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 Kris napomenuo, ja proučavam ljudski mozak - funkcije i strukturu ljudskog mozga. I želeo bih da malo razmislite o svemu što to povlači za sobom. Ta želatinasta masa - teška oko kilogram i po - može da vam stane na dlan a sposobna je da promišlja neizmerna međuzvezdana prostranstva. Sposobna je da promišlja značenje beskonačnosti a i samu sebe kako promišlja značenje beskonačnosti. Tu čudnovatu rekurzivnost koju nazivamo samosvešću lično smatram Svetim Graalom neurologije i nadam se da ćemo jednog dana razumeti 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.
Dobro, dakle, kako proučavati taj misteriozni organ? Mislim, tu je 100 milijardi nervnih ćelija, malih svežnjeva protoplazme koji međusobno intereaguju i iz te aktivnosti izranja čitav spektar sposobnosti koje nazivamo ljudskom prirodom i ljudskom svešću. Kako do toga dolazi? Pa, postoji mnogo načina da se pristupi funkcijama ljudskog mozga. Jedan pristup, koji uglavnom koristimo, jeste proučavanje pacijenata sa trajnim oštećenjem neke male regije mozga, kod kojih je došlo do genetske promene u nekoj maloj regiji mozga. U tim slučajevima ne dolazi do sveobuhvatnog umanjenja svih vaših mentalnih kapaciteta, niti do nekakvog otupljenja vaše kognitivne sposobnosti. U stvari, dobijamo visoko selektivan gubitak jedne funkcije dok druge funkcije ostaju netaknute, na osnovu čega možemo prilično pouzdano da pretpostavimo da je taj deo mozga na neki način umešan u medijaciju te funkcije. Tako možete da mapirate funkciju u okviru strukture i da tako otkrijete šta tačno rade moždana kola da bi generisala tu konkretnu funkciju. I to je ono što pokušavamo da uradimo.
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.
Daću vam nekoliko iznenađujućih primera. U stvari, daću vam tri primera, svaki u trajanju od šest minuta, tokom ovog govora. Prvi primer je jedan neobičan sindrom po imenu Kapgrasov sindrom. Ako pogledate prvi slajd, to su temporalni režnjevi, čeoni režnjevi, parietalni režnjevi, OK - režnjevi koji sačinjavaju mozak. A ako pogledate, zaturena unutar unutrašnje površine temporalnih režnjeva - ovde ne možete da je vidite - nalazi se mala struktura nazvana fusiform gyrus. Nju nazivaju licem mozga, pošto, kada je ona oštećena, više ne možete da prepoznajete ljudska lica. Još uvek možete da ih prepoznate po glasu i da kažete - pa da, to je Džo - ali ne možete da ih pogledate u lice i da znate ko je to. Čak ni sebe ne možete da prepoznate u ogledalu. Mislim, znate da ste to vi, jer kada namignete i odraz namigne, i znate da je to ogledalo, ali ne prepoznajete zaiste 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. Dakle, taj sindrom je dobro poznat i izaziva ga oštećenje fusiform gyrusa. Ali postoji još jedan redak sindrom, zapravo toliko redak, da je vrlo malo doktora uopšte čulo za njega, čak i među neurolozima. To se zove Kapgrasova samoobmana, a to vam je pacijent koji je inače sasvim normalan koji je pretrpeo povredu glave, izašao iz kome, inače potpuno normalan, pogleda svoju majku i kaže, "Ovo izgleda baš kao moja majka, ova žena, ali ona je uljez - to je neka druga žena koja se pretvara da je moja majka." E sad, zašto se to događa? Zašto bi bilo ko - a radi se o osobi koja je inače potpuno lucidna i inteligentna po svakom pitanju, ali kada pogleda svoju majku, uključuje se ta obmana, i on kaže da to nije njegova 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.
Sad, najčešća interpretacija, koju ćete naći u svim psihijatrijskim udžbenicima, jeste frojdovska, i glasi da je taj momak - i isti argument se da primeniti i na žene, da znate - ali ja ću da pričam samo o momcima - kada ste mala beba, mlada beba, osećate snažnu seksualnu privlačnost prema svojoj majci. To je takozvani Edipov kompleks. Ne kažem vam da verujem u to, ali to je standardno frojdovsko gledište. I tako, kako rastete, korteks se razvija, i inhibira te latentne seksualne porive prema vašoj majci. Hvala Bogu, jer biste inače svi bili seksualno uzbuđeni kada vidite svoju majku. A onda se dogodi da vas nešto zvekne u glavu, ošteti vam korteks i omogući da svi ti latentni seksualni porivi izrone, buknu na površinu i iznenadno i neobjašnjivo zateknete sebe kako ste seksualno uzbuđeni svojom majkom. Pa kažete sebi, "Bože moj, ako je to moja mama, kako to da se seksualno palim? To mora da je neka druga žena. Neki uljez." To je jedina interpretacija koja vašem oštećenom mozgu 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 baš nikada nije imalo smisla. Jeste vrlo ingeniozan, kao i svi frojdovski argumenti - (Smeh) - ali meni nije imao mnogo smisla, jer sam video tu istu samoobmanu, pacijenta koji ima istu samoobmanu prema svojoj pudlici. (Smeh) Rekao bi, "Doktore, ovo nije Fifi, izgleda baš kao Fifi, ali to je neki drugi pas." Je l' da? E sad, pokušajte tu da primenite frojdovsko objašnjenje. (Smeh) Počećete da govorite o latentnoj bestijalnosti u svim ljudima, ili nečem sličnom, što je naravno, poprilično 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?
E sad, šta se tu stvarno događa? Da bismo objasnili taj čudnovati poremećaj, proučavamo strukturu i funkcije normalnih vizuelnih tokova u mozgu. Normalno, vizuelni signali dolaze u očne jabučice, pa idu u vizuelne oblasti mozga. Postoji u stvari 30 oblasti u zadnjem delu mozga koje se tiču samo vida, a pošto se sve to obradi, poruka odlazi u malu strukturu po imenu fusiform gyrus, gde opažate lica. Postoje neuroni koji su osetljivi na lica. Možete ih zvati licem mozga, je l' da? O tome sam govorio ranije. E sad, kada je ta oblast oštećena, gubite sposobnost da vidite lica, 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 te oblasti, poruka se preliva u strukturu nazvanu amigdala, u limbičkom sistemu, emotivnoj srži mozga, a ta struktura, po imenu amigdala, procenjuje emotivni značaj onoga u šta gledate. Da li je to lovina? Da li je predator? Da li je partner/ka? Ili je nešto potpuno trivijalno, kao komadić tkanine ili parče krede ili - ne bih baš da upirem prstom u to ali - ili cipela ili nešto takvo? OK? Nešto što možete potpuno da ignorišete. Tako da, ako je amigdala uzbuđena, i radi se o nečemu važnom, poruka se preliva u autonomni nervni sistem. Srce počinje da vam brže tuče, počinjete da se znojite da biste oslobodili toplotu koju ćete stvoriti - radom mišića. I sva sreća da je tako, jer možemo da vam stavimo dve elektrode na dlan i izmerimo promenu u otporu kože koju stvara znojenje. Tako mogu da odredim, kada gledate u nešto, da li ste uzbuđenji ili uspaljeni ili ne, OK? Vratiću se na to za minut.
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, moje ideja je bila, kada taj momak pogleda u objekat, kada pogleda u svoju - u bilo koji objekat, u stvari, to ide u vizuelne oblasti i - obrađuje se u fusiform gyrusu, i prepoznajete ga kao stabljiku graška ili sto ili čak svoju majku, OK? A onda se poruka prelije u amigdalu i odlazi niz centralni nervni sistem. Ali možda je kod tog momka žica koja ide iz amigdale do limbičnog sistema - emotivne srži mozga - presečena nekom nesrećom. A pošto je fusiform netaknut, momak još uvek može da prepozna svoju majku, i kaže, "O da, ovo izgleda kao moja majka." Ali pošto je žica do emotivnih centara presečena, on kaže, "Ali kako to da, ako je to moja majka, ne osećam nikakvu toplinu?" Ili užas, kao što može da bude slučaj, zar ne? (Smeh) I zato, on kaže, "Kako da opravdam ovaj neobjašnjivi nedostatak emocija? Ovo ne može biti moja majka. To je neka čudna 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 testirati? Pa, prvo što uradite, kada biste uzeli bilo koga od ovde prisutnih i postavili ih ispred ekrana, i merili galvansku reakciju kože, i prikazivali slike na ekranu, mogao bih da izmerim kako se znojite kada vidite neki objekat, kao što je sto ili kišobran - naravno, ne znojite se. A ako vam pokažem sliku lava, tigra, ili erotski poster, počnete da se znojite, je l' da? I, verovali ili ne, ako vam pokažem sliku vaše majke - govorim o normalnim ljudima - počnete da se znojite. Čak ne morate ni da budete Jevrejin. (Smeh)
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, šta se događa - šta se događa ako to pokazujete ovom pacijentu? Uzmete pacijenta i pokazujete mu slike na ekranu i merite mu galvansku reakciju kože. Stolovi i stolice i tkanina, ništa se ne događa, kao kod normalnih ljudi, ali onda mu pokažete sliku njegove majke, i galvanska reakcija izostaje. Nema emotivne reakcije na njegovu majku zato što je žica koja vodi od vizuelnih oblasti do emotivnih centara presečena. Dakle, njegov vid je normalan pošto su mu vizuelne oblasti u redu, njegove emocije su normalne - smejaće se, plakati, i tako dalje i tako bliže - ali žica od vida do emocija je presečena i to dovodi do samoobmane da je njegova majka uljez. To je divan primer onoga što radimo, uzmemo neki bizaran, naizgled neshvatljiv neurološko-psihijatrijski sindrom i kažemo da je standardno frojdovsko gledište pogrešno, da je u stvari moguće doći do tačnog objašnjenja u okviru poznate neuroanatomije mozga.
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.
Usput, ako pacijent potom ode i majka ga pozove telefonom iz sobe pored - pozove njega - i on podigne slušalicu i kaže, "Ej, mama, kako si? Gde si?" Nema samoobmane preko telefona. A onda mu ona priđe posle sat vremena, a on kaže, "Ko si ti? Izgledaš skroz kao moja majka." Razlog je u tome što postoji zasebna putanja iz centara sluha u mozgu do emotivnih centara i ona nije presečena u nesreći. Dakle, to objašnjava zašto prepoznaje majku preko telefona, i nema problema. 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 sva ta kompleksna kola neurona postavljena u mozgu? Da li je to prirodno, genetski ili zavisi od odgoja? A tom problemu pristupamo razmatranjem još jednog čudnovatog sindroma poznatog kao fantomski ud. A svi znate šta su fantomski udovi. Kada nekome amputiraju ruku ili nogu, zbog gangrene, ili ako je izgubite u ratu, na primer, u Iraku - to je sada ozbiljan problem - nastavljate da imate vrlo živ osećaj prisustva te nestale ruke, i to se zove fantomska ruka ili fantomska noga. U stvari, možete dobiti fantoma skoro bilo kog dela tela. Verovali ili ne, čak i unutrašnjih organa. Imao sam pacijente kojima je uklonjena materica - histerektomija - koji su imali fantomsku matericu, uključujući i fantomske menstrualne tegobe u odgovarajuće doba meseca. I u stvari, jedan student me je pre neki dan pitao, da li imaju fantomski PMS? (Smeh) Tema zrela za naučno ispitivanje, ali nismo još uvek krenuli tim putem.
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."
OK, znači sledeće pitanje je, šta je moguće saznati o fantomskim udovima pomoću eksperimenata? Jedna od stvari koje smo otkrili je da oko polovine pacijenata sa fantomskim udovima tvrde da mogu da pomere fantoma. Potapšaće njime brata po ramenu, njime će odgovoriti na telefon, mahnuti u odlasku. To su vrlo snažni, upečatljivi osećaji. Pacijent nema samoobmanu. Zna da ruka nije tu ali je to ipak snažno čulno iskustvo za pacijenta. Ali ipak se to polovini pacijenata ne događa. Fantomski ud - reći će: "Ali doktore, fantomski ud je paralizovan. Fiksiran je, stisnut u grču i grozno boli. Kada bih samo mogao da ga pomerim, možda bi bol uminuo.
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?
E sad, zašto bi fantomski ud bio paralizovan? Zvuči kao oksimoron. Ali kada smo pregledali dokumentaciju slučajeva, otkrili smo da je kod ljudi sa paralizovanim fantomskim udovima prava ruka bila paralizovana zbog povrede perifernih nerava, nerv koji je išao u ruku je presečen, isečen, recimo, u nesreći s motociklom. Tako da je pacijent imao pravu ruku, koja boli, u povezu, nekoliko meseci, ili godinu, a onda je zaveden željom da ukloni bol u ruci, hirurg amputirao ruku, i onda dobijete fantomsku ruku sa istim bolovima, je l' tako? I to je ozbiljan klinički problem. Pacijenti postanu depresivni. Neki čak do i samoubistva.
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 se taj sindrom može lečiti? Zašto se pojavljuje paralizovan fantomski ud? Kada sam pregledao dokumentaciju slučajeva, otkrio sam da su imali pravu ruku i da su nervi u ruci bili presečeni i da je prava ruka bila paralizovana i u povezu nekoliko meseci pre amputacije i da se taj bol potom preneo na samog fantoma.
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 to događa? Kada je ruka netaknuta, ali paralizovana, mozak šalje komande ruci, prednji deo mozga joj govori "Pokreni se", ali vizuelni odgovor koji dobija kaže "Ne". Pokreni se. Neću. Pokreni se. Neću. Pokreni se. Neću. I to se upiše u moždana kola i to nazivamo naučenom paralizom, OK? Mozak uči, zbog Hebove asocijativne veze, da sama komanda da se ruka pokrene stvara osećaj paralizovane ruke, a onda, kada amputirate ruku, ova naučena paraliza se prenosi u - u sliku vašeg tela i u vašeg fantoma, 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)
E sad, kako pomoći ovim pacijentima? Kako da "odučite" naučenu paralizu da biste ga rešili tog iscrpljujućeg, stisnutog grča fantomske ruke? Pa, rekli smo, šta ako sad pošaljete komandu fantomu, ali mu date vizuelni odgovor da je komanda poslušana? Možda biste mogli da ga rešite fantomskog bola, fantomskog grča. Kako to postići? Pa, virtuelnom realnošću. Ali to košta milione dolara. Iznašao sam način da to uradim za tri dolara, ali nemojte da kažete mojim finansijerima. (Smeh)
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.
OK? Potrebno je napraviti, kako sam je nazvao, kutiju ogledala. Uzmete kartonsku kutiju sa ogledalom u sredini i onda tu stavite fantoma - tako je došao moj prvi pacijent, Derek. Ruka mu je bila amputirana pre 10 godina. Imao je brahijalnu avulziju, tako da su nervi bili presečeni a ruka paralizovana, u zavoju godinu dana, a onda je ta ruka odsečena. Imao je fantomsku ruku, iscrpljujuće bolnu i nije mogao da je pomeri. Paralizovana 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."
I tako je došao i ja sam mu dao ogledalo, tako, u kutiji, koju zovem kutijom ogledala. I pacijent stavi svoju fantomsku levu ruku, koja je stisnuta i u grču, na levu stranu ogledala i normalnu ruku na desnu stranu ogledala i zauzme isti položaj, zgrčen, i pogleda u ogledalo - i šta iskusi? Vidi kako je fantom "vaskrsao", jer gleda u odraz svoje normalne ruke u ogledalu i izgleda kao da je fantom vaskrsao. "E sad", rekao sam, "sad gledaj, mrdaj fantoma - svoje prave prste ili pomeraj svoje prave prste dok gledaš u ogledalo." Dobiće vizuelni utisak da se fantom pomera, je l' tako? To je očigledno, ali zapanjujuća stvar je da pacijent tada kaže, "O Bože, moj fantom se ponovo pomera, a bol, stisnuti grč, nestaje."
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 ne zaboravite, moj prvi pacijent koji je došao - (Aplauz) - hvala vam (Aplauz) Moj prvi pacijent je došao i pogledao u ogledalo i ja sam mu rekao, "Pogledaj u odraz svog fantoma." I on je počeo da se kikoće, kaže "Vidim svog fantoma". Ali nije on glup. Zna da to nije stvarno. Zna da je to odraz u ogledalu, ali je to živopisno čulno iskustvo. E sad, rekao sam mu, "Pomeraj svoju normalnu ruku i fantoma". On kaže, "O, mogu da pomeram fantoma. Znate šta. Boli". Ja kažem, "Pomeraj svoju normalnu ruku". A on kaže, "O Bože, moj fantom se ponovo pomera, ne mogu da verujem! A bol nestaje". OK? A ja sam onda rekao, "Zatvori oči". I on zatvori oči. "I pomeraj svoju normalnu ruku". "O, ništa - opet je zgrčena". "OK, otvori oči". "O Bože, O Bože, opet se pomera!" Bio je kao dete u poslastičarnici.
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.
I dobro, ja sam na to rekao, ovo dokazuje moju teoriju o naučenoj paralizi i kritičnoj ulozi vizuelnih ulaznih podataka, ali neću baš da dobijem Nobelovu nagradu zato što sam naterao nekoga da pomera svoj fantomski ud. (Smeh) (Aplauz) To je potpuno beskorisna sposobnost, ako malo bolje razmislite. (Smeh) Ali onda sam počeo da shvatam, možda i druge vrste paralize koje susrećete u neurologiji, kao šlog, fokalne distonije - možda imaju naučenu komponentu koju možete da prevaziđete pomoću jednostavnog ogledala.
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" - pre svega, čovek ne može da ide okolo sa ogledalom da bi umanjio bol - rekao sam mu, "Vidi, Derek, odnesi ga kući i vežbaj s njim nedelju ili dve. Možda ćeš, posle određenog perioda vežbanja, moći da završiš s ogledalom, da "odučiš" paralizu i počneš da pokrećeš svoju paralizovanu ruku i da se rešiš bola." Rekao je OK i odneo ga kući. Ja sam rekao, "Vidi, 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 odneo kući i zove me posle dve nedelje i kaže, "Doktore, nećete verovati". Ja kažem, "Šta?" A on će, "Nestao je". Ja kažem, "Šta je nestalo?" Pomislio sam da je možda kutija ogledalo nestala. (Smeh) On kaže, "Ne, ne, ne, znate onog fantoma koga sam imao poslednjih 10 godina? Nestao je". I ja sam rekao - zabrinuo sam se, rekao sam, Bože, mislim, promenio sam ovom čoveku njegovu sliku o telu a šta sa eksperimentisanjem na ljudima, etikom i svim tim? I rekao sam mu, "Derek, da li ti to smeta?" A on će, "Ne, poslednja tri dana nemam fantomsku ruku pa tako ni fantomski bol u laktu, ni stiskanje, ni fantomski bol u podlaktici, svi bolovi su nestali. Ali problem je što mi fantomski prsti i dalje vise sa ramena, a vaša kutija ne doseže dotle". (Smeh) "Pa ako biste mogli da promenite dizajn i stavite mi je na čelo, znate, da bih mogao i to da izvedem i da uklonim i fantomske prste?" Mislio je da sam nekakav 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.
E sad, zašto se to događa? Zato što je mozak suočen sa ogromnim konfliktom čula. On dobija poruke vidom koje kažu da se fantom vratio. Sa druge strane, nema odgovarajuće recepcije, mišićni signali kažu da nema ruke, je l' tako? A sistem motoričkih komandi kaže da je ruka tu i zbog tog konflikta, vaš mozak kaže, ma sve to dođavola, nema fantoma, nema ruke, jasno? Povuče se u neku vrstu poricanja i negira signale. A kada ruka nestane, bonus je da nestaje i bol zato što ne možete da imate bol bez tela koji tako pluta, u prostoru. 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, ta tehnika je isprobana na desetinama pacijenata od strane drugih grupa u Helsinkiju, tako da bi mogla da se pokaže kao vredna za lečenje fantomskih bolova i ljudi su je čak isprobali prilikom rehabilitacije od šloga. Šlog se inače smatra za oštećenje nerava, i da ništa ne možete da uradite po tom pitanju. Ali, ispada da je određena komponenta paralize izazvane šlogom takođe naučena, i da se ona možda može prevazići pomoću ogledala. To je testirano i u kliničkim uslovima i pomoglo je mnogim, 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, sada ću malo da promenim brzinu za treći deo mog govora, koji se tiče čudnovatog fenomena zvanog sinestezija. Nju je otkrio Frensis Galton u XIX veku. Inače, bio je rođak Čarlsa Darvina. On je skrenuo pažnju na to da određeni ljudi u populaciji, koji su inače potpuno normalni, imaju sledeću posebnost - svaki put kada vide broj, vide ga u boji. Petica je plava, sedmica žuta, osmica je boje kruške, devetka indigo, OK? Pazite, ovi ljudi su inače potpuno normalni u svemu drugome. Ili čisto C. Nekada tonovi evociraju boje. C je plavo, F zeleno, neki drugi ton može biti žut, je l' da?
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? To se zove sinestezija - Galton je to nazvao sinestezijom, mešanjem čula. Sva naša čula su zasebna. Ovim ljudima su čula izmuljana. Zašto se to događa? Jedan od dva aspekta ovog problema je izuzetno intrigantan. Sinestezija se prenosi u porodicama, tako da je Galton rekao da je ona zasnovana na nasleđu, na genetici. Drugo, sinestezija se tiče - i to me dovodi do poente - a tiče se glavne teme ovog predavanja, koje je o kreativnosti - sinestezija je osam puta češća među slikarima, pesnicima, romanopiscima i drugim kreativnim ljudima u opštoj populaciji. Zašto je to tako? Odgovoriću vam na ovo pitanje. Na njega nikada do sada nije dat odgovor.
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, šta je sinestezija? Šta je izaziva? Pa, postoje mnoge teorije. Jedna teorija je da su prosto ludi. To baš nije naučna teorija, pa možemo da je zaboravimo. Još jedna teorija glasi da su navučeni na kiselinu ili travu, je l' tako? E sad, tu bi moglo da bude neke istine pošto je toliko češća u San Francisku nego u San Diegu. (Smeh) OK. Sad, treća teorija kaže - pa, hajde da se zapitamo šta 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.
Tako da smo našli da su oblast zadužena za boje i ona zadužena za brojeve jedna pored druge, u fusiform gyrusu. Tako da smo rekli da je došlo do određenog prespajanja između boja i brojeva u mozgu. Tako da svaki put kada vidite broj, vidite odgovarajuću boju, i zato dobijete sinesteziju. Sad se prisetite - zašto se to događa? Zašto bi kod nekih ljudi došlo do prespajanja žica? Sećate se da sam rekao da se nasleđuje u porodici? To vam je nagoveštaj. A to je da postoji abnormalan gen, mutacija gena koja izaziva 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.
U svima nama, kako se ispostavilo, svi smo rođeni sa svime povezanim sa svime ostalim. Svaka regija mozga je povezana sa svakom drugom i one su doterane tako da stvaraju tu karakterističnu modularnu arhitekturu odraslog mozga. Tako da, ako postoji gen koji izaziva to doterivanje, i ako taj gen mutira, onda imate manjak doteranosti između susednih oblasti mozga, a ako je to između brojeva i boje, dobijete broj-boja sinesteziju. Ako je između tona i boja, dobijate ton-boja sinesteziju. Za 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, šta ako se taj gen eksprimira svuda u mozgu, tako da je sve međusobno povezano? Pa, razmislite o tome šta umetnici, pisci i pesnici imaju zajedničko, sposobnost da se upuste u metaforično mišljenje, povezujući naizgled nepovezane ideje, kao što su, "to je Istok, i Džuliet je Sunce." E, ne kaže se da je Džuliet sunce - je l' to znači da je ona sjajna kugla vatre? Mislim, šizofreničari to rade, ali to je druga priča, je l' tako? Normalni ljudi kažu da je topla poput sunca, da je sjajna kao sunce, da je blagorodna 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)
Sad, ako pretpostavite da je ovo veće prespajanje zajedno s konceptima takođe u različitim delovima mozga, onda će to stvoriti veću naklonjenost ka metaforičkom razmišljanju i kreativnosti u ljudima koji imaju sinesteziju. I odatle osam puta češće pojavljivanje sinestezije među pesnicima, umetnicima i piscima. OK - to je izuzetno frenološki pogled na sinesteziju. Poslednja demonstracija - mogu li da dobijem minut? (Aplauz)
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. Pokazaću vam da ste svi sinestete, ali da to poričete. Evo nečega što ja zovem marsovska abeceda, baš kao vaša abeceda, A je A, B je B, C je C, različiti oblici, različite foneme, je l' tako? Evo marsovske abecede. Jedno je Kiki, drugo je Buba. Koje je Kiki a koje Buba? Koliko vas misli da je ovo Kiki a ovo Buba? Podignite ruke. Pa, jedan ili dvoje mutanata. (Smeh) Koliko vas misli da je ovo Buba, a ovo Kiki? Podignite ruke. 99 posto.
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, niko od vas nije Marsovac, kako ste to uradili? Zato što ste svi izveli poprečno modeliranje - sinestezijsko apstrahovanje - što znači da mislite da je ova oštra infleksija, Kiki, u vašem zvučnom korteksu, trepljaste ćelije vam se ježe, Kiki, podražavajući vizuelnu infleksiju - iznenadnu infleksiju - tog iskrzanog oblika. E, ovo je vrlo važno, jer to vam govori da se vaš mozak prepustio primitivnoj - to je prosto - izgleda kao blesava iluzija, ali ti fotoni u vašim očima obrađuju taj oblik i trepljaste ćelije u ušima aktiviraju zvučni obrazac ali mozak je u stanju da izvuče zajedničkog sadržaoca. To je primitivan oblik apstrahovanja, i sada znamo da se on odvija u fusiform gyrusu u mozgu zato što, kada je on oštećen, ovi ljudi gube sposobnost da izvedu Buba Kiki, ali takođe 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 upitate tog čoveka, šta znači "Nije zlato sve što sija, šta to znači?" Pacijent na to kaže, "Pa, ako je metalno i svetlucavo, ne znači da je zlato. Morate da mu izmerite specifičnu težinu, OK?" Tako da im metaforičko značenje potpuno izmiče. Ta oblast je oko osam puta veća kod viših - naročito kod ljudi, nego kod nižih primata. Nešto veoma interesantno se događa ovde u angularnom gyrusu pošto se tu nalazi raskršće između sluha, vida i dodira, i on je postao ogroman kod ljudi - i nešto vrlo interesantno se događa. I ja mislim da je to osnova mnogih jedinstveno ljudskih sposobnosti kao što su apstrakcija, metafora i kreativnost. Sva ova pitanja koja su filozofi proučavali milenijumima, mi naučnici možemo da započnemo da istražujemo slikanjem mozga i kroz proučavanje pacijenata i postavljanje pravih pitanja. Hvala vam. (Aplauz) Izvinite. (Smeh)