SIO387: Chemical Imbalance, Personality Tests, Double Empathy Problem, and More! It's a Psych QnA!

Transcript

This transcript was generated automatically and may contain errors — the audio is the record.

0:00:12 Thomas: Hello, and welcome to Serious Inquiries Only. This is episode 387, I'm Thomas Smith, and I'm already joined by Stormy Decisis, Dr. Alan Smirbeck. How you doing, Alan?

0:00:22 Alan: I am splendiferous, glad to be on.

0:00:25 Thomas: Can I just say, you're better than Splendiferous. You've made me Splendiferous, because But in an effort to, you know, hopefully have all of our episodes recorded, all of our ducks in a row, as they say, before Lydia and I head out to with Remy, by the way, head out to QED, take a little bit of a trip. A that's a tall order, getting all that recorded ahead of time. I don't know if I've ever been able to successfully do that. But in effort to do that, I mentioned to you that, oh, yeah, we're trying to get this done. And so Stormy, we were already going to do this Q but here's Stormy with the most organized, amazing like, hey, I got the questions ready. Eddie. Here's of them. Here is all this stuff. I just want to thank you so much for being amazing at this. I can't tell you how much helps this and I am really looking forward to these episodes. So, not only is Stormy amazing for those reasons, also, I hear we have some developments on the little library donations you wanted to do.

0:01:13 Alan: So, if anybody is new with this episode, I've been trying to get banned books into little free libraries in, you know, near schools or libraries where they're, they're being banned. I put out a call and a few people responded and said that they live near a school or library that's banning books or restricting them or something like that, and that they would place them. So, I've worked with these people and set up an Amazon wish list, and I'm going to give you URLs that'll take you to that wish list. And it's just a list of commonly banned books, you can buy one, send it to them, and they will put it in a little free library, so, and teens and adults will have open and free access to these books. Sure.

0:01:59 Thomas: A truly excellent idea. I love it. So, you are going to hand them out now and I will put them in the show notes as well. One.

0:02:04 Alan: So it's all in lowercase, and it's tiny.cc slash kbandbooks, and band is b-a-n-n-e-d, so that's t-n-y dot c-c slash k-b-a-n-n-e-d b-o-o-k-s, and I got three people, so I have three URLs, URLs, but you're just going to change that K to an L or that K to an S. So it's tiny .cc slash L banned books, tiny .CC slash S banned books. So if you pop on there and you buy them a book, it'll get placed near a library that's censoring it.

0:02:28 Thomas: Oh.

0:02:40 Thomas: Gotcha. Okay. Love. This super cool idea, it's awesome you set it up. I will put those in the show notes, and I'm sure they will fill up immediately. Um, sure to, uh, to click on those, everybody, this is a really good idea. All right, with that said, let's get to our Q&A. We had a lot of good questions on patreon.com/seriouspod Stormy again was kind enough to go through them. And because, know, you this is sort of medical health, you know, related stuff, mental health related stuff, Stormy has abridged some of the questions to make sure they're, you know, kosher, they're make sure sure they're not going out of bounds in terms of medical advice type stuff. And so normally I kind of read the questions word for word from you folks, but I think it'll more make sense to use Stormy's abridged version of the questions for some of them, just because that'll be smooth for everybody. So just a heads up, sorry for putting some number of words or taking words out of your mouth. We've done probably both.

0:03:42 Alan: I like, mean, I've had Sea Witch problems with sea witch is stealing my voice. So now I have become the sea witch and I'm stealing your voice.

0:03:49 Thomas: There you go. No. And with Michael Ardren, who asks, we often hear the term chemical imbalance when trying to explain conditions such as depression or bipolar. Is there any truth to that term? And I remembered, I think I've done something on this, but always worth a refresh. What do you think?

0:04:09 Alan: So there was a paper recently that was saying, you know, hey, we've analyzed all the data and we've shown that depression is not a serotonin deficit. And it was sort of trying to claim that like, see, psychiatry is bogus. All the the psychologists and psychiatrists and biomedical researchers were like, no, we already knew that. That's not News. It is kind of news to the public because we have a public image of this sort of chemical imbalance, because there can be ways that talking about these things in biomedical terms can reduce stigma somewhat. You, someone says like, hey, it's not just, you know, oh, you're having the sads. Have something chemically different in your brain. Of course, every thought you have is something chemally different in your brain, that's what thinking is.

0:04:16 Thomas: Right. Yeah. Yeah, right. I feel like it's also people help people not be like, well, have you tried just not being sad or have you tried to get your bootstraps a good tug and not being depressed anymore? I feel like it helps a little bit. I know it's certainly for me, it helps helps a bit to be like, no, I mean, chemicals, man. I don't know. It's not something I can just like stop.

0:05:10 Alan: I motivation is also chemicals. But I think to the extent that it removes some of that that judgment or self -blame or things like that, it's good, but that doesn't make it true. Is no psychological disorder I'm aware of that is simply a matter of too much or too little of a neurotransmitter. First of all, we're hardly ever talking about the amount of neurotransmittor. We're talking about its level of activity, activity.

0:05:15 Thomas: Yeah.

0:05:38 Thomas: Hmm. Stupid question. Yeah, what's a neurotransmitter?

0:05:43 Alan: Neuron fires, that's an electrical impulse that moves along the body of the neuron and a little tentacle that sticks out called an axon.

0:05:51 Thomas: We have tentacles in our brain? Oh, my God.

0:05:53 Alan: Yes, it's very pornographic in there. So

0:05:55 Thomas: Yeah! Don't tell Aaron Rabinowitz. He's going to love this.

0:05:58 Alan: Then the the tentacles, you all hentai with other tentacles called dendrites. But here's the thing. They actually touch. They're very prudish. So the electricity does not hop from one neuron to another.

0:06:11 Thomas: They soak, though? So, they have one neuron. You get in a bed.

0:06:14 Alan: Mean, weirdly, that is close, because two neurons have a gap between them called a synapse, and the first neuron, the the one with the axon, spits out chemicals, and those chemicals hit the other neuron. Are neurotransmitters. Transmission within a neuron is electrical. In between them, it's chemical. They don't touch.

0:06:16 Thomas: Oh. My god, that's so funny, huh?

0:06:37 Alan: And

0:06:36 Thomas: That's so interesting. Why the hell is that? It's just that the way it evolved? And seems to work or something? Yeah, interesting.

0:06:40 Alan: Don't know, man. Evolution? So that that's Why, like an electroencephalogram, an EEG, can detect brain brain activity through electricity, because it's detecting the electricity of what's firing. But that's also why if you take a drug that alters your brain chemistry, it doesn'T make electrical things fire. It you hardly ever actually consume, well, you never consume a neurotransmitter. In rare cases, you consume a precursor.

0:07:00 Thomas: Yeah, hmm.

0:07:09 Alan: Um, only for Parkinson's disease really, but

0:07:09 Thomas: Like you mean in chemical terms, like, you consuming, as in you take a pill that I gotcha.

0:07:15 Alan: As in, like, you don't just take a pill, because actually, most neurotransmitters, your brain is surrounded by a membrane called the blood-brain barrier, that keeps germs out, um, it also keeps most everything else Out.

0:07:16 Thomas: Yeah keeps, like, everything out? Right.

0:07:26 Alan: Right. So, um, most drugs, most neurottransmitters, can't get through the blood brain barrier.

0:07:26 Thomas: Yeah. Crazy.

0:07:34 Alan: If you just ate a handful of serotonin, you would have absolutely no effect on your brain. It would do is it would make you shit yourself, because true.

0:07:34 Thomas: Crazy. Nothing? And That would affect your brain. You

0:07:45 Alan: You'd probably feel a little bad about it. Molecules in the body are reused. They're used for multiple things, because you don't have that many genes.

0:07:45 Thomas: Feel Huh? Yeah.

0:07:53 Alan: It's like in the tens of thousands. So they reuse stuff. So serotonin is also, there's serotonine receptors in your gut that tell your gut to move food along. If you ate a bunch of serotonin, it would never even reach your brain, but it would tell your gut to shit yourself.

0:08:01 Thomas: Yeah.

0:08:10 Thomas: Is that, you know, for us to avoid killing ourselves by eating something over the course of a zillion years of evolution or something? Like, it's really, it really protects the brain from that stuff?

0:08:19 Alan: Most of your cells are always being replaced. And so let's say you had some damage to some cells in your heart. They can be replaced with brand new heart cells. Any heart cell is just as good as any other heart cell. At least if they're the same type, they're both the same muscle, right? But your neurons store information and learning through the exact pattern of connections with other neurons. Neurons. And so if you replaced that neuron with a new neuron, you'd lose something. The way your immune system works in a lot of cases is it gets rid of a bad cell and replaces it with a good one. If any kind of disease got into your brain, wouldn't just be able to, you know, get rid of the bad cells and replace them with new ones because you'd loose something. Thing. The decided, we're going to keep everything the fuck out of your brain, because we can't afford to go replacing bad cells. We preserve them at all costs. And the at all cost means it's really hard to get things into your brain.

0:08:34 Thomas: Yeah, Yeah, right, yeah.

0:09:21 Thomas: That's been a real challenge with just trying to develop medications for these things, right? Because it's like, well, how do we get it past the blood -brain barrier?

0:09:27 Alan: So I mentioned Parkinson's disease, and Parkinson's is closest the I'm aware of to a a imbalance. So Parkinson's disease, there is a single tract of dopamine using neurons. It goes from a part of the midbrain up to what we call the basal ganglia, which is a set of structures kind of towards the middle of your brain. We call them subcortical. Cortex is the outer edges. This is sort of towardsthe middle. That of dopamine -using neurons is dying. And that's what Parkinson's is. We can somewhat replace that activity by giving you more dopamine. If we just gave you dopamine, it wouldn't get in. But what we can give you is a precursor molecule that can in, and then the brain can turn it into dopamine. It's called L -DOPA or levodopa, and it's been Parkinson's medication for decades now. It has a downside side because there's no neurotransmitter that does just one thing. In fact, the rule I always tell people is anytime you think you understand neuroscience, that's a good sign you're wrong, it's insanely complicated. When people take L-DOPA, they don't just replace those bad dopamine neurons.

They also overstimulate a bunch of other dopamine neurons, so can start having hallucinations, um, actually most of them say they don't really mind their hallucinations, they're just kind of there and they're kind of like, oh, that's annoying, um, they can actually, if they had a compulsive or addictive problem like alcoholism or compulsive gambling, um, can come back in full force or it can start brand new. There are people with Parkinson's who started these drugs and, you gambled away their life savings.

0:10:12 Thomas: Hmm. Hmm. Yikes.

0:11:07 Alan: That's the closest we have to a chemical imbalance. It really is pretty much just this one neurotransmitter, but it's one neurotrasmitter in one part of the brain. That's why when we try to treat it, we have problems because the drug goes over all the brain, most disorders, disorders, it is true that there's a neurotransmitter that is more or less active in a particular part of the brain, and even then only in particular So serotonin doesn't just have the serotonine receptor, it actually has about a dozen. So it's not just all serotonins is high or low, there's little too much serotonan activity in this part of the brain with this receptor.

0:11:20 Thomas: Gotcha.

0:11:48 Thomas: So trying to target just that sounds tricky.

0:11:51 Alan: It is. Nothing, again, Parkinson's is the exception, but it's not like depression is having too little serotonin or something like that. To say, for example, For example, schizophrenia. Right now, some of the best available science says that it's having too much dopamine activity in one part of your brain, a part that has to do with perception and sort of generating ideas and memory. And so that's why people with schizophrenia, when you ask them, like, hey, what'd you do over the weekend? Might think, well, I saw a soccer game. Soccer, soccer isn't a ball. Balls are circles. Cookies are circles, the moon is a circle. And so then they say like, eye the moon.

0:11:59 Thomas: Mm -hmm. But Hmm. Oh, wow. Sounds really difficult to deal with. Holy moly.

0:12:33 Alan: It is, schizophrenia can be an incredibly disabling disease. So that part is overactive. But then there's another part of the brain that involves things like motivation and starting activities that's underactive. And so contrary to the stereotype of schizophrenic people being, you know, disruptive and violent, in reality, a lot of schizophrenics people are like a bump on a log. Engage They in almost no activity. They don't talk very much. Kind of sit there. And executive function is a whole bunch of related abilities.

0:12:33 Thomas: Yeah. Right.

0:12:46 Thomas: Hear that. Does share any commonality with the executive dysfunction or is that a totally different kind of mechanism? Gotcha.

0:13:12 Alan: And this is specifically the ability to initiate things, sort of the motivation to do things that these this sort of subtractive symptom where we've taken something that's normally there. Like, you know, most of the time, if you haven't showered for two days, you want to shower. You feel icky. There's people with schizophrenia here that they just don't. They don't care. There's too much dopamine activity in one area and too little in another area. And, and also want to point out that that is only part of what schizophrenia is.

0:13:35 Thomas: Wow. Right. Sure.

0:13:46 Alan: That's why Parkinson's is unique in that Parkinson's really is in large part this one thing. Else, there might be something where there's a little too much activity or too little activity in an area, but that's only part part of it.

0:14:00 Thomas: Gotcha.

0:14:01 Alan: I'll say that when it comes to medications, just because something isn't caused by a deficit doesn't mean that a drug won't work. You don't have a headache because you have an ibuprofen deficit, but ibupropen treats a headache.

0:14:13 Thomas: Right, yeah. Yeah, yeah, exactly. I think that same analogy was used. My main takeaway, I remember one of them from that that episode was like, I, I've always noticed that, um, my particular, uh, so I'm on, uh, Wellbutrin and they say like, well, start taking this and within 10 to 20 days, you might feel better. No, it takes a while. It takes like, oh, you know, full effects months maybe. Uh, and I was like oh, okay. If I forget to take my Wellbutrin by one in the afternoon, I will pass out because I'm like, something's wrong. Like, even if I don't know that I did. I'll start being really tired.

0:14:50 Alan: Can actually explain that. It's a little bit of a long explanation, but I can explain that,

0:14:55 Thomas: And yeah, that's why I remember that takeaway, takeaway, it making sense in that episode. The fact that like, you know, and actually now that I start to say it, I don't remember exactly why. So yeah, feel free to remind me why that makes sense.

0:15:09 Alan: Meaning serotonin -affecting drugs, generally speaking, alter serotonin activity very, very quickly, within hours. That's, again, a reason we've known for years that that's not what depression is. It's not a serotoner deficit, is that doesn't magically cure your depression. What happens is, you have more more serotonin just hanging out in that synapse, and that your receptors slowly change because they adapt to the new serotonine levels. And that adaptation takes, what takes weeks.

0:15:24 Thomas: Oh yeah. Yeah.

0:15:44 Alan: But then if you forget a dose, your serotonin levels really do go down. That does affect your mood. The long-term adaptation is what really treats the depression. But

0:15:48 Thomas: Yeah, yeah. Gotcha. Here's how about it, and it may be my entirely invented thing, but the way I was making sense of it in my brain, I just remembered, is it sort of subjectively feels like it, it's almost like, you a given, I don't know, event or something where you kind could of have a range of reactions to it. It's almost like, well, this is giving me just a little boost in everything. Like, oh, you know, something, something kind of negative happened. How upset am I? I? And it's like it felt like, OK, over time, just getting a little bit of help with each of those little things, like each of those, whatever it may be in the day, each of these little events over time that does build up and improve your overall mood versus it doesn't just all of a sudden this chemical creates happiness. It's like that's why over time it kind of adds up in that way that maybe me making sense of it, and it might be wrong. What do you think? Does that seem like a description that makes any sense?

0:16:45 Alan: Mean, that makes sense. I wouldn't say that's actually what's happening on a neurological level. But to be clear, what's actually happening is insanely complex. There's absolutely no way I can do it justice. But the very, very brief version is that one of the things about depressed brains is that they're not very adaptive. Learning goes slower and learning is a change in behavior in response to stimuli. And what call brain -derived neurotrophic factor, which is a chemical in the brain that helps grow new connections. So I told you those axons and those dendrites, you know, it's like the part in the hentai where the bunch of tentacles come out. So we need a chemical to make that happen. And that is not very active in depression. So you're not being very adaptive. And serotonin activity you get on antidepressants seems to help restore that flexibility, that learning. So you can cope better with things because you can start doing different behaviors instead of just being like, yep, this sucks. And sitting there and being like yep, it sucks.

0:16:49 Thomas: Mm-hmm. Mm-hmm, right. Yeah. Well,

0:17:51 Alan: Sucks.

0:17:51 Thomas: That strikes me as very compatible. Like that might be some of the subjective experience of, like what I said might be the subjective experience of what you're talking about a little bit. Don't you think? It's like, it's helping with those little, you know, thingies that happen every day over time. Those little, like, what would that feel like if not kind of what I described?

0:18:10 Alan: Guess what I was reacting to was it sounded to me like you were saying that it's sort of making you a little bit happier. It's not clear to me that that's what it's doing, but that it's making you more able to do the things that will eventually make you happier.

0:18:24 Thomas: That is actually, actually what I was, the second thing was, what I was going to jump in saying, like, that effect is it's making me a little happier over time, but I was saying the reason it's doing that is because with each of these little kind of, I don't know, events or whatever, like it just feels a little, like a little bit of an edge, a little bit of a, I don't, like a crutch or a stilt or something, on each one, you know, and over time that has the effect. I, you know, again, I think it's obviously I'm putting it in clumsier terms, but I actually kind of think I was describing the subjective experience of what you're saying. So maybe that, it might've been from that episode that I developed it, which was an expert. So maybe that's, maybe that's why, but that's cool.

0:18:56 Alan: Yeah. And I'm also saying serotonin is the function of antidepressants, but most antidepressants work on more than one neurotransmitter. And a lot of them also include norepinephrine, which pretty directly influences wakefulness and alertness. One thing about depressed people is they don't do much. They Stop doing a lot of things, and then they stop getting the reinforcement that would come from doing those things. Like, you talk to people and you get the the benefit of having socialized, But if you just Lay there and don't talk. So norepinephrine kind of getting you to like start paying attention to a thing or get up and do a thing, um, going to be that same thing of moving you towards a cycle of it's not that it actually makes you feel good, it's that it helps you do a things that Will make You feel good.

0:19:16 Thomas: Yeah. Yeah, yeah.

0:19:40 Thomas: That eventually did.

0:19:41 Alan: No.

0:19:41 Thomas: Yeah totally. Now, and also Welbutrin is not, yeah, that's not an SSRI or whatever, right? That's a different, yeah. But yeah, no, that totally, that total fits. While we did a mini version of that old episode, I'm glad we did cause I had forgotten and it is a really fascinating topic and it all all kind of make sense. Seems I like the way that was getting reported, like you said, it was this whole, see, there is no chemical imbalance. It's like, yeah, that's not exactly right though. Like it's, isn't more nuanced explanation and I'm glad that you've given it to us because that makes sense.

0:19:47 Alan: It's not Um, It would be like if someone was saying like, we just learned that chemotherapy, chemotherapy does nothing to remove ghosts from your blood. We're showing that chemotherapy is nonsense. And be like, man, but nobody thought it was ghosts in your blood, I don't know what your problem is.

0:20:25 Thomas: Yeah. The only difference is I think some people maybe did think it was ghosts in your blood in this instance, just because it's a complicated thing that a lot of lay people, I think, that is how we thought of it when it comes to the depression stuff. I'll just speak for myself, but all

0:20:35 Alan: No, that is definitely true. And, you know, I believe in psychiatric medication, but I'm not a fan of pharmaceutical companies. Pharmaceutical companies have definitely spread the chemical imbalance. Balance, I nicest way to put it for them is that that was the clearest way they could put it to a relatively uneducated population in a 30-second commercial. They definitely suggest in their commercials that it's just, oh, you just don't have very much serotonin or something like that.

0:21:02 Thomas: Well, great question. Great answer. Here we've got a lot of questions, but you've nicely summarized them from Nathan of the Math, which is an interesting name. Number one, you differentiated between disabilities that prevent speech, e .g. Stephen Hawking, to those that stop people from processing language. How How have scientists managed to establish that there are people who do not really have language, in quotes?

0:21:27 Alan: If somebody has language before in their life and then they've lost speech, speech, it's really pretty easy, um, all we have to do is figure out what motor thing they can do, even if it's just, uh, puffing air or blinking their eyes. And then I'll say them a picture and I'll say a sentence and I'll say, like, blink your eyes twice if this Sentence describes this picture and once if it doesn't, um, Stephen Hawking's case, he could already read, read and write. So they just had to figure out what he could do motorically. That case, he could twitch his cheek, I believe. Set up a thing that, you know, let him pick out letters and words and he composed full sentences. It was really straightforward.

0:21:48 Thomas: Right. Right. And he degraded over time. I mean, starting in his, like, 20s, I think. So it's, yeah.

0:22:09 Alan: But even, you know when people have like a stroke or something and they suddenly lose A ton of motor ability, we can just find out whatever motor skills they have left, whatever voluntary muscles they can move, and adaptive technology people are incredible with What they Can do, setting Up something called an eye gaze board, so, like, a camera that points at your eye and you just move your eyes to look at different parts of the board and you can, like, start spelling out messages. So If we're talking about somebody who could already read and write, or Even someone who who already knew language, again, I can show you two pictures of a boy being chased by a dog and a dog being chased by a boy and say, "Look, at the boy is chased by the dog."

0:22:14 Thomas: Right. Mm -hmm. Yeah.

0:22:36 Thomas: Crazy. -mm.

0:22:52 Thomas: Mm

0:22:52 Alan: And if I do that, you know, 50 times and you keep looking at the right picture, then you understand language. A little different when I'm talking about somebody who has never spoken. Spoken.

0:22:52 Thomas: -hm. Exactly. Yeah. -jm.

0:23:03 Alan: Really good truism, though, is you you have language, it should be able to influence your behavior in some way. So for one thing, when I'm talking about people that I would say don't have language we're usually talking about, people with severe to profound intellectual disability, and that shows up in lots and lots of domains, not just language. So these are people, for example, who, you know, babies learn to, like, pick up small a desirable thing by, an M&M by the time, you know, there may be 16 months. This is someone who might be four years old before they can pick up an M & M successfully.

0:23:09 Thomas: Mm. Mm. Yeah. Yeah.

0:23:37 Thomas: Yeah. I mean you're not giving your 16 -month -old M &Ms just saying. In, don't do that. They'll choke. You don't give them stuff that small, but that's okay. I get it.

0:23:43 Alan: Yes, no. Their whole functioning, as far as we can see, that would be a motor skill, but also, for example, an adaptive behavior like drinking through a straw or anything. Receptive language. So I would talk to the person's caretakers and say, hey, if you say out loud, we're going to have pizza, does the person react Do they react any differently than if you say, we're going to have broccoli?

0:24:07 Thomas: Yeah.

0:24:08 Alan: They show any sign of caring, of reacting to that? Or if you use words to say, "We're going the pool," do they show any sign knowing what's going to happen? Like, do the pick up a bathing suit? So, if we're talking about somebody who has, say, severe cerebral palsy and they can't move their lips and tongue, if you say, "We're gonna have pizza," you might see they might make a sound or their face might light up. And if you, "We're going to have broccoli," they might make a different sound even if they can't fully form the words. So that tells me that someone doesn't react differently to those, I'm starting to get a picture that they don't know what those words mean at all.

0:24:10 Thomas: Yeah. Yeah.

0:24:47 Thomas: They just really like broccoli. But, you know, you can eliminate that variable.

0:24:51 Alan: If would first do like a preference evaluation to figure out what it is they like, and then go from there. But the first thing I would do is observe the person just doing whatever they want so I can figure out what motor skills they have. So can they pick up an object that's about, you know, two inches in diameter? Can they touch something that's in front of them but where you'd have to reach across your, your body. And I'll just watch them move about with a play space or any kind of thing, and just watch what they can do. Then I'll present them with a task where, know, they're highly motivated. So if I know They Really Like Oreos, I'll say, like, "The Oreos are in the yellow box. Where are the Oreos?" See if they reach for the yellow boxes. If I know that they can reach, and I know they want Oreos, that's going to give me some really good information.

0:24:54 Thomas: Yeah. Yeah. It does feel like this isn't really that difficult as long as you're engaged and paying attention and doing it kind of scientifically, right? Right.

0:25:49 Alan: Feel like it's one of those things that people are, it's almost a perspective-taking problem because I think it's easy for us to imagine what it would be like to be you and unable to speak, to sort of be trapped in there. And that's a nightmare scenario for a lot of people. It's very hard to imagine not knowing the words. Don't think most of us can imagine that. That's So how facilitated communication got started, is people believed that these severely, profoundly, intellectually disabled individuals must be like me. They must have the language and just not be using it, not be able to use it, in reality they don't have the words. And I think that's very hard to imagine.

0:26:10 Thomas: Yeah. Yeah, Yeah, it's hard to imagine not having language but still having the ability to have these preferences, and you could still express certain things but without language. Right.

0:26:41 Alan: You can have preferences. So I want to be very careful not to compare intellectually disabled adults to children because they're not the same. But I'm sure you've noticed that your baby, your youngest, already has some preferences. How do you know those preferences? Well, you observe his behavior. You observe that he smiles a bit more or he calms down faster.

0:26:49 Thomas: Hmm. Yeah he screams nonstop if we don't give him exactly what he wants. Yeah yeah yeah

0:27:10 Alan: I mean, so that's, it's the same thing with a person with severe intellectual disability. You notice that when you hand them an Oreo, they eat it right away. And when you hands them broccoli, they don't eat it. And they may use different noises. It just might be when you give them an oreo, when you gave them broccoli. You have to get to know the person over time.

0:27:21 Thomas: Yeah.

0:27:32 Thomas: Think it's hard. I was agreeing. I think it is hard for us to kind of imagine what that would be like.

0:27:35 Alan: It really is. And really believe that that's kind of at the root of why people believe in things like facilitated communication, because they just can't bring themselves to believe that this person isn't like them.

0:27:36 Thomas: Yeah.

0:27:48 Thomas: Yeah, question number two, also from the same source, and that was Nathan of the Math. More broadly, are there any examples of clever experimental design, I guess you have gone into a little bit of this, that helped researchers distinguish two very similar phenomena or get at where the error is occurring in some of these disabilities or disorders that that you find interesting or would like to share?

0:28:11 Alan: A lot of what we would call neuropsychological or psychoeducational assessment, that's exactly what it's about. Out. So if you bring me a kid who can't do math word problems, I'm going to give some tests that isolate each part of that. So one, can the kid read? Even before that, can the kid understand language? Do they have a language disorder? Can they read to get the words from the page into language? Can they figure out what math problem they need to do from the words? Then they do the arithmetic? Then can they express the result? And so there's tests that bring it down so you're only doing one of those things at a time.

0:28:25 Thomas: Yeah, isolating variables.

0:28:49 Alan: Exactly what it is. Cool tricks to it. I just talked about like with language, you know, if usually the way I can tell that you understand me is you talk back. I could show that you understanding me by setting up a way for you to respond by blinking. Then I know that it's not just your inability to move your lips and tongue, if you still can't do it by blinking, and I know you can control your blink, then you don't understand. The person wanted some cool examples, so I'll give you one kind of cool example. Abstract shape, just a bunch of lines going everywhere is actually very hard to remember.

0:29:25 Alan: I show you a sequence of familiar objects like cup, key, star, and then I show you a whole bunch of things and I say, okay, point to the ones you just saw, that's pretty easy. And you know why it's easy? Because in your head you're not remembering the pictures, you're just going in your head cup, keys, star. You're remembering the words. Then if I give you one where that's not going to work, so if I show you three different teddy bears, like they just look a little different, and then I show a field of 10 teddy bears, and I say, point to the ones you just saw, you'll do a lot worse. Everyone does.

0:29:24 Thomas: Yeah, yeah.

0:29:59 Alan: Because if you go in your mind teddy bear, teddy bear, teddy bear, doesn't help. Um, we were looking at someone who doesn't have language, their performance on those two tasks would be equal, um, Can tell you that almost everyone who doesn't have language, so impaired generally, we couldn't give them that task because we couldn't get them to, like, learn what they were supposed to do.

0:30:08 Thomas: Interesting. Yeah, that's fascinating.

0:30:22 Alan: If in rare cases where someone, has like a very localized stroke that makes them lose language, you can give them the teddy bear task and they're better at it than most people, but they do the same same as that as on Cupkey Star.

0:30:21 Thomas: Yeah, interesting. That's That's cool. What a cool example. There anything where you need to use that one test where it's like if like blue, but the word says green.

0:30:44 Alan: Yeah, no, we use that task.

0:30:45 Thomas: Is, yeah, what does that do? Yeah.

0:30:47 Alan: A form of executive function, what we call response inhibition. So when you see the word blue, you have gotten so good at reading at this point in your life that your brain just goes, that's the word blue. It does it so fast that you have to inhibit that because the task was to say the ink color. And my favorite story about that is the CIA used that to root out Russian spies. So So the word in Russian. If you don't speak Russian, it's super easy. You just name the ink colors because you can't read those words. But if you speak Russian then have to inhibit which slows you down.

0:30:59 Thomas: Yeah. Right. Yeah, and I Always thought, couldn't you just like blur your eyes really hard or something to try to get around that? Yeah.

0:31:29 Alan: A bit. You know, there's kind of tricks to it. It. We But definitely still use that task for different kinds of things.

0:31:35 Thomas: That's Cool. All right, uh, David Backspino Breaker asks, I have to ask because no one asks adults, what's your favorite dinosaur? Wait,

0:31:36 Alan: Oh, that's a good question. The one with like all the like plates sticking out of its back?

0:31:52 Thomas: You don't mean Stegosaurus, do you? Oh, How Could You not remember Stegosaurs? Yeah, that, that one rules. It's hard to beat that one.

0:31:53 Alan: Do mean Stegosaurus. I like that guy. Yeah, no, that'S a good one.

0:31:59 Thomas: I feel like this person also asked the pajama party this, or somebody else also did, because I've had this dinosaur conversation a few times recently.

0:32:07 Alan: I feel like that's one of the worst parts about growing up is this like no one even cares about my dinosaur dinosaur preferences.

0:32:12 Thomas: Lack of dinosaurs. Triceratops is hard to beat. Stegosaurus is hardto beat. Those are pretty cool. I feel, like, other dinosaurs must have been really jealous. Like, what the fuck, man? I'm just basically a lizard. And you've got all these cool, like this plate mail arranged in different ways. How did you evolve that? Like, yeah, I don't know.

0:32:28 Alan: Nervous because I feel like a lot of what I learned as a child about dinosaurs has changed.

0:32:30 Thomas: Effortlessly. Yeah. Yeah.

0:32:35 Alan: I'm almost like, oh, I like this one. And somebody will be like, no, that one doesn't exist. It was proven to be two children in a trench coat. I've stuck with it.

0:32:37 Thomas: Yeah, it's not real. There was the two children dinosaurs in a trench coat, famously. That hoax, yeah.

0:32:47 Alan: The little rascals.

0:32:49 Thomas: Elias Armando Garcia Guevara asks, "I would like to hear your thoughts on the myriad of personality sorting tests, like four lenses, MBTI, six hats, big five." You could could have been making up any of these and I wouldn't know, except I do remember MBTI, I think, aka OCEAN, etc, that are popular in big business. Do you think they actually help with team dynamics, collaboration, or leadership? Yeah.

0:33:12 Alan: So I don't know the four lenses or the six hats. So I'm just going to assume you made that up. The MBTI is a test that was entirely invented by non -specialists, and it was invented actually derived from Jung, who was a disciple of Freud's. So not talking about a great intellectual lineage. The MBTI just doesn't, when we measure its effectiveness and things, your personality should be pretty stable over time. Time, a big problem with the MBTI is your personality on it changes like in a couple of months, and it shouldn't.

0:33:17 Thomas: Oh, oh.

0:33:31 Thomas: Yeah, Jordan Peterson's favorite, yeah.

0:33:50 Thomas: Yeah. That the NTJ, yeah.

0:33:53 Alan: That's the one that gives you those four letters.

0:33:53 Thomas: Whatever. Those. Are. Yeah. Okay, that's right, yeah.

0:33:55 Alan: A big problema with it is that it rates you as to whether you're like more intuitive or more sensing. Almost all of these are arranged in a bell curve. So most people are pretty close to the middle.

0:34:05 Thomas: And. So it's like trying to get you to choose binaries, yeah.

0:34:10 Alan: And it's just saying like, well, you're slightly on the sensing side, like, yeah man, but you're really close to the middle, and trying to make a category out of something that is a pretty smooth continuum, and so it's really stupid. The Big Five actually is a very scientific thing.

0:34:16 Thomas: Yeah. Yeah. That's that's. Real interesting.

0:34:29 Alan: Yeah. So what they did there is something called factor analysis, where they measured tons and tons of traits, and then they used statistics to figure out which ones tended to go together. So people who are outgoing also tend to be friendly. Put all of the things together and make as many clusters as the data forms, and the data form five or six clusters, depending on how you you do it.

0:34:52 Thomas: Yeah.

0:34:53 Alan: So in a big five test, you measure them as a continuous thing. So you can be all the way from very introverted to a little introverted, to in the middle, to a Little Extroverted, to very extroverted. We're not putting people into categories. That is a valid personality test, and the statistics on it are good. The question is, do you think it actually helps with team dynamics, collaboration, and leadership.

0:35:17 Thomas: Yeah, I was gonna say, what do you use that for? Yeah.

0:35:20 Alan: Not actually sure that it does. Know, if you know someone's a bit more introverted, you might be able to sort of play to their strengths. And, you know, I'm going to give you this task where you're going to work alone for a while versus this more social task. What I haven't seen is evidence that taking the test is any better than just briefly interacting with the person, because it probably doesn't matter for people who are in the middle, which is most people, and people who are on the extremes you probably pick up on it pretty quickly, so.

0:35:50 Thomas: That makes sense, yeah.

0:35:51 Alan: Seen them talk of using them in hiring. So if I'm hiring a salesperson, I do want an extrovert.

0:35:58 Thomas: Probably, but maybe not, it just kind of depends.

0:36:00 Alan: Then if I'm hiring people. You know, people aren't necessarily going to be super honest on the personality test, so.

0:36:06 Thomas: And. Like a lot of actors are introverts, and so while you might want to be like, well, the the networking part, that I'll be honest, as an introvert, that is something I sorely like, like when I see the who are like, they have the, they know all the names and numbers, and they're like, "Yeah, I know this guy." And you remember that guy, and blah, blah, blah, and they have all these connections. I'm like, "Yeah, that's wizardry, I could never do that." Like, maybe if I tried my fucking ass off, I could artificially create that. But if it's just the case of like, okay, when you're involved in a sale, you know, how are you making that sale, sale that I could see, who knows? I could go either way. I mean, if you're really good at knowing your stuff and being able to appeal to people in different ways, maybe you're a great salesman as an introvert. Who knows?

0:36:46 Alan: I'm not a personality researcher, but, um, I do know is that personality only a mild predictor of behavior, so. If you're a. Very extroverted person, in any given decision, I can predict that you're a little more likely to do the more extroverted thing, but.

0:36:54 Thomas: Hmm. Oh, interesting.

0:37:05 Alan: Be sure of exactly what you're going to do, because the situation matters a lot. If idea you're saying you're a very introverted person, but you become very talkative and social on a podcast. So that that situation makes you more talkative. If I was going to say, well, I don't want to hire an introverted podcaster, then I would miss out on someone who is able to adapt to that situation.

0:37:07 Thomas: Yeah. Yeah, well, not only that, that may just be an incorrect assumption about how an introverted acts on a podcast, you know, that might be applying how they might act in a social situation and applying that inappropriately to a podcast, which is not as social as you might think, you know, like, so that could be that as well. I mean, not kind of, kind of applying the wrong thing to that.

0:37:47 Alan: And there aren't that many careers where I think people have really established with scientific data what personality traits are associated with high performance in that career. I don't think there's a ton of that. I think there is a little for certain things like sales. All of that's to say that I don't actually think it's likely to be all that valid or useful, even if you are using the Big Five, which really is a valid measure of your personality. Personality, the only thing that I could see as an advantage is simply if it gets people thinking about how can I be more accommodating and adaptive to others, so if it get some manager thinking, know, some of my employees really don't like this kind of task as much as this kind, how can I be responsive to that? I don't know that the test actually adds anything, but if it of gets people into that mindset, that might be helpful.

0:38:23 Thomas: Yeah.

0:38:37 Thomas: Whereas prior would be, I wouldn't necessarily expect this crap to work because I would expect in our kind of economy, there's going to be a lot of people trying to justify their, their jobs. And I feel like this This will be one of those ways of like, yeah,

0:38:50 Alan: Well, that's like I said, if I was going to salespeople, hire they're going to be like, well, they must want extroverts. So I'm going to say extrovert. For some kinds of psychological tests, we do have ways of catching if you're being dishonest. We don't really have those on personality tests, specialists because

0:39:06 Thomas: I'm Just saying, like, as a middle manager or some crap, being able to say, "Oh, no, I have this analysis, which leads to blah, blah, blah." I feel like there's going to be a lot of BS involved in having those kind of things, even if they don't really work, as long as they're not like actively harming your recruitment in a serious way that anyone would notice. Anything you do that kind of just seems like it would work is probably a benefit to you because then you're justifying your job. That's all I'm saying.

0:39:31 Alan: I mean, I, like I said, I think, I'm not a personality researcher. I'm also not a career sciences kind of person, but the data I've tended to see from like counseling says that will you be unhappy in a job that is a really bad mismatch to your Personality. So if you are a quiet, nervous person, you know, door -to -door sales is not going to go well for you. There doesn't seem to be a ton of benefit to being the perfect match.

0:39:46 Thomas: Oh, God. Yeah. Gotcha.

0:39:59 Alan: You want to avoid the really bad mismatches, but the perfect matches doesn't seem to help a lot. Again, that's that's not my area, so I want be clear that that's sort of what I've heard.

0:40:04 Thomas: Yeah, that makes sense. And just speculating, you would imagine if that's the the case, case, people are probably going to self -sort anyway, for the most part, if it's like has to be a severe mismatch, like you would expect that, you know, because I am not fucking getting a job as a door to our salesman. I mean, for most part, you think people would probably self -sort at least to that degree.

0:40:28 Alan: I'd think so, and I I don't think you need a test to tell you that.

0:40:31 Thomas: Yeah, exactly. I've got your test right here. I'm not taking this job. Fuck that. I am not doing it.

0:40:31 Alan: Um, I think that there that are uses for personality tests, especially in research and sometimes in clinical work, um, as someone who doesn't really know themselves very well. You know, some people go into career counseling and they're like, I don't know, maybe I could be an architect, architect, or a landscaper, or work in a factory, or maybe I could cook things. And you're like, okay, we have no starting points here. So, you know, using that to get a starting point, again, might be helpful. That doesn't actually say anything as to whether it's valid.

0:40:57 Thomas: Yeah. Sure. Right. Well, a great name here, patron Dr. Butterscotch, Purr.HD. Love that. Is it a cat? I assume, but who knows. Ask, I'd love to hear Dr.

0:41:26 Thomas: Smirbeck's opinion on the double empathy problem, its impacts on research about theory of mind, and further research that would be useful. Is Historically, autistic people were believed to have impaired theory of mind and empathy compared to non -autistic folks, as well as a general impairment in social skills. Is part of what leads to the common media portrayal of autistic folks as having no social skills or empathy. The double empathy problem states that it isn't that autistic people have impaired theory -of -mind, but rather a different one, and that empathizing across this boundary between the two theories of mind is harder, but that empathy difficulty applies both ways. Interesting.

0:42:02 Alan: The first thing I'd want to touch on is there's no magical it underneath the disorder. Remember, it's just a collection of symptoms that tend to go together. So when this person says historically autistic people were believed to have an impaired theory of mind and empathy, are central traits to what defines the circle of autism. I wouldn't say that it's a belief. I mean, it is something we have tested with all kinds of research. I want to be clear that in most of this research, when we say people are are making like a theory of mind error, they're not perceiving things in an autistic way that's just like a different culture, where like, you know, there are cultures that make more and less eye contact. It's not like that.

0:42:23 Thomas: Oh, okay.

0:42:45 Alan: Making error. So for example, a classic test, I show the kid a cookie box, and I say, what do you think's in here? And the kid says, cookies. And then I open it up, and what's inside is a matchbox car. Then I close it back up, and I say, hey, if your mom comes in here and we show your mom this box, what is she going to say is inside of it?

0:42:55 Thomas: Okay. Right. Yeah.

0:43:04 Alan: Developing person says cookies. An autistic person says matchbox car. If mom is autistic, according to double empathy, the kid should be guessing mom than most people. But here's the thing. Mom is not going to stay matchbox. Car. Mom might fail to guess cookies, but that actually isn't very likely, but she's not going to guess matchbox car.

0:43:07 Thomas: Right, right. Yeah, yeah, right, that makes sense. It's not a mismatch unless you would, you know, some sort of extrasensory perception is the thing you're sensing.

0:43:35 Alan: So basically what I'm saying is that I say that it's a media portrayal or a stereotype that autism is associated with poor theory of mind and social skills. That's a central feature of the disorder. It's sort of like saying, you know, why does the the media always portray dyslexics as bad at reading? Because that's kind of what dyslexia is.

0:43:46 Thomas: Yeah yeah.

0:43:55 Thomas: To say media portrayals are always good or right or yeah

0:43:57 Alan: I'm not saying the media, but I'm saying this person said, like, there's this media portrayal, and I wouldn't say no social skills or no empathy, because that's, don't know how you would have no social skill. Recently, there have been people diagnosed with autism who do not have some of the cardinal features of the disorder. There's people who are like, hey, you know, I have autism because I have some autistic -like traits, but I don't have these major cardinal features of this disorder. My social skills aren't impaired. Might have some unusual social behaviors, but I'm not impaired. So to me that's drawing the the circle too big. It's like if someone said, well, I'm the kind of dyslexic who's good at reading.

0:43:58 Thomas: Yeah yeah that's also probably yeah yeah

0:44:39 Alan: Not saying that person doesn't have problems or need assistance or anything like that, but I'm saying that putting not sure that that's useful.

0:44:44 Thomas: It's not really useful to call them dyslexic, yeah. Yeah

0:44:47 Alan: And in particular, because it worries me when I hear a question like this,

0:44:48 Thomas: Then you've got all kinds of people saying, oh, did you know that dyslexia people actually can read fine? And it's like, ah, that's not quite it.

0:44:58 Alan: Because a lot of people with autism really need assistance with perspective -taking and theory theory theory theory theory theory theory of mind. So if we start, you know, making the circle so big that we're losing this cardinal feature, to me that's to be helpful. And is sort of saying that their experience of having an intact theory of mind and good perspective -taking, that it is possibly applying to all of autism, and that that does not appear to be true. Have tons and tons of ways of assessing theory of mind and empathy and perspective taking. People with autism, on average, do poorly with those, except there are a few people diagnosed generally fairly recently who have some key features of autism, but not others. So the question is, maybe should those people be in a different Maybe should we start having a different term for them? The bubble gotten too big?

0:44:59 Thomas: Yeah yeah Yeah, yeah,

0:45:50 Alan: If we're starting to talk about dyslexics who are good at reading, which to me, an person who has good social skills is a little like talking about a dyslexic person who's good at readign. Um,

0:46:00 Thomas: And if there's a distinction just because I'm worried people might react badly to that. Not can have like, you a disadvantage or perhaps a deficit, but work to overcome it and, Like, you but that would still mean they are having to work a little harder, but someone might not even really know that they're doing that, right, at some point. Okay.

0:46:17 Alan: I would say that you had to have had impairment in your social skills at some point in your life, and it needs to have been marked to, you know, to a substantial degree, and it needs to have not been caused by something else. So if you weren't socializing because you were socially anxious, that's different than having difficulty understanding someone else's perspective. So I have an autistic family member who, was recent, 30, they're called me on the phone because they were having a problem with a car. I said, well, what's the problem? And And they said, oh, it's that, realizing that I could not see what they could see.

0:46:23 Thomas: Okay. Hmm. Right. Oh, yeah. Yeah.

0:46:55 Alan: So that's an impaired perspective taking. You know, in someone who has average to above average cognition, they're still perspective taking in a way and making an error that most people would stop making when they're quite young. So the, the also said that what they're thinking is that autistic people can understand autistic people and non-autistic people can understand non-autistic people, and what happens is there's problems crossing that boundary. So it's not actually that autistic people aren't good at understanding others, it's that they're only good at understanding other autistic people. So that, that seems to be what the question is saying the double empathy problem is. Again, I don't actually think that that's consistent with the data. So again, the little autistic kid who you showed the box of cookies who says, well, my mom will think there's a matchbox car in there. Mom's autistic, the kid's still wrong. Mom's not going to think there is a match box car in their.

0:47:31 Thomas: Yeah, right, right. Right?

0:47:47 Alan: Empathy is going to occur. There's like a sequence of steps. So first, a person has to display an emotion. You have to perceive even interpret that. My guess is that if a person with autism is saying like, I can understand typical people better than they can understand me. Of all, I would wonder if that is actually true, because we don't often get feedback on our guesses about what other people are thinking and feeling. Even if it is true, one possibility is that typical people are displaying their emotions in predictable ways.

0:48:18 Thomas: Hmm.

0:48:19 Alan: If I see you cry, I can use my social skills to interpret that you're probably sad. If when I'm sad, I count by sevens, it doesn't matter how good your social skills are, you can't interpret that.

0:48:29 Thomas: Yeah? Without knowing ahead of time. Yeah yeah.

0:48:33 Alan: If people with autism, again, many of them display their emotions in very atypical ways, and so other people aren't necessarily going to understand that. But importantly, those atypical ways, it's not like another culture. It's not like they're just speaking French and other French speakers understand them. With autism don't automatically understand each other's way of expressing because it's not like there is an autistic way to do it. It's just that they're not doing it the typical way.

0:48:59 Thomas: Makes sense.

0:49:00 Alan: Wonder if where some of this is coming from is that some of the people who have this perspective know many other people who are very, very similar to them, who also carry an autism diagnosis, but who also have an experience of, for example, feeling that they have a very intact theory of mind and very normal empathy. And so they're talking to other people who have a very, very similar set of symptoms and abilities, it's much easier to tell what those people are feeling. But guess is that that person would be no better than anyone else at telling what someone who has a different, more severe, more classical presentation of autism is feeling. So that's my guess. I obviously don't know this individual and I don't have a lot of experience with this person. I don't know their personal experiences, but

0:49:40 Thomas: Yeah. Now That all makes sense. Well, we're already out of time, so I think, you know, again, because we're trying to get everything ready, normally I don't mine going a bit long, but we don't have the breathing room currently, so we're going to have to call it. And there are still so many questions. I think we'll do what we did with Dr. Brian Gillis. I think we'll do a part two, because there are way too many good ones to there. So you're game to stick around, Stormy, what do you think? A part two next time?

0:50:08 Alan: Absolutely. Absolutely.

0:50:09 Thomas: All right. Well, I want to thank you for joining us. We could once again remind people, check those show notes for the links to donate books for Stormy's Little Library project, essentially. Really good idea. Cool stuff. Looking forward to seeing the results of that. And anything else you want to throw out there before we call it?

0:50:28 Alan: No, just if you want to go follow those links, if you have a few bucks, send a book their way and they'll put it in a little free library for people to pick up.

0:50:38 Thomas: Love it. Looking forward to Stormy answering more of your questions. Well, the patrons questions in the next episode. Can't wait. Right.

0:51:01 Thomas: Like, what the fuck, man? I'm just basically a lizard. And