Essentials: Understanding & Healing the Mind | Dr. Karl Deisseroth

**Andrew D. Huberman** (0:00)
Welcome to Huberman Lab Essentials, where we revisit past episodes for the most potent and actionable science-based tools for mental health, physical health and performance. And now, my conversation with Dr. Karl Deisseroth. Well, thanks for being here.

**Karl Deisseroth** (0:17)
Thanks for having me.

**Andrew D. Huberman** (0:17)
So for people that might not be so familiar with the fields of neuroscience, etc., what is the difference between neurology and psychiatry?

**Karl Deisseroth** (0:27)
Psychiatry focuses on disorders where we can't see something that's physically wrong, where we don't have a measurable, where there's no blood test that makes the diagnosis. There's no brain scan that tells us this is schizophrenia, this is depression for an individual patient. And so psychiatry is much more mysterious. And the only tools we have are words. Neurologists are fantastic physicians. They see the stroke on brain scans. They see the seizure and the pre-seizure activity with an EEG. And they can measure and treat based on those measurables. In psychiatry, we have a harder job. We use words. We have rating scales for symptoms. We can measure depression and autism with rating scales. But those are words still. And ultimately, that's what psychiatry is built around.
It's an odd situation because we've got the most complex, beautiful, mysterious, incredibly engineered object in the universe. And yet all we have are words to find our way in.

**Andrew D. Huberman** (1:36)
So do you find that if a patient is very verbal or hyperverbal, that you have an easier time diagnosing them, as opposed to somebody who's more quiet and reserved, or I can imagine the opposite might be true as well?

**Karl Deisseroth** (1:51)
Well, because we only have words, you put your finger on a key point. If they don't speak that much, in principle, it's harder. The lack of speech can be a symptom. We can see that in depression. We can see that in the negative symptoms of schizophrenia. We can see that in autism. Sometimes by itself, that is a symptom of reduced speech. But ultimately, you do need something. You need some words to help guide you. And that, in fact, there's challenges that I can tell you about where patients with depression, who are so depressed, they can't speak. That makes it a bit of a challenge to distinguish depression from some of the other reasons they might not be speaking. And this is sort of the art and the science of psychiatry.

**Andrew D. Huberman** (2:31)
Do you think you will ever have a blood test for depression or schizophrenia or autism? And would that be a good or a bad thing?

**Karl Deisseroth** (2:41)
I think ultimately there will be quantitative tests. Already efforts are being made to look at certain rhythms in the brain using external EEGs to look at brain waves effectively. But ultimately what's going on in the brain in psychiatric disease is physical and it's due to the circuits and the connections and the projections in the brain that are not working as they would in a typical situation. And I do think we'll have those measurable at some point. Could it be abused or misused? Certainly, but that's I think true for all of medicine.

**Andrew D. Huberman** (3:16)
I want to know, and I'm sure there are several, but what do you see as the biggest challenge facing psychiatry and the treatment of mental illness today?

**Karl Deisseroth** (3:27)
I think we have, we're making progress on what the biggest challenge is, which I think there's still such a strong stigma for psychiatric disease, that patients often don't come to us, and they feel that they should be able to handle this on their own. And that can slow treatment, it can lead to worsening symptoms. We know, for example, patients who have untreated anxiety issues, if you go for a year or more with a serious untreated anxiety issue, that can convert to depression. And you can add another problem on top of the anxiety. And so it would be, you know, why do people not come for treatment?
They feel like this is something they should be able to master on their own, which can be true, but usually some help is a good thing.

**Andrew D. Huberman** (4:21)
That raises a question related to something I heard you say many years ago at a lecture, which was that this was a scientific lecture. And you said, you know, we don't know how other people feel. Most of the time, we don't even really know how we feel. You could elaborate on that a little bit. And the dearth of ways that we have to talk about feelings. I mean, there's so many words, I don't know how many, but I'm guessing there are more than a dozen words to describe the state that I call sadness. But as far as I understand, we don't have any way of comparing that in a real objective sense.