Full transcript of neuroscientist Rachel Wurzman’s TEDx talk on Disconnected Brains: How isolation fuels opioid addiction @ TEDxMidAtlantic conference.
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Rachel Wurzman – Neuroscientist
What does it mean to be normal? And what does it mean to be sick?
I’ve asked myself this question from the time I was about seven, when I was diagnosed with Tourette syndrome.
Tourette’s is a neurological disorder characterized by stereotyped movements I perform against my will, called tics. Now, tics are technically involuntary, in the sense that they occur without any conscious attention or intention on my part.
But there’s a funny thing about how I experience tics. They feel more unvoluntary than involuntary, because I still feel like it’s me moving my shoulder, not some external force. Also, I get this uncomfortable sensation, called premonitory urge, right before tics happen, and particularly when I’m trying to resist them.
Now, I imagine most of you out there understand what I’m saying, but unless you have Tourette’s, you probably think you can’t relate. But I bet you can. So, let’s try a little experiment here and see if I can give you a taste of what my experience feels like. All right, ready?
Don’t blink. No, really, don’t blink. And besides dry eyes, what do you feel? Phantom pressure? Eyelids tingling? A need? Are you holding your breath?
Aha. That’s approximately what my tics feels like.
Now, tics and blinking, neurologically speaking, are not the same. But my point is that you don’t have to have Tourette’s to be able to relate to my experience of my premonitory urges, because your brain can give you similar experiences and feelings.
So, let’s shift the conversation from what it means to be normal versus sick to what it means that a majority of us are both normal and sick. Because in the final analysis, we’re all humans whose brains provide for a spectrum of experiences. And everything on that spectrum of human experiences is ultimately produced by brain systems that assume a spectrum of different states.
So again, what does it mean to be normal, and what does it mean to be sick, when sickness exists on the extreme end of a spectrum of normal?
As both a researcher who studies differences in how individuals’ brains wire and rewire themselves, and as a Touretter with other related diagnoses, I have long been fascinated by failures of self-regulation on the impulsive and compulsive behavioral spectrums. Because so much of my own experience of my own body and my own behavior has existed all over that map.
So with the spotlight on the opioid crisis, I’ve really found myself wondering lately: Where on the spectrum of unvoluntary behavior do we put something like abusing opioid painkillers or heroin?
By now, we all know that the opioid crisis and epidemic is out of control. Ninety-one people die every day in this country from overdose. And between 2002 and 2015, the number of deaths from heroin increased by a factor of six. And something about the way that we treat addiction isn’t working, at least not for everyone.
It is a fact that people suffering from addiction have lost free will when it comes to their behavior around drugs, alcohol, food or other reward-system stimulating behaviors. That addiction is a brain-based disease state is a medical, neurobiological reality. But how we relate to that disease — indeed, how we relate to the concept of disease when it comes to addiction — makes an enormous difference for how we treat people with addictions.
So, we tend to think of pretty much everything we do as entirely voluntary. But it turns out that the brain’s default state is really more like a car idling in drive than a car in park. Some of what we think we choose to do is actually things that we have become programmed to do when the brakes are released.
Have you ever joked that your brain was running on autopilot? Guess what? It probably was. OK? And the brain’s autopilot is in a structure called the Striatum.
So the striatum detects emotional and sensory motor conditions and it knows to trigger whatever behavior you have done most often in the past under those same conditions.
Do you know why I became a neuroscientist? Because I wanted to learn what made me tic.
Thank you, thank you. I’ve been wanting to use that one in front of an audience for years.
So in graduate school, I studied genetic factors that orchestrate wiring to the striatum during development. And yes, that is my former license plate.
And for the record, I don’t recommend any PhD student get a license plate with their thesis topic printed on it, unless they’re prepared for their experiments not to work for the next two years.
I eventually did figure it out. So, my experiments were exploring how miswiring in the striatum relates to compulsive behaviors. Meaning, behaviors that are coerced by uncomfortable urges you can’t consciously resist.
So I was really excited when my mice developed this compulsive behavior, where they were rubbing their faces and they couldn’t seem to stop, even when they were wounding themselves. OK, excited is the wrong word, I actually felt terrible for them.