#14 — ”Psychedelics, Impulsivity, and Brain Stimulation” with Dr. Heather Berlin *On Consciousness*

“In many cases you can see an immediate effect, as in chronic depression – suddenly you turn on the electrodes – you don't tell them when it's on or off, right? And their whole face lights up. And you ask, "What do you feel like?" And they say, "Oh, it feels wonderful. It feels like I won the lottery! It's so great!"   – Dr. Heather Berlin, Neuropsychologist and Assistant Clinical Professor at Mount Sinai   Episode 14: "Psychedelics, Impulsivity, and Brain Stimulation" with Dr. Heather Berlin *On Consciousness*    In this episode, our guest is neuropsychologist Dr. Heather Berlin, an Assistant Clinical Professor in Psychiatry at Mount Sinai School of Medicine. Dr. Berlin conducts research to better understand the neural basis of impulsivity, compulsivity, and emotion with the goal of more targeted treatment. She employs neuroimaging and neuropsychological and psychopharmacological testing of brain lesion and compulsive, impulsive, and personality disorder patients. She is also interested in the neural basis of consciousness, dynamic unconscious processes, the use of psychedelics to treat mental disorders, and in the neural basis of creativity. We discuss her work and interests in this episode.   Talking Points:   0:00 – Introduction  3:09 – Impulse Control and Associated Brain Areas  9:27 – Finding a Balance: Healthy Brain vs Impairment and Self Regulation 17:40 – The Essence of Obsessive-Compulsive Disorders 24:40 – The Big News: Deep Brain Stimulation as an Effective Treatment for OCD 29:29 – Brain Aspects of Stress and Resilience  37:01 – How Effective is Deep Brain Stimulation? 41:59 – Advances in Psychedelic Research 45:15 – Psilocybin and Ego Dissolution  54:18 – Pharmaceutical Addiction Tapering 58:12 – Flow States, Mystical Experiences: “The Cosmic Perspective”  01:04:46 – Possibilities   Summary:   Dr. Berlin has done an enormous range of work, which you can distill into this very profound question: “How do we control our unwanted impulses, our desires, our emotions, our reactions with other people?” These are very common questions, starting very early in life. For example, imagine yourself as a child looking at the most delicious food, let’s use ice cream, and not being allowed to eat it… impulse control is having to wait. Impulse control is not just a problem in childhood, it is perhaps the major problem in adults who have significant psychological troubles. This includes the addictions, but also severe mood swings that adults want to change, but do not seem to have the power to change in these moments. When it is hard to control repeated impulses, we talk about compulsions; cigarette smoking can be seen as a compulsion. When repetitive thoughts are hard to regulate, we talk about obsessions.  There seems to be a tug of war between those deep midbrain nuclei and the control system which involves the prefrontal cortex. Various areas of the prefrontal cortex have somewhat different effects, but prefrontal is associated with self regulation, while midbrain nuclei have to do with impulses, motivations, emotions, and so on. The prefrontal cortex is sometimes called the “organ of civilization” or as Heather dubs it, “the brake system”. The Big News It is amazing how low level electrical stimulation by microscopic electrodes can profoundly change human mood disorders, like severe depression. The brain areas stimulated include the nucleus accumbens and ventral striatum of the basal ganglia, and local areas in the prefrontal cortex.  “Medical science is often an art as well as a science, but Deep Brain Stimulation (DBS) really can have significant effect and impact on people with difficult-to-treat conditions, like OCD (Obsessive Compulsive Disorder), but also people with intractable or untreatable depression,” says Dr. Heather Berlin. DBS can be surprisingly effective. As Dr. Berlin points out, “DBS is a huge success story. 40 to 50% of patients with severe untreatable depression, and about 60 to 70% of patien