(Announcer) Please welcome to the stage Dr. David Hendricks.
(Applause)
Tashi delek - that's how you say hello in Tibetan.
Today I'm really happy to be here
to share thoughts that have been on my mind every day since 1989.
My talk today, I hope, you will find some benefit in.
That's the basic motivation I have in talking to you today.
The subject matter of my talk
is going to appear to you today
just to be a little bit on the academic side,
and there's a reason for that.
Before my own recovery,
the only emotions that were easy for me to access
were anger and depression.
And one of the true gifts of my recovery
was the ability to access a full range of emotional responses,
and I haven't yet got the hang of all of the more tender emotions,
so I tend to break into tears easily.
So staying on the academic side is the best thing for a macho man like me
so I don't break down in front of you.
So, the other thing I want to say
is that even though the presentation may seem at points academic,
it has a deep soulful purpose
because it's been my passionate intention over the years
to try to relieve the suffering of addiction particularly,
but also mental illness.
Before I start, the last thing I'd like to say
is that I'd like to dedicate this talk today
to my old Buddhist teacher, who died last year.
So Buddha said,
"The mind is everything. What we think we become."
Because I really believe that to be true,
I'm often made really uneasy
when I see the kind of crazy stuff that goes around in my own mind.
But what's in my mind today is really more peaceful and calm
than it was in the many years during my rough childhood,
where my father was incessant
in his attempts to shame me and break me down,
and it's certainly clearer and better than it was
during the uncontrollable anger of my 20 years as an alcoholic.
I figured that if Picasso can have a blue phase,
then I'm entitled to an alcoholic phase, which I'm glad is over.
But at the end of that career,
I really didn't believe that I would ever be able to have a normal life.
But I joined AA anyway,
and within one year of that,
I met my Buddhist teacher and I began to meditate,
and I began to practice the Buddhist philosophy of mind,
which was the most profoundly useful psychological system I'd ever encountered.
And then three years later,
the unexpected miracle of a top-to-bottom revolution in my entire life occurred -
something we call "sobriety in recovery."
This has been a pivotal event in my life,
and at the time that it occurred,
it's become my fundamental motivation in life
to try to help other people who suffer as I did
to also achieve the same kind of redemption
that I was lucky enough to achieve.
So,
what I would like to do is to see if there's any fundamental truths
that we can bring out of my little miniature biography today,
and I'd like to start in childhood.
Recent brain imaging studies of maltreated children
revealed extensive structural abnormalities
in multiple regions of the brain,
and enough damage to the brain so that the brain of these kids
has actually reduced as much as 10% in size below normal.
When you look at the painful images, these brain images, of these children,
it's difficult to understand how they could ever have a decent life,
but it wasn't until the publication of the Adverse Childhood Event Study,
the ACE Study, a few years ago
that what these kids were going to face in adulthood became clear.
Now the ACE Study was a groundbreaking clinical epidemiologic study
that did two things for the first time in the history of clinical research,
and that is that it looked for -
I'm going to put all this up so you have a chance to see it.
For the first time in clinical research of this type,
it looked for all of the types of adversity
that kids could go through at one time.
It's hard for me to believe it wasn't done before this -
it was always fragmented -
but in this study,
all forms of adversity that children could suffer were looked at,
and they were eight in number,
and they include physical, emotional, and sexual abuse,
witnessing the mother being abused,
divorce or separation,
and being raised by a parent that was criminal, mentally ill, or drug addicted.
The study - the second thing that was done
was that the study was done
in a very large well-designed population of study subjects
on whom med and psych records existed
so that the results of the study
accurately represent the experience of the entire U.S. adult population.
64% said that they had experienced
at least one form of these eight forms of adversity.
I've done my math about Millikan Auditorium.
And I'm sorry to tell you,
but it has probably already occurred to some of you looking at the screen
that 230 of you also likely experienced one form of adversity growing up,
and that 140 of you experienced two types of adversity -
two of the eight - that's 40% of the US population,
and 13% experienced four or more,
like me or like 45 of you.
So the first thing that we know from the ACE Study
is that adversity is very common and that most of us in this room share it.
What do you think the ACE Study would predict the likelihood
that these suffering children would use drugs in adulthood?
This is a graph that depicts on its vertical axis
the likelihood of injecting drugs as an adult
plotted against childhood experience on the horizontal axis.
The way this works is that for those that report no adversity,
the likelihood of injecting drugs is very low,
but among those who have only one species of adversity during childhood,
the risk triples,
and for those that have two of any of the eight …
or three …, or four or more …
80% of all addicted adults in the United States today
come from this population of people that were abused as children.
What would you guess about the likelihood of mental illness in their future?
This is a bar graph that depicts a likelihood of committing suicide -
surely, the ultimate marker of emotional suffering -
in adulthood plotted against childhood experience.
And again, the zero represents an ACE score of zero,
that among those who had no reports of childhood adversity,
the risk of committing suicide as an adult was very low - vanishingly small.
For those that had one type of adversity in their childhood experience …
two types …, three of the eight …,
four …, five …, six …, and seven or more …
In the article where these results were first published,
the authors said
that the linkage between being abused as a kid and killing yourself as an adult
was so strong
as to be unprecedented in the history of epidemiologic studies.
And they further concluded
that the vast majority of suicides in the United States every year
are attributable to only one thing, and that is their abuse as children.
So the 20th century closed on an extremely dark note.
What we knew at that time
is that adversity altered the structure of the brain of these kids,
and that these structural alterations
set the stage for emotional states
that accounted for the majority of the suffering in the United States
due to drug addiction and mental illness.
But science made this picture even blacker
when it said that once these suffering kids reach young adulthood,
there wasn't anything anybody could do to help them,
because by that time the brain had lost the capacity to ever change,
essentially entombing them in their suffering.
This is what I was taught in medical school,
and I absolutely refuse to believe it.
And it turns out that I was right not to believe it,
because at the dawn of the 21st century, enough light shone in on this problem
to reveal that the brain had had a science of its own all the time
and had the capacity for radical change,
and that it could do it even in adulthood.
So what I'd like to talk to you about now is two major mechanisms that the brain has
in order to restructure itself
and to create different and new functional potentialities.
This is a photo micrograph of the hippocampus,
which is one of the most remarkable areas of the brain.
And over the years of study, it's become my second favorite bodily organ.
(Laughter)
Sniggering?
(Laughter)
Okay, this is total transparency -
my favorite bodily organ is my anterior insular cortex.
(Laughter)
Alright, so the thing that's remarkable about this -
this is a beautiful picture -
these green guys, all along here, are brand-new baby neurons.
So one of the major resources the brain has to change
is the birth of new brain cells.
I love these little guys.
If there was one place that they could do the most good,
it would be here in the hippocampus,
which is Grand Central Station
of the brain's capacity to form new learning experiences
and consolidate that into retrievable memory.
And what happens, apparently, is that whatever we're required to do -
to grow, to adapt to current life situations,
like recover from mental illness or addiction -
constitutes the marching orders for these little green guys
to begin to migrate up into the body of the hippocampus,
where all life's experiences
are already encoded and find the right place to plug in
in order to encode new learning experiences
that can be remembered.
And the second that they plug in, the brain has changed.
And the second that these new neurons
add their voice to the internal mental conversation,
the vector of thought and feeling shifts.
And the second that these new learning experiences are in place -
and by new learning, I don't mean one plus one equals two,
I mean important stuff,
like I just discovered that I'm a pretty decent person after all -
that experience
immediately begins to compete with the messages from the past,
and for all abused kids, the message is "you're a bad kid,"
so that the "I'm a good person" message
can come to dominate "I'm the bad kid" message,
which is really hopeful and really cool.
But what's also really cool
is the second mechanism that I wanted to tell you about
by which the brain changes,
and that's a very complex molecular machine
that exists inside the neuron in the brain, called epigenetics,
which has the capacity, in response to current life experience,
to physically move into the nucleus of the cell
where it shuts genes off and on in order to help us adapt.
So I'd like to tell you about a recent laboratory experiment
that goes to the heart of what we're talking about here today,
and it's an experiment
that deprives rat pups of the maternal care that they need.
When they don't get that,
the epigenetic machine becomes aware of it,
it physically moves into the nucleus of the cell,
where it shuts off a gene
that's responsible for the control of the stress reaction in the brain,
and when that gene doesn't work, the brain can't control stress.
So once a stress reaction begins, it can't be stopped.
And this out-of-control stress is toxic for central nervous tissue:
it kills brain cells, it reduces the brain in size and distorts its architecture.
But you see, those are exactly the forces that were responsible
for the abnormalities in the brain imaging studies
of these maltreated children that we talked about earlier.
The other thing that it does
is it makes these rat pups act mentally ill.
So this molecular and genetic configuration in the brain
are the changes that drive the behaviors
that we diagnose as post-traumatic stress disorder
in clinical practice.
But if later, the maternal care that these rat pups need
is provided to them,
the epigenetic machinery hears about this,
this complex molecular machine moves back into the nucleus of the cell,
where it switches the gene responsible for the stress response back on -
stress comes under control, the brain is healed,
and the rat pups stop acting mentally ill,
and they get on with perfectly normal lives.
And this is exactly analogous to the situation of maltreated children.
And we learned from this
that if we want to give to our patients in recovery
the same epigenetic gift of healing
that these rat pups enjoyed in this experiment,
then we'd better be really careful
about how we go about the process of repairing it
in our patients in treatment.
So in our treatment program,
my wife and I
try to provide as much as we can every one of our patients
with two new parents -
she and I.
And we have a commitment to stick with them for a minimum of five years,
and this is a period of time that science indicates
that is necessary for these brain changes to come to completion.
Okay, so where are we now in this conversation?
We know that adversity changes the brain,
and we know that these brain changes sets the mood in the brain
and that these moods drive the processes of addiction and mental illness.
But we also know now, in the 21st century,
Western science teaches us
that the physical brain is being changed all the time
under the dynamic influences of epigenetics and neurogenesis.
But whereas Western culture
is really good about looking at the outside world
and manipulating physical matter,
our Western culture doesn't provide us
with a very deep understanding of the nature of mind -
the internal mental world,
how to really pay attention to what's going on there,
how to sort out the meaning of mental events,
and how to guide these mental events for maximum growth,
so that what happens is that a change is usually or often willy-nilly,
and the results are half-baked.
But,
20 centuries ago, Buddhist philosophy of mind
had a very detailed and profoundly intelligent understanding
of the nature of mind.
It had techniques
so that we could really pay attention to what was going on there.
It had the ability
to sort out mental events, understand their operational nature,
and how to use them for maximal human growth and spiritual development.
So, now I'm supposed to say, What now?
So I'm going to say, What now?
So, my wife and my professional partner are both Buddhists.
We've been mental health and addiction treatment professionals
for a decade,
and so she and I decided many years ago
that we were going to take a really close look
at the Buddhist philosophy of mind
and see whether or not we could integrate it into our treatment program
so we could do a better job
helping the people that came to us with these disorders.
So, after many years of preparation, we left the United States a few years ago,
and we traveled to the seat of the Tibetan people in exile
in North India.
And over about two-year period of time,
she and I selected a specific Tibetan text,
which was a text on human psychology from the Buddhist perspective,
and then working separately, we each then translated that text
over about a seven- or eight-month period of time.
And this is a text that in Tibetan is "Sem dong sem jung" -
it means "The mind and that which arises from mind,"
or more loosely translated, "The mind and its functions,"
or "Mind and mental functions."
And after we translated it,
then we had the good fortune to be able to study this translated material
with Buddhist scholars who were respected for their mastery of this subject matter.
So, when we finished,
we came back to the United States and set up a treatment program
in Traverse City.
But before I tell you about that,
I would like to share with you
one more piece of evidence that's necessary to have
before we're able to take all the pieces of puzzle
that I've talked to you about today
and put it together into an improved treatment methodology for these disorders.
And this has to do with recent brain imaging evidence
demonstrating that meditation has a profound positive impact
on multiple regions of the central nervous system,
including those areas of the brain damaged by childhood adversity.
So that only after four hours of a sitting meditation practice -
four hours of sitting in meditation, divided up over days or whatever -
brain imaging technology shows a marked enhancement
of the activation and the operational strength
of those brain regions that are responsible for focused attention,
what's called "mindfulness" in the lay press,
and then after only 11 hours of sitting meditation practice,
brain imaging proves
that the actual density of living tissue in these brain regions has been increased,
so they've been muscled up and bulked up
so that their functional capacity has changed,
so they can really pay attention
to whatever you choose to focus your attention on.
This is an example
of sustained attention of the mind as distinct from the brain
changing the structure of the brain and giving it enhanced functional capacity.
But we had this experience all the time.
The mind is always telling the brain what to do -
so if I say wiggle this finger,
the brain says, "Okay," and it finds the appropriate area in the motor cortex
that controls the finger, the right nerve,
and the finger wiggles.
So what I'm suggesting
is that if we became more astute about training the mind
to find any area that we wanted,
we could learn how to access specifically those regions in the mind
that were damaged by childhood adversity,
and by focusing and encouraging their sustained operation,
beef them up to cure it.
So this is the way this new treatment methodology works:
We practice quiescent meditation
until we beef up the areas of the brain
that are responsible for focused attention
until they become strong enough that we can use that as a tool,
like a lens to look inside
and to actually observe the arising of thoughts and feelings
from moment to moment in our own minds.
By enumerating a relatively short list
of mental functions that mind is capable of performing,
Buddhist psychology helps us here
because as they arise,
we can properly identify them and give them names.
And what this does is facilitate bringing meaningful order
to a realm of our inner mental experience that's often very confusing for us.
The second thing that Buddhist psychology does to help us here
is that it actually assigns a moral weight or value to these mental functions
so that now we've got them sorted out and we've got them named
and we know what's going on:
we learned that they are bifurcatable
into two mutually distinctive areas of functionality -
harmful and beneficial -
and we observed that when the harmful mental functions operate,
it reduces our mental health and our happiness,
but when the mental functions that belong to a beneficial domain of mind
are operational,
our mental health is increased along with our happiness.
The third thing that Buddhist psychology does to help here
is to give us efficient and useful techniques
by which we can begin to modulate internal mental activity.
We've sorted things out.
We now see
that they exist in the two categories of harmful and helpful,
but now we can actually take a hand
and we can develop the mental discipline that's required
in order to recognize the incipient operation of negative mental functions
and reduce their power over us,
and to recognize the benefits of positive mental functionality
and encourage and strengthen them.
So, for example, if I am a person who has some training in these matters
and I'm going through my day
and I suddenly become aware that this person that I'm dealing with
is really pissing me off,
I see the arising of anger from the domain of negative mental functions,
and I take a step back because I know I'm in danger -
I don't want to be hurt, I don't want that person to be hurt,
and I certainly don't want to have to suffer the mental consequences
that will necessarily arise
if I allow that motivation to motivate my behavior.
If I have some training and control,
I can switch my motivation and intentionality to the positive domain
so only they can operate to motivate my behavior.
When we have the subjective experience of positive emotionality,
it is important to realize
that that experience that we have
is the end product of the result
of a number of distributed different brain regions
that are cooperating together in a tightly wired neural network
to produce that sensation.
So that means,
just like the mind controls the brain,
I can use the mind and learn how to command the brain
to go into those neural circuits
and navigate specifically to the brain regions
that were damaged by a childhood adversity.
Little kids who've been abused don't have any trouble feeling negative affect,
but they do have trouble feeling positive affect,
which means
that it was precisely the domains of the brain responsible for positive affect
that were injured by childhood adversity.
So by using these techniques of Buddhist psychology,
what I'm really doing
is navigating to them by mindful attention -
I am sustaining their operation,
and we know that sustained operation
beefs them up and make them stronger and stronger
until such time as they begin, for the first time, to function normally.
The first moment of normal functionality of these circuits
is experienced objectively
as the acquisition of sobriety in recovery.
When I achieve sobriety in my own recovery efforts,
it was a feeling like my soul was rising like a raft from the bottom of the ocean
to stand up for the first time,
and what came with it was a sense of enduring peace
and a certainty I would never drink again.
There wasn't any need to drink anymore because everything was working okay.
So what's really happening here
is that we're using a powerfully focused mind
that we get from a meditational practice
within an overarching construct and guidance
of a Buddhist psychological system of mind, of understanding the mind.
And what we're really doing is,
for the first time, we have the ability to take conscious control
of the brain's physical resources, dynamic resources for change,
which is epigenetics and neurogenesis,
and we direct them to heal the wounds of the past
and to restore to us the right to be who we choose to be for the first time.
Any of us can do this at any time;
it doesn't matter where we stand on the continuum of human development.
So you don't need to worry about the brain's capacity to change;
all you have to do is to be really serious about training the mind,
and it'll happen automatically.
Buddha said,
"Mind is everything. What you think you become."
Thank you very much.
(Applause)