Thomas Insel: Toward a new understanding of mental illness
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- Опубликовано: 19 сен 2024
- Today, thanks to better early detection, there are 63% fewer deaths from heart disease than there were just a few decades ago. Thomas Insel, Director of the National Institute of Mental Health, wonders: Could we do the same for depression and schizophrenia? The first step in this new avenue of research, he says, is a crucial reframing: for us to stop thinking about "mental disorders" and start understanding them as "brain disorders." (Filmed at TEDxCaltech.)
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Music and dance therapy has done amazing things in my life, truly amazing. I was 13 when I first experienced depression and I'm 27 now and still do it because it keeps me very happy and connected with reality. But what do you mean "not the way it is practiced today?"
Thomas Insel, if you are reading this...I'd like to give information I've discovered about brain disorders. I started to experience depression at age 13, had a panic attack at age 23, severe anxiety at age 26. Throughout my life of very high ups and very low downs, and lots of personal research, I've "cured" myself so to speak. I really want to be part of the movement that changes what we know about brain disorders and how we can help others.
Bravo Thomas,
Very few people have the courage to talk about how much we still have to learn about Mental Illness in the context of childhood.
For example their is still so much that we don't know, about disorders of mood or personality and how those disorders manifest themselves among our kiddos that are spending time every day battling low self-esteem and negative cycles of thinking.
-Hamz
This all sounds wonderful to academics and researchers, actual clinicians that sit with people just roll their eyes.
I'm a clinician who actually sits with clients and this stuff is the reason we do the work to begin with.
@@renniegrant3704 then I am rather curious in which country you practice because most clinicians don’t hinge towards the biomedical model
@@davidtenklooster1744 Depends on the clinician and particularly the age of the clinician. If you embarked on a career when the big breakthroughs in neuroimaging were starting in the 2000s like myself then you are more likely to adhere to the biomedical model. IMO.
This stuff is what keeps me motivated as a clinician as I look at the state of the discipline today and where it is heading, however kicking and screaming. Otherwise it would all seem hopeless. I'm very excited about the surge in psychedelic therapy as we can finally get results in very difficult cases with it.
This sounds really amazing to me, and the direction things need to go. It's too bad it feels like the opposite of where we're heading.
Thomas Insel is very optimistic. I really do hope science comes up with solutions to brain disorders-be it depression or ADHD. On a completely separate note, early detection and early intervention of inequality and a strong social safety net would give the United States of America the best outcome as well.
We'll always be wrong whenever we start our sentences with "we'll always be..."
As a schizophrenic im loving this man right now. I cant express how important it is to me for people to understand that that it does stem from a very real and physical error in the brain. It completely changes people attitude toward me.
The drugs we have now are MUCH better than the drugs 20-30 years ago. It used to be that someone had to be either totally mad or nearly comatose, no in between. Now, it is possible for most people to experience minimal side effects but it requires a willingness and ability of the doctor and patient to work together as a team with other mental health professionals. Throwing pills at every sypmtom is what gets many people all those horrible side-effects.
I was diagnosed at age 9... and I am still not 100% stable and functional. Even early detection does not solve everything. Until we can create specialize medications and therapies for each individual, the problem in all mental disorders goes on. No two people suffer in the same way. So even with the mass amount of drugs available, and variety of therapies out there, people continue to suffer, and play guinea pig until the perfect combination is found. It's hard.
Neighbor was a PGA golfer. Friends. Never too sure of travel or weather. I agree to mow his lawn. 15 minutes tops. Knocks one day. Not real mad but concerned. On video is me taking a $20 lawn chair out of back yard. Looks just like me. I was mortified down to my toes. Wrote him a check for $50. Apologies accepted, but took the key back to his gate. Went to Dr. MRI of brain. Nothing ! Went to a shrink. Made progress but not on the chair thing. Can’t treat what can’t remember but other issues got better. Stopped after a year.Golfer moved. Two years almost to the day, KNOCK KNOCK. Another video, another chair but they could tell it wasn’t me, besides I was 700 miles away. If he hadn’t driven to my home, I’d never known. I cried. Hugged him for driving all that way.
Early prevention and detection is incredibly crucial in reducing mortality rates. Mental illness is an early onset disease, with most people having it in their early years of their life. We are on the new frontier for innovations with mental illnesses, but there are still basic things that we are doing that are holding us back. Chemical imbalances in the brain are a big cause for many of these illnesses, so it is time to start treating this like diseases of the brain. That does not mean that it is not multifactorial, and we still have so much to learn about the brain. In order to understand mental disorders we must understand the complexity of the brain. With new medical technology on the rise and being developed rapidly, we are learning new things every day. There are predictable patterns in the brain that contribute to these disorders so the more we understand them, the better we can help the patient. I think that continuing research on the brain is crucial to helping patients with mental illnesses to give them the best care they can get. I agree with Doctor Insel when he says that we should treat these as brain disorders. If we treat these as behavioral disorders, we can still get the big picture but still miss the small details that matter the most. We are on the brink to having the tools to predict these brain changes before the symptoms start. Therefore if we can see those brain changes, we can predict the symptoms and take care of them before they even start or at the very least be proactive with a treatment plan. We study the effects of various drugs on the parts of the brain where these diseases affect the most, therefore it should be classified as a brain disorder. Even before that we can research the brain to find the sources of these diseases so we can follow the patterns. When we can successfully predict these chemical/functional patterns in the brain, we can detect a disease as early as possible. When we can do early detection we can prevent a disease from spiraling out of control or taking over and we can treat that disease and come up with a plan as soon as possible. That is not only incredibly beneficial for the patient but the physician as well because you can avoid a whole bunch of future issues.
He's s a such humble man devoting his life to understand brain disorders.
This is merely the second "analysis" of mental illness that I've ever encountered of yours, and overall, I immensely respect your efforts to not only understand but elevate the entire spectrum, from treatment approach and resource accessibility to addressing cultural factors that influence utilization. People like you and undertakings like this are precisely why I was personally drawn to study, with he hopes of one day entering and ultimately transforming (for the better) our healthcare system. I'm just curious about/puzzled by one aspect; it seems you "dance around" specifically acknowledging that mental health is a social disease.
I have yet to read your book, though I hope to, and I absolutely understand that such claims can carry ramifications, hence your delicate approach (to my knowledge) thusfar. Again, it mostly intrigues me and I'd love/prefer to receive a first-hand elaboration on the subject, rather than be resigned to speculation.
Are all of the statistics stated herein only relevant for the United States of America? Thank you so much for this video! It’s full of Hope for such a sensitive topic that’s often difficult to discuss. My thoughts and prayers are with anyone who suffers from or has been impacted by mental or behavioral disorders.
Refunds, because we all love dealing with them-important info
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A " new understanding " is a nice way of saying they were wrong .
The issue i have with this is what about cptsd ptsd dissociative disorders etc. If you focus soley on biology and genetics what do you do about those?
this is wonderful and makes me tear up a bit
Mostly in agreement with your statement there.
However to 1) No, because WE cannot predict it - giving US the illusion this is important and worthwhile. Our actions will NOT be the same after this conversation is over, because it changes us slightly, even if by using energy/becoming more agitated/awake.
Cogently put. Ideally we could adopt a pluralistic approach that tempers neurological research with insight from the social sciences. Instead of stigmatizing and attempting to alter individuals who are diagnosably "weird," we can learn to legitimize their valuable perspective of the human experience. On the other hand, we can strive to aid and understand those whose severe condition isolates them from communication or drives them to cause undue harm to themselves and others.
"The polarization of brain medicine into two specialties may in part reflect an intuitive Cartesian dualism in human psychology. Children intuitively accept that certain mental functions, such as perception, planning, or mental calculation, require the brain; however, other functions, such as emotion, desire, belief, or pretense, are independent of the physical organ.
Related studies have demonstrated that even adults struggle to acquire scientific knowledge that clashes with the innate intuitions of childhood, and tend to revert to intuition for unfamiliar scenarios. Thus, one intriguing possibility is that early failures to identify structural lesions for certain brain disorders, coupled with an innate human reluctance to ascribe certain mental functions to the organ itself, allowed two separate disciplines of brain medicine to emerge.
This resulted in the current situation: a Cartesian divide between neurology, for disorders of the ‘wires’, and psychiatry, for disorders of the ‘psyche’."
- Trends in Cognitive Sciences, February 2016
I believe the current practices are quite simplistic, if I am not mistaken... More molecular ingredients within great music and expressive movement ought to be used for the betterment of mental health.
Does anyone know where he is getting these statistics from? I want to use this for a paper I'm writing but I need to cite him.
You can cite and quote him directly as he is a recognized expert in the field.
Precisely, glad I'm not the only one seeing it that way.
Great!
I know this was posted a long time ago... but I've been saying for years that the way to overcome brain disorders is to start testing and diagnosing children as early as humanly possible. I've been told that it's unethical to diagnose children, and I staunchly disagree. If you diagnose them with something they actually have, like bipolar disorder or schizophrenia or other disorders, it will give them the chance at a normal life. But we don't, we diagnose them with disorders that are allowed to give kids, like Autism and ADHD, giving these kids medication that might actually make their conditions more severe and more catastrophic. We need to learn how to accurately diagnose children, so they don't have to wait until they are 18 or older to start getting a better range of diagnosis options. Limiting a child's diagnosis is limited the possibilities of healthy outcomes.
Enjoyed this talk.
I always thought that behaviour is mostly dépendent on peer pressures, surroundings expectations, routines and customs, forced patterns, etc. In plain words: OUTSIDE causes. Brain disorders, mental handicaps, intellect underdevelopment were very rarely related to INTENTIONAL behaviour.
No. There is a vast amount of evidence now that much of our behaviour originates from the inside out. Or it is a complex feedback process between inside and outside.
Many children start developing symptoms before social pressures begin to have any impact on them. Many adolescents and young adults raised in healthy environments develop brain disorders anyway.
told a fraction of the whole story. brain disorders can't be clubbed into diseases. they are totally different things.
The problem with SSRI's and suicide is that the drugs bring back energy levels faster than emotive levels. People still feel terrible, but have the energy to end their life. That is why close monitoring in the early days of taking the meds is vital. Not taking the meds is worse.
Well, I'm a student, so it's not a scientific statement, but generally speaking brain has an ability to compensate the loss of function in whatever damaged structure, because healthy neurons in different areas can do the job of those malfunctioning while needed. It's all about the connections between them. And I guess, that during this 10 years brain can adjust the way I described it, but afterwards the steadily increasing use of compensation mechanisms exceeds it's range and the symptoms occur.
what about my friend kieth who fell when he was 6 and hit his head and never grew up mentally, he went to church every week, what did he do to jesus?
Ok, good point. Not every function can be managed by every part of the brain. What I had in mind were the functions of neocortex' (which we commonly call just cortex) neurons, hippocampus is made of archicortex (different type). For example people that suffered a stroke can lose some of their limb function and regain it by rehabilitation. And they do by "forcing" other neurons to create new connections, because the old neurons died.
The laws of physics define the relationship cause/effect of everything. "free will" and (apparently) random events can be explained/predicted by the laws of physics. It's possible to predict dice rolls based on physical equations if we have all the information about the system: gravitational field, air friction, initial velocity and angular velocity, etc. Of course, it is almost impossible for a human to have all this information in advance so we prefer to say dice rolls are random events.
Great talk, but not sure I support the premise. The loss of grey matter/cortical function is not evident in many schizophrenics with continuing intellectual reserve/capacity. Either that, or we need to differentiate the brain condition of schizophrenia into those with intellectual decay and those without.
It's disorderly when it cripples you and significantly impact your way of life. There's normal reaction and then there's depression. Depression sucks all joy from your life no matter how happy you should be. The very fact that you seem unable to see any positives in the world and life would qualify you as "depressed" coupled with other people.
I'm depressed too but at least I realize I have a problem and I need help.
THANKS TED
I wish he was right... Hopefully it gets better, but right now its a crises level issue
enjoyed your lecture....
Besides brain needs some time to answer a lesion. Compensation (creating new synapses) is a slow process and scooping a part of the brain is a sudden event, which brings sudden effects. When we talk about mental illnesses like schizophrenia - they progress gradually, so the brain can deal with it for some time, but still the degeneration is faster and that's why one day we observe pathological behavior changes.
You didn't understand me, I guess. It's like urinating on an electric fence, getting shocked, so you're cutting this particular part through with scissors just to not get shocked again and the whole fence loses its ability to keep the animals in the fenced area. You would then need to find a way to fix this broken wire, which is nearly impossible if you don't want to let the current flow a way it shouldn't flow at all. Same goes for the brain, yet it's a lot more difficult to handle.
Love this talk!
What does fix mean? and who determines what normal is?
*physics equations
Since the cells, molecules and respective reactions in our brain must respect the determinism imposed by the laws of physics, so our actions or "free will", which are just a product of these reactions.
The advantage of the illusion of "free will", ie., deciding what is best based on our past experiences and intelligence, compared to a dedicated architecture that only serves one purpose is the fact it can learn and adapt to different scenarios.
Check out his book, “Healing: Our path from mental illness to mental health”.
You know there are certain areas responsible for certain behaviors and emotions. If you want to limit one of the behaviors, you will definitely limit more than just this particular one as it is part of a wire. It will change your personality dramatically and I doubt people know what will happen with them, if they get one of their brain diseases cured. S/he might not be the same person anymore (in a negative way) so you have to be really careful and think through such procedure.
Yes but as we grow older the environment and social aspects shape our brain and it's wiring. That's why babies are born normal, then as they grow older all sorts of dangers are doomed to affect a human being, that's unescapable
Thank you! Was going to say..
The trick is to remove all abitrary barriers that are holding back your career. Then you will be amazed at the opportunities that come your way.
Yes and no. To further the analogy; understanding how a transistor works is a huge step away from fully understanding the design of a modern processor.
Not taking them is worse? Unless you develop suicidal thoughts and behaviors. And while they are most dangerous going on AND coming off, the danger is always present. No physician would prescribe a drug that might cause strokes to a person at risk for strokes. To give sad people a drug with a possible side effect of suicidality is the very definition of "malpractice."
wrong word. more like Biological Signal Processing. A simulation implies pre programmed parameters, we are constantly rewriting and re-configuring the software as its running.
Hmm. Made a little mistake back there. Free-will is an illusion, not consciousness. Consciousness is related with cognition. It is what helps us get information/awareness from the outside world and from ourselves, which is then used to take the right decisions. It is like a very sophisticated sensor and one of the most important tools for our survival.
I have ADHD, pretty severe, but I manage it and am functional, happy, and successful. Not sure if it should be lumped with schizophrenia, etc. Just saying.
"Diagnostic and Statistical Manual of Mental Disorders".
It's the standard (APA?) manual of psychiatry that provides the formal description of each mental disorder and their criteria. It listed homosexuality as a disorder until its seventh printing in '74. On a casual reading, well over half, if not most of the population would have at least one disorder of one kind or another.
I've also read it described the 'billing manual'.
Wise words!
Well when you introduce the social element or environment than the computer model doesn't work. Our mental issues are more complex - social, economic and political factors influence every single part of our lives. They are linked to our conditions, living standards and health.
I would argue against this, though not definitively, since behavioural problems are only extant upon societal perspectives. After all, "depression" sans clinical depression is purely perspective. Those that choose to be cynical are often labeled in such a way. "Everything sucks...people aren't nice...etc."
To establish that "every" psychological condition (the word psycho has roots in thought function) is uniformly categorize everything mental behaviour as non-normal, which isn't true.
Not al parts of the brain function for the same thing. Te parts that keep the personality and behavior intact can be unchanged, and at that same moment the motor o sensory areas can be affected. You can find some changes early in the brain that not necessarily affect the persons "mind" but they can help to predict future psychiatric manifestations.
Did Judy Rappaport really discover the changes occured in the human brains due to schizophrenia or actually rather the damage caused by the drugs used to treat schizophrenia in the brains of these unfortunate people? That's the most important question that awaits a satisfactory answer. If it's the latter rather than the former then needless to say that this creates of an issue of liabilities.
Going back to the scientific law that from nothing comes nothing, applying that to moods emotions and memory it's easier to see that much of who we are and what we feel has a biological foundation within our organic brain as an organ. I know a gentleman that, other than being an alcoholic was a loving functional "normal" human male. Drs gave him vivitrol and he slipped fast into DPD and depression w anxiety. How does a chemical cause a change in mood and emotion if they're just psych disorders?
The brain is a necessary but not sufficient cause for the mind. Of course studying the brain and its obscure mechanics will reveal much about our objective selves. But our objective selves are mostly boring to us. It's our subjective stance towards the world that gives such force to dis-ease with the world, whether it be a dis-ease with the common forms of logic, dis-ease with social norms, dis-ease with one's self. Yes, you feel shitty definitively. But should you?
How about a new legal and health care framework?
Schizophrenia is a thinking disorder. A thought disorder. And if u don't believe me, take the word of Stephen Stahl. I am a psychiatrist at Patton State Hospital. I work with Stephen Stahl . . . in so far as I go to his lectures on didactics days.
I hate it when people use the phrase "a fraction of" because every number is a fraction of any other number, no matter how much smaller or larger one is than the other.
People often say this at first. They need a little prodding to think again. Really try hard to think if there is any abitrary barrier in your life that is road block to employment. Sometimes it's the most obvious thing in the world.
For brain disorders, behavioral changes are the last thing to change. WOW
I use the word in its most literal and general sense here, but I'm referring to the claim that the brain is not sufficient cause for the mind and, more specifically, the seemingly arbitrary separation of the objective and subjective self.
So we are arriving a consensus here. Our actions are the product of the structure and chemical reactions that happen in our brain, which in turn, can be fully predicted by the laws of physics. A system where every chain of events can be fully predicted by some laws or rules is a deterministic system.
Ok, but that's another thing. I am talking about human intelligence, which means the ability of a person to solve a problem in a certain period of time. That's a personal trait.
Actually, there can be medical issues with the brain in depressed people. It can be a combination of factors. Low serotonin levels, low levels of neurotransmitters, over active sympathetic nervous system. The problem is that there are too many factors. You can't directly measure brain chemistry easily, and people's lives will affect how they feel, so you can't easily say this will be the quick fix. There are depressed people who are well off.
he means that maybe not the effect is wrong, but the world we like in.
There is a limitation on human knowledge in almost every field. In Maths, there are several equations that are unsolvable. About the "brains can't understand brains", I also don't agree. A brain might be too complex for a human to understand it on his own, but that's why in science we tend to separate problems into different parts or subproblems. Each part is then solved by a different researcher.
you cant separate light from dark same is the body and disease..treatment to it is universality of vision.. by being original and versatile..
Dysthymia, " bad state of mind ", sometimes also called neurotic depression, dysthymic disorder or chronic depression, is a mood disorder, consisting of the same cognitive & physical problems as in depression, with less severe, but longer - lasting symptoms. Replacement for the term " depressive personality " in the late 1970's. IRA P.S. So, he didn't catch that, what's the worst than depression itself. I was there & know for sure. I was on electroshocks for a month ( 3 times a week ), didn't help a thing, was on Zoloft ( antidepressant ) didn't help at all, on the contrary weight gain ( 20 - 25 kilos ) which was more depressive. Then, I put my medicine in the garbage, bought a bike, sat on & went to the Center for Rehab every day. My psychiatrist ( good one, run this Center ), but didn't realized that's dysthymia, but hey, who I'm to tell her ( I told her just about medicine in garbage, after 2 months ). Then, she said, it's OK. But, when I saw something like this video, it's on my mind, maybe soon. P.P.S. My condition was unchanged for 3 years. 2 years I wasn't working at all. Now, I work for more than 6 months & if want some pause I just go to the Center for 2 - 3 days & go on with my life. Also, have a dog & a cat, go to walk, pet them ... It's in short, just like that. ;)
I cant click the like button hard enough. times like these, I miss the old youtube system of _ out of 5 stars
Evolution is using our consciousness and creativity to evolve evolution. In other words our next great leap in evolutionary advancement is based in our technology as defined by our curiosity and intelligence. The purpose of our intelligence is to make the next step.
Well not exactly a computer, an interactive information processor of some sort though.
Even if you knew, how they're wired together, you don't know what happens if you cut one of the wires. That makes the brain complex.
Ideally, yes, but one exception: drugs (PLUS talk therapy) to prevent severe disruption (eg, losing one's job or, worse, suicide). Drugs don't cure anything, but they can make room for the other, harder stuff.
Pity that here, in the UK, and in New Zealand, there is no public funding for talk therapy. If you don't have cash, you're doomed to drugs (legal or otherwise) and your own devices. Which, if were adequate, would mean you'd not be in that position to begin with.
Our universe is deterministic, and 'free-will' is an illusion.
Great talk. It nice to see Mental health being talked about in a way that doesn't make it the person's fault that they are ill. I can see a time when an MRI or similar scan of the brain will be part of the annual checkup.
In regards to religion, there is no statistical difference in mental health inside or outside religion.
He doesn't mention medication, but that is the likeliest intervention. Apart what the anti-pharma conspiracy folks say, the drug interventions are getting better.
Not according to Stuart Hameroff. I've only seen his videos recently but spent some time trying to find out if it's a hoax or not. So far nothing has turned up.
I would assume that the overall deaths would go down from decades ago. the number might not be totally accurate
dsm?
Ya... its about the economics of the situation, not the most healthy. *sigh. Sad world we live in when a good number of psychotropic drugs have side effects that do as much or more damage then disease itself. That is when early intervention with talk therapy may be the best way forward. But... some companies would lose out - not economical...
But it might be disorderly to see a peaceful neighborhood as an organization out to get you, to feel unbearable anxiety from being around people, and to be controlled by addictions and ruin your life.
Well this conversation won't lead us to anywhere. You believe in mind and conscious awareness as something ethereal that can't be explained through the basic reactions that happen in your brain. I don't. However, recent studies are starting to show that the brain is just like any other machine, but a bit more sophisticated. For me, believing that the brain is a magical box that can't be explained through physics is almost like believing in the God of the gaps.
Here comes the free will vs determinism debate.
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If you want to particularize awareness to just awareness of ourselves or our "mind", thinks don't change that much in your favor. Machines aren't only aware about the outside World but also about their own status.
It seems quite silly to compare the awareness of machines to the awareness of human beings because one is really basic (maybe things will change in a near future) while the other is very sophisticated.
Nice to see a sane comment on RUclips (no sarcasm intended).
Criticizing reductionism - and projecting it onto psychosocial models - as a prelude to arguing for a ‘new’ brand of biological reductionism. Clever.
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Many of todays diseases in our young has to do with what society asks of them. You have to be skinny, you have to have this education, you have to have sex, you have to succedd, you have to... This amount of presure creates most of the problem or inflate the ones who happear late in life. We have to start saying that it's ok, if you're a little big, it's ok, not to be #1 in class, it's ok, to be #2 in sports, it's ok if you don't have sex. Life is already the big challenge we all have to face.
That's why people are working on things like this: ruclips.net/video/ol0RuS1Y2Gs/видео.html
It is all a matter of percentages. The percentage of people who commit suicide because of meds is smaller than the percentage of people who would commit suicide if no one went on meds. It is the same with all medication and even surgery. You play the odds and hope that you don't lose.
At 7:06 look at the brain pic at the left hand side and tell me what you see.
The Diagnostic and Statistical Manual of Mental Disorders
Look, we (deterministic people in general) have strong arguments against the existence of free-will and why it is an illusion. You might not agree with all of them, but that's ok. However, calling us ignorant would be the same thing or worst than (because determinism is not an actual belief) calling an atheist ignorant. Ignorance means that you're clueless about a topic, not that you're wrong.
Also, intelligence is a personal trait just like personality.