Well, as Chris pointed out, I study the human brain, the functions and structure of the human brain. And I just want you to think for a minute about what this entails. Here is this mass of jelly, three-pound mass of jelly you can hold in the palm of your hand, and it can contemplate the vastness of interstellar space. It can contemplate the meaning of infinity and it can contemplate itself contemplating on the meaning of infinity. And this peculiar recursive quality that we call self-awareness, which I think is the holy grail of neuroscience, of neurology, and hopefully, someday, we'll understand how that happens.
Kao što je Chris spomenuo, bavim se proučavanjem ljudskog mozga -- funkcijom i građom ljudskog mozga. Želio bi da promislite na trenutak o svemu što to povlači za sobom. Ta želatinozna masa -- kilogram i pol teška može vam stati na dlan ruke, a sposobna je promišljati o međuzvjezdanim prostranstvima. Sposobna je promišljati o značenju beskonačnosti i može samu sebe promatrati kako promišlja o značenju beskonačnosti. Tu neobičnu rekurzivnost, koju nazivamo samosvijest, osobno smatram Svetim Gralom neuroznanosti, neurologije, te se nadam da ćemo, jednog dana, razumjeti kako ona nastaje.
OK, so how do you study this mysterious organ? I mean, you have 100 billion nerve cells, little wisps of protoplasm, interacting with each other, and from this activity emerges the whole spectrum of abilities that we call human nature and human consciousness. How does this happen? Well, there are many ways of approaching the functions of the human brain. One approach, the one we use mainly, is to look at patients with sustained damage to a small region of the brain, where there's been a genetic change in a small region of the brain. What then happens is not an across-the-board reduction in all your mental capacities, a sort of blunting of your cognitive ability. What you get is a highly selective loss of one function, with other functions being preserved intact, and this gives you some confidence in asserting that that part of the brain is somehow involved in mediating that function. So you can then map function onto structure, and then find out what the circuitry's doing to generate that particular function. So that's what we're trying to do.
Dakle, kako proučavati ovaj misteriozni organ? 100 milijardi živčanih stanica, sitnih snopova protoplazme u medusobnoj interakciji, iz čega izranja čitav spektar sposobnosti koje nazivamo ljudskom prirodom i ljudskom svijesti. Kako do toga dolazi? Pa, postoji mnogo načina kako bi se objasnile funkcije mozga. Jedan, najčešće korišten, jest proučavanje pacijenata s trajnim oštećenjem neke male regije mozga, u kojoj je došlo do genetske promjene. U tom slučaju ne dolazi do sveobuhvatnog umanjenja svih vaših mentalnih kapaciteta, niti do otupljenja kognitivnih sposobnosti. U stvari, dobijemo visoko selektivan gubitak jedne funkcije dok druge funkcije mozga ostanu netaknute, na temelju čega možemo pouzdano pretpostaviti da je taj dio mozga umiješan u ostvarivanje te određene funkcije. Tako možete mapirati funkciju unutar strukture, i potom otkriti koji dio mozga je važan za nastanak određene funkcije. I to je ono što pokušavamo napraviti.
So let me give you a few striking examples of this. In fact, I'm giving you three examples, six minutes each, during this talk. The first example is an extraordinary syndrome called Capgras syndrome. If you look at the first slide there, that's the temporal lobes, frontal lobes, parietal lobes, OK -- the lobes that constitute the brain. And if you look, tucked away inside the inner surface of the temporal lobes -- you can't see it there -- is a little structure called the fusiform gyrus. And that's been called the face area in the brain, because when it's damaged, you can no longer recognize people's faces. You can still recognize them from their voice and say, "Oh yeah, that's Joe," but you can't look at their face and know who it is, right? You can't even recognize yourself in the mirror. I mean, you know it's you because you wink and it winks, and you know it's a mirror, but you don't really recognize yourself as yourself.
Prikazat ću vam nekoliko iznenađujućih primjera. Zapravo, tri primjera, svaki u trajanju od šest minuta. Prvi primjer je izuzetno neobičan sindrom po imenu Capgras. Ako pogledate prvi slajd, vidite sljepoočni, čeoni i tjemeni režanj mozga -- oni tvore mozak. Ukoliko pogledate, smještena u unutrašnjoj površini sljepoočnih režnjeva -- ovdje je ne možete vidjeti -- nalazi se mala struktura, vretenasta vijuga (gyrus fusiformis). Nju nazivaju licem mozga jer, kada je ona oštećena, više ne možete prepoznati ljudska lica. Možete ih još uvijek prepoznati po glasu i reći -- da, to je Joe, ali ne možete ih pogledati u lice i znati tko je to. Čak ni sebe ne možete prepoznati u zrcalu. Mislim, znate da ste to vi jer kad namignete i odraz namigne, i znate da je to zrcalo, ali ne prepoznajete sebe kao sebe.
OK. Now that syndrome is well known as caused by damage to the fusiform gyrus. But there's another rare syndrome, so rare, in fact, that very few physicians have heard about it, not even neurologists. This is called the Capgras delusion, and that is a patient, who's otherwise completely normal, has had a head injury, comes out of coma, otherwise completely normal, he looks at his mother and says, "This looks exactly like my mother, this woman, but she's an impostor. She's some other woman pretending to be my mother." Now, why does this happen? Why would somebody -- and this person is perfectly lucid and intelligent in all other respects, but when he sees his mother, his delusion kicks in and says, it's not mother.
OK. Taj sindrom je dobro poznat i izaziva ga oštećenje vretenaste vijuge. Ali postoji još jedan rijedak, zapravo toliko rijedak sindrom da je vrlo malo liječnika, čak i neurologa, uopće čulo za njega. Zove se Capgrasov sumanuti poremećaj, a to je pacijent koji je sasvim normalan, koji je imao ozljedu glave, izašao iz kome, inače sasvim normalan, pogleda svoju majku i kaže, "Ovo izgleda kao moja majka, ova žena, ali ona je uljez -- to je neka druga žena koja se pretvara da je moja majka." Zašto se to događa? Zašto bi netko -- a radi se o sobi koja je inače razumna i inteligentna u svakom pogledu, ali kada pogleda svoju majku, pojavi se sumanuta ideja i kaže da to nije majka.
Now, the most common interpretation of this, which you find in all the psychiatry textbooks, is a Freudian view, and that is that this chap -- and the same argument applies to women, by the way, but I'll just talk about guys. When you're a little baby, a young baby, you had a strong sexual attraction to your mother. This is the so-called Oedipus complex of Freud. I'm not saying I believe this, but this is the standard Freudian view. And then, as you grow up, the cortex develops, and inhibits these latent sexual urges towards your mother. Thank God, or you would all be sexually aroused when you saw your mother. And then what happens is, there's a blow to your head, damaging the cortex, allowing these latent sexual urges to emerge, flaming to the surface, and suddenly and inexplicably you find yourself being sexually aroused by your mother. And you say, "My God, if this is my mom, how come I'm being sexually turned on? She's some other woman. She's an impostor." It's the only interpretation that makes sense to your damaged brain.
Najčešće objašnjenje ovoga, koje ćete pronaći u svim udžbenicima psihijatrije, jest frojdovsko i glasi da je taj momak -- i isto se može primijeniti na žene ali ja ću pričati o momcima -- kada je bio mala beba, osjećao je snažnu seksualnu privlačnost prema majci. To je takozvani Edipov kompleks. Ne kažem da vjerujem u to, ali to je klasično frojdovsko gledište. Kako rastete, moždana kora se razvija, i inhibiraju se latentni seksualni porivi prema vašoj majci. Hvala Bogu, jer biste inače svi bili seksualno uzbuđeni kada vidite svoju majku. A onda se dogodi da vas nešto udari u glavu, ošteti vam moždanu koru, i omogući da svi latentni porivi izrone, buknu na površinu, te iznenada i neobjašnjivo zateknete sebe kako vas seksualno uzbuđuje vlastita majka. Pa kažete sebi, "Bože, ako je to moja mama, kako to da me seksualno privlači? To je sigurno neka druga žena. Neki uljez." Ta interpretacija vašem oštećenom mozgu jedino ima smisla.
This has never made much sense to me, this argument. It's very ingenious, as all Freudian arguments are -- (Laughter) -- but didn't make much sense because I have seen the same delusion, a patient having the same delusion, about his pet poodle. (Laughter) He'll say, "Doctor, this is not Fifi. It looks exactly like Fifi, but it's some other dog." Right? Now, you try using the Freudian explanation there. (Laughter) You'll start talking about the latent bestiality in all humans, or some such thing, which is quite absurd, of course.
Meni to objašnjenje nikada nije imalo smisla. Ono je vrlo genijalno, kao i svi frojdovski argumenti -- (smijeh) -- ali meni nije imalo smisla, jer sam vidio tu istu sumanutost, pacijent koji ima istu sumanutost prema svojoj pudlici. (smijeh) Rekao bi, "Doktore, ovo nije Fifi, izgleda isto kao Fifi, ali to je neki drugi pas." -- Istina? E sad pokušajte tu primijeniti frojdovsko objašnjenje. (smijeh) Počet ćete govoriti o prikrivenoj sodomiji u ljudi, ili o sličnom, što je prilično apsurdno.
Now, what's really going on? So, to explain this curious disorder, we look at the structure and functions of the normal visual pathways in the brain. Normally, visual signals come in, into the eyeballs, go to the visual areas in the brain. There are, in fact, 30 areas in the back of your brain concerned with just vision, and after processing all that, the message goes to a small structure called the fusiform gyrus, where you perceive faces. There are neurons there that are sensitive to faces. You can call it the face area of the brain, right? I talked about that earlier. Now, when that area's damaged, you lose the ability to see faces, right?
Dakle, što se stvarno ovdje događa? Kako bismo objasnili taj čudnovat poremećaj, proučavamo građu i funkciju normalnih vidnih puteva u mozgu. Normalno, vidni podražaji dolaze do očne jabučice, pa idu u vidna područja moždane kore. Postoji 30 vidnih područja u zatiljnom diijelu mozga, nakon što se sve to obradi, poruka odlazi u malenu strukturu po imenu vretenasta vijuga, gdje opažate lica. Tamo su smješteni neuroni osjetljivi na lica. Možete ih zvati licem mozga, je l' tako? O tome sam govorio ranije. Kad je to područje oštećeno, izgubili ste sposobnost da vidite lice, je l' tako?
But from that area, the message cascades into a structure called the amygdala in the limbic system, the emotional core of the brain, and that structure, called the amygdala, gauges the emotional significance of what you're looking at. Is it prey? Is it predator? Is it mate? Or is it something absolutely trivial, like a piece of lint, or a piece of chalk, or a -- I don't want to point to that, but -- or a shoe, or something like that? OK? Which you can completely ignore. So if the amygdala is excited, and this is something important, the messages then cascade into the autonomic nervous system. Your heart starts beating faster. You start sweating to dissipate the heat that you're going to create from muscular exertion. And that's fortunate, because we can put two electrodes on your palm and measure the change in skin resistance produced by sweating. So I can determine, when you're looking at something, whether you're excited or whether you're aroused, or not, OK? And I'll get to that in a minute.
Ali iz tog područja, poruka odlazi u strukturu nazvanu amigdala u limbičkom sustavu, emocionalnoj srži mozga, a ta struktura, amigdala, procijenjuje emotivni značaj onoga što gledate. Je li to lovina? Grabežnjivac? Partner? Ili je to nešto beznačajno poput komada tkanine, ili komada krede ili... ili -- ne bih baš pokazao u to ali -- ili cipela ili nešto poput toga? OK? Nešto što možete u potpunosti zanemariti. Ukoliko je amigdala podražena i radi se o nečem važnom, poruka odlazi u autonomni živčani sustav. Srce počinje brže kucati, počinjete se znojiti kako biste oslobodili toplinu koju ćete stvoriti mišićnim radom. I sva sreća da je tako jer vam možemo staviti dvije elektrode na dlan i izmjeriti promjenu otpora kože, koja nastaje znojenjem. Tako mogu utvrditi, kada gledate nešto, jeste li uzbuđeni ili niste, OK? Vratit ću se na to za tren.
So my idea was, when this chap looks at an object, when he looks at his -- any object for that matter, it goes to the visual areas and, however, and it's processed in the fusiform gyrus, and you recognize it as a pea plant, or a table, or your mother, for that matter, OK? And then the message cascades into the amygdala, and then goes down the autonomic nervous system. But maybe, in this chap, that wire that goes from the amygdala to the limbic system, the emotional core of the brain, is cut by the accident. So because the fusiform is intact, the chap can still recognize his mother, and says, "Oh yeah, this looks like my mother." But because the wire is cut to the emotional centers, he says, "But how come, if it's my mother, I don't experience a warmth?" Or terror, as the case may be? Right? (Laughter) And therefore, he says, "How do I account for this inexplicable lack of emotions? This can't be my mother. It's some strange woman pretending to be my mother."
Dakle moja je ideja bila da, kada taj momak pogleda u objekt, u svoju -- u bilo koji objekt, zapravo -- to ide u vidna područja i obrađuje se u vretenastoj vijugi, i prepoznajete ga kao grašak, stol, ili svoju majku, OK? Tada se poruka seli u amigdalu i odlazi u autonomni živčani sustav. Ali je možda kod tog momka spona koja ide od amigdale do limbičkog sustava prekinuta tijekom nesreće. A zato što je vijuga netaknuta može još uvijek prepoznati svoju majku, te reći, "O da, ovo izgleda kao moja majka." Ali pošto je spona do emocionalnih centara presječena on kaže, "Ali kako to da, ako je to moja majka, ne osjećam nikakvu toplinu?" Ili užas, kao što zna biti slučaj. Jel' tako? (smijeh) Stoga on kaže, "Kako da opravdam ovaj, neobjašnjivi, nedostatak emocija? Ovo ne može biti moja majka. To je neka druga žena koja se pretvara da je moja majka."
How do you test this? Well, what you do is, if you take any one of you here, and put you in front of a screen, and measure your galvanic skin response, and show pictures on the screen, I can measure how you sweat when you see an object, like a table or an umbrella. Of course, you don't sweat. If I show you a picture of a lion, or a tiger, or a pinup, you start sweating, right? And, believe it or not, if I show you a picture of your mother -- I'm talking about normal people -- you start sweating. You don't even have to be Jewish. (Laughter)
Kako to ispitati? Kada biste bilo koga od prisutnih stavili ispred ekrana i mjerili galvansku reakciju kože te prikazali slike na ekranu mogao bi izmjeriti kako se znojite kada vidite objekt poput slola ili kišobrana -- naravno, ne znojite se. Ali ako vam pokažem sliku lava, tigra ili erotsku sliku, počet ćete se znojiti, jel'da? I, vjerovali ili ne, ako vam pokažem sliku vaše majke -- govorim o normalnim ljudima -- počet ćete se znojiti. Čak ne morate biti Židov. (smijeh)
Now, what happens if you show this patient? You take the patient and show him pictures on the screen and measure his galvanic skin response. Tables and chairs and lint, nothing happens, as in normal people, but when you show him a picture of his mother, the galvanic skin response is flat. There's no emotional reaction to his mother, because that wire going from the visual areas to the emotional centers is cut. So his vision is normal because the visual areas are normal, his emotions are normal -- he'll laugh, he'll cry, so on and so forth -- but the wire from vision to emotions is cut and therefore he has this delusion that his mother is an impostor. It's a lovely example of the sort of thing we do: take a bizarre, seemingly incomprehensible, neural psychiatric syndrome and say that the standard Freudian view is wrong, that, in fact, you can come up with a precise explanation in terms of the known neural anatomy of the brain.
E sad, što se događa ukoliko to pokazujete ovom pacijentu? Uzmete pacijenta i pokazujete mu slike na ekranu i mjerite njegovu galvansku reakciju kože. Stolovi, stolice, tkanina...ništa se ne događa, kao kod normalnih ljudi, ali kad mu pokažete sliku majke, galvanska reakcija kože izostaje. Ne postoji emotivna reakcija prema majci zato što je prekinuta spona između vidnih područja i emotivnih centara. Dakle, vid mu je uredan jer su vidna područja netaknuta, emocije su mu normalne -- smijat će se, plakati... -- ali je spona vid-emocije prekinuta i to dovodi do sumanutosti da je majka uljez. To je divan primjer onoga čime se bavimo, uzmemo bizaran, naizgled neshvatljiv neuropsihijatrijski sindrom, kažemo da je frojdovsko gledište pogrešno, te da je moguće pronaći točan mehanizam u okviru i s pomoću neuroanatomije.
By the way, if this patient then goes, and mother phones from an adjacent room -- phones him -- and he picks up the phone, and he says, "Wow, mom, how are you? Where are you?" There's no delusion through the phone. Then, she approaches him after an hour, he says, "Who are you? You look just like my mother." OK? The reason is there's a separate pathway going from the hearing centers in the brain to the emotional centers, and that's not been cut by the accident. So this explains why through the phone he recognizes his mother, no problem. When he sees her in person, he says it's an impostor.
E da, ako taj pacijent ode i majka ga nazove on će podići slušalicu i reći, " Ej mama, kako si? Gdje si?" Ne postoji sumanutost preko telefona. A onda mu ona nakon sat vremena priđe , a on kaže, "Tko si ti? Izgledaš kao moja majka." OK? Razlog je postojanje zasebnog puta, od slušnih centara u mozgu do emotivnih, koji nije prekinut nesrećom. To objašnjava činjenicu zašto majku prepoznaje preko telefona. A kada je vidi uživo, kaže da je to uljez.
OK, how is all this complex circuitry set up in the brain? Is it nature, genes, or is it nurture? And we approach this problem by considering another curious syndrome called phantom limb. And you all know what a phantom limb is. When an arm is amputated, or a leg is amputated, for gangrene, or you lose it in war -- for example, in the Iraq war, it's now a serious problem -- you continue to vividly feel the presence of that missing arm, and that's called a phantom arm or a phantom leg. In fact, you can get a phantom with almost any part of the body. Believe it or not, even with internal viscera. I've had patients with the uterus removed -- hysterectomy -- who have a phantom uterus, including phantom menstrual cramps at the appropriate time of the month. And in fact, one student asked me the other day, "Do they get phantom PMS?" (Laughter) A subject ripe for scientific enquiry, but we haven't pursued that.
OK! Kako su ti putevi postavljeni u mozgu? Da li je to urođeno ili zavisi o odgoju? Tome problemu pristupamo razmatranjem drugog zanimljivog sindroma poznatog kao fantomski ud. Svi znate što je fantomski ud. Kada nekome amputirate ruku ili nogu, zbog neke bolesti poput gangrene ili sve učestalijih nesreća, još uvijek imate jak osjećaj prisustva nestale ruke, te se to zove fantomska ruka ili noga. U stvari, možete dobiti fantom skoro pa bilo kojeg dijela tijela. Vjerovali ili ne, čak i unutrašnjih organa. Imao sam histerektomirane pacijentice koje su imale fantomsku maternicu, ukljičujući i menstrualne grčeve u odgovarajuće doba mjeseca. Jedan me je student pitao neki dan, imaju li i fantomski PMS? (smijeh) Tema zrela za znanstveno proučavanje...OK
OK, now the next question is, what can you learn about phantom limbs by doing experiments? One of the things we've found was, about half the patients with phantom limbs claim that they can move the phantom. It'll pat his brother on the shoulder, it'll answer the phone when it rings, it'll wave goodbye. These are very compelling, vivid sensations. The patient's not delusional. He knows that the arm is not there, but, nevertheless, it's a compelling sensory experience for the patient. But however, about half the patients, this doesn't happen. The phantom limb -- they'll say, "But doctor, the phantom limb is paralyzed. It's fixed in a clenched spasm and it's excruciatingly painful. If only I could move it, maybe the pain will be relieved."
Znači sljedeće pitanje je, što možemo saznati o fantomskim udovima eksperimentiranjem? Jedna od stvari koju smo otkrili je da oko polovice pacijenata s fantomskim udovima tvrdi kako mogu micati njima. Potapšat će brata po ramenu, podići će slušalicu telefona, mahnuti njime. To su vrlo snažni, živopisni osjećaji. Pacijent nema sumanute misli. Zna da ruka nije tu ali je to ipak snažan osjećaj koji pacijent doživljava. Ipak, polovini pacijenata se to ne događa. Fantomski ud -- reći će, "Ali doktore, on je paraliziran. Fiksiran je, u grču i nepodnošljivo bolan. Možda bi bol popustila kada bih ga mogao pomaknuti."
Now, why would a phantom limb be paralyzed? It sounds like an oxymoron. But when we were looking at the case sheets, what we found was, these people with the paralyzed phantom limbs, the original arm was paralyzed because of the peripheral nerve injury. The actual nerve supplying the arm was severed, was cut, by say, a motorcycle accident. So the patient had an actual arm, which is painful, in a sling for a few months or a year, and then, in a misguided attempt to get rid of the pain in the arm, the surgeon amputates the arm, and then you get a phantom arm with the same pains, right? And this is a serious clinical problem. Patients become depressed. Some of them are driven to suicide, OK?
Zašto bi fantomski ud bio nepomičan? Zvuči kao oksimoron. Ali kada smo pogledali u dokumentaciju, otkrili smo da je kod pacijeneta s paraliziranim fantomskim udom ta ruka i prije amputacije bila paralizirana zbog ozljede perifernih živca, živac koji inervira ruku je prekinut u, npr., automobilskoj nesreći. Tako da je pacijent imao pravu ruku koja boli, koja je u zavoju mjesecima, te je onda obmanut željom da ukloni bol u ruci kirurg amputirao ruku, i onda dobijete fantomsku ruku sa istim bolovima, jel' tako? To je ozbiljan klinički problem. Pacijenti postanu depresivni. Neki čak dovedeni do samoubojstva, OK?
So, how do you treat this syndrome? Now, why do you get a paralyzed phantom limb? When I looked at the case sheet, I found that they had an actual arm, and the nerves supplying the arm had been cut, and the actual arm had been paralyzed, and lying in a sling for several months before the amputation, and this pain then gets carried over into the phantom itself.
Pa kako onda liječiti taj sindrom? Zašto se pojavljuje paralizirani fantomski ud? Kada sam pregledao dokumentaciju, otkrio sam da su imali pravu ruku i da su živci bili prekinuti, te da je prava ruka bila paralizirana i u zavoju nekoliko mjeseci prije amputacije, i da se bol prenijela na fantom.
Why does this happen? When the arm was intact, but paralyzed, the brain sends commands to the arm, the front of the brain, saying, "Move," but it's getting visual feedback saying, "No." Move. No. Move. No. Move. No. And this gets wired into the circuitry of the brain, and we call this learned paralysis, OK? The brain learns, because of this Hebbian, associative link, that the mere command to move the arm creates a sensation of a paralyzed arm. And then, when you've amputated the arm, this learned paralysis carries over into your body image and into your phantom, OK?
Zašto se ovo događa? Kada je ruka čitava, ali paralizirana, mozak govor ruci, "Pokreni se", ali dobiva odgovor, "Neću." Pokreni se. Neću. Pokreni se. Neću. I to se ugradi u moždane puteve, i to nazivamo naučenom paralizom. Mozak, zbog Hebbianove teorije, uči da sama naredba da se ruka pomakne stvara osjećaj paralizirane ruke, a kada amputirate ruku, ova naučena paraliza se prenese u sliku vašeg tijela i u fantom, OK?
Now, how do you help these patients? How do you unlearn the learned paralysis, so you can relieve him of this excruciating, clenching spasm of the phantom arm? Well, we said, what if you now send the command to the phantom, but give him visual feedback that it's obeying his command, right? Maybe you can relieve the phantom pain, the phantom cramp. How do you do that? Well, virtual reality. But that costs millions of dollars. So, I hit on a way of doing this for three dollars, but don't tell my funding agencies. (Laughter)
Kako pomoći ovim pacijentima? Kako ga odučiti naučenu paralizu da biste ga oslobodili iscrpljujućeg grča fantomske ruke? Što ako pošaljemo naredbu fantomu, ali mu damo vizualni odgovor da je naredba poslušana? Moža biste ga mogli osloboditi fantomske boli i grča. Kako to postići? Pa...virtualnom stvarnošću. Ali to košta milijune dolara. Pronašao sam način da to napravim za tri dolara, ali nemojte to reći mojim sponzorima. (smijeh)
OK? What you do is you create what I call a mirror box. You have a cardboard box with a mirror in the middle, and then you put the phantom -- so my first patient, Derek, came in. He had his arm amputated 10 years ago. He had a brachial avulsion, so the nerves were cut and the arm was paralyzed, lying in a sling for a year, and then the arm was amputated. He had a phantom arm, excruciatingly painful, and he couldn't move it. It was a paralyzed phantom arm.
Potrebno je napraviti, takozvanu, kutiju zrcala. Uzmete kartonsku kutiju sa zrcalom u sredini, i onda stavite fantom -- tako je došao Derek, moj prvi pacijent. Amputirana mu je ruka prije 10 godina. Imao je brahijalno otrgnuće, tako da su živci bili presječeni i ruka paralizirana u zavoju godinu dana, a potom amputirana. Imao je fantomsku ruku, iscrpljujuće bolnu i nepokretnu. Bila je to paralizirana fantomska ruka.
So he came there, and I gave him a mirror like that, in a box, which I call a mirror box, right? And the patient puts his phantom left arm, which is clenched and in spasm, on the left side of the mirror, and the normal hand on the right side of the mirror, and makes the same posture, the clenched posture, and looks inside the mirror. And what does he experience? He looks at the phantom being resurrected, because he's looking at the reflection of the normal arm in the mirror, and it looks like this phantom has been resurrected. "Now," I said, "now, look, wiggle your phantom -- your real fingers, or move your real fingers while looking in the mirror." He's going to get the visual impression that the phantom is moving, right? That's obvious, but the astonishing thing is, the patient then says, "Oh my God, my phantom is moving again, and the pain, the clenching spasm, is relieved."
Ja sam mu dao tu kutiju sa zrcalom, koju zovem kutijom zrcala, jel' tako? I on je stavio lijevu fantomsku ruku unutra, na lijevu stranu zrcala i normalnu, zdravu ruku na desnu stranu zrcala, i zauzeo isti, zgrčeni, položaj i pogledao u zrcalo -- i što je doživio? Vidio je kako je fantom "uskrsnuo", zato što zapravo gleda u zdravu ruku u zrcalu, koja izgleda kao da je fantom "uskrsnuo". "Sad", rekao sam, "sad gledaj, mrdaj fantom -- svoje prave prste ili pomiči svoje prave prste dok gledaš zrcalo." Dobit će dojam da se fantom pomiče, jel' tako? To je očigledno, ali zapanjujuće je to da pacijent tada kaže, "O Bože, moj fantom se ponovno pomiče, a bol i grč nestaju."
And remember, my first patient who came in -- (Applause) -- thank you. (Applause) My first patient came in, and he looked in the mirror, and I said, "Look at your reflection of your phantom." And he started giggling, he says, "I can see my phantom." But he's not stupid. He knows it's not real. He knows it's a mirror reflection, but it's a vivid sensory experience. Now, I said, "Move your normal hand and phantom." He said, "Oh, I can't move my phantom. You know that. It's painful." I said, "Move your normal hand." And he says, "Oh my God, my phantom is moving again. I don't believe this! And my pain is being relieved." OK? And then I said, "Close your eyes." He closes his eyes. "And move your normal hand." "Oh, nothing. It's clenched again." "OK, open your eyes." "Oh my God, oh my God, it's moving again!" So, he was like a kid in a candy store.
I zapamtite, moj prvi pacijent koji je došao -- (Pljesak) Hvala! Moj prvi pacijent je došao i pogledao u zrcalo, a ja sam mu rekao, "Pogledaj odraz fantoma u zrcalu." I on se počeo hihotati, "Vidim svoj fantom." Ali nije on glup. Zna da to nije stvarno. Zna da je to odraz u zrcalu, ali je to živopisno osjetno iskustvo. "A sada pomiči svoju normalnu ruku i fantom", rekao sam mu. On kaže, "O, mogu pomicati fantom. Znate. Boli." Ja kažem, "Pomakni svoju normalnu ruku." A on će, "O moj Bože, fantom se ponovno miče, ne mogu vjerovati! A bol nestaje." OK? I onda sam rekao, "Zatvori oči." Zatvorio ih je. "I pomakni normalnu ruku." "O, ništa -- opet je u grču." "OK, otvori oči." "O Bože, o Bože, opet se pomiče!" Bio je kao dijete i slastičarnici.
So, I said, OK, this proves my theory about learned paralysis and the critical role of visual input, but I'm not going to get a Nobel Prize for getting somebody to move his phantom limb. (Laughter) (Applause) It's a completely useless ability, if you think about it. (Laughter) But then I started realizing, maybe other kinds of paralysis that you see in neurology, like stroke, focal dystonias -- there may be a learned component to this, which you can overcome with the simple device of using a mirror.
Ovo dokazuje moju teoriju o naučenoj paralizi i ključnoj ulozi vizualnih ulaznih podataka, ali neću baš dobiti Nobelovu nagradu zato što sam nekoga natjerao da pomakne fantomski ud. (Smijeh) (Pljesak) To je potpuno beskorisna sposobnost, ako malo razmislite. (Smijeh) Ali onda sam počeo shavćati, da možda i druge vrste paralize koje možete susresti u neurologiji možda imaju naučenu komponentu koje se možete riješiti pomoću zrcala.
So, I said, "Look, Derek" -- well, first of all, the guy can't just go around carrying a mirror to alleviate his pain -- I said, "Look, Derek, take it home and practice with it for a week or two. Maybe, after a period of practice, you can dispense with the mirror, unlearn the paralysis, and start moving your paralyzed arm, and then, relieve yourself of pain." So he said OK, and he took it home. I said, "Look, it's, after all, two dollars. Take it home."
Pa sam mu rekao, "Vidi, Derek" -- prije svega, ne može čovjek okolo hodati s zrcalom da bi umanjio bol -- "uzmi ga doma i vježbaj s njim tjedan, dva. Možda, nakon nekog vremena, uspiješ odučiti paralizu i počneš pomicati svoju paraliziranu ruku, i riješiš se tada boli." Pristao je i uzeo ga sa sobom. "Na kraju krajeva to je dva dolara. Nosi ga kući."
So, he took it home, and after two weeks, he phones me, and he said, "Doctor, you're not going to believe this." I said, "What?" He said, "It's gone." I said, "What's gone?" I thought maybe the mirror box was gone. (Laughter) He said, "No, no, no, you know this phantom I've had for the last 10 years? It's disappeared." And I said -- I got worried, I said, my God, I mean I've changed this guy's body image, what about human subjects, ethics and all of that? And I said, "Derek, does this bother you?" He said, "No, last three days, I've not had a phantom arm and therefore no phantom elbow pain, no clenching, no phantom forearm pain, all those pains are gone away. But the problem is I still have my phantom fingers dangling from the shoulder, and your box doesn't reach." (Laughter) "So, can you change the design and put it on my forehead, so I can, you know, do this and eliminate my phantom fingers?" He thought I was some kind of magician.
I on ga je odnio kući i nakon dva tjedna me nazvao, i rekao mi, "Doktore, nećete vjerovati." "Što?" "Nestao je." "Što je nestalo?", pitam ja. Mislio sam da je kutija zrcala nestala. (Smijeh) "Ne, ne, ne, znate onog fantoma kojeg sam imao 10 godina? Nestao je." Ja sam rekao -- zabrinuo sam se. Rekao sam, Bože, mislim, promijenio sam ovom čovjeku sliku o tijelu, a što je s eksperimentiranjem na ljudima, etikom i ostalim? Rekao sam: "Derek, da li ti to smeta?" On kaže, "Ne, posljednja tri dana nemam fantomsku ruku pa ni bol, ni grčeve, svi bolovi su nestali. Ali problem je što mi fantomski prsti i dalje vise sa ramena, a vaša kutija ne doseže do tamo." (Smijeh) "Pa ako biste mogli promijeniti dizajn i staviti mi je na čelo znate, da bih mogao ukloniti i fantomske prste?" Mislio je da sam mađioničar.
Now, why does this happen? It's because the brain is faced with tremendous sensory conflict. It's getting messages from vision saying the phantom is back. On the other hand, there's no proprioception, muscle signals saying that there is no arm, right? And your motor command saying there is an arm, and, because of this conflict, the brain says, to hell with it, there is no phantom, there is no arm, right? It goes into a sort of denial -- it gates the signals. And when the arm disappears, the bonus is, the pain disappears because you can't have disembodied pain floating out there, in space. So, that's the bonus.
Ali, zašto se ovo dogodilo? Zato što je mozak suočen s ogromnim konfliktom osjetila. Dobiva vidne poruke koje kažu da se fantom vratio. S druge strane, nema odgovarajućeg odziva, mišićni signali kažu da nema ruke, jel' tako? A sustav motoričkih naredbi kaže da je ruka tu, i zbog toga konflikta mozak kaže, ma dovraga, nema fantoma, nema ruke, jel 'tako? Povuče se u neku vrstu poricanja -- negira signale. A kada nestane ruka, nestaje i bol zato što ne možete imati bol bez tijela. Tako da je to bonus.
Now, this technique has been tried on dozens of patients by other groups in Helsinki, so it may prove to be valuable as a treatment for phantom pain, and indeed, people have tried it for stroke rehabilitation. Stroke you normally think of as damage to the fibers, nothing you can do about it. But, it turns out some component of stroke paralysis is also learned paralysis, and maybe that component can be overcome using mirrors. This has also gone through clinical trials, helping lots and lots of patients.
E sad, te tehnika je isprobana na desecima pacijenata od strane drugih istraživača, tako da bi se mogla pokazati kao vrijedna za liječenje fantomske boli, i čak je isprobana u rehabilitaciji nakon moždanog udara. Moždani udar se smatra oštećenjem živaca, s kojim ništa ne možete napraviti. Ali se čini kako je jedan dio paralize također naučen, i da se može riješiti pomoću zrcala. Ovo je također je prošlo klinička testiranja, i pomoglo mnogim pacijentima.
OK, let me switch gears now to the third part of my talk, which is about another curious phenomenon called synesthesia. This was discovered by Francis Galton in the nineteenth century. He was a cousin of Charles Darwin. He pointed out that certain people in the population, who are otherwise completely normal, had the following peculiarity: every time they see a number, it's colored. Five is blue, seven is yellow, eight is chartreuse, nine is indigo, OK? Bear in mind, these people are completely normal in other respects. Or C sharp -- sometimes, tones evoke color. C sharp is blue, F sharp is green, another tone might be yellow, right?
OK, promijenit ću brzinu za treći dio mojeg govora, koji se odnosi na čudnovat fenomen nazvan sinestezija. Otkrio ju je Francis Galton u 19. stoljeću. Inače rođak Charlesa Darwina. On je istaknuo da postoje određeni ljudi u populaciji, koji, inače potpuno normalni, imaju sljedeću posebnost -- svaki put kada vide broj on je obojan. 5 je plava, 7 žuta, 8 boje kruške, 9 indigo plava, OK? Imajte na umu da su oni potpuno normalni u svakom drugom pogledu. Nekada tonovi evociraju boje. C je plavo, F zeleno, drugi ton može biti žut, jel' tako?
Why does this happen? This is called synesthesia. Galton called it synesthesia, a mingling of the senses. In us, all the senses are distinct. These people muddle up their senses. Why does this happen? One of the two aspects of this problem are very intriguing. Synesthesia runs in families, so Galton said this is a hereditary basis, a genetic basis. Secondly, synesthesia is about -- and this is what gets me to my point about the main theme of this lecture, which is about creativity -- synesthesia is eight times more common among artists, poets, novelists and other creative people than in the general population. Why would that be? I'm going to answer that question. It's never been answered before.
Zašto se ovo događa? Galton je to nazvao sinestezija, miješanje osjetila. Sva naša osjetila su odvojena, zasebna. Ovim ljudima su ona zbrkana. Zašto? Jedan od dva aspekta problema je veoma intrigantan. Sinestezija se javlja u obiteljima, tako da je Galton rekao da je nasljedna, zasnovana na genetici. Drugo, sinestezija je -- što me dovodi do poante glavne teme ovog predavanja, a to je kreativnost -- osam puta češća među umjetnicima i ostalim kreativnim ljudima u općoj populaciji. Zašto je tome tako? Odgovorit ću vam. Nikada prije nije odgovoreno zašto je tako.
OK, what is synesthesia? What causes it? Well, there are many theories. One theory is they're just crazy. Now, that's not really a scientific theory, so we can forget about it. Another theory is they are acid junkies and potheads, right? Now, there may be some truth to this, because it's much more common here in the Bay Area than in San Diego. (Laughter) OK. Now, the third theory is that -- well, let's ask ourselves what's really going on in synesthesia. All right?
OK, što je sinestezija? Što je izaziva? Pa, postoje mnoge teorije. Jedna teorija je da su doslovno ludi. To baš i nije znanstvena teorija, pa je možemo zanemariti. Druga teorija je da su napušeni, jel' tako? E sad, tu bi moglo i biti istine zato što je puno češća tu nego u San Diegu. (Smijeh) OK. Sad, treća teorija kaže -- idemo se zapitati što se zaista događa u sinesteziji? U redu?
So, we found that the color area and the number area are right next to each other in the brain, in the fusiform gyrus. So we said, there's some accidental cross wiring between color and numbers in the brain. So, every time you see a number, you see a corresponding color, and that's why you get synesthesia. Now remember -- why does this happen? Why would there be crossed wires in some people? Remember I said it runs in families? That gives you the clue. And that is, there is an abnormal gene, a mutation in the gene that causes this abnormal cross wiring.
Otkrili smo da su regije mozga za boje i brojeve jedna pored druge u vretenastoj vijugi. Pa smo rekli da je došlo do slučajnog prespajanja između boja i brojeva u mozgu. Tako da svaki put kada vidite broj, vidite i odgovarajuću boju, i zato dobijete sinesteziju. Podsjetite se -- zašto se to zbiva? Zašto bi došlo do prespajanja kod nekih ljudi? Sjećate se da se pojavljuje u obiteljima? To vam nešto govori. I to da postoji abnormalan gen, mutacija gena, koja uzrokuje abnormalno prespajanje.
In all of us, it turns out we are born with everything wired to everything else. So, every brain region is wired to every other region, and these are trimmed down to create the characteristic modular architecture of the adult brain. So, if there's a gene causing this trimming and if that gene mutates, then you get deficient trimming between adjacent brain areas. And if it's between number and color, you get number-color synesthesia. If it's between tone and color, you get tone-color synesthesia. So far, so good.
Svi mi, kako je dokazano, smo rođeni s međusobno povezanim regijama mozga. Svaka regija mozga je povezana s drugom regijom, i one su uređene tako da stvaraju karakterističnu modularnu građu odraslog mozga. Tako da ako postoji gen koji to uređuje, i ako on mutira, onda imate smanjenu uređenost između susjednih regija mozga, a ako je to između brojeva i boja onda dobijete broj-boja sinesteziju. Ako je između tona i boje onda dobijete ton-boja sinesteziju. Do sada je sve jasno.
Now, what if this gene is expressed everywhere in the brain, so everything is cross-connected? Well, think about what artists, novelists and poets have in common, the ability to engage in metaphorical thinking, linking seemingly unrelated ideas, such as, "It is the east, and Juliet is the Sun." Well, you don't say, Juliet is the sun, does that mean she's a glowing ball of fire? I mean, schizophrenics do that, but it's a different story, right? Normal people say, she's warm like the sun, she's radiant like the sun, she's nurturing like the sun. Instantly, you've found the links.
Ali što ako se taj gen ispoljava svugdje u mozgu, tako da je sve međusobno povezano? Razmislite što sve umjetnici, pisci i pjesnici imaju zajedničko, sposobnost da se upuste u metaforičko mišljenje, povezujući naizgled nepovezive ideje, kao što je, "to je istok, a Julia je Sunce." Ne kaže se da je Julia sunce -- znači li to da je ona sjajna kugla vatre? Mislim, shizofreničari to rade, ali je to sasvim druga priča. Normalni ljudi kažu da je topla poput sunca, da je sjajna kao sunce, da je njegovana kao sunce. Odmah ste našli veze.
Now, if you assume that this greater cross wiring and concepts are also in different parts of the brain, then it's going to create a greater propensity towards metaphorical thinking and creativity in people with synesthesia. And, hence, the eight times more common incidence of synesthesia among poets, artists and novelists. OK, it's a very phrenological view of synesthesia. The last demonstration -- can I take one minute? (Applause)
Ako pretpostavite da je ovo veće prespajanje zajedno s konceptima u različitim dijelovima mozga, onda će to stvoriti veću sklonost metaforičkom razmišljanju i kreativnosti u ljudi s sinestezijom. i otuda osam puta češća pojavnost sinestezije među pjesnicima, umjetnicima i piscima. OK -- to je frenološki pogled na sinesteziju. Posljednja demonstracija -- mogu li dobiti minutu još? (Pljesak)
OK. I'm going to show you that you're all synesthetes, but you're in denial about it. Here's what I call Martian alphabet. Just like your alphabet, A is A, B is B, C is C. Different shapes for different phonemes, right? Here, you've got Martian alphabet. One of them is Kiki, one of them is Bouba. Which one is Kiki and which one is Bouba? How many of you think that's Kiki and that's Bouba? Raise your hands. Well, it's one or two mutants. (Laughter) How many of you think that's Bouba, that's Kiki? Raise your hands. Ninety-nine percent of you.
OK. Pokazat ću vam da ste svi vi sinesteti, ali to poričete. Evo nešto što ja zovem marsovska abeceda, baš kao vaša, A je A, B je B, C je C, različiti oblici za različite glasove, jel' tako? Evo imate marsovsku abecedu. Jedno je Kiki, a jedno je Buba? Koje je Kiki, a koje Buba? Koliko vas misli da je ovo Kiki, a ovo Buba? Podignite ruke. Pa, jedan ili dva mutanata. (Smijeh) Koliko vas misli da je ovo Buba, a ovo Kiki? Podignite ruke. 99%
Now, none of you is a Martian. How did you do that? It's because you're all doing a cross-model synesthetic abstraction, meaning you're saying that that sharp inflection -- ki-ki, in your auditory cortex, the hair cells being excited -- Kiki, mimics the visual inflection, sudden inflection of that jagged shape. Now, this is very important, because what it's telling you is your brain is engaging in a primitive -- it's just -- it looks like a silly illusion, but these photons in your eye are doing this shape, and hair cells in your ear are exciting the auditory pattern, but the brain is able to extract the common denominator. It's a primitive form of abstraction, and we now know this happens in the fusiform gyrus of the brain, because when that's damaged, these people lose the ability to engage in Bouba Kiki, but they also lose the ability to engage in metaphor.
E sad, nitko nije Marsovac, kako ste to uradili? Zato što ste svi izveli poprečno modeliranje -- sinestetsku apstrakciju -- što znači da mislite da je ova oštra modulacija, Kiki, u slušnoj kori mozga, trepetljikave stanice se podraže, Kiki, imitirajućii vizualnu modulaciju -- iznenadnu modulaciju -- tog šiljastog oblika. Ovo je vrlo važno, jer vam govori da se vaš mozak prepustio primitivnom -- ali tako je -- izgleda kao blesava iluzija ali ti fotoni u vašim očima obrađuju taj oblik i trepetljikave stanice u ušima aktiviraju zvučni obrazac, ali mozak je sposoban izvući zajednički nazivnik. To je primitivan oblik apstrakcije, i sada znamo da se on zbiva u vretenastoj vijugi mozga zato što kada je on oštećen, ovi ljudi gube sposobnost da izvedu Buba Kiki, ali također gube sposobnost za metaforu.
If you ask this guy, what -- "all that glitters is not gold," what does that mean?" The patient says, "Well, if it's metallic and shiny, it doesn't mean it's gold. You have to measure its specific gravity, OK?" So, they completely miss the metaphorical meaning. So, this area is about eight times the size in higher -- especially in humans -- as in lower primates. Something very interesting is going on here in the angular gyrus, because it's the crossroads between hearing, vision and touch, and it became enormous in humans. And something very interesting is going on. And I think it's a basis of many uniquely human abilities like abstraction, metaphor and creativity. All of these questions that philosophers have been studying for millennia, we scientists can begin to explore by doing brain imaging, and by studying patients and asking the right questions. Thank you. (Applause) Sorry about that. (Laughter)
Ako pitate tog čovjeka što znači "Nije zlato sve što sja", Pacijent na to kaže, "Pa, ako je metalno i sjajno, ne znači da je zlato. Morate mu izmjeriti težinu." OK? Dakle, potpuno su izgubili smisao za metaforu. Ta regija je oko osam puta veća kod viših -- naročito kod ljudi -- nego kod nižih primata. Nešto vrlo zanimljivo se događa ovdje u angularnoj vijugi, zato što je sjecište između sluha, vida i dodira, i postalo je ogromno kod ljudi -- i nešto se vrlo zanimljivo tu događa. I ja mislim da je to osnova mnogih sposobnosti jedinstvenih ljudima kao što je apstrakcija, metafora i kreativnost. Sva pitanja koja su filozofi proučavali tisućljećima, mi znanstvenici možemo istraživati snimanjem mozga, proučavajući pacijente i postavljajući prava pitanja. Hvala vam. (Pljesak) Oprostite na ovome. (Smijeh)