So good evening everyone and welcome. I'm Nells Pearson professor of English and director of the humanities Institute And I'm glad to see you all out here tonight for the third annual humanities at work lecture featuring dr. Alice Weaver Flaherty I'm Nells Pearson and as I already said right and I wanted to start things off by thanking some of the people who've helped make this possible tonight in particular Dean Richard Greenwald the College of Arts and Sciences and The core writing program as well as the program in health studies and the MFA in creative writing who have partnered with the humanities Institute in making tonight possible. So thanks very much to those folks. I Just want to say a few words about the humanities at work initiative Which we in the Institute started about three years ago because we saw this somewhat ironic dichotomy That had developed in about the past decade decade or so maybe 10 to 15 years And that's that on the one hand you have this increasing Assumption that what students need to study in college has to be tied to specific pre-determined career aspirations And yet on the other hand over the same time We've seen increasing evidence that in actual fact our data-driven and interconnected world is creating ever greater demand for the more Flexible and individualistic intellectual skills that are taught in the humanities and really Every day now it seems we're hearing more stories about how algorithms specialists are calling on humanists to offer non-formulaic Interpretations how the real visionaries in technology business and government often turn out to be those who majored in the liberal arts and How the creative and artistic dimensions open up crucial pathways in medical sciences understanding of the human mind and body So I think it's really evident and important that we on college campuses start to talk more about the Multidimensional impact that the study of the humanities is having in our everyday society and So certainly part of the reason we're so glad to have dr. Flaherty here with us And I'm really delighted to introduce her tonight for those reasons She holds an MD from Harvard as well as a PhD from the Massachusetts Institute of Psychiatry She is a joint associate professor of neurology and Psychiatry at Harvard Medical School and a physician at Massachusetts General Hospital where she treats patients with movement and mood disorders Her research work includes primate electrophysiology Parkinson's disease and creativity At Mass General Hospital. She's director of the movement disorders fellowship and co-director of its deep brain stimulation unit Dr. Flaherty was a site principal investigator for the GAD AAV trial of the first successful genetic treatment of Parkinson's disease Her text the Massachusetts General Hospital Handbook of neurology Received a national award for its innovative approach and has been multiply translated Her work on the neurology of idea generation has been featured most recently in the Cambridge Handbook of the neuroscience of creativity And she also writes books that I can understand and most of us can understand Both her popular book on creativity the midnight disease dealing with writer's block and the neurology of human creativity As well as her children's book the luck of the Loch Ness monster have won national awards are multiply translated and have been dramatized Dr. Flaherty has been profiled in publications ranging from the New York Times to National Geographic She's appeared in a five-part radio topia podcast the great god of depression And is a subject of kareen botz's award-winning short film bedside manner The title of her talk this evening is theatrical medicine Empathy performance and the art of the cure so please join me in giving a warm Fairfield welcome to dr. Flaherty Turned my mic on sorry Can you all hear me now? I Tend to talk quietly and then I get faster and faster and faster when I get excited And so if that starts to happen people should just interrupt with a question or wave their hands or something So I'm gonna talk about The relationship between medicine and theater and I'm not somebody who had any interest in either of those when I was young I was not a theater jock and I actually hated doctors and it's you know It's probably some counter phobic thing that I actually became one. It was also so that I would never have to go to one again I could just treat myself but One thing that has struck me and I came to this realization probably too late is just how well art and medicine have to work together and the the one of the points of this talk is that medicine and all science really need art and That is something that we can all do as as practitioners or whatever field we go into And that good communication in any field really requires acting especially in colleges There's such an emphasis on the word that we forget that body languages is Crucial and the funniest one of the funniest fights I ever saw in an academic meeting was when some it was there was a bunch of psychologists and linguists and one of the more Academic ones said well, that's really smart and this guy just blew up He just blew up he started yelling and then he insulted everybody in the room like really effectively And and then the guy who's the linguist was like well There was nothing wrong with the words that I said and and I was thinking only a linguist would think that You know the emotion behind it wasn't much more important. So we're not going to make that mistake And so in that mode, I'm you know doctors like really easy solutions to complicated problems And this talk is going to have one weird old trick that's going to help you deal with difficult people in any field and then the other thing about Art helping science is that science can really help art in a lot of complicated ways And I'll talk both about the science behind what it is to be a good caregiver or what it is to actually try and Be sick in an effective way, you know like get to get better And how to communicate with people in that situation and also the biology of creativity, which is something that's interested me So why I'm using medical it medicine as an example one is like at this this point That's all I know about and then the other is that all of us actually are patients and caregivers and some of you Young healthy people may not believe that yet But I know everybody else knows it and even some of you young ones may have been taking care of your mother with who had multiple Sclerosis while you were growing up or a grandmother or So there's all these caregiver relationships that aren't formalized that are very important And then finally the the sort of the metaphor of medicine the idea of people needing things and people other people helping them Or not helping them. That's really the fundamental thing that holds society together So this is just a microcosm. I think and also have a sort of cheap art science interaction here Which is this Michael Michelangelo the God-creating Adam there's a lot of evidence that Michelangelo actually actually was trying to imitate the human brain when he drew God in that shape So how does our influence medicine we can give a lot of Examples and I'll just point out a few in some ways It's it's the artistic ability to communicate that's really effective here, but here's a couple one is that Things like even a BBC soap opera can actually have much more effect on health behavior than all the you know Dry handouts that you get in the doctor's office, and there was a BBC soap opera which killed off one of its its stars with Pap you know with a cervical cancer and then like they studied in the number of pap smears that people were asking for went up Significantly so not all the effects are good. It's those of you who know Gertis novel the sort of the young verter It started a suicide Epidemic that really like increased the death rate by suicide and young men were killing themselves in the sort of verter costume of well I think it was a yellow waistcoat and blue and they were all you know They found him so romantic even though the novel is in some ways about a stalker but To move on So one of the ways that art shapes our daily practice of medicine is just in the idea that We have to have a certain amount of artfulness and this is I'll talk about this in the future When we act sick or when we play doctor, that's a really disturbing idea. It makes it sound fake and I'll get to that but the other thing it does is it transmits medical beliefs, and I've used this picture This is actually a early early Picasso I think he was like 15 years old when he painted this and it was to win a contest which he did and it's called science and charity and I Think it's actually great for I think there's a lot of nursing students here This is a great picture because it shows the difference. Oh, I'm gonna get to this later. You know what forget everything I said I have a more I'm gonna come back to that but then the final thing that art can do is eat suffering and The idea that art is is like a medicine and can be good for people a lot of you know A lot of people read stories of other people with the same problems They feel less alone Freud talks about sublimation and how we can take our suffering and turn it into art Then there's memorism, which of course these days is big, you know, everyone just takes all their pain They put it in the book they get it published in the pains now outside of them, which is very Satisfying and then there's some real biological things like it turns out people with Parkinson's can actually Move better when they do it to a beat when they do it to music They can some people who are just like they go like this over to the radio and then turn the radio on and then they can dance so it's a really powerful effect and Expressive art therapy like people writing about what they've suffered with asthma actually improves like measurably improves lung capacities and things like that So here we have the poster child for that, which is phyloctetes Who was a Greek he was with Odysseus and he had this horrible smelly foot wound and they left him on some island because It was so gross, but in the end the André Gide version of it He actually consoles himself by the way he describes his suffering and So that's that's What that's about so now I'm gonna argue that the art of medicine is theater and Also that this makes us really uncomfortable for important important reasons to think about the You know doctors all have some layer of cultural pretensions and they go to the symphony and so forth but Their idea of what art is is a little degraded and so because I'm surrounded by humanists I should probably expose my biases so the way doctors when doctors like to talk about the art of medicine And they usually mean bedside manner sometimes if they're a surgeon They mean just the skill the sort of the mechanical skill of the performance of surgery But then after that they're understanding where it gets a little squiffy and one of the things that Art kind of means the unscientific part the part you can't really teach and that's really frustrating if you can't put it in a Textbook does it really exist and then there's a much more disturbing notion of art as really meaning artful or manipulative or Deceptive and so art is seen as fake and so doctors want to present themselves as Not artful and sincere but acting sincere of course is an oxymoron And then it's not always good for the patient if I tell you what I really think of you. That's not helpful Not you But theater really isn't just a metaphor in in in medicine because You know doctors like to brush under the rug the fact that Medicine arose from these healing rituals, you know with shamans and it was all about the laying on of hands And all there was was placebo. There were no medicines that were effective for a long time like medical doctors the Academy doctors only separated themselves from I just realized there's no clock in the room. Oh dear and I've turned my watch over there. It's 15 minutes. Okay That they only separated themselves from the quacks relatively recently and in the 21st century There's been a lot of theater coming right back into, you know, there's we still have operating theaters We still have special costumes. I mean like what other Professions do people wear special costumes besides priests doctors and probably in its soldiers But we have now hired actors who come in to help doctors learn how to be doctors better And so but the costumes and the theatrics a lot of that is actually very important in Helping the connection between caregivers and patients like have some meaning That's even beyond the cure even beyond the biology of what's going on and they can be really meaningful for everyone involved And I mentioned placebo effect because that's an incredible example of how important really theater is in medicine where I think everybody's familiar with the idea that a placebo depends on your expectations if I take a pill thinking it's a painkiller It will help my pain even if it's actually something that you know biologically makes my pain worse and vice versa The more important thing in medicine is often the no-cebo effect So someone who's had several very bad experiences with medicine the next medicine they take their heart's gonna race They're gonna feel short of breath because of their anxiety They'll expect their pain to get worse and it will and so you can you can often have a really difficult situation You finally find a drug that works But you have to first get the patient over that that hump and the way that you communicate The patient you teach the patient to expect one thing or another is incredibly powerful There's a lot of data. This is just a cartoon of it But that first of all we all know that many drugs the biological effect is on top of really huge placebo effect And also that the placebo effect is much bigger in trials where there's like very caring Research coordinators and everyone's paying attention to the patients and they think they're doing something new When you bring that drug out into the community the placebo effect is pretty small because it's like some primary care doctor Who's harried saying yeah, take this maybe it'll help So that aspect of theater is very important because we the placebo effect is real It's something that you can measure in the brain You can change it by putting an electrode in the book in the right part of the brain and with with medicines And if you don't have a placebo effect You're losing a big part of the benefit of any kind of intervention So I mentioned that in the 18th century doctors finally started to have some drugs that worked They had like you know, um foxglove for dropsy and they had opiates and so forth and so they started to separate themselves from the quacks and The problem is they're trying to not act like quacks what they did was they didn't want the theatrics of the medicine shows They had the scientific expression and the you know the impassiveness and so forth. That was still an act Right. It's actually a very difficult act that many med students have trouble acquiring and it's an it's an act That has its own problems I mean if you want that from your doctor it may be reassuring but many people don't and in a lot of cases It harms the placebo effect because the doctor feels that scientifically He has to tell you all the side effects before he tells you what might happen. That's good and so forth So here I want to get back to that Picasso painting because Especially for all the nursing students, you notice the nurse is on the light side of the room. She's nurturing She's offering some food and she's holding the baby the doctor's on the dark side of the room He's not making eye contact with the patients. He's just looking at the data. He's measuring her pulse and So I think that there's a lot saying that a lot there about doctors but so it matters But the other thing that's kind of interesting to think about is is this kind of interpretation of art as the handmade of Healing is that good for art because Picasso himself he didn't want to do this painting his father kind of dictated it to him And it was like to please the crowds and you know, it was popular For him this sort of programmatic art was actually not what he wanted to do and it's not what he's famous for So there's a lot to art that we're neglecting when we look at it in this way So one of the things that I got interested in was the role that theater has actually in healing doctors and making them more effective So when I was in med school, we didn't have these standardized patient programs where we had you know We might have had resuscitation and that was it in terms of theater But now most med students have had a fair amount of experience where they're doing Exams with patients who are trained to give feedback They're doing it in front of advisors and they're coming through at least the ones I've seen have been much better. They come out with much better bedside manner than me and many of my Colleagues, so I got interested in that and I ended up actually becoming a standardized patient for a couple of I both did the Teaching and then I also did the patient thing and this is actually a current boss's documentary where I was being a delirious patient I'm not a great actor. I can do delirium and anger and that's about it And that was a med student who when I told him that I was a doctor who wrote down grandiose on his And But the so all I'm saying is very doctor-centered because of course that's what doctors are And one of the things that struck me more and more partly because I accidentally had like six or seven major medical Illnesses and also my family all of which got better, but there was a whole series of things where I was in and out of the hospital I was like eight different services when I was a resident So I started thinking about patients and what patients need to do and how patients have to act now I had it really easy.  So I was like You know I could look up my own labs And I could boss people around and I called a consult on a Depressed patient in the next bed and told the surgeon that I had done that and so forth I knew that my patients couldn't get away with that But I also became aware of how some of them made me a much better doctor And I think for a lot of you in nursing this is like of course, but for doctors This is really surprising news and and they were able to you know express Gratitude in a way that made me want to help them and they were able to explain their symptoms in important ways So I got really interested in the amount of acting that patients have to do now patients They get terrified by this idea that they're acting You know because the worst thing is the doctor to say oh, you're just acting sick, right?  They'll say she's not really in pain So it's a really hard line that people have to To to cover So they often talk about I should probably look at my slides and see what's coming up They often try to think that they have to act naturally, but They don't get any guidance in that I'm gonna tell you in a minute why acting naturally causes its own problems and I Guess the bottom line here is that we're old in the sense that I'm using the word acting We're always acting as soon as you have to make a choice in a behavior, you know Past the age of five or acting and for young people that can feel very disturbing I think a lot of kids in high school and college they feel fake they feel like they've been taught these manners They don't want to do them They may have to act like a college student all of a sudden or behave in a certain way at work and and med students go through This too they're trying to play doctor and they feel incredibly fake and that's very disturbing So I want to kind of sympathize and also say you got to deal with it because the only way It's ever gonna feel real is if you do it enough that you get you know You've incorporated it into your sense of yourself. So when we talk about acting sick or illness behavior There's a lot of it. That's actually pretty hard-wired. It's biological and just as an example I'm giving you the six basic facial emotions that are you know, pretty much universal and None of us we don't need to be taught how to cry deaf kids know how to cry blind kids know how to win You know The only thing that we actually do need to learn and there is a lot that we need to learn is when not to But just as another example because it's interesting to me how much a lot of illness behavior is also defeat behavior And it's very conserved. So the kowtow Lobster that we you can you can tell which lobster is gonna win that fight, right? It's the one with the bigger power pose and Dogs kowtow Lobster's kowtow at the end of the fight. It's it's very hard-wired But there's also a huge amount that's learned and that's where it gets really complicated because it differs in different cultures So when I mentioned acting naturally the problem is that acting naturally is acting like a baby It's when you cut your finger and you start screaming if you do that in an ER people are gonna blow you off They'll say, you know, this is just attention-seeking so you have to know how to act in the ER that you happen to be in for instance if you're in an ER in Illinois it's very different from an ER in New York, and it's different from an ER in Mumbai. So Where do we learn to act sick?  They may have very real pain. It's it's coming across the wrong way So where do patients get a better education? That's something I'm very interested in and I won't go into it now But I have been doing some sort of frivolous things like I made this little wallet card to hand to people Not things not to do when you're in the ER and I'll just focus on a few of them Many of you already know them do not ever say I have a very high pain threshold It's like everybody says that and it's just like he's protesting too much Like he's had to a lot of people saying that pain doesn't really that's not really big pain a lot of other things You know, you can't be too anxious, but you also can't be too blasé about it You can't have too many weird drug reactions like I had one patient I just told her don't go in and tell them your weird list of drug reactions first Or they're gonna think you're a hypochondriac. I'll skip these other things But you know if you want the card you can ask me later. So I'm gonna mention the role of empathy I have first of all, I'm gonna assume everybody that's here probably is pro empathy, you know The kind it's a selection bias. So I'm actually gonna say a few things that are a problem with this concept Which I would never say to another audience But the role of empathy is something that I think also humanities departments are very interested in because there's some evidence that you know Reading novels teaches you empathy and in a lot of ways. That's good. So Here's a slide that doctors sometimes use when they talk about the power of empathy And I think a lot of you you look at that and you feel the girls distress You feel the creepiness of the feet on the face and everything So it's a very powerful emotion at least for those of you who hate our arachnids But the fact is it's also completely false in this case that girl is actually smiling She's wearing eye makeup. She was and this is a patient that's but a picture that's been turned sideways And this is her pet Tarantula, you know, and so we feel like we're feeling her distress. No, it's a totally an illusion And so there's the strength of the emotion and then there's the fact that it's sometimes very wrong that we have to always keep in mind I'm not gonna talk too much about cognitive perspective taking which is I think everybody thinks that that's a good idea to be able to know what the other person's point of view is But it's this emotional aspect that gets very fraught in in medicine So the thing that that bug me, I think that was mentioned I actually trained as a neurologist and so we have like zero bedside manner I mean we're kind of the worst we're worse than orthopedists and And so I didn't I was probably one of the people that came into medicine with the lowest empathy that mine actually got better Or as most people actually lose in med school But so my bias is a little bit anti empathy But I hope to make you understand at least some some some are the reason why part of it is that patients Just don't perceive your empathy, you know There's this idea that you're feeling their pain and the old psychoanalyst that's all they could do They weren't allowed to show it right, but they would feel it that didn't help anybody, right? You you don't know what they're feeling. It's only the expression that patients see And there's also the fact that empathic emotion can be incredibly painful I mean that's a lot of med students have been nursing students have a huge problem with that And the most empathic ones are often the people that then have to run out of the room because it's so painful But then there's this other side which is that the surgical approach where you just fix it And you don't have to show any emotion that can backfire to partly because the surgeon didn't actually Listen or ask enough questions to find out what you are feeling and then the other is it can just be just really Disturbing now any of you who haven't seen this video. I wanted to show it, but I don't have enough time and So go on YouTube. It's like the best video on the fix it versus You know just listening approach ever.  He's like that must be really hard for you And then she gets to a point where she says and every time I take my sweater off it snags And he just loses it and starts to try and fix things again. And so there's you know, there's different ways of looking at it but One of the things about caregiving that I think has been really interesting over the last The last number of years is that there looks to be a system in our bodies that helps that underlies Biologically underlies our feeling other people's motions or thinking that we feel them and it turns out that even it It's related to the mirror neuron system as some of you may know in which when we see somebody else doing something There's a system in our brain that makes us want to do it too, whether it's like your mother Sweeping the floor kids learn that way they by imitating their their parents Or if you're looking at somebody who's having an emotion and your face will kind of automatically take on that emotion too Not everybody for instance people with autism have much less of that it obviously varies from person to person But it's a pretty common thing. It's even in rats and monkeys and so forth And so infants do it too.  So The thing that was transformative for me is it's so much easier than trying to be calm when somebody's really really upset and It turns out that By and because we're never going to be mirroring their expressions as vividly as they do You can actually sort of deescalate things because if that person and I hope this is obvious But this applies to not just patience but to your boss to your kids when they're having a tantrum I was told to use this with angry schizophrenics in the ER to calm them down like you must hate this place And I didn't have the nerve to try that so I tried it on my kids and it was like Amazing. It was amazing. I'm still a bad mother, but I can calm them down when they're having tendons and So the the interesting thing is like, you know when I'm mirroring some somebody's emotion I'm especially because I'm a wasp I'm not doing a as nearly as vivid a job of it then there You know they've got empathy too so they're mirroring my emotion and then it sort of deescalates like this And once it's basically like once you're vibrating on the same frequency then you can change it But if I'm really calm and I say you must be so upset with me for taking the keys to the car And not letting you go to the prom and stuff like that. You're it's so patronizing, right? Don't you just want to hit me? And another thing that's kind of related to this is that often having words that are discordant with your body language Can really help calm people down. So there's a great study I think I'll remember the name of them in a minute But they they looked at telling patients anxious patients that their MRI results were good, you know, like, you know Don't worry. You don't have a brain tumor. It's great You can go home right not nearly as effective as as looking worried and saying you know actually the results were okay And we think it's safe. It looks like concern, right? It doesn't look like I'm scared It's like I know how important this is to you. So Just keep that in mind the next time you're trying to calm someone down whether it's your boss or anybody else So this is the transition we want right? Everybody's gonna be happy happy happy in the end But you can do it the other way too when someone's not caring right you can get them revved up So one final thing about empathy that that this is something I learned from the humanists humanists from a friend of mine Doris summer who mutual friend of ours Who said you know Alice empathy is really imperialist just you know talking about post-colonial? literary analyses of some of these texts were the you know the white writer just decides he Understands the suffering of the black man in Africa and no he actually doesn't and of his thinking that he's having Empathic emotions is just like so wrong that One of the things she taught me was it's much better to use that emotion that we have To ask just to ask questions and say well What is it like for you to at least get engaged and then let them tell you what it's actually like and not imagine that you know So I mentioned a little bit about the like the art of medicine the art of illness of being a patient actually has Some science behind it, and I'll just mention a few examples, but one is the biology of complaining So we all think of that as being something you learn and it totally is but there's also some very Interesting genes involved. So why do dentists but not surgeons think that redheads are sissies It turns out that the melanocortin receptor mutation that makes them redheads actually makes them insensitive to lidocaine So they're screaming because the lidocaine didn't work But it actually makes them bizarrely a little more sensitive to morphine So the surgeons who are giving them morphine, they think they're okay We're right And there's you know, there's all sorts of aspects of stoicism and complaining that are very medical like battlefield and analgesia You know like in a in a war or in a soccer game where you don't even feel the pain because you're so hyped up That that's learned and it's it's a virtue But it also depends on your endorphin levels and you can block it with an altrexone You can take a stoic person and turn them into a sissy simply by giving them an opiate blocker and you know We can say this is the it's it's actually something that mediates the placebo or a response to like you can block placebo effects by giving endorphin blockers There's also a lot of biology of being a bad caregiver which has interested me so someone did a study looking at How doctors become numb they had doctors who'd had about two years of training look at a painful procedure and They did brain scans of them and showed that the areas that normally light up when you're feeling empathic Didn't light up anymore and their brains were actually behaving more like people with autism that don't naturally have that reaction So it's like a learned autism and there's lots of good reasons for that You don't want to suffer as much as every patient you see But it's also kind of creepy how many other Aspects of sort of the autistic personality and you know And I'm obviously Generalizing unfairly about people with autism because doctors are way sicker than people with autism You know like in a lot of cases so but the poor eye contact the rapid monotone speech The use of jargon all these things that we think of as being very off-putting in people with autism Doctors acquire that on purpose to protect themselves and it turns out actually maybe that's why a lot of people with autism do Too that in fact they're so sensitive to other people's emotion that they have to shut them out so Then I finally I'm gonna come to the The science behind behind creativity because that was something that got me interested in this field to start with so when I was a How much of this story do I want to tell the when I was a in my series of illnesses one of the things that happened was I Got pregnant with twins. It was a high-risk pregnancy and actually both of them died fairly late in the pregnancy I delivered one alive and one dead and then the second the live one died and After that I had a postpartum mania. I just went totally I Got very agitated. It was it was partly everyone's like, oh, this is grief dear I was like, yeah, I know but I have all the you know like well excited I have all these things I want to do and one of the things I wanted to do was write all the time And I was part of me was sort of interested in that it was like, oh, you know, I'm having hypergraphia That's a thing and I'd read about it and you know, we get that from temporal lobe disturbances And so part of me was thinking what you know, what's going on with my brain? But then I like wrote three books. I had I did quite a lot of things. I was on TV a lot During this sort of prolonged I lasted about seven years where I was up and down like that And so I got interested in what was going on in my brain because if I could be hyper graphic was that related to what was Happening in other people's brains when they had writer's block and so this is based on some of the research I did at that point and We think of creativity again as being something that you learn or that it's a virtue but it's also something that's biological and Just to clarify because we always have to define things that you know, right? so creative work I'm just going to use this very simple definition that it's something that's both novel and useful and That turns out to be actually quite a useful way of thinking about it It's got lots of things that are influencing it But one of the things that's important I think is that it that drive turns out to be more important than talent Which is good because drives a little bit easier to manipulate in the in the brain and So a lot of the drive comes from these sort of subcortical projections that are Coming from sort of emotion areas in the brain Who has talent which sometimes we think of like the left brain right brain stuff like the left brain is talented at like number crunching and You know doing your taxes and the right brain is like the creative part That's actually, you know an oversimplification. You need both sides to do it, but that's much more involved in like the actual talent part of it but I'm going to talk about drive because That's something that you can change much faster like talent takes a long time to change But we can have zero drive one hour and then huge amount the next and sometimes that's very disturbing so one of the simplest ways about thinking of human drives that turns out to be very powerful is The fact that there's just two different drive systems in our brain. This is not just creativity. Obviously. It's everything There's Gold drive, which is what you want here. We have the amoeba model, right? So he wants to eat this thing or it let's say it and not be sexist And he's also got fear drive. He's running away from the pointy scary thing So there's this that's the two factors one is the valence whether it's positive toward something you want or Negative away from something you don't want and then the other factor is the energy just how activated you are so It turns out that this has implications for creativity, but even more broadly It's very important anytime. We want to change our state It turns out to be easier to change valence like whether you're attracted or afraid of something than it is to change the Intensity of the emotion and that is why everybody hates their ex-husband or their ex-wife They don't just have indifference to them because it you can't get to zero You can only change the emotion from love to to hate So what that means is when you're trying to when there's something you're afraid of like You know seeing your a patient for the first time or talking to your boss It's easier to reframe it as excitement and to say oh, I'm so excited to be doing this today to go talk to my boss It's great. That's actually an easier mind game to play than it is to say. Oh, I'm fine about this It's nothing But when we look at the here, I'm starting to get all neurology and wonky on you But when we look at the two drive systems in the brain, they have different chemistry. They're located in different spots They also of course have the different valence and they they manifest differently. So if you're If you're fleeing system if your fear system is too high, that's actually a kind of an OCD state But if you're seeking system is too high, that's actually an addiction state It's something that you actually want people with OCD don't want to be doing what they're doing and It turns out that the drive the desired drive the seeking drive is actually better at triggering creativity So that has several implications one is all of us have to manage our drive either at work or in academics and We often do it really badly and think that we have to cultivate our anxiety like I treat a lot of like Harvard and MIT professors and I'll say like gosh It seems like you're wasting a lot of energy being anxious every day And they're like oh well I can't I have to stay anxious or I just won't get any work done and they've been anxious so long They forgot that there's a whole other drive system that they could be curious and interested and driven from that way So part of the reason for that is actually Stockholm syndrome because our bosses and our deans and so forth know It's easier to motivate us with fear to motivate somebody else rather than getting them engaged Which is harder you just scare them right and so after we've been in that kind of system so long We think oh fear is good fear is good So don't and then a related thing is don't overuse willpower willpower turns out to be a very Limited resource. I mean it's energetically expensive. It's hard to do our willpower is not all that good in general And there are a lot of alternatives In which you can just minimize your use of willpower and one is habit Like if you can get yourself to make a habit of going to the gym Then it doesn't take any willpower. It's easy and in fact when it gets disrupted you get annoyed And you want to you want to go to the gym So how we form that those habits is a whole other talk But the one of the easiest things is to find environments that just give us the right queuing for habits Like if you're trying not to eat don't work in the kitchen if you're trying to work go to the library where everybody's gonna look at You funny if you start goofing off Some of this is obvious but it's interesting when we get to the fact that there are drugs that affect these systems and I'm gonna mention serotonin boosting drugs by which I mean SSRIs like Prozac and most of the common Antidepressants these days because they're very good at lowering fear drive They're not so good at boosting desire at boosting gold driving in some cases. They even decrease positive Motivation so that is linked to a lot of the side effects that these drugs have I mentioned this cuz like on average probably 10 or 20 percent of you are on an SSRI or have been and so I Treat a lot of students and people in academics who've had experiences with these drugs and many stop them because they say I felt bland or you know, I wasn't afraid of my PhD thesis anymore but I just didn't care about it and that's a problem with a drug that only decreases fear drive and There's a lot of ways of dealing with that one is to tweak it by adding in a drug that boost dopamine like be propion things like that and Just as a disclaimer Don't just go home and stop your SSRI if you've been having these side effects because you're gonna get a terrible rebound Effect just come and talk to me instead of doing that But now we're on the subject of dopamine which dopamine is as probably many of you know It's sort of the molecule of motivation and it's it's a positive motivation It's not fear motivation and it turns out that it does a lot to help creative drive And there's a lot of people who've written books on stimulants sometimes not the best books But you know, I'm gonna use Dr. Like Robert Louis Stevenson as the As the poster boy for this cuz he wrote Dr. Jekyll and Mr. Hyde in like six days on cocaine I also have a patient. In fact, I have a number of patients I treat them for Parkinson's with things that boost their dopamine and some of them get very creative Some of them become gamblers or hypersexual, but some of them start writing or making music And this is a CD that one of my patients I keep pushing this and there's actually not is there a light? Yeah, well, I'm just kind of waving it around so I'll stop That they You know, this is a guy who had no experience of music started taking Parkinson's meds Taught himself to play the piano taught himself to harmonize has had several DCDs published had a symphony That was performed to help, you know raise money for Parkinson's and so on and finally as a freakier example There are actually brain stimulators that if you put them in the right part of the brain in the right person They can make them creative by changing their drives This was a totally accidental thing that happened to one of my patients and it's happened to a few others where we were actually treating her Tourette syndrome, but the Electrode also got her if we turned it on in one part of her brain she got super revved up and She had all these new ideas and some of them were kind of flaky But she was pretty smart and a lot of them were good and her she was a editor and her boss was saying You know like what did they put in your brain and can can I have one? At the same time if we turned it on in another area, she got really depressed. She didn't care about anything. She just stayed in bed This was one experiment. We did with her. I mean, she's not an artist. So this is not Proof of that much, but this is when her stimulation was on and this is her flower When it was off like things are just so much more half, you know offhand and haphazard So that was like just sort of an easy way. We could just turn it on and off and change your creative state So that of course brings us to the question of you know, what drug should I take to finish my my paper for? class and What we all do everybody in college does is think about stimulants And there's actually some good evidence that careful intermittent use of stimulants can be helpful No one does that they all take too many of them and no one's gonna listen to what I'm saying anyway But just so you know it's the tolerance and the rebound that are the biggest problems So you use Adderall every day, whether it's your own or your friends You're going to need more and more and a lot of the mood benefit that you get in the first few days Wears off not every drug does that but a lot a lot of the stimulants You build up tolerance really fast then you stop it and you get a horrible rebound where you're just so tired and you think oh I need this med but in fact all you're experiencing is the wearing off of the You know that your body had been compensating for the medicine you take the medicine away and then you're way too tired so Stimulants can also when they're at too high level they can actually over stimulate you so that you can't do any creative work Or any work at all. There's like a Tuning curve where you want to have exactly the right amount of stimulation to be in the zone and When you're too high up you end up in this like deer in the headlights You're so frozen with activation that you can't work or you're too low and you're asleep So it's a difficult balance that all of us do every day whether it's with caffeine or with other things Just briefly I will go over a few other neurochemicals because they are what we Think about a lot alcohol. I think like A lot of people who get too stimulated they drank a lot of coffee to wake up and then they want to relax and they can't They're too wired and they they're they're Worrying too much about what their boss is gonna think and they can't write so then they have a glass of alcohol But it doesn't kick in fast enough So maybe they have a second one and then of course they've overshot a little bit They wake up with a hangover so they have more coffee and you get in this stimulant Sedation cycle there is some evidence I don't want to mostly do that alcohol can reduce people's creative anxiety and that can be useful in the very short term The way that it does it though is by lowering your standards It's like I you think this is pretty good, you know, it looks good because I'm drunk so you're not so anxious about it That's not terrible. I mean you can actually You can actually get more done if you're not too critical of your work It's just that in the long run you don't want to be using something that's neurotoxic because unfortunately alcohol Even at very low doses does cause problems with the brain now.  Yes I drink too. I wish that I know like What do I want to say just what what is that guy the most interesting guy in the world world says drink drink wisely, you know The was that the Doseki said so the So opiates opiates actually probably hurt creativity and that's especially upsetting for musicians because there's such a long tradition of musicians who are heroin addicts and Not so many writers although Coleridge, you know with his his opiate addiction was maybe one outlier But it turns out that part of the reason we like them is that the endorphins that when you have an aha moment It releases endorphins. So like the pleasure of discovery is endorphin mediated So people kind of like that about opiates. It gives you that pleasure of discovery, but at the same time it's making you Too tolerant you get used to the medicine and then you don't get any kick from your own endorphins So you don't get any actual pleasure of discovery. You only get the pleasure from the bigger doses of opiates Then the final problem with all looking at all the drugs is there are so many creative people who are addicts But it turns out it's not a correlation is not causality many people with many creative people have mood disorders Many people with mood disorders are alcoholics or drug addicts, but it's not then the two things aren't causative so that brings us to I'll just talk briefly about some safer things which In some ways, I didn't set up. I didn't set up a lot of this bike I left out some bits about the sort of ebb and flow in your brain between Just spilling out the ideas like I talked about how alcohol can make you Perfectly happy to put out a lot of ideas and that actually that can be helpful because it may come up with some good Ones just by accident But then if you're editing too soon and making two to rigid judgments about your About your work that can be bad So what you want is environments where you can have ideas and not feel too anxious about them And that's what think tanks are and that's to some extent what and you know Academic institutions are where we can explore ideas. We can write papers without having our job on the line And so a place like this even with you know all colleges and universities have their defects But they are places where you can explore and and generate ideas without getting slammed And then I mentioned the fact that mild brain stimulants things like exercise and light therapy Which are safer for your brain can be quite helpful and we did a couple of experiments with even just light boxes Which I can show you how to build for like 20 bucks Where bright light early in the morning which tricks your brain into thinking that it's the summer Turns out that people tend to be much more creative and active in the summer than the winter Sort of a hibernation instinct when you trick your brain with early morning light Into thinking that it's summer you start performing better and I'm mentioning this especially because of this weekend is daylight savings so for those of you who are looking forward with that to to that with dread come up to me afterwards and I'll show you how to make a light box for $20 and Then finally exercise so a lot of people when they're finishing a big paper They say I have to let's say that your PhD thesis right after spend all my time at my desk I have to be working this is the most important thing and it turns out that you would probably do better if you just took a You know an hour and went off and exercised now. I did not believe this when I was in graduate school. I was a total total weenie I had like zero You know interested in exercise except a few things but The thing that convinced me was my patients how much better they did when they were exercising So I became sort of like a geezer jock and then I found all the data showing the exercise actually boost creativity So but if you don't have time what do you do you get a treadmill desk and you can build one for like 50 bucks? You get one on Craigslist you have to saw off the top and put it under your desk works great And you can both exercise if you you have to pace yourself, right? Like if you're working too hard all your energy goes into your work into your Writing like you cannot really generate text walking five miles an hour uphill but It can actually Give you a lot of energy and people who think while they're walking like a lot of people will just walk around and come up with Ideas in the winter they can do that in the privacy of their own home So I mentioned when I was talking about addiction and mood disorders this link that we all it's sort of fabled between Mental illness and creativity, which is another way that the sort of medicine creative link comes back and This this definition that I mentioned which sounds a little bit oversimplified about creativity being novel and useful in a particular context that shows how close it is to To madness or the craziness because crazy is novel but not useful, right now That's also culturally dependent So you have a crazy something could be a crazy idea in one culture and then quite useful in another culture So it's not something that's inherent in the person. It's the person in a context But there has been a fair amount of evidence now looking for mental illnesses that are then Neurological illnesses as well brain illnesses that are linked to creativity. There's a lot of them that are Sort of rumored or fabled to be linked that there's really not much evidence for The ones that there's more evidence for is hypomania, which is not full mania, but like mild mania Schizotypy, which is not full schizophrenia, but mild schizophrenia Temporal lobe dysfunction like some people with temporal lobe seizures like Dostovsky or Lewis Carroll That activity actually made them more creative Parkinson's disease drugs. I mentioned what oddly there's less evidence for is depression There's so many people so many writers with depression that and Creative people in general that we've always linked them, but it turns out that nobody's writing when they're depressed They're writing maybe in the hypomanic periods after they come out of the depression But it's not the depression itself. That's good for their brain and People that are just too sick like fully manic people fully schizophrenic people are not performing Creative work Autism I mentioned because of course we're all familiar with the phenomenon of autistic savants, which is really a We think of it as a phenomenon of talent like this kid who can just suddenly compose or or as perfect pitch And can do all these amazing Improvisations it turns out that's actually drive driven as well that what gets autistic kids to learn these skills as they practice all the time They don't describe the drives well because they're not articulate about their emotions But that's the phenomenon But it tends not to be a particularly creative type of Talent because people are often like they're doing very representational or they draw what they see and so forth It's still an amazing thing And then attention deficit deficit disorder is another thing that there's not too much evidence either that it helps or hurts Creativity and similarly with the meds like a lot of people with ADHD will say my meds make me less creative There's a whole other interesting thing going on which is people with ADHD sometimes get a sort of a dysphoric Sensation from the meds so it feels unpleasant, but it's not actually hurting their work So things get complicated So I wanted to talk about creativity a little bit because it becomes so fraught You know you have people say how could you say that Virginia Woolf had bipolar disorder? You know she was that was the highest level of health and you know It's insulting to her to say that well You know actually it's insulting to people with bipolar disorder to treat it like some kind of vice for one thing but the other thing is that Even people who were quite ill like Sylvia Plath who had you know, I'm probably Manic depression as well. She said herself that when she was sicker. She was not more creative. She was just sick That was all she was so I will stop there And I'm happy to take questions And if people have questions later, she'd feel free to email me is this on yeah, okay, so If you have a question, I can just come over to you with the microphone So maybe Alice can hear you a little bit better Hi there, I was really interested in what you were saying about people almost developing signs of autism to cope with too much Sensitivity could you speak or do you know if there's research about? Does that become to a point of no return like can somebody overuse that so much that they can't go back to being more? I don't think so I mean I don't know if there's any research on that Subject but what I would say is probably not because I know so many of my colleagues who get totally shut down at work And then can go home and actually can still have relationships with their family and their friends They just put patients in a different category. You know what? I mean, it's a little bit like what we do with you know People of other races or nationalities like they're not really people so they start shutting people patients out that way But they can do it Quite flexibly and there are some pretty interesting and scary experiments of how fast we can lose empathy There's an experiment where you're playing an economic game Like one of these things where someone can cheat you or not like the prisoner's dilemma and you're doing it in a brain scanner And so it's a situation where either someone cheats you or they don't cheat you and then later as part of the experiment You see that person. It's not really that person, but you see them getting an electric shock So if they didn't cheat you most people have empathic brain response like oh, that's awful if they cheated you the men that they studied actually experienced pleasure and And they also had no empathy activity in their brains And this is in the course of like a 10-minute game that they played it can change that much so I Said men there because it actually turned out that women behaved very differently in this experiment and the women were they Didn't have the decrease in their empathy so I probably shouldn't go it's a very complicated paper, but It was interesting to think about why and at first I thought well women are just less vindictive But then I thought like well if it was a different thing like I don't care whether I lost five dollars But if it was my daughter that that guy had been mean to I would totally be pushing the button to shock I'm so it may just have been the the reward that was used So I can tell you where it's from in the brain because it's a brain defect that I know I have I have a lot of trouble not being funny, and it's a problem when people are dying, right? I mean you don't want to be telling jokes. I mean you can try and make them appropriate, but So all the weird disorders have German names are like these dead German guys So Vitzel such fact I mean I guess that's just it's not somebody's name. It's just Vitzel suit is the it's a inferior frontal lesion that makes you See things as funny when they're not and then Mariah, which I think is a little bit more anteriorly in the brain makes you just tell jokes compulsively and I Don't know. Maybe it was my manic episode that just fried those areas, but it's a problem Is that did that answer your question or did it just seem glib because I'm actually serious see even when I'm serious I sound like I'm joking, but it is a problem for me not to be funny not something I share Yes So it's very popular. I had a slide that was anti narrative medicine But I took it out because it was kind of mean but doctors love the so narrative medicine for those of you Who don't know and it has very good origin. So Arthur Kleinman who's a guy who wrote a book called the illness narrative? Talked about how we should understand patients sense of themselves in their story. We can understand their life We'll understand their illnesses a lot better What it has and now there's institutes like Columbia has an instituted or I don't know if it's an institute or what? But they have a narrative medicine program where people will do things like You know a lot of times it's writing out as patients story as you know as in a literary way You know there's lots of advantages to that. You're you're kind of esthetizing the experience in a way that can make it less painful You know you turn it into a story and it's beautiful and it has meaning and it's more bearable for the doctor There's also some things that are creepy about it Like you're basically being taught to read the patient like a book and the patient is just this passive thing That's opening and you're the critic, you know like oh well, that's a good part of that story or that's pretty boring and try and It's not allowed. That's why I like I actually I mean I was a writer I came to Art and medicine from that perspective, but I started to realize how it totally shut the patient out of the story at best They're just like Performers and then you judge like how good their performance was but there's no sense of the interaction You know the text doesn't talk back to you so It's it's a big thing and it's very useful for a lot of people So I don't want to there's not too many other ways that you can make pain bearable And yet not like just brush it under the rug except by turning it into an aesthetic experience So I don't want to minimize that but narrative medicine I think is very much based on the words and not the gestures and not the human interactions and So yeah, that's my bias, but it's very big I did go by it that Purdue fast and then I was kind of stuck later because I tried to say some other things that depended on depended on my not having Skimmed over that. Oh That so is this the one? Yeah, so Some of the drive stuff the ventral tegmental area is down in the front It's like inferior frontal area, which it has a lot to do with positive drives and the nucleus accumbens Actually the ventral none of you care. Sorry. I'm being a neurologist VTA is a little bit further back nucleus Cummins is a little forward you're a fey in the cingulate which control Serotonin production they're back in the brainstem, but they're going very broadly to the cortex now most of the like the business end of it What we experience is the stuff that's happening in the cortex, but these are the Sort of midbrain fibers that are coming up and Stimulating you or not Yeah Yeah, I think that's really interesting for one thing I see so many of my patients who start to write poetry or paint or whatever as they're trying to process you know either their own illness or illness of some family member or a death and so it's clearly in that sense provoking creativity Chronic trauma you're too busy fighting off the bad thing to be creative You know, that's why Neanderthals didn't do a lot of art because they were too busy not being eaten and so forth I mean they did some I don't want to say bad things about Neanderthals, but So there's a great book by Susan Suleiman who's a she was a French professor Which I can't remember the name of but maybe you do yeah, so anyway, she wrote about people who had It was children children who had had very traumatic childhoods during World War two and how many of them became artists and how it affected their art There's a really cool example that she talked about there's a book in French that he doesn't use the letter e anywhere in the book It's and it's sort of this joke, but it also was serious because For him the letter e symbolized his parents I think it was like it was like the pronoun that he thought of them they'd been killed in World War two So it was a book that was his parents were absent from There were also some very funny reviews like one guy didn't realize what was going on He's like there's such weird word choice in this book, you know and it was also hard to translate but There are a lot of One of the things that trauma does is it makes you it makes you pretty activated, right? Like people with trauma histories are very hyper vigilant that kind of activation if it's to the right degree can make you very creative I think most people with PTSD their problem is they're so activated all the time. They can't sleep They can't stop scanning the room for danger. They don't have the You know, they've got too much else on their plate to be creative So I would say like single trauma is probably better and in general probably one of the reasons that mental illness may be Useful for creativity is mental illness is kind of like trauma without the actual trauma Like you're somebody who's so revved up like if you have like when I was manic. I had no neat I was in a very, you know comfortable situation. I was just revved up all the time, but I wasn't fighting off anything So I had all this extra energy and I worked as if my life depended on it even though it didn't I mean That's sick, right? I mean it was it was ridiculous and if I'd been in a different environment I would have just crashed and burned But that excessive Motivation that you see in some people with mental illness without the trauma It's kind of like you get the benefit without the having to deal with the trauma It caused a lot of trauma, but that's separate And you talk about how evolutionarily we got from there to here and even currently There are cultural differences. There's some societies. There's some groups that are less artistic Oh, I'm so glad you and that's such an interesting question So a paper that influenced me greatly is actually an Adam Gopnik article in the New Yorker There were such interesting ideas in that paper that have never really been I mean he was the guy that thought him up But what his his paper his article was called The fifth blade and it was like why are there now razor blades that have five blades in them? Like why are there so many different types of razor blades like that's ridiculous, right? And he was talking about how it happens because we have so much resources and so much luxury that we have We can just go off and make a new razor or we can have like 50 different types of ketchup and you know All the wonderful software this come out because we have the resources to do that and so he said Necessity is not the mother of invention Necessity makes you have to work to stay alive and it's luxury. That's actually the mother of invention And then he had actually some evolutionary data showing that you can use a sort of Speciation art analogy so when we think of Like survival of the fittest that doesn't produce a whole lot of variety of species all the helpful mutants that that Evolve, you know, they're all born in times of luxury where everybody survives, you know, there's enough food for even the The guy with the new the new growth on his head that's going to turn into an eye even he survives And then later when when necessity comes along it kills off a lot of those a lot of the species in a few of them survive I don't know if I'm speaking too fast to make that clear, but the idea is that You need you need to have the resources to be able to play when you think about Most creative ideas are bad, you know, they're just sort of by definition 99% of them are going to be wrong and If you're in a dangerous environment, they're going to get you killed if you're in a rich environment You can have all sorts of bad ideas and say oh that was a bad idea, but you're none the worse for it so the only problem is that there's also the issue of motivation and Fear and you know even fear is not as good as as curiosity But it's way better than no motivation in terms of doing creative work So having had something that gets you going, but then also having a lot of resources is probably the best Intermediate did I answer your question or did I go off a wall? Yes, and no, I think you know the five types of five five bladed razors That's a first world issue right but when you think of the number of problems that are facing the less developed countries there obviously is a huge need for creativity and there's also a lot of very cool creative stuff that's being done and You know the fact is we don't need all that much like the the mathematician Ramana John I think was his name that That he grew up in a little village in India, you know and he was very poor But he had enough food to stay alive and he had enough free time that he could do math puzzles in his head And so that was a situation where he didn't have luxury in our sense of the word But he had the luxury of free time and that's all he needed, you know met Mathematicians only need a piece of paper and a pencil Another aspect of that, you know the idea that our brains are maybe getting more creative I Don't know, you know probably they'll they'll unearth some Neanderthal DNA and into some iceberg and be able to recreate a Neanderthal and we can test those hypotheses, but I think that Clearly, you know we think of creativity in terms of high art and like This sort of but there's creativity in everyday life That's also super important like everybody needs to be creative to figure out like how to get to work on time or Things like that that that are the same things in our brain And so that pretty much any environment those are going to be selected for it's just the sort of foofy first-world creativity That we call creativity that He's a lot of luxury at that level. Yes when you were talking about drive like there are different Brain it's cortical areas that are involved in making a machine versus making music probably But but in the terms of drive, they're the same But you know, here's the problem those same areas that are causing creative drive and curiosity They're also involved in libido and in excessive spending and all sorts of other drives that tend to get to go right along What you know so like Picasso having how many women did he slept with I forget so there is some correlation between being very Driven in one field and some less socially acceptable fields, you know, I'm a sort of Amateur in that field. I'm very interested in it like why is our brain so influenced by music, right? like what makes everybody march in step like you don't have to be taught to walk to the beat and There's clearly there's a there's a great old David Attenborough Documentary on the origin of music where who's just kind of speculating but I like to speculation So I'll repeat them and one of them is you know, there's for if you look at other species music has several roles It's made made attraction territory defense and nurturing behavior like lullabies basically so it's like marching tunes Ballads or you know love songs and lullabies and that's kind of the basis of what they're doing for us, too Only they've we've made it much more complicated The I can tell you in Parkinson's that there is a gate pattern generator in the The brain stem they get screwed up in Parkinson's so they have a lot of trouble with gate ignition once they get started They can walk But if you make a beat even a metronome or if you sing like if I have a patient who's got gate freezing If I sing or I go left right left right then he can start walking with that kind of cue So there are these pattern generators that seem to be very involved there I think a lot of the other like say maybe music and asthma or something that may be In more in the sense of if music lifts your spirits, that's good for your breathing because you sweet less adrenaline and you're you know Your bronchioles might open up. So some of that is mood made mood motivated, but not everything and There are definitely people that know more than me about that. I think we'll take just one more and then and then wrap things up Have seen you So you've spoken a lot about the neurological or chemical makeup and science behind creativity But I'm wondering I guess the reverse of the corollary. So thinking about then how we use art and creativity to then create new Chemical makeups or chemistry within the brain. I'm thinking like art therapy or writing and journaling for medical recovery So what have you found within that kind of realm? There's there's not a whole lot of evidence for art therapy Except it likes and I should take that back like some of those things where people wrote about their medical problems And then their problems were measurably better Maybe we state your question and I'll maybe think of something smarter to say when I have more time Yeah, I mean there's definitely data in Rheumatoid arthritis or maybe it's osteoarthritis, but arthritis asthma and then there's like the whole separate thing of like Parkinson's words kind of some brain stem thing going on and There's all sorts of oh, there's like a great project in Children's Hospital in Boston where they get kids with asthma cameras and just tell them to take pictures of their lives And their asthma gets better.  Sometimes it's mediated by mood, but you know, is that so wrong? But the question is like if you could make them happy in some other way is the art important. I don't know but There's also I mean, there's some defects of like mental illnesses that are like over like rumination You know people who are depressed and they're constantly chewing on their problem Some of those end up turning into like philosophers philosophers ruminate, right? Like it's it's a way of turning your mental illness into a into an academic field So that's what do I want to do with that is that good, I think so yes, it's good Thank you very much It's always good to end it with a shout out to philosophers. So Thank you all for coming and if you're interested Alice's book the midnight disease is up here for sale The bookstore has a few up here. Thanks all for coming out


Epithelium is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. Epithelial tissues line the outer surfaces of organs and blood vessels throughout the body, as well as the inner surfaces of cavities in many internal organs. An example is the epidermis, the outer most layer of the skin. There are three principal shapes of epithelial cell, squamous, columnar, and cuboidal. These can be arranged in a single layer of cells as simple epithelium, either squamous, columnar, or cuboidal, or in layers of two or more cells deep as stratified layer either squamous, columnar or cuboidal. In some tissues a layer of columnar cells may appear to be stratified due to the placement of the nuclei, this sort of tissue is called sugestratified. All glands are made up of epithelial cells. Functions of epithelial cells include secretion, selective absorption, protection, transcellular transport, and sensing. Epithelial layers contain no blood vessels, so they must receive nourishment via diffusion of substances from the underlying connective tissue, through the basement membrane. Cell junctions are well employed in epithelial tissues.