The Biden administration has released a proposal to raise standards in nursing homes. Why one expert calls it the most significant development for the industry in decades -- and why it might still not be enough.
Guest Host: Indira Lakshmanan
For more than two decades, Dr. David Kessler, a former Food and Drug Administration commissioner, has researched the ways tobacco and food control our actions. What fascinates him most is how these substances can override both reason and will, directing our behavior. He says the latest brain research indicates that the same neurological process that drives us to chain-smoke or over-eat is responsible for many mental illnesses. Diane talks with Dr. Kessler about how our minds become taken hold by certain triggers and thoughts and what we can do about it.
- Dr. David Kessler Former commissioner, the Food and Drug Administration; author, "The End of Overeating;" former dean, Yale School of Medicine; pediatrician
Read An Excerpt
Excerpt taken from CAPTURE: Unraveling the Mystery of Mental Suffering. Copyright 2016 by David A. Kessler, MD. Harper Wave is an imprint of HarperCollins Publishers.
MS. INDIRA LAKSHMANANThanks for joining us. I'm Indira Lakshmanan sitting in for Diane Rehm. Could the same mental processes that leads someone to become addicted to cocaine or cigarettes also cause disorders like depression? In a new book, former FDA commissioner, Dr. David Kessler, argues that there are specific brain circuits that underlie destructive impulses and thoughts. His book is called "Capture: Unraveling The Mystery Of Mental Suffering."
MS. INDIRA LAKSHMANANDr. David Kessler joins me now in the studio. Welcome, Dr. Kessler.
DR. DAVID KESSLERThank you for having me.
LAKSHMANANAnd to you, all of our listeners, we will be taking your comments, your questions and your calls throughout the hour. You can phone us on 1-800-433-8850. You can send us an email to firstname.lastname@example.org, or you can join us on Facebook or Twitter. So Dr. Kessler, let's start with an explanation of what you mean by the term "capture." It's in the title of your book.
KESSLERCapture is the process by which our attention is hijacked and our brain's commandeered by forces outside of our control. Simply put, a stimulus, it could be a place, a thought, a memory, a person takes hold of our attention. It shifts our perception. The theory of capture is composed of three basic elements. There's a narrowing of attention. Something seizes our control. There's a perceived loss of control and there's a change in affect or emotional state.
LAKSHMANANAll right. So in other words, capture is when something commands our attention or compels us to act against our will. So give us an example of how this works with something like smoking, which starts out, for many people, as a pleasure, but it then becomes a need or something that starts out like a bad mood and becomes continuous, like depression.
KESSLERThat's what got me started back 20 years ago. We did the investigation into the tobacco industry and I had to learn everything I could about nicotine. Why do I pick up that cigarette, if I'm a smoker, and smoke 780,000 more? Addiction is really cue-induced wanting. The way it works is that stimulus, that nicotine focuses my attention. If I'm a smoker, there's thoughts of wanting. I actually have the cigarette. It changes how I feel. It's a very effective drug.
KESSLERA few minutes later, I go why did I do that? The next time I see the cigarette, right, I do it again and every time I engage in that behavior, I strengthen the neuro circuits.
LAKSHMANANAll right. Well, all of this arises based on your research and your work from this very complex circuitry in the brain. Break it down for us lay people who are not doctors or medical scientists. How does this work?
KESSLERCapture is the mechanism, I think, underlying much of mental illness. Our attention gets hijacked. It affects how we feel. There is this feedback loop. The important thing...
LAKSHMANANIt starts all with a stimulus, right?
KESSLERBut, of course, it starts with a stimulus, but that's part of this cycle. And why does a certain stimulus affect me and may not affect you? The secret, the key, is if that stimulus, based on some past experience, past learning, past memory, has to have some meaning for me. I'm driving across a bridge somewhere. To somebody, that may be exciting. To someone else, that may be very threatening. I get on a plane. I'm going home. I'm going somewhere. Someone may view that in a very positive way. Someone may view that very fearful.
KESSLERCapture's neutral. We can be captured by things that are positive. We can be captured by things that are negative. But a key element is this perceived lack of control. Of course, I'm in control, but there's a sense, there's a pull that something is doing something to me that I don't fully control.
LAKSHMANANAll right. Well, explain to us how this is different based on each individual. In other words, some people are prone to addiction and other people are not. And so tell us what is different about certain people's brains that as you say, smoking is going to affect one person in one way, make them a smoker who's going to addict -- who's going to smoke 700,000 cigarettes over the rest of his or her life and someone else may not.
KESSLERThat's exactly right. The one thing, though, that is universal is that all of us have these brain circuits whereby we attend selectively. That's part of all of us. What I'm going to attend to. In the studio, there are thousands of stimuli that are bombarding -- what you're looking at and what I'm focusing on are not necessarily the same thing. We get captured. Everyone gets captured and that's really the key because I think it's so important to understand the mental suffering. Mental illness is explainable. It does not have to be a mystery. I think it's time to pull back the curtain on mental illness.
LAKSHMANANYou know, it's fascinating because it's another way, the way you've described in your book, that we can come to understand mental illness, which is so perplexing and so painful and has such a cost to society, not only in terms of the individual lives and families that it affects, but also a financial cost on our healthcare system. So is there something that you have learned from your research that dates back to the FDA looking into smoking addiction or overeating? We know that obesity and overeating are a concern of our current first lady, Michelle Obama.
LAKSHMANANIs there something that can be learned from the medical research into these kinds of addictions to food and cigarettes that helps us really understand what triggers in our brain then cause depression or mental illness?
KESSLERIn addiction, the learning, memory, habit and motivational circuits are at work. Take depression. What captures my attention in depression? What happens in depression is that the negative stimuli, all right, the negatives about myself, things I can't even get away, I'm constantly cued, they very much seize control and that's what I focus on. Let me read you something...
KESSLER...that I found absolutely fascinating. It'll take me a minute but it's from somebody you and I know. This was written back in 1987 and it was a letter that was written to someone's dear friend who had gone to a clinic in Florida for food addiction and here's how the letter starts. "The whole idea of addiction fascinates me not only as it relates to food and alcohol, but as it relates, in my case, to a relationship." Not food or alcohol, but a relationship, right? "I can describe it as a fear, a basic insecurity, that comes over me when I imagine myself without that relationship.
KESSLERIt's as though I have to constantly quiet the internal hunger for closeness, for affirmation, for love, for acceptance, which I don't seem to be able to supply to myself. The fear of abandonment is so overwhelming that I drive myself deeper and deeper into depression. My ongoing struggle is to quiet the non visible demons that drive me. Not to food or drink, but to self doubt and hunger for others' adoration." The person who wrote that, Diane Rehm, 30 years ago. There is not a better description of capture. Not food necessarily, not alcohol, right, but that self doubt becomes the object of capture.
LAKSHMANANWow. Writing about her own relationship, which she has written about more recently in her latest book, "On My Own." It's very powerful. You're talking, in this case, about obsession. Again, not with perhaps a substance, not with a food, but in this case, dependence on an individual.
KESSLERCertainly obsession is a part of it. But emotion, motivation, attachment, many of those concepts, really, when you look at it, are a part of capture. What fascinated me was trying to connect the dots. It's obvious in the case of addiction with tobacco, alcohol, that chocolate chip cookie that's sitting there, why does that have such power over me?
LAKSHMANANI wish there were a chocolate chip cookie sitting here. I'd be eating it right now.
KESSLERBut how it grabs your attention. But that same circuitry responsible for grabbing my attention, why that chocolate chip cookie turns into -- from I want that chocolate chip cookie to I need that chocolate chip cookie, that cycle, that seizing of attention, that arousal, those thoughts of wanting, right, those urges, that momentary bliss when I eat it and, you know, I am zoned out, I am very happy and then two minutes later, why did I do it.
LAKSHMANANDr. David Kessler, former FDA commissioner and author of the new book, "Capture: Unraveling The Mystery Of Mental Suffering." We will have more with Dr. Kessler when I'm back. Please, stay with us.
LAKSHMANANWelcome back, I'm Indira Lakshmanan, sitting in for Diane Rehm. Joining me this hour is Dr. David Kessler, who served as FDA commissioner from 1990 to 1997. He's a pediatrician and former dean of the Yale Medical School, author of the New York Times bestseller, "The End of Overeating," something I think all of us would love to be able to reach an end to, and the author of the new book, "Capture: Unraveling the Mystery of Mental Suffering."
LAKSHMANANDr. Kessler, tell us a little bit more about how the neural pathways work in the brain and how your latest study sort of turns on its head the medical profession's current view of mental illness as a malfunctioning of the brain.
KESSLERWe all have experiences in our everyday life of where our attention gets hijacked. If a bear walked into the studio right now, you'd stop paying attention to me.
LAKSHMANANThat would be a legitimate reason to have my attention hijacked.
KESSLERSo we all can -- we all see it, I mean, in our everyday lives. What's important is to understand how the past experiences, past learnings, past memories, affect, I mean, capture. These are in essence grooves that get laid down, and once I'm in that groove, those neural circuits actually get strengthened each and every time I get exposed to a stimulus, to a cue, and I react to it. The important thing, and this is something I care very, very much about, I think many people look at mental illness and people who suffer, and it's not just about mental illness, it's about a whole array of emotional distress, and look at somebody who's mentally ill and look at that person as broken.
KESSLERCapture is part of all of us. Now while you or I get captured by something, it's going to be based on our life experiences, every single exposure to every cue, every time react. I mean, no one's going to be able to find every single experience you've had over your lifetime, but if you add up all those experiences and the way you've responded, your affect to those, you understand how these circuits get strengthened. So it's part of all of us.
KESSLERWhat may capture you or me might be very different, and there may be a different threshold of susceptibility. But it's the important thing is not that people who suffer are broken, and I think there's hope.
LAKSHMANANWell, let me ask you because I wonder, is this nature or nurture what you're describing? To what extent are we born with certain neural pathways and the circuits that you describe in your book that make us susceptible to capture, and to what extent is that learned? We have an email from a listener called Nancy, who said, could Dr. Kessler speak to the impact of trauma in early life, especially the first year of life? Does he find that brain structure and development are altered negatively and permanently?
KESSLERIt's a very insightful comment. What is trauma? It's some stimulus -- something's happened to me. I -- it had an effect, it changed how I feel. I have those memories. Then anything associated with that trauma, any cue that -- even indirectly could be associated with that trauma, can then stimulate that affective response. I mean, take depression. Let's say I believe I'm a fraud, right, or I have this enormous self-doubt, or I'm no good, all right. That makes me feel sad, but then that sadness itself becomes, that output becomes the input because I start paying attention to that sadness and go, something's wrong, and you end up in this cycle.
LAKSHMANANWhat we refer to as the vicious cycle, of course. Let me ask you, you know, you say that the medical profession is viewing mental illness wrongly, that this is not really a broken mind, a malfunctioning of the mind. It seems as if your work is, in a way, going in the opposite direction of the American Psychiatric Association's classification system.
KESSLERWhat we've learned, what psychiatry has taught us, is that certain symptoms get classified, and we put a label on it, and we may call it depression or may call it bipolar. And then we believe that descriptor becomes the cause, that depression with a capital D is the cause of depression. And I think that's important, and I think we can -- we can look past those labels and look at these circuits and see how these circuits respond and make us feel and act in a depressed way. That's what's key.
LAKSHMANANWell, let me ask you, then, does not understanding -- if psychiatrists and doctors currently don't understand how what you refer to as capture works, is that the reason that medication may not always be effective in treating mental disorders?
KESSLERRemember I, you know, had the privilege of being at FDA and ran FDA and studied the antidepressants. There's no doubt that the antidepressants have some efficacy, not in every one. But what do those drugs really do? They just quiet down the circuits. They don't affect what seizes my attention. They don't -- they may quiet down how I respond, but they're more of a Band-Aid.
LAKSHMANANWell, Jarrod, one of our listeners, has posted a comment on our website, saying, this theory is useful if it leads to an effective therapy. So what is the effective therapy?
KESSLERI think that's something that I spent a lot of time thinking about. Take Alcoholics Anonymous. Why does it work? What are you doing when you're dealing with addiction to alcohol? What does AA do? It provides a different way of looking at alcohol. There's the fellowship, right. Alcohol used to be my friend, it now becomes my enemy. My -- one of the questions that I have studied and thought a lot about, time will tell. I think that the best way to treat being captured, whether it's by a negative stimuli or an addictive substance or a fear, is to find something else that's going to capture me that has even more importance to me.
KESSLERI don't think we can get rid of these brain circuits. If you look at psychotherapy, what is it? It's really trying to get people to have this perceptual shift, and the real I think key to capture is that the real treatment for capture may be finding something else that captures us.
LAKSHMANANAll right, well let's take a call. We've got -- our board is lighting up here with people wanting to you about capture. Let's go to Ross from Haynes City, Florida. Ross, you're on the air.
ROSSOh thank you, thank you very much. Dr. Kessler, I'm a psychiatric physician assistant and hypnotist, and so my question is, how is what you're describing related to dopamine, and when I help someone change their -- at a subconscious level their response, whether to a substance or to a traumatic event in the past, am I changing the engram itself, or am I changing the neurotransmitter involved?
LAKSHMANANOkay, well, he's using some technical language there. Perhaps you can explain what our caller is saying and then also give us the answer.
KESSLERThere's certainly a biological basis to capture, and all these neural circuits have a biological basis. Dopamine's involved in intentional learning. I mean, it gates our attention. So I think it's very key. But It ink what you're doing is you're changing how I perceive the stimulus. You're giving that stimulus some other meaning than it had before. So that stimulus may not be any more as important as it was.
KESSLERBut I think in the end, you're going to have to find something that's equally or actually more important, more meaning, I think that's what's at play in much of psychotherapy and I think even hypnosis.
LAKSHMANANInteresting. You know, you use in your book the example of the very troubled life of the incredibly gifted author David Foster Wallace. He was best known for his 1996 book "Infinite Jest," and he killed himself eight years ago at the age of 46. He suffered from depression. Tell us about him and why you chose him as an example in your book.
KESSLERFrom an early age, David wanted to be exempt from the ordinary. He wanted to excel, first as a student and later as a writer. He wanted to be read in 100 years, and he wanted others to recognize his genius. Yet as soon as he succeeded, if he earned an A-plus or received critical acclaim, he grew uneasy and then despairing. He wanted to be this very good person but suspected something crooked about the way in which he achieved success, something false in him.
KESSLERHe was haunted, and the reason he was haunted by this, something he called the fraudulence paradox. Something about that notion stuck and became a reflexive thought. Any number of things could threaten his credibility, critical praise, academic success, romantic attention, someone laughing at his jokes. He saw himself in such moments, his life to him became one lonely performance.
LAKSHMANANYou know, you describe very powerfully the thoughts that are so self-destructive inside the mind of this man. I think that many people who are gifted and talented and, you know, excel in their field like he did may be haunted by thoughts of what if I'm a fraud, or what if some critic takes me apart on the pages of the New York Times. But why are these thoughts crippling for some people, like they were for David Foster Wallace, and not for so many others?
KESSLERDepression involves a continual focus on negative thoughts, experiences, memories and feelings to the exclusion of all else. No matter what David succeeded at, whether personal or professional, he filtered out everything that reflected on him and took in everything that could be construed badly. Sure, I mean, many of us, you know, have these views, I mean, am I a fraud, am I really competent. We have those thoughts. But they don't take over. We don't filter out everything else.
KESSLERWe may have these thoughts for a moment. David had it this -- as part of this -- really it was a self-perpetuating spiral that led to his suicide.
LAKSHMANANI'm Indira Lakshmanan, and you're listening to the Diane Rehm Show. If you'd like to join us in our conversation with Dr. David Kessler, former FDA commissioner and author of "Capture: Unraveling the Mystery of Mental Suffering," you can call us on 1-800-433-8850. You can send us an email to email@example.com. Join us on Facebook, or send us a tweet to @drshow.
LAKSHMANANSo another person who you use an example in the book is the comic John Belushi, and you talk in his case about the circuitry of the brain and the sort of reward mechanism we have, stimulus, neural response and how it relates to addiction, in the case of Belushi his addiction to cocaine. Tell us more.
KESSLERThe power of addiction lies in its grip on the reward circuitry of the brain. Whenever we encounter a salient stimuli, our neural response conditions us to behave in the same way over and over again. All Belushi, you know, could offer, you know, was I've got to have it. That's how he talked about cocaine. He didn't understand why it really had commandeered his whole life. He could be triggered because there was a scene on "Saturday Night Live" that he really wanted to be in but that he wasn't going to be in, and that could trigger him to need to use cocaine.
KESSLEROr he could have this great success that was so exciting that that triggered him. But it is the grip of -- on those circuits, all right. But what are those circuits? Those circuits are part of all of us. They're the learning, memory, habit and motivational circuits.
LAKSHMANANOne of the things that fascinates me most in your book is this question of whether capture, this notion, you know, the obsessions in our brain, can lead us to cause violence against others. And I was struck by your use of the example of Ted Kaczynski, the famous Unabomber. We had his brother actually on the show not long ago, having written a memoir about Ted's incredibly sad life in the sense that he was really quite a genius but had a lot of very negative things that happened to him as a young man, including being used as a subject for mental tests at Harvard University, shock therapy and other things.
LAKSHMANANSo tell me, you know, when does capture lead to violence?
KESSLERKaczynski left teaching and abandoned his urban life to live as a survivalist in the Montana wilderness. This is what Kaczynski -- let me just read to you this brief excerpt that Kaczynski wrote in his diary in July 1978. Yesterday was quite good. Heard only eight jets. Today was good in the early morning, but later in the morning there was aircraft noise almost without intermission for I would estimate about an hour. Then there was this very loud sonic boom. This was the last straw and reduced me to tears of impotent rage. But I have a plan for revenge.
KESSLERHe goes in to the wilderness. All he wants to do is to be left alone. What captures his attention? Those planes that are flying overhead.
LAKSHMANANAnd so the distraction and in this case, you know, the capture of his brain by these technological noises that were bothering him so much, end up becoming the trigger for his violence against others. I mean, you also used the example of Dylan Klebold and Eric Harris, who were the Columbine High School killers, where you say that capture also affected them.
KESSLERHere is Harris in his diary. Everyone is always making fun of me because of how I look, how weak I am. Well, I will get you all back, ultimate revenge here. You people could have shown more respect, treated me better, treated me more like a senior and maybe I wouldn't have been as ready to tear your heads off. That's where a lot of my hate rose from.
LAKSHMANANDr. David Kessler, former FDA, author of "Capture: Unraveling the Mystery of Mental Suffering." We will continue our conversation after this short break. I'm Indira Lakshmanan, sitting in for Diane Rehm. Stay with us.
LAKSHMANANWelcome back. I'm Indira Lakshmanan sitting in for Diane Rehm. And joining me this hour is Dr. David Kessler, the former FDA commissioner and former dean of the Yale Medical School. He's also the author of the new book, "Capture: Unraveling the Mystery of Mental Suffering." Now, Dr. Kessler, you know, our board here as lit up with people calling in and sending emails who have, you know, who are fascinated by your theory, but also want to know what does it mean.
LAKSHMANANHere's one email from Carlyle who says, "Great show. What concerns me is Kessler has yet another diagnosis but no obvious prescription. Fascinating philosophy, but what is the cure?"
KESSLERAs a physician, the reason I spent the last number of years writing and trying to understand "Capture" is really to alleviate suffering. That is the goal. The most heartening aspect of "Capture" is the possibility of being released from suffering by escaping the orbit of this feedback loop that causes profound distress. We can find stability and self-awareness, I think, by exchanging one capture for another. But no one really has explained that.
LAKSHMANANWell, you know, that is fascinating, exchanging on capture for another. We have a tweet from a listener, Laura, who says, "Capture makes total sense to me. I only quit smoking once I started swimming." So in that case she has replaced one addiction, I guess, with another. We have Cheryl, who says, "To me, addiction seems like a car driving on a neural highway. And the more you drive that same road day after day, the more those thoughts become habit and addiction. Take another route over and over and you can minimize that neural pathway that your car is otherwise stuck on." Is Cheryl right?
KESSLERShe's exactly right. Our environments, be they historical, physical, economic, dictate what become salient for each of us, forging patterns that in turn determine how we experience the world and, ultimately, who we become.
LAKSHMANANSo your advice as a medical professional, as a doctor is, you know, obviously, people who are suffering from addiction or mental illness, they need to be seeing a psychiatrist or a psycho therapist. But if they've read your book, how can it help them in their treatment?
KESSLERTo understand that what is pulling, the reason they feel the way they feel is not something's broken with -- inside them. It's very important to understand that this mechanism, I think, is universal. Capture allows us to focus, to be moved, to act with purpose. Right. The mechanism does not, in and of itself, give meaning to our lives, but it allows us to search for an experience. It allows us to grow and recover.
LAKSHMANANAll right. Let's go to the phones. We have a listener, Joel, in Rockville, Md. Joel, go ahead.
JOELHi, you guys there?
LAKSHMANANYes, go ahead, please.
JOELI just wanted to say, yeah, as somebody who has fought with a number of demons over the course of his life, a lot of what Dr. Kessler is saying is making sense. So I know that evolutionary psychology is a very sketchy science at best, if one can even call it a science. But I was wondering if Dr. Kessler would be willing to speculate on, I guess, the why of why the brain works this way. What advantages would this -- it's clear, you know, what disadvantages this, you know, particularly -- particular wiring of the brain might confer. But what advantages, what, you know, evolutionary -- possible evolutionary boosts would this have conferred upon our ancestors or even to us?
LAKSHMANANAll right. Thank you, Joel. So evolution, it determines us. Why have our brains developed this way?
KESSLERThe ability to have our attention hi-jacked, even before we decide to focus in a certain direction -- look at the advantages of that. If there is a threatening animal or something and my attention gets grabbed by that, I mean, if I'm a bird and I'm flying overhead and of all the things that I could be looking at, if I can see something move, it grabs my attention. If that signals food, of course, there is an evolutionary advantage.
LAKSHMANANWell, all right. So then that leads me to the next question, which is capture can also grip us in positive ways, right? How can we use it to our advantage?
KESSLERGreat creativity, spirituality, right, the divine, right? All those can have very positive effects. I mean, look at the painter J. DeFeo. She spent eight years in San Francisco but in the '60s. Eight years working on one painting to the point where that painting weighed some 2,000 pounds and they had to cut a hole in her apartment. She wouldn't leave that apartment. Enormous creativity, enormous focus…
KESSLER…came out of, you know, that capture. Greatness, I mean, look at whatever you or I consider great and meaningful acts, right, capture is a -- can be a very positive, as well as negative, mechanism. It's neutral, right, but we can be captured by positive things and we can be captured by negative things.
LAKSHMANANI imagine it also means that people can be captured by positive or negative ideologies or social causes. How can capture be reduced, its effect on us, if it has become destructive. I mean, you mention this artist, but I also imagine that during those eight years that she was obsessively painting that picture, how she was making a living, what about her family, how -- what about the impact it had on the rest of her life. So how do you reduce it if it becomes a negative for you?
KESSLERWell, you mentioned ideology. Capture can be very significant when that salient object that captures us is ideological. Ideologies have a powerful allure, especially to the disenfranchised. The individual becomes dedicated to a higher cause, which promises to give meaning to his life, to connect him with something greater than the self. Look at, you know, look at these terrorists. More than a need to destroy, I would argue is at play. Acts of terror are perpetuated by people who are captured by an idea. I'm not excusing it, but we need to understand it.
LAKSHMANANAnd so in terms of reducing the hold of this capture on people's brains, such as terrorists who are motivated by this ideology, how do we do that? How do we disconnect people from that obsession once it has become destructive?
KESSLERYou have to substitute something that captures, that's even more important to them than their destructive acts.
LAKSHMANANSo does your book also have applications for counter-violent extremism programs, for example, that the government is undertaking? And ways to help people, you know, who are gripped by one thing or another, whether it's ideology or something else.
KESSLERI never thought when I started writing about emotional distress and mental illness, right, where I would end up. The thing about the book is and as a (unintelligible) you know, mental suffering is number one. But once you understand capture, right, I found myself, right, looking at violence, looking at ideology, looking at terrorism, right. But also looking at the positive side, spirituality. This is part of who we all are. It's universal.
LAKSHMANANAll right. Let's go to the phones. Marielle, in Chapel Hill, N.C. is on the phone. Marielle, go ahead.
MARIELLEHi. Thank you for taking my call. And I'm so excited to get this book, not only for myself, but for my family. I'm a person who has been dealing with almost everything that you've been talking about, addiction to alcohol and recently cigarettes to kind of curbed that addiction. I'm also an artist that doesn't really know what my purpose in life is. And I do see the positives and the negatives of being captured. I can substitute one addiction with the other. One's positive and then just kind of have that conversation with yourself, where it's like, okay, don't do this, do this.
MARIELLESo I guess my question is, you know, how to actually tap more into the positive, because the negative always come into the equation as well. Like you kind of have this attitude where, you know, what's the point? I've dealt with depression. I've been diagnosed bi-polar, OCD, and also PTSD. I've been in healing transitions in Raleigh. And I've also been in Holly Hill, which is kind of a -- I wouldn't call it a mental institution, but it's a rehabilitation place. So I guess my question is how to tap into the more positive side of capture.
LAKSHMANANAll right. Well, Marielle, thank you so much for sharing your story. It's so personal and it seems like the book is so applicable. Dr. Kessler?
KESSLERAn understanding of the process of capture, I think, can lead to a more balanced life. At the very least, such insight can allow us to discern and perhaps even influence what captures us. Is there freedom from capture? Can we throw a switch and see the entire stage, every trapdoor and spike and rafter for what it is? Look, in the most basic sense the answer was no. Our attention is, by its very nature, selective in reinforcing. But we can put ourselves in those situations. Maybe I can't will capture, but I can put myself in the situation so it takes hold.
LAKSHMANANI'm Indira Lakshmanan and you're listening to "The Diane Rehm Show." If you'd like to join us and have a question for Dr. Kessler, former FDA commissioner and author of the new book, "Capture: Unraveling the Mystery of Mental Suffering," you can reach us on 1-800-433-8850. You can send us an email to firstname.lastname@example.org or you can connect with us on Facebook or Twitter. Let's take another call from Lee, in Central Lake, Michigan. Lee, go ahead.
LEEHi. Yes, thank you. I'm calling in regards to perhaps maybe cycles through generations of -- in the negative captures and in regards to my son, how to keep him from continuing a pattern.
LAKSHMANANAnd that pattern was started by whom?
MARIELLEI don't know. I think it's with generations. Perhaps -- and from what I know or understand and in a family in his father's side. And we're going through a divorce and I'm trying to co-parent with his father's personal experience and history with addiction and negative ways of handling triggers in life.
LAKSHMANANOkay. Lee, thank you so much for sharing your story. So Lee is concerned about her two-year-old son and whether he's gonna be affected either by, you know, the biological hereditary issues of depression and anxiety in his family or also whether he might be affected by spending time with a parent who suffers from these conditions.
KESSLERNo question that those experiences that he will have certainly are going to affect him. But that doesn't mean that there is no hope. What's very important to me and important to me as a pediatrician, right, these things are happening to us. They're happening to eight-year-olds and ten-year-olds and fourteen year-olds. That 14-year-old who's having the -- a bad thought, right, who wants to -- the thought automatically comes in to his or her head, they may harm themselves or may do harm to someone else. And then feels bad about that thought.
KESSLERAnd then no one -- that person -- that young person doesn't talk to anyone and slowly what you see is these children become more and more into their own head because there's shame they don't want to talk. If you understand capture, you understand. And I think it's something you can talk your children about, you know, when they can understand that just because you have these thoughts or these feelings or feel out of control, doesn't mean you're bad.
LAKSHMANANWe have an email from a listener, Elizabeth, in Peterborough, N.H., who's addressing the question of resilience, which we hear a lot about in treatment of mental illness and how people cope with tragedies in their lives. She says, "Aren't some people more -- just born more perseverant than others? Can over-thinking or thinking loops be seen as a downside of perseverance that might be acceptable to a certain degree, in order not to lose useful perseverance? And is some over thinking actually mental illness? At what point does it become mental illness?"
KESSLERI think we have to realize that terms like mental illness -- once we have an understanding that there is this continuum, this over-thinking, who among us does not over-think? I make a slight, right, there's a negative comment. I can't shake that. For David Foster Wallace, he could filter out everything except those negative comments. Most of us can go on, but I think that's the result of experiences throughout our life.
LAKSHMANANI want to read another email from Latasha, in Merrimack, N.H., who says that over several times in her 49 years she's been clinically depressed and attempted suicide three times. Medications for depression, bi-polar, anxiety, have all proved to be handicapping until she was introduced to cognitive behavioral therapy.
LAKSHMANANShe says, "Dr. Kessler is right on target. I now can keep negative thoughts and fears at bay by distracting myself with hobbies, personalized meditations, nature walks, plenty of sleep, a healthy diet and most important, confronting these problems immediately. These have been successful in keeping me stable without any medication, for the last four years and counting." Similarly, we have someone -- Margaret, from Whitesboro, N.Y., who's saying cognitive behavioral therapy should be able to help with capture. Are they right?
KESSLERAbsolutely, they are right. I mean, hurray. Capture is a lens, it's a way of looking at why we do think and feel that which we wished we did not do, think and feel. It's a hypothesis. I mean, one of the great things about putting out the book is I need to hear, I mean, what did we get right, what did we get wrong.
LAKSHMANANQuick 10-second answer, Eileen emails to ask whether brain training works as a way to retrain and change our neuro circuitry for a variety of conditions like anxiety, depression, ADHD and addiction.
KESSLERFind something that it becomes more salient, more important. That is in essence, brain training.
LAKSHMANANAll right. Wonderful. Thank you so much for an incredibly illuminating hour. Dr. David Kessler, former FDA commission, former dean of Yale Medical School and author of "Capture: Unraveling the Mystery of Mental Suffering." I'm Indira Lakshmanan sitting in for Diane Rehm. Thanks so much for listening.
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