[1:12:32] thinking it's interesting or even
[1:12:33] damaging themselves or others. Are all
[1:12:36] of those hyperdopamineergic states?
[1:12:39] >> Is it just this motivational circuitry
[1:12:40] just gasp pedal to the floor?
[1:12:43] >> And what does it tell us about
[1:12:44] motivational states? Because I do think
[1:12:45] the extremes are are interesting. So, I
[1:12:48] don't know much about mania, but it
[1:12:50] turns out um when I was having to prov
[1:12:53] present a lecture on motivational
[1:12:55] disorders, I thought I would dip in to
[1:12:58] the neuroscience of addiction. I'm not
[1:13:00] an addiction expert. And to my surprise,
[1:13:03] almost every drug of addiction, whether
[1:13:05] we go from nicotine to alcohol to heroin
[1:13:08] to cocaine to amphetamine, almost every
[1:13:11] drug of addiction hijacks that dopamine
[1:13:14] system. when we were talking about this
[1:13:16] circuitry that goes from the basil
[1:13:18] ganglia to the frontal loes and I don't
[1:13:21] think that's a coincidence that we find
[1:13:24] when that circuitry is not working as in
[1:13:27] David that you can get profound loss of
[1:13:30] motivation apathy when that circuitry is
[1:13:33] on overdrive because it's been hijacked
[1:13:35] by these drugs you get states of hyper
[1:13:38] motivation so of course this is going to
[1:13:40] be overly simplistic to think dopamine
[1:13:44] levels
[1:13:45] are the only factor that affect our
[1:13:48] motivation. But it certainly turns out
[1:13:50] to be a very important factor in the
[1:13:53] sort of graduating the level of
[1:13:55] motivation we have to seek particular
[1:13:58] outcomes. And of course in the drug
[1:14:00] addiction literature that's really
[1:14:02] become what do you find
[1:14:05] incentively salient
[1:14:08] to act in order to try and get that
[1:14:11] outcome. But it's the same circuitry.
[1:14:14] And isn't that an amazing thing that
[1:14:16] neuroscience has stumbled on? People who
[1:14:18] study apathy like me would not
[1:14:21] necessarily study the addiction
[1:14:22] literature. But when you do, you find
[1:14:24] that there's absolute convergence
[1:14:26] between this circuitry on the one hand
[1:14:29] being hypoactive and leading to apathy,
[1:14:33] on the other hand being hyperactive and
[1:14:36] leading to addictive states. There's a
[1:14:39] lot that's been said about, you know,
[1:14:40] are we constantly getting dopamine hits
[1:14:43] with online behavior? And there's, you
[1:14:45] know, platforms are incentivized to keep
[1:14:47] us scrolling. This is certainly true.
[1:14:50] >> It seems almost compulsive
[1:14:52] >> more than it feels rewarding. I mean,
[1:14:54] it's a interesting thing to observe
[1:14:56] oneself engaging in a behavior where the
[1:14:59] reward is gone. The subjective sense of
[1:15:01] the reward is gone, but we proceverate.
[1:15:03] >> There are two things here. One is yes, I
[1:15:05] agree with you that this sort of
[1:15:07] behavior, doom scrolling, etc. occurs,
[1:15:09] but I think the evidence that there are
[1:15:11] dopamine hits when you're doing this
[1:15:13] isn't really very strong.
[1:15:15] >> I agree and I'm grateful that you said
[1:15:17] that because people say, "I'm doing this
[1:15:18] for dopamine. I'm doing this for
[1:15:20] dopamine."
[1:15:21] >> Certain platforms and certain content
[1:15:23] does take us into drama and high
[1:15:25] arousal.
[1:15:26] >> I don't know if there's dopamine
[1:15:27] associated with it. We could explore
[1:15:28] that perhaps. It's an area I'm very
[1:15:31] interested in. But a lot of it is sort
[1:15:34] of,
[1:15:34] >> if I may, mindless numbing out type
[1:15:37] behavior. It doesn't feel good. It
[1:15:39] doesn't feel bad.
[1:15:41] >> People do often report that when they
[1:15:43] put the thing away, they're like, "Oh my
[1:15:44] god, I wasted some more time." But
[1:15:45] they're not really so down in the trough
[1:15:47] that they don't do it again.
[1:15:48] >> So, there must be something somewhere in
[1:15:50] between. I agree. I don't think of it as
[1:15:52] like dopamine hits. It's something else.
[1:15:55] >> It can be something else. But the second
[1:15:57] point that you're making here is you may
[1:15:59] not actually like it what you're doing.
[1:16:01] You may even be aware that you don't
[1:16:02] like it. And of course in drug addiction
[1:16:04] that's also sometimes a paradox that
[1:16:07] addicts seek this thing they want but
[1:16:10] they don't necessarily like it. They
[1:16:12] don't necessarily get pleasure from it
[1:16:14] if they consume it. And of course there
[1:16:16] is this dissociation in the neuroscience
[1:16:20] literature between wanting the
[1:16:22] motivation to go and try and find that
[1:16:26] rewarding outcome versus liking the
[1:16:28] hedonic pleasure from getting it. And
[1:16:31] the evidence suggests that wanting
[1:16:34] pursuit of a goal is mediated or
[1:16:37] modulated at least by dopamine whereas
[1:16:40] actually the liking the pleasure you
[1:16:42] might get from an outcome is not that
[1:16:45] seems to be related to uh opioid
[1:16:48] neurotransmitters in the brain. I think
[1:16:51] there's quite a lot of nice work by Kent
[1:16:53] Buridge and his colleagues on this in
[1:16:54] rodent models but the principles still
[1:16:56] apply. There can be a dissociation
[1:16:59] between wanting to do something and
[1:17:00] actually liking it.
[1:17:01] >> You're the first person to say that, you
[1:17:03] know, online scrolling probably doesn't
[1:17:05] lead to a ton of dopamine release. It
[1:17:07] seems the experiment should be done.
[1:17:09] It's not hard to get people to scroll
[1:17:11] while in a scanner, look at nucleus, and
[1:17:14] adjust the content. So there was an old
[1:17:17] experiment and it was done with a PET
[1:17:19] scanner many years ago in the
[1:17:20] Hammersmith Hospital in in London when
[1:17:23] the original scanning experiments were
[1:17:25] being done. And they used uh a dopamine
[1:17:29] receptor liant, something that will
[1:17:32] light up when this dopamine receptor
[1:17:37] drug attaches to dopamine receptors. And
[1:17:40] in an indirect way, you can work out how
[1:17:43] much binding of dopamine receptors is
[1:17:46] occurring endogenously with this with
[1:17:48] this technique. And they found that when
[1:17:50] someone was playing a video game, there
[1:17:52] was evidence that there was certainly
[1:17:54] more dopamine release in the vententral
[1:17:57] stratum in the basil ganglia. But the
[1:17:59] pausing out, the sort of deconstructing
[1:18:02] whether that dopamine release is due to
[1:18:05] the motivation you're getting when
[1:18:06] you're playing that game versus the
[1:18:09] liking that you're getting, the pleasure
[1:18:11] you're getting is not so
[1:18:12] straightforward, especially with pet,
[1:18:14] you know, which doesn't have the sort of
[1:18:15] temporal resolution of doing this. So in
[1:18:18] some ways it sounds straightforward to
[1:18:20] do the experiment but actually the
[1:18:22] subjective experience of liking and
[1:18:25] pleasure you're getting has to be
[1:18:28] temporarily dissociated
[1:18:30] >> from the motivation to act. Uh and
[1:18:34] that's not so straightforward.
[1:18:36] >> I'd like to take a quick break and
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[1:20:14] I think of dopamine, of course, being
[1:20:17] involved in movement,
[1:20:18] >> which is why when it's depleted, yeah,
[1:20:20] >> people get Parkinson's or Parkinsonian
[1:20:23] like symptoms.
[1:20:24] >> But also, it seems that dopamine in an
[1:20:26] indirect or a direct way is involved in
[1:20:29] thought movement. Like, it's involved in
[1:20:32] moving thoughts and ideas forward, which
[1:20:34] is sort of a piece of motivation. Yeah,
[1:20:36] >> it's not the whole thing, but and so in
[1:20:39] these hyperdopamineergic states like
[1:20:42] people take empetamines or they're
[1:20:43] manic. It's like everything is about the
[1:20:45] future. It's from now forward. I don't
[1:20:46] know if people reflect on the past at
[1:20:48] all in those states, but
[1:20:50] >> yeah,
[1:20:50] >> having seen never I've never tried
[1:20:52] methamphetamine. I've never fortunately
[1:20:54] I don't have mania, but it seems like
[1:20:55] people are all about what could happen
[1:20:57] next. Yeah,
[1:20:57] >> that's where they get themselves into
[1:20:58] trouble is it's kind of a fire hose of
[1:21:01] that stuff.
[1:21:02] >> Social media is an interesting one
[1:21:03] because you're constantly updating the
[1:21:05] stimulus. You're giving likes, you might
[1:21:09] be receiving likes, you can make
[1:21:10] comments. And so if you think about it,
[1:21:12] it's like the perfect video game that
[1:21:14] goes in a infinite loop.
[1:21:17] >> You just keep going and going and going
[1:21:19] and you're never going anywhere.
[1:21:22] >> But all the proper bells and whistles
[1:21:23] are getting tapped on. At least when I
[1:21:25] go to Vegas, which I do from time to
[1:21:27] time. Yeah.
[1:21:27] >> I like gambling a little bit. M like you
[1:21:30] could walk out with some or a lot more
[1:21:33] money or you could lose some or a lot of
[1:21:36] money.
[1:21:36] >> I generally break even or win a little
[1:21:38] bit like most people cuz I'm tempered in
[1:21:41] it. But at least there's a potential
[1:21:42] outcome you can take elsewhere,
[1:21:44] >> right? So I think about this all the
[1:21:47] time like what video game are you
[1:21:49] playing on social media? Not as a
[1:21:51] creator but as a consumer.
[1:21:52] >> What game are you playing?
[1:21:53] >> I mean what video game are we playing in
[1:21:56] reality in this?
[1:21:57] >> That's the big one. Yeah. Well, you're
[1:21:59] from Oxford. I'm from California.
[1:22:00] [laughter] So, you asked the big
[1:22:01] questions.
[1:22:02] >> No, but just coming back to some of the
[1:22:04] points you made. Dopamine depletion
[1:22:06] >> of course can lead to Parkinson's
[1:22:08] disease. But interestingly, a lot of
[1:22:10] researchers are thinking, is it really
[1:22:12] just action or is it motivation to
[1:22:14] action? So, you know, the classical
[1:22:16] thing they describe is if a Parkinson's
[1:22:19] patient is in a house and they've just
[1:22:21] realized it's burning, they will be able
[1:22:23] to run out of that house.
[1:22:24] >> Is that right?
[1:22:25] >> Yeah. So that's what they will say is
[1:22:27] that the motivation signal has suddenly
[1:22:29] ramped up to a level where it engages
[1:22:32] the action system. So it's a different
[1:22:34] way of framing why is there a reduction
[1:22:37] of action? Why is there bradicynesia, a
[1:22:40] slowing of movement in people with
[1:22:42] Parkinson's disease? That's really
[1:22:44] interesting. It doesn't just have to be
[1:22:45] about motor control. It could be the
[1:22:48] motivation to act just as we said with
[1:22:50] David, right? Because the Parkinson's
[1:22:53] pathology affects the basil ganglia.
[1:22:55] Basil ganglia is important for action,
[1:22:57] but it also has these motivation signals
[1:23:00] that link those motivations like there's
[1:23:03] a burning house here. I've got to run
[1:23:05] out to action to the outcome. And the
[1:23:08] second piece you mentioned, I think
[1:23:10] brings up the other question. Dopamine
[1:23:12] in the human brain isn't all about
[1:23:14] motivation to action. There's dopamine
[1:23:17] in other parts of the brain. We know
[1:23:19] from some really classical work by
[1:23:22] Patricia Goldman Rakit, for example,
[1:23:24] that dopamine is important for working
[1:23:25] memory, short-term memory. It's
[1:23:27] important for holding memories in mind.
[1:23:30] And it's probably very important for
[1:23:32] executive function, the kinds of things
[1:23:35] that we might think of as either
[1:23:37] initiating action or stopping it,
[1:23:39] inhibiting it. You know, stopping our
[1:23:41] impulsive thoughts from getting out. You
[1:23:43] know, we might think someone is
[1:23:45] addressed inappropriately, but you and I
[1:23:47] wouldn't say that to them. But someone
[1:23:49] who might have a change in their
[1:23:50] dopamine system affecting let's say the
[1:23:53] frontal lobe can somehow lose that
[1:23:55] control and become disinhibited.
[1:23:58] So initiation of action, stopping
[1:24:00] action, possibly switching from one goal
[1:24:03] to another and also those higher order
[1:24:06] things, you know, planning ahead, being
[1:24:08] able to think about planning ahead.
[1:24:10] Dopamine might also be important for
[1:24:12] those aspects of executive control. So I
[1:24:14] wouldn't want your audience to think all
[1:24:16] that dopamine does is this motivation to
[1:24:18] action. There's a lot of evidence it
[1:24:20] does other stuff.
[1:24:21] >> The Parkinson's person in the burning
[1:24:24] home is a remarkable result.
[1:24:27] >> Remarkable result
[1:24:29] >> completely changes the conceptual
[1:24:32] framework around Parkinson's and what it
[1:24:35] is at a circuit level. We've also done
[1:24:37] some more I guess constrained
[1:24:40] experimental studies, research studies
[1:24:42] in Parkinson's disease where my
[1:24:44] colleague Sanjay Manahar and I were
[1:24:46] looking at eye movements. And eye
[1:24:48] movements are very ballistic. They're
[1:24:50] they're pre-programmed. You know, they
[1:24:52] have a particular velocity. And what
[1:24:54] we've managed to show is if you increase
[1:24:56] the incentive, the reward you get if you
[1:24:59] make a rapid eye movement, you can find
[1:25:02] that the velocity of eye movements in
[1:25:05] Parkinson's disease can increase just as
[1:25:08] it can increase in you and me. But if
[1:25:09] you add dopamine to to a patient with
[1:25:14] Parkinson's disease, that velocity
[1:25:17] increases even further. you've increased
[1:25:19] the vigor of a simple thing like an eye
[1:25:23] movement. So that goes along with this
[1:25:25] idea that it's not just inaction,
[1:25:28] you need incentives for action and
[1:25:31] dopamine is important for those
[1:25:33] incentives. In some sense, the the
[1:25:36] person with mild Parkinson's, while we
[1:25:38] wouldn't wish this on anybody,
[1:25:41] >> um, is hyperrational, like they're not
[1:25:44] going to initiate action unless it's
[1:25:46] there's really a potential payoff. I
[1:25:49] mean, many people have an excess of
[1:25:51] energy, so they can afford to like move
[1:25:52] about and do all sorts of things and
[1:25:54] pick things up and put them down and a
[1:25:56] lot of wasted energy out there. I'm not
[1:25:58] saying that people should give
[1:25:59] themselves Parkinson's by any stretch,
[1:26:01] but
[1:26:03] there does seem to be a kind of built-in
[1:26:06] feature slashflaw of this dopamineergic
[1:26:09] system that it's so subject to learning.
[1:26:12] >> So, prior experience can really bias us
[1:26:15] towards or away from things. That's good
[1:26:17] and bad, right? But also, you know, that
[1:26:21] the person with Parkinson's, just the
[1:26:23] mere fact that they need an elevated
[1:26:25] motivation to hit some threshold for
[1:26:27] action, I think it reveals a lot about
[1:26:30] people without Parkinson's. Like, we're
[1:26:31] we're wasting a lot of energy all day
[1:26:33] long.
[1:26:34] >> You might say it'd be efficient just to
[1:26:36] do nothing. Maybe David was very
[1:26:37] efficient. You know, he didn't do
[1:26:39] anything.
[1:26:40] >> His roommates definitely took care of a
[1:26:41] lot. It sounds like it's not it's not
[1:26:43] functional for an adult to be like that
[1:26:45] after a while, but society sort of
[1:26:47] operates on this. Yeah,
[1:26:48] >> there's largely been made some room for
[1:26:51] people who are just not going to
[1:26:52] contribute and other people who
[1:26:54] overcontribute and then it's a
[1:26:55] distribution
[1:26:56] >> and sort of what allows us to to
[1:26:58] function
[1:26:59] >> at risk of going into really um high
[1:27:02] high level territory here. You said
[1:27:04] something you said you know what game
[1:27:05] are we playing here after all?
[1:27:07] >> It's an important one I think to ask. We
[1:27:09] don't want to go down that rabbit hole
[1:27:10] too often or too deeply because we can
[1:27:12] get lost. We have our roles to carry out
[1:27:14] in life after all. But I think about
[1:27:17] this a lot. You know, I do think the
[1:27:19] first third to half of one's life,
[1:27:22] assuming people live somewhere between
[1:27:24] 70 and 100 years of age, is about
[1:27:28] learning all these contingencies,
[1:27:30] developing social skills, what works,
[1:27:32] what doesn't work, hopefully avoiding
[1:27:34] traumas, but if you have some,
[1:27:35] eventually overcoming those, seeing that
[1:27:37] not everything has to end that way in
[1:27:39] that domain. And you know, and then you
[1:27:41] hit the middle of your life and you do a
[1:27:42] few more rounds of learning and
[1:27:45] extending oneself and building oneself
[1:27:47] and family and culture and but then
[1:27:50] there does seem to be something that
[1:27:52] happens to all humans is they they start
[1:27:54] reflecting a little or a lot
[1:27:56] >> like what game are we playing here? Were
[1:27:58] we just leveraged by all these
[1:28:00] evolutionarily constrained circuits and
[1:28:03] drives
[1:28:04] >> or is there something that we're
[1:28:06] >> supposed to focus on or aspire to? And
[1:28:09] then I think most people just shove it.
[1:28:10] It's just way too much to think about.
[1:28:12] It's really heavy to think like maybe
[1:28:14] there is really no purpose in this. And
[1:28:16] then it's also fun and and can really
[1:28:19] lift you up to things like oh this is
[1:28:21] cool. Like this this game we call life
[1:28:23] is actually a really amazing gift.
[1:28:26] >> Yeah.
[1:28:26] >> Which is sort of where I live these
[1:28:27] days. Like
[1:28:28] >> think I'm so grateful my parents made me
[1:28:30] like that alone. Like I have no gripes
[1:28:32] about anything else anymore because they
[1:28:35] made me like I'm here. So many people
[1:28:36] didn't make it here. It's it's a great
[1:28:39] place to start. Yeah. You know, one's
[1:28:41] day and then you have to go do stuff.
[1:28:42] So, how do you conceptualize like what
[1:28:45] we're going after and and for each of
[1:28:47] us, I think it is important to step back
[1:28:49] and ask these highle questions,
[1:28:50] especially after age about 35, 40
[1:28:54] because the early part you really are
[1:28:55] just trying to acquire the skills to
[1:28:56] navigate life.
[1:28:57] >> Yeah. I think your background makes a
[1:28:59] huge difference and as you were speaking
[1:29:01] I was thinking of course this also
[1:29:03] speaks to culture, right? The culture in
[1:29:06] which you grew up also defines some of
[1:29:09] the goals, the aspirations, the
[1:29:10] ambitions you have. It could be the
[1:29:12] larger culture growing up in the United
[1:29:14] States versus growing up in the culture
[1:29:17] of your family as well. Those are
[1:29:19] obviously important aspects. So when you
[1:29:23] are growing up, I think a lot of it is
[1:29:26] dominated by the environment. You call
[1:29:28] them contingencies, the culture in which
[1:29:30] you're growing up. But in a way, of
[1:29:33] course, as we're growing up, we are also
[1:29:35] contributing to that culture. You know,
[1:29:38] if we have kids, we are also
[1:29:41] transmitting this information. And
[1:29:43] perhaps the one of the most important
[1:29:44] things that people do between
[1:29:46] generations is transmit the culture, the
[1:29:49] culture, the local culture of the home,
[1:29:52] the domestic home, the wider culture in
[1:29:54] terms of the values shared by the tribe
[1:29:57] you happen to be a member of. All of
[1:30:00] those things shape what we do. And
[1:30:03] perhaps a generation ago, even a
[1:30:05] generation or two ago, people didn't
[1:30:07] have the luxury of reflecting back on
[1:30:10] what on earth are we doing this for.
[1:30:12] They were surviving. They were just
[1:30:13] surviving. And of course, there are many
[1:30:15] people in the world today who are also
[1:30:17] surviving. They're going, you know, what
[1:30:18] are you on about? You know, I just have
[1:30:20] to survive. This is not a game of
[1:30:22] anything else. We've got to a point as
[1:30:24] humans though where we have the luxury
[1:30:26] some of us that we can have time to even
[1:30:30] consider what this is all about. And one
[1:30:33] of those things I think is where our
[1:30:35] culture is going. That's really
[1:30:37] important. It's a very big question in
[1:30:39] the US at the moment in terms of what is
[1:30:41] the culture? What are the values we
[1:30:44] consider to be part of the tribe? How
[1:30:46] big is the tribe actually? How many
[1:30:48] tribes are there? That's so important, I
[1:30:50] think, in influencing my answer to that
[1:30:53] question is thinking, yeah, what game
[1:30:55] are we playing? Well, we're playing a
[1:30:57] game that's been played for centuries
[1:30:59] and generations, and that has led to
[1:31:03] human culture as we know it, highly
[1:31:05] successful in so many ways, but also
[1:31:08] capable of dysfunctional activity as we
[1:31:11] know. as a physician. Um I'm sure there
[1:31:14] are many reasons you go to work each
[1:31:16] day, but just you personally if if
[1:31:18] you're willing, uh where does your mind
[1:31:20] go when you reflect on your career,
[1:31:22] past, present, and future? Do you think
[1:31:25] about making a specific type or size of
[1:31:28] contribution? Like what's deeply
[1:31:30] satisfying for you? I've got to the
[1:31:32] point where if [snorts] I have to make
[1:31:34] decisions or choices about things to do,
[1:31:39] I am going to make what I would call my
[1:31:41] deathbed decision here. I want to think
[1:31:44] that when I am passing away on my
[1:31:48] deathbed, I can look back on this
[1:31:50] decision and think that was a valuable
[1:31:52] thing to do for me. I take pride in it.
[1:31:55] I did something useful. It could be for
[1:31:57] me. It could be for my family. It could
[1:31:58] be for somebody else. But I can look
[1:32:00] back on that and think that was worth
[1:32:02] it. So if someone gives me an option of
[1:32:05] doing something that I would say no that
[1:32:07] really would not be something I would be
[1:32:09] proud of or value
[1:32:11] in any way esteem, I just say no. So the
[1:32:14] juice for me is do only the things if
[1:32:17] you can if you have that option do only
[1:32:20] the things that you think will be
[1:32:23] valuable in time to come. That's I think
[1:32:26] I've got to that point where I can think
[1:32:28] like that. And obviously there are some
[1:32:30] things we just cannot avoid. What did
[1:32:31] you call it? Wood. Wood. What was your
[1:32:34] >> Oh, chop wood. Carry water.
[1:32:35] >> Chop wood. Chop wood. Carry water.
[1:32:36] >> Yeah, that's a friend of mine who came
[1:32:38] from a blueco collar background and now
[1:32:40] he's an academic and a clinician. And he
[1:32:44] just said, you know, there's some things
[1:32:45] just like you just when you grow up on a
[1:32:47] in a farmish community. He wasn't like
[1:32:50] farm per se, but you know, it's like
[1:32:51] rural community. You know, there's
[1:32:53] certain times a year where you just chop
[1:32:54] wood, carry water. It's no fun. like you
[1:32:57] don't necessarily want to do it but the
[1:33:00] pleasure at the end of the day is in
[1:33:01] having chopped a lot of wood and carried
[1:33:03] a lot of water.
[1:33:04] >> Yeah. And sometimes as you said you got
[1:33:06] to do that
[1:33:07] >> to make the other things happen. So I
[1:33:09] understand that. I'm just giving you the
[1:33:11] extreme view. So for me the juice is try
[1:33:14] and focus such that you do the stuff you
[1:33:17] you really think is valuable. That's
[1:33:19] really important to me. I understand
[1:33:21] that that may not be an option for many
[1:33:23] people. Well, I think almost everybody,
[1:33:25] not everyone, but almost everybody has
[1:33:27] the option to read book A or book B,
[1:33:30] listen to podcast A or B or episode A or
[1:33:33] B. And and I don't think we put quite as
[1:33:35] much thought into the decision-m around
[1:33:37] those these days. I try and do more of
[1:33:38] it. And um I [clears throat] appreciate
[1:33:40] your answer because
[1:33:41] >> I think for people who hear
[1:33:43] conversations with folks like you who
[1:33:46] are very accomplished, they assume that
[1:33:48] they're just sort of on a locomotive of
[1:33:50] achievement. work, achieve, work,
[1:33:53] achieve, and you had all this. Right.
[1:33:54] Exactly. But I know based on the short
[1:33:57] time we've had the opportunity to
[1:33:59] interact and the way you answer your
[1:34:01] questions
[1:34:02] >> that you think carefully about what to
[1:34:05] work on next because it's a huge
[1:34:06] investment to work on a David versus you
[1:34:09] could work on anything. You're a
[1:34:10] neurologist. You could quit neurology
[1:34:12] probably and just write. You could do
[1:34:14] any number of different things. So as
[1:34:15] you have more skills and more agency
[1:34:17] that the choice-making process becomes
[1:34:19] increasingly important, not less. Y
[1:34:21] >> I'd like to talk a bit about your work
[1:34:24] on the way we sometimes can get
[1:34:27] dissociated from our environment but not
[1:34:30] necessarily dissociative disorders
[1:34:32] >> but [laughter] if we could do a little
[1:34:34] experiment with the audience you know I
[1:34:36] think everyone is familiar with the idea
[1:34:37] of closing their eyes and being inside
[1:34:39] of themselves then opening their eyes
[1:34:41] and still feeling yourself but also
[1:34:43] sensing the outside world
[1:34:46] >> and then moving through the world in a
[1:34:47] way where you're they're kind of going
[1:34:49] back and forth quickly you're sort of
[1:34:50] out there, but in here, out there. Of
[1:34:52] course, we're always in here. It's all
[1:34:54] an ab an abstract construction in our
[1:34:56] brain,
[1:34:57] >> but you've studied patients where
[1:34:59] they're not seeing big swaths of the
[1:35:01] outside world. Maybe you could explain
[1:35:02] what that's called and what it is and
[1:35:04] how it changes their perception of
[1:35:06] experience on the inside because this is
[1:35:09] something that I hope I'll never truly
[1:35:11] understand. Although, maybe you have an
[1:35:12] experiment where I can shut down some
[1:35:14] stuff and do it. But this is a really
[1:35:17] important aspect of being a human that
[1:35:19] we've never discussed on this podcast
[1:35:21] and hardly anyone talks about. We can go
[1:35:23] in here, we can be out there, but
[1:35:24] usually we're somewhere in between. How
[1:35:26] does all this stuff work?
[1:35:27] >> So the way many people would think about
[1:35:29] this is either internal attention or
[1:35:31] external attention. I mean attention is
[1:35:33] just a term we use and most of the
[1:35:36] audience will be very familiar with the
[1:35:38] idea of attention to things in the
[1:35:40] outside world. Why do we have a system
[1:35:43] for attention? And the way that many
[1:35:45] neuroscientists would put this is that
[1:35:47] the brain has limited capacity, right?
[1:35:49] It doesn't have capacity to process all
[1:35:52] the information in the outside world.
[1:35:54] It's coming at us in our eyes. It's
[1:35:57] coming at us in our ears. It's coming at
[1:35:59] us in our touch receptors in our skin.
[1:36:04] So if we were to upload all that
[1:36:07] information which is coming at a
[1:36:09] millisecond basis, it would be storing
[1:36:12] terabytes of information every minute or
[1:36:15] so. We don't have that capacity. Nor
[1:36:17] should we because we don't want to have
[1:36:20] neural space devoted to stuff that isn't
[1:36:22] important. Do you remember Google
[1:36:25] glasses? They were supposed to record
[1:36:27] everything that you saw through the day.
[1:36:30] They weren't successful when they came
[1:36:31] out because most people realize that
[1:36:33] actually most of the things that are
[1:36:34] happening during the day are boring.
[1:36:36] They're not very interesting. They
[1:36:38] shouldn't be things we pay attention to.
[1:36:42] So the first point is the brain has
[1:36:45] limited capacity. So some process has to
[1:36:48] be there to select the stuff that is
[1:36:50] important for you. And that process we
[1:36:53] call attention. And how does that work?
[1:36:56] Right? One way that many people think
[1:36:58] that works for the external deployment
[1:37:01] of attention is that items are competing
[1:37:05] for the selection of processing. That
[1:37:08] sounds a bit of a nebulous thing, but
[1:37:10] imagine you're walking down the street
[1:37:11] and suddenly you see a bit of a building
[1:37:14] is falling off and coming towards you.
[1:37:16] That grabs your attention. And
[1:37:18] neuroscientists call that, you know,
[1:37:20] bottomup attention, right? It's a
[1:37:23] sensory stimulus that's really
[1:37:24] important. It's grabbed your attention.
[1:37:26] You got to move.
[1:37:27] But you can also have goal directed top-
[1:37:31] down attention. You go to a busy railway
[1:37:33] station, you're going to meet a friend
[1:37:35] and she said, "I'm going to be wearing a
[1:37:36] red dress." So you can filter out
[1:37:40] everything else apart from all the
[1:37:42] people who are wearing something red and
[1:37:44] that gets you to a faster state of
[1:37:47] finding the person you're going to meet.
[1:37:48] So we've got bottom up attention, we've
[1:37:51] got top down goal- directed attention.
[1:37:53] But where do we normally deploy this? I
[1:37:55] mean, so if there's something very
[1:37:57] important bottom up, like a bit of a
[1:37:59] building falling towards you, that will
[1:38:01] grab your attention because the system
[1:38:03] is designed, our systems are designed to
[1:38:07] devote all the resources that we have to
[1:38:09] that very important threat. Now, in
[1:38:11] terms of goal directed attention, that
[1:38:14] might also in include internal thoughts.
[1:38:18] So if I'm in a lecture and I'm listening
[1:38:21] to somebody, I may fade in and out of
[1:38:25] attending externally
[1:38:27] and then I might be captured by internal
[1:38:30] thoughts. I might be thinking, yeah, I
[1:38:33] should have really made some plans for
[1:38:35] this evening because I haven't really
[1:38:37] done that. How can I what can I do this
[1:38:38] evening? Right? Should I make a booking
[1:38:40] for a restaurant or something like that?
[1:38:42] I should have done that earlier. I'm now
[1:38:43] thinking my attention is captured by
[1:38:46] these internal thoughts. So one way that
[1:38:50] we have tried to understand this stuff
[1:38:53] is that items are competing for our
[1:38:55] attention. Either external items or
[1:38:58] internal thoughts are competing for
[1:39:01] where we are focusing our resources. So
[1:39:03] attention is really just a way of
[1:39:07] explaining the fact that we're devoting
[1:39:09] our brain resources to this particular
[1:39:13] location in space or this thought. So
[1:39:17] closing your eyes thinking internally is
[1:39:20] really just an extreme form of putting
[1:39:23] all your resources into a particular
[1:39:26] thought. But that happens as I said even
[1:39:28] with your eyes open you can be
[1:39:30] distracted by this thought in your head
[1:39:33] even though your eyes are open and there
[1:39:35] are things going at them because in this
[1:39:37] competition for selection at that moment
[1:39:41] that thought has captured your neural
[1:39:44] processing and that's happening because
[1:39:46] the brain has limited capacity. Things
[1:39:48] are competing for selection
[1:39:51] because of that limited capacity. So you
[1:39:53] can only focus your processing on a
[1:39:56] small number of items at a time, perhaps
[1:39:58] even just one.
[1:39:59] >> I think if you pulled most people, they
[1:40:02] would say that they experience too much
[1:40:06] inner what's been called chatter. We had
[1:40:08] Ethan Cross on the podcast. He's a
[1:40:10] psychologist at University of Michigan
[1:40:12] and he wrote a book about chatter. And
[1:40:14] people would love to turn off their
[1:40:18] thoughts because most of what people
[1:40:21] report as their inner chatter is not
[1:40:24] pleasant. It's not necessarily
[1:40:25] unpleasant. It's not like you're a
[1:40:27] terrible person. You're what are you
[1:40:29] doing with yourself? Or it's just it's a
[1:40:31] nuisance. I do think that some of the
[1:40:33] more effective people I've known in life
[1:40:35] have low activation energy and they seem
[1:40:38] to think, make a decision. Once they
[1:40:43] make the decision and there could be
[1:40:44] some contemplative time first to be
[1:40:46] fair. They make a decision and then they
[1:40:49] are able to be fully engaged in the
[1:40:51] thing and they're able to turn down the
[1:40:54] volume on their inner landscape. Their
[1:40:57] attention drifts out. Maybe it's in
[1:41:00] themselves only in so far as it's
[1:41:03] required to do the thing really well. I
[1:41:05] actually think this might be the flow
[1:41:07] state
[1:41:08] >> is you know dare I say flow is a whole
[1:41:11] thing as you know and it gets
[1:41:12] bastardized a lot and I don't want to do
[1:41:15] that but
[1:41:17] >> there's a real cost an energetic cost to
[1:41:20] being in a conversation and being
[1:41:22] somewhat in one's head except if you're
[1:41:24] me only as required to you know think
[1:41:27] about where we could go next this kind
[1:41:28] of thing it's it's just not helpful to
[1:41:31] be in one's head very often unless
[1:41:33] you're contemplating or making decisions
[1:41:34] It's great to just like turn that stuff
[1:41:36] off. I think most people would feel that
[1:41:38] way.
[1:41:39] >> It must vary an an awful lot, I think,
[1:41:41] cuz we're usually so attentive to
[1:41:44] external cues, events, right? Whether
[1:41:47] it's an appointment, something coming in
[1:41:49] email, text, or conversation, whatever.
[1:41:53] Sometimes we also do need that space. I
[1:41:55] think that there's an a hypothesis we
[1:41:58] could wager would be that one of the
[1:42:01] things that's [snorts] so enticing about
[1:42:03] um high arousal
[1:42:05] media or social media
[1:42:08] >> is that it takes people out of their
[1:42:09] heads.
[1:42:10] >> Y
[1:42:11] >> I'm just throwing this out there for
[1:42:12] sake of discussion. Maybe it's not about
[1:42:14] what they're seeing as much as what
[1:42:16] they're not having to think about.
[1:42:17] >> Mhm.
[1:42:18] >> Like [clears throat] I know a lot of
[1:42:19] people that listen to audiobooks. I have
[1:42:21] a friend, she tells me that she has to
[1:42:22] be really careful that she doesn't like
[1:42:24] listen to certain types of audio books.
[1:42:26] She'll just
[1:42:27] >> use that as a way to detach from a bunch
[1:42:30] of other stuff that she just doesn't
[1:42:32] want to think about.
[1:42:33] >> Right. Okay.
[1:42:33] >> There's a whole market for distraction
[1:42:35] and numbing and and arousal and um
[1:42:38] thinking in a structured way internally
[1:42:40] is not easy.
[1:42:41] >> I was about to say it's hard, right?
[1:42:43] It's hard.
[1:42:43] >> So, it's like this thing we were talking
[1:42:45] about, making a decision can be hard for
[1:42:48] some people. thinking through a problem
[1:42:51] and the potential solutions. I mean, you
[1:42:53] know, there are some people who love it.
[1:42:56] They love the permutations. Here's the
[1:42:58] problem. How many ways could I solve it?
[1:43:01] And they'll go down one route and think,
[1:43:03] you know, branching tree. Ah, yeah. If
[1:43:05] you go down this route, you could do A,
[1:43:06] B, or C. On the other hand, if you go
[1:43:08] down this route, you could do D, E, and
[1:43:10] F. And they love that. They love the
[1:43:12] fact that there are these permutations.
[1:43:14] Whereas for me, I'd rather narrow it
[1:43:17] down very quickly and go down this is my
[1:43:20] favorite route and okay, there are one
[1:43:22] or two choices to be made here. So there
[1:43:24] are different styles of thinking in your
[1:43:26] head, you know, and maybe for some
[1:43:28] people who don't necessarily love the
[1:43:31] permutations, but end up thinking there
[1:43:33] are so many permutations. That's a big
[1:43:34] thing to do. There's there are too many
[1:43:36] choices here. So I'd rather just listen
[1:43:38] to the, you know, the audio book.
[1:43:41] >> I have a colleague at Stanford. I'm sure
[1:43:42] you've heard of him, Carl Daiserov,
[1:43:44] psychiatrist, developer, co-developer
[1:43:47] with several others of optogenetics. And
[1:43:49] when he came on the podcast, he was
[1:43:50] actually our first guest.
[1:43:52] >> He said that he spends time every night
[1:43:54] after his then young kids went to sleep.
[1:43:56] And now still he'll spend an hour or two
[1:44:00] just forcing himself to think in
[1:44:02] complete sentences.
[1:44:04] >> That's no small task.
[1:44:06] >> What discipline,
[1:44:07] >> right? I think most of us who like to
[1:44:09] think and think about permutations will
[1:44:12] often write and do flowcharts because
[1:44:14] it's it's a little bit out there. It's a
[1:44:17] little easier than structuring
[1:44:18] everything in here.
[1:44:19] >> Well, you have to have such a great
[1:44:21] working memory system if you've got it
[1:44:23] all in here. And as we know, the more
[1:44:26] you put into that working memory system,
[1:44:27] the bigger the burden, right? Capacity
[1:44:30] limits mean that you can't hold, most of
[1:44:32] us can't hold lots and lots of
[1:44:34] permutations. We may be limited. And
[1:44:36] maybe that's what I'm expressing in
[1:44:38] myself is I I like to keep it really
[1:44:40] focused and have two or three
[1:44:41] alternatives in my working memory
[1:44:43] system. Whereas if you're confronted
[1:44:46] with 15 20 possible solutions, that's
[1:44:49] quite a hard thing for the working
[1:44:50] memory system to hold on to. And our our
[1:44:53] own work in memory has suggested the
[1:44:55] quality of the information you have for
[1:44:57] for the stuff you hold is diluted. the
[1:45:01] more you add into the working memory
[1:45:03] system, the quality with which you
[1:45:05] remember each bit of information is
[1:45:07] reduced. So there is also a cost from
[1:45:11] holding everything in mind. I don't know
[1:45:13] if these studies still hold, but my last
[1:45:14] read of the studies on working memory
[1:45:16] and dopamine suggested that some people
[1:45:19] have a low, others medium, and others
[1:45:22] quote unquote high level of baseline
[1:45:24] dopamine. This is a tricky term and our
[1:45:26] science colleagues they're going to go
[1:45:27] ahead and you know might roll their eyes
[1:45:29] a little bit at the way I'm describing
[1:45:31] it but for sake of discussion low medium
[1:45:32] or high baseline dopamine and that if
[1:45:35] you give somebody a drug to increase the
[1:45:37] amount of dopamine in their system and
[1:45:40] they are in the low or medium baseline
[1:45:43] group they experience a boost in working
[1:45:45] memory their ability to keep thoughts
[1:45:47] online for short periods of time make
[1:45:48] use of that information. But that
[1:45:50] somebody who's already sealinged out,
[1:45:52] yeah, on dopamine doesn't afford them a
[1:45:54] benefit, maybe even degrades their their
[1:45:57] ability. I find those studies
[1:45:59] fascinating, especially given the fact
[1:46:00] that so many people take stimulants.
[1:46:02] >> Yeah.
[1:46:03] >> You know, whereas a few years ago there
[1:46:05] were some people taking Adderall, Rolin,
[1:46:07] and most every 90% of adults drink
[1:46:10] caffeine worldwide. I mean, it's
[1:46:12] incredible. Now, nicotine is everywhere.
[1:46:17] oral nicotine use in women, men, young
[1:46:20] people, and dopamine is a big part of
[1:46:23] the nicotine story. I mean,
[1:46:24] acetylcholine as well.
[1:46:26] >> Yeah.
[1:46:26] >> So, these people who are now addicted to
[1:46:29] nicotine, I don't care what people say.
[1:46:31] It's a you're not necessarily robbing
[1:46:33] people to get money for your pouches of
[1:46:35] nicotine, but tell them to stop and then
[1:46:37] it's like, I'm not gonna stop. They go
[1:46:39] from one pouch to three to eight
[1:46:41] >> to a canister every couple of days or
[1:46:43] even day. This is like
[1:46:45] >> happening. I'm not judging it, but
[1:46:47] chances are they're not getting a
[1:46:48] cognitive benefit, right? That they're
[1:46:50] just able to hang in there with their
[1:46:52] normal baseline.
[1:46:53] >> My reading of that literature, the
[1:46:55] psychopharmarmacology literature in
[1:46:57] terms of cognitive enhancement is
[1:46:59] absolutely what you said. If you start
[1:47:01] from a low baseline of performance, you
[1:47:04] might get some positive boost. It's
[1:47:06] quite small, but you might get it. But
[1:47:08] if you are actually quite a high
[1:47:10] performer, then you risk getting worse.
[1:47:15] with this is called the inverse U-shaped
[1:47:17] curve. I don't mean and so I tell the
[1:47:20] students that I teach, you know, about
[1:47:21] this sort of stuff, you're probably not
[1:47:24] going to be in that low baseline state
[1:47:27] given where you you're here at this
[1:47:29] university. Uh so just think twice about
[1:47:32] taking some stimulant that you want to
[1:47:34] get a better grade because actually the
[1:47:36] evidence would be that you might get
[1:47:38] worse from doing it. So yeah, you have
[1:47:41] to be very careful with this. There seem
[1:47:43] to be real individual differences which
[1:47:45] depend on our intrinsic
[1:47:48] uh chemistry, neurochemistry. The
[1:47:51] history of nicotine is fascinating. It's
[1:47:53] almost as if ever since humans
[1:47:54] discovered it, they find some way to get
[1:47:57] it into their system. And once they
[1:47:58] figure out that that way is really bad
[1:48:00] for them, like it can kill them from
[1:48:02] lung cancer. Takes a couple of years and
[1:48:04] they figure out another way. And then
[1:48:05] it's almost like humans love to eat and
[1:48:09] consume plant alkaloids. Like they just
[1:48:10] have to do it. They just got to feel
[1:48:12] different than their their natural
[1:48:14] chemistry will allow them to.
[1:48:15] >> I mean, this is our culture, right?
[1:48:17] That's what's happened over years. I
[1:48:19] mean, as you say, if we look back, let's
[1:48:22] say in South America, the cultures of
[1:48:25] how people use stimulants in various
[1:48:27] ways that goes back, you know, thousands
[1:48:29] of years. It's not something new. So,
[1:48:31] this is what our brains are used to in
[1:48:33] terms of stimulation in some way. and
[1:48:35] many of the drugs of addiction okay not
[1:48:37] the not the more modern things but have
[1:48:40] that propensity have been around because
[1:48:43] the culture has allowed that to happen
[1:48:46] in some way. So this is really important
[1:48:48] I think in terms of how our
[1:48:50] neurochemistry sort of interfaces with
[1:48:53] our cultures. I have to imagine that
[1:48:55] given you work on attention and you work
[1:48:58] on motivation and apathy that you get a
[1:49:00] lot of emails from parents or even kids
[1:49:02] and young people about ADHD
[1:49:05] >> and many people think that they have
[1:49:07] attentional issues. Do you think there
[1:49:09] are a lot of people that don't
[1:49:11] necessarily have attentional issues?
[1:49:13] They just haven't figured out how to
[1:49:14] stop and think and make a decision about
[1:49:16] what to do next. I'm not trying to be
[1:49:17] disparaging here. I think that as each
[1:49:20] of the psychiatric disorders has become
[1:49:24] kind of more in the public discussion
[1:49:26] like people will say OCD they'll say oh
[1:49:29] on the spectrum they'll say
[1:49:31] >> you know I have ADHD and these are real
[1:49:33] clinical issues but I think
[1:49:36] >> there's kind of a feedback where people
[1:49:38] start to notice their lack of attention
[1:49:40] maybe I have ADHD maybe I should take
[1:49:42] stimulants you know do you get a lot of
[1:49:44] questions about ADHD and do you think
[1:49:46] it's a real thing for for many adults,
[1:49:49] for many kids, or do you think there's
[1:49:51] kind of a perception that we have an
[1:49:53] issue that we don't necessarily have?
[1:49:54] It's just lack of good old discipline.
[1:49:56] >> I do get a lot of questions. I think it
[1:49:57] is a real issue for some people.
[1:49:59] Interestingly, you know, the number of
[1:50:01] people who remain with the diagnosis of
[1:50:04] ADHD into adulthood if they had it as
[1:50:07] children can reduce actually the numbers
[1:50:09] reduce in terms of people who continue
[1:50:11] to have adulthood. So, that's
[1:50:12] interesting that there is some
[1:50:13] plasticity in the brain. But I also
[1:50:16] think that this is not mutually
[1:50:18] incompatible with the view that there's
[1:50:20] also overdiagnosis. And I think we need
[1:50:22] very careful ways of making diagnosis
[1:50:27] because the conventional way is you take
[1:50:30] a history from a person about what the
[1:50:33] problem is. You may then do some degree
[1:50:36] of cognitive testing and that degree of
[1:50:38] cognitive testing varies enormously
[1:50:40] between different specialists.
[1:50:43] And then you have to decide where is
[1:50:46] normality. Essentially that's what
[1:50:47] you're asking cuz you and I also get
[1:50:49] attention lapses from time to time. We
[1:50:51] also don't always perform well. Uh we
[1:50:54] have difficulty in sustaining attention.
[1:50:57] So where do we put that marker of
[1:50:59] normality? It will always be a
[1:51:02] continuum. Right? So we're going to have
[1:51:03] to place this marker in terms of
[1:51:06] diagnosis at some point. And often that
[1:51:09] might be a point where you think it's
[1:51:11] actually having a detrimental functional
[1:51:14] effect on somebody's performance whether
[1:51:17] it's scholastic or whether it's in
[1:51:20] social ways or whatever it is. And then
[1:51:21] it becomes more difficult because you
[1:51:23] know you that's that's a much more
[1:51:25] subjective thing to decide. You've got
[1:51:27] your cognitive test but now you have to
[1:51:29] make a decision about whether this is
[1:51:32] subjectively something that's having an
[1:51:34] impact on their everyday lives.
[1:51:37] That might be one of the places where
[1:51:40] some of the fuzziness in diagnosis
[1:51:43] comes.
[1:51:44] >> Long ago, we had a guest on the podcast
[1:51:45] who's an expert in ADHD who shared that
[1:51:48] kids and adults with ADHD actually can
[1:51:50] focus quite intensely on things they
[1:51:52] really
[1:51:53] >> enjoy and are curious about.
[1:51:56] >> Reminds me of the Parkinson's patient
[1:51:57] running out of the house.
[1:51:59] And it raises the question of whether we
[1:52:02] should train to have better levels of
[1:52:05] attention, longer duration attention by
[1:52:08] doing boring stuff
[1:52:10] >> as opposed to trying to find the thing
[1:52:12] that hooks us all the time. That too,
[1:52:15] but maybe we should do more chop wood,
[1:52:16] carry water stuff. [laughter] You know,
[1:52:18] >> you know, in the Second World War, there
[1:52:20] were these studies in Britain uh for
[1:52:23] radar operators because they would look
[1:52:25] at this screen. It's a very boring
[1:52:27] screen and they're looking out for
[1:52:30] German fighter planes or bombers coming
[1:52:32] over the channel. Most of the time there
[1:52:34] isn't anything, but they could have
[1:52:36] false positives. They could push the
[1:52:38] button because they think they saw a
[1:52:40] blip or they might drift off, which was
[1:52:44] more the worry is that they were
[1:52:46] drifting off. Their sustained attention
[1:52:48] was drifting off and therefore they
[1:52:49] would miss a really important event on
[1:52:53] their radar screens. And it turns out
[1:52:55] that there is something we call a
[1:52:57] vigilance decrement. Over time, if
[1:52:59] you're doing something boring and dull,
[1:53:02] healthy brains, you will find a
[1:53:04] reduction in your ability to detect
[1:53:06] these boring, very infrequent events.
[1:53:09] You can measure it. And one of the
[1:53:11] problems that's been found in ADHD is
[1:53:14] there can be a difficulty in sustaining
[1:53:16] attention over time.
[1:53:18] Not necessarily because they miss
[1:53:19] things, but also the variability in
[1:53:22] response is something that's become a
[1:53:24] signature of people with ADHD. They're
[1:53:27] far more variable than people who are
[1:53:29] not giving that diagnosis if we believe
[1:53:31] the diagnosis was made correctly at that
[1:53:34] time. And I think that's telling us
[1:53:36] something really important about this
[1:53:37] because that variability might reduce if
[1:53:40] the motivation to do this was better. So
[1:53:45] you mentioned intrinsic motivation in
[1:53:47] the sense that if they're doing
[1:53:48] something they're really interested in,
[1:53:49] they might be more focused in in order
[1:53:52] to do that. And the neuroscience, I'm
[1:53:54] not a specialist in ADHD, but the
[1:53:56] neuroscience that I have read about
[1:53:58] suggests that it's not only the parietal
[1:54:01] and frontal regions of the brain which
[1:54:03] are important in deploying attention to
[1:54:05] the external world. There may also be
[1:54:09] dysfunction in the basil ganglia in
[1:54:11] people with ADHD.
[1:54:14] that's been referred to in some ways as
[1:54:15] being involved in working memory, but it
[1:54:17] can also probably be involved in
[1:54:19] motivation. So, we're bringing these
[1:54:21] themes together here that attention
[1:54:23] might also be related to motivation
[1:54:26] because you're more likely to pay
[1:54:27] attention to something that you think is
[1:54:31] intrinsically rewarding to you. Maybe we
[1:54:33] could drill just a little bit further
[1:54:35] into the nucleus encumbent and this
[1:54:36] basil ganglia circuitry because I think
[1:54:40] most everyone is familiar with the fact
[1:54:41] that some goals are very short-term. I'm
[1:54:44] going to make a cup of coffee. I'm going
[1:54:45] to drink the coffee. Some are long-term.
[1:54:48] I always say, you know, if nothing else,
[1:54:50] you know, get a PhD because you'll teach
[1:54:52] yourself that you can work on things for
[1:54:54] long periods of time, sustain a lot of
[1:54:55] effort and uncertainty and it
[1:54:58] >> provided you complete it and I trust you
[1:55:00] will, you get something at the end and
[1:55:02] say there you have this ability to say,
[1:55:04] well, I can do hard things, uncertain
[1:55:06] things over four to six years.
[1:55:09] >> I mean, that's not alone a reason to do
[1:55:11] it. Hopefully, you're interested in what
[1:55:12] you're doing. It really helps. But do
[1:55:15] you think there are ways that this
[1:55:17] circuitry learns different time
[1:55:20] contingencies that it must, right? I
[1:55:22] mean, if the same circuitry is involved
[1:55:24] in motivating to make a cup of coffee
[1:55:26] because it feels worth it to me to get
[1:55:27] the caffeine and the taste that's
[1:55:30] responsible for
[1:55:32] trudging through something over several
[1:55:34] years, an endeavor or relationship of
[1:55:36] any kind. And it's the same circuitry
[1:55:39] that suggests there's a really robust
[1:55:42] and dynamic dial on on how it integrates
[1:55:46] time, right? I mean I mean it's a
[1:55:48] totally different game. In one case it's
[1:55:51] like a slot machine
[1:55:52] >> that has a high probability of success
[1:55:54] like making the coffee, right? It's
[1:55:56] almost every time you actually get the
[1:55:58] coffee. And in the other one it's like
[1:56:00] we're talking years. So the same
[1:56:02] neurons, they're clocking over vastly
[1:56:05] different time scales. How does that
[1:56:08] work?
[1:56:08] >> So I think most of the studies that have
[1:56:10] been done are over very short time
[1:56:12] scales. They're what you're talking
[1:56:13] about, you know, the slot machine type
[1:56:14] of study. We've also done some studies
[1:56:17] recently looking at perseverance, but
[1:56:19] again, they're not over years that we
[1:56:22] normally have to think about when we're
[1:56:24] making long-term goals. I don't think
[1:56:26] it's necessarily
[1:56:28] timekeeping in the basil ganglia that's
[1:56:31] the issue here. I think these are much
[1:56:33] higher level goals and plans that you
[1:56:36] might think are being constructed in the
[1:56:39] cortex, particularly the frontal cortex.
[1:56:41] You know, we talked about executive
[1:56:42] control and planning. Planning has not
[1:56:44] been studied in great detail except for
[1:56:46] some relatively simple problem solving
[1:56:48] tasks that patients are given to do
[1:56:50] which usually can be done within a few
[1:56:53] minutes. But this [clears throat]
[1:56:54] extended
[1:56:56] long-term
[1:56:57] planning and perseverance, I don't think
[1:57:00] that's something that the basil gang do.
[1:57:03] Those networks are there from the
[1:57:05] lamprey, right, to solve
[1:57:07] >> getting my motivation signal to action.
[1:57:10] But this extended motivation to do
[1:57:13] something over years for a a long-term
[1:57:17] goal, I think must be something which is
[1:57:19] different from what's going on just in
[1:57:21] the basil ganglia. And of course then it
[1:57:23] also brings into this issue about what's
[1:57:26] called temporal discounting. So if I say
[1:57:28] to someone you will get this great
[1:57:31] rewarding outcome but you have to
[1:57:33] persevere for one year or I say to them
[1:57:37] you'll get this sort of mediocre outcome
[1:57:40] and you'll get it within a week. People
[1:57:42] will differ in which ones they'll
[1:57:44] choose.
[1:57:44] >> What are the current data on that? Does
[1:57:46] it divide in some sort of like two
[1:57:48] marshmallow experiment kind of way?
[1:57:49] [laughter] Still, you know,
[1:57:51] >> the marshmallow experiments have
[1:57:52] obviously become very controversial in
[1:57:54] terms of
[1:57:55] >> I heard they were debunked. Then someone
[1:57:56] came on the podcast who works on these
[1:57:57] and said the debunk was debunked.
[1:57:59] >> Yeah, I'm not an expert on those
[1:58:00] studies, but I think the key thing I'm
[1:58:03] just trying to explain is that also
[1:58:04] people differ in their levels of how
[1:58:08] they will discount the reward that
[1:58:11] they're willing to take
[1:58:14] >> with time.
[1:58:15] >> And that varies enormously between
[1:58:17] people. So, what is it that allows
[1:58:19] someone to say, "I'm going to wait for
[1:58:21] the bigger reward after a year rather
[1:58:24] than take this mediocre reward in a
[1:58:26] week." I don't think we've we've really
[1:58:28] got the neuroscience of that. Now, it's
[1:58:30] tempting to say that to pursue long-term
[1:58:33] goals, you know, you want to break it up
[1:58:34] into short-term goals and
[1:58:36] >> but I always think about these
[1:58:38] asymmetries like if you if we said that
[1:58:40] we said, okay, you know, you have a
[1:58:41] five-year goal and in order to get
[1:58:43] there, you're going to use the same
[1:58:44] reward circuitry and motivation
[1:58:46] circuitry, but you're really going to
[1:58:48] pay attention to the small wins along
[1:58:49] the way, the incremental wins.
[1:58:51] >> The risk is that you also pay attention
[1:58:53] to the failures along the way, right?
[1:58:55] Because in the end, it's binary. you
[1:58:56] either get the thing or you don't in
[1:58:58] most cases certainly with a degree.
[1:59:01] >> But with wins and losses, they're graded
[1:59:04] as we say, you know, like they're not
[1:59:05] zero or one, they're 0 to 10. And it's
[1:59:08] very subjective. And so I feel like
[1:59:10] perseverance for me has a lot to do with
[1:59:13] making the pain
[1:59:17] a shorter experience than the win. Like
[1:59:19] like carrying forward our wins and our
[1:59:22] memories of being motivated. Like if we
[1:59:24] kind of allow those to seep into our
[1:59:26] self-concept a little bit more, then
[1:59:28] it's sort of like, oh yeah, you can do
[1:59:29] hard things, but it's it's a little bit
[1:59:31] of self-d delusion, but it's a
[1:59:32] functional self-d delusion, right?
[1:59:33] >> Of course. Of course.
[1:59:34] >> You know, I don't know how one could get
[1:59:35] a medical degree without engaging in
[1:59:38] some amount of functional self-d
[1:59:40] delusion.
[1:59:41] >> Yeah. I mean, it's tough.
[1:59:43] >> Yeah. [laughter] You've worked on, as I
[1:59:44] mentioned earlier, a huge number of
[1:59:46] issues. I don't expect us to go into all
[1:59:48] of them today, but I know many people
[1:59:49] are interested in Alzheimer's disease
[1:59:51] >> and uh the loss of memory due to aging.
[1:59:54] What in your mind are some of the more
[1:59:56] interesting findings of past, present,
[1:59:58] and maybe anything that you did in
[2:00:00] particular that changed your notions of
[2:00:03] memory and and Alzheimer's?
[2:00:05] >> I think one of the most interesting
[2:00:07] things that much of the audience would
[2:00:09] not be aware of is Alzheimer's disease
[2:00:12] does not necessarily equal dementia.
[2:00:14] people can have Alzheimer's disease and
[2:00:17] not get dementia. So, we found this out
[2:00:20] from post-mortem studies. People have
[2:00:22] been followed as they age. Uh they've
[2:00:25] donated their brains and it turns out
[2:00:27] that perhaps 20 to 30% of these
[2:00:30] individuals who never had dementia have
[2:00:34] Alzheimer pathology. What do we mean by
[2:00:36] that? We mean that when we look down
[2:00:38] under the microscope, you can see the
[2:00:40] signature of Alzheimer's disease. You
[2:00:42] can see plaques which are made up of
[2:00:45] this protein amaloid which has been
[2:00:48] deposited in the brain. You can see
[2:00:50] tangles which are made out of this
[2:00:52] protein towel. And you can see that also
[2:00:56] perhaps some of the neurons have uh
[2:00:59] suffered. They've died in these brains
[2:01:02] and yet the person never developed
[2:01:05] dementia. So the first point I think is
[2:01:07] really important is Alzheimer's disease
[2:01:10] can increase in the brain as we age but
[2:01:13] it doesn't necessarily have to lead to
[2:01:16] dementia which is a really important
[2:01:17] point. So what's the difference between
[2:01:19] the people who can
[2:01:22] cope with this burden of pathology in
[2:01:25] their brain and remain cognitively
[2:01:29] relatively intact? Why do they have this
[2:01:32] cognitive resilience? And a lot of
[2:01:35] people are investing
[2:01:37] uh funds to try and work out what's the
[2:01:39] difference between these people. Of
[2:01:41] course, there might be biological
[2:01:42] differences and lifestyle differences.
[2:01:44] It could be, you know, the people who
[2:01:46] can be resilient are the ones who've had
[2:01:49] a routine of physical exercise. They
[2:01:51] made sure their blood pressure never got
[2:01:53] too high. They've made sure that, you
[2:01:56] know, they don't have pre-diabetes or
[2:01:58] diabetes or they check for it. Their
[2:01:59] cholesterol is under control. They're
[2:02:01] not drinking too much alcohol. they're
[2:02:03] not smoking. All of those things can be
[2:02:05] important. But it turns out that
[2:02:07] actually there are other factors that
[2:02:09] can be just as important. You know, we
[2:02:11] talked a little bit about these. Those
[2:02:14] include that having that sense of
[2:02:16] purpose, making sure that you have a
[2:02:18] network of people, that you're socially
[2:02:21] connected as your age, and also
[2:02:23] remaining curious, open to new ideas.
[2:02:26] Those factors turn out to be almost as
[2:02:29] important as some of the physical things
[2:02:31] we do. And we're just scratching the
[2:02:33] surface of trying to understand how
[2:02:36] those factors affect the biology. How is
[2:02:39] it that having a sense of purpose
[2:02:42] makes a difference to how you cope with
[2:02:45] this burden of pathology in your brain?
[2:02:48] But in a way, that's a really
[2:02:50] interesting optimistic thing to learn
[2:02:52] about Alzheimer's disease that it
[2:02:55] doesn't necessarily always lead to
[2:02:56] dementia. And by the way, I should also
[2:02:58] just explain for the audience that
[2:03:00] although Alzheimer's disease is the
[2:03:01] leading cause of dementia, there are
[2:03:03] many many causes of dementia. So again,
[2:03:06] Alzheimer's disease is not the only
[2:03:08] thing that can cause dementia. In terms
[2:03:11] of our own work, one of the things that
[2:03:14] we've really tried to do is extend the
[2:03:17] kind of work we were talking about with
[2:03:19] loss of motivation and apathy [snorts]
[2:03:21] into people who develop Alzheimer's
[2:03:24] disease. And in fact, perhaps even
[2:03:26] before we're aware they've developed
[2:03:28] [snorts] it. A lot of studies in the
[2:03:30] last few years have shown that if we
[2:03:32] just study healthy aging people, they
[2:03:36] don't have dementia, they don't have any
[2:03:38] diagnosis of a neurological disorder.
[2:03:41] What we find is that those individuals
[2:03:44] who score highly on just self-reported
[2:03:48] questionnaires for motivation, if they
[2:03:50] score highly for apathy, they have twice
[2:03:54] the risk of developing Alzheimer's
[2:03:56] disease than people who don't.
[2:03:59] And the conclusion that is emerging is
[2:04:04] that Alzheimer's disease is not
[2:04:05] necessarily just about cognitive
[2:04:08] impairment. It can also lead to
[2:04:10] behavioral changes long before you
[2:04:14] develop any sign of cognitive
[2:04:16] impairment. And one of those behavioral
[2:04:17] changes happens to be apathy, loss of
[2:04:20] motivation. So if you can pick that up
[2:04:24] at an early stage, could you potentially
[2:04:27] do something about it? Because the
[2:04:29] evidence suggests that these pathologies
[2:04:32] in Alzheimer's disease, the amaloid and
[2:04:34] the tow that's being laid down in the
[2:04:36] brain, that can be more than 10 years,
[2:04:40] perhaps more than 15 years before
[2:04:42] somebody presents to a doctor with
[2:04:45] cognitive complaints. So we've got this
[2:04:47] huge window maybe 10 to 15 years before
[2:04:50] someone comes along and has a diagnosis
[2:04:53] of Alzheimer's disease. So if we could
[2:04:56] detect this at the earliest stages maybe
[2:05:01] the drug therapies that have developed
[2:05:03] and shown very small changes the
[2:05:05] monoconal antibodies that mop up amaloid
[2:05:08] have shown that even in established
[2:05:09] early Alzheimer's disease they can make
[2:05:11] a small difference to the trajectory of
[2:05:13] the illness. Maybe those monoconal
[2:05:16] antibodies could make a difference if
[2:05:18] you could do something 15 years before
[2:05:21] someone develops Alzheimer's disease if
[2:05:23] we could detect it in the brains. So I
[2:05:26] guess these are perhaps some of the most
[2:05:28] interesting things that I think um I've
[2:05:31] been stimulated by in the last few
[2:05:32] years.
[2:05:33] >> I wasn't aware that one could have
[2:05:35] plaques and tangles so-called
[2:05:37] Alzheimer's characteristic signs of
[2:05:40] Alzheimer's and yet not have dementia.
[2:05:42] Sounds like certain people by virtue of
[2:05:44] having sense of purpose engaging in the
[2:05:46] world and who knows maybe even the
[2:05:48] reflection back onto who they are sense
[2:05:50] of self being reinforced I'm making up
[2:05:52] that portion of the story but I like the
[2:05:54] idea uh no basis for it but uh no direct
[2:05:57] data for it rather are resilient to
[2:06:00] their own internal landscape. It's an
[2:06:02] interesting way of thinking about
[2:06:03] neurodeenerative disease because we
[2:06:05] think about exercise, crossword puzzle,
[2:06:07] social connection, Mediterranean diet
[2:06:09] and all these things, you know, and good
[2:06:11] cardiovascular health in general
[2:06:13] buffering us against the uh pressures of
[2:06:15] the outside world. But the idea that our
[2:06:19] thoughts, our self-concept, our emotions
[2:06:21] could buffer us against our internal
[2:06:24] neural landscape,
[2:06:26] that's pretty exciting because that's
[2:06:28] something that, as you mentioned, if you
[2:06:29] could start early enough
[2:06:30] >> Yeah. Well, it would benefit us anyway.
[2:06:33] Why wouldn't we do it? Of course.
[2:06:35] >> Right. It's just good for us across the
[2:06:37] board.
[2:06:37] >> What's the harm in doing that?
[2:06:38] >> Right.
[2:06:39] >> Yeah. But that is an exciting new
[2:06:41] development. Uh but of course that has
[2:06:43] all sorts of implications. Um
[2:06:46] would you tell someone they have
[2:06:48] Alzheimer pathology in their brain when
[2:06:50] they weren't going to develop dementia?
[2:06:53] >> You're spoiling spoiling the party here,
[2:06:55] right?
[2:06:55] >> That's a tough one. You know, these days
[2:06:57] there's a lot of interest in whole body
[2:06:59] MRI. friend of mine who's a neurosurgeon
[2:07:02] says that he gets people in his clinic
[2:07:04] all the time who spotted things in a you
[2:07:07] know they paid to go get their own MRI
[2:07:11] and it saved their life but he gets a
[2:07:13] lot of calls from people that are
[2:07:15] concerned about white spots on the brain
[2:07:17] or growths in the brain that are
[2:07:19] basically of no concern clinically and
[2:07:22] it's a tough call and there's a
[2:07:23] financial piece where some people can
[2:07:25] afford to do this and some people can't
[2:07:27] and so it's become a point of contention
[2:07:28] but
[2:07:30] >> this This is how we used to talk about
[2:07:31] genetic data in the late 80s, early 90s.
[2:07:33] I remember the discussion like, would
[2:07:35] you want your genome?
[2:07:36] >> And some people say, well, if I'm going
[2:07:38] to get Huntington's, well, wait, no,
[2:07:39] maybe I wouldn't want to know. And other
[2:07:41] people say, oh, I would absolutely want
[2:07:43] to know. It's it's a very complicated
[2:07:45] issue.
[2:07:45] >> Yeah. And you need informed choice. So,
[2:07:47] you need to have enough information
[2:07:48] before you make that choice. And of
[2:07:50] course, as you said, maybe some people
[2:07:52] are financially able to do this sort of
[2:07:53] stuff and others aren't. So, it has huge
[2:07:56] implications going forward. But again,
[2:07:58] you know, there's so much excitement in
[2:08:02] brain diseases that we we couldn't
[2:08:04] potentially think about treating years
[2:08:06] ago. For example, the landscape in
[2:08:08] multiple sclerosis. When I was a junior
[2:08:11] neurologist, all we had was steroids,
[2:08:13] corticosteroids to give to people who
[2:08:15] had relapses of multiple scerosis. Now,
[2:08:18] there are a huge range of immune
[2:08:21] therapies for multiple scerosis, which
[2:08:23] has transformed the lives of people with
[2:08:26] that diagnosis. and the disability in
[2:08:29] that condition. You can't be a general
[2:08:30] neurologist in you know looking after
[2:08:32] multiple sclerosis patients. You have to
[2:08:34] be a real hypers specialist because
[2:08:36] there are so many therapeutic
[2:08:39] possibilities and for neurodeenerative
[2:08:41] diseases it's a tough call as well but
[2:08:44] so much has happened in a condition
[2:08:46] which was thought pretty untreatable 30
[2:08:48] years ago apart from giving steroids. So
[2:08:50] I think this is an area that's become
[2:08:52] really exciting. it's a good time to
[2:08:54] become a neurologist if anyone's
[2:08:56] thinking about it. Whereas maybe a few
[2:08:58] years back I had a more depressing view
[2:09:00] of neurology. It sounds like things are
[2:09:02] really on the upswing in terms of tools
[2:09:04] and approaches for treatment. Again, 30
[2:09:06] years ago, deep brain stimulation for
[2:09:09] Parkinson's disease was just being
[2:09:11] introduced. And I used to think what are
[2:09:13] these guys doing? They're putting these
[2:09:14] patients through this terrible surgery.
[2:09:16] There's risks of infection, hemorrhage,
[2:09:18] all these kind of things. Now I look
[2:09:20] back and I think you have to take those
[2:09:22] pioneering steps, take the risks because
[2:09:25] there are patients with Parkinson's
[2:09:26] disease who have had their lives
[2:09:28] transformed by this sort of radical
[2:09:31] treatment where you have deep brain
[2:09:33] stimulation of the basil ganglia. I mean
[2:09:35] that's an incredible achievement and so
[2:09:39] if you could have that why can't you
[2:09:40] have deep brain stimulation in other
[2:09:42] neurodeenerative diseases provided you
[2:09:44] found the targets for that stimulation
[2:09:47] well and why can't you have focal
[2:09:50] neuropharmacological
[2:09:52] uh treatment which would mean that you
[2:09:54] wouldn't necessarily get any of the
[2:09:56] toxic side effects or or unwanted side
[2:09:59] effects of drugs that you might give
[2:10:02] systemically or introvenously in some
[2:10:04] I I think these things are coming.
[2:10:06] >> I think so, too. I'm excited about
[2:10:08] intersectional methods like giving a
[2:10:10] drug that potentially could increase
[2:10:12] dopamine everywhere, but you give
[2:10:14] another compound that directs it
[2:10:16] specifically to the components of the
[2:10:18] brain that you're interested in and so
[2:10:20] you relieve side effects. That that
[2:10:21] stuff is being done in animal models and
[2:10:23] we're not quite there. I feel like we're
[2:10:25] getting there.
[2:10:25] >> That's right. and and some of my
[2:10:26] colleagues in Oxford and elsewhere in
[2:10:28] the world are, you know, using focused
[2:10:30] ultrasound to open up the bloodb brain
[2:10:32] barrier, the zip that covers the brain
[2:10:35] so that it's focally opened up at the
[2:10:38] location you want to deliver the drug.
[2:10:40] >> Oh, that's cool.
[2:10:41] >> I mean, that's, you know,
[2:10:42] >> very cool.
[2:10:42] >> Fantastic if you can achieve it.
[2:10:44] >> I'm excited and encouraged by these MS
[2:10:46] results. Um, we have a colleague here
[2:10:49] that has MS and, um, we haven't done an
[2:10:52] episode about it yet. uh we need to but
[2:10:54] that's super encouraging. Super
[2:10:56] encouraging.
[2:10:57] >> It really is transformative in that
[2:10:59] field.
[2:10:59] >> You've been very generous with your
[2:11:01] time. Before we uh wrap up, can I just
[2:11:03] ask you a few more questions?
[2:11:04] >> Of course.
[2:11:04] >> Okay. Um people will wonder if there's
[2:11:07] anything they can do to increase their
[2:11:09] attention or ability to stay focused in
[2:11:12] stuff that isn't super engaging for
[2:11:14] them. Is that a is that a skill? the
[2:11:17] studies that have been done there have
[2:11:18] really focused on things like playing
[2:11:23] video games or stuff like that and you
[2:11:25] can improve on those sort of tasks but
[2:11:27] what you mentioned before this doesn't
[2:11:29] necessarily generalize to other types of
[2:11:32] activity so it seems to be very task
[2:11:35] specific domain specific in in that way
[2:11:37] hyperdomain specific so training your
[2:11:41] attention I'm not sure there is such uh
[2:11:45] such great literature which I would
[2:11:47] think you I could point you to this has
[2:11:49] been also tried in people with stroke
[2:11:51] and who lose attention like the neglect
[2:11:54] syndrome and again things improve on the
[2:11:56] task but they don't necessarily
[2:11:58] generalize to other tasks can we train
[2:12:01] to not get distracted so the inverse of
[2:12:04] that this is might seem like a crazy
[2:12:06] example but in the world of mouse
[2:12:08] genetics I learned a long time ago that
[2:12:10] it takes many generations to evolve a
[2:12:12] trait but it doesn't take very many
[2:12:14] generations to devolve all of a trait.
[2:12:16] So, you can just breed some mice, breed
[2:12:18] some mice, pretty soon you'll get
[2:12:19] interesting mutations um that you can
[2:12:21] study and you can find the role of
[2:12:23] particular genes, put them back in. But
[2:12:24] if you go and you try and say, "Oh, you
[2:12:26] know, we're going to like breed mice for
[2:12:27] a while until we get an interesting
[2:12:29] outlier and then we're going to study
[2:12:30] that outlier." You're going to you're
[2:12:31] going to be an old old human before you
[2:12:34] even get something that might be
[2:12:35] interesting. And that's [clears throat]
[2:12:36] a for me was a very informative example
[2:12:39] because in the realm of attention maybe
[2:12:41] we can't get better but maybe we're
[2:12:42] doing a lot of things in our daily life
[2:12:44] that are degrading our attention and we
[2:12:46] just rescue a little bit of that and
[2:12:47] we're like oh I'm actually much better
[2:12:49] at focusing than I thought.
[2:12:51] >> Yeah. So I think although there might
[2:12:52] not be a great deal of evidence that you
[2:12:54] can intrinsically train your attention
[2:12:56] to do better generally
[2:12:58] what you could do is to cut out things
[2:13:00] that are distracting for you. I mean you
[2:13:02] know these are simple things that people
[2:13:04] will be very familiar with. Make sure
[2:13:05] you don't get notifications. That's a
[2:13:07] really important thing that many people
[2:13:09] don't do, right? Or keep your email open
[2:13:12] while you're doing something else. Make
[2:13:14] sure that there isn't some sort of
[2:13:15] distracting noise wherever you're doing
[2:13:17] this. So, you could do things in your
[2:13:20] environment to cut down distracting
[2:13:23] stimuli that will capture your
[2:13:24] attention.
[2:13:25] >> I sometimes wonder if there's both a
[2:13:27] pleasure and a pain in giving something
[2:13:30] our full attention. M I now look at the
[2:13:32] world as okay what's effective in
[2:13:34] grabbing people's attention and
[2:13:35] distracting them what's effective in
[2:13:37] grabbing people's attention and engaging
[2:13:39] them okay well drama arousal and numbing
[2:13:43] out are very effective at grabbing
[2:13:45] people's attention but I think I and
[2:13:47] others have experienced this thing I
[2:13:50] know I have perhaps others where when
[2:13:52] you try hard to really focus on
[2:13:54] something it's a pleasure once you get
[2:13:57] through it and you get someplace but
[2:13:58] there's a kind of a pain to it also
[2:14:00] [snorts]
[2:14:01] And so perhaps the attention economy
[2:14:03] isn't so much about grabbing people's
[2:14:05] attention. It's about distributing it
[2:14:06] over a certain array of things where
[2:14:09] they can potentially make money. I think
[2:14:10] about this a lot lately and I think wait
[2:14:12] what I'm getting back when I'm
[2:14:14] >> getting much better getting so focused
[2:14:16] cuz I have a pretty laser focus when I
[2:14:18] want to. I learn a lot of it in here.
[2:14:19] I'm not thinking about anything else.
[2:14:22] But were my mind to flip to something I
[2:14:24] can grab it right back. Is my attention
[2:14:26] and focus getting better or are we just
[2:14:28] not allowing ourselves to get pulled
[2:14:30] into the array of other things? This has
[2:14:32] been a pleasure I should say. But as you
[2:14:35] say, hard work is hard work. Focus is
[2:14:37] hard work and hard work involves a bit
[2:14:39] of friction. Does this make sense?
[2:14:41] >> Yeah. And and I I think it goes back to
[2:14:43] that conversation we were having about
[2:14:46] economy of what you do. You know, is it
[2:14:48] better to be inert? Is it better to
[2:14:51] allow your attention to just focus on
[2:14:53] one thing or is it better to allow it to
[2:14:56] be deployed widely to be captured by
[2:14:59] different things? So there might be an
[2:15:02] economical benefit for the brain
[2:15:05] >> and for Andrew to just devote resources
[2:15:10] to a few things rather than to many
[2:15:12] things. So reduce the choices.
[2:15:14] >> I don't normally ask these sorts of
[2:15:15] questions, but I feel compelled to ask
[2:15:17] and feel free to say pass. Uh what do
[2:15:19] you do for um enrichment? Uh I don't
[2:15:23] like the word fun. For enrichment uh
[2:15:25] when you're not thinking about the brain
[2:15:27] or or engaging with, you know, family
[2:15:29] and that sort of thing. Like what what
[2:15:30] do you like to do to stimulate your mind
[2:15:31] if 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
[2:15:38] from. I mean, I I do physical things,
[2:15:40] too. I'll go to the gym as well, but but
[2:15:42] the thing I really like I wish I had
[2:15:44] more time for
[2:15:45] >> is art and painting. If I could do that,
[2:15:48] I'd be I would love it. But I know I'd
[2:15:50] have to devote a lot of resources and
[2:15:52] time to do that properly to do it. Well,
[2:15:54] >> what do you draw? Is it neural related?
[2:15:56] Is it by
[2:15:57] >> I drew the figures, for example, in the
[2:15:58] book. I really enjoyed that doing that.
[2:16:01] But I can, you know, I can draw anything
[2:16:03] else that I fancy. It could be a still
[2:16:05] life, whatever it is. But but I don't
[2:16:07] take a huge amount of time, but I get a
[2:16:08] lot of pleasure from doing it.
[2:16:10] >> And you have thoughts about other things
[2:16:11] while you do it, ideas and that
[2:16:13] >> and that will come. But there is a just
[2:16:14] an intrinsic pleasure from disengaging
[2:16:17] from everything else and just you know
[2:16:18] even if you spend half an hour on
[2:16:21] something like this which doesn't
[2:16:24] necessarily have value to anybody else.
[2:16:26] It's just for you. It's something you're
[2:16:28] doing and maybe improving your skill in
[2:16:31] this. So maybe that's what I what you
[2:16:34] might call enriching.
[2:16:35] >> No, it certainly is. Uh as someone who
[2:16:37] likes to draw, I can relate. But no
[2:16:39] matter what people enjoy doing, I hope
[2:16:41] uh they heard your answer clearly. I I
[2:16:43] knew there was a reason I asked, which
[2:16:45] is interesting people always have a lot
[2:16:48] of interests. This is like kind of
[2:16:50] obvious when you hear it, but it's like
[2:16:52] interesting people have a lot of
[2:16:53] interests and they they pursue them even
[2:16:55] if they're not trying to, you know, have
[2:16:57] their work in the Guggenheim or
[2:16:58] something. Although you probably will
[2:16:59] knowing you, you Oxford types, you know.
[2:17:02] Thank you, Dr. Massud Hussein. I
[2:17:04] appreciate you very much for the work
[2:17:06] you do. Your patients certainly
[2:17:08] appreciate you for the science you're
[2:17:10] doing in addition to the clinical work,
[2:17:11] for the fact that you write books, that
[2:17:14] you go on podcasts, and that you share
[2:17:17] information that is interesting and
[2:17:19] relevant to everybody because this is
[2:17:21] after all the the human experience.
[2:17:22] Sometimes pathologies and overcoming
[2:17:24] them, but always the reflections on the
[2:17:26] quote unquote normal everyday human
[2:17:29] experience is what's so relevant to
[2:17:31] everybody. I've thoroughly enjoyed this
[2:17:33] conversation. and hopefully we can
[2:17:34] encourage you to come back across the
[2:17:36] pond to talk to us again in a few years
[2:17:37] because you're moving at a rapid rate
[2:17:39] and it's going to be hard to keep up
[2:17:40] with your discoveries, but please do.
[2:17:42] >> Thanks for a really stimulating
[2:17:43] conversation. Thank you.
[2:17:45] >> Thank you for joining me for today's
[2:17:47] discussion with Dr. Massud Hussein. To
[2:17:49] learn more about his work and to find a
[2:17:51] link to his book, please see the links
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[2:20:05] Thank you once again for joining me for
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[2:20:08] Hussein. And last but certainly not
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