Brains, conflict, and democracy with Dr. Sebastian F. Winter, MD [Ep. 12]

In this episode Laura interviews Sebastian F. Winter, a physician-scientist working at the intersection of public health policy, medicine, and academia with a vision to shape healthcare and inspire a lasting social impact. 

He is currently Head of Policy and Research at the International Bureau for Epilepsy (IBE), where he works with an interdisciplinary team committed to make epilepsy a global public health priority and improve the lives of over 50 million people living with epilepsy worldwide.

Beyond previous roles in clinical medicine and research, he co-founded and co-lead a social venture that promotes mental health and peace-building among refugee communities. A globally trained MD-PhD with exposure to various healthcare systems across four continents, he is passionate about public health and education policy (past projects at WHO Europe and UNESCO), as well as academic research, including projects in neurotoxicity, oncology, refugee mental health, brain health, NCD prevention, and public health ethics.

His work has been published in peer-reviewed journals such as Neuro-Oncology, Neurology, the European Journal of Cancer, The Brookings Institution Press, Conflict Resolution Quarterly, and the International Journal of Health Policy and Management, and he has gathered substantial experience as a public speaker at international conferences and platforms including TEDx.

An alumnus of the German Academic Scholarship
and PhD head of Policy and Research atthe International Bureau of Epilepsy,
co-founder and Chief Medical andScientific office at Resolute and

(00:32):
affiliate researcher at Harvard MedicalSchool and Massachusetts General Hospital.
So welcome, Sebastian.

Sebastian F Winter: thank you so much Laura. (00:40):
undefined
I really appreciate this kind invitationand opportunity to be on your.

Laura (00:46):
Well, I am very excited to have you here, as you know, partly
because of your research, which isfascinating, and partly because this
is actually the second member of thewinter family we've had on this podcast.
So , you know, it's we've had Helentalking about Resolute before and
you're gonna talk about a differentangle and also some of the fantastic
research you've been doing,

Sebastian F Winter (01:04):
Thank you so much.
And I think it's wonderful also thatyou had Helen on and truly appreciate
the opportunity to be able to speaka little bit more about Resolute
and the work we've done there.
And to talk about some of theother research I've been doing
over the past couple of years.

Laura (01:20):
Super.
So speaking of your research then, becausewhen you look at your profile, I can
see you've written about spinal surgery,about cancers, about human dignity, about
brain tissue necrosis, which is somethingI really wanted to be able to say.
So what actually is your specialtyor your area of interest?

Sebastian F Winter (01:37):
That's actually a very, a good question and a good summary
of the research portfolio I've beentrying to establish over the past years.
So I think it's it's really tellingperhaps that, you know, I'm I found
it difficult to put my uh, foot ontoa specific thing onto a specific area.
But I've been very interested inexploring various areas and I started

(01:59):
out actually with, during neuroscience,so I have an undergraduate degree in
neuroscience, and through that gotinterested more and more in, into the
clinical elements of neuroscience andwhat relevance that has in society.
So I then ventured into medical school,and this is where I was of course very
passionate about all things brain relatedespecially neurosurgery and neurology.

(02:20):
So I had the chance actually to goabroad and do some fantastic internships
with some of the leaders in the fieldas I've been to Toronto San Diego.
But also just other other areasincluding South Africa and Japan.
And that really sparked an interestin you know, different healthcare
systems and different approachesthat we take to solving neurologic

(02:42):
disease and brain conditions.

Laura (02:44):
Basically you sound like the Percy fort of medicine, right?
Because I mean explorer back in theday and I feel like you're doing
the modern version of that Oh.
so that's fantastic.

Sebastian F Winter (02:58):
And on this journey through medical school, I've been
very fortunate to also reach out tosome of the more uh, systemic uh,
issues and get in touch with that.
So I did a couple of, of internshipsat at W H O and unesco, and that
really sparked my interest inthe systemic factors, right?
Because it's of course, one thingto to see patients in the hospital.

(03:19):
And it's extremely gratifying to dothat because you have this immediate
feedback that you're adding value.
But I also quickly realized that you'rein this big machinery and that there's
of course other factors that areinfluencing health at a population level,
and that it's actually quite importantthat we look at those for society.
And that there was a lot of greatindividuals out there doing exactly

(03:41):
that whether it's, you know,health policy or public policy or
systems approaches to neuroscience.
And that really I think it then tookoff when I co-founded Resolute with
my sister Helen, that I realizedthe importance of actually kind of
trying to translate medical knowledgeinto solving societal issues.
And I was very inspired actually by thisby this great physician who was actually

(04:04):
at Charlie Medical University, whichwas my medical school, my alma mater.
His name is Vir, and he was actuallyknown for a founding cell pathology.
What I don't think a lot of peopleknow as the founder of social medicine.
And he had this famous quote sayingthat medicine is a social science

(04:25):
and politics is nothing elsebut medicine at a larger scale.
And when I heard that as a student,I thought it was fantastic because
it's really tapping into thiselement that with medicine, because
we are so close to humans, right?
And we're trying to amelioratesuffering it's essentially what we do,
even if, you know, situations do notnecessarily allow for a good outcome.

(04:46):
You're always trying to do noharm and to prevent suffering.
And ultimately, as societies and associetal level, particularly of course,
in, in democratic nations, this is whatwe are striving to do collectively.
And I thought that, you know, thatreally stuck with me and seeing that
in, in action doing something on theground, I think was very in instrumental

(05:07):
for subsequently venturing into theseother fields that you mentioned.
And of course, that's, it's alittle bit all over the shop
ranging from brain tissue necrosisto you know, global health.
But I hope that, in someways some of these things can
can add value down the line.

Laura (05:22):
Absolutely.
And you know, as you were talkingabout medicine as a social science,
I found that really interest.
And I'm not sure how popular that viewis amongst the medical community as well.
Because, I mean, what it made me reallyreflect upon is how um, medicine and
how we view different people's bodiesactually really influences society, right?
Because I mean, we hear about women'sbodies not being researched in the

(05:45):
same way or only from a fertilityand reproduction standpoint.
We hear about black bodies and, you know,bodies of color, sort of not actually
having the same kind of diagnoses forskin conditions or other conditions
as well, or interpretations of pain.
And so it's, it becomes reallyobvious at that point, I suppose,
that medicine is social and the waywe view the world affects how we

(06:05):
view the body in the way we view thebody affects how we view the world.
So really interesting intervention.

Sebastian F Winter (06:12):
That's absolutely uh, uh, true and a very important point.
And I think also the medical field,as you say, has a lot to learn, right?
I mean, if we are looking forinstance the effects of sex and gender
and how different conditions uh,manifest themselves so differently
between men and women and also youknow, across different ethnicities.

(06:33):
That's something wheremedicine has to play a lot of.
Up.
Right?
If you think about, for instance,clinical trials being run and the
majority of cases, vast majorityof cases in, in males, right?
And then we're giving the sametreatment and doses to females, right?
And so I think there's a lot ofa lot of impetus to change that
obviously and rightfully so.
So there's, I think, a tremendousamount of catch up to be played

(06:56):
to be made in this field.
And this also of coursepertains to the brain.
So there's a big uh, movement ininstitution, the Women's Brain Project,
who are doing exactly that, right?
We are looking at differences.
In a brain structure, function,manifestation of diseases
between men and women.
And of course there is so muchthat we don't know yet, but so much

(07:18):
how we can truly enrich the field.
And it all ultimately boils downto personalized medicine, right?
So, so also on this microscale, howcan we best serve each individual
person with their own specific elementsand in the sense of you know, brain
function, behavioral attributes, right?
That's ultimately where we want to get at.
But of course that'sdefinitely a long road ahead.

(07:39):
But yeah, very important also forthe medical field to take note
and to prioritize those areas.
You mentioned

Laura (07:45):
Let's talk a bit about this work you've done, . with
Helen and with Resolute.
Cause you've mentioned it a littlebit already and I saw as well that
you wrote this paper together.
I think with Helen's first author,so I'm not gonna steal her credit
about psychosocial peer mediationas a sustainable method for conflict
prevention and management amongstrefugee communities in Germany.

(08:05):
And can, I guess that your contribution tothat paper will have been something to do
with medicine or stress or trauma perhaps.

Sebastian F Winter (08:15):
That's exactly right.
So I'm a very big proponent of ofevidence based policies and when we.
A co-founded resolute you know, wewere doing all of these activities and
workshops and I was always thinking,okay, are we actually adding value
and is this making a difference?
And clearly the answer wasyes, and we could see that.

(08:35):
But kind of being a geeky scientist andcoming from that angle, I was very keen
for us to actually take a step backand say, okay, let's analyze what we've
done over the past couple of years.
And and Helen thought it was afantastic idea to do that and kind
of go back and identify, okay whatare actually the key elements that
is making this work successful?
And what are kind of the barriersand challenges that we need to

(08:56):
overcome and how can we kind ofnicely package that also into a
paper that adds value to the field?
And that can potentially serve as, youknow, maybe not a blueprint, but a.
Attempt for others to look at thiswork and see how they can apply
that in their own unique settings.
Right.
Because, I mean, Germany is not the onlycountry where of course there's, there's

(09:17):
you know, migration and consequences fromthe and I don't like this term refugee
crisis, but it is, of course, it wasa humanitarian crisis in 2015, 2016.
And we took the bulk of ofrefugees coming to Europe.
But of course, we alsohave a migratory issues.
In other in other countries.
Right.
And so if you're thinking about,for instance the US and and the

(09:38):
migratory conflict there, right?
So there's, I think, a lot ofscope for some of these concept
which will hopefully dig in aminute to to be applied elsewhere.
And I think that was therationale behind this paper.
And to also have resolute b not just aproject on the ground, but also to kind
of showcase that work and create a littlebit of a think tank to, to push the field.

(09:59):
So this was our humbleattempt at doing that.

Laura (10:03):
Okay.
It sounds really interesting, butjust to take a step back for a moment,
so how did this study actually work?
Because I understand that resolute,of course, helps with peer mediation
training amongst refugees inrefugee camps and other similar
circumstances, particularly in Germany.
And so, I mean, how did youactually do this study or how did

(10:23):
you actually see results from thiskey mediation training over time?

Sebastian F Winter (10:28):
Um, so essentially the way it works just going back a
little bit is that we saw a definiteneed when you know, this migratory
crisis happened in 2015, 2016.
That of course it presented hugechallenges and not just integration into
German society, but also the and this iswhere kind of the medical elements come.

(10:49):
Indeed, the psychosocial sequela.
Of a conflict, right?
And of escaping conflict.
And it's some in the field havedescribed this as kind of this a
triple hit theory of trauma whereyou know, you're fleeing conflict
and violence in your home country.
A lot of these peoplehave lost family members.
They've been prosecuted, they'velost their homes, they've lost

(11:10):
their economic existence, and.
Forced out of their country onthen another life threatening and
existential journey that oftentimescan also result in death and despair
and loss of life to then come intoa host country, which is initially,
I mean, yes, it is a host country,but it is also a hostile environment
for many that come there, right?

(11:32):
And of course you're trying to dothe best on a, from a humanitarian
standpoint to address immediate needs.
But once these immediate needsthat's usually kind of physical
and first psychosocial supportare addressed, then their second
step is, okay, what do you do now?
Right?
And so a lot of the refugees and peoplewho are fled from Syria and and Iraq
and other places they have been inthese shelters for many years, right?

(11:56):
Some of them have been there for,I don't know, five five years.
More.
And the question is,okay, what happens now?
And it's very difficult, ofcourse, to establish a new
identity in a new country, right?
There are all of these democratichurdles and barriers, and it's
definitely one of, I think, one ofthe most complex problems to solve.
So I don't want to kind of criticize thegovernment there on, on these efforts.

(12:18):
And I a lot of people in HS in hindsighthave actually also congratulated
macle on making the decision,that humanitarian decision to say,
okay, we're gonna open our doors.
And I think it has enrichedthe country in many ways.
But of course, there areproblems that come with this
that you need to address, right?
And I'm just talking about the f So wehave an incidence of 50% in many cases
of posttraumatic stress disorder, right?

(12:39):
Based on this triple theoryof trauma that I explained.
And this of course, leads totremendous challenges, including
conflicts, which we what, which isthe focus of your podcast, right?
And conflicts and society and issueswith integration and mental health.
And so coming from that perspectiveI tried to build a curriculum with
Helen, who is of course and you'veinterviewed her, trained a mediator

(13:02):
and lawyer who is a little bit bringingthis conflict, this concept of peer
mediation to Germany because this is quiteactive, as you know, in the us and it's
carried out in schools, for instance.
But it's not so well known in Germany yet.
And we saw this or rather Helen sawthis this possibility here to really
add value and establish peer mediationmechanisms in shelters, which basically

(13:25):
means that a neutral, a third partyamong the community of refugees mitigates
and salt and prevents conflicts andserves as a first contact point.
But then actually piggybacking onthat it makes sense to, to to foster
a brain health and and mental healthliteracy with these peer mediators.
And actually, Psychosocial peer mediatorseducate psychosocial peer mediators who

(13:49):
can also serve as this first contactpoint when somebody notices that they're
struggling with their mental health andwhen there are clearly issues that can
be adequately addressed and dealt with.
Right.
And again, this goes back to doingawareness and doing advocacy work because
a lot of people, a lot of individuals,and it goes for all societies and of

(14:11):
course also western societies wheremental health is still a big taboo.
Right.
And you would think that thiswill change and hopefully it
will, but it still hasn't.
Right?
It's to generate that first levelof awareness to say, well, this is a
biological response to chronic stressand peak stress and trauma levels,
which is manifesting in so many ways.
You know, some people would say,well, I've been having chronic back

(14:31):
pain for, I don't know, two years,and it started when I was coming to
Germany and, you know, they've gone tophysicians and of course nothing is.
And necessarily wrong with theirback, but it's a psychosomatic
manifestation of that trauma, right?
It's just one example.
And so, so creating thatfirst step of awareness is a,
is an absolute game changer.
And when we saw that givingthese workshops, we saw that is

(14:53):
really the, where the value lies.
Now, to come back to your actual questionis how was the study uh, uh, carried out?
So we did quite a few uh, workshopsacross Berlin uh, Brenton board
uh, , , so several counties.
Uh, At Germany and we try to evaluatebest and distill best practices
and challenges and opportunity.

(15:14):
And this was really a thingthat we kind of did on the go.
It took us years to refinethis curriculum, right?
Initially we were, and you've discussedthis with Helen, very naive, you know,
just going to the local language sheltersand language cafes and talking to to
refugees and to German volunteers who areteaching them German and asking, Hey, do
you think this program makes any sense?
Can you see value of this program?

(15:35):
And then once we were going into refugeeshelters, we very quickly realized
that our approach which was kind ofmy very academic approach, doing like
a top down presentation on what brainhealth is and what chronic stress is,
that's never going to work, right?
That's the complete wrong approach.
And so we flip.
Concept 180 degrees toa bottom up approach.

(15:56):
And Helen was very instrumental to thatto completely create a curriculum that
is very interactive, highly dialogueand role play based, and essentially
a learning by doing experience.
And that really, I think for us, wheresome key learnings that we try to distill
in that paper and other key learning, Ithink in addition to these interactive
role plays and fostering a dialoguewas to foster intercultural dialogue.

(16:20):
So, not just doing theseworkshop with with refugees and
homogenous group, but actually.
Inviting German locals, invitinglocal neighbors to these workshops.
And it was just fantastic.
It was fantastic to see whathappened then, because all of
these issues of friction and allof these conflict points were being
discussed, but in a controlled format.

(16:40):
So, and that really helped to breakdown barriers and stereotypes because
I think one of the main reasonsfor stereotypes and preconceived
notions and barriers to occur is thatthere is a lack of dialogue, right?
But if you actually facilitate thisdialogue, you create this platform some
magical things can happen on both sides.

Laura (16:58):
And so how actually is it that you create this
platform as you've described it?

Sebastian F Winter (17:03):
We realize that the instrument to, to really do that.
the initial instrument is of coursebuilding trust, because you cannot just
force people and bring them in a roomand then say, okay, now talk about.
I don't know.
Some German people on a train will notsit next to the person wearing a knee cup
or a hijab or something like that, right?
You cannot, I mean, that's not gonna work.

(17:23):
You need to build this.
Initial trust to be able to discussculturally sensitive issues.
And so we created this uh, toolthat we call the Story Sharing Forum
which is this initial way for us tostimulate dialogue and to have refugee
participants share their story.
And the good thing is this kind ofcreates ownership for them because
they can decide which elementsof the story they want to share.

(17:45):
Sometimes they decide toshare this also through art.
So we would have art sessions where youknow, people would draw their story and
it's a lot easier because then you cankind of just narrate what you have drawn.
And it's not, it's, youknow, it takes it away.
It takes attention a little bit awayfrom your individual state of mind.
. So there, there are a lot ofelements that we try to distill.
And final one I think I shouldhighlight is having refugees as co

(18:09):
trainers and having refugees withinResolute, because I can never go
as a person who is not experiencedthis trauma and this journey and the
experience of fleeing your home country?
Fortunately I never had to experiencethis, so I cannot relate, I can
relate on different levels, butI cannot relate on that level.
And I think in order for thisto be a success and in order to

(18:32):
create role plays and to create acurriculum that truly adds value, it
needs to be a realistic curriculum.
And in order to build trust, you alsoneed to have peers from that same group.
And so actually when when you'relooking at Resolute I think something
like 50% of our volunteers and ourstaff members are refugees or have
a refugee or migration background.
And I think that was truly instrumentalfor us to build that trust and resident

(18:56):
to be able to scale into various regionsand then ultimately for us to conduct this
evaluation and also conduct the paper.
Yeah.

Laura (19:03):
Wow.
Okay.
I mean it's absolutely fascinatingand kudos to you and the whole
team on this adaptive processit sounds like in the end.
So I mean that must have taken alot, you know, cause you go in there,
you're like, oh we'll teach them this.
And then suddenly you'regoing, nothing is working.
And that's very hard to deal with.
And so I wanna circle back for amoment because you mentioned this
idea of a psychosocial peer media.

(19:26):
And so I'm just kindahop, you can clarify for.
Exactly what this is because I mean,recently a colleague sent me an article
about, I think it was a jurisdiction inthe US and they started sending mediators
to mental health problems or, you know,domestic disputes and stuff like that.
And I was like, oh, well actually a lotof mediators aren't really psychologists.

(19:48):
Right.
And so I'm wondering, I mean, actuallywhat do the psychosocial peer medias
actually know or need to know, andwhat's the limits around what they
can do or what they can cope with?
At least as far as resolute is concerned?

Sebastian F Winter (20:00):
Yeah, no, that's a wonderful question and I think a
very important one because I thinkthere comes a point where you need
to know where you're in this systemacross the care trajectory, right?
And so for us, we understand ourselves andwe train our psychosocial peer mediators
as the first level of support where theoverall mission is to generate awareness

(20:23):
and to be able to channel individualswho need professional psychosocial help.
To the right resources, right,facilitate that that channeling
into the right hands, right?
Because quite often there's not evenawareness that there are so many
psychosocial counseling servicesand the professional services
available, for instance, in Berlin,and this awareness is just not there.

(20:45):
So a lot of it is also recognizinginitially that there is a problem, right?
Recognizing red flags oftrauma be it social withdrawal
be it recurrent conflicts.
And I think this is where mediationcomes into play because individuals
who are traumatized and who haveperhaps a psychiatric comorbidity or

(21:05):
depression anxiety are more prone toto have the conflicts which can result
of course also in violent alter.
But they are also often morevictims of this conflict.
So it's a reciprocal thing where,of course your ability to resolve
a potential dispute is impairedto some degree based on right, the
effects of this mental health issuethat you may be going through.

(21:29):
And this can of coursebe exploited in conflict.
So these individuals tend to be morevictims of conflict, but also reciprocal.
They find it difficult to solvethis conflict and that potentially
are more prone to find themselvesin situations of conflict, right?
Which is also why there'shigh incidences of conflict.
It's one of the reasons why there'shigh incidences of conflicts in refugee
shelters, you know, and then someof these shelters, there's police

(21:50):
presence almost on a daily basis.
Right.
There are other factors.
There's monomy, there's boredom.
When you're just confined to one place,there's cultural issues, et cetera.
We don't have to go into that.
But that's an important question.
I think that you know, for us itwas important to understand that
mediation, a lot of mediationis ultimately, Psychology.
Right.
And I think mediators who are reallygood are the ones that also are

(22:14):
able to empathize and to understandthe psychological ramifications
of a partic particular conflict.
And they're able to appease both parties.
They're able to understand how to letother people safe face, how to reconcile
difficult, invisible psychologicalbarriers to potential conflict resolution.
And here, of course, I mean,this doesn't have to be on a very

(22:37):
sophisticated scale, but it's reallyteaching our mediators, the, and we
call this the biocycle social concept.
It's an official w h o term, right?
Looking at the bio the psycho bio EDS.
Of conflict and consequences ofconflict and looking at specific
mental health factors and how theymanifest themselves in behavior, right?
So these are people who you can ideallyapproach where your own peers who will

(22:59):
then be able to also not just recognizethat there's a problem, but also be able
to sit down with you, elaborate on thisproblem educate the person making the
person aware that this is treatable.
First of all, it's a treatable condition.
And then as a next step, and that'sthe important step, offering concrete
information to this individual wherethey can get professional help.

(23:21):
Right?
And so we've established actuallya numerous of these shelters, peer
mediation clinics, which are basical.
You know, sometimes even physicaloffices where the management of the
shelter says, okay, you have thisoffice here as peer mediators and
individuals can come to you your peerscan come to you and resolve problems.
And so the shelter's management isoften very, very grateful that is in

(23:41):
place because it's obviously a lotbetter if peers from the same group can
resolve their own disputes rather than.
External mediators or even police comein and you know, once the conflicts
have, have escalated and been exacerbatedby factors to kind of, be able to
resolve it before it comes to that.
So I think that is our mission.
But I also don't want to say thatthese are professional, professionally

(24:03):
trained trauma consoles isactually quite the opposite, right?
It's also not our intention to do that.
Our intention is to build that initiallevel of awareness and to make sure
that these individuals who have theseissues and who need help don't get
lost in the system because that'sthe fundamental problem, right?
That they're not aware and that itwill go unnoticed and that it will get
worse, and that it will lead to youknow, worst case death of despair if

(24:27):
societal withdrawal addiction financialruin, all of these things, right?
This is what we want to prevent.
So there's also big angle of preventionin our mental aware program, which
is the mental health program that I.
Yeah, I created that

Laura (24:40):
Fantastic.
I love that you just, at the veryend there, you're like, oh, by
the way I created this program

Sebastian F Winter (24:45):
it took a it's like,

Laura (24:46):
oh yeah, I did do this.
So that's, you know,that, that's incredible.
And so if I guess if I can summarizewhat I've understood then it's that,
these peer medias are being trainedreally as mental mental health first
aiders in a way so they can pointthe direct, but they're not expected
to be full trauma psychologist andthat is probably even inappropriate.
Right.
So, alright, good.

(25:07):
All right.

Sebastian F Winter (25:07):
In a nutshell.
Uh, Yes.
Sorry lengthy explanation there.
and

Laura (25:11):
I dunno.
Okay.
Super.
But I mean, you mentioned this roleof trauma and conflict and of course
it's not, Refugees who experiencetraumas, a lot of people out there
who are living with trauma and theeffects of trauma on a regular basis.
And so this brings me then to a paper, aworking paper you've just produced, which
was about brain health and policy, makinga new concept to strength and democracy.

(25:37):
This is a lot of very fancywords in the title, and I'm
very excited about the content.
So just to sort of jump in, I mean,what are the links between trauma and
conflict and democracy in the wider world?
Huge question.
That's actually reallydifficult to answer.
. Sebastian F Winter: I think that's a huge question.
It is a very, a good question isI think in part what we try to

(25:59):
answer with this paper, right?
And I think there's, of course, beyondconflict, but conflict is, I think one
of the main reasons as to why democraciesare suffering around the world.
And config is also, I think,of course, a main yeah.
Consequence of of brainill health, if you will.
It's an awkward term but of suboptimalbrain health and vice versa.

(26:21):
It also
Suboptimal know somehow sounds worse.
sounds worse
You and your suboptimal brain

Sebastian F Winter (26:27):
That's true.
So, so, so I think that's whysemantically, you have to be
always careful, I think withthe term brain health, right?
Because what we want, and it's, we makethis point on the paper, what we want
to prevent is kind of nutopia, whereit's all about optimizing brain health
and streamlining human beings to themaximum possible and creating kind of
like a brave new world, if you will.

(26:48):
Right.
I think, you know, and there's always,there will always be power brokers
who will try to use that to theiradvantage and stratifying citizens and
to like brain healthy, superior andstop optimal uh, brain health people.

Laura (27:03):
yeah, it's really interesting Cause you've just mentioned this idea
of politicians, stratifying peopleby their brain, healthiness, right?
But isn't that in effect whatwe already have in many ways?
Because you tend to find that peopleof lower socioeconomic status tend
to be those who are suffering as aresult of mental health issues, right?

(27:23):
Whether it's trauma ordepression or anxiety.
And they're also the ones who have lessaccess to resources to help redress that.
At the other end of things, you've gotpeople, from what I understand, who are
because of the lack of mental healthproblems perhaps emotionally functional
or more able to emotionally regulate.
They have less issues sort ofgetting along with people and

(27:43):
progressing in their careers andin their workplaces as well, right?
So isn't that kind ofwhat we already have?

Sebastian F Winter (27:49):
Yeah, I think that's a, that's an excellent point.
And I think in many ways it comes down tothis issue of brain health equity, right?
Because brain health is obviously agood that we need to be able to maximize
and to provide for across all levels ofsociety and across all settings, right?
And that is really, I think,a herculean task based on what

(28:13):
you have mentioned, right?
That circumstances.
And we call these often the negativesocial determinants of health
or even of brain health, right?
And you've mentioned a few here, youknow, for instance, economic insec,
security lack of education stigma,discrimination against people with,
for instance, neurological conditions.
All of these factors ultimatelyare barriers to brain health.

(28:34):
And I think it makes sense when we'rethrowing around the term brain health.
It makes sense to look into definitions.
And believe me, a lot of peoplehave tried, there have even been
papers on this to to define whatdoes brain health actually mean.
Right.
And there's a, I think 2022 is a milestoneyear for the brain health community

(28:54):
because w h o has taken a lead andlaunched a position paper on brain health
where they define brain health essentiallyas a state where every individual can
learn, maximize their full potential,optimize their cognitive, psychological,
neurophysiological and behavioral aspects.

(29:19):
Adapt to changing environments.
And that is a very complexdefinition, but it has some, I
think, some key elements, right?
So it's a state in whicheverybody can learn, which is a
precondition for anything, right?
For brain development and formaximizing our own potential, right?
And this is individual, this potential.
So this is a person-centered approach,and it is a life course approach, right?

(29:41):
So, so I want to live in a worldwhere you know a three year old
child can optimize and can hittheir developmental milestones.
And at the same time, an 80 year oldwith, I don't know multiple comorbidities
is still able to enjoy quality brainhealth and participate in society, right?
And we of course, have huge,we're a huge step, a big step

(30:03):
away from realizing that, right?
We have huge challenges.
I think this goes hand inhand with the burden also of
neurological disease that we see.
So the second big paper asto why the neuro community is
so excited and why people arespeaking of a neurology revolution.
The second paper, in addition to the brainhealth paper by W H O is the what we call
iap, the Intersect Global Action Plan forepilepsy and other neurological disorders.

(30:29):
Because we have seen over thepast 35 years that it has been an
incredible increase in MNS disorders.
MNS is kind of a term formental, neurological and
substance use disorders, right?
All disorders pertaining to thebrain and nervous system ultimately.
And now just to give you a figure,one in three people will develop
a neurological condition at somepoint in their lifetime, right?

(30:52):
So we're talking about the secondleading cause of mortality worldwide.
And the first leading causeof disability world, right?
So that's a huge amount, and it doesn'teven include depression, where we know
that half a billion people on the planetare suffering from depression, right?
So if you take all of this together,that is a ginormous burden of disease.

(31:14):
It is, it comes at a detriment to eachindividual, but also to societies and
democracies while we're on the topic.
And it is also costing trillionsof dollars in lost productivity.
If you wanna take an economic angle, whichobviously in policy always makes sense
because people also want to know whatis feasible from a financial standpoint,
and where do we need to put our money at?

(31:35):
And arguably, is this wherewe need to put our money at?
Because it is hemorrhaging dollarsand it is much more important from
my perspective as a clinician andneuroscientist, it is causing loss of
life and loss of healthy life years.
And it is it is coming with hugepolitical consequences in the,
specifically now in the 21st centurywith unprecedented challenges, as you

(31:57):
know, that we need to deal with, right?
And these, many of these challengesare brain health challenges,
which we refer to in the paper.
Yeah, so we're very excited for policymakers to hopefully take note and to
understand that arguably the brain shouldbe central on the policy agenda because
we use our brains for everything, right?
And with other brains there.
no humanity.

Laura (32:18):
Yeah, it's true.
It's I mean I'm actually reallywondering there, cause you mentioned
this range of neurological conditionsand depression, what have you, and
I'm wondering before we get into the,the key findings of this paper um,
about the role of climateanxiety, which is increasingly
recognized as an issue, right?
And it's that sort of depressionslash anxiety around climate change

(32:40):
and what it's gonna do to us andwhat the future can really hold.
So, I mean, do you feel that thatis also gonna feed into this problem
as climate change becomes worse?

Sebastian F Winter (32:50):
Absolutely.
100%.
I think that's a fascinating pointyou're making there because initially
it doesn't seem so obvious, like whatis the link between climate change and
brain health and, you know, societies.
But there is a massive linkif you're thinking about macro
level stuff, for instance, wholepopulations being displaced as
a consequence of climate change.
I think the.

(33:11):
Is the highest ever the U NH C R figure of people being
forcibly displaced at the moment.
And it's not just conflicts andwarfare but also climate change, right?
If you're thinking about famine inducedby you know, droughts, et cetera,
that displaces whole populations andit completely shifts whole ecosystems
and societal ecosystems and it causesnot just disruption at population

(33:33):
level, but also at an individual level,as you say, with climate anxiety.
And a lot of people are wondering,like, you know, do I want to live
in a world where we may not seetomorrow and it may not be livable?
Do I want to give birth to a child and putthe next generation on this planet, right?
So, and I think these are all valuablethoughts, and it's causing a lot
of disruption to people's minds.
In addition to this, these more measurableeffects we talk about this as the, we

(33:57):
refer to this as the exposome, right?
And this is basically allenvironmental exposure.
To our bodies, you know, from pollutantsto micro and nanoplastics the effects of
which were only beginning to understand.
And this does not only happen ofcourse to animals, but it also
happens to human beings, right?
And so there's something like 80,000neurotoxins, some of which have been

(34:21):
directly linked to neurodegenerativeconditions such as Parkinson's
disease and Alzheimer's diseasethat we're growing up with, right?
And so you have to think about this whenyou know the brain is developing and
the brain developing takes a long time.
It takes, human beings are so muchdependent on their primary caregivers,
on their parents for such a longtime because the brain takes the

(34:43):
darn long to, to develop, right?
And myelination, whichis basically the forming.
Of of an isolating sheath of Mylan aroundthe nerves to make them conduct faster.
Right it's like the wiring,the cables around our neurons.

Laura (34:56):
They fly together.
They wire together, right?

Sebastian F Winter (34:58):
fire together and they wire together, but they only do
that if this myelination properly occurs.
And this occurs up untilyour early twenties.
Right.
To give an example.
So, so for me, and presumably alsofor you, it's, we're already on this
declining and where the myelination hasfinished but it develops for a long time.
Right.
And what if we are increasingly findingourselves in situations where the young

(35:19):
generation which are really the, theleaders of the future are growing up with
this exposure in addition to all of theother challenges that we talked about.
Right?
So climate change, I think has a huge.
Impact on brain health and vice versa.
If we were to flip this, we mustbecome more climate aware, right?
This is something super intangible.
As a concept.
There is a super high scientific,something like 99% scientific

(35:41):
agreement that climate changeis real and is happening.
Yet the societal awareness, or atleast the impetus to understand
and to adopt a climate friendlymindset is just not there.
So how do we get there, right?
How do we elicit that behavioral changein people and what can our democratic
institutions do to you know, not justcombat the effects of climate change

(36:01):
by agreements and you know, carbontexting, et cetera uh, but also how to
elicit that, that change in behavior,and that's really difficult, right?
So it's definitely an issue that shouldbe high on the agenda, fostering climate
awareness and and the climate mindset.

Laura (36:15):
And you know as you were talking as well about the youth today and beyond
climate, I was reading just earlierabout the effects of covid and isolation
on people of formative years and justthe implications people are already
seeing as far as social capabilityas far as trauma, but also just as
far as basic cognitive functioning.
Like reading, like there's childrenwho are years behind and young

(36:36):
adults starting to attend universitywho just don't have those skills.
So I think that we're not in a greatplace for brain health, are we?

Sebastian F Winter (36:44):
Absolutely.
And this is another important point we'veseen with the Covid pandemic in many ways.
The I think various factors.
One is the difficulty for governments andfor policy makers to use scientific facts.
And based on that to implement policies.
And we've seen that nations whohave actually done this and who
have implemented the policieshave done a lot hell, lot better

(37:05):
than other nations, right?
Be it, I mean, the simple termwould be the use of masks.
And it's not just the US wherepeople are struggling to do this.
We've also seen this year in Germanywith politicians taking very long to
implement a measure that just is rootedin evidence and makes a lot of sense.
But it has taken a long time to adopt tothe point where it made people insecure

(37:26):
about what is now right and what is wrong.
And has certainly caused a lot ofexcess deaths related to covid.
But also on a more individual level,we've seen the I don't wanna say lack
of resilience, but it is in many ways alack of resilience to these catastrophes,
which will invariably happen again, right?
This is these pandemics,people have warned us of this.

(37:47):
They have been position papers.
In the past on this and analyses and it'svery likely that something like a covid
will occur and more and more frequently.
And so our inability to cope withthat on a societal level because of
a lack of resilience, I think speaksvolumes to what we must do to invest
into fostering resilient brains.
Now the question is how doyou foster resilient brains?

(38:10):
Right?
That's a whole new field.
But we may think about startingwith young brains and pushing
educational programs that foster.
Character traits, like resilience, like,wisdom in a way, like, empathy, right?
So these are all.
I think issues where we need to understandhow do we program our brains, or how
do we foster and nurture brains in away where we can become more resilient

(38:34):
citizens, where we can you know, enduresomething like a lockdown, which is
a super artificial construct, right?
And it costs so much anxiety anddepression and so many consequences that
you've mentioned with delayed developmentand whole years of schooling being lost.
And we can only begin to understandwhat the long term sequel of that are in
the future as these children will thenbecome the next generation of leaders.

(38:58):
And the same goes actually for digitaltechnology and regulating that, right?
I mean, it's recently I think.
I saw a, it must have been like a oneyear old child with who's trying, and
then instead of a pacifier the parentswould give this child an iPad, right?
To watch something.
And the question is this, I mean,
Yeah.
mean, Yes, in many ways that'sthe new digital age, right?

(39:18):
But understand what are the longterm consequences to that, right?
Because our brains are not necessarilyattuned as we've seen, to understanding
and to processing information atthat type of speed at that age.
So of course, certainly we can leveragetechnology positive impact on all
pro-technology and individualizedteaching and development, but we also must
understand the flip side and the potentialharmful effect of digitalization.

(39:42):
And so I think that is a very bigtopic that we're discussing in this
paper because as we've seen, andbringing this back to democracy is
how fragile democracies can really bewhen, and this and disinformation are.
Used by foreign actors to interfere inelections in referenda to spark and to

(40:02):
spike and instigate partisan Chisholmpolarization uh, internal radicalization
that destabilizes democracies.
And we've seen this in the us.
We've seen it in Europe with uh,elections and rise of right wing parties
for instance in Germany and France.
Now in Italy we've seen it with Brexit.

(40:22):
We see it with other autocratic nationslike China who are using technology
for mass surveillance purposes, right?
So we're not to get too political.
But I think allowed for, yes, I think,you know, I always struggle a little bit
with this as a, primarily as a medicaldoctor and as a scientist, because what
you want to do, I think is to remainobjective because that's how you.
How you measure things incontrolled settings, but we

(40:45):
cannot do this in the real world.
In, in medicine, we can say,okay group A takes a pill and we
see what happens to the outcome.
And group B, which is completelyrandomized and matched
will not get the treatment.
And then we see what happens, right?
But these are artificial conditions.
It works for randomized controlled trials.
It doesn't work in the real world where werely on what we call natural experiments.
You're looking at what is going on.

(41:06):
to give you an example, for instancewe know that sugary beverages are bad
for the body and certainly also forthe brain, and they cause diabetes
and obesity and all sorts of badthings that we don't want to happen.
So how do you disincentivize peoplefrom drinking sugary drinks while
you put into place sugar tax, right?
Which is the ultimate policy measureto say, well, we're gonna just
make those drinks more expensive,and now there's a 20% sugar tax.

(41:30):
So people have done this, forinstance, in the UK or in Mexico.
And then we measure, does this actuallyreduce sugar consumption, which we know is
bad for the body and for the brain, right?
But we can only kind of comparewhat was the baseline of sugary
drinks consumption before this taxand what happens after the tax.
And that's our natural experiments.
And as you know, there's so many variablesthat will influence that behavior.

(41:53):
And maybe people say, well, now Idon't have sugary drinks anymore.
Now I'm going to, I don'tknow, eat more chocolate.
Or the food industry will say,well now we're gonna repackage and
reformulate our products, right?
So there's so many variables thatwe can control and it makes it,
I think, very difficult to also.
Push policy makers to say, Hey, youneed to invest into brain health
because they want see results, right?

(42:15):
They want to be able to say, well,this policy has worked, this policy
has been a success, but for thatwe must understand how do we in the
first place measure brain health?
That, that in itself is an incrediblycomplex undertaking to measure these
different levels of brain health from justphysiological health to what we talked
about Laura, like resilience and wisdomand fostering information literacy.

(42:37):
So that in itself is very complex.
And then the second point being, how doyou measure success of democracies, right?
That's also easy.
Of course, we know

Laura (42:44):
Yeah.
Oh my God.
Yeah.

Sebastian F Winter (42:46):
It's safeguarding human rights.
It's all of these things.
It's effective governance,it's checks and balance.
know these things, but still as apolitical scientist, you know, that that's
also a very disputed and difficult field.
Right?
So to put it simply, it's a very complexundertaking, but I hope that with this
paper, at least some policy makers willtake notice that we should try to solve

(43:08):
and tackle these 21st century challengesby investing more into brain health.
That's, I think theunderlying key message.
And hopefully this can spark a fieldwhere we can do these natural experiment
and build on this initial proposition.

Laura (43:23):
Great.
And so just to break it down even more,what are the concrete implications
of poor brain health for democracy?
I mean, even with the problemswith defining like what
are the actual issues I.

Sebastian F Winter (43:37):
So, so there are a lot of issues obviously to break down.
One that comes to mind immediatelyis despair and hopelessness, right?
There is a lot of, and there's a wholethink tank actually at the Brookings
Institution led by Carol Grey, who'sdone wonderful work in this field to
analyze, okay, what is actually happening.
Of course this is kind of in the base inthe us but it applies to many societies.

(43:59):
Why is, for instance, the, you know,this Trump phenomenon happening.
Why did this happen and howis society shifting and why
do we have something like.
Us life expectancy being on the decline,I mean, why, what is driving that?
And the answer is, it's deaths of despair.
By, and death of the despair isessentially suicide and deaths by

(44:20):
alcohol and drug poisoning, right?
And then you have to understand,you have to think about what drives
individuals to to these extreme positions.
And clearly it comes downto to brain health, right?
It comes down to the, theiropportunities or actually the lack.
Opportunities.
It becomes, it comes down tohaving a feeling of despair,

(44:42):
which means essentially being theplight of many who are ambivalent
as to whether they live or die.
Right?
I mean, that's a very extremeposition, but we have, we also refer
to these, I think, During theseelections and when Trump was elected
the forgotten men and women, I
to be that, that phrase who havevoted on these extreme positions.
And it is actually also a failure ofsociety collectively to include these

(45:04):
individuals into civic participation.
Because one of the pillars of democracythat we haven't mentioned and talked about
yet, and I think it's a tiller that oftengets ignored, is civic participation.
Right?
Because how do you ensurechecks and balances?
How do you make sure that theright candidates are elected?
How do you make sure that the rightpositions are being advocated for?
It essentially in, in functiondemocracies that people who are doing

(45:28):
that on a local, on a communal level,and who are taking part in dialogue.
And Helen, I have spoken about thisdialogue and we're trying to, we are big
proponents of dialogue work because thisis how you resolve issues and this is
how you find common ground even acrossparty lines and so I think there is a,
an overall lack of civic participation,and there are many factors for this.

(45:49):
One of them is of course brain ill healthother factors are digitalization where
of course we live more and more in adigitalized world and we tend to look
more on a phone and respond via textthan engaging in actual dialogue, right?
So then there are many elements thatlead to this disengagement, but this
is of course one of the factors,despair, not just lowering average
years life expectancy, but alsocausing the destabilization and extreme

(46:12):
polarization because such individuals are.
Potentially more prone to adoptthese extremely polarized positions.
We know that social media is amplifyingthat hugely because our attention, and I
hope that by now everyone has understoodthat we are the product and that attention
is being monetized in these systems.
Uh,
So that is taken away.

(46:33):
Of course, it is feeding usonly reinforcing positions.
Push us to the extreme because there isa lack of genuine real world dialogue.
And often, as you know, as a politicalscientist and mediator, that that dialogue
is very much a cornerstone of resolvinganything and finding a common ground.
But if we don't even have thisdialogue to begin with, then I

(46:54):
think we're in for big trouble.
So this is one position by whichdemocracies are being destabilized.
It is internal internal destabilizationthrough polarization, through extremism.
Think about cyber recruiting youknow, from all kinds of extremist
spectra, which is increasinglyhappening to susceptible individuals.
But it's also ironically thestate of the brain, right?

(47:15):
So unhealthy brains are more orstressed brains that have gone
through through a lot mentallyor physically are more prone to.
Buy into misinformation.
So it's a very interesting ongoingarea of research that we are more
susceptible to simplistic populousmessaging than seeing the truth.
Because the truth let's face is quiteoften it's very complex and multifaceted

(47:37):
and difficult and boring, right?
People It's exciting emotionally
right?
And yeah.
And that's that makes it verydifficult to convince people and
their whole field's actually emerging.
Now by w h o, there is a field of infoepidemiology emerging after this whole
covid disinformation mess happenedthat w h o stepped up to say, okay,
we need to create a whole new field tounderstand how can we shield our citizens?

(48:01):
How can citizens shield the.
From disinformation, which isessentially targeted misinformation.
And there are various techniques frompre bunking preemptively to debunking
to to even inoculation, which issort of vaccin cognitive vaccination,
where you present someone with a storythat is essentially fake news and you

(48:22):
make them realize that it's fake andyou prime them to be able to better
understand what is fake and what is real.
Because we do live, unfortunately, in thisboth truth era, where we have, as we have
famously heard, alternative facts and andwe must deal with this as citizens, right?
There are so many things to deal with.
And on top of that, wheredo we get our information?
From and what is credibleanymore and what isn't?

(48:43):
And what does a truthor fiction look like?
That is incredibly difficultfor the human brain to discern.
And it gets more and more complicatedwith, as we're talking about the Web 3.0.
And so we could sit hereand talk all day about this.

Laura (48:57):
Yeah, absolutely.
Like a 13 hour podcast, if not longer.
Absolutely.
And so, so then I will ask youjust one final question then.
Based on this page you just producedabout brain health and policy
making, if you had a magic w.
And you can make all the governmentsin the world do one thing to assist

(49:18):
brain health and therefore democracy.
We're gonna actually, we'regonna limit this to democratic
governments in the world.
The other ones might not beso interested in democracy.
What,
What would you do with that magic wand?
What would be the one thing you would do?

Sebastian F Winter (49:29):
Well, I think that's that's the million dollar question.
Um,
So I don't think there is a.
Bullet approach to solvingall of these questions.
I think what I would want tosee is leveraging insights that
we have from neuroscience now.
And it's true that it has taken thefield hundreds of years to get to

(49:50):
this point, but we're now at the pointwhere, We're starting to understand the
complexity of the human brain, right?
Which is difficult because we have ahundred a hundred billion neurons and a
hundred trillion synaptic connections.
So exceeding the number ofnumbers of stars in the universe.
So how are you going to understandfully you know, what the, what nuance
interventions look like on the brain?
It is very difficult, but to understandthat we are on the way to do that, and

(50:13):
that we have medical neuroscientificinsights, which should not just sit
in, in journals and somewhere on abookshelf , we need to actually translate
these into informing our policies,and this has been so underleveraged.
And for me, the magicbullet my personal approach.
If there was one thing I would startwith education because of course,

(50:33):
as we've talked about We we needto bring up the next generation of
leaders who will solve all of thesedifficult issues and the mess that we
find ourselves in, frankly, right now.
And it is this realization that each andevery one of us has an individual brain
that can maximize its own potential.
But in order to do that, we need toprovide external stimuli and learning

(50:55):
environments that are favorable to that.
And it's not just kind of learningand cognitive heart, cognitive skills.
So not just heart, brainskills, but it's also
uh,
values.
And it's one aspect I think that wedidn't touch on and that I was very
keen to embed into this paper is theconcept of dignity neurosciences.
And this was proposed by Tara Whiteand Megan Gonsalves at Brown University.

(51:19):
Fascinating paper wherethey've essentially shown.
Human dignity and human rights, forautonomy self determination unconditional
worth, et cetera, that these rightsare fundamentally nested in the
emergent properties of the human brain.
And I think if we can take these, if wecan take human dignity as a moral for

(51:40):
fostering brain health at a global scaleand for brain health directed policy
making, then we're on a very good road.
And this comes back to, tocharacter elements, or you could
even call these virtues, right?
Such as resilience or empathycompassion capacity for dialogue.
These are all, I think, character traitsthat, that unite us across partisan lines.

(52:03):
And we need to be able to establishcommon ground on those, right?
Because otherwise, when we get siloedand we have the political lens on
and we have our partisan positions,this is when downstream conflict, as
you well know, happen and exacerbate.
And this is the, I think theantidote to that is to really foster
these common dignity principlesthat each and every one of us has.

(52:25):
And these principles help us alsoto deal with challenging issues.
We haven't spoken yet about, and I thinkthis would be a whole other podcast about.
The dual use of neurotechnology.
And yesterday we heard Elon Musk andNeurolink talking about implantation
of brain chips to restore visionand to help with spinal cord injury.
But, and make no mistake, I think thesetechnologies they're first going to be
medical, but I think the end game has beenpointed out is to keep up with ai, right?

(52:49):
And to create a brain computerinterface technology so powerful
to be able to augment bandwidthand to be able to implement and
integrate AI in our processes.
And this technology, of course,has to be regulated, right?
And we're so far behind.
In regulating that technology andin even understanding it, and policy
makers are very far behind on that.
I think we've all seen mark Zuckerberg'shearing with Facebook this, the senate

(53:13):
hearing where you could really see thisintergenerational clash between policy
makers who do not even know how to loginto and what Facebook is actually doing
at Meta is doing behind the scenes.
Right.
So we've seen also the.
Of this.
And clearly these companies, ofcourse, they've connected people.
Of course, you can apply bcis, bringcomputer interface for for medical
purposes and for good in the world.

(53:35):
But it also needs a regulatoryframework and it needs a
global regulatory framework.
And I think coming back to dignity,neuroscience and human dignity as a
fundamental principle can help us asa kind of light motif and moral compos
to inform some of these decisions.
So those would be my, maybe my two,if you allow things, is to invest into
education and character virtues andto take a human dignity approach to

(54:01):
some of these very, very ethically,highly challenging innovations And
yeah, advancements for humanity.

Laura (54:09):
Well I feel like you did the magic wand equivalent of using the third
wish for a wish for three more wishes.
It was yes.
It was very interesting . And looks,Sebastian, I feel like we could talk
all day, but I know you have thingsto do, so I won't trap you, but I
might have to have you back in future.
But In the meantime, for those whoare interested in learning more about

(54:29):
your work, where can they find you?

Sebastian F Winter (54:32):
So they can find me on Twitter and
LinkedIn where I'm fairly active.
And I also have a personal websitewhere some of my research is accessible
or actually I'm trying to make itavailable as as much as possible.
Obviously their pays andwhatnot with science, it's
another issue for another talk.
But that's sf.com.
So sebastian friedrich sf.com.

(54:54):
Yeah.
And thank you so much, Laura,once again for this opportunity.
You really enjoyed our chat
and,
and dialogue, and it's always veryinspirational to, to have a sparing
partner to discuss issues becausethere's so much work to be done
and we're really in, in embryonicstages and taking baby steps.
But I hope that it's, you know,the right push for the field.

Laura (55:13):
Absolutely.
No well, thank you so much again,Sebastian, and for everyone else.
Until next time, this is Laura May withthe Conflict to Be podcast for Mediate.com