Transcriber: Amanda Chu
Reviewer: Peter van de Ven (Announcer) Please welcome to the stage
Dr. David Hendricks. (Applause) Tashi delek - that's how you say
hello in Tibetan. Today I'm really happy to be here to share thoughts that have been
on my mind every day since 1989. My talk today, I hope,
you will find some benefit in. That's the basic motivation I have
in talking to you today. The subject matter of my talk is going to appear to you today just to be a little bit
on the academic side, and there's a reason for that. Before my own recovery, the only emotions
that were easy for me to access were anger and depression. And one of the true gifts of my recovery was the ability to access
a full range of emotional responses, and I haven't yet got the hang
of all of the more tender emotions, so I tend to break into tears easily. So staying on the academic side
is the best thing for a macho man like me so I don't break down in front of you. So, the other thing I want to say is that even though the presentation
may seem at points academic, it has a deep soulful purpose because it's been my passionate
intention over the years to try to relieve the suffering
of addiction particularly, but also mental illness. Before I start,
the last thing I'd like to say is that I'd like to dedicate
this talk today to my old Buddhist teacher,
who died last year. So Buddha said, "The mind is everything.
What we think we become." Because I really believe that to be true, I'm often made really uneasy when I see the kind of crazy stuff
that goes around in my own mind. But what's in my mind today
is really more peaceful and calm than it was in the many years
during my rough childhood, where my father was incessant in his attempts to shame me
and break me down, and it's certainly clearer
and better than it was during the uncontrollable anger
of my 20 years as an alcoholic. I figured that if Picasso
can have a blue phase, then I'm entitled to an alcoholic phase,
which I'm glad is over. But at the end of that career, I really didn't believe that I would ever
be able to have a normal life. But I joined AA anyway, and within one year of that, I met my Buddhist teacher
and I began to meditate, and I began to practice
the Buddhist philosophy of mind, which was the most profoundly useful
psychological system I'd ever encountered. And then three years later, the unexpected miracle of a top-to-bottom
revolution in my entire life occurred - something we call "sobriety in recovery." This has been a pivotal event in my life, and at the time that it occurred, it's become my fundamental
motivation in life to try to help other people
who suffer as I did to also achieve
the same kind of redemption that I was lucky enough to achieve. So, what I would like to do is to see
if there's any fundamental truths that we can bring out
of my little miniature biography today, and I'd like to start in childhood. Recent brain imaging studies
of maltreated children revealed extensive
structural abnormalities in multiple regions of the brain, and enough damage to the brain
so that the brain of these kids has actually reduced
as much as 10% in size below normal. When you look at the painful images,
these brain images, of these children, it's difficult to understand
how they could ever have a decent life, but it wasn't until the publication
of the Adverse Childhood Event Study, the ACE Study, a few years ago that what these kids were going to face
in adulthood became clear. Now the ACE Study was a groundbreaking
clinical epidemiologic study that did two things for the first time
in the history of clinical research, and that is that it looked for - I'm going to put all this up
so you have a chance to see it. For the first time
in clinical research of this type, it looked for all
of the types of adversity that kids could go through at one time. It's hard for me to believe
it wasn't done before this - it was always fragmented - but in this study, all forms of adversity that children
could suffer were looked at, and they were eight in number, and they include physical,
emotional, and sexual abuse, witnessing the mother being abused, divorce or separation, and being raised by a parent that was
criminal, mentally ill, or drug addicted. The study - the second thing that was done was that the study was done in a very large well-designed
population of study subjects on whom med and psych records existed so that the results of the study accurately represent the experience
of the entire U.S. adult population. 64% said that they had experienced at least one form
of these eight forms of adversity. I've done my math
about Millikan Auditorium. And I'm sorry to tell you, but it has probably already occurred
to some of you looking at the screen that 230 of you also likely experienced
one form of adversity growing up, and that 140 of you experienced
two types of adversity - two of the eight -
that's 40% of the US population, and 13% experienced four or more, like me or like 45 of you. So the first thing
that we know from the ACE Study is that adversity is very common
and that most of us in this room share it. What do you think the ACE Study
would predict the likelihood that these suffering children
would use drugs in adulthood? This is a graph that depicts
on its vertical axis the likelihood of
injecting drugs as an adult plotted against childhood experience
on the horizontal axis. The way this works is that for those
that report no adversity, the likelihood of injecting
drugs is very low, but among those who have only one species
of adversity during childhood, the risk triples, and for those that have two
of any of the eight … or three …, or four or more … 80% of all addicted adults
in the United States today come from this population of people
that were abused as children. What would you guess about the likelihood
of mental illness in their future? This is a bar graph that depicts
a likelihood of committing suicide - surely, the ultimate marker
of emotional suffering - in adulthood plotted
against childhood experience. And again, the zero
represents an ACE score of zero, that among those who had no reports
of childhood adversity, the risk of committing suicide as an adult
was very low - vanishingly small. For those that had one type of adversity
in their childhood experience … two types …, three of the eight …, four …, five …, six …, and seven or more … In the article where these results
were first published, the authors said that the linkage between being abused
as a kid and killing yourself as an adult was so strong as to be unprecedented in the history
of epidemiologic studies. And they further concluded that the vast majority of suicides
in the United States every year are attributable to only one thing,
and that is their abuse as children. So the 20th century
closed on an extremely dark note. What we knew at that time is that adversity altered
the structure of the brain of these kids, and that these structural alterations set the stage for emotional states that accounted for the majority
of the suffering in the United States due to drug addiction and mental illness. But science made this picture even blacker when it said that once these
suffering kids reach young adulthood, there wasn't anything
anybody could do to help them, because by that time the brain
had lost the capacity to ever change, essentially entombing them
in their suffering. This is what I was taught
in medical school, and I absolutely refuse to believe it. And it turns out that I was right
not to believe it, because at the dawn of the 21st century,
enough light shone in on this problem to reveal that the brain had had
a science of its own all the time and had the capacity for radical change, and that it could do it even in adulthood. So what I'd like to talk to you about now
is two major mechanisms that the brain has in order to restructure itself and to create different and new
functional potentialities. This is a photo micrograph
of the hippocampus, which is one of the most
remarkable areas of the brain. And over the years of study, it's become
my second favorite bodily organ. (Laughter) Sniggering? (Laughter) Okay, this is total transparency - my favorite bodily organ
is my anterior insular cortex. (Laughter) Alright, so the thing
that's remarkable about this - this is a beautiful picture - these green guys, all along here,
are brand-new baby neurons. So one of the major resources
the brain has to change is the birth of new brain cells. I love these little guys. If there was one place
that they could do the most good, it would be here in the hippocampus, which is Grand Central Station of the brain's capacity
to form new learning experiences and consolidate that
into retrievable memory. And what happens, apparently,
is that whatever we're required to do - to grow, to adapt
to current life situations, like recover from
mental illness or addiction - constitutes the marching orders
for these little green guys to begin to migrate up
into the body of the hippocampus, where all life's experiences are already encoded
and find the right place to plug in in order to encode
new learning experiences that can be remembered. And the second that they plug in,
the brain has changed. And the second that these new neurons add their voice to the internal
mental conversation, the vector of thought and feeling shifts. And the second that these
new learning experiences are in place - and by new learning,
I don't mean one plus one equals two, I mean important stuff, like I just discovered that I'm a pretty
decent person after all - that experience immediately begins to compete
with the messages from the past, and for all abused kids,
the message is "you're a bad kid," so that the "I'm a good person" message can come to dominate
"I'm the bad kid" message, which is really hopeful and really cool. But what's also really cool is the second mechanism
that I wanted to tell you about by which the brain changes, and that's a very complex
molecular machine that exists inside the neuron
in the brain, called epigenetics, which has the capacity,
in response to current life experience, to physically move
into the nucleus of the cell where it shuts genes off and on
in order to help us adapt. So I'd like to tell you
about a recent laboratory experiment that goes to the heart
of what we're talking about here today, and it's an experiment that deprives rat pups
of the maternal care that they need. When they don't get that, the epigenetic machine
becomes aware of it, it physically moves
into the nucleus of the cell, where it shuts off a gene that's responsible for the control
of the stress reaction in the brain, and when that gene doesn't work,
the brain can't control stress. So once a stress reaction begins,
it can't be stopped. And this out-of-control stress
is toxic for central nervous tissue: it kills brain cells, it reduces the brain
in size and distorts its architecture. But you see, those are exactly
the forces that were responsible for the abnormalities
in the brain imaging studies of these maltreated children
that we talked about earlier. The other thing that it does is it makes these rat pups
act mentally ill. So this molecular and genetic
configuration in the brain are the changes that drive the behaviors that we diagnose
as post-traumatic stress disorder in clinical practice. But if later, the maternal care
that these rat pups need is provided to them, the epigenetic machinery hears about this, this complex molecular machine
moves back into the nucleus of the cell, where it switches the gene responsible
for the stress response back on - stress comes under control,
the brain is healed, and the rat pups stop acting mentally ill, and they get on
with perfectly normal lives. And this is exactly analogous
to the situation of maltreated children. And we learned from this that if we want to give
to our patients in recovery the same epigenetic gift of healing that these rat pups enjoyed
in this experiment, then we'd better be really careful about how we go about
the process of repairing it in our patients in treatment. So in our treatment program, my wife and I try to provide as much as we can
every one of our patients with two new parents - she and I. And we have a commitment to stick
with them for a minimum of five years, and this is a period of time
that science indicates that is necessary for these brain changes
to come to completion. Okay, so where are we now
in this conversation? We know that adversity changes the brain, and we know that these brain changes
sets the mood in the brain and that these moods drive the processes
of addiction and mental illness. But we also know now, in the 21st century, Western science teaches us that the physical brain
is being changed all the time under the dynamic influences
of epigenetics and neurogenesis. But whereas Western culture is really good about looking
at the outside world and manipulating physical matter, our Western culture doesn't provide us with a very deep understanding
of the nature of mind - the internal mental world, how to really pay attention
to what's going on there, how to sort out the meaning
of mental events, and how to guide these mental events
for maximum growth, so that what happens is that a change
is usually or often willy-nilly, and the results are half-baked. But, 20 centuries ago,
Buddhist philosophy of mind had a very detailed and
profoundly intelligent understanding of the nature of mind. It had techniques so that we could really pay attention
to what was going on there. It had the ability to sort out mental events,
understand their operational nature, and how to use them for maximal
human growth and spiritual development. So, now I'm supposed to say, What now? So I'm going to say, What now? So, my wife and my professional partner
are both Buddhists. We've been mental health
and addiction treatment professionals for a decade, and so she and I decided many years ago that we were going to take
a really close look at the Buddhist philosophy of mind and see whether or not we could
integrate it into our treatment program so we could do a better job helping the people that came to us
with these disorders. So, after many years of preparation,
we left the United States a few years ago, and we traveled to the seat
of the Tibetan people in exile in North India. And over about two-year period of time, she and I selected
a specific Tibetan text, which was a text on human psychology
from the Buddhist perspective, and then working separately,
we each then translated that text over about a seven-
or eight-month period of time. And this is a text that in Tibetan
is "Sem dong sem jung" - it means "The mind
and that which arises from mind," or more loosely translated,
"The mind and its functions," or "Mind and mental functions." And after we translated it, then we had the good fortune to be able
to study this translated material with Buddhist scholars who were respected
for their mastery of this subject matter. So, when we finished, we came back to the United States
and set up a treatment program in Traverse City. But before I tell you about that, I would like to share with you one more piece of evidence
that's necessary to have before we're able to take
all the pieces of puzzle that I've talked to you about today and put it together into an improved
treatment methodology for these disorders. And this has to do
with recent brain imaging evidence demonstrating that meditation
has a profound positive impact on multiple regions
of the central nervous system, including those areas of the brain
damaged by childhood adversity. So that only after four hours
of a sitting meditation practice - four hours of sitting in meditation,
divided up over days or whatever - brain imaging technology
shows a marked enhancement of the activation
and the operational strength of those brain regions that are
responsible for focused attention, what's called "mindfulness"
in the lay press, and then after only 11 hours
of sitting meditation practice, brain imaging proves that the actual density of living tissue
in these brain regions has been increased, so they've been muscled up and bulked up so that their functional
capacity has changed, so they can really pay attention to whatever you choose
to focus your attention on. This is an example of sustained attention of the mind
as distinct from the brain changing the structure of the brain and
giving it enhanced functional capacity. But we had this experience all the time. The mind is always
telling the brain what to do - so if I say wiggle this finger, the brain says, "Okay," and it finds
the appropriate area in the motor cortex that controls the finger, the right nerve, and the finger wiggles. So what I'm suggesting is that if we became more astute
about training the mind to find any area that we wanted, we could learn how to access
specifically those regions in the mind that were damaged by childhood adversity, and by focusing and encouraging
their sustained operation, beef them up to cure it. So this is the way this new
treatment methodology works: We practice quiescent meditation until we beef up the areas of the brain that are responsible
for focused attention until they become strong enough
that we can use that as a tool, like a lens to look inside and to actually observe
the arising of thoughts and feelings from moment to moment in our own minds. By enumerating a relatively short list of mental functions
that mind is capable of performing, Buddhist psychology helps us here because as they arise, we can properly identify them
and give them names. And what this does is
facilitate bringing meaningful order to a realm of our inner mental experience
that's often very confusing for us. The second thing that Buddhist psychology
does to help us here is that it actually assigns a moral weight
or value to these mental functions so that now we've got them sorted out
and we've got them named and we know what's going on: we learned that they are bifurcatable into two mutually distinctive areas
of functionality - harmful and beneficial - and we observed that when the harmful
mental functions operate, it reduces our mental health
and our happiness, but when the mental functions
that belong to a beneficial domain of mind are operational, our mental health is increased
along with our happiness. The third thing that Buddhist
psychology does to help here is to give us efficient
and useful techniques by which we can begin
to modulate internal mental activity. We've sorted things out. We now see that they exist in the two categories
of harmful and helpful, but now we can actually take a hand and we can develop
the mental discipline that's required in order to recognize the incipient
operation of negative mental functions and reduce their power over us, and to recognize the benefits
of positive mental functionality and encourage and strengthen them. So, for example, if I am a person
who has some training in these matters and I'm going through my day and I suddenly become aware
that this person that I'm dealing with is really pissing me off, I see the arising of anger from the domain
of negative mental functions, and I take a step back
because I know I'm in danger - I don't want to be hurt,
I don't want that person to be hurt, and I certainly don't want
to have to suffer the mental consequences that will necessarily arise if I allow that motivation
to motivate my behavior. If I have some training and control, I can switch my motivation
and intentionality to the positive domain so only they can operate
to motivate my behavior. When we have the subjective experience
of positive emotionality, it is important to realize that that experience that we have is the end product of the result of a number of distributed
different brain regions that are cooperating together
in a tightly wired neural network to produce that sensation. So that means, just like the mind controls the brain, I can use the mind
and learn how to command the brain to go into those neural circuits and navigate specifically
to the brain regions that were damaged
by a childhood adversity. Little kids who've been abused don't have
any trouble feeling negative affect, but they do have trouble
feeling positive affect, which means that it was precisely the domains of
the brain responsible for positive affect that were injured by childhood adversity. So by using these techniques
of Buddhist psychology, what I'm really doing is navigating to them
by mindful attention - I am sustaining their operation, and we know that sustained operation beefs them up and make them
stronger and stronger until such time as they begin,
for the first time, to function normally. The first moment of
normal functionality of these circuits is experienced objectively as the acquisition
of sobriety in recovery. When I achieve sobriety
in my own recovery efforts, it was a feeling like my soul was rising
like a raft from the bottom of the ocean to stand up for the first time, and what came with it
was a sense of enduring peace and a certainty I would never drink again. There wasn't any need to drink anymore
because everything was working okay. So what's really happening here is that we're using
a powerfully focused mind that we get from a meditational practice within an overarching
construct and guidance of a Buddhist psychological system
of mind, of understanding the mind. And what we're really doing is, for the first time, we have the ability
to take conscious control of the brain's physical resources,
dynamic resources for change, which is epigenetics and neurogenesis, and we direct them
to heal the wounds of the past and to restore to us the right to be
who we choose to be for the first time. Any of us can do this at any time; it doesn't matter where we stand
on the continuum of human development. So you don't need to worry
about the brain's capacity to change; all you have to do is to be really serious
about training the mind, and it'll happen automatically. Buddha said, "Mind is everything.
What you think you become." Thank you very much. (Applause)
