If Your Brain Changes, Are You Still You? With Dr. Masud Husain

What makes you you?

Is it your memories? Your personality? Your sense of humor? Your motivation? What happens when a neurological disease changes one of those things?

In this episode of Causes or Cures, Dr. Eeks talks with neurologist, neuroscientist, and author Dr. Masud Husain about his new book, Our Brains, Our Selves: What a Neurologist's Patients Taught Him About the Brain.

Drawing on the stories of seven patients with different neurological conditions, Dr. Husain explores how changes in the brain can profoundly affect identity, behavior, memory, motivation, humor, and our relationships with others.

We discuss pathological apathy after stroke, personality changes caused by frontotemporal dementia, memory and Alzheimer's disease, the neurological basis of humor, and how cultural and spiritual beliefs shape the way people understand illness. We also explore bigger questions about free will, responsibility, consciousness, and whether there may be aspects of human experience that lie beyond a purely biological explanation.

Dr. Husain shares what decades of caring for patients with neurological disorders have taught him about the brain—and about what it means to be human.

Dr. Masud Husain is Professor of Neurology and Cognitive Neuroscience at the University of Oxford and a Professorial Fellow at New College, Oxford. His work spans neurology, neuroscience, psychology, and brain imaging, with a focus on understanding how the brain supports cognition in both healthy individuals and people with neurological disorders. He is also Editor-in-Chief of Brain, one of the world's leading and most influential neurology journals. Our Brains, Our Selves is his first book.

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Transcript

SPEAKER_00 0:00

Welcome to the Considers or Hewers Clipcast, your gateway to understanding health and groundbreaking medical research in a fun and easy to understand way. With Dr. Eaks as your host, join us as we sit down with the world's leading doctors and scientists to unravel the mysteries of health. From practical tips and well-being to the latest breakthroughs in medical research, we covered a moment. Don't forget to subscribe. Let's ignite our curiousity and together dive into today's episode.

SPEAKER_01 0:30

Hello, hello, everybody, and welcome to this episode of Causes or Cures. I'm Dr. Eeks, your host, and thanks for joining in. So, what if the things we think make us us? Our motivation, our memories, our sense of humor, our personality, even our beliefs, can be altered by changes in the brain. Changes that can come on really quick sometimes. In this episode, I'm joined by neurologist, neuroscientist, and first-time author, Dr. Massood Hussein, to discuss his fascinating book, Our Brains Ourselves. What a neurologist's patients taught him about the brain. Through the stories of seven patients living with neurological conditions, Dr. Hussein explores some of the biggest questions we can ask about ourselves. What is identity? Who are we? How much control do we really have over our behavior? How reliable are our memories? And if the brain changes, do we become someone else? We talk about stroke, dementia, motivation, humor, memory, spirituality, consciousness, relationships, and what these patients taught him about the fragile and remarkable relationship between the brain and the self. If you've ever wondered where you end and your brain begins, this conversation is for you. Give me a few minutes here, guys, while we connect to Dr. Hussein. All right, everybody, we are connecting with Dr. Massood Hussein, and we're going to hear about his wonderful book that I read. But first, Dr. Hussein, thank you so much for joining. And do you mind telling our listeners a little bit about yourself and the type of work that you do?

SPEAKER_04 2:35

Thanks for having me, Erin. I'm a neurologist, so I see patients with clinical neurological problems, and I'm also a cognitive neuroscientist. So I work on the fundamental aspects of things that our brains normally do, like memory and motivation. So I try and combine both of those aspects. And unusually I also work in the Department of Psychology here. So all of this works in the University of Oxford and our affiliated hospitals. And I'm at that intersection between psychology, cognitive neuroscience, and neurogy.

SPEAKER_01 3:12

So you're busy, uh to say the least. So let's talk about your book. Uh in your book, and for our listeners, we follow seven patients with different neurological conditions and how changes in the brain can alter who they are. A major theme that runs through the stories is identity, uh, both personal identity and social identity. So I was curious, what made you focus on identity as the central thread of the book?

SPEAKER_04 3:44

Yeah. So when I was first thinking about the book, I was thinking simplistically in terms of trying to describe what it's like for a person to lose one fundamental cognitive function, you know, whether it could be memory, it could be language, motivation, whatever it is, and recounting those stories, because I think people don't quite understand how that goes in terms of the conversation you have with a neurologist and how a neurologist embarks on this detective investigation, really, by talking to you about trying to understand what's going wrong. And in and of itself, I thought this is great because I think most people don't know how it works. They would be really intrigued to find out. But it struck me that there was a much bigger story here, and that story is really that each of the people that I describe in the book, and many others that I don't describe in the book, not only have a change in a cognitive process, like memory, for example, but they also change in themselves. And not only do they change in terms of their personal identity, who they are and the way they come across, but they also change in terms of their social identity, how they connect to other people. And it struck me that essentially what this book would really be about was trying to uncover what makes people who they are. And one way you find out who you are is when something goes wrong. You know, people say know thyself, but actually you can know a lot about yourself when something goes wrong. And that's what we see as observers in people who drew develop brain disorders. And so I wanted to tell those stories in a compelling way, and I and I hope that's what comes across. But I also wanted the bigger story here, which is that the feeling of self, the uh feeling of you as an individual is something really complex, and it's not simply about physical identity. You know, I could say, look, Erin is different from me, we occupy different bodies, and because we're delimited in these different physical systems, that's what makes us different. But as many philosophers have argued, um, that can't be it. That isn't enough. You know, if if Erin's consciousness was to swap into my body and my consciousness wants to go into her body, who would I call Erin? It wouldn't it wouldn't be the physical person, it would be where Erin's consciousness went. And for us, that conscious state is really all about the emergence of identity from the different cognitive functions that brains undertake.

SPEAKER_01 6:37

Your book is very compelling, and that's the one thing I really liked about it because I kept wanting to read, you know, it was the little mystery. Like this patient comes into your office and describes her symptoms, and you know, it kind of feels like the reader is solving the case alongside you and seeing how you go about it. So um I think that's why, you know, because some books, obviously, medical books can be super boring, but this definitely kept me not to bash any authors, but like no.

SPEAKER_04 7:04

I mean, um, that's the way it is. That actually is the way it is, Aaron. So I've been doing this for over 30 years, and from my point of view, each new person comes in with a different problem. Now, of course, not everybody has a neurological condition. Some people who have memory symptoms don't have you know something like Alzheimer's disease. They may be anxious, they may have low mood, they may be sleeping poorly, there may be all sorts of stresses in their lives. And it's just as good for us to feel that we can reassure them and say, look, you don't have a terrible neurological disorder, and this is something that we can actually treat. About a third of the patients we see are actually people who don't have a terrible neurological disorder and someone who we might be able to reassure. So every everyone who comes in is in some ways a new mystery to unravel. Now, some mysteries are faster to unravel than others, but they're still mysteries.

SPEAKER_01 8:02

So I wanted to ask about David. In David's story, he develops pathological apathy after a stroke, and you describe the pathway between the basal ganglia and the frontal cortex, and how you gave him medication and it seemed to restore some of his motivation. And that made me think about how we often view motivation as a matter of willpower and choice. And you talk a little bit about this in the book, you know, about I guess a normal person's level of apathy. Could could that be already dictated by our brainwiring? So, my question for you was from a neurological perspective, given all the cases you've seen beyond David's, I suppose, how much of motivation do you think is actually under our control?

SPEAKER_04 8:50

Yeah. Well, in a way, I hadn't really thought about this a great deal until I met David. You know, David was a young man in his 30s who suddenly loses all motivation. He was incredibly sociable, very productive at work. And then suddenly he stops being any of those things. And the reason that happened to him was he he had suffered two tiny little strokes which affected the basal ganglia, these deep nuclei in the brain. And people had misinterpreted his apathy as being someone who's depressed. But it got so profound that he lost his job, he couldn't be bothered to get social security benefit. He had some very nice friends who said, come and live with us, and then regretted it almost immediately because David did nothing. He waited for them to come home, cook for him. He didn't help out in any way domestically. He was absolutely completely lacking in motivation, but not depressed. And it was something very, very striking for us. We worked out that one of the reasons that he was this way was because of where those strokes had affected him, and those strokes link, as you say, the basal ganglia to the frontal lobes, uh, where motivation links to action. And that's why he there was no action in David. He was completely inert because he couldn't be bothered to do anything. But with him, we could change the situation because we gave him a drug that targets the dopamine system, and that made him a completely different man. So three months after this drug, the man who did nothing came back to see us. We could barely recognize him. You know, he he was he wasn't really having a shower when we met him. He came back in a suit, he'd had a haircut, he had a job, and and most amazingly, he had a new girlfriend. You know, he was see nobody before this. So, what that showed to us is a brain disorder could extinguish motivation, and you could restore it with a drug that treats the dopamine system in the brain. Now, David is incredibly rare. He was uh a really pivotal moment for me and my research into this. But it turns out that apathy is a big problem across many different brain disorders, including neurodegenerative ones like Alzheimer's or Parkinson's or vascular dementia. But of course, it begs the question is our level of motivation set by our biology?

SPEAKER_02 11:24

Yeah.

SPEAKER_04 11:25

I'm not arguing that everything can be reduced to biology and brain circuits, because there is a lot of stuff that happens to us in terms of our everyday experiences. But we took a group of Oxford University students and we selected them for different levels of motivation and we put them into the scanner while they were having to make choices about whether they thought a particular objective was worth putting in the effort for. Was the reward worth the physical effort to do this? And interestingly, to our surprise, we found there were differences in brain activity across these peoples, depending on their level of motivation. So the brain areas that were active when people are making that decision, is this reward worth the effort? Include the basal ganglia, the areas that had been affected in David stroke and the frontal cortex. But what we were surprised with was that there was more activity in the people who were more apathetic. We're talking about healthy individuals who are more apathetic. And we we were puzzled by this to begin with, but we wondered whether actually what we were seeing is the fact that they are actually using more brain power. There's a cost to them to make these decisions, and maybe that's why they find that aversive. Oh my goodness, it's it's hard work making that decision. I'd rather not make that decision at all, so I do nothing. And that is a really interesting insight into why somebody could look inert, why they could look like they can't be bothered. It's too much work trying to work out whether I want to do this or not. I just I won't do it. Um, and so we have been working on trying to understand the mechanisms underlying apathy, not only in patients with brain disorders, but also in healthy individuals.

SPEAKER_01 13:27

Yeah. Because, you know, I just remember when I when I went to school at West Point, like, you know, there's a lot there was so much focus on motivation, you know, like you have to be motivated, motivated. So when I was reading that, I was like, geez, how much of motivation is just already set? And because we link it to success as a society, you know what I mean?

SPEAKER_04 13:44

Like, yeah, yeah. And interestingly, there's a study performed in West Point graduates, you know, which they were looking at grit. This is a term which is about how much perseverance, how much resilience have you got?

SPEAKER_02 13:57

Yeah.

SPEAKER_04 13:58

And it turns out that the measures of grit that were employed in that study correlate very strongly with the levels of apathy that we we measure. So these two constructs, independently derived in different kinds of populations, are actually highly correlated. We're looking at the same kind of underlying brain mechanisms that underlie your ability to be resilient and persevere under setbacks and what we would call apathy and motivation when you're having to decide whether a particular task is worth the effort.

SPEAKER_01 14:34

Yeah. Along the same lines, I was reading Sue's story, and you describe her outfits, the pink cowboy outfit, I think, which is a great visual. I I think I might have one actually. But and she was diagnosed with behavioral variant frontotemporal dementia, and her personality drastically changed. And you describe that beautifully, you know, the reader really can see the transformation. But again, I was just thinking about, you know, when we see extreme behavior in society and we're all so quick to judge, and you know, we have the whole criminal justice system. And I kept wondering like, how much is in people's control? You know, and I wonder if we'll ever figure that out one day.

SPEAKER_04 15:17

Well, um, I mean, Sue uh is an unusual patient. As you said, she developed this condition called frontotemporal dementia. And essentially she had been a very demure, timid housewife who nobody would have thought anything of beforehand in terms of her behavior being abnormal. But she became this very disinhibited person who just speak her mind, tell people what she thought about their dress sense or what she thought about their behavior when you know they're out. Um, she became a completely different person, and her husband couldn't believe what she was doing. But what was happening there was that you know the normal mechanisms in the frontal lobe that suppress the kinds of things that we would reflexively want to say or do that we don't do because we think it's inappropriate, it's culturally inappropriate, or it's socially inappropriate, were no longer being inhibited. But as you say, we see people like that all the time. And one of the intriguing things is if you look at some people who have been convicted for crimes, and you look at a prison population, as not a small percentage of those people actually have brain disorders or had traumatic brain injury which has affected the frontal lobe, or other kinds of brain pathology which have affected the frontal lobe. So you're asking a question about well, have we actually not taken that into account when we're judging people in terms of their behavior? And of course, not not everything can be reduced to biology, but it's it's interesting that some of these people do have pathological changes in their brain.

SPEAKER_01 17:09

Yeah, and it makes you just think about you know how if we move forward to being a more empathic society and really want to help people instead of just like putting people in jail where there's not a lot of reform happening in many prisons, um, just makes you think bigger questions.

SPEAKER_04 17:29

Absolutely. And of course, the problem is you can't scan everyone you meet and that's the explanation.

SPEAKER_01 17:36

Yeah. Not yet. It's too bad that I don't know if there's any research. You know how well there are with like dogs can sniff out Parkinson's disease and stuff like that. I wonder if maybe one day you could get to dogs to like as like cost-effective scanners.

SPEAKER_04 17:55

Well, what is happening, Erin, is that um new blood tests, of course, that some of your listeners might have heard about, which uh detecting nanomole amounts, tiny, tiny amounts of the proteins that build up in the brain in neurodegenerative conditions. And they include Alzheimer's disease. We can now measure amyloid and tau, which build up in the brains of people who develop Alzheimer's uh disease in the blood. We're using that in the clinic now. But we're also measuring other proteins. So, for example, Parkinson's disease is associated with a completely different type of protein that builds up in the blood called alpha synuclein. And we're beginning to measure that also in the blood. And we may be able to do this at a point years before anyone develops symptoms. That seems to be the case, because many of these neurodegenerative conditions start at 10, maybe 15 years in the brain before someone goes to see a neurologist. So that's a long time window. And if if we can develop effective disease modifying treatments, that's a time window in which you can intervene before someone develops the symptoms. And in you know, someone like Sue, we were talking about who developed frontotemporal dementia, it's a different type of protein, it's called TDP43. Again, there are labs out there trying to be able to measure this protein in the blood at a point long before a patient would present in the way Sue does.

SPEAKER_01 19:34

And would you start treatment then if they're not showing something?

SPEAKER_04 19:39

That is that is an interesting question because what that opens up is a really interesting ethical question because there are people who have Alzheimer's pathology in their brains, but never develop Alzheimer's dementia. Right. And they are thought to have what's been termed cognitive reserve. In some ways, their brain can take the load of that protein being deposited without it affecting their cognitive abilities in the way that other brains may not be able to, you know, um deal with. So what is it that differentiates someone in whom Alzheimer pathology doesn't lead to dementia versus in another person where it does? And that's the interesting thing about being able to detect Alzheimer's disease early. If you weren't gonna develop dementia, do you want to go through some very highly invasive way of trying to treat that dementia using intravenous drugs to try and clear these proteins from the blood if you weren't actually gonna get it? So that's a that's going to be another important problem for us in the next couple of decades.

SPEAKER_01 20:52

Goodness. It's like you you make one discovery and then there's like another can of worms, another I mean that's that's how things advance. Very true. It's never like a clear path. It's um oh, there's this problem here. Um I wanted to talk about humor a little bit. In Michael's case, he had semantic dementia, and you describe how he gradually loses words and knowledge. And I kind of found his story the most heartbreaking, I think, on a personal level, because it's just like you could see his whole world disappearing. You know, he didn't know how to name things and describe things. And it reminded me when I went to this comedy show because this comic, he was smart and he told this joke, and like nobody in the audience got it. I'm not saying they were dumb, but they just weren't as tuned in as he was. And he said he goes, To laugh, you gotta know things, you gotta know things to laugh. And so your story made me think of that. And how, you know, our sense of humor is very much tied, in my opinion, to our identity. So I wanted to ask you about that, you know, in your experience. What about sense of humor and how much does that play into identity and you know people's ability to kind of be themselves?

SPEAKER_04 22:07

Well, I think you put a finger on it because what you might find funny may not be found funny by other people, not only not only where you live, but obviously cult different cultures differ enormously in what they think is funny and what they might think is offensive. You know, that that's huge. So true. Yeah. Yeah. And and you know, famously, the British sense of humor is really considered odd by many people because it's kind of self-deprecating, you know, it's it's not the kind of humor that normally people would would think is funny. These these sort of British comedy so shows sometimes do well because they're so odd in the United States.

SPEAKER_01 22:46

You know, they're they're dry, yeah.

SPEAKER_04 22:48

They're very dry. But yes, um, humor is a very important part of our identities, and obviously, it's also a very important part of our social identities because, as you say, if I tell a joke and it falls flat, I'm not necessarily getting on with the person I'm telling. But if somebody else has my sense of humor, then we get on. We laugh at that, we think that's funny, and you think that already breaks the kind of distance between us. We can, you know, get on in other ways. So humor is a very important part of our identities. And uh Michael, who I describe in in the book, doesn't have Alzheimer's disease, he doesn't have frontotemporal dementia, he has a different kind of neurological problem, as you say, called semantic dementia. And he came to see me because he felt that he was no longer as fluent in conversation as he used to be, that you know, he had difficulty finding words. And I couldn't really detect anything when I was talking to him. But it was only when we were talking about what he used to play as sport when he was much younger that we found there was a problem. Because many of your listeners might know about this really curious British sport called rugby. Um, Michael used to play rugby, and I asked him which position did he play in, and he didn't understand what the word position meant. And that's when it started to dawn on me that actually what he has is a problem in understanding the meaning of words, semantics. And there's a really great uh book by Gabriel Garcia Marquez, you know, 100 Years of Solitude, where he describes a whole town where they're losing their memory, but they're not losing the memory of what has happened in the past. They're losing their semantic memory, their understanding of concepts, words, what they mean. So to get around this, you know, they're saying, okay, um, we we can't remember what these words mean, uh, what these objects are. Let's let's put labels on everything. Let's put a label here. This is a table, this is a cow, this is a chair, you know. We'll remember these things because we put the labels on them. But then they start to realize that even putting the label doesn't give them the meaning. You know, we use labels, words, to mean things. A table could mean a thousand different types of table. If you showed me those tables, I'd say that that's a table, it's a different type of table. I understand what a table is, what it's for, what the meaning of the word table is. So just giving them the label, though, without the connection to the meaning, meant that they didn't understand what that was. And it's similarly, the first thing that Michael's wife detected in him was not that he was losing his words, but that he was losing his sense of humor. So a man who was able to be very witty now was not doing that. And he couldn't also understand other people's jokes, including his grandson, who he used to find very funny. Um, and that was the first clue that he couldn't really understand humor. And you know, many humorous lines depend on a flip of the meaning of a word, what it really means, right? And so if you don't understand that, you'll you wouldn't find that funny. So, yes, sadly, he he had developed this condition, which meant that he was losing concepts of the world around him.

SPEAKER_01 26:28

Yeah. I think because I always try to use humor to connect, like even in like like Scicom scientific communications work, I always try to bring in humor. And it's funny sometimes because I'll tell a joke and like it totally doesn't land, but other times it goes over well. And it's always it's humbling and it's it's interesting, it's like a you know a journey. But I just kept thinking, like, oh gosh, if I lost my sense of humor, I don't even know where I guess you've got to judge your audience well, right?

SPEAKER_04 26:57

And also brave to try try the joke.

SPEAKER_01 27:01

It's interesting sometimes, and well, I notice this in in scientific communications. If I share like a summary or a blurb of something, and even if I don't throw a joke in, um, I'll always do like this check. I'll put it in front of me, I'll be like, will this offend anyone? Because I don't feel like dealing with like armies coming from corners of the internet. And I'm like, no, I think that's okay. Yeah, that's a phrase. I'm saying what I want, I mean well. And then sometimes I'll post and all of a sudden I'll get a comment and someone's offended by something, and I didn't see it coming. It's very interesting.

SPEAKER_03 27:34

I think it's inescapable in the world we live in, it's inescapable. Someone will be offended, even if it's someone will be offended.

SPEAKER_01 27:45

Hypothesis that I'm I'm settling on. Let's talk about memory. Obviously, there's a lot of fear around losing memory. And you described it in your book in Trisha's case, a patient who had early onset Alzheimer's disease. Um and but you write about memory and how easily memories can be shaped by the way questions are asked or by the stories we tell ourselves about events, and you kind of talk about how there's this pattern that we might fit memories into. From your perspective as a neurologist, how reliable are our memories in general?

SPEAKER_04 28:20

Well, I think many of us think of memory as like, you know, press replay. We'll we'll just think back and be able to perfectly recall what happened in that way. But what we realize through the science is that memory is not like a recording, it's not like a video recording, it is a reconstruction of what happened. And what you're alluding to here is also important for eyewitness testimony. You know, there's a famous, famous study many years ago when someone played a very short clip of a bank robbery, and then afterwards they put up eight different people and ask the participants in this in the study to point to the person who had been the bank robber. And every one of them pointed to someone in that lineup, and yet none of those eight people had been in the video, right? That's the kind of level our memories work at. Um, in less dramatic form, um, Elizabeth Loftus did this again, this beautiful study where she showed people a collision of two cars, a video clip of car two cars colliding. They bumped into each other. But then she would ask the people who'd been watching it, how what speed had they collided? What speed did they smash into each other? What speed did they bump into each other? So just by changing that word about the accident, she found that the speed estimates, if you said smashed into each other, were 10 miles per hour much faster than if you said bumped into each other. And then a week later she said, Remember that video clip I gave you? What did you think about the glass uh on the floor? Do you remember where it had fallen or whatever? And the people who had heard her ask the question, smashed, were more likely to say there was glass on the floor, the windscreen had smashed, but it hadn't. Right. So it's so impressive that our memories are affected and misled by the way we can ask, frame a question. But but you know, that's that's what we know about healthy memory. But in patients like Trish, who had early onset Alzheimer's disease, her husband, Steve, became particularly worried that her memory wasn't as good as before, but became very concerned because they'd gone on a little holiday. They'd gone on a little holiday to Cornwall, which is a lovely part of Britain, and um they'd had a great time, they were coming back, they were packing the car, and at that point she says to her husband, Steve, Oh, you can't come back with me. My husband will be very upset if you were to come back. Because Trish had thought that she'd met somebody new who was her lover, and of course she couldn't bring her lover back home. And Steve was obviously completely thrown by this and said, Oh, no, no, no, I know I know your husband really well. Why don't you give him a call? And um, I'm sure he'll be fine with me coming home. And while she's calling him, he steps out and takes the call, and she's saying, Do you mind if I bring Steve along? And he says, No, no, no, I know Steve really well. Bring him along. Um, and that's the kind of level where you know your memory can let you down. And even you know, months later, she might say, I wish you you Steve would work out who's staying with me tonight. Yeah, it's that kind of level where your your the fidelity of your memory can be affected to the point that you're not really sure who your partner is at that time.

SPEAKER_01 32:22

So, did she actually think she met she had two different boyfriends? Or like, did she believe because he wrote about imposter syndrome, I thought, in there a little bit. Yeah, yeah, no.

SPEAKER_04 32:30

So she, although she denied it, um, she clearly did think there were two different boyfriends. And when she was you know confessing that to me, she said, You won't tell Steve, will you, about this? And I said, No, no, no. And she said, you know, the funny thing is, the other boyfriend is also called Steve. It's it's that kind of level that she hadn't really appreciated that this was unlikely to be the case. Uh, and of course, some people also experience a far more florid thing where they they think they actually think that there are duplicates, doppelgangers of family members. And you know, this is the capgrass syndrome, sort of misidentification syndrome. She didn't quite have that because she didn't like she lacked the insight to know that this was a duplicate of Steve. She just thought there were two different people. Well, uh, yeah. But she was in denial that there was any problem with her memory, and some people are, you know.

SPEAKER_01 33:27

Yeah, that's that's that was tough to read those parts and how you're trying to navigate and get them to see. So many of the patients in your book are relatively young, I suppose. Like you talk like people in their 50s developing progressive neurological diseases, uh, and some treatments seem to help their symptoms, but the disease, the disease still progresses. You always make that note. And in your experience, how much variability is there in how these illnesses unfold? And have you ever seen patients stabilize for longer than expected, where you they stand out to you?

SPEAKER_04 34:04

Yeah, no, the variability is huge. We have we have people with neurodegenerative conditions we have treated for 10, 15 years, and it's been a very, very slow progression. And it's also not clear why some people progress so slowly and others don't. But I think what we've also learned is that um even if we can't cure somebody of some of these conditions, the types of treatment that can help symptoms can make a huge difference. So, you know, we started talking about identity and what creates a self. What we are trying to do with our treatments is to try and preserve that identity as much as possible. And that can be done in certain in certain conditions. You know, we we have people with Lewy body disease. One of the cases in the book has Lewy body disease. And to our surprise, uh, we can, with certain drugs, maintain both cognitive function and get rid of some of the neuropsychiatric symptoms of that condition. One of them is actually visual hallucinations. It can be very frightening that you see people in the room around you, um, often at night, often in the early hours. And that can be very, very frightening to people. But some of our medications are able to abolish that. And that that's been really important in many people's lives. So obviously, we now live far longer than we used to. Life expectancy is so much higher, and therefore, people are far more at risk of developing some of these neurodegenerative conditions. I think on the positive side, there's a lot of research being done. And on the other side, some of these symptomatic treatments can make a big difference to some of our patients.

SPEAKER_01 35:54

What are your thoughts on prevention? You know, there's this whole push to be healthier and longevity, um, and you know, like diet, exercise, the usual.

SPEAKER_04 36:07

It's it's I think it's absolutely crucial because although we may not have lots of treatments that are curative, if we were to be able to prevent things happening earlier, we could make a difference. So it turns out that the decline in Alzheimer's disease can be compounded if your vascular supply to the brain is suboptimal. And why might your vascular supply to the brain, the blood supply to the brain, be compromised? Well, if you have high blood pressure or you have a high blood glucose, you're diabetic, or a high cholesterol, or if you smoke, or if you drink far too much, all of these things can compromise the blood supply to the brain. And um, in one study that we did looking at tens of thousands of people in the UK biomank, we found that if your blood pressure, systolic blood pressure was even one millimeter of mercury above 140, as you went up with that blood pressure, it made a difference to your cognitive processing speed. So if you can make that intervention in your 50s and 60s long before you might suffer from dementia, it can make a huge difference, I think, in terms of trying to delay the impact. So, as I said, um, you might be developing Alzheimer pathology, but not everyone gets Alzheimer's dementia. And one way that you might be able to defer that is to try and optimize the control of these vascular risk factors.

SPEAKER_01 37:43

Well, that's good to that's that's hopeful and positive, I think.

SPEAKER_04 37:48

That also includes exercise because that's a really important determinant of vascular risk.

SPEAKER_01 37:54

Yeah. So let's talk a little bit about cultural beliefs and spirituality. Um, in Wahid's story, you write about how cultural beliefs shaped his fear of being labeled mad. And I think there's a little bit of that anywhere you look. And you mentioned that many South Asian communities in the UK believe in uh djinn and spiritual causes of illness. On my podcast, I've been exploring how spiritual and religious beliefs shape people's health decisions. And, you know, for example, I was raised Catholic, I went to Catholic school, and the possibility of possession by a spiritual being is just part of the faith, right? Exorcisms is part of the faith. So you can't really call this misinformation. It's not health misinformation. It's it's more fundamental to a person's identity. It goes deep. And I think it actually influences a person more than health misinformation. I don't have that study or anything, but that's just my hypothesis. And I was wondering what your thoughts were on that. How do you navigate the spiritual realm or spiritual beliefs in your work?

SPEAKER_04 38:56

I mean, it depends on each individual that we see, right? Yeah. So I don't bring the spirituality to to the practice in some ways, but but I'm uh sensitive to other people's spiritual uh inclinations and their religious inclinations. So you mentioned Wahid. In fact, he came to see me because of visual hallucinations. He was very frightened of telling me that. He turned out to have Lewy body disease, but he didn't feel like he could tell either his family or members of his community, because, as you say, the they would think that he was possessed by a spirit, a djinn, or as we might say in English, a genie in some way, you know, an evil spirit. And um, it's very difficult to dispel those views if that's what you've broke been brought up with from a very young age. You know, that's that's the interpretation you would make. So we can be as logical as we like and try and explain to somebody, well, no, there aren't any genies, but that isn't necessarily going to change their view of the fact that there are djinn and genies in the world who can possess people. So I think what we can do is to try and reassure people that, for example, we don't think they're mad. He was uh worried that he would be locked up, he'd go to some asylum, some institution, because that's where he thought people with hallucinations go. He didn't think that that could be explained by anything else. And and I think for him, the proof of what we were saying was uh successful treatment. And that took a little while with the medications that we used, but when we were successful, we could gain his confidence that what we were doing was something that might actually be helping him and reassuring him that we didn't think he was mad at all. This was an understandable problem that we knew about could happen with this condition. Um and because some of these conditions are rare, or even if they're not rare, people don't really know much about them. Education is a huge part of what we try to do. And of course, how much information you give someone depends on their background and and also their willingness and interest to learn about this stuff, because some people just don't want to know. They don't want to know all these details because they find that frightening.

SPEAKER_01 41:29

Yeah.

SPEAKER_04 41:30

So so to to you have to be very careful about the way you explain something. It depends on what you think somebody would be able to cope with in terms of the explanation and the level of sophistication you go into. Um I I don't particularly do anything in terms of trying to explain this in a spiritual way. You know, I I don't necessarily subscribe to that, so I don't see why I should um try and do something which I don't necessarily believe in myself, but I will try and explain it as as well as I can for the person.

SPEAKER_01 42:06

Um that was actually my next question. I was curious because you spend so much time studying the brain and just disorders of the brain. And I was just curious if you think there may be aspects of human experience that lie beyond the purely material, or are you mostly it's all in the brain? No, no, no.

SPEAKER_04 42:24

I think I think um people can have experiences that would be very difficult to explain in a reductionist way. In fact, you know, we're all having very, very different experiences. And I couldn't tell you exactly what the molecular mechanisms were that led to that experience versus another one. But I think for us to have experiences, this must be something that we're explaining in terms of brain activity. Now, if there is a way to prove that you could have something more than that, I'd be very interested to see it. But it's actually quite difficult to prove, you know, that. Um, and that that's a problem.

SPEAKER_01 43:05

Yeah, no, I I completely agree. For me, I I need to have like a little, I don't know if it's magic. And I always tell myself if it's a delusion, I'm okay with it. It's a delusion that I accept. Uh but I like to think that there's something more. That gets me through the day.

SPEAKER_04 43:24

I mean, the question is, who created this experience? Was it something that your brain created, or was it something else? And I guess what we're talking about is who do we give this agency to, right? The experience that you had, could that be really something that your brain had created? Um, you know, a hallucination is something you would think, well, it's no, it's not me, because it's happening out there. It's something that's happening out there, it's not created by my brain. But you know, in some ways, neuroscientists now think even perception is like a controlled hallucination. It's not like we're just a Camera taking in this visual information and that's all we do. We are interpreting the play of light and dark, the colours on our retina, uh, because it's a flat retina, right? We are interpreting that information in terms of objects, shadows, movements, understanding what the what that fleeting change might be over a two-dimensional retina in terms of three-dimensional space. This is a very big thing for a brain to do. So it's actually interpretation of the visual scene as we're getting it through our eyes, is what we're doing. And that interpretation is open to biases. You know, what you might think as a shadow, I might think is oh my goodness, that's an that's a person there. And we can all do that, right? We can mistake a shadow as a as an individual and all the rest of it. So in a way, even normal perception is a kind of controlled hallucination.

SPEAKER_01 44:59

That's really interesting. Clearly, I feel like there's people who are more perceptive than others, and maybe they get, you know, some somebody might say, Oh, they have a sixth sense. And I'm like, I think they're just really tuned in.

SPEAKER_04 45:12

Yeah, they they they also, you know, we don't have to call it sixth sense, reading the room. You know, that's a term use, right? Yeah, but it really means that you're paying attention to what's going on around you in a way that other people don't.

SPEAKER_02 45:27

Yeah.

SPEAKER_04 45:27

The people don't read the room, um, and and interpreting it. You're interpreting the smiles. Is that really something positive or are they being cynical? You're making an interpretation of the same visual scene that another person might think there's nothing in there. I I don't read anything in this, right? So even reading the room is is actually uh an active inferential process when we're doing that.

SPEAKER_01 45:54

Yeah. I think a lot of people like Chat GPT and like the I've I've had, I mean, even friends using it as like a I'm gonna I'm putting therapist in quotes because not really a therapist, but um, I think because it's trained to like hyper focus on like every word that you put in. And you know, for humans, that it might be unusual, and especially in today's society, like to have that much focus and have this machine just like hang on your every word. And it's I I think people are getting addicted to it, like actually forming almost like relationships with it.

SPEAKER_04 46:31

I think it's it's actually a lot of people doing that, but it but it's also very good in the way it's uh that's a that's a great point, Erin. Um we should we should discuss that in more detail or something, you know. Um tell me about your childhood or whatever it is.

unknown 46:46

Yeah.

SPEAKER_01 46:47

I mean, and I know doctors do that, you know, they ask the open-ended questions, but it's you know, chat GPT is like always on for you and like always like there to analyze your thoughts and sit with you and help you work through a plan. It's um it's a little creepy, but it's uh helpful, but creepy.

SPEAKER_04 47:02

Exactly. I mean, I haven't I haven't used it in quite that way, but but I have used it where it has hallucinated or confabulated in the sense that you know academically you ask it a question and it comes up with a great answer, but it gives you a reference you cannot find. Yeah. And you and you say, Where can I find this reference? And then it'll come good catch. You know, yeah. It doesn't exist.

SPEAKER_01 47:27

That's happened to me too. I've asked it for like sources for certain things. Like, can you like find anything that supports this? And then I'll like, okay, that author doesn't exist, that paper doesn't exist. So we have to be really careful and don't copy and paste. Always tell that to people like, don't just copy and paste, make sure you look to see if it's an actual thing.

SPEAKER_04 47:44

Yeah, so it can it can confabulate. And so yeah, it has to be wary about large language models, yeah.

SPEAKER_01 47:50

Yeah. So you work with patients facing you know devastating neurological illnesses. And do you find it emotionally difficult to carry these stories with you? Or does just your work change the way you think about your own brain and mortality? Um, or like what's your philosophy for kind of coping, I guess?

SPEAKER_04 48:11

Yeah, I I think we do take patients' stories back home with us. I know patients may not think that, but we actually take those stories back home with us. Um, and I suppose when you file first start as a doctor, you you'll you take more of those stories home with you because they're new to you. And the more you see, I guess you get a little bit more used to seeing those stories. But um I don't think you you ever become immune to the personal and you know societal impact that some of these conditions have. And of course, if you if you read the book, you'll see that one of the things we do is also talk to the partner or you know, the friend of the person on their own. And that's when the revelation really comes clear that what might seem to be perfectly fine according to the patient is not perfectly fine at home. So the deep impact that some conditions have, not only on the person who's suffering it, but also on the people around them. You know, many husbands or wives will say, Well, this isn't the person I married, this is a completely different person now. And you know, I'm really a carer. Um, they don't really care about me in the sense that I thought they did. So it has a huge impact on other people, and you can't but be affected by that. And in terms of coping, I think we just have to think about the positive things. We do try to bring something to that difficult situation. And I say to the medical students, even if it's not treatments, the the other thing that people really appreciate is the humanity of meeting a doctor who cares. Because uh if they leave my office feeling a little even a little bit better than when they came in, because they'd had a human contact, they'd had a conversation with somebody who seemed to be empathetic towards them, who really wanted to listen to what they were saying. And often it's just about listening. I think that you can make a difference as a doctor to someone's life, even in that very small way.

SPEAKER_01 50:25

Absolutely, I agree with that 100%. Um, it's like that quote: you sometimes you don't remember what people say, but you always remember how they made you feel. Um I think that's true.

SPEAKER_04 50:35

That's particularly true in medicine, you know, because the study suggests that most patients remember only 10% of what is said in a consultation. So the other thing I say is to the students, just say less, you know. Don't bombard people with too much.

SPEAKER_01 50:56

Brevity is the soul of wit. I my last question for you what what do you hope readers take away from this book?

SPEAKER_04 51:05

I I hope that apart from what we've been talking about, which is uh a deep insight into neuroscience and how patients can tell us about how the brain works and how that can change their identity and self, I hope they will take away some bit of that humanity that comes across in the relationship between a doctor and a patient. So, you know, the the the book covers neurology, neurological disorders, but it also covers some aspects of philosophy and social psychology about the self, yeah, what makes a self. But I think it also reveals how we ourselves are so fragile, you know, that that this could happen to anyone, but I think it's uh telling us something a little bit also about how wonderful brains are that they create these selves. There's something also positive about this. Our brains can do this in such a sophisticated manner.

SPEAKER_01 52:03

Yeah. Sort of like in a bittersweet kind of way. It's because it's sad when it when it goes away, but it's you know, yes, but for most of us, it's it's you know, it's doing pretty well.

SPEAKER_04 52:14

And yeah, it's it's been there with us for this long. And you know, the vast majority of us are actually uh have brains that are working positively for us.

SPEAKER_01 52:27

Well, yeah, I I hope that's the case in my case, but um knock on wood, like my superstition. Um and it it is a great book, and I encourage my listeners to read it. And it's available on Amazon in the US now.

SPEAKER_04 52:42

Is it's it's it comes out in April, and there's a US launch in April, but it's available uh on Amazon now, yeah.

SPEAKER_01 52:50

Okay. Um and I'll be sure to include the link. And um, I hope people read it. It's very good. And I have to ask, this was your first book, if I remember.

SPEAKER_04 52:59

It is, yeah. It's my first book for the public.

SPEAKER_01 53:00

Did you enjoy writing it?

SPEAKER_04 53:03

I I I did. Uh, but you know, once you've written it, which was a couple of years ago now, uh, you think, oh, no one's gonna read this. But it's been fantastic that um people have enjoyed it and then it got the um Royal Society best.

SPEAKER_02 53:16

I saw that.

SPEAKER_04 53:18

So, you know, that's a real, a real Philip for someone who's written a book for the first time to think, oh my goodness, people actually appreciate it. So no, it's been it's been a really positive experience.

SPEAKER_01 53:29

That's great. Do you think you'll write more?

SPEAKER_04 53:32

It's on the way.

SPEAKER_01 53:33

Oh, okay. Thanks.

SPEAKER_03 53:35

It's on the way.

SPEAKER_01 53:36

Now now you are officially a writer.

SPEAKER_03 53:39

I don't know about that. Yeah.

SPEAKER_01 53:41

Now see, thanks so much. This was great. I really appreciate it. And uh whatever you write next, like I'll be on the lookout for sure. Great job with the book. Yeah, and congrats on the award. I saw that. I'm like, that's a pretty prestigious award to get.

SPEAKER_04 53:54

Thank you very much, Aaron. Thanks a lot.

SPEAKER_01 53:56

Enjoy the rest of your day.

SPEAKER_04 53:58

Thank you. Bye.

SPEAKER_01 53:59

Bye. All right, everyone. I hope you enjoyed today's conversation. If you'd like to learn more, check out Dr. Hussein's book, Our Brains, Ourselves. And of course, the link for that is in the show notes. Definitely read it. It's it's it's a good read, I promise you. As always, if you enjoyed this episode, please follow, rate, and review causes or cures wherever you listen to podcasts. You can also visit bloomingwellness.com. That's my little personal hub for more health and public health content or personal essays, whatever I feel like writing, really. And you can subscribe to my newsletter while you're there, because I write whatever I want in there too. It's kind of nice. It's a little place to just express your ideas. Um, and now for today's closing quote, this one is from Emily Dickinson, the great Emily Dickinson. The brain is wider than the sky. For put them side by side, the one, the other will contain with ease, and you keep aside. Until next time, goodbye for now.