>> you're watching the tv. for a complete television schedule visit booktv.org. you can also follow one behind the scenes on social media, book tv, on twitter, instagram and facebook. >> carl is a professor of bioengineering and psychiatry at stanford university and investigator howard hughes medical institute. the winner ofne the prize he teaches and directs stanford's undergraduate degree and bioengineering and treats patients with the mood disorders and autism. katherine is the higgins a professor of molecular and cellular biology professor of artsit and sciences at harvard university investigator at howard hughes medical institute. they'll be discussing carl's new book projections, a story of human emotions. professor has spent his life

pursuing truth about the human mind both as a renowned cynical psychiatrist and a researcher creating and developing the revolutionary yield of uses life projections s a larger story about the material origins of human emotions, bridging the gap between the agent circuits of our brain and the poignant moments of suffering our daily lives. nature praise the book as a moving analysis of the human brain and emotions and a great read. i'm very pleased to turn things over to our speakers, the digital podium is yours carl and katherine. >> thank you. >> thank you very much. >> it is really a delight to be discussing this bookis with you. to put these into the context how i hurt about your book. i know you as a colleague, as

a neuroscientist some hill has really revolutionized and we will talk a little bit about that later. we have meetings we talk about the brain, about circuitry, about behavior, one of these zoom meetings that we have, we discuss literature, reading and poetry. you told me you were finishing writing a book. so obviously i want to read it. you were kind enough to send me your book. i just loved the book. it has so much a richness it's a beautifully written. i understand what you did for a long time. you talk a lot about the format of the book. so why don't you tell us about your book?

who is your audience? what is the message you want to convey? >> first of all catherine, thank you for that>> wonderful introduction. it's really good to connect with you thisy way. i enjoy are similar in conversations, i have always known you are a kindred soul oppression and the arts as well as the science. so thank you for taking the time to do this. it really brings back memories from my earlier time at harvard just to see the name harvard square mentioned in the times around that. it also just to see you and text me again that is truly meaningful, thank you for taking the time. and i will tell you, the book was something i always loved as you have always loved literature, writing,re the power of the words to stir emotion. i have marveled at that, wondered aboutwo that. my whole life growing up into

adulthood, through critical practice and the progress always returning to literature. very hard to share with the broad public, the essence of what we do it is a challenge even to convey what we do too many scientists. to answer your question, the first challenge was if i want to share some of the excitement of the science, if i want to share the important experiences from the clinic. if i want to help everybody

understand this better, this moment in time and our progress toward understanding ourselves is going to be very challenging to figure out how to do it. what is the right voice, what is the what the book is. it is a mix of science and medicine and a love of language. i know that is strange. it is the only thing i could think ofou i could see going forward. >> you mentioned you were d bringing to three aspects of

your personality. psychiatry so you as an md. everyone's imagination and the third one is technology. let's start with psychiatry. i found this interesting because at the beginning of your book, first you say emergency psychiatry provides context something very poignant about what you describe both you as physicians, even a one story, the story is told from the perspective of the patient not from the perspective of the physician. what brought you to psychiatry? at the beginning of your book you say psychiatry was the least i would have suggested a giant selected. the feel of psychiatry and by

contrast my own experience how did you come about to select psychiatry? >> it surprised me, as much as anybody. i had the greatest respect for people from psychiatry. i did not understand it as a specialty the challenges they fiface is so different from other fields of medicine. there are no real measurable's and psychiatry. there are no real blood draws that tell you, what the person is suffering from, brain scans do not say that. it's all words. we make diagnoses and track responses to treatment with the rating scales. those are all words too. it's all words and it has to be done artfully and scientifically. it's very different in that

sense from all the branches of the government. i was completely reset in a single moment, medical student doing a required required psychiatry rotation. a medical student towards the end and the training done the surgery i loved it was a everything about it was invigorating. you talk about experiences that are transformative, the very first day as on the psychiatry award, patient burst into the room where i was sitting, i saw a human being in front of me he was intact in every way, nothing

altered physically. but i saw an instant through what he was yelling at me, i saw how radically different his reality was from mine. for somebody who had wondered about the construction of reality, that was interesting. then his wordses were also interesting to. he was creating a motion, not to sugarcoat his suffering, he was suffering froms a very serious disorder, the nature was so creative and unusual someone who was always intrigued by words i was also struck by that as well. he had a complex delusion that became clear. what changed my whole life in that moment was realizing this was something totally understood so the need was

greatest compared to any other field of medicine compared to how far we need to go. the need was great the suffering was among us. it was so interesting. i was almost a little guilty thow it was there suffering at the same time. but to seell all of those together and realize someone who cares about words and language this is what matters, how it is expressed and treated. at least in large part. that re- moment reset me and i became a psychiatrist in that moment. it is good to deal with them experience cannot prejudge things before you experience them directly. >> i always send my students get out of their comfort zone. that is a nice example of that. would you say really those to

your second perspective of imagination. in citing the book and has redeemed psychiatry and ideas fromy literature for understanding patient. i see value literature as much as science and thinking about the mind. can you go over this again? and also, to put these also into context ial understand as a child you were an avid reader you were waiting for your eyes to go bad. you mentioned going to and from school held on the handlebar of your bike. we complain about people that

is pretty extreme. >> it was extreme. did twice collide with parked cars. the something shocking is being absorbed in a book and suddenly flying to the air and landing. it happened more than once. i was aas slow learner. the interesting thing about imagination side and how science particularly with the brain there is a modern perspective that can help make this clear. i will begin by saying cares at interviews, using words to bring out from within. to do that artfully you cannot do it crudely. you have to elicit what our garden, hidden or poorly

understood and our experiences from the patient. you have to look at these in a careful, respectful, and slow way. it's almost like you are doing ysomething with words that could never be done they could not be done with a microscope, certainly could not be done with a scalpel. not even with electrodes, with a modern recording electrodes and imaging more precisely getting something more important going on than any other that's part of how the words are. but then we think about the imaginative experiences of whativ people have gets reflected in literature we realize how these stir us and affect our emotions are directly and powerfully, even

separate from the dictionary definition of words or the usual construction of sentences, can make us feel things very deeply and powerful, realizing what goes on there, something like what would say in neuroscience today is a projection from a multidimensional space into something that is accessible and interpretable to the human conscious mind. we hear has all this complexities down and do something unitary and can tractable. realizing what literature does, what poetry does in making us feel these things that are precise in the sense of being a repeatable, powerful, and describable, that is pretty important when

it comes to understanding the brain. that iser accessing something that currently science and medicine cannot reflect. in the book, what i try to do a certainly present the science side in the medicine side. each story about these human beings is to use words to reflect that interstate and help people imagine, help people's minds work to create that state within themselves. that was the hopewi and goal to bring that side together with science and medicine. >> you bring the third dimension, which is ne neuroscience. you explain haven fascinated by a student with biology and the ability to go from a molecular to try to understand what is happening to the

audience. why don't you tell w us a little bit about your development of the technology of genetics that has revolutionized by being able to access is a lot excited and neuroscience try to reflect the excitement of the other technologies because aspects of the book of my own as well it's important to does allow us to move beyond correlation to study real-time causation, real-time causality in the mind. so i opted genetics, we have a broad audience here. it's pretty easy to understand

conceptually. at the weight think of using light opposite of how we normally think about it. normally we think of using lights to observe pretty bring information and using light. you certainly know, is the opposite of that were sending light into aig system to change things, to make things happen. to do this in a very precise way. to brain cells in real time during complex behaviors, during complex or by doing so we can see what really matters, which sells it matter which can give rise to these complex states and processes. when they subvert the normal function. this works, as you know through a process of bringing forms of single cells used by

microbes worked with the natural light to the brain. there are single proteins called microbial that turn lights intoic ion flow across the surface of membrane itself we need to turn that into information. it's the code for on and off in the tour neurons on and off. her projections across the he brain, we can actually cause those cells to be turned

on or off during real-time behavior and understand it turns out active on how the parts of the brain give rise to the beauty and mystery of the system working together. >> give us a specific example. each and how you are informed by experiments the kick hearing capacity talk about too opposite behavior how they

interacted gets. the thoughts and experiments to really in spire you in your wamedicine. >> but was so exciting, as as all the science is being developed and as we were gaining technology but gaining insights in fact in this is my clinic office here where i see patients. i specialize in both depression and autism spectrum disorders. i would have patients, these are very difficult conditions to treat and do not respond to

medication. i would help treat anxiety and so on. but the social behavior and challenges. they are people who live on opposite extremes of the socialo spectrum. one was on theis autism spectrum, charles although he was able to speak as someone with autism can't he was able to speak effectively but had very significant social deficits and could not make eye text i contact. if something to look in the eyes of a person, which we often see and autism. the other extreme, very, very hyper social individual who ndformed connections rich and complex imagery effortlessly and seem to connect all streams of information

together in a beautiful tapestry float out effortlessly. in my own way i was amazed by both of these, i was seeing them at the same time as we were studying octave genetics social interaction in mice. i tried to reflect some of the feelings they get stirred by that when you see y patients expressing often debilitating but quite interesting states. to go and be able to test thingsng directly in the animals that are guided by what we see in the patients. i'll type up the neuroscience. catherine, your work is probably the best example for the social interaction and to study social behavior. i was inspired by your work

parenting this states from the experience of humanity and also of mammals in general, can be studied in a rigorous way and how those parks are unified into the hole. how you and your colleagues did some amazing experiments in the complex state of parenting can be broken down into particularti connections that guide to define the end, retrieve the young, bring them back to the nest and other projections that govern the actual care in the grooming and so unpaid that was a beautiful illustration how we could identify how the parts can give rise and complex states part tractable. we can identify components that matter, that areif causal.

that is certainly part of the overall picture. we're also in my lab some experiment on social behavior asas well. we found b we could tune the balance of activity for excited cells and their actively stimulating other neurons and or inhibiting other neurons for a been hypothesized the balance between the two kinds of cells might be important in autism. because a number of evidence are susceptible to seizures and epilepsy. it was studied in the laboratory ashe well. he had excitedhe tori cells found profound behavior can be

corrected by flipping it around. as this was happening at this very nice young gentleman, charles i was able to talk to him and ask himim about very specific symptoms that he had including this by contacting which is striking many people have friends or family who are on the autism spectrum will know very well this very interesting symptom. i contact almost seems like it is avoided. iwhen i contact it's very fleeting and it's terminated very quickly by the person. so i was able to ask my patient about this while it was going on. i tried to reflect in r the book what a privilege a moment this really is to be able to setting things in labs and talk about their experience in ways that were directly connected. he reflected to me, the reason he was looking away, the recent eye contactta was

difficult for him, it was not fear, is not anxiety, it was the information was overwhelming. there was too much content, too much information and overwhelmed him. he knew that would be a problem he was looking away for thator reason. the reason that was such a transcendent moment it goes directly onto under the conditions where the excitation there was a deficit of information processing. this is an answer to your question to try to capture the feeling to talk to patients

and get these to expresses best from modern neuroscience can bang that excitement as part of that chapter. >> is another chapter also on some essential, you find very striking. there are several patients, this brings you to some reflection of hunger, thirst, bring some of your own and your life and how on the one

hand you can stimulate a very specific behavior being engaged. there are also other areas of the brain may be controlling these discuss what free will could be, tell me more about this? it is to what neuroscience is trying to understand or the limits. >> these questions get really to the heart of the self is, how it can go wrong, how it can become fragmented or almost too powerful. the eating disorders, anorexia and bulimia, first of all i spend many months as a

physician on a pediatric inpatient psychiatry ward, which is a mostly in large part occupied anorexia patients. this is so heartbreaking these children are suffering in this way that they refused to eat and they become extremely ill and can die from this. if you think about what is really going on here, like how can we study this, the first question is how we regulate feeding when we are hungry or thirsty, which cells are govern the appropriate response.

it is been really helpful for that. there are cells and the extended hypothalamus that have been identified they are not just correlated with but in real time control the active intake of food or water when hungry or thirsty. the state of feeling bad of being thirsty for example, when we are thirsty as we all know we don't just go and get water that may seemed like a subtle difference. it actually is in other parts of the state going to get water and feeling bad those are bound up together. after genetics has helped us to identify the cells that govern the i states just as parenting works. that has helped us understand the cells that control the behaviors. but what is interesting, and eating disorders the patients know, it is not as if they don't know they are hungry. they know there is an emptiness there.

the patient who has anorexia, is not blind to the hunger. it's not as if the hunger cells are shut down and that is what they are no longer taking in the food. that is clearly not the case. you can understand this by talking to them. : : hunger is there but there's something else on top of that the changes their response to hunger and that's got to be something very powerful considering how important the drive to eat into drink are. so this layering of something on top that has the ability to exert a tolerance control over these drives is what's going on with these disorders. so in the chapter there is i think some very -- you reflect

on some of the heart rendering and this case the positive case of an eatin >> was really helpful because when we were doing it even when the book was being written, we were carrying out experiments in my laboratory so carrying out brain line recording with the electrodes all across the brain while we were making animals thirsty or not thirsty. and animal that is thirsty will lick for water until it's no longer thirsty and that is normal if you simulate that you can make an animal that was stated and no longer

licking water. that is pretty interesting so that helps you to show the cells they connect to the other interesting parts of science but if you notice an interesting thing reflected in the paper that we published when we just stimulated the thirst neurons just to see what the brain was doing almost all parts of the brain you could tell and had been thirsty and had a lot of water then no longer thirsty and stimulated the thirst neurons only was it behavior as if it was but all the other drones look like they were in the thirst mode but some are not

completely fooled so there were i some areas and in the prefrontal cortex that were effective but it wasn't the thirsty but something else and there is a part that could resist the instructions if you will and so this i thought was very important there are parts of the brain and we could identify them as some of them with hunger and thirst and structures and cells in connections of patients of anorexia and bulimia to come and alter these drives.

so at the same time as the clinical cases areni going on there was a promise for understanding. >> the cases we discussed before are easy to model that you mention other cases so for example talk about henry and what ise interesting is when you talk to him you actually become angry at him because he is manipulating you and there is something in him you are trying to help him but you be term upsets so tell us here.

>> so to pick up on the fact two still have a ways to go in the borderline t personality and not all the chapters show a path toward understanding or resolution by the science some are just human stories to say not only what is known about the science what this condition is. and borderline is one of those in that typical human experience. and the story that i tell here is the psychiatrist that will recognize this that when we

feel an emotion it is important to recognize that is likely also something others will have experienced to because you can use that to helplp the patient so even if it is something like anger and makes me feel angry i shouldn't try to pretend that i'm feeling that. >> but it comes with experience. >> it certainly comes and we recognize that it is there and i need to use this so in this case the patient comes to a very deep and helpful

connection by recognizing that anger. and there's a lot of interesting neuroscience but we have a long way to go to understanding this disorder i want to bring the whole community up to speed on what this is or as mysterious as it is it is consistent it is real it isca biological and something that are brothers and sisters and friends and colleagues who areas suffering as hard as it is to understand, it is real and euro science gets us that way to an understanding. >> one of the last questions i see in the q&a so what's next for you or euro science and i

are working with mice what about nonhuman primates like epigenetic's's are presentable somehow. >> primarily it is basic science and has given us so manyns insights because you deliver a gene my colleague in switzerland has very recently use that have white sensitivity - - light sensitivity on those who are blind so there will be cases that are useful that much more significant is any treatment that is more powerful we just

need understanding what we'ret doing now is clinical trials suggest today i came from the hospital when we were doing thisis experiment to understand dissociation where the self and people areof aware of the experiences but they don't attribute them to themselves they don't care as much about them this shows up than most people is common in ptsd so mysterious that it has actually helped us to understand the state so going back-and-forth from the laboratory to a clinical setting we have patience that are undergoing clinical care to findtr the source of seizures with the normal course of treating patients to give them the best call on —- possible

care but also as they come together and linking that back to things that we can do. so that is the future we're going right to people with amazing insights into very fundamental and mysterious question with the unity of self which is more than i can ever help for on —- hope for and then these light responses that were identified by a botanist. so it's not bonnie that helps us understand in some ways the most mysterious parts of ourselves. i think that's a great story for people to know.

>> so what you said a few minutes ago to understand complex behaviors by breaking them down. how does this relate to the phenomenon? so to bring them together how far can you go? >> of course you lose something very important only by being together in that sense that you can't speak too much about anyone part in isolation because you can work withnd a precision of individual cells where they are still in the functioning brain so it's

a different kind every direction you're not actuallyy we do reducing the system it stays intact what you are increasing the precision. has been largely informative and have done experiments where we can play in and deliver input individually specified cells into the visualth cortex and we can cause amounts to behave for it to see something that isn't really there and just like what corresponds to naturally happen with the visual stimulus and with that internal representation that psychologists have sought to understand what is that internal representation?

we can see it and provided an that corresponds to what happens naturally. we have not encountered a limit on what we can do in principle if you can have patterns of activity so the promise of keeping the system in tact with the revolution to access still has a long way to go in many things to be discovered using this approach. >> so which are the basic emotions are is that the interpretation quick.

>> it's a very deep question and again. ofe course except there's not a single spot in the brain that governs emotions or that governs actions we often do use words like top-down and bottom-up but we are increasingly realizing that choices and actions and feelings are distributed everywhere and represented everywhere. why that is the case is another question but certainly the case all over. on theio motion related decisions those that have the parts of the brain that you share with fish that are deeper and older these can all

respect to the aspect of emotional states so the first answer iss that emotion is really over and basic emotions when you say what is a basic a motion? we have fear and attentiveness trying to defend themselves with aggression and anger and we can see things happening and behaviors that correspond with amazing commonalities with the same basic structures to express these emotional changes and those that are

relevant. so they are represented in a way across the land. >> so to talk about emotions so what is uniquely human and you say they are very important for psychiatry. how do tears appear? why do we cry? >> been on —- that is an important distinction. it is very clear other animals express grief and today more and and even have facial

expressions and make us think of grief or morning. but what is very interesting is emotional tears the drops coming from our tear ducts appear toit be a human trait even a great ape cousins don't shed emotional tears per se. not only are we pretty special in that regard but also you can quantify the effect of tears people studying human beings have digitally altered the presence of tears of human faces and they are much more powerful at stirring emotions than any other facial expression. that is one interesting thing. that is a fact.

>> although not completely involuntary they are largely involuntary tears have come when we haven't wanted them to come so to some extent it is a truth channel reflecting the information that is not entirely under our control. and we know it's a most powerful impact to help. so it raises the evolutionary questions that can phase what is a ground truth that cannot be so easy? and for social organisms like us or that lives and communities to help each other build and has some access and actually makes sense for what

is really true and deep and i response to that so there is a storyer the other patient who could not cry and other than the details of what happens to the patient it is a terrible tragedy and hear someone who could cry before but couldn't has experience w with grief but could not cry so that ability was deleting on —- from that complexmp state and what they could find is the unique thing that had happened to him there was no hope anymore for the patient not only was it a tragedy but the nature was that shehe had no further help and that raises the sad and tragic and interesting question if there is no hope it's probably not worth it of

the trouble of tears is no longer worth it so this is something we can link to anatomy and behavior and down to the brainstem that we think the part that governs tears or the parts that govern breathing and just a few little projections across the brain to turn and emotional state into one that carries largely uncontrollable expression as a truth channel and it's interesting to identify what may be present in others. >> that's interesting.

questions from someone in the audience when you identify interest with of the genetics can you have a prediction? >> the question of the direct link treatment comes up because i see patients in the clinic and these are patients we don't have all the treatments we would like to have these amazing insights coming from the laboratory and the fastest way to get these insights and we are working on that authority helping blind people see again which is amazing but it doesn't have to be a direct application the thing about this technology is once you know what matters

than any treatment can become very powerful and one great example is the disassociation question is a very debilitating system and we could identify cells in those methods that cause dissociation and those activity patterns thativ cause them and then we can understand themm much better or what cells might be available and now to say there is a unique set of proteins that now has a strategy armed with this precise knowledge that is

useful to help us develop treatments so that iss the most important clinical and outcome to make any treatment more potent. >> the last question is educational how to refine the most important question? >> this is something i get asked a lot and i try not to be too definitive i don't want to seem as if i have any answers at all but that can be the worst possible thing for me to tell people this is you should do it so i'm not doing that but i will say that the world is complex and life is short and most interesting

that strikes a cord with you to make you think about it all the time just because you love and it is amazing to you so that's the first thing i would say the only other thing i would add to that to try to have a mix of things that seem hard and seem easy but also be aware you could be wrong about what is hard and what is easy in this happens all the time sometimes the things i think are the hardest but it is the other way around try a few things have a few projects in a new line but above all just follow the beauty. >> thank you so much actually

i'm sure you have a lot of stories and memories and much more to say. >> i do. but for me, someday, yes. [laughter] this was a big undertaking for me with more than 20 years of medicine and science so i may take a breather for a little bit. >> thank you so much for this fascinating conversation and thanks to all of you out there watching and spending your evening with us please learn more about this remarkable book i reposted the link in the chat and on behalf of harvard bookstore and the harvard library have a good night keep reading and stay

safe and well and thank you again to both of you. >> i think the honest answer about what we learned about donald trump is all of the basic boundaries of who he is

and how he governs our pretty well known by s the is impulse interested in his own benefit and not so interested in anybody else and also doesn't follow any will book or project norms and carriers very little what washington should do what is polite and proper. the new thing that we learned that was even shocking to us as a hardened journalist but the degree to which he was willing to put american lives and the democracy and peril for his own personal gain and to maintain that grip on power. that he became addicted to and lost and so even looking as if

the reporters were silently adequate on —- acquiescing standing by their man were secretly and then near panic about the danger he was putting the country and during black lives matter protest, pandemic, and then finally the riots that he help to insight input is the president and vice president in the crosshairs and in mortal danger