0:00:01.634,0:00:03.701
What does it mean to be normal?

0:00:04.857,0:00:06.733
And what does it mean to be sick?

0:00:09.087,0:00:12.544
I've asked myself this question[br]from the time I was about seven,

0:00:12.568,0:00:15.091
when I was diagnosed[br]with Tourette syndrome.

0:00:15.115,0:00:17.219
Tourette's is a neurological disorder

0:00:17.243,0:00:22.679
characterized by stereotyped movements[br]I perform against my will, called tics.

0:00:23.524,0:00:26.539
Now, tics are technically involuntary,

0:00:26.563,0:00:29.778
in the sense that they occur[br]without any conscious attention

0:00:29.802,0:00:31.402
or intention on my part.

0:00:32.228,0:00:36.997
But there's a funny thing[br]about how I experience tics.

0:00:37.021,0:00:41.641
They feel more unvoluntary[br]than involuntary,

0:00:41.665,0:00:44.625
because I still feel like it's me[br]moving my shoulder,

0:00:44.649,0:00:46.249
not some external force.

0:00:46.696,0:00:51.521
Also, I get this uncomfortable sensation,[br]called premonitory urge,

0:00:51.545,0:00:52.915
right before tics happen,

0:00:52.939,0:00:55.323
and particularly[br]when I'm trying to resist them.

0:00:55.633,0:00:58.681
Now, I imagine most of you out there[br]understand what I'm saying,

0:00:58.705,0:01:02.177
but unless you have Tourette's,[br]you probably think you can't relate.

0:01:03.776,0:01:05.042
But I bet you can.

0:01:05.664,0:01:08.681
So, let's try a little experiment here[br]and see if I can give you

0:01:08.705,0:01:11.807
a taste of what my experience feels like.

0:01:11.831,0:01:12.981
Alright, ready?

0:01:13.776,0:01:15.053
Don't blink.

0:01:15.077,0:01:16.688
No, really, don't blink.

0:01:16.712,0:01:19.918
And besides dry eyes, what do you feel?

0:01:21.509,0:01:22.857
Phantom pressure?

0:01:23.794,0:01:25.103
Eyelids tingling?

0:01:25.945,0:01:27.095
A need?

0:01:27.810,0:01:29.405
Are you holding your breath?

0:01:29.429,0:01:30.580
(Laughter)

0:01:30.604,0:01:31.755
Aha.

0:01:31.779,0:01:32.929
(Laughter)

0:01:35.942,0:01:39.458
That's approximately[br]what my tics feels like.

0:01:40.315,0:01:44.006
Now, tics and blinking,[br]neurologically speaking, are not the same,

0:01:44.030,0:01:48.578
but my point is that you[br]don't have to have Tourette's

0:01:48.602,0:01:53.601
to be able to relate to my experience[br]of my premonitory urges,

0:01:53.625,0:01:59.272
because your brain can give you[br]similar experiences and feelings.

0:02:00.078,0:02:05.879
So, let's shift the conversation from[br]what it means to be normal versus sick

0:02:05.903,0:02:11.181
to what it means that a majority of us[br]are both normal and sick.

0:02:12.697,0:02:16.054
Because in the final analysis,[br]we're all humans

0:02:16.078,0:02:20.928
whose brains provide[br]for a spectrum of experiences.

0:02:22.563,0:02:25.309
And everything on that spectrum[br]of human experiences

0:02:25.333,0:02:29.696
is ultimately produced by brain systems

0:02:29.720,0:02:32.653
that assume a spectrum[br]of different states.

0:02:33.744,0:02:36.419
So again, what does it mean to be normal,

0:02:36.443,0:02:38.403
and what does it mean to be sick,

0:02:38.427,0:02:43.442
when sickness exists on the extreme end[br]of a spectrum of normal?

0:02:45.880,0:02:49.578
As both a researcher who studies[br]differences in how individuals' brains

0:02:49.602,0:02:51.372
wire and rewire themselves,

0:02:51.396,0:02:54.395
and as a Touretter[br]with other related diagnoses,

0:02:54.419,0:02:59.025
I have long been fascinated[br]by failures of self-regulation

0:02:59.049,0:03:03.318
on the impulsive and compulsive[br]behavioral spectrums.

0:03:03.342,0:03:07.466
Because so much of my own[br]experience of my own body

0:03:07.490,0:03:08.728
and my own behavior

0:03:08.752,0:03:11.077
has existed all over that map.

0:03:13.561,0:03:18.335
So with the spotlight[br]on the opioid crisis,

0:03:19.636,0:03:23.056
I've really found myself[br]wondering lately:

0:03:23.080,0:03:26.696
Where on the spectrum[br]of unvoluntary behavior

0:03:26.720,0:03:31.867
do we put something like abusing[br]opioid painkillers or heroin?

0:03:33.569,0:03:39.379
By now, we all know that the opioid crisis[br]and epidemic is out of control.

0:03:40.084,0:03:43.108
Ninety-one people die every day[br]in this country from overdose.

0:03:43.464,0:03:46.113
And between 2002 and 2015,

0:03:46.137,0:03:49.733
the number of deaths from heroin[br]increased by a factor of six.

0:03:52.125,0:03:56.664
And something about the way[br]that we treat addiction isn't working,

0:03:56.688,0:03:58.422
at least not for everyone.

0:03:59.569,0:04:03.005
It is a fact that people[br]suffering from addiction

0:04:03.029,0:04:04.947
have lost free will

0:04:04.971,0:04:11.069
when it comes to their behavior[br]around drugs, alcohol, food

0:04:11.093,0:04:14.160
or other reward-system[br]stimulating behaviors.

0:04:14.792,0:04:18.935
That addiction is a brain-based[br]disease state

0:04:18.959,0:04:22.022
is a medical, neurobiological reality.

0:04:23.625,0:04:26.149
But how we relate to that disease --

0:04:26.173,0:04:31.529
indeed, how we relate to the concept[br]of disease when it comes to addiction --

0:04:31.553,0:04:35.665
makes an enormous difference[br]for how we treat people with addictions.

0:04:37.420,0:04:42.479
So, we tend to think of pretty much[br]everything we do as entirely voluntary.

0:04:43.000,0:04:45.887
But it turns out[br]that the brain's default state

0:04:45.911,0:04:51.892
is really more like a car[br]idling in drive than a car in park.

0:04:52.672,0:04:55.180
Some of what we think we choose to do

0:04:55.204,0:04:59.219
is actually things that we[br]have become programmed to do

0:04:59.243,0:05:01.029
when the brakes are released.

0:05:02.950,0:05:07.084
Have you ever joked that your brain[br]was running on autopilot?

0:05:08.196,0:05:09.346
Guess what?

0:05:09.744,0:05:11.053
It probably was.

0:05:11.871,0:05:13.029
OK?

0:05:13.053,0:05:18.217
And the brain's autopilot[br]is in a structure called the striatum.

0:05:19.903,0:05:25.615
So the striatum detects[br]emotional and sensory motor conditions

0:05:28.006,0:05:34.435
and it knows to trigger[br]whatever behavior you have done most often

0:05:34.459,0:05:37.193
in the past under those same conditions.

0:05:39.546,0:05:41.990
Do you know why I became a neuroscientist?

0:05:43.540,0:05:45.911
Because I wanted to learn[br]what made me tick.

0:05:45.935,0:05:48.389
(Laughter)

0:05:48.413,0:05:49.959
Thank you, thank you.

0:05:49.983,0:05:51.246
(Laughter)

0:05:51.270,0:05:54.498
I've been wanting to use that one[br]in front of an audience for years.

0:05:54.522,0:05:56.164
(Applause)

0:05:56.188,0:05:59.443
So in graduate school,[br]I studied genetic factors

0:05:59.467,0:06:03.201
that orchestrate wiring[br]to the striatum during development.

0:06:04.458,0:06:08.003
And yes, that is my former license plate.

0:06:08.027,0:06:09.439
(Laughter)

0:06:09.463,0:06:11.273
And for the record, I don't recommend

0:06:11.297,0:06:15.407
any PhD student get a license plate[br]with their thesis topic printed on it,

0:06:15.431,0:06:18.104
unless they're prepared[br]for their experiments not to work

0:06:18.128,0:06:19.299
for the next two years.

0:06:19.323,0:06:20.477
(Laughter)

0:06:20.501,0:06:22.108
I eventually did figure it out.

0:06:22.132,0:06:27.545
So, my experiments were exploring[br]how miswiring in the striatum

0:06:27.569,0:06:29.633
relates to compulsive behaviors.

0:06:29.657,0:06:32.434
Meaning, behaviors that are coerced

0:06:32.458,0:06:35.835
by uncomfortable urges[br]you can't consciously resist.

0:06:36.165,0:06:40.117
So I was really excited[br]when my mice developed

0:06:40.141,0:06:42.379
this compulsive behavior,

0:06:42.403,0:06:45.649
where they were rubbing their faces[br]and they couldn't seem to stop,

0:06:45.673,0:06:47.601
even when they were wounding themselves.

0:06:47.625,0:06:50.490
OK, excited is the wrong word,

0:06:50.514,0:06:53.434
I actually felt terrible for them.

0:06:54.514,0:06:58.816
I thought that they had tics,[br]evidence of striatal miswiring.

0:06:59.973,0:07:01.782
And they were compulsive,

0:07:01.806,0:07:05.679
but it turned out, on further testing,

0:07:05.703,0:07:10.466
that these mice showed[br]an aversion to interacting

0:07:10.490,0:07:12.557
and getting to know other unfamiliar mice.

0:07:12.581,0:07:14.625
Which was unusual, it was unexpected.

0:07:14.649,0:07:17.919
The results implied that the striatum,

0:07:17.943,0:07:20.942
which, for sure, is involved[br]in compulsive-spectrum disorders,

0:07:20.966,0:07:26.128
is also involved in human[br]social connection and our ability to --

0:07:26.152,0:07:29.113
not human social connection,[br]but our ability to connect.

0:07:32.387,0:07:34.474
So I delved deeper,

0:07:34.498,0:07:37.323
into a field called social neuroscience.

0:07:37.347,0:07:39.641
And that is a newer,[br]interdisciplinary field,

0:07:39.665,0:07:42.357
and there I found reports[br]that linked the striatum

0:07:42.381,0:07:45.196
not just to social anomalies in mice,

0:07:45.220,0:07:46.672
but also in people.

0:07:47.458,0:07:53.135
As it turns out, the social[br]neurochemistry in the striatum

0:07:54.243,0:07:58.950
is linked to things[br]you've probably already heard of.

0:07:58.974,0:08:00.403
Like oxytocin,

0:08:00.427,0:08:04.602
which is that hormone that makes[br]cuddling feel all warm and fuzzy.

0:08:05.475,0:08:09.083
But it also implicates[br]signaling at opioid receptors.

0:08:09.943,0:08:12.379
There are naturally occurring[br]opioids in your brain

0:08:12.403,0:08:15.792
that are deeply linked[br]to social processes.

0:08:18.754,0:08:23.493
Experiments with naloxone,[br]which blocks opioid receptors,

0:08:23.517,0:08:28.851
show us just how essential[br]this opioid-receptor signaling is

0:08:28.875,0:08:30.447
to social interaction.

0:08:33.736,0:08:38.054
When people are given naloxone --[br]it's an ingredient in Narcan,

0:08:38.078,0:08:41.362
that reverses opioid overdoses[br]to save lives.

0:08:41.386,0:08:43.847
But when it's given to healthy people,

0:08:43.871,0:08:47.537
it actually interfered[br]with their ability to feel connected

0:08:47.561,0:08:50.373
to people they already knew[br]and cared about.

0:08:51.275,0:08:57.156
So, something about not having[br]opioid-receptor binding

0:08:57.180,0:09:01.145
makes it difficult for us to feel[br]the rewards of social interaction.

0:09:02.270,0:09:03.762
Now, for the interest of time,

0:09:03.786,0:09:06.794
I've necessarily gotten rid[br]of some of the scientific details,

0:09:06.818,0:09:08.984
but briefly, here's where we're at.

0:09:10.228,0:09:14.204
The effects of social disconnection[br]through opioid receptors,

0:09:14.228,0:09:16.514
the effects of addictive drugs

0:09:16.538,0:09:19.029
and the effects of abnormal[br]neurotransmission

0:09:19.053,0:09:21.910
on involuntary movements[br]and compulsive behaviors

0:09:21.934,0:09:24.823
all converge in the striatum.

0:09:26.839,0:09:30.371
And the striatum[br]and opioid signaling in it

0:09:30.395,0:09:33.283
has been deeply linked with loneliness.

0:09:36.877,0:09:40.394
When we don't have enough signaling[br]at opioid receptors,

0:09:40.418,0:09:46.131
we can feel alone in a room full of people[br]we care about and love, who love us.

0:09:46.774,0:09:51.283
Social neuroscientists, like Dr. Cacioppo[br]at the University of Chicago,

0:09:51.307,0:09:54.147
have discovered that loneliness[br]is very dangerous.

0:09:54.873,0:09:56.133
And it predisposes people

0:09:56.157,0:10:00.330
to entire spectrums[br]of physical and mental illnesses.

0:10:04.515,0:10:07.873
Think of it like this:[br]when you're at your hungriest,

0:10:07.897,0:10:11.103
pretty much any food[br]tastes amazing, right?

0:10:11.127,0:10:15.847
So similarly, loneliness[br]creates a hunger in the brain

0:10:15.871,0:10:21.063
which neurochemically hypersensitizes[br]our reward system.

0:10:22.355,0:10:25.308
And social isolation[br]acts through receptors

0:10:25.332,0:10:29.283
for these naturally occurring opioids[br]and other social neurotransmitters

0:10:29.307,0:10:31.736
to leave the striatum in a state

0:10:31.760,0:10:35.910
where its response to things[br]that signal reward and pleasure

0:10:35.934,0:10:38.881
is completely, completely over the top.

0:10:39.307,0:10:42.339
And in this state of hypersensitivity,

0:10:42.363,0:10:46.577
our brains signal deep dissatisfaction.

0:10:47.976,0:10:52.751
We become restless,[br]irritable and impulsive.

0:10:53.769,0:10:57.476
And that's pretty much when I want you[br]to keep the bowl of Halloween chocolate

0:10:57.500,0:11:00.354
entirely across the room for me,[br]because I will eat it all.

0:11:00.378,0:11:01.529
I will.

0:11:01.553,0:11:05.219
And that brings up another thing[br]that makes social disconnection

0:11:05.243,0:11:06.687
so dangerous.

0:11:07.346,0:11:09.680
If we don't have the ability[br]to connect socially,

0:11:09.704,0:11:14.545
we are so ravenous for our social[br]neurochemistry to be rebalanced,

0:11:14.569,0:11:16.863
we're likely to seek relief from anywhere.

0:11:16.887,0:11:22.728
And if that anywhere[br]is opioid painkillers or heroin,

0:11:22.752,0:11:28.813
it is going to be a heat-seeking missile[br]for our social reward system.

0:11:30.601,0:11:36.305
Is it any wonder people in today's world[br]are becoming addicted so easily?

0:11:39.022,0:11:40.839
Social isolation --

0:11:44.926,0:11:46.076
excuse me --

0:11:47.736,0:11:49.203
contributes to relapse.

0:11:49.953,0:11:54.080
Studies have shown that people[br]who tend to avoid relapse

0:11:54.104,0:11:58.903
tend to be people who have broad,[br]reciprocal social relationships

0:11:58.927,0:12:00.956
where they can be[br]of service to each other,

0:12:00.980,0:12:02.244
where they can be helpful.

0:12:02.268,0:12:04.076
Being of service lets people connect.

0:12:06.101,0:12:07.251
So --

0:12:09.863,0:12:15.265
if we don't have the ability[br]to authentically connect,

0:12:15.289,0:12:19.541
our society increasingly lacks[br]this ability to authentically connect

0:12:21.101,0:12:25.355
and experience things that[br]are transcendent and beyond ourselves.

0:12:25.379,0:12:26.977
We used to get this transcendence

0:12:27.001,0:12:30.214
from a feeling of belonging[br]to our families and our communities.

0:12:30.238,0:12:33.312
But everywhere, communities are changing.

0:12:33.800,0:12:40.361
And social and economic disintegration[br]is making this harder and harder.

0:12:42.414,0:12:44.970
I'm not the only person to point out

0:12:44.994,0:12:48.438
that the areas in the country[br]most economically hard hit,

0:12:48.462,0:12:51.932
where people feel most desolate[br]about their life's meaning,

0:12:51.956,0:12:54.100
are also the places

0:12:54.124,0:13:00.678
where there have been communities[br]most ravaged by opioids.

0:13:02.284,0:13:05.752
Social isolation acts[br]through the brain's reward system

0:13:05.776,0:13:08.776
to make this state of affairs[br]literally painful.

0:13:09.720,0:13:14.030
So perhaps it's this pain,[br]this loneliness,

0:13:14.054,0:13:17.038
this despondence

0:13:17.062,0:13:20.440
that's driving so many of us[br]to connect with whatever we can.

0:13:21.434,0:13:22.584
Like food.

0:13:23.757,0:13:25.557
Like handheld electronics.

0:13:26.360,0:13:29.868
And for too many people,[br]to drugs like heroin and fentanyl.

0:13:29.892,0:13:33.625
I know someone who overdosed,[br]who was revived by Narcan,

0:13:34.753,0:13:38.435
and she was mostly angry[br]that she wasn't simply allowed to die.

0:13:38.459,0:13:42.657
Imagine for a second how that feels,[br]that state of hopelessness, OK?

0:13:43.959,0:13:47.988
But the striatum is also a source of hope.

0:13:48.012,0:13:51.695
Because the striatum gives us a clue[br]of how to bring people back.

0:13:53.560,0:13:56.656
So, remember that the striatum[br]is our autopilot,

0:13:56.680,0:13:58.242
running our behaviors on habit,

0:13:58.266,0:14:02.633
and it's possible to rewire,[br]to reprogram that autopilot,

0:14:02.657,0:14:04.338
but it involves neuroplasticity.

0:14:04.362,0:14:07.085
So, neuroplasticity[br]is the ability of brains

0:14:07.109,0:14:09.871
to reprogram themselves,

0:14:09.895,0:14:12.379
and rewire themselves,[br]so we can learn new things.

0:14:12.403,0:14:14.990
And maybe you've heard the classic[br]adage of plasticity:

0:14:15.014,0:14:17.814
neurons that fire together, wire together.

0:14:18.323,0:14:19.507
Right?

0:14:19.531,0:14:23.839
So we need to practice social[br]connective behaviors

0:14:23.863,0:14:26.966
instead of compulsive behaviors,[br]when we're lonely,

0:14:26.990,0:14:30.728
when we are cued to remember our drug.

0:14:33.371,0:14:37.458
We need neuronally firing[br]repeated experiences

0:14:37.482,0:14:41.156
in order for the striatum to undergo[br]that necessary neuroplasticity

0:14:41.180,0:14:47.180
that allows it to take[br]that "go find heroin" autopilot offline.

0:14:47.204,0:14:52.053
And what the convergence[br]of social neuroscience, addiction

0:14:52.077,0:14:54.871
and compulsive-spectrum disorders[br]in the striatum suggests

0:14:54.895,0:14:56.601
is that it's not simply enough

0:14:56.625,0:14:59.640
to teach the striatum healthier[br]responses to compulsive urges.

0:15:00.038,0:15:05.807
We need social impulses[br]to replace drug-cued compulsive behaviors,

0:15:05.831,0:15:12.045
because we need to rebalance,[br]neurochemically, our social reward system.

0:15:12.069,0:15:13.234
And unless that happens,

0:15:13.258,0:15:15.921
we're going to be left[br]in a state of craving.

0:15:16.331,0:15:19.807
No matter what besides our drug[br]we repeatedly practice doing.

0:15:25.539,0:15:30.396
I believe that the solution[br]to the opioid crisis

0:15:30.420,0:15:34.045
is to explore how social[br]and psychospiritual interventions

0:15:34.069,0:15:37.990
can act as neurotechnologies in circuits

0:15:38.014,0:15:41.406
that process social[br]and drug-induced rewards.

0:15:42.783,0:15:47.894
One possibility is to create[br]and study scalable tools

0:15:47.918,0:15:50.403
for people to connect with one another

0:15:50.427,0:15:52.029
over a mutual interest

0:15:52.053,0:15:54.220
in recovery through[br]psychospiritual practices.

0:15:54.244,0:15:57.506
And as such, psychospiritual practice[br]could involve anything

0:15:57.530,0:16:01.014
from people getting together[br]as megafans of touring jam bands,

0:16:02.959,0:16:06.975
or parkour jams, featuring[br]shared experiences of vulnerability

0:16:06.999,0:16:08.189
and personal growth,

0:16:08.213,0:16:11.318
or more conventional things,[br]like recovery yoga meetups,

0:16:11.342,0:16:14.208
or meetings centered[br]around more traditional conceptions

0:16:14.232,0:16:16.080
of spiritual experiences.

0:16:16.104,0:16:18.310
But whatever it is,

0:16:18.334,0:16:20.934
it needs to activate

0:16:20.958,0:16:23.879
all of the neurotransmitter[br]systems in the striatum

0:16:23.903,0:16:26.680
that are involved[br]in processing social connection.

0:16:29.411,0:16:31.775
Social media can't go[br]deep enough for this.

0:16:31.799,0:16:35.077
Social media doesn't so much[br]encourage us to share,

0:16:35.101,0:16:36.688
as it does to compare.

0:16:36.712,0:16:41.212
It's the difference between having[br]superficial small talk with someone

0:16:41.236,0:16:45.771
and authentic, deeply connected[br]conversation with eye contact.

0:16:46.442,0:16:49.733
And stigma also keeps us separate.

0:16:49.757,0:16:53.184
There's a lot of evidence[br]that it keeps us sick.

0:16:53.806,0:16:58.046
And stigma often makes it safer[br]for addicts to connect with other addicts.

0:16:58.656,0:17:03.449
But recovery groups centered around[br]reestablishing social connections

0:17:03.473,0:17:08.358
could certainly be inclusive[br]of people who are seeking recovery

0:17:08.382,0:17:11.342
for a range of mental health problems.

0:17:12.093,0:17:15.915
My point is, when we connect[br]around what's broken,

0:17:17.902,0:17:20.830
we connect as human beings.

0:17:21.998,0:17:27.924
We heal ourselves[br]from the compulsive self-destruction

0:17:27.948,0:17:31.347
that was our response[br]to the pain of disconnection.

0:17:32.180,0:17:38.371
When we think of neuropsychiatric[br]illnesses as a spectrum of phenomenon

0:17:38.395,0:17:41.260
that are part of what make us human,

0:17:41.284,0:17:44.847
then we remove the otherness of people[br]who struggle with self-destruction.

0:17:45.307,0:17:48.712
We remove the stigma

0:17:49.924,0:17:53.386
between doctors and patients[br]and caregivers.

0:17:53.966,0:17:59.299
We put the question of what it means[br]to be normal versus sick

0:17:59.323,0:18:02.323
back on the spectrum[br]of the human condition.

0:18:02.831,0:18:07.841
And it is on that spectrum[br]where we can all connect

0:18:07.865,0:18:12.007
and seek healing together,[br]for all of our struggles with humanness.

0:18:12.873,0:18:14.436
Thank you for letting me share.

0:18:14.460,0:18:18.515
(Applause)