Stanford University.
OK.
Good.
Thank you for
notching me once more.
OK.
So various organizational
things, now that
we are here in the last gasp.
One thing is, make
sure you go online,
fill out the online evaluations.
The other various review stuff.
The TA's are giving a review
tomorrow from dawn until 3:30.
What time are you guys starting?
1:30.
1:30 to 3:30.
Where?
321.
321.
OK.
Read it on the board, unlike me.
I will pick up on office
hours, then, from 3:30 to 6:00.
And operators will be
standing by overnight.
But I think that's
the preparative stuff.
Let's see.
Before starting
this last lecture,
something that
absolutely has to be done
is to once again emphasize what
an amazing bunch of TA's you
guys lucked out in having.
I've been doing this class
for hundreds of years,
and these guys are peerless.
So thank them.
They have been amazing
in every regard.
[APPLAUSE]
[SHOUTS]
OK.
I guess this needs
to be notched down.
So we start off.
Thank you guys.
You really were amazing.
So starting off.
What's a lot of what we have
been doing for the last 30
lectures or whatever it is here?
We've often been wrestling
with a behavior occurs,
an interesting behavior,
a social behavior,
an abnormal behavior,
destructive one.
A behavior occurs, and
obviously our centerpiece
throughout has been,
why did it happen?
And all of our buckets,
and our buckets
that we have
magically evaporated.
And at the core, over and over
with the why did this happen,
is another question that
lurks through there, simply
because very often,
we are not asking
why did this behavior occur,
some human social behavior that
is completely benign, but often
some fairly disastrous ones.
Why did this behavior occur?
Very often what is
between the lines
there is, whose fault is it?
Whose fault is it that this
abnormal behavior occurred?
And where that immediately
barrels us into
is back to the frontal cortical
sections of earlier lectures,
that whole business of volition
and culpability and-- God
help me for saying
the phrase again
the first time since the first
lecture-- free will, things
of that sort.
Quick survey.
How many of you are
finishing the class
less wedded to the
notion of free will
than when you started?
OK.
More so?
No change whatsoever?
What did I say?
Can you repeat that?
Hands up.
OK.
So a number of you.
And ultimately, this
material-- no single factoid,
but I think all of it together--
is a hugely complicating issue
for notions of free will,
for notions of vulnerability,
for notions of
culpability, all of that
built around this question
often lurking between the lines,
which is, why did
that behavior occur?
Whose fault is it?
As a boring subset
of that one is,
why did this behavior occur?
Who is worthy of praise for it?
That one is ultimately equally
interesting, but probably less
pressing in society.
But where are these
behaviors coming from?
And we've gotten
really good at doing
some moderately
sophisticated things
in dealing with the answer
to a question like these.
And a great example of
that is with epilepsy.
500 years ago, if you
had an epileptic seizure,
where is this behavior coming
from was absolutely clear,
which was demonic possession
of some sort or other,
a staggering,
heartbreaking literature
of the history of
treatments of epileptics
and the response to epilepsy.
If in the process of somebody
having a seizure 500 years ago,
they flung their arms
around and struck
somebody else in the
process, it would
be considered some version
of assault and battery,
in most of Western
European countries,
again, explained with
a demonic underpinning.
And we're in a
different position now.
If today somebody has a
seizure and in the process,
they strike and break
something, they're
not to be held legally
responsible for if they
strike somebody.
That is not assault and battery.
It is a ludicrous idea, because
somewhere around 1900 or so,
most people in this
country got trained
with a thought,
an explanation, a
where did this
behavior come from that
is as defining of everything
that is good about our culture
world.
Most people got to think
the following thing.
It's not him, it's his disease.
And that is a huge landmark
transition from 500 years ago,
people being burnt at the
stake with some really
bad attribution given to us
having the capacity to draw
an absolute line between the
essence of who that person is
and the action potential storms
that happen every now and then.
It's not him, it's his disease.
We're spectacular
at doing something
like that with epilepsy.
We are lousy at doing it in
all sorts of other domains.
One example, schizophrenia.
Back to schizophrenia again, and
the abnormal behaviors of it,
and the occasional violence
associated with it, lower than
in non-schizophrenia people,
but the occasional violence
and, of course, the
classic case again,
that guy John Hinckley trying
to kill Reagan in the 1980s.
Paranoid schizophrenic,
floridly so, and that very wise
jury of, in retrospect, some
remarkably unsophisticated
people deciding, it's not
him, it's his disease,
and put him in a
psychiatric hospital.
And the apoplexy that
went through this country
in response to with
the editorials,
the senatorial
bloviating crap about,
he's getting away with
this, he's getting away,
he is responsible, showing
an utterly limited ability
for people in this country, and
some extremely powerful ones,
to draw a line between the
essence of who this John
Hinckley is and the dopamine
abnormalities in his brain.
And we have trouble drawing
that line as well, doe example,
in the realm of
parents and teachers
and guidance
counselors making sense
of the biology of
learning disabilities,
the biology of dyslexias, and a
whole world of people not very
good yet at drawing a line
between that and the person.
And instead, out come concepts
like lazy and stupid and things
of that sort that have a
long, long well-maintained
in the history of
education in this country.
And a lot of people in positions
of power, parents et al, still
have not gotten
very good at drawing
the line between the essence
of who that person is
and the biological
constraints that
are superimposed on top of it.
What you begin to see after
a while is something very
interesting, which
is going to be one
of the main points of
this last structure, which
is, as more and more
information in this world
of behavioral social
biology, whatever it is we're
calling this, as more and
more of this has occurred,
as we get more and more domains
where we have to at least begin
to consider there's a line
in between the essence of
and the abnormalities
of-- at some point,
this is going to stop
being the biology of them
and their disorders and is
going to be the biology of us.
And when things get
really close to home
at that point, that's
where a lot of people
get very, very anxious
and very skittish about,
essentially, the
punchline from a class
like this, the
transition from them
and their existing in
a different category
with a boundary, with a
bucket, versus the rest of.
Us as it gets closer
and closer to home,
the transition from
them and disease to us
and individual differences
and quirks and idiosyncrasies,
and a biology that is just
as much of a biology as them
and their diseases, where
the subtleties come in.
And where there has to have been
that case, sort of that sense
challenging, is looking at some
of the subtle neuropsychiatric
disorders that we have in
the class, a few of which
I'll go over again here,
but a few new ones,
where over and over
it's the theme of,
there's not that much
difference between me and them.
I imagine exactly
what the continuum is.
It is not clear whatsoever
where the line should be drawn,
the new category of
normal versus abnormal.
Case after case of this.
One obvious one most
recently emphasized,
schizotypalism, schizotypal
personality disorder.
And when you look at
the range of symptoms,
this is not a
psychiatric disorder.
This really is not, and
justifies the transition
to schizotypal personality,
rather than a disorder.
It isn't a psychiatric disease
to consult astrologers.
It isn't a psychiatric disease
to go to Star Trek conventions.
It isn't any of these things.
It is one extreme in one
axis of human behavior,
and it is one where,
by definition, we're
beginning to sense the biology
of it lurking around out there.
We know it's got something
to do with the same genetics
that you find in the fuller
loaded version in schizophrenia
itself.
We could begin to imagine
that this is the biology of us
and some of our
quirky obsessions,
versus them and
their schizophrenia.
More examples.
We endlessly heard about the
frontal lobe in this class,
and we heard about the
boring, easy examples, when
it is blown out
of the water, when
you have Phineas Gage,
when you have frontally
damaged disinhibited murderers.
We've heard all about those,
and those are the easy ones.
Those are not so easy if the
vast majority of states in this
country cannot deal with the
notion at a criminal trial that
somebody with no frontal cortex
is not a biologically normal
human.
But nonetheless,
that's relatively easy
compared to the
issue that we really
have to think about, which is,
the person sitting next to you
has a different frontal
cortex than you do.
And you, by now,
can come up-- yes,
it's the person on
the left, seeing
sort of where the
eyes are shifting--
and coming up with
this obvious fact
that this makes a difference.
This makes a difference not in
explaining why one person here
might be a serial murderer and
the next person not, but just,
who's got it together
with the studying?
Who's going to do an
all-nighter Thursday night?
Who has what sort
of personality?
Who is too shy to say
something or other?
Who's the one who is
always the first to say--
and this world of
individual differences.
And you have no shortage by
now of ways in which that
may manifest itself.
How many neurons and
how many synapses
and what sort of
receptors and all of that?
You could go on all week long
as to the possible underpinnings
of that, and you
could go on all week
long as to what events--
genetic, prenatal, et cetera--
might have brought that about.
But the whole
critical thing there
is the transition from
them and their brains
with no frontal cortex left
to making sense of the fact
that all of us with perfectly
normal frontal cortices
nonetheless all
have different ones.
And at some point,
this transition
brings the term frontal,
frontal disinhibition, out
of the realm of pathology.
I mean, a great
example of this--
in terms of how
commonplace this now
is among of biological
psychiatry types-- you'll
be at some conference, and some
poor, quivering grad student
gets up to give a short talk.
And this is the first
talk the person ever gave,
and they're obviously like
a total nervous wreck,
and they manage to sort
of limp through the end,
and they're a sopping rag at the
end there, but they've done OK.
And then some total jerk
big shot in the field
gets up from the back
row and savages the guy,
and gets him on stupid
statistics, minutiae,
and chest thumps and
attacks his enemies
and yells at him for not
citing, and going on and on.
And somebody is
going to lean over
to somebody else
in the audience,
and referring to the
guy back, saying, jesus,
he is getting more
frontal every day.
And that may not
just be a metaphor.
That may be a way of hinting at
the biology that is absolutely
there.
Why?
Some of us do some things
like that, and some of us
would die rather than be that
forward or that disinhibited,
those individual differences.
And we surely know
they are there,
and we're beginning
to understand the baby
steps of different versions
of dopamine receptors
in the frontal cortex, that
whole world of transitioning
from them and the front of their
head blown out of the water
to us and our
individual differences.
Another domain of this, another
realm of insight, and that's
this disease
Huntington's Disease.
And you will perhaps recall
back to the very first class,
making reference to what turned
out to be Huntington's, what is
very often the profile of
somebody with Huntington's.
Middle aged guy
suddenly starts behaving
in some outrageous way,
disinhibited, all of that,
that whole business of,
there's behavioral features
to this disease.
Huntington's Disease is
a neurological disorder.
Huntington's Chorea-- the
term chorea, choreography,
body movement, Huntington's
uncontrolled writhing
that eventually consumes
the entire body 24/7.
The person eventually,
not so long,
soon, dies from choking
to death on their saliva
because their muscles
aren't coordinated any more.
Totally horrile
neurological disease.
But what has taken
people years is
to realize that that's not
what Huntington's looks like
at the beginning.
And instead it's the profile,
the scenario that I gave
in the very first class, again.
Middle aged guy, happy
marriage, in the suburbs,
jobs, 2.73 kids and dogs,
all of that sort of thing.
And the one day he suddenly
punches somebody at work.
Then the wife discovers he's
having an affair with whoever.
Then he gets arrested for
brawling drunkenly in a bar
and he never used to drink.
And then he embezzles
all the funds from work
and disappears forever, until
a year or two later, when
he shows up in a neurology ward
at the other end of the country
because he's getting tremors.
And what people
have now figured out
is, two or three years
before Huntington's is
a neurological
disorder of movement,
it's a psychiatric
disorder of disinhibition,
and is one where
you begin to see
a behavioral profile like this.
And what you see is,
by the time you've
got early stage
Huntington's patients
when they're
hospitalized, they are
famous for coming
on to the staffers
or showing up in the day room
without their pajama bottoms,
or just famous for
doing stuff like that,
the disinhibited behavior
of Huntington's patients.
And what's remarkable
there is, people have known
for a long time what
the neuropathology is
of Huntington's, Huntington's,
the movement disorder.
And it's the disintegration
of some motor
pathways in the brain.
Now that people have genetic
markers for the disease,
know with some likelihood who's
going to get it when, what's
become apparent now is, two or
three years before you start
getting damage in
the part of the brain
having to do with motor
control, you get damage
in the frontal cortex.
Huntington's is
initially a disease
of frontal cortical degradation.
And what is remarkable
about that is,
this is a genetic disorder
which immediately barrels us
into the, this a
maladaptive trait.
You are dead by the
time you're 50 or so.
Our usual question,
why is it evolving,
why is it being maintained
in the population,
seeing a theme of a hidden
benefit of Huntington's, which
is that disinhibited
behavior a couple
of years before the
neurological symptoms do you in.
During that time
window, individuals
with Huntington's out-reproduce
their unaffected siblings.
They become, among other
things, sexually promiscuous,
and they pass on more
copies of their genes.
And what you suddenly
see at that point
is framed from the
standpoint of arms
that won't stop moving-- we're
talking neurology-- framed
from the standpoint of
number of copies of genes.
This is an evolutionary advance.
This is something
which behaviorally
increases reproductive success.
Onset is typically
around age 40,
so catching it around that
time, which is typically
around the point where
reproductive activity--
reproduction goes
down in humans.
So getting an extra
little blip out there
from the standpoint of an
evolutionary biologist,
this isn't a disease.
This is a great invention
where the bill happens
to come a while later, but
there is no free lunch.
And framed that way, this
was a very different way
of thinking about this disease.
But what was most striking is,
when you first hear about it
and somebody says,
OK, what do you
think the causes of
this behavior are?
What causes this?
And the ones that most
readily come to mind
is, the guy's a jerk.
The guy's having
a midlife crisis.
The guy's what,
like, oh, no, it's
actually a single
gene defect where
there's too many glutamines.
That, and it's a disease of
a single gene goes wrong,
and out comes this.
And we need to
consider is, there's
individual variation in
aspects of that system
long, far outside the range of
what would get a disease label.
And it doesn't take too
much imagination, again,
to translate that into why
the person sitting next to you
is a little more this way
and a little less that way.
Just the same challenge
for us going from them
to what makes us, us.
Next example.
Disease I've only briefly
mentioned, I think, previously.
Tourette's disease.
Tourette's disease.
Everybody knows about
Tourette's disease,
which is, it's
this disease where
people curse uncontrollably.
Scatology.
Tourette's disease,
that doesn't begin to
scratch the surface of
what Tourette's is about.
With Tourette's, yes,
you get that scatology.
You also get inappropriate
gesturing, tics, facial tics,
gestures of all sorts,
aggressive ones,
sexually inappropriate ones,
all sorts of vocalizations,
barking sounds, animal sounds.
It is just a torrent of
behaviors coming out.
Now the critical thing when
looking at Tourette's is,
this is different from
the inappropriate behavior
of somebody with frontal damage.
Frontal damage is
closer to home.
Every single day, I
would bet all of us
have thoughts that are boastful
or lustfall or petulant
or whatever, where we
would die if anybody
knew we were thinking that.
And damage the frontal
cortex, and when you think it,
you say it.
It is not the secret desire
of every Tourette's patient
to bark like a dog and
make quacking sounds once
every seven seconds.
And finally, thanks to the
damage of that disease,
they are disinhibited to do so.
This is an astonishingly clear
example of a line between
the essence of who that person
is and these weird hiccups
of the id that occur in the
limbic system with Tourette's.
And again, in its milder
form, it's not a disease.
It's individual variation.
Now remarkably with
Tourette's, of course,
people are beginning
to learn something
about the biology of it.
There's a genetic component.
It's probably not that strong.
Beginning to see brain
imaging correlates of it.
One totally weird possible way
to wind up with Tourette's, and
this is a brand new class
of pediatric diseases called
PANDAS, PANDAS
diseases, which stands
for-- do not write this down--
which stands for Pediatric
Autoimmune Neuropsychological
Disorders Associated
with Streptococcus.
Here's what happens.
You have a three-year-old,
four-year-old kid who gets
a strep infection and runs a
high fever and winds up being
the one in 10,000 kids in this
situation where something goes
wrong, recovers from the
fever, everything is fine,
and then two weeks
later explodes into tics
and obsessive patterns and
Tourette's-like disinhibitions.
And where did this come from?
Totally paralyzing.
And none of the
normal drugs work.
And suddenly someone
stumbles on what does work.
You give the child a drug that
suppresses their immune system.
Things go back to normal.
Then a couple years later,
they have some other fever
and they spike a high
fever, and two weeks later
they explode back
into these tics,
these disinhibited behaviors,
these obsessions, all of that.
What's going on?
What appears to be the case
is in the subset of people
with a high fever, these
kids, the blood brain barrier
opens up in a way that
allows the immune system
to get to places in the brain
where the immune system isn't
supposed to be.
And you form
antibodies that attack
elements of your own brain,
of your own central nervous
system.
And this is what turns
out to be the case.
It appears to be, in some
cases, an autoimmunie disorder,
the treatment being, give the
person immune suppressants.
And when you look at adults with
Tourette's disease or adults
with obsessive
compulsive disorder,
they have far
higher than expected
at chance levels appearance of
antibodies in their bloodstream
against constituents of
their nervous system.
And they have a higher
than expected rate
of these childhood fevers.
The sort of stuff we've
been getting throughout,
groping at these strange
little pieces of making sense
of this stuff.
And have something like that,
and you wind up with a disease
that has this bizarre array
of symptoms that you see
in Tourette's.
And some years ago, I actually
had somebody in this class who
had Tourette's.
And it wasn't bad.
He had like a few facial
tic sorts of things.
And after the first
couple of classes,
he came to office hours
and was kind of describing
that he had Tourette's
and he was very glad
that I was familiar
with his disease,
and explaining that this
was sort of something that
occasionally became
disruptive in classes.
And if it would be possible,
it might make sense
to have an exam in a sep--
and he spent the entire time
doing this.
This was the disease.
This was the essence
of who he was.
And you could not ask
for a clearer line.
Look at this.
500 years ago you have
Tourette's disease.
It tends to have an adolescent
onset of the symptoms.
It's got somewhat of a
bias female to male ratio.
And certainly you've got a
13-year-old girl who suddenly
starts cursing uncontrollably
with bizarre sexual references
or whatever.
And what's the only
possible conclusion?
You've got someone
possessed by the devil
who should be treated
appropriately.
Look at where we've
gotten to in 500 years.
We've gone from taking
people like that
and burning them at the
stake to letting them take
the MCATs in a different
room from everyone
else so they don't disturb
them with the barking.
We've gotten real good, with
a disease like Tourette's,
of drawing the line over the
disease and who the person is.
That's a realm where we've
gotten a lot of progress.
More of these subtleties,
again, what in some ways
was one of the most challenging
pieces of the religion lecture,
making sense of
have a brain that
has uncontrolled epileptic
firing for a couple of minutes
once every six months, and
you're much more interested
in the philosophy of religion,
the temporal personality
business.
And again, that
challenge of, most of us
have gotten to our
religious stances
through a great deal of
hard work and introspection.
And, even if only once in
the history of the universe,
somebody instead
has gotten there
because their neurons
have synchronized firing
in their limbic systems
once every six months,
that is very challenging to
the sense of no longer talking
about them, and very
challenging to the sense
of making sense of us as
autonomous individuals
within our own control.
Other realms of this.
OCD.
Again, we've got some sense,
after the last lecture,
of what it looks
like and just how
incredibly, incredibly crippling
it is in its extreme forms.
These people cannot
leave their homes.
These people cannot function.
They most certainly
cannot hold down jobs.
It is just as destructive of
a disease, in its worst forms,
as is schizophrenia.
And people are beginning
to learn something
about the biology
of it, that link
to childhood high fevers
and strep infection.
Some evidence of
genetic component to it.
There is first
neuroimaging being done.
And you might remember that area
of the brain, basal ganglia.
Or maybe not.
Have I actually
mentioned basal ganglia,
or have I just wished to?
OK.
Basal ganglia.
Motor area.
What people are beginning
to see is, in OCD,
put someone in a
scanner, and there
is increased metabolic
rate in the basal ganglia,
this part of the brain
involved in movement,
involved in making sense
of the compulsions,
the need to tap a certain
number of times, the need
to arrange the utensils so that
they are perfectly parallel.
The need to-- it's like there's
an itch in the motoric systems
there.
And people are beginning
to understand that one.
Take somebody with OCD and
treat them successfully.
It's typically with SSRI's,
serotonin uptake inhibitors,
which also work for
aspects of depression.
Treat someone effectively,
and the metabolic rate
in the basal ganglia
goes back down to normal.
The pieces begin to fit there.
Getting into even
stranger realms--
because these diseases, by
now, have mostly even passed
the disease of the
month TV special,
they are becoming to
be understood so well.
Then there's a whole
world out there
of the most bizarre possible
diseases you can imagine.
Here's one of my favorite ones.
It's called Jerusalem Syndrome.
This one is great.
This is such a bizarre disease.
Jerusalem Syndrome.
Shockingly, you can only get
through Jerusalem Syndrome
in Jerusalem.
Here's what you get.
It's gotten to be a rule-out.
The person who gets it cannot
have problems with depression
or anxiety.
Rule out all the other
psychiatric disorders.
It's a standalone diagnosis.
Here's the sort of person
who gets Jerusalem Syndrome.
An American, highly
religious Southern Baptist
on their first trip
ever to the Holy Land.
Two other requirements
that virtually
are in every single case.
The person has to be
relatively on their own.
At the end of the day, they
are in a room by themselves,
and they have to be having
huge problems with the jet lag.
In other words,
they're up at all sorts
of weird times of
day, and really
in soggy shape because of that.
Here's what happens.
This is the person who's been
waiting their entire life
to finally come to the
Holy Land, has been saving,
has been whatever.
They scrape together.
They go there.
This will be the land
where Christ walked.
And they get there and
they see that Jerusalem
is like a normal city.
There's traffic jams,
there's smog, there's noise,
there's pickpockets,
there's McDonald's.
There's all of that, and
they're disappointed.
They are shattered by this.
And something comes
unhinged, and something
comes unhinged in the
middle of the night there.
They're not being able to
sleep alone in that room,
dealing with this
shocking realization
that the place they had
dreamt of their entire life
doesn't exist anymore.
And something cracks.
Here's the detail that I love.
In every single
one of these cases,
the person rips apart
the hotel room bed,
shreds the-- not the mattress,
the sheet-- shreds the sheet,
takes their clothes off,
and before you know it,
they're on a street
corner in Jerusalem
dressed in a toga
preaching to everyone,
telling them to go
back to simpler ways.
The psychiatry SWAT
team from the hospital
there shows up,
takes the person,
puts him in the hospital there
for a couple of days or so.
Their head clears.
Ships them back to
Biloxi or wherever,
and they never have
a problem with this
again for the rest
of their life.
They get 50 cases of
this a year in Jerusalem.
This is a recognized syndrome.
People publish papers
about Jerusalem Syndrome.
It struck me, though,
that there is actually
a very easy cure for it,
which is, in Jerusalem, in all
the hotel rooms, if the sheets
always were plaid or something.
Something about the white just
begs to be pulled into a toga,
and that sort of pushes
them over the edge.
But this is a real disease.
More of these.
Stendhal's disease.
Stendhal disease you can
only get in its official
form in the city of Florence.
And Stendhal, the
well-known-- what
was he, a philosopher or
writer or hockey player?
Writer.
Yes, the well-known writer,
thank you, Stendhal,
who, describing the first
time he came to Florence,
and this sense of
vertigo and nausea
and complete loss
of control that
came from seeing one too many
amazing, priceless, unmatchable
frescoes, where you get
into a manic state from it
and you can't take it anymore.
And you come out
running like a wild boar
through the streets of Florence.
This occurs with some
regularity there,
and this is termed
Stendhal Syndrome.
There are papers written
about the subject.
More of these.
Then there is a disease
which, trichotillomania--
these
impossible-to-pronounce ones,
people who eat hair, people
who eat hair obsessively.
Not just the anxious
version, sometimes,
of somebody who's kind of like
chewing their hair when they're
sort of anxious.
But instead this is where a
person is pulling hair off
of their brush in
order to eat it.
They go over to someone's house
and they go to the bathroom
and open up and find the
brushes and the combs
there to pull the hair off.
This is an incredibly disturbed
disease, where at an extreme,
you get somebody who has
consumed so much hair that it
forms a hairball.
It blocks their stomach, and
this is life-threatening.
It forms a plug of
hair with a long strand
of it coming up the esophagus.
And this is life-threatening.
And you have to take
it out surgically.
And it's this whole clot of
hair with this thing that
was going up in the esophagus.
And what is this disease called?
It's called Rapunzel's
Syndrome because
of the long stretch of hair.
How weird is that?
What is that about?
Just imagine we start with
one of our charts here,
and we say, steals hair from
friends' bathroom brushes,
and sort of say, try to do
that one of working our way
backwards of what happened
the second before,
to evolution of whatever.
How bizarre is that?
That's like nothing compared
to the next two diseases,
that are so hard to
pronounce I'm not even
going to attempt to.
Actually the first disease
is pretty run of the mill
and pretty straightforward.
The first of these
is merely the disease
of people who can only become
sexually aroused by amputees.
Whoah.
OK.
That's a little bit peculiar.
That makes like the person
with it seem like the kid
next door compared to this one.
This is the disease
of someone who
has a body dimorphism image.
It's a body
integrative disorder.
This is someone who,
their entire life,
has believed they are meant
to have a limb missing.
Their sense of themselves
involve them being an amputee.
This is a real disease.
This is a real disease
where people have websites
where they communicate
with each other about how
to have industrial
accidents, accidents
that will remove a limb, where
it will look like an accident.
There are secret physicians
who will do this.
There was a paper in
a neuroethics journal
a couple of years ago
by a physician arguing
that one should be
willing to carry out
the surgery on a person
who wants this done,
because they will find a way to
do it disastrously otherwise.
As termed by the person
who first described it,
this is a new way of being mad.
And this is terrain
like you cannot imagine.
Finally, most
shocking of all, this
was a case report a couple
years ago of somebody
who had stroke damage
to the cortical area
towards the frontal cortex,
but also a little bit in one
other area.
And as the case
report described,
this person, in the
aftermath, became
obsessed with polka music.
Polka music.
This was like some gang
member Hell's Angel guy
who had, like, brain damage
after one brawl too many.
And out the other
end, this is someone
who's willing to slash you to
bits if you disagree with which
is the best polka group coming
out of Krakow these days,
or some such thing.
The person spent a dozen hours
a day listening to polka music.
What the hell is with that?
what?
Damage there?
We're just seeing these
totally bizarre ways
in which things can go wrong.
Things can go wrong in
merely peculiar ways.
Things can go wrong in ways
that destroy people's lives.
So what are we to make
of things like this?
This whole world of these subtle
neuropsychiatric disorders
where, with each one of
them, it's easier and easier
to imagine how it
translates into not them
and their disease, but our
individual differences.
One thing to appreciate
is that the majority
of these that fall in
this category, they
didn't even have
names 50 years ago.
There wasn't a way of
describing, or even imagining,
that biology could go wrong
in this particular way.
And there weren't
even names for those.
Most of these didn't
have names 10 years ago.
And what's obvious
then is, there's
no way the science
is going to stop.
Just more and more
of these names
are going to appear, more
and more of these syndromes
and disorders.
And at some point,
every single one of us
is going to have two or
three of those labels.
And what happens at
that point, because this
is describing a
very close array of
human individual variability.
I do not have OCD.
But I will count
stairs on occasion.
I, during periods of
anxiety, will do that.
Obviously I have only
one clothing style
for the last 10 weeks.
Every day, coming here, I
go through the same sort
of rehearsal saying,
I am not going
to start off the lecture today
by saying, OK, let's get going.
And then I've done it again.
And I don't have OCD.
I have that weird, weird
compulsive behavior,
or ritualistic ones.
Obsessional.
OK.
Here's what I've been wasting
most of today thinking about.
I have a grant due
next week, and I'm
getting so little
done on it that I'm
beginning to get anxious.
So I've been having
this whole repeated
pattern of this intrusive force
thinking about, Charlie Bit Me.
So I think about Charlie Bit Me.
Then I think, this
can't be for real.
They had to have had
professional actors.
Then I think,
that's not possible.
There's no way
you can get a baby
to bite the finger that way.
Then I think, if this
was actually staged,
I am deeply hurt by
the YouTube people.
Then I think about
how his accent
sounds when he says Charlie.
Then I realize I'm
moving my lips.
Then I say, OK, you
got a grant due.
Stop screwing around already.
Whoah, Charlie Bit Me.
What a cool video.
I wonder if they staged it.
This has been going
on for all of today.
This is not OCD, but
it's elements of.
And just as every one
of us has elements
of some of these, where all of
these individual differences
come in.
And at some point we will
have to deal with the fact
that the same exact
biology, writ large, that
may make somebody a
schizophrenic in a milder form,
will have them being
very interested
in metamagical issues, and
in the mildest form allows
you to have a fantasy
while standing on line
in the supermarket.
It's the same biology
on the same continuum.
And somewhere in there it stops
being them and their diseases
and becomes us and who we are.
So one of the
challenges with that
is, what's going
to happen as we get
more and more of these
names that describes us more
and more, and we understand
the neurotransmitters
and the early experience and
the genes and all the last 10
weeks.
And as we understand
more and more of that,
something often
happens at that point,
which is, people begin to get
real uncomfortable, real sense
of being threatened.
For this tremendous
fear that what
if those scientists accidentally
go and explain everything
when we're beginning to
see biologies of tastes
and religion and who
likes risk and who
is capable of being
faithful and who is not,
and who has-- and this realm
with individual differences,
and begin to see the
machinery underneath.
Lots of people get
uncomfortable at that point,
because it challenges one of
the pretenses that we all,
virtually all,
desperately cherish,
which is the notion that we
are utterly, utterly unique,
that each one of us is this
flame of individuality that
cannot be captured, that
cannot be constrained,
that defines us, this
individuality that is just
bubbling away there.
And there go those scientists
learning more and more
about less and less.
And they may mess that up.
They may wipe out that
sense of our uniqueness.
And that worry was
perfectly encapsulated.
This famous story,
science fiction story,
by Arthur C. Clarke called
The Nine Billion Names of God.
Wonderful metaphor for this.
This is a bunch
of Tibetan monks,
and apparently in some
branch of Tibetan Buddhism,
there is a belief that God
has nine billion names,
an obvious metaphor for the
unknowable, the unattainable.
And in this story,
these monks team up
with a bunch of
computer scientists
with the greatest
computer around that
they program to start
printing out the names of God.
And what happens in the story
is, as it's cranking through
and it is going to name the
nine billion names of God,
as it cranks through this,
as each new name comes out,
one of the stars in
the sky goes dark.
And that's a perfect metaphor
for this fear that people have,
which is, if inadvertently
scientists go and learn
everything with each new
soulless factoid that turns us
just into a bunch of equations
or biochemical pathways,
that with each new factoid,
one of the stars in the sky
will go dark as we lose
some of our individuality,
as we lose some of what
makes us who we are.
There is no reason
to worry about this,
and this is for two reasons.
First off, even if scientists
went and inadvertently
explained everything,
that still would not
take away the wonder of it.
You can take a gazelle
leaping and turn it
into a whole bunch of
biomechanical equations.
You could turn Bach
into Kontrapunkt Rules,
and that does not in
the slightest change,
or should not in the
slightest change, our capacity
to be moved intensely by them.
And there's no reason why
something should lose its power
simply because it turns out to
have layers of complexity that
were not initially available
to us, which we slowly attain.
It should not destroy that
sense in the slightest.
The second reason why this
isn't something to worry about
is, scientists are never going
to inadvertently go and explain
everything about
everything, because we've
seen throughout the
class over and over
and over again, every time
one question gets answered,
10 more get generated,
half a dozen
of which are much
more interesting
questions than you
started off with.
It is a fractal.
It is an infinite fractal
of knowledge to be attained.
They're never going to go
and inadvertently explain
everything.
Wonderful quote
from the geneticist
Haldane-- he's the one who
came up with two brothers
are eight cousinss--
another one of these,
where he once said, "Life is not
only stranger than we imagine.
Life is stranger
than we can imagine."
Scientists are never going to
inadvertently go and explain
everything.
The purpose of science is not to
cure us of a sense of mystery.
The purpose of science is
to constantly reinvent it.
So that's one realm in
which people are threatened
by all the sorts of
knowledge and where
this is going in terms of
describing the what makes us
who we are.
There is another
realm, not just the,
what happens to our sense of
selfness, another realm of,
what does society do with this?
What does society do as we get
more and more of these terms
and we understand more and
more where the gears are,
where the controls are,
where the challenges are
to the sense of autonomy
and agency in people?
What's going to
happen at that point?
What's clear is, if you are
poor or poorly connected,
you are screwed, because as
more and more of these labels
are given out, that's
just the excuse that's
needed to deny you a job or
health care or fair housing.
That is clearly an enormous
danger with knowledge of this.
But hopefully what
happens instead,
on a more optimistic note, is
somewhere in all these continua
that this class was
about, you see, there
but for the grace of God, and
a couple of neurotransmitters
and three or four more
receptors, could go I,
as you begin to see
a continua as you
begin to see all sorts of
realms that are tragically
done in biology.
We have no trouble looking at
a schizophrenic and seeing,
this is a disease,
and this is someone
who needs our care and
forgiveness and protection.
And we are in a world now where
people who obsessively count
numbers eight hours
a day, we will
have to be able to view that
as just as much a disease that
is just as much deserving
of care and protection
and understanding.
With any luck, what all this
knowledge is going to do
is force us to extend an
umbrella of protection,
a realm of empathy,
into areas we
could never have
dreamt of before,
but never have dreamt of.
The same exact
extent that if you
took the wisest,
most compassionate,
most introspective person
on earth from 500 years ago
and told them
epilepsy is a disease,
it would have made
no sense at all.
And we are certainly
sitting here
with a whole world
of things where
it could make no sense to us
at all, where we will come
to see that it has biological
components as strongly as any
of these others.
And we will have this
challenge of seeing
that this is a realm not of
judgement, but of protection.
And when we reach
that point, we will
have discovered that
when we describe somebody
as being healthy, when we say we
are healthy, what we are really
saying is, we merely have the
same diseases that everybody
else does.
And with any luck,
out of this will come
a great deal of compassion.
OK.
So that's where all
of this may play out
in terms of the
challenge to people's
sense of individuality,
what society
should do with knowledge
like this as it emerges.
What's probably
most important is
what all this stuff means
in terms of impacting you
and your interactions
in society,
and what you will wind up doing.
One of the irritating
themes, probably
the most irritating concept
in this whole course,
is the one of modulation,
these stupid if-then clauses,
because what they
say over and over
and over again is, just when
you think you've figured out
what is causing behavior, oh no,
it's not actually causing it,
it is amplifying the
preexisting tendency of this
or damping or modulating or
imposing a contingent clause.
Doesn't anything cause anything?
It's like the entire
point of this class
that nothing ever actually
starts a behavior.
Everything is modulating, so
you could never figure out
how stuff is actually working.
Why does this have
to be so complicated?
And one thing that
comes out of the,
why does this have
to be so complicated
is, why does it have to be
so difficult to do something
helpful, then in
any of these realms?
And I know for a fact that
a large majority of you
have the desire to do that,
figuring in some of the things
you want to do with
the rest of your life.
And what is really
easy is to come out
of a course like
this saying, it's
really impossible
to change anything
because it is so
incredibly complex.
It is really hard
to do it because
of how complicated it is.
But it's not impossible.
It's really hard
to do it because it
will require not only
doing vast amounts of work
of collecting vast
amounts of information,
but then trying to
synthesize it and trying
to intuit when you should
stop paying attention
to the vast amounts
of information.
It is doable, but it
will be incredibly hard,
because down the line,
every time one of you guys
will choose to try
to do something
with a level of excellence
that comes to people here very
easily, every time you
choose to do something,
you are facto saying
no to 20 other things.
And some of those other things
will be very, very important
things to you.
And those are tough
choices to make.
And it will be doable but
hard because something
that's probably utterly
inconceivable to you guys,
but which is, at some point
you're going to get tired.
And it gets a lot harder
to try to turn all of this
into how can you
make things better.
But you guys need to do that.
Here's a story.
And this was about my father.
My father was an architect,
an architectural historian.
And part of his career he
taught in NYU, but McCarthy Era.
Things didn't work out,
and he wound up teaching
in this crappy little
architectural night
school in Brooklyn for
years and years on end.
This was as flea-bitten of a
place as you can possibly get.
And every now and then I would
go to see a lecture of his.
And he was a
spectacular lecturer.
And he would do this thing.
One of the lecturers,
he's in there
and he's putting up pictures of
the most beautiful, important
buildings on earth,
and Versailles
and the pyramids of Giza, and
this or that incredible palace,
and all of that.
And here's these guys sitting
in this night school who
are, like, working as
draftsmen during the day,
and this is really
a ragtag bunch,
and putting up these pictures
of the most beautiful archi--
and you know exactly what it
is to inspire these people,
to move to the grid.
And no, that's not
what he's doing.
He's putting up these
pictures, and he's
yelling at these people saying,
for too long architects have
been whores of the wealthy.
What they do is we
build their palaces,
we build their mausoleums,
we build their forts.
And there's Versailles and
there's the Giza and all.
And I do not want to see you
being the whores of the wealthy
and the whores of the powerful.
You are to-- and
he's yelling at them.
He's yelling at them about this.
And these are folks
who they're going
to be lucky if they do,
like, illegal garage
extensions in Canarsie
in Brooklyn someday.
And he's yelling
at them about this.
And I'm sitting
there thinking, this
is the stupidest
thing I've ever seen.
And it took some time to
realize that no, in fact,
this was not at all stupid.
And in fact, this was
something remarkably respectful
he was doing, because
he was saying to them,
you have the capacity to sin.
You have the
capacity to do wrong.
And implicit in granting the
power to people like that,
and also intrinsic
in that is, thus
you have the capacity to
attain a state of grace
through the work
that you will do.
Great other story,
Robert Oppenheimer,
when the first atomic bomb
was tested, and went off,
made an amazing
statement, which is "Now
even physics knows sin." and
the statement there being
that even something
as abstract as physics
can, on some metaphorical,
some secular level, know sin.
Even within the realm of
putting together buildings,
if you do it toadying
for the wrong people,
this could count as
a state of sinning,
and intrinsic in that
is the possibility
of a state of grace, even in
worlds like being a physicist
or being an architect.
It's not hard to see
that one for you guys,
though, because of
who you all are.
All of you here are privileged.
You are powerful.
You will have powerful
resources and connections
your entire life.
And it will constantly intersect
with the last 10 weeks.
And it is guaranteed that some
of you, at various points,
will have 30 seconds to
decide with somebody in an ER
who has taken a
vast amount of pills
to try to kill themselves.
You need to decide, is it them?
Is it their disease?
Is there even a boundary?
Do I give the command
against their will
to have their stomach pumped?
Every one of you, at some
point, will make decisions
about quality of life, if you
go into medical professions,
as to when you pull a plug.
Almost certainly,
some of you in here
will be judges
someplace or other,
wrestling with some of the
exact issues brought up.
Some of you in here
will be legislators
deciding how money
should be spent, what
things money is a waste on.
And you guys will be
in positions like that,
because if anybody will
wind up with those powers,
it will be guys.
And if you remember
any of this stuff, what
will seem the easiest
thing to remember
is, it's so complicated, it
is impossible to fix anything.
It is impossible to
make things better.
And so I want to finish the
class with two final thoughts
here.
One is, even though
it's complicated,
you've got to do something.
Wonderful, cool thing I
heard about in archeology.
And I don't know if this is
really true or urban legend.
But when you excavate a site,
what you are supposed to do
is excavate only
about half of it.
You leave the other
half for the people
in the future with better
techniques and better
understanding, and
leave something
intact there to keep from
your blundering hands.
And the next person who then
excavates does only half,
and half at every
juncture, saying,
leave the possibility that
people will be thinking
very differently in the future.
Work with the
possibility that some
of the things we feel
certain about right now,
the smartest and most
compassionate of people
500 years ago, felt that
way about epilepsy or things
of that sort.
It's complicated.
Just because it's
complicated, that's
not an excuse to do nothing.
If anybody is going to do
it and make a difference,
it will be you guys.
The other final point is to
do in one last dichotomy, one
last artificial bucket, one that
runs through this business way
too often.
You don't have to choose between
being compassionate and being
scientific.
So go and do both.
And good luck.
[APPLAUSE]
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