275. The Disrupted Mind (2)
2 (11m 34s):
If at all, there's a gap between neurology and neuroscience, for obvious reasons of disciplines, of time, of availability, of professional, you know, training it's in a sense inevitable. And also first another structural reason that neuroscience as are also seeing the books in our neuroscience is dealing with Jeanette, the generic, healthy brain. Well, now that's changing. Whereas neuro neurology is talking about the individual patient who is alien. So how does that, how do you put the two together now, again, there are many more people doing that now, but it's slow. And certainly in that clinic, you didn't see much cutting edge science being thrown in it. The patients simply because, well, the analysis of their cases, rather simply because, you know, you can just can't do everything.
2 (12m 22s):
The physicians I was in presence of were extraordinary. I have to say extraordinary collisions and seeing such clinical attention at work. Is it extraordinary is, is, is a mind blowing experience. And I've always had a great fast-food passion for medicine, as much as for science, there are different things. So, and then number three, as I was writing, as you mentioned before, I'd realized my own mother who had already been showing sense of confusion really was developing clear dementia and that I could not exclude her from my story because there were patients there. So we're about to develop dementia.
2 (13m 2s):
We're headed because indeed what was happening to her sense of self. I mean, the question was very pertinent in my own life and I would have been hypocritical. It would have been also a lie to write a book with as if this wasn't happening and what helped me decide it was okay to do so, because I did hesitant was, well, first this idea coming from phenomenology and the philosophical tradition, which is really antichrist, cheesy, just the idea that you can not study, but that the subject has to be present within any kind of study of the object. The subject in the sense is what we are. It cannot be abstracted. It must be fully there.
2 (13m 43s):
So abstracting myself really would have been wrong. That's number one. And also number two, I realized, well, again, as I said before, the fact that so many people develop dementia, it was almost like a way of, well, seeing how my experience could be of some sort of help or what to others. And also how I could honor my own mother by doing so, because my mother had was a poet, a poet, a writer, and intellectual or her life. And she had their form calls, a lot of cognitive reserve.
2 (14m 23s):
She had within this dementia, she lost her episodic memory, meaning her long-term memories, but her verbal sagacity was extraordinary. And she said amazing things. And there was a poetry to her being and her emotions were not affected. So she was still present in some way. So we'll talk more about that too there for, so that's it. So all of these are levels helped each other. And then since the, you know, the patients, the signs in my own experience and my mother will this fed on each other.
1 (14m 60s):
So yeah, I really loved your book because of that. Most neuroscience books and consciousness books that I read are about, you know, the generic human, the generic brain or whatever. And I love your work and that of Oliver sacks, who you referenced, you know, cause it's not about, you know, the generic brain it's about that person's brain right there, that guy he's having this particular problem. Why is that? And, and, and also, I just want to get your sense of what these hospitals are like. I think most people have an image. They have a mental hospital that comes out of one, flew over the Cuckoo's nest, which was Ken Keasy his attempt to show, you know, we have a problem here.
1 (15m 39s):
These places are pretty grim. And I remember when I was an undergraduate at Pepperdine university in Malibu, we, I took an abnormal psych class and we had to do a internship at Camry hill, state hospital up the coast. And it was just like right out of Ken Casey's one flew over the Cuckoo's nest. I mean, it was grim. I thought, oh, I will never go into clinical psych this terrible. And, and so it sounds like the place you were at was way, way better, much more humane.
2 (16m 9s):
It wasn't a mental hospital. The participants here is one of the largest hospitals in Europe. If not the largest one, it's a huge hospital. It's a beautiful campus. And this was just one unit within the center for the study of nervous system, with lots of different departments. It was almost like a university campus. Really. It's not a specifically a mental hospital, the psychiatric clinic in Paris that is most well-known is sent on, which is not at all grim, but it's not this, this pity is very large, really quite wonderful place, full of activity and very good medicine.
2 (16m 50s):
Yeah. And that unit was, you know, it was not, yeah. Sorry.
1 (16m 55s):
Let's say since you do history of ideas, what's your sense of progress in treating, say schizophrenia or dementia or Alzheimer's or any of these brain disorders? How far we've come? How far we still have to go?
2 (17m 11s):
Well, the, yeah, again, so schizophrenia, I think there's in psychiatry, right? There's is different from neurology, right? So we're talking about, I should say more about this actually, before I answer your question directly, I will say more about this. I think it's important. The participants here hospital was the ground upon which neurology and psychiatry really had important moments in their development and where they separated. They weren't apart. At first, it was a study of the, of the brain mind. What happened was more does the time when Alzheimer himself discovered those rogue proteins, so to speak responsible for then, but we know over the Alzheimer's dementia, you understood that there was an organic, specific organic lesion responsible for the disease.
2 (18m 11s):
Whereas in psychiatry, there's no visible organic lesion. You don't really know what's going on in the Murray. Now things have changed today, and this is why this neuropsychiatry clinic was important. This is why neuro psychiatry needs to reform as one, perhaps, perhaps insofar as we, what, what counts as organic or not is no longer the same as what was the case in the early 20th century, late 19th century. Now we, we know that most ailments of the mind do have some core kind of organic basis. We just don't quite know always what they, these, this organic basis is now Freud was wasn't at that one point on the B2 campus he worked with <inaudible>.
2 (19m 1s):
We translated him back when he returned foster and he himself is a neurologist at first, it's not forget that. Right. And he, then the reason why he left neurology, because it was because he realized that the signs of mind, the mind size of his day would not, was not sophisticated enough to give him the answers to the questions about the self that he had. And that's why he developed, then it's the psychoanalysis. But on the basis then of the, initially of the study of hysteria, that Chuck who was very famous for doing with the help of photography and so on, the story has been told many times, many books.
2 (19m 44s):
I do tell it at some, at some points as, I mean, some level in my book as well. It's, it's very important part of the history of all this. So there is still a kind of the, again, this unit was framed because there is a kind of no man's land between neurology and psychiatry. In many patients, the pain, many of the patients I saw were patients who have what we call functional diseases means you don't really know what's going on. We know something's going on. We don't know what it is that includes chronic pain. I think one person in five in the U S has chronic pain actually worldwide and includes all sorts of ailments. You know, like IBS has a, is, is a functional disease, all those, what one calls today, conversion disorders, which were called hysteria at some point, which can all be called, which have now different kinds of names.
2 (20m 31s):
Those are in between. We don't quite know what they're about, but they're definitely about the brain, body messaging. And the certainly about it. Some interoceptive issues, which are now being studied, but were not yet present in the clinic. Those are the issues I was mentioning. So there's Monday, of course, the many theories of what's been going on. What's interesting also is that the, the medications that we, that have been developed for, for psychiatric disorders, such as schizophrenia, target neurotransmitters, primarily, but we don't really know a lot of time. We don't really know what they're doing, why, you know, they do help.
2 (21m 13s):
They do help. So I would be the last person to say, no, no psychosis is, you know, can be helped. The problem is of course, that these medications have all sorts of, of concert medical side effects, which are very unfortunate very often. So it's not yet there. The root causes of these issues are still not being highly researched a lot. We just don't quite know yet what's going on, but there are many hypothesis that coming out also of the interception research, which are really need to be brought into the public realm. And I think it's starting to have neurological diseases such as dementia or specifically neurological.
2 (21m 53s):
There really are. I mean, as one neurologists put it during a session, right? I wrote that down too. In the book, he said, we could just call them all protein apathy, meaning the pathologies of the proteins in our near that we know that when the neurons within the neurons, like for example, the nuts timer, it's certainly tell protein you're responsible, but not only, there's all sorts of other things going. I mean, all sorts of other theories. I'm every day, there's a new one. They're billions invested in dementia. And specifically also Alzheimer's research. We don't yet have answers. We don't yet have treatments, but it's ongoing.
2 (22m 34s):
I mean, I think that we will, but the many, many theories, not all of them are compatible with each other, you know, medications that are presented suddenly as a possibility possible solution, which a couple of years down the line show themselves to not do anything. There's a lot of that going on.
1 (22m 55s):
Yeah. There's periodic stories here of, of new drugs to treat Alzheimer's and, and then you just don't hear about it anymore. And then you read stories about like, oh, you can help prevent Alzheimer's if you do Sudoku puzzles and you read and you journal every day and or you exercise every day and all this stuff and it, and then nothing ever comes of these things, it just seems like a really hard problem. But on that distinction, you're making there, you know, if there's an obvious neurological problem, a tumor, an injury, a stroke, you know, something like that, that you can see in an MRI scan, it feels differently than when you can't see it. Right. But it all has to be neurological.
1 (23m 37s):
It all has to operate on the machinery, right. Even if it's a purely environmental cause, and there's no genetics whatsoever, there's no tumor, no lesion, but it's still operating on the machinery. Where else would it operate? Right. So it has to be neurological at some base level.
