1:40

Well, let me start off by saying actually these lights only give me a dim impression that
there's a lot of primates out there.
1:47
So i'm not entirely sure what I'm seeing here. But let me start off by thanking
1:53
Justin and Peter. It is a delight to be here and a delight to see one's ex-students
flourishing and all that sort of stuff,
2:02
amid making me feel very elderly. Okay. So let me start off, I just got here a couple of
hours ago. So I pretty much
2:10
don't know anyone here. So i feel empowered to ask all sorts of invasive personal
questions of you guys. Okay. How many of you here have a family
2:19
history of heart disease, cancer, high blood pressure,
2:27
ulcers, stroke? Well, there's a hand there that's not even going down between the
2:32
questions. Okay. That is not good. How many of you have a family history of somebody
with a really bad case of leprosy?
2:43
No hands. How about that cousin you're stuck sitting next to with thanksgiving, the one
going to the bathroom every 10 minutes because of the dysentery?
2:51
Not that either. How about that extra special relative who's just teeming with liver
parasites the size of your fists?
3:00
Not much there either. And, all things considered, this is not very surprising. Very few of
us in this room seriously worry about smallpox or scarlet fever.
3:10
Few of us gets malaria during the rainy season. Few of our mothers died in childbirth.
Nobody in this room is malnourished.
3:18
We're not like normal animals. We don't get sick the way normal animals do. We don't
die the way they do. Basic, normal mammalian death. You drink some contaminated
water and you're dead from dehydration two days later.
3:30
And what do we do? We spend 80 years having our bodies go to hell on us. So we do.
Oh great! I've got to listen to what for the next hour?
3:38
This is actually fabulous news, because this is westernized disease
3:43
for the most part. We are not plagued by infectious diseases, diseases of poor nutrition,
poor hygiene. Instead, we live
3:51
well enough and long enough to slowly fall apart over time. and this is a magnificent
advance in the human experience
3:59
okay just to give you a sense of it like a little more than a century ago 1900 what do you
think were the leading causes of death in the united states
4:08
tuberculosis good what else childbirth if you were a woman between
4:14
ages 20 and 40 the single medically riskiest thing you could do in 1900 was attempt to
give birth what else was up there
4:22
influenza pneumonia tuberculosis influenza number one on the list the flu nobody dies
of the flu anymore 1918 worst winter world war one people
4:32
being blown out of trenches all over europe and if you were sent to the war that winter
your chances of surviving were better
4:37
than if you got the flu eight million war deaths in world war one 40 million dead civilians
that winter from the flu nobody under
4:46
age 100 dies of the flu anymore instead we die of these totally bizarre diseases
4:52
that never used to exist on this planet in any sort of frequency totally weird diseases like
heart disease
4:59
and cancer and diabetes and alzheimer's and what you suddenly realize is
5:04
this is a very novel realm we've entered in terms of making sense of which of us are sick
and which are healthy okay 20 000 years ago you're some 20
5:14
year old hunter-gatherer and you have screwed up big time you've made a major
medical mistake you've just eaten some reed buck riddled
5:22
with anthrax and the medical outcomes absolutely clear you've got like a three-day life
expectancy
5:28
these days as a 20-year-old you make a major medical mistake you decide a healthy
diet consists of a lot of red meat and saturated fats and
5:36
maybe a drink every other day or so and it's not at all clear what the outcome's going to
be you may be dead in your grave at 50 or you may be running
5:44
marathons with your grandkids when you're 85. and in lots of ways the central question
for westernized medicine is
5:52
so why do some of us last to 50 and some to 85. some of it's got to do with like nuts and
bolts biology what your liver does
5:59
with cholesterol or stuff like that but some of it's got to do with questions nobody ever
had to ask before in medicine totally
6:07
bizarre questions like what's your psychological makeup or what's your social status or
how do
6:14
people with your social status get treated in your society or how about this one get the
answer to this question and you will have done
6:21
more good for the health of humanity than anyone since like jonas salk inventing the
polio vaccine why is it that when we feel like nobody
6:30
loves us we eat oreo cookies answer that one and you have just solved half the
6:36
cases of diabetes in this country this is totally bizarre stuff that has
6:41
something to do with which of us are healthy or sick that has everything to do with it and
what we've entered is this
6:48
very strange world when we look at the diseases that do us in these diseases of slow
accumulation of damage from lifestyle over time
6:56
these are predominantly diseases that can be caused by or be made worse by stress
and most of us in this room
7:05
will have the profound westernized luxury of dropping dead someday of a stress-related
disease so nonetheless amid that great news it's
7:13
a good thing if that happens later rather than sooner so it's worth learning about this
okay we start off with definitions
7:19
i start off with a word i guarantee all of us had 9th grade biology with any luck you have
not thought about this word since then do you remember
7:27
homeostasis homeostasis having an ideal body temperature
7:33
having an ideal level of glucose in your bloodstream having an ideal everything being in
homeostatic balance a stressor is anything in the outside world that
7:44
knocks you out of homeostatic balance your zebra a lion has left out ripped your
stomach open and your injuries are dragging in the dust and you still need
7:51
to get out of there this counts as being out of homeostatic balance or you're that lion
you're that lion who's half starved to death and if
7:58
you don't chase down that zebra successfully you're not going to survive the night short-
term physical crisis and what you
8:05
do at that point is you turn on the stress response you secrete adrenaline 11d other
hormones i won't torture you
8:13
with what you do is you reestablish homeostatic balance that's all you need to know
about the subject if you're a zebra or a lion
8:21
if you're human though you got to expand the definition in a critical way yes a stressor
can be when your body's been knocked out of homeostatic balance
8:29
in addition a stressor can be when you think you're just about to be knocked out of
homeostatic balance
8:35
if it turns out that you're right that's great an anticipatory stress response woo here
comes the elephant maybe i'll increase my blood pressure
8:43
now before it stomps me rather than after that could be very adaptive on the other hand
if you think you're just about to be knocked out of
8:50
homeostatic balance and you really aren't about to be and you think that way all the
time there are medical ways of describing you
8:57
you're being neurotic as hell you're being anxious you're being paranoid you're being
hostile try to describe global warming
9:06
to a hippo and it's going to have no idea what you're getting all upset about but that's
the critical point we do the critical point of the whole thing is
9:16
we turn on the exact same stress response as that zebra running for its life or a lion
running for a meal
9:22
and we turn it on for purely psychological reasons and that's the punchline of the entire
field that's not what it evolved for
9:31
for 99 percent of beasts on this planet stress is three minutes of screaming terror after
which it's either over whether you're
9:38
over with and what do we do we turn on the same stress response for 30-year
mortgages and that's not what it is for and what
9:45
we see here is this is why we and other really cognitively sophisticated primates are the
ones who
9:52
get mowed over by stress-related disease this is a system that evolved for dealing with
short-term physical crises and we turn it on for chronic
10:02
psychosocial stress now listening to this description something should seem sort of
questionable though i'm describing
10:09
okay the stress response you turn this on if you're a zebra you're injured you're bleeding
you're hypotensive
10:17
or if you're the lion you're starving you're hypoglycemic these are very different physical
states and one of the things they pound into
10:24
your head in biology is your body comes up with a very specific solution for a very
specific challenge if you're
10:31
hot you don't shiver your body does something very differently than that yet here's the
stress response which does the exact same thing
10:38
whether you're injured starving too hot or too cold why should you turn on the same
stress response in all these circumstances
10:46
and this was a question wrestled with by the guy who's officially sort of the godfather of
stress and health this was an austrian physician in the
10:53
1930s named han selye who starred in the whole field because he was very smart and
very intuitive and very insightful and very
11:01
creative and apparently he was totally lame at handling lab rats and this is how he
started the field celie was this young assistant professor
11:09
he's at mcgill university montreal and he was looking for some research project and
some biochemist down the hall
11:16
had isolated some hormone out of somebody's pancreas or something nobody knew
what the stuff does so celia decides that's it i'm going to
11:23
figure out the effects of this pancreatic stuff on the body so what do you do you go down
the hall you get a bucket load of the pancreatic
11:29
stuff from your body you come back and you start injecting lab rats and apparently celie
simply was not very good at handling lab
11:37
rats so he's in there every day with the rats injecting the rats and dropping the rats and
chasing the rats and the rats
11:42
chasing him and half the morning with a broom getting around from underneath the sink
months of this goes by and he discovers
11:48
something amazing all of the rats have stomach ulcers celie is euphoric he's just
discovered the
11:56
effects of this pancreatic crud on the body it gives you a peptic ulcer now fortunately
being a good scientist
12:03
celie was also running a control group rats that he's injecting every day with saline
instead of the pancreatic stuff so he's in there with the control rats
12:11
injecting them and dropping them chasing them chasing him he checks out the control
rats and they all have stomach ulcers
12:18
okay so your average scientist at this point gives up and goes to business school but
soviet thinks about this and he says this is totally screwed i'm
12:27
seeing the exact same thing in the controls in the experimentals it's got nothing to do
with the pancreatic stuff what do they have in common well i'm
12:34
pretty inept at handling these guys they can't be having such a hot time here maybe
what i'm seeing is some sort of
12:39
non-specific response of the body to generalized unpleasant trees and celie's
12:46
insight was to at that point systematically expose rats to generalized unpleasant trees
put some of them up in the roof of the
12:53
building in the winter or down in the boiler rooms or rooms with loud noise or rooms
filled with cat pee or who knows what and he always sees the same thing
13:00
they get stomach ulcers we know exactly what soy had just discovered this was the tip
of the iceberg of stress-related disease and celie was
13:09
the guy who popularized what was this obscure term from metallurgy about torsional
strain on metals he's
13:16
the one who said these animals are under stress and they turn on certain systems in
their body that saves them from the stress but if
13:24
they turn it on for too long you get sick everybody thought he was out of his mind
because again you're trained your body
13:32
solves specific challenges in very specific ways and here's celie with his imaginary
stress response that gets turned on
13:39
exactly the same if you're injured starving too hot too colder on a blind date why should
you turn on the same exact
13:46
stress response and all these circumstances and it turns out it makes a great deal of
sense because whether you are that zebra or
13:54
that lion if you're going to survive the crisis there's certain things you need to do with
your body
14:00
first off above all else you need energy not energy tucked away in your fat cells
14:05
for some building project next spring energy right now to hand to whichever muscles are
going to save your neck and with the onset of stress you secrete
14:14
adrenaline and a bunch of other hormones and they go to the storage sites in your body
your liver your fat cells they mobilize energy at a storage form
14:23
dump it into the circulation it's like you go to the bank and you empty out the savings
accounts and turn it into cash
14:30
circulating glucose and you hand it over to whichever muscles are going to save you
makes wonderful sense
14:37
whether you were that zebra or that lion the next thing you do makes perfect sense as
well you've just done all this amazing
14:43
biochemistry and dumped all this energy in your bloodstream you want to deliver it as
fast as possible to your exercising muscles
14:50
your heart speeds up your blood pressure increases your breathing rate you increase
your cardiovascular tone all as part of the strategy get that
14:58
glucose get that oxygen to your thigh muscles in two seconds instead of three you're
that much more likely to survive
15:06
now the next things you do during stress make perfect sense which is you turn off all the
long-term building projects
15:14
if there's a tornado do this afternoon you don't spend the day outside gardening you
don't worry about long-term projects until you know
15:20
there's a long term you shut down everything that is not critical you shut down digestion
by definition if you are that lion you
15:28
are not staggering up from some all-you-can-eat buffet and if you are that zebra the
energy you're mobilizing for your muscles
15:34
you're ener mobilizing it from fat cells in just a couple of seconds digestion is slow it
takes forever it costs a fortune
15:43
you're trying to avoid being somebody's lunch don't worry about digesting breakfast and
we all know the first step of that
15:49
suppose you get stressed speaking in public what happens your mouth gets dry you've
stopped secreting saliva the
15:56
first step of shutting down the whole gastrointestinal tract with the onset of stress you
shut down growth you shut down
16:04
reproduction big expensive optimistic things to be doing with your body and this is no
time for it you know you're running for your life there's a
16:12
lie in two steps behind you you ovulate some other time don't do it
16:18
right now hit puberty next week grow antlers some other day don't even think about
sperm with the onset of
16:24
stress you shut down growth you shut down tissue repair every sex hormone on earth
disappears from the bloodstream do it later if there is a
16:32
later next so you're that zebra and your inners are dragging in the dust this might be a
good time to
16:39
perk up your immune system a little bit just in case of some effective stuff with the onset
of stress immune defenses are enhanced finally
16:48
a whole bunch of hormones secreted during stress get into your brain and short term
their effects are
16:55
fabulous they sharpen memory they increase glucose and oxygen delivery to
17:00
your brain your sensory thresholds are sharper you even release this neurotransmitter
dopamine
17:07
which makes you feel good your memory is working that's that flash bulb memory
17:12
where were you when you heard the news i'm willing to bet every single person in this
room no matter how long they live
17:19
you will all remember exactly where you were when you heard the news that miley
cyrus was joining the supreme court some stuff you just file away forever
17:30
because it's important your brain needs to get a signal this one do not forget so what
you see here is everything going
17:37
on here is exactly what you want to do if you're that zebra or that line you're mobilizing
energy you're delivering where it's needed you're
17:43
shutting off on essentials you're fighting infections you're thinking more clearly all you
have to do to appreciate that
17:49
is look at a couple of weirdo human diseases where people can't do this one of them is
called shy drager syndrome another one is addison's
17:57
disease these are not diseases where oh you're now more at risk for certain cancers
this is like somebody with undiagnosed
18:04
addison's goes running for the commuter bus one morning and drops dead from
hypoglycemic shock so we've gotten our first critical
18:12
take-home message here which is if you plan to get stressed like a normal mammal you
had better turn on your stress
18:18
response or else you got about a 30-second life expectancy for most of us though the
far more important take-home message revolves
18:27
around so what if you're turning on the stress response too often too long for purely
psychological
18:34
reasons and what you get there then is disease at the other end of it now celie was the
first person to wrestle with this issue
18:43
why is it that chronic stress makes us sick and he came up with an explanation in the
1930s and had dominated the field
18:50
for the next 40 years which was too bad because he was totally wrong okay here's what
he thought was going on along comes the stressor
18:58
knocks you out of homeostatic balance you turn on the stress response you re-establish
homeostasis but the stressor goes on for too long
19:06
and thus you enter what celie called the exhaustion phase you run out of the stress
response your adrenals run out of adrenaline your
19:15
pituitary runs out of its stress hormones it's like your military runs out of ammunition and
you're just left
19:21
defenseless there with the stressor pummeling you turns out this was totally imaginary
there was no such thing as this
19:27
exhaustion phase no organism on earth has ever been so stressed that it runs out of
adrenaline you don't deplete the stress response
19:34
the problem is that after a while it's not that your military is running out of ammunition
after a while you're spending so damn
19:42
much in your military that you don't do health care or social services or education or any
of that stuff and like after a while the stress
19:53
response is more damaging than the stressor especially if the stressor was some
psychological nonsense everything you're
19:59
doing here is pennywise and dollar foolish it's inefficient it's less than optimal all of this
is
20:06
built around it's an emergency it's an emergency fix later grow layer don't do it right now
and if
20:11
every day is an emergency you pay the price for it at the metabolic level mobilize
energy because the line's running after you
20:20
no problem at all mobilize energy from your storage sites chronically because you're
chronically psychologically stressed
20:26
and among other things your muscle mass decreases muscle is one of your main
energy storage sites you get atrophy of muscle
20:34
myopathy for extremely complex reasons you're using your energy really inefficiently for
insanely complex reasons
20:42
you're now more at risk for adult onset insulin resistant diabetes now adult onset
diabetes is one of those interesting diseases
20:50
that our great great great great grandparents never even dealt with this is a disease of
getting older in a typically westernized way putting on
20:59
weight getting more sedentary and everything down to the molecular level that goes
wrong in your cells with adult onset diabetes
21:07
stress exacerbates the process same punch line at the cardiovascular
21:13
level if a line is chasing you and your blood pressure is 180 over 120 you're not
suffering from high blood pressure you're saving your life
21:20
on the other hand if your blood pressure is 180 over 120 every time you're stuck in
traffic or something you're not saving your life you are
21:27
suffering from stress induced hypertension and you do that chronically enough and
you're going to damage your
21:34
cardiovascular system okay 30 seconds on stress and heart disease what's the
scenario we all know about
21:40
guy gets horrible news and he's wailing about something and he suddenly clutches his
chest in pain kills over dead
21:47
sudden cardiac arrest this has never happened this is like a movie plot this never occurs
in real life instead what actually happens requires
21:55
you to have like arcane knowledge of high school physics explaining why like toilet bowl
plumbing wears out
22:01
after a while you got a tube and you got fluid moving through the tube and by definition
if the fluid is moving
22:09
through with more force elevated blood pressure you begin to get fluid turbulence
pounding away on the walls of your blood
22:16
vessels causing little bits of pitting and scarring and tearing and then you get
inflammation there and then that's
22:23
exactly where like glucose and cholesterol and fat wants to glom onto
22:28
to clog your arteries where's the glucose and cholesterol and fat coming from that's the
stuff you're mobilizing into your circulation in the
22:35
previous slide so you get this synergistic double whammy here between the metabolic
stress response and the cardiovascular
22:42
setting you up for the number one killer in this country cardiovascular disease now this
link between stress and heart
22:50
disease is so solid that it accounts for the most famous personality profile in all of
medicine
22:57
and it's one where basically if you're coming out to a lecture on a perfectly nice evening
to be outside taking a walk instead
23:04
i suspect it applies to like 80 percent of the people in this room which is those of us in
here who have type a personality
23:13
okay type a personality type a was first described in the 1950s by a pair of cardiologists
in san francisco friedman and roseman
23:21
here was their original formulation time pressured hostile impatient low self-esteem
joyless striving okay like 90 of us
23:32
and what they observed back there in the 50s was if this was your personality profile
you were more at risk for heart disease
23:40
cardiologists hated these guys you're some like eisenhower cardiologist and all you're
thinking about is like
23:47
blood lipids and heart valves and here are these guys saying no you need to sit down
you're patient and talk to them christ who wants to
23:54
talk to their patients and talk to them and say okay so suppose you're in the
supermarket and you pick the line that's moving
24:01
slowly do you go berserk at that point that's got something to do with heart disease total
resistance to the concept and it wasn't until the 1980s that
24:10
enough studies had been done that it became clear type a is for real big time if you
have type a personality you are more at risk for cardiovascular
24:20
disease than if you smoke than if you were overweight than if you have elevated
cholesterol levels a huge risk factor now what became clear
24:29
by the 80s was the critical component in the type a profile the piece that is the one that
24:35
contributes to the cardiovascular disease and it's a term now that is used in the field if
you have
24:41
toxic hostility toxic hostility this attributional style where everything that happens around
you is proof that they're out to get you
24:49
they're out to get you more than everyone else and the only thing to do is watch your
back 24 7 and keep a knife ready
24:55
this is the style where you're in the supermarket and you've picked the slow line and you
want to kill the son of a bitch kid
25:03
behind the cash register come on come on how do you know i have a one o'clock
meeting trying to screw me up no don't ask the old lady how she is today come
25:09
on come on come on i'm gonna die someday i get to you know if this is what you're
doing instead of checking out the alpha
25:14
sightings in the national enquirer your blood pressure is going to go up and if this is
what you're doing every time somebody
25:21
could have held the elevator door open for you but didn't if you're doing this 40 times a
day you're going to pound away at your blood
25:28
vessels set up for cardiovascular disease and these days the main question in that field
is
25:35
insofar as you were toxically hostile what's worse for your heart expressing those toxic
emotions or keeping them repressed inside what's
25:43
clear is expressing them is worse for everybody else's cardiovascular health but what is
the cost of repressing strong physiological emotions
25:51
so that's an area of a lot of ongoing research okay so that's stress and heart disease
actually how did those guys first figure
25:59
out about type a personality given how much that was coming out of left field and i
actually got to hear the story
26:06
some years ago out of the horse's mouth himself meyer friedman the cardiologist who
first described type a died a few years ago in his early 90s
26:14
saw his last patient a week before he died was working full-time at a cardiology unit ucsf
medical center as he used to say i'm still type a but
26:23
i'm a type a tortoise now and here's the story he would tell in
26:28
the 50s he and his partner had this cardiology practice everything was going great
except for this one weird thing which is
26:35
they were spending a fortune having to reupholster the armchairs in the waiting room
what's this about who knows whatever
26:43
it's part of the overhead every month this upholsterer comes and there's a chair or two
that needs to be fixed
26:49
one month the upholsterer is out on vacation replacement upholstery comes in takes
one look at the chairs and discovers type a personality
26:56
he says what is wrong with your patients nobody wears out chairs this way and
27:01
they have one of them left and as you can see here the front two inches of the armrests
and the seat cushions are totally
27:09
shredded and the rest of the chair is perfectly fine it's like every night there's like dwarf
beavers in there clawing away the chair what is this this
27:16
is the type a profile this is somebody with type a personality this is what they do to a
chair when they're waiting in the waiting room
27:23
with their cardiologists to hear if there's bad news or not this is not just figuratively but
literally sitting on the edge of your
27:30
statement seat and squirming and clawing and all of that this is what somebody who's
type a does to a chair in that circumstance
27:37
okay so what happens at that point if science is working right and you know
27:43
friedman should grab him like good god man what you've discovered were like like
midnight conferences between upholsterers and cardiologists
27:51
or or or teams of idealistic young upholsterers sweeping across america and coming
back with the news that no
27:59
you don't find chairs like these in podiatrists offices that's what should have happened
what happens instead
28:06
here's where 90 year old dr friedman starts looking all sheepish he says he says i told
my nurse get this man out of here i'm this
28:14
important cardiologist i can't waste my time with him give him this damn check get him
out of my face he was too type a to listen to the guy and it
28:21
wasn't until about five years later that he collaborated with the psychologist and back
came the type a profile
28:28
they said oh my god the upholstery he was right to this day they have no idea who that
guy was
28:35
now let's see it is late afternoon in san francisco i'm willing to bet there's some bar in
san francisco right now where
28:42
there's like this 110 year old retired upholsterer and get this guy going and he's going to
go on and on about how he discovered
28:49
type a personality exactly what occurred so one of the dark chapters in my profession
okay moving on digestion shut down your
28:59
digestive system for two minutes running for your life it's not a big deal shut it down
chronically and there's all sorts of
29:05
gastrointestinal disorders you're more at risk for most famously ulcers back to celie in
the 1930s the first stress-related
29:13
disease stress causes ulcer stress causes ulcers canonical knowledge everybody
knows this and then about 25
29:19
years ago there's this revolution in ulcerology turns out there's a bacteria called
helicobacter pylorus
29:27
turns out the bacteria is responsible for about 90 percent of ulcers in the west it gets into
your stomach it generates
29:34
oxygen radicals and blows holes in the walls of your stomach it's a bacterial disorder
this was an enormous contribution the two guys who
29:42
discovered against the nobel prize amazing the evening this is announced every
gastroenterologist on earth goes out that evening and celebrates
29:50
this is the greatest news they've ever heard because they're not going to have to sit
down their patients and make eye contact
29:56
and say if you have any stressful way it's got nothing to do with stress here's some
antibiotics get out my office it's got nothing to do
30:03
with stress it's got everything to do with stress because only 10 percent of people with
the bacteria
30:08
get the ulcer you've got to have the bacterial risk factor but you've got to have a lifestyle
risk factor overlapping as well
30:17
stress stress does not cause ulcers the bacteria does what does stress do when you got
an ulcer beginning to start
30:25
your stomach's reasonably good at repairing it and rebuilding the wall there before the
ulcer gets troublesome
30:32
unless you're chronically stressed and every day your stomach walls are saying ah do it
tomorrow do it tomorrow it feels like we're being
30:39
chased by a predator psychological stress shuts down the reparations there so here we
have a classic example of
30:47
interactions between the organic causes of disease and the psychogenic stress is still
very relevant
30:54
to making sense of ulcers next growth shut down growth for three
31:00
minutes while you're running for your life not a big deal our theme by now shut it down
chronically this can be problematic especially if you were a kid
31:07
all kids are are big long-term building projects and for reasons of psychological stress
you keep saying do it tomorrow do it
31:14
tomorrow you can impair growth and at an extreme you have one of the truly bizarre
outposts of medicine
31:22
a disease of kids who stop growing for reasons purely of psychological stress
31:28
known as psychogenic dwarfism psychosocial dwarfism stress dwarfism
31:33
these are kids who are years behind the normal growth rates and there's no disease
they're not malnourished there's no parasites
31:42
you check their bloodstream there's like no growth hormone you give them synthetic
growth hormone nothing happens the whole system is shut
31:49
down and at that point you start poking around in their background and often out comes
some appalling
31:55
psychological stressor and the amazing thing is get them out of that stressful setting
technical term do a parentectomy on them
32:02
and growth will resume at that point this is incredibly well understood how
32:08
this works open up any textbook of endocrinology go to the chapter on growth and i
guarantee there will be the obligatory picture of
32:16
the stressed dwarfism kid you know those pictures of stunted cues like naked in front of
the growth chart with a rectangle over the
32:22
eyes and turn the page and i guarantee there's the obligatory follow-up picture the kid in
a different environment two
32:29
years later he's like six foot fourteen he's playing for the nba it's everything's you know
there's still the rectangle and nakedness but
32:36
everything else gets better and what you see there is this is the system with an amazing
capacity to recover remarkable cases of this for
32:45
example this was a case report a few years ago this was a child brought in from an
extremely abusive psychological setting
32:52
into new york hospital with stress dwarfism and as documented in the paper at the time
he came into this pediatric unit
33:00
zero growth hormone in his bloodstream over the next few months he became very
close with one nurse there and this was like the first normal
33:08
emotional relationship of his life after a couple of months normal growth hormone levels
for his age at that point the nurse goes on vacation
33:18
by the end of her two-week vacation he's back down to zero nurse comes back a week
later he's back up to there
33:26
think about this the rate at which this child was depositing calcium in his bones could be
entirely predicted by how safe and loved he was
33:35
feeling the world you can't ask for a much better example of what's going on here
affects every outpost in the body
33:43
now the issue with stress dwarfism amid people understanding exactly which hormones
are due or what the issue of course becomes how common
33:51
is this disease if you were shorter than average and you were not obviously
malnourished as a kid are you a victim of stress dwarfism did
33:58
your parents do that to you no this is not like oh very stressful childhood we were
moving all the time this is not like acrimonious divorce
34:06
this is nightmare psychopathology this is the police and the social workers breaking
down the door of an apartment
34:13
and finding the kid chained to the radiator and smeared and excrement and just
nightmare stuff and get the kid out of
34:20
that setting and there's recovery the clinical consensus is this is a once in a career
disease that you see extremely rare
34:28
except it's not so rare it pops up all over the place kids in war zones kids in areas of civil
strife
34:37
a research assistant of mine and i think we've got the data to show that kids who wound
up in the japanese american internment camps in world war
34:44
ii had mild stress dwarfism that pops up all over the place one classic study in the 60s
34:51
looking at rites of passages from cultures all over the planet rights of passages in one
culture they take you out of the desert and stake you
35:00
down and cover you in poison ants and some other culture you play the piano for your
grandmother and her friends or whatever's done in your tribe they did
35:07
like 80 tribal comparisons they controlled for genetics back comes the finding stressful
rites of passages during the first few years
35:14
of life two inches shorter as an adult big effect let me tell you about the single
35:21
creepiest example of stress dwarfism i've ever heard of if for some inexcusable reason
you ever find yourself
35:27
reading chapter after chapter about growth hormone you're going to notice there's a
weird thing which is a lot of the chapters make
35:34
reference to peter pan some quote from peter pan or some snide comment about tinker
bell i've seen this for years i had no idea
35:42
what this was about until one day i stumbled on an explanation and this was a chapter
about the psychological regulation of growth and
35:48
was talking about stress dwarfism gave the following case history eight-year-old boy
growing up in victorian england in the
35:56
1870s one day he sees his beloved older brother killed in front of him in an accident
36:01
this destroys the family there were no other siblings the father was like emotionally non-
existent this was the mother's favorite child and
36:09
this victorian swoon she takes to her bed with the shades drawn for the next 10 years
this kid growing up in this horrible emotional isolation he goes
36:18
into the bedroom with a tray of food for his mother and she's saying oh david david is
that you david have you come to me have you
36:25
david the dead son david are you finally oh it's only you growing up being
36:32
only you apparently the only thing she ever spoke to him about was this idea she
grabbed onto which was if david had to die he'll always be my
36:40
perfect little boy who never grew up and became a man who didn't need his mother
anymore he'll always be my perfect little boy
36:46
because he didn't grow up and grow up and grow up this kid hears this with a
vengeance middle class family no evidence of
36:51
disease or malnutrition boy stops growing there at age eight lives to age 60 4 foot 10 as
an adult unconsummated
37:00
marriage incredible example of stress dwarfism and then then the chapter concludes by
informing us that as an adult this was
37:10
the author of the much beloved children's classic peter pan this was j.m barry the guy
who wrote peter pan who's incredibly
37:18
screwed up this guy all he did was crank out book after play after novella about boys
who die and come back as ghosts and
37:26
marry their mothers his private journals were full of sadomasochistic fantasies about
little boys
37:32
this guy spent the rest of his life dealing very unsuccessfully with this stress dwarfism so
think about that the next time you see johnny depp
37:40
up on a movie okay next next reproduction your gonads
37:47
your gonads your gonads are not going to be working very well if you were chronically
stressed if you were a female mammal of virtually any species
37:55
if you were chronically stressed your cycles will become irregular lengthened they may
stop all together stress induced amenorrhea stress-induced
38:04
and ovulation and people understand exactly how those work which hormones are
working at the brain at the pituitary at the
38:11
ovaries of the uterus to shut things down let me tell you about one of those steps
because it's got to do with a very weird
38:17
thing that female mammals do including human females which is they secrete a certain
amount of male
38:23
sex hormones into the bloodstream hormones that are related to testosterone androgen
type hormones they come out of the adrenal glands not
38:32
a ton of the stuff maybe five percent the levels you would see in the male nonetheless
you got to get rid of it unfortunately
38:38
female mammals come with this enzyme and fat cells that take circulating androgens
and does biochemistry 101 and converts
38:48
them to estrogens great perfect problem solved everyone lives happily ever after what if
you're stressed
38:54
what if you're stressed like the locusts have come and eaten your crops and you're
subsisting on 800 calories a day what if you're slowly starving
39:02
your fat stores are slowly getting depleted and at some point you have too little
functional fat cells
39:09
to do the androgen to estrogen conversion one problem is there's now a little bit less
estrogen in the bloodstream
39:15
bigger problem is the androgen levels build up there and that shuts down every step in
the system that's why starvation shuts down
39:22
ovulation that's why voluntary starvation anorexia does the same and that's why some
women who do
39:30
massive massive amounts of exercise will stop ovulating as well because you get below
a critical fat muscle ratio there now this is something
39:40
that's been studied at length in girls for example it's always studies of very serious ballet
dancers or gymnasts
39:47
what you see is significant delay in the onset of puberty one study for example this was
done on the olympic gymnastics squad from
39:55
romania you know those 60 pound 15 year olds getting the gold medals all over the
place what was the average age of which these kids started
40:02
menstruating 19. 12 and a half is the western average
40:08
once hitting puberty women who do tons of athletics is best studied long distance
runners women who run an average of 40 to 50
40:16
miles a week that's typically the range where fat stores are getting below threshold
where you begin to have ovulatory
40:22
irregularities i can tell you the exact same story about men men who run 40-50 miles a
week sperm count goes down there's mild testicular
40:32
atrophy okay wait a second i thought exercise was good for us exercise is good for us
and in fact a
40:39
lot of exercise is very good for us that doesn't mean though that an insane amount of
exercise is insanely good for us
40:45
it means at some point too much of a good thing is just as bad as too little you've
passed a point of homeostatic balance
40:52
and all you need to do to get an appreciation for that is imagine you sit down some
hunter gatherer from the kalahari desert and say you know
40:59
where i come from we have so much food and so much free time that sometimes we'll
just go run 26 miles in a day for the sheer pleasure
41:07
and they're going to say are you crazy that's stressful i mean throughout hominid history
if you're running 26 miles in a day
41:15
either you are very intent on eating somebody or somebody's intent on eating you this is
not normal physiology so we get a cautionary note
41:23
here meanwhile over at the male end of things with the onset of stress down go
testosterone levels anesthetize
41:31
a guy slice into his belly for surgery 10 minutes later testosterone is plummeting first
year male medical students during
41:38
exam periods down go testosterone drop the rank of a male baboon at a hierarchy
down goes testosterone here's a stressor which thank god i have
41:47
no personal experience with at all but apparently it's not fun to be in the marines
apparently it's kind of a drag
41:54
especially during basic training this was this classic study 1970 new england journal of
medicine looking at military recruits during
42:01
basic training were now on top of everything else they had to pee into little dixie cups for
the psychiatrist
42:06
and back comes the finding guys in the in the marines during their first couple of months
of service they have the circulating androgen
42:13
levels of like vatican choir boys that's how much the system is shut down
42:19
okay so people understand exactly which stress hormones are working at the brain the
pituitary and the testes to shut down testosterone synthesis
42:28
during stress the question you gotta ask at this point is so what are the consequences
of testosterone levels declining during
42:36
stress and amazingly enough the answer is there's no consequences at all testosterone
turns out to be this vastly
42:44
overrated hormone like basically all you need is like a thimble full of stuff and a couple
of sperm and you're in business
42:50
you've got to knock out like 90 percent of the guys testosterone levels to seriously
impair fertility stress what does it do at its worst only
42:58
about a 60 decline it's not suppressed enough that it makes a difference the problem
during stress is not that
43:05
testosterone levels go down the problem is that penises go down
43:10
okay am i allowed to talk about this in champaign urbana here okay finally we come to
the first like useful point in this damn lecture so how
43:19
do erections work okay so erections in order to i just saw
43:25
somebody there pick up a pen for the first time okay so how do erections work in order
to have an erection
43:33
you gotta have a spinal cord now most of what your spinal cord does is totally boring
and makes you shake hands and sign checks and foxtrot
43:40
or who knows what but then there's the part that does the good stuff the stuff you
normally don't have any control over stuff that is
43:47
automatic like goose flesh and orgasms and pupillary contractions and blushing
43:53
things that are automatic and thus run by the automatic nervous system also known as
the autonomic nervous system
44:00
now the autonomic nervous system comes in two halves first half sympathetic nervous
system emergency arousal adrenaline
44:08
stress response all hell breaking loose second half the parasympathetic nervous system
calm vegetative function you take a nap you
44:18
turn on the parasympathetic nervous system you eat a big starchy meal you turn on the
parasympathetic nervous system
44:25
you get disemboweled by a lion you turn off the parasympathetic nervous system it
works in opposition with a sympathetic
44:31
okay so here's the rule in order to get an erection you've got to turn on the
parasympathetic nervous system
44:38
you have to be calm and vegetative okay so you got your erection now what
44:43
happens next maybe for some social reason having to do with the context that brought
about the erection maybe
44:51
you start feeling a little bit less calm and vegetative maybe your heart rate increases a
little maybe your breathing rate maybe your
44:58
muscles are starting to do some work slowly you're starting to turn on the sympathetic
nervous system more time goes by your heart is racing
45:06
your toes are curling you're sweating you're breathing fast all of that eventually you get
to this point where your whole body is screamingly
45:12
sympathetic except for this one lone outpost we are desperately holding on to
parasympathetic tone as long as possible finally can't take anymore you turn off
45:19
the parasympathetic turn on the sympathetic and ejaculate
45:25
okay so that's how erections work so what happens during stress what happens
45:30
during stress you're not very calm and vegetative you can't get the erection stress
induced imminency or you can have a second problem suppose
45:39
you manage to get the erection and you think like oh no donald trump who knows why
you accelerate the transition you accelerate the
45:50
transition from parasympathetic to sympathetic the whole thing goes too fast either you
can't get the erection
45:57
or premature ejaculation incredibly easy for this to occur current estimates are 60
percent of the
46:03
visits by men in this country going to doctors about erectile dysfunction turn out not to
have an organic disease basis
46:11
but instead are psychogenic stress-related okay second useful piece of information so
how do you tell the difference
46:18
between a case of organic infancy and psychogenic so a guy comes to you says he
hasn't been able to have an erection during sex
46:25
in the last six months and you're wondering well is the stress related or does he have a
pituitary tumor whatever
46:31
you take advantage of a weird thing that male primates including human males do
which is when they go into rem
46:38
sleep rapid eye movement sleep they get erections i've no idea why i've talked to earth's
penis experts nobody has an explanation
46:46
for this nonetheless male primates get rem sleep erections so here's what you do the
guy who hasn't
46:52
been able to have an erection during six sex and months what you do is you give him
this handy-dandy little penile pressure cuff
46:58
transducer thingy that he takes home and just before he goes to sleep he puts it on the
base of his penis and wires it up and
47:05
satellite relays and 24-hour operators in bangalore and the next day
47:11
the next day you got your answer which is if this guy hasn't been able to have an
erection during sex in the last six months but 30 seconds into his first rem
47:18
stage he has a perfectly normal erection he doesn't have a pituitary tumor it's stress
related that's how you distinguish between the
47:25
two do you still get the nocturnal erections if that's the case it's stress related very easy
to actually maybe this is not
47:32
so easy because you got this electronic device and it's beeping and the wires and
you're so sure it's going to electrocute you that's a stressor in and of itself
47:40
this is what is done in the majority of sexual dysfunction clinics in this country i kid you
not you take a long string of
47:48
postage stamps you lick them at one end and you wrap them around the guy's penis
and the next morning if the stamps have
47:54
been torn loose the guy had an erection during the night can you believe like how
elegant this is like five bucks
48:02
you get a lab result it's fabulous yeah oh of course insurance won't reimburse you for
the stance but
48:09
still you know maybe obamacare still has a chance okay so
48:15
what we see here is another outpost of vulnerability and perhaps we should hurdle on
before i embarrass myself further your immune
48:22
system your immune system so as we heard before with the onset of stress you
enhance your immune defenses with chronic stress
48:29
something very different occurs with chronic stress not only does the immune system go
back to baseline you suppress immunity
48:38
with chronic stress you become immune suppressed and this is the starting point for just
this irresistible syllogism
48:45
insofar as chronic stress chronically suppresses the immune system chronic stress
should set you up for more infectious diseases
48:53
and this is the basic premise behind this field that emerged about 25 years ago
psychoneuroimmunology the notion that
49:00
what's going on here is affecting your immune defenses in a quarter century into this
field it's clear that's exactly how it works
49:08
for all the boring stuff when you were under stress the common cold becomes more
common you're at more risk for mononucleosis
49:16
for herpes viral flare-ups reactivation what's far less clear is what about bigger realms of
49:23
infectious disease how about if you have aids your immune system declining if you're
severely stressed does it
49:30
decline even faster jury is out on that one it seems to have to do with personality type as
an intervening variable
49:38
how about the biggest one on everybody's list when it comes to worrying about disease
so what's the relationship between
49:44
stress and cancer and everybody knows the answer to that which is cancer is a stress
related
49:51
disease stress can cause you to have cancer stress can cause you to come out of
remission
49:57
from cancer stress can accelerate the growth of tumors everybody knows about this
sufficiently so that some years ago there was a study
50:04
in jama journal the american medical association looking at women who had just gotten
a metastatic breast cancer
50:09
diagnosis where they were asked so what do you think is the cause of your cancer and
by more than a two to one margin the most common answer was
50:17
stress too much stress in my life stress has virtually nothing to do with cancer there has
never been
50:25
a decent prospective human study longitudinally that shows that stress increases the
risk reoccurrence or growth rate of any
50:33
type of tumor when they're well controlled there have been all sorts of studies showing
how stress can accelerate tumor
50:40
growth in lab rats we know how it works my lab did some of that work but it turns out
these are types of cancers that are completely
50:46
irrelevant to human cancer this is a realm where there's not much connection at all amid
all those things on the right sides
50:54
of these charts you need to worry about this is one domain where you don't why is it
important to emphasize this because of all of these highly
51:02
credentialed quacks who are making a fortune off of cancer patients saying my special
brand of stress therapy will
51:10
slow down your cancer stop it reverse it credit cards accept it there's no science to
support this bad medicine bad
51:17
science bad ethics this is a domain where you don't have to worry okay so quickly let's
hurtle back to domains where you do have to worry okay
51:25
so back to stress in your brain we saw short term does all sorts of great stuff chronically
51:32
bad news chronically stress will damage a part of your brain called the hippocampus
which is essential for learning and
51:39
memory stress has something to do with failure of memory consolidation there
51:45
shrinkage of neurons disconnecting of synapses at an extreme killing of neurons
inhibition of the birth of new neurons
51:52
there and this is turning out to be relevant to humans and a number of scary realms
people with chronic stress due to ptsd
52:01
post-traumatic stress disorder combat trauma or sexual abuse trauma and what you see
there is atrophy of the hippocampus only the
52:09
hippocampus the more severe the trauma history the more atrophy the more memory
problems best evidence is this is not reversible
52:18
second syndrome pertinent to the 10 to 15 percent of us in this room destined to have
major clinical depression the
52:26
poster child and psychiatry of a stress related disorder it involves chronically elevated
stress hormone levels and
52:33
scads of studies now showing atrophy of the hippocampus only the hippocampus the
more severe the depression history the more atrophy
52:41
the more memory loss and as far as most studies show at this point this is not a
reversible process meanwhile next door to the hippocampus
52:50
is a brain region called the amygdala and in the amygdala things are real different
hippocampus does learning and memory for you
52:58
amygdala teaches you to be afraid it does fear it does anxiety and while stress is
atrophying away those hippocampal
53:08
neurons stress is making neurons and the amygdala work better than usual they
expand their
53:14
connections the synapses become more excitable people with ptsd have amygdalas
that grow larger than normal
53:22
stress makes it easier for you to associate things with fear that are not actually valid and
makes you harder to detect
53:31
to detect safety signals this is the link between stress and anxiety meanwhile over in
that part of the brain where
53:38
you're releasing dopamine which has something to do with pleasure with the onset of
stress chronic stress and you're depleted of dopamine what is
53:47
this setting us up for explaining the link between stress and depression the defining
symptom of depression is anhedonia hedonism the pursuit of
53:57
pleasure and hedonia the inability to feel pleasure this is the neurochemical link why
chronic stress is a major
54:05
precipitating factor for depression so okay if you're still awake at this point you should
be depressed as hell
54:12
okay so amid that it must seem like a miracle that any of us are still alive
54:17
actually let me make this worse one last stress related disease this is like stress for
2000. how many of you have heard of a disease called
54:24
idiopathic alopecia areata
54:29
okay a few hands this is the profoundly rare state of somebody being so so traumatized
by something that over the next few days
54:39
their hair turns white and falls out this is for real people understand like what the
immune system is doing the hair follicles there
54:46
it's real it's a once in a career disease but nonetheless this is free look at this you're
chronically stressed you get high blood pressure you get
54:52
diabetes you get flatulent your sex life is ruined your brain gets damaged and your hair
falls out how is it any of us are still
54:59
functioning here why haven't we all collapsed into puddles of stress-related disease and
the critical thing is most of us
55:06
don't most of us cope and what's been clear from the first day of the field with celie
55:12
is some individuals cope with stress better than others what i want to spend the last
couple of minutes on is how we understand this to
55:21
work why do some bodies and more importantly some psyches deal better with stress
than others okay so if we're talking about
55:29
individual differences and stress responsiveness here we're not talking about physical
stressors finish this lecture
55:36
go outside unexpectedly be gored by an elephant and you're gonna have a stress
response there's no way you can't reframe your
55:43
experience and grow from adversity or who knows what you're gonna have a stress
response finish the lecture go outside and have
55:49
kind of a tense ambiguous interaction with someone and only some of us will have a
stress response
55:57
what is it about that gray zone of psychosocial interactions that is more stressful for
some individuals and others
56:04
what we're asking here is what is it that makes psychological stress stressful and
remarkably a
56:11
massive literature stretching back decades shows what precisely are the building blocks
of psychological stress
56:18
okay here's a schematic summary of the gazillion studies what they would sort of show
take a lab rat put him in the cage every
56:25
now and then he gets a shock mild shock and nonetheless with enough of them this is
stressful blood pressure goes up
56:33
heart rate goes up risk of ulcer goes up as shown here you're giving the rat a stress
related disease
56:40
now second line in a second cage there's another rat psychology jargon the second
56:47
rat is yoked to the first rat every time the first rat gets a shock so does the
56:53
second same intensity same duration same everything according to celie in 1930 both
of their bodies are being knocked out of
56:59
homostatic balance the exact same extent except for a critical difference which is every
time that second rat gets a shock
57:06
it can go over to the other side of the cage where there's another rat and it can bite the
crap out of it and you know what that rat's not going to
57:13
get an ulcer the guy is biting isn't going to get one but this one doesn't he has an outlet
for his frustration third line now we have in the second
57:22
cage a second rat getting the same shock same duration same intensity same
everything but each time he gets a shock he can go over and there's a bar of wood
57:30
that he could gnaw on with his teeth and he doesn't get an ulcer he has a hobby okay
now the next line
57:39
what we have here is same shock same intensity same everything but 10 seconds
before each shock the second rat
57:46
a little warning light comes on and the rat doesn't get an ulcer for the same external
stressor we are more protected when we get
57:55
predictive information when is it coming how bad is it going to be how long is it going to
last and we all know that principle every
58:01
time we ask the dentist how much more drilling and we all know the difference between
the dentist that says two more bits and
58:07
we're done on the one that says yeah it could be it could be weeks you're gonna be
here and when the dentist says two more bits of drilling
58:13
bad news you're not done yet good news the second that second bit of drilling is over
with you're safe for the rat in the first
58:20
line any second you can be a half second away from the next shock next line this is a
rat that's been
58:28
trained to press a lever by pressing the lever it decreases the likelihood of getting a
shock today the rat is yoked to the first one
58:36
getting the same shocks as the first guy but there's a lever in there the lever is
disconnected the leverage has done nothing whatsoever but the rat doesn't
58:42
know what so he's in there pounding away the lever saying this is great just imagine
how many stock you're getting otherwise he thinks
58:48
he has control for the same external stressor a sense of control makes things less
stressful
58:55
jumping ahead to the final line shock a rat and now it goes over to the other side of the
cage where there's a rat that it knows and likes and they groom
59:03
each other and it doesn't have a stress response wow science has finally proven that
friends are good for your health
59:10
science has proven this big time when you look at all of behavioral medicine and all of
health psychology
59:16
there are two of the biggest predictors out there as to mortality rates across all diseases
the first one
59:23
taps into every one of the factors on the slide which is never ever make the mistake of
being born into a poor
59:32
family because your health is going to pay for it the rest of your life the link between
health and socioeconomic status very heavily
59:39
mediated by stress the second biggest predictor is if you got a choice in the matter don't
be socially isolated and you look
59:48
at the extremes of social isolation versus social affiliation significant other others small
group of
59:55
friends community group you're intentionally involved with for the same disease impact
almost a threefold difference in mortality rate
1:00:02
and that's after you control for stuff like ooh people who live alone just eat cheetos for
dinner and nobody reminded to take their meds
1:00:08
control for that and social isolation is an aching stressor for every primate out there
including us
1:00:15
and a huge health risk factor so what is it that makes psychological stress
1:00:20
stressful for the same external misery you are more likely to feel subjectively stressed
1:00:27
more likely to turn on a stress response and more at risk for stress-related disease if
you feel like you have no control no
1:00:35
predictability no outlets for the frustration if you interpret things as getting worse and you
have nobody's shoulder to cry on
1:00:43
and basically this is the place to stop because again none of us are getting ulcers
because we're being chased by saber-toothed
1:00:50
tigers none of us are ever gonna have to wrestle people for canned food items and
bombed out supermarkets
1:00:56
instead we are going to have this luxury of living well enough and long enough amid our
psychological stressors to pay the medical cost
1:01:04
and that's the critical point at the end to the extent that we are smart enough to have
invented these psychosocial stressors
1:01:11
and then stupid enough to have fallen for them we all have the potential to instead be
wise enough to keep them in
1:01:17
perspective so on that note thank you for your attention and good luck with your
stressors
1:01:51
wow i see my mother did manage to call all of you before the lecture today thank you
he's still blushing from the erection
1:01:59
topic so uh welcome back to that i wanted to ask you a question this is i
1:02:04
have a strategy of coping and i'm not sure it's it's the best strategy um i so i i experience
a lot of stress and so
1:02:11
my here's my coping strategy i always am expecting the worst so basically
1:02:18
you know when i'm applying for a grant or something i'm i'm expecting not to get it if i'm
you know submitting a paper i'm
1:02:23
expecting it to get rejected and this is a coping strategy for me because if uh you know if
it turns out that i don't get the grant then i'm not really
1:02:31
let down and that's in a way it helps me predict the stressor but on the other hand i'm
thinking about
1:02:36
it i'm thinking well then i'm always constantly thinking about the worst and it's kind of a
pessimistic attitude
1:02:42
so basically my question is is this a bad strategy yes
1:02:50
i would recommend first just taking out your adrenal glands that that will probably be
more effective okay what we have here is the difference
1:02:56
between bad outcomes and unpredictable outcomes the problem with over always
expecting the worst
1:03:03
is you're probably not really expecting the worst you're expecting maybe your grant
won't get a good score you're not expecting to
1:03:10
be disemboweled by your grant review committee so it's a moderately bad outcome that
you're now over expecting
1:03:16
that you're now expecting and the trouble is when something good happens it's good
but what it also tells you is hey
1:03:23
i thought i understood how the world worked and my model as to what cause and effect
is about here is not quite so great
1:03:31
and i blew it on expecting something good to happen maybe i'm blowing it also and
expecting really bad stuff to happen the
1:03:37
unpredictability there outweighs the goodness of it and various like
1:03:42
classic studies have shown that under circumstances where you give rats more a bigger
food pellet than they
1:03:50
expected for this amount of level pressing good news but whoa they thought they
understood how the world works within
1:03:57
the right parameters that's more stressful because it's telling them they don't really
understand how the
1:04:03
world works that's fine for a bigger food pellet but what else don't i understand so you're
saying when i get the grant
1:04:09
then it's uh then you have to convince yourself why you knew you were going to all
along yeah
1:04:17
i have a question that maybe reframes the topic which is we look at stress and its
consequences and there's the inverse of stress which is a
1:04:25
sense of well-being or flourishing and i'm curious in your research if you look at that and
um perhaps it's doing these four things
1:04:33
really well but um is there a body of work that you can point to or are you motivated to to
you know study around people who seem
1:04:41
to be flourishing who live longer who seem to cope better okay this celie back in the 30s
tried to introduce a word that never caught on
1:04:50
which was eustress e-u-s-t-r-e-s which is good stress and somehow that
1:04:56
never quite became popular but it was built around the fact that like a goal if you study
stress
1:05:04
biology or stress psychology or anything the goal is not to eliminate stress from our lives
because the trouble is we love stress we love stress when it's
1:05:13
the right kind when it's the right kind we pay good money for it we like push to see the
front watch like what exciting tournament is
1:05:21
happening we pay good money to get on roller coasters and get terrified we love stress
when it's good so the question
1:05:28
becomes what constitutes good stress and it turns out that it's within a
1:05:34
fairly narrow parameter good stress consists of a stressor that's not too extreme you get
on the roller coaster and you
1:05:42
know there's a chance you're going to be made a little bit queasy afterward not
decapitated it's not too long lasting it's not for
1:05:49
nothing roller coaster rides aren't three weeks long so it's transient moderate and most
of all it's occurring in what's overall a
1:05:56
benevolent environment because when we're feeling safe we love to give up control and
predictability because we
1:06:04
love being surprised in safe settings what do we call that we call that play we call that
stimulation we call it getting it to the
1:06:10
optimum amount i mean what are dogs doing when they play the dominant one
crouches down and says for the next whatever length of time i'm
1:06:18
gonna i'm gonna sort of eliminate our dominance relationships so you can put your teeth
on my throat
1:06:24
or my privates or whatever and it's gonna be okay you're safe now come and surprise
me and i'll try to surprise you too
1:06:30
what we call the optimal amount of stress is stimulation and in that regard the opposite
of play is not
1:06:38
work the opposite of play is depression it's getting just the right amount of stress and of
course what the gigantic challenge is is
1:06:46
one person's version of just the right amount is what's like perforating somebody else's
stomach there the enormous individual differences but
1:06:54
what the successful aging people generally show is a capacity to respond to moderate
stress responses
1:07:02
and to be able to distinguish between those and the big persistent ones
1:07:08
um so i i had a question about depression so we talked a little bit about this the other
day depression has been increasing
1:07:15
in our society now year after year and it doesn't appear to be due to a
1:07:20
difference in the way we diagnose the illness it appears to be a true increase in the
incidence of depression and it doesn't seem to be
1:07:28
keeping pace with any possible genetic changes in our population so that means that
there's something in our environment
1:07:34
that's been changing over the years that's increasing the incidence of depression and
the question for you is what do you
1:07:40
think that is well you get some important hints when you sort of look at the
demographics of the epidemiology
1:07:48
epidemiology of that in more detail the increasing rate with each sort of decade
1:07:53
or so is due to increased numbers of people who are getting their first depressions as
1:07:58
adolescents or young adults in other words increasing number of people who have now
joined the lifelong ranks of depressives
1:08:08
so you sit there and like there's really no way that being like your typical american
adolescent these days is truly more
1:08:15
stressful than like being in the dust bowl or being a medieval peasant or who knows you
you really can't make i mean be be a
1:08:23
be a farmer in the developing world watching locusts doing your crops and like that sort
of beats bullying in lots
1:08:31
of ways but when you look at it it's not that we have more stressors this is the stressors
we have are overwhelmingly
1:08:39
inventions of our lifestyle where i think things have gone awry is we have less sources
of support
1:08:46
and i think that takes two forms one is i'm the last person on earth to start spouting
norman rockwell sort of stuff but the rate of divorces and the
1:08:55
disintegration of the traditional nuclear family or anything that clank falls for stability in a
family that has to be a big factor
1:09:03
the other is this incredibly american god-given right that we all expect
1:09:08
which is to be able to be mobile and anonymous we are more than any country in the
world we live
1:09:14
further on the average than where we were born we move more frequently we have a
lower likelihood of knowing the names of our neighbors
1:09:21
and that's what makes silicon valley possible that's what makes you know maasai goat
herders don't invent silicon valley
1:09:28
people who are willing to go anywhere and work whatever and work 24 7 and who
knows if they ever learn the name of their neighbor because that's
1:09:36
not the point and you move on to the next one and along comes like a 911 and half of
the country discovers they
1:09:42
don't know the names of their neighbors and that's the trade-off all of us want this right
we have more unlisted phone numbers back
1:09:50
when that was something in common than in any other like country on earth more
mobility we want to be able to move and we want to
1:09:57
be anonymous and we want to be able to come up with a new persona and a new
accent and a new name and a new who knows what
1:10:04
and then we discover we have none of the traditional primate forms of social support i
suspect that's where it's coming from
1:10:10
what about social media though in social uh being having an online social presence
does that does that influence this positively or negatively and in
1:10:17
some ways it elevates your sense of where you are in the socio-economic status in
other ways it may bring you closer um all things
1:10:24
considered as the father of two teenagers i think it's basically awful what it does
because it opens up all sorts of venues
1:10:32
people and circumstances and things you never even knew existed before can now
make you feel crappy about yourself and diminished
1:10:40
and insecure and not adequate and not up to measure and what it also does is train you
to mistake like
1:10:46
the most like fruit fly level of model systems of what passes
1:10:52
for like human sociality for actual real like connectiveness
1:10:59
but how do i really feel about it many of you may not know i'm an investor in social
media so
1:11:07
i feel like this is um so along those lines you know it seems
1:11:15
like the coping mechanisms here um are what many people might take away from
tonight's talk which is you know how do you
1:11:21
in the world that we live in apply this and i'm curious if any of these four things and
maybe there's more
1:11:27
have gained elevation in your mind in the last years and if others have lost elevation do
you think we should be focused more
1:11:33
on some versus others yep all things considered i think the one
1:11:38
that has probably gained most improvements is social support if you got a choice in the
matter amid
1:11:46
all of those there more control over when your boss wastes your time with them like
pointless meeting more predictabilities
1:11:53
you know whatever more you know health club memberships as an outlet more
1:11:59
walls to punch with your near frustration um the literature seems pretty clear that when it
works right the social support
1:12:05
is the one that's most effective is there a type of social support you know is it one good
friend a group of kids which brings the next question
1:12:12
at the same time the one that's lost the most sort of veneer is social support because of
the enormous tendency people have to confuse
1:12:21
like mere acquaintanceships or friday night whatever is with actual it's like hard it takes
a long time it takes a great deal of patience it takes
1:12:29
reciprocity and maturity and selflessness and all this stuff that all of us like fail miserably
at at various points real real sustained
1:12:38
social affiliation is like a very hard thing for primates to get good at including us what the
studies tend to
1:12:46
show though is there's no particular difference between a significant other a small group
a community i mean
1:12:53
they're all equally effective but within that i mean where the tarnishing comes from is
nothing is more corrosive to us
1:13:02
when we discover that a supposed source of social support was actually just an
acquaintance after all and that it wasn't really there
1:13:11
an interesting recent study published a couple of weeks ago in pnas a very prestigious
journal in the country a little big
1:13:18
long longitude longitudinal study looking at how much does social isolation impact
health
1:13:25
and does it do it during young adulthood as much as an old age and the general punch
line was it's a terrible thing for you lifelong
1:13:32
and this is like a standard finding in the literature quantitative measures how many
people do you talk to on a
1:13:39
regular basis how many people could you borrow money from how many organizations
do you a quantitative measure what was unique
1:13:46
about this study was they also took qualitative measures they asked people to assess
on some scale
1:13:52
how much support do you get from the people closest to you how much strain do you
get from the people closest to you
1:14:01
and that came the first finding which is the quality of the relationships trumped quantity
far more in terms of impact on health
1:14:08
but what was really the most interesting thing in the study was if you have the choice in
the matter between making a new close supportive friend
1:14:15
or getting rid of that high maintenance friend who's been like you've needed like a hole
in the head for the last 30 years the source of
1:14:22
strain was more of an adverse effect on health than source of support being a good
thing on health which i thought was
1:14:28
extremely interesting so i'm going to ask one last question and then what i'd like to ask
the audience if they would like to ask a
1:14:35
question to go to the microphones on other side my last question is uh about
antidepressants so as you know um
1:14:43
antidepressants are widely prescribed and many of the big clinical trials that have been
done with these antidepressants like ssris as you
1:14:50
know have failed suggesting that the antidepressants don't do any better than placebo
however if you talk to any clinician or
1:14:57
psychiatrist who prescribes these medications or people who take them they will swear
that they work and so my question to you
1:15:03
is one do they work and two is there any chance we're gonna get out of the dark ages in
terms of how they
1:15:09
work um yes and no i think the dark ages are
1:15:14
going to be there for a long long time i think the reason why on on the average one-third
of major depression patients
1:15:23
fail to respond to antidepressants and another third respond would give up on them
because of the severity of the side effects
1:15:29
um so in other words there are oceans of clinically depressed people out there
1:15:34
who are not being adequately helped by the best of current neuropsychopharmacology
the question becomes why is that there's
1:15:41
just a whole like menagerie of antidepressants out there working on by now five six
different
1:15:47
neurotransmitter systems where in most cases it's guesses as to how selectively it's
actually working on one versus the other
1:15:54
so there's like a gazillion different permutations of combinations and different dosages
at the same time as with like every
1:16:02
interesting human disease it's actually a whole bunch of different diseases and
heterogeneous and people have such a poor sense at
1:16:09
this point you get your average clinician of course thinks that they're better than the
average clinician
1:16:15
and what they also think is that they have a good intuition this kind of depression
responds best to this combination
1:16:22
have this much of drug a this much of drug whatever and this mixture and because i
saw one fantastic response once
1:16:30
and it's sheer well i'll try to find a good term for it it is it is a posteriori theorizing as to
how these things work
1:16:41
it's like an amazingly complex system like lose a parent to death when you
1:16:47
were a child and 60 years later you were more at risk for this disease like throw one
medication in there and
1:16:53
you expect that to be able to do it it's going to be a long long time nonetheless amid that
pessimism and amid the considerable side effects
1:17:02
of these drugs and the fact that god knows what neurological costs we're going to
discover down the line from 50 years of ssris or whatever and
1:17:10
oh my god nonetheless an unmedicated major depression is one of the most life
threatening
1:17:17
diseases on earth the drugs with all their side effects are a really miserable solution
these days but they're far better than the alternative
1:17:27
so um in the last few minutes are there any questions on the side i can't see if people
are over there or not we have one okay
1:17:48
thank you for taking my question really enjoyed the talk um we have a 13 year old son
at 13 years old who developed chronic nausea
1:17:57
and had a multi-million dollar workup and tried all these meds and everything
1:18:02
ultimately to make a long story short what ended up helping him was vagal nerve
stimulation and ever since then i've been reading
1:18:11
a lot about it and what i don't understand what i know is that it is fda approved for
medicine for depression that is not responsive to
1:18:21
medication why isn't it approved for depression at all and and let's do away with some of
these meds
1:18:28
um let's see i start off by pointing out that i know tons about like rats and monkeys and
neurons and dishes but i'm
1:18:36
not a clinician but my sense is that vagal nerve stimulation is upping the
parasympathetic component of the common vegetative half
1:18:45
and there's drugs that will do it as well and it happens to be more effective this way um i
don't know why it's not used more
1:18:51
broadly say for other realms but everybody out there is always looking for what termed
off label novel uses for various
1:18:59
techniques if it works someone's going to find it soon that it does
1:19:06
thank you for the wonderful lecture and my question is how do i tell if i'm stressed too
much or not
1:19:15
well if you have to ask you are there's one possible answer
1:19:21
more useful one maybe a different way of framing it is so what are amid all the different
from common to incredibly arcane diseases that are
1:19:29
stress sensitive what are the most vulnerable spots where the the canaries in the mine
shaft varying from person to person tending to
1:19:37
be gastrointestinal sensitivity which could range from everything from suppressed
appetite to stimulated appetite to constipation to
1:19:44
the runs and everything is so something's out of whack at the gastrointestinal level
sleep disruption and females disruption
1:19:52
of regular cycling and major mood disruption depression
1:19:57
problems with concentration anxiety i mean maybe the most likely symptom for you
would be if your hair turns white and falls out
1:20:05
and otherwise you're just fine but for most people those are the most vulnerable spots
1:20:13
also thank you very much for the talk and your fear and aggression lectures which i kind
of stole off of youtube for something i was teaching so do you think
1:20:21
there's a fundamental incompatibility between the brains we evolved with and the type
of information we're required to hold on
1:20:27
to and use to exist in a modern society and doesn't that sort of play into the
unpredictability aspect i can't hold on to when i need to
1:20:35
pay my accounts and what do i do with obamacare now that i'm going back to school
and how will i lose my insurance
1:20:41
these arbitrary rules and the tax code whatever very hard to hold on to very hard to
predict would have huge impacts on what actually
1:20:47
happens in your life and once you fall off the beaten path you know it can be very hard
to get back into the functional part of
1:20:54
society so that causes a lot of fear what do you think about that well i mean it's very
easy to lament sort of modern life but
1:21:03
you know the wheel and vaccines and a few other things like that are good things to
have come up with so the the solution is not to sort of
1:21:12
like we all go scarify ourselves and go wear loincloths or something um in that there are
many benefits to it in terms of what are the sources of like
1:21:23
our modern malaise and predicament in terms of westernized lifestyle industrial lifestyle
urbanized
1:21:30
in lots of ways what it comes down to i think the most fundamentally bizarre thing we do
1:21:36
as a primate that makes the least sense to other primates and is sort of most impactful
and foundational to all of this
1:21:43
is more than any other primate we encounter strangers and we have anonymous
interactions like every like rule about brain size or
1:21:53
primates versus body size suggests that humans should be living in communities of
about 150 people which is about the average for
1:22:00
hunter-gatherer extended fusion fission communities there and obviously life is
1:22:06
very different we do something that no other primate does we encounter more strangers
standing online at
1:22:14
starbucks than like our hunter-gatherer ancestors would do in a lifetime and we have
more capacity to be both the
1:22:20
perpetrator and a victim of an anonymous act than any other species one of the things
we do
1:22:28
is as a compensation skyara norenzayan at university british columbia has noted this
really interesting thing it's only when
1:22:36
cultures get large enough that people start having interactions with strangers that they
invent what are called moralizing gods
1:22:44
gods who care about what humans are doing and punish you what we do is hunter-
gatherer gods could care less what humans are up
1:22:54
to they're all feasting or goat hurting or who knows what but by the time you get to big
anonymous interactions one of the things humans do
1:23:01
is invent various forms of external monitoring but on the most fundamental level what
happens when you are interacting
1:23:09
very often with strangers is you don't understand what their motives are and on a certain
level that's reduced to
1:23:17
okay you're in trouble with the irs oh my god stressor what's stressful about it this
person can make a decision that
1:23:24
could either be benign for you or could make you miserable for years to come and you
don't know who their grandparents were
1:23:30
you don't know like what like circumcision ceremony they went through or what their and
who knows what
1:23:37
but mainly dealing with strangers means that you're dealing constantly where you
1:23:42
don't know what people's motives are and the control and predictability aspects just
come roaring to the forefront then i'm sorry
1:23:50
we only have time for one more quick question and then justin you can wrap it up okay
can we have one question peter's gonna
1:23:56
say one question is that okay and then at the end of this um we do have a book signing
outside if
1:24:02
people want to meet robert so we'll take one more question here and then we'll finish
with peter's question hi thank you i had a good time tonight it was fun coming
1:24:10
um my question is in relation to procrastination so i'm a huge procrastinator i'm sure a
lot of people here
1:24:18
are and in part i really enjoy it because when i know that i'm under pressure i get things
done
1:24:26
and you know i'm able to write those papers faster for my students and so
1:24:31
forth so i you know i'm wondering what the impact of that is on health outcomes
1:24:39
my sense is only knowing how rats and baboons go about procrastinating for paper and
deadlines but my sense is it pretty
1:24:49
much takes two forms one is if someone is simply not very good at
1:24:54
time budgeting or time discounting if i do this later instead of now it will seem that much
1:25:01
less burdensome or whatever that you're just like not good at that um the other which i
think is the much
1:25:08
more pernicious less fixable version is if the procrastination is driven by
1:25:13
anxiety i can't do it i can't do it i can't do it until all my pencils are sharpened i can't do it
until
1:25:20
i've done three more rounds of preparation because i really can't understand the stuff
and i'm a fraud and they're going to find out
1:25:26
i think the you're just not very good at like remembering how many days away one week
is with deadlines is much less
1:25:34
troublesome than when the procrastination is just secondary to a gnawing sense of dis
ease and anxiety
1:25:41
about the world so my final question is a personal one since you know we all are you're
adoring fans and uh with the
1:25:50
success you've had as a scientist to someone who's brought it to a popular stage i'm
curious if you go back to robert
1:25:56
zapolsky at age 21 what advice would you give him because some of that may be
relevant for people at the beginning of their
1:26:01
academic careers and
1:26:07
okay
1:26:12
two answers which are actually intertwined um and the first one will seem very sort of
1:26:20
blindered in terms of the research um when i was 20 i started doing my field work in
africa with baboons and for about 30 years afterward i spent my
1:26:28
summers there back and forth going back to the same animals interested in what your
social rank has to do with what stress-related diseases
1:26:35
you have and when i was 21 if you asked me what explained baboon psychosocial
health and thus
1:26:41
humans was social dominance and social hierarchy and like you know i was like a sub-
adult male
1:26:49
primate so of course like hierarchical stuff seemed very important and it took me about
20 years in my work
1:26:54
to realize the social support factors and the personality stuff was far far more important
so
1:27:02
it would have saved me about 20 years at work to have mentioned that to myself at that
time um but in the broader sense what i think
1:27:10
winds up being exactly the same answer is um i wish if i could talk to my 21 year old self
1:27:18
and actually be convincing it would be to have been less ambitious
1:27:27
mr robert supposedly thank you
1:27:42
you
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