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Oxford neurologist reveals how small brain changes can rewrite who we are

Dave’s got a brain — he’s pretty sure, anyway, since the MRI never mentioned otherwise — and this week he, with M3 Gizzy Lundquist and M2s Akshaj Joshi and Isa Perez-Sandi sit down with University of Oxford neurologist Masud Husain to talk about what happens when that brain stops working the way it’s supposed to. Husain’s new book, Our Brains, Ourselves: What a Neurologist’s Patients Taught Him About the Brain, walks through seven patients whose identities came apart when a single cognitive process — memory, language, attention, motivation — went sideways, and the crew digs into David, a young finance guy with two tiny basal ganglia strokes who became so profoundly apathetic he couldn’t be bothered to shower, get his Social Security benefits, or put on the music he loved, until a Parkinson’s drug brought him back: new suit, new haircut, new job, new girlfriend, all from restoring one chemical pathway.

Husain almost named the book Outsiders, until his editor worried the parallel between “outsider through brain damage” and “outsider through migration” was too politically loaded to sell, but it’s a parallel that traces straight back to Husain’s own childhood, recording himself on his dad’s reel-to-reel to practice sounding more BBC and less like a kid who’d just moved from the Indian subcontinent. Isa and Akshaj push him on the biology of motivation itself: an Oxford scanner study found apathetic students show more basal ganglia and frontal lobe activity than motivated ones when weighing a reward, not less, because deciding whether something’s worth the effort turns out to be the expensive part. Husain is blunt about the dopamine-detox mythology built around doom scrolling. The evidence, he says, is thin; and he’s just as forthright about where psychiatry and neurology actually diverge: not by nature, but by which one currently has biomarkers, as illustrated by NMDA receptor encephalitis, a condition that looks exactly like schizophrenia until someone finds the tumor causing it.

Also, hemispatial neglect, Lewy body hallucinations, the Bayesian prediction machine your brain runs every time you mistake a shadow for your spouse, and Akshaj corners Husain on the hard problem of consciousness with a theory involving meditators and alpha-wave synchronization. None of them solve it. Good hour of trying, though.

Episode credits:

• Producer: Dave Etler
• Co-hosts: Isa Perez-Sandi, Akshaj Joshi, Gizzy Lundquist
• Guest: Masud Husain
• Production: SCP Media Lab–Anna Royer, Cyrus Barati, Isa Perez-Sandi, Zach Grissom, Sarah Upton, Srishti Mathur, David Lee, and Jacob Thompson 

The views and opinions expressed on this podcast belong solely to the individuals who share them. They do not represent the positions of the University of Iowa, the Carver College of Medicine, or the State of Iowa. All discussions are intended for entertainment purposes only and should not be taken as professional, legal, financial, or medical advice. Nothing said on this podcast should be used to diagnose, treat, or prevent any medical condition. Always seek qualified professional guidance for personal decisions.

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