Randolph Nesse: Are There Good Reasons For Bad Feelings? The Evolution of Mental Disorder

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Randy as as the father of
evolutionary psychiatry and one

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of the founding fathers of
evolutionary medicine in

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general, I I try to figure out
how often Someone Like You is a

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psychiatrist practicing in this
field.

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Very practical field.
How often do you think about the

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mind body problem?
From a philosophical

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perspective, of course.
Even I used to think about it

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all the time.
As another graduate and a

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medical student, I was
preoccupied by the mind body

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problem and consciousness.
And as I think I warned you

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prior to agreeing to come on the
podcast, I decided at some point

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that I wasn't going to make
progress on those problems.

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So many smart people have been
thinking about them not just for

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decades but for hundreds of
years that the fact that there's

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still huge disagreements and not
even a sense of.

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Definite progress towards an
agreed upon solution made me

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think that I should focus on
easier problems.

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Like why is there depression?
Well, that to me that doesn't

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sound like a very easy problem,
but you.

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Exactly managed to approach this
very well.

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Right.
But let's talk about free will

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and consciousness too, because,
I mean, you have had many

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distinguished guests on your
show.

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Talk about both of them.
And I certainly was interested

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before.
Do you feel like there's been

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progress made on trying to
understand free will in

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particular?
Let's start there.

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Well, so when I when I named
this podcast Mind Body Solution,

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obviously paying homage to the
Mind Body problem, I I never

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really thought we'd find the
solution.

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It was more to take micro steps
forward to defining the

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solution.
But in terms of free will, I

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mean, I've had some really good
guests.

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Kevin Mitchell spoke to Dob
Chomsky about it a few times and

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it seems like everybody, still
nobody really knows the answer.

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Some have no choice but to have
free will.

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Some people believe the
opposite.

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It seems to me like the
philosophical debate will

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continue till I die.
I think this is just.

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I think you're right in the
sense that it's it's a great

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platform to for the discourse of
trying to understand these

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problems more, but actually
applying it, it becomes quite

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difficult.
What are your thoughts on it?

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So, you know, the the time when
I really decided that I was

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going to take a different angle
is just a throwaway line and a

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book by Michael Rouse, and it
was about the origins of

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morality, which I think we can
make progress on.

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I'd like to talk with you about
that, but, he said, You know.

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If we didn't believe in free
will, we couldn't hold other

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people responsible for their
actions.

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So we so natural selection
certainly even who knows if we

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have free will or not.
But we have to believe in it so

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that we can hold others
responsible for their actions.

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Otherwise there could be no more
morality, culture, cooperation

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and and and the like.
And I think that's really true.

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I mean and and I think that's
one of the difficulties of.

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Saying there is no free will
because immediately you went

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into the issue of can you hold
other people responsible for

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their actions and and do you
feel responsible for your

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actions or can you get away with
anything because it's not really

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your fault.
It's a very different question

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about why we believe in it
compared to does it exist.

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I think I think you're right
because the the moral

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responsibility aspect also forms
a big part of that discussion.

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And they when I had Greg Caruso
on the channel, he he had that

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infamous book artist called Just
Desserts with Daniel Dennett and

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they they both compatible about
free will.

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They believe it does exist.
I mean sorry they both Dennett

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thinks it does exist but it's
compatible with determinism.

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Whereas Greg Cruso believes in
what's known as hard

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incompatibilism and he believes
that things like moral luck play

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a big role in shaping who we
are.

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Thomas Nagle once coined this
term moral luck, where there's

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different luck involved in in
bringing us to who we are, and

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he feels that hard.
Incompatibilism is a great

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reason.
So believing that free will is

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an illusion and does not exist
is a great way to avoid

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retributivism.
Very difficult word to say, he

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thinks that praiseworthiness,
blameworthiness, these are not

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terms we should be using because
essentially none of us truly

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deserve either.
We're based on these luck

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mechanisms that take us to where
we are, and yet we should use

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the system somehow to avoid
giving us praise and blame.

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What do you think about that?
I might not be doing a great job

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at explaining his words, but.
No, but this is right, and I'm

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looking forward to talking about
the orgs of morality with you.

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I've recently dug into Derek
Parfit's work and his work on

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the necessity of who are we
responsible to is his question.

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And we're responsible not only
to people around us, but even to

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the future.
And he makes quite a deep

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argument to to justify that.
But what he doesn't do is talk

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about the origins of our
capacities.

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And he does all these marvelous,
so philosophical, imaginative

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mind experiments.
But he eventually refers to

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intuition about does it match
our intuition or not?

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And my question is, where do
those intuitions come from?

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And I've been very preoccupied
by that because I was really

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traumatized back when I first
learned about evolutionary

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biology.
And especially Dick Alexander

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was one of the people who was at
the University of Michigan.

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And I got to know Bob Trevers as
well.

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And.
And they both believed that, you

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know, we deceive other people to
better deceive ourselves so we

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can trick them and advance the
interests of our genes.

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I found that quite traumatic
actually.

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Trying.
I mean, I went into medicine

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because I thought I'd want to
help people.

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And the idea that maybe I'd been
deceiving myself the whole time,

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and I was just, it was, you
know, it was very traumatic.

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So that sent me out of many
years, course, of trying to

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understand how natural selection
could have shaped the capacity

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for morality, guilt, love,
commitment and all the rest in a

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way that was consistent with
benefits to genes.

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I mean so many people.
See that problem?

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And they say, oh, that means
there must be group selection

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somehow, or it must be because
of cultural group selection.

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Well, cultural group selection
is a real force.

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It's it's powerful, but but how
does it all get started?

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Certainly not by group
selection.

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Yes, there are benefits to
groups if more individuals in

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the group are cooperative and
and do things to help the group.

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But.
But the point that George

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Williams pointed out in 1966 is
still not fully appreciated by

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many people.
And it is that if the

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individuals within the group
vary and some contribute more to

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the group at a cost of their own
reproductive success, those

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genes are going to go away.
So what's the solution to that?

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I can talk you through the first
I thought about commitment

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theory, which is the
mathematical game theory about

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you know, if you if you could
convince somebody that you will

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help them in the future, even
when it's not in your interest,

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then you can have a much deeper,
richer relationship that's much

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more valuable than a
relationship just based on

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exchange.
But let me pause there and see

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how this fits with your
interests in the origins of

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morality.
I think well, I'm curious to

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know what conclusion you draw
after that.

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What is your problem with
commitment theory?

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At that point, I'll address.
That I think it's real.

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And I think in many groups,
especially religious groups,

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there's an extremely high entry
barrier and there's an even

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higher exit barrier.
So once you make a commitment to

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your group, you had better do
things that are good for members

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of that group, even when it's
not in your interest.

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I often tell a joke about
somebody walking into a church

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and saying, yeah, I want to join
the church.

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And the minister says, well, why
do you want to join?

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And the person says, well, I
might get sick and I want

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somebody to take care of me and
visit me when I'm sick and

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giving me food and money.
And the minister says, no, you,

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you just don't get it.
You know, the whole point is

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that you're supposed to do unto
others even when it's not in

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your interest.
That's the whole point.

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It's based on commitment and
love and charity, not unexpected

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to get something.
So I I was very committed to

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that.
I did a whole book on evolution

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and commitment theory and I
think it does explain a lot of

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our capacities.
But in everyday life, it's not.

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It's not that easy to find
examples.

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I think you do.
You find examples of guilt.

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You do find examples of of
people who take care of their

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spouses even when they get a
fatal illness and and the like.

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You also see a lot of examples
of people who don't.

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And for part of my career, I ran
a seminar for cancer patients

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and their caretakers and
caregivers, and I was a

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psychiatrist working on a cancer
ward.

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And it was horrifying to hear
have people dealing with

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chemotherapy and dealing with
cancer.

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It was more horrifying to see
people recognize that they were

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going to die and that nothing
could really done about it.

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But the most horrifying thing
about the experience were the

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ones where where some husband
said, oh, you know what, I know

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you have to go through chemo now
and I know you're probably going

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to die, but I guess I've never
really loved you.

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What that the idea that people
would would leave in those

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circumstances?
It's just so horrifying.

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And of course the poor person
can't recover from that lack of

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how do you get trust in anyone
again after something like that?

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So, and I find that I found
those kind of experiences so

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horrifying that it it made me
both want to better understand

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how the other people who did
stick with their partners

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through everything thick and
thin.

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I wanted to understand how that
capacity came about.

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What do you make of it?
Well, first of all, I think

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that's also, I agree that is
pretty, that's pretty ruthless.

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Firstly, I mean, I think
particularly we're both doctors

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in this field, it's very easy to
see the diversity of human

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experience.
Isn't it amazing?

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I mean, there's no such thing as
one human nature.

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Yeah, it's just the sounding.
And people talk about culture.

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Yes, culture influences a lot,
but even within a culture.

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I mean, there's some people who
are completely committed to

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partners and other people who
are who seem committed for years

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and then turn out to be
completely self interested.

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Whoa, my gosh, it's so hard to
grasp this.

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It's very difficult.
And I often think that one of

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the functions of this podcast
was to show just how difficult

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intellectually and practically
the the mind body problem is

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because of how difficult it's
been to understand psychiatry.

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I mean, we've had revolutions
and waves where we thought, OK,

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we've got the answer, neural
correlator, we've got it, it's

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love dopamine, it's
schizophrenia, we've got it,

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we've got the certain genes.
There's so much happening and

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time after time we're left
disappointed.

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What are your thoughts on this?
You know, I keep thinking that I

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should offer the world a
solution first of all, a simple

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explanation and then a simple
cure.

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Because I could get rich and
famous and everybody would.

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It's very easy.
Lots of people do that.

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But I don't think it's possible.
I mean I think many of these

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disorders are products of
competing genes and very complex

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and playotropic systems.
And it's we're we're

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intrinsically vulnerable I would
say to many of these disorders.

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So let's pause here for just a
second and decide whether we

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want to go more that direction
or whether we can go back to

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morality and see if we can
figure out that.

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I think maybe that would be best
first since we were already

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there.
Is that OK?

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Noam Chomsky once told me that
when people talk about all these

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philosophical debates regarding
free will and morality, they

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often forget to talk about the
most sane conclusion that we

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need to draw.
And that is common sense.

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I mean, nobody walks around
assuming they don't have free

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will.
And that's the biggest problem

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is that even the philosophers
talk about an illusion of free

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will.
Don't apply that in their

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practical life.
Anything.

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That's right.
So I've actually been talking a

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bit in other podcasts and the
like.

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About how belief in free will
causes problems, and in

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particular, I mean there's
nobody who starts taking heroin

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who says, you know, I'm probably
going to get addicted, it's

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worth it.
They all are confident that I

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have free will.
I can decide whether to take it

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or not.
And very often, after using

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drugs for a time, they'll stop
just to prove to themselves that

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they have free will and in the
face of of addicting substances.

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I I find it astounding that
anyone can decide to stop using

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such substances and actually
stop.

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It's just and and many people
can't.

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You know and and the amount of
willpower.

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Is it willpower?
What is it?

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I think studying people who
successfully decide to stop and

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stop even though the whole
wiring of their brain and their

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behavior control mechanisms have
been hijacked by drugs.

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But those are the people we need
to study.

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It's just so amazing that it's
possible.

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I think it's always important
for us to do something like

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that, to to actually look at
these big cases in society where

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people are able to able to
achieve such cuz that's a feat,

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that's that's something that is.
And if we don't really focus on

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studying those phenomena is do
you think it's just funding or

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just lack of intellectual
creativity?

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It's a matter of how do you do
it.

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I mean, we know how to study
genetic causes by really big

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studies and measuring genes and
correlating with various states.

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How do you study this kind of
thing?

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What data do you get or how do
you analyze it?

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And This is why it's still in
the realm of philosophy.

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I'm not so much in the realm of
neuroscience and let's talk

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about how morality evolved.
What do you think with the basic

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components of this evolutionary
process?

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So I basically lay awake nights
for months and years worrying

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about this and finally went back
to an article by Mary Jenn W

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Everhard.
And she is an insect biologist

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who talked in the articles in, I
think 1978 and then in early

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1980s about what she called
social selection.

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She wasn't explicitly about
morality at all.

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It was about how insect
societies organized.

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But here's what she pointed out.
She says.

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Look at Peacock's tail.
And I've always thought

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peacock's tails were just as
extreme as our capacity for

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morality.
Our capacity for morality is

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very, very expensive.
It's elaborate and and

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complicated.
And the peacock's tail is too.

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And the peacock's tail is shaped
by being chosen by the female

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pea hen.
And as long as they like

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Peacocks with large tails,
that's going to shape these

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extravagant things.
So it's a matter of choice.

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One person, Miller, I think it
was who who was it wrote about

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this and I talked about the fact
that we do choose our mates

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partly based on who is good, and
I think that might be a

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neglected factor.
But I think Susan.

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But the the whole idea, advanced
by Mary Jane W Everhart, is that

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we choose our social partners
just as we choose our sexual

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partners.
And who do we choose?

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We choose the individuals who
have the most to offer and offer

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it to us and are honest,
trustworthy, kind, and pathic.

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And who will feel guilty if they
betray us.

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And guess what?
These are the traits that we

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associate with morality.
I think that the capacity that

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social selection and partner
choice is the key to the origins

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of morality.
It gets shaped further by

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cultural group selection and all
the rest.

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00:15:56,120 --> 00:15:59,360
But I think this is a powerful
and not fully recognized

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explanation for morality.
Peter Hammerstein and Ronald

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00:16:02,520 --> 00:16:05,920
Doughy have written the whole
book about economics and

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partners choice and its origins
for for morality, and Peter

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Hammerstein in particular has
done a whole book on origins of

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cooperation.
So this isn't entirely new idea,

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but people haven't really
grasped that, if in fact.

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Individuals in a group are
constantly assessing everybody

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00:16:22,510 --> 00:16:24,750
else in the group and saying I
want to pick that one.

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They always try to pick the
person who first of all has the

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most resources, will give it to
them reliably and isn't that

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interesting.
This is what we do in life.

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We keep trying to figure out who
among the people I'm around

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would have a good relationship
that would benefit me and can I

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00:16:44,690 --> 00:16:47,010
get them to choose me as a
partner.

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So we do all kinds of things to
try to be the kind of person

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that would be a preferred
partner.

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We show off.
We accumulate riches.

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We share our riches in potlatch
like ceremonies take other than

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I mean I was in Newport Beach
last week.

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00:17:02,630 --> 00:17:05,109
And it was just amusing to see
these, you know, many

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00:17:05,109 --> 00:17:07,790
multimillion dollar yachts
cruising so people could have a

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00:17:07,790 --> 00:17:10,510
drink together and gigantic
houses.

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00:17:10,510 --> 00:17:15,190
I mean, this is all no display.
It's conspicuous consumption, of

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00:17:15,190 --> 00:17:18,349
course, but it's been There's a
reason for it though.

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It's because people want to
advertise what they have to

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00:17:21,910 --> 00:17:25,030
offer in order to get the best
possible partners to choose

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00:17:25,030 --> 00:17:27,190
them.
And this has a very, very

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00:17:27,190 --> 00:17:30,030
unfortunate side effect.
The results in the hierarchy for

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00:17:30,030 --> 00:17:33,350
those who have the most to offer
and offer it, you know, honestly

325
00:17:33,430 --> 00:17:37,070
with integrity, pair up with
each other and people have less

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00:17:37,070 --> 00:17:40,710
to offer and who are maybe less
good at telling what other

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00:17:40,710 --> 00:17:43,070
people want and less honest or
down there.

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00:17:43,430 --> 00:17:45,750
And then there are other people
down at the bottom off the

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00:17:45,750 --> 00:17:48,950
screen who don't have that much
to offer.

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00:17:49,950 --> 00:17:54,990
And and we wonder why many
people who are disadvantaged.

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00:17:55,660 --> 00:17:59,900
Aren't necessarily having as
much integrity and commitment to

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00:17:59,940 --> 00:18:02,740
other people.
Sometimes they do, which is very

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00:18:02,740 --> 00:18:05,980
important.
But but this creates A hierarchy

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00:18:06,500 --> 00:18:10,260
of partnerships, and those who
have the most connect with those

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00:18:10,260 --> 00:18:14,140
who have the most.
And the whole damn thing shapes

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00:18:15,780 --> 00:18:18,700
extraordinarily strong
capacities for morality.

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00:18:19,330 --> 00:18:21,490
And I don't think we should call
them, you know, just in the

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service of our genes.
It isn't the service of our

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00:18:23,290 --> 00:18:25,650
genes.
It only evolves because it

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00:18:25,650 --> 00:18:29,090
benefits the individual, but
it's not any short term

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00:18:29,090 --> 00:18:33,010
calculated anything.
Anybody who takes that view is

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00:18:33,010 --> 00:18:35,050
not a good partner.
What do you make of all that?

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00:18:35,970 --> 00:18:39,170
Well, as you were saying that
about something that did come to

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my mind was was Richard Dawkins
when he wrote The Selfish Gene.

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00:18:42,570 --> 00:18:46,890
I mean paved a way for a certain
way of thinking about this topic

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00:18:46,890 --> 00:18:50,000
for a lot of people and that is,
I mean certain acts of kindness,

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00:18:50,000 --> 00:18:55,320
certain things like altruist
behaviors always tend to secure

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00:18:55,320 --> 00:19:00,240
some sort of a gene survival.
And in essence, do you think

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00:19:00,240 --> 00:19:03,600
that first of all, do you think
that it holds to be true in the

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00:19:03,600 --> 00:19:07,200
long run or do you think that
the social gene is more

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00:19:07,200 --> 00:19:12,240
important so for accumulate
accumulation of genes over time,

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00:19:12,400 --> 00:19:15,920
different variations including
partners, society, etc?

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00:19:15,920 --> 00:19:19,720
Do you think over time that
we're better adapted to?

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00:19:20,160 --> 00:19:22,280
Sorry, let me just rephrase this
cuz I feel like I'm getting a

355
00:19:22,280 --> 00:19:26,040
bit lost for words here.
If you take account our own

356
00:19:26,040 --> 00:19:30,320
genes trying to proliferate and
continue within society versus

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00:19:30,320 --> 00:19:33,960
that of trying to proliferate
the genes of others with your

358
00:19:33,960 --> 00:19:36,200
own, do you think it's more
important for your own to get

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00:19:36,200 --> 00:19:40,330
through, or to get others across
instead of yours or in spite of

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00:19:40,330 --> 00:19:43,050
yours?
So what you're edging towards, I

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00:19:43,050 --> 00:19:47,130
think is the idea of pin
selection, which Bill Hamilton

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00:19:47,490 --> 00:19:51,770
showed us all in 19 and two big
papers 1964.

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00:19:53,010 --> 00:19:55,930
And that idea, as probably most
of your listeners already know,

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00:19:56,170 --> 00:20:00,330
is that we can do things that
sacrifice our own benefits and

365
00:20:00,330 --> 00:20:02,690
even our own personal
reproductive success.

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00:20:03,180 --> 00:20:06,340
If it sufficiently benefits
relatives who have the same

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00:20:06,340 --> 00:20:08,500
genes that are identical by
dissent.

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00:20:09,060 --> 00:20:11,980
And this idea has completely
revolutionized the study of

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00:20:11,980 --> 00:20:16,100
animal behavior, and it explains
all kinds of altruistic behavior

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00:20:16,100 --> 00:20:21,180
that is otherwise inexplicable.
But it doesn't explain a lot of

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00:20:21,180 --> 00:20:24,700
complex social behavior in
humans, where we have these deep

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00:20:24,700 --> 00:20:27,260
relationships with people who
are not related to us.

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00:20:27,730 --> 00:20:30,410
The vast majority of our close
relationships are, of course,

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00:20:30,410 --> 00:20:32,290
with people who are related to
us.

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00:20:32,650 --> 00:20:35,050
And all these politicians keep
trying to pass on their

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00:20:35,050 --> 00:20:39,050
presidencies or their kingships
to their kids and and and all

377
00:20:39,050 --> 00:20:41,530
the rest of it.
It's very, you know, nepotism is

378
00:20:41,530 --> 00:20:44,530
very, very deep for very good
evolutionary reasons.

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00:20:44,890 --> 00:20:48,510
But nonetheless, we humans do
have this capacity to feel

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00:20:48,750 --> 00:20:51,590
commitment and loyalty and to
make sacrifices for other

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00:20:51,590 --> 00:20:55,110
individuals and for our groups.
And then the constant, instant

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00:20:55,110 --> 00:20:58,030
question is yes, is that because
the groups benefit, and groups

383
00:20:58,030 --> 00:21:00,910
with more is such individuals do
better than other groups, Those

384
00:21:00,910 --> 00:21:02,990
groups do do better than other
groups.

385
00:21:03,430 --> 00:21:07,310
But that's not the reason that
natural selection has maintained

386
00:21:07,310 --> 00:21:09,670
those genes.
It's because the individuals

387
00:21:09,670 --> 00:21:13,600
within those groups who do those
things and have those tendencies

388
00:21:13,840 --> 00:21:17,240
on the average have more
offspring and benefit their

389
00:21:17,240 --> 00:21:21,080
relatives more than others.
So if the Dawkins is completely

390
00:21:21,080 --> 00:21:25,080
right that you can think of
selfish genes and you should

391
00:21:25,080 --> 00:21:29,800
think of anything that has to
benefit the genes otherwise it's

392
00:21:29,800 --> 00:21:33,600
going to get eliminated.
But, but this is so confusing

393
00:21:33,600 --> 00:21:37,520
for people.
I watch this one thing on the

394
00:21:37,520 --> 00:21:41,200
anniversary of Dawkins 30th,
30th anniversary of the book, I

395
00:21:41,200 --> 00:21:44,600
was invited to contribute a
chapter, which I did, and I said

396
00:21:44,600 --> 00:21:47,480
I'll do it so long as I can name
the chapter whatever I want.

397
00:21:47,480 --> 00:21:50,480
And they said that's okay.
And so I wrote a chapter called

398
00:21:51,560 --> 00:21:55,280
Why So Many People with selfish
Genes are Generally Pretty Nice,

399
00:21:55,480 --> 00:22:01,450
except for their hatred of the
book The Selfish Gene and and

400
00:22:01,570 --> 00:22:03,650
and in that.
In that chapter I talk about the

401
00:22:03,650 --> 00:22:07,530
origins of morality in partner
choice, which is in At the end

402
00:22:07,530 --> 00:22:09,730
of his book, Dawkins says now
that we know that gene's

403
00:22:09,730 --> 00:22:12,690
yourself, which we can decide to
triumph over those.

404
00:22:13,090 --> 00:22:19,330
Well, that's pretty lame.
So he he often says that he his

405
00:22:19,330 --> 00:22:22,050
initial title for the book was
The Immortal Gene, because a lot

406
00:22:22,050 --> 00:22:24,450
of people, that's what he wanted
to name it.

407
00:22:24,450 --> 00:22:27,570
But obviously with publishers
you have to sort of bite your

408
00:22:27,570 --> 00:22:29,450
tongue and sort of go with
what's going to sell.

409
00:22:29,850 --> 00:22:33,010
But do you think that would have
been a better?

410
00:22:33,130 --> 00:22:37,410
I think the book, you know, the
analogy he makes in the metaphor

411
00:22:37,610 --> 00:22:40,290
was brilliant.
Then it's got legs, obviously,

412
00:22:40,570 --> 00:22:44,290
and the controversy it stirred
has further advanced its

413
00:22:44,290 --> 00:22:46,970
influence.
If only people could understand,

414
00:22:46,970 --> 00:22:49,410
however, that I mean.
I've written several articles

415
00:22:49,410 --> 00:22:52,970
for philosophy journals about
why selfish genes make generous

416
00:22:52,970 --> 00:22:56,650
people, and people
misunderstand.

417
00:22:56,650 --> 00:22:59,250
They think that because genes
are, and I've seen this actually

418
00:22:59,370 --> 00:23:02,250
harm people.
I've seen people who learn that,

419
00:23:02,490 --> 00:23:05,730
you know, all individuals are
shaped by natural selection to

420
00:23:05,730 --> 00:23:07,330
do things that benefits their
genes.

421
00:23:07,570 --> 00:23:10,770
And they say to themselves, oh,
I've been a sucker.

422
00:23:11,050 --> 00:23:13,410
I've been doing things to
benefit my friends and my

423
00:23:13,410 --> 00:23:15,360
groups.
I'm going to just start doing

424
00:23:15,360 --> 00:23:17,640
things for myself.
I think this is genuine.

425
00:23:18,480 --> 00:23:20,960
That I mean, I was at the
origins of the human behavior

426
00:23:20,960 --> 00:23:24,240
and evolution of society and
evolutionary psychology and and

427
00:23:24,240 --> 00:23:28,320
there are a number of people who
you know, that insight that all

428
00:23:28,560 --> 00:23:32,680
behavior by all organisms must
ultimately increase gene

429
00:23:32,680 --> 00:23:37,410
transmission, harm their lives.
I can.

430
00:23:37,450 --> 00:23:40,210
I can imagine that that's it
sounds very accurate to me

431
00:23:40,210 --> 00:23:43,370
because it the book is so
misinterpreted.

432
00:23:43,530 --> 00:23:46,250
So for the most part I hear
someone talk about it they're

433
00:23:46,250 --> 00:23:49,050
they're often you can clearly
hear where it goes wrong.

434
00:23:49,170 --> 00:23:54,370
Something I did want to ask you
about this was, do you feel that

435
00:23:54,650 --> 00:23:58,330
when you tell people you're an
evolutionary psychiatrist, that

436
00:23:58,610 --> 00:24:03,130
because obviously lots of people
won't know that you're this kind

437
00:24:03,130 --> 00:24:05,370
hearted man who's trying to
figure out why humans are

438
00:24:05,370 --> 00:24:06,890
suffering, trying to do all
these?

439
00:24:07,930 --> 00:24:10,850
Things to help humanity.
And yet immediately the

440
00:24:10,850 --> 00:24:14,170
association of the word
evolution rubs people the wrong

441
00:24:14,170 --> 00:24:16,690
way.
Sometimes they just tell this

442
00:24:16,690 --> 00:24:20,050
guy's gonna explain things in
terms of bio mechanisms that's

443
00:24:20,050 --> 00:24:22,490
going to ruin this entire human
experience.

444
00:24:22,770 --> 00:24:24,010
How do you feel this has
happened?

445
00:24:25,700 --> 00:24:27,580
It's real.
I mean, when George Williams and

446
00:24:27,580 --> 00:24:30,100
I first started Darwinian
medicine, he insisted on using

447
00:24:30,100 --> 00:24:33,380
the word Darwin because he said
Darwin deserves credit and

448
00:24:33,540 --> 00:24:36,180
evolution is too general.
Evolution just means change.

449
00:24:36,180 --> 00:24:39,140
And Darwinian refers to change
as a result of natural

450
00:24:39,140 --> 00:24:41,740
selection.
So, I mean, he got his way after

451
00:24:41,740 --> 00:24:44,460
we talked about it for a day.
But it was only a few years

452
00:24:44,460 --> 00:24:46,020
later.
It was really clear that the

453
00:24:46,020 --> 00:24:49,500
word Darwinian was a red flag
for so many people made them.

454
00:24:49,700 --> 00:24:52,420
They say, oh, Darwin, Darwinian
and Nazis, you know, that was

455
00:24:52,420 --> 00:24:55,140
their association.
And so most of us agreed to

456
00:24:55,140 --> 00:24:56,780
change it to evolutionary
medicine.

457
00:24:56,780 --> 00:25:01,620
It's exactly the same thing.
But even that, as you say, is

458
00:25:01,620 --> 00:25:04,340
problematic for many people,
especially in the United States,

459
00:25:04,940 --> 00:25:07,460
where, you know, I I would
never, you know, introduce

460
00:25:07,460 --> 00:25:10,140
myself to a patient as an
evolutionary psychiatrist.

461
00:25:10,420 --> 00:25:15,140
It's not that relevant, really.
In fact, I tell people that if

462
00:25:15,420 --> 00:25:19,100
they meet a Doctor Who says I'm
an evolutionary Dr. they should

463
00:25:19,100 --> 00:25:23,630
be very, very skeptical because
probably that person is touting

464
00:25:23,630 --> 00:25:27,590
some wacko, you know, post cures
of some sort or another.

465
00:25:28,190 --> 00:25:31,990
Much better to use evolutionary
biology in our understanding of

466
00:25:31,990 --> 00:25:36,590
it to both understand people and
make sure that we try to use

467
00:25:36,590 --> 00:25:38,750
whatever treatments have been
best shown to really be

468
00:25:38,750 --> 00:25:42,070
effective.
Have you ever spoken about?

469
00:25:42,950 --> 00:25:45,030
I'm not sure if anyone's ever
asked you this, but who are some

470
00:25:45,030 --> 00:25:47,750
of your favorite evolutionary
biologists?

471
00:25:48,270 --> 00:25:50,430
Do you consider Darwin to be one
of the greatest scientists of

472
00:25:50,470 --> 00:25:52,650
all time?
Of course, of course.

473
00:25:53,650 --> 00:25:56,570
But you notice me, everybody
talks about that.

474
00:25:56,570 --> 00:26:00,050
There's a great tendency for we
humans to deify certain

475
00:26:00,050 --> 00:26:03,010
individuals.
And it's it's fascinating, isn't

476
00:26:03,010 --> 00:26:08,450
it, that we want super.
And it doesn't matter what field

477
00:26:08,450 --> 00:26:11,930
you're in, you know, whether
it's opera or sports or or

478
00:26:11,930 --> 00:26:14,610
something, there's always always
somebody that's that everybody

479
00:26:14,610 --> 00:26:16,850
is supposed to follow.
And even now many people say,

480
00:26:16,850 --> 00:26:21,010
well, Darwin said and and and
we're and just like Freud, you

481
00:26:21,010 --> 00:26:25,770
know that many Freudians quote
Freud to make their argument and

482
00:26:26,010 --> 00:26:30,530
why that you you think that
after 100 years or 200 years

483
00:26:30,530 --> 00:26:33,050
things would have advanced
substantially.

484
00:26:33,690 --> 00:26:38,530
But nonetheless, Darwin's
insight was spectacular, along

485
00:26:38,530 --> 00:26:42,010
with Wallace, who had a somewhat
different moral, anarchyan view.

486
00:26:43,480 --> 00:26:46,760
And the fascinating thing,
again, is that nobody actually

487
00:26:46,760 --> 00:26:49,880
really thought about it before.
His grandfather, you know, came

488
00:26:49,880 --> 00:26:54,400
very, very close.
In his great poems of Anomia,

489
00:26:54,800 --> 00:26:57,880
the opening phrases talk about
the origins of everything in

490
00:26:57,880 --> 00:27:01,520
snails.
He even had book plates for his

491
00:27:01,520 --> 00:27:05,600
books.
Darwin's grandfather, saying

492
00:27:05,600 --> 00:27:08,760
everything from snails in the
local vicar, said that you

493
00:27:08,760 --> 00:27:10,800
really shouldn't have that
painted on the side of your

494
00:27:10,800 --> 00:27:14,640
coach.
You're going to lose patience.

495
00:27:15,000 --> 00:27:16,960
And I'll see to it that you lose
patience.

496
00:27:17,280 --> 00:27:19,920
So I guess he had it painted
over on his coach, but he put it

497
00:27:19,920 --> 00:27:23,520
on his on his books.
But this is, you know, I

498
00:27:23,520 --> 00:27:26,360
sympathize with this.
And I think just telling people

499
00:27:26,360 --> 00:27:30,040
that, you know, you don't
understand Israel evolution and

500
00:27:30,040 --> 00:27:33,620
quit all this silly religion
things, my gosh, I mean, across

501
00:27:33,620 --> 00:27:37,540
the whole world people get
great, great relief and great

502
00:27:37,540 --> 00:27:40,980
benefit from their spiritual
beliefs and belonging to such

503
00:27:40,980 --> 00:27:44,500
groups, much more so than any of
us gain from joining scientific

504
00:27:44,500 --> 00:27:46,260
groups.
And I think you know, to

505
00:27:46,260 --> 00:27:50,020
ridicule that or to lack of
respect for it, it's just as

506
00:27:50,020 --> 00:27:53,900
hugely naive.
I I think I agree with that

507
00:27:53,900 --> 00:27:57,140
sentiment.
I think that it's it's often

508
00:27:57,420 --> 00:27:59,660
people can't help but to
discuss.

509
00:28:00,280 --> 00:28:02,040
Evolution with religion and vice
versa.

510
00:28:02,040 --> 00:28:04,920
I mean, someone who's religious
can't help but counter anyone

511
00:28:05,400 --> 00:28:07,960
who's talking about anything
remotely non religious with some

512
00:28:07,960 --> 00:28:12,040
sort of an evolutionary critique
or I'll bring it into it.

513
00:28:12,040 --> 00:28:15,880
So it's weird how they're just
not mutually exclusive for

514
00:28:15,880 --> 00:28:19,430
people.
It's just and Richard of course,

515
00:28:19,470 --> 00:28:22,230
I mean he's he's not done much
about evolution.

516
00:28:22,230 --> 00:28:26,950
In recent years he's mostly
advocated atheism and tried to

517
00:28:26,950 --> 00:28:29,910
make the argument that religion
is an evil force in the in the

518
00:28:29,910 --> 00:28:32,030
world.
And he's certainly right that

519
00:28:32,030 --> 00:28:36,430
there's a lot of evil that is
initiated and proposed by

520
00:28:36,670 --> 00:28:38,550
religious conflicts and and the
like.

521
00:28:39,070 --> 00:28:42,750
But there's also a lot of good,
and I just think the the idea

522
00:28:42,750 --> 00:28:46,430
that we can dismiss it, I mean
people, every generation has a

523
00:28:46,430 --> 00:28:48,990
couple of people who say this
religious stuff is stupid to

524
00:28:48,990 --> 00:28:52,550
quit doing it and they get a lot
of attention and the world goes

525
00:28:52,550 --> 00:28:55,670
on just the same.
And and there's always new

526
00:28:55,670 --> 00:28:57,150
religions forming all the time
as well.

527
00:28:57,670 --> 00:29:00,030
And that isn't that interesting.
Yes, indeed.

528
00:29:00,390 --> 00:29:02,190
Yeah.
No, there's the advocates.

529
00:29:02,190 --> 00:29:06,310
I mean, there's always gonna be
something new IT about the

530
00:29:06,310 --> 00:29:08,390
evolution of that, why it's
occurring all the time.

531
00:29:09,270 --> 00:29:11,830
Yes, right.
Do you ever think about that?

532
00:29:13,240 --> 00:29:14,960
I don't think I heard that.
Sorry, I said.

533
00:29:14,960 --> 00:29:17,000
Do you ever think about the
evolution of religions and why

534
00:29:17,000 --> 00:29:22,200
they keep occurring this way?
You know, I almost spent several

535
00:29:22,200 --> 00:29:25,200
years of my life writing about
the evolution of religious

536
00:29:25,200 --> 00:29:29,760
impulses and religions.
I finally decided also not to do

537
00:29:29,760 --> 00:29:32,480
that one, along with not trying
to solve consciousness and free

538
00:29:32,480 --> 00:29:36,400
will, because it just seemed
that there wasn't going to be a

539
00:29:36,400 --> 00:29:38,840
specific solution.
But a lot of other people have

540
00:29:38,840 --> 00:29:43,140
taken it on and I think quite
successfully talked about, you

541
00:29:43,140 --> 00:29:47,380
know how the cognitive and
emotional tendencies Robert

542
00:29:47,380 --> 00:29:50,900
Wright in particular, I I
especially like his work on this

543
00:29:50,940 --> 00:29:54,300
and because he he took the
trouble to actually understand

544
00:29:54,300 --> 00:29:57,980
and study religions instead of
just you know globalized

545
00:29:57,980 --> 00:30:01,020
discussing them.
So I think his work about that

546
00:30:01,020 --> 00:30:03,180
is quite profound.
There's several other people who

547
00:30:03,180 --> 00:30:06,290
have also worked on that.
I think it's quite fascinating

548
00:30:06,290 --> 00:30:08,210
when you think about the field
of proprietary and how it's

549
00:30:08,210 --> 00:30:11,370
grown over time, I mean the
evolution of psychiatry, let's

550
00:30:11,370 --> 00:30:14,050
say.
And you had these two great

551
00:30:14,410 --> 00:30:17,530
psychiatrists at the time in
terms of Sigmund Freud and Carl

552
00:30:17,530 --> 00:30:19,410
Jung.
And you can sort of see how

553
00:30:19,410 --> 00:30:24,730
these two figures sort of divert
almost just separate and you've

554
00:30:24,730 --> 00:30:27,050
got these group of thinkers
below.

555
00:30:27,510 --> 00:30:30,110
And and the way they sort of
approach these fields, I mean,

556
00:30:30,110 --> 00:30:31,870
you've got the Freud, the
Freudian thinkers,

557
00:30:32,390 --> 00:30:35,070
psychoanalyzing things and then
you've got the the Jungians.

558
00:30:35,070 --> 00:30:38,510
What are they called?
And there's always with with

559
00:30:38,550 --> 00:30:42,430
those who support Freud, it
seems to be a lot more hard,

560
00:30:42,430 --> 00:30:44,590
harsh science.
And then those who love Carl

561
00:30:44,590 --> 00:30:47,510
Jung, it's a lot soft and always
linked to some sort of a

562
00:30:47,510 --> 00:30:50,670
spiritual practice.
Have you noticed and do you

563
00:30:50,670 --> 00:30:52,110
agree with it?
And do you?

564
00:30:52,110 --> 00:30:54,670
What are your thoughts on it In
general?

565
00:30:54,670 --> 00:30:57,650
Yes, I mean, we should just
pause and note that Freud's

566
00:30:57,650 --> 00:31:01,730
great discovery was that there
really is an unconscious and it

567
00:31:01,730 --> 00:31:04,770
gets us to do a lot of things
without our knowledge.

568
00:31:06,210 --> 00:31:08,890
And you know, many
psychiatrists, they dismiss all

569
00:31:08,890 --> 00:31:10,650
the Freudianism and
psychodynamics.

570
00:31:10,930 --> 00:31:14,250
And that's sympathetic because
if you pay attention, a lot of

571
00:31:14,250 --> 00:31:18,090
what we do is in fact motivated
by our unconscious.

572
00:31:18,530 --> 00:31:22,130
And early on in my career, I I
was so impressed by all of this

573
00:31:22,130 --> 00:31:25,170
that I decided to try to
understand why there was an

574
00:31:25,170 --> 00:31:28,010
unconscious.
So I've given up in the problem

575
00:31:28,010 --> 00:31:30,050
of consciousness that I stuck
with the problem of the

576
00:31:30,050 --> 00:31:33,170
unconscious.
Why on earth would natural

577
00:31:33,170 --> 00:31:34,770
selection?
Because it's not just things

578
00:31:34,770 --> 00:31:36,650
that don't come to
consciousness.

579
00:31:36,890 --> 00:31:38,970
They're active forces of
repression.

580
00:31:39,410 --> 00:31:42,690
And it really seemed implausible
to me that those those

581
00:31:42,690 --> 00:31:46,630
capacities for repression and
all of the ego defenses that

582
00:31:46,630 --> 00:31:50,070
those could exist unless they
had some adaptive value.

583
00:31:50,070 --> 00:31:54,550
And again we go back to Bob
Trivers and Dick Alexander and

584
00:31:54,550 --> 00:31:58,470
they're very cynical view that
we deceive ourselves so that we

585
00:31:58,470 --> 00:32:02,470
can better deceive others.
If if we're, if if we don't know

586
00:32:02,470 --> 00:32:04,990
we're lying, it's better to lie
other.

587
00:32:05,350 --> 00:32:08,390
And so I I took I, I'll pose
that.

588
00:32:08,390 --> 00:32:11,510
I think I said that's not what I
see in myself or in my patients.

589
00:32:11,670 --> 00:32:14,910
My patients are lying awake
nights wondering if they

590
00:32:14,910 --> 00:32:17,710
accidentally failed to smile at
someone on the street.

591
00:32:17,710 --> 00:32:20,990
You know, this, this is not the
case of somebody, you know,

592
00:32:20,990 --> 00:32:24,870
trying to trick other people.
So I worked on that and wrote

593
00:32:24,870 --> 00:32:26,910
several chapters and articles
about it.

594
00:32:27,070 --> 00:32:30,710
And I came to a conclusion that
actually Trevis and Alexander

595
00:32:30,710 --> 00:32:36,360
were often right.
Quite often we do stay unaware

596
00:32:36,360 --> 00:32:40,040
of our wind impulses, especially
sexual impulses, in order to

597
00:32:40,040 --> 00:32:43,440
pursue them without having to
blame ourselves and and and the

598
00:32:43,440 --> 00:32:47,040
lag.
But I also argued that the

599
00:32:47,040 --> 00:32:50,400
ability for repression and eager
defenses also preserves

600
00:32:50,400 --> 00:32:55,280
relationships.
Because if you are acutely aware

601
00:32:55,480 --> 00:32:58,280
of everything anybody else does
and the fact that it might be,

602
00:32:58,520 --> 00:33:02,920
you know, a diss or or an insult
or or betrayal, it's very hard

603
00:33:02,920 --> 00:33:05,790
to have friends.
And I think with with some of my

604
00:33:05,790 --> 00:33:09,630
psychoanalyst friends, sometimes
a little awkward because, you

605
00:33:09,630 --> 00:33:11,990
know, sometimes they're, they
have their psychoanalytic

606
00:33:11,990 --> 00:33:15,150
antenna turned on and every tiny
thing you say could be

607
00:33:15,150 --> 00:33:18,590
interpreted as something else.
There might be hostile impulses

608
00:33:18,590 --> 00:33:21,150
behind it and that would a pain
that that all is.

609
00:33:21,150 --> 00:33:23,630
It's much better, I think, to
just be unaware.

610
00:33:24,130 --> 00:33:26,650
I thought that when I first
wrote these articles and several

611
00:33:26,650 --> 00:33:30,330
other people wrote similar
things at the time, that

612
00:33:30,330 --> 00:33:33,370
psychoanalysts would say, wow,
we finally have a real

613
00:33:33,370 --> 00:33:38,290
biological foundation for our
field that has not come to pass.

614
00:33:38,530 --> 00:33:41,890
And I think, for a pretty
obvious reason that pointing out

615
00:33:41,890 --> 00:33:45,090
that defenses and the
unconscious are in fact valuable

616
00:33:46,330 --> 00:33:50,530
is is challenging for people who
spent their whole careers trying

617
00:33:50,530 --> 00:33:53,640
to in themselves and other
people make the unconscious

618
00:33:53,640 --> 00:33:56,160
conscious.
Now certainly our benefits to

619
00:33:56,160 --> 00:33:59,800
making the unconscious conscious
in many, many circumstances and

620
00:33:59,920 --> 00:34:02,360
the whole psychoanalytic method
is brilliant for making that

621
00:34:02,360 --> 00:34:04,400
possible.
I can't imagine practicing

622
00:34:04,400 --> 00:34:06,600
psychiatry without knowing the
basics of that.

623
00:34:07,760 --> 00:34:11,920
But psychoanalysis remains, you
know, devoted to to Freud and

624
00:34:12,239 --> 00:34:14,360
and the core ideas and its
elaborations.

625
00:34:14,560 --> 00:34:18,920
Without going back to this idea
about why the capacity for

626
00:34:19,460 --> 00:34:23,820
denial and projection and
reaction formation and the like

627
00:34:23,820 --> 00:34:27,420
all exist.
On Thursday.

628
00:34:28,540 --> 00:34:31,380
Just for for context for the
business, today is Monday and on

629
00:34:31,380 --> 00:34:32,699
Thursday I'm chatting to Mark
Solmes.

630
00:34:32,699 --> 00:34:34,139
I'm not sure if you're familiar
with his work.

631
00:34:34,780 --> 00:34:37,020
No, no.
So Professor Mark Sops, he's

632
00:34:37,020 --> 00:34:40,340
from Cape Town, here in South
Africa as well and he's one of

633
00:34:40,340 --> 00:34:43,420
The Pioneers of dreams and he
understood the neuropsychology

634
00:34:43,420 --> 00:34:45,739
of dreams.
But he's a huge Freudian thinker

635
00:34:45,739 --> 00:34:49,679
and he loves his work and.
Gets upset about this idea that

636
00:34:49,679 --> 00:34:52,840
people as you said, I mean they
don't really appreciate some of

637
00:34:52,840 --> 00:34:57,400
the work Freud actually has done
it caught up in the in the

638
00:34:57,400 --> 00:35:01,200
incorrect aspects of the theory
and I think that's a big

639
00:35:01,200 --> 00:35:03,480
problem.
I think people often forget when

640
00:35:03,560 --> 00:35:07,680
that things happen in context
and we remove all context when

641
00:35:07,680 --> 00:35:10,040
we talk about it today because
we think we're so much brighter

642
00:35:10,040 --> 00:35:13,560
than he was at the time.
Only bright is of the

643
00:35:13,560 --> 00:35:19,290
information about it is and.
When you think about the field

644
00:35:19,290 --> 00:35:21,850
of psychiatry, I mean, as we
were going through this

645
00:35:21,850 --> 00:35:25,850
progression, I mentioned that,
OK, is there anything about free

646
00:35:25,850 --> 00:35:28,250
will, by the way, that you wanna
still touch on or morality?

647
00:35:29,490 --> 00:35:32,250
I think we've done free will and
morality as best we can in a

648
00:35:32,250 --> 00:35:33,770
very short period.
Let's move on.

649
00:35:34,170 --> 00:35:36,650
So a consciousness.
Look, I'm gonna save that.

650
00:35:36,650 --> 00:35:38,050
I think maybe.
Is there anything about

651
00:35:38,050 --> 00:35:40,290
consciousness specifically that
you wanna mention before we

652
00:35:40,650 --> 00:35:41,530
move?
Because there's so many, we

653
00:35:41,530 --> 00:35:43,700
couldn't, yeah, we could talk
more about that.

654
00:35:43,700 --> 00:35:47,180
But I think we're on a on a
track to get into evolution and

655
00:35:47,180 --> 00:35:48,820
why we're vulnerable to mental
disorders.

656
00:35:48,820 --> 00:35:50,660
And that's what I actually know
about South.

657
00:35:50,660 --> 00:35:53,540
Let's talk about that.
Randy, with that, you know

658
00:35:53,540 --> 00:35:57,980
quite, you know a lot.
I read your books, I've even

659
00:35:57,980 --> 00:36:00,060
watched some of your podcasts,
and I'm trying my best to also

660
00:36:00,060 --> 00:36:02,260
make sure that you give us some
new content today, because I've

661
00:36:02,660 --> 00:36:05,220
I've watched the concept so much
and I don't want I want to

662
00:36:05,220 --> 00:36:08,020
listeners to leave this knowing
a lot more about your views on

663
00:36:08,020 --> 00:36:09,820
this topic, and a lot more as
well.

664
00:36:10,990 --> 00:36:12,790
First of all, I just want to
touch briefly on that

665
00:36:13,230 --> 00:36:18,470
conversation I started earlier
about these layers of attempts

666
00:36:18,470 --> 00:36:22,990
that we've made overtime, the
neurobiological ones, the the

667
00:36:22,990 --> 00:36:26,670
invention of brain scans, Mri's,
Eeg's, all these things.

668
00:36:26,670 --> 00:36:28,470
And we thought we were always
going to solve this problem.

669
00:36:28,830 --> 00:36:31,830
And you said it would be great
to have this, this one poll that

670
00:36:31,830 --> 00:36:34,270
would solve all your problems.
But tell me about why this is

671
00:36:34,270 --> 00:36:36,550
such a big problem?
Why is it so difficult for

672
00:36:36,550 --> 00:36:39,510
people to understand?
How is it that certain?

673
00:36:40,050 --> 00:36:44,330
Biological factors result in
psychological illness at some

674
00:36:44,490 --> 00:36:49,170
point.
Gosh, I mean, first, let's both

675
00:36:49,170 --> 00:36:53,170
agree that these are desperately
important and tragic problems

676
00:36:53,170 --> 00:36:56,770
worldwide.
And everybody agrees, Yep,

677
00:36:56,770 --> 00:36:59,130
they're not simple.
That's a good place to start.

678
00:37:00,210 --> 00:37:04,470
But nonetheless, everyone is so
desperate for a solution that

679
00:37:04,470 --> 00:37:06,710
when someone proposes something
that might be a solution,

680
00:37:06,710 --> 00:37:09,390
whether it's psychoanalysis or
behavioral therapy or cognitive

681
00:37:09,390 --> 00:37:13,550
behavioral therapy or drug
therapy or ECT or or something,

682
00:37:13,550 --> 00:37:15,910
everybody says finally, finally,
finally, and they become

683
00:37:16,350 --> 00:37:17,670
advocates for that kind of
therapy.

684
00:37:17,830 --> 00:37:21,750
Nowadays it's it's psilocybin
and and psychedelics and

685
00:37:21,750 --> 00:37:25,430
ketamine and the like.
And I think for all of us we can

686
00:37:25,430 --> 00:37:29,030
hope that some that these things
work and they do work for some

687
00:37:29,030 --> 00:37:32,550
people and and generalizations.
You know, ketamine is good,

688
00:37:32,550 --> 00:37:34,570
ketamine is bad.
I don't know.

689
00:37:34,570 --> 00:37:38,410
We should do proper studies and
do double blinded controls as

690
00:37:38,410 --> 00:37:42,610
best we can and follow up with
people and you know, not try to

691
00:37:42,610 --> 00:37:44,490
prove that it works to prove
that it doesn't work.

692
00:37:44,810 --> 00:37:47,650
We should try to have an open
mind and and see.

693
00:37:47,970 --> 00:37:50,570
But on the other hand after
you've been around a while and

694
00:37:50,570 --> 00:37:54,330
I've been around a while, you
see all these enthusiasms for

695
00:37:54,330 --> 00:37:57,690
new things and they haven't
worked out any of them.

696
00:37:58,050 --> 00:37:59,530
There's two kinds of
enthusiasms.

697
00:37:59,530 --> 00:38:01,930
One is the explanation and one
is the treatment.

698
00:38:02,650 --> 00:38:08,590
And I think you know we in 2002,
gosh, the genome had just been

699
00:38:08,590 --> 00:38:12,510
sequenced and I had the
privilege of talking with Jim

700
00:38:12,510 --> 00:38:15,790
Watson and others at that time
and and we were all saying

701
00:38:15,790 --> 00:38:18,030
finally we're going to find the
source for schizophrenia.

702
00:38:19,390 --> 00:38:22,310
And and I believe that we would
too, but we all believed we

703
00:38:22,310 --> 00:38:24,230
would.
We thought we'd find the bad

704
00:38:24,230 --> 00:38:26,950
common genes and that would lead
us to the pathways and that

705
00:38:26,950 --> 00:38:28,950
would lead us new drugs and
finally finally find that we

706
00:38:28,950 --> 00:38:32,230
would really have a scientific
understanding of the cause and

707
00:38:32,230 --> 00:38:33,470
it would lead us to new
treatments.

708
00:38:33,750 --> 00:38:36,790
And the disappointment has been
absolutely devastating.

709
00:38:37,150 --> 00:38:40,390
And I some people are honest
about that, but but not as much

710
00:38:40,390 --> 00:38:42,590
as they need to be.
I mean it's just it's absolutely

711
00:38:42,590 --> 00:38:46,990
tragic that it hasn't worked and
now we need to, you know, pull

712
00:38:46,990 --> 00:38:49,950
up our bootstraps and move on.
But where do we move on to?

713
00:38:50,920 --> 00:38:53,760
And just to summarize some of
that data, in case your viewers

714
00:38:53,760 --> 00:38:58,120
don't all know it, we we now
know there are thousands of

715
00:38:58,120 --> 00:39:01,720
genes that influence the risk of
schizophrenia, the vast majority

716
00:39:01,720 --> 00:39:04,760
of which increase your risk by
1% or less.

717
00:39:05,950 --> 00:39:08,830
And furthermore, the first thing
we're all taught in psychiatry

718
00:39:08,830 --> 00:39:12,310
about diagnosis is that
schizophrenia and bipolar

719
00:39:12,310 --> 00:39:14,110
disease are fundamentally
different illnesses.

720
00:39:14,110 --> 00:39:17,790
So, and so why is books and
chapters and and studies of men

721
00:39:17,790 --> 00:39:19,750
to figure out which one does
this patient have?

722
00:39:20,110 --> 00:39:23,190
And now we know that the genes
overlap massively.

723
00:39:23,710 --> 00:39:26,390
It's to its considerable extent
the same genes.

724
00:39:26,750 --> 00:39:30,710
So the disappointment, you know,
in fact the DSM, probably some

725
00:39:30,710 --> 00:39:33,790
of your listers are share my
frustration with simplistic

726
00:39:33,790 --> 00:39:39,290
diagnostic categories.
Gosh, when they wrote the DSM

727
00:39:39,290 --> 00:39:42,170
three, the idea was that it
would be a temporary document

728
00:39:42,370 --> 00:39:45,370
until we finally finally found
the genes and brain mechanisms

729
00:39:45,570 --> 00:39:48,850
and we could define our
diagnosis based on specific

730
00:39:48,850 --> 00:39:51,330
pathophysiology.
Like the rest of medicine, it

731
00:39:51,330 --> 00:39:54,890
was a grand dream and not only
has it not been reached, it's

732
00:39:54,890 --> 00:39:57,210
very clear now it will not be
reached.

733
00:39:57,970 --> 00:40:00,090
Is that too strong?
I so hope it will be reached, I

734
00:40:00,090 --> 00:40:02,550
really do.
I hope we can find some brain

735
00:40:02,550 --> 00:40:07,830
pathway, some kind of neuron
type that is way more common in

736
00:40:07,830 --> 00:40:10,070
people with schizophrenia or
bipolar disease because we so

737
00:40:10,070 --> 00:40:13,830
badly need to find find better
treatments for these things.

738
00:40:14,590 --> 00:40:17,310
But you better not bet on it.
I think we need to take

739
00:40:17,310 --> 00:40:20,030
different approaches.
My approach to this is to in

740
00:40:20,030 --> 00:40:23,950
fact ask why we're all so
vulnerable to these things.

741
00:40:24,070 --> 00:40:27,390
Do you know that even the people
with the fewest genes that

742
00:40:27,470 --> 00:40:30,070
predisposed to schizophrenia can
still get it?

743
00:40:31,210 --> 00:40:34,490
If you do polygenic scores, you
can take people who have the

744
00:40:34,490 --> 00:40:37,450
lowest polygenic scores.
You go through the whole genome

745
00:40:37,610 --> 00:40:41,490
and they have very few, few
genes that increase the risk of

746
00:40:41,490 --> 00:40:43,570
schizophrenia.
But some people in those groups

747
00:40:43,570 --> 00:40:46,250
still get it.
Yes, it could be because they

748
00:40:46,250 --> 00:40:49,010
have very, very rare genes of
large effect.

749
00:40:49,010 --> 00:40:53,250
It's it's possible.
But what I think we should be

750
00:40:53,250 --> 00:40:58,340
asking is why the whole system
is vulnerable, not just for

751
00:40:58,340 --> 00:41:00,860
schizophrenia.
Epilepsy is another really good

752
00:41:00,860 --> 00:41:03,220
one.
I mean highly heritable disease.

753
00:41:03,420 --> 00:41:06,260
In that case, there are a few
genes that are common and have

754
00:41:06,260 --> 00:41:08,260
more impact than for
schizophrenia.

755
00:41:08,580 --> 00:41:11,980
But why is it that that disease
remains So we all have a

756
00:41:11,980 --> 00:41:15,540
capacity for epilepsy and it's
not an adaptation, it's it's

757
00:41:15,540 --> 00:41:19,260
just how the system goes wrong
in response to what?

758
00:41:19,500 --> 00:41:27,220
Trauma, toxins, fever,
infection, any any number of

759
00:41:27,220 --> 00:41:30,420
things can set off epilepsy.
It seems like the whole system

760
00:41:30,420 --> 00:41:34,220
has been pushed to some peak of
performance that's right enough

761
00:41:34,220 --> 00:41:38,140
to a Cliff edge where it's
vulnerable to substantial

762
00:41:38,140 --> 00:41:39,620
failure.
And you know, many, many

763
00:41:39,620 --> 00:41:42,900
machines are programmed.
Engineers design many machines

764
00:41:42,900 --> 00:41:46,740
to be pushed to the edge, and
especially machines that are

765
00:41:47,260 --> 00:41:50,380
race cars, things that are
competing, you know, they're all

766
00:41:50,380 --> 00:41:53,690
vulnerable because to get a race
car that's as fast as possible

767
00:41:53,690 --> 00:41:56,610
has to be very, very light and
that makes it fragile.

768
00:41:57,170 --> 00:41:59,810
And this argument can be used
for schizophrenia.

769
00:41:59,930 --> 00:42:02,570
Before, I'll wrap this up in a
second, just with a paper that

770
00:42:02,570 --> 00:42:07,170
I've really liked recently by
Lou looking at the history of a

771
00:42:07,170 --> 00:42:09,650
Leo's that influence the risk of
schizophrenia.

772
00:42:10,090 --> 00:42:14,290
And their short answer is that
those that are derived that are

773
00:42:14,290 --> 00:42:17,610
new are more likely to protect
against schizophrenia.

774
00:42:18,190 --> 00:42:21,830
Those that are ancestral alleles
that are old are more likely to

775
00:42:21,910 --> 00:42:24,950
increase the risk of
schizophrenia, suggesting that

776
00:42:24,950 --> 00:42:28,390
the very fast selection for our
amazing capacities for language

777
00:42:28,390 --> 00:42:31,750
and intelligence and social
skills may have, you know,

778
00:42:31,750 --> 00:42:34,910
disrupted all kinds of
connections and systems in the

779
00:42:34,910 --> 00:42:37,190
brain in a way that makes them
vulnerable.

780
00:42:37,510 --> 00:42:41,310
And natural selection is still
now trying to make the brain

781
00:42:41,310 --> 00:42:44,270
more robust from the kinds of
failures that result.

782
00:42:45,710 --> 00:42:47,750
Do you think a massive factor
around this because you were

783
00:42:47,750 --> 00:42:51,870
talking about how the even if
you have the genes that if you

784
00:42:51,870 --> 00:42:54,230
have a very few genes that would
predispose you to certain

785
00:42:54,230 --> 00:42:56,550
illnesses.
Let's say that we're still

786
00:42:56,550 --> 00:42:58,430
finding it.
Because I think one of those

787
00:42:58,430 --> 00:43:02,350
reasons would be the fact that
we're just so diverse in the

788
00:43:02,350 --> 00:43:04,430
sense that we have billions of
us at this point.

789
00:43:05,030 --> 00:43:08,230
If if study enough of us at this
point, the odds of someone

790
00:43:08,230 --> 00:43:11,510
having something increases so
much more because of how many

791
00:43:11,510 --> 00:43:14,770
there are of us.
With smaller population chunks

792
00:43:14,770 --> 00:43:17,850
at that point, these rates of
illnesses were just dropped

793
00:43:17,850 --> 00:43:21,450
tremendously because of that,
and I'm not sure what you're

794
00:43:21,450 --> 00:43:22,650
meaning there.
Indeed there.

795
00:43:26,490 --> 00:43:28,930
Sorry Randy, I think you broke
off a little there.

796
00:43:29,210 --> 00:43:31,330
Am I?
Am I still functioning on your

797
00:43:31,330 --> 00:43:41,170
side?
Randy, I've lost you.

798
00:43:43,010 --> 00:43:45,410
Let's make sure if my
connection's fine on this side.

799
00:43:53,700 --> 00:43:56,580
Brandy I'm just going to send
you a mail, just because I

800
00:43:56,580 --> 00:44:28,410
can't.
Hey Randy, thanks.

801
00:44:28,650 --> 00:44:32,810
You managed to successfully
managed to successfully reboot

802
00:44:32,810 --> 00:44:34,130
there.
Yeah.

803
00:44:34,130 --> 00:44:36,570
And then take as long as
sometimes that's that's good.

804
00:44:36,570 --> 00:44:39,650
I don't know what happens if
they say they're upgrading me to

805
00:44:39,690 --> 00:44:41,850
a faster connection.
Maybe that was it.

806
00:44:42,010 --> 00:44:43,890
Who knows?
Well, I have.

807
00:44:43,930 --> 00:44:46,370
I'm actually surprised and I
went by very fast.

808
00:44:48,410 --> 00:44:50,730
Yes, it's more to say, let's see
what else we want to cover.

809
00:44:50,730 --> 00:44:52,130
Where were we?
OK.

810
00:44:52,130 --> 00:44:54,730
Wait, Randy, I just want to
quickly ask you.

811
00:44:55,210 --> 00:45:00,510
You touched on the DSM.
And the DSM, do you ever find it

812
00:45:00,630 --> 00:45:03,670
limiting and concerning in the
fact that it's so?

813
00:45:04,030 --> 00:45:06,990
It's such a basic description of
the human experience?

814
00:45:07,190 --> 00:45:11,270
Well, that's my opinion.
So you'd love a little anecdote

815
00:45:11,270 --> 00:45:13,990
about all of this.
And Dan Stein is one of my close

816
00:45:13,990 --> 00:45:16,270
colleagues, a psychiatrist there
in Cape Town.

817
00:45:16,630 --> 00:45:18,710
I can have huge admiration for
him.

818
00:45:18,710 --> 00:45:22,390
And and we decided that we'd use
an evolutionary approach to

819
00:45:22,390 --> 00:45:25,640
propose a better diagnostic
system because it's really clear

820
00:45:25,640 --> 00:45:28,640
that there are evolutionary
explanations for why humans are

821
00:45:28,640 --> 00:45:30,560
vulnerable to some of these
disorders.

822
00:45:31,000 --> 00:45:33,000
So we worked on this for about a
year.

823
00:45:33,320 --> 00:45:35,000
They can we come up with
something better.

824
00:45:35,600 --> 00:45:38,600
And at the end of that time, we
concluded, you know what, the

825
00:45:38,600 --> 00:45:41,520
DSM is really a pretty good
description of what we

826
00:45:41,520 --> 00:45:44,840
clinicians see.
And everybody's mad at it and

827
00:45:44,840 --> 00:45:48,560
complains about it because they
are unable to find specific

828
00:45:48,600 --> 00:45:51,720
neuroscience causes for those
diseases.

829
00:45:52,120 --> 00:45:54,440
And the nationalists use of
mental health to abandon it.

830
00:45:54,760 --> 00:45:57,840
And they decided we're not going
to require it anymore because we

831
00:45:57,840 --> 00:46:00,720
can't find the specific
neuroscience causes for these

832
00:46:00,720 --> 00:46:02,600
diseases.
Therefore there must be

833
00:46:02,600 --> 00:46:04,080
something wrong with the
diagnosis.

834
00:46:04,440 --> 00:46:07,320
Wait a second, that's a huge
assumption, isn't it?

835
00:46:07,520 --> 00:46:10,720
That's an assumption that there
are specific neuroscience causes

836
00:46:10,920 --> 00:46:13,840
for each of these diseases,
their their brain mechanisms.

837
00:46:13,920 --> 00:46:16,960
Absolutely.
And the brains of disorders are

838
00:46:16,960 --> 00:46:18,920
absolutely different from other
people's brains.

839
00:46:19,380 --> 00:46:22,500
But can we find something
specific like the plaques and

840
00:46:22,500 --> 00:46:27,100
tangles and Alzheimer's disease
or like a a missing kidney and

841
00:46:27,100 --> 00:46:30,780
kidney disease?
So far we haven't been able to.

842
00:46:30,780 --> 00:46:33,980
Again, I hope we will still.
I really hope we do.

843
00:46:34,340 --> 00:46:40,220
But 30 years has not given a
single biomarker for any mental

844
00:46:40,220 --> 00:46:44,300
disorder except for things like
Alzheimer's disease and chorea

845
00:46:44,660 --> 00:46:47,140
which are people hoped that
their other metal disorders

846
00:46:47,140 --> 00:46:49,260
would be like those and they're
not like those.

847
00:46:49,580 --> 00:46:51,820
And it's just I think part of
the problem is that the brain is

848
00:46:51,820 --> 00:46:54,860
an information system.
You know it's it's not.

849
00:46:55,220 --> 00:46:58,700
I mean metabolic systems are
complex enough, but information

850
00:46:58,700 --> 00:47:03,340
systems are shaped by all kinds
of tradeoffs and and performance

851
00:47:03,340 --> 00:47:07,420
peeps that are close to Cliff
edges and the nature.

852
00:47:07,420 --> 00:47:12,220
I I just gave a a talk
associated with the symposium at

853
00:47:12,220 --> 00:47:14,980
the International Society for
Evolution Medicine Public Health

854
00:47:14,980 --> 00:47:18,220
last week.
The body and the mind are not

855
00:47:18,220 --> 00:47:21,860
like machines.
And we use this metaphor of body

856
00:47:21,860 --> 00:47:25,340
as machine and mind as a
computer because we need those

857
00:47:25,340 --> 00:47:28,100
kind of frameworks to help think
about things.

858
00:47:28,460 --> 00:47:30,260
But they fundamentally mislead
us.

859
00:47:30,760 --> 00:47:33,120
They lead us to think that there
are modules that are very

860
00:47:33,120 --> 00:47:36,840
specific and distinct of a sort
that an engineer would would

861
00:47:36,840 --> 00:47:39,200
devise.
They let us to think that, you

862
00:47:39,200 --> 00:47:42,640
know, the brain has little
sections that go connected to

863
00:47:42,640 --> 00:47:46,240
each other, but the way computer
modules are connected to each

864
00:47:46,240 --> 00:47:48,320
other.
But when you think about how the

865
00:47:48,320 --> 00:47:51,560
brain was actually formed, there
are little tiny allelic

866
00:47:51,560 --> 00:47:55,840
differences that make some kind
of change of neuronal migration

867
00:47:55,840 --> 00:48:01,020
or receptors response or a
synapse, and that makes overall

868
00:48:01,340 --> 00:48:04,540
an individual have an advantage.
But it also screws up three

869
00:48:04,540 --> 00:48:06,820
other things.
And then there's another allele

870
00:48:06,820 --> 00:48:08,100
that interferes with that
allele.

871
00:48:08,100 --> 00:48:11,540
I mean, the kind of complexity
is not like the complexity of

872
00:48:11,540 --> 00:48:14,740
machines or computers.
I call it organic complexity.

873
00:48:15,140 --> 00:48:18,580
And it's an awful vision because
we love science, because science

874
00:48:18,580 --> 00:48:22,700
simplifies things.
What about if reality is a kind

875
00:48:22,700 --> 00:48:26,380
of complexity that's almost
impossible to describe because

876
00:48:26,380 --> 00:48:30,070
it's so alien?
I think, I mean, you're hitting

877
00:48:30,070 --> 00:48:31,830
the nail on the head right
there, because I think that

878
00:48:32,110 --> 00:48:33,790
that's precisely the issue we're
going to have with

879
00:48:33,790 --> 00:48:36,030
consciousness.
People claim to have all these

880
00:48:36,030 --> 00:48:40,390
solutions all the time, the
brain, and that's it.

881
00:48:40,590 --> 00:48:43,870
For some people, the even
mentioning the brain in the

882
00:48:43,870 --> 00:48:46,350
philosophical discussion
regarding consciousness is a

883
00:48:46,350 --> 00:48:49,390
huge mistake.
You get philosophers who believe

884
00:48:49,390 --> 00:48:51,470
that consciousness is the
fundamental reality.

885
00:48:51,470 --> 00:48:57,370
You get people who?
Who take it to a non human

886
00:48:57,370 --> 00:49:01,010
related realm, so it becomes
difficult obviously to disprove

887
00:49:01,010 --> 00:49:04,730
those theories, but some present
very logical arguments.

888
00:49:04,730 --> 00:49:07,530
I mean I think because obviously
when you when we're doctors

889
00:49:07,810 --> 00:49:10,370
practicing medicine learning
about the body, we clearly see

890
00:49:10,730 --> 00:49:12,850
the relationship between mind
and body very differently.

891
00:49:13,130 --> 00:49:17,850
But when we think about this
field and consciousness as a

892
00:49:17,850 --> 00:49:21,130
whole, I think it's just way too
complicated, I think, trying to

893
00:49:21,130 --> 00:49:25,070
understand the brain.
Just the brain alone is already

894
00:49:25,070 --> 00:49:28,390
too complicated.
I think we're barking up a tree

895
00:49:28,390 --> 00:49:32,710
that's very difficult to climb.
So the other project I've been

896
00:49:32,710 --> 00:49:38,030
involved in for years with Fred
Nihot, who is a mathematician

897
00:49:38,030 --> 00:49:40,910
who studies the folate
metabolism system.

898
00:49:41,310 --> 00:49:46,190
That's the system that generates
methyl groups that are crucial

899
00:49:46,190 --> 00:49:48,510
for use throughout the body.
There are about 32 genes

900
00:49:48,510 --> 00:49:53,460
involved, and his model has very
fancy equations showing how all

901
00:49:53,460 --> 00:49:56,100
of those genes are connected to
each other with enzymatic

902
00:49:56,100 --> 00:49:59,660
pathways, and furthermore how
feedback and positive feedback

903
00:49:59,660 --> 00:50:02,060
and negative pathways control
the whole system.

904
00:50:02,660 --> 00:50:06,700
And we've used this to try to
see if in fact the individuals

905
00:50:06,700 --> 00:50:11,500
at the extremes of good ability
to do methylation or not so good

906
00:50:11,500 --> 00:50:14,100
ability to do methylation.
And those people really do have

907
00:50:14,100 --> 00:50:17,320
problems like spinal increased
atherosclerosis and things.

908
00:50:17,640 --> 00:50:21,840
So it should be possible to find
the genes that are characterized

909
00:50:21,960 --> 00:50:25,120
that characterize those
individuals who can't have as

910
00:50:25,120 --> 00:50:29,240
much capacity for methylation.
But when we run the model, we

911
00:50:29,240 --> 00:50:34,280
find out that there is no
specific cluster of genes that

912
00:50:34,280 --> 00:50:36,080
predicts who will be in that
group.

913
00:50:36,800 --> 00:50:42,080
And the reason is that each of
those genes has either a

914
00:50:42,080 --> 00:50:46,130
positive or negative effect on
fitness, depending on what other

915
00:50:46,130 --> 00:50:49,650
genes whether alleles are there.
And again, we're back to this

916
00:50:49,650 --> 00:50:52,730
kind of complexity that's
fundamentally different from the

917
00:50:52,730 --> 00:50:56,250
kind of described complexity
that we teach in biochemistry

918
00:50:56,250 --> 00:51:00,130
textbooks.
And we we think this might help

919
00:51:00,130 --> 00:51:01,890
to explain this inheritability
too.

920
00:51:01,890 --> 00:51:04,770
So that's speculation until we
publish it and get it peer

921
00:51:04,770 --> 00:51:07,290
reviewed.
But it's been a wonderful

922
00:51:07,290 --> 00:51:10,880
project because it instead of
just talking about organic

923
00:51:10,880 --> 00:51:14,520
complexity, we have a real
demonstration of how you know,

924
00:51:14,680 --> 00:51:19,240
most medical research trying to
find specific genes for specific

925
00:51:19,240 --> 00:51:24,640
diseases has not fully taken
cognizance of the kinds of

926
00:51:24,640 --> 00:51:28,880
organic complexity that mean
that there's not one particular

927
00:51:28,880 --> 00:51:30,880
cluster of genes that causes the
disease.

928
00:51:31,160 --> 00:51:33,200
There are all kinds of
interacting genes that are

929
00:51:33,200 --> 00:51:36,000
different and different
individuals that lead to certain

930
00:51:36,160 --> 00:51:41,110
vulnerable systems failing.
Yeah, I think it's absolutely

931
00:51:41,110 --> 00:51:43,510
true.
I mean the dynamics of a brain

932
00:51:43,790 --> 00:51:47,230
or the dynamics of a mind in
general are so.

933
00:51:47,270 --> 00:51:49,110
I mean there's so many ways to
think about it.

934
00:51:49,110 --> 00:51:51,790
There's is the evolutionary
perspective, there's the genetic

935
00:51:51,790 --> 00:51:55,030
perspective, there's the
neurochemistry, biochemistry,

936
00:51:55,030 --> 00:51:59,390
just there's so much in there
that it's gonna simulation and a

937
00:51:59,390 --> 00:52:02,630
combination of so many different
collaborative encartas.

938
00:52:02,630 --> 00:52:04,850
I mean this is.
Something that everybody's going

939
00:52:04,850 --> 00:52:06,490
to have to give put a given
input.

940
00:52:06,490 --> 00:52:11,250
Social scientists,
neurosciences, everybody has to

941
00:52:11,250 --> 00:52:14,730
have a say at some point.
So you can bring me up to date,

942
00:52:14,730 --> 00:52:17,690
Kevin, because one conclusion
I've come to about this not

943
00:52:17,690 --> 00:52:21,610
being deep into the field in
recent years is that, I mean,

944
00:52:21,610 --> 00:52:24,890
the capacity for consciousness
does give a very big selective

945
00:52:24,890 --> 00:52:29,170
advantage because we can play
things out in our mind without

946
00:52:29,170 --> 00:52:32,050
having to actually do them.
We can imagine what would happen

947
00:52:32,050 --> 00:52:34,570
if we told that person about
what we'd done.

948
00:52:34,890 --> 00:52:38,010
We we can imagine what would
happen if we walk through that

949
00:52:38,010 --> 00:52:40,650
forest when there's a big wind
and limbs are falling.

950
00:52:40,650 --> 00:52:44,050
I mean, instead of having to die
and having to lose our friends,

951
00:52:44,250 --> 00:52:49,010
we can anticipate and play out
mentally things and get a big

952
00:52:49,010 --> 00:52:50,890
advantage of it.
A bunch of people have said

953
00:52:50,890 --> 00:52:52,250
that.
You can help me understand who's

954
00:52:52,250 --> 00:52:54,850
saying that kind of thing?
Well, I think there's there's

955
00:52:54,850 --> 00:52:56,410
different approaches at this
point.

956
00:52:56,410 --> 00:52:58,770
I've spoken to so many people
who have the varying views.

957
00:52:58,770 --> 00:53:01,850
You've got a certain.
People who work in the evolution

958
00:53:01,850 --> 00:53:06,010
of minds and try to understand
intelligence of cognition very

959
00:53:06,010 --> 00:53:07,930
separately.
So they try and start in other

960
00:53:07,930 --> 00:53:11,890
forms of what we call quote UN
quote consciousness, but they

961
00:53:11,890 --> 00:53:13,610
use various other platforms to
do it.

962
00:53:13,610 --> 00:53:18,050
So intelligence for example and
then just focus on micro forms

963
00:53:18,050 --> 00:53:21,210
of these sort of proto conscious
States and work your way up.

964
00:53:21,210 --> 00:53:23,250
But if you think of a cell, for
example, people like Michael

965
00:53:23,250 --> 00:53:25,930
Levin.
Several others are working on

966
00:53:25,930 --> 00:53:30,130
various intelligent aspects of
cells and how if you slowly add

967
00:53:30,130 --> 00:53:34,770
those layers up, you get this
more complex system of what we

968
00:53:34,770 --> 00:53:35,970
call consciousness at this
point.

969
00:53:36,130 --> 00:53:39,170
But then you've got others.
You've got people who work but

970
00:53:39,170 --> 00:53:41,970
not bars.
You've got Staniless de Hain who

971
00:53:41,970 --> 00:53:46,290
work on theories like a global
workspace theory, different

972
00:53:46,290 --> 00:53:49,810
theories of consciousness, where
you take it as information,

973
00:53:49,810 --> 00:53:52,250
trying to reach certain
workspaces within the mind

974
00:53:52,250 --> 00:53:55,010
where?
I don't, to be honest, I don't

975
00:53:55,010 --> 00:53:57,130
know the ins and outs of the
actual theory.

976
00:53:57,130 --> 00:54:00,290
But in a nutshell, we have to
sort of have this what is known

977
00:54:00,290 --> 00:54:04,810
as a meta cognitive ability.
We have to be able to think on

978
00:54:04,810 --> 00:54:07,130
what we're actually thinking
about, so thinking about

979
00:54:07,130 --> 00:54:08,450
thinking, right?
Exactly.

980
00:54:08,450 --> 00:54:11,250
So at some point we can't just
have a thought and not think

981
00:54:11,250 --> 00:54:14,650
about its repercussions.
It's important, but I want to

982
00:54:14,650 --> 00:54:18,850
ask you the fitness payoffs of
having thoughts about thoughts.

983
00:54:19,170 --> 00:54:21,010
So this meta cognition that we
have.

984
00:54:21,590 --> 00:54:25,310
It takes a lot, and your brain
is 2% of the body weight, but

985
00:54:25,550 --> 00:54:28,430
that burns 20% of your overall
calories.

986
00:54:28,430 --> 00:54:32,830
I mean, is this worth it or is
it worth thinking this much?

987
00:54:34,990 --> 00:54:36,990
There are also costs to thinking
a lot.

988
00:54:37,390 --> 00:54:39,870
I've treated many, many patients
with obsessive compulsive

989
00:54:39,870 --> 00:54:43,600
disorder and they get trapped in
a loop where they worry they

990
00:54:43,600 --> 00:54:45,120
might have done something to
hurt somebody.

991
00:54:45,120 --> 00:54:48,000
So they drive around the block
to see if they did, and then

992
00:54:48,000 --> 00:54:50,000
they drive around the block.
There isn't anybody in the

993
00:54:50,000 --> 00:54:52,040
street.
So they drive again because they

994
00:54:52,040 --> 00:54:56,030
might have missed it.
Fascinating disorder and and

995
00:54:56,030 --> 00:54:59,190
there must be something deep
about the structure not only of

996
00:54:59,190 --> 00:55:02,830
human cognition but of human
morality that, you know, makes

997
00:55:02,830 --> 00:55:07,270
these people vulnerable to that
particular kind of failure in in

998
00:55:07,270 --> 00:55:09,310
the brain.
But I do think what we've been

999
00:55:09,310 --> 00:55:12,950
talking about more broadly, the
capacity to think about thinking

1000
00:55:13,300 --> 00:55:17,700
and the capacity to anticipate
and run scenarios in our mind

1001
00:55:17,700 --> 00:55:22,260
instead of in reality, has to
give big advantages, especially

1002
00:55:22,260 --> 00:55:26,460
in social circumstances.
Because the kinds of complexity

1003
00:55:26,460 --> 00:55:31,860
we we encounter in social
situations are just vast and we

1004
00:55:31,860 --> 00:55:33,820
we do have these things could we
call intuition.

1005
00:55:35,220 --> 00:55:37,980
And and I should say that, I
mean, I often referred some of

1006
00:55:37,980 --> 00:55:41,660
my patients to psychotherapists
who I thought were superior to

1007
00:55:41,660 --> 00:55:46,160
me because they had a more
intuitive, automatic, empathic

1008
00:55:46,160 --> 00:55:49,920
sense for what was going.
I wasn't bad, but other people

1009
00:55:49,920 --> 00:55:52,200
were better at that kind of
thing.

1010
00:55:52,200 --> 00:55:54,680
And that that's still a
different kind of we call it

1011
00:55:54,680 --> 00:55:56,960
social intelligence.
But I think that doesn't really

1012
00:55:56,960 --> 00:56:01,160
do justice to this intuitive
kind of understanding that that

1013
00:56:01,160 --> 00:56:04,360
many people that we all have and
some people have in spades.

1014
00:56:05,440 --> 00:56:07,960
I think, yeah.
Especially when you're working

1015
00:56:07,960 --> 00:56:10,000
in a field like psychiatry.
I mean that biopsychosocial

1016
00:56:10,000 --> 00:56:11,720
approach is important.
It's important for a

1017
00:56:11,720 --> 00:56:14,400
psychiatrist to reach that point
where they believe that

1018
00:56:14,400 --> 00:56:17,080
psychologists or might do a
better job with this.

1019
00:56:17,080 --> 00:56:19,960
Or someone who knows
psychotherapy is able to do a

1020
00:56:19,960 --> 00:56:23,040
better job with this because
that interdisciplinary approach

1021
00:56:23,040 --> 00:56:25,920
is always fundamental to the
management of a patient.

1022
00:56:27,570 --> 00:56:29,930
So I did.
I did lots of psychotherapy and

1023
00:56:30,090 --> 00:56:32,970
dynamic therapy and behavioral
therapy and cognitive therapy

1024
00:56:33,210 --> 00:56:35,450
and medication therapy and and
and the like.

1025
00:56:35,450 --> 00:56:38,490
I mean, one of the reasons I
started pursuing evolutionary

1026
00:56:38,490 --> 00:56:41,090
approaches, and it was even
before I met George Williams, I

1027
00:56:41,130 --> 00:56:43,250
published my first paper in
1984.

1028
00:56:43,650 --> 00:56:46,970
It was because I wanted some way
of of being able to offer

1029
00:56:47,290 --> 00:56:51,610
everything we know to a patient
and not just the same old, same

1030
00:56:51,610 --> 00:56:54,090
old kind of treatment for
everybody.

1031
00:56:54,750 --> 00:56:57,790
Now, I do sympathize.
In order to get really good at

1032
00:56:57,830 --> 00:57:00,470
either doing psychodynamic
therapy or cognitive therapy or

1033
00:57:00,470 --> 00:57:03,270
drug therapy, you really
probably should specialize

1034
00:57:03,830 --> 00:57:07,230
because you're trying to do it
all, you know, leaves you off

1035
00:57:07,230 --> 00:57:10,310
and making mistakes.
But on the other hand, at least

1036
00:57:10,510 --> 00:57:13,190
trying to think about all
possible options for each

1037
00:57:13,190 --> 00:57:15,430
individual.
And again, one of my biggest

1038
00:57:15,430 --> 00:57:18,950
conclusions is we really must
understand individuals as

1039
00:57:18,950 --> 00:57:22,630
individuals because trying to
understand where their emotions

1040
00:57:22,630 --> 00:57:26,380
come from can't be done just by
looking at what cues they've

1041
00:57:26,380 --> 00:57:29,740
experienced.
Emotions arise only in the

1042
00:57:29,740 --> 00:57:33,220
context of that individual and
what goals that individuals

1043
00:57:33,220 --> 00:57:36,260
pursuing and what strategies
they're using and what hopes

1044
00:57:36,260 --> 00:57:37,740
they have and what fears they
have.

1045
00:57:37,740 --> 00:57:42,860
And it's very individualized.
And you know, you can't do that.

1046
00:57:42,940 --> 00:57:45,540
You know, with a questionnaire.
You've got to sit down and talk

1047
00:57:45,540 --> 00:57:48,820
with people, but I think this
kind of data, I call, I call

1048
00:57:48,820 --> 00:57:51,580
this the difference between
ideographic understanding.

1049
00:57:51,580 --> 00:57:54,220
That means an individualized
narrative understanding at this

1050
00:57:54,220 --> 00:57:56,860
particular instance and a
nomathetic understanding, which

1051
00:57:56,860 --> 00:58:00,500
is a lawful generalization.
And almost all of our research

1052
00:58:00,500 --> 00:58:03,340
in psychiatry has been an
attempt to create groups,

1053
00:58:03,620 --> 00:58:06,660
patients with depression,
patients with OCD, patients with

1054
00:58:06,660 --> 00:58:10,260
ADHD and try to say things that
are true about everybody in the

1055
00:58:10,260 --> 00:58:15,540
group for some disorders.
That's OK, things like ADHD.

1056
00:58:15,540 --> 00:58:19,260
But when you talk about
emotional problems, I mean, what

1057
00:58:19,260 --> 00:58:22,500
emotions a person is
experiencing is a combination of

1058
00:58:22,860 --> 00:58:26,300
what experiences, what situation
they're in, how they're viewing

1059
00:58:26,300 --> 00:58:30,420
that situation, and their brain.
And all three of those things

1060
00:58:30,420 --> 00:58:32,820
can be influenced to change how
they're doing.

1061
00:58:33,180 --> 00:58:36,020
Yeah, now precisely.
And I think what often goes

1062
00:58:36,020 --> 00:58:39,740
under the radar is swept under
the rug is the fact that these

1063
00:58:39,740 --> 00:58:43,020
diverse experiences that we've
evolved over time are

1064
00:58:43,020 --> 00:58:45,230
fundamental to.
Takes to life.

1065
00:58:46,230 --> 00:58:49,510
Having anxiety for example, is
so important for you.

1066
00:58:50,750 --> 00:58:53,230
We often don't think about it
this way and you often speak

1067
00:58:53,230 --> 00:58:55,670
about it this way.
But tell me about this journey

1068
00:58:55,670 --> 00:58:59,350
and how OK, we're left
disappointed with what the

1069
00:59:00,110 --> 00:59:02,870
Neuroscan revolution has done
for us or the genetic one has

1070
00:59:02,870 --> 00:59:05,910
done for us.
And then you finally decide, OK,

1071
00:59:05,950 --> 00:59:10,030
this is it needs more psychiatry
needs something else and you go

1072
00:59:10,030 --> 00:59:11,750
into this evolutionary medicine
part and.

1073
00:59:12,250 --> 00:59:14,490
It takes you somewhere profound
because at some point you're

1074
00:59:14,490 --> 00:59:17,210
able to think about this very
differently and apply it.

1075
00:59:17,530 --> 00:59:20,650
Talk to me about that.
So you know, everything in

1076
00:59:20,650 --> 00:59:22,850
biology has two kinds of
explanation.

1077
00:59:23,170 --> 00:59:25,970
One is about how it works and
the other is how it got there

1078
00:59:26,010 --> 00:59:29,050
and what good it is, if it's
useful at all.

1079
00:59:29,740 --> 00:59:32,860
And so this was the foundation
for my project with George

1080
00:59:32,860 --> 00:59:36,180
Williams and I I started with
evolutionary psychiatry Tevin

1081
00:59:36,460 --> 00:59:39,340
and I quickly realized that, you
know, we had to understand the

1082
00:59:39,420 --> 00:59:43,380
origins of disease itself in
general first before we could

1083
00:59:43,380 --> 00:59:47,140
make progress in understanding
the evolutionary origins for

1084
00:59:47,140 --> 00:59:49,140
vulnerability to mental
disorders.

1085
00:59:49,460 --> 00:59:53,060
And so that was a a good twenty
year sidetrack which has been

1086
00:59:53,060 --> 00:59:55,940
very satisfying and I think it's
led to so many people doing

1087
00:59:55,940 --> 00:59:59,990
wonderful work using some
categories that we came up with

1088
00:59:59,990 --> 01:00:01,750
as a foundation.
I mean why?

1089
01:00:01,750 --> 01:00:04,870
I mean I was out in medical
school that Yep, mutations

1090
01:00:04,870 --> 01:00:06,990
happen and therefore you have to
get used to the idea that

1091
01:00:06,990 --> 01:00:10,070
disease happens, but that is a
very important one.

1092
01:00:10,110 --> 01:00:12,590
Natural selection can't
eliminate all mutations.

1093
01:00:13,020 --> 01:00:14,460
But there are a bunch of other
things.

1094
01:00:14,700 --> 01:00:17,100
Another one is that natural
selection can't start fresh.

1095
01:00:17,420 --> 01:00:20,540
So lots of systems like, for
instance, our backs and our our

1096
01:00:20,540 --> 01:00:23,660
hernias and our varicose veins,
you know, there are all kinds of

1097
01:00:23,660 --> 01:00:26,500
complications from standing
upright because natural

1098
01:00:26,500 --> 01:00:30,140
selection can't start fresh.
Then there's development.

1099
01:00:30,380 --> 01:00:34,470
Development is variable and you
know, even if the genes are

1100
01:00:34,470 --> 01:00:36,830
identical, the developmental
process is a little bit

1101
01:00:36,830 --> 01:00:39,790
stochastic and so that's going
to leave in variations.

1102
01:00:39,990 --> 01:00:42,390
And then there's the matter of
living in different

1103
01:00:42,390 --> 01:00:44,350
environments.
We're in very different

1104
01:00:44,350 --> 01:00:45,950
environments than those we
evolved in.

1105
01:00:46,270 --> 01:00:48,910
And that certainly is
responsible for the majority of

1106
01:00:48,910 --> 01:00:52,510
chronic disease now, but aren't
responsible for that much mental

1107
01:00:52,510 --> 01:00:54,470
disease.
I'm very uncertain we don't have

1108
01:00:54,470 --> 01:00:56,550
good data on that.
Some people say that all

1109
01:00:56,550 --> 01:00:58,670
depression and anxiety is a
product of living in a modern

1110
01:00:58,670 --> 01:01:01,400
culture.
Yeah, but Cicero said that too,

1111
01:01:02,000 --> 01:01:04,480
back in the ancient Rome.
So, you know, I think we should

1112
01:01:04,480 --> 01:01:07,000
be skeptical about that kind of
thing.

1113
01:01:08,080 --> 01:01:10,440
And then there, so the things
I've just been mentioning that

1114
01:01:10,440 --> 01:01:12,560
in fact, just in the last few
months I've come to something

1115
01:01:12,560 --> 01:01:13,600
new.
You wanted something new.

1116
01:01:13,600 --> 01:01:16,000
This is it.
The things I've just mentioned

1117
01:01:16,000 --> 01:01:17,560
are things that natural
selection can't do.

1118
01:01:18,200 --> 01:01:21,440
There are limitations of natural
selection, but there are other

1119
01:01:21,440 --> 01:01:26,920
things that natural selection
does do very, very well and

1120
01:01:26,920 --> 01:01:29,080
nonetheless leaves as vulnerable
to disease.

1121
01:01:29,490 --> 01:01:34,170
In particular, it maximizes gene
transmission at the expense of

1122
01:01:34,690 --> 01:01:37,810
health, welfare, longevity,
happiness and all the rest.

1123
01:01:38,290 --> 01:01:39,970
And there are huge examples of
that.

1124
01:01:39,970 --> 01:01:43,530
I mean, is sex a problem?
Yeah, it sure is for almost

1125
01:01:43,530 --> 01:01:46,850
everybody.
And no, Different cultures try

1126
01:01:46,850 --> 01:01:49,610
to deal with it different ways,
and no solution is perfectly

1127
01:01:49,610 --> 01:01:51,770
satisfactory.
Different individuals try to

1128
01:01:51,770 --> 01:01:54,570
deal with it different ways.
I mean, it's really a problem.

1129
01:01:55,040 --> 01:01:57,880
And then there's obligations to
kin versus obligations to

1130
01:01:57,880 --> 01:02:00,680
ourselves.
Very complicated, constant

1131
01:02:00,680 --> 01:02:04,600
conflicts arise, and there's no
easy solution to those kinds of

1132
01:02:04,600 --> 01:02:06,960
things.
And then the final category is

1133
01:02:06,960 --> 01:02:09,800
tradeoffs.
And my current project is really

1134
01:02:09,800 --> 01:02:12,920
trying to connect these
evolutionary explanations for

1135
01:02:12,920 --> 01:02:17,280
disease vulnerability to able to
the similar explanations for why

1136
01:02:17,280 --> 01:02:21,390
machines fail.
And it turns out that machines

1137
01:02:21,390 --> 01:02:24,910
fail in very for very similar
and different ways they an

1138
01:02:24,910 --> 01:02:28,150
engineer can start fresh so that
they're not constrained that

1139
01:02:28,150 --> 01:02:30,390
way, except they can't always
start fresh.

1140
01:02:30,870 --> 01:02:33,590
And my favorite example there is
a tragic one that's the Boeing

1141
01:02:33,590 --> 01:02:36,630
737 Max.
You know, the engineers there

1142
01:02:36,630 --> 01:02:40,980
were rushed because of an arms
race competing with Airbus,

1143
01:02:41,140 --> 01:02:43,860
which had a new, larger, more
fuel efficient plane.

1144
01:02:44,180 --> 01:02:46,580
So they couldn't start from
fresh to Boeing engineers.

1145
01:02:46,580 --> 01:02:50,180
They had to build it on their
existing Boeing 737 and expand

1146
01:02:50,180 --> 01:02:53,540
it to be among 737 Max.
That meant they expanded it.

1147
01:02:53,540 --> 01:02:55,940
That meant they moved the wing.
Once they moved the wing, it was

1148
01:02:55,940 --> 01:02:59,330
prone to stalling on takeoff.
Well, that would be bad if it's

1149
01:02:59,330 --> 01:03:02,330
stalled.
So they put in the sensors so

1150
01:03:02,330 --> 01:03:06,330
that if it was about to stall,
the sensor said it's about to

1151
01:03:06,330 --> 01:03:08,890
stall, I'm going to take over
the autopilot and put the nose

1152
01:03:08,890 --> 01:03:12,170
down and that prevented stalls
and crashes.

1153
01:03:12,770 --> 01:03:14,730
But what happened when the
sensor failed?

1154
01:03:15,250 --> 01:03:17,690
When the sensor failed, it
pointed the nose down and took

1155
01:03:17,690 --> 01:03:19,090
the plane straight down into the
ground.

1156
01:03:19,090 --> 01:03:22,570
Now the pilots were supposed to
know that they should take the

1157
01:03:22,570 --> 01:03:25,690
plane off of autopilot, but they
weren't all trained to do that.

1158
01:03:26,410 --> 01:03:30,460
So this talk about a vulnerable
system, it was There was no

1159
01:03:30,460 --> 01:03:33,420
redundancy in that system.
Natural selection would never

1160
01:03:33,420 --> 01:03:37,380
make a system like that with one
part and no backup backup

1161
01:03:37,380 --> 01:03:39,180
mechanism.
But on the other hand, it's

1162
01:03:39,180 --> 01:03:42,620
fascinating to see that this
tragedy resulted in part from

1163
01:03:42,620 --> 01:03:44,700
path dependence.
That means the Boeing engineers

1164
01:03:44,700 --> 01:03:47,100
could not start fresh.
It led to all kinds of

1165
01:03:47,100 --> 01:03:49,460
tradeoffs.
The tradeoffs led to what seemed

1166
01:03:49,460 --> 01:03:53,340
to be a simple solution, and it
wasn't a very good, adequate

1167
01:03:53,340 --> 01:03:56,140
solution.
So there's all kinds of I, I

1168
01:03:56,140 --> 01:03:59,780
great hopes that our our
knowledge now about evolutionary

1169
01:03:59,780 --> 01:04:03,980
explanations for why bodies fail
can prove useful in engineering

1170
01:04:04,140 --> 01:04:07,220
because their whole areas of
engineering called failure

1171
01:04:07,220 --> 01:04:11,500
analysis of several kinds and
they're not as systematic as

1172
01:04:11,500 --> 01:04:13,540
they could be.
And so that's it's a very

1173
01:04:13,540 --> 01:04:17,780
exciting area of current work.
Well, I think with that being

1174
01:04:17,780 --> 01:04:21,220
said, Randy, why did mental
illness evolve?

1175
01:04:23,290 --> 01:04:26,210
Mental illness did not evolve.
And you'll see.

1176
01:04:26,210 --> 01:04:28,930
And I just published the largest
paper I've ever published in The

1177
01:04:28,930 --> 01:04:31,570
World Psychiatry.
It's something of my manifesto,

1178
01:04:31,930 --> 01:04:35,570
Open Access for Evolutionary
Foundations for Understanding

1179
01:04:35,570 --> 01:04:37,690
Mental Disorders.
And the first point I'm making

1180
01:04:37,690 --> 01:04:41,330
there is that trying to ask
about the evolutionary function

1181
01:04:41,330 --> 01:04:43,130
of a mental disorder is just a
mistake.

1182
01:04:43,810 --> 01:04:45,570
They're not adaptations.
They're not useful.

1183
01:04:46,330 --> 01:04:48,090
We shouldn't be asking why
they're useful.

1184
01:04:49,170 --> 01:04:53,170
It is useful to ask why
capacities for emotions exist.

1185
01:04:53,690 --> 01:04:57,170
And that's the theme of my book
Good Reasons for Bad Feelings.

1186
01:04:57,410 --> 01:05:01,770
There are good reasons why these
negative feelings exist because

1187
01:05:01,770 --> 01:05:04,090
they're useful.
At least for our genes, they're

1188
01:05:04,090 --> 01:05:07,830
useful.
And we need to understand those.

1189
01:05:07,990 --> 01:05:11,630
It's not because being angry is
benefiting our genes right now.

1190
01:05:11,630 --> 01:05:14,990
Usually it's just wrecking our
relationships, you know, and our

1191
01:05:14,990 --> 01:05:18,030
sexy impulses and our anxious
impulses.

1192
01:05:18,270 --> 01:05:20,750
Usually they're excessive
because of the smoke detector

1193
01:05:20,750 --> 01:05:22,270
principle, which we can talk
about.

1194
01:05:22,710 --> 01:05:25,390
But again, the Princeton larger
principle here is that these

1195
01:05:25,390 --> 01:05:29,270
special states of operation were
shaped to deal with different

1196
01:05:29,270 --> 01:05:34,230
kinds of situations, which is a
very different position than

1197
01:05:34,230 --> 01:05:37,430
some evolutionary psychology
types who say that they want to

1198
01:05:37,430 --> 01:05:39,710
find a specific function for
each emotion.

1199
01:05:40,430 --> 01:05:41,990
I'm arguing they have many
functions.

1200
01:05:42,870 --> 01:05:45,950
Different emotions are not basic
emotions that are separate from

1201
01:05:45,950 --> 01:05:47,510
each other.
They're not in dimensions.

1202
01:05:47,790 --> 01:05:51,790
They're different, overlapping
suites of responses that adjust

1203
01:05:51,790 --> 01:05:55,640
the phenotype to cope with that
situation and not all that well

1204
01:05:55,680 --> 01:05:58,320
a lot of times.
And the situations overlap and

1205
01:05:58,320 --> 01:06:01,560
the responses overlap.
So this whole idea that we can

1206
01:06:01,760 --> 01:06:05,320
label and measure certain
emotions as specific things,

1207
01:06:05,560 --> 01:06:09,120
once again, organic complexity
is a reality we'd rather not

1208
01:06:09,120 --> 01:06:10,840
see.
We'd rather.

1209
01:06:11,120 --> 01:06:12,840
If you want to do emotions
research, hey, you've got to

1210
01:06:12,840 --> 01:06:14,840
measure emotions, you've got to
count them, you've got.

1211
01:06:14,960 --> 01:06:18,240
But what if the reality is much
more messy?

1212
01:06:19,760 --> 01:06:22,040
And I think something a lot of
the time when people think about

1213
01:06:22,040 --> 01:06:24,360
emotions, they forget about the
fact that this effective

1214
01:06:24,360 --> 01:06:28,120
component of of human behavior
is very much driven by

1215
01:06:28,120 --> 01:06:32,680
homeostatic needs and act more
than anything else.

1216
01:06:32,680 --> 01:06:36,360
So a lot of these emotional
states are actually behavioral

1217
01:06:36,360 --> 01:06:38,160
states in order to get something
done.

1218
01:06:38,960 --> 01:06:40,480
That's right.
And we we all.

1219
01:06:42,840 --> 01:06:44,960
And they're not that well
defined.

1220
01:06:45,480 --> 01:06:48,870
I mean, I mean, what do you have
a good discussion with your

1221
01:06:48,870 --> 01:06:51,310
spouse about whether your
marriage is going, whether or

1222
01:06:51,310 --> 01:06:53,710
not just before dinner, when
you're hungry?

1223
01:06:54,190 --> 01:06:57,030
That's not smart.
It's because people then, when

1224
01:06:57,030 --> 01:06:59,710
they're hungry, you know, are
kind of irritable and they're

1225
01:06:59,710 --> 01:07:02,990
not sensible.
Much better to do that after

1226
01:07:02,990 --> 01:07:04,670
you've had dinner and before you
take a drink.

1227
01:07:05,470 --> 01:07:07,510
Because if you take a drink,
that too is going to put you in

1228
01:07:07,510 --> 01:07:10,590
a special state that makes you
really vulnerable to screwing up

1229
01:07:10,590 --> 01:07:14,390
your relationship.
I mean, and that's a big part of

1230
01:07:14,390 --> 01:07:17,950
why the illegal system often
gets a lot critiques, because

1231
01:07:18,470 --> 01:07:22,150
you notice the huge trend in
people go getting death

1232
01:07:22,150 --> 01:07:26,030
penalties or getting a very
hefty sentence just before lunch

1233
01:07:26,030 --> 01:07:29,550
break.
It's a very yeah that that

1234
01:07:29,550 --> 01:07:32,590
research has been criticized
recently as as possibly not

1235
01:07:32,590 --> 01:07:36,270
being replicable, but I find it
plausible and be fun to see if

1236
01:07:36,270 --> 01:07:39,030
it gets replicated or not.
It sounds very plausible.

1237
01:07:39,030 --> 01:07:41,750
I mean, we are very much driven
by.

1238
01:07:42,180 --> 01:07:43,660
Our needs.
And once in the moment, if

1239
01:07:43,780 --> 01:07:47,780
someone's hungry, you see the
irritation in their face and

1240
01:07:47,780 --> 01:07:50,660
somebody gets mad at somebody at
work and comes home and kicks

1241
01:07:50,660 --> 01:07:54,060
the dog, poor dog.
But you know these, these, it's

1242
01:07:54,060 --> 01:07:57,020
not as if these, these are very
sophisticated mechanisms, but

1243
01:07:57,380 --> 01:08:00,300
they're kind of messy.
They go off and they take take

1244
01:08:00,300 --> 01:08:03,740
over us for a while or or we get
anxious about one's particular

1245
01:08:03,740 --> 01:08:05,780
thing.
And that anxiety spreads to

1246
01:08:05,780 --> 01:08:09,260
other kind of things.
It's not not nice and neat and

1247
01:08:09,260 --> 01:08:11,840
clean.
You mentioned the smoke detector

1248
01:08:11,840 --> 01:08:13,240
principle.
I think it's important for the

1249
01:08:13,240 --> 01:08:14,600
listeners and viewers to
understand that.

1250
01:08:14,600 --> 01:08:17,040
I mean, when you think about a
general smoke detector in a

1251
01:08:17,040 --> 01:08:20,600
building and you and we know
that you have to program this to

1252
01:08:20,800 --> 01:08:25,600
detect anything from a from,
from a little small candle that

1253
01:08:25,600 --> 01:08:28,279
might be burning a little bit
more smoke than anything to an

1254
01:08:28,279 --> 01:08:31,840
actual fire.
But but the odds of in a

1255
01:08:31,840 --> 01:08:34,960
situation that's not deadly for
you is much more important and

1256
01:08:34,960 --> 01:08:36,640
we need that to happen in order
for us.

1257
01:08:37,149 --> 01:08:41,029
To avoid what could be a
devastating fire, let's explore

1258
01:08:41,029 --> 01:08:42,910
this a bit.
That's it.

1259
01:08:43,790 --> 01:08:46,390
It's a control system.
That's where selection doesn't

1260
01:08:46,390 --> 01:08:49,670
just shape emotions, it shapes
control systems to express those

1261
01:08:49,670 --> 01:08:52,750
emotions in the situations when
they're likely to be useful.

1262
01:08:53,630 --> 01:08:57,149
So how does it do that?
Well, it monitors all kinds of

1263
01:08:57,149 --> 01:08:59,590
things that might or might not
be causally related.

1264
01:09:00,460 --> 01:09:03,700
A dark place with loud noises.
And that's kind of a dangerous

1265
01:09:03,700 --> 01:09:06,460
place, even if you know
perfectly well that it's not

1266
01:09:06,620 --> 01:09:10,500
very dangerous.
So natural selections is

1267
01:09:10,979 --> 01:09:14,100
creating into that control
mechanism all kinds of different

1268
01:09:14,100 --> 01:09:16,260
cues.
And you're thinking to go back

1269
01:09:16,260 --> 01:09:19,740
to consciousness and the like.
You think about, well, it could

1270
01:09:19,740 --> 01:09:24,000
be it could be a murderer at my
door knocking on the door at

1271
01:09:24,000 --> 01:09:26,520
2:00 AM, or it could be a
neighbor whose car is stuck in

1272
01:09:26,520 --> 01:09:28,880
the snow.
Or, you know, our minds

1273
01:09:28,880 --> 01:09:31,960
immediately go to creating all
these different possibilities, a

1274
01:09:31,960 --> 01:09:36,040
good project for consciousness
to create possible alternatives

1275
01:09:36,200 --> 01:09:39,439
so that we can prepare for
different possible outcomes.

1276
01:09:39,680 --> 01:09:42,000
But many people tell me that my
greenest contribution to

1277
01:09:42,040 --> 01:09:45,200
anything is is a smoke detector
principle that essentially takes

1278
01:09:45,319 --> 01:09:49,240
signal detection theory and
points out that all the systems

1279
01:09:49,240 --> 01:09:52,319
shaped by natural selection,
control, behavior and everything

1280
01:09:52,319 --> 01:09:56,600
else are shaped to maximize
average benefits over the long

1281
01:09:56,600 --> 01:10:01,200
run.
So, and the example I often use

1282
01:10:01,200 --> 01:10:04,960
is, you know you hear a sound
behind a rock as you go to get

1283
01:10:04,960 --> 01:10:07,880
water for your family in Africa
with only a wooden spear.

1284
01:10:08,160 --> 01:10:10,760
And you have you hear the noise.
Should you run?

1285
01:10:11,440 --> 01:10:13,880
Could be a lion.
If it's a lion, you'll probably

1286
01:10:13,880 --> 01:10:18,480
get killed if you don't run.
It could be just a mouse or a

1287
01:10:18,480 --> 01:10:20,640
monkey or something, in which
case you really should get water

1288
01:10:20,640 --> 01:10:24,080
for your family.
But the risk of 1 is so much

1289
01:10:24,080 --> 01:10:27,840
greater than the other.
I mean, call it 100 calories to,

1290
01:10:28,080 --> 01:10:31,240
you know, run away.
Call it 100,000 calories your

1291
01:10:31,240 --> 01:10:34,600
life.
If the lion gets you, that's

1292
01:10:34,600 --> 01:10:38,560
1000 to one.
That means that you should flee

1293
01:10:38,560 --> 01:10:42,000
anytime that the noise is loud
enough to indicate a greater

1294
01:10:42,000 --> 01:10:46,610
than one in 1000 chance.
And that means that you can have

1295
01:10:46,610 --> 01:10:49,530
lots of false alarms.
This completely changed how I

1296
01:10:49,530 --> 01:10:51,970
treated my patients with anxiety
disorders.

1297
01:10:52,250 --> 01:10:55,410
I always previously in my heart,
I thought, you know what?

1298
01:10:55,410 --> 01:10:57,010
You've been to the grocery store
5 times.

1299
01:10:57,090 --> 01:10:59,570
Nothing bad has happened.
Why are you so agoraphobic?

1300
01:10:59,570 --> 01:11:01,210
Why are you still having anxiety
attacks?

1301
01:11:01,610 --> 01:11:04,610
And then I realized that that's
how the system is designed.

1302
01:11:05,050 --> 01:11:07,850
It's designed to have many false
alarms, just like a smoke alarm,

1303
01:11:08,090 --> 01:11:11,290
because that is optimum.
And that's the case for every

1304
01:11:11,290 --> 01:11:14,570
other system too.
Something as simple as vomiting.

1305
01:11:14,810 --> 01:11:18,210
How many molecules of a toxin do
you need in your stomach to set

1306
01:11:18,210 --> 01:11:20,370
it off?
Well, the cost of that response

1307
01:11:20,370 --> 01:11:23,410
is not that great.
The cost of not removing toxins

1308
01:11:23,410 --> 01:11:24,690
from your stomach could be
fatal.

1309
01:11:25,370 --> 01:11:29,090
And so that system, so this, the
another related thing that

1310
01:11:29,090 --> 01:11:31,770
you're especially interested on
take is so why does it have to

1311
01:11:31,770 --> 01:11:35,210
feel so bad?
Why can't we just say, oh, this

1312
01:11:35,210 --> 01:11:36,890
is a dangerous situation?
I think I'll leave.

1313
01:11:37,860 --> 01:11:41,980
But all of these situations are
akin to physical pain, which

1314
01:11:41,980 --> 01:11:45,180
motivates us to get the heck out
of there and not do it again.

1315
01:11:45,940 --> 01:11:48,700
And this, this is what makes
negative emotions so painful and

1316
01:11:48,700 --> 01:11:51,740
difficult.
We can tell ourselves, oh, it's

1317
01:11:51,740 --> 01:11:53,580
not really dangerous.
That doesn't do a bit of good.

1318
01:11:54,180 --> 01:11:56,700
I kept thinking when I, you
know, I had the privilege of

1319
01:11:56,700 --> 01:11:59,740
helping to start the Anxiety
Disorders Clinic at University

1320
01:11:59,740 --> 01:12:01,580
of Michigan.
I worked there for 30 years with

1321
01:12:01,580 --> 01:12:05,220
George Curtis and with Jim
Abelson, who have taken it over.

1322
01:12:05,500 --> 01:12:08,940
And at first I thought I could
actually convince people, no,

1323
01:12:08,940 --> 01:12:11,740
the spiders aren't dangerous.
Let's talk about it made no

1324
01:12:11,740 --> 01:12:14,860
difference whatsoever,
Absolutely, you know, useless

1325
01:12:15,140 --> 01:12:16,460
patients said.
I know it's not dangerous.

1326
01:12:16,460 --> 01:12:19,420
Why are you saying that?
There's a whole different level

1327
01:12:19,420 --> 01:12:24,100
of the mind that consciousness
can't influence very well.

1328
01:12:25,140 --> 01:12:28,340
You can, however, have influence
on those things by using a

1329
01:12:28,340 --> 01:12:32,460
person's consciousness to
convince them to come closer to

1330
01:12:32,460 --> 01:12:34,820
the spider and let it crawl in
them, even though they're having

1331
01:12:34,820 --> 01:12:38,160
a lot of anxiety.
And that experience rewires the

1332
01:12:38,200 --> 01:12:43,320
mind so that the anxiety fades.
And when patients understand

1333
01:12:43,320 --> 01:12:46,280
that they cooperate a lot better
with the behavior of therapy and

1334
01:12:46,280 --> 01:12:49,000
just telling them something
general about conditioning or

1335
01:12:49,000 --> 01:12:52,440
something.
Yeah, I think another great

1336
01:12:52,440 --> 01:12:55,200
thing.
You talk about the way you break

1337
01:12:55,200 --> 01:13:01,080
down these experiences into sort
of a 4 by 4 chart of having two

1338
01:13:01,080 --> 01:13:01,760
months.
Yes, right.

1339
01:13:02,680 --> 01:13:04,680
Let's let's run through that a
bit because I think it makes it,

1340
01:13:04,680 --> 01:13:06,680
it breaks it down nicely and
then we're able to move forward

1341
01:13:06,680 --> 01:13:07,960
to the conversation a bit
easier.

1342
01:13:08,480 --> 01:13:10,640
Yeah.
I mean, one of the amazing

1343
01:13:10,640 --> 01:13:13,000
things I'd never thought about
this is some work with Isaac

1344
01:13:13,000 --> 01:13:14,560
Marks, who's a great inspiration
to.

1345
01:13:14,560 --> 01:13:17,120
I mean, you wrote an article
many years ago called Fear and

1346
01:13:17,120 --> 01:13:19,040
Fitness.
He was the greatest world's

1347
01:13:19,040 --> 01:13:21,000
greatest anxiety researcher at
the time.

1348
01:13:22,000 --> 01:13:24,480
And we suddenly realized his
work together, that there was a

1349
01:13:24,480 --> 01:13:29,500
whole missing anxiety disorder,
not enough anxiety, and we named

1350
01:13:29,500 --> 01:13:32,940
that hypophobia and that nobody
comes for treatment saying, I

1351
01:13:32,940 --> 01:13:35,340
don't have enough anxiety.
Doctor Nessie, could you please

1352
01:13:35,340 --> 01:13:37,700
treat me?
On the other hand, is a

1353
01:13:37,700 --> 01:13:40,860
potentially fatal disorder.
And there are people.

1354
01:13:40,860 --> 01:13:42,180
I mean, where do you find those
people?

1355
01:13:42,180 --> 01:13:46,140
You find them in unemployment
lines and jail and the morgue

1356
01:13:46,780 --> 01:13:48,620
from just not having enough
anxiety.

1357
01:13:49,020 --> 01:13:52,740
And the majority of the vast
majority of men, when you take

1358
01:13:52,740 --> 01:13:57,120
statistics on their death
threats, Yes then.

1359
01:13:57,360 --> 01:13:59,720
And that brings up another
insight that came from this that

1360
01:13:59,720 --> 01:14:04,000
I think is welcome in these
days, Lots of books and articles

1361
01:14:04,000 --> 01:14:06,040
and try to figure out what's
wrong with women.

1362
01:14:06,280 --> 01:14:08,200
Why do they have more anxiety in
men?

1363
01:14:08,400 --> 01:14:09,880
Is it the culture?
Is it the USA?

1364
01:14:09,920 --> 01:14:11,920
No.
Every place you look, women have

1365
01:14:11,920 --> 01:14:13,960
more anxiety in men, even with
other species.

1366
01:14:15,360 --> 01:14:18,400
Why?
Well, there must be something

1367
01:14:18,400 --> 01:14:20,600
about women's brains or
serotonin receptors.

1368
01:14:20,800 --> 01:14:23,600
There is something different
about women's brains that makes

1369
01:14:23,600 --> 01:14:27,160
them I didn't know, but that's
the proximate explanation.

1370
01:14:27,320 --> 01:14:29,360
What's the evolutionary
explanation?

1371
01:14:29,720 --> 01:14:33,600
The evolutionary explanation is
that women actually have about

1372
01:14:33,600 --> 01:14:36,520
the right amount of anxiety.
On average, men have too little

1373
01:14:36,520 --> 01:14:40,040
for their own good and about the
right amount for maximizing a

1374
01:14:40,040 --> 01:14:43,440
transmission of their genes.
This could all be fixed in just

1375
01:14:43,440 --> 01:14:46,920
a few dozen generations.
If only women would really

1376
01:14:46,920 --> 01:14:49,400
prefer men who were very
cautious.

1377
01:14:51,060 --> 01:14:53,500
And women do not prefer men who
are very cautious.

1378
01:14:53,780 --> 01:14:57,780
They prefer men who will go risk
their lives to protect them.

1379
01:14:59,060 --> 01:15:03,220
And men who are very cautious
don't win battles with other men

1380
01:15:03,220 --> 01:15:05,980
and competing for resources.
And for women.

1381
01:15:06,380 --> 01:15:08,140
It's really an unpleasant
insight, isn't it?

1382
01:15:08,140 --> 01:15:11,180
I mean, don't you wish everybody
could just be sensible and get

1383
01:15:11,180 --> 01:15:14,180
along?
I wish we could, but that's not

1384
01:15:14,180 --> 01:15:16,260
the way it is.
Yeah, I mean, we often see this

1385
01:15:16,260 --> 01:15:18,730
taken to the.
To the extreme, I mean overall

1386
01:15:18,730 --> 01:15:20,730
not really often because a lot
of people also have this

1387
01:15:20,730 --> 01:15:24,450
misinterpretation of the fact
that when you see psychotic or

1388
01:15:24,450 --> 01:15:27,370
schizophrenic patients or manic
patients that this is a very

1389
01:15:27,370 --> 01:15:30,170
common thing.
I mean to the average person,

1390
01:15:30,250 --> 01:15:32,690
they believe that these are the
most common illnesses and it's

1391
01:15:32,690 --> 01:15:34,490
not.
I mean, we really see patients

1392
01:15:34,970 --> 01:15:36,490
coming and we're acutely
psychotic.

1393
01:15:36,490 --> 01:15:38,250
It's not one of those things you
see every day.

1394
01:15:38,770 --> 01:15:41,570
But sorry, continue there,
Randy.

1395
01:15:42,140 --> 01:15:44,820
I was just going to say, I mean,
anxiety disorders and depression

1396
01:15:44,820 --> 01:15:47,860
disorders aren't just the most
common and that's more than 2/3

1397
01:15:47,860 --> 01:15:51,300
of all psychiatric patients.
And but it's also these are

1398
01:15:51,380 --> 01:15:54,460
leading disorders for all
medical disorders, huge

1399
01:15:54,460 --> 01:15:59,100
suffering and problems from
these emotions that seem to be

1400
01:15:59,100 --> 01:16:01,220
out of control.
And I should emphasize also I've

1401
01:16:01,220 --> 01:16:03,820
just said the smoke detector
principle and how that explains

1402
01:16:04,060 --> 01:16:07,420
how a lot of these responses are
in fact normal.

1403
01:16:07,860 --> 01:16:10,460
It's coming from normal
mechanisms, but useless.

1404
01:16:11,470 --> 01:16:14,310
But we should also emphasize
that a lot of people do have

1405
01:16:14,310 --> 01:16:18,350
brains that aren't working
right, that give them excesses

1406
01:16:18,350 --> 01:16:21,830
of depression or anxiety.
And their their mother had it,

1407
01:16:21,830 --> 01:16:24,070
their grandmother had it, you
know that their brains are

1408
01:16:24,070 --> 01:16:25,910
different.
So I think the, again,

1409
01:16:25,910 --> 01:16:28,350
generalizations about it's
caused by culture, it's caused

1410
01:16:28,350 --> 01:16:31,030
by experience, it's caused by
genes, it's different for

1411
01:16:31,030 --> 01:16:33,870
different people.
And we shouldn't neglect the

1412
01:16:33,870 --> 01:16:37,350
possibility that many people do
really have brain disorders.

1413
01:16:38,110 --> 01:16:40,350
That doesn't necessarily mean
the best way to treat them as

1414
01:16:40,350 --> 01:16:42,760
drugs.
Often other kinds of treatments

1415
01:16:42,760 --> 01:16:46,160
are very effective, but we
should be thinking about all the

1416
01:16:46,160 --> 01:16:49,320
possible causes.
At this point, I think maybe

1417
01:16:49,800 --> 01:16:53,920
break that down into the four by
four, why don't you go ahead and

1418
01:16:53,920 --> 01:16:55,080
do that.
I think you have that right in

1419
01:16:55,080 --> 01:16:58,240
mind.
Yeah, cuz I I find it great this

1420
01:16:58,240 --> 01:17:00,560
this way of thinking about it.
Well you you brought up that the

1421
01:17:00,560 --> 01:17:02,640
first one.
I mean people who have too

1422
01:17:02,640 --> 01:17:06,960
little anxiety and when to a
point where it becomes

1423
01:17:07,080 --> 01:17:09,960
detrimental to their existence.
And then on the flip side.

1424
01:17:10,680 --> 01:17:13,160
You're gonna have somebody who
has too much anxiety to a point

1425
01:17:13,160 --> 01:17:17,120
where the existence just remind
me the other two were.

1426
01:17:18,320 --> 01:17:21,440
But I mean it was really about
positive and negative emotions.

1427
01:17:21,680 --> 01:17:23,800
There also can be too much
positive emotion.

1428
01:17:24,040 --> 01:17:29,160
Yes, which is bad and neglected
or too little negative emotion.

1429
01:17:29,720 --> 01:17:31,800
So those are the two that are
always neglected.

1430
01:17:32,120 --> 01:17:34,560
Until the rise of positive
psychology, people weren't

1431
01:17:34,560 --> 01:17:37,320
really aware of how beneficial
positive emotions could be.

1432
01:17:37,800 --> 01:17:39,240
They just thought that was kind
of normal.

1433
01:17:40,030 --> 01:17:42,150
But I think a lot of good
research has demonstrated that

1434
01:17:42,150 --> 01:17:45,950
positive emotions also can be
very useful if they are

1435
01:17:45,950 --> 01:17:48,350
expressed in the right
circumstance.

1436
01:17:48,990 --> 01:17:52,750
My gripe with some of positive
psychology is that it suggests

1437
01:17:52,950 --> 01:17:57,150
that it's good to be positive
almost every circumstance, and

1438
01:17:57,150 --> 01:18:01,010
it's not.
I do think, however, to defend

1439
01:18:01,050 --> 01:18:05,170
positive psychology overall.
In general, we humans have the

1440
01:18:05,170 --> 01:18:08,450
very unfortunate tendency of
having way more negative

1441
01:18:08,490 --> 01:18:13,450
feelings that are useful for us,
and for that reason anything we

1442
01:18:13,450 --> 01:18:17,970
can do to in general boost
positive affect is beneficial.

1443
01:18:18,570 --> 01:18:20,130
Yeah, I like that.
OK, I like that point.

1444
01:18:20,130 --> 01:18:23,850
Because lately you can tell that
the positive psychology movement

1445
01:18:23,850 --> 01:18:26,050
has become very much political.
At this point, it's.

1446
01:18:27,030 --> 01:18:28,150
Great.
Difficult to talk about this

1447
01:18:28,150 --> 01:18:30,910
topic without people getting a
bit too political about it,

1448
01:18:30,910 --> 01:18:33,670
because they don't seem to
understand that sometimes it's

1449
01:18:33,670 --> 01:18:37,150
important to have these
realistic negative feelings.

1450
01:18:37,150 --> 01:18:40,950
And in fact, we know that as a
human species, we're often

1451
01:18:40,950 --> 01:18:42,510
plagued by these negative
thoughts.

1452
01:18:42,870 --> 01:18:47,350
A lot of them, and a lot of them
are for our benefit, keeping us

1453
01:18:47,350 --> 01:18:50,190
out of dangerous situations.
A lot of them, though, are for

1454
01:18:50,190 --> 01:18:54,550
our genes, benefit our entity
and resentment and wishes for

1455
01:18:54,550 --> 01:18:57,040
revenge and the like.
I mean, a lot of those are

1456
01:18:57,040 --> 01:18:59,600
trying to get us to do things
that might advance our status

1457
01:18:59,600 --> 01:19:02,640
and our genes that are
reproductive success at a real

1458
01:19:02,640 --> 01:19:05,400
cost to ourselves.
On the other hand, if you don't

1459
01:19:05,400 --> 01:19:08,960
do the kind of competition that
those emotions are motivating,

1460
01:19:09,360 --> 01:19:11,160
you don't do very well with life
either.

1461
01:19:11,760 --> 01:19:15,920
So I I mean, so many people so
wish that we could all just get

1462
01:19:15,920 --> 01:19:19,280
along, and I do too.
But I think in order to do that,

1463
01:19:19,280 --> 01:19:23,060
we should try to be realistic
about the evolutionary forces

1464
01:19:23,060 --> 01:19:26,740
that shaped our tendencies to
compete for maximizing

1465
01:19:26,740 --> 01:19:31,460
reproductive success.
When you spoke about those

1466
01:19:31,460 --> 01:19:34,500
hypophobic patients, you often
see this also taken to an

1467
01:19:34,500 --> 01:19:37,940
extreme.
When you think of a manic

1468
01:19:37,940 --> 01:19:43,180
patient, the dangers of having
this hypophobia, the fact that

1469
01:19:43,180 --> 01:19:47,540
you go all out and then cause
harm to that extent.

1470
01:19:48,790 --> 01:19:52,030
So patients in a manic state,
it's not so much that they lack

1471
01:19:52,030 --> 01:19:55,430
anxiety, is that their
motivation to do grand things

1472
01:19:55,430 --> 01:19:59,070
very quickly just escalates and
escalates.

1473
01:19:59,270 --> 01:20:02,190
For most of us, I think, you
know after we have a great

1474
01:20:02,190 --> 01:20:07,030
success, we come down pretty
quickly in our our meeting last

1475
01:20:07,070 --> 01:20:09,630
last week at the International
Society for Evolution of

1476
01:20:09,630 --> 01:20:12,590
Medicine and Public Health.
It was a great success and I

1477
01:20:12,590 --> 01:20:15,670
suppose it was a great success
and a couple of days later I was

1478
01:20:15,670 --> 01:20:19,470
feeling kind of down like, gosh.
Was that right?

1479
01:20:19,470 --> 01:20:23,030
And no, Do you do you ever have
that experience of a great

1480
01:20:23,030 --> 01:20:24,990
success followed by feeling
down?

1481
01:20:25,510 --> 01:20:29,910
Quite often some people call
this an important opponent

1482
01:20:29,910 --> 01:20:33,310
process thing, but I think it's
exactly what's needed.

1483
01:20:33,710 --> 01:20:36,470
So you keep your from spiraling
out of control because if you

1484
01:20:36,470 --> 01:20:39,270
have a great success, you think,
well, I am hot shit, I'm going

1485
01:20:39,270 --> 01:20:40,510
to do more.
I'm going to do this, I'm going

1486
01:20:40,510 --> 01:20:42,470
to Bubba.
I can stay up all night, right?

1487
01:20:42,950 --> 01:20:46,990
You know then you get it just
spirals up and and eventually

1488
01:20:46,990 --> 01:20:50,590
the person in mania crashes into
a depressive episode after some

1489
01:20:50,590 --> 01:20:53,790
safety mechanism tips off
because they're just completely

1490
01:20:53,790 --> 01:20:57,430
exhausted and and the like.
So.

1491
01:20:57,550 --> 01:21:00,470
So I think most of us have
mechanisms to protect us from

1492
01:21:00,470 --> 01:21:03,390
going into an out of control
positive feedback cycle of

1493
01:21:03,390 --> 01:21:07,150
escalating ambition and energy
and all the rest.

1494
01:21:07,470 --> 01:21:10,330
And if you lack that, you're in
trouble.

1495
01:21:10,770 --> 01:21:13,890
This is what I mean by trying to
understand these disorders, not

1496
01:21:13,890 --> 01:21:16,410
just in terms of brain
mechanisms, and not just in

1497
01:21:16,410 --> 01:21:19,010
terms of psychological
mechanisms, in terms of why

1498
01:21:19,010 --> 01:21:22,570
people are different, but in
terms of how the mechanism is

1499
01:21:22,570 --> 01:21:26,010
usually regulated and why it
might be vulnerable to

1500
01:21:26,010 --> 01:21:29,130
dysregulation.
So in this particular instance

1501
01:21:29,130 --> 01:21:33,050
I'm proposing that in bipolar
disease we should be looking for

1502
01:21:33,330 --> 01:21:38,130
a lack of the usual come down
after success that affects most

1503
01:21:38,130 --> 01:21:41,230
of us.
And I don't see maybe that

1504
01:21:41,230 --> 01:21:43,550
research has been done and
applied to bipolar disordered

1505
01:21:43,550 --> 01:21:46,070
field of evolution or
psychiatrist so broad it's

1506
01:21:46,070 --> 01:21:47,390
really hard to keep up with all
of it.

1507
01:21:48,230 --> 01:21:50,790
There's so many avenues that are
ripe for being pursued.

1508
01:21:51,190 --> 01:21:52,990
Yeah, they are.
And what are your thoughts on

1509
01:21:52,990 --> 01:21:56,510
the R doc criteria as opposed to
the DSM?

1510
01:21:57,630 --> 01:22:00,670
You know, it was proposed as an
alternative.

1511
01:22:00,710 --> 01:22:02,230
It's but not really an
alternative.

1512
01:22:02,590 --> 01:22:05,270
And it has a great advantage of
thinking about functional

1513
01:22:05,270 --> 01:22:07,310
significance of different
things.

1514
01:22:07,630 --> 01:22:10,550
But it's not based on function
for what you know.

1515
01:22:10,550 --> 01:22:13,150
It's based on these
abstractions, functions, not

1516
01:22:13,150 --> 01:22:16,230
about how do these different
capacities increase gene

1517
01:22:16,230 --> 01:22:19,030
transmission and how could we
look for the same kinds of

1518
01:22:19,030 --> 01:22:22,790
things and other other species,
so on the red track.

1519
01:22:22,790 --> 01:22:25,030
But it hasn't accomplished
nearly what it hoped to

1520
01:22:25,030 --> 01:22:27,230
accomplish.
And it isn't the diagnostic

1521
01:22:27,230 --> 01:22:32,070
system either.
I mean, I I was so satisfied to

1522
01:22:32,070 --> 01:22:35,790
work with Dan Stein and conclude
that we were wrong that

1523
01:22:36,150 --> 01:22:38,990
evolution does not offer a great
solution to the problem of

1524
01:22:38,990 --> 01:22:42,910
psychiatric diagnosis, except to
recognize that these kind of

1525
01:22:42,910 --> 01:22:46,750
messy clinical categories we
have are pretty useful, and they

1526
01:22:46,750 --> 01:22:49,710
describe what we see, even if
they don't map to specific

1527
01:22:49,710 --> 01:22:52,150
causes.
You know, you mentioned Dan

1528
01:22:52,150 --> 01:22:56,190
Stein and there was this time we
were exchanging emails and I was

1529
01:22:56,190 --> 01:22:57,670
busy doing the Masters in
philosophy.

1530
01:22:57,670 --> 01:23:01,110
At the time I had emailed him
because I wanted to do a Masters

1531
01:23:01,110 --> 01:23:02,430
in neuroscience with him so
badly.

1532
01:23:03,160 --> 01:23:04,840
He's a legend here in Captain as
well.

1533
01:23:04,840 --> 01:23:08,200
I mean the world.
But and then I was disappointed

1534
01:23:08,200 --> 01:23:10,000
cuz he told me.
Unfortunately I wasn't allowed

1535
01:23:10,000 --> 01:23:14,000
to because it's a full time
position and at the time and I

1536
01:23:14,000 --> 01:23:17,880
often think about how much I
regret just not leaving the

1537
01:23:17,880 --> 01:23:19,520
first one and just going into
that one.

1538
01:23:20,360 --> 01:23:21,600
What is it like working with
Dan?

1539
01:23:22,380 --> 01:23:25,340
So there's still time.
He's written what I consider to

1540
01:23:25,340 --> 01:23:29,180
be the most brilliant book ever
on philosophy and psychiatry is

1541
01:23:29,300 --> 01:23:33,140
it's so deep and it just makes
it just makes me feel like I'm

1542
01:23:33,140 --> 01:23:36,660
an amateur at everything because
you know, I mean he he knows not

1543
01:23:36,660 --> 01:23:39,220
only all kinds of things about
psychiatry and diagnosis and

1544
01:23:39,220 --> 01:23:42,220
neuroscience but he knows the
depths of different kinds of

1545
01:23:42,220 --> 01:23:45,060
philosophical approaches and
weaves them all together is just

1546
01:23:45,550 --> 01:23:48,510
inspiring and intimidating and
the like.

1547
01:23:49,150 --> 01:23:52,030
But he's such a friendly guy and
open to all kinds of things.

1548
01:23:52,070 --> 01:23:54,670
And we were supposed to teach a
course at the American

1549
01:23:54,670 --> 01:23:57,790
Psychiatric Association this
year and there was an illness in

1550
01:23:57,790 --> 01:24:01,110
his family so he couldn't make
it and he definitely should have

1551
01:24:01,110 --> 01:24:04,510
stayed home for a month to he
was minor but he who's needed

1552
01:24:04,950 --> 01:24:08,110
back there in Cape Town.
But he's just what what an

1553
01:24:08,150 --> 01:24:10,650
amazing, wonderful person there
are.

1554
01:24:10,650 --> 01:24:14,130
Also, if your readers aren't
aware, or your listeners aren't

1555
01:24:14,130 --> 01:24:16,650
aware of.
The movement of evolutionary

1556
01:24:16,650 --> 01:24:19,610
psychiatry is growing quite
nicely now and it's really

1557
01:24:19,610 --> 01:24:23,610
largely due to Riad Abed and
Paul Sengen Smith, who have been

1558
01:24:23,610 --> 01:24:26,530
the editors of a volume and
edited volume from Cambridge

1559
01:24:26,530 --> 01:24:29,530
Press called Evolutionary
Psychiatry sponsored by the

1560
01:24:29,530 --> 01:24:32,840
Royal College of Psychiatry.
I think that and their interest

1561
01:24:32,840 --> 01:24:36,280
group that they sponsor and the
lectures that they sponsor have

1562
01:24:36,280 --> 01:24:38,720
really brought in.
I think they have 2000 people

1563
01:24:38,720 --> 01:24:41,360
now, 2000 psychiatrists and
their special interest group,

1564
01:24:41,760 --> 01:24:44,960
nothing like that in the states.
We're we're behind compared to

1565
01:24:44,960 --> 01:24:48,120
what what they've advanced.
Henry O'Connell has started a

1566
01:24:48,120 --> 01:24:51,680
similar group in Ireland and
he's advancing the cause there

1567
01:24:52,830 --> 01:24:57,190
and but it's it's it's early
phases and for all early

1568
01:24:57,190 --> 01:24:59,830
creative endeavors, you know,
there are risks as well as

1569
01:24:59,830 --> 01:25:02,270
benefits.
And it's very challenging for

1570
01:25:02,270 --> 01:25:05,310
psychiatrists who don't know
much about evolution to

1571
01:25:05,310 --> 01:25:09,110
distinguish the wheat from the
chaff because sometimes the most

1572
01:25:09,110 --> 01:25:12,630
intriguing ideas that spread
fast are not necessarily the

1573
01:25:12,630 --> 01:25:16,790
ones that are true.
So it's and and this is hard for

1574
01:25:16,790 --> 01:25:19,110
all of us, as you know.
I'm not saying there's any quick

1575
01:25:19,110 --> 01:25:20,710
easy solution.
I think the whole field is

1576
01:25:20,710 --> 01:25:23,130
struggling to figure out, So
what are our standards of

1577
01:25:23,130 --> 01:25:27,010
evidence for a good evolutionary
explanation, not for the

1578
01:25:27,010 --> 01:25:31,330
disease, but for why we all are
vulnerable to the disease.

1579
01:25:32,010 --> 01:25:36,210
And there's, I mean, we're just
beginning this and I think, you

1580
01:25:36,210 --> 01:25:39,730
know, it's premature to make any
global generalizations.

1581
01:25:39,930 --> 01:25:43,010
I really hope though that people
who love evolutionary psychiatry

1582
01:25:43,010 --> 01:25:45,970
won't just say it's the greatest
thing and then people don't

1583
01:25:45,970 --> 01:25:48,730
attack it as everything about it
is wrong.

1584
01:25:48,970 --> 01:25:52,090
It's not a theory, it's applying
a basic science that's been

1585
01:25:52,090 --> 01:25:55,490
missing and it's hard work and
we're just getting started.

1586
01:25:55,850 --> 01:25:59,450
There's no funding specifically
and it's not like finding genes

1587
01:25:59,450 --> 01:26:01,730
for a disorder.
There's no specific method we

1588
01:26:01,730 --> 01:26:03,930
can just turn to.
I think it's going to continue

1589
01:26:03,930 --> 01:26:06,770
to take a lot of thought and
patience and and trying to

1590
01:26:06,770 --> 01:26:10,560
figure things out.
You know you mentioned Dan Stein

1591
01:26:10,560 --> 01:26:13,920
and when I worked at Falkenburg
Hospital, which is it's the

1592
01:26:14,240 --> 01:26:16,840
hospital that's directly linked
to the University of Cape Town

1593
01:26:16,840 --> 01:26:19,920
where Dan works.
And I remember the time while

1594
01:26:19,920 --> 01:26:21,960
working there, I once watched
the lake show of yours.

1595
01:26:22,120 --> 01:26:23,280
I think it was a lecture of
yours.

1596
01:26:23,280 --> 01:26:25,200
I actually can't remember
because this was years ago, but

1597
01:26:25,720 --> 01:26:30,200
it was discussing how psychosis
or patients, people who move

1598
01:26:30,200 --> 01:26:32,720
from country to country.
I'm correct me if I'm wrong.

1599
01:26:32,720 --> 01:26:36,560
Randy, if this wasn't you but.
The evolution of psychosis and

1600
01:26:36,560 --> 01:26:40,520
and having these paranoid
delusions can occur occur quite

1601
01:26:40,520 --> 01:26:43,720
often in in foreigners who leave
their country and move into

1602
01:26:43,720 --> 01:26:45,560
other countries.
And there's there's a there's a

1603
01:26:45,560 --> 01:26:48,760
good approach to why this
happens because of course when

1604
01:26:48,760 --> 01:26:52,920
you enter a new environment this
tendency to be over critical of

1605
01:26:52,920 --> 01:26:55,240
your people around you and to
overthink it.

1606
01:26:55,240 --> 01:26:58,440
It could be a beneficial tool
and to be suspicious because

1607
01:26:58,440 --> 01:27:00,320
they're probably not your
relatives and they might wish

1608
01:27:00,320 --> 01:27:03,480
you harm.
So, but let's let's back up a

1609
01:27:03,480 --> 01:27:05,610
second.
I mean, I I've just been

1610
01:27:05,610 --> 01:27:09,170
traveling in Europe in the last
few you can just walk into a

1611
01:27:09,170 --> 01:27:12,250
whole restaurant in a different
city and it's very unlikely

1612
01:27:12,250 --> 01:27:15,010
anybody won't murder you or even
steal your wallet.

1613
01:27:15,010 --> 01:27:17,050
And they're likely to be
friendly.

1614
01:27:17,810 --> 01:27:20,810
How is that possible?
Chimpanzees can't do that.

1615
01:27:21,330 --> 01:27:23,890
They they try to move to a
different group and that they're

1616
01:27:23,890 --> 01:27:25,730
going to get beat up, killed or
or something.

1617
01:27:26,860 --> 01:27:31,500
But somehow human cultures in
general have these welcoming,

1618
01:27:31,500 --> 01:27:35,500
you know, tendencies of
hospitality, traditions and

1619
01:27:35,500 --> 01:27:37,940
cultural traditions.
You still have to watch your

1620
01:27:37,940 --> 01:27:40,180
back.
If you're in a group that you

1621
01:27:40,180 --> 01:27:42,940
know doesn't know, where you
don't have contacts.

1622
01:27:42,940 --> 01:27:45,540
And the first thing you do with
a strange group is try to figure

1623
01:27:45,540 --> 01:27:48,510
out who do you know that I know
to try to figure out if you can

1624
01:27:48,510 --> 01:27:51,990
trust the person and and
somebody that that they're going

1625
01:27:51,990 --> 01:27:55,790
to that if you tell on them it's
going to reflect badly on them.

1626
01:27:57,070 --> 01:27:59,390
But humans, the first thing is
that we can almost have this

1627
01:27:59,390 --> 01:28:03,870
amazing capacity for hospitality
and trust and assessing others.

1628
01:28:04,510 --> 01:28:07,310
But it's also true if you move
into a new group, especially

1629
01:28:07,310 --> 01:28:12,390
young men moving into new
groups, sometimes the suspicion

1630
01:28:12,830 --> 01:28:16,310
goes out of control.
And I do think that's another

1631
01:28:16,470 --> 01:28:18,990
angle I'm trying to understand.
Psychosis is.

1632
01:28:19,270 --> 01:28:22,550
And we all get a little bit
suspicious often, sometimes

1633
01:28:22,550 --> 01:28:24,630
appropriately.
Sometimes it's a smoke detector

1634
01:28:24,630 --> 01:28:26,110
principle.
It's too much suspicion.

1635
01:28:26,830 --> 01:28:29,670
But with patients with
psychosis, their suspicion

1636
01:28:29,870 --> 01:28:32,990
escalates and more suspicion
leads to the conviction that

1637
01:28:32,990 --> 01:28:36,110
people are spying on me and
wishing me harm.

1638
01:28:36,670 --> 01:28:41,230
And that often leads to odd
behavior, in which case people

1639
01:28:41,230 --> 01:28:43,230
start pointing at the person
from behind their back and

1640
01:28:43,230 --> 01:28:46,510
saying that one is odd.
And of course that leads people

1641
01:28:46,510 --> 01:28:50,990
to act more suspicious, because
people are so this this isn't by

1642
01:28:50,990 --> 01:28:54,230
any means a full explanation of
psychosis, but it's one of the

1643
01:28:54,230 --> 01:28:57,590
factors that I think can
escalate psychosis, especially

1644
01:28:57,590 --> 01:29:00,910
in a strange situation.
Army boot camp, for instance, is

1645
01:29:00,910 --> 01:29:03,790
very likely.
But do those things routinely

1646
01:29:03,790 --> 01:29:06,270
cause psychosis?
Do most people move into a

1647
01:29:06,270 --> 01:29:07,750
foreign country experience
psychosis?

1648
01:29:07,750 --> 01:29:13,750
No, the rates, rates are
increased some a little bit, but

1649
01:29:13,750 --> 01:29:17,230
it's not as if it's an
adaptation to become psychotic.

1650
01:29:18,110 --> 01:29:21,190
It's an adaptation to be
somewhat more suspicious in a

1651
01:29:21,190 --> 01:29:25,110
group of strangers, and that, I
think, sets a predisposition in

1652
01:29:25,110 --> 01:29:28,670
place.
Do you feel that humans at this

1653
01:29:28,670 --> 01:29:33,550
point, I wouldn't say evolving?
Well yeah, we can, cuz they're

1654
01:29:33,550 --> 01:29:38,060
changing so rapidly, I mean.
The technological revolution and

1655
01:29:38,060 --> 01:29:40,740
the way things are just
continuously changing, I mean,

1656
01:29:40,780 --> 01:29:45,300
every year it seems to be an
exponential growth in technology

1657
01:29:45,300 --> 01:29:49,500
and the way we think and the way
we're evolving our protocols and

1658
01:29:49,500 --> 01:29:51,060
policies and the way the humans
are.

1659
01:29:51,060 --> 01:29:53,100
Just at this point, it's
becoming so rapid.

1660
01:29:53,100 --> 01:29:56,580
Do you feel that when we look
back at our evolutionary roots,

1661
01:29:57,900 --> 01:30:00,300
it's becoming such a diverse
experience at this point that

1662
01:30:00,300 --> 01:30:03,060
it's very difficult for us to
pinpoint a?

1663
01:30:04,550 --> 01:30:06,710
Well, let me rephrase this in a
way that makes more sense to

1664
01:30:06,710 --> 01:30:09,710
what I'm also thinking.
Do you think that we're evolving

1665
01:30:09,710 --> 01:30:12,550
so fast at this point that it
becomes difficult to talk about

1666
01:30:12,550 --> 01:30:17,750
the evolution of humans, or
we're not evolving very fast?

1667
01:30:17,910 --> 01:30:21,230
In contrast to our environments?
Our environments are indeed

1668
01:30:21,230 --> 01:30:24,430
changing very rapidly and it's
very important, especially for

1669
01:30:24,430 --> 01:30:27,190
physical health, to pay
attention to the vast

1670
01:30:27,190 --> 01:30:30,670
differences in diet, exercise
and social structures that

1671
01:30:30,670 --> 01:30:35,280
account for a lot of problems.
But is it the case that we can't

1672
01:30:35,280 --> 01:30:37,600
keep up?
I mean, I'm sure you're aware of

1673
01:30:38,240 --> 01:30:41,760
railway car syndrome, when
people could first travel by

1674
01:30:41,760 --> 01:30:44,600
railway cars.
A lot of psychiatrists claim

1675
01:30:44,600 --> 01:30:48,680
that most of the city was caused
by railway cars and the ability

1676
01:30:48,680 --> 01:30:50,600
to travel very fast.
And when the telephone was

1677
01:30:50,600 --> 01:30:55,080
invented, that was supposed to
be the end of of things, of

1678
01:30:55,080 --> 01:30:57,320
course.
And and then they are inability

1679
01:30:57,320 --> 01:31:01,000
to predict our ability to adapt.
I remain fascinated.

1680
01:31:01,720 --> 01:31:03,640
You may or may not have been
there at the beginning of

1681
01:31:03,640 --> 01:31:08,760
e-mail, but I certainly was and
nobody predicted how it was

1682
01:31:08,760 --> 01:31:12,080
going to take over our lives.
If we thought about it, maybe we

1683
01:31:12,080 --> 01:31:14,760
could have a way of contacting
people without bothering them.

1684
01:31:15,920 --> 01:31:19,160
I mean, that's, that's it.
The charm and the price of

1685
01:31:19,160 --> 01:31:23,440
e-mail is, is, you know, leaving
a message that's and now it's

1686
01:31:23,440 --> 01:31:25,640
taken over our lives, but it's
been displaced.

1687
01:31:25,920 --> 01:31:27,880
You can't reach anybody by
e-mail anymore.

1688
01:31:28,080 --> 01:31:31,880
You got to use text or WhatsApp
or or something, something else.

1689
01:31:32,840 --> 01:31:36,000
And this does create pressures
and how many people have a zero

1690
01:31:36,000 --> 01:31:38,720
inbox?
Most of us go to sleep wondering

1691
01:31:38,720 --> 01:31:42,000
if we can get through tomorrow's
emails and then 10 more come in

1692
01:31:42,000 --> 01:31:45,880
as we do five.
I guess that causes anxiety, but

1693
01:31:46,760 --> 01:31:49,720
that share with me the feeling
that or the people are so

1694
01:31:49,720 --> 01:31:53,960
adaptive we can adapt to all
these different things.

1695
01:31:54,400 --> 01:31:57,360
I mean I will come.
I was saved by WhatsApp and

1696
01:31:57,360 --> 01:31:58,800
e-mail.
Yeah yeah.

1697
01:31:59,560 --> 01:32:02,240
Without it and and soon.
Yeah.

1698
01:32:03,560 --> 01:32:05,920
It's astounding what these
things we can adapt to.

1699
01:32:07,800 --> 01:32:10,560
On the other hand, we shouldn't
neglect the possibility that

1700
01:32:10,560 --> 01:32:14,040
great harm is being done, the
number of hours people are

1701
01:32:14,040 --> 01:32:16,360
watching pornography instead of
having sex.

1702
01:32:16,680 --> 01:32:19,360
Yipes.
There is some that.

1703
01:32:19,360 --> 01:32:22,080
I mean all this idea that social
media are causing a huge

1704
01:32:22,120 --> 01:32:25,850
epidemic of depression and
anxiety maybe.

1705
01:32:25,850 --> 01:32:28,650
I mean it is true that everybody
puts good stuff about their life

1706
01:32:28,650 --> 01:32:34,090
on on the media and especially
on YouTube and and the like.

1707
01:32:34,290 --> 01:32:36,970
And so we all get the idea other
people's lives are better than

1708
01:32:36,970 --> 01:32:39,010
they are and we feel bad about
ourselves.

1709
01:32:39,010 --> 01:32:41,610
And I mean that's that's a
standard social comparison

1710
01:32:41,610 --> 01:32:45,330
theory thing.
So, so maybe we are now at a

1711
01:32:45,330 --> 01:32:47,490
point.
On the other hand, people adapt

1712
01:32:47,490 --> 01:32:48,930
so well.
There's so many different

1713
01:32:48,930 --> 01:32:50,570
things.
I think we shouldn't assume that

1714
01:32:50,850 --> 01:32:53,890
we're helpless spawns we we can
do pretty well.

1715
01:32:55,110 --> 01:32:57,510
The other hand, I'm glad, I'm
glad I don't have young kids and

1716
01:32:57,510 --> 01:32:59,350
trying to decide when to give
them a cell phone that they

1717
01:32:59,350 --> 01:33:01,550
could access everything.
I don't know what I do about

1718
01:33:01,550 --> 01:33:03,470
that.
Because that's I was just gonna

1719
01:33:03,470 --> 01:33:05,790
ask you about that.
What's your hypothesis on that

1720
01:33:05,830 --> 01:33:07,470
as a whole?
I mean, this environment that

1721
01:33:07,470 --> 01:33:10,430
we've curated, crafted for
ourselves, how do you think it

1722
01:33:10,430 --> 01:33:13,510
is impacting our minds?
I don't know.

1723
01:33:13,670 --> 01:33:15,830
I mean, I'm sorry.
I mean this.

1724
01:33:16,310 --> 01:33:20,310
These are subjects for research
and we need comparison.

1725
01:33:20,310 --> 01:33:24,510
Populations.
Yeah.

1726
01:33:26,390 --> 01:33:29,430
And the the fact that cell
phones are coming in, even the

1727
01:33:29,430 --> 01:33:33,630
populations that were recently
hunter gatherers, and that

1728
01:33:33,630 --> 01:33:36,950
that's the single most valuable
possession because it's a way of

1729
01:33:36,950 --> 01:33:40,270
connecting with other people
that you have to get cell phone

1730
01:33:40,270 --> 01:33:42,150
minutes.
And how can a young girl get

1731
01:33:42,150 --> 01:33:44,390
cell phone minutes if she
doesn't have a job?

1732
01:33:45,390 --> 01:33:48,310
That's a very sad story.
There's only one way she can

1733
01:33:48,310 --> 01:33:51,790
probably get minutes, and it
completely wrecks potential

1734
01:33:51,830 --> 01:33:56,660
culture, Culture.
I mean, so many people

1735
01:33:56,660 --> 01:34:00,700
prognosticate about the future.
By the way, would you tell me if

1736
01:34:00,700 --> 01:34:02,980
the international stock markets
are gonna be going down or up

1737
01:34:02,980 --> 01:34:07,900
for the next few weeks?
It's impossible.

1738
01:34:07,900 --> 01:34:09,940
We can't.
But that's the thing.

1739
01:34:10,980 --> 01:34:13,690
I mean, lots of people make a
living telling that exactly.

1740
01:34:13,690 --> 01:34:16,170
Lots of people.
And and it's fabulous that

1741
01:34:16,170 --> 01:34:19,370
people, people are so eager for
advice and so they all get their

1742
01:34:19,370 --> 01:34:23,010
guru to tell them what's what's
gonna happen and and then they

1743
01:34:23,010 --> 01:34:26,530
tend to continue to believe the
guru even after it's proven

1744
01:34:26,530 --> 01:34:27,770
wrong.
So.

1745
01:34:28,210 --> 01:34:30,770
Yeah, no.
So there's, I mean, lately I've

1746
01:34:30,770 --> 01:34:32,930
seen a lot of things where it's
like beware the guru, like

1747
01:34:32,930 --> 01:34:35,250
people giving these counter
solutions to these problems.

1748
01:34:35,690 --> 01:34:37,930
And even within those counter
solutions, they tend to start

1749
01:34:37,930 --> 01:34:39,570
giving you advice that goes
beyond their own.

1750
01:34:41,530 --> 01:34:45,310
And I mean I I might I might
laughs yet to and there there's

1751
01:34:45,310 --> 01:34:47,910
still time.
I mean, sometimes I I do think

1752
01:34:47,910 --> 01:34:50,630
that an evolutionary perspective
gives you a different

1753
01:34:50,630 --> 01:34:54,310
perspective on life and our
minds and our emotions and what

1754
01:34:54,310 --> 01:34:57,510
we're trying to do.
And and I'm tempted to, you

1755
01:34:57,510 --> 01:35:02,150
know, offer advice and solutions
and and say, yeah, we shouldn't

1756
01:35:02,150 --> 01:35:05,310
care so much about worldly
things and sex because it's just

1757
01:35:05,310 --> 01:35:08,190
a trick to.
But but that doesn't actually do

1758
01:35:08,190 --> 01:35:09,310
much good.
I don't think.

1759
01:35:10,050 --> 01:35:14,570
So I'm going to stick to my role
as as a scientist who tries to

1760
01:35:14,730 --> 01:35:17,130
explain why we're vulnerable to
these disorders.

1761
01:35:17,490 --> 01:35:21,170
And I'll leave it to others,
mainly to figure out how these

1762
01:35:21,170 --> 01:35:23,490
findings can be used to improve
life.

1763
01:35:24,090 --> 01:35:28,050
Randy, which mental illness do
you find most fascinating?

1764
01:35:29,890 --> 01:35:34,210
Gosh, I mean all the emotional
disorders, but I think obsessive

1765
01:35:34,210 --> 01:35:37,850
compulsive disorder is so
amazingly specific.

1766
01:35:39,150 --> 01:35:41,830
I mean you, I'm not sure how
many of your viewers are are

1767
01:35:41,830 --> 01:35:45,950
familiar, but it's not people
being careful and meticulous.

1768
01:35:45,950 --> 01:35:48,070
That's called obsessive
compulsive personality.

1769
01:35:48,310 --> 01:35:51,270
Those are people who wish other
people would be as careful as

1770
01:35:51,270 --> 01:35:54,190
they are and they feel superior.
But obsessive compulsive

1771
01:35:54,190 --> 01:35:57,070
disorder are.
Those people are kind of the

1772
01:35:57,150 --> 01:35:58,830
opposite of someone with
paranoia.

1773
01:35:59,550 --> 01:36:01,310
People who are paranoid think
bad.

1774
01:36:01,350 --> 01:36:02,950
Other people are going to do
something to them.

1775
01:36:04,330 --> 01:36:05,810
Many of, and I had this
privilege.

1776
01:36:05,810 --> 01:36:07,810
I mean, when I started seeing
patients with obsessive

1777
01:36:07,810 --> 01:36:11,450
compulsive disorder, I diagnosed
them as psychotic because they

1778
01:36:11,450 --> 01:36:15,250
had false beliefs that they
could catch HIV from a toilet

1779
01:36:15,250 --> 01:36:16,330
seat.
That's a false belief.

1780
01:36:16,330 --> 01:36:19,290
It must be psychosis.
And only after we started seeing

1781
01:36:19,290 --> 01:36:22,290
dozens and finally hundreds of
patients with obsessive

1782
01:36:22,290 --> 01:36:25,370
compulsive disorder that account
to recognize this is a

1783
01:36:25,370 --> 01:36:29,490
remarkably similar syndrome.
These people are afraid that

1784
01:36:29,490 --> 01:36:32,690
they might accidentally put some
poison in the brownies they bake

1785
01:36:32,690 --> 01:36:35,290
for their child's class.
They're afraid that they might

1786
01:36:35,290 --> 01:36:37,610
accidentally run somebody down
and not notice it.

1787
01:36:37,610 --> 01:36:41,090
So they call the police and say,
did anybody report anybody

1788
01:36:41,090 --> 01:36:44,370
getting run down on Broadway
last last Tuesday?

1789
01:36:45,770 --> 01:36:48,850
So that's very interesting.
Furthermore, they're afraid that

1790
01:36:48,850 --> 01:36:52,210
some tiny mistake on the
airport, like not locking the

1791
01:36:52,210 --> 01:36:56,290
door, would lead to catastrophe.
And the number of people I've

1792
01:36:56,290 --> 01:36:59,250
seen who had to drive home and
miss work because they thought

1793
01:36:59,250 --> 01:37:02,650
they left the hair curler on.
And then they drove home and

1794
01:37:02,650 --> 01:37:04,770
checked it, and then they drove
back to work again, but they

1795
01:37:04,810 --> 01:37:08,410
thought maybe they didn't check
it properly and maybe they

1796
01:37:08,410 --> 01:37:09,930
accidentally plugged it in
again.

1797
01:37:10,770 --> 01:37:15,010
It's almost as if these people
have hostile impulses that are

1798
01:37:15,010 --> 01:37:18,090
not properly controlled.
Not exactly like that, but

1799
01:37:18,090 --> 01:37:21,530
something like that.
And when you think about what's

1800
01:37:21,530 --> 01:37:26,440
needed for humans to thrive in a
very complex social system where

1801
01:37:26,440 --> 01:37:30,320
we're all constantly inhibiting
our impulses and often not aware

1802
01:37:30,320 --> 01:37:34,800
of them, anything that made you
globally aware of those kinds of

1803
01:37:34,800 --> 01:37:37,680
things that normal people are
not aware of would lead you to

1804
01:37:37,680 --> 01:37:41,040
take protective actions like
double checking the door and

1805
01:37:41,040 --> 01:37:43,360
triple checking to make sure you
didn't put any.

1806
01:37:43,600 --> 01:37:47,610
And I've had patients who run to
school to take the brownies back

1807
01:37:47,610 --> 01:37:49,970
just before the kids in the
classroom are about to eat their

1808
01:37:49,970 --> 01:37:53,770
brownies because she's afraid
she put dishwater detergent in

1809
01:37:53,770 --> 01:37:59,010
it instead of baking soda.
I mean, and making these people

1810
01:37:59,010 --> 01:38:01,330
suffer so terribly.
As for cleaning, I mean, it's

1811
01:38:01,330 --> 01:38:03,690
not just washing your hands.
So we've seen people who who

1812
01:38:03,690 --> 01:38:07,050
wash their hands down to the
bone and people who take showers

1813
01:38:07,250 --> 01:38:10,370
not just for 10 minutes, not for
10 minutes, but standing in cold

1814
01:38:10,370 --> 01:38:15,270
water for two hours.
There's something wrong in the

1815
01:38:15,870 --> 01:38:20,230
control system for these people,
and it might yet be something

1816
01:38:20,230 --> 01:38:22,310
specific in the brain and the
caudate nucleus.

1817
01:38:22,310 --> 01:38:25,310
There are hints that the caudate
nucleus is a site of this.

1818
01:38:25,590 --> 01:38:28,630
An obsessive compulsive disorder
is one of those disorders that

1819
01:38:28,630 --> 01:38:33,150
can be set off specifically by
neuroleptics, certain known

1820
01:38:33,150 --> 01:38:37,240
antipsychotic drugs that seemed
to induce typical obsessive

1821
01:38:37,240 --> 01:38:40,080
compulsive disorder in certain
unfortunate people.

1822
01:38:40,280 --> 01:38:43,400
So I think this might be a
condition that really does have

1823
01:38:43,400 --> 01:38:47,960
a specific neuro anatomical
neurochemical basis, but it

1824
01:38:47,960 --> 01:38:52,080
remains fascinating that it all
goes together in the same way.

1825
01:38:53,120 --> 01:38:56,880
So a fascinating disorder and
has not been.

1826
01:38:56,920 --> 01:38:59,360
I mean, some people write about
evolution and obsessive

1827
01:38:59,360 --> 01:39:03,350
compulsive disorder with respect
to cleanliness and the benefits

1828
01:39:03,390 --> 01:39:07,710
of cleaning rituals, but that's
just a small part of obsessive

1829
01:39:07,710 --> 01:39:11,310
compulsive disorders.
It's a much deeper moral, social

1830
01:39:11,710 --> 01:39:14,350
self-control kind of syndrome.
It is, Yeah.

1831
01:39:14,350 --> 01:39:17,030
I mean, I mean those people
obviously also focusing on those

1832
01:39:17,030 --> 01:39:20,750
obsessions and compulsions that
deal with something clean where

1833
01:39:21,110 --> 01:39:24,630
there is tremendously in that
regard, right, right do.

1834
01:39:25,350 --> 01:39:29,550
You think that we run the risk
as medical professionals?

1835
01:39:30,500 --> 01:39:32,660
Over medicalizing human
experiences.

1836
01:39:34,620 --> 01:39:40,900
Oh my goodness, we certainly do.
Much of the conversations I have

1837
01:39:40,900 --> 01:39:44,300
with people is about their
diseases and their interpreting

1838
01:39:44,500 --> 01:39:47,460
is this.
Do I have major depression?

1839
01:39:48,620 --> 01:39:52,460
When I started off in my career,
everybody asked me, Dr. Nesi, do

1840
01:39:52,460 --> 01:39:57,560
I have neurosis And I had a you
know standard explanation saying

1841
01:39:57,560 --> 01:40:01,000
what neurosis is and what it
isn't and we're all it was never

1842
01:40:01,000 --> 01:40:05,320
very satisfying to them.
More recently with with the DSM,

1843
01:40:05,320 --> 01:40:09,480
people would say doctor Nesi, do
I have major depression and that

1844
01:40:09,480 --> 01:40:11,400
you know then you can go through
the symptoms with them.

1845
01:40:11,400 --> 01:40:15,000
That's a simplistic way, but a
much better way I think is to

1846
01:40:15,000 --> 01:40:17,960
try to talk about, you know, you
have excess low mood.

1847
01:40:19,010 --> 01:40:22,530
It's not good for you.
And in your particular case, it

1848
01:40:22,530 --> 01:40:25,930
really is excess and we need to
do whatever we can to get you

1849
01:40:25,930 --> 01:40:29,330
back to a more realistic view of
yourself and the world.

1850
01:40:29,690 --> 01:40:33,810
And that might include changing
your social situation, changing

1851
01:40:33,810 --> 01:40:36,850
how you view the world, using
medications, using cognitive

1852
01:40:36,850 --> 01:40:40,010
therapy.
But, but, but many patients are

1853
01:40:40,010 --> 01:40:43,170
able to understand that the
capacity for low mood can be

1854
01:40:43,170 --> 01:40:46,530
useful, even though it usually
is not.

1855
01:40:47,780 --> 01:40:50,300
And I think one of the great
contributions of evolutionary

1856
01:40:50,300 --> 01:40:54,860
psychiatry is helping patients
to get get away from stigma and

1857
01:40:54,860 --> 01:40:57,500
get away from feeling I am a
defective human being because I

1858
01:40:57,500 --> 01:41:00,700
have a mental disorder,
especially for emotional

1859
01:41:00,700 --> 01:41:03,260
disorders.
Recognize that that there are

1860
01:41:03,260 --> 01:41:06,420
good reasons for bad feelings
helps a lot of people to

1861
01:41:06,420 --> 01:41:09,180
realize, oh wait a second, there
are advantages as well as

1862
01:41:09,180 --> 01:41:12,900
disadvantages to being a person
who has more anxiety than usual,

1863
01:41:13,380 --> 01:41:16,660
and I need to get back to the
more average amount of anxiety

1864
01:41:16,660 --> 01:41:19,300
doing whatever I can.
But I think that's an

1865
01:41:19,740 --> 01:41:23,540
unanticipated and unappreciated
substantial benefit of an

1866
01:41:23,540 --> 01:41:26,740
evolutionary view for patients.
And by the way, you don't have

1867
01:41:26,740 --> 01:41:30,430
to go talking about evolution,
because that just puts a lot of

1868
01:41:30,430 --> 01:41:32,310
people off.
Instead, you talk about, you

1869
01:41:32,310 --> 01:41:34,630
know, there are good reasons for
these feelings.

1870
01:41:34,830 --> 01:41:38,510
They can be useful, they can be
functional, but they often are

1871
01:41:38,510 --> 01:41:40,110
not.
But they can be.

1872
01:41:40,270 --> 01:41:43,910
Let's try to figure out in your
case if this is useful for you,

1873
01:41:44,670 --> 01:41:48,550
or useful for your relatives, or
not useful at all.

1874
01:41:49,590 --> 01:41:52,270
It's almost a complete, a
complete shift of a perspective

1875
01:41:52,270 --> 01:41:55,350
because there was a time where
people didn't have these.

1876
01:41:55,830 --> 01:41:59,670
These words that displayed or
portrayed their experience and

1877
01:41:59,910 --> 01:42:02,870
and you those patients who want
that word, they want the word

1878
01:42:02,870 --> 01:42:04,510
depression because they get that
closer.

1879
01:42:05,070 --> 01:42:08,750
But in this case we're not not
saying remove the word, you're

1880
01:42:08,750 --> 01:42:11,390
saying change the perspective of
how we don't actually use the

1881
01:42:11,390 --> 01:42:13,590
word.
It's not to go back to the old

1882
01:42:13,590 --> 01:42:16,830
way, it's actually to have a
completely new way of of not

1883
01:42:16,830 --> 01:42:20,390
necessarily medicalizing it.
And that's why I use the phrase

1884
01:42:20,390 --> 01:42:24,420
low moon, because depression has
been completely hijacked by the

1885
01:42:24,420 --> 01:42:27,300
pharmaceutical companies.
And if you say depression, the

1886
01:42:27,300 --> 01:42:29,620
person says I have a defect that
needs drug treatment.

1887
01:42:30,380 --> 01:42:34,780
So if you if you recognize that
low mood is normal or can be

1888
01:42:34,780 --> 01:42:37,940
normal and useful or can be
excessive, that helps people put

1889
01:42:37,940 --> 01:42:40,140
it in the context of real life
for real people.

1890
01:42:41,700 --> 01:42:46,060
And overall in terms of with
that link to to big pharma and

1891
01:42:46,300 --> 01:42:50,060
and the way these, these fields
have been so completely taken.

1892
01:42:50,450 --> 01:42:54,770
Apart by these companies and
monopolize in that sense, do you

1893
01:42:54,770 --> 01:42:58,970
find that that's the big effect
that's causing us to not succeed

1894
01:42:58,970 --> 01:43:00,290
in this field?
I mean, do you feel that

1895
01:43:00,290 --> 01:43:03,650
psychiatry is suffering so much
because of these issues, the

1896
01:43:03,650 --> 01:43:07,150
politics?
You know my well, I ran the

1897
01:43:07,150 --> 01:43:09,830
psychiatry residency training
program at Michigan for seven

1898
01:43:09,830 --> 01:43:13,270
years as a great privilege.
And my my goal in that was for

1899
01:43:13,270 --> 01:43:17,070
every psychiatrist, be very
sophisticated as a

1900
01:43:17,070 --> 01:43:20,190
psychotherapist, A dynamic
understanding of people, of

1901
01:43:20,190 --> 01:43:23,590
cognitive behavioral therapy, of
neuroscience, of pharmacology.

1902
01:43:24,910 --> 01:43:29,930
But times have changed, and I
mean, if I were running a public

1903
01:43:29,930 --> 01:43:33,970
health service, for instance,
and trying to allocate resources

1904
01:43:33,970 --> 01:43:37,730
to optimally provide for the
wealth of for the benefits of my

1905
01:43:37,730 --> 01:43:40,410
population, would I have
psychiatrists doing

1906
01:43:40,410 --> 01:43:42,210
psychotherapy?
No.

1907
01:43:42,210 --> 01:43:44,250
They're the only ones who know
enough about the drugs to make

1908
01:43:44,250 --> 01:43:46,890
the decisions.
We should mainly be using their

1909
01:43:46,890 --> 01:43:52,530
special expertise to do that.
Unfortunately, everybody tends

1910
01:43:52,530 --> 01:43:55,410
to think that their perspective
and their treatment is the best

1911
01:43:55,410 --> 01:43:58,520
one.
And so you get these continuing

1912
01:43:58,520 --> 01:44:02,160
arguments about drugs are great,
drugs are useless, or, you know,

1913
01:44:02,160 --> 01:44:04,400
psychotherapy is great,
psychotherapy is useless.

1914
01:44:05,640 --> 01:44:10,400
And I think we should continue
to try to educate all clinicians

1915
01:44:10,720 --> 01:44:14,120
to be respectful of the benefits
you can get from other kinds of

1916
01:44:14,120 --> 01:44:16,080
treatment and other kinds of
perspectives.

1917
01:44:16,960 --> 01:44:20,920
And what I was coming to though
is no, I think it's it's not

1918
01:44:20,920 --> 01:44:23,880
realistic for psychiatrists in
the most case to and I had a

1919
01:44:23,880 --> 01:44:26,160
privileged position where I
could do psychotherapy.

1920
01:44:26,640 --> 01:44:30,200
My income didn't depend on it.
Most psychiatrists, if they want

1921
01:44:30,200 --> 01:44:32,880
to make a proper living, they
need to prescribe drugs a lot

1922
01:44:33,760 --> 01:44:36,600
and they can't spend as much
time with their patients as as I

1923
01:44:36,600 --> 01:44:40,880
was blissfully offered in my
position, so.

1924
01:44:41,710 --> 01:44:45,030
Yeah, I mean, particularly like
here in South Africa, the, the

1925
01:44:45,030 --> 01:44:49,310
overburdened population, the the
lack of resources, the fact that

1926
01:44:49,310 --> 01:44:51,990
we're stuck in this dilemma
renders it impossible.

1927
01:44:51,990 --> 01:44:54,630
I mean in an ideal world, if we
could spend a couple hours with

1928
01:44:54,630 --> 01:44:59,230
the patient, suss out the
individual as a whole and and

1929
01:44:59,230 --> 01:45:02,470
thereafter tailor the treatment
as you want, that would be just

1930
01:45:02,470 --> 01:45:05,710
perfect, but relatively
impossible.

1931
01:45:06,970 --> 01:45:10,010
Many clinics are now giving
psychiatrists only half an hour

1932
01:45:10,010 --> 01:45:14,130
or even 15 minutes to see a
patient and gosh, I think that's

1933
01:45:14,130 --> 01:45:17,450
just completely inadequate.
On the other hand, what happens

1934
01:45:17,450 --> 01:45:20,850
if you have 1000 patients and
one psychiatrist and how do you

1935
01:45:20,890 --> 01:45:24,370
optimize that resources.
These are public health problems

1936
01:45:24,370 --> 01:45:27,370
and I don't know good solution.
Let's help certain.

1937
01:45:27,890 --> 01:45:30,210
I mean artificial intelligence
will assist with this in the

1938
01:45:30,210 --> 01:45:31,490
future.
I mean, maybe.

1939
01:45:32,570 --> 01:45:33,690
Help.
Help.

1940
01:45:34,050 --> 01:45:35,590
Yeah.
Treatments at some point.

1941
01:45:35,950 --> 01:45:38,830
And then, you know, I should say
that, you know, people criticize

1942
01:45:38,830 --> 01:45:42,630
for psychiatrists for being just
drug prescribing people and the

1943
01:45:42,630 --> 01:45:44,270
like.
But gosh, I keep meeting

1944
01:45:44,270 --> 01:45:46,910
psychiatrists who went into it
because they really want to

1945
01:45:46,910 --> 01:45:50,950
understand people and who really
care about their patients and

1946
01:45:50,950 --> 01:45:53,390
they get frustrated when they're
put in positions where they

1947
01:45:53,390 --> 01:45:57,150
can't provide optimal care And
and they're intellectually

1948
01:45:57,150 --> 01:46:00,270
curious.
And I think no evolutionary

1949
01:46:00,270 --> 01:46:03,470
approaches to psychiatry are
intrinsically interesting and

1950
01:46:03,470 --> 01:46:05,950
appreciated by a lot of
psychiatrists, whether they're

1951
01:46:05,950 --> 01:46:08,950
mainly prescribing, mainly doing
psychotherapy, mainly running a

1952
01:46:08,950 --> 01:46:11,750
clinic with many social workers
and psychologists and others.

1953
01:46:12,110 --> 01:46:16,030
So I think no one shouldn't
generalize about psychiatrists.

1954
01:46:16,030 --> 01:46:18,350
One should recognize that
there's a lot of really smart,

1955
01:46:18,350 --> 01:46:22,310
interesting, committed people in
there, along with some duds who

1956
01:46:22,310 --> 01:46:25,470
are, you know, just just doing
what what's expected and

1957
01:46:25,990 --> 01:46:28,770
collecting paycheck.
Yeah, I think a lot of the time

1958
01:46:28,770 --> 01:46:31,370
is they're anesthetized and
they're almost dehumanized by

1959
01:46:31,370 --> 01:46:36,090
the system itself and from the
outside to be, to be, to lack

1960
01:46:36,090 --> 01:46:38,570
this empathy that they enter
much.

1961
01:46:38,570 --> 01:46:42,090
I mean, it was partly one of the
reasons why I eventually lived

1962
01:46:42,090 --> 01:46:46,530
is it's just too much, it's too
difficult and and it sets your

1963
01:46:46,530 --> 01:46:49,450
soul so.
So this might be a place to wrap

1964
01:46:49,450 --> 01:46:53,450
up with Kevin.
I began my career as a

1965
01:46:53,450 --> 01:46:56,410
psychiatrist who was embedded in
an internal medicine clinic.

1966
01:46:57,290 --> 01:47:00,170
My office was next to the
internists and the nurses, and I

1967
01:47:00,170 --> 01:47:04,010
spent all day seeing patients
with, you know, hypertension and

1968
01:47:04,010 --> 01:47:08,370
diabetes and obesity and cancer
and heart attacks and all the

1969
01:47:08,370 --> 01:47:12,090
rest, and a lot of depression
and anxiety and other kinds of

1970
01:47:12,090 --> 01:47:16,170
problems, lots of alcoholism.
They were hoping that I could

1971
01:47:16,170 --> 01:47:18,970
come in and in a few minutes set
patients straight.

1972
01:47:20,050 --> 01:47:22,930
It was very quickly clear I was
a junior psychiatrist at that

1973
01:47:22,930 --> 01:47:25,610
point, that that wasn't going to
happen.

1974
01:47:25,890 --> 01:47:28,210
I was able to provide good
referrals and I was able to

1975
01:47:28,490 --> 01:47:31,930
educate the interns about the
nature of mental problems much

1976
01:47:31,930 --> 01:47:35,130
better.
But I was explicitly assigned

1977
01:47:35,610 --> 01:47:39,050
when I took that position of the
the idea that the funding it

1978
01:47:39,050 --> 01:47:41,250
supported.
It was that I was supposed to

1979
01:47:41,450 --> 01:47:45,730
help the internist become more
empathic and more patient and

1980
01:47:45,730 --> 01:47:47,690
more emotionally attuned to
their patients.

1981
01:47:49,620 --> 01:47:53,820
And I watched and I listened.
And after about a year, I

1982
01:47:53,820 --> 01:47:56,660
realized that it was essential
for people doing that kind of

1983
01:47:56,660 --> 01:48:00,380
work and seeing very sick people
every 15 minutes, all week long,

1984
01:48:00,740 --> 01:48:04,340
to have big barriers and
distance and not to get too

1985
01:48:04,340 --> 01:48:08,340
tangled up with too much emotion
and empathy and emotional

1986
01:48:08,540 --> 01:48:12,100
connection.
And I think what you mentioned,

1987
01:48:12,620 --> 01:48:16,100
it did it to me, too.
I found myself getting toughened

1988
01:48:16,100 --> 01:48:20,390
up some by seeing so many people
suffering so much and not being

1989
01:48:20,390 --> 01:48:23,670
able to offer anything, you
know, very dramatic that that

1990
01:48:23,670 --> 01:48:26,390
was very helpful.
And this, this was exactly at

1991
01:48:26,390 --> 01:48:28,670
the time when I was writing
those papers about evolution of

1992
01:48:28,670 --> 01:48:32,630
psychodynamics.
And you know, my own conclusion

1993
01:48:32,630 --> 01:48:36,550
that sometimes denial and other
kinds of things that keep

1994
01:48:36,550 --> 01:48:38,990
certain things out of
consciousness is useful.

1995
01:48:40,500 --> 01:48:43,940
And on the other hand, I think
as I continued my work in

1996
01:48:43,940 --> 01:48:47,140
psychiatry and got to spend more
time with specific patients, I

1997
01:48:47,140 --> 01:48:50,700
got to know over years or even
decades, I think some of my

1998
01:48:50,700 --> 01:48:53,580
sensitivity came back and.
And now that I'm not seeing

1999
01:48:53,580 --> 01:48:56,980
patients regularly and out of
that kind of stress of being

2000
01:48:56,980 --> 01:49:01,140
feeling responsible for people
in that same way, it's much more

2001
01:49:01,140 --> 01:49:04,060
like living a regular life
instead of being enmeshed and

2002
01:49:04,060 --> 01:49:07,810
trying to help so many people.
Well, Randy, I think your your

2003
01:49:07,810 --> 01:49:11,650
work is incredible and the body
of knowledge you've given us is

2004
01:49:11,650 --> 01:49:13,210
phenomenal and thank you so much
for that.

2005
01:49:13,490 --> 01:49:15,890
Any final words for how we
should approach mental illness

2006
01:49:15,890 --> 01:49:17,610
and mental health as we close
off?

2007
01:49:18,610 --> 01:49:20,690
Not not really.
I think I've had my say, and I

2008
01:49:20,690 --> 01:49:24,130
appreciate your work on these
grand questions of consciousness

2009
01:49:24,130 --> 01:49:26,650
and morality and and free will
and the like.

2010
01:49:26,650 --> 01:49:29,410
They deserve continuing
discussion, even though I've

2011
01:49:29,730 --> 01:49:32,770
taken leave from trying to solve
those problems.

2012
01:49:33,290 --> 01:49:35,370
Well, thank you so much, Randy.
I appreciate that.

2013
01:49:35,770 --> 01:49:36,610
Thank you so much.