-
What does it mean to be normal?
-
And what does it mean to be sick?
-
I've asked myself this question
from the time I was about seven,
-
when I was diagnosed
with Tourette syndrome.
-
Tourette's is a neurological disorder
-
characterized by stereotyped movements
I perform against my will, called ticks.
-
Now, ticks are technically involuntary,
-
in the sense that they occur
without any conscious attention
-
or intention on my part.
-
But there's a funny thing
about how I experience tics.
-
They feel more unvoluntary
than involuntary,
-
because I still feel like it's me
moving my shoulder,
-
not some external force.
-
Also, I get this uncomfortable sensation,
called premonitory urge,
-
right before tics happen,
-
and particularly
when I'm trying to resist them.
-
Now, I imagine most of you out there
understand what I'm saying,
-
but unless you have Tourette's,
you probably think you can't relate.
-
But I bet you can.
-
So, let's try a little experiment here
and see if I can give you
-
a taste of what my experience feels like.
-
Alright, ready?
-
Don't blink.
-
No, really, don't blink.
-
And besides dry eyes, what do you feel?
-
Phantom pressure?
-
Eyelids tingling?
-
A need?
-
Are you holding your breath?
-
(Laughter)
-
Aha.
-
(Laughter)
-
That's approximately
what my tics feels like.
-
Now, tics and blinking,
neurologically speaking, are not the same,
-
but my point is that you
don't have to have Tourette's
-
to be able to relate to my experience
of my premonitory urges,
-
because your brain can give you
similar experiences and feelings.
-
So, let's shift the conversation
from it means to be normal versus sick,
-
to what it means that a majority of us
are both normal and sick.
-
Because in the final analysis,
we're all humans
-
whose brains provide
for a spectrum of experiences.
-
And everything on that spectrum
of human experiences
-
is ultimately produced by brain systems
-
that assume a spectrum
of different states.
-
So again, what does it mean to be normal,
-
and what does it mean to be sick,
-
when sickness exists on the extreme end
of a spectrum of normal?
-
As both a researcher who studies
differences in how individuals' brains
-
wire and rewire themselves,
-
and as a Touretter
with other related diagnoses,
-
I have long been fascinated
by failures of self-regulation
-
on the impulsive and compulsive
behavioral spectrums.
-
Because so much of my own
experience of my own body
-
and my own behavior
-
has existed all over that map.
-
So with this spotlight
on the opioid crisis,
-
I've really found myself
wondering, lately,
-
where on the spectrum
of unvoluntary behavior
-
do we put something like abusing
opioid painkillers or heroin?
-
By now, we all know that the opioid crisis
and epidemic is out of control.
-
Ninety-one people die every day
in this country from overdose.
-
And between 2002 and 2015,
-
the number of deaths from heroin
increased by a factor of six.
-
And something about the way
that we treat addiction isn't working,
-
at least not for everyone.
-
It is a fact that people
suffering from addiction
-
have lost free will
-
when it comes to their behavior
around drugs, alcohol, food
-
or other reward-system
stimulating behaviors.
-
That addiction is a brain-based
disease state --
-
is a medical, neurobiological reality.
-
But how we relate to that disease --
-
indeed, how we relate to the concept
of disease when it comes to addiction --
-
makes an enormous difference
for how we treat people with addictions.
-
So, we tend to think of pretty much
everything we do as entirely voluntary.
-
But it turns out
that the brain's default state
-
is really more like a car
idling in drive, than a car in park.
-
Some of what we think we choose to do
-
is actually things that we
have become programmed to do
-
when the brakes are released.
-
Have you ever joked that your brain
was running on autopilot?
-
Guess what?
-
It probably was.
-
OK?
-
And the brain's autopilot
is in a structure called the striatum.
-
So the striatum detects
emotional and sensory motor conditions
-
and it knows to trigger
whatever behavior you have done most often
-
in the past, under those same conditions.
-
Do you know why I became a neuroscientist?
-
Because I wanted to learn
what made me tick.
-
(Laughter)
-
Thank you, thank you.
-
(Laughter)
-
I've been wanting to use that one
in front of an audience for years.
-
(Applause)
-
So in graduate school,
I studied genetic factors
-
that orchestrate wiring
to the striatum during development.
-
And yes, that is my former license plate.
-
(Laughter)
-
And for the record, I don't recommend
-
any PhD student get a license plate
with their thesis topic printed on it,
-
unless they're prepared
for their experiments not to work
-
for the next two years.
-
(Laughter)
-
I eventually did figure it out.
-
So, my experiments were exploring
how miswiring in the striatum
-
relates to compulsive behaviors.
-
Meaning, behaviors that are coerced
-
by uncomfortable urges
you can't consciously resist.
-
So I was really excited
when my mice developed
-
this compulsive behavior,
-
where they were rubbing their faces
and they couldn't seem to stop,
-
even when they were wounding themselves.
-
OK, excited is the wrong word,
-
I actually felt terrible for them.
-
I thought that they had tics,
evidence of stridal miswiring.
-
And they were compulsive,
-
but it turned out, on further testing,
-
that these mice showed
an aversion to interacting
-
and getting to know other unfamiliar mice.
-
Which was unusual, it was unexpected.
-
The results implied that the striatum,
-
which, for sure, is involved
in compulsive-spectrum disorders,
-
is also involved in human
social connection and our ability to --
-
not human social connection,
but our ability to connect.
-
So I delved deeper,
-
into a field called social neuroscience.
-
And that is a newer,
interdisciplinary field
-
and there, I found reports
that linked the striatum
-
not just to social anomalies in mice,
-
but also in people.
-
As it turns out, the social
neurochemistry in the striatum
-
is linked to things
you've probably already heard of.
-
Like oxytocin,
-
which is that hormone that makes
cuddling feel all warm and fuzzy.
-
But it also implicates
signaling at opioid receptors.
-
There are naturally occurring
opioids in your brain
-
that are deeply linked
to social processes.
-
Experiments with naloxone,
which blocks opioid receptors,
-
show us just how essential
-
this opioid-receptor signaling is
to social interaction.
-
When people are given naloxone --
it's an ingredient in Narcan,
-
that reverses opioid overdoses
to save lives.
-
But when it's given to healthy people,
-
it actually interfered
with their ability to feel connected
-
to people they already knew
and cared about.
-
So, something about not having
opioid-receptor binding
-
makes it difficult for us to feel
the rewards of social interaction.
-
Now, for the interest of time,
-
I've necessarily gotten rid
of some of the scientific details,
-
but briefly, here's where we're at.
-
The effects of social disconnection
through opioid receptors,
-
the effects of addictive drugs
-
and the effects of abnormal
naurotransmission
-
on involuntary movements
and compulsive behaviors
-
all converge in the striatum.
-
And the striatum
and opioid signaling in it
-
has been deeply linked with loneliness.
-
When we don't have enough signaling
at opioid receptors,
-
we can feel alone in a room full of people
we care about and love, who love us.
-
Social neuroscientists, like Dr Cacioppo
at the University of Chicago,
-
have discovered that loneliness
is very dangerous.
-
And it predisposes people
-
to entire spectrums
of physical and mental illnesses.
-
Think of it like this:
when you're at your hungriest,
-
pretty much any food
tastes amazing, right?
-
So similarly, loneliness
creates a hunger in the brain
-
which neurochemically hypersensitizes
our reward system.
-
And social isolation
acts through receptors
-
for these naturally occurring opioids
and other social neurotransmitters
-
to leave the striatum in a state
-
where its response to things
that signal reward and pleasure
-
is completely, completely over the top.
-
And in this state of hypersensitivity,
-
our brains signal deep dissatisfaction.
-
We become restless,
irritable and impulsive.
-
And that's pretty much when I want you
to keep the bowl of Halloween chocolate
-
entirely across the room for me,
because I will eat it all.
-
I will.
-
And that brings up another thing
that makes social disconnection
-
so dangerous.
-
If we don't have the ability
to connect socially,
-
we are so ravenous for our social
neurochemistry to be rebalanced,
-
we're likely to seek relief from anywhere.
-
And if that anywhere
is opioid painkillers or heroin,
-
it is going to be a heat-seeking missile
for our social reward system.
-
Is it any wonder people in today's world
are becoming addicted so easily?
-
Social isolation --
-
excuse me --
-
contributes to relapse.
-
Studies have shown that people
who tend to avoid relapse
-
tend to be people who have broad,
reciprocal social relationships
-
where they can be
of service to each other,
-
where they can be helpful.
-
Being of service lets people connect.
-
So --
-
if we don't have the ability
to authentically connect,
-
our society increasingly lacks
this ability to authentically connect
-
and experience things that
are transcendent and beyond ourselves.
-
We used to get this transcendence
-
from a feeling of belonging
to our families and our communities.
-
But everywhere, communities are changing.
-
And social and economic disintegration
is making this harder and harder.
-
I'm not the only person to point out
-
that the areas in the country
most economically hard hit,
-
where people feel most desolate
about their life's meaning,
-
are also the places
-
where there have been communities
most ravaged by opioids.
-
Social isolation acts
through the brain's reward system
-
to make this state of affairs
literally painful.
-
So perhaps it's this pain,
this loneliness,
-
this despondence
-
that's driving so many of us
to connect with whatever we can.
-
Like food.
-
Like handheld electronics.
-
And for too many people,
to drugs like heroin and fentanyl.
-
I know someone who overdosed,
who was revived by Narcan,
-
and she was mostly angry
that she wasn't simply allowed to die.
-
Imagine for a second how that feels,
that state of hopelessness, OK?
-
But the striatum is also a source of hope.
-
Because the striatum gives us a clue
of how to bring people back.
-
So, remember that the striatum
is our autopilot,
-
running our behaviors on habit,
-
and it's possible to rewire,
to reprogram that autopilot,
-
but it involves neuroplasticity.
-
So, neuroplasticity
is the ability of brains
-
to reprogram themselves,
-
and rewire themselves,
so we can learn new things.
-
And maybe you've heard the classic
adage of plasticity:
-
neurons that fire together, wire together.
-
Right?
-
So we need to practice social
connective behaviors
-
instead of compulsive behaviors,
when we're lonely,
-
when we are cued to remember our drug.
-
We need neuronally firing
repeated experiences
-
in order for the striatum to undergo
that necessary neuroplasticity
-
that allows it to take
that "go find heroin" autopilot offline.
-
And what the convergence
of social neuroscience, addiction
-
and compulsive-spectrum disorders
in the striatum suggests
-
is that it's not simply enough
-
to teach the striatum healthier
responses to compulsive urges.
-
We need social impulses
to replace drug-cued compulsive behaviors,
-
because we need to rebalance,
neurochemically, our social reward system.
-
And unless that happens,
-
we're going to be left
in a state of craving.
-
No matter what besides our drug
we repeatedly practice doing.
-
I believe that the solution
to the opioid crisis
-
is to explore how social
and psychospiritual interventions
-
can act as neurotechnologies in circuits
-
that process social
and drug-induced rewards.
-
One possibility is to create
and study scalable tools
-
for people to connect with one another
-
over a mutual interest
-
in recovery through
psychospiritual practices.
-
And as such, psychospiritual practice
could involve anything
-
from people getting together
as megafans of touring jam bands,
-
or parkour jams, featuring
shared experiences of vulnerability
-
and personal growth,
-
or more conventional things,
like recovery yoga meetups,
-
or meetings centered
around more traditional conceptions
-
of spiritual experiences.
-
But whatever it is,
-
it needs to activate
-
all of the neurotransmitter
systems in the striatum
-
that are involved
in processing social connection.
-
Social media can't go
deep enough for this.
-
Social media doesn't so much
encourage us to share,
-
as it does to compare.
-
It's the difference between having
superficial small talk with someone,
-
and authentic, deeply connected
conversation with eye contact.
-
And stigma also keeps us separate.
-
There's a lot of evidence
that it keeps us sick.
-
And stigma often makes it safer
for addicts to connect with other addicts.
-
But recovery groups centered around
reestablishing social connections
-
could certainly be inclusive
of people who are seeking recovery
-
for a range of mental health problems.
-
My point is, when we connect
around what's broken,
-
we connect as human beings.
-
We heal ourselves
from the compulsive self-destruction
-
that was our response
to the pain of disconnection.
-
When we think of neuropsychiatric
illnesses as a spectrum of phenomenon
-
that are part of what make us human,
-
then we remove the otherness of people
who struggle with self-destruction.
-
We remove the stigma
-
between doctors and patients
and caregivers.
-
We put the question of what it means
to be normal versus sick
-
back on the spectrum
of the human condition.
-
And it is on that spectrum
where we can all connect
-
and seek healing together,
for all of our struggles with humanness.
-
Thank you for letting me share.
-
(Applause)