[MUSIC]
So, Robert Sapolsky was my professor when we were students
at Stanford University, many moons ago.
And Robert made a huge influence on my
wanting to be a scientist.
He was simply the most influential and
outstanding, compelling professor at
stanford,
because of the way he connected with his
students. And because of his incredible
gift at lecturing, which you're all about
to witness,
and as you might imagine Robert has
quite a number of impressive
accomplishments in his career -- including
the MacArthur Genius Fellow,
loads of highly influential scientific
articles, and research awards.
But perhaps one of his greatest
accomplishments are the books that have
been so incredibly
popular and so impactful to so many
people that he's written.
My personal favorites are
"The Trouble with Testosterone: a Primates Memoir"
and "Why Zebras Don't Get Ulcers,"
which is the topic of today's lecture.
And so let's please all join me in
welcoming Dr. Robert Sapolsky to the
stage.
[Applause]
Well, let me start off by saying actually
these lights only give me a dim
impression that there's a lot of
primates out there.
So i'm not entirely sure what I'm seeing
here. But let me start off by thanking
Justin and Peter. It is a delight to be
here
and a delight to see one's ex-students
flourishing and all that sort of stuff,
amid making me feel very elderly.
Okay. So let me start off, I just got here a
couple of hours ago.  So I pretty much
don't know anyone here. So i feel
empowered to ask all sorts of invasive
personal questions of you guys.
Okay. How many of you here have a family
history of heart disease,
cancer, high blood pressure,
ulcers, stroke? Well, there's a hand there
that's not even going down between the
questions.
Okay.  That is not good. How many of you
have a family history of somebody
with a really bad case of leprosy?
No hands. How about that cousin you're
stuck sitting next to with thanksgiving,
the one going to the bathroom every 10
minutes because of the dysentery?
Not that either.  How about that extra
special relative
who's just teeming with liver parasites
the size of your fists?
Not much there either.  And, all things
considered, this is not very surprising.
Very few of us in this room seriously
worry about smallpox or scarlet fever.
Few of us gets malaria during the rainy
season.
Few of our mothers died in childbirth.
Nobody in this room is malnourished.
We're not like normal animals. We don't
get sick the way normal animals do.
We don't die the way they do.
Basic, normal mammalian death.
You drink some contaminated water and you're dead from dehydration two days later.
And what do we do? We spend 80 years
having our bodies go to hell on us.
So we do. Oh great! I've got to listen to
what for the next hour?
This is actually fabulous news, because
this is westernized disease
for the most part. We are not plagued by
infectious diseases,
diseases of poor nutrition, poor hygiene.
Instead, we live
well enough and long enough to slowly
fall apart over time.
and this is a magnificent advance in the
human experience
okay just to give you a sense of it like
a little more than a century ago 1900
what do you think were the leading
causes of death in the united states
tuberculosis good what else
childbirth if you were a woman between
ages 20 and 40 the single medically
riskiest thing you could do in 1900
was attempt to give birth what else was
up there
influenza pneumonia tuberculosis
influenza number one on the list
the flu nobody dies of the flu anymore
1918 worst winter world war one people
being blown out of trenches all over
europe and if you were sent to the war
that winter
your chances of surviving were better
than if you got the flu
eight million war deaths in world war
one 40 million dead civilians
that winter from the flu nobody under
age 100 dies of the flu anymore instead
we die of these totally bizarre diseases
that never used to exist on this planet
in any sort of frequency
totally weird diseases like heart
disease
and cancer and diabetes and alzheimer's
and what you suddenly realize is
this is a very novel realm we've entered
in terms of making sense of which of us
are sick and which are healthy
okay 20 000 years ago you're some 20
year old hunter-gatherer
and you have screwed up big time you've
made a major medical mistake
you've just eaten some reed buck riddled
with anthrax
and the medical outcomes absolutely
clear you've got like a three-day life
expectancy
these days as a 20-year-old you make a
major medical mistake you decide a
healthy diet consists of
a lot of red meat and saturated fats and
maybe a drink every other day or so and
it's not at all clear what the outcome's
going to be you may be dead in your
grave at 50 or you may be running
marathons with your grandkids when
you're 85.
and in lots of ways the central question
for westernized medicine is
so why do some of us last to 50 and some
to 85.
some of it's got to do with like nuts
and bolts biology what your liver does
with cholesterol or stuff like that
but some of it's got to do with
questions nobody ever
had to ask before in medicine totally
bizarre
questions like what's your psychological
makeup
or what's your social status or how do
people with your social status get
treated in your society
or how about this one get the answer to
this question and you will have done
more good for the health of humanity
than anyone since like jonas salk
inventing the polio vaccine
why is it that when we feel like nobody
loves us we eat oreo cookies answer that
one and you have just solved half the
cases of diabetes in this country
this is totally bizarre stuff that has
something to do with which of us are
healthy or sick
that has everything to do with it and
what we've entered is this
very strange world when we look at the
diseases that do us in
these diseases of slow accumulation of
damage from lifestyle over time
these are predominantly diseases that
can be caused by
or be made worse by stress and most of
us in this room
will have the profound westernized
luxury of dropping dead someday of a
stress-related disease
so nonetheless amid that great news it's
a good thing if that happens
later rather than sooner so it's worth
learning about this okay we start off
with definitions
i start off with a word i guarantee all
of us had 9th grade biology
with any luck you have not thought about
this word since then do you remember
homeostasis homeostasis
having an ideal body temperature
having an ideal level of glucose in your
bloodstream having an ideal everything
being in homeostatic balance a stressor
is anything in the outside world that
knocks you out of homeostatic balance
your zebra a lion has left out ripped
your stomach open and your injuries are
dragging in the dust and you still need
to get out of there
this counts as being out of homeostatic
balance or you're that lion you're that
lion who's half starved to death and if
you don't chase down that zebra
successfully you're not going to survive
the night
short-term physical crisis and what you
do at that point
is you turn on the stress response you
secrete adrenaline
11d other hormones i won't torture you
with what you do is
you reestablish homeostatic balance
that's all you need to know about the
subject if you're a zebra or a lion
if you're human though you got to expand
the definition in a critical way
yes a stressor can be when your body's
been knocked out of homeostatic balance
in addition
a stressor can be when you think you're
just about to be knocked out of
homeostatic balance
if it turns out that you're right that's
great an anticipatory stress response
woo here comes the elephant maybe i'll
increase my blood pressure
now before it stomps me rather than
after that could be very adaptive
on the other hand if you think you're
just about to be knocked out of
homeostatic balance
and you really aren't about to be and
you think that way all the time
there are medical ways of describing you
you're being neurotic as hell
you're being anxious you're being
paranoid you're being
hostile try to describe global warming
to a hippo and it's going to have no
idea what you're getting all upset about
but that's the critical point we do
the critical point of the whole thing is
we turn on the exact same stress
response
as that zebra running for its life or a
lion running for a meal
and we turn it on for purely
psychological reasons
and that's the punchline of the entire
field that's not what it evolved for
for 99 percent of beasts on this planet
stress is
three minutes of screaming terror after
which it's either over whether you're
over with and what do we do we turn on
the same stress response for 30-year
mortgages
and that's not what it is for and what
we see
here is this is why we and other really
cognitively
sophisticated primates are the ones who
get mowed over by stress-related disease
this is a system that evolved for
dealing with short-term physical crises
and we turn it on for chronic
psychosocial stress
now listening to this description
something should seem sort of
questionable though i'm describing
okay the stress response you turn this
on if you're a zebra
you're injured you're bleeding you're
hypotensive
or if you're the lion you're starving
you're hypoglycemic
these are very different physical states
and one of the things they pound into
your head in biology is
your body comes up with a very specific
solution
for a very specific challenge if you're
hot you don't shiver your body does
something very differently than that
yet here's the stress response which
does the exact same thing
whether you're injured starving too hot
or too cold
why should you turn on the same stress
response in all these circumstances
and this was a question wrestled with by
the guy who's officially sort of the
godfather of stress and health
this was an austrian physician in the
1930s named han
selye who starred in the whole field
because he was very smart and very
intuitive and very insightful and very
creative and apparently he was
totally lame at handling lab rats and
this is how he started the field
celie was this young assistant professor
he's at mcgill university montreal
and he was looking for some research
project and some biochemist down the
hall
had isolated some hormone out of
somebody's pancreas or something nobody
knew what the stuff does
so celia decides that's it i'm going to
figure out the effects of this
pancreatic stuff on the body
so what do you do you go down the hall
you get a bucket load of the pancreatic
stuff from your body you come back
and you start injecting lab rats and
apparently celie
simply was not very good at handling lab
rats so he's in there every day with the
rats
injecting the rats and dropping the rats
and chasing the rats and the rats
chasing him and half the morning with a
broom getting around from underneath the
sink
months of this goes by and he discovers
something amazing
all of the rats have stomach ulcers
celie
is euphoric he's just discovered the
effects
of this pancreatic crud on the body it
gives you a peptic ulcer
now fortunately being a good scientist
celie was also running a control group
rats that he's injecting every day with
saline instead of the pancreatic stuff
so he's in there with the control rats
injecting them and dropping them chasing
them chasing him he checks out the
control rats and
they all have stomach ulcers
okay so your average scientist at this
point gives up and goes to business
school but soviet thinks about this
and he says this is totally screwed i'm
seeing the exact same thing in the
controls in the experimentals it's got
nothing to do with the pancreatic stuff
what do they have in common well i'm
pretty inept at handling these guys
they can't be having such a hot time
here maybe what i'm seeing is some sort
of
non-specific response of the body to
generalized unpleasant trees and celie's
insight was to at that point
systematically expose rats to
generalized unpleasant trees
put some of them up in the roof of the
building in the winter or down in the
boiler rooms or rooms with loud noise or
rooms filled with cat pee or who knows
what and he always sees the same thing
they get stomach ulcers we know exactly
what soy had just discovered this was
the tip of the iceberg
of stress-related disease and celie was
the guy who popularized
what was this obscure term from
metallurgy
about torsional strain on metals he's
the one who said
these animals are under stress and they
turn on certain systems in their body
that saves them from the stress but if
they turn it on for too long
you get sick everybody thought he was
out of his mind
because again you're trained your body
solves specific challenges in very
specific ways
and here's celie with his imaginary
stress response that gets turned on
exactly the same if you're injured
starving too hot too colder on a blind
date
why should you turn on the same exact
stress response
and all these circumstances and it turns
out it makes a great deal of sense
because whether you are that zebra or
that lion
if you're going to survive the crisis
there's certain things you need to do
with your body
first off above all else you need energy
not energy tucked away in your fat cells
for some building project next spring
energy right now to hand to whichever
muscles are going to save your neck
and with the onset of stress you secrete
adrenaline and a bunch of other hormones
and they go to the storage sites in your
body your liver your fat cells
they mobilize energy at a storage form
dump it into the circulation
it's like you go to the bank and you
empty out the savings accounts and turn
it into cash
circulating glucose and you hand it over
to whichever
muscles are going to save you makes
wonderful sense
whether you were that zebra or that lion
the next thing you do makes perfect
sense as well
you've just done all this amazing
biochemistry and dumped all this energy
in your bloodstream you want to deliver
it as fast as possible to your
exercising muscles
your heart speeds up your blood pressure
increases your breathing rate you
increase your cardiovascular tone
all as part of the strategy get that
glucose get that oxygen
to your thigh muscles in two seconds
instead of three you're that much more
likely to survive
now the next things you do during stress
make perfect sense
which is you turn off all the long-term
building projects
if there's a tornado do this afternoon
you don't spend the day outside
gardening you don't worry about
long-term projects until you know
there's a long term
you shut down everything that is not
critical you shut down digestion
by definition if you are that lion you
are not staggering up from some
all-you-can-eat buffet
and if you are that zebra the energy
you're mobilizing for your muscles
you're ener mobilizing it from fat cells
in just a couple of seconds
digestion is slow it takes forever it
costs a fortune
you're trying to avoid being somebody's
lunch don't worry about digesting
breakfast
and we all know the first step of that
suppose you get
stressed speaking in public what happens
your mouth gets dry
you've stopped secreting saliva the
first step of shutting down the whole
gastrointestinal tract
with the onset of stress you shut down
growth you shut down
reproduction big expensive optimistic
things to be doing with your body
and this is no time for it you know
you're running for your life there's a
lie in two steps behind you
you ovulate some other time don't do it
right now
hit puberty next week grow antlers some
other day don't even
think about sperm with the onset of
stress you shut down
growth you shut down tissue repair every
sex hormone on earth disappears from the
bloodstream do it later if there is a
later
next so you're that zebra and your
inners are dragging in the dust this
might be a good time to
perk up your immune system a little bit
just in case of some effective stuff
with the onset of stress
immune defenses are enhanced finally
a whole bunch of hormones secreted
during stress
get into your brain and short term their
effects are
fabulous they sharpen memory they
increase glucose and oxygen delivery to
your brain
your sensory thresholds are sharper you
even release this neurotransmitter
dopamine
which makes you feel good your memory is
working that's that flash bulb memory
where were you when you heard the news
i'm willing to bet every single person
in this room no matter how long they
live
you will all remember exactly where you
were when you heard the news that miley
cyrus was joining the supreme court
some stuff you just file away forever
because it's important
your brain needs to get a signal this
one do not forget
so what you see here is everything going
on here is exactly what you want to do
if you're that zebra or that line
you're mobilizing energy you're
delivering where it's needed you're
shutting off on essentials you're
fighting infections
you're thinking more clearly all you
have to do to appreciate that
is look at a couple of weirdo human
diseases where people can't do this
one of them is called shy drager
syndrome another one is addison's
disease
these are not diseases where oh you're
now more at risk for certain cancers
this is like somebody with undiagnosed
addison's goes running for the commuter
bus one morning
and drops dead from hypoglycemic shock
so we've gotten our first critical
take-home message here
which is if you plan to get stressed
like a normal mammal
you had better turn on your stress
response or else you got about a
30-second life expectancy
for most of us though the far more
important take-home message revolves
around
so what if you're turning on the stress
response too often
too long for purely psychological
reasons
and what you get there then is disease
at the other end of it now celie was the
first person to wrestle with this issue
why is it that chronic stress makes us
sick
and he came up with an explanation in
the 1930s and had dominated the field
for the next 40 years which was too bad
because he was totally wrong
okay here's what he thought was going on
along comes the stressor
knocks you out of homeostatic balance
you turn on the stress response you
re-establish homeostasis but the
stressor goes on for too long
and thus you enter what celie called the
exhaustion phase
you run out of the stress response your
adrenals run out of adrenaline your
pituitary runs out of its stress
hormones
it's like your military runs out of
ammunition and you're just left
defenseless there with the stressor
pummeling you
turns out this was totally imaginary
there was no such thing as this
exhaustion phase no organism on earth
has ever been so stressed that it runs
out of adrenaline
you don't deplete the stress response
the problem is
that after a while it's not that your
military is running out of ammunition
after a while you're spending so damn
much in your military that you don't
do health care or social services
or education or any of that
stuff and like after a while the stress
response is more damaging than the
stressor
especially if the stressor was some
psychological nonsense everything you're
doing here
is pennywise and dollar foolish it's
inefficient
it's less than optimal all of this is
built around
it's an emergency it's an emergency fix
later grow layer don't do it right now
and if
every day is an emergency you pay the
price for it
at the metabolic level mobilize energy
because the line's running after you
no problem at all mobilize energy from
your storage sites chronically because
you're chronically psychologically
stressed
and among other things your muscle mass
decreases
muscle is one of your main energy
storage sites you get atrophy of muscle
myopathy for extremely complex reasons
you're using your energy
really inefficiently for insanely
complex reasons
you're now more at risk for adult onset
insulin resistant diabetes now
adult onset diabetes is one of those
interesting diseases
that our great great great great
grandparents never even dealt with
this is a disease of getting older in a
typically westernized way putting on
weight getting more sedentary
and everything down to the molecular
level that goes wrong in your cells with
adult onset diabetes
stress exacerbates the process
same punch line at the cardiovascular
level if a line is chasing you
and your blood pressure is 180 over 120
you're not suffering from high blood
pressure you're saving your life
on the other hand if your blood pressure
is 180 over 120 every time you're stuck
in traffic or something
you're not saving your life you are
suffering from stress
induced hypertension and you do that
chronically enough and
you're going to damage your
cardiovascular system
okay 30 seconds on stress and heart
disease what's the scenario we all know
about
guy gets horrible news and he's wailing
about something
and he suddenly clutches his chest in
pain kills over dead
sudden cardiac arrest this has never
happened this is like a movie plot this
never occurs in real life
instead what actually happens requires
you to have like
arcane knowledge of high school physics
explaining why
like toilet bowl plumbing wears out
after a while
you got a tube and you got fluid moving
through the tube
and by definition if the fluid is moving
through with more force
elevated blood pressure you begin to get
fluid turbulence
pounding away on the walls of your blood
vessels causing little bits of pitting
and scarring
and tearing and then you get
inflammation there and then that's
exactly where like glucose and
cholesterol and fat wants to glom onto
to clog your arteries
where's the glucose and cholesterol and
fat coming from that's the stuff you're
mobilizing into your circulation in the
previous slide
so you get this synergistic double
whammy here between the metabolic
stress response and the cardiovascular
setting you up for
the number one killer in this country
cardiovascular disease
now this link between stress and heart
disease is so
solid that it accounts for the most
famous personality profile in all of
medicine
and it's one where basically if you're
coming out to a lecture on a perfectly
nice evening to be outside taking a walk
instead
i suspect it applies to like 80 percent
of the people in this room
which is those of us in here who have
type a personality
okay type a personality type a was first
described in the 1950s
by a pair of cardiologists in san
francisco friedman and roseman
here was their original formulation time
pressured
hostile impatient low self-esteem
joyless striving okay like 90 of us
and what they observed back there in the
50s was if this was your personality
profile
you were more at risk for heart disease
cardiologists
hated these guys you're some like
eisenhower cardiologist
and all you're thinking about is like
blood lipids and heart valves and here
are these guys saying
no you need to sit down you're patient
and talk to them christ who wants to
talk to their patients
and talk to them and say okay so suppose
you're in the supermarket
and you pick the line that's moving
slowly do you go berserk at that point
that's got something to do with heart
disease total resistance to the concept
and it wasn't until the 1980s that
enough studies had been done
that it became clear type a is for real
big time if you have type a personality
you are more at risk for cardiovascular
disease than if you smoke
than if you were overweight than if you
have elevated cholesterol levels
a huge risk factor now what became clear
by the 80s
was the critical component in the type a
profile
the piece that is the one that
contributes to the cardiovascular
disease
and it's a term now that is used in the
field if you have
toxic hostility toxic hostility this
attributional style
where everything that happens around you
is proof that they're out to get you
they're out to get you more than
everyone else and the only thing to do
is watch your back 24 7 and keep a knife
ready
this is the style where you're in the
supermarket
and you've picked the slow line and you
want to kill the son of a bitch kid
behind the cash register come on come on
how do you know i have a one o'clock
meeting trying to screw me up no don't
ask the old lady how she is today come
on come on come on i'm gonna die someday
i get to
you know if this is what you're doing
instead of checking out the alpha
sightings in the national enquirer
your blood pressure is going to go up
and if this is what you're doing every
time somebody
could have held the elevator door open
for you but didn't
if you're doing this 40 times a day
you're going to pound away at your blood
vessels
set up for cardiovascular disease and
these days the main question in that
field is
insofar as you were toxically hostile
what's worse for your heart
expressing those toxic emotions or
keeping them repressed inside what's
clear is expressing them is worse for
everybody else's cardiovascular health
but what is the cost of repressing
strong physiological emotions
so that's an area of a lot of ongoing
research okay so that's stress and heart
disease
actually how did those guys first figure
out about type a personality
given how much that was coming out of
left field
and i actually got to hear the story
some years ago out of the horse's mouth
himself meyer friedman the cardiologist
who first described type a died a few
years ago in his early 90s
saw his last patient a week before he
died was working full-time at a
cardiology unit ucsf medical center
as he used to say i'm still type a but
i'm a type a tortoise now
and here's the story he would tell in
the 50s
he and his partner had this cardiology
practice everything was going great
except for this one weird thing which is
they were spending a
fortune having to reupholster the
armchairs in the waiting room
what's this about who knows whatever
it's part of the overhead
every month this upholsterer comes and
there's a chair or two that needs to be
fixed
one month the upholsterer is out on
vacation replacement upholstery comes in
takes one look at the chairs and
discovers type a personality
he says what is wrong with your patients
nobody wears out chairs this way and
they have one of them left
and as you can see here the front two
inches of the armrests
and the seat cushions are totally
shredded and the rest of the chair is
perfectly fine it's like every night
there's like dwarf beavers in there
clawing away the chair what is this this
is the type a profile
this is somebody with type a personality
this is what they do to a chair
when they're waiting in the waiting room
with their cardiologists to hear if
there's bad news or not
this is not just figuratively but
literally sitting on the edge of your
statement seat and squirming and clawing
and all of that
this is what somebody who's type a does
to a chair in that circumstance
okay so what happens at that point
if science is working right and you know
friedman should grab him
like good god man what you've discovered
were like like midnight conferences
between upholsterers and cardiologists
or
or or teams of idealistic young
upholsterers sweeping across america
and coming back with the news that no
you don't find chairs like these in
podiatrists offices
that's what should have happened what
happens instead
here's where 90 year old dr friedman
starts looking all sheepish
he says he says i told my nurse
get this man out of here i'm this
important cardiologist i can't waste my
time with him give him this damn check
get him out of my face he was too
type a to listen to the guy and it
wasn't
until about five years later that he
collaborated with the psychologist and
back came the type a profile
they said oh my god the upholstery he
was right
to this day they have no idea who that
guy was
now let's see it is late afternoon in
san francisco i'm willing to bet there's
some
bar in san francisco right now where
there's like this 110 year old retired
upholsterer
and get this guy going and he's going to
go on and on about how he discovered
type a personality
exactly what occurred so one of the dark
chapters in my profession
okay moving on digestion shut down your
digestive system for
two minutes running for your life it's
not a big deal shut it down chronically
and there's all sorts of
gastrointestinal disorders you're more
at risk for
most famously ulcers back to celie in
the 1930s the first stress-related
disease
stress causes ulcer stress causes ulcers
canonical knowledge
everybody knows this and then about 25
years ago there's this revolution in
ulcerology
turns out there's a bacteria called
helicobacter pylorus
turns out the bacteria is responsible
for about 90 percent of ulcers in the
west
it gets into your stomach it generates
oxygen radicals and blows holes in the
walls of your stomach
it's a bacterial disorder this was an
enormous contribution the two guys who
discovered against the nobel prize
amazing the evening this is announced
every gastroenterologist on earth
goes out that evening and celebrates
this is the greatest news they've ever
heard
because they're not going to have to sit
down their patients and make eye contact
and say if you have any
stressful way it's got nothing to do
with stress here's some antibiotics get
out my office it's got nothing to do
with stress it's got everything to do
with stress
because only 10 percent of people with
the bacteria
get the ulcer you've got to have the
bacterial risk factor
but you've got to have a lifestyle risk
factor overlapping as well
stress stress does not cause ulcers the
bacteria does
what does stress do when you got an
ulcer beginning to start
your stomach's reasonably good at
repairing it
and rebuilding the wall there before the
ulcer gets troublesome
unless you're chronically stressed and
every day your stomach
walls are saying ah do it tomorrow do it
tomorrow it feels like we're being
chased by a predator
psychological stress shuts down the
reparations there
so here we have a classic example of
interactions between the organic causes
of disease
and the psychogenic stress is still very
relevant
to making sense of ulcers
next growth shut down growth for three
minutes while you're running for your
life not a big deal our theme by now
shut it down chronically this can be
problematic especially if you were a kid
all kids are are big long-term building
projects
and for reasons of psychological stress
you keep saying do it tomorrow do it
tomorrow
you can impair growth and at an extreme
you have one of the
truly bizarre outposts of medicine
a disease of kids who stop growing for
reasons purely of psychological stress
known as psychogenic dwarfism
psychosocial dwarfism stress dwarfism
these are kids who are years behind the
normal growth rates and
there's no disease they're not
malnourished there's no parasites
you check their bloodstream there's like
no growth hormone
you give them synthetic growth hormone
nothing happens the whole system is shut
down
and at that point you start poking
around in their background
and often out comes some appalling
psychological stressor
and the amazing thing is get them out of
that stressful setting
technical term do a parentectomy on them
and growth will resume at that point
this is incredibly well understood how
this works
open up any textbook of endocrinology go
to the chapter on growth and i guarantee
there will be the obligatory picture of
the stressed dwarfism kid you know those
pictures of
stunted cues like naked in front of the
growth chart with a rectangle over the
eyes
and turn the page and i guarantee
there's the obligatory follow-up picture
the kid in a different environment two
years later he's like six foot fourteen
he's playing for the nba
it's everything's you know there's still
the rectangle and nakedness but
everything else gets better
and what you see there is this is the
system with an amazing capacity to
recover remarkable cases of this for
example
this was a case report a few years ago
this was a child brought in from an
extremely abusive psychological setting
into new york hospital with stress
dwarfism and as
documented in the paper at the time he
came into this pediatric unit
zero growth hormone in his bloodstream
over the next few months
he became very close with one nurse
there and this was like the first normal
emotional relationship of his life
after a couple of months normal growth
hormone levels for his age
at that point the nurse goes on vacation
by the end of her two-week vacation he's
back down to zero
nurse comes back a week later he's back
up to there
think about this the rate at which this
child was depositing
calcium in his bones could be entirely
predicted by how safe and loved he was
feeling the world
you can't ask for a much better example
of what's going on here
affects every outpost in the body
now the issue with stress dwarfism amid
people understanding exactly which
hormones are due or what
the issue of course becomes how common
is this disease
if you were shorter than average and you
were not obviously malnourished as a kid
are you a victim of stress dwarfism did
your parents do that to you
no this is not like oh very stressful
childhood we were moving all the time
this is not like acrimonious divorce
this is nightmare
psychopathology this is the police and
the social workers
breaking down the door of an apartment
and finding the kid
chained to the radiator and smeared and
excrement and just
nightmare stuff and get the kid out of
that setting and there's recovery
the clinical consensus is this is a once
in a career disease that you see
extremely rare
except it's not so rare it pops up all
over the place
kids in war zones kids in areas of civil
strife
a research assistant of mine and i think
we've got the data to show
that kids who wound up in the japanese
american internment camps in world war
ii
had mild stress dwarfism that pops up
all over the place
one classic study in the 60s
looking at rites of passages from
cultures all over the planet
rights of passages in one culture they
take you out of the desert and stake you
down and cover you in poison ants and
some other culture you play the piano
for your grandmother and her friends or
whatever's done in your tribe they did
like 80 tribal comparisons they
controlled for genetics
back comes the finding stressful rites
of passages during the first few years
of life
two inches shorter as an adult big
effect
let me tell you about the single
creepiest example of stress dwarfism
i've ever heard of
if for some inexcusable reason you ever
find yourself
reading chapter after chapter about
growth hormone you're going to notice
there's a weird thing
which is a lot of the chapters make
reference to peter pan
some quote from peter pan or some snide
comment about tinker bell
i've seen this for years i had no idea
what this was about until one day i
stumbled on an explanation
and this was a chapter about the
psychological regulation of growth and
was talking about stress dwarfism
gave the following case history
eight-year-old boy
growing up in victorian england in the
1870s
one day he sees his beloved older
brother killed in front of him in an
accident
this destroys the family there were no
other siblings the father was like
emotionally non-existent
this was the mother's favorite child and
this victorian swoon she takes to her
bed with the shades drawn for the next
10 years this kid growing up in this
horrible emotional isolation he goes
into the bedroom with a tray of food for
his mother
and she's saying oh david david is that
you david have you come to me have you
david the dead son david are you finally
oh it's only you growing up being
only you apparently the only thing she
ever spoke to him about
was this idea she grabbed onto which was
if david had to die he'll always be my
perfect little boy who never grew up and
became a man who didn't need his mother
anymore he'll always be my perfect
little boy
because he didn't grow up and grow up
and grow up this kid hears this with a
vengeance
middle class family no evidence of
disease or malnutrition
boy stops growing there at age eight
lives to age
60 4 foot 10 as an adult unconsummated
marriage
incredible example of stress dwarfism
and then then the chapter concludes by
informing us that as an adult this was
the author of the much beloved
children's classic peter pan
this was j.m barry the guy who wrote
peter pan who's incredibly
screwed up this guy all he did was crank
out
book after play after novella about boys
who die and come back as ghosts and
marry their mothers
his private journals were full of
sadomasochistic fantasies about little
boys
this guy spent the rest of his life
dealing very unsuccessfully with this
stress dwarfism so think about that the
next time you see johnny depp
up on a movie okay
next next reproduction your gonads
your gonads your gonads are not going to
be working very well if you were
chronically stressed if you were a
female mammal of virtually any species
if you were chronically stressed your
cycles will become irregular
lengthened they may stop all together
stress induced amenorrhea stress-induced
and ovulation
and people understand exactly how those
work which hormones are working
at the brain at the pituitary at the
ovaries of the uterus to shut things
down
let me tell you about one of those steps
because it's got to do with a very weird
thing that female
mammals do including human females which
is
they secrete a certain amount of male
sex hormones into the bloodstream
hormones that are related to
testosterone androgen type hormones
they come out of the adrenal glands not
a ton of the stuff maybe five percent
the levels you would see in the male
nonetheless you got to get rid of it
unfortunately
female mammals come with this enzyme and
fat cells
that take circulating androgens
and does biochemistry 101 and converts
them to
estrogens great perfect problem solved
everyone lives happily ever after what
if you're stressed
what if you're stressed like the locusts
have come and eaten your crops
and you're subsisting on 800 calories a
day what if you're slowly starving
your fat stores are slowly getting
depleted
and at some point you have too little
functional fat cells
to do the androgen to estrogen
conversion
one problem is there's now a little bit
less estrogen in the bloodstream
bigger problem is the androgen levels
build up there and that shuts down every
step in the system
that's why starvation shuts down
ovulation
that's why voluntary starvation anorexia
does the same and that's why some women
who do
massive massive amounts of exercise will
stop ovulating as well
because you get below a critical fat
muscle ratio there now this is something
that's been studied at length
in girls for example it's always studies
of very serious ballet dancers or
gymnasts
what you see is significant delay in the
onset of puberty
one study for example this was done on
the olympic gymnastics squad from
romania you know those
60 pound 15 year olds getting the gold
medals all over the place what was the
average age of which these kids started
menstruating
19. 12 and a half is the western average
once hitting puberty women who do tons
of athletics
is best studied long distance runners
women who run an average of 40 to 50
miles a week
that's typically the range where fat
stores are getting below threshold
where you begin to have ovulatory
irregularities i can tell you the exact
same story about men
men who run 40-50 miles a week sperm
count goes down there's mild testicular
atrophy
okay wait a second i thought exercise
was good for us
exercise is good for us and in fact a
lot of exercise is very good for us that
doesn't mean though that an insane
amount of exercise is insanely good for
us
it means at some point too much of a
good thing is just as bad as too little
you've passed a point of homeostatic
balance
and all you need to do to get an
appreciation for that is imagine
you sit down some hunter gatherer from
the kalahari desert and say you know
where i come from we have
so much food and so much free time that
sometimes we'll just go run 26 miles in
a day for the sheer pleasure
and they're going to say are you crazy
that's stressful
i mean throughout hominid history if
you're running 26 miles in a day
either you are very intent on eating
somebody or somebody's intent on eating
you this is not normal
physiology so we get a cautionary note
here
meanwhile over at the male end of things
with the onset of stress
down go testosterone levels anesthetize
a guy
slice into his belly for surgery 10
minutes later testosterone is plummeting
first year male medical students during
exam periods down go testosterone
drop the rank of a male baboon at a
hierarchy down goes testosterone
here's a stressor which thank god i have
no personal experience with at all
but apparently it's not fun to be in the
marines
apparently it's kind of a drag
especially during basic training this
was this classic study
1970 new england journal of medicine
looking at military recruits during
basic training
were now on top of everything else they
had to pee into little dixie cups for
the psychiatrist
and back comes the finding guys in the
in the marines during their first couple
of months of service
they have the circulating androgen
levels of like vatican choir boys
that's how much the system is shut down
okay so people understand exactly which
stress hormones are working at
the brain the pituitary and the testes
to shut down testosterone synthesis
during stress the question you gotta ask
at this point
is so what are the consequences of
testosterone levels declining during
stress
and amazingly enough the answer is
there's no consequences at all
testosterone turns out to be this vastly
overrated hormone
like basically all you need is like a
thimble full of stuff and a couple of
sperm and you're in business
you've got to knock out like 90 percent
of the guys testosterone levels to
seriously impair fertility
stress what does it do at its worst only
about a 60
decline it's not suppressed enough that
it makes a difference
the problem during stress is not that
testosterone levels go down
the problem is that penises go down
okay am i allowed to talk about this in
champaign urbana here
okay finally we come to the first like
useful point in this damn lecture so how
do erections work
okay so erections in order to i just saw
somebody there pick up a pen for the
first time
okay so how do erections work in order
to have an erection
you gotta have a spinal cord now most of
what your spinal cord does is totally
boring and makes you
shake hands and sign checks and foxtrot
or who knows what but then there's the
part that does the good
stuff the stuff you normally don't have
any control over stuff that is
automatic like goose flesh and orgasms
and pupillary contractions and blushing
things that are automatic and thus run
by the
automatic nervous system also known as
the autonomic nervous system
now the autonomic nervous system comes
in two halves first half
sympathetic nervous system emergency
arousal adrenaline
stress response all hell breaking loose
second half
the parasympathetic nervous system calm
vegetative function you take a nap you
turn on the parasympathetic nervous
system
you eat a big starchy meal you turn on
the parasympathetic nervous system
you get disemboweled by a lion you turn
off the parasympathetic nervous system
it works in opposition with a
sympathetic
okay so here's the rule in order to get
an erection
you've got to turn on the
parasympathetic nervous system
you have to be calm and vegetative
okay so you got your erection now what
happens next
maybe for some social reason having to
do with the context that brought about
the erection maybe
you start feeling a little bit less calm
and vegetative
maybe your heart rate increases a little
maybe your breathing rate maybe your
muscles are starting to do
some work slowly you're starting to turn
on the sympathetic nervous system
more time goes by your heart is racing
your toes are curling you're sweating
you're breathing fast all of that
eventually you get to this point where
your whole body is screamingly
sympathetic except for this one lone
outpost we are desperately holding on to
parasympathetic tone as long as possible
finally can't take anymore you turn off
the parasympathetic turn on the
sympathetic and ejaculate
okay so that's how erections work so
what happens during stress what happens
during stress you're not very
calm and vegetative you can't get the
erection stress induced imminency
or you can have a second problem suppose
you manage to get the erection
and you think like oh no donald trump
who knows why you accelerate
the transition you accelerate the
transition
from parasympathetic to sympathetic the
whole thing goes too
fast either you can't get the erection
or
premature ejaculation incredibly easy
for this to occur
current estimates are 60 percent of the
visits by men in this country
going to doctors about erectile
dysfunction turn out not to have an
organic disease basis
but instead are psychogenic
stress-related
okay second useful piece of information
so how do you tell the difference
between a case of organic infancy and
psychogenic
so a guy comes to you says he hasn't
been able to have an erection during sex
in the last six months
and you're wondering well is the stress
related or does he have a pituitary
tumor whatever
you take advantage of a weird thing that
male primates
including human males do which is when
they go into rem
sleep rapid eye movement sleep they get
erections
i've no idea why i've talked to earth's
penis experts nobody has an explanation
for this
nonetheless male primates get rem sleep
erections
so here's what you do the guy who hasn't
been able to have an erection during six
sex and months what you do is you give
him this handy-dandy little penile
pressure cuff
transducer thingy that he takes home and
just before he goes to sleep he
puts it on the base of his penis and
wires it up and
satellite relays and 24-hour operators
in bangalore and the next day
the next day you got your answer which
is if this guy hasn't been able to have
an erection during sex in the last six
months but 30 seconds into his first rem
stage he has a perfectly normal erection
he doesn't have a pituitary tumor it's
stress related
that's how you distinguish between the
two do you still get the nocturnal
erections
if that's the case it's stress related
very easy to actually maybe this is not
so easy
because you got this electronic device
and it's beeping and the wires and
you're
so sure it's going to electrocute you
that's a stressor in and of itself
this is what is done in the majority of
sexual dysfunction clinics in this
country
i kid you not you take a long string of
postage stamps
you lick them at one end and you wrap
them around the guy's penis
and the next morning if the stamps have
been torn loose
the guy had an erection during the night
can you believe
like how elegant this is like five bucks
you get a lab result
it's fabulous yeah oh of course
insurance won't reimburse you for the
stance but
still you know maybe obamacare still has
a chance okay so
what we see here is another outpost of
vulnerability and perhaps we should
hurdle on before
i embarrass myself further your immune
system your immune system so as we heard
before with the onset of stress
you enhance your immune defenses with
chronic stress
something very different occurs with
chronic stress
not only does the immune system go back
to baseline you suppress immunity
with chronic stress you become immune
suppressed
and this is the starting point for just
this irresistible syllogism
insofar as chronic stress chronically
suppresses the immune system
chronic stress should set you up for
more infectious diseases
and this is the basic premise behind
this field that emerged about 25 years
ago
psychoneuroimmunology the notion that
what's going on here
is affecting your immune defenses in a
quarter century into this field
it's clear that's exactly how it works
for all the boring stuff
when you were under stress the common
cold becomes more common
you're at more risk for mononucleosis
for herpes viral
flare-ups reactivation what's far less
clear
is what about bigger realms of
infectious disease
how about if you have aids your immune
system declining
if you're severely stressed does it
decline even faster
jury is out on that one it seems to have
to do with personality type as an
intervening variable
how about the biggest one on everybody's
list
when it comes to worrying about disease
so what's the relationship between
stress
and cancer and everybody knows the
answer to that
which is cancer is a stress related
disease
stress can cause you to have cancer
stress can cause you to come out of
remission
from cancer stress can accelerate the
growth of tumors
everybody knows about this sufficiently
so that some years ago there was a study
in
jama journal the american medical
association looking at women who had
just gotten a metastatic breast cancer
diagnosis where they were asked
so what do you think is the cause of
your cancer and by more than a two to
one margin the most common answer was
stress too much stress in my life stress
has virtually
nothing to do with cancer there has
never been
a decent prospective human study
longitudinally
that shows that stress increases the
risk reoccurrence or growth rate of any
type of tumor
when they're well controlled there have
been all sorts of studies
showing how stress can accelerate tumor
growth in lab rats
we know how it works my lab did some of
that work but it turns out these are
types of cancers that are completely
irrelevant to human cancer
this is a realm where there's not much
connection at all
amid all those things on the right sides
of these charts you need to worry about
this is one domain where you don't why
is it important to emphasize this
because of all of these highly
credentialed quacks
who are making a fortune off of cancer
patients saying
my special brand of stress therapy will
slow down your cancer stop it reverse it
credit cards accept it
there's no science to support this bad
medicine bad
science bad ethics this is a domain
where you don't have to worry
okay so quickly let's hurtle back to
domains where you do have to worry okay
so back to stress in your brain we saw
short term
does all sorts of great stuff
chronically
bad news chronically stress will damage
a part of your brain called the
hippocampus
which is essential for learning and
memory stress has something to do with
failure of memory consolidation there
shrinkage of neurons disconnecting of
synapses
at an extreme killing of neurons
inhibition of the birth of new neurons
there
and this is turning out to be relevant
to humans and a number of scary realms
people with chronic stress due to ptsd
post-traumatic stress disorder
combat trauma or sexual abuse trauma and
what you see there is
atrophy of the hippocampus only the
hippocampus
the more severe the trauma history the
more atrophy the more memory problems
best evidence is this is not reversible
second syndrome pertinent to the 10 to
15 percent of us in this room
destined to have major clinical
depression the
poster child and psychiatry of a stress
related disorder
it involves chronically elevated stress
hormone levels and
scads of studies now showing atrophy of
the hippocampus only the hippocampus
the more severe the depression history
the more atrophy
the more memory loss and as far as most
studies show at this point
this is not a reversible process
meanwhile next door to the hippocampus
is a brain region called the amygdala
and in the amygdala things are real
different hippocampus does learning and
memory for you
amygdala teaches you to be afraid it
does
fear it does anxiety and while stress
is atrophying away those hippocampal
neurons
stress is making neurons and the
amygdala work
better than usual they expand their
connections
the synapses become more excitable
people with ptsd have amygdalas that
grow larger than normal
stress makes it easier for you to
associate
things with fear that are not actually
valid and makes you harder to detect
to detect safety signals this is the
link between
stress and anxiety meanwhile
over in that part of the brain where
you're releasing dopamine
which has something to do with pleasure
with the onset of stress chronic stress
and you're depleted of dopamine what is
this setting us up for explaining
the link between stress and depression
the defining symptom of depression
is anhedonia hedonism the pursuit of
pleasure and hedonia
the inability to feel pleasure this is
the neurochemical link
why chronic stress is a major
precipitating factor
for depression so okay if you're still
awake at this point you should be
depressed as hell
okay so amid that it must seem like a
miracle that any of us are still alive
actually let me make this worse one last
stress related disease
this is like stress for 2000. how many
of you have heard of a disease called
idiopathic alopecia areata
okay a few hands this is the profoundly
rare state
of somebody being so so traumatized by
something that over the next few days
their hair turns white and falls out
this is for real
people understand like what the immune
system is doing the hair follicles there
it's real it's a once in a career
disease but nonetheless this is free
look at this you're chronically stressed
you get high blood pressure you get
diabetes you get flatulent your sex life
is ruined your brain gets damaged and
your hair falls out
how is it any of us are still
functioning here why haven't we all
collapsed into puddles of stress-related
disease
and the critical thing is most of us
don't
most of us cope and what's been clear
from the first day of the field with
celie
is some individuals cope with stress
better than others
what i want to spend the last couple of
minutes on is how we understand this to
work why do some bodies
and more importantly some psyches deal
better with stress than others
okay so if we're talking about
individual differences and stress
responsiveness here
we're not talking about physical
stressors finish this lecture
go outside unexpectedly be gored by an
elephant and
you're gonna have a stress response
there's no way you can't reframe your
experience and grow from adversity or
who knows what
you're gonna have a stress response
finish the lecture go outside and have
kind of a tense ambiguous interaction
with someone and
only some of us will have a stress
response
what is it about that gray zone of
psychosocial interactions
that is more stressful for some
individuals and others
what we're asking here is what is it
that makes
psychological stress stressful and
remarkably a
massive literature stretching back
decades shows
what precisely are the building blocks
of psychological stress
okay here's a schematic summary of the
gazillion studies what they would sort
of show
take a lab rat put him in the cage every
now and then
he gets a shock mild shock and
nonetheless with enough of them
this is stressful blood pressure goes up
heart rate goes up
risk of ulcer goes up as shown here
you're giving the rat a stress related
disease
now second line in a second cage there's
another rat psychology jargon the second
rat is yoked to the first rat every time
the first rat gets a shock so does the
second same intensity same duration same
everything
according to celie in 1930 both of their
bodies are being knocked out of
homostatic balance the exact same extent
except for a critical difference which
is every time that second rat gets a
shock
it can go over to the other side of the
cage where there's another rat
and it can bite the crap out of it and
you know what that rat's not going to
get an ulcer the guy is biting isn't
going to get one but this one doesn't
he has an outlet for his frustration
third line now we have in the second
cage a second rat getting the same shock
same duration same intensity same
everything but each time he gets a shock
he can go over and there's a bar of wood
that he could
gnaw on with his teeth and he doesn't
get an ulcer
he has a hobby okay now the next line
what we have here is same shock same
intensity same everything
but 10 seconds before each shock the
second rat
a little warning light comes on and the
rat doesn't get an ulcer
for the same external stressor we are
more protected when we get
predictive information when is it coming
how bad is it going to be how long is it
going to last
and we all know that principle every
time we ask the dentist how much more
drilling
and we all know the difference between
the dentist that says two more bits and
we're done on the one that says
yeah it could be it could be weeks
you're gonna be here and when the
dentist says two more bits of drilling
bad news you're not done yet good news
the second that second bit of drilling
is over with
you're safe for the rat in the first
line any second
you can be a half second away from the
next shock
next line this is a rat that's been
trained to press a lever
by pressing the lever it decreases the
likelihood of getting a shock
today the rat is yoked to the first one
getting the same shocks as the first guy
but there's a lever in there the lever
is disconnected the leverage has done
nothing whatsoever but the rat doesn't
know what so he's in there
pounding away the lever saying this is
great just imagine how many stock you're
getting otherwise he thinks
he has control for the same external
stressor
a sense of control makes things less
stressful
jumping ahead to the final line shock a
rat and now it goes over to the other
side of the cage where there's a rat
that it knows and likes and they groom
each other and
it doesn't have a stress response wow
science has finally proven that friends
are good for your health
science has proven this big time when
you look at
all of behavioral medicine and all of
health psychology
there are two of the biggest predictors
out there
as to mortality rates across all
diseases the first one
taps into every one of the factors on
the slide which is
never ever make the mistake of being
born into a poor
family because your health is going to
pay for it the rest of your life
the link between health and
socioeconomic status very heavily
mediated by stress
the second biggest predictor is if you
got a choice in the matter
don't be socially isolated and you look
at the extremes
of social isolation versus social
affiliation
significant other others small group of
friends community group you're
intentionally involved with
for the same disease impact almost a
threefold difference in mortality rate
and that's after you control for stuff
like ooh people who live alone just eat
cheetos for dinner and nobody reminded
to take their meds
control for that and social isolation is
an
aching stressor for every primate out
there including us
and a huge health risk factor so what is
it that makes psychological stress
stressful
for the same external misery you are
more likely to feel subjectively
stressed
more likely to turn on a stress response
and more at risk for stress-related
disease
if you feel like you have no control no
predictability
no outlets for the frustration if you
interpret things as getting worse
and you have nobody's shoulder to cry on
and basically
this is the place to stop because again
none of us are getting ulcers because
we're being chased by saber-toothed
tigers
none of us are ever gonna have to
wrestle people for canned food items and
bombed out supermarkets
instead we are going to have this luxury
of living well enough and long enough
amid our psychological stressors to pay
the medical cost
and that's the critical point at the end
to the extent that we are
smart enough to have invented these
psychosocial stressors
and then stupid enough to have fallen
for them we all have the potential to
instead
be wise enough to keep them in
perspective so on that note
thank you for your attention and good
luck with your stressors
wow i see my mother did manage to call
all of you before the lecture today
thank you he's still blushing from the
erection
topic so uh welcome back to that
i wanted to ask you a question this is i
have a strategy of coping
and i'm not sure it's it's the best
strategy um i
so i i experience a lot of stress and so
my here's my coping strategy i always
am expecting the worst so basically
you know when i'm applying for a grant
or something i'm i'm expecting not to
get it if i'm
you know submitting a paper i'm
expecting it to get rejected and this is
a coping strategy for me because
if uh you know if it turns out that i
don't get the grant then i'm not really
let down
and that's in a way it helps me predict
the stressor
but on the other hand i'm thinking about
it i'm thinking well then i'm
always constantly thinking about the
worst and it's kind of a pessimistic
attitude
so basically my question is is this a
bad strategy
yes
i would recommend first just taking out
your adrenal glands that that will
probably be more effective
okay what we have here is the difference
between bad outcomes and unpredictable
outcomes
the problem with over always expecting
the worst
is you're probably not really expecting
the worst
you're expecting maybe your grant won't
get a good score you're not expecting to
be disemboweled by your grant review
committee
so it's a moderately bad outcome that
you're now over expecting
that you're now expecting and the
trouble is when something good happens
it's good but what it also tells you is
hey
i thought i understood how the world
worked and
my model as to what cause and effect is
about here is not quite so great
and i blew it on expecting something
good to happen maybe i'm blowing it also
and expecting
really bad stuff to happen the
unpredictability there outweighs
the goodness of it and various like
classic studies have shown
that under circumstances where you give
rats
more a bigger food pellet than they
expected for this amount of level
pressing
good news but whoa they thought they
understood how the world works within
the right parameters
that's more stressful because it's
telling them
they don't really understand how the
world works that's fine for a bigger
food pellet but what else don't i
understand
so you're saying when i get the grant
then it's uh
then you have to convince yourself why
you knew you were going to all along
yeah
i have a question that maybe reframes
the topic which is we
look at stress and its consequences and
there's the inverse of stress which is a
sense of well-being or flourishing and
i'm curious in your research if you look
at that and
um perhaps it's doing these four things
really well but
um is there a body of work that you can
point to or are you motivated to
to you know study around people who seem
to be flourishing who live longer who
seem to cope better
okay this celie back in the 30s tried to
introduce a word that never caught on
which was eustress e-u-s-t-r-e-s
which is good stress and somehow that
never
quite became popular but it was built
around the fact
that like a goal if you study stress
biology or stress psychology or anything
the goal is not to eliminate stress from
our lives because the trouble is
we love stress we love stress when it's
the right kind when it's the right kind
we pay good money for it we like push to
see the front
watch like what exciting tournament is
happening we pay good money
to get on roller coasters and get
terrified we love
stress when it's good so the question
becomes what constitutes good stress
and it turns out that it's within a
fairly narrow parameter good stress
consists of
a stressor that's not too extreme
you get on the roller coaster and you
know there's a chance you're going to be
made a little bit queasy afterward not
decapitated
it's not too long lasting it's not for
nothing roller coaster rides aren't
three weeks long
so it's transient moderate and most of
all it's occurring in what's overall a
benevolent environment
because when we're feeling safe we love
to give up
control and predictability because we
love being surprised in safe settings
what do we call that
we call that play we call that
stimulation we call it getting it to the
optimum amount i mean what are dogs
doing when they play
the dominant one crouches down and says
for the next whatever length of time i'm
gonna
i'm gonna sort of eliminate our
dominance relationships
so you can put your teeth on my throat
or my privates or whatever and it's
gonna be okay
you're safe now come and surprise me and
i'll try to surprise you too
what we call the optimal amount of
stress is stimulation
and in that regard the opposite of play
is not
work the opposite of play is depression
it's getting
just the right amount of stress and of
course what the gigantic challenge is is
one person's version of just the right
amount is what's like perforating
somebody else's stomach there
the enormous individual differences but
what the
successful aging people generally show
is a capacity to respond to moderate
stress responses
and to be able to distinguish between
those and the big persistent ones
um so i i had a question about
depression so
we talked a little bit about this the
other day depression has been increasing
in our society now year after year
and it doesn't appear to be due to a
difference in the way we diagnose the
illness it appears to be a true increase
in the incidence of depression
and it doesn't seem to be
keeping pace with any possible genetic
changes in our population so that means
that there's something in our
environment
that's been changing over the years
that's increasing the incidence of
depression
and the question for you is what do you
think that is
well you get some important hints when
you sort of look at the demographics of
the epidemiology
epidemiology of that in more detail the
increasing rate with each sort of decade
or so
is due to increased numbers of people
who are
getting their first depressions as
adolescents or young adults
in other words increasing number of
people who have now
joined the lifelong ranks of depressives
so you sit there and like there's really
no way that
being like your typical american
adolescent these days is truly more
stressful than
like being in the dust bowl or being a
medieval peasant or who knows
you you really can't make i mean be be a
be a
farmer in the developing world watching
locusts doing your crops and
like that sort of beats bullying in lots
of ways but
when you look at it it's not that we
have more stressors this is
the stressors we have are overwhelmingly
inventions of our lifestyle where i
think
things have gone awry is we have less
sources of support
and i think that takes two forms one is
i'm the last person on earth to start
spouting norman rockwell sort of stuff
but the rate of divorces and the
disintegration of the traditional
nuclear family or anything that clank
falls for stability in a family that has
to be a big factor
the other is this incredibly american
god-given right that we all expect
which is to be able to be mobile and
anonymous
we are more than any country in the
world we live
further on the average than where we
were born we move more frequently we
have a lower likelihood of knowing the
names of our neighbors
and that's what makes silicon valley
possible that's what makes
you know maasai goat herders don't
invent silicon valley
people who are willing to go anywhere
and work whatever and work 24
7 and who knows if they ever learn the
name of their neighbor because that's
not the point
and you move on to the next one and
along comes like a 911
and half of the country discovers they
don't know the names of their neighbors
and that's the trade-off all of us want
this right
we have more unlisted phone numbers back
when that was something in common than
in any other
like country on earth more mobility we
want to be able to move and we want to
be anonymous and we want to be able to
come up with a new persona
and a new accent and a new name and a
new who knows what
and then we discover we have none of the
traditional primate forms of social
support
i suspect that's where it's coming from
what about social media though in social
uh being having an online social
presence does that does that influence
this positively or negatively and in
some ways it elevates your sense of
where you are in the socio-economic
status in other ways it
may bring you closer um all things
considered as the father of two
teenagers i think it's basically awful
what it does
because it opens up all sorts of venues
people and circumstances and things you
never even knew existed before
can now make you feel crappy about
yourself and diminished
and insecure and not adequate and not up
to measure
and what it also does is train you to
mistake like
the most like fruit fly
level of model systems of what passes
for like human sociality
for actual real like connectiveness
but how do i really feel about it
many of you may not know i'm an investor
in social media so
i feel like this is um
so along those lines you know it seems
like the coping mechanisms here
um are what many people might take away
from tonight's talk which is you know
how do you
in the world that we live in apply this
and
i'm curious if any of these four things
and maybe there's more
have gained elevation in your mind in
the last years and if others have lost
elevation
do you think we should be focused more
on some versus others yep
all things considered i think the one
that has probably gained most
improvements
is social support
if you got a choice in the matter amid
all of those there
more control over when your boss wastes
your time with them like pointless
meeting more predictabilities
you know whatever more you know health
club memberships as an outlet more
walls to punch with your near
frustration um
the literature seems pretty clear that
when it works right the social support
is the one that's most effective is
there a type of social support
you know is it one good friend a group
of kids which brings the next question
at the same time the one that's lost the
most sort of veneer
is social support because of the
enormous tendency people have to confuse
like mere acquaintanceships or
friday night whatever is with actual
it's like hard it takes a long time it
takes a great deal of patience it takes
reciprocity and maturity and
selflessness and all this stuff that all
of us like fail miserably at
at various points real real sustained
social affiliation
is like a very hard thing for primates
to get good at
including us what the studies tend to
show though is
there's no particular difference between
a significant
other a small group a community i mean
they're all
equally effective but within that i mean
where the tarnishing comes from
is nothing is more corrosive to us
when we discover that a supposed source
of social support was actually just
an acquaintance after all and that it
wasn't really there
an interesting recent study published a
couple of weeks ago
in pnas a very prestigious journal in
the country a little big
long longitude longitudinal study
looking
at how much does social isolation impact
health
and does it do it during young adulthood
as much as an old age and the general
punch line was
it's a terrible thing for you lifelong
and this is
like a standard finding in the
literature quantitative measures
how many people do you talk to on a
regular basis how many people could you
borrow money from
how many organizations do you a
quantitative measure what was unique
about this study was they also took
qualitative measures
they asked people to assess on some
scale
how much support do you get from the
people closest to you
how much strain do you get from the
people closest to you
and that came the first finding which is
the quality of the relationships
trumped quantity far more in terms of
impact on health
but what was really the most interesting
thing in the study was if you have the
choice in the matter between making a
new close supportive friend
or getting rid of that high maintenance
friend who's been like you've needed
like a hole in the head
for the last 30 years the source of
strain was more of an adverse effect on
health
than source of support being a good
thing on health which i thought was
extremely
interesting so i'm going to ask one last
question and then what i'd like to ask
the audience if they would like to ask a
question to go to the
microphones on other side my last
question is uh
about antidepressants so as you know um
antidepressants are
widely prescribed and many of the big
clinical trials that have been done with
these antidepressants like ssris as you
know have failed
suggesting that the antidepressants
don't do any better than placebo however
if you talk to any clinician or
psychiatrist who prescribes these
medications
or people who take them they will swear
that they work and so my question to you
is
one do they work and two
is there any chance we're gonna get out
of the dark ages in terms of how they
work
um yes and no i think the dark ages are
going to be there for a long long time
i think the reason why on on the average
one-third
of major depression patients
fail to respond to antidepressants and
another third respond would give up on
them because of the severity of the side
effects
um so in other words there are oceans of
clinically depressed people out there
who are not being adequately helped by
the best of current
neuropsychopharmacology
the question becomes why is that there's
just a
whole like menagerie of antidepressants
out there
working on by now five six different
neurotransmitter systems
where in most cases it's guesses as to
how selectively it's
actually working on one versus the other
so there's like
a gazillion different permutations of
combinations and different dosages
at the same time as with like every
interesting human disease
it's actually a whole bunch of different
diseases and heterogeneous
and people have such a poor sense at
this point
you get your average clinician of course
thinks that they're better than the
average clinician
and what they also think is that they
have a good intuition
this kind of depression responds best to
this combination
have this much of drug a this much of
drug whatever and
this mixture and because i saw one
fantastic response once
and it's sheer well i'll try to find a
good term for it
it is it is a posteriori
theorizing as to how these things work
it's like an amazingly complex system
like lose a parent to death when you
were a child
and 60 years later you were more at risk
for this disease
like throw one medication in there and
you expect that to be able to do it
it's going to be a long long time
nonetheless amid that pessimism
and amid the considerable side effects
of these drugs and the fact that god
knows what neurological costs we're
going to discover down the line
from 50 years of ssris or whatever and
oh my god
nonetheless an unmedicated major
depression
is one of the most life threatening
diseases on earth the drugs with all
their side effects are a really
miserable solution these days but
they're far better than the alternative
so um in the last few minutes are there
any questions on the side
i can't see if people are over there or
not we have one okay
thank you for taking my question really
enjoyed the talk
um we have a 13 year old son at 13 years
old who developed chronic nausea
and had a multi-million dollar workup
and tried all these meds and everything
ultimately to make a long story short
what ended up helping him was vagal
nerve stimulation
and ever since then i've been reading
a lot about it and what i don't
understand what i know is that it is
fda approved for medicine
for depression that is not responsive to
medication why isn't it approved for
depression
at all and and let's do away with some
of these meds
um let's see i start off by pointing out
that
i know tons about like rats and monkeys
and neurons and dishes but i'm
not a clinician but my sense is that
vagal nerve stimulation
is upping the parasympathetic component
of the common vegetative half
and there's drugs that will do it as
well and it happens to be more effective
this way
um i don't know why it's not used more
broadly say for other realms but
everybody out there is always looking
for what termed
off label novel uses for various
techniques
if it works someone's going to find it
soon that it does
thank you for the wonderful lecture and
my question is how do i tell if i'm
stressed too much
or not
well if you have to ask you are there's
one possible answer
more useful one maybe a different way of
framing it is so what are
amid all the different from common to
incredibly arcane diseases that are
stress sensitive
what are the most vulnerable spots where
the the canaries in the mine shaft
varying from person to person tending to
be gastrointestinal
sensitivity which could range from
everything from suppressed appetite to
stimulated appetite to constipation to
the runs and everything is so
something's out of whack at the
gastrointestinal level
sleep disruption and females disruption
of regular cycling
and major mood disruption depression
problems with concentration anxiety i
mean maybe
the most likely symptom for you would be
if your hair turns white and falls out
and otherwise you're just fine
but for most people those are the most
vulnerable spots
also thank you very much for the talk
and your fear and aggression lectures
which i kind of stole off of youtube for
something i was teaching so do you think
there's a fundamental incompatibility
between
the brains we evolved with and the type
of information we're required to hold on
to and use to exist in a modern society
and doesn't that sort of play into the
unpredictability
aspect i can't hold on to when i need to
pay my accounts and
what do i do with obamacare now that i'm
going back to school and how will i lose
my insurance
these arbitrary rules and the tax code
whatever very hard to hold on to very
hard to predict
would have huge impacts on what actually
happens in your life and once you fall
off the
beaten path you know it can be very hard
to get back into the functional part of
society so that causes a lot of fear
what do you think about that well i mean
it's very
easy to lament sort of modern life but
you know the wheel and vaccines and a
few other things like that are good
things to have come up with
so the the solution is not to sort of
like we all go scarify ourselves and go
wear loincloths or something
um in that there are many benefits to it
in terms of what are the sources of like
our modern malaise and predicament in
terms of
westernized lifestyle industrial
lifestyle urbanized
in lots of ways what it comes down to i
think
the most fundamentally bizarre thing we
do
as a primate that makes the least sense
to other primates and is sort of most
impactful and foundational to all of
this
is more than any other primate we
encounter strangers
and we have anonymous interactions like
every like rule about brain size or
primates versus body size
suggests that humans should be living in
communities of about 150 people
which is about the average for
hunter-gatherer extended fusion fission
communities there and obviously life is
very different
we do something that no other primate
does we encounter
more strangers standing online at
starbucks
than like our hunter-gatherer ancestors
would do in a lifetime
and we have more capacity to be both the
perpetrator
and a victim of an anonymous act
than any other species one of the things
we do
is as a compensation skyara norenzayan
at university british columbia
has noted this really interesting thing
it's only when
cultures get large enough that people
start having
interactions with strangers that they
invent what are called moralizing gods
gods who care about what humans are
doing and
punish you what we do is hunter-gatherer
gods could care less what humans are up
to they're all feasting or goat hurting
or who knows what
but by the time you get to big anonymous
interactions one of the things humans do
is invent
various forms of external monitoring but
on the most fundamental level
what happens when you are interacting
very often with strangers is
you don't understand what their motives
are and on a certain level that's
reduced to
okay you're in trouble with the irs oh
my god stressor what's stressful about
it
this person can make a decision that
could either be benign for you or could
make you miserable for years to come
and you don't know who their
grandparents were
you don't know like what like
circumcision ceremony
they went through or what their and who
knows what
but mainly dealing with strangers means
that you're dealing constantly where you
don't know what people's motives are
and the control and predictability
aspects just come
roaring to the forefront then i'm sorry
we only have time for one more quick
question
and then justin you can wrap it up okay
can we have one question peter's gonna
say
one question is that okay and then at
the end of this um
we do have a book signing outside if
people want to meet
robert so we'll take one more question
here and then we'll finish with peter's
question hi
thank you i had a good time tonight it
was fun coming
um my question is in relation to
procrastination so i'm a
huge procrastinator i'm sure a lot of
people here
are and in part i really enjoy it
because
when i know that i'm under pressure i
get things done
and you know i'm able to write those
papers faster for my students and so
forth
so i you know i'm wondering what the
impact of
that is on health outcomes
my sense is only knowing how
rats and baboons go about
procrastinating for paper
and deadlines but my sense is it pretty
much takes two forms one is
if someone is simply not very good at
time budgeting or time discounting if i
do
this later instead of now it will seem
that much
less burdensome or whatever that you're
just
like not good at that um the other which
i think is the much
more pernicious less fixable version is
if the procrastination is driven by
anxiety
i can't do it i can't do it i can't do
it until all my pencils are sharpened i
can't do it until
i've done three more rounds of
preparation because i really can't
understand the stuff and i'm a fraud and
they're going to find out
i think the you're just not very good at
like remembering how many days away one
week
is with deadlines is much less
troublesome than
when the procrastination is just
secondary to a
gnawing sense of dis ease and anxiety
about the world
so my final question is a personal one
since you know we all are
you're adoring fans and uh with the
success you've had as a scientist to
someone who's brought it to a popular
stage i'm
curious if you go back to robert
zapolsky at age
21 what advice would you give him
because some of that may be relevant for
people at the beginning of their
academic careers and
okay
two answers which are actually
intertwined
um and the first one will seem very sort
of
blindered in terms of the research um
when i was 20 i started doing my field
work in africa with baboons and for
about 30 years afterward i spent my
summers there back and forth
going back to the same animals
interested in what your social rank has
to do with what stress-related diseases
you have
and when i was 21 if you asked me what
explained
baboon psychosocial health and thus
humans was
social dominance and social hierarchy
and like
you know i was like a sub-adult male
primate
so of course like hierarchical stuff
seemed very important
and it took me about 20 years in my work
to realize the
social support factors and the
personality stuff
was far far more important so
it would have saved me about 20 years at
work to have mentioned that to myself at
that time
um but in the broader sense what i think
winds up being
exactly the same answer is um
i wish if i could talk to my 21 year old
self
and actually be convincing it would be
to have been less ambitious
mr robert supposedly thank you
you
