Genius, Mental Illness and Everything in Between: Dr. Lamont Tang (Transcript)

Here is the full transcript of Dr. Lamont Tang’s talk titled “Genius, Mental Illness and Everything in Between” at TEDxHongKongED 2013 conference.

Listen to the audio version here:

TRANSCRIPT:

“No Great Mind Has Ever Existed Without a Touch of Madness”

So I’d like to first start out with a quote that no great mind has ever existed without a touch of madness. This was observed from Aristotle in 300 B.C. And I think this observation probably has been noted even beforehand, before Aristotle. But to what extent do we actually know that madness and genius are related? I’ll touch a little bit on this today.

But first, I’d just like to do the flip side of this. If you’re mad, it doesn’t mean that you’re a genius. This is encapsulated in my favorite cartoon. Calvin says, “I’m a genius, but I’m a misunderstood genius.” Hobbes says, “What’s misunderstood about you?” And Calvin says, “Nobody thinks I’m a genius.” And so today I’m going to dispel some myths about mental illness.

Myths About Mental Illness

And the first three out of the long list, and I’ll only spend time today on the third point, but the first two is that mental illness, one myth is mental illness is caused by bad parenting. We know that the data suggests that most diagnosed individuals actually come from good families. The second myth is that the mentally ill are violent and dangerous. The data, again, suggests otherwise. Most mentally ill people are actually the victims, not the perpetrators.

And today I’ll spend more time on people, on the myth that people with a mental disorder are not smart, that they’re not capable of having a successful career or even a brilliant career. Again, the data suggests that people with mental disorders have average to above-average intelligence.

And so I’ll just highlight just a few “geniuses”.

Edgar Allan Poe on the left, eminent poet in the 19th century. He killed himself when he was about 40. He suffered from bipolar. He had immense periods of prolific productivity in his manic stage, when he had lots of energy, feeling like he was invincible and vulnerable. But he also succumbed to periods of depression and suicidal thoughts, which led to his eventual death.

Then we’ve got Van Gogh, everybody should know, the guy who cut off his left ear. He also suffered from a lot of depression. He coped with drinking. And finally, he succumbed when he was 37 with self-inflicted gun wounds.

And we’ve got Sylvia Plath, one of the eminent poets of the 20th century. She also had a very long history of depression, and she killed herself when she was 30.

Finally, we’ve got John Nash. Perhaps some of you might better know the movie “A Beautiful Mind.” Russell Crowe plays John Nash, and he founded a branch of mathematics known as game theory, and won the Nobel Prize for that.

Destigmatizing Mental Illness

And so today, I just want to talk more about mental illness and sort of destigmatize it so that people have compassion for some of these individuals. And so as a neuroscientist, I study this three-pound piece of meat, this biochemical, electrical, I think, a fascinating organ. Just to tell you a little bit about its complexity, your brain has 100,000 miles worth of blood vessels. It can go around the world four times over. You have 100 billion neurons, and each one of those neurons contacts another 1,000 neurons. So it’s a remarkably complex organ.

Structural and Functional Deficits

But today, I’ll talk to you mainly about structural and functional deficits at the macro level, what we typically use brain scans to look into the inside of the head. And here’s a cartoon of some of the major areas of the brain. I’m not going to quiz you afterwards, but I’d just like you to focus on the cortical areas.

And the reason to focus on the cortical areas is because a lot of mental illness actually stems from this area. I mean, of course, there are many other areas that impact, but it’s curious that through evolution, from invertebrates such as the lobster, and then going to fish, mice, frogs, birds, and all the way to monkeys and humans, that humans have by far the largest volume of cortices. That’s indicated in orange, that piece of brain there.

The Cortex and Mental Disorders

And this, you can consider, is the pinnacle of evolution. This is how we have our advantage over everybody else. This is how we plan ahead. This is how we carry out our plans. This is how we make decisions. This is how we make all our executive decisions. And so when we think about mental disorders such as schizophrenia, we often take for granted as normal people that our mental representations of the world are always constant.

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Imagine what you would be like as a schizophrenic patient. This is something that approximates the disorganization, some of the delusions, the hallucinations that people suffering from schizophrenia might experience. Obviously, this is just an image, but you can imagine your audio information streams, your visual audio information streams. All of these will be discombobulated.

And furthermore, you might have some deficits in being able to do basic functions, just planning ahead, just having some simple working memory tasks. And so in our community, today I’ll just focus mainly on schizophrenia, but there’s also mania, depression, and many other mental illnesses. I’ll touch upon mania and depression just a little bit.

But I just want to make one statement first. I’m not going to back it up. These disorders can affect persons of any age, race, religion, or income. It affects everybody. And today I hope to convince you that mental illnesses are not the result of some personal weakness or some lack of moral fiber or that you had a poor mom or bad dad. It affects all of us.

And so you might be asking, why should you care? The World Health Organization has identified schizophrenia as one of the ten most debilitating diseases affecting human beings. So I hope that by giving you some biological, physical, and genetic evidence to suggest that this is a real illness, that this will come to an understanding of mental health issues that will bring awareness to our communities and help bring these individuals along.

Causes of Schizophrenia

So the first bad news is there is no one cause of schizophrenia. However, the data suggests that there’s biological, environmental, and genetic factors. There’s currently no reliable way to predict whether one will develop schizophrenia or not. However, we do have some handles on neurotransmitters and neuromodulators, some hypotheses. But it’s really our ability now to produce images that have identified some structural and functional deficits. I’ll quickly go here.

So one of the first things you’ll notice between twins where one of them suffers from schizophrenia and the other is normal, you’ll notice that the ventricles is much larger in the schizophrenic brain. There’s a decrease in hippocampus. That’s the brain organ that’s in control of working memory. There’s a decrease in overall size. And there’s also an abnormal development of prefrontal cortex, which I mentioned before, is in charge of all your executive functions, planning.

Hypofrontality in Schizophrenia

And so the other phenomena that clinicians have noticed is hypofrontality. And so this is… You can just think of a heat map where the warm colors indicate loss of brain activity and green or cooler colors as low brain activity. So we have a pair of twins, one on the right side, this is the unaffected twin. On the left side is the schizophrenic twin. And what you’ll notice is in the frontal area you have much lower activity. And this is thought to account for some of the inability of schizophrenic patients to organize their thoughts, to properly, temporally bind all the information that they need to properly execute whatever actions they have planned.

The other interesting thing to note is people who are schizotyped, this is a milder form of schizophrenia, they also exhibit these same symptoms. And when you give them tests of creativity and originality, they actually score very high. And one thought for this is because schizophrenics and schizotypes tend to be unable to filter the information, they’re able to hold lots of information in their head. A lot of the normal people, they will cut out all the unnecessary information.

When you recombine them, just like that image, you can see that there’s a lot of substrate for them to recombine details or ideas into new forms that many of us won’t be able to. And so just as a small trivia, we all know that the brain has two hemispheres. The left side is analytical, the right is the creative. And anecdotally, and also studies suggest, that men process information primarily from this left side of the brain, and women tend to use both sides.

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And I can say from personal experience, my wife, she can drive the car, she can brush her teeth, do her makeup, and do everything, whereas I myself can barely chew gum and walk at the same time without tripping over myself. And one of the reasons people think is there’s this brain structure called the corpus callosum, which connects the left side and the right side. And this relay allows more information and allows women, presumably, to be somewhat more creative, also to multitask.

Causes or Symptoms of Schizophrenia?

So in terms of what we know from the data I’ve given you, are these the causes or are these the symptoms of schizophrenia? I would argue that these are more actually the symptoms. We have the hyperfrontality phenomenon, the enlarged ventricles. We’ve got some ideas about dopamine and neurotransmitters, but we really want to understand the genetics of this.

And so one of the cleanest ways to do this is to do adoption studies of twins where it’s a natural experiment where you’re disassociating the genetics from the environment. So in these identical twins, if you have one twin that has schizophrenia, what’s the likelihood that the other also has schizophrenia? It turns out that in identical twins, it’s only about 50%. And that’s somewhat striking because if you assume that it’s a purely genetic disease, it should be 100%. And so what this is telling us is this is sort of a messy gray area. It’s not a black or white issue.

Genes and Mental Illnesses

And so a question that I often get is, okay, we sequenced the genome in 2000, 2003. We now have a dozen, two dozen genes that are susceptibility genes for schizophrenia. So why are these genes so controversial? And why is this all so complicated? I’ll give you two… one fundamental answer.

The first is that genes do not encode for psychiatric illnesses. A gene does not encode for hallucinations, delusions, panic attacks, or manic episodes. But what they do do is they build the fundamental building blocks, amino acids, proteins, which then build your cells in the brain. These are called neurons. And these neurons then connect to each other, forming networks, brain circuits.

And finally, these circuits give rise to behaviors such as perception, cognition, your moods, all your deepest thoughts. So you can imagine going from each of these different scales of organization, there are a lot of biological mechanisms that allow for robustness, that allow compensation. So it can’t be just one single gene for complex phenomena such as mental illness.

Genetic Complexity and Mutational Load

The other piece of it is there’s genetic complexity. If you imagine in the white circles, these are people who are normal. And in the red circles, you have people who have schizophrenia. And these little puzzle pieces, these indicate mutations. In these mutations, you can see that people who have 0, 1, or 2 mutations have little mutational load, and they’re normal. However, as you get to 3 to 4 mutations, that’s when these genes interact. And this is what can tip you in the threshold in addition to environmental triggers to get you into the regime of schizophrenia. And so I’ll quickly go over…

You know, we have a dozen, two dozen genes. I won’t go over all of them. We have these susceptibility genes. We also now know that there are some environmental insults from infection, nutrition, environmental chemicals. And we know that each of these processes will interact, and this can cause gene impairments. This will also cause…

When you have changes in gene expression, you’ll have changes in neurochemical and metabolic changes. Once you have these kind of changes, you change the network activity of your circuits. Once you have these changes in network activity, you have changes in brain activity, and this could, in principle, lead to mental illness.

Gene-Environment Interactions

So I’d like to give you two pieces of data about gene environmental interactions. Here is data from science. This is Science Magazine, one of the eminent journals for scientists. And this is a rather simple study looking at the genetic background of people with different forms of serotonin. So there’s a short form and a long form. You can inherit a short and a long form from your mom and your dad. So there’s three possibilities, three genetic backgrounds, short, short, short, long, and long, long.

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And what you find is if you ask people the number of stressful events over 10 years and what qualifies as a stressful event is the loss of a loved one, spouse, sibling, parent, or loss of a job, as you go from 0 to 1 to 2 to 3 to 4, from 0 to 2, you see relatively little differences between the genetic backgrounds. As you get to 4, you start seeing this contrast and the probability that one of these individuals becomes depressed. In this case, it’s the short, short form.

Another gene-environment interaction is the incidences of schizophrenia due to cannabis use during teenage years. So this might be of interest to both teenagers and parents here in the audience. In blue are the boring people like me, the non-users. And then you’ve got the green cannabis users. And you’ve got the three different backgrounds. Again, it doesn’t really matter. It’s just met-met, val-met, and val-val. And what you’ll see is only in the genetic background where you have val-val, there’s about a five-fold increase in the incidence of developing schizophrenia if you’ve used marijuana during your teenage years.

And so there are two things you can think about on this. If you’re a parent, you might want to get your kid genotyped and sit him down and say, “Hey, here’s the data.” But if you’re a kid and you happen to be met-met, you’re like, “Hey, Mom, it doesn’t really matter. I can smoke all the weed I want. It doesn’t really matter.”

Mental Illness and Biological Basis

So I hope through these very short vignettes I’ve showed you that mental illness is not something due to just your own lack of moral character or your upbringing, that there’s actually a real physical, biological basis to it. It’s something akin to asthma, diabetes, or heart disease, where, for example, in diabetes or heart disease, cholesterol is an indicator for heart attack, but it doesn’t predict necessarily a heart attack.

In the same way, we have these susceptibility genes now that help us understand what your risk factors are. But still, it seems like a lot of society still believes that a person who’s mentally ill still needs to have their own willpower, that they have to be able to pull themselves out of it.

So the way I think about this is like telling a person who has amputated legs to run across the room. This is equivalent for a person with a mental health issue that they have a broken brain, as indicated by this cartoon. So hopefully today… There are treatments out there. With the right combination of medications and or therapy, we know that we can help alleviate a lot of the symptoms. We can’t cure schizophrenia. We don’t have any cures for mental illnesses yet. But I’m very hopeful with the science that we’re coming out with today that in the next decade or two, we shall have some cures.

Conclusion

I’d like to end with just saying that one in five people will be diagnosed with a mental health problem this year. These individuals will come from all walks of life. And that my main concern today is that there’s this information so that you can share it with your family and friends so that when your own brother or sister or your friend is suffering from one of these mental illnesses, you can learn to recognize some of these symptoms. You can diagnose with bioinformatics technology now to help people get the treatment that they need and that they can seek the outcomes that will benefit their life and they can have a happy, productive, and successful life.

And so that’s what I’ll leave you with today. Thank you.