Ep101 "Why do people walk away from bad events with different outcomes?"

What enables some people to keep going when everything falls apart? We all know someone who’s been through hell and comes out standing. This episode is about resilience. Join Eagleman with guest Dr. Jonathan Downar to discover what happens in the brain when we face adversity. Is resilience something you’re born with, or is it something your brain can develop? What does any of this have to do with The Diving Bell and the Butterfly, using magnetic fields to zap the brain, the less famous partner to the reward system, or what seemingly unrelated disorders in psychiatry all have in common? 

Episode Transcript

Speaker 1 (00:05):
What happens in the brain when we face adversity and
why do two people with the same hardship walk away
with such totally different outcomes. Is resilience something that you're
born with or is it something your brain can develop?
And if so, how, what does any of this have
to do with the diving bell and the butterfly, or

(00:27):
using magnetic fields to zap the brain or the less
famous partner to the brain's reward system, or.

Speaker 2 (00:35):
What seemingly unrelated.

Speaker 1 (00:37):
Disorders in psychiatry all have in common. Welcome to Inner
Cosmos with me David Eagleman. I'm a neuroscientist and an
author at Stanford, and in these episodes we sail deeply
into our three pound universe to understand why and how
our lives look the way they do. Today's episode is

(01:09):
about resilience. We all know someone who's been through hell
and somehow comes out standing. Maybe you know a person
undergoing chemotherapy who still manages to raise a family and
be a good parent, or a refugee who rebuilds their
life from nothing, or a friend who keeps going after

(01:31):
losing her job. There's something about resilience going on here
that's different from what a lot of other people would
do in the same situation.

Speaker 2 (01:40):
We're thinking about.

Speaker 1 (01:41):
This one a young man who gets an early onset
motor neuron disease and slowly ends up completely paralyzed in
a wheelchair and eventually loses his ability to speak, but
he keeps on plugging along and eventually ends up becoming
one of the premire mathematical physicists in the world. This

(02:03):
is the story of Stephen Hawking. How did he stay
so resilient in the face of a slowly creeping disease
that ate his body but didn't seem to slow him down?

Speaker 2 (02:16):
That kind of drive, that kind of adaptation.

Speaker 1 (02:19):
It raises the question what enables some people to keep
going when everything falls apart? What is human resilience made of?
In this episode, we're going to answer this question by
diving into the brain. And I'm going to do so
with my colleague and friend, Jonathan Downer, who's been on
Inner Cosmos before, and he's one of the most compassionate

(02:41):
and insightful thinkers that I know. He has an MD
and specializes in psychiatry, and he also has a PhD
in neuroscience, and he's become one of the world's experts
in transcranial magnetic stimulation, which is a technique that we'll
come back to in a minute now. Jonathan was on
Inner Cosmos about a year ago to talk about depression,

(03:03):
and that episode moved and inspired a huge number of people.
So I've wanted to sit down with Jonathan again to
zoom out the camera one notch to talk about an idea,
change and focus the idea that clinical depression is actually
one expression of a more fundamental issue, one that has

(03:26):
accidentally surfaced as neuroscientists around the globe have performed hundreds
and hundreds of individual studies and then looked at the
emerging shape that all of these studies were pointing to.
What we'll learn today is an issue that sets right
at the center of our lives. So let's dive in
with Jonathan Downer to understand it. So, Jonathan, we've all

(03:53):
known people who are in very terrible circumstances in life,
and yet they figure out a way to keep going.
So we might by this says resilience, So tell us
about resilience. Yeah, So it's a fascinating topic to get into.

Speaker 3 (04:06):
I think a good example to start us off by
way of illustration. You and I in our textbook talked
about the case of Jean Boubie, who was the author
of The Diving Bell and the Butterfly. I really like
his examples. He had an absolutely horrific situation in which
this was a successful author and editor of the French
fashion magazine a magazine, and he unfortunately suffered a tiny

(04:31):
little stroke in his brain stem that left him with
this syndrome called locked in syndrome. And for those who
are hearing about that for the first time, it's a
horrible syndrome where the output passages from your the output
tracks from your brain down to the spinal cord, and
the muscles are just severed by the stroke. So you're
perfectly awake, you're perfectly conscious, you can feel sensations, but
you can't send any signals out to your body, and

(04:54):
there's no recovery. He was then bedridden and the only
part of his body he could move where he could blink,
and that was pretty much all he could do, and
with the assistance of some of the people who work
with him, he would use a blinking code to specify
letter by letter what he wanted to say.

Speaker 1 (05:11):
Specifically, the assistant would read out the letters of the
alphabet in order of their frequency, and then when she
got to the right letter, he would blink his eye
and she would write down that letter and then start
the process over again.

Speaker 3 (05:24):
Yeah, and so the fact that he was even able to, like,
I don't know what would happen to you or I
or most of the people I know if they were
in that situation.

Speaker 2 (05:31):
Certainly.

Speaker 3 (05:32):
I mean, imagine having an inch which you can't scratch
because you can't move, or a pain in your leg,
or a cramping your leg that you can't do anything
about for hours. It's very hard to maintain a positive
attitude in a situation like that. And yet he was
able to laboriously blink out an entire book describing his experience,
which the butterfly exactly. So, when I think about the

(05:53):
fact that, to me, the most remarkable part about this
is that is not the stroke or the fact that
there's an assistant with this amazing blinking code. To me,
the astonishing part is the fact that there's a there's
a resilient spirit in there that's capable of doing that,
that is laying there in this betting it somehow has
the patience and the resilience and the I guess the

(06:13):
inner fortitude to do something like that.

Speaker 2 (06:17):
So what is that about?

Speaker 3 (06:18):
So we I mean, there are a few different ways
of looking at resilience that's been studied to death, and
there are whole books that have been written on it.
You can talk about psychological sources of resilience. You can
talk about cultural practices and interventions and therapies that support it.
You can talk about you know, social practices that support it.

(06:41):
What I want to dive into a little bit is
the actual neural circuitry behind it. Because we are learning
a lot about what that neural circuitry is, and it
turns out that there are indeed specific brain circuits which
support our ability to be resilient. So, for example, a
person who suffers a terrible stroke, if these circuits are
preserved and the person can actually function a lot better

(07:04):
than you would expect given the circumstances they're in. And
then surprisingly, if those circuits are damaged in the stroke,
the person may have minimal physical limitations and yet is
not functioning at all. Is to sort of emotionally always
getting stuck on things, cognitively always getting stuck on things,
and just not able to get up and start moving.
So I think what would be interesting to get into

(07:25):
a little bit is the circuitry that we've been able
to delineate behind the general ability to be resilient to
life stresses and challenges and the general ability to function.

Speaker 1 (07:34):
And just before we get into the details of the circuitry,
what is the variation in the circuitry across the population.

Speaker 2 (07:42):
Yeah, so that's fascinating.

Speaker 3 (07:43):
There's been a lot of studies done on that using
techniques using MRI scans. So, for example, you can have
a person going the scanner and you can actually map
the thickness of their gray matter across the hole using
a technique called boxel based morphometry. So they take all
the little voxels in the scan and they look at
how thick the grain matter is in different areas, and

(08:04):
they can compare people who have more resilience versus less resilience.
There was a famous study done, I guess about a
decade ago now where they did exactly the question we're
asking about. They took a whole bunch of people who
had suffered horrible adverse childhood experiences. There's actually a psychological
questionnaire called the adverse childhood experiences questionnaire. So all these people,

(08:26):
you know, had been through horrible traumatic experiences, and yet
a subset of them had never gone on to develop
post traumatic stress disorder or depression or any other sort
of classic you know, axis one mental disorder, and the
question was, what's going on with them? It turns out
that there were specific areas of the frontal lobes that
had thicker gray matter. In these areas we were pinpointing

(08:49):
specifically as an area we can get into called the
left or salalateral prefrontal cortex, but it's actually a network
of areas in the brain. Who seemed if you just had,
by luck of the draw, you happen to have more
gray matter in these areas, then you were more likely
to be resilient to even quite horrible adverse childhood experiences.

Speaker 1 (09:08):
And is it luck of the draw a genetic issue
or is it environmental practices or social practices.

Speaker 3 (09:15):
It's a really good point there are you know, the
literature around resilience suggests that there's a lot to this,
so you know, there is although there is some genetic
component to resilience that I think that is greatly overshadowed
by one's environment and one's psychology and one's upbringing and
the practices that one implements. Early adverse childhood experiences are
really bad for people's resilience, whereas growing up in a

(09:37):
supportive childhood environment and having social supports and sort of
a calm parenting environment and all the rest of it
can often provide a person with quite a lot of
resilience that they can tap into later on in life.

Speaker 1 (09:49):
Yeah, although there are you know, like everything it's a
gene environment interaction. There are these studies done by Steven
Swami with monkeys where he is looking at these monkey
t and with half the adolescent monkeys he has them
with their mothers and the other half he has them
just with their peers. So they're raised with peers, and

(10:12):
just like in junior higher high school, monkey peers are
mean to one another. And so he looks at who
ends up doing well and who doesn't, and it turns
out it's not as obvious as you would think. It
turns out that there are genetic predispositions that cause some
of the monkeys in the bad group being raised with
their peers to still do fine and others not. So

(10:36):
there's definitely an interaction between how you're raised and what
you come to the table with genetically.

Speaker 2 (10:43):
So let's jump.

Speaker 1 (10:44):
Into what you see when you're looking at this in
the brain scanner. What are these prefrontal areas that you're
talking about. So I think that might be a good
place to start. So on the one hand, you know,
let's say we have this technique called box based morphometry
that's capable of pinpointing areas of gray matter they're thicker
versus thinner in certain groups of people. And let's say

(11:07):
we've used that to find people were unusually resilient to
developing access one disorders despite adverse childhood experiences. The flip
side of that would be looking at people who do
have access one disorders and saying okay. And this was
an enterprise that began, and I guess around twenty ten
or so on. They started being able to gather up
big data sets of lots of people who had succumbed

(11:27):
to depression or bipolar disorder OCT substance use anxiety disorders PTSD.

Speaker 2 (11:33):
And this is what you mean by access one disorder,
So access one disorder exactly.

Speaker 3 (11:36):
So the sort of the classic sort of psychiatric disorders
DSM one is the Diagnostic and Statistical Manual, and so
the access one of that is just one way of
describing formal clinical psychiatric disorders. So this was a team
led by a meet at Ken at Stanford University and
Madaline Goodkind was the first author, And in twenty fifteen

(11:57):
they gathered up over two hundred studies that had been done,
or close to two hundred studies that have been done
looking at the thickness of grain matter across all these
different disorders, and they asked a really interesting question, are
all the different disorders like OCD and PTSD are.

Speaker 2 (12:10):
They completely different?

Speaker 3 (12:10):
Do they all involve different brain circuits or is there
some common element like if you did a bend diagram
and overlaid them all. Is there some common element to
all the brain disorders that we have lumped into the
basket of psychiatric disorders as opposed to neurological disorders.

Speaker 1 (12:25):
And so amazing by the way that we can do
this now because we have enough brain scans from enough
patients with different disorders that for the first time in
history we can ask that question.

Speaker 2 (12:34):
It was fair. Yeah, absolutely, So what do they find fascinating?

Speaker 3 (12:36):
So they turn out that yes, indeed, if you overlapped
all the maps of all these two hundred different studies
involving I think close to seven thousand patients versus healthy controls.
There were indeed some areas which were universally thinned out
across all these different disorders, and as you might expect,
they belong to the same network that this resilient network was,

(12:56):
except it was in the other direction. So people will
then use with quite thick gray matter in this network
of regions were resilient to disorder. And on the other hand,
if you looked at people who had these disorders PTSD
or anxiety, one common element they all had was that
this specific network of regions was a little bit thinner
in terms of the gray matter. There are a bunch

(13:18):
of different networks in the brain that perform various functions.
Some of them move your upper body or your lower body,
or do vision or hearing. This particular network having an
interesting name, it's called the salience network.

Speaker 2 (13:30):
And so what was need about this popped out?

Speaker 3 (13:32):
The common element across all these different disorders when people
lose their resilience is the salience network. And on the
other hand, if your salience network is intact, then you
tend to have this resilience.

Speaker 1 (13:43):
So help us understand this a little bit more so,
if you have less resilience, how does that connect with
psychiatric disorders?

Speaker 3 (13:52):
So that's really I think that's a really great question
and the right way of putting it. So the salience network,
it helps understand what the salience nets works function seems
to be. What was need about discovering that the salience
network was involved is that separately, people had been studying
the saliens network for fifteen years. I accidentally did my
PhD audit back in the late nineteen nineties before we really.

Speaker 2 (14:13):
Knew what it was.

Speaker 3 (14:14):
But its job seems to be a thing called cognitive control,
the ability to self regulate your thoughts and your behaviors
and your emotions. What's unique about it in terms of
the brain regions it involves is it has some brain
reasons that are part of the limbic system, the so
called emotional system the brain, but it also has some
areas that are part of the brain's kind of executive

(14:34):
function and cognitive system. So it's out of all the
various dozens of brain networks that are there, it uniquely
seems to break between the limbic system and the cognitive
system between sort of reason and emotion, and you will
see people activating it when they have to inhibit a
particular thought in order to do or a prepotent response.
So a classic example that would be the go No

(14:56):
Go task, which is a task where people have a
signal that tells inn apress button and then another signal
says no, wait, don't do that, and so you have
to inhibit that predisposition.

Speaker 1 (15:05):
So for example, if if the banana comes on the screen,
I pound the button, and if the strawberry appears on
the screen, I have to not hit the button.

Speaker 2 (15:11):
That's a great example, that'd be it.

Speaker 3 (15:13):
Another example would be the classic stroop task, which in
the stroop task, this is a tricky one. If you
ever have to try it, you can They have them
online if you ever want to go and try them.
With the word blue will be written in red ink
or the word red will be written in green ink,
and you have to not say the word, which is
the thing you want to do, but you have to
actually push past that prepotent response and say the color

(15:33):
of the word, even though there's an interference effect there.
So the stroop task and all these things volitionally activates
your cognitive control capacity. It essentially allows you to stop
ruminating to or and to focus on what kind of
response you're going to make, so the salience network will
kick in. If a person, I'll give you an example,
if you, for example, got bored with what I was

(15:54):
saying right now in your mind started to wander till
yesterday or.

Speaker 2 (15:57):
Tomorrow or why.

Speaker 3 (15:59):
I usually say this lectures, and you know, it's a
room full of people, so you know, you could always
see the people like some people are paying attention to
It's totally natural. It's very hard to focus your attention
for a long time, so people start thinking about something
else and then maybe suddenly I say something interesting and
their attention comes back again. At that moment when you
stop mind wandering and you return to the present moment,
your salience networking is activating at that moment. For people

(16:23):
who have done mindfulness meditation, we've all experienced this.

Speaker 2 (16:25):
You know, Okay, I'm going to be mindful.

Speaker 3 (16:27):
I'm going to pay attention to my breathing, and then
after about you know, three seconds, your brain starts wandering
off to something you have to do later that day
or whatever. And then and you wander and wander and
then after about a minute you're like, oh, I actually,
I wasn't supposed to be doing that. I'm supposed to
be paying attention to my breath, and at that moment
of mindfulness you return. So at the moment of mindfulness
being again, your salience network comes on as you break

(16:48):
the train of thought. So we can imagine that as
we go through life, we're often not in the present moment.
We're ruminating about the past or the future or something else.
But the moment that we snap out of it and
return to the present moment the sailing this network seems
to activate every time that happens. So you can imagine
what would happen if the sailings network goes down. If
you lose that capacity to easily snap out of things,

(17:10):
then your ruminations will just keep going and keep going
and keep going. And the minute that you can't snap
out of things, all of a sudden, it's harder to function.

Speaker 2 (17:18):
Right.

Speaker 3 (17:19):
So, you know, all of us, if we're faced with
a stressful situation, let's say we start worrying about it
and thinking about something horrible that's happened, you know, if
we lost someone important to us. But as long as
we can snap out of that thought and return to
our task or our work or whatever doing. We don't
have an access one disorder. We have stress, we have distress,
but we don't have disorder. But the day you can't

(17:39):
snap out of it again is the day you flip
over into having a disorder.

Speaker 1 (17:44):
So, with this understanding coming into focus, what kind of
therapeutic approaches are there?

Speaker 2 (17:52):
Beautiful? So let's go to that.

Speaker 3 (17:54):
So let me also tie that back to resilience, because
I'll say, resilience has a few different As we start
to tease apart this circuitry, we start to realize that
resilience has a few components to it. One of this
isn't the only circuit behind resilience, but one of the
circuits behind resilience is this salience network and its role
of cognitive control and the ability to snap out of
mind wandering and rumination. So that thing we call cognitive

(18:16):
control or cognitive flexibility is one of the ingredients of resilience,
and it is one that can be enhanced over time,
as you say, one of the classic ways to enhance it.
We know that, as I mentioned during Moments of Mindfulness,
that the salience networks engage. So people who wish to
enhance their resilience, mindfulness based stress reduction and mindfulness based

(18:36):
cognitive therapy are tried and true sentxuries old, I mean
thousands of years old methods that if you spend years
and years practicing, you can strengthen one your capacity to
be in the present moment or at least return to
the present moment when you need to, and to maintain
yourself there. When you're sitting there meditating for ten or
twenty minutes, every time you catch yourself and bring yourself back.
You can think about that as one rep. It's like

(18:58):
one sit up of this system. And so the idea
behind ten years of mindful at practices you're going to
do a whole lot of situps and at the end
that that system is going to be fairly strong.

Speaker 1 (19:06):
So we have mindfulness meditation is one way to practice this.
How else are you thinking about this from the neurological point?

Speaker 3 (19:13):
Yeah, I think that's great. So there are Yeah, So
that's exactly it. So that's one way of doing it.
When people go for there are. Evidence based psychotherapy is
like cognitive behavioral therapy, and that's a little bit different
from mind welellss. You're not merely returning to be present
with whatever feelings or thoughts are there. But the trick
is when you get into a difficult situation and your
emotional state goes out of control or your behavior goes

(19:34):
out of control. In cognitive behavioral therapy, we teach ourselves
to reframe situations or thoughts in a different way, so
we're actually exerting cognive control to look at the situation
a bit differently and figure out whether our emotions and
our thoughts are proportionate to the situation or disproportionate, and
then try and bring them back again. And that also
involves activatingly at these regions. So those are tried and

(19:56):
true methods that have been out there. I'm not aware
of any specific medication that in a targeted way boost
these things. So there are medications that help with the
access one disorders, but I'm not aware of a medication
that specifically does this one thing of enhancing one's cognitive control. Uh.
You know, stimulants for some people and things like ADHD
when they are is just a little underactive. There are

(20:17):
certain groups of people who find that they gain contentitive
control on you know, people with ADHD, for example, may
find that medications enhance their ability to exercise or exert
cognitive control.

Speaker 1 (20:43):
One of your errors expertise is transcriminal magnetic stimulation, So
tell us about that.

Speaker 2 (20:49):
That's exactly where I was going.

Speaker 1 (20:51):
So first, for the benefit of the listenership, tell us
what TMS is, and then tell us how it applies here.

Speaker 3 (20:58):
Perfect, Okay, So yes, So right now, we've got this
target circuit in the brain that we'd really love to
strengthen because if only we could strengthen it for people,
they would have more cognitive control, and they'd have more
resilience and so on. And medications don't do it for
most people, but and therapy takes a really long time,
and not everyone has the capacity to do it.

Speaker 2 (21:16):
But if we could.

Speaker 3 (21:16):
Somehow stimulate that area and turn it on over and
over again, like do the sit ups for people, then
you know, we could be able to strengthen it. And
the method that we're using successfully to do that right
now is called transcranial magnetic stimulation. TMS is the short form.
It's a method for stimulating the brain non invasively. So

(21:37):
in the old days, you want to stimulate the brain,
you have to do surgery, open up the skull and
implant use an electrode to stimulate the brain. Nowadays we
can do that non invasively using a device that stimulates
the brain through the skull using powerful focused magnetic field pulses.
So a little inductor paddles placed over the target region

(21:58):
of the brain and it'p little quick pulses. It's powerful
enough that if you apply the little pulses to the
area of your hand that moves your thumb, for example,
you'll actually see the person's thumb move. And I think
you and I have gone through that as a little demonstration,
and it was discovered back in the nineteen ninety is
that if you do this not once or twice, but
if you do this hundreds of times, you can strengthen

(22:19):
the circuits that you're stimulating via the mechanisms of neuroplasticity,
which of course you've discussed elsewhere at length. The neurons
that you fire together will gradually wire together. So when
you deliver tms to any area of the brain, not
only do you activate that area, but the other areas
it's connected to will also light up, and they all
fire together, and they all wire together. So you can

(22:40):
sort of do hundreds of sit ups for a person
in about three minutes of TMS using these sequences of pulses.
It's been known for a long time dorsal that TMS
two regions like the dorsalateral proof on cortex and so on.
Back in nineteen ninety five, it was first demonstrated that
this can be useful in treating depression, and then it
turned out to be useful in treating other things like

(23:00):
anxiety and other targets turned out to be useful in
OCD and PTSD and binge eating disorder and bolivia orvosa
and lots of other conditions. Interestingly, when we look back
at what areas we'd been stimulating back in the nineties
and later on, it turned out that a lot of
the areas we were activating with TMS corresponded very nicely
to this network, this alience network, which had been active

(23:22):
across many different disorders. For those of us in the field,
that solved the mystery where we come in and say, look,
I thought we were just trying to treat the page.
And when I opened my TMS clinic in twenty ten,
we kept seeing this. We'd have a person who came
from the eating disorders clinic. Oh, well, but you know
you're depressed, so let's see if we can help you.
So we treat the depression and they come back in
and they say, well, Doc, you didn't tell me my
Bolivia was going to go away. And they said, wow,

(23:45):
that's interesting. How do you think about that? And then
you'd have a person who came in for depression, but
their bigger picture they were a veteran with PTSD and
they come and say, you know, I'm not having flashbacks anymore.
I can walk into Walmart now without having panic attacks,
Like my anxiety is way down. You'd have other people
who'd walk in and say, you know, I took a

(24:06):
mindfulness course once and I just couldn't do it, but
I noticed after the TMS, now I can do mindfulness,
or say I took a therapy course once and I
tried to learn how to do CBT and I tried
the techniques and you know, I really I tried for
two years. I was like teaching it to my roommate
and she could do it, but I couldn't do it.
But now after the TMS, I can do it now,
like it actually works now. So there's a synergy between

(24:27):
these areas of brain and our ability to stimulate them
with TMS. And what we've noticed as we stimulate these
areas is is it turned out to be very hard
to just treat the person's depression or just treat their PTSD.

Speaker 2 (24:38):
If it kicked in and worked, a lot of things
got better.

Speaker 3 (24:42):
And it was really fascinating what they would come in
and you would ask them, Okay, well, okay, I see
the numbers on your scale are down, but just tell me,
in your own words, what's different now, And they say,
you know, it's really weird.

Speaker 2 (24:53):
You know.

Speaker 3 (24:53):
Traditionally, I'm constantly ruminating about my body image all day,
Like I can't stop thinking about my weight, I can't
think about the way I look. And then I noticed that,
you know, I had a and then someone said, someone
made a comment, my aunt made a comment about my appearance.
And normally that would have ruined my entire day, and
I would have been still ruminating about it when I
went to bed, and it was really weird. I noticed

(25:16):
an hour later that I just wasn't thinking about it.
I was kind of over it. I was thinking about
other things again. And so these are the kind of
things people would keep on talking about that some challenge
would come along and what they were used to over
years of having the disorders.

Speaker 2 (25:30):
Not a challenger come along. Okay, that's my week gone.

Speaker 3 (25:32):
I'm going to be stuck ruminating about this for the
rest of the week.

Speaker 2 (25:35):
I won't be able to do anything.

Speaker 3 (25:37):
And what they kept noticing was saying, yeah, I get upset,
and then twenty minutes later, I'm over it. And I said, well,
is that a weird experience? You feel like you're being
emotionally numbed or emotionally blunted.

Speaker 2 (25:47):
No.

Speaker 3 (25:47):
No, I still have my emotions, but I can get
over things now and I don't overreact as much as
I used to. My reaction is like sort of, you know,
more proportionate. And I find I can and say, what's
the experience like? And they use words like willpower and control?
They say, I feel more like I'm in control again.
I feel like I have that willpower thing that everyone's
been telling me. I need more of that. Their subjective

(26:09):
experience of having this network strengthen is an experience of
greater willpower, greater control.

Speaker 1 (26:17):
And so does it matter which part of the network
was stimulated or were these many different studies stimulating various
different parts, but it all happened to be of this network.

Speaker 3 (26:26):
Well, so it's been a long time piecing that together
because in the TMS literature, different people targeted. Some people
will do the left hemispheres, someone do the right hemisphere,
someone go in the middle between between the two hemispheres,
and so on. And now that we've got enough of
these studies and we put them together, it looks like
you kind of get fairly similar results no matter which
as long as it's one of the members of this
network of regions, all the other networks are lighting up

(26:49):
as well, And so it seems to have a similar
effect when we scan people while we do TMS. You
see that when you're stimulating one area, all the other
areas and its network will light up.

Speaker 2 (27:00):
And how effective is this approach?

Speaker 1 (27:04):
Is it ninety percent of patients get better in some
way as it ten percent?

Speaker 3 (27:08):
So that's been that remembering the TMS is a technology.
So if you asked me the question in nineteen ninety five,
it would be asking a little bit like how far
can your electric car drive in nineteen ninety five versus
how far can your electric car drive in twenty twenty five.

Speaker 2 (27:22):
There's the good. Dow says, there's progress.

Speaker 3 (27:24):
The early TMS studies were only getting about ten or
fifteen percent of people their emission, but they were also
only doing about ten or fifteen sessions of treatment. And
then later studies did about thirty sessions of treatment and
got about thirty percent of people better. And then later
studies did about fifty sessions of treatment and sometimes you
get fifty percent of people better. And then other studies
were using MRI guidance to kind of fine tune the

(27:47):
location of the stimulation, and it turns out some people,
it turns out there because of their anatomy, you need
to have map their anatomy a little more closely to
get the coil over the right spot. But the biggest breakthrough,
I think in the last two or three years is
noticing that TMS require, as we mentioned, it requires the
brain to have neuroplasticity. Right. There are implantable brain stimulators

(28:11):
that people use for Parkinson's and depression and so on,
and then a surgeon will implant them like a little
pacemaker in the target circuit and then you walk around
with it all day long. TMS isn't like that you
sit in the chair, you get a session a treatment
for three minutes, and after a bunch of sessions you
then it has to keep lasting for weeks or months,
even after you've gotten the treatment done. So the only
way that that works is if you have neuroplasticity, and

(28:34):
some people just don't have very much. We don't know why,
but there's a lot of variation. So when we treat
a bunch of people with depression, about twenty percent of
people show really strong and really rapid response, and then
about ten percent of people show nothing at all, and
everyone else is somewhere in the middle.

Speaker 2 (28:48):
It's almost like you're bailing.

Speaker 3 (28:49):
A bit of a leaky boat, so you're kind of
bailing it out, but they're getting worse, and then they
tend to keep coming back. These are the ones who
seem to need more plasticity. And one of the ways
that has just come out in the last two orths
years to make TMS a lot better is it turns
out that there are some simple, off the shelf old
medications that enhance the brain's plasticity, and if you take

(29:09):
those medications a little like an hour or so before
you get your TMS sessions, it works a lot better,
and it lasts a lot longer.

Speaker 1 (29:17):
Give us a sense of what some of these meds are,
just in case the name strikes that any was familiar.

Speaker 2 (29:21):
Happy to do it, so there is.

Speaker 3 (29:23):
So my colleague Alex McGear at the University of Calgary
back in twenty twenty two publish a paper in Gemo
Psychiatry using an old it's actually an old anti tuberculosis
medication called de cyclosarine. Decyclo Sarine works on the brain's
glutamate system. If we want to get really nerdy, it
acts on the NMDA receptor. The NMDA receptor is the

(29:43):
receptor that detects whether two neurons are being fired at
the same time and then responds to that by strengthening
the connection between them. So you need your NMDA receptors
to do that whole plasticity thing where the neurons that
fire together wire together. So what happens if you add
a medication that tickles the NMDA receptor and kind of
helps it stay open a little bit longer and then
do the tms. Decycoserian has been around since the fifties

(30:05):
and psychiatrists have been using it and medical researchers have
been using it not for tuberculosis, but to try and
enhance plasticity while they give therapy and give other kinds
of treatments exposure therapy and phobias and OCD and so on,
And I think one of my colleagues described the results
as myth after many many years, the result was sort
of some But interestingly, it might just be that those

(30:27):
kind of therapies don't provide the direct kind of potent
immediate stimulation of the neural connections the way that TMS does.
Because the first time this was tried for TMS, the
effect was not small. It doubled the remission rate, and
that was just giving it for the first ten out
of twenty sessions of TMS. You know, instead of the
twenty percent remission rate you might expect with twenty sessions,

(30:49):
it went up to forty percent. And then actually just
two months ago Alex mcgerr's team went back and they
tried it again for all twenty sessions and the remission
rate went from twenty percent to seventy percent, eighty five
percent of people showing at least. So it turns out
there are a lot of people who just need more
plasticity to do well on TMS, and TMS actually can

(31:11):
be extremely powerful if you just enhance the plasticity first.
So that was and then of course this is just
about depression. So he also went to a different brain
area that was involved in OCD. Because there is a
TMS protocol for OCD, OCD is a tough nut to
crack among TMS researchers. We think of it obsessed with

(31:32):
compulsive disorders reckoned to be one of the toughest things,
just for when they do clinical studies on OCD, they
will often declare thirty five percent improvement in symptoms as
a strong response, and they if you like, we don't
expect to cure you of your OCD. If we can
even get your thirty five percent better, we'll call that
a win. That's often how structure studies are done. Alex

(31:54):
mcgear's team when they did this in OCD, they found
that twenty sessions. Uh, there's a school or there's a
scale from zero to forty called the Yale Brown Obsessive
Compulsive Score. It's the standard clinical scale you used to
measure how bad somebody's OCD is. And you know you'll
have a person who might have a score of twenty
six which would be severe, or thirty which would be

(32:15):
very severe, and twenty sessions of TMS would reduce their
score by about two or three points, but with decyclicerine
it was closer to ten points of reduction in twenty sessions.

Speaker 2 (32:27):
Great, so it's a big difference.

Speaker 3 (32:29):
And you know, the question is, well, okay, TMS is
used for lots of other things, like TMS is being
used for other brain circuits and Parkinson's and Alzheimer's, so
could this be used to treat lots of things. There's
a second wave of enhancing plasticity, which is dopamine. So
dopamine has a lot of roles in the brain, but
it does look like TMS relies upon dopamine for at
least some of the plasticity. And there have been studies

(32:51):
done in both in laboratory and in the real world
in which if you give people medications that boost their
dopamine levels, like el dopa for example, Parkinson's drug that
adds dopamine to the brain, and then you do the
TMS the excited where ATMs protocols get stronger, the effect
of the TMS gets stronger, so you're boosting plasticity.

Speaker 2 (33:10):
So it looks like.

Speaker 3 (33:10):
There's at least two or three different receptor and neurotransmitter
systems that.

Speaker 2 (33:14):
Can be used to do this. How about a seedyl colin.
That's an interesting one.

Speaker 3 (33:17):
So that hasn't been try yet, but you know there
are easily four or five or six different methods for
doing this. I don't know if you've had Lee Williams
come in and talks of Lee Williams here at Stanford
has been looking at it at guanphisine, not necessarily on
a cell colin, but looking at guanfessine to see what
that's a third neurotransmitter system involving neuropinephrin, and has been

(33:41):
showing that people with problem there are specific people with
depression who stand out for having particularly prominent difficulties with
cognitive control. And here's a medication called guafisene that isn't
normally used as an antidepressant, but in these patients, they
who happen to have what they call the cognitive control
that fense. This medication does work as an antidepressant for

(34:04):
these folks, probably by enhancing their cognitive control so they
don't get stuck in rumination all the time.

Speaker 1 (34:09):
Right, Yeah, you know, this is such an exciting moment
in time. We're in neuroscience where everybody has been doing
these studies and we well know that to get a
patient and do a study and so on a ton
of work to do one patient, two patients, and suddenly
we can do these meta analyzes and put together the

(34:31):
big picture and start seeing the jigsaw puzzle more broadly.
So what our next steps. We're almost halfway through twenty
twenty five. Now where is this all going?

Speaker 3 (34:40):
Absolutely so, first of all, one of the there are
two directions that the field is going in right now.
One of them, which I think is a broader trend
in psychiatry in general, is the field of personalized medicine.
So let's look at your symptoms and let's see if
we can achieve a higher chance of success by looking
at your specific symptoms and personalizing maybe the frequency of

(35:01):
treatment or the type of medication we use, or the
location of the coil based on your specific parameters. Which
is great if it works, but the downside of courses,
it also has a lot more complexity. So you know,
psychiatric treatments are already costly and hard to get, and
so this makes them more costly and more hard to
get the other potential approach that we could try not
to say that then there's certainly going to be a
role for that. Personalized medicine is certainly looking very exciting.

(35:22):
But there are some things there's a different approach where
we try not to personalize and when we simply try
to come up with the sort of greatest good for
the greatest number approach. And so I want to unpack
that a little bits to point at the idea that
there might be some brain story. I mentioned earlier, there
are some brain circuits that are universally involved across a
variety of different disorders. And so one of the questions

(35:44):
I asked one of my colleagues at Harvard who have
been doing one of these brain mapping type studies and seeing,
instead of mapping the circuits that are associated with depression
or PTSD or addictions or whatever, we notice that some
people just have resilience, so they actually function much better
than expected. For those of us whore working clinics and
see thousands of patients, you'll see these people who have
like terrible depression and yet somehow like they're still functioning

(36:06):
really well. Or people who have terrible Parkinsons and can
barely move, and somehow they're still kind of functioning or
you know, have had a stroke that's crippling to them,
and as we mentioned earlier, somehow still functioning and then
functioning mentally and in the activities of daily life, like yes,
they're super you know, there's somehow still. I actually saw
a gentleman, what was it, I don't know whose name.

(36:27):
We were having brunction pol Walta just up the road
and there was a little man, it looked in his
nineties in a wheelchair by himself, and he was out
for a while. He was using one leg and his
heel to drag his wheelchair along one foot at a time,
and he smiled and waved to us, and he kind
of crept along sidewalk for his morning stroll. And he
was and I don't know who got him into the

(36:48):
chair or how he's getting along, but there he was,
just using one foot to drag himself around the block
for a little morning scroll. And so we can evaluate
how severe your symptoms are, but we can independently evaluate
how well you're functioning in daily life. So that gentlemen
I mentioned would be an example of someone who if
you measured their physical symptoms, they would be totally crippled.

Speaker 2 (37:04):
But if you actually they're still.

Speaker 3 (37:06):
Getting up every morning and walking around and having breakfast
and doing all their stuff, So on that level, they're
better than expected. So the question becomes, let's run an
analysis of strokes or lesions or other things and figure
out are there areas that correlate with your better than
expected or worse than expected number if we think of that,
But and they do, they pop out and one of
the two There are two circuits that popped out of

(37:27):
that analysis, which was led by Beatrice Milano and with
my colleague Shan Sidiki and his group over at Harvard.
They went through a whole bunch of stroke patients and
they looked at their ability to function in general. And
the circuits that popped out. Number one involved this one
of these salients network circuits that I talked about. But
there was a second circuit that was down just above

(37:48):
the eye in another circuit we haven't gotten to yet,
called the orbit of frontal cortex, and it was also involved,
but in the opposite polarity. In other words, it was
actually good to have lesions in this area. And if
this area was preserved you were more likely to be
functionally impaired. How do we understand that? So that's an
interesting one because this circuit is also pretty well studied
and it is the counterpart to the brain's so called

(38:11):
reward circuit. So the brain most of us know, has
this sort of a reward circuit whose job it is
to identify goals that are worth pursuing and to motivate
us to go and pursue those goals. The problem is
that that would only allow us to pursue positive goals.
We also need a partner circuit to identify potential pitfalls
or problems, challenges, threats, and to establish goals to avoid

(38:32):
those things and motivate ourselves to avoid those. If you
don't have both circuits, you're in trouble. The brain needs
to be motivated to seek out stuff, but also needs
to be motivated to avoid the bad stuff. And the
circuit that was overactive in these stroke patients, or so
to speak, or was the one that was the so
called non reward circuit, whose job it was to be

(38:53):
motivated to essentially to generate negative motivations.

Speaker 1 (38:58):
It looks like, so you said that was overactive in
the stroke patients is that there's a specific thing we
think is happening in that circuit, it can enter into
a feedback loop, right.

Speaker 3 (39:07):
And this is a theory by a professor in the
UK called Professor Edmund Rules. He'd been studying the orbit
of frontal cortex region in monkeys and humans for decades
and he after many years, realized that this circuit tended
to get stuck in a feedback loop in depression, and
he proposed what I think is a very lovely theory

(39:29):
called the non reward attractor theory of depression. So, in
the non reward attractor theory of depression, you have a
circuit whose job it is, to what it's functioning properly,
is to identify threats, so you can then start to
think about solutions and go and solve them. But if
it gets stuck in a feedback loop, then you can't
stop thinking about it even when you're not solving it.

(39:49):
I think all of us have experienced the sensation at
times of the difference between you know, working on a
problem versus just worrying about a problem where you're not
really solving it, but you're awake at two in the
morning years thinking about the same thing over and over
and over again, and you're not really getting anywhere, but
you just keep going and keep going, and you can't
get back to sleep, and you really just need to
stop thinking about it because you're not going to solve
it right now, and snap out of it and go

(40:09):
back to sleep now if you can't. And if that
goes on all day long, you're not functioning because you're
sitting there ruminating and going round and around on problems.
Maybe it's a one out of ten problem that your
brain is treating as a ten out of ten problem.
Maybe it's a three out of ten problem that your
brain should be spending five minutes on and spending eight
hours on. But the point is that while it's doing that,
you're not getting up, you're not having breakfast, you're not functioning,

(40:31):
you're not going to work, you're not really you're not
fully present, you're not doing things.

Speaker 2 (40:53):
I'll give you an example of this.

Speaker 3 (40:54):
There was a woman described in the literature who is she,
among other things, had she had sought treatment for many
years for alcohol dependence. So she was somebody who drank
about ten drinks a day and somehow functioned through this
recently well. But was drinking ten drinks a day, and
it sought treatment from physicians for this in a variety
of different ways.

Speaker 2 (41:14):
Not a boich. You have been successful.

Speaker 3 (41:15):
In her fiftyes, she suffered a stroke and the strength
was the stroke happened to land. It was a small stroke,
just in this little circuit, and she immediately found it
that she no longer had any desire or interest in
consuming alcohol, and the alcohol, the use that she'd been.

Speaker 2 (41:31):
Trying to get her over for years just kind of
went away.

Speaker 3 (41:34):
Other people with strokes in these areas, there are people
who have obsessed with compulsive disorder and have suffered this
is a weird thing that they had OCD for thirty
or forty years, and then one day they have a
stroke in their old age and the OCD goes away.
So yeah, So there are situations where this circuit gets
stuck in a feedback loop and the best thing you
can do here function is to just get out of

(41:54):
the feedback loop. Now, losing the circuit altogether is pretty drastic, right,
That's what we'd rather do is just turn it down
a little bit, and TMS can be used to do that.
Back in around twenty sixteen seventeen, I had a patient
who had come for TMS, and we tried the standard
TMS of one of these salience network cress and we
didn't get anywhere. So then we tried another salience network

(42:16):
cretion and for reasons you know and I've described, that
didn't do much either. And then she said, well, please,
I please try something else because I you know, the
next step normally would have been to go to electroconvulsive
therapy or shock therapy, and she really didn't want to
do that. So I said, well, there is this other
area that's been tried in OCD, and you don't have OCD,
but you do have a kind of depression that reminds

(42:37):
us of OCD because you just kind of get obsessed
with the same negative things about yourself. And when you
described me what your depression is like, it sounds almost
like an ocd ish flavor of depression. So if you will,
like you can come in and I'll give you this
treatment which has been used for OCD, and we'll say,
maybe let's see if your OCD ish depression gets somewhere.
And it was a complete remission. We also had scans

(42:59):
on her and we were able to show that normally
when we do TMS, we strengthen this salience network, and
you can see this connection strengthened.

Speaker 2 (43:07):
In her case.

Speaker 3 (43:08):
We scanned her before and after, and when she got better,
it had nothing to do with the salience network. Instead,
we had suppressed the over connection between this orbit of
frontal region and its little loop of activity down into
the reward circuitry.

Speaker 2 (43:21):
So what happened to her after was what was what
was it like for her?

Speaker 3 (43:24):
What she said was that essentially she was now free
of ruminations. I'll give you, and we had other people
come and do it, So I'll give you a really
illustrative example of one person who had a little bit
of both. She had a bit of column AN and
a bit of COLUMNB. So not only did she have
a tendency to be really obsessive and self critical and ruminative,
but she also tended to be quite impulsive and a

(43:44):
bit ADHD like and had difficulty with the cognitive control.

Speaker 2 (43:47):
So she really struggled.

Speaker 3 (43:49):
And she came to us from the eating sort of program,
and she bring she had blimior nervosa, so she would
spend a couple of hours a day binge eating and
then purshing it up and binge eating, and pershing. She
also had a lot of intrusive thoughts about her body
image and negative body thoughts. She had PTSD symptoms. She
had a lot of different things. So we gave her
the standard TMS and her depression scores went down by

(44:11):
about half, and she said, well, this is really interesting,
Like I feel somewhat better, like I noticed, like I'm
feeling less anxious and less depressed. And you certainly helped
me with my bolimia because I haven't had any urges
to beings or pursed, like those impulses are just gone.
But I still think about suicide every day, and I
still think about how horrible my body looks every day,

(44:32):
and I can't enjoy anything. And so we talked about
it a bit. And when I heard about these obsessions,
I said, well, you know, we could try going to
this other area that's typically an OCD area and see
if these obsessive thoughts you have about body image and
suicide and so on, let's see what that does. Because
a couple of other patients have been helped by it.
It was a while before we could get her in.

(44:52):
The clinic had a lineup, so we treated her and
then she came back in. This was lovely about She
came in and I asked her how she was doing,
and her scores down to the single dishits she was
doing really, really well. And I asked her, but what
was it like? And she said, well, I'll tell you
what I noticed. It was this past weekend. I was
playing with my niece and nephew, and I noticed that
I was smiling, and I noticed I was feeling pleasure,

(45:14):
like joy, which is weird. I hadn't felt that in
twenty years. And then I thought about it, and I
realized I actually hadn't thought about suicide all day, and
that hasn't happened for twenty And I realized I hadn't
thought about suicide for days, which hasn't happened.

Speaker 2 (45:26):
I was able to enjoy things.

Speaker 3 (45:27):
And then I realized I'd eaten a hamburger four days ago,
and normally i'd still be thinking about that.

Speaker 2 (45:32):
Hamburger, regret about you, regret exactly.

Speaker 3 (45:36):
I'd still be thinking like, why did you do that you?
And I realized that I just wasn't worried about the burger.
I'd eaten it, and yeah, I was a little upset
about it, but then I just wasn't thinking about it anymore.
But this was three or four months after her original treatment.
She said, but could I come back and have the
previous one again, because I'm starting to get back into
my binging and pershing behavior. That's that part is coming

(45:57):
back again. So you can see it what we would
in neuropsychology, a double dissociation, where treatment of one circuit
is helping with the person's impulses and their cognitive control.
And after treatment there she felt a stronger sense of
agency of self control with this first set of areas
around this alience network.

Speaker 2 (46:15):
With the second set of.

Speaker 3 (46:16):
Areas, she was feeling freedom from being trapped in a
circle of rumination on negative thoughts. But as the first
one wore off, she was losing that control piece. And
that highlights the two elements of resilience that come from this.
That what the ingredients of resilience seed be these two circuits.
Number one, having more self control or agency or a
sense of will to snap out of things or control

(46:37):
what you're thinking about. And number two, the ability to
not get stuck in a circle of rumination on the
same stuff, the ability to exit that circle. If you
have those two things, you're resilient.

Speaker 1 (46:49):
So cut to a quarter century from now when this
is all very well worked out and every shopping mall
has a TMS clinic that you can walk into and.

Speaker 2 (47:01):
I hope are there soon.

Speaker 1 (47:01):
Yeah, Okay, The question is how will people know whether
they should go in and get this stream. It's like
it's like doing a tune up on your car. But
how do you know, you know, is there some variety
that would be useful to have in our society. How
do you know when you should get it at what level?

Speaker 3 (47:22):
Yeah, it's a really interesting question, particularly because TMS is
a technology, so it gets better, it gets faster, it
gets cheaper over time. So you know, it's the example
of you know, when I was a kid, we talked
about flying to like space tourists who would go up
to flying space hotels, and that hasn't happened yet because
the cost of flying a space would have to come
down a lot before most of us can afford to
do that. And likewise, TMS presently is still pretty expensive.

(47:44):
But you know, the costs are coming down and the
availability is going up, and so the threshold for and
TMS happens to have an excellent safety profile, So the
question would become of when to go and get TMS.
Right now, it is an FDA cleared technique, and it
is the FDA is the cleared to be a prescription treatment,
so one one does go to a physician and obtain
a prescription to get TMS.

Speaker 2 (48:07):
And in the.

Speaker 3 (48:08):
Past, most insurers and pairs would require people to have
tried three or four or five or six different medications
before they often four medications or more before they were
allowed to apply for coverage for TMS. Now those numbers
are coming down and people are able to go earlier on.
So I think what we'll see is that it may

(48:28):
be that you'll be able to go for TMS to
enhance your functional capacity. Just knowing that we have these
two target circuits, people will be able to go in and.

Speaker 2 (48:38):
Across a wide variety of disorders.

Speaker 3 (48:40):
So at the moment, TMS is FDA cleared in depression,
it's FDA cleared in OCD, and in chronic pain a
couple of other conditions. But what might happen is it
might be cleared across a wide basket of different conditions.
And because the TMS really isn't what's interesting is we
discovered the TMS isn't treating the depression.

Speaker 2 (48:57):
It's indirectly treating that by just.

Speaker 3 (48:59):
Generally enhancing your self control and allowing you to not
get stuck in rumination. And that turns out to be
useful not just for depression, but for lots of things.
So where I hope we end up in hopefully a
lot less than twenty five years, maybe in five years,
would be in a situation where people can come in
across a wide variety of conditions and maybe not waiting

(49:20):
until they're extremely severe and until they've tried lots of
other things. But you know, there may even be a
world where you know, even and this is one thing
people are working on, is even before going to medications,
where people might be able to go and pursue this
treatment right away. As you know, So when a person
first starts to realize that they're encountering significant difficulty functioning
because of the severity of their anxiety or depression or

(49:42):
whatever it be, that they can go in and get
essentially a top up of resilience.

Speaker 2 (49:47):
The thing that we all wish we had.

Speaker 3 (49:49):
That comes back to a dinner conversation we had ten
years ago where I was sitting with some friends and
as a dinner conversation starter, we said, okay, let's go
around the room and let's say you had the abilit
to just rub a magic lamp and a genie would
would you could say one word and then everyone in
the world would.

Speaker 2 (50:06):
Be gifted that thing. So what would you?

Speaker 3 (50:08):
And we all went around the table, and the one
I chose was happened to be resilience. I said, the
world would just run better if we could all have
a little bit more resilience. So I would love to
get to a world where we just generally have this
treatment that enhances one's ability to be resilient, And if
we could get that out to everybody with you know,
a relatively short.

Speaker 2 (50:26):
Treatment, not that we shouldn't.

Speaker 3 (50:28):
Also, you know, people can go and do mindfulness and
cognitive therapy and all these other things, and that.

Speaker 2 (50:33):
That takes time and skill set.

Speaker 3 (50:35):
It's it's like piano lessons, You've got to put putting
your time and your hours to do it. But I
think those piano lessons will go faster for people if
we can use if we can drop on their inner strengths.
Let's pull out your maximum because we all have these
circuits and we all have neuroplasticity. So every human being
has every human beings brain, as you've discussed many times,

(50:56):
has the ability to rewire and change itself, and every
human being has somewhere in though theo's circuits that allow
us to do cognitive control and to escape from rumination
and so on. These are all innercapacities that are hit
that are within all of us, and some of them
it's on the surface the highly resilient people, but in
people who aren't feeling resilient, where people do have these
access one disorders, it's not that they don't have that capacity,

(51:18):
it's just it's latent, it's hiding, and we're now having
a capacity by combining targeted brain stimulation with neuroplasticity enhancement,
we can bring out the person's inner strengths. And I
think that's something that is just would be I wish
if we could have everybody listening to is just no
one thing, is that all of us have these inner
strengths inside us, and some of us has been hidden

(51:40):
en dormant for a long time. But I think every
one of us those abilities are there and we can
bring them to the surface.

Speaker 1 (51:49):
That's beautiful. Let me just ask one last question I
wanted to come back on, which is the influence of
our social lives on resilience.

Speaker 3 (52:00):
That's beautiful and I'm really glad you brought that up,
because up until now, everything we've been talking about with
resilience is are like are like. The human atom he's
just started for individuals in isolation is one human brain
just by itself, a bunch of circuits inside a skull.
But we don't live as little atoms. No, no human
as an island.

Speaker 2 (52:19):
We all have.

Speaker 3 (52:20):
We live within a broad social fabric. And I think
you can delve into any number of beautify written books
on resilience, we'll talk about one of the greatest and
most important things supporting a person's resilience is the social
supports and fabric that they have around them. Most challenges
can be faced if they're not faced alone.

Speaker 2 (52:40):
I think most of it.

Speaker 3 (52:41):
I talked to a colleague of mind, and he talked
about how his favorite part of medical training was actually
in medical school, which some people see is the toughest part.
So but the thing is, I had these two buddies,
and the three of us we did all our studying together.
We worked through it was all we were these comrades,
and we felt like when we faced the world, we
were unstoppable. Like you know, it's a very stressful thing
going through training in medical school, but as long as
I have my two buddies with me, we could face anything. Yeah,

(53:04):
and I think a lot of us have that experience.
So there's been is, you know, a tremendous amount of
research done on the importance of social fabric and social
supports and a strong social network.

Speaker 1 (53:12):
Well, what would you recommend for people? What do you
recommend for people in terms of building a social life.

Speaker 2 (53:18):
Well, it's I mean, it's tricky.

Speaker 3 (53:20):
I think there's certainly been a shift over the last
decade in terms of, you know, how people spend their time,
and if everybody else is just locked away on, you know,
in solitary activities of one type or another, then it's
harder and harder to go out there and find people
to do social things with. But I find that the
way people build social communities is often either through mutual
connections or through mutual activities. So you can meet friends

(53:43):
through other friends, and you can and so friends are
good at introducing other friends, and activities are also good
at introducing and connecting people.

Speaker 2 (53:50):
Together.

Speaker 3 (53:51):
So one way you can kind of get two birds
of one stone is you know, running clubs have become
incredibly popular, just to take one random example of ways
that people have decided to sort of quit dating apps
and instead of just go out and go on these
big running clubs. And this is how young singles are
kind of meeting each other is by finding some kind
of activity in common. But whether you fall into that
category or not, I think there are I think a

(54:13):
variety of different websites and so on out there, like
meetup dot com is an old one that's been around forever.
I thought it was quite clever, the idea that you
just have various activities and people could connect over an
activity or an interest that they had in common. So
I think whether it's reaching out to a faith community
if you're somebody who follows a particular faith, or whether
it's an interest group, or whether it's a physical activity
like exercise or running, I think finding activities to connect

(54:37):
with other people who have that common interest is a
really really great way of strengthening your connections with other people.

Speaker 2 (54:43):
Finding common purpose among cultures.

Speaker 3 (54:48):
It's interesting if you go read up on the culture
of Okinawa Okinawa's for various is identify as one of
these blue zones where people live unusually long and so on.
But one of the interesting things that they talk about
is the unusual psychological resilience of people in Okinawa and
the concept of which I was introduced to recently. I'm
probably going to say it wrong, but eke guy is

(55:09):
a there's a word, eke guy. I'm probably going to
butcher this, but as I understand it, it is the
idea of having a purpose or a calling or a
cause and part of the culture there is that you know.
And it could be something incredibly small, it's like literally
like breaking a beach and keeping it tidy, or it
could be or it could be something lars like trying
to save the world from a resilience deficit.

Speaker 2 (55:30):
It could be anything whatsoever.

Speaker 3 (55:33):
But the idea that part of resilience involves in making
sure that your life is imbued with meaning and that
you have some kind of compass or some kind of
guidance to it. And so I think if you can
find that activity that you choose with the people around
you to be a meaningful activity, something you find that
gives you purpose and meaning in life, that carries eke guy.
And if on top of that it's not just a
personal meaning, but if you can then use that as

(55:54):
a nucleus to build a community of other people around
that common purpose, there incredibly resilience to be had and
being a member of a community of other people, all
of whom are dedicated to a common and meaningful cause.
And I think if you don't have access to a
TMS machine, I think that's certainly the compass that I
would lean into.

Speaker 1 (56:18):
That was my conversation with Jonathan Downer. So what is resilience.
We've long thought about it as a psychological trait. We
talked about grit or determination or optimism. But what today's
conversation hopefully makes clear is that resilience has a physical
footprint in the brain. It's not just about what you

(56:41):
choose to think. It's about how your networks are operating.
It involves a carefully orchestrated interplay between brain areas involved
in emotion and reward and control and so on. And
these brain networks can dip the balance between breaking down
and bouncing back. And I think this is some of

(57:04):
the most exciting and practical work happening in neuroscience. People
are identifying these circuits and they are influencing them using
tools like PMS, and this can, when it works, enhance
a person's ability to function across a whole spectrum of disorders.

(57:25):
And so one lesson that emerges is that resilience isn't
just something we summon after disaster strikes. It's something we
can build ahead of time. It's something we can cultivate
in the brain like a form of mental infrastructure, one
that helps us face whatever is coming down the pike next.

(57:46):
And as our knowledge improves and the technology improves, this
all may eventually lead to a paradigm shift in mental health.
Instead of treating one disorder at a time, like depression
or anxiety PTSD, what if we focused upstream, What if
we try to increase resilience itself across the board. Of course,

(58:09):
biology is only part of the story. Social support, culture,
personal meaning. These are all powerful factors and addressable factors
when we're thinking about resilience in our lives. But it's
amazing to realize that even in the hardest moments, the
exact state of the networks in your brain matters for

(58:30):
the degree to which you can be an active participant
in recovery. Maybe if we come to understand resilience in
the brain and psychologically and socially, we can help more
people to thrive. So thanks for tuning in today. If
this episode moved you or challenged you, or sparked questions,

(58:51):
I'd love to hear from you. Pop me an email
at podcast at eagleman dot com and if you ask
me to, I can pass your note on to Jonathan
as well. And if this episode made you think about
someone in your life who embodies resilience, please share this
episode with them. Science is catching up to something that
people have known in their bones for a long time.

(59:13):
The mind can bend without breaking, and sometimes in that
bending it gets stronger. So until next time, take care
of your brain so you can take care of each other.
Go to Eagleman dot com slash podcast for more information
and to find further reading, and check out and subscribe

(59:36):
to Inner Cosmos on YouTube for videos of each episode
and to leave comments. Until next time, I'm David Eagleman
and this is Inner Cosmos.