Health. Book passage is honor to welcome New York Times a bestselling author, doctor David Kessler and his new book, capture. Capture. Unraveling the mysteries of mental suffering. What we think, feel, and acted in ways we wish we did not. In his not. In his new book, our author explores the question, over the course of the investigation he identifies underlying factor behind much of our emotional struggles and mental suffering. Its the first new theory on Mental Illness in 50 years. Capture is an intimate exploration of the most enduring mind of all. Please, give a warm welcome. I had to learn everything i could about nicotine, about addiction. Then i became very interested in overeating and trying to understand why that Chocolate Chip Cookie has such power over me. The mechanism in both seem to me to be somewhat simple, a stimulus, hijacks our attention based on past learning impasse memory. There is arousal and increased attention. These thoughts of wanting. I eat the cookie and they have this momentary list. Nothing else is getting through in my brain. Two minutes later i go, why did i do that . And the next time im exposed to something associated with a Chocolate Chip Cookie. Id do it again. I strengthen those narrow circuits so i had to learn everything i could about those conditions all and driven behaviors and there was something that seemed to me to be evident, that where all of us are wired to focus on the most salient stimuli in our environment. What i mean by that . Gift walked in he would start listening. He would smell smoke and that becomes most salient and important stimuli. If i take out a gun right now that would capture at least most of your attention. So i was very interested, i wanted to understand whether that mechanism that was at play in nicotine and overeating, the question was did the mechanism also involve an array of affect if conditions . And certainly one of the most important affect if conditions is depression. Very few families are not touched in some way by someone who has experienced this debilitating illness. So where do you go look . Where do you go really understand what the cause of depression is . If i ask you what causes depression in 2016, what are you going to say . What is the answer, someone . Life. Drugs. Drama. Genetic susceptibility. Chemical imbalance. It sounds like from all those answers we probably dont know. When you think about it, 2016 and we are really not sure. There is no real hard Scientific Evidence that in fact theres a chemical imbalance. As i was asking this question, one of the great young writers certainly of this generation David Foster Wallace had committed suicide and i became very interested. He and i went to the same college. He decade later but i really wanted to understand what drove david to suicide. Let me. The opening paragraph of the book really where the book starts. He laughs more than a dozen lamps burning in his workroom. They shone upon the desk and on the unfinished manuscript neatly stacked on top of it. Next to the manuscript was a twopage letter. This was a scene evening David Foster Wallace hanged himself. Wallaces suicide at the age of 46 devastated the literary community. He was at the time acclaimed as the boldest, most innovative writer of his generation. His novel was brought widely lauded by critics and thought it redefines postmodern american fiction. The manuscript on the desk which he despaired of ever completing would be published posthumously. Those novels later would be argued contain some of his best work. Despite his frustration with not being able to complete the book his life had never been better. He had married four years earlier and was comfortably settled in california with a teaching job he loves. Why then did he take his own life . What was the underlying cause of his depression that governed david stieb unhappiness . Depression. Every time i ask what caused davids illness and suicide, all i heard was the word depression with a capital d. From an early age wallace wanted to be exempt from the wanted to excel as a student and later as a writer and he wanted others to recognize his genius. He wanted to be. In 100 years yet his sin is he succeeded and he earned an a he grew uneasy and then despairing pity wanted to be a good person but suspected something crooked about the way in which he achieved success, something false in himself. Wallace was haunted as he wrote himself by the fraudulence paradox. As an adult he was always on high alert, always sensitive to signs of the beguiling imposter. In the margins of the book he scribbled the following. Grandiosity, the constant need to be seen as a superstar. Something about this notion stuck and became a reflexive fox, one that made him them feel very bad whenever he encountered something that threatened a sense of credibility and any number of things could threaten his credibility, critical praise, academic success, romantic attention, someone laughing at his jokes. In such moments his life became a lonely performance. Everything else receded into the background. The feeling encompassed him more strongly each time he experienced it, gaining traction in his mind. Depression, depression i would hypothesize and baltic continual focus on negative thoughts, experiences, memories and feelings to the exclusion of all else. The process of being captured by the negative seems to be particularly true for david. It would be impossible to know how many ways he was gripped by selfdoubt but it seems fair to say he was seized by his selfdestructive refrain. He knew it that he felt powerless to change it. This is what he wrote, quote what goes on inside is just too fast and huge and all interconnected to do words to sketch the outlines of most one tiny part of it at any given time. No matter what success either personal professional david filtered out Everything Else ever thought to dwell on him and took in everything that could be constructed or construed badly. This kind of detriment that filtering can only lead to enormous pain. In this heartbreaking life a selfperpetuating spiral lead to suicide. In other instances selfharm, it can lead to selfharm of different kinds. Wallaces focus rarely shifted from his tormenting thoughts. He felt as though he existed within a zero dark world inside, ashamed and locked in. But some might view as narcissist behavior and artist seeking praise and protection is more accurately understood in wallaces case as an overwhelming debilitating sense of anxiety and unhappiness. There were many times when david was funny, happy and loving but he was never able to shift his attention away from what made him feel bad for a sustained period of time. He could not as he once wrote quote perceive any other person or thing as independent of the universal opinion. Everything he wrote is part of the problem. What becomes salient in depression is the negative perception of the self, the self doubts, the failures, the sense of needing a fraud. How does that intentional focus make him feel . That selfdoubt . Incredible intense sadness and then what captures that sadness, that output then becomes the input that you see this vicious cycle sustaining itself. Is it possible, is it possible to unravel the mystery of Mental Illness to decide where the underpinnings of a range of intense mental distress . We talk about pressure and addiction or anxiety is it they are different afflictions. And yes there are different symptoms associated with them that there are really i would argue, there are really responses to a neuroprocess that happens in all of us. Let me suggest, and i understand this is a bold assertion, but i think there is a common mechanism underlying many of our emotional struggles and Mental Illnesses. Simply put, a stimulus, a place, i thought, and memory that takes a hold of our attention. Our attention becomes focused on that stimulus the way we think and feel and often what we do may not be what we consciously want to happen. The theory of capture involves three rule essential elements in narrowing of attention and a perceived lack of control. But theres a sense that something is pulling and a change in affect our emotional state. Something commands our attention in a way that feels uncontrollable and in turn influences our behavior we experience capture. Capture seizes our attention quietly. We sense a mental shift that we do not understand where it comes from. The experience occurs outside of conscious control and we surrender to it before we perceive it. There is an automaticity. It is the way our brains process a new dimension. When we are john to a particular stimulus we asked in response to the feeling or in need. Every time we respond we strengthen the neurocircuits that prompt us to repeat these actions. There are grooves in essence. You can think about it that certain groups but in essence its a strengthening of the neurocircuits. Theres a biological correlates. Neurons that fire together strengthen together. Those neurocircuits. Theres a biological basis to why certain stimuli, why our attention shifts to certain stimuli. Based on past learning and pass memory, distinct past experiences shape what my attention will focus on. As we continue to react in the same ways to the same stimulus over time we are sensitized. Learning memory they have little circuitry of our brains, these are not special circuits. Who has these learning memory circuits and im . We all do and what happens when we sensitized those neurocircuits are thoughts feelings and actions can arise automatically. William james, i went back to. His papers, really one of the last great psychologists talked about attention. He wrote in one of his lectures, the question he asked was why are certain ideas so strong as to coerce attention . How then does the stimulus becomes salient for you or me . At its simplest level it could be the color, shape, motion novelty can give an object salience. There is also salience and powerful desires a mediator distant rolls, attitudes towards diversity or opportunity and major life events. Anything that is meaningful to us can capture our attention. The same can be profoundly salient to one and generate no response at all in another. Lets just go through, i dont have time tonight to go through all the affect of conditions but lets just go through some of them and ask the question what captures us in each of these thoughts . In anxiety, what has become salient to the person who suffers from anxiety . Rather than that Chocolate Chip Cookie creating thoughts of one thing and anxiety, what captures my attention to make me fearful. It could be going over. For me it could be going over the Golden Gate Bridge that may not in all our rows or trigger any one of you. You could be standing on a ledge it could be fear of being a fraud or an expectation, something bad is going to happen. And to the eating disorders. Anorexia, what becomes salient . Obviously food becomes salient. Rather than overreading thoughts of wanting, the food is going to make me feel bad, but sometimes there are multiple captures going on. If i can take an apple and slice it into 80 pieces and over an entire day i can just eat that slice every hour or so how do you think thats going to make me feel . It will make me feel in control. That could make me feel good so is anorexia in fact a fear of food or is it a love of control . And drama, we can be captured by a harm that was done to us and posttraumatic stress disorder. Captured by an event that was life changing. Being abandoned. If you. Sylvia plat this old chapter in sylvia plat the fear of being abandoned. Hypochondriac, what is it . I become hyperalert to some buddies symptom and by focusing on that body symptom i become fearful that something is terribly wrong. In the manic things of bipolar illness, it is still the void. Anything thats going to make me feel better, the reward, constant striving is what captures me. Virginia woolf became very focused on the fear that she was going to be institutionalized. She was afraid that others would label her as going mad and the one thing she didnt want to do because it would interfere with her work, was to have that. Hemingway, the ambassador of cuba from washington is dispatched and told hemingway to get out of cuba. He says and they are using a word about you in washington and the word was traitor. Hemingway said i am not political. This is where i write. This is where i love to be put that use of the word he became increasingly concerned about his finances and his inability to write and he would never write again. Addiction, the power of addiction lies in the grip of being able to hold the same neurocircuits. Whenever we encounter a stimulus and neuroresponse conditions us to behave in the same way over and over again. Its certainly true for alcohol. There is power in that. The great writer who talked about the effect of capture really focused on that queue, her attention to the queue. I love the sounds of drink, the slide of the court as it eased out of the wine bottle, the distant glug, glug of booze pouring into a class glass the clatter of ice cubes in the tumbler. Wasnt the drink itself, it was all the cues. In fact capture is a result. Certainly an addiction, the cues take over. Queues have no significance in absence of association with past experience. If you have never been a smoker i can assure you that crinkling of the cellophane the image of the campbell are the cowboy will have no resonance. Certainly wont prompt you to have the urge for a cigarette. For john belushi who died of cocaine and heroin mixtures, what were the triggers . If you didnt get into a scene on saturday night live if he had a scene and it was Great Success , he would use but the one thing he said was i dont understand why i cant stop. I talk about how capture can lead to behavior that is harmful. Certainly when you are dealing with, when youre captured by things about the self is one of the most devastating forms of capture. Why . I could eliminate tobacco for my empire and i could take all the food queues out but its the self that is the focus of my attention and what cant i get away from . You cant escape itself but what happens when someone is captured not by the self but when the object is external, when a person becomes captured by an abiding sense of rage. Psychopathic behavior, psychopathy has traditionally been understood as what . To. Any books about psychopathic behavior they will tell you the psychopath locked lack eight conscience or failure of empathy that these focus only on what is absent in the mines. What then one might ask his present . Along with derek liebold eric harris murdered 13 people in the Columbine High School in 1999. Throughout his journals he was very interested in focusing on peoples own words, not someone who interpreted but understanding what was going on in the minds at the time of people. You. In these journals that harris poses as someone who had a grudge against his peer group the social injustices of a High School Culture that is excluding him. He gets his yearbook and this is what he writes in his diary. If i could nuke the world i would and then he goes on everyone is always making fun of me because of how i look. How fa and league i am, 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 wouldnt have been as ready to tear your heads off. That is where a lot of my hate comes from. You see in essence in this child, in this adolescent the slides, the slides in high school that he could not shake. So he wrote, i know what all of you are thinking and what to do to make you feel bad. It wasnt just about him feeling bad but what was he going to do to feel better . Quote harris i feel like god and i wish i was having everyone being officially lower than me. I argue now that i am higher than most anyone in the world. Ted kaczynski began a bummer, hard time adjusting to other people. No question, awkward, very very smart decides to become a survivalist in montana wilderness. The ford he started sending those bombs in the mail july 24, 1978 this is what he wrote in his diary. I ask you when you listen to this tell me what became salient. Yesterday was quite good, heard only eight jets. Today was good in the Early Morning but later in the morning there was an aircraft noise almost without intermission. I would estimate about an hour and then there was a very loud sonic boom. This was the last straw and reduced me to tears of infinite rage but i have a plan for revenge. He wanted to be left alone. By silence i dont mean all silence has to be excluded. Most natural sounds are soothing a few exceptions like thunder and raven cries are magnificent and i enjoyed them but aircraft noise is an insult, a slap in the face get a symptom of the evil of water and society. Invasion of technology, you want to be left alone but he counted the number of jets that would fly over his cabin. Sirhan sirhan three days before he killed Bobby Kennedy is watching a tv broadcast where kennedy promises to sell 50 phantom jets to israel. All of a sudden Sirhan Sirhan a Christian Palestinian created such rage. Adam lanza, newtown, what became salient . Mass murder in and of itself became salient. Capture is even more significant when the salient object is ideological. After all ideologies have a power for powerful lure. The individual becomes dedicated to a higher cause which promises to give some meaning to his or her life to connect him or her with something greater than the self. It is more than a need to destroy. I am not giving excuses but we need to understand that what drives a terrorist attack or, these terrorists are captured by an idea. At some point in their development terrorists become enthralled by the belief that they are causing fighting for a cause larger than them and the truth transcends itself. But here is the important part and here is the real key. Not only a recaptured by something thats meaningful, we can be captured by positive stimuli. Capture is neutral. The zero responses the most salient stimuli in our environment can be negative but they also can be positive. Conversion or dedication to a greater cause can also result in the opposite. Benevolence that positively influences the lives of others. What is spiritual experience . Ritual experience has been described as a feeling of absolute dependence of being grasped by an ultimate concern. They might may involve moments of release from ordinary perception. The catalyst may be spiritual or aesthetic in nature. A home, landscape a moment of quiet meditation. The feeling of it at times comes sleeping in like a gentle tide pervading the mind with the tranquil mood of deepest portion. That was the description by the german theologian rudolf otto several hundred years ago. David wallace wrote about this. He understood capture and understood the neurocircuits but he understood the relationship between the human and the divine. Wallace came to believe that there is no such thing as not worshiping. Everybody worships euros. Our only choice then is what to worship and the compelling reason for maybe choosing some sort of god or spiritual type thing to worship be it all off or the mother goddess are the four noble truths are some in viable set of Ethical Principles is pretty much anything else you worship that will keep you alive. Rewiring of the brain or strengthening of the neurocircuits in different ways as possible because capture applies to the positive as well as the negative experiences. Charitable acts, athletic pursuits, spiritual transcendence. My goal, capture is a way to look at mental suffering. My goal was to try to pull back. Depression was a label we gave to a group of symptoms and then then we set off right with causes that group of symptoms . We set the label, the name depression. What we need to do is to pull back the curtain. I think if we could understand, if people could understand if you feel a loss of control and feel it is something as pulling at you and you dont know why, those are the past wave to psychic pain. Somewhere in this bookstore a big box called building stories, and if you open one of the works in building stories, in that first page, theres a big circle that says i want to go to sleep and never wake up. Chris suffered from enormous, heartbreaking depression. But then something changed. This is what chris told me. All of a sudden youre no longer the protagonist. Why . What happened . Right . He had a child, and that changed everything for him. All of a sudden youre no longer the protagonist. The movie has a new cast. All of a sudden youre a supporting actor x you sudden and you suddenly realize that thats what youve been all along. And thats the way every human being should be. And thats the way you really should be living your life. In light of new priorities, it became clear to him at least in his case his social anxiety, his hypersensitivity these were his own words, this is the way he shifted his own perception he said, you know, all that anxiety are really just a very selfindulgent form of melancholy and egotism on the part of the bearer. Thats the way he changed it. Its not that im agreeing with him, but he changed the way he perceived his is selfdoubt, what he was feeling. Capture allows us to focus, to be moved, to act with purpose. The mechanism, right, does not in and of itself give meaning to our lives; rather, it allows us to search for and experience meaning. Over the course of a lifetime, each of us creates a coherent account out of the jumble, often fragmentally chaos of life. Were bombarded with thousands of stimuli, any one of which can become meaningful at any given instance, right . Over time for all of us certain characters and experiences emerge as central. Others proved tangential, soon to be forgotten. Right . Joan didion summed it up well in a few words we tell ourselves stories in order to live. We become captured by certain things, and we need to make sense out of our world. Is there freedom from capture . Can we throw a switch and see the entire stage, every trap door and spike and rafter for what it is . In the most basic sense, the answer is, no. Attention is, by its very nature, selective and selfreinforcing. Our environment, each of our environments, each of our own personal experience, our history, our economic situations we find ourselves, the physical situations we find ourselves in dictates what becomes salient for us. It forges patterns that determine how to we experience the world and, ultimately, who we become. The important part, we may not be able to will what captures, but what captures us can change. Thank you very much. [applause] we have a few minutes for q a if anybody has questions [inaudible] your conclusion presupposes that therapies like dbt and cbt would not be therapeutic or helpful many light of being captured. So i would like to hear what you think about those modalities as a possible therapy. Theres been a lot of, you know, many different schools of psychotherapy, many different tools. But when you look at whats at the core of all of them, i think, to change how i respond to a certain stimulus. And it gives me tools. Again, i cant will it. But i think i can put myself in position to be able, i mean, to have at least a chance at becoming captured by manager else. Cog by something else. Cognitive behavioral therapy i think, you know, certainly, changing how i perceive my world. Dbt, the ability to change how i react, i mean, emotionally, right . They all tend to, we tend to think about them, you know, for certainties orders this one works, that one works, but theyre really about critical per seven call we have accept chul shifts. One of the psychotherapists who i talked to in the book, a young psychotherapist really, i mean, summed it up, i mean, for me when she we were talking about freedom, and she said, she was very uncomfortable with freedom from capture. I dont think either one of these modalities get you freedom from capture. But i think she focused very much on release. And, again, no doubt its hard work. But its one of the most essential tools that we have. I think we have a couple questions up here [inaudible] [inaudible conversations] good evening, dr. Kessler. First of all, thank you for your service to our country. Thank you. [applause] thank you. Thats very important. I have a particular question for you that has to do with the children that our particular organization serves which are the 1. 5 million very young children, 617, who are incarcerated for juvenile crime. And weve investigated what leads them to those activities and what can get them out. And im particularly interested in your thoughts on the developmental stage of adolescence. And i dont do the work because im altruistic, i do it because the kids are fascinating and because of their altruism and loyalty thats endemic to that stage. And i wonder if you have comments about that. Absolutely, you know, enormously insightful point about that stage. Theres a section, and i didnt expect to go there. I mean, i really wanted to focus, i mean, on mental stress and mental suffering in depression and anxiety and ocd and in eating disorders, right . You said they have it all, right . But i ended up looking at a number of cases in the book of violence. I was drawn there. Youll remember i was struck, i watched the entire trial of james holmes. That was the aurora theater neuroscientist ph. D. Student who dressed up as batman and killed dozens of people in aurora, colorado. And what struck me, you know, hes 22, 23 by the time he commits that act. You go back and try to understand how, you know, how these circuits built over the 22 years of his life, and as the age of about 13 he says i start having these very bad thoughts. I started thinking about hurting myself. I started thinking about hurting someone else. And hes asked why didnt you seek help. And he says, i couldnt. Because if i did, if i told people i was having these bad thoughts, that i was, in essence, captured by these intrusive thoughts that we all have, right . My parents would view me as bad. Ask and you just and you just sit there and you listen to that, and you will to that as a doc or as a therapist or as a parent, and you just say you just wish you could have interceded and said to this young man and gotten him, you know, the appropriate Mental Health care. But to explain to him, i mean, and this is what i think is absolutely key. If theres any, anything that i could emphasize for me of after spending the last number of years writing the book is that people who suffer, theyre not broken. I mean, some do horrendous and terrible things, and we cant excuse it. But there is a continuum. If i told you, be i just said to if i just said to the to you on this planet theres an organism, theres a species, and that species has the ability to think, to act rationally, but that species also has the ability to be captured by certain stimuli and not shake those stimuli and to focus on those stimuli, and those stimuli are going to effect how those pee cease feel. Thats the species feel. And i said to you, all right, if you just knew that biologically, what would you expect the world to look like . What would you expect people to be captured by . And the answer is, you know, theres a whole range of things. Some are going to be captured by spiritual experiences, some are going to be captured by hatred of others, hatred of self, some are going to be captured by drugs, right . Be i mean, when you if you want toest the hypothesis, you dont have to go much further than just looking at the world around us. But certainly, right, i mean, the goal for me, i mean, is to be able to explain to people whats going on, because thats at least the first step. Weve got time for two more questions. This gentleman in the back here. Youre talking about the neurolock call basis. Neurological basis. What kind of hard evidence do you have to go along with some of these phenomena or any special cases . So if you theres about 120 pages of footnotes in the book, right . [laughter] and happy to go through that. Because whats important is, i mean, there are scientific methodologies, right . Theres f america ris fmris. And we can look. Increasingly, when you look at the neurological literature, you see the importance of salience in a range of disorders, and you can measure intentional capture and effective response. But just go pack to your basic neurobiology because any theory has to be able to be explained, right . In terms of how neurons work. And so what can neurons do . Neurons fire, right . Neurons can fire preferentially. And neurons, that preferential firing can, in fact, be strengthened. So so that, in fact, neurocircuits can respond to certain stimuli over other stimuli, right . So when you realize that intentional capture really correlates with how neurons working and then you look for specific evidence in a range of disorders, increasingly, i mean again, no ones really looked across the board. Youd have to look at the literature in each and every disease , but i think youre finding increasing evidence for intentional bias whether its in depression or in mania or anxiety or obsession. One more question. Right here, the gentleman down here [inaudible] hi there. So i was wondering, i guess with sort of the release of the latest dsm and it seems like diagnoseable disorders are becoming sort of more and more granular in the sort of afflictions that are considered pathology, and i was wondering how, i guess, youd your