Ming Tsuang, "Brain, Mind and Spirituality" - God and Computers: Minds, Machines, and Metaphysics (A.I. Lab Lecture Series)

PRESENTER: Yes, welcome, and thank you all for coming to the third lecture of our Fall lecture series, God and Computers, Minds, Machines, and Metaphysics. I first, like always, would like to thank our sponsors. I specifically would like to mention the Electrical Engineering and Computer Science Department at MIT. And also the Sir John Templeton Foundation, and the rest of our sponsors you can find on the website. And I put them this time on both sides. So if you want to visit the websites, you will find the abstracts of the past talks, and future talks, and also some links.

In the first lecture of this series, we heard Paul Penfield, the head of the Electrical Engineering Computer Science Department here at MIT, talking about the character of scientific theories. He expressed his personal opinion, that science would not be completely sufficient to describe what he called the human factor. His examples were love, and grief, and other things. Last week, this very human factor was described by Marc Hauser from Harvard from a comparative ethology perspective. So he said that animals, particularly monkeys and apes, share several of these human factors with humans. Like self-awareness, or the notion of belief. And they also can develop rituals. However, he said that they lack the notion of moral agency.

Today, now, we will hear about another aspect of the human factor from a psychiatric perspective. And I'm very pleased and very honored to welcome Professor Ming Tsuang here today. Professor Tsuang is currently head of the Harvard Medical School department of Psychiatry at the Massachusetts Mental Health Center. And he is also director of the Harvard Institute of Psychiatric Epidemiology and Genetics. He's internationally known for his research on schizophrenia, and also other mental disorders. He holds an MD, a PhD, and a doctorate of science, and several honorary degrees. And besides numerous awards and honors, he's a member of the National Academy of Science, a member of the Acadamia Sinica of Taiwan, and he also just received the Lifetime Achievement Award from the International Society of Psychiatric Genetics.

Among his interests is spirituality, with its effect on mental disorders. And I'm really, really glad that you are now here to share with us your ideas on the brain, mind and spirituality. Welcome.

[APPLAUSE]

TSUANG: It is an honor. And thank you very much for inviting me here. Today I'm going to discuss with you our brain, and mind, and spirituality. I'd like to start off with the brain, and then the brain function, and the mind, and then go into how to tackle the spirituality from the epidemiological point of view. So let's start with the first slide. You can you see it from there?

It's the mind and the brain. Essential to understand the mental process that, essentially, has changed dramatically throughout the human history. The heart, liver, and other organs were believed to be the key to mental functions. Particularly from Chinese traditional medicine, still consider a liver, and kidney, and the other sexual organs seem to be playing an important role in the mental function, and physical functions.

And let us talk about the ancient Greeks' concept. All living things drew vitality from pneuma, essentially air, derived from the cosmos. And then, so this is related to Chinese Tai chi, and the various kind of yin and yang. And growth, movement, and thought were caused by alteration in this cosmos, pneuma. And the liver, essentially, is the natural spirit. Heart is considered to be vital spirit. And brain, animal spirit. All participated. This is the ancient Greeks' concept.

And the modern scientific view, from 16th and 17th century, the concept of nervous system being developed. And essentially, brain and spinal cord being considered as central to the function to the nervous system. And peripheral nervous system is essentially nerves throughout the body, which are actually, essentially, under the direction of central nervous system. So center is in the brain. And so just to give you, for those who are-- I know there are several eminent neuroscientists here-- forgive me in giving the elementary brain structure for those who have not seen the brain. Unlike some of the neuroscientists that are dealing with this every day.

So essentially, this is the brain. And we have a cranial bone, which protects us. And you have a dura, an arachnoid, and pia maters. If you have a concussion, you may have a bleeding inside of the dura, under dura mater, subdural hematoma, and various kind of conditions. And this cerebral spinal fluid, this is just to give you our brain. And the brain, somehow, has the very important demarcation for anatomist. And the neurophysiologist. And the neurochemist. To really point out which part to study.

So the frontal lobe-- I thank you to have this for me. So frontal lobe is here, and then the prefrontal. These, and the primordial cortex. So this is very important. I'm going to elaborate the mind, mental function, and the brain. And this is the marking, called Sylvian fissure. And under which is temporal lobe, and the parietal lobe. And the sensory cortex is here. And here is a demarcation, it's called central sulcus. And occipital lobe.

And in what way this is related to our mental function? The major external brain structure, as I showed you, frontal lobe is the executive function. Doing things, thinking about the things, and the planning for the future. And temporal lobe is the auditory processing, and related to language. Of course, you see the frontal lobe also involved in language. And parietal lobe, this is the summary of what we know, touch, and balance. And occipital lobe, in the back, is related to vision.

And brainstem is inducing the sleep, arousal, heart rate, and breathing. So these are, essentially, the brain structure and the functions. So let us see from this side, the frontal lobe, then parietal lobe, as I talk about, then the temporal lobe, occipital lobe in the back, and the brain stem. This is the vital organ. Vital, very vital, to our survival. So even without this part, if this is unhurt, still we can survive. And respiration, heart rate, are controlled by this area. And cerebellum is related to balance and the movement.

So from outside which you can see, for us to discuss the brain function. and the mind, we need to know the major internal brain structures. So hypothalmus. This is related to our thirst, hunger, and sexual function. Cerebellum is the balance and movement. And corpus callosum connects the two cerebral hemispheres. And thalamus is important relay station for sensory processing relay.

So in this sense, you can see already, here, the inside, as I already talked about, corpus callosum, which connects the two sides of the brain. We have a left side and right side. And these two are very symmetrical. One side can really function. We know from some of the patients, even losing one side, still can survive. And so, this is the corpus callosum. And then I talk about the hypothalamus. And this is the pituitary gland. And then the pineal gland. And the thalamus is here. Thalamus. And the medulla, this is the brain stem. Midbrain pons, and cerebellum.

So this is just to give you some of the brain structure. And another important thing in mental function from a psychiatric point of view is the emotion. How you feel. And the limbic system controls emotion, and memory, and also all functions. And this is the limbic system inside. So hypothalamus, olfactory valve tract, they are connected to this. And mammilary bodies-- in some dementia due to alcoholism, mammilaries tend to have bleeding.

And amygdala, and hippocampus, and fornix, and thalamus. This is actually consisting of the important structure for our emotions. And the various important function of mind. And then, there are various nucleus within the brain. And this is the coded nucleus. And the putamen, caudate, and the globus pallidus substantia negra. This is related to Parkinson's, and so on. And the reason I show this is that, in the past, we thought that this has nothing to do with the mental function. But now we know, these are also related very specifically with the schizophrenia research, which we are doing. So I'd just like to introduce very quickly the anatomical structure, for us to understand what I'm going to talk about.

So this is on the anatomical level. But within the brain, there are many, many cells we call neurons. And neurons have a nucleus and an axon, and with myelin sheath. Covered with the axons. And then, are connected with synapse to another neuron. So neuron has the axon, and also has a dendrite, to connect. One cell to connect to another is actually very important. So this is the two neurons in synoptic contact.

And this neural network is the, as I showed you, is the signal transmission from one neuron to another. And it's been done electrochemically. And so, a nerve cell fires, then signals go to the next neuron, and small white nodes are synapses. Gap between cells. In the case of multiple sclerosis, those are-- the one which I showed you, that myelin sheath has been affected, so that it sort of, say, the electricity is not efficiently passed on. So there is the movement disorder. So this is the very important function of the mind. In order for a two to connect.

And now, I'd like to talk about the brain development. A human being is unique, and I'd like to show you the brain development. How it develops to have you, now, with the mature brain. Brain develops beginning in the first months in utero. And neurons migrate to genetically pre-planned regions, which is very important. That cells migrate from the bottom to the top, to the cortex. The maximum neural migration at the middle trimester.

So the migration may be affected in the second or first trimester by virus, or malnutrition, or trauma. It may affect the brain cells, the configuration. That is what I'm going to talk to you about. The current theory of neurodevelopmental malfunction of the brain, leading to schizophrenia. Am I standing here, can you see it? If I go there, they cannot see. So there's no way. So I should stand here.

OK. Neural migration. This now becomes very important. Schizophrenia, once upon a time thought as the possession by devil. At that time, we didn't know. So ascribe everything to those superstitions. But now, with the new development in neuroscience, we now know that neural migration is very important. Neurons migrate in a highly organized fashion. Is the pre-plan. But as I say, a virus, genetically malformation, may affect this neuron migration. The earliest migrants from initial deep layer later arrive and assume places closer to the cortical surface.

So just to illustrate to you, those are the all in the superventricular, or ventricular cells, migrate to the top in the cortical plate, where our thinking, our feeling, and everything is very important. Executive function. So migration. And the earlier ones stop here, but the later ones come to the top. And sometimes, there is the order to ask some of those older ones to die, in order to save the younger ones, to go to the top. so it's very interesting that the brain is wired in that sense.

So all the cells, the new ones, actually come to the top layers. So this development differentiates us from other types of creatures. This, developed by Paul MacLean, represents the brain in evolutionary terms. From reptilian brainstem, survival, respiration, heart rate, and the mammalian, limbic, with the emotional . System and the neomammalian, actually cortex for our cognition. So just to give you some illustration. This is the reptilian, and this is the limbic system. And then, neomammalian, this is us, representing the greater area of the cortex. And the cells all migrate to the cortex. And there, you can see, they're well arranged, and well connected from one neuron to another, for their function.

So the important area which has been discovered by Broca. Is the Brocas area, named after Paul Broca. French neurologist of the 19th century. And it's essentially our speech center. Is at the left, inferior, frontal lobe. And essential for linguistic fluency. And if you have a stroke, then if this area is affected on the left side, if you are right-hand side, a person, left side affected, then you have aphasia. You cannot speak. So this is the Brocas area. This area.

And so in terms of the brain and the mind, the brain is well integrated so that we can do whatever you like to do. In terms of thinking, in terms of feeling, in terms of your behavior. It's totally integrated with the brain, and the spinal cord, and peripheral nervous system. And what we recently found was that in schizophrenia, which was originally considered to be possessed by the devil. So you can hear the voices, which is devil voices. You believe someone is going to harm you. And that kind of abnormal behavior was thought of as the aberration. Because of the possession by the devil.

But recently, with the neuroscience development, we know that-- I'm going to show you the PET scanning, I show you that the normal brain is on the left. And the brain of the person with schizophrenia is on the right. The schizophrenic brain demonstrates lower blood flow. We can test the blood flow in the frontal lobe. So essentially, you can see that the normal, and the abnormal, you can see the blood flow is different. Because the cell configuration is different.

So another one, I'm showing you normal brain on top. Schizophrenic brain in the middle. Then, with the drug treatment, all the brain function in schizophrenia. So this, also, we can now see from the PET scanner. Normal, and the schizophrenia, and after application of the neuroleptics. Which treat the symptoms of schizophrenia. And this, now, we can show from PET scanners.

So essentially, to give you a summary, in psychiatry when we examine the mental function, these are the three cardinal aspects-- we call mental status-- we examine. And to characterize, what is the function of the mind. Mind cannot be seen. But as a psychiatrist, we see the mind when mind is functioning. And three-dimensional approach to the mental function is the, you think, you feel, and you behave. And these three, all of us are well integrated. So when you think about the happy events, you are feeling. Feel high. And you become sort of elated and restless.

So these are the congress functions. However, in the case of mania, it's a hyperfunction. You have lots of ideas, and you feel that you are so great. You become the President of the United States. These days, become the President of the United States is not as good as before. [LAUGHTER] And you are overactive. So that is the mania.

And the depression is the hypofunction of these three. So however, these three functions are congress. In schizophrenia-- this is just for illustration. In schizophrenia, these three functions of mind, something happened here. And current theory is that, brain functions are disturbed. So when you believe that people are trying to harm you, yet your expression is apathetic, not fearful. And then, you are supposed to run, because someone is trying to harm you. But this person sits there still. So this is the concept of schizophrenia. Different from mania and depression. So our study, during the last 30 years, our group are trying to find what are the potential risk factors affecting the brain for this cerebral function to become incongruous.

So essentially, what I'm saying is that, schizophrenia is no longer the myth. It's a brain disorder. And we are now trying to tackle, what are the genetic components of it. What are the environmental components-- particularly intra-uterine condition, and after birth-- in what way the environment actually interacts with the congenital malformation. So our group, in collaboration with the Mass General Neuroimaging, we showed that this is a normal control of the normal person, volunteer. In the case of schizophrenic patients, lateral ventricle becomes bigger. And inferior lateral ventricles are bigger. Because their brains shrink. Essentially, the cortex and the other area of the brain volume decreases. So the lateral ventricle, where we are supposed to have our cerebral spinal fluid occupy there, is more. So this is the indication of the brain becoming smaller.

And not only that, thalamus, or lateral ventricle, is actually wider. And these thalamus, which I've already shown to you, putamen, pallidum, hippocampus, amygdala complex. This is all related to feeling and emotion. Smaller than normal control. Now the research which we are doing is this. Not only we are studying schizophrenia patients, we are now studying the relatives of schizophrenia. Where we are doing the collection of DNA, and to test the genes.

But to capitalize on that opportunity, we compare the relatives who are not schizophrenia yet. Still they show differences, comparing with normal. Essentially, I show you these are the areas which have been affected even in the relatives. So it means that, in the past, we don't know when to intervene, to prevent the onset of schizophrenia. Now we know the earlier treatment, the better. And even better is before the treatment, if we can find cognitive deficit. And the neuroimaging abnormalities. We may be able to prevent them. So this is our work.

So in addition to that, we use the functional MRI. The control comparing with relatives of schizophrenia. And of course, us the schizophrenia is like this. But this is the milder. Essentially, for the normal, you don't need to use so much energy to do the assigned tasks. In schizophrenia, and the relatives, because their brain cells are arranged in such an inefficient way, they have to utilize so much brain areas to perform the same function as the controls.

So current, very strong hypothesis, and with scientific evidence, is the neurodevelopmental models. These propose that there's some combination of genetic and non-genetic areas, leads to maldevelopment of the brain in childhood. And we can see that neuropsychological abnormality in children of schizophrenic patient. And the obstetrical complication in birth of schizophrenic patient all impact to result into a schizophrenic brain. And therefore, brain and mind, is normal, it's well integrated. In schizophrenia, which is the area of our research for a long time, we feel that we can really study brain to identify schizophrenia. And also, this is all in research. It's not that in a practical application, yet. We are trying to find the gene for schizophrenia.

So what we are doing is that the National Institute of Mental Health supports us to collect 200 families in which two or more are affected. And we interview all of the family members, and then we collect the DNA. And nationally, we are collecting another 200. And then, from there, we like to study, what are the potential genes. We already know there is no one gene for schizophrenia. There must be many genes to interact with the environment to develop.

And not only that, what we are studying is the subthreshold of schizophrenia. It's called schizotaxia. In Paul Meehl's term. Essentially, those who have not developed schizophrenia yet, but they have a tendency to inherit schizophrenia, a trait. And using the neuropsychological, cognitive deficit, and MRI family study of schizophrenia, we are tackling that what is that genotype and what is the phenotype of schizophrenia.

So the current concept is this. It's a vulnerability with a genetic or the intra-uterine abnormalities with a stress model. And if the stress is-- the environmental risk factors-- is higher, then it becomes schizophrenia. And if not, it's a subthreshold called spectrum disorders of this kind, and genetic predisposition.

So this is pretty much to summarize the current theory of schizophrenia. We have not found one gene for schizophrenia yet. We know there are several genes involved. So essentially, to summarize current finding of the concept of schizophrenia, before I move into spirituality, is that schizophrenia, from ancient, biblical teachings, all considered to be possessed by the devil. But now, with the scientific approach, neuroscience, we now know schizophrenia is a disorder, mainly from brain. And it affects the thinking, and feeling, and the behavior.

And we now think, our group, thinks that from available data, there is a genetic predisposition. An early environmental insult develops into the maldevelopment of the brain. Particularly in cortex. And here, the doctor [INAUDIBLE] here, in his hospital, the McLean Hospital, they are actually analyzing the brain neurons' arrangement in the cortex. And find the arrangement on each layer seems to be not all properly arranged, in comparing with normal.

So it's the neural developmental abnormalities. And the later environmental insult. Particularly at the addresses. These are all present, but they're silent. And later, particularly at the teen age, or adolescence period, where neurons, the brain growth, and the external environmental insult, essentially result in, the brain cannot react to the demands of the environment. Because the brain is already abnormal. And then, followed up with brain dysfunction and schizophrenia.

And then, schizophrenia causing psychosis. Psychosis, by that meaning, these cerebral functions become incongruous. And then, hearing voices. And then, can hear own thoughts aloud. Or they have many, many bizarre delusions related to many things. And in the past, when we don't know the satellite function, some of the patients already believe that, oh, I can travel to other universe. And but now, seems to be real. So that is no longer the delusions. So delusions, the definition has to be interpreted from the cultural context.

So the important part is this. If schizophrenia develops, psychosis develops, it triggers the current theory. It triggers potentially becoming the neural degeneration. There is no evidence yet. But that we know if a schizophrenic psychosis episode develops, first episode you don't treat. Then, second episode, third episode. Then it is very difficult to treat. So current emphasis is on how to prevent the onset of psychosis.

And at the Massachusetts Mental Health Center, we are trying to develop the prevention center and now it is not just to treat. We are trying to develop a prevention strategy, both from biological and the environmental point of view. So once it was a myth. Now, we understand the brain. And with an NIH effort, called Decade of Brain, lots of efforts are being utilized to study the brain of schizophrenia, and affective disorders, and others.

So this is just to give you some of the current study on brain and mind. Now with this background, with spirituality. We are like in the old days. Spirituality is a myth, and spirituality is the superstitious concept. In particular at MIT, where they are all so reasonable. All so logic. So spirituality, when you talk about it, it is a myth. It is the superstition.

But schizophrenia, the reason I use schizophrenia, was this. That in the past, schizophrenia considered to be a myth. But that with the scientific approach of the neuroscience, we are able to tackle them. Now we consider this to be treatable. And if we can clone the genes, we will be able to develop the real treatment, and prevention, and so on. So with this as a basis, I'm now going to move into a very difficult area of the spirituality. Particularly for great scientists, like here at the MIT.

I'm not saying that there are no great scientists at Harvard. Because I'm just saying that we are here, at MIT. [LAUGHTER] So forgive me eminent professor coming from Harvard. Forgive me. Because we are utilizing MIT's space.

So the reason we couldn't do schizophrenia research is that there was no definition. Definition is according to professors definition. Professors say, this is schizophrenia, when it was a Dark Age of psychiatry. Now, we develop all kinds of criteria, which we study internationally, which I participate. And we do the long-term follow-up and family studies. We already know there are essentially good criteria for diagnoses, but not necessarily for research. So now, we at least have an operational definition of schizophrenia.

In spirituality, I was invited to NIH, to the alternative medicines conference. And I ask-- there are many, many experts there. I say, could you define for me, what is spirituality? Apparently, a Dark Age of psychiatry, where everyone has their own definition of schizophrenia. Nowadays, we have a common criteria. So it is important to develop the criteria, before we're launching into the spirituality.

When you read in the magazine, in the Time magazine, and the New York Times, they are talking about, if you pray more, than your health is better. Those kind of things. We need to do rigorous research. I believe we cannot do it completely. Like in schizophrenia, we did it, but we only scratched the surface. And I sort of feel that doing research on spirituality is like doing schizophrenia research in the Dark Age of psychiatry. And the operational criteria is very important. To really tackle, is spirituality related to health? Ill health, mentally, or physically.

And from my practice of seeing patients, many patients in the past, seldom they talk about the spiritual dimension. Now, if you ask which denomination-- which religion are you affiliated with, they'll start to talk. Particularly for many patients. They like us to really engage in the mind, brain, and spiritual dimensions. And if your patients are interested in using the spirituality dimension to help their illness, why should you deny them? You know that,

From your own existence, even though you don't know where the mind is-- but now we know it is in brain. And we know the function. And because we operationalize, what is a mental function. For the spirituality research which we are now launching on, we have to have at least some spiritual, operational definition. So this is not the definition which I'm proposing. I'll just give you one example of, you have to characterize, what is schizophrenia.

In doing spirituality research, we have to characterize measurable spiritual dimension. I'm not saying that with this, we can understand all the spirituality. Like in schizophrenia, we characterize them, we understand the brain. Yet we still don't know many, many aspects of schizophrenia. But at least that we can get to some aspects of schizophrenia, like this. Our group now launching into the spirituality research. And I'm going to give you some of the spirituality research affecting the health, which we are now contemplating to launch on.

But before that, let us-- how many minutes do I still have? Tell me.

PRESENTER: 15 to 20.

TSUANG: 15 to 20. OK. So this, for me to organize this very important aspect of this spirituality research. The participation in organized religion, participation in non-organized speech or activities, prayer and meditation, read sacred scriptures, profess a relationship with God, or an outward spirituality. Profess to believe in the corporal spirit or soul. Gives unselfishly about your time, and resources to help others. This is a very broad definition of spirituality.

So with this, if we can characterize them, then we'll be able to use the epidemiological technique to really study them. The current report-- I'm not saying current reports are all wrong. They are tilted to a very subjective interpretation of the result. Which I'm going to emphasize.

So we need to think about-- in epidemiology you're always thinking about the rate. The numerator, and denominator. So this is talking about the denominator. When you talk of the rate of those who pray versus those who do not pray, you have to have, which population are you talking about. And then, operational definition is the numerator.

So here, in various populations, whether you study children, teenagers, or elderly, or severely mentally ill, or chronically ill, or disabled, and economically disadvantaged minorities, terminally ill, or dying-- essentially just do a census of, have you gone to church. And you don't know which kind of population are you studying. You don't know the denominator. That is a problem of the research in this area.

So when we study them, we need to-- in schizophrenia, there are several subtypes. We subtype them, and study them. Then we know how to study efficiently. So the gender, some of them never report what is the sex-- what is the gender. And then report that you do this, then this happens. That is all a very, very erroneous approach to the study of spirituality. It is so difficult to study. Then if you mix the denominators, then you are unable to study them. Then what religion, education, socioeconomic status.

When you read in the New York Times, they talk about the various kinds. And seldom they characterize the denominator from which the population are drawn. And then, the operational definition of the spirituality, this is a very important aspect of epidemiology, in which I'm specializing. The mind is a psychiatric epidemiology. Meaning studying the mind, and the function of the mind.

Then we use that technique to see if we can operationalize spirituality to a certain extent. I'm not saying perfect, like schizophrenia. We have operational criteria to study brain. We now need to study our spirituality using a similar technique. And then, another deficit is that, in some of the report which you read, they seldom have a control group. There is no comparison group. They just study them. It is not going to get anywhere.

So the control group to examine placebo effect, this is difficult to study. But we can design it with a comparison group to study, what is the placebo effect. So in addition to that, you say improve. What is improve? There is no criteria for outcome. So it is difficult to characterize them. You need to study the physical health, and then characterize them. In heart disease, cancer, or mortality, mental health, psychiatric diagnosis, substance abuse, and the helplessness, hopelessness, and coping style. And various kinds of suicide attempts. And more importantly, the marital status, socioeconomic status.

Apparently, focus is not good. Can you focus a little bit? It's all right. The educational outcome and arrest and conviction. OK. That's fine. Thank you. Thank you very much.

So outcome has to be assessed, in order to study the spirituality and its impact on health, physical and mental health. So this assessment has to be reliable. You need to develop the assessment form. And which test, and retest, reliability of the assessment. And then, train people to really come up with a reliable assessment of outcome. And this outcome has to have-- it's not just reliable. It has to have its validity. And it has to be objective, and standardized. And when you are interviewing, by comparing the control group and the experimental group, it has to be blind

When we study schizophrenia relatives, we don't know what kind of relatives are we studying. This kind of a modern epidemiological technique has to be utilized. So the epidemiological study, we tend to jump to cause and effect. In schizophrenia, in the beginning, we thought that there's a cause and effect relationship. We don't know there is a cause, one cause. We know the risk factors. Using the same analogy that, if there is an evidence that spirituality is associated with improved health outcome, we'll want to know whether there is a cause and effect relationship.

Cause and effect. Spirituality leads to lower levels of anxiety, versus association, spirituality and low anxiety are actually intertwined. Related with the correlation. So cause and effect, we-- so usually it's the published paper, or the newspaper talking about, it's usually the correlation. It's not the cause and effect, and written in such a way to mislead people. To really think that there is a cause and effect relationship.

And then, the cause and effect, it is helpful to classify the concept of cause. Traditional concept of unnecessary cause. And the traditional concept of sufficient cause. An epidemiological concept, of contributory cause. Those need to be applied. And essentially, in complex situations with many contributing factors, one also needs to consider supportive criteria for a contributory cause. Strength and consistency of the association between spirituality and health outcome. And if this is biologically plausible. That is important. And evidence of relationship between increased spirituality and better health outcomes.

And the interpretation of the result. Could not be a subjective, should be based on the evidence. And the extrapolation to a new population. Once you find the new finding of the spirituality and health relationship, you need to apply it to another denominator, and to see if it could be generatable.

So I'll just give you one example of what we have, and what we are beginning to do. It is my personal conviction, from my own practice, and my own personal belief, that spiritual dimension is there. And I believe that, with the rigorous current research methodology which we use for schizophrenia, we can apply to study spirituality and its relationship with health. Particularly, with mental health, which is my area. And I witness that the patient, one to one, spirituality affects the patients very much. Particularly in drug abuse, in the depression, and so on.

So we now have the huge sample of the twins, about 4,000 twin pairs. And the conceptual model is this. Essentially, here we have concordant, monozygotic twins. All right? And if we develop a speech of scale, the mean score, and then this is very difficult to see, because I simplified it. But I will use a few minutes to elaborate this to conclude. This is what I reported to the National Institute of Drug Abuse to study them.

Essentially, the identical twins, they share all the genes in common. And what becomes different is that there's some other factors, which is not genetics, affecting the concordance or discordance. Concordance meaning, that both identical twins are non-abusers. Never abused drugs. Never been diagnosed as the drug abuse. Then the abuser, are those, both identical twins in the pair are drug abusers. And discordant meaning, that one twin, monozygotic, identical twin, is non-abuser, and another one is abuser. OK?

So the inference here is that, if you are both abusers, then control for genetics makeup. And the mean score of spirituality, hypothesis which I would like to test, should be the lowest. And the concordant one, in the middle. Then discordant twins, who share the same genetic makeup, yet this person is non-abuser. And this person says, spirituality score is high. So essentially, if spirituality is a protective factor, abusers should score relatively low on spirituality.

Non-abusing members of pairs, concordant for non-abuse, that is low risk subject, have spirituality score intermediate. Between abusers and non-abusers from discordant pairs. Because non-abusers from discord pairs which have a high spirituality scores are assumed to be at high risk for drug abuse. The absence of abuse suggests the presence of a protective spirituality factor. I'm just talking about one way of approaching them.

Then another dimension of the spirituality, which Templeton's Foundation is very interested in, is how to tie the spirituality dimension about thankfulness, and forgiveness, to relate it to physical health. And the mental health. So we now are collecting the twins who served in the Vietnam-- Vietnam veterans. Served in the Vietnam combat theater. And some of them, identical twins, both are there. Some of them, both are in the continental United States. They total, 4,000 pairs.

We can study their post-traumatic disorders. Post-traumatic stress disorder in the combat. You see your friend die. And why some of them are still thankful? And why some of them are bitter? And we can control for the environment, and the genetic makeup, to study them.

So in a nutshell, what I'm saying is this. It is difficult to study spirituality. And I have to confess that we cannot understand spirituality fully, but that spirituality is there. And that, if we think that we are just a brain and mind, you are underestimating yourself. There is a spiritual dimension. Love, and the thankfulness, forgiveness. Those are considered to be a very important, vital part of spirituality.

So like the schizophrenia research, if we can tie this together, at least from epidemiological, risk factors design, we'll be able to characterize them. Then later, it's not a dream. Now with the neuroimaging, with the brain abnormality, which we can characterize them, we may be able to find that at those areas I'm dreaming, those areas which actually expresses thankfulness, or forgiveness. Like the Vietnam era. Being killed, friend being killed by Vietnamese, and still now can't forget. Those kinds of tendencies are actually very much about genetics and environmental interaction.

We now know that the-- you may not believe it-- the data, if you characterize well, spirituality has the familial and the genetic tendencies. But not all genetics, Shared environment is also very important. So in conclusion, what I'm saying is that, doing schizophrenia for the last 35 years, I'm personally convinced that spirituality, which is my personal belief, with the existence of the spirituality. I'd really like to tackle this very difficult subject. Do it properly. And then, we'll be able to understand the mind, brain, and spirituality. My time is up. Thank you very much.

[APPLAUSE]

PRESENTER: Thank you so much. Are there any questions? Do you want to take questions yourself, or?

TSUANG: Oh, you.

PRESENTER: Yes, please. [INAUDIBLE] Yeah, we are a little bit over time, so.

AUDIENCE: You said that you were going to-- predicting the scale. My question is that, you have a mean score. The important thing is, how do you decide, what is a mean score? Who decides it?

TSUANG: OK. You, essentially rate spirituality operational--

AUDIENCE: No, what's the scale of spirituality?

TSUANG: All of the operational criteria, which I talked about. We can develop the-- there are already many scales of spirituality. Then you would rate each twins. Then you picked up the mean. It's called mean score. And there are many scores. And we trying to develop our own to suit our own study population. Yes.

AUDIENCE: Getting back to schizophrenia for a minute.

TSUANG: Yes.

AUDIENCE: You showed that it's a form of a structural defect in the brain. At the same time, I guess it's known, I think that it usually onsets in the teenage time. And you also said that it comes in episodes. So if it's a structural defect, why does it have this specific onset and episodic behavior?

TSUANG: That is a fact that we are really trying to understand. And this has been a very, very important question. Why having this maldevelopment already there, at the birth, and why it do not to have an onset very early. And usually occurs from the age 15, 16, that is, a teenage period. The current theory is this, that the brain development has not matured yet. Until the teenage. And when, in the adolescent period, there are demands from the environment. Brain's demands from the environment become heavier and heavier. And at that time, all the maturity of the brain actually accomplishes at that time.

In schizophrenia brain, it has not been accomplished. That immature brain cannot cope with the environmental stress. So usually, that is the time. Because the brain is so inefficient, then to respond to the environment, it cannot function. Therefore, develops the symptoms. That is a current theory. An episode is, when you don't treat a psychosis, psychosis may become the triggering effect for another episode. So it needs to be treated. So our current approach is, how to find those children who have not developed schizophrenia, yet.

Yet we know there are genetic risk factors, and environmental factors, with the brain imaging abnormality. How to help them not become schizophrenic. So schizophrenia research is now moving into prevention mode. It is a cutting edge of research. Not in everywhere, yet. Yes?

AUDIENCE: [INAUDIBLE] the existence of spirituality, and also you mentioned [INAUDIBLE]. How do you think this spirituality is related to soul, the existence of soul? And how do you think the role of Bible plays in your mean?

TSUANG: Specifically, you want my opinion?

AUDIENCE: Yes. [INAUDIBLE] Forgiveness and thankfulness. There's a lot of examples, a lot of illustrations in the Bible. How important do you think the Bible plays in a role?

TSUANG: Yes, the Bible actually is the description of the spirituality. All of the parables, all the example which have been shown, is to show the existence of soul. And that is part of our spiritual dimension. The Bible is the document of the spiritual manifestation of the human behavior, and also God's interaction with human beings. So I hope that answers your question. I may need to take another one to deal with your questions.

AUDIENCE: If I understood what I think I heard you say, you bypass the question about the neurophysiological basis of-- independence of neuroanatomy in spirituality by saying, we can't really deal with that. However, if we can find a correlation of spirituality and health, and find a neurological substrate for it, that's good enough. Right?

TSUANG: Not good enough. Then, if we can-- like schizophrenia, we are doing neuroimaging of brain. It is not good enough. We'd like to go into prevention mode. And then, we are trying to find where, if we use the particular drugs, which part of the brain is affected? And when we are doing psychotherapy, the patients says, your statement, doctor, what do you tell me, I feel so relieved with my burden. And in the future when you are doing psychotherapy, you may be able to do PET scanner, or a functional MRI, to show which brain areas are affected.

So what I'm trying to do, if we really find that thankfulness, and forgiveness, is actually related to mental health, I'd like to see, when one feels thankful, one feels to be able to forgive, which part of the brain is actually related. Then we'll be able to really do something. So this is the first step. And for schizophrenia research, I've been involved for 30 years, and I only accomplished a little bit. In this spirituality, I don't think this is going to be easier than schizophrenia. But if all of us acknowledge we have the spiritual side of us, depending on how you define it. OK? Is that OK?

PRESENTER: Yeah, sure. We have five more minutes.

TSUANG: Five more minute. Yes?

AUDIENCE: You mentioned, you already touched on the brain [INAUDIBLE] the visual [INAUDIBLE] and the different brain [INAUDIBLE]. How about just talking about consciousness, that also goes on, a nd also, how about spirituality, especially in related to--

PRESENTER: You wouldn't mind repeating the question? The thing is, perhaps just for other people who weren't here last week. We heard last week a lot about consciousness. So that would be interesting.

TSUANG: Consciousness actually is the entire brain integration. But if you'd like to ask me, where are the important aspects of the consciousness in our brain, I didn't talk about this reticular formation. Near the brain stem and up, there are reticular formations, which is absorbing the external stimuli. And then pass along to higher cortex. And to keep you alert. And that is the total integration of the entire brain. And to be aware of what is going on.

And how to tie this with spirituality? If you have a cognitive function, you are in communication with the supernatural. And that is also part of the-- you have cognition. Are able to perceive, able to realize the existence. You have communication from your spiritual dimension. So either you can say, there is no such thing, but from our practice, and my personal experience, I firmly believe at this time, that there is the spiritual dimension. Which applies to my patients, and to myself.

And where it this located? Probably related to, as you say, the consciousness. Cognitive function. But it's also related to feeling, emotion. Which I talk about. So we don't have an exact location. If I can get to that, I'll not be here. I have to go to Stockholm.

PRESENTER: I think one more question. We can have one more question.

AUDIENCE: There have been a number of physiological findings on the attributes of so-called spiritual adepts, for example, Buddhist monks. Some of which is actually at [INAUDIBLE] MIT. Are you aware of studies of the sort of neurological differences between, let's say, experienced meditators, and non-meditators, or people who might be considered to be highly spiritual, and others who are not?

TSUANG: Yeah, there are lots reports. But for me, to really say that is credible, to meet the criteria, which actually illustrates it. So I have not come up with a good study which I can quote. So sorry, I don't have. Yeah, there are several publications. But if you use the epidemiological approach to that, those are, should I say, shaky. Shaky. Because the use of the denominator and the numerator are not in accordance with our criteria.

But on the personal level, one to one, I'm talking about the application to everyone. To the huge population. That is what epidemiology is doing. But person to person, if you talk to a person, they firmly believe that the mind meditation actually affects my physical well-being. And if he say that, who are you to deny that he doesn't feel that? No. Individually, my patient tells me, after you talked to me, and you say, prayer me help in my first-- I was a Catholic. But I never went to any church. But now I'm depressed. Then, I start to pray. And, lo and behold, I feel better.

Whether it's a placebo effect or not, individual case. So we have to divide the individual dimension, and the whole epidemiological. So one to one, who am I to deny this patient's statement of his condition? I cannot. That is the important things to differentiate.

PRESENTER: Unfortunately, we have to stop.

[APPLAUSE]

TSUANG: Thank you. Thank you very much.

PRESENTER: Thank you so much for coming. That was wonderful.