she discusses her book "brainwashed" the seductive appeal of mindless neuroscience at the 14th annual national

book festival from the washington d.c.. ♪ ♪ >> welcome to the national book festival. i am windy meloni of the u.s. copyright office and the library of congress. before we begin please note we are reporting this presentation for later webcasting. if you ask a question during the presentation and you are giving us permission to include you in the webcast. also please turn off all electronic devices. it is now my pleasure to introduce sally satel. sally satel assists resident scholar at the american enterprise institute. from 1988 to 1993 she was an

assistant professor at yale university where she remains a lecturer. satel is the author of many scholarly articles and books including drug treatment, the case for coercion and pcm d. how political correctness is corrupting medicine. in "brainwashed" the seductive appeal of mindless neuroscience, published by basic books in 2013, she and co-author psychologist scott lilienfeld reveal how many of the real world applications of human neuroscience gloss over its limitations and complexities often it's gearing that many factors in psychology that shape our behavior and identities. satel and lilienfeld analyze what brain scans another neurotechnologies can and cannot tell us about ourselves and they stress the complex nature of our selfhood, free will and personal responsibility. "brainwashed" was a finalist for

the 2013 los angeles times book prize in science. please welcome sally satel. [applause] >> it's great to see everyone. thank you and apologies about the slide projector. it's a little small but most of my slides aren't very busy. in fact my first slide is a copy of the cover of the book and to be honest right after we decided on that, i really thought of a better title. now i want it to be "50 shades of grey" matter. [laughter] that's not just the play on a popular model but it explicitly meant to invoke eight concept of seduction. in this case the seduction into certain beliefs about behavior

that technologies like brain scanning can lead us to. in the epitome of seduction i would say in neuroscience is a brain scan which is now the signature technology of modern neuroscience. in fact some would say that the brain scan has replaced the boards at him as a symbol of science. that's a brain scan and it's really quite a wondrous thing. the reason why i consider it a perfect storm of seduction is really so many forces converge on it. it's absolutely dazzling technology. we are not going to go too much into that because it's very complicated but it's amazing technology and like all technologies promises objectivity and a more scientific. it's about the brain.

neuroscience is of course about the brain which is a masterwork of nature. about 80 billion cells or nerve around each communicating with thousands of others which is more connections than the milky way. these are just some of them. it's the organ of the self and people tend to think understandably that it can reveal all kinds of secrets about human nature. it's visual and we are highly visual primates which is not something you can say for example about jeans. anyone can see a brain scan but it's much harder to see nucleic acid. and lastly there's an element, almost an element of surprise that accompanies brain scans. people tend to think, especially people who are not steeped in science and not particularly sophisticated in that realm and why should they be? the average person reading the science times, oh my -- it's in

the brain. it's in the brain. it's a very key phrase. of course it's in the brain. all thoughts and emotions are in the brain. where else would the biological correlates of behavior, emotion and thinking be? they are not in the pancreas, they are in the brain. you see headlines and of course you see the political bias affects brain activity accompanied by a brain scan. that anxieties in the brain. of course it's in the brain and as a psychiatrist these kinds of headlines really annoy me. proof that depression is real because we have her brain scanned to show that and anorexia or ptsd, and now that we know suffering is real. we knew it before and we didn't get a brain scan to tell us that. we need a brain scan to tell us some things. right now it's mainly in the realm of research. there are that many clinical applications but if you a new

realm of research in very good research but like so much of research when it filters through the press and into the popular media things get distorted. the phrase in the brain is seductive in another way because it kind of carries and exculpatory with, but that don't blame me, don't blame my brain and also the notion that axe lights up you hear the phrase lights up, which all that means is that there is increased activity in a particular area of the brain. their size activity in the brain. if there is not you are dead. anyway if axe lights up than y behavior inevitably happens and that is not the case either. we will be talking a lot about that but you can see why that axe and why inevitably following would be so appealing to trial lawyers and indeed now there's a whole new, all whole new field

called neural law which is looking at the implications of brain science for understanding the criminal mind. but it's a really nice story, that defense attorneys can tell. you see your honor my client has this in his brain and he could not control himself. he could not form the intent aided to commit a crime. this is a misreading of narrow imaging. sometimes, without question, people do have problems with their brains that rendered them legally insane so that they are not culpable. all kinds of damages, damage can happen to one's cognitive apparatus, rendering people either not culpable at all or less culpable lets say so that

they are not excused but their sentences mitigated. that happens clearly but the point is that at this point in time, and things might change as technology evolves, but at this point in time we cannot distinguish who those people are through brain scans. we can distinguish an impulse that is your sister pulled from one that was not resisted. this is a key point i want to return to as well. finally another misconception of popular readings of brain scans is the notion that you can actually pinpoint emotions or subtle emotions are complex feelings. that's just simply not true and in fact that kind of activity has led to the phrase, some to accuse oversimplification of the breeding of brain images as

being akin to neo-phrenology, that's original phrenology as if the brain is highly modular in specific areas of are involved solely with certain kinds of reactions. now clearly certain parts of the brain are more involved and more heavily mediated with certain kinds of reactions. we know about the imola dust -- amygdala. we talk about fear reactions but that particular part of the brain also happens to figure prominently in processing receptions of novelty or surprise so there is not a one-to-one correspondence. in fact circuitry is really where it is and all neuroscientists of course know this. again a lot of the problem here is how popular neuroscience has been, has come through the

media. there are some wonderful science journalist who know the background and are very careful and others a little less so. then there's that whole crop of people called neural entrepreneurs who are trying to make a book -- make a buck selling things that have to do with education neuroscience and a lot of facts that one has to be very careful about. really circuitry is where it is and that is where neuroscientists are focusing most of their energy. how the various regions interact with each other. it's enormously complicated. that is why i said as mri is still basically the research tool. we are probably one foot into a 10-mile long journey on understanding the brain but nonetheless these brain images have migrated into the public sphere, where the implied promise of decoding the brain one can see why politicians are

so interested. in fact there are some public relations groups that offer neuroimaging in an attempt to advise their clients about how to make their candidates more appealing. this is actually from an op-ed in "the new york times" from 2007 where candidates were shown to swing voters and the reactions of those voters brains were supposedly indicative of what the candidate would have to do to appeal to the more. this is neuroscience at its most popular and sort of dumbed down. marketers are very interested. this is a book, very clever title by a famous narrow marketer trying to tap into the brain through brain scans or eeg or other technologies that will reveal brain-based data, to tap

into the brain to learn what consumers want. kind of like cutting out the middleman and going straight to your brain. certainly we would love to find out a good lie detector and we have a whole chapter on this as well. frankly this is one of the few where there are some proof of concept that there are narrow signatures that can distinguish between truth telling and lying but it would be almost impossible at this time to apply it in the real world. in a laboratory setting with lots of controls, it has some fairly good validity. then there is the question of how we gauge the pull of temptation from oreos to cocaine and then defense attorneys as i mentioned before trying to prove that their clients lack of malign intent or even free will. i would offer a book to anyone who knows who these two guys

are. i think someone said -- leopold and lion. i may owe you a book. as i said we devote a chapter to neuromarketing and lie detection and neurolaw and we try to tease apart the hype from what seems promising from other technical obstacles in achieving an ultimate goal of being able to infer something about the mind from the brain and one of the conceptual barriers to doing that and what is flat-out neuroscience. with that as the background, i want to focus on the part of the book that to me and i don't know if i spite -- speak for my co-author scott lilienfeld but to me this is one of the most interesting things, which is a

culturally significant implications of our growing ability to explain behavior in neurological terms. in other words, the better we get at describing human behavior through biology, and we are only going to get better at it, how is that going to affect the way we think about human freedom, the freedom to choose our actions? i'm going to explore this through addiction. i actually am an addiction psychiatrist. that's my area of specialty, so i can say with complete honesty that for at least 20 years, 20 years e, i have been very very interested in the way addiction is conceptualized and portrayed to the public. frankly this is the way it is talked about now.

in the media, and educational campaigns, pardon me. this is your brain literally on cocaine. it's a new frying pan ad. actually this represents a very legitimate and very interesting experiment. not interesting in terms of its results. we expect the results but the fact that we can visualize the results is pretty darned amazing. basically, this study has two general paradigms. one, you take someone who has a cocaine problem and you expose them in a brain scanner. this happens to be a pat scannon but at the same general notion. using metabolic energy or fmi brain scanning uses blood flow

but they both reflect increased enhanced activity in the brain. so you take someone who has a cocaine problem. you put them in a scanning apparatus and you show them films. there are little mirrors in these machines and a person looks up and they can see a film of people using cocaine, cocaine paraphernalia and they experience a subjective desire to use cocaine and their brain will reflect what we called the reward area, a special activation and that is effectively didn't neurocorlett of their desire to use cocaine. any show that same person a picture of the beach or a meadow or something neutral, you don't elicit the same kind of metabolic activity, in this case mainly dopamine activity. the other version of it is you

have two people, one is a cocaine user and one is not. you show them both the films of people using and you get this reaction. the person who has the cocaine history but not in the person who has never used cocaine, as you might expect. anyway it has been replicated a lot. it's great. but the way it's described is that this is the brain being hijacked by cocaine, specifically referring to the hijacking of the limbic system which is a complex and fairly old brain circuitry and contains regions you may have heard out of, the amygdala, the hippocampus, and others and it mediates reward and memory and emotion. but the language is that it hijacks the brain, cocaine

hijacks this limbic system and of course the implication, sometimes left is an implication stated outright is that when someone's brain looks like this effectively, they are out of control. they can no longer, they no longer have control over their actions in their drug use is involuntary. it's the existence of these changes like many experts now call addiction brain disease. a brain disease because they are operating in the changes of addiction. that is true, there are changes in the context of addiction but still unable brain disease deserves a lot of scrutiny. first, changes to the brain are not a signifier of pathology. learning italian changes the brain, as you know. there is much plasticity that is involved with learning.

alzheimer's changes the brain. addiction is not learning italian. your language lessons don't take on the quality of a compulsion like a crackhead nor is it like alzheimer's with its own inexorable progression to dementia is completely beyond the control of the sufferer. the brain changes of alzheimer's disease render the patient completely resistant to any rewards or sanctions. if you said to your grandmother, grandma i'm going to give you a million dollars if your memory doesn't deteriorate. or grandma i'm going to shoot you if your memory deteriorates, it won't matter. but the brain changes of addiction thank goodness do not impair the capacity to be deterred. i realize that may sound especially for people who have known addicts, that may sound a little strange or it a sound not strange at all because people

who lived with people who use drugs can see the decisions they're making every day that make them more or less vulnerable. but in any case just going into the lab we know that rewards can and do modify the course of behavior which in some sense is the essence of voluntariness. if a behavior can be modified by its consequences. that sounds a little too theoretical to let me give you an example. these are vietnam vets. in june of 1971 president nixon became panicked that there would be a flood of veterans from southeast asia coming back to the inner-city and further inflame the heroin epidemics in big cities that were already underway. he was afraid of this because and it was true that at least half of all g.i.s had tried

opium and heroin in vietnam where it was very very abundant and about 15 to 20% have actually been addicted. so he was very concerned, so they instituted a program called operation golden flow. everyone had to go to the bathroom in a cup and if it was positive you are not leaving vietnam. to make a long story short almost everyone passed the test, everyone who is using an addicted to heroin pass the test. a few who didn't were given an extra week to clean up and then i came back to the united states. then, a researcher at the university of washington followed these people for three years and was expecting to see higher rates of re-addiction.

once they were back home they would resume their habits. but only about 12% had used in the three years that they had come back. that was very very surprising but also very encouraging. frankly it's what really lies at the heart of recovery and reasonable public policy for addiction which is the intelligent use of sanctions and reports, which we could make very good use up in the criminal justice system. it's a different issue about legalizing and i'm not going to get into legalization, taking the system as we find it to the extent that we can divert people from incarceration because of nonviolent drug crimes and put them in drug courts. we have been doing that for years and these courts are based on the principles of behavior which is that swift, certain but

not severe sanctions can really shape behavior and drug courts have been going on for quite a while and are quite successful. that's just one example. there are many others in the book but the point is that if you just focus at the level of the brain and he just talked about the nucleus and the hippocampus. i apologize. you would not think about shaping behavior. when you are told something is a brain disease you think it's involuntary. how do i work with my patients so that they don't crave? well we come up with strategies to allow them to do what's called self binding, ways to basically put barriers between themselves and their drugs or you have probably heard the common ones, stay away from people, places and things. thanks so much.

deposit your paycheck. don't have money available. i had a patient who used to shoot up and every time he looked at his arms were of course he had tracks it would stimulate a sense of craving so he had to wear longsleeved shirts all the time or he would find himself to arouse. avoid boredom. this is the kind of thing people have to do. the point is this involves motivation. this involves conscious engagement. again if we focus too much on the level of the brain we are not going to pay attention to these things. that is what i'm describing, were patient sort of bind themselves, not to the mast in this case that create barriers to their use to recognize situations of vulnerability like

hearing the siren song of cocaine but restraining yourself in some way. okay, so addiction is a good example and this discussion thus far is a good example of what scott and i call neurocentrism and that is one of the problems we think with the way neuroscience has been popularized. neurocentrism is the idea that human behavior can be best explained by looking solely or primarily at the brain, that somehow that level of analysis gives you the most authentic, true, reliable understanding of a behavior. it's probably true if you have alzheimer's disease. addiction, no. post-traumatic stress disorder, no. depression, no. the problem with a neurocentered view as you will use medication

too much. i don't oppose medication, i work in a methadone clinic but to think that methadone is the answer in and of itself is clearly not true. you are going to downplay the importance of psychology and behavior and we can't afford to lose the mind in the age of brain science. when i referred to the mind i'm talking privately about feelings, thoughts, desires and intentions, memories and subjectivity. i don't want you to think for a minute we are falling into any kind of dualism trap. the mind is wholly dependent upon the brain, no questions there. all subjective experience is mediated through the brain. no brain, no consciousness but it's very important to realize that the physical worlds from one level of analysis, and i'm going to skip to my level.

i apologize. you probably can't see that very well but basically all the levels of analysis starting with the environment and ending up with, i guess it ends up at jeans. it could end up at quantum physics that we can't yet use the physical worlds from the cellular level to predict activity at the psychological level. if you want to understand, if you are reading a book and you want to understand what the text means for example you don't subject the ink to a chemical analysis. that's not the level that's going to inform you about the meaning of the book. these are just different levels of analysis and the important thing is that some questions are answered better at one or more of these levels. others are answered best at others. they are not right or wrong. this addiction affect the brain?

of course it does but if we stay at that level we are going to miss a lot. so it's not just addiction but biological explanations of complex behavior can mislead in the courtroom as well and trial lawyers love that and they are counting on jurors to get seduced as well. as i mentioned before again, there are certainly cases where people's brains are defective and they can't be held legally accountable. it's just that brain images are not helpful in distinguishing who they are. i have to say yet and maybe that will change at some point but it can be highly misleading and biological explanations in general influence the way we think about responsibility over action. there have been many interesting studies explaining behavior in

biological terms and compared to psychological terms. for example my brain -- that's a big flip. just describing some sort of neurocorrelate of behavior or genetic explanation and people are much more likely to attribute less blame to the person that they had committed a crime and this is an explanation given for their behavior. the impulse to punish is a lot less severe when people understand it as being a behavior that was caused by a brain problem as opposed to a childhood problem. this can also backfire as when people accept a biological explanation for mental illness and substance abuse, the desire for social distance and the stigma enhances and they have less faith that therapy will work and they believe they are

more dangerous. this is important to know. it's important to know the implications of how we describe behavior, i'm not telling you how you should describe behavior. you don't want to manipulate explanations so as to elicit specific kinds of reactions. if the problem is in the brain for example you have to be truthful and talk about that. but it's interesting how these explanations do affect our fundamental intuitions of human agency and my point is simply that they can be manipulated. now let's go a little bit deeper for 15 more minutes. i will leave a little time for discussion but i want to go a little deeper.

when lawyers use brain scans in capital cases which is now pretty much daily, they are making the point that their client couldn't form an intent or their client couldn't reason properly. their client had some sort of poor control but the implication is that the default circumstance is that while most people can't control themselves. most people do know what they are doing. most people can be deterred but not my client. but some neuroscientists and some philosophers are taking, going a step further and they are arguing that no one has the capacity for choice, that none of us could act other than we did and that all of us, not just criminals, are not in control of their actions at any point. wow.

now you will recognize this of course is the fiendish ancient debate about free will. which we are not going to resolve here, just so you know. now many neuroscientists claim we don't have free will and, this is not new. this debate has been going on for centuries but they do argue that neuroscience will make this clear. basically neuroscience will finally resolve the free will debate. that debate that neuroscience will finally clear up their free will debate. this brings us to another very interesting aspect here. implications of brain science for morality more generally, not just whether an individual could or could not control themselves or should be responsible but whether the concept of responsibility at all is a

coherent one. this gets us back to our boys. now in 1924, i think everyone probably knows the story on hyde park chicago. these two brilliant kids wanted to commit the perfect crime so they found a 14-year-old boy and killed him and drove him to indiana, put his body and a drain pipe, went home and played cards, called the families, the family of a child and said they needed the ransom. they were very pleased with themselves and thought they had gotten away with it. well they didn't. three days later, probably one of them drop their glasses and they traced it to leopold and loeb. their families hired famous attorney clarence darrow who the next year went on to inherit the wind.

so it was a monthlong trial and in fact literally 90 years ago today and at the end of it, there was a 12 hour summation by clarence darrow. he basically was arguing for life in prison as opposed to hanging. he did succeed although the judge said it had to do with their youth, not his argument. darrow's argument was right right out of you call that determines playbook. in other words while i will tell you what he said. why did they kill little bobby franks? not for money, not for spite, not for hate. they killed him because they were made that way. they were nature's victims. and this is the essence, i'm sure you remember this from philosophy 101 but the notion of determinism which is that each act be performed perform criminal or otherwise follows from a cause and given the same

conditions, the same results will flow every time. again, we are talking for example all the causes that go into a person, the genes, your experiential history, your environment, your genetic history and the context you are in at the moment. the idea is that all these impinge on an individual cell so at the moment of having to make a decision, there is basically, you kind of faded to make one choice. there's no one real choice, whether you are going to choose soup over salad or murder or for mercy. there was no real choice to be made because up until that moment of decision you couldn't could have chosen otherwise based on its whole history, this whole causal parade. now again i'm assuming it sounds familiar, remember there is no

praise, there is no blame because you couldn't have done otherwise. he just acted based on all the forces impinging on you. certainly that's not an intuitive view of how we act. on the other hand it is true that much of our behavior is caused and much of it is caused and unconscious ways. that's true, but how is neuroscience, and i compared here and i have two quotations. the bottom on words is where victims of our own circumstances in the top one is clarence darrow. the bottom was a neuroscientist. where all victims of neuronal circumstances. if that's true then what happens? well this goes away. there is no blame. it means we have to change our criminal justice system radically. turn it into one that is highly

utilitarian, where we might put people in jail but it's to deter them from acting again and deter others who would observe how we have punished them, to contain dangerous people and to rehabilitate them but no punishment. now as i said these debates have been going on for a long time and now with the addition of neuroscience they lead up to this question. maybe you can't read it. it says, is there a way to preserve moral responsibility and a world in which all events leading up to the moment of choice determine what that choice will be and the better we get at understanding the neural pathways will actually see that process. this is what happens to me when i think about it. it's a tough one. it ends in tears. i'm not resolving it but the point is that neuroscience is

not resolved it either in the way philosophers have largely dealt with it is to just think about the kinds of freedom that are necessary to make a choice. the kind of freedom you think is necessary is the kind that is completely uncaused where people essentially operate in a vacuum, which is hard to imagine how that could happen. all of your behaviors are cause. some you are aware of and some you are not so aware of but unless you live in a causal vacuum then there's no such thing as ultimate free will. okay, those people are called hard determinist and they do go towards the utilitarian view of the criminal justice system. then you have people and i'm a little bit more sympathetic to this, the compatible list -- compatible list view which says as long as people can reason, came to liberate and game plan

and change their minds, but that's enough freedom for people to be considered to have free will. if there's something wrong with your brain so that you can't reason or to liberate our response to deterrence or respond to reason then maybe you as an individual to have your freedom compromise that maybe you should be excused. but as a species, we do have free will. i don't know how you come down on that but neuroscience is not going to help you resolve it. so i should end there. i i see that i only have five more minutes. of course i do have more to say. the book as leeches -- basically a closer by. i consider it much more culture book than a science book. i think it's inevitable that as biological manifestations and explanations and mechanisms are understood, they are going to have enormous therapeutic

benefit. we didn't even talk about the benefits and another to talk later today in this room about neuroscience and i assume he will talk a lot about that as well. it is the final scientific frontier. that's all very true but we shouldn't get seduced into thinking too mechanically about ourselves into reductively about human nature simply because we are learning more about how we function. thank you so much. [applause] i guess there might be time for two questions. i'm sorry. [inaudible] >> i don't think you're thing was on but the question was does aa work and the short answer is

aa works for home networks. i don't mean to be flip but it saves some people's lives. most treatments don't have the greatest rate. aa doesn't either so at an individual level yes it can be lifesaving but the average person won't stop drinking right away. but the kinds of treatments that work the best are ones we don't use. please don't use these rewards and sanctions very much which is a shame unless you are a doctor or a pilot and that if you lose your license we have all kinds of builds and contingencies for you like you've got something to lose and you are going to lose it unless you shape up. the rates of recovery and professionals are 95% because a there is so much to lose them bay there are people with skills as well but you are dealing with

a different kind of population. but they don't do -- they do much better, professionals do much better in terms of recovery when there are contingencies attached to them as well. >> hi. could you talk a little bit pleased about food addiction because you said you are from yale. being that yale also has the food addiction scale and that is the marriage of the survey of behavior with neuroscience and brain scans and so forth but that is poised to impact legislation and the prepared food industry. >> i have written, actually the picture comes from an article that i wrote about it. last year there was a research study that got an enormous amount of attention. it compared rats,, rats are fine but there's so much that can

extrapolate to humans. anyway that cocaine, oreos were as addictive as cocaine. i don't know if you recall back in the idea was that because they concluded this because you see some of the same neural signatures and a sister in humans as well. the reward pathway that i mentioned is of course elicited by food and sex than anything pleasurable and cocaine. it's very fast so i think to say food addiction is like cocaine. what it shows us is that people have a desire for it. there's anticipation and then there is desired and in fact it may register a anticipation more than it does actual. the same principles apply as they do to addiction in the sense that or to any behavior that is ritual to the extent

that we can learn the cues that make us more or less vulnerable and with motivation and other kinds of techniques we can overcome them. i certainly am not arguing that some of the same merrill mechanisms are engaged but what i would argue against though is that the person is rendered helpless. i do think you're exactly right, there've been a lot of product liability efforts to big food and this is potentially a trial lawyers the dashed dream to make it as analogous to addiction is possible and that would be a real abuse of science. >> i'm just a little confused. i am addicted to ice cream. it is not my brain. where's that addiction located?

>> that's one of the first thing i said, of course it would be in the brain. that's exactly where it is. that's where everything is. it's almost trivially true to say something is in the brain. there are things in the brain we haven't found. if you recall the awful crime in 2001 of andrea gates, this poor woman who had postpartum psychosis and drowned her kids. there was no brain scan in her trial. there was none but even if they attempted to bring one and now it probably wouldn't reveal much. we can even make the most significant psychiatric diagnosis like postpartum psychosis, bipolar, schizophrenia. we can't make those diagnoses with great certainty based on brain scans. i am sure we will one day or with other information. obviously genetic information is also difficult. there are 100 genes involved

with schizophrenia so it's very complicated. we will get there i do think that we are not there yet. so again it's a limited technology and responsible neuroscientist know that. they really cringe when they see it being applied so sloppily in the public realm. they cringe but we loved the book. >> do you believe that there is a pre-genetic disposition that people are born to have addictions? save for example of you were an alcoholic you are automatically going to be addicted to something else? >> certainly there's no question there are genetic predispositions do these things. genetic predisposition can be anything from how pleasurable we

find a certain let's say alcohol varies a lot. some people find it disgusting and typical of certain asian populations where they can't metabolize alcohol very well. there will won't be a lot of alcoholism there simply because they can. remember if your parents are alcoholic, some people say just don't even try it. why even put yourself in that position but it's not like your mother has huntington's heaven pervaded me have that gene. it's not a simple genetic transition at all. we are talking probability and in this case as i said you can address of the most simple way which is not even go near it at all or pace yourself. there are all kinds of strategies a person can use so that if they do feel things are getting out of control they can pull back. i must tell you that most people pull back.

clinicians tend to see people who have trouble. in fact there's something called the clinician solution which is a problem and i'm sure i've engaged in it myself as well where we extrapolate too vigorously from the people we see in the clinic to the people in the general universe. we saw this after 9/11. there was an assumption that new york city would be traumatized. the amount of money that went into mental health services was astounding. it turned out that look if you were in the tower of course you could have had a severe psychiatric reaction. if you knew someone who died you were vulnerable but the vast majority of people were upset as hell but not pathological at all. people are resilient. that's not the people's psychiatry. we see the people who have trouble coping and b.c. addicts

for example who don't come on their own. so many do but that's not who we see and that's not who we research. that's not to say you don't come in for treatment if you are having trouble. you come in right away and don't wait for it to play out because you could get aids or all kinds of things could happen. a natural history is for people to recover on their own. on that optimistic note, i will stop. thank you. [applause] ♪ ♪