Almost every drug of addiction, whether

we go from nicotine to alcohol to heroin

to cocaine to amphetamine, almost every

drug of addiction hijacks that dopamine

system we were talking about. We find

when that circuitry is not working that

you can get profound loss of motivation,

apathy. When that circuitry is on

overdrive because it's been hijacked by

these drugs, you get states of hyper

motivation. So, of course, this is going

to be overly simplistic to think

dopamine levels are the only factor that

affect our motivation, but it certainly

turns out to be a very important factor

in graduating the level of motivation we

have to seek particular outcomes.

>> Welcome to the Huberman Lab podcast,

where we discuss [music] science and

science-based tools for everyday life.

>> [music]

>> I'm Andrew Huberman and I'm a professor

of neurobiology and opthalmology at

Stanford School of Medicine. My guest

today is Dr. Massud Hussein who is a

neurologist and neuroscientist at Oxford

making key discoveries about the

relationship between motivation and

pleasure. Today we discuss what really

determines our level of drive and

determination to do everything from

getting up to go to school or work to

pursuing long hard challenges that last

many years. We start off by talking

about the opposite of motivation, which

of course is apathy. And as you'll

learn, perhaps surprisingly, apathy is

separate from one's desire for

something. We also discuss something

very useful, which is how you can change

your own perception of your own effort

level. Today's discussion really gets to

the heart of motivation and

procrastination and how anyone, healthy

or otherwise, can leverage that

understanding to their benefit. As

you'll soon hear, Dr. from Massud

Hussein is a remarkable scientist,

neurologist, and communicator. Indeed,

he's the author of a spectacular book.

I've read it. It's entitled Our Brain,

Ourselves, and it's a terrific read if

you want to learn more about how your

brain works, how it can change over

time, and how it makes you who you are.

Before we begin, I'd like to emphasize

that this podcast is separate from my

teaching and research roles at Stanford.

It is, however, part of my desire and

effort to bring zero cost to consumer

information about science and science

related tools to the general public. In

keeping with that theme, today's episode

does include sponsors. And now for my

discussion with Dr. Massud Hussein.

>> Dr. Massud Hussein, welcome. Thank you

for having me. You've worked on a huge

variety of topics. Alzheimer's,

attention, apathy. We're definitely

going to talk about apathy. Spatial

neglect, which I'm guessing most of our

audience probably doesn't know exactly

what that is. I'd like to start with the

one that sounds like a bit of a downer,

but as a window into understanding

motivation and these states of

excitement that most of us would like to

be in, but let's talk about and really

define through your lens what is apathy?

How does the brain bring about this

thing that we call apathy? And is apathy

just a lack of motivation? Yeah, I mean

these are big questions and I think the

way we've approached them is somewhat

serendipitous in the sense that you

[snorts] know 15 years ago I wasn't

studying apathy or motivation like many

people I might think someone's lazy or

they're highly motivated but that's a

sort of psychological state it's a

personality and it was only about 15

years ago I started beginning to be

aware that there may be a an important

biology underlying motivation and when

that biology goes wrong, it can lead to

loss of motivation and even pathological

apathy. And the way this happened was

completely out of the blue. Uh I was

then working in London at the National

Hospital for Neurology in Queens Square

at UCL. And we received a letter from a

doctor describing a guy in his 30s. And

this guy had been a highly productive

person. He was in finance. He was also

really liked socially, had a wide

network of friends. But suddenly he had

become completely different from being

highly motivated. He went to I'm not

interested. I can't be bothered. And

that was both at work as well as with

his friends. So people began to think

this is something really different in

this guy David. What's happening? They

wondered if he had become depressed.

That's why he wasn't really functioning.

and he went to see his doctor who

started him on an anti-depressant but it

made no difference. He was still the

same. So he lost his job. He got fired

because he had lost motivation and he

was so apathetic that he couldn't be

bothered to get social security benefit.

So his friends said, "Okay, come and

stay with us." And they regretted it

almost immediately because David did

nothing. He just sat there in a chair

all day long waiting for his friends to

come back, do the cooking, clean. They

needed to prompt him to have a shower

because he literally just sat there. His

level of motivation was almost zero.

When we got to see him, and it was

difficult because he'd never come to his

appointments. We I had to phone him up

to say, "Look, I am going to be here

tomorrow.

Please come." and he grudgingly said,

"Okay, I'll I'll try and make it." And

he was, of course, late. Um, he came and

there was this very sad guy. He, you

know, he was disheveled, really not

looking after himself, stains on his

shirt. But the one thing he wasn't was

unhappy. He was absolutely happy about

life, right? Which was the perplexing

thing. He'd lost his job. He'd lost his

apartment because he wasn't paying the

rent. Couldn't be bothered to get social

security. But there he was really happy

about what was happening in life,

looking forward to something that he

didn't know what, but he was still

looking forward to good things in life.

So when I asked him, why aren't you

doing anything when you're at home? What

would you what would you normally do? I

would listen to some music. So why

aren't you listening to music? Because

it would take me some time to put my

music system together. How long would it

take? 5 minutes. So this was really sort

of revelatory for me. The effort of

putting the cables together for his

music system. Taking out the

loudspeakers was too much in terms of

the pleasure he could obtain from

listening to music. It turned out that

David had a very unusual neurological

problem. His MRI brain scans revealed

that he had two tiny little strokes in

the basil ganglia. These are deep nuclei

in the brain which are evolutionally

wellconserved. They go back to the

earliest vertebrate that we still have

the lampay 360 million years old. And

the key thing that we've discovered from

the neurohysiology of the lampay is the

basil ganglia are important in linking

motivation signals to action. Some

people call it motivation to act. So in

an organism like the lamprey, motivation

signals might be hunger or sex that lead

to action to fulfill those goals. In

David, these strokes in the vententral

stratum, what what's called the nucleus

encumbent in in animals led to no

motivation signals leading to action.

Nothing happened. But if you prompted

him, go take a shower, come on, he would

do it. But of his own valition, he

wasn't motivated to act. And that was

really something that was extraordinary

for us because here was a man who had

been highly motivated and that

motivation had been extinguished by

these two tiny little strokes which

didn't affect him physically but

affected his behavior. And the studies

that we performed with David to try and

understand this led us to the concept

that we might be able to deconstruct

this nebulous thing called motivation.

>> May I ask a question? It's fascinating.

Um, and I'm sure everyone including

myself is also wondering what became of

David. But before you tell us, was it

the case that he would feel overwhelmed?

Like I want to listen to music, but that

five minutes feels like a huge effort.

That's a long effort. Or was it the case

that he didn't really want it either?

Because the way you've described these

lesions is a is a severing of the

wanting from the engagement in the

process to have. Yeah.

>> But of course, as you and I know, neural

circuits are never that simple.

>> No, of course not. Yeah. And he never

expressed it unless we asked him. But he

would say that it's too much effort to

put this system together. So [snorts]

even if he was asked, "What would you

like to do?" He might say, "I'd like to

listen to music." Why aren't you doing

it? Because it's too much effort to do

it. Right? And that became a real

insight into how our brains work when we

make decisions about is this potential

action worth the effort in terms of the

reward that will arise from it. Because

[clears throat]

it turns out that if we look at apathy

across many different neurological

disorders, one common trait that we

found when we ask people is this

particular option worth the reward if it

was requiring this much physical effort.

We find that everyone is willing to work

for high rewards.

But the difference between motivated

people and apathetic people is at the

level of the low rewards. Apathetic

people are more inclined to say, "Nah, I

don't think this is worth the effort, so

I won't do that option." That's a really

interesting signature that we found when

people make that decisions. But in

someone extreme like David, almost

nothing incentivized him to put in

effort to act unless he was prompted to

do so. But going back to what happened

to him, one of the things we've learned

from the neuroscience of the basil

ganglia and motivation to act is that

dopamine is a key neurotransmitter, a

key chemical in the brain which is

important in the neural circuitry. And

that's when we thought okay is there

anything we can do for this guy to

improve his motivation. So initially we

tried Leodopa L-dopa which is the drug

that Oliver Saxs describes in Awakenings

and many people have seen the film and

it's used a lot in Parkinson's disease

for treatment. We slowly ramped up that

drug but seemed to make absolutely no

difference behaviorally to David or on

our tests of reward sensitivity. We we

developed some ways of measuring that.

So we were about to give up and then I

suddenly thought look let's use the

other drug that we use for the dopamine

system and that class of drugs acts

directly on dopamine D2 and D3 receptors

rather than being a precursor to making

dopamine in the brain like leodopa and

this drug rapinroll

latches onto dopamine receptors directly

and stimulates the dopamine circuitry.

So we slowly ramped up this drug

thinking is it going to be any different

or not? But 3 months after we started

this medication, he came back, David

came back to see us and I did not

recognize this guy in the waiting room

because first of all, he'd had a shower,

he'd had a haircut, he was wearing a

suit, he had a new job, and most

impressively, he had a new girlfriend

because in the state he'd been in, he

was seeing nobody. but he'd obviously

been motivated to get out there and, you

know, see if he could find a new

partner. I was absolutely delighted for

him, but so astonished that we could go

in a human biological

system where someone has tiny lesions in

the bas ganglia and has their motivation

[clears throat] extinguished. We could

go from that to recovering motivation by

using a drug that we already have that

affects the dopamine circuitry. And of

course, David is really rare. This kind

of bilateral in both sides of the basil

ganglia being affected tiny little

strokes. This this is extremely rare.

It's reported and it leads to

pathological apathy. But it turns out

that apathy is really common across

neurological disorders. And the way we

thought about it is if a pathological

process whether it's a stroke or whether

it's Alzheimer's disease or whether it's

Parkinson's disease or even some

inflammatory disorder affecting the

nervous system like multiple scerosis.

If that pathological process is

affecting this circuitry it can lead to

loss of motivation. And that's what

we're really interested in is to think

about the circuits that are affected and

also trying to deconstruct motivation in

terms of [clears throat] what's actually

going on in the brain. What does this

circuit really doing for us that leads

to this behavior we call motivated

behavior?

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like to drill into motivated behavior

and the dopamine system. And thank you

for sharing what became of David because

uh always nice when medicine can deliver

a a victory story.

>> Absolutely. Yeah.

>> Because as some people may recall that

L-dopa for the treatment of Parkinson's

had these transient improvements that

sometimes can be dismaying for people,

right? People get better and then they

get worse again. And I'm sure there's

additional progress being made there. We

still need to do an episode all about

Parkinson's, but we'll reserve that for

another time.

>> In thinking about motivation

and the fact that there's really one

system for most types of motivation,

this is kind of what the David story

suggests, right? That these basil

ganglia, nuclei, nucleus encumbent are

underlying all sorts of motivations to

listen to music, to shower, to find a

romantic partner, to work, to take care

of oneself as opposed to distributed

networks for motivation. Yeah,

>> that's interesting in its own right, I

think. But many people are probably

familiar with feeling really motivated

to do certain things but not others.

Even if there isn't a pain point

associated with doing, I don't know,

maybe somebody likes arithmetic but they

don't like literature or vice versa.

Putting aside individual variation based

on family history, psychology, traumatic

experiences, is it true that certain

people by virtue of the way that their

dopamine system is kind of tuned up like

how willing these neurons are to fire or

not fire in different circumstances are

just motivated people. I mean, you see

this sometimes like

>> you know, I've had two different

bulldogs. The first one is like let's go

and it's like and you have to really

[clears throat] coax them along. The

other one, let's go, okay, and just go.

Some people are like this. Hey, like

let's go. They pop up, they go. other

people more reluctant, but I think most

of us are somewhere in between. So,

clinically and outside of the clinic, do

you think that some people's

dopamineergic neurons are just more

willing to fire in response to everyday

activities, novel activities, and the

super exciting stuff? And I have a very

specific reason for asking this, but

I'll I'll keep it quiet for now because

I really want to understand is there a

continuum of motivation? And if so, can

it exist both between individuals and

within individuals?

>> So, taking your first question, it turns

out that this circuitry we're talking

about, it's called the misolyic

circuitry that links the basil ganglia

to the frontal loes, is almost like a

final common pathway for motivation

signals to engage with the action

systems of the brain. So, it could be

hunger, it could be thirst, it could be

sex. These are primary motivation

signals that many animals have. But as

you said, there are other motivating

signals that we may also want to engage

with. We may have other goals, whether

it's arithmetic or to learn a new

language or to go out into the park,

whatever it is. Now how those different

types of motivation signals are weighted

or valued within our brains to engage or

not engage this circuitry to lead to

action is actually a very very

interesting area. So one thing that

we've learned is even apathy might be in

different domains. The research in this

area started with behavioral apathy.

What we can measure is someone inert or

are they active doing something? Then

other kinds of work suggested there

might also be social apathy. You know we

might know colleagues who seem to be

very very motivated to work but they

don't want to engage with other people

or do things like go to a party or

something like that. They may also be

emotional apathy. So there are people

who seem to have very blunted responses

to things that you and I might either

find, you know, something that we want

to congratulate people for or feel sad

about if they had an issue. These people

seem to not have that kind of range of

motivational responses. And some people

argued that there's also cognitive

apathy. So whereas someone might be

apathetic to do something physical, they

might not necessarily be apathetic for

doing something cognitive, being curious

about the world, reading the newspaper,

finding out what's going on in the

world. And there may be dissociations.

So someone could be socially apathetic,

but you know, cognitively very highly

motivated. So how does that happen? How

do these different domains vary if

there's one final con system? And of

course this is where we have to think

about the fact that brain circuits are

complicated. And the kinds of signals

that are being developed for behavior,

cognition, social interaction or emotion

are being formulated in different parts

of the brain even though they might

funnel through this basil ganglia system

to engage the action systems in the

frontal lobe. And even more granular if

we want to get to that, you know,

whether you want to learn a new language

or you want to do arithmetic or go to

the park or whatever it is, how do you

weight these different motivation

signals? So, one way we've thought about

this is, you know, let's imagine today

it's a beautiful day out there. What are

the things you could do? And I'm sure

Andrew, you could give me 20 things you

could do, but you can't do them all at

once. So somehow you have to prioritize

what's the thing that you value most.

And the way we conceive of this is a

sort of a neuroeconomic decision-m where

you look at those 20 things and you go

okay how rewarding do I think each of

these things are and then you also think

well how effortful is that going to be

and it could be physical effort it could

be cognitive effort social effort

emotional effort whatever it is and out

of that kind of system where you do a

calculation

you will find the thing for you that you

will value most given the level of

effort required and that's what emerges

as your motivated behavior at that time.

>> Do you think people do that computation

consciously?

>> I don't think they have to do it. We

could do it consciously, right? If I

>> because I don't wake up I look at my

schedule and I have to do this, this,

and this. I actually schedule my

workouts. I schedule time with others

and things, but it's sort of the the

constellation of things in my life. I'm

not doing a very conscious waiting of

this versus that. Although occasionally

when there's a conflict in scheduling, I

have to select this is more valuable to

me than that. But it's not something

that I generally sit back and think and

I probably should. We probably all

should sit back and think, okay, what is

the best use of my time? Effort, reward,

payoff, but we we sort of just go about

life.

>> Yeah. And I think what you're really

getting me towards discussing is the

fact that each behavior has a kind of

activation

hill that we have to cross to think,

yeah, I could start this. So for some

people, let's say learning a new

language is a mountain. That's a huge

kind of effort to put in. Whereas for

other people, it's barely a mount. You

know, I I don't think of that as a big

burden, a big activation hill that I've

got to cross before I get there. So

there's the activation barrier before I

even think of starting. And these things

are not necessarily consciously being

considered. It's just you have these

biases because you've got experiences.

The fact, hey, I wasn't that good at

learning Spanish. Do I really want to

spend a lot of energy in learning

French? Those biases add up and affect

the way you do that calculation. We were

talking about reward versus effort. And

essentially

that's a very important way I think that

we make a decision. Much of that could

be subconscious.

>> I'll tell two brief anecdotes if if I

may to set the texture for the next uh

question.

>> Years ago I was at a PhD thesis at

Stanford, a student, I'll just name her

because she did a wonderful job in her

thesis. Her name was Lauren Casease. She

was not my student. I attended because

she was working on neural regeneration

and she had screened an enormous number

of molecules for their ability to

inhibit or promote neural regeneration.

Super important problem as you and I

both know that still hasn't been solved.

Yeah.

>> And it was really striking how many

molecules she had evaluated. And I'll

never forget her advisor's introduction.

He said one of the best things about

Lauren

>> is that she has very low activation

energy. Meaning there's the opportunity

to do an experiment. she'd get up and do

the experiment and say, "Ah, that was an

interesting molecule. Move to the next

one." And it occurred to me then that

having low activation energy, provided

the thing that you do doesn't get you

injured or killed, is really a

spectacular thing in life because you

just get a lot more life out of days

lived. So, you kind of wonder about the

Lauren cases of the world. Are these the

people where somebody says, "Hey, you

know, uh, we need to do this thing like

like take out the recycle and it's a ton

with the roommate something back when,

you know, and it's like, okay, I'll do

that later." There's so much energy lost

in the deliberation in the feeling like

the effort reward trade-off. You don't

want to waste your time doing things,

but you also don't want to waste your

time thinking about whether or not

you're wasting your time. So let me take

you up on that because after seeing

David we thought about exactly this

problem and we got a bunch of Oxford

students and believe it or not at Oxford

just like Stanford I'm sure there's a

whole range of motivation amongst the

students there are people who are highly

motivated the Laurens and then there are

people who are actually surprisingly

apathetic they might be very smart

people but they have high activation

energy levels they need to cross that

barrier to do something and we put them

into the MRI scanner and we looked at

their brain activity when they were

given these choices. Is this option with

this much reward worth this much

physical effort? You just say yes or no.

Would you do it or not? We could then

look across this neuroeconomic space by

parametrically

changing the level of reward that we're

offering and parametrically changing the

level of effort. And it turned out just

as we'd found in patients, the apathetic

students were all willing to work for

high rewards, but they weren't willing

to work for low rewards. Interesting.

>> Now in the brain, what we find is that

the vententral parts of the basil

ganglia, vententral stratum nucleus

encumbent is active as well as the parts

medial frontal areas, frontal lobe areas

in these healthy students when they're

simply making the decision. is this

option worth the reward for this much

effort? So they're not doing anything.

They're just thinking about it. And we

thought great, this is really fantastic

because now we have convergence from the

stroke patient that we saw with the

basil ganglia lesions who lost

motivation and now we can see that

healthy individuals when they're having

to make this decision show activation in

the same area that was lost in David as

well as the frontal loes. But the

paradox here was that we found greater

activity in those regions in the

students who were apathetic

compared to the students who are

motivated. And we were not expecting

that. We thought if you lack motivation,

your brain activity when you're being

asked to do this would just be lower. So

the way we have resolved this problem is

to think actually this is showing us

something very important. It's showing

us that apathetic people use more brain

energy when they're making this

decision. They have a bigger activation

energy barrier to overcome because when

they're making that decision, the brain

is consuming more energy. It's consuming

more glucose when it's doing that. Now,

of course, in the scanner, in this sort

of experimental situation,

everyone's willing to do the task.

They're making those decisions. But

imagine these people at home if you're

confronted with, "Oh my goodness, I'm

going to have to work hard just to

decide whether I should do this option

or not. Maybe I would just won't do it."

And that's, I think, a really important

insight into what you might do to

energize motivation in people who might

be apathetic because it's showing us

that that activation barrier that I was

talking about in a way exists in the

brain. Physiologically you can show that

these people are working harder to make

the same decision compared to motivated

people.

>> Fascinating experiment by the way. So

elegant in its simplicity, but the

paradoxical piece of more activity in

these dopamineergic circuits in the

apathetic folks tells me, and correct me

if I'm wrong, that there's a cost to

thinking about the effort required plus

the cost of the actual effort required

that compounds and puts some people out

of the game.

>> Exactly. So, you know, the Lauren, the

the student you were talking about, has

low activation energy. She obviously

doesn't need to burn a lot of brain fuel

in terms of thinking I I can do this.

I'm going to do it. And you know she

reminds me of something that happened to

me when I was a PhD student. I was in

Oxford and we would sit around having

tea thinking about great studies we

could do. nothing really happened and

then I came to be a posttock at MIT and

was surrounded by these highly motivated

people and I can remember we disc had

the same kind of discussion and then one

of them would go yeah well let's do that

tonight and I'd go tonight and that was

the level of difference it just blew my

mind that there were people who could

just go right let's do it

[clears throat]

>> and I think that's been a real lesson

for me that you can achieve things if

you if you think in this way.

>> Well, the other anecdote, I'll keep this

brief, is a is a slightly humorous one,

but it's designed to illustrate a point,

which is I try not to spend too much

time on social media unless I'm actively

learning on there because I do find

things that are really interesting and

educate me sometimes just for

entertainment. But there's a a post I

came across um it's a little parody skit

where uh a woman walks into the room and

her uh husband or boyfriend is playing a

video game and she says, "Hey, do you

mind um hanging up those pictures that

are in the hall? They've been there for

a few days." He's like, "Yeah, yeah,

yeah, yeah." And she walks out. She like

shakes her head and she has an idea. She

walks back in and she says, "Hey, do you

mind showing me how to hang those

pictures in the hallway? I'd love to

learn how." And he's like, "Boom." And

it like, you know, he launches into, you

know, so she's tapped into a component

of his motivational circuitry where the

opportunity to to teach clear literally

gets him around this uh this activation

energy thing like all of a sudden the

activation energy required to do the

same thing just drops to zero. And it's

a very good example because you know one

thing you got to think about is how can

you change that barrier for people.

Either you make the effort less. Let's

say you got a part task to do. You could

break it down into subcomponents so the

activation level doesn't seem quite so

formidable. Or you could change the

incentive. And this is what happened in

your example, right? The incentives

change because now the guy is thinking

ah now the the reward here is to show

her how I do this. That's the thing I

will get the pleasure from, the reward

from. Right? So I think that's the other

insight we got is how do you change

people's motivation in a practical way?

Well, you have to think if this is

really happening in the brain that

you're making decisions about whether

this reward is worth the effort. You can

either increase the reward or change it

in some way in terms of something that's

meaningful for the person or you change

the effort required to accomplish maybe

part of the task or perhaps start you

know just initiate the task and often

starting can be a huge motivational

pull. You know, this gets to um some uh

sticky territory around the actual

versus the perceived utility of lots of

things that are on the internet

including in the health and dare I say

wellness space which is the following.

There's this idea that if you do for

instance a hard run or a hard workout

that you are teaching yourself how to do

hard things that can translate to doing

hard things in other domains. So as

psychologists, neuroscientists, we talk

clinicians, we talk about the domain

specificity, but that's just nerdy speak

for like does one thing translate to

another circumstance. Are you teaching

yourself an algorithm of I did a hard

thing this morning, you know, I did the

cold shower I don't like. I did the

workout I may or may not have wanted to

do, but so now I'm more empowered or and

I've thought about this quite a bit or

do we have a finite amount of energy and

the most rational approach is to is to

think okay what's actually going to

provide me the most benefit today? Like,

can we really get momentum and

understanding of our underlying

motivational circuitries? Or is it the

case that we're diluting ourselves? I'm

not attempting to undercut a lot of

content I've done previously, but I've

had plenty of um hard workouts and then

gotten to the other thing I needed to do

and went like, I don't want to do this.

I'm tired from that workout this

morning. [laughter and clears throat]

But we are also familiar with the fact

that if something really intriguing or

exciting to us is presented to us,

suddenly it's like we're a different

human being. It's a complete state

change. So, I'm I'm curious. I'm not

asking you to editorialize about the

health and wellness space, but more

globally, can we teach ourselves to

lower our activation energy in a way

that can serve us well across the board?

I think we can because it turns out

obviously some of these things that

people use psychologically to improve

their motivation can be framed in

exactly the way I put it to you that the

what we're doing here is trying to

either increase the reward or change the

nature of the incentive you know if it's

something novel and salient that you

think ah this is really interesting it's

rewarding for me or we reduce the effort

so just using these simp this simple

principle might be enough for someone to

think about how to do it. You know,

planning out your day or week in advance

for some people makes life better

because every time they're having to

make a decision on the fly if they're

just doing it without planning it out

means that the it's costing, right?

Every decision has a cost in terms as

we've seen the brain having to put in

invest fuel to make that decision. So if

you're having to do that every time you

make a decision, that can seem very

burdensome. Whereas if you did it once

in a big way where you planned it out

for the day or the week, maybe the costs

in terms of the activation energy

required for the brain is much lower for

you if you do that. So it's a simple

thing to do. Dividing up a task, let's

say you're given a project by your

manager, it's going to take you three

months to accomplish from it. seems

absolutely formidable because you have

no idea of where to start. What if you

could break it down into smaller tasks

which bring down that mountain the

activation energy required to get that

small thing done. Let's say first of all

let's research one area of this and get

a handle on that and if we get that done

this is a sort of if then kind of

construct if we get that done we can

then move on to a second piece of work.

It would also help if your manager said,

"Well done for getting that bit done."

Right? That's that's also a motivation

pull to think, "Yeah, actually I don't

need to get the whole piece done to get

the reward of somebody identified that

as a positive thing to have done." I

would love to see an experiment done

where the perception of one's effort to

do something can be separated from the

actual effort and really get to the meat

of whether overthinking or even thinking

at all about the effort takes us away

from having more quote unquote

motivation or even better performance.

And I haven't had time to think this

through, but as you were describing

David and his transformation and this

experiment on the undergraduates

of valuing different outcomes, I wonder

if you could put somebody on a

stationary bike and put them in a

virtual environment

>> and measure the effort required to climb

a hill and you could adjust the

difficulty,

>> but you change the perception of how

steep that hill is, right? If we could

translate that to the real world like to

to learn something to learn how to tango

for instance you know I have Argentine

relatives it'd be nice to learn how to

tango that's pretty cool skill right

there's a lot required you had to go to

the class you got to drive there find

the teacher you if you're the one who's

supposed to lead then it's like

especially embarrassing if you can't do

it so there

>> sounds like you've already started

>> yeah started this process but that's

very different than the actual work

involved in doing it which in most cases

turns out to be much lower than the

perceived effort Yeah.

>> So is there a way to tease these things

apart?

>> I think not in exactly the way you

suggested about the treadmill and the

and changing the perception of the

gradient, let's say, that's coming. But

that wouldn't that be interesting

because what we then get is subjective

value of effort versus the real effort

the physiological effort whatever it is

you know oxygen consumption the glucose

required the lactic acid that's building

up all of those parameters and seeing

how that diverges but I bet you we would

find that there's a huge variation in

subjective valuation

>> and it could go either way it could

>> we have a good friend Ken Ry out who's

like a very famous within the

marathoning community like endurance

athlete and he does this mind game on

his opponents when he runs and he wins

races in the Gobi Desert at like age 50

plus he'll run up next to his

competitors an actual event and he'll

take his earbuds out and he'll say I

don't know what it is I never get tired

and then he wins

>> and these are guys that he couldn't

catch up to

>> barely until then and he dominates them

so there's a psychological thing

happening in both of them right and I

think he does as much for himself as he

does for them. And many competitive

athletes have talked about when they see

a great competitor starting to fail, how

it gives them this sense that they have

like a booster pack. Y

>> and it's not the nicest example because

I'm not big on motivating through

competition, per se, but it says

something about our perceived effort of

our own, whether or not we're overcoming

the challenge. And if we see someone

else falling into a psychological trap

like that, presumably it allows us to

access the inverse of that psychological

trap. It's like we get a boost.

>> Yeah. And I think what you've said is

within the individual, you can change

your subject evaluation of the same

effort you're running on the Gobi

Desert, right? It's the same effort

you've been putting in for miles and

miles. And suddenly you have

subjectively valued this thing as less

effort

>> and you're going to now, you know, get

the booster.

>> Wild, right?

>> Well,

>> it shouldn't work in terms of the the

the laws of physics and chemistry and

biology. The hill is the hill.

>> Yeah.

>> And of course, it speaks to the brain's

critical role. It suggests that there's

a cost all along that you weren't

acknowledging, right? like you're

removing some additional effort as

opposed to like getting more

>> energy from you know from the sky.

>> Yeah. You're not going to get that. So

it is also the way you framed it for

yourself right the activation energy

required to do this to get that little

bit more uh from this. So I think you

know this simple principle actually

takes us quite a long way.

>> You had a book that was tremendously

successful. We'll put a link to it in

the show notes captions. And it was

tremendously successful because it's an

awesome book. Tons of learning there.

Super interesting. First book of its

kind in a long while to really educate

people on the brain and its workings.

There have been others, but yours really

did spectacularly well for its content,

but you also won a big award for this,

right? Do you ever think about that in

terms of how hitting the pinnacle of

something impacts our perception of the

next effort and the next potential

outcome? I mean, we think of this as

quote unquote reward prediction error,

but this has broad implications for

whether constant scrolling on social

media is actually adjusting dopamine

circuits in a way that makes rewards in

the real world less enticing, or whether

success in one domain truly leads to

confidence and success and lower

activation energy in another domain, or

whether or not it puts a certain

pressure on us because, you know, the

rewards might not feel as great. I'm not

trying to undercut any of your own

relationship to this book, but what is

the relationship between prior rewards

or failures, memory and motivation?

>> So, we've talked about this calculation

about reward and effort. We've gone into

that in some detail. Once the behavior

is initiated, it's not just initiation,

it's also persevering to make sure we

get to the end. And then at the end, if

we get to the outcome of what we wanted

to achieve, we can have a hedonic

pleasureful experience. That's what we

wanted. Or we could have an aversive

response. You know, we put all this

effort in and actually it turned out it

was an apt terrible decision. And we've

all made those, right?

>> Oh, yeah. [laughter]

>> Not me. I understand. Oh, of course.

Yeah.

>> And the outcome, you know, whether it's

a great pleasureful hedonic response or

whether it turned out to be absolutely

awful and very aversive obviously is

graded. But that graded outcome

is important for learning. What

neuroscientists call reinforcement

learning. And that learning comes back

to affect the way we make that decision

I was talking about. Which of the 20

things I could do today do I prioritize?

Because if it turned out that I

prioritized one which turned out to be

absolutely awful, next time it's coming

up in my menu of things I could do, I am

going to devalue that. So my subjective

evaluation of that particular choice

would be much lower. The learning

mechanism is really important for

choices in the future. You were talking

about how previous experiences affect

your motivation to do things. Well, my

motivation to do that terrible thing is

really going to be low next time it

comes up. So, I might pick something

completely new, perhaps something which

gives me something novel and salient

that I haven't experienced before. It

might turn out to be a bad thing, but I

don't know. I'm going to give it a go.

So, I think learning is a really

important mechanism in motivation. And

of course, guess what? The evidence

suggests that dopamine is not only

important in in terms of this decision-

making about whether this is worth the

effort or not. It's also very important

in the human brain and in animal brains

for learning from previous actions.

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Seems to me that the most advantageous

approach would be to have a lot of

generalizability about the process of

overcoming activation energy and just

getting into action toward a goal.

>> Like if you do the hard workout that

morning or maybe you write a certain

passage, let's take it out of exercise.

exercise always. It's kind of a cliche

example by now. You know, you're trying

to learn violin or you're trying to

learn a language and it's hard, but you

do a little bit of that before going to

work that it does set you up to be able

to engage in effortful things throughout

the day. Some things you like to do,

some things you don't want to do. Okay,

let's let's assume that one could

achieve that. But in terms of failures,

you want a ton of domain specificity

because if the person says, you know

what, I'm going to go after this

athletic goal or cognitive goal or

scholastic goal and they fail.

>> If they attach the effort process and

not the specific goal to their memory in

some broad way, then it could be I try

things and I fail. Things being like

everything, right? And that's how you

described David. So I'm struck by the

potential for an asymmetry in the way

that this reward motivation circuitry

works. On the one hand, it's very

generic. On the other hand, we have a

lot of ability to say, well, I'm put in

a ton of work, and I'm talking about

myself now, to try and learn a musical

instrument as a kid. Total failure. Dogs

howled, parents cringed, everyone

cringed. I was happy to put it away.

>> But I've put effort towards other

things, and it's worked out fabulously.

It's good to know that it wasn't just

effort.

>> Yeah.

>> Right. But if you don't obey punishment

and failure, you're also setting

yourself up for a very hard life. No one

wants to be the person with low

activation energy who's kind of an idiot

because they're always trying things and

they never work out. That's I think what

keeps a lot of people in the chair, so

to speak, wondering if they should put

effort towards this or that. And that's

why they, dare I say, watch too many

videos about motivation. Right? you want

to watch the right ones. But you know,

you get the point.

>> Yeah. So, this is generic in the sense

that this pathway we've been talking

about is a, if you like, a final common

pathway where all of these signals

converge. So, in David, it took out this

final common pathway. The strokes took

out the final common pathway and

therefore we saw no motivation signal

really was prompting him in any way of

his own accord valitionally to do

something. Now the other point you make

about the fact that you don't want this

to be something that generalizes to all

kinds of decision-m otherwise you'd

think you're a failure if every time you

did something and it didn't work you'd

say oh I generalized to everything so it

doesn't seem to be like that and we can

understand that if it's if this is the

final common pathway there the signals

for decisions about playing violin

learning a new language whatever it is

are being computed elsewhere in the

brain to engage this system. This is

just the final common pathway to get you

that vigorous energy over the activation

energy barrier to initiate the action.

And then of course, you're not going to

be any good at the violin or salsa

dancing or tango if you don't persevere.

You have to persevere. And that's the

other really important part of

motivation. You know, we know a lot of

people who start things and then we also

know the non-competers, the people who

are always so energetic but actually

don't finish, right? So, it's almost as

important to be able to finish and

complete as initiate actions. Perhaps it

should be required learning to do some

things that you're very passionate

about, but intentionally do things that

you maybe even loathe just a little bit

even if provided they're not damaging to

sell for others or something because

there's a real value in just what I call

chop wood carry water where you just

>> and I have this mode sometimes where I

just really don't want to do something

and I say like all right chop wood carry

water I'm doing it just to do it and you

finish and you feel pretty good about

the effort and the thing you're kind of

like h all right got it done I'm just

glad to have it done but to be a

functional human being generally you

need both and and I'm asking this on

behalf of many many questions I get

about motivation or how do you find your

passion and I always say well you find

your passion by getting good at effort

in things that you're not passionate

about so that when you eventually find

your passion you can just get there much

faster you can't just sit around waiting

to be passionate

>> and that's sort of what David was doing

and it wasn't pulling him forward for

it. Exactly. No, that's right. And uh

you know, obviously there are different

ways of getting your passion, but as you

say, if you're just waiting for it to

happen, it may not happen. The other

thing that was important about what we

were just speaking about is if you do

for some reason generalize maladaptively

to thinking this didn't work and I tried

this, this didn't work, and I tried this

and I'm really bad at this. That can

lead not only to loss of motivation, but

what we might call clinical depression.

Because one of the things that happens

in depression is you think you're not

good at anything. Even though you know

that might be an unreliable objective

measure of your performance. Everything

you do seems bad. It hadn't been a

terrible outcome. And one of the areas

that we're really getting into is trying

to work out the difference between

depression and apathy. And it turns out

it's quite complicated. But there are

some people who have pure apathy, no

depression like David. And there are

other people who can be depressed, they

can be sad, they can be hopeless about

the future, but they don't necessarily

lose motivation. They can have pure

depression. And to make life really

complicated, there are people who would

fulfill the criteria for both apathy and

depression. They fit in the overlap

between those two syndromes. And trying

to understand the biology of what

separates depression from loss of

motivation as we see in apathy is is one

of the important areas of research at

the moment.

>> None of us want to be the person who

just doesn't motivate to do anything.

None of us want to be the person who

motivates to do everything. And none of

us want to be the person who invests

lots and lots of time and energy in lots

of things and underneath it all doesn't

really want the things they're going

after. This sort of the tapestry of the

internet self-help motivation. And

there's so much I really have to say

this. I've wanted to say this for a long

time and it's the appropriate time. I

think there's so much BS about oh is

something pulling you forward or are you

pushing yourself to it? You should do

things out of love. No, you should do

things to serve others. both wonderful

in in principle and practice, but

there's this idea and I think it's a

false idea that there's some specific

thing working on behalf of others,

knowing what the purpose of what you're

doing that that is somehow going to

unlock this circuitry.

>> What I'm realizing today is the

circuitry is the same. The learning

about what engages that circuitry

>> is based on our historical understanding

and probably the messages that we hear

in our family, etc. This is a worthwhile

pursuit. It's hard. keep going. Trust

me, it's going to work out in the end,

even if it doesn't work out the way you

think. Exactly. Those are very valuable

messages to hear. But my question is

this.

>> For any of us, we've also seen the

person who is very very excited to try

everything. Every idea is something that

they take action on and they seem

resilient to the fact that it never

really goes anywhere. It's almost like

their self-concept is divorced from the

outcomes. Other people have it in the

opposite direction where like you said

they're trying things, they're getting a

reasonable amount of success certainly

against the backdrop of averages, but

maybe they have one big failure or a

couple and then suddenly their whole

self-perception is altered.

>> Where does self-perception come into all

of this? Like one's beliefs about

themselves.

>> Yeah. and their ability to do hard

things both for reward and just for the

sake of getting good at hard work seems

like an immensely valuable feature of

the human psyche and I don't think we

have a name for that but like the

self-concept piece yeah

>> in my mind is really important

>> I don't [clears throat] think we have a

mechanistic explanation for the

differences you've just suggested you

know psychologically we could think

there are many reasons for that some

people don't have high ambitions they're

happy to sit at the 50% level maybe 51%

52% in terms of where they sit in the

population and other people are not

happy with that. That's not what they

were brought up in this world to do.

They want to be at the top 2% if

possible at the 1%. I don't think we

have at the moment a good idea of the

neuroscience that distinguishes between

those two types of individuals

>> of ambition.

>> Of ambition. Yeah.

>> Yeah. I don't know why I'm obsessing

about this at the moment. I feel like a

lot of the pain of the world is about

people trying to understand what they

should strive for. A friend long ago,

she said to me something. She goes,

"Flo, don't fight." And I was like,

"What do you mean?" She's like,

"Everything with you was like this like

intense pursuit." And I said, "But I'm

in I'm in love with the things I'm

doing." And she said, "Well, it's just a

lot." I thought, and then I realized

like, oh, yeah, she really flows through

life. She's accomplished, but it's just

kind of in flow. Like there isn't this

push energy. And you know in Eastern

medicine and philosophy they talk about

like it gets interesting right at the

level of neuro anatomy they talk about

sort of like whether or not you're

pushing yourself from the back of your

body versus being pulled from the front.

I mean it's mystical and vague to

somebody like me trained in western

science but I think they're on to

something

>> like whether or not you're expending

extra energy kind of forcing yourself to

do things. Yeah.

>> In your undergraduate students your

patients

>> I'm assuming you see the full range.

>> I do. Yeah.

>> If you were to editorialize a little

bit, what do you think is the the key to

both satisfaction from work,

satisfaction, realistic satisfaction

from outcomes and and kind of uh peace

like a good life?

>> Well, it's interesting, isn't it?

Because there and there is some research

on this. you know, the Harvard U study

of aging looked at these people, these

men who I think were in their late teens

um and followed them up uh to their 60s

and 70s. And my recollection of that

data is really interesting that there

are some people who lived a kind of

average life and they had a average

family, they had average income, they

had an average house. And then there

were other people who really looked like

they were going to soar and something

happened to those people along the way.

They didn't saw, they they fell. And

then finally there was another group who

actually did saw and were right up here.

But when they looked at the happiness

levels of these people, it was the

average person who actually would

self-report the highest levels of

happiness. So ambition doesn't

necessarily equate with happiness, which

I think many people would agree with

with that. But on the other hand, it

seems to be such an important thing for

humans, right? For so many humans, it's

not sufficient just to be at the 50%. We

really want to propel ourselves, whether

we're pushed or pulled, whatever it is.

We want to get there. So, it would be a

great area of research, wouldn't it? To

find out how ambition is encoded in the

brain and how does it work, you know,

because there's also the question of

realistic ambition. So, if someone had

told me when I was younger, don't be

stupid, be realistic. You're never going

to get to Oxford as an undergraduate.

And you're never going to have a career

where you're going to be doing clinical

neurology as a clinically qualified

person doing neuroscience research,

editing a journal, writing a book.

That's not going to happen. If I had

thought in those ways, it probably

wouldn't have happened. I just didn't

think that we should have these

boundaries to what you can do.

>> Yeah. The early messaging is key.

>> I think it is. Yeah.

>> Yeah. I'm the son of a scientist and I

was born and raised in Silicon Valley

and I realize only now that it

completely shaped my brain in terms of

like you want to do something you go try

it and there's a good chance you can

succeed and I mean even friends that

went the way of athletics if they didn't

succeed there they started companies

that succeeded and and some crashed and

burned mind you in all these domains in

academia too we see it right ambition

doesn't protect against disease or poor

judgment in a lot of times either But it

is fascinating and and maybe our species

needs a distribution of kind of

motivational circuitries in the way you

describe certainly developing new

technologies that transform medicine.

Yeah,

>> someone needs to do that. They can't be

happy with just the scalpel and the

current surgical mask and the current

questionnaire that you ask patients in

psychiatry. I mean, we need tool

builders and that takes a vision of

something that doesn't exist or kind of

sense that there's something else.

>> Absolutely. And so, you know, God bless

the the people that do that, but also

>> it's nice to have members of society

that are just happy living their lives

because otherwise, what else is all that

technology [laughter] for, right?

>> Yeah. No, I'm not making any judgments

here. I'm just saying it's a really

intriguing thing if you could get any

kind of handle on what what makes this

happen, this range of ambition. I didn't

think we were going to discuss

psychedelics and we don't have to if if

if you don't want to. But these days

there's growing interest in what are

essentially and let's talk about classic

psychedelics. Let's forget MDMA is not a

psychedelic folks. It's an impathogen.

Ketamine is not a psychedelic. It's a

dissociative anesthetic. So people lump

these things together and we'll move

ibain and LSD and the those are

different in the realm of psychedelics.

Psilocybin is one that's increasingly

being used in clinical trials and

>> it's not a cure all but many people who

do who are in these clinical trials come

through talking about a kind of a more

connected sense of self to the world and

you know it seems to um take the edge

off of the hyper ambitious miserable

person.

>> That's my observation anyway. And it

also seems to take some people with

major depression to a place of like oh I

actually could change. I could get a

different outcome which is

[clears throat] simply plasticity.

>> Yeah.

>> So what is your thought about our

ability to radically change our

self-perception right

>> in terms of our ability to do things in

the world accomplish things in the world

because that's really what getting over

depression is about. It's about

imagining a different outcome for

oneself.

>> Yeah. It's a very important question and

I'm not an expert on psychedelics but I

think there is some emerging research on

the effect of psychedelics on what is

called anhidonia lack of pleasure that

you could get from something. So you

know we talked about changing effort but

it could be that one variable that

happens in people with low mood is that

they devalue the reward. Everything

seems bland. It doesn't seem pleasureful

anymore. So psychedelics seem to have an

effect on the self. That principle is

really interesting because the kind of

patients that I study, the kind of

patients that I describe in the book are

people in whom there was a change in the

self. There was a change in the way they

portrayed themselves to the world, their

social identity, but also in their

personal identity. And this is a really

big area. I mean, what what makes the

self? But the key thing here is that the

self can change. The self is not set in

stone. We talked about psychedelics, but

even even simple things like if you have

too much thyroxine, thyroid hormone

floating around in your body and you're

in hypothyroid state, people might be

surprised to hear that that can cause

not only irritability but cognitive

impacts on your processing. It can also

be the same. You know, sometimes if you

have lack thyroxine, if you're hypo

thyroid, your cognitive functions may go

so low that sometimes people wonder if

you're developing dementia. It can be

that bad. Now, most people wouldn't

think thyroxine, why would that affect

the self? It's a hormone that affects

metabolism, for example. But of course,

thyroxine also affects neurons. And I'm

just using this as an example to show

that something that seems as simple as

having too much or too less of a

particular hormone that we all need can

alter the self. The way that the self is

in people with brain disorders from

stroke, from Alzheimer's disease, from

Parkinson's disease, from traumatic

brain injury, the self can change

remarkably. And what I try to illustrate

in the book is that you can have one

domain of cognitive function affected.

It could be memory. It could be

perception. It could be attention. It

could be your understanding of concepts.

It could you be your representation of

your body or the way you control your

behavior. Someone may become very

impulsive. Each of those domains in and

of themselves contribute to our

perception of the self. I mean Marvin

Minsky, one of the pioneers of AI,

called this the society of mind. You

know the self emerges from the interplay

and the activity of this society of

mind. If we take one of the modules out

of that society, memory, attention,

language, whatever it is, the self is

changed. It's not that you've deleted

the self. The self has changed and it's

observable. You know, someone's personal

identity can change, their social

identity can change. So, I think the key

point here is the self is not immutable.

It's something that can change. People

might think my personality is this way.

It can never change. Well, your

personality is the product of your

society of mind. The cognitive processes

that are going on all the time, of which

we are consciously aware of only a

fraction under the hood. 95% of the

stuff is going on without us consciously

being aware of these processes.

>> It seems and I'm not trying to play

psychologist here that fulfilling roles

in our [clears throat] daily lives is an

important part of our self-concept. You

know, I'm a student, I'm a teacher, I'm

a husband, I'm a wife, I'm a whatever it

happens to be feeds back heavily on our

notions of self. Yeah.

>> Are we fulfilling this role well or less

well? But there's another piece and I

know this exists more in Eastern

philosophy and I am not versed in that

where we wake up each day and we know

who we are. We don't forget who we are.

>> We're carrying our prior life experience

to that day. And I love the idea that we

can change ourselves at the level of

like optimism or anything. To me, that's

like the apex of neuroplasticity.

>> But of course, we want to hold on to

something consistent. We don't want to

wake up and not know where we are or who

we are. That's super scary, too.

>> So, is it the case that when we take on

a new role that we are fundamentally

changing? And it also seems that unless

we're very young, most people don't add

new roles over time. I mean, they might

become a parent or a grandparent, have

some friends, but you sort of have a

limited number of roles in life. And so,

it seems like doing new things could

actually change the self. And that

[snorts] seems exciting. And I think

it's not a depressing thought to me that

many [clears throat] people probably

would like to change themselves somewhat

or a lot. They want to feel like a

different person,

>> but not so different that they lose

touch with the prior person so they can

look at the the Is that is that

catching?

>> Yeah, I understand where you're coming

from. So on the one hand, of course, our

ideas of who we are, ourselves rely on

our embodied self. We occupy a body.

>> Mhm.

>> My body, the one I occupy, is different

from yours. And so we have different

physical identities in that respect. But

we also have different perspectives,

experiences, and those experiences give

us our firsterson experiences. You know,

if I put my hand in the fire, I'm the

one who's going to feel the pain. If I

pick up this cup, I have agency of what

I do. Those are my first person

experiences. and the physical identity

in terms of both the body that I occupy

and the first person experiences that I

have stretch back over time and

therefore I have more confidence that

this is me.

>> Mhm.

>> I've occupied this body. It's grown up.

It's also aging and I've had these

experiences that make me me. I've made

these choices. I made these decisions. I

had these memories. That's what

contributes to my personal identity. And

the other bit you mentioned was really

relates to social identity, my roles.

When someone asks you, who are you? Tell

me a little bit about yourself. It's

inevitable that we'd say, well, I I grew

up in San Francisco in the Bay Bay Area.

I did this. I went to as an

undergraduate to here. I had these

experiences. If you're religious, you

might say this is my faith. If you

follow a particular sporting team, you

might say, "I'm a big fan of this

particular team." If you were influenced

by some very important people in your

field, you might say, I am part of that

school of thinking in this way that

defines your social identity and that's

a really important part of who you are.

So there's the personal identity, the

body, the first person experiences and

there's a social identity. And again,

social identity over time is is very

very important to change from these

things which we have grown up with these

identities is possible. As we've said,

it's possible through something hormonal

like changes in thyroxine. It's possible

through brain disorders. But these

principles suggest that it's possible

through what we do.

>> And interestingly, I think there is an

evidence base for this. So, as we grow

older, for example, as you're coming to

retirement, your

network of friends, your social

connections often shrinks. People may

have moved away. You're going to no

longer have the colleagues that you

interacted with because you're going to

retire. Your family is now old. your

children have moved away, the network is

shrinking. But it turns out that the

data show across many studies that

people who keep relationships increase

or maintain the number of social

relationships they have, they have a far

less risk of developing dementia than

those who don't. If we correct for all

other confounding factors, people who

have a sense of curiosity, who are

open-minded, want to engage in something

new, perhaps a new hobby, a new pursuit,

whatever it is, they also have a far

lower risk of developing dementia. And

you mentioned this term sense of

purpose. So, you know, that's used or

misused in various ways in different

places. But if we take sense of purpose

as thinking you know I get up in the

morning with a sense of I need to do

this I have a purpose in life those

people who say that are also more

resilient to cognitive decline over time

>> which is a remarkable thing.

>> It's incredible. Yeah.

>> And it makes me wonder if the key to

evolving the self is about verbs not

labels.

>> Mhm. which sounds like a very California

newagy like let's be about verbs not

labels but I mean it because if you're a

scientist like people will say like I'm

a scientist okay so you get a degree in

science awesome as an undergraduate

somebody does that means they learned a

lot of science but if you're a doctor a

physician you're a physician and a

scientist and many other things too

it's really about the things that you

did and do in those roles that really

shape your brain just having a PhD D I

can promise you doesn't do anything for

you and no one really cares after a

short while. But the things you learn,

the failures, the the your strivings,

your successes, like those really shape

your self-concept. Goes back to what we

were talking about before about they

shape our thinking about what we could

do or potentially not do if we were to

strive, which raises a very specific

question. What does David now think

about apathetic David? And what does

David now think about David before he

became apathetic? His memory of self is

as interesting to me as the

transformation. Although the

transformation is clinically like

remarkable and awesome and I just want

to tip my hat to it again. I mean you

saved a life basically. It's so cool and

physicians do this. This is my

admiration for physicians. But what does

he think? Is he like, "Oh yeah, I was in

a state, you know, I need more dopamine.

I take this drug. I have more dopamine

and now I'm good." And how has that

evolved over time? No, I think after he

improved, he certainly looked back on

the situation he was in and could not

believe that he couldn't create that

effort that

>> disbelief.

>> Yeah.

>> Like a disconnect like how could that

>> how could I not have done that because

all he had to do is put the cables

together to, you know, listen to music,

right? It's such a simple thing. He

didn't have to do a huge amount. But

this is like somebody who has a skill

telling somebody else like, "Hey, you

just like dunked the basketball and

you're like, [laughter] "Yeah, but

>> but if it's you telling yourself, how

can how can I how could I be like that?"

>> Because obviously he has memories of

what he used to be like before those

strokes hit him that he was this highly

productive, very socially engaged

person. So, I guess you can see it

afterwards, but at the time you you

can't necessarily have you don't

necessarily have the inside. It's

interesting this week I was reading that

um Carly Simon uh was speaking about the

fact she's developed Parkinson's

disease, but she mentioned that one of

the biggest problems is her apathy. She

can't believe that she's become

apathetic. Now, she obviously has

insight into the problem that she's

developed apathy, but nevertheless can't

necessarily change that because, you

know, there's if circuits that affect

motivation are not firing as they should

be. No matter what you think, you're not

necessarily going to be able to change

things.

>> Yeah. That's like if anyone has ever had

transranial magnetic stimulation, it

it's like they can inhibit your ability

to move a finger and it's like you can

>> will that finger to move with everything

you've got

>> and it doesn't move and then they take

the coil off your head and it just you

can tap your finger. It's it's a

remarkable thing to feel that it's

painful in in a psychological way. Very

painful. We've all heard of mania. I'm

not an expert in mania, but seems that

when people are manic, they have tons of

energy, tons of motivation. Yeah. To do

everything, everything is a good idea.

>> And it's mostly about them, you know.

Same if you see people on

methamphetamines, it's not a very

empathic state. It's not about like what

can I do for society with all this extra

energy. It's a very me state. You see

this cocaine, empetamines, manic states.

It's every idea is a great one and

there's billions of ideas. So much so

that people are doing trivial things

thinking it's interesting or even

damaging themselves or others. Are all

of those hyperdopamineergic states?

>> Is it just this motivational circuitry

just gasp pedal to the floor?

>> And what does it tell us about

motivational states? Because I do think

the extremes are are interesting. So, I

don't know much about mania, but it

turns out um when I was having to prov

present a lecture on motivational

disorders, I thought I would dip in to

the neuroscience of addiction. I'm not

an addiction expert. And to my surprise,

almost every drug of addiction, whether

we go from nicotine to alcohol to heroin

to cocaine to amphetamine, almost every

drug of addiction hijacks that dopamine

system. when we were talking about this

circuitry that goes from the basil

ganglia to the frontal loes and I don't

think that's a coincidence that we find