Hey, and welcome back to Resilience, Unravelled. Another week and another fantastic guest. And this week, I'm delighted to announce someone from across the pond and 5 hours behind, I think. And the person sitting in front of me is Norm Rosenthal. So, I'm very much looking forward to talking to him about all sorts of things. Fascinating collection of books he's written, so I can't wait to start. So first of all, hi there, Norm. How are you?
Norman:I'm great. Hi. A pleasure to be here.
Russell:Fantastic. So where in the world are you?
Norman:I am just outside of Washington, DC. Bethesda, Maryland.
Russell:Very great. I love it. Washington is a beautiful city, isn't it?
Norman:It is very grand.
Russell:Very grand indeed. And very expensive for hotels, as I remember from the last time I was there.
Norman:Indeed.
Russell:So tell us a bit about yourself, Norm. Tell me a little bit about your background. What is it that you do?
Norman:Well, I grew up in Johannesburg, South Africa. And from a very early age, 16, I knew I wanted to do research in psychiatry, research in the brain.
Russell:Okay.
Norman:And that drove a lot of my activities professionally. I became a doctor in Johannesburg. I came to New York City, got my psychiatry training at Columbia, and then I came to the National Institute of Mental Health, the NIMH, which was and is a premium psychiatry research facility in the country and perhaps in the world.
Russell:Yes.
Norman:There I stumbled upon something that became the core of my research career, although I've done other things as well, and I can get into that a little bit in a moment. But I've had a dual ambition, and that is to be a writer, to be a doctor. I wanted to be a psychiatrist. I was fascinated in how the brain works. But brain can be elucidated through science, but it can also be elucidated through art and literature.
Russell:Yes.
Norman:So it's that convergence of science, art, and literature that has governed my career. I've been a practicing psychiatrist, a researcher, a businessman. I did clinical trials, but now I see myself mostly as a writer.
Russell:Has this been a planned approach, or have you been doing one of those life plans, or it's been a sort of an emergent career.
Norman:Emergent is the right word, I think, of 2001 Space Odyssey, where they sort of find the obelisk, and it points to something else, and then it goes further and further, and its how life has a shaping influence on how our core ambitions and goals actually manifest themselves.
Russell:Right. And it's fascinating here to talk about research, because there's a lot of spurious research around the brain. There's a lot of cod psychology dressed up as psychiatry. There's a lot of very flaky claims made around brain science. I mean, that's my view. You seem to be nodding. What do you think?
Norman:I think it's true. I think a lot of findings cannot be reproduced by other centres and therefore you have to wonder what happened? Was it just wishful thinking? Was it crookery? Was it just an honest mistake? Is not really a real phenomenon. That's why replication is crucial, even though it's more boring. People like to have published something that's new, not that's replicated. But I think that it's hard to have research that holds up in different centres and over time, yes, been important for me.
Russell:And that's fascinating. I mean, we can think of probably two of the most celebrated psychological experiments and different from psychiatry because there's different evidence based, but things like goal theory, the famous writing down your goals, which is something that never existed, and then the old prisoner experiment as such, like never existed. And then the whole notion around food and food diaries makes that sort of interesting research very flawed. And I think it's only now, since we're saying better quality research, that we're actually seeing genuine links between the brain, what we eat, exercise, the health of the organ, and then our ability to actually manipulate our own sort of wellbeing and health. And then, of course, then if you want to do all this jazzy stuff around purpose and all that values and all that all blah, you can. But you have to start with the fundamentals about how the human ticks based on sensible.
Russell:So you talked about the fact that one of the things that you're famous for, I guess, is SAD. So maybe you could unpack that a little bit for us.
Norman:Well, yes, I was fortunate to arrive at the NIH at a time when a rather fascinating discovery was occurring. And that was that light did more than just enable us to see. Everybody knew light caused you to see. And the rods and the cones in the eye mediated that function of the eye. But at that time, it was found that in humans, bright light could suppress melatonin secretion. Now, melatonin is a hormone that's secreted by a tiny little gland called the pineal tucked in the centre underneath the brain. And it's very important for seasonal rhythms throughout the animal kingdom. So now certain things began to be appreciated. Firstly, that light did more than just enable vision. Secondly, that perhaps people could be seasonal because melatonin was being suppressed by light. And then in the context of these new findings, a scientist approached us, somebody who was an engineer and who had noticed seasonal rhythms in his own life, and that as the days got shorter, he got depressed.
Norman:And as they got longer, he emerged and brought him into our centre and exposed him to bright light during one of his depressions and he emerged. So, you know, as they say, one swallow does not a summer make. And so, we needed to get a group of people. And that's when I went to the media and recruited through the media people who came forward pouring out in thousands. There was no internet at that time. So, they sent us letters and their little notes would drop out and they would be like messages from far away in the universe saying, this is real. This is happening to me. And then we started doing, as we have to do controlled studies using bright light and controls and found that, yes, there was a syndrome, it is called we called it Seasonal Affective Disorder, which had the catchy acronym of Sad that it did respond to bright light in controlled studies.
Norman:And then we had to try to replicate our own findings. We had to have other people replicate our findings, which they did. And so were off and running. And that really led to the key discovery of my research career. There were other things and there are other things, and they're interesting in their own right. But this is the thing for which I'll probably best remembered.
Russell:Yes. So, let's unpack it a bit more for me, for those people in the audience that aren't technicians or who are interested in it, but maybe don't understand it. So, what's going on when light is producing this seasonal effect? So, there's obviously some sort so you mentioned panel and there's obviously a hormonal cascade of some description. Maybe cascade is the wrong term. But what's physically going on in our heads or in our brains when we have too much or too little or the wrong sort of light?
Norman:Well, rodent experiments now show that light has a direct activating, mood altering effect in rodents, and they've actually delineated the neural pathways that enable this to happen. And interestingly, they are not mediated through the classical eye receptors, the classical retinal receptors, the rods, and the cones. They are intrinsically photosensitive, these cells. They actually respond to light directly and have circuits that go to other places than the ones that the rods and cones go to. So, they don't act through our circadian rhythms, which we know a lot about. They don't act through making us more active. Maybe they act that way as well. But there's also this sort of separate pathway relatively recently discovered. So really, it was one of those rare situations where the human research preceded the animal research. Now, these circuits by which the light comes in through the eye and goes to these various brain centres are complex.
Norman:So you could imagine that if there were barriers or impediments at a number of different points along the way that could be responsible for this syndrome occurring. So, the most fascinating cases for me was a middle-aged man who had for two years had Seasonal Affective disorder. Now, it's very unusual to hit a man in middle age. And I asked, have you moved your occupation? Maybe you used to work outdoors and now you're indoors. Or maybe you lived up in a penthouse where there was lots of light and now you're in the basement, but none of the above applied. And so we got through the interview and I was telling him how to start using light therapy and his wife said, well, what about his cataract? Oh, what cataract? Two years before or three years before, just before the syndrome started, he had a motor accident, his eye was injured and now there was like a carapace or covering over one eye.
Norman:He'd lost half of the light coming into his eyes. So, it was a beautiful example of how at the very front end of the system, you can have some kind of barrier or impediment that would then cause this whole cascade of symptoms. But there are others. There's one study that shows a subtle deficiency in the retina. You have to use special equipment to elicit this and so on and so forth. Maybe they're secreting too much or too little melatonin. Maybe they're neurotransmitters serotonin, you know, that famous neurotransmitter that is affected by Prozac and other antidepressants. There's evidence that there could be errors at all of these junctures and we don't actually know. We've tried to elicit the genes because there's a genetic basis for it, but so far nobody has been able to find the genes responsible. We had one study that looked at a serotonin related gene and sure enough, it was different in patients and in controls. Never got replicated. That's the problem, you see. You can't just have one good finding; it's got to be replicated before you can really believe it.
Russell:And there are billions and billions of series of letters, aren't they, with the genetic code? So, finding the error is the challenge. I know there's a particular form of cancer being used, an AI algorithm, which has actually found a link. So, it may well be that AI is going to open up these genetic or predispositions. What's interesting then, the effects of Sad are often described as a form of depression. So there seems to be a correlation between depression, but there's no causation, is there? So, you can have depression without being sad. Is that true? So, it's not the only cause of.
Norman:Depression that is true, but here's an interesting fact. The light therapy that is so helpful and potent for Sad can actually help people with non-seasonal depression, right? Turns out that light is a general therapeutic principle that can be useful across the board in a number of different psychiatric conditions.
Russell:So that classic piece of advice that people get, which is get off your couch and go for a walk, is, whilst this exercise isn't good for you, it's actually just about exposing yourself to more natural light, plus the exercise itself, even absent the light. But when you combine the two, then you've potent mix.
Russell:Yeah. When we're talking about light therapy, are you talking about things like Sad boxes, light boxes, waking up to different forms of light? Is that something that's actually an actual proper therapeutic approach or is this more marketing people getting excited?
Norman:Well, it is a legitimate approach and marketing people sometimes are excited for good reason. Obviously, they can market. When you look at the offerings for light boxes, watch out, because the teeny-weeny ones put out as much light, but you have to have your nose exactly in the right place to get it. So, I like a bigger light. And in my book, I do mention the exact lights that I have found, we have found to be effective for light therapy. Not the teeny ones, not the cheap ones, but the ones that have actually been studied in research. In research. You in Britain have got some very good lightbox companies.
Russell:Yes, and it's interesting because I know you've written a book on jet lag and, I mean, I'm just interested how much jet lag affects is that more of a circadian rhythm type thing or is that affected by light as well?
Norman:Well, it is a circadian rhythm thing, but light is very important in regulating circadian rhythms. Like, for example, if you use light very late at night, you'll push the rhythms later. If you use it very early in the morning, you'll push it earlier. So light is important for circadian rhythms, independent of its effects on mood.
Russell:I see. That makes sense. So, you've also written a lot of books. We were chatting earlier, I was looking at all your stuff. You've written a lot about transcendental meditation as well, so I just wondered I know we're here to talk about sad, but it's tickled my interest vibe, because meditations got quite a lot of flaky research attached to it, I always think. So, I just wondered if you could take us through the sort of evidence based on TM or maybe there doesn't need to be. Maybe it's just a practice that actually correlates with feeling better?
Norman:No, there's tons of evidence, actually, but what I often get intrigued when I do something and I find it potent personally, and that motivates me. So, it's not a coincidence that when I came from South Africa to the United States, I actually experienced winter depression for the first time in my life and I would come out in the spring and summer, and it never happened in South Africa. So, I thought, something very strange is going on inside me. And that really has been a driving force because originally people laughed at me and mocked me and at professional meetings they'd say, Come, let's stand under the lights, I'm already getting depressed, and so on and so forth. But I had the conviction because I had experienced it myself. So, segue across to transcendental meditation. There was something I'd done as a medical student back in South Africa.
Norman:I didn't take it very seriously. It was like one of those cool things that you do. But then a patient of mine, 35 years later in my office is telling me that transcendental meditation has really made him feel very happy. Most of the time I told him I've done it myself, and then I let it lapse and blah, blah. And he said, you’ve got to get back to it. So, it was like a voice coming to me from the universe. I got back, I relearned it, and I've now practiced it for 17 years. And I did it this morning. I can tell you it is an extraordinarily potent and effective technique. It's not hooked to any religion or any belief system. It's just a standalone technique. And I was so intrigued. Plus, there's a lot of research on it. It lowers blood pressure. I saw it help people with post-traumatic stress disorder.
Norman:So that motivated me to write the book Transcendence. And then I meditated for another five years, and I wrote another book on the subject. Now, you don't write two books on something unless you really feel that it's done you a lot of good. And it has seen it in my patients. So that's why that led me on that particular track.
Russell:And I may have this all about face. Forgive me if I do because it's tricky keeping up with things. But Transcendental Meditation is the one where you have a mantra and you repeat that and such like, and if that's right. Is that right?
Norman:Yes.
Russell:Because there's a lot of research on vagus nerve and the effects of humming and such like, and I just wondered if there's a correlation between those two sorts of systems or that's just cod psychology, because I do see quite a lot of research around that sort of area at the moment.
Norman:Well, I think that's very important. The vagus nerve is vagus in Latin is wanderer.
Russell:Wanderer?
Norman:It wanders all throughout the body. It's so widespread through its roots and through its branches and connections. And I believe that a lot of these techniques that cause you to relax physically and mentally are having a powerful effect on the vagus. Now, for example, one thing the vagus does is it actually activates the bowel. So, it clicks in when you're digesting your food. It causes peristalsis and it activates the bowel. And I have often noticed when I sit down and meditate, my tummy can begin to rumble, and it's the vagus nerve clicking in and doing its job. So, yes, I think there may be many pathways to relaxation and many ways to relax, including the actions of the vagus nerve.
Russell:How fascinating. Norm, how can people find out more about your work?
Norman:Well, the first thing is my website, normandrosenthal.com, they can also look for the latest book, which is a distillation of everything that I know and want to tell people about seasonal affective disorder or Sad and how to treat it. Bottom line is you want to use multiple different approaches. You don't just want to say, oh, I've got a light box, and that's it. You've got to use lots of things. I quote the poet, Greek poet Archelacus, who said the fox has many tricks, but the porcupine has one big trick. And our big trick with sad is light therapy. But you need to use many tricks, exercise, cognitive interventions, socialisation, and other things that I elucidate in the book. And that is what I've learned and that is what I do with my own patients in my clinical practice. And I recommend to people who have this particular problem.
Russell:Fantastic. Well, I've just bought it, so it's on Amazon co UK. So, I'm fascinated. So, you have one sale, so that's great. I'm sure you have millions and millions.
Norman:Everything starts with the journey of 1000 miles starts with a single step.
Russell:So I'm really fascinated by this. So, I have just purchased a copy and looking at it, what's poetry RX all about?
Norman:Oh, I have been entranced with poetry and I have been convinced that poetry has therapeutic potencies.
Russell:I agree. Yeah.
Norman:And for years I had collected in my mind poems that moved me, that meant something to me. So finally, I found a mode to express this that would be accessible because you don't want a long treatise. So, I collected 50 poems, and I organized them into categories loving and Losing the Human Experience, all the way through to Aging and Dying. And I collected them in groups, and I put the poem out there because you should never do anything on the page where the poem appears. It's got to stand by itself. And then I told people what I thought it meant to me and what I thought you could take away from the poem. I gave like four or five takeaways that are very relevant because I've learned that from my clinical practice. And then I gave a little vignette about the poem and the poet, how this creation organically came from the mind of this brilliant and amazing human being.
Norman:So I did that 50 times and it's turned out to be extremely popular. People have it at their bedsides and they keep telling me, you must do more of those poems. I said, well, maybe, but right now I'm doing something else. But it has been a very popular book.
Russell:Yeah. Yes, I intrinsically agree with you about that. I instinctually agree with your analysis of poetry. I think it brings together rhythm, it brings together imagination, doesn't it? Brings together structure. It brings so many different cognitive elements together which are very different from fiction. And fiction has its own use and reading nonfiction as well. But there is something OD about poetry, doesn't it? Perhaps because there doesn't have to be a point to it. It's a bit like any sort of great art. It's been created for the benefit of someone who wants to create great art. And actually, then it's about someone who it's left to all of us to interpret it for ourselves.
Norman:Exactly. In fact, you might be interested that there was one study done, it's a German study of people who listened to great poetry while being in an MRI machine, and it showed that it had two measurable effects. The one was like it got their nerve endings, like the nerve endings that occur when you shiver or the hair like your hair stands on end. They could measure that and at the same time they could see that in the reward centre in the brain, people were being activated in that way by listening to great poetry. So, I think that I wouldn't say it's a lost art, but it's an art that could use more attention because of the great powers that it has and that's why it survived for thousands of years.
Russell:Yeah, well, and I absolutely agree with you, because actually, in a funny story, because, of course, my own very first career was as a professional musician, so I worked in the world of classical music. And it's the same as a similar sort of thing. There are huge therapeutic benefits from classical music and something about the sort of particular modality, the rhythms. There's a lot of research around box fugues and such like, in the complex rhythms and interplay and the way the brain is activated and processes that stuff. And I think there's something just genuinely exciting about the arts and our mental health, which just needs the evidence which all exists to somehow become more understandable, maybe that's the word. And the fact that we can use that. Your idea about measuring the hairs on your arms, I think that's brilliant, because it's very relatable, isn't it?
Norman:It is. And obviously it would be wonderful to see the research or do the research, but the realities are research is so expensive and difficult to do that in the meanwhile, we must rely on our instincts. If our instinct is saying there's something really there, let's go with our instinct until the research gets done catches up.
Russell:And I think it's about one's own modality, isn't it? I think I find music more inspiring because, of course, I've got a background and understanding of it. And you often find people who are quite the old sort of idea, the old multi-intelligence idea of auditory recognition, I think would appreciate poetry. Whereas often people who have the sort of imagery type thing tend to seem to like pictures and pictorial type stuff. And I know it's Howard Goddamn, there's not much research to back up what he says. But it's about finding your own thing, isn't it's? About finding the thing that works for you, not necessarily having to advocate it for everybody else. Because different things work differently for a range of people. That's why I like your poetry thing because it's sort of new and it's different, isn't it?
Norman:It really is. I did sit with it for years before I could find a way to express it that has been accessible to people. And I was very happy with because poetry I was rejected by four agents and two editors before I found the little publisher that could, so to speak, that would pick it up. And they've been very pleased with how it's done, and so have I. And also, it's not only how many copies you sell, but the feeling that you've actually moved people. And people have come to me and said, you know that poem, that book, I love that book. It's by my bedside. One of my friends said, well, how is this doing in the ratings? And I said, we just had a presentation. And someone came up to me at the end and said, such and such a book changed my life.
Russell:I said, how many sales do you need to have to make to equate with shipping? To just know you've really helped people is very powerful, and it's because of the difference between people buying something and people reading it, and I think we often forget that. So that's fascinating. No, I've just actually noticed the time and I promised that this would be done by now, but it's been so fascinating that I've sort of jibbed on. So, thank you for spending time with us today. So, people, if you're interested in finding out more about Norm, it's normanrosental.com. His latest book is Defeating SAD, which is Seasonal Affective Disorder. It's on Amazon, certainly in the UK, and that means it's everywhere else. And if you go to Norm's page, there's tons of other books. Gifted Adversity, Transcendence Emotional Revolution, St. John's Wort, tons of stuff. I'm going to have a good old dig around later on. Thank you for spending so much time with us today, Norm. I really do appreciate it's been absolutely brilliant.
Norman:Thank you. I've really enjoyed it.
Russell:Smashing. You take care.