1 00:00:00,000 --> 00:00:03,490 The following content is provided by MIT OpenCourseWare 2 00:00:03,490 --> 00:00:05,984 under a Creative Commons license. 3 00:00:05,984 --> 00:00:09,225 Additional information about our license and MIT 4 00:00:09,225 --> 00:00:14,462 OpenCourseWare in general, is available at ocw.mit.edu. 5 00:00:14,462 --> 00:00:15,670 PROFESSOR: 6 00:00:15,670 --> 00:00:19,500 Good afternoon. 7 00:00:26,690 --> 00:00:30,690 Now that all you turkeys are back from Thanksgiving. 8 00:00:30,690 --> 00:00:31,550 I shouldn't have said that. 9 00:00:31,550 --> 00:00:34,300 How was Thanksgiving? 10 00:00:34,300 --> 00:00:37,580 Good. 11 00:00:37,580 --> 00:00:41,230 As I'm wrapping up the sleep and dreams thing, I should 12 00:00:41,230 --> 00:00:42,580 look around and see whether people look 13 00:00:42,580 --> 00:00:45,630 like they're awake. 14 00:00:45,630 --> 00:00:48,940 How many people discharged a substantial amount of their 15 00:00:48,940 --> 00:00:53,050 sleep debt over the last few days? 16 00:00:53,050 --> 00:00:53,490 Good. 17 00:00:53,490 --> 00:00:58,880 The rest of you are still rolling around. 18 00:00:58,880 --> 00:01:00,720 I am going -- 19 00:01:00,720 --> 00:01:03,580 I'm going, but I'm coming back. 20 00:01:07,980 --> 00:01:13,450 I think I'm going to depart a little from the organization 21 00:01:13,450 --> 00:01:17,650 of the lecture that's on the lecture notes, and I will 22 00:01:17,650 --> 00:01:22,330 trust on your talents to figure out where -- 23 00:01:22,330 --> 00:01:24,725 I might even point out where I've gone to -- but I'm going 24 00:01:24,725 --> 00:01:29,360 to re-organize things a bit, because it occurred to me that 25 00:01:29,360 --> 00:01:41,660 I can organize at least the first part of the lecture in 26 00:01:41,660 --> 00:01:44,910 the form of a sort of a summary statement about Freud, 27 00:01:44,910 --> 00:01:48,370 who I'm going to abandon fairly shortly here. 28 00:01:48,370 --> 00:01:53,350 And I can work two examples -- one of them about dreams and 29 00:01:53,350 --> 00:02:02,050 one of them about abnormal psych, where Freud or Freud's 30 00:02:02,050 --> 00:02:04,790 followers are wrong in both cases. 31 00:02:04,790 --> 00:02:07,590 But in one case, we can do this business that I've been 32 00:02:07,590 --> 00:02:10,970 doing for the last few lectures of saying look, we 33 00:02:10,970 --> 00:02:13,820 can salvage something important out of Freud's 34 00:02:13,820 --> 00:02:18,080 ideas, and in the other case, which will turn out to be the 35 00:02:18,080 --> 00:02:21,860 abnormal psych case, we'll say that, in this case, Freud's 36 00:02:21,860 --> 00:02:23,280 followers are simply wrong. 37 00:02:23,280 --> 00:02:31,000 And have been superceded by later work. 38 00:02:31,000 --> 00:02:37,470 So let me start by picking up in sleep and dreamland talking 39 00:02:37,470 --> 00:02:42,340 about dreams. 40 00:02:42,340 --> 00:02:45,220 Well, I won't ask if anybody had any good dreams over the 41 00:02:45,220 --> 00:02:49,820 course of their catching up on sleep over Thanksgiving. 42 00:02:52,770 --> 00:02:53,650 I know what I'll ask. 43 00:02:53,650 --> 00:02:56,600 I will ask how many people did sleep and dream stuff in 44 00:02:56,600 --> 00:02:58,810 recitation? 45 00:02:58,810 --> 00:02:59,440 Not many. 46 00:02:59,440 --> 00:02:59,870 OK. 47 00:02:59,870 --> 00:03:02,170 How many people can remember? 48 00:03:02,170 --> 00:03:03,680 Not many. 49 00:03:03,680 --> 00:03:05,350 Oh, good, good, that's encouraging. 50 00:03:08,720 --> 00:03:14,000 All right, that allows me to ask one of the things that 51 00:03:14,000 --> 00:03:17,060 tends to surprise people sometimes is that there's a 52 00:03:17,060 --> 00:03:21,970 fair degree of commonality in at least some of the dreams 53 00:03:21,970 --> 00:03:23,620 that people have. 54 00:03:23,620 --> 00:03:28,090 They seem like such idiosyncratic personalized 55 00:03:28,090 --> 00:03:31,140 stories, that it's surprising to discover that some of the 56 00:03:31,140 --> 00:03:37,050 plot lines go across individuals. 57 00:03:37,050 --> 00:03:38,620 It's a weird state, right. 58 00:03:38,620 --> 00:03:41,085 I mean it's clear there are weird aspects of 59 00:03:41,085 --> 00:03:43,240 the sleeping state. 60 00:03:43,240 --> 00:03:49,890 The normal laws of physics seem to be suspendable -- 61 00:03:49,890 --> 00:03:54,350 you can fly sometimes, do things like that. 62 00:03:54,350 --> 00:03:56,620 You can fall for hours and hours and 63 00:03:56,620 --> 00:04:00,160 never hit the ground. 64 00:04:00,160 --> 00:04:04,100 The normal laws of reality testing or the awake state of 65 00:04:04,100 --> 00:04:07,850 reality testing seems to be up, because you can fly and it 66 00:04:07,850 --> 00:04:09,220 doesn't strike you as weird. 67 00:04:09,220 --> 00:04:11,950 When you wake up you say that was weird, but if you think 68 00:04:11,950 --> 00:04:15,170 about it, while you were flying around or doing 69 00:04:15,170 --> 00:04:17,380 whatever other video game kind of thing you were doing in 70 00:04:17,380 --> 00:04:20,510 your dreams, yeah, that was just the way things were. 71 00:04:20,510 --> 00:04:24,450 If you have the same problem with reality testing, when 72 00:04:24,450 --> 00:04:32,230 you're awake you end up in the part of the course on abnormal 73 00:04:32,230 --> 00:04:33,480 psych that we'll get to in a minute. 74 00:04:33,480 --> 00:04:38,550 It's diagnostic of having a variety of forms of mental 75 00:04:38,550 --> 00:04:43,840 illness if you cannot tell the difference between dream state 76 00:04:43,840 --> 00:04:46,400 and awake state, that's not healthy. 77 00:04:46,400 --> 00:04:49,460 When you're dreaming you can't tell, but you're not 78 00:04:49,460 --> 00:04:50,800 clinically insane. 79 00:04:55,590 --> 00:04:59,120 There was one other sense in which it was different from 80 00:04:59,120 --> 00:05:02,110 the awake state that I wanted to make sure that I mentioned, 81 00:05:02,110 --> 00:05:04,670 but now I don't remember what it is. 82 00:05:04,670 --> 00:05:10,040 Oh, yes, just to point out that the transfer from 83 00:05:10,040 --> 00:05:12,350 experience to episodic memory does not 84 00:05:12,350 --> 00:05:14,460 work well for dreaming. 85 00:05:14,460 --> 00:05:17,760 This is why you forget your dreams so readily is that you 86 00:05:17,760 --> 00:05:20,080 know when you wake up that dream is just sort of there 87 00:05:20,080 --> 00:05:22,870 sitting around in some sort of short-term buffer, and if you 88 00:05:22,870 --> 00:05:25,930 don't do something like write it down or repeat it yourself 89 00:05:25,930 --> 00:05:31,420 you discover that those normal mechanisms that take your 90 00:05:31,420 --> 00:05:34,580 experiences and transfer them into some sort of long-term 91 00:05:34,580 --> 00:05:39,670 memory, they're just not working. 92 00:05:39,670 --> 00:05:44,630 So, that said, let's see if we can conjure up--yup? 93 00:05:44,630 --> 00:05:47,315 AUDIENCE: Especially when people say they 94 00:05:47,315 --> 00:05:49,770 know they're dreaming. 95 00:05:49,770 --> 00:05:55,490 PROFESSOR: All the stuff about different states of sleep and 96 00:05:55,490 --> 00:06:00,310 awakeness should be seen as not absolutely categorical. 97 00:06:00,310 --> 00:06:03,470 So there are these borderline states -- the sort of jargony 98 00:06:03,470 --> 00:06:08,370 term is liminal states where you're in between 99 00:06:08,370 --> 00:06:12,490 being asleep and awake. 100 00:06:12,490 --> 00:06:14,760 In the course of a normal night's sleep, you'd probably 101 00:06:14,760 --> 00:06:17,570 wake up out of REM sleep and different bits of you are 102 00:06:17,570 --> 00:06:21,310 coming online at different times, and you may be aware, 103 00:06:21,310 --> 00:06:23,750 still asleep, but I'm not quite asleep. 104 00:06:23,750 --> 00:06:26,380 How many people have had the experience of saying I'm 105 00:06:26,380 --> 00:06:32,040 waking up here and I want to know how the story comes out? 106 00:06:32,040 --> 00:06:34,250 Yeah, yeah. 107 00:06:34,250 --> 00:06:36,440 It's always cause you're waking up at the good parts. 108 00:06:36,440 --> 00:06:39,120 Or how many of you have the other experience, which I 109 00:06:39,120 --> 00:06:42,470 think maybe what you're getting to which is I'm asleep 110 00:06:42,470 --> 00:06:45,790 here and this dream is not a good dream and it's time to 111 00:06:45,790 --> 00:06:47,460 wake up out of this dream. 112 00:06:47,460 --> 00:06:49,700 I'm going to wake myself up. 113 00:06:49,700 --> 00:06:50,770 Fewer. 114 00:06:50,770 --> 00:06:55,230 Now, are there people here who are experts at what's known as 115 00:06:55,230 --> 00:06:56,370 lucid dreaming? 116 00:06:56,370 --> 00:07:00,090 Lucid dreaming is a sort of a halfway state where people 117 00:07:00,090 --> 00:07:09,060 claim to be able to control the plot line of their dreams. 118 00:07:09,060 --> 00:07:12,280 There are books in the bookstore that will both claim 119 00:07:12,280 --> 00:07:14,870 that they can train you to do this, and maybe you can, I 120 00:07:14,870 --> 00:07:15,330 don't know. 121 00:07:15,330 --> 00:07:16,670 It sounds good. 122 00:07:16,670 --> 00:07:20,470 I mean all those people who said, oh man, I woke up and I 123 00:07:20,470 --> 00:07:22,740 wanted to hear out the thing came out. 124 00:07:22,740 --> 00:07:25,190 If you'd go and train yourself to be a lucid dreamer maybe 125 00:07:25,190 --> 00:07:27,740 you can go and keep it going. 126 00:07:30,530 --> 00:07:34,190 I have these extremely frustrating dreams that I'm 127 00:07:34,190 --> 00:07:39,570 sure a good analyst would have a field day with, but I choose 128 00:07:39,570 --> 00:07:42,780 to think that they are basically nice, simple, 129 00:07:42,780 --> 00:07:45,520 transparent dreams. 130 00:07:45,520 --> 00:07:49,950 I like to ski, I dream about skiing, but in my dreams I 131 00:07:49,950 --> 00:07:53,910 spend a great deal of time getting up the mountain and I 132 00:07:53,910 --> 00:07:57,040 never get to ski. 133 00:07:57,040 --> 00:08:01,050 I get to the top and the snow melts or something like that. 134 00:08:01,050 --> 00:08:04,030 No, I don't want to hear your interpretation of what this is 135 00:08:04,030 --> 00:08:05,690 all really about or anything -- 136 00:08:05,690 --> 00:08:09,640 I can do that, too, and make up all those good stories. 137 00:08:09,640 --> 00:08:13,860 But in any case, I sometimes think I'm going to get one of 138 00:08:13,860 --> 00:08:17,110 these lucid dreaming books because dammit, before I die 139 00:08:17,110 --> 00:08:20,110 I'm going to get to ski down that mountain. 140 00:08:20,110 --> 00:08:22,720 The conditions are always a great, look a lot better than 141 00:08:22,720 --> 00:08:25,150 they do in the northeast when you actually go skiing. 142 00:08:29,040 --> 00:08:35,230 So, let us consider a couple of plot lines. 143 00:08:35,230 --> 00:08:37,760 Some of the things, there's a sort of element that show up 144 00:08:37,760 --> 00:08:38,500 in people's dreams. 145 00:08:38,500 --> 00:08:42,260 How many people have had falling dreams? 146 00:08:42,260 --> 00:08:45,660 How how many people have ever hit the ground? 147 00:08:45,660 --> 00:08:48,200 Usually you don't hit the ground, right -- you wake up 148 00:08:48,200 --> 00:08:50,240 just before you hit the ground. 149 00:08:50,240 --> 00:08:55,510 Oh, there's a whole raft of sort of pseudo-scientific 150 00:08:55,510 --> 00:08:57,460 nonsense about--. 151 00:08:57,460 --> 00:09:00,650 How many people have ever been killed in their dreams? 152 00:09:00,650 --> 00:09:01,740 A fair number. 153 00:09:01,740 --> 00:09:04,410 Well, that's presumably a counter examples to the theory 154 00:09:04,410 --> 00:09:08,390 that if you die you in your dreams you die for real. 155 00:09:08,390 --> 00:09:09,960 It's one of those great assertions. 156 00:09:09,960 --> 00:09:12,590 How would you know that was true? 157 00:09:12,590 --> 00:09:13,790 Right. 158 00:09:13,790 --> 00:09:15,000 What were your dreaming about? 159 00:09:15,000 --> 00:09:16,410 I don't know, I'm dead. 160 00:09:18,990 --> 00:09:23,780 But typically, typically people report that you wake up 161 00:09:23,780 --> 00:09:29,890 just before you get killed by the whatever it is that's 162 00:09:29,890 --> 00:09:30,610 going to kill you. 163 00:09:30,610 --> 00:09:33,020 But the plot lines get more elaborate than that. 164 00:09:33,020 --> 00:09:36,860 How many people have had dreams -- this is typically a 165 00:09:36,860 --> 00:09:41,860 dream of grade school, the grade school era where you 166 00:09:41,860 --> 00:09:45,970 show up in school inappropriately dressed in 167 00:09:45,970 --> 00:09:47,370 some fashion. 168 00:09:47,370 --> 00:09:53,680 All right, anybody care to describe one of those? 169 00:09:53,680 --> 00:09:56,600 Sorry, I heard a--. 170 00:09:56,600 --> 00:09:57,930 Somebody wave a hand if you want to 171 00:09:57,930 --> 00:09:59,470 actually tell us the -- 172 00:09:59,470 --> 00:10:00,930 you don't have to tell us your dream. 173 00:10:00,930 --> 00:10:02,670 It's fine. 174 00:10:02,670 --> 00:10:04,240 Nobody wants to-- 175 00:10:04,240 --> 00:10:06,760 How inappropriate was it? 176 00:10:06,760 --> 00:10:09,540 I mean it doesn't get much more inappropriate than I was 177 00:10:09,540 --> 00:10:11,650 buck naked, I suppose, which is the stand-- 178 00:10:11,650 --> 00:10:13,640 My version of it happened to be that -- 179 00:10:13,640 --> 00:10:16,690 I still vividly remember what must have been a kindergarten 180 00:10:16,690 --> 00:10:20,580 dream because I ended up in my kindergarten classroom of 181 00:10:20,580 --> 00:10:23,950 driving down the street from my house to my school in my 182 00:10:23,950 --> 00:10:29,520 crib, which presumably, by the time I was in kindergarten I 183 00:10:29,520 --> 00:10:32,760 was long out, and I ended up in school in 184 00:10:32,760 --> 00:10:36,280 my crib in my pj's. 185 00:10:36,280 --> 00:10:37,990 All right, so you don't have to tell us 186 00:10:37,990 --> 00:10:41,620 what you weren't wearing. 187 00:10:41,620 --> 00:10:47,710 There is a characteristic of this dream which is that once 188 00:10:47,710 --> 00:10:53,250 you get there, once you end up in class, what happens? 189 00:10:53,250 --> 00:10:55,900 Anybody got any intuition about the 190 00:10:55,900 --> 00:10:57,450 common plot line here? 191 00:11:03,260 --> 00:11:04,860 AUDIENCE: People point and laugh. 192 00:11:04,860 --> 00:11:07,000 PROFESSOR: Oh, people point and laugh. 193 00:11:07,000 --> 00:11:08,250 Do you believe it? 194 00:11:12,520 --> 00:11:14,110 Where's the inappropriately dressed crowd? 195 00:11:14,110 --> 00:11:15,280 Raise your hand if you were in the 196 00:11:15,280 --> 00:11:16,520 inappropriately dressed class. 197 00:11:16,520 --> 00:11:19,450 It's dropped, the numbers are dropping. 198 00:11:19,450 --> 00:11:21,990 OK, not inappropriately dressed right now, this is in 199 00:11:21,990 --> 00:11:22,630 your dreams. 200 00:11:22,630 --> 00:11:23,860 Inappropriately dressed. 201 00:11:23,860 --> 00:11:26,760 How many people agreed that what happened was they pointed 202 00:11:26,760 --> 00:11:28,630 and laughed? 203 00:11:28,630 --> 00:11:31,850 No, it's only in Russia. 204 00:11:31,850 --> 00:11:34,970 The characteristic form of this dream 205 00:11:34,970 --> 00:11:37,950 is that nobody notices. 206 00:11:37,950 --> 00:11:40,140 I mean that's not to say that you're weird for 207 00:11:40,140 --> 00:11:40,950 having the variant -- 208 00:11:40,950 --> 00:11:42,770 either that or you're making it up, I don't know. 209 00:11:42,770 --> 00:11:47,760 But that you would think, I would think if I showed up, if 210 00:11:47,760 --> 00:11:50,835 I drove my crib in here, everybody's going to point and 211 00:11:50,835 --> 00:11:52,380 they're going to laugh. 212 00:11:52,380 --> 00:11:53,440 But they don't. 213 00:11:53,440 --> 00:11:55,260 This is assumed to be some sort of a 214 00:11:55,260 --> 00:11:57,370 school anxiety dream. 215 00:11:57,370 --> 00:12:00,030 School anxiety dreams of some sort are quite common. 216 00:12:00,030 --> 00:12:02,770 They also morph as you get older. 217 00:12:02,770 --> 00:12:10,900 So, how many people have had a dream of the form where -- 218 00:12:10,900 --> 00:12:13,120 well, all right, let's rephrase this. 219 00:12:13,120 --> 00:12:15,430 We'll get the form out of you. 220 00:12:15,430 --> 00:12:18,770 Has anybody had what they would consider to be an exam 221 00:12:18,770 --> 00:12:22,090 anxiety dream? 222 00:12:22,090 --> 00:12:23,740 Anybody willing to describe that? 223 00:12:23,740 --> 00:12:26,360 I don't think they mostly involve being grossly 224 00:12:26,360 --> 00:12:28,530 inappropriately dressed. 225 00:12:28,530 --> 00:12:29,340 Yeah, OK. 226 00:12:29,340 --> 00:12:33,470 AUDIENCE: Before the psych mid-term I started [INAUDIBLE] 227 00:12:33,470 --> 00:12:37,530 psychological theories that don't actually exist. 228 00:12:37,530 --> 00:12:39,000 PROFESSOR: Psychological -- that's a 229 00:12:39,000 --> 00:12:42,770 novel form of the dream. 230 00:12:42,770 --> 00:12:43,640 Any good ones? 231 00:12:43,640 --> 00:12:45,580 Well, I won't ask you that. 232 00:12:45,580 --> 00:12:47,940 AUDIENCE: [INAUDIBLE]. 233 00:12:47,940 --> 00:12:51,080 AUDIENCE: OK, so one version is the I overslept and you 234 00:12:51,080 --> 00:12:53,300 missed the exam. 235 00:12:53,300 --> 00:12:55,240 Variance thereon? 236 00:12:55,240 --> 00:12:55,730 Yeah. 237 00:12:55,730 --> 00:12:58,806 AUDIENCE: I slept until about an hour before the exam. 238 00:12:58,806 --> 00:13:01,370 Woke up and didn't study [INAUDIBLE]. 239 00:13:01,370 --> 00:13:03,165 PROFESSOR: OK, I haven't studied enough for the exam, 240 00:13:03,165 --> 00:13:05,760 and perhaps because -- 241 00:13:05,760 --> 00:13:07,500 something is going to make it uh-oh. 242 00:13:07,500 --> 00:13:08,580 Yeah. 243 00:13:08,580 --> 00:13:10,850 They all pointed at you and laughed at you, right. 244 00:13:10,850 --> 00:13:13,785 AUDIENCE: The exam was in some other language. 245 00:13:13,785 --> 00:13:16,720 PROFESSOR: Yeah, well that happens. 246 00:13:16,720 --> 00:13:18,790 Yeah, the exam was in another language. 247 00:13:18,790 --> 00:13:23,840 How many people have had the version where you realize in 248 00:13:23,840 --> 00:13:27,360 your dream that you have an exam in this course and you've 249 00:13:27,360 --> 00:13:30,720 never been to the course? 250 00:13:30,720 --> 00:13:33,490 Medieval French -- 251 00:13:33,490 --> 00:13:35,780 I've got the Medieval French exam, I've never taken 252 00:13:35,780 --> 00:13:37,550 Medieval French. 253 00:13:37,550 --> 00:13:44,070 Or there are also versions of this where you get to the exam 254 00:13:44,070 --> 00:13:46,520 and you realize that there's something about the exam -- 255 00:13:46,520 --> 00:13:48,890 the different language thing is a good example of this 256 00:13:48,890 --> 00:13:50,970 where you look at the exam and you realize there's no way I'm 257 00:13:50,970 --> 00:13:52,230 passing this exam. 258 00:13:52,230 --> 00:13:55,500 Not because you didn't make up the right psych theory, but 259 00:13:55,500 --> 00:14:04,060 because I can't see the page in some weird way, or 260 00:14:04,060 --> 00:14:06,270 sometimes -- oh, somebody was telling me this morning of a 261 00:14:06,270 --> 00:14:09,980 great version where I realize I'm going to be late to the 262 00:14:09,980 --> 00:14:12,590 exam and it's down the other end of the infinite corridor, 263 00:14:12,590 --> 00:14:17,010 and the infinite corridor really is infinite. 264 00:14:17,010 --> 00:14:19,000 You're just going down it forever. 265 00:14:19,000 --> 00:14:21,650 Anyway, if you haven't had that dream 266 00:14:21,650 --> 00:14:25,380 don't worry, you will. 267 00:14:25,380 --> 00:14:28,450 When I was an undergrad at Princeton, somebody did a 268 00:14:28,450 --> 00:14:29,650 study of this. 269 00:14:29,650 --> 00:14:36,760 25% of the freshman class, 50% of the sophomore class, 75% of 270 00:14:36,760 --> 00:14:39,600 the junior class, and you can see where this goes. 271 00:14:39,600 --> 00:14:44,070 It's an extremely common college era type dream. 272 00:14:44,070 --> 00:14:45,970 And it doesn't get better after that. 273 00:14:45,970 --> 00:14:49,820 All that happens is that, if you stay in academia, is that 274 00:14:49,820 --> 00:14:51,690 the form moves. 275 00:14:51,690 --> 00:14:56,080 Any number of my colleagues have reported 276 00:14:56,080 --> 00:14:58,650 dreams where the -- 277 00:14:58,650 --> 00:15:03,490 this is the grad school version coming up here -- the 278 00:15:03,490 --> 00:15:06,890 dream where your thesis committee comes to you and 279 00:15:06,890 --> 00:15:10,820 says it was a big mistake, we're taking the PhD back, or 280 00:15:10,820 --> 00:15:13,950 that you have to take your oral exams over again -- the 281 00:15:13,950 --> 00:15:17,090 thing you crammed for months and then forgot all of it the 282 00:15:17,090 --> 00:15:19,780 next week, or something like that. 283 00:15:19,780 --> 00:15:23,710 And then if you end up in my position actually teaching, it 284 00:15:23,710 --> 00:15:30,140 just flips around the exam anxiety dream where you have 285 00:15:30,140 --> 00:15:33,370 dreams where you get up in front of the class and you 286 00:15:33,370 --> 00:15:36,560 realize Medieval French, I don't know anything about 287 00:15:36,560 --> 00:15:38,480 Medieval French, what do you mean I'm supposed to talk 288 00:15:38,480 --> 00:15:41,560 about Medieval French for the next hour? 289 00:15:41,560 --> 00:15:45,110 Now you may think that having anxiety dreams about not 290 00:15:45,110 --> 00:15:48,100 knowing what you're talking about is not that far from 291 00:15:48,100 --> 00:15:52,136 reality in the case of some of us who -- 292 00:15:52,136 --> 00:15:55,480 I won't say more about that anymore. 293 00:15:55,480 --> 00:15:58,850 But there are these sort of common themes 294 00:15:58,850 --> 00:16:00,040 that run through dreams. 295 00:16:00,040 --> 00:16:02,940 People have known this forever, and people have 296 00:16:02,940 --> 00:16:05,100 attempted to interpret dreams forever. 297 00:16:05,100 --> 00:16:09,320 So there's dream interpretation in the Bible. 298 00:16:09,320 --> 00:16:12,690 I'm sure in whatever culture you or your ancestors came 299 00:16:12,690 --> 00:16:17,260 from there's a canon of dream interpretation. 300 00:16:17,260 --> 00:16:23,640 Have I mentioned Lucretius's great book De Rerum Natura, On 301 00:16:23,640 --> 00:16:26,500 the Nature of Things? 302 00:16:26,500 --> 00:16:26,850 Yeah. 303 00:16:26,850 --> 00:16:27,280 Maybe. 304 00:16:27,280 --> 00:16:29,600 Some people think so, some people don't think so. 305 00:16:29,600 --> 00:16:32,750 Oh well, what you gonna do? 306 00:16:32,750 --> 00:16:36,770 Roman author, and it really is about the nature of things. 307 00:16:36,770 --> 00:16:40,600 It's everything, you know, it's 1801 and 801 and 900, and 308 00:16:40,600 --> 00:16:43,060 it's all rolled in one great big book. 309 00:16:43,060 --> 00:16:46,090 But he's got a nice dream theory in there in which he 310 00:16:46,090 --> 00:16:51,200 says that lawyers dream of court cases and sailors are 311 00:16:51,200 --> 00:16:54,030 wrestling with the winds and things of that sort 312 00:16:54,030 --> 00:16:57,030 suggesting, as Freud would later suggest that every dream 313 00:16:57,030 --> 00:17:01,640 reflects something about the preceding day. 314 00:17:01,640 --> 00:17:04,080 Oh, let me say something about that. 315 00:17:04,080 --> 00:17:06,170 I think I'm jumping ahead in my handout again. 316 00:17:06,170 --> 00:17:08,560 Oh well. 317 00:17:08,560 --> 00:17:12,610 This was always assumed anecdotally to be true. 318 00:17:15,250 --> 00:17:16,810 You may have had this experience. 319 00:17:16,810 --> 00:17:21,210 You do something all day and you dream about it all night. 320 00:17:24,380 --> 00:17:26,240 There wasn't much data on this. 321 00:17:26,240 --> 00:17:31,290 Bob Stickgold at Harvard Med has now gone off and collected 322 00:17:31,290 --> 00:17:32,700 some beautiful data on this. 323 00:17:32,700 --> 00:17:38,550 What he did was he got people to play Tetris, a lot Tetris. 324 00:17:38,550 --> 00:17:43,590 Then he sent them to bed with little wires on their head and 325 00:17:43,590 --> 00:17:45,610 when they went into REM sleep he kicked them -- pow -- 326 00:17:45,610 --> 00:17:46,690 what are you dreaming about? 327 00:17:46,690 --> 00:17:49,130 Oh man, bricks, they're falling, man. 328 00:17:52,930 --> 00:17:55,900 Nice clear evidence -- of course, there's a non-Tetris 329 00:17:55,900 --> 00:17:57,030 control group. 330 00:17:57,030 --> 00:17:59,720 You kick them, oh I'm flying down the infinite corridor. 331 00:17:59,720 --> 00:18:00,960 You know, something else. 332 00:18:00,960 --> 00:18:03,340 The Tetris group dreamed about Tetris. 333 00:18:03,340 --> 00:18:08,710 The coolest thing about Stickgold's experiment is that 334 00:18:08,710 --> 00:18:12,280 he tested a population of amnesics -- patients with the 335 00:18:12,280 --> 00:18:15,270 same basic problem as HM. 336 00:18:15,270 --> 00:18:18,360 Remember HM, no new long-term memories. 337 00:18:18,360 --> 00:18:19,570 Learn how to play Tetris? 338 00:18:19,570 --> 00:18:20,450 Grr. 339 00:18:20,450 --> 00:18:20,870 What are you doing? 340 00:18:20,870 --> 00:18:21,880 I'm playing Tetris. 341 00:18:21,880 --> 00:18:22,570 Five minutes later. 342 00:18:22,570 --> 00:18:23,190 What were you doing? 343 00:18:23,190 --> 00:18:24,260 I don't know. 344 00:18:24,260 --> 00:18:25,920 Right, doesn't remember any of this. 345 00:18:25,920 --> 00:18:29,170 So he takes these amnesics, they play Tetris for a while, 346 00:18:29,170 --> 00:18:30,530 they're having a great time. 347 00:18:30,530 --> 00:18:32,940 You send them to bed, you kick them in the 348 00:18:32,940 --> 00:18:33,630 middle of the night. 349 00:18:33,630 --> 00:18:34,390 What are you dreaming about? 350 00:18:34,390 --> 00:18:36,750 Oh, bricks, bricks, the bricks are falling. 351 00:18:36,750 --> 00:18:39,510 They were dreaming about Tetris even though they didn't 352 00:18:39,510 --> 00:18:42,240 remember ever having played Tetris. 353 00:18:42,240 --> 00:18:43,340 That was pretty cool. 354 00:18:43,340 --> 00:18:45,780 Anyway, there's now experimental evidence for this 355 00:18:45,780 --> 00:18:50,230 notion that your dreams incorporate material from the 356 00:18:50,230 --> 00:18:51,390 preceding days. 357 00:18:51,390 --> 00:18:54,770 Freud asserted that all dreams incorporated something from 358 00:18:54,770 --> 00:18:55,580 the preceding day. 359 00:18:55,580 --> 00:18:56,690 Is that absolutely true? 360 00:18:56,690 --> 00:19:02,690 Well, that's one of those assertions like all snowflakes 361 00:19:02,690 --> 00:19:05,490 are different, that's kind of hard to prove. 362 00:19:05,490 --> 00:19:08,860 But certainly material from the preceding day gets 363 00:19:08,860 --> 00:19:09,250 incorporated. 364 00:19:09,250 --> 00:19:10,310 Is that a hand? 365 00:19:10,310 --> 00:19:10,980 That is a hand. 366 00:19:10,980 --> 00:19:13,470 AUDIENCE: I was just wondering, so there an 367 00:19:13,470 --> 00:19:17,704 experiment done where they had these animals running through 368 00:19:17,704 --> 00:19:18,950 the [INAUDIBLE]. 369 00:19:18,950 --> 00:19:21,980 PROFESSOR: Oh, yes, thank you for reminding me. 370 00:19:21,980 --> 00:19:26,056 AUDIENCE: I was just wondering that [INAUDIBLE], when they 371 00:19:26,056 --> 00:19:29,113 were in, when the [UNINTELLIGIBLE], their 372 00:19:29,113 --> 00:19:35,790 brains, I mean is a fMRI where it's showing activity-- 373 00:19:35,790 --> 00:19:37,100 PROFESSOR: Answer's pretty good, she's going to give the 374 00:19:37,100 --> 00:19:39,450 rest of the story here. 375 00:19:39,450 --> 00:19:42,710 None of you guys are from that lab, right? 376 00:19:42,710 --> 00:19:44,490 It's done here. 377 00:19:44,490 --> 00:19:51,670 So, if you look in the brain of, in the hippocampus of a 378 00:19:51,670 --> 00:19:55,110 rat, what you discover is the hippocampus not only is there 379 00:19:55,110 --> 00:19:58,410 encoding the rat's episodic memories in some sense maybe 380 00:19:58,410 --> 00:20:01,660 but, it's also serving as a spatial map. 381 00:20:01,660 --> 00:20:08,010 So when a rat learns a maze, it develops a map of that 382 00:20:08,010 --> 00:20:10,420 maze, in effect, in its hippocampus, and it develops 383 00:20:10,420 --> 00:20:13,910 cells that are so-called place -- it's got place cells and 384 00:20:13,910 --> 00:20:16,460 the place cells develop responses that are specific to 385 00:20:16,460 --> 00:20:17,760 a specific place. 386 00:20:17,760 --> 00:20:21,040 So, the rat's running around in a maze, and this cell goes 387 00:20:21,040 --> 00:20:24,120 off right here -- nananana -- go over here, different cell 388 00:20:24,120 --> 00:20:25,540 goes off -- nananana -- 389 00:20:25,540 --> 00:20:27,510 go over here, different cell goes off. 390 00:20:27,510 --> 00:20:30,490 And as the rat learns the maze, you, the experimenter, 391 00:20:30,490 --> 00:20:33,610 can watch the rat learning this because you can watch 392 00:20:33,610 --> 00:20:36,290 cells in the hippocampus lighting up 393 00:20:36,290 --> 00:20:38,000 in order, in effect. 394 00:20:38,000 --> 00:20:40,720 So now the rat does this all day -- nananana. 395 00:20:40,720 --> 00:20:43,780 OK, the rat goes to sleep, the rat goes into REM sleep. 396 00:20:43,780 --> 00:20:46,860 All mammalian species, except for the spiny anteater -- 397 00:20:46,860 --> 00:20:49,630 don't ask me why I know that -- all mammalian 398 00:20:49,630 --> 00:20:51,720 species have REM sleep. 399 00:20:51,720 --> 00:20:53,850 So you kick the rat, you ask the rat what he 400 00:20:53,850 --> 00:20:55,810 was dreaming about. 401 00:20:55,810 --> 00:20:58,300 Rat doesn't say nothing. 402 00:20:58,300 --> 00:21:01,390 But, if you're recording from his hippocampus while he's 403 00:21:01,390 --> 00:21:04,670 asleep, what you see is the same cells lighting up in 404 00:21:04,670 --> 00:21:06,620 order again. 405 00:21:06,620 --> 00:21:09,110 Who knows what the rat's actually experiencing, but 406 00:21:09,110 --> 00:21:13,110 what the rat's hippocampus is doing is running the maze. 407 00:21:13,110 --> 00:21:18,580 This is, first of all, part of the argument for sleep having 408 00:21:18,580 --> 00:21:20,690 something to do with consolidation of memory and 409 00:21:20,690 --> 00:21:26,650 learning, and it's also an argument for the possibility 410 00:21:26,650 --> 00:21:33,560 at least that the rats are dreaming away there, too. 411 00:21:33,560 --> 00:21:40,280 Well now, arguably Freud's greatest work is 412 00:21:40,280 --> 00:21:42,590 Interpretation of Dreams -- that's the name of the book -- 413 00:21:42,590 --> 00:21:43,760 big, fat book. 414 00:21:43,760 --> 00:21:45,680 Still kind of fun to read but it's kind of long -- 415 00:21:45,680 --> 00:21:48,110 from 1900. 416 00:21:48,110 --> 00:21:50,810 Remember that Freud was writing before we knew any of 417 00:21:50,810 --> 00:21:55,650 this stuff about REM sleep or anything of that sort. 418 00:21:55,650 --> 00:22:03,160 And what Freud thought was happening was that pressure 419 00:22:03,160 --> 00:22:06,650 was building up in your unconscious. 420 00:22:06,650 --> 00:22:09,900 So let's switch from sort of it dungeon model to sort of a 421 00:22:09,900 --> 00:22:10,740 plumbing model. 422 00:22:10,740 --> 00:22:13,970 Well, we've got the boiler down in the dungeon and it's 423 00:22:13,970 --> 00:22:16,870 building up pressure -- this repressed material that we've 424 00:22:16,870 --> 00:22:17,435 been talking about. 425 00:22:17,435 --> 00:22:20,540 It's building up pressure and it's going to blow the roof 426 00:22:20,540 --> 00:22:23,990 off the whole building unless we vent some of the pressure. 427 00:22:23,990 --> 00:22:26,750 And so you've got to be able to -- whoosh -- get some of 428 00:22:26,750 --> 00:22:27,830 that out of there. 429 00:22:27,830 --> 00:22:34,490 One of the ways to do it is dreams -- to release this 430 00:22:34,490 --> 00:22:36,490 while you're asleep. 431 00:22:36,490 --> 00:22:44,020 Now what Freud said was that dreams start when some hunk of 432 00:22:44,020 --> 00:22:50,470 the preceding day, that he called the day residue, some 433 00:22:50,470 --> 00:22:55,330 idea, some activity, some something made an association 434 00:22:55,330 --> 00:22:59,990 with something down in your repressed -- 435 00:22:59,990 --> 00:23:02,250 in your unconscious. 436 00:23:02,250 --> 00:23:04,930 And that allowed this unconscious prisoner to try 437 00:23:04,930 --> 00:23:06,790 and make a break for freedom. 438 00:23:09,340 --> 00:23:15,660 The form of that break would be an effort to fulfill this 439 00:23:15,660 --> 00:23:18,780 repressed wish, if you like -- that's why it was called wish 440 00:23:18,780 --> 00:23:20,030 fulfillment -- 441 00:23:28,790 --> 00:23:31,850 meant that you were going to try to fulfill one of these 442 00:23:31,850 --> 00:23:36,250 repressed wishes while you were asleep. 443 00:23:36,250 --> 00:23:42,350 There's a problem with that, said Freud, which is if you 444 00:23:42,350 --> 00:23:46,390 take the materials out -- the repressed material to be this 445 00:23:46,390 --> 00:23:50,280 stuff that's repressed because it's unacceptable to you, to 446 00:23:50,280 --> 00:23:53,570 the conscious you, to the ego, what's going to happen if you 447 00:23:53,570 --> 00:23:54,500 start dreaming about it? 448 00:23:54,500 --> 00:23:56,850 Well, we've already gotten part of the answer here. 449 00:23:56,850 --> 00:24:01,260 Many people here have had dreams so awful that they've 450 00:24:01,260 --> 00:24:04,340 deliberately woken themselves up out of them. 451 00:24:04,340 --> 00:24:09,470 Now most of those dreams, I would imagine, were dreams 452 00:24:09,470 --> 00:24:11,650 where the monster's about to put the bite on you or 453 00:24:11,650 --> 00:24:13,080 something like that. 454 00:24:13,080 --> 00:24:16,830 What Freud said is that look, if you were going to start 455 00:24:16,830 --> 00:24:20,000 dreaming about, oh, let's dismember my little brother -- 456 00:24:20,000 --> 00:24:22,440 oh, look at his little guts. 457 00:24:22,440 --> 00:24:25,850 Stuff like that, that would be really gross and really 458 00:24:25,850 --> 00:24:28,290 disturbing and you would say to yourself, I don't want to 459 00:24:28,290 --> 00:24:29,650 be having this dream. 460 00:24:29,650 --> 00:24:30,960 And you would wake up. 461 00:24:30,960 --> 00:24:34,550 So what you need to do is to disguise the 462 00:24:34,550 --> 00:24:36,630 material in the dream. 463 00:24:36,630 --> 00:24:41,540 So you've got, said Freud, the latent content of the dream 464 00:24:41,540 --> 00:24:44,150 that you don't know about. 465 00:24:44,150 --> 00:24:51,590 The latent content is the repressed material that's 466 00:24:51,590 --> 00:24:53,600 trying to be vented out. 467 00:24:53,600 --> 00:25:03,570 What you see is the manifest content, which is the 468 00:25:03,570 --> 00:25:06,570 storyline of the dream. 469 00:25:06,570 --> 00:25:11,130 It's hidden material -- it is hiding the latent content from 470 00:25:11,130 --> 00:25:13,440 you so that you can sleep. 471 00:25:13,440 --> 00:25:17,580 Freud argued that the primary role of the sort of sleep 472 00:25:17,580 --> 00:25:21,370 mechanism was to protect the sleeper, to keep you asleep 473 00:25:21,370 --> 00:25:25,600 and allow you to sleep, and allow this sort of venting of 474 00:25:25,600 --> 00:25:32,210 repressed steam to take place. 475 00:25:32,210 --> 00:25:35,770 Were you to show up in analysis the reason your 476 00:25:35,770 --> 00:25:38,290 dreams would be, what Freud called the royal road to the 477 00:25:38,290 --> 00:25:41,720 unconscious, was if you could work back from the manifest 478 00:25:41,720 --> 00:25:45,300 content to the latent content, which was a job of analysis, 479 00:25:45,300 --> 00:25:48,270 not a job of picking up some supermarket guide to your 480 00:25:48,270 --> 00:25:51,470 dreams, but a job of working with you and an analyst. 481 00:25:51,470 --> 00:25:53,740 But if you could go back from the manifest content to the 482 00:25:53,740 --> 00:25:56,530 latent content, you'd know something about what it was 483 00:25:56,530 --> 00:25:58,370 that was bugging you. 484 00:25:58,370 --> 00:26:01,390 Now the fact that, like repression as a whole, the 485 00:26:01,390 --> 00:26:04,960 fact that you have these disguised dreams all the time 486 00:26:04,960 --> 00:26:08,730 doesn't mean that you're somehow sick and diseased. 487 00:26:08,730 --> 00:26:10,950 It means that's part, again, of what it means to 488 00:26:10,950 --> 00:26:12,160 be human for Freud. 489 00:26:12,160 --> 00:26:13,600 You're going to need repression, you're going to 490 00:26:13,600 --> 00:26:17,930 need to be able to bubble off some of this repressed energy, 491 00:26:17,930 --> 00:26:22,296 and dreams are a nice safe way to do it. 492 00:26:22,296 --> 00:26:26,030 That's an interesting theory, but it runs into some major 493 00:26:26,030 --> 00:26:28,730 problems, which, of course, Freud didn't know about 494 00:26:28,730 --> 00:26:31,830 because he died in 1939 and REM wasn't discovered for 495 00:26:31,830 --> 00:26:33,740 another couple of decades or so. 496 00:26:33,740 --> 00:26:37,630 When REM is discovered it becomes a lot harder to 497 00:26:37,630 --> 00:26:42,950 believe that you are boiling up this little poof of 498 00:26:42,950 --> 00:26:49,740 repressed energy every ninety minutes like clockwork. 499 00:26:49,740 --> 00:26:51,400 That's a bit surprising. 500 00:26:51,400 --> 00:26:53,350 Well, that's a bit surprising. 501 00:26:53,350 --> 00:26:58,140 More surprising is if you look at babies, a one month old is 502 00:26:58,140 --> 00:27:01,320 REMing a great deal more than you're REMing. 503 00:27:01,320 --> 00:27:03,810 How much repressed stuff does a one month old baby 504 00:27:03,810 --> 00:27:05,210 have to deal with? 505 00:27:05,210 --> 00:27:05,770 Not much. 506 00:27:05,770 --> 00:27:07,510 How about a lion? 507 00:27:07,510 --> 00:27:09,910 Lions, they REM all the time. 508 00:27:09,910 --> 00:27:12,720 Apparently predators show more REM than prey, as I recall. 509 00:27:12,720 --> 00:27:16,200 So yeah, all the mammals are sitting there doing this REM 510 00:27:16,200 --> 00:27:21,740 thing, right, you know lions, except for like Scar in the 511 00:27:21,740 --> 00:27:23,780 Lion King and stuff like that. 512 00:27:23,780 --> 00:27:27,350 There's not a lot of repressed work that a lion presumably 513 00:27:27,350 --> 00:27:28,940 has to deal with. 514 00:27:28,940 --> 00:27:30,020 Or a cow -- 515 00:27:30,020 --> 00:27:34,190 cows don't REM that much, but you know, ah, I really wanted 516 00:27:34,190 --> 00:27:35,640 to hurt the grass. 517 00:27:35,640 --> 00:27:38,290 I feel bad about the -- 518 00:27:38,290 --> 00:27:39,850 I don't know. 519 00:27:39,850 --> 00:27:52,290 So presumably, now what's going on when you dream and 520 00:27:52,290 --> 00:27:54,350 when you go into REM is that there are centers down in your 521 00:27:54,350 --> 00:28:01,160 brain stem that spray of vast amount of activity up into 522 00:28:01,160 --> 00:28:05,600 cortex and light it up as though you were awake -- 523 00:28:05,600 --> 00:28:07,840 that's what you end up seeing in REM. 524 00:28:11,560 --> 00:28:15,370 One of the senses in which Freud was right is the sense 525 00:28:15,370 --> 00:28:21,390 in which dreaming does protect the sleeper. 526 00:28:21,390 --> 00:28:23,510 If you light up -- 527 00:28:23,510 --> 00:28:26,340 you're trying to go to sleep, right, and I light up cortex 528 00:28:26,340 --> 00:28:29,080 by coming into your room, turning on all the lights and 529 00:28:29,080 --> 00:28:33,200 turning the stereo way up, you have trouble sleeping. 530 00:28:33,200 --> 00:28:35,730 Well your brain's doing the same kind of thing when you go 531 00:28:35,730 --> 00:28:39,810 into REM sleep, but you've got to do something with all that 532 00:28:39,810 --> 00:28:42,640 cortical activity or you're just going to wake up. 533 00:28:42,640 --> 00:28:45,950 So you turn it into this storyline for who knows who to 534 00:28:45,950 --> 00:28:50,500 watch on the big wide screen TV in your brain. 535 00:28:50,500 --> 00:28:57,090 In that sense you do end up protecting 536 00:28:57,090 --> 00:28:59,140 your sleep by dreaming. 537 00:28:59,140 --> 00:29:01,900 In fact, many -- 538 00:29:01,900 --> 00:29:05,210 Freud wasn't thinking about alarm clocks, but an example 539 00:29:05,210 --> 00:29:08,810 of this would be how many of you have incorporated your 540 00:29:08,810 --> 00:29:11,900 alarm clock into a dream and managed to 541 00:29:11,900 --> 00:29:15,320 successfully stay asleep? 542 00:29:15,320 --> 00:29:19,330 Well that's sort of a non-Freudian sense in which 543 00:29:19,330 --> 00:29:23,220 the dream engine is protecting your sleep. 544 00:29:23,220 --> 00:29:25,980 I want to stay asleep here, there's a loud noise, well I 545 00:29:25,980 --> 00:29:27,960 don't know where this loud noise is coming from, my brain 546 00:29:27,960 --> 00:29:30,930 stem's making these loud noises all the time, so let's 547 00:29:30,930 --> 00:29:35,520 just pretend it's from the inside and not the outside and 548 00:29:35,520 --> 00:29:37,730 we can dream that we're getting up. 549 00:29:37,730 --> 00:29:38,960 Right, dream that we're getting up. 550 00:29:38,960 --> 00:29:41,450 We'll dream that we're going to class and taking the exam 551 00:29:41,450 --> 00:29:44,200 and then we wake up and it really is halfway through -- 552 00:29:44,200 --> 00:29:46,080 don't do this at the final, please. 553 00:29:46,080 --> 00:29:48,330 It's so lame. 554 00:29:48,330 --> 00:29:50,130 Particularly since the exam's at -- 555 00:29:50,130 --> 00:29:52,720 the 900 final's 1:30, right? 556 00:29:52,720 --> 00:29:54,940 Got plenty of time to wake up by 1:30. 557 00:29:54,940 --> 00:29:59,885 But every year somebody wanders in at like 2:30, 3:00 558 00:29:59,885 --> 00:30:02,910 o'clock with the big bags under the eyes, right. 559 00:30:02,910 --> 00:30:04,160 So you do sort of believe them -- 560 00:30:04,160 --> 00:30:06,530 I just woke up. 561 00:30:06,530 --> 00:30:11,010 Well, good, sit down, see if you can see the exam. 562 00:30:11,010 --> 00:30:17,726 Anyway, so there's that sense in which Freud had a point 563 00:30:17,726 --> 00:30:19,970 that sleep was protecting the dreamer. but is there any 564 00:30:19,970 --> 00:30:21,350 meaning to it? 565 00:30:21,350 --> 00:30:24,260 Is there any sense in which there there's 566 00:30:24,260 --> 00:30:26,850 meaning in your dreams. 567 00:30:26,850 --> 00:30:29,810 I mean after all you are dreaming because your brain 568 00:30:29,810 --> 00:30:34,510 stem decided to throw all the switches in your visual cortex 569 00:30:34,510 --> 00:30:37,570 or something and you're busy trying to stay asleep. 570 00:30:37,570 --> 00:30:40,640 I think there is a sense in which you might be able to 571 00:30:40,640 --> 00:30:43,260 argue that you could get something meaningful at a 572 00:30:43,260 --> 00:30:44,270 dream -- you're not just looking at 573 00:30:44,270 --> 00:30:46,900 static on the brain. 574 00:30:46,900 --> 00:30:49,790 Actually, I thought of a way to demo this, but I didn't 575 00:30:49,790 --> 00:30:51,160 bring any of the props because I only saw it 576 00:30:51,160 --> 00:30:52,210 when I saw this thing. 577 00:30:52,210 --> 00:30:54,100 So, a piece of paper -- 578 00:30:54,100 --> 00:30:56,240 I've probably got a piece of paper. 579 00:30:56,240 --> 00:30:58,000 Who's got a coin on them? 580 00:30:58,000 --> 00:31:00,800 Somebody have a coin? 581 00:31:00,800 --> 00:31:02,500 Let's see if I can make this work. 582 00:31:05,650 --> 00:31:08,670 That looks pretty so far. 583 00:31:08,670 --> 00:31:09,760 And I also need a pencil. 584 00:31:09,760 --> 00:31:11,500 Somebody have a pencil -- it works better with a pencil 585 00:31:11,500 --> 00:31:12,480 than with a pen. 586 00:31:12,480 --> 00:31:13,810 Oh my goodness, it's coming all the way 587 00:31:13,810 --> 00:31:15,060 from the cheap seats. 588 00:31:18,750 --> 00:31:21,200 Visual search. 589 00:31:21,200 --> 00:31:23,240 Oh, you wanted to do this because -- 590 00:31:23,240 --> 00:31:24,730 he's got a fancy coin. 591 00:31:24,730 --> 00:31:26,660 This is very cool here. 592 00:31:29,840 --> 00:31:31,990 All right, pencil, got a pencil? 593 00:31:31,990 --> 00:31:32,830 Here we go. 594 00:31:32,830 --> 00:31:35,950 OK, this is my brain. 595 00:31:40,700 --> 00:31:43,050 Thank you. 596 00:31:43,050 --> 00:31:47,180 Didn't you have something else you needed to do today? 597 00:31:47,180 --> 00:31:49,020 Well actually, it's just my cortex -- 598 00:31:49,020 --> 00:31:50,270 it can just be my cortex. 599 00:31:55,600 --> 00:31:56,760 Well that's my cortex under there. 600 00:31:56,760 --> 00:31:58,920 This is my brain stem. 601 00:31:58,920 --> 00:32:02,400 So now I will spray activity across my cortex here, and 602 00:32:02,400 --> 00:32:03,740 let's see if this sort of works. 603 00:32:11,140 --> 00:32:14,930 It looks like squat, doesn't it? 604 00:32:14,930 --> 00:32:16,580 Well you know what? 605 00:32:16,580 --> 00:32:18,680 That's a really boring dorkey demo. 606 00:32:21,210 --> 00:32:22,570 It's a fidelity issue. 607 00:32:22,570 --> 00:32:24,410 I can see what-- 608 00:32:24,410 --> 00:32:27,000 Use a different pencil? 609 00:32:27,000 --> 00:32:28,170 A wooden pencil. 610 00:32:28,170 --> 00:32:29,650 No, no, no, no. 611 00:32:29,650 --> 00:32:31,490 It looks just fine from here. 612 00:32:31,490 --> 00:32:34,280 Here, we'll try the other side up, see if that works any 613 00:32:34,280 --> 00:32:37,030 better but I don't think it will. 614 00:32:37,030 --> 00:32:39,880 Do it at more of an angle? 615 00:32:39,880 --> 00:32:41,350 Hold the pencil up more of an angle. 616 00:32:41,350 --> 00:32:43,860 All right, we'll try this one more time. 617 00:32:43,860 --> 00:32:45,690 Oh look, maybe we're getting -- 618 00:32:45,690 --> 00:32:47,980 I don't know, what are we getting? 619 00:32:47,980 --> 00:32:51,060 We're getting nothing. 620 00:32:51,060 --> 00:32:52,480 We're getting nothing that you're going to see. 621 00:32:52,480 --> 00:32:54,050 Oh yeah, no, you can sort of see something 622 00:32:54,050 --> 00:32:55,480 but it's really boring. 623 00:32:55,480 --> 00:32:56,320 Well that was lovely. 624 00:32:56,320 --> 00:32:57,570 Here we go. 625 00:33:10,470 --> 00:33:14,810 Here's what I was doing that didn't work but makes a 626 00:33:14,810 --> 00:33:17,410 brilliant model anyway. 627 00:33:17,410 --> 00:33:19,060 You can try this for yourself. 628 00:33:19,060 --> 00:33:22,760 If you stick a coin under a piece of paper and rub a 629 00:33:22,760 --> 00:33:26,130 pencil over it, you can actually see the shape of the 630 00:33:26,130 --> 00:33:28,790 pattern on the coin. 631 00:33:28,790 --> 00:33:31,520 Anybody here ever done brass rubbing or greystone rubbing 632 00:33:31,520 --> 00:33:33,250 or any of that sort of--? 633 00:33:33,250 --> 00:33:34,100 No. 634 00:33:34,100 --> 00:33:34,510 A few people. 635 00:33:34,510 --> 00:33:35,160 All right. 636 00:33:35,160 --> 00:33:40,030 Look, the point is that by spraying random noise across a 637 00:33:40,030 --> 00:33:43,330 structured object, in effect, I can see 638 00:33:43,330 --> 00:33:45,480 something of the structure. 639 00:33:45,480 --> 00:33:49,270 Boy, this took more minutes than it should have. 640 00:33:49,270 --> 00:33:53,960 By spraying random noise from your brain stem, across your 641 00:33:53,960 --> 00:33:57,640 particular brain, the particular dreams that you get 642 00:33:57,640 --> 00:33:59,140 are going to say something about 643 00:33:59,140 --> 00:34:00,780 that underlying structure. 644 00:34:00,780 --> 00:34:10,140 So, Attila the Hun, when he was dreaming was not dreaming 645 00:34:10,140 --> 00:34:15,810 about trains going into tunnels or stuff like that, 646 00:34:15,810 --> 00:34:19,620 because Attila the Hun didn't know anything about trains. 647 00:34:19,620 --> 00:34:21,910 You dream about trains, they may or may not -- 648 00:34:21,910 --> 00:34:24,440 trains going into tunnels, you know it's sort of a classic 649 00:34:24,440 --> 00:34:28,700 supermarket dream analysis image of a sexual dream or 650 00:34:28,700 --> 00:34:29,630 something like that. 651 00:34:29,630 --> 00:34:32,890 It may or may not be a sexual dream, but the content of that 652 00:34:32,890 --> 00:34:37,050 dream, that set of imagery, is a function of 653 00:34:37,050 --> 00:34:38,750 your particular brain. 654 00:34:38,750 --> 00:34:41,010 If your dream about Tetris after playing Tetris all day, 655 00:34:41,010 --> 00:34:43,260 it's because you were playing the Tetris, not because 656 00:34:43,260 --> 00:34:44,940 somebody else was playing Tetris. 657 00:34:44,940 --> 00:34:49,080 So it could well be if you thought you had a process for 658 00:34:49,080 --> 00:34:54,380 going back from the storyline that's there to protect you 659 00:34:54,380 --> 00:34:58,340 from waking up with all that noise in your head to the 660 00:34:58,340 --> 00:35:01,960 underlying structure of your mind, if you had a process 661 00:35:01,960 --> 00:35:04,980 that you thought worked, then it follows that you might 662 00:35:04,980 --> 00:35:07,340 actually get some sort of interesting meaning out of 663 00:35:07,340 --> 00:35:08,000 your dreams. 664 00:35:08,000 --> 00:35:10,200 Now it's quite a leap to decide that you actually know 665 00:35:10,200 --> 00:35:11,790 how to do this. 666 00:35:11,790 --> 00:35:13,800 Analysts think they do. 667 00:35:13,800 --> 00:35:15,730 People who write guides to dream 668 00:35:15,730 --> 00:35:19,690 interpretation think they do. 669 00:35:19,690 --> 00:35:23,070 I think I'll just leave it at that as an exercise for the 670 00:35:23,070 --> 00:35:26,010 reader to go and decide whether or not they've got 671 00:35:26,010 --> 00:35:30,310 deep meaning in their dreams. 672 00:35:30,310 --> 00:35:36,410 So that's an example where Freud didn't know the 673 00:35:36,410 --> 00:35:41,690 subsequent hundred years of sleep research, so if you 674 00:35:41,690 --> 00:35:43,900 actually read Interpretation of Dreams, a lot of it would 675 00:35:43,900 --> 00:35:45,740 sound kind of odd at this point. 676 00:35:45,740 --> 00:35:51,210 But the core ideas that sleep needs to protect you, keep you 677 00:35:51,210 --> 00:35:58,350 asleep and that it's sort of a re-packaging of this activity 678 00:35:58,350 --> 00:36:04,560 of your mind, those seem to be core ideas that can still do a 679 00:36:04,560 --> 00:36:06,110 certain amount of work for us. 680 00:36:06,110 --> 00:36:10,670 Now a place where the effort to apply Freudian ideas did 681 00:36:10,670 --> 00:36:17,590 not pan out is in the treatment of schizophrenia. 682 00:36:17,590 --> 00:36:20,030 So I'm going to jump to talking about that, and I may 683 00:36:20,030 --> 00:36:22,530 or may not manage to jump back to the other things that I 684 00:36:22,530 --> 00:36:24,960 claimed I was going to jump back to. 685 00:36:24,960 --> 00:36:26,810 But I might. 686 00:36:30,960 --> 00:36:42,710 So, in the middle part of 20th century, mental hospitals in 687 00:36:42,710 --> 00:36:48,230 the U.S. were filled with chronic schizophrenics. 688 00:36:48,230 --> 00:36:54,260 Schizophrenia is an extremely disabling disease when it's in 689 00:36:54,260 --> 00:36:56,100 its florid state. 690 00:36:56,100 --> 00:37:01,250 So, schizophrenia, the word comes from split mind. 691 00:37:01,250 --> 00:37:06,720 As it says on the handout, for five points free on the final 692 00:37:06,720 --> 00:37:11,210 exam probably, not the same thing as a multiple 693 00:37:11,210 --> 00:37:13,640 personality disorder. 694 00:37:13,640 --> 00:37:18,280 The split in the mind is a split that 19th century 695 00:37:18,280 --> 00:37:21,900 psychiatry saw between emotional life 696 00:37:21,900 --> 00:37:23,050 and cognitive life. 697 00:37:23,050 --> 00:37:26,970 It is, in fact, sort of an unfortunate term because it 698 00:37:26,970 --> 00:37:29,800 does make people think that it's the same thing as 699 00:37:29,800 --> 00:37:31,290 multiple personality disorder. 700 00:37:31,290 --> 00:37:34,220 It's not. 701 00:37:34,220 --> 00:37:39,210 Multiple personality patients can actually function at least 702 00:37:39,210 --> 00:37:43,930 somewhat in the world reasonably well. 703 00:37:43,930 --> 00:37:47,460 Floridly schizophrenic patients do not work well out 704 00:37:47,460 --> 00:37:51,620 there in the world, that's why they end up hospitalized. 705 00:37:51,620 --> 00:37:57,420 The sorts of symptoms that you get are hallucinations, 706 00:37:57,420 --> 00:38:03,810 hearing voices, paranoid delusions often of vast 707 00:38:03,810 --> 00:38:06,050 conspiracies to control your mind. 708 00:38:06,050 --> 00:38:08,680 You can see this as sort of an adaptive response, right. 709 00:38:08,680 --> 00:38:13,050 If your mind, if some chunk of you, in a sense, knows that 710 00:38:13,050 --> 00:38:18,260 your mind is out of control, it's not an unreasonable 711 00:38:18,260 --> 00:38:21,990 irrational thought to believe that somebody else is doing 712 00:38:21,990 --> 00:38:24,570 this to you. 713 00:38:24,570 --> 00:38:28,550 So it may, in some sense, be reasonable to think, to 714 00:38:28,550 --> 00:38:31,020 imagine how people could come to believe that their mind is 715 00:38:31,020 --> 00:38:33,850 being controlled by somebody else. 716 00:38:33,850 --> 00:38:38,050 The sorts of things that led to the notion of 717 00:38:38,050 --> 00:38:38,850 a dissocation -- 718 00:38:38,850 --> 00:38:40,780 I shouldn't say dissociation -- of a split between 719 00:38:40,780 --> 00:38:44,260 cognition and emotion, another characteristic of 720 00:38:44,260 --> 00:38:47,280 schizophrenia is so-called inappropriate affect. 721 00:38:47,280 --> 00:38:51,630 That's just jargon for showing the wrong emotions at the 722 00:38:51,630 --> 00:38:52,910 wrong time. 723 00:38:52,910 --> 00:38:57,860 The sort of classic symptom is laughing at the funeral. 724 00:38:57,860 --> 00:39:01,390 You know, if you're just yucking it up at graveside or 725 00:39:01,390 --> 00:39:06,850 something like that, people will think that that is not 726 00:39:06,850 --> 00:39:13,180 normal, and it is, in fact, one of the characteristics of 727 00:39:13,180 --> 00:39:13,950 schizophrenia. 728 00:39:13,950 --> 00:39:16,340 And that schizophrenia's sort of a messy diagnosis -- not 729 00:39:16,340 --> 00:39:21,710 every schizophrenic has every one of these symptoms. 730 00:39:21,710 --> 00:39:28,690 But you can imagine that by the time you're gripped by 731 00:39:28,690 --> 00:39:32,510 fantastical thoughts and conspiracy theories and you're 732 00:39:32,510 --> 00:39:35,640 hearing voices and seeing things that aren't there, that 733 00:39:35,640 --> 00:39:41,810 this is pretty disabling stuff. 734 00:39:48,900 --> 00:39:50,870 It's not so disabling that you can't be out there in the 735 00:39:50,870 --> 00:39:51,660 world, by the way. 736 00:39:51,660 --> 00:39:55,670 When I was a graduate student, the MIT Department was called 737 00:39:55,670 --> 00:39:56,870 psychology. 738 00:39:56,870 --> 00:40:00,320 One of the reasons, though perhaps not one of the more 739 00:40:00,320 --> 00:40:05,160 serious reasons, for changing the name was that my doctoral 740 00:40:05,160 --> 00:40:07,550 advisor who was chair of the department got tired of 741 00:40:07,550 --> 00:40:10,230 getting phone calls from people who wanted to know 742 00:40:10,230 --> 00:40:14,290 about stuff like abnormal psychology, which nobody at 743 00:40:14,290 --> 00:40:16,620 the MIT Department ever did anything with. 744 00:40:16,620 --> 00:40:19,870 So he would always get the phone call or his secretary 745 00:40:19,870 --> 00:40:22,540 would get the phone call and she was instructed to say, 746 00:40:22,540 --> 00:40:27,100 don't call us, they do that stuff at Harvard. 747 00:40:27,100 --> 00:40:32,060 I remember one time when I was a grad student that rather 748 00:40:32,060 --> 00:40:35,590 than phoning up, one of these people came to the lab and he 749 00:40:35,590 --> 00:40:39,580 wandered into the lab and said that he knew that we were 750 00:40:39,580 --> 00:40:44,380 controlling his mind with microwaves beamed from this 751 00:40:44,380 --> 00:40:49,770 location and he wanted us to stop right now. 752 00:40:49,770 --> 00:40:52,300 I'm there sort of uh-oh. 753 00:40:52,300 --> 00:40:59,100 But my advisor with great presence of mind I thought, 754 00:40:59,100 --> 00:41:02,420 walked over to the biggest rack of equipment in the lab, 755 00:41:02,420 --> 00:41:06,100 threw the biggest switch he could find, said there, does 756 00:41:06,100 --> 00:41:07,960 that feel better? 757 00:41:07,960 --> 00:41:12,790 The guy said yes and left. 758 00:41:12,790 --> 00:41:16,630 I'm not sure I recommend this as a treatment for delusional 759 00:41:16,630 --> 00:41:18,610 patients, but it worked in this -- 760 00:41:18,610 --> 00:41:20,600 and then we changed the name of the department. 761 00:41:23,110 --> 00:41:30,000 In any case, it can be very disabling and it often can 762 00:41:30,000 --> 00:41:33,080 lead to hospitalization. 763 00:41:33,080 --> 00:41:34,810 What would Freud have said about it? 764 00:41:34,810 --> 00:41:38,140 What Freud said about it was these are not patients that I 765 00:41:38,140 --> 00:41:39,540 want to deal with, basically. 766 00:41:39,540 --> 00:41:45,000 He doesn't write extensively about schizophrenia and says 767 00:41:45,000 --> 00:41:47,590 in various places that look, if you're going to do 768 00:41:47,590 --> 00:41:50,520 psychoanalysis, the first thing you need is a patient 769 00:41:50,520 --> 00:41:51,980 that you can at least talk to. 770 00:41:51,980 --> 00:41:55,790 Anna O. With her collection of hysterical symptoms may have 771 00:41:55,790 --> 00:42:02,380 been in psychiatric trouble some variety, but you could 772 00:42:02,380 --> 00:42:03,820 talk to her about it. 773 00:42:03,820 --> 00:42:06,210 You could engage in this dialogue. 774 00:42:06,210 --> 00:42:13,200 If you've got a patient who is delusional and hallucinating 775 00:42:13,200 --> 00:42:16,410 there's not much Freud thought you could do with them. 776 00:42:16,410 --> 00:42:23,180 However, his followers thought you could and developed a 777 00:42:23,180 --> 00:42:30,690 theory growing out of Freudian psychodynamic ideas of where 778 00:42:30,690 --> 00:42:32,400 schizophrenia came from. 779 00:42:32,400 --> 00:42:37,130 So in the mid-20th century, psychiatric hospitals were 780 00:42:37,130 --> 00:42:41,950 filled with schizophrenics and filled with good Freudianly 781 00:42:41,950 --> 00:42:45,240 trained analysts attempting to treat them. 782 00:42:45,240 --> 00:42:49,530 What they thought the cause was the so-called 783 00:42:49,530 --> 00:42:53,950 schizophrenogenic parent, typically Mother. 784 00:42:53,950 --> 00:42:58,650 Schizophrenogenic is a great word. 785 00:42:58,650 --> 00:43:02,580 It's somebody who generates schizophrenia. 786 00:43:02,580 --> 00:43:06,410 Anyway, a schizophrenogenic mother, what was the problem 787 00:43:06,410 --> 00:43:12,920 here, the problem was what the therapists perceived as a 788 00:43:12,920 --> 00:43:16,410 double-bind situation that the mother was somehow 789 00:43:16,410 --> 00:43:17,840 putting the child in. 790 00:43:17,840 --> 00:43:20,100 The mother was saying come here, come here, come here, go 791 00:43:20,100 --> 00:43:21,930 away, go away, go away, I love you, I love you, I love you, 792 00:43:21,930 --> 00:43:23,490 get away, get away, get away. 793 00:43:23,490 --> 00:43:27,340 Somehow both saying come near me and get away from me at one 794 00:43:27,340 --> 00:43:30,680 and the same time, and that this was literally 795 00:43:30,680 --> 00:43:32,350 driving the child mad. 796 00:43:32,350 --> 00:43:34,690 Now why would they have come up with such a theory? 797 00:43:34,690 --> 00:43:41,730 One of the reasons was that onset of schizophrenia is 798 00:43:41,730 --> 00:43:45,820 quite typically late adolescence, early adulthood. 799 00:43:45,820 --> 00:43:49,200 Oh, that reminds me to reiterate or iterate for the 800 00:43:49,200 --> 00:43:51,220 first time, if I haven't mentioned it yet -- no, I 801 00:43:51,220 --> 00:43:53,650 think I did mention it. 802 00:43:53,650 --> 00:43:57,440 Remember what I was saying about psychiatric 803 00:43:57,440 --> 00:43:59,350 hypochondria -- 804 00:43:59,350 --> 00:44:03,360 the notion that if I sit around and lecture about 805 00:44:03,360 --> 00:44:08,630 psychiatric disorders, you shouldn't go and be feeling 806 00:44:08,630 --> 00:44:12,120 your brain for the rest of the term saying oh man, I'm going 807 00:44:12,120 --> 00:44:14,730 to wake up with a dissociative disorder tomorrow and that's 808 00:44:14,730 --> 00:44:16,700 going to progress to schizophrenia and dimentia and 809 00:44:16,700 --> 00:44:19,790 I'm going to be dead. 810 00:44:19,790 --> 00:44:25,570 The fact that schizophrenia has a typical onset in a 811 00:44:25,570 --> 00:44:29,660 population of about your age doesn't mean that tomorrow 812 00:44:29,660 --> 00:44:31,400 we're going to have 300 schizophrenic 813 00:44:31,400 --> 00:44:33,540 students in this class. 814 00:44:33,540 --> 00:44:34,790 It does happen. 815 00:44:37,880 --> 00:44:40,990 What convinced me -- 816 00:44:40,990 --> 00:44:44,610 a small aside. 817 00:44:44,610 --> 00:44:48,410 When you're discussing abnormal behavior, which we 818 00:44:48,410 --> 00:44:52,220 are now, there are two senses of that. 819 00:44:52,220 --> 00:44:56,000 One sense of that is all behaviors that you care to 820 00:44:56,000 --> 00:44:58,690 measure have some variability in them. 821 00:44:58,690 --> 00:45:03,890 You can simply assert that everybody above two standard 822 00:45:03,890 --> 00:45:06,750 deviations or something is abnormal. 823 00:45:13,010 --> 00:45:15,990 We'll see as we go along that there are times when that is 824 00:45:15,990 --> 00:45:19,970 not an unreasonable thing to do. 825 00:45:19,970 --> 00:45:23,360 There are other times when it's a whacky thing to do. 826 00:45:23,360 --> 00:45:26,620 All right, for a wacky example, virtually everybody 827 00:45:26,620 --> 00:45:29,330 here is abnormal in that sense, but then the axis is 828 00:45:29,330 --> 00:45:31,410 SAT score, right. 829 00:45:31,410 --> 00:45:33,480 Most of you are up here in the upper tail of the 830 00:45:33,480 --> 00:45:34,400 distribution. 831 00:45:34,400 --> 00:45:36,270 Sure it's abnormal but we don't consider it as 832 00:45:36,270 --> 00:45:38,670 pathological, right? 833 00:45:38,670 --> 00:45:40,690 At least not in this community. 834 00:45:43,410 --> 00:45:47,890 So the other possibility is that sure, the normal 835 00:45:47,890 --> 00:45:52,180 population is distributed like this, but there is a disease 836 00:45:52,180 --> 00:45:55,450 state of some sort that looks like this that's essentially 837 00:45:55,450 --> 00:45:59,980 discontinuous with the normal state. 838 00:45:59,980 --> 00:46:05,235 Arguments have been made, notably by a psychiatrist in 839 00:46:05,235 --> 00:46:08,970 the '60s whose name is probably pronounced something 840 00:46:08,970 --> 00:46:11,750 like Shosh -- a Hungarian name. 841 00:46:11,750 --> 00:46:14,910 Anybody happen to know the right answer? 842 00:46:14,910 --> 00:46:19,430 Anyway, Thomas Szasz will do or Shosh or something. 843 00:46:19,430 --> 00:46:23,420 In any case, he made the argument that in a book 844 00:46:23,420 --> 00:46:26,500 entitled Being Sane in an Insane World, that 845 00:46:26,500 --> 00:46:29,560 schizophrenia was simply a way to adapt to the fact that the 846 00:46:29,560 --> 00:46:32,010 Russians had lots of bombs and we had lots of bombs and we 847 00:46:32,010 --> 00:46:35,010 were all going to blow each other up, and that it was just 848 00:46:35,010 --> 00:46:39,540 one position on this normal curve. 849 00:46:39,540 --> 00:46:41,750 It's an interesting argument. 850 00:46:41,750 --> 00:46:46,880 But if you actually see somebody in the midst of a 851 00:46:46,880 --> 00:46:51,220 florid schizophrenic break from reality, 852 00:46:51,220 --> 00:46:53,110 it's hard to believe. 853 00:46:53,110 --> 00:46:56,260 I had, when I was an undergraduate, the roommate of 854 00:46:56,260 --> 00:47:00,750 a close friend of mine had such a break. 855 00:47:00,750 --> 00:47:05,220 It's unmistakable -- it's at once fascinating and deeply 856 00:47:05,220 --> 00:47:06,120 frightening. 857 00:47:06,120 --> 00:47:10,460 This was a friend of ours who became delusional -- she was 858 00:47:10,460 --> 00:47:16,140 hallucinating, she absolutely couldn't function, and was 859 00:47:16,140 --> 00:47:20,420 scaring the heck out of her roommate and she eventually -- 860 00:47:20,420 --> 00:47:24,610 actually, she eventually did fine. 861 00:47:24,610 --> 00:47:28,980 We caught up with her like twenty years later, and people 862 00:47:28,980 --> 00:47:30,790 do recover from schizophrenia and she was doing 863 00:47:30,790 --> 00:47:31,900 quite well, thank you. 864 00:47:31,900 --> 00:47:35,900 But in any case, she was the data point, that at least for 865 00:47:35,900 --> 00:47:39,150 me, argued strongly for the notion that this is a 866 00:47:39,150 --> 00:47:48,380 different state, not just a position on a continuum. 867 00:47:48,380 --> 00:47:54,350 In any case, the psychiatrists were busy trying to treat this 868 00:47:54,350 --> 00:47:58,860 with sor of Freudian psychotherapeutic techniques. 869 00:47:58,860 --> 00:48:00,870 It wasn't working. 870 00:48:00,870 --> 00:48:02,850 This wasn't because they were bad people -- these were 871 00:48:02,850 --> 00:48:07,320 well-intentioned people doing the best by their lights that 872 00:48:07,320 --> 00:48:08,980 they could, it just wasn't working. 873 00:48:08,980 --> 00:48:11,800 It was a case where the theory was just wrong. 874 00:48:11,800 --> 00:48:15,650 Oh, one of the engines that moved theory away from this, 875 00:48:15,650 --> 00:48:20,070 by the way, were parent advocacy groups. 876 00:48:20,070 --> 00:48:27,880 You've got to imagine that having a seriously ill child, 877 00:48:27,880 --> 00:48:30,230 whether that's a physical illness or a mental illness, 878 00:48:30,230 --> 00:48:34,230 is very traumatic for parents, period. 879 00:48:34,230 --> 00:48:40,840 But imagine how you would feel if the leading theory was that 880 00:48:40,840 --> 00:48:45,500 this was your fault, that you had done this to your child. 881 00:48:45,500 --> 00:48:48,210 Not intentionally, of course, but it was you 882 00:48:48,210 --> 00:48:49,310 who had done it. 883 00:48:49,310 --> 00:48:51,690 Parents simply didn't believe it. 884 00:48:51,690 --> 00:48:54,400 And as science started to emerge suggesting that in 885 00:48:54,400 --> 00:48:57,440 schizophrenia's case it was much more like a brain disease 886 00:48:57,440 --> 00:49:05,000 than like the product of bad mothering, that groups, 887 00:49:05,000 --> 00:49:07,760 funding groups -- you know, the guys who send you lots of 888 00:49:07,760 --> 00:49:11,020 mail at this time of year saying send us your check and 889 00:49:11,020 --> 00:49:14,170 we'll support good research on this disease that disease or 890 00:49:14,170 --> 00:49:19,400 whatever, a number of these groups powered by parents of 891 00:49:19,400 --> 00:49:23,410 schizophrenics were helping to move the research away from 892 00:49:23,410 --> 00:49:25,250 the notion of a schizophrenogenic mother. 893 00:49:25,250 --> 00:49:27,210 But what really did it was it just didn't work. 894 00:49:27,210 --> 00:49:31,350 Nobody could make this story work. 895 00:49:31,350 --> 00:49:38,050 The psychiatric hospitals are no longer filled with 896 00:49:38,050 --> 00:49:42,160 schizophrenic patients, and that's not because of a great 897 00:49:42,160 --> 00:49:44,940 breakthrough in Freudian psychotherapy, 898 00:49:44,940 --> 00:49:47,140 it's because of drugs. 899 00:49:47,140 --> 00:49:51,480 In the '50s drugs like Thorazine, Chlorpromazine is 900 00:49:51,480 --> 00:49:56,320 the technical name, came on the market. 901 00:49:56,320 --> 00:50:02,510 In this particular case these are drugs that block dopamine 902 00:50:02,510 --> 00:50:04,610 receptors -- dopamine's a neuro transmitter, the 903 00:50:04,610 --> 00:50:07,470 receptor on the other side of the synapse. 904 00:50:07,470 --> 00:50:16,230 Thorazine decreased the uptake of dopamine, and that served 905 00:50:16,230 --> 00:50:21,210 to ameliorate the florid symptoms of schizophrenia, in 906 00:50:21,210 --> 00:50:22,330 particular. 907 00:50:22,330 --> 00:50:25,640 You put somebody on Thorazine and they didn't hallucinate 908 00:50:25,640 --> 00:50:30,270 anymore, and their paranoid dilusions slipped away. 909 00:50:30,270 --> 00:50:35,400 Oh, let me tell you another anecdote about schizophrenics. 910 00:50:35,400 --> 00:50:37,200 Schizophrenics I have known. 911 00:50:37,200 --> 00:50:42,590 We had a very interesting woman who was the librarian in 912 00:50:42,590 --> 00:50:46,120 the department here some years ago -- 913 00:50:46,120 --> 00:50:55,180 PhD Classicist and also, she was schizophrenic and 914 00:50:55,180 --> 00:51:02,200 successfully medicated and functioned well as the psych 915 00:51:02,200 --> 00:51:06,250 department librarian when on medication. 916 00:51:06,250 --> 00:51:09,870 Anytime I tell you the root of something like schizophrenia, 917 00:51:09,870 --> 00:51:12,650 the Latin and Greek roots of these words, it's because I'm 918 00:51:12,650 --> 00:51:15,140 remembering what she taught me. 919 00:51:15,140 --> 00:51:19,080 But she would slip off of her medication. 920 00:51:19,080 --> 00:51:22,220 You could tell when she was slipping off her medication 921 00:51:22,220 --> 00:51:25,560 because her handwriting, her handwritten notes would start 922 00:51:25,560 --> 00:51:27,900 getting smaller and smaller and longer and longer. 923 00:51:27,900 --> 00:51:31,750 She developed this micro-writing and very 924 00:51:31,750 --> 00:51:33,980 extensive writing, and then the content would 925 00:51:33,980 --> 00:51:35,640 start to slip, too. 926 00:51:35,640 --> 00:51:37,570 And she would also start -- 927 00:51:37,570 --> 00:51:39,920 if it got dim in the library you knew you were in for 928 00:51:39,920 --> 00:51:43,370 trouble because she became photophobic. 929 00:51:43,370 --> 00:51:46,190 One of the interesting problems here and one of the 930 00:51:46,190 --> 00:51:49,690 problems in treatment was that as she fell off her medicine 931 00:51:49,690 --> 00:51:50,920 she became paranoid. 932 00:51:50,920 --> 00:51:52,460 What was the nature of her paranoia? 933 00:51:52,460 --> 00:51:55,150 The nature of her paranoia was that people wanted to control 934 00:51:55,150 --> 00:51:56,970 her brain using chemicals. 935 00:51:56,970 --> 00:51:58,950 Well that was exactly true. 936 00:51:58,950 --> 00:52:01,810 But if we would tell her, you gotta start taking your 937 00:52:01,810 --> 00:52:04,810 medicine, that was just evidence for her that we were 938 00:52:04,810 --> 00:52:07,080 trying to control her brain, which was true. 939 00:52:07,080 --> 00:52:11,970 So it wasn't even really -- it's very tricky stuff. 940 00:52:11,970 --> 00:52:14,150 I mean it's funny and sad at the same time. 941 00:52:14,150 --> 00:52:18,790 Eventually, she was no longer able to control this and was 942 00:52:18,790 --> 00:52:24,440 no longer able to hold the job, which was sad. 943 00:52:24,440 --> 00:52:29,450 But it's also a real issue, a real medical ethics issue. 944 00:52:29,450 --> 00:52:34,190 When the hospitals were emptied by these drugs, the 945 00:52:34,190 --> 00:52:37,960 promise was that supports would be placed in the 946 00:52:37,960 --> 00:52:42,640 community that would it make it possible for medicated 947 00:52:42,640 --> 00:52:45,210 schizophrenics to function. 948 00:52:45,210 --> 00:52:47,670 It's not a cure because the medicines are imperfect. 949 00:52:47,670 --> 00:52:50,780 For instance, it's not the case that dopamine -- 950 00:52:50,780 --> 00:52:54,020 the problem in schizophrenia isn't that dopamine is bad 951 00:52:54,020 --> 00:52:56,990 stuff and if you have lots of it you're in trouble. 952 00:52:56,990 --> 00:52:59,880 It is clear that in schizophrenia, bits of the 953 00:52:59,880 --> 00:53:02,470 brain are awash in too much dopamine, but if 954 00:53:02,470 --> 00:53:03,370 you wipe out -- 955 00:53:03,370 --> 00:53:06,630 if you just blanket, push down dopamine, other bits of the 956 00:53:06,630 --> 00:53:10,660 brain which really like dopamine are starved for it. 957 00:53:10,660 --> 00:53:14,430 The sorts of symptoms that you get when dopamine is removed 958 00:53:14,430 --> 00:53:16,320 from these chunks of the brain are the symptoms of 959 00:53:16,320 --> 00:53:20,110 Parkinson's disease -- muscle tremors, an inability to 960 00:53:20,110 --> 00:53:22,140 initiate voluntary activity. 961 00:53:22,140 --> 00:53:27,200 So a patient overmedicated on Thorazine isn't hallucinating 962 00:53:27,200 --> 00:53:30,230 anymore, but is also sort of inert. 963 00:53:30,230 --> 00:53:33,760 So it's not trivial to just say take this pill, great 964 00:53:33,760 --> 00:53:34,430 you're cured. 965 00:53:34,430 --> 00:53:37,120 It was clear that management was going to be needed. 966 00:53:37,120 --> 00:53:39,780 It was clear in many cases that people were going to need 967 00:53:39,780 --> 00:53:43,630 housing that was like sort of halfway housing, not complete 968 00:53:43,630 --> 00:53:48,910 independence, but you could be out in the world and you 969 00:53:48,910 --> 00:53:50,760 wouldn't need to be hospitalized anymore but you'd 970 00:53:50,760 --> 00:53:52,490 need some sort of continuing care. 971 00:53:52,490 --> 00:53:57,160 The problem is that we've systematically not given 972 00:53:57,160 --> 00:54:01,000 enough, basically money and resources to that. 973 00:54:01,000 --> 00:54:09,090 The result is there are numbers of imperfectly -- 974 00:54:09,090 --> 00:54:13,460 perfect medication isn't out there yet -- but inadequately 975 00:54:13,460 --> 00:54:19,195 medicated, unsuccessfully medicated patients who ought 976 00:54:19,195 --> 00:54:20,810 to be cared for, but who are not being cared 977 00:54:20,810 --> 00:54:24,270 for for by the system. 978 00:54:28,420 --> 00:54:30,070 Schizophrenics are over-represented in the 979 00:54:30,070 --> 00:54:35,740 homeless population because if you are not successfully 980 00:54:35,740 --> 00:54:40,180 medicated it's hard to hold a job, it's hard to keep an 981 00:54:40,180 --> 00:54:43,380 apartment or something like that and you 982 00:54:43,380 --> 00:54:44,310 end up on the street. 983 00:54:44,310 --> 00:54:47,660 That loops back to this issue about your paranoid delusion 984 00:54:47,660 --> 00:54:50,610 about somebody trying to control your mind. 985 00:54:50,610 --> 00:54:54,100 When is it OK then, now that you're on the street, now that 986 00:54:54,100 --> 00:54:58,290 you're floridly schizophrenic again, when is it OK for us as 987 00:54:58,290 --> 00:55:01,940 a society to come in and say guess what, we don't care that 988 00:55:01,940 --> 00:55:03,820 you think we're trying to control your mind, we're going 989 00:55:03,820 --> 00:55:06,770 to medicate you whether you want to or not because it's 990 00:55:06,770 --> 00:55:08,870 for your own good. 991 00:55:08,870 --> 00:55:11,090 You can argue yeah, it's for your own good, but there's 992 00:55:11,090 --> 00:55:14,000 lots of things that -- you know, I might decide it's for 993 00:55:14,000 --> 00:55:16,910 your own good that you should sleep eight hours a night. 994 00:55:16,910 --> 00:55:18,320 Do I get to enforce that? 995 00:55:18,320 --> 00:55:20,190 No, I don't. 996 00:55:20,190 --> 00:55:24,320 If I decide that it's good for you to take a drug that is 997 00:55:24,320 --> 00:55:27,760 going to, in fact, control your mind, when do I get to do 998 00:55:27,760 --> 00:55:30,830 that, and this ends up in court regularly, and it ends 999 00:55:30,830 --> 00:55:33,600 up on talk radio all the time, right, because it's a sort of 1000 00:55:33,600 --> 00:55:36,410 thing that yakking head talk radio loves 1001 00:55:36,410 --> 00:55:37,580 to get excited about. 1002 00:55:37,580 --> 00:55:42,260 You know some judge declares that some clearly 1003 00:55:42,260 --> 00:55:47,670 schizophrenic individual has a constitutional right to live 1004 00:55:47,670 --> 00:55:53,020 under a bridge yelling obscenities at you, and talk 1005 00:55:53,020 --> 00:55:55,700 radio goes nuts. 1006 00:55:55,700 --> 00:55:57,750 It's an interesting question. 1007 00:55:57,750 --> 00:56:00,040 It's not a question with an easy answer. 1008 00:56:00,040 --> 00:56:04,200 When do you get to decide that you're allowed to take control 1009 00:56:04,200 --> 00:56:10,640 over somebody else's mental life? 1010 00:56:10,640 --> 00:56:19,030 At the present, the view of schizophrenia is, as I say, 1011 00:56:19,030 --> 00:56:21,290 much more that it's a distinct state of brain 1012 00:56:21,290 --> 00:56:22,640 disease of some sort. 1013 00:56:22,640 --> 00:56:23,960 What might cause it? 1014 00:56:23,960 --> 00:56:29,360 Well, the fact that a pill that reduces the effects of 1015 00:56:29,360 --> 00:56:32,630 dopamine does something tends to suggest to people that 1016 00:56:32,630 --> 00:56:35,450 there's a biological cause there. 1017 00:56:35,450 --> 00:56:37,890 In the case of schizophrenia that well maybe true, but it's 1018 00:56:37,890 --> 00:56:40,630 important to note that that doesn't need to be true. 1019 00:56:40,630 --> 00:56:44,030 Things that are cured or symptoms that are cured by 1020 00:56:44,030 --> 00:56:48,300 pills aren't necessarily symptoms that are caused by 1021 00:56:48,300 --> 00:56:53,600 bad genes or bacteria or some biological story like that. 1022 00:56:53,600 --> 00:56:56,100 A perfectly nice example is motion sickness. 1023 00:56:56,100 --> 00:56:59,830 You go on an airplane, you get bounced around, you throw up. 1024 00:56:59,830 --> 00:57:01,410 What are you going to do about this? 1025 00:57:01,410 --> 00:57:05,920 Well, you can take scopolamine or meclizine that's Bonine -- 1026 00:57:05,920 --> 00:57:09,260 Bonine is meclizine and dramamine is scopolamine -- 1027 00:57:09,260 --> 00:57:13,640 two perfectly nice drugs that affect your vestibular system, 1028 00:57:13,640 --> 00:57:16,070 and they will keep you from getting motion sick. 1029 00:57:16,070 --> 00:57:19,880 That's not because you've got bad motion sickness genes or 1030 00:57:19,880 --> 00:57:22,030 you got the motion sickness bacteria. 1031 00:57:22,030 --> 00:57:25,640 It's a biological treatment, if you like, for an 1032 00:57:25,640 --> 00:57:29,980 environmentally caused disorder. 1033 00:57:29,980 --> 00:57:35,900 I point that out only to make the point that what cures or 1034 00:57:35,900 --> 00:57:38,470 treats a disorder doesn't necessarily tell you 1035 00:57:38,470 --> 00:57:40,440 what the cause is. 1036 00:57:40,440 --> 00:57:44,790 There's not one-to-one mapping there -- that's important to 1037 00:57:44,790 --> 00:57:46,140 keep in mind. 1038 00:57:46,140 --> 00:57:48,430 But the drugs certainly do help with the symptoms. 1039 00:57:48,430 --> 00:57:54,280 What psychopharmacologists work on a lot now is getting 1040 00:57:54,280 --> 00:57:56,240 drugs that work better. 1041 00:57:56,240 --> 00:57:59,610 All right, we want to reduce dopamine here but not here. 1042 00:57:59,610 --> 00:58:02,140 Well it turns out that there's a bunch of different dopamine 1043 00:58:02,140 --> 00:58:03,120 receptors -- 1044 00:58:03,120 --> 00:58:06,660 let's make a drug that only acts at this location and not 1045 00:58:06,660 --> 00:58:07,540 at this location. 1046 00:58:07,540 --> 00:58:13,660 That's a sort of project that psychopharmacology works on at 1047 00:58:13,660 --> 00:58:14,450 the present time. 1048 00:58:14,450 --> 00:58:20,930 But I want to go back and talk about the possible causes of 1049 00:58:20,930 --> 00:58:24,940 mental illness, but I'll do that after we take a brief 1050 00:58:24,940 --> 00:58:26,190 break here. 1051 01:00:09,140 --> 01:00:10,640 OK. 1052 01:00:10,640 --> 01:00:16,630 What I want to do with the remaining portion, probably 1053 01:00:16,630 --> 01:00:21,370 all of the remaining portion, of today's lecture is to make 1054 01:00:21,370 --> 01:00:25,940 two points, which I have already alluded to. 1055 01:00:25,940 --> 01:00:29,370 One of them is that there are multiple roots into mental 1056 01:00:29,370 --> 01:00:33,180 illness, not just any sort of single root, and you're going 1057 01:00:33,180 --> 01:00:36,540 to need to work this out on a case-by-case basis. 1058 01:00:36,540 --> 01:00:42,340 The other related point is that the border between normal 1059 01:00:42,340 --> 01:00:46,250 and abnormal is not necessarily a sharp clearly 1060 01:00:46,250 --> 01:00:46,750 marked one. 1061 01:00:46,750 --> 01:00:50,270 Oh, by the way, if you're interested in this latter 1062 01:00:50,270 --> 01:00:54,860 point, there's an article in today's New York Times science 1063 01:00:54,860 --> 01:00:58,780 section about really exactly this point in the context of 1064 01:00:58,780 --> 01:01:01,350 eating disorders -- a topic that I hope to get to before 1065 01:01:01,350 --> 01:01:03,190 the end of the course -- 1066 01:01:03,190 --> 01:01:11,990 where it's very important to be able to give a label to 1067 01:01:11,990 --> 01:01:13,520 psychiatric conditions. 1068 01:01:13,520 --> 01:01:15,020 Why is that important? 1069 01:01:15,020 --> 01:01:20,130 In part it's important because third party payers will pay if 1070 01:01:20,130 --> 01:01:24,190 you have a disorder, but they won't pay if you're just 1071 01:01:24,190 --> 01:01:26,590 feeling a little screwed up, right. 1072 01:01:26,590 --> 01:01:28,130 So you gotta have a labeled disorder. 1073 01:01:28,130 --> 01:01:32,210 So, there's been a big movement within the American 1074 01:01:32,210 --> 01:01:34,840 Psychiatric establishment to come up with 1075 01:01:34,840 --> 01:01:37,110 clear diagnostic criteria. 1076 01:01:37,110 --> 01:01:40,490 The nice thing about, you know you go into your pediatrician 1077 01:01:40,490 --> 01:01:45,655 and getting a throat culture for strep is that I can grow 1078 01:01:45,655 --> 01:01:49,460 it in the lab, and if you got strep you got strep, and I'd 1079 01:01:49,460 --> 01:01:51,720 give you something for strep. 1080 01:01:51,720 --> 01:01:55,070 Mental illness is almost never like that. 1081 01:01:55,070 --> 01:02:00,330 You got some collection of symptoms, are they adequate to 1082 01:02:00,330 --> 01:02:03,120 get you the definition of this disease? 1083 01:02:03,120 --> 01:02:09,360 The Times article is pointing out that therapists are having 1084 01:02:09,360 --> 01:02:14,540 a real problems with people who any idiot can see has, 1085 01:02:14,540 --> 01:02:18,980 let's say, an eating disorder, but the official criteria for 1086 01:02:18,980 --> 01:02:24,350 anorexia nervosa, the eating disorder of self-starvation, 1087 01:02:24,350 --> 01:02:27,790 are you have to have boom, boom, boom, boom and boom. 1088 01:02:27,790 --> 01:02:30,300 Well, if you're missing that boom, you 1089 01:02:30,300 --> 01:02:32,120 can't make the diagnosis. 1090 01:02:32,120 --> 01:02:34,370 What do you call them now? 1091 01:02:34,370 --> 01:02:37,100 Anyway, so today's New York Times science section, go 1092 01:02:37,100 --> 01:02:38,380 check it out. 1093 01:02:38,380 --> 01:02:43,920 In the meantime, let us return to 1900 to talk a bit about 1094 01:02:43,920 --> 01:02:47,280 possible causes of mental illness. 1095 01:02:47,280 --> 01:02:54,350 In 1900 half the patients in American mental hospitals had 1096 01:02:54,350 --> 01:02:57,840 a disorder known as dementia paralytica. 1097 01:02:57,840 --> 01:02:59,940 This is the bad stuff. 1098 01:02:59,940 --> 01:03:05,150 It's a disorder that starts with mania and grandiosity as 1099 01:03:05,150 --> 01:03:06,400 its symptoms. 1100 01:03:09,540 --> 01:03:14,830 If you think that you are Jesus and that you can turn 1101 01:03:14,830 --> 01:03:19,360 water into wine and stuff like that, except in the rare case 1102 01:03:19,360 --> 01:03:23,730 where that turns out to be true or something, it's a 1103 01:03:23,730 --> 01:03:30,560 psychiatric symptom and it would be a manic 1104 01:03:30,560 --> 01:03:32,740 symptom of some sort. 1105 01:03:32,740 --> 01:03:35,810 If you think you're the reincarnation of Napoleon and 1106 01:03:35,810 --> 01:03:38,950 this time you're going to get the invasion of Russia right 1107 01:03:38,950 --> 01:03:41,590 or something like that, you know, that's the sort of thing 1108 01:03:41,590 --> 01:03:44,730 that gets you into psychiatric care. 1109 01:03:44,730 --> 01:03:49,770 In the case of dimentia paralytica, it then proceeded 1110 01:03:49,770 --> 01:03:51,980 to the other two bits of the name. 1111 01:03:51,980 --> 01:03:55,970 Dementia, people became demented, they then became 1112 01:03:55,970 --> 01:03:58,990 paralyzed, lost control their muscles and then they died. 1113 01:03:58,990 --> 01:04:02,140 This is not a good disorder. 1114 01:04:02,140 --> 01:04:04,740 It has disappeared essentially. 1115 01:04:04,740 --> 01:04:07,570 Why? 1116 01:04:07,570 --> 01:04:11,400 Does anybody happen to know the answer? 1117 01:04:11,400 --> 01:04:12,050 Yes. 1118 01:04:12,050 --> 01:04:14,750 Which person? 1119 01:04:14,750 --> 01:04:16,320 What are you looking behind you for? 1120 01:04:16,320 --> 01:04:19,040 How many people are wearing witchy hats? 1121 01:04:22,860 --> 01:04:27,620 How long have you thought you were a witch? 1122 01:04:27,620 --> 01:04:29,350 Anyway, you were saying. 1123 01:04:29,350 --> 01:04:35,695 AUDIENCE: This is caused by bacteria I think, or something 1124 01:04:35,695 --> 01:04:37,980 that they like [INAUDIBLE]. 1125 01:04:37,980 --> 01:04:39,140 PROFESSOR: Well, all right. 1126 01:04:39,140 --> 01:04:42,060 The problem is people know too much around here. 1127 01:04:42,060 --> 01:04:45,150 You can fish around for all sorts of interesting answers, 1128 01:04:45,150 --> 01:04:47,600 like one of the possible reasons for a diagnosis to 1129 01:04:47,600 --> 01:04:50,620 disappear is you fractionate the disorder into a bunch of 1130 01:04:50,620 --> 01:04:53,010 other stuff and we've now renamed it and this is now 1131 01:04:53,010 --> 01:04:55,000 called Alzheimers and a few other things. 1132 01:04:55,000 --> 01:04:57,540 But no, in fact, this is an outside pathogen. 1133 01:04:57,540 --> 01:05:03,460 In this case, dementia paralytica was the result of 1134 01:05:03,460 --> 01:05:06,070 tertiary third stage syphilis. 1135 01:05:06,070 --> 01:05:09,760 The reason you don't see it anymore is that nobody gets to 1136 01:05:09,760 --> 01:05:11,080 third stage syphilis anymore. 1137 01:05:11,080 --> 01:05:12,870 If you show up with symptoms of syphilis 1138 01:05:12,870 --> 01:05:15,320 somebody treats you. 1139 01:05:15,320 --> 01:05:19,070 This was the result, by the time the organism had gotten 1140 01:05:19,070 --> 01:05:21,040 to your brain and chewed up your brain. 1141 01:05:23,700 --> 01:05:26,140 So it disappeared with treatment. 1142 01:05:26,140 --> 01:05:31,830 But it points out is that one of the roots to mental illness 1143 01:05:31,830 --> 01:05:37,900 is an assault, a biological assault from the outside. 1144 01:05:41,550 --> 01:05:47,150 So there are theories, unproven theories that a rise 1145 01:05:47,150 --> 01:05:50,720 in autism, that's been seen in this country over the last 1146 01:05:50,720 --> 01:05:54,130 couple of generations, is due to some sort of external 1147 01:05:54,130 --> 01:05:58,520 insult to the nervous system, not clear what it is, but 1148 01:05:58,520 --> 01:06:01,460 there are proposals out there that something that we're 1149 01:06:01,460 --> 01:06:03,650 doing to the environment is causing 1150 01:06:03,650 --> 01:06:06,040 more autism, for example. 1151 01:06:08,730 --> 01:06:14,680 But this is an example of a clearly biologically rooted 1152 01:06:14,680 --> 01:06:16,030 mental illness. 1153 01:06:18,660 --> 01:06:25,180 Perhaps the extreme other end of the scale would be -- well, 1154 01:06:25,180 --> 01:06:26,520 it's more like a triangle. 1155 01:06:26,520 --> 01:06:36,310 We could have biology, we could have an environmental 1156 01:06:36,310 --> 01:06:39,970 disorder, and we could have what you might consider to be 1157 01:06:39,970 --> 01:06:43,580 a societally defined disorder. 1158 01:06:43,580 --> 01:06:47,430 The distinction here is this is a case where the 1159 01:06:47,430 --> 01:06:52,130 environment somehow really does make you insane, and this 1160 01:06:52,130 --> 01:06:55,320 is a case where we take the normal distribution and 1161 01:06:55,320 --> 01:06:59,220 declare the upper tail of the distribution to be a 1162 01:06:59,220 --> 01:07:02,460 psychopathology of some sort. 1163 01:07:02,460 --> 01:07:05,100 So let's look for examples of both of these. 1164 01:07:05,100 --> 01:07:07,010 A perfectly nice example -- 1165 01:07:07,010 --> 01:07:12,050 not nice -- an example of an environmental disorder would 1166 01:07:12,050 --> 01:07:17,670 be what was called shell-shock in World War I and would now 1167 01:07:17,670 --> 01:07:21,400 probably be more generally lumped under the category of 1168 01:07:21,400 --> 01:07:23,840 traumatic stress disorder. 1169 01:07:23,840 --> 01:07:35,600 Exposure to extreme stress and being shot at can produce a 1170 01:07:35,600 --> 01:07:39,220 range of disabling psychiatric symptoms. 1171 01:07:39,220 --> 01:07:45,940 So, in World War I when people were fighting this insane 1172 01:07:45,940 --> 01:07:50,770 warfare of having vast numbers of people in entrenched 1173 01:07:50,770 --> 01:07:55,010 positions shelling each other and just charging at each 1174 01:07:55,010 --> 01:08:00,160 other, some fraction of the population of 1175 01:08:00,160 --> 01:08:02,470 soldiers cracked up. 1176 01:08:02,470 --> 01:08:04,540 They just couldn't function. 1177 01:08:04,540 --> 01:08:07,610 They would cry hysterically, they would just lie there and 1178 01:08:07,610 --> 01:08:10,450 not do anything. 1179 01:08:10,450 --> 01:08:16,010 The first reaction of the military to such things is to 1180 01:08:16,010 --> 01:08:18,750 decide that this is insubordination and to shoot 1181 01:08:18,750 --> 01:08:22,630 you or something of that sort for failing to obey orders. 1182 01:08:22,630 --> 01:08:28,410 But it became clear to medical folks during World War I that 1183 01:08:28,410 --> 01:08:32,010 this was not a voluntary act, this was 1184 01:08:32,010 --> 01:08:33,510 a psychiatric problem. 1185 01:08:38,580 --> 01:08:42,170 They went and pulled people back behind the lines, worked 1186 01:08:42,170 --> 01:08:45,000 very hard to treat them so that they could return them to 1187 01:08:45,000 --> 01:08:49,580 the war in a sort of a sick irony. 1188 01:08:49,580 --> 01:08:56,220 But this is a disorder that is clearly environmental. 1189 01:08:56,220 --> 01:08:58,650 Now there's probably some -- 1190 01:08:58,650 --> 01:09:04,040 not everybody who's placed under stress produces a post 1191 01:09:04,040 --> 01:09:06,790 traumatic stress disorder, so it's clear that there's some 1192 01:09:06,790 --> 01:09:10,910 underlying variation of unknown nature that makes some 1193 01:09:10,910 --> 01:09:13,130 people vulnerable to it and some people not. 1194 01:09:13,130 --> 01:09:17,070 But the precipitating cause here is environmental. 1195 01:09:17,070 --> 01:09:21,650 Now this is something that's a topic of a lot of current 1196 01:09:21,650 --> 01:09:27,660 interest in psychiatry and in clinical psychology. 1197 01:09:27,660 --> 01:09:31,040 Because as it's been appreciated that this sort of 1198 01:09:31,040 --> 01:09:38,390 trauma does produce psychiatric symptoms, efforts 1199 01:09:38,390 --> 01:09:41,900 are made to prevent this when it's clear 1200 01:09:41,900 --> 01:09:42,920 it's going to happen. 1201 01:09:42,920 --> 01:09:48,690 So, first responders, the police and firemen who are 1202 01:09:48,690 --> 01:09:51,320 going to be the first guys that crash scenes or into 1203 01:09:51,320 --> 01:09:55,340 burning buildings, are going to see really terrible stuff, 1204 01:09:55,340 --> 01:10:00,290 and it's known that that's going to produce a collection 1205 01:10:00,290 --> 01:10:02,800 of psychiatric symptoms. 1206 01:10:02,800 --> 01:10:07,280 So, an interesting question is well if you know that, what 1207 01:10:07,280 --> 01:10:11,580 could you do perhaps to ameliorate the situation? 1208 01:10:11,580 --> 01:10:16,310 One very popular idea has been that after a crisis -- 1209 01:10:16,310 --> 01:10:22,790 I mean you hear this all the time when something really bad 1210 01:10:22,790 --> 01:10:25,920 happens like a school shooting or something, one of the 1211 01:10:25,920 --> 01:10:27,900 things you do is you immediately pour in a bunch of 1212 01:10:27,900 --> 01:10:30,500 therapists, and the idea is is you get people together to 1213 01:10:30,500 --> 01:10:32,200 talk about it. 1214 01:10:32,200 --> 01:10:35,670 One particular modality of therapy is you basically get 1215 01:10:35,670 --> 01:10:40,560 all your firefighters who were at this scene into a room 1216 01:10:40,560 --> 01:10:44,910 together to talk it through, and that this has been 1217 01:10:44,910 --> 01:10:47,650 proposed as a mechanism for preventing 1218 01:10:47,650 --> 01:10:49,830 these stress disorders. 1219 01:10:49,830 --> 01:10:53,680 Unfortunately, a big study came out last year suggesting 1220 01:10:53,680 --> 01:10:56,520 sounds lovely, doesn't work. 1221 01:10:56,520 --> 01:10:59,040 Not that it does anything particularly bad or anything, 1222 01:10:59,040 --> 01:11:01,720 it just doesn't work. 1223 01:11:05,270 --> 01:11:10,060 What it points out is that the state of the art is a little 1224 01:11:10,060 --> 01:11:12,800 like the problem I was talking about with Freudian attempts 1225 01:11:12,800 --> 01:11:16,430 to explain schizophrenia. 1226 01:11:16,430 --> 01:11:21,170 These are difficult problems where good well-meaning 1227 01:11:21,170 --> 01:11:25,330 clinicians try stuff out that doesn't necessarily work. 1228 01:11:25,330 --> 01:11:28,690 Very hard to get a clear feeling from this, from 1229 01:11:28,690 --> 01:11:32,070 reading the popular press where you get one miracle cure 1230 01:11:32,070 --> 01:11:35,820 after the other and then the miracle cure fades away, but 1231 01:11:35,820 --> 01:11:37,610 it fades away in the literature somewhere -- you 1232 01:11:37,610 --> 01:11:42,780 don't get to see this very clearly if you just sit there 1233 01:11:42,780 --> 01:11:47,550 reading the science section of Time magazine or 1234 01:11:47,550 --> 01:11:48,390 something of that sort. 1235 01:11:48,390 --> 01:11:55,280 Anyway, so third stage syphilis munches up your mind, 1236 01:11:55,280 --> 01:11:58,940 trench warfare munches up your mind. 1237 01:11:58,940 --> 01:12:05,690 Are there diseases that are defined purely by society and 1238 01:12:05,690 --> 01:12:08,130 what does that mean? 1239 01:12:08,130 --> 01:12:09,270 Are those legitimate? 1240 01:12:09,270 --> 01:12:10,930 Well, let's talk about one that's not terribly 1241 01:12:10,930 --> 01:12:12,330 legitimate. 1242 01:12:12,330 --> 01:12:16,710 I don't think anybody here is deeply familiar with the 1243 01:12:16,710 --> 01:12:19,760 disorder called drapetomania. 1244 01:12:19,760 --> 01:12:22,690 Any drapetomania experts? 1245 01:12:22,690 --> 01:12:23,400 No. 1246 01:12:23,400 --> 01:12:25,070 OK. 1247 01:12:25,070 --> 01:12:28,470 Any Greek scholars? 1248 01:12:28,470 --> 01:12:28,970 No. 1249 01:12:28,970 --> 01:12:30,260 So we're not going to get anybody to tell us 1250 01:12:30,260 --> 01:12:31,730 what the root is. 1251 01:12:31,730 --> 01:12:35,570 So, it's not a manic desire to put up drapes. 1252 01:12:35,570 --> 01:12:41,060 It's drapeto comes from a Greek root having to do with 1253 01:12:41,060 --> 01:12:45,130 wandering off, and the mania's the mania part. 1254 01:12:45,130 --> 01:12:48,870 So it's an insane desire to wander away. 1255 01:12:48,870 --> 01:12:51,310 All right, that sounds like it could be insane. 1256 01:12:51,310 --> 01:12:57,910 This is a disorder discovered by a doctor named Cartwright 1257 01:12:57,910 --> 01:13:02,280 in Louisiana in the 1840s. 1258 01:13:02,280 --> 01:13:06,110 He writes about it in a book endearingly titled, 1259 01:13:06,110 --> 01:13:09,410 Peculiarities of the Negro Race. 1260 01:13:09,410 --> 01:13:13,890 So you need to think -- all right, time to review your AP 1261 01:13:13,890 --> 01:13:15,830 American history. 1262 01:13:15,830 --> 01:13:18,710 Right, 1840s, Louisiana. 1263 01:13:18,710 --> 01:13:23,540 If you are a member of the negro race you are what? 1264 01:13:23,540 --> 01:13:24,460 A slave. 1265 01:13:24,460 --> 01:13:26,820 If you are a slave you might do what? 1266 01:13:30,340 --> 01:13:36,970 Well you might wander off or run away. 1267 01:13:36,970 --> 01:13:38,910 It wasn't that Cartwright discovered this. 1268 01:13:38,910 --> 01:13:40,980 People knew that slaves ran away. 1269 01:13:40,980 --> 01:13:44,110 But rather like earlier attitudes towards people 1270 01:13:44,110 --> 01:13:46,940 cracking up on the battlefield, the standard 1271 01:13:46,940 --> 01:13:50,170 attitude towards the slave that ran away was 1272 01:13:50,170 --> 01:13:52,280 that's a bad slave. 1273 01:13:52,280 --> 01:13:58,150 Right, he's just bad, and what we should do is catch him and 1274 01:13:58,150 --> 01:14:00,970 beat him and put him back to work. 1275 01:14:00,970 --> 01:14:05,200 Cartwright was an odd sort of liberal from the sound of it 1276 01:14:05,200 --> 01:14:09,550 in the sense that he said, no, no, no, no, no -- they're not 1277 01:14:09,550 --> 01:14:11,670 bad, they're sick. 1278 01:14:11,670 --> 01:14:15,180 Because after all, as he understood it, the proper 1279 01:14:15,180 --> 01:14:21,370 place for a slave for an African American was to be a 1280 01:14:21,370 --> 01:14:22,960 slave, right? 1281 01:14:22,960 --> 01:14:28,400 So if you wandered off, you weren't being a healthy, 1282 01:14:28,400 --> 01:14:29,160 normal slave. 1283 01:14:29,160 --> 01:14:33,000 You'd gone up here somewhere and you were being abnormal. 1284 01:14:33,000 --> 01:14:36,230 He also, by the way, had a lovely biological theory about 1285 01:14:36,230 --> 01:14:41,420 the cause of this, which was decarbonized blood. 1286 01:14:41,420 --> 01:14:43,810 I don't know, it sounds like it would do 1287 01:14:43,810 --> 01:14:45,060 something bad to me. 1288 01:14:48,380 --> 01:14:50,230 And he had a treatment regimen. 1289 01:14:50,230 --> 01:14:53,980 Remember that the standard treatment for a slave who ran 1290 01:14:53,980 --> 01:14:59,070 away was catch him, beat him and put him back to work. 1291 01:14:59,070 --> 01:15:02,710 Cartwright said, when you catch him, what you need to do 1292 01:15:02,710 --> 01:15:09,770 is slap some oil in with a broad leather strap and put 1293 01:15:09,770 --> 01:15:10,970 him to work. 1294 01:15:10,970 --> 01:15:12,230 All right, so the treatment didn't 1295 01:15:12,230 --> 01:15:13,350 sound all that different. 1296 01:15:13,350 --> 01:15:20,660 In any case, it's a pretty clear case of a disorder 1297 01:15:20,660 --> 01:15:24,860 defined entirely by society. 1298 01:15:24,860 --> 01:15:25,590 There's not a -- 1299 01:15:25,590 --> 01:15:27,480 I don't know, decarbonized blood not withstanding. 1300 01:15:27,480 --> 01:15:31,320 There's not an organism there. 1301 01:15:31,320 --> 01:15:32,770 There's not -- 1302 01:15:32,770 --> 01:15:35,400 well, you can think of the environment as causing the 1303 01:15:35,400 --> 01:15:37,750 slave to run away, but not in the sense 1304 01:15:37,750 --> 01:15:39,380 of causing a disorder. 1305 01:15:39,380 --> 01:15:42,690 We would consider this to be essentially a normal -- 1306 01:15:42,690 --> 01:15:45,660 we'd be with Thomas Szasz on that, that's a sane reaction 1307 01:15:45,660 --> 01:15:52,510 to an insane world, perhaps, to be a slave and to run away. 1308 01:15:52,510 --> 01:15:57,360 Now, you might argue that we don't do that anymore, but if 1309 01:15:57,360 --> 01:16:02,750 you were to, say, OK, what this is, is weight. 1310 01:16:02,750 --> 01:16:06,810 Let's make this normal distribution weight. 1311 01:16:06,810 --> 01:16:11,070 The Surgeon General is perfectly happy and all sorts 1312 01:16:11,070 --> 01:16:14,590 of outfits are perfectly happy to declare that if you're 1313 01:16:14,590 --> 01:16:17,660 above this level whatever it is, you're abnormal, you're 1314 01:16:17,660 --> 01:16:20,180 overweight. 1315 01:16:20,180 --> 01:16:24,580 And there are plenty of theories, folks psychological 1316 01:16:24,580 --> 01:16:28,820 and otherwise, that basically give a psychiatric spin to 1317 01:16:28,820 --> 01:16:30,890 what's going on there, right. 1318 01:16:30,890 --> 01:16:36,560 If you've heard theories of obesity being -- there are pop 1319 01:16:36,560 --> 01:16:38,670 theories that oh, they're overcompensating -- 1320 01:16:38,670 --> 01:16:41,190 that they're eating to substitute for the lack of 1321 01:16:41,190 --> 01:16:46,000 love in their life, or it's a lack of self-control, or it's 1322 01:16:46,000 --> 01:16:50,500 because they have gene for fatness. 1323 01:16:50,500 --> 01:16:52,500 All of this might be true at some level. 1324 01:16:52,500 --> 01:16:59,060 I'm not casting any doubt on the particular theory, that's 1325 01:16:59,060 --> 01:17:00,210 a separate topic. 1326 01:17:00,210 --> 01:17:03,990 But you gotta realize that what you're doing is taking an 1327 01:17:03,990 --> 01:17:06,140 essentially normal distribution with the 1328 01:17:06,140 --> 01:17:08,280 exception of some very few -- 1329 01:17:08,280 --> 01:17:12,120 there are a small number of clear pathologies of weight 1330 01:17:12,120 --> 01:17:12,970 regulation. 1331 01:17:12,970 --> 01:17:15,060 Mostly what you're doing is taking one tail of the 1332 01:17:15,060 --> 01:17:18,470 distribution, declaring it to be abnormal, and putting an 1333 01:17:18,470 --> 01:17:21,430 explanation on it. 1334 01:17:21,430 --> 01:17:28,280 How you understand that is culturally dependent. 1335 01:17:28,280 --> 01:17:32,020 How we talk about obesity is in part defined by how we talk 1336 01:17:32,020 --> 01:17:33,680 about beauty. 1337 01:17:33,680 --> 01:17:38,680 In cultures where obesity is considered beautiful, you 1338 01:17:38,680 --> 01:17:42,670 don't get theories that say it's an abnormality, right? 1339 01:17:42,670 --> 01:17:47,080 So in some fashion we do this all the time. 1340 01:17:51,560 --> 01:17:55,330 In the remaining time, what I want to do, and then I'll loop 1341 01:17:55,330 --> 01:18:02,510 back to this point, is look on your handout on page three. 1342 01:18:02,510 --> 01:18:07,520 Let's do a little bit of armchair diagnosis here. 1343 01:18:07,520 --> 01:18:08,520 We don't have much time. 1344 01:18:08,520 --> 01:18:13,420 Quickly read these three vignettes and quickly decide 1345 01:18:13,420 --> 01:18:18,770 where they lie on the scale from fine to very weird. 1346 01:18:18,770 --> 01:18:22,590 I'm deliberately using very casual language there in order 1347 01:18:22,590 --> 01:18:26,510 to suggest that you not think deeply about whether or not 1348 01:18:26,510 --> 01:18:29,570 you're giving them a psychiatric diagnosis here, I 1349 01:18:29,570 --> 01:18:30,920 just want to know whether they're nuts. 1350 01:18:36,360 --> 01:18:37,960 We'll collect a little data. 1351 01:18:37,960 --> 01:18:39,410 How are we going to collect this data? 1352 01:19:04,010 --> 01:19:07,300 Don't cheat off your neighbors, please, and 1353 01:19:07,300 --> 01:19:08,790 [? wavel ?] in when you're done. 1354 01:19:08,790 --> 01:19:11,250 How many people are done? 1355 01:19:11,250 --> 01:19:11,990 Most people are done. 1356 01:19:11,990 --> 01:19:14,600 OK, good enough. 1357 01:19:14,600 --> 01:19:17,130 In the interest of getting some data relatively quickly, 1358 01:19:17,130 --> 01:19:27,200 let's group between -- 1359 01:19:27,200 --> 01:19:30,140 let's do aluminum hat boy, Jim. 1360 01:19:30,140 --> 01:19:35,750 How many people gave him a sort of 1-3, he's fine? 1361 01:19:35,750 --> 01:19:38,990 4-7 he's a little weird. 1362 01:19:38,990 --> 01:19:41,410 I take it we got a lot of population-- 1363 01:19:41,410 --> 01:19:42,660 All right. 1364 01:19:45,170 --> 01:19:46,420 So Jim's here. 1365 01:19:49,470 --> 01:19:52,050 How about Jack there at the bottom -- we'll 1366 01:19:52,050 --> 01:19:53,550 come back to Sam. 1367 01:19:53,550 --> 01:19:54,970 How many people thought Jack was in the 1368 01:19:54,970 --> 01:19:57,010 1-3 he's fine category? 1369 01:20:00,100 --> 01:20:00,830 A bunch of people. 1370 01:20:00,830 --> 01:20:04,670 How many people thought he's in the 4-7 category? 1371 01:20:04,670 --> 01:20:06,790 A bunch more people. 1372 01:20:06,790 --> 01:20:09,200 Let's give him some hash marks here so we can tell the 1373 01:20:09,200 --> 01:20:11,110 difference. 1374 01:20:11,110 --> 01:20:12,930 So this is -- what is his name? 1375 01:20:12,930 --> 01:20:14,180 Jack. 1376 01:20:17,240 --> 01:20:19,430 How many people thought he was very weird? 1377 01:20:19,430 --> 01:20:21,350 So only a very few. 1378 01:20:21,350 --> 01:20:23,930 So, you can, in fact -- 1379 01:20:23,930 --> 01:20:26,280 so Jim is sort of the guy who came to my lab all those years 1380 01:20:26,280 --> 01:20:28,980 ago, and Jack can be found in Harvard Square any time 1381 01:20:28,980 --> 01:20:32,620 selling some far left newspaper and yelling at you 1382 01:20:32,620 --> 01:20:36,060 about the fact that we're all controlled by something, and 1383 01:20:36,060 --> 01:20:40,050 we just consider them to be sort of weird but kind of -- 1384 01:20:40,050 --> 01:20:41,950 this is in the realm of free speech. 1385 01:20:41,950 --> 01:20:44,250 All right, let's take a look at Sam. 1386 01:20:44,250 --> 01:20:49,350 How many people thought Sam's just fine? 1387 01:20:49,350 --> 01:20:50,050 OK. 1388 01:20:50,050 --> 01:20:53,570 How many thought Sam was just in the middle? 1389 01:20:53,570 --> 01:20:54,130 OK. 1390 01:20:54,130 --> 01:20:57,200 How many thought that Sam was pretty weird? 1391 01:20:57,200 --> 01:21:00,180 All right, so that looks-- 1392 01:21:00,180 --> 01:21:02,540 I need some space here. 1393 01:21:10,070 --> 01:21:15,250 Well actually, lots of fines, a few less in the middles, and 1394 01:21:15,250 --> 01:21:17,700 almost as many weird. 1395 01:21:17,700 --> 01:21:19,480 Pretty wide distribution, right. 1396 01:21:19,480 --> 01:21:22,480 The other two are very heavily skewed. 1397 01:21:22,480 --> 01:21:26,440 Could somebody in the fine department 1398 01:21:26,440 --> 01:21:29,600 explain why he's fine? 1399 01:21:29,600 --> 01:21:30,570 Yes, find person. 1400 01:21:30,570 --> 01:21:32,162 AUDIENCE: I think he's weird, I just 1401 01:21:32,162 --> 01:21:33,120 don't think he's disabled. 1402 01:21:33,120 --> 01:21:36,310 PROFESSOR: I need somebody who thinks he's fine, fine. 1403 01:21:36,310 --> 01:21:38,260 Yes. 1404 01:21:38,260 --> 01:21:39,510 Yes, you pink person. 1405 01:21:42,340 --> 01:21:45,680 AUDIENCE: He's just a stamp collector -- he sounds fine. 1406 01:21:45,680 --> 01:21:47,070 PROFESSOR: A stamp collector. 1407 01:21:47,070 --> 01:21:49,380 All right. 1408 01:21:49,380 --> 01:21:55,490 The trick here is there is a two-word variation between 1409 01:21:55,490 --> 01:21:58,830 what half of you have and what the other half of you have. 1410 01:21:58,830 --> 01:22:03,150 Let's see if that makes a difference. 1411 01:22:03,150 --> 01:22:06,190 The people who don't have the stamp collector one know the 1412 01:22:06,190 --> 01:22:13,690 difference, which is that one half of you have his major 1413 01:22:13,690 --> 01:22:17,310 passion is collecting stamps, and the other have his major 1414 01:22:17,310 --> 01:22:18,880 passion is collecting women's undergarments. 1415 01:22:22,460 --> 01:22:24,150 Right. 1416 01:22:24,150 --> 01:22:26,520 That is the only difference here. 1417 01:22:26,520 --> 01:22:27,170 Yes? 1418 01:22:27,170 --> 01:22:28,420 AUDIENCE: [INAUDIBLE] 1419 01:22:37,370 --> 01:22:39,490 PROFESSOR: You know, actually that's lovely because I could 1420 01:22:39,490 --> 01:22:45,000 probably expand the description. 1421 01:22:45,000 --> 01:22:48,920 If I said he used to write all of his relatives and asked 1422 01:22:48,920 --> 01:22:53,650 them to send him used stamps, nobody would 1423 01:22:53,650 --> 01:22:54,720 think that was weird. 1424 01:22:54,720 --> 01:22:57,220 If I said he used to write to all his relatives and asked 1425 01:22:57,220 --> 01:23:02,860 them to send used underwear, that's really weird, right? 1426 01:23:05,430 --> 01:23:08,500 If I changed it a little more to say -- 1427 01:23:08,500 --> 01:23:09,100 what is his name? 1428 01:23:09,100 --> 01:23:14,020 Sam was a shy, withdrawn man, the president of the Haines 1429 01:23:14,020 --> 01:23:19,020 underwear company and at the corporate headquarters he had 1430 01:23:19,020 --> 01:23:22,750 the big underwear exhibit or something, then he becomes 1431 01:23:22,750 --> 01:23:24,810 less weird. 1432 01:23:24,810 --> 01:23:29,320 Given the time, let me just reiterate the point that what 1433 01:23:29,320 --> 01:23:33,560 this is intended to illustrate is that the border between 1434 01:23:33,560 --> 01:23:38,590 what makes you weird and what makes you just a little 1435 01:23:38,590 --> 01:23:42,060 different is not clear. 1436 01:23:42,060 --> 01:23:44,820 It's not something that we can define nice and sharply. 1437 01:23:44,820 --> 01:23:47,000 See you Thursday.