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Hunting for Hedonia (2019)
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On a cold Sunday morning, he passed a nurse in the hallway. 'How do I get to the 14th floor?', he asked. There's something in me I do not like. It keeps making me do things I don't want to do. I don't want to be me anymore. You said they told you you were dead, is that correct? They say they can change me into someone else put electrodes in my brain. I'm not sure I believe them, he said. - Don't let me do it. - I won't let you do it. The man almost jumped on that Sunday morning 50 years ago. But he was drawn back from the edge by a doctor. This was Robert Heath, the psychiatrist who'd admitted him. We still have a feeling that we're working in the dark. We actually don't know what's going on and the real problem is in understanding this thing here. This is perhaps the most complicated organ in the whole universe. The brain is the central integrator of all behavior. Bob was trying to focus on the idea that there was a deficiency - an innate deficiency in that quality of pleasure. And began slowly trying to focus on where in the brain that pleasurable or those pleasurable areas might reside. Heath was on a mission. He was searching for the seat of pleasure in the brain. He called it Hedonia. Hedonia means pleasure and searching for the brain's pleasure center would later get him into great trouble. So much so that he was written out of history and forgotten. But 30 years later the idea of going into the brain to cure the mind arose again. Today, the most ambitious neurosurgeons are targeting a broad range of different brain diseases with neuromodulation. Depression is going to be the first huge public health problem that is addressed with neuromodulation. Addiction, obesity and opioid abuse. Tourette works. OCD works. If the tools are there and the brain is our new frontier what are we going to discover? What if we could open up the potential of the brain to learn skills and facts a lot better? People are going to want that. What kind of future lies ahead for the human mind? Will probing the brain bring happiness or misery? We are exploring how brains and machines work together, right? The dynamic between humans and machines is ultimately changing. I get into ethical quandaries... You can imagine all sorts of weird applications that hopefully make people uncomfortable. What kind of legacy would these grand ambitions leave behind? There are explorers, conquistadores in science, and that's who they are. Some of them discover continents, some of them drown in the ocean. It was a revolution when the Food and Drug Administration in the late nineties approved a new treatment for Parkinson's disease. They called it Deep Brain Stimulation. Instead of giving medications neurosurgeons would insert ultrathin electrical wires into the brain to correct the debilitating shaking and stiffness. A little bit more room there. Here comes the fun part. Most people say that's the most painful part of the whole deal. Ready? You will feel a little stick. I want you to breathe in and out slowly. One, two, three, breathe. He laughs at it. Is that all you've got? Give me a second here. I'll fix that back. We're going to put a little pad behind your neck to make it more comfortable. What kind of music do you want? You don't have any early Beatles, do you? We have early Beatles. The system is simple. A battery under the skin feeds a stimulator that delivers a current directly to neurons. To find the exact spot in the brain and the right current the patient has to be awake during the operation. Alright, are you ready? Loud noise! That drill bit stops itself if it hits something soft. As long as it's pushing against something hard like bone... You're having fun? Most people, when they train in movement disorder you see somebody who is shaking, you see a funny walk you see eyelids closing too much, a neck twitching, you see a tick... Why does that happen? Why is this movement happening? The brain is amazing and beautiful and the most complex object in the known universe. There are a hundred billion neurons each with an average of a thousand connections to other neurons and so the complexity and connectivity of this organ sort of dwarfs the kidney. And your brain is you. Your kidney is not you. You can take a kidney out and you're still you. But if I injure part of your brain I take away a part of you. There's still some background at 18.6. The green there, that's actually noise out of your brain. It's just noise. We often say this is like driving through Europe. As he goes through different regions of the brain it's like when you drive through Europe and they speak different languages. In Amsterdam or the Netherlands they speak one language. The border speaks a different language, when they ask you for your passport. You head into Germany, guess what? The language changes again and then down to Italy for a little wine. But everybody's speaking different languages. Same thing. As he goes from top to bottom here, he's gonna look for different languages and then Dr. Barmore on your right side, one of the neurologists is going to move your arms and legs around with Dr. Almeida to see which cells are responding to movement. That tells us where the motor regions are in the brain. One of the amazing things in retrospect about a guy like Bob Heath... We are talking about 1950. 65 years ago, when he was doing this every day. We calculate our coordinates from the X-rays make the adjustments in the various planes on the machine then we're in a position to drill the barrel holes and to lower the electrodes into place. Electrodes are carried down by means of rather stiff guides and after they're lowered to the proper depth determined by this millimeter scale here we clamp the wires into place, and turn this back up. After they're fixed with a plastic button we're in the position to do our recording and to give treatment. And you've told me you had these voices that troubled you. - Yeah. - Tell me about those. Bob was trying to focus on this bizarre syndrome that we're calling schizophrenia. Looking for pleasure, believing as they did, as Bob did with the first few people, who had electrodes placed that the septal area did seem to show abnormal electrical activity which changed when a stimulus was somehow placed there. ...and we'll send you home. - Alright, congratulations! - See you later. Good job! After hundreds of operations surgeons began to compare notes and something unusual came to light. Once in a while a Parkinson's patient would react strangely and surprise everyone. I had met this patient, you know... many times, several times. I'd never seen her smile before, and she always seemed pretty miserable. As I was turning the voltage up, the most remarkable thing happened. Michael Okun is talking to her while we were doing this and he says, 'What are you feeling?' As she says, I feel happy! We had tapped into an interface in the brain between the motor and the limbic behavioral functions. When we submitted it for publication the response was 'No, this can't be real.' Now we know, fast-forward a couple of decades that this has been reproduced all around the world. What looked to most surgeons to be an odd side effect was really a breakthrough. And in 2001, this was picked up on by an outsider. Neurologist Helen Mayberg who had long researched the mechanisms of depression became the first to try deep brain stimulation to understand mood. We'd been thinking about this thought experiment for a while. The most amazing thing about that first time was in fact that nobody knew what to expect. So to actually have a patient change state in front of our eyes was very emotional. How can it not be? You just want nothing bad to happen to this patient while you indulge in testing an idea. And all of a sudden her face changes. That was the moment where I said: I don't know what this is or what we are doing but we better figure this out because maybe this really is the start of something. The circuitry that controls your emotional state and the circuitry that controls your ability to move - they're the same. And interwoven within that circuitry in the human brain are the representations for mood how you feel, the representations for emotions the representations for what we call associated circuits, how you think. You're gazing from a window to life but it's impossible for you to take part in life. You're just gazing through this milky window and see people, what they're doing what... there is life and there... Just take part in life but I can't. You're like locked in your own world. It's like a foggy dew when I try to remember the last time I was happy I was lucky, I felt these feelings. We have a pleasure if we eat something really good. Our system really immediately knows that's something good, that's something to be repeated. Hedonia is one of the key driving factors not only of us, actually of all vertebrates. Hedonia tells you what's good for you in a not so subtle way. And Hedonia is very important for sex drive for our reproduction, romantic love, music. All of these functions are no longer there in depression. At this point in my life I wouldn't say that it is a life. Life is very far away. I once read the expression 'cancer of soul'. It very likely means what it says because it destroys your soul and your feelings and your thoughts and so you're at the point where you say: I can't bear the pain anymore. And I don't want to live anymore. I'm pretty much always depressed, have been since I was nine. I become very isolated. I'm like sliding down into the bottom of a well. It's very, very dark... There's no one there. There's really no light. I feel that... ...that I have no contribution to make whatsoever that I'm basically worthless. So why even make the attempt to get out? Many of these patients are basically stuck, without options. They live in a purgatory that to me is indescribable. They don't respond to therapy or any of the multitude of drugs they failed ECT. Those patients are at the end of the line. I get away with it, because... ...my husband is... He's a really good man. He takes good care of me. As a resident I met a very, very desperate patient. He was a government employee and he was afflicted with a horrible destiny. He had repetitive depression and I met him at his seventh episode. He came to the clinic in Bern where I worked at the time and he said: Oh, doctor. It's depression striking again. Please, please, please, don't make me participate in group therapy again. Which I thought was an odd thing. I said, OK, I'll talk to my boss. I went to the boss and the boss said: Oh yeah, this is a cathartic moment in the life of this patient. He shows some aggression. This aggression is good. Aggression against his depression, we need to use it. He will have group therapy. What doesn't kill a patient will make him stronger. This was a particularly stupid statement because this patient hanged himself six weeks later. This destiny impressed me tremendously and I'm not against psychotherapy. Psychotherapy is very useful in every patient. We couldn't treat depression without psychotherapy but sometimes patients need more. And I like action in psychiatry. I like that something is going on. I dislike months and years of talking with patients about same thing. If they suffer so hard something needs to happen. When I was Chief of Psychiatry in New York State, the census then in all of the New York State Hospitals approached 90,000 people. 90,000 people permanent... quote: ...permanently assigned to various mental hospitals. It was a massive, massive thing. There was essentially nothing to do so far as treatment was concerned for some of those who were lobotomized. There was electroshock and we would sometimes give them two, three, four a day. Enough to where they were reduced to slobbering pieces of protoplasm. There really was no treatment. Those days... How does one put it? Those people were locked up and forgotten. And we were all young and vigorous and wishing we could do better. Robert Heath was making his way in New York the promised land of American psychiatry with a practice on Park Avenue and tenure track at Columbia University. He caught the eye of an ambitious dean who wanted to make Tulane University a 'Harvard of the South'. Robert Heath dazzled the dean and Tulane offered the young man the keys to a kingdom of his own. Chief of both neurology and psychiatry at just 34! It was unheard of. This would have been the summer of 1952-53. If you were sitting in a room and you wanted to, in your mind, conjure up the most magical person good-looking, filled with authority filled with all sorts of confidence who was that man? That was Dr. Heath, Head of Psychiatry and Neurology. First word that comes to mind is imperious. Gregory Peck in kind of appearance. Very glamorous and... ...suave. He took me on a tour of his lab which I felt was really amazing for an undergraduate to have him spend time doing that. He started to talk about what was going on in that lab. He already, from what I could tell was wondering how he might transpose that whole concept of behavioral anhedonia, lack of pleasure to neurophysiology and began slowly trying to focus on where in the brain that pleasurable or those pleasurable areas might reside. He realized this is not an emotional problem, this is a brain disease. Most psychiatrists looked at it as, 'Oh well, they have a psychotic break.' But Heath was trying to figure out what happens in the brain. This is the old Charity Hospital in New Orleans. Robert Heath went here every day to walk the halls of the third floor and make his rounds. He wanted his psychiatric ward to be the most modern in the country. Today, the hospital is abandoned and plans are being made to tear it down. They did it first with cats, a couple of animals to show that there was abnormal electrical activity when one put a wire down deep. You'd walk through the halls and there'd be six Rhesus monkeys sitting in chairs with wooden collars around their necks with wires hanging out of their heads. It was a pretty exotic thing for a medical student to see all that. But ultimately, of course, he began using that on humans. That sound we are hearing now is coming from the normal brain. In some ways it's comparable to the distant roar of a four-engine plane. This is a mentally ill patient. Notice the difference in sounds coming from his brain. It sounds like a plane with its engines misfiring. In a way that's just what's happening. A dramatic approach to say the very least! To insert these microelectrodes deep into the brain and have them stay there for periods of time to measure and stimulate. And we bought into it, because they were new ideas - It was thrilling! Just the fact that you could record what was going on in the brain and talk to the patient and then you could stimulate an area of the brain and have him tell you how it changed his feelings. I thought that was fascinating. I didn't know whether I was at the frontier of American science and he was bringing me there or I was doing experiments on humans that had no right to be going on. The next patient, she will be known as P6, with her father... Schizophrenia was always Robert Heath's big passion. He called it 'the most disabling disorder in all of medicine'. Robbing young people of their lives and crippling whole families with its massive stigma. He was sure he would succeed in curing schizophrenia. And even if it is one of the most complex disorders of the human mind the task perfectly matched his ambition for greatness. How is your mood? It's so hard to say. Tell me as best you can. Mediocre. Mediocre? - 60 pulses. - Is there a difference? Not sure I do right now. I feel a little wiggly and... 90 pulses. - What are you laughing about? - I don't know. - Are you doing something to me? - What makes you think that? I have no idea. What in the hell are you doing? Tell me what you thought. Maybe you're stimulating some goodie place. What makes you say we're stimulating a goodie place? Well, I wouldn't be laughing. Somehow the word got out that what's- her-name had shown this huge response. Everybody was running around as if they were on dope. Eureka! Look what we've discovered! It was like that. This is happening. It looks like we've done it! And they went on to do other patients of course. I guess you could say that I'm really disturbed about feeling good. - Because it's foreign? - It's completely foreign. So you've never felt this way in your life? Felt this good in your life? No. I've... I've been trying to pick out something trying to find something in my background that I can relate it to, but I can't. Does it have any bad effects on you? No bad effects at all. If I could buy one I would take one home. - You want to take one home? - Yes. I'd be glad to. It's on the dock. Now I can write my name so I can read it, and... It seems like I can do anything now. Some things a 70-year-old can't do, but he thinks he can when he thinks he's still 20 and then he looks in the mirror and thinks: Who's that old guy looking at me? I don't think he can do this anymore. Essential tremor... As soon as you put your hands out they start shaking right away. Now mine, I put them out and they just don't. And I feel like almost normal again. Katherine, today is week 24 of the open stimulation. And although we will see you next week again today is the primary end point of... - The big day. - Actually the big day. Let me just show... Today is May 22nd. How are you doing? Good! I am happy more than not. I experience joy in... ...almost everything I do. There's always something about it even if it's just the fact that I'm doing it. I usually find... ...some kind of joy. I enjoy my life. Never have before. Never really had a life before. So, it's kind of like, you know... Well as Jim calls me, Catherine 2.0. You improved on the old one. You've always had this feeling? Can you tell me any more about this? I can't do anything. I know everything is going on but it seems like I can't be a part of it. You can't be a part of it. You feel like you don't belong? Yeah, I didn't want to leave home. And it seems like the other part of the world was just something that I didn't belong in. Some kind of a dream. You think you feel just as bad now as before the operation? Yes. Now the treatment is started. She's receiving a very minute amount of current. Actually, it amounts to only five thousandths of an ampere delivered to a very specific region in the brain. But I don't like to feel me. No, I just want to hit something. You want to hit something? But I wouldn't feel any different, so I just want to get something and tear it up. You want to get something and tear it up? You feel you want to tear that up? Yeah. Take it, so I won't. Now the current has been reduced. She is receiving four thousandths of an ampere and is changing in behavior. Look at that smile you've got now. Why does that make me do that? I don't like to do that. You really told me off. Remember? I know, but I couldn't help it. I didn't have any control over it. It was just coming... I was just thinking things and I couldn't help it. Tell me what you were thinking? I wanted to slap your face. I wanted them to cut that off and I was mad at you because you wouldn't tell them to. I saw her and I said, What was the stimulator put in for? And she said, I was suicidally depressed. And I said, Did it work? And she said, I'm alive and I'm not depressed. It's what saved my life. I'm thinking My Lord! This stuff really did work. - Hi! How are you feeling? - Hi! I'm just fine. Good. How is everything at home with that big girl of yours? Oh, she's just fine. She is a handful sometimes, though. We're beginning to make correlations between the mind and brain activity and hope this will be helpful particularly in treating the major mental illnesses, the psychoses. So, in the not too distant future it won't be necessary for one person out of ten spending some time in the mental hospital. We in the field even dare to hope that the mental hospital will be a thing in the past. I remember it vividly. Bob's weekend place in Mississippi. A small place that he'd go to take some people, and do some fishing, was called Hedonia. A little farm. He called it Hedonia. This is where he's talking about whether it's an autoimmune disease, schizophrenia. So, I guess they're still considering that as a possibility. I remember very distinctly trying to get a feeling for what his relationship was to his son and I never knew, never could tell. He never became a presence. That's why I wonder whether he survived because Bob Heath worked night and day, night and day. The lab was open all the time, his lights were on all the time he worked every weekend. It's amazing coming back here and looking through some of the stuff in the office and seeing how much of it there is. And the whole concept of his research kind of being lost in a way and then the same sort of procedures that he did back in the 60s and 70s are now being rediscovered by modern physicians. It's like... It's all here! He has got all these papers and all these citations. And what happened to all of his stuff? There are like probably hundreds of different papers with his name on. After a few positive results in the operating room Heath mounted a larger trial. He carefully selected 22 young men and women with schizophrenia facing a lifetime in mental institutions. Several years. You've been having these voices all during that time? Yes. And what do these voices say to you? - I don't answer them back. - You don't answer them back? Why don't you answer them back? I was scared. Heath's group worked for two years operating, following up with the patients, gathering data and analyzing how the treatment affected each one of them. How long have you been working for this engineering company? - 11 months. - Do you like that job? Oh yes. It's not hard work. People are very nice and everything, and I haven't been in trouble. How about the symptoms that were terribly distracting? I don't have any of those anymore. Hallucinations? And your rage for impulses where you... Oh no, none of those anymore. - How are you getting on? - I'm doing wonderful. I don't have any more trouble like I did have. And I don't have those dreams, I don't have those voices... I have more control over myself. It's just so much different from the way I was and the way I am now. It's unexplainable really, you can't... You can't really explain it. When it appeared that the treatment helped half of the patients Heath decided to break the news in an invitation-only seminar where he presented everything for a select group of leading peers. These men were some of the most respected names in psychiatry and they did not approve of his methods. They suspected that the patients got so much attention and care that the apparent effect was placebo. Most of the discoverers are nerds by the very nature of the work. In contrast to the thick lenses, the dirty shirt, and you know... Bob was the anti-nerd. First, he was a great tennis player, a great golfer absolutely at home with himself socially. He was very good at raising money and it was usually a sort of charismatic interaction with a wealthy family or a foundation or something like that. He was one of these guys you couldn't stay away from. He was just... How can I put it? A temple of charisma. The kind of guy, I think, that many other academic people from what I've seen around, would wish they were. Some of them, I know, were waiting for him to win the Nobel Prize. That's how highly he was thought of in those days. Oh yes, that's a Nobelist. He put together neurochemistry, neurophysiology. And I think some of them hated Bob for that. I think it's the simplest, most primitive kind of thing that happens with we human beings. It's called jealousy. I fell in love with him, actually. That's the simplest way to say it. I wanted to become him, which was common. Not uncommon. He was so charismatic and mysterious in a way. In spite of his apparent confidence, I got the feeling that he was working at being right. We know a lot about how the brain works now and we know a lot more about what deep brain stimulation is doing. I would say, the days of 'we don't really know what we are doing but it obviously works', is an exaggeration. But I certainly wouldn't say that we are extremely sophisticated and we understand every aspect of what we are doing because that's not true either. You're doing a procedure in the most important part of the human body that controls emotions, decisions, cognition, everything. And we're still investigating Gilles de la Tourettes obsessive-compulsive disorder, epilepsy, depression and other severe illnesses where there is a chance and hopefully it will help some patients. We started a study on obsessive-compulsive disorder and the day that our study went on to the NIH website, she called us. She had contamination fears. She knew that this was illogical. When her husband goes out to the store he has to buy all of the groceries and then there is a transfer that happens at the door of their garage where he opens the cereal box and pours the cereal... Just like in an operating room, when you transfer something sterilely. ...pours the cereal into her sterile container and then enters the house and then throws away the dirty containers from the grocery store. He comes home from work and because he has been out in a contaminated world he has to go through decontamination procedures to get into his own home, or his wife can't handle it. So he literally drives his car to the garage, closes the door, strips naked takes a shower in the bathroom at the entrance and then is allowed by his wife to come into the house naked and clean. But to make a long story short, I have pictures of her now riding horses with her daughter and she really got her life back. For OCD at least it's become clear that it's the posterior border posterior superior border of the nucleus accumbens where we get our most potent beneficial effect. The nucleus accumbens is the final common pathway for pleasure in the human brain. It lights up in the functional MRI scanner when you give someone chocolate or if you tell someone to have a sexual fantasy or you give a drug addict his drug of choice. That's the part of the brain that lights up most reliably with reward. He looked like a sweet blond boy, but he was confined in a mental hospital heavily drugged and tied to a bed. His parents found Robert Heath while searching for a way to get their son out of hospital and give him some kind of life. David was obviously retarded. I don't know what his IQ is, but it's probably around 70. He was incarcerated in the state mental hospital because of his violence. He could not be around other people. He was considered the most violent patient ever in a state mental hospital. That's saying a lot. It was a mental health counseling appointment for David and his family. I remember we were just all sitting like this in the waiting room and he... it was directed... and just into the wall. I'm gonna kill her... And everybody heard it. Everybody! The doctors come running out and they took him. And my mother cried and cried and cried and cried. From that day on, it was the beginning of him in and out of the home and being taken for periods of time or then eventually the confinement into Mandeville. When he's home I'm always definitely afraid that he'll harm someone away from the house. We all know that he self-inflicts wounds upon himself. Heath used a new version of his brain pacemaker. Donald Richardson was the surgeon who implanted the device in David's cerebellum. From the back of his neck it would send gentle pulses through to the damaged emotional structures in David's brain. After he got over the surgery and the stimulator was adjusted he was able to leave the mental hospital and move back home with his parents. He got a job working in a Burger King or some place like that cleaning up and was totally pacified. Do you remember how you felt when you were doing all of that fighting? Do you remember the fight when you attacked your dad and your mother? Yeah, I remember that. That seems to be under control again. You know, it was hard for them to see such great pain and suffering and to know that he has been helped. What do you think about it, David? You've done good! Only doctor Heath took care of me. Well, we tried. You tell Dr. Richardson... you planted a real good device in him. Tell him what happened in Washington DC. Security guards grabbed me out of the line. What line? Where was I taking you? I was in The White House. - And what happened? - A service guy came and... Why did they pull you out and what did they do to you? Thought you had a knife or bomb on you? You put it on AM and turn it as low frequencies as it will go and you pick up the magnetic output from the stimulator. Did you hear it? That was it. Burp. It only stimulates for very short periods of time. Everything is going great and Heath is enjoying the best of all worlds until the arrival of the 1970s. The counterculture was booming then. It was a time for ripping down authorities. Popular art and films like 'One Flew over the Cuckoo's Nest' show mental institutions in a new and crude way. The public mood is turning against all of psychiatry. And the exclusive privileged world of doctors is being questioned. This turmoil reaches Congress where Ted Kennedy puts psychosurgery on trial. Heath is summoned to explain his work. Rivals in his field accuse him of being the devil in a white coat. I was very embarrassed for Dr. Heath. I didn't realize... ...really the antipathy most of the field of that time had for Heath. He had... ...overly blessed his luck. The Gregory Peck of the 1950s becomes a crazy mad scientist planting electrodes in people's brains turning them into human pincushions. People had the idea that he just stuck electrodes in everybody's head. This also happened, remember at a very strange political time in this country. And as one goes along in time one begins to realize how important sociopolitics is. Not just in the way countries are run, but in the way science is done. Kennedy asks: Is this not opening the door to mind control? Yes or no? Heath does what he can but when they're done on the Hill psychosurgery is dead. And Robert Heath who spoke against lobotomy in the 1950s is now being cast as a lobotomist. To Heath it's all a waste of time. He went back to the lab to continue his work. He saw the upheaval as a minor blow. But what came out next would change everything. In his quest for pleasure it was natural for Heath to study sexuality. Experiments were carried out in the lab where he would measure sexual arousal in patients. And then an opportunity arose that played right into his hunt for pleasure. A young man was admitted and diagnosed as chronically suicidal and depressed. During therapy he disclosed how he wanted to be free of his homosexuality. At the time homosexuality was registered in the DSM the list of mental illnesses. It was a time when parents took their sons to get shock treatment to their testicles if they had homosexual tendencies. Heath offered the young man treatment. He saw an opportunity to see if he could change the brain's pleasure preferences. I myself... I'm gay, as I think I mentioned to you. And Bob knew it, we didn't talk about it. Because you don't talk about things like that particularly. I'm sure there were people around that... would have wanted to do that. I wouldn't want to do it now. I probably might have wanted to do it then but... It's a different time and different ways. In those days they thought that homosexuality was a pathology that should be treated like any other kind of psychiatric disorder. Unfortunately the psychoanalysts were the worst about that. I knew that he had turned his interest but I didn't realize he had gone so far as to do a clinical study. Electrodes were implanted in the young man's pleasure center. He had a remote control and could stimulate himself. He used it when watching heterosexual porn and after a while he was ready to meet a woman. A 21-year-old prostitute was hired. The young man and the woman would be alone in the lab with Heath and his technicians recording from his electrodes in another room. The young man had intercourse with the woman for the first time. The results of the study proved successful, but no one is sure what became of the young man after the study. The research was published in a scientific journal but when it later reached the public, the reaction was brutal. Heath faced intense criticism. Times had changed and new voices celebrating diversity were on the rise. You can insert an electrode and do stimulation to either block or drive. So, if you do MRI on me and I'm in love with you and my wife says no good let's put an electrode to block that area, so I'm not in love with you. This is the consequence. We never went that far. It's unethical, it's not needed. This tool it's too valuable to be used for these issues. You can have atom energy to drive boats and to get electricity and you can have it to make a bomb. Same thing. A fool with a tool is still a fool. Maybe you have heard that quote before. So, I'm beginning to get a little bit worried and a little bit uncomfortable because we're going to put something into the brain and we're going to change somebody's personality. The personality changes, people become more impulsive and that's probably going to change somebody's personality. They are going to seem a lot more impulsive in the store, on Amazon.com and in casinos. So, that's changing personality, if we make you more impulsive. Some people may change the character of their personality how friendly they are, whether they're angry. We published a number of years ago in the National Institutes of Health that we commonly would make people angry, with certain targets in the brain. That could be interpreted as a change in personality. I knew there would be a change, but not that I would be clobbered over the head. I got louder and more dramatic and if it's something that is disturbing the situation then I start to get angry. No filter, no filter whatsoever. I don't have one. I just say whatever comes into my head. I don't even stop to think if it's going to hurt somebody. It's just oh! And I don't hesitate to talk anymore, so... - Would you have surgery again? - Yes. Yes! Absolutely, there is no question. It's a resounding yes, because... ...it saved my life. I probably would not be alive right now, if I hadn't had surgery. Every psychiatric treatment be it medication, be it psychotherapy, changes factors of emotion and cognition, which are parts of personality too. And if it wouldn't do that it wouldn't be worthwhile to do it. So yes, personality is changing has to change, when we talk about emotion and cognition. Many people don't want to have something to do with illness, depression. They want to push it away. It means weakness, illness is weakness. You are not a full member of society. So, everything that is weak... ...perhaps reminds oneself of their own weakness. Perhaps there is a possibility a very, very good possibility to live again and to be healed or to get better. It's not the end. I try not to put too much stress on it because I don't want to be... ...too much disappointed. But for me it's... ...the last possibility that I could return to life. I could feel good feelings again. I could see sunlight again with feelings in my heart. Otherwise I will go on as a living dead. Most of the human trials that I've been involved with were people who had just miserable lives with no hope. And we offered them hope and not just oh, we hope this might work but we had strong reasons to believe that it would work with enough evidence to convince an institutional review board: Hey! This is worth trying! I would say I'm probably on the aggressive side in terms of moving to human clinical trials. And so, obesity and opioid abuse are the two biggest public health problems crises really, in United States right now. And this one application of neuromodulation has the potential to make a huge difference in that domain. If we can do that, I think that's going to be a huge game changer. Maybe we could fix it with some new molecular tool down the line. Am I going to stop what I'm doing until someone does that? Sorry that bothers you. Let me introduce you to a sick person. Given that what we have is safe, available and is working, I'll take it. What if we were soon able to modulate every aspect of the human mind? This would open a door to manipulate things that we consider sacred and essential to who we are. What if, for example you could take away the pain of traumatic memories with an electrode? The veteran was part of the initial attack on Iraq which was in 1991. He was working in a tank. This battle lasted all day and all night. If you type in on the Internet highway of death you get images of this and... Sorry, I didn't expect this. It's a long highway of littered tanks and bodies and vehicles and pieces of this and that, blown up and it's horrifying. What happened is that after the battle the next day he and his unit were sent to do a kind of damage assessment. And that's when the most traumatic experience that basically changed this man's life occurred. He just saw these dismembered and charred bodies. And, there's one particular image of a corpse that was blackened and scarred and the man he describes has one eye partly coming out of his head. There were flies, you know, it was hot. You think that the most traumatic thing is that people are trying to kill you but the most traumatic thing is killing other people. Within weeks after that he began having nightmares of this charred corpse that would actually envelop him and he would experience it, feel it. He would wake up screaming and sweating and he would... The only thing he could think of to get rid of it was to take showers. Cold showers. And he'd spend like two hours in the shower to wash the contamination off and try to get back to sleep. He'd only sleep again for like an hour and then be woken up again. He suffered with this for more than 20 years. Every day. During the surgery he experienced positive images from his childhood. He described these wonderful scenes from his homeland, very colorful and he could smell fresh bread being cooked. He'd say, Oh wow, that feels good, Dr. Koek. Leave it there! Don't change it. Four to five months after initiation he stopped having nightmares. And he's had a total of three since then so that's... ...15 months ago. I still take medication, I still need some medication. So, I tried to stop, but I couldn't. Too many things were going on. I was angry, I was upset a lot. I just didn't feel right, so I went back on it. So, medication still makes a difference. Chemically something is going on in there that needs to tweaked. And whatever area of the brain that's getting electrified it's quieted the bad stuff. It was literally like being blind for 54 years and somebody turned the switch on and the whole world is there and you could see it. Wow! OK, I've been in a coma for 54 years and I'm awake and there is some cool stuff out here. Heath was always a believer in his technology despite the heavy criticism from his peers and the public. It turned out he was not alone. In 1977, The New York Times drops a bomb. The CIA's cold war MKULTRA program is outed. On top of the Vietnam atrocities it now looks like government agencies are in the business of brainwashing. In the shadow of Watergate this is the time for disclosure. And thousands of secret documents surface. Heath's name is on them. I think he became totally seduced by two very, very attractive motivations. One was a great deal of money that the government offered them to do that work. And two, their belief often that they were being patriots. That this was good and valuable to the country. Heath was testing a new drug, Bulbocapnine a drug the Russians were also testing. This was not a drug that you wanted to test on regular patients so Heath used inmates from Angola Prison the so-called Alcatraz of the South. He himself called it a horrendous place. - Don't you want to talk to me? - No. - Why won't you talk to me? - I'm tired. Tired of me talking to you? Or are you angry at me? The results were inconclusive. Then the CIA asked him to use his electrodes to do work on the brain's pain system. Inflict pain to patients for the military? This was where he drew the line. If I had wanted to be a spy, I would have been a spy. I'm a doctor and I practice medicine, he told The New York Times. But it was too late. He had already fallen from grace. Maybe that's the story of pioneers, real pioneers that don't just wanna be smart but can walk into territory that nobody else could or would. I think in history, frankly there have always been people with original, unique ideas and then rarely, when it works become enormous heroes. Those who fail almost inevitably are seen as monsters. They were doing this for their own egos they are monomaniacally pursuing this direction and they should be called out for what they are. These almost sadistic creatures using patients as guinea pigs. I think ultimately that's what happened to Bob. And monomaniacal would probably be the last word in the world that I would ever use to describe a person like Bob Heath. The irony is of course almost every idea he's had is going to turn out to be true. There is an odd cloud that has tainted the legacy that resulted from a few experiments and lines of research that he conducted. Family members are concerned that the negative things that have kind of been allowed to be swept under the rug by time be brought back out, because no objective story of his career his research, could leave those out and be legitimate. You've got to include that. Because that was the truth. It actually happened. So, as long as they know the full story... Maybe Robert Heath was too far ahead of his time. Culture changes and today our perspectives on the brain are radically different than 50 years ago. What used to be frightening is now for some an exciting opportunity. DARPA, or the Defense Advanced Research Projects Agency invests in breakthrough technologies for national security. The agency that gave us the Internet and GPS has now invested 70 million dollars in research of deep brain stimulation. 10% of the 22 million American veterans that fraction, live with neuropsychiatric kinds of conditions. So we asked the question, is there something we can do about this? Can we develop new knowledge and new technology in order to solve this problem of neuropsychiatric illness? Treatment also opens up to the possibility of enhancement. Treating memory disorders is one of DARPA's ambitions. In Philadelphia Michael Kahana's group is working with patients to gather data trying to understand how memory is created. To them, memory is the key to understanding the brain. Memories are what make us who we are. They are everything for us. Our knowledge, our experience, our identity. My grandmother became kind of my nanny as a child and she had some profound life experiences for example in WW2. She never talked about them, she never said anything about them. I never heard about them. But they determined how she reacted to things then I find, with my children here, how many years later, half a century later that I'm reacting to them in ways that my wife or other people may find strange. Why am I reacting that way? Because of something in her memory. And I don't even know what it is, right? It's just carried through time. I actually believe that we carry around vastly more memories detailed memories of our past, than we have an access to at any one time. Sieg Heil. It's one small step for man. Any second now the Berlin Wall... Some day people will consider elective restoration of their own thoughts. I know people will find that scary, but that's for other people to figure out. Today with my devices, I'm recording my life in a way because I'll just have somebody infuse it back through a chip into my brain when I can't have those memories myself. All technologies across the board can be used in a variety of ways. They could either be used for good or be used for ill. And that's a fundamental property of technology. In an age when both sides have come to possess enough nuclear power to destroy the human race several times over... In order to stay ahead of understanding that technology deeply we have to see all of the angles and ask all of those questions. We've got to understand the technology in a very deep way. You get better at it. And the risk gets lower and lower and a predicted benefit gets higher and higher and then the calculation starts to blur. Plastic surgery didn't arrive on the scene as an esthetic surgery. I don't mean to disappoint anyone. It came because people had burns and people needed reconstructions and people had accidents. And then maybe it's OK to do an operation to make someone who has a normal nose, have a pretty nose. And at some point we're going to do operations to take people who are essentially normal and make them function better. Make their brains work better. It's not a question of if we're going to do that, but when that happens. It's not going to be about putting wires in people and changing them. It will be a subsection that will develop and I'm not even going to call them out by name. It will be AI, because that technology is way beyond what we can do. Is the brain more than just a high-powered computer? If a computer did simulate a whole lifetime of experience would we discover that the computations that the brain does are just not possible for computers? Or maybe we would discover that it's easy. I don't know. It's a great mystery. Today, when I hear a lot people talking about AI alone I think they're missing a bigger part of the story here. We're exploring how brains and machines work together, right? I think the dynamic between humans and machines is ultimately changing. It will certainly change human behavior in fundamental ways. Limbic circuits are the most powerful circuits that control our behavior. And if we take someone who is doing this in a normal way and we turn him into someone who is up here their fundamental behavior is going to change. And we would have to adjust to a whole new normal. The commercial interest is maybe at the top of the list of what I worry about. And if it's not done in an ethical way and the steps aren't taken correctly... If somebody jumps the gun, it can ruin it for everybody else that comes after. The ethics become important. When is it OK to do that? Who should have an access to that? Should it be wealthy people? We have to make the decisions right, keep the train on the tracks and move forward. And we can be more than incrementally a step at the time. We can take some leaps but if we're just going to capture that multi-billion dollar market I think we have already seen, we could destroy ourselves. We have entered a new landscape with great promises and tempting horizons. But we're also in unknown territory. The trail to discovery is open and scientists with pioneering minds are blazing it at high speed. How do we steer our course into the future? What will we find on our journey into the brain? And are we ready for whatever that might be? |
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