Ep 14: “Psychedelics, Impulsivity, and Brain Stimulation” with Dr. Heather Berlin *On Consciousness*
“In many cases you can see an immediate effect, as in chronic depression – suddenly you turn on the electrodes – you don't tell them when it's on or off, right? And their whole face lights up. And you ask, "What do you feel like?" And they say, "Oh, it feels wonderful. It feels like I won the lottery! It's so great!"
– Dr. Heather Berlin, Neuropsychologist and Assistant Clinical Professor at Mount Sinai
Episode 14: "Psychedelics, Impulsivity, and Brain Stimulation" with Dr. Heather Berlin *On Consciousness*
In this episode, our guest is neuropsychologist Dr. Heather Berlin, an Assistant Clinical Professor in Psychiatry at Mount Sinai School of Medicine. Dr. Berlin conducts research to better understand the neural basis of impulsivity, compulsivity, and emotion with the goal of more targeted treatment. She employs neuroimaging and neuropsychological and psychopharmacological testing of brain lesion and compulsive, impulsive, and personality disorder patients. She is also interested in the neural basis of consciousness, dynamic unconscious processes, the use of psychedelics to treat mental disorders, and in the neural basis of creativity. We discuss her work and interests in this episode.
- 0:00 – Introduction
- 3:09 – Impulse Control and Associated Brain Areas
- 9:27 – Finding a Balance: Healthy Brain vs Impairment and Self Regulation
- 17:40 – The Essence of Obsessive-Compulsive Disorders
- 24:40 – The Big News: Deep Brain Stimulation as an Effective Treatment for OCD
- 29:29 – Brain Aspects of Stress and Resilience
- 37:01 – How Effective is Deep Brain Stimulation?
- 41:59 – Advances in Psychedelic Research
- 45:15 – Psilocybin and Ego Dissolution
- 54:18 – Pharmaceutical Addiction Tapering
- 58:12 – Flow States, Mystical Experiences: “The Cosmic Perspective”
- 01:04:46 – Possibilities
Dr. Berlin has done an enormous range of work, which you can distill into this very profound question: “How do we control our unwanted impulses, our desires, our emotions, our reactions with other people?” These are very common questions, starting very early in life.
For example, imagine yourself as a child looking at the most delicious food, let’s use ice cream, and not being allowed to eat it… impulse control is having to wait. Impulse control is not just a problem in childhood, it is perhaps the major problem in adults who have significant psychological troubles. This includes the addictions, but also severe mood swings that adults want to change, but do not seem to have the power to change in these moments. When it is hard to control repeated impulses, we talk about compulsions; cigarette smoking can be seen as a compulsion. When repetitive thoughts are hard to regulate, we talk about obsessions.
There seems to be a tug of war between those deep midbrain nuclei and the control system which involves the prefrontal cortex. Various areas of the prefrontal cortex have somewhat different effects, but prefrontal is associated with self regulation, while midbrain nuclei have to do with impulses, motivations, emotions, and so on. The prefrontal cortex is sometimes called the “organ of civilization” or as Heather dubs it, “the brake system”.
The Big News
It is amazing how low level electrical stimulation by microscopic electrodes can profoundly change human mood disorders, like severe depression. The brain areas stimulated include the nucleus accumbens and ventral striatum of the basal ganglia, and local areas in the prefrontal cortex.
“Medical science is often an art as well as a science, but Deep Brain Stimulation (DBS) really can have significant effect and impact on people with difficult-to-treat conditions, like OCD (Obsessive Compulsive Disorder), but also people with intractable or untreatable depression,” says Dr. Heather Berlin.
DBS can be surprisingly effective. As Dr. Berlin points out, “DBS is a huge success story. 40 to 50% of patients with severe untreatable depression, and about 60 to 70% of patients with severe OCD all have significant improvement in people who’ve tried every first line treatment and nothing has worked. In many cases you can see an immediate effect, as in chronic depression -- suddenly you turn on the electrodes -- you don't tell them when it's on or off, right? And their whole face lights up. And you ask "What do you feel like?" And they say "Oh, it feels wonderful. It feels like I won the lottery! It's so great!" And as they're talking, you turn off the electrodes and you just see their whole affect drop right back down.”
Surprising Advances in Psychedelic Research
In the 1960s, psychedelics got a mixed reception, because many people had spectacular experiences, but physicians often wondered if there were harmful side effects. Now we are seeing a return to psychedelics as a promising treatment for different neuropsychiatric conditions.
The new therapies always combine the psychedelic-assisted treatment with the presence of a specialized psychotherapist. Dr. Berlin gives us a summary of the new discoveries in the use of psychedelics, including MDMA for the treatment of PTSD, psilocybin to treat anxiety and people with end of life issues, ketamine, a dissociative anesthetic, for the treatment of severe depression and particular suicidality, and more recently DMT (or ayahuasca) as a treatment for certain psychiatric illnesses.
After 50 years of persistent efforts to find solutions, in the last decade we finally have treatments with dramatic positive effects. Dr. Heather Berlin presents us with recent medical breakthroughs for very severe life problems that have been difficult to address.
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Dr. Heather Berlin is a dual-trained neuroscientist and clinical psychologist, and assistant clinical professor of psychiatry at the Icahn School of Medicine at Mont Sinai in NY. She explores the neural basis of impulsive and compulsive psychiatric and neurological disorders with the aim of developing novel treatments. She is also interested in the brain basis of consciousness, dynamic unconscious processes, and creativity. Clinically, she specializes in lifespan (child, adolescent, and adult) treatment of anxiety, mood, and impulsive and compulsive disorders (e.g. OCD), blending her neural perspective with cognitive behavioral therapy, mindfulness, and humanistic approaches. You can visit her website at https://www.heatherberlin.com/