Dog Carpal Pad

>> wiser: i wanted to tell you first how iapproach the course which is the reverse, exactly in opposite order of textbooks, althoughi'm probably too late because i've seen one textbook coming out that is actually in thatorder. in any case, and what i want to talk to you about is why i do it this way as wellas tell you, share with you things i share with the students about pain and touch. probablythat's all we'll have time to do, either interesting

Dog Carpal Pad, empirical finding or interesting twist orinteresting angles, that sort of thing. and i would very much like to be interrupted.[laughs] truly, it's not much fun to just talk at people,so please, anytime you need a clarification or comments or whatever, it's more than welcome.so before i start though, i'm going to be

out of order with one of my slides. and onething i do with the students as well as prospective students here when i talk to them is i askthem at the beginning of the course if you had to lose one of your senses so you cankeep all the others, which one would you lose and why? and if you had to keep only one,which one would you keep and why? and if you're not too bashful, i think i'd love your reactionto that. there is no right or wrong answer although i have my prejudices, [laughs] okay. >> workshop participant: i think i would liketo say i would have to keep vision. >> wiser: and which one would you lose ifyou had to? >> workshop participant: taste.

>> wiser: taste, okay. >> workshop participant: i'd lose taste andkeep touch. >> wiser: keep touch, okay. >> workshop participant: i would lose smell. >> wiser: you would lose smell? >> workshop participant: because when i gointo like [unclear] stores, i get nauseous. [laughter] >> wiser: my son does too. yeah, there arelots of smell ... and which one would you ...

>> workshop participant: i'll keep sight. >> wiser: you'll keep sight. we don't havetime for everyone, but let me do this, if you kept one, who would vote for sight? who would vote for hearing? who would vote for touch? who would vote ... what's left ... taste? smell? and pain is a sense. so vision has it, right? all right, so we'll see what develops in thenext hour and whether by any chance you change

your mind. i'm not saying you have to. i'mreally not. sorry for the small letters here. so basicallythis is what i start with; this is what i end with. and the reason is that it's veryhard to motivate vision. in other words, if you take a class on september first, whatever,and you say, "we are going to understand how vision works." on average, the students willlook at you and say, "what do you mean? you just need light and light make things visible.yeah, light hits your retina and that's how you really know the apple is there, but, bigdeal." or, "okay, fine we're going to learn how the retina works." now, what i try to teach is that, well, thatthere is a deep problem to solve with vision,

that no ... yes, you need light to see butto say light make things visible is really not saying very much. how does it? and i tryto, over the course of vision, to say that light is both, yes, the carrier, what excitesyour retina. i am not denying that, obviously, but also it is the carrier of informationabout objects. when the light hits the apple, some of the wavelengths get selected and ithits your retina in a certain angle and it makes patches on the retina of a certain size,blah, blah, blah. but the fact is that there are no apples in your mind or your brain oranything like that. so vision is really a construction processby which your brain processes a lot of information from your retina in lots of different waysand then somehow puts it together and you

experience an apple. but in between - andthen i go philosophical a little bit, not too much because not many students stick toit - we don't really know what's out there. you see it as an apple. and a student mademy day one day saying, "yes, and my philosophy professor [unclear] here says, what apple?[laughs] so she got it. but it's very hard to starta class that way, of course that way, because it's a complicated idea, that you constructan understanding out of the data that your retina provides and it ends up being experiencedas an apple. on the other hand, pain is not hard to motivatein several ways. first, it's very interesting. emotionally, students will either be horrifiedor interested or both by the different gory

details i present about pain or not too much.so there is an intrinsic emotional interest, but it's also much simpler because unlike... of course, there is an apple there so you see it as long as there's light. mostof us do not live in pain, so pain is an abnormal event. therefore, there's something to explainbecause everything that doesn't work according to normal requires an explanation. so automaticallyif i say let's understand pain, that makes a lot more sense to students as an enterprise.also, unlike the apple you perceive the apple as the thing out there as you should becauseif the caveman hadn't seen the tigers out there and had said the tigers are a constructionof my mind, blah, blah, blah, we wouldn't be here, right? [laughs]

so it's very important we see the apple isout there and that we perceive it automatically and don't think about how it happened. it'salso important we take our finger away from the stove, the finger, but that's taken careof as well. but basically pain is an inner ... you know the pain is not in the knife,right? the pain is in you. so you experience it inside instead of outside,so that's much more compatible with understanding the role of the brain and the nervous systemwhich is also part of you. and then as i said, it's an abnormal event, so you can say howdoes the knife, which doesn't have pain in it, whereas the apple is [unclear] so theknife is not painful. how do you go from cutting your skin to a painful experience? i'll talka little bit more about that after covering

the philosophy of the course. so what that allows me to do is introducea sort of meta vocabulary in terms of transduction, neurotransmission, processing, receptors,pathways, all of those things within a context which is not too overwhelming. it allows meto do a lot about the role of the brain because not everybody perceives pain the same way.there are cultural effects so there are lots of systems interacting with each other soi can have a foray into ... not construction, pain is pain, but certainly the way that it'smediated by a lot of factors in an understandable way, and then you can slowly generalize toother things. that's what i said, [laughs] more or less.

so this is the essence of what i teach in the pain, soi spend a lot of time on pain. if you look at textbooks, there are two pages on painand the half of the textbook is on vision. and i spent a third of the semester ... well,not quite, on pain and touch. so the knife cuts my skin, it causes intenseskin deformation. i can talk about the external energies, mechanical energy in this case,that causes electric activity in my skin receptors. there's transduction, signals go along pathwaystowards my cortex. there are neural transmissions, and i'm experiencing pain. so this is whati call the sensation perception lens, meaning that's a way ... and i tell students thereare other ways to study perception, obviously, than by talking about the brain but that'sthe approach i take.

so it's a lens through which you analyze andsystematize perceptual experiences. and then it can be generalized. i mean, not the nextday, but it's the same words but it's applied to vision. i mean, almost the same words,right, and so the goal is that they see the relationship between the two. that doesn'tmake vision ... vision is more complicated than pain; there is no doubt [laughs]. butat least it makes ... the issues are a little more transparent. any questions, commentsso far? so touch is next because as for pain, youhave to ... i mean, something acts on you with touch, or you act on something to touchsomething; whereas, with vision, it's like you sit there and you see, right? so thereis something in common between touch and pain.

and then it's a little more complex becausethere are several kinds of receptors. by the way, i never have time to know how the studentsparticularly feel but i absolutely love the biomechanical, the engineering aspect of skinreceptors. it's one of the ... i'm enthusiastic about many things. [laughs] i just think that the way those things workis absolutely mind-blowing. and then, of course, in this case, the texture of something, etcetera, it's out there unlike there is an outside stimulus but that's what in my workon science teaching i call the stepping stones. so it's a way towards understanding visionin this case that's not as complicated to master, but helps you get there more easilythan if you had done it. so it's a learning

progression, if you wish. then i go to test taste and smell which alsohave outside stimuli that have to travel to your nose or be on your tongue, et cetera.and then i use what i showed you in the previous slide: before, during, and after each sense.i say, okay, let's review the lens, what's different, what's the same. hopefully, overthe semester, it makes the perception lens more meaningful. so in other words once we reach vision, hopefullythe students at least understand there's something to explain and have perhaps a little bit ofa framework to do it. so catching student's ... yes?

>> workshop participant: [unclear] i problematize,you mean turning this into an analytic procedure? >> wiser: okay, good. thank you for catchingme on this. it's a jargon word from learning science. it means making it a problem, makingit something that's worth thinking about and doing problem solving and finding a solutionabout it. in other words, it is not the case that there is nothing to explain about visionother than the light hits it and reaches your eye. it means turning into a real inquirytopic worth spending your time on. does that make sense? >> workshop participant: yes. >> wiser: thank you. yeah, it's as i saida jargon word. so catching the student's interest.

why do we feel pain? that allows me to introducethe evolutionary argument that is a theme then when the student knows "why" can meanmany things and we have to keep things straight. but there is a why in the sense of evolution;there is a why in terms of how the receptors work. there are lots of different why's, butthat's an important one. what would life be without pain? i'll get to that. we talk about pain relief which is interestingbecause they're familiar with that. they also know somebody with fibromyalgia or intractablepain of other kinds and we can talk about that. and then we talk about cultural effects,which is interesting as well. basically then, i present different pathways and say, look,it explains a lot of things. it explains why

you take tylenol rather than aspirin for headaches,but you take aleve rather than something else for muscle pain, whatever. i know it wheni teach it. why people did lobotomies long ago and what's carpal tunnel syndrome? i'llshow you, we relate that to simple, well, to me simple, to them horrifying pathwaysdiagrams. but basically i try to say i'm not makingyou suffer for the sake of it, but there is a reason to learn these pathways because theyexplain things, and then we can play problem solving. like if somebody had pain here, whatcould you do to help this person? or given the diagrams that i showed you, how do youthink hypnosis works to relieve pain and stuff like that? so it allows them to do some problemsolving instead of just memorizing all those

very arcane words. okay, this i'm going to go quickly on becausei have the feeling you know this. so i also try to make it interesting to them like whyyou shouldn't turn your ipod so loud and, of course, take drugs, and then relate itto all sorts of things about real life, different ... so all this is in your handouts. is itokay if i just move on? all right. consumer marketing, why is it they have nogreen lights over the lettuce and yellow lights over the pepper. of course in the course ofthe course, we talk about hearing aids and cochlear implants and the surgery. i try tohave somebody actually who had a cochlear implant to try to explain what the experiencewas, which i highly recommend, if you know

somebody who is willing. because it's notwhat people think and it's really worth hearing from somebody who had an implant what theexperience is like. >> workshop participant: there's a great littlevideo that you can show that shows a little girl who had a cochlear implant at age twoand how she hears sound for the very first time and her expression is [unclear]. >> wiser: yes, that's right. that's right. >> workshop participant: it's perfect, perfectfor that. >> wiser: that's right. but then what adultswill tell you, even those who are very happy with their implant is that it's very unsettlingwhen you first have it because you hear clicks

you don't hear, especially if you had hearingbefore and you know what it was like to hear music or speech. it's nothing like that. soyou have to re-educate yourself, to translate those clicks - that's what i've been told- into sounds. so i think it's well worth anything that it seems to me in high schoolthat makes students aware of all the worlds. either social ones or perceptual ones or motorones i find very important. and then there is, should you have any intellectualcuriosity? you know, what do infants perceive? why do we see in black and white at night,et cetera? and then, i try to balance because of course individual styles ... some metaphysics.will we ever know the external world? know the tree in the forest, of course, althoughthey know that one. do the senses tell the

truth? if a martian had eyes and a martianbrain, what would the martian coming to earth see? this one is interesting. would a person blindfrom birth who recovers her sight, what do they see? and i have actually one of my mentorswhen i was a graduate student in [unclear] has studied that sort of thing for a longtime, first with babies because now it's caught early and therefore a cataract can be operatedon, i think, around four months or something like that. but in the old days, in the olddays when i was young there was no, i don't think, such detection. it was not until ... peoplewere not operated in their cataract until late, but by then there is the sensitive criticalperiod. so your brain atrophies is not the

word, but the visual cortex loses a lot ofits ability. light hits your retina, but as an adult there's not a whole lot, it depends. some people have been incredibly depressedafter cataract removal because it's nothing like what they hoped for and they are essentiallyat least legally blind. they see light colors but ... and so it comes and in a way lifewas simpler given how little ... i'm telling you, i'm not making a judgment. i'm just reportingsome of the things i've read. okay, so with babies they're still malleable enough, i meantheir brain, then that problem doesn't occur and with visual experience they develop completelynormally. but then now there are those doctors who go help people in less privileged countrieswhere there are cataracts still in adults

or older children, et cetera. and so theyare relieving that and at the same doing research in young people of different ages to see howmuch they recover, et cetera. so that's, for example, something i would include in my readingsnext time. that should be interesting. and so they also say why is it that it's veryeasy to tell which of the two sets of black dots has more dots, but if you're like me,you have to count the blue. you can't do it with the blue ones. you have to count. sothat's particularly perceptual. i don't teach about that. i teach about i think cognitivedevelopment, but we have two systems that rats have and a lot of other animals. one,to keep track of a small number of things and that's how their mother keeps track of... there is quack and lack and knack and

if they're all there. [laughs] but then there is this which is a processthrough what's called the magnitude estimation system which is a way ... it doesn't tellyou it's the same, it tells you whether there is more or not. if they are enough more onone side than the other and babies, it has to be twice as many, but they show you theyknow and then adults it's about 25 percent. there is a difference of one so that's whyi would think that you didn't immediately know. anyway, there's lots of very interesting things.so developing counting among other things consists through the words involving countinglinking these two things to each other to

get the sense of number. that's part of myresearch, but that's not what i teach. then i say why do we have sensory and perceptualsystems? how do we differ from plants? why do plants don't have vision? [laughs] andthat can create interesting classroom discussions [laughter] because, as you know probably,different people have very different ideas about plants, right? it's not just entertaining; i think it's interesting.i don't think that students necessarily have thought about why do we have a nervous systemand plants don't or at least not much of one. that is related to the fact we move and theydon't. that's an important fact, and that's not necessarily something that taught in biology,i think.

so i want to now go back to pain. do you haveany questions about the teaching of sensory perception in general or my course in generalbefore i go into specific topics? >> workshop participant: do you connect thesesorts of problems into brain areas? >> wiser: yes. that's going to come, yeah.i try not to overwhelm them with it and i don't ... no, the test is not about the names.and with my pain diagram you're going to see soon, basically on the exam i have an unlabeleddiagram because i don't want them to memorize it for the sake ... but yes. no, actuallya very important part of it is to show the role of the brain as an interpreter. yes,absolutely. so i'm not going to go through this. you knowwhat pain is for.

one thing that i find interesting is thatwhen you hurt yourself, your body releases histamines to maintain and increase the pain,maybe you all know this, so that you will pay more attention to it. and then what'salso interesting is that the nerve signals, talking about more of the nervous system,are very different for the pain that maintains you now in one place and taking care of itversus the immediate reaction. it's a totally different mechanism with extremely differentspeed of neural transmission. can i go on at this pace? so this one, youdon't have to read all this but basically it's about recent work in neurology. it'srelevant to how we learn to avoid painful stimuli. basically, you have originally neuronsthat respond to intense stimuli, and then

you have others that encode dangerous visualstimuli and then when you touch the fire or cut yourself with a knife or whatever, i'msimplifying the least to say the two neurons connect and remain connected so next timeyou see a knife, or the needle at the doctor [laughs] you will have a warning signal. andyou also feel it about others, if you're not a psychopath. meaning when you see the needleapproach somebody else's arm, the same neurons are going to get into play. that's how youfeel empathy. i mean, that's one of the mechanisms for empathy. so it's a little bit like mirrorneurons but it's not. >> workshop participant: yeah, speaking ofmirror neurons -- >> wiser: yeah, it is. i'm sorry.

>> workshop participant: that isn't the mirrorneurons. >> wiser: no. those are not mirror neurons.they are visual neurons and then pain ... i don't like to call them this way because itlooks like they are really different. i mean, some neurons have spectacles [sounds like]and others ... so the one in the pain system, i mean, they are in the temporal lobe, butthey are neurons that originally react only if you get hurt. and then there are neuronsoriginally that reacts to visual stimuli and then they get connected. they're designedto be connected obviously. now they both fire at the same time when you see without feelingthe pain, and that's the basis of a warning signal.

>> workshop participant: so is that evidenceof learning? >> wiser: yes, that's definitely evidenceof learning, oh yeah. it's also evidence of predisposition. i don't know how much we wantto go into the nature/nurture, but certainly the learning wouldn't take place if therewas not something that predispose those neurons. it's not any neuron randomly that connectsso not every neuron, when you look at the fire, lots of neurons activated while youlook at it, not all of them are even potentially connecting to your pain neuron. so there isi would say genetically predisposed potential connection about which i know nothing, butthat means that given the right experience, the connection will be made. i love the questionbecause it's a tough topic for young students,

but it's a 100 percent nature and 100 percentnurture. but it's not necessarily obvious but that's certainly my mantra. yes. >> workshop participant: the last one meansthat not only is the person being pricked ... >> wiser: yeah, but has to look at it. >> workshop participant: ... but observerswith the same brain neurons are active, you can see this in a cat scan, for example [unclear]the example of it. so the act of observing triggers exactly the same sort of brain activityas ... >> wiser: as the act, yes. so in that senseit's a bit like in spirit like motor neurons where, you know, at first you have to actto activate them and then you just have to

think about acting or just the verb. i don'tknow if you know this, that when you listen to sentences, the verbs like jumping, let'ssee, when you hear jumping, it activates the neurons, the motor neurons that are involvedin jumping. that's another thing i love. [laughs] >> workshop participant: that's why visualization... >> wiser: i'll get to you in one second. >> workshop participant: that's why visualizationexercise ... >> wiser: exactly. that's right. that's whyit's not an idle ... absolutely. yeah, and also it solves a lot of stuff in languageand language development. where does meaning come from? and i'm not saying that's the answer,but it's part of it. yes, finally.

>> workshop participant: [unclear] the personwho observes the person getting the injection has to have experienced this though. >> wiser: yes. there are no obvious questions... >> workshop participant: [unclear] for thefirst time, i get the first shot ... >> wiser: right, but from then on [laughs]you know that about your pets and children probably. >> workshop participant: so let's see howit may help the children out [unclear]. >> wiser: not mine. >> workshop participant: the connection thenbetween empathy and perception of pain, it

seems that that would be a very interestingplace. >> wiser: i think so. yes, absolutely. >> workshop participant: the non-empatheticfeel the pain less or less profoundly or in a different ... ? >> wiser: i don't know. it's a fabulous question,and i don't know the answer. but if you measured the ... of course then there is the culture.it's complicated because the simple hypothesis would be that people who have a high thresholdshould be less empathetic. and there is a sense in which people say, "oh come on, itdoesn't hurt." yes. so in that sense i think it might be true, but then there is the cultureplaying that may develop empathy or they'll

make you a tough guy, then it gets complicated.but it's a great question to research at least. >> workshop participant: what if, let's saya diagnosed sociopath has a perfectly normal response like this, so what intervenes tomake them less sensitive? >> wiser: we don't know, right. i don't know.but that's also a great question. i don't know if they have ... >> workshop participant: what's the disconnect? >> wiser: yeah. you're right, so maybe thedisconnect is right there already and maybe it's much higher up, absolutely. >> workshop participant: so if you've experiencedone kind of pain before such as getting an

injection, because we now have connected thesevisual neurons to these neurons that are connected with pain, will the next injection hurt evenmore? >> wiser: it does but that's separate becausefrom what i've just said, no ... oh, because you mean now your pain neuron - interesting- is receiving input both from ... and the vision ... >> wiser: wow. you see, we could set up awhole lab. i don't know. but there is something that may or may not be related, that the experienceof pain tends to ... there is a phenomenon that has a name that you don't habituate topain. on the contrary, it's like allergies, it gets worse. i'm sorry, i don't rememberenough. but those are great questions. and

you would need a pretty precise, i think,neurophysiological recording to see that pain neuron is fired. and i think working on painis tricky both ethically and ... do you want to do it? no. let's see who ... yeah. >> workshop participant: is there like a generalizedresponse to pain? so i'm thinking of social learning that comes with these things. soeven if you've never been stung by a bee, you see other people freak out. so if you'veexperienced one kind of pain, when you think about a pain that you've never had before,does it activate the pain neurons? >> wiser: i would think not, but that's aspeculation. and here is my personal take on it. i'm the queen of this dungeon, so i'lltry to keep this short. but i was last week

at the fantastic monologue by somebody namedmike daisey. >> workshop participant: yeah, with the apple. >> wiser: yeah, exactly. and i mean i hadseen spalding gray before but he is absolutely phenomenal in my view. and this monologuewas about a lot of things including narrative and making the point. i don't know if he studiedpsychology or not but that they all know, almost know of all memory. my story has apoint related to this. i like to announce that [unclear]. and that's what proust was trying to do inthe remembrance of things past. every time you remember something, you remember it abit differently. you change it and then in

fact they've shown, i don't have it here,but neurologically there are new connections being made when you remember something. sowhat you store again, when you store to be remembered later, is not what you got out.and proust was hoping to get to the bottom of this. well, apparently it can be done. and daisey was talking about everything inhis narrative and nancy noswell [phonetic], john brunner [phonetic] and the idea thatwe are narrative beings. we make sense through narratives. i'm very sympathetic to that.so he said think about what you remember. try to think of a trip that you really enjoyedand something that struck you. i know the first time i saw venice, i waslucky enough to be on a really crummy but

whatever boat that came through one of thosecanals and stopped in front of san marco. it was an experience. do i feel it? no. i'mtelling you the story because i've told it a lot, too much probably, but i don't reallyremember the experience. no. those of you women who had children, do you remember thepain of childbirth? no. when it starts again with your second child, you say, oh my god,i remember this. but in between you can't call it up. so that's what daisey was tryingto say. there are no ... you cannot evoke. i'm making a strong statement, but i certainlyhave not been able to sit in a chair and put myself in a state of pain, not any more thati can evoke somebody's face in all the details, no. that's what memory people can do, butdo you see what i mean? so that was a long,

long answer that i think was relevant to yourquestion, that i don't think one can evoke those raw sensations. not anymore. you canevoke red. you know what red looks like. it's all through language, right? i'm not sayingyou should agree with me obviously. >> workshop participant: [unclear] >> workshop participant: but when you sayyou can't evoke the senses, i noticed when you said venice, your face lit up. yet, whenyou said trollenberg [phonetic] [laughter] your facial structure and your body posturewere so different. >> wiser: yeah, but it could be ... here,we're probably going too far on my own tangent, but i think it can be through language. that'swhy when you read novels, i don't know if

you do, but you sometimes cry or laugh. soi'm not saying you can't have emotions. i'm talking about the really raw experience. ortry to imagine a bell. can you really hear it? now some people are better than othersfor sure, but i guess i'm very language filtered. >> workshop participant: [unclear] for a whileyou can bring out grief in the same ... >> wiser: the sense of grief ... >> workshop participant: ... that you feltit initially. >> wiser: but that's very cognitive. i meanit has physical, but it's not just physical >> workshop participant: or the memory ofthe experience of grief. when i think about someone, when i think about my dad, i feelthat sense of loss again. i don't remember

the feeling of i got the phone call that hewas gone. >> wiser: right. you can tell it. i mean,you remember in the way we mean we remember, but you can't relive it. >> workshop participant: i know i don't everwant to relive it, that's usual. but i certainly still feel that sense of loss, the same waythat i still feel that sense of joy from the first time they put my son in my arms. it'slike the best moment in my life bar none. >> workshop participant: uh-huh, you summedit up when you said the sense of joy. >> wiser: well, that's the question, right? >> workshop participant: i'm still happy withthat memory or that ...

>> wiser: that's different, right? the memorymakes you happy. that doesn't mean you ... i'm being a bit hard, but it doesn't mean youare evoking your happiness from back then. >> workshop participant: i'm trying to createthe arguments that my students will create and they will create it. >> wiser: and they matter, yeah. if you hadlived with my son, you would have a long experience to go through. [laughs] >> workshop participant: if we think about... when you're getting an injection using needles [unclear]. the nurse says you're goingto feel a pinch, the visualization technique. does that excite the areas in the brain ...

>> wiser: well, that was the question before. >> workshop participant: ... that make usthink it's going to be a pinch. if she had said it's going to be a needle stick, allright, or a skin puncture ... >> wiser: would it be different? >> workshop participant: are you fooling thebrain into thinking that, oh, well ... >> wiser: you expect a pinch. do you thinkthat's why they say pinch? i always thought it's because ... what's the right word? >> workshop participant: i wonder if they're[unclear]. >> wiser: that's very interesting.

>> workshop participant: ... tickle. >> wiser: a tickle, right. >> workshop participant: the doctors and nursesto a child used to say, you know, it's just a little bee sting. >> wiser: a little bee sting. [laughter] yeah,right. now, i move to the next presentation. so what if we didn't feel pain? now you probablyhave the answer, et cetera, but your students might not. the first reaction might be, "idon't know." have you asked them? that would be fantastic.

do they say that? >> workshop participant: oh yeah. >> wiser: so i won't go ... do you know aboutleprosy? so that's something i talk about. talking about brain areas, i tend to relatethe areas of the brain not related to pain and then when we move to touch i contrastit, et cetera. yes? >> workshop participant: what are the self-reportsof people with the ‘a' symbol for pain? what kind of things do they say?

>> wiser: well, i haven't interviewed them. >> workshop participant: do they say, on ascale of 1 to 10, that was an 8. >> wiser: they just don't feel it. >> workshop participant: because they cangive it up. i'm asking i guess, can they give it a label and say, yeah, that was an 8. howdo you feel about the 8? i didn't care. is that what it is? >> wiser: no, no. i think it's like askinga blind person what they think color is. they feel touch, right? but i think that if youreally don't have it, and there are conditions where you just don't have it, and then i don'tthink it would make any sense. and of course,

as you know, it's a horrible thing. >> workshop participant: ... of a girl whodoesn't feel any pain that's been interviewed and you can find out [unclear]. >> wiser: oh, really? >> workshop participant: they talk about howdangerous it is ... >> wiser: it is horribly dangerous. >> workshop participant: and pain is superimportant that [unclear] realize that. >> wiser: that's right. and in fact this isan old one, but missy [phonetic] who died early and it's about ... and again, studentsare not necessarily aware of, but even not

turning in your sleep. i mean, the reasonyou turn in your sleep and that's good for you is because it's painful to be in the sameposition. so you end up with lots of skeletal problems, of course, burns. what i read is that individuals without paindie young because it's just too hard to keep one's self alive. culture, that's always a hit. this is whereyou can ask me to stop because not everybody likes to hear. so there is a ceremony in aparticular region of india where men will put hooks through their back - i haven't seenit, i talk about it as if i did - and will report not experiencing pain, although theydo know in regular life.

>> workshop participant: you really want toshow them something that maybe it's a small one-minute clip. remember the old movie, allof us in here that are experienced in pain, a man called horse, where he becomes a partof the tribe. and they put the hooks in his >> wiser: that's right. >> workshop participant: it's called the sundance, right? >> workshop participant: ... chest. i guessand he pulls it back, pulls it back. it's a part of manhood. it's perfect. >> wiser: that's right. that's exactly thesame thing. you're right. >> workshop participant: but it's only a minute.they show a little tiny minute of it. a man

called horse, who was the guy in it? >> workshop participant: richard harris. >> workshop participant: fantastic. and thenhe becomes part of the tribe. that's a manhood >> workshop participant: warrior initiation. >> workshop participant: ... warrior initiation,yes. >> wiser: very nice. good idea. and then thisis just how, you know, culture is not just words. and i'm not saying ... no, not everybodybut on average in a certain culture, people have a higher pain threshold than others.there are also gender differences in our culture and elsewhere.

so here's something you can do. it has a namecalled the cold pressure effect and i never understood why there was the word pressurein it. but anyway, you hold your hand in very cold water for five seconds and you rate howcold it is and how unpleasant it is. and then you can do it with hot water or you can keepwith the ice water. and you do it for 10 seconds and you rate how unpleasant it is. and thenyou ask students before they do it to predict how the sensation of cold and the unpleasantnessare going to change with the amount of time. so what's your prediction? do you understandwhat i'm saying? so are they going to increase both in the same way or ...? >> workshop participant: it will become lessthe longer you ...

>> wiser: i'm sorry? >> workshop participant: it will become lesspainful the longer your hand is in there. >> wiser: that's different. that's habituation. i don't know if it happens within secondsactually. i think it takes a long time before ... solet's assume there is no habituation. yes. >> workshop participant: i think the hot wateris going to be give them a much higher [unclear] response. >> wiser: yeah, that's right. the hot wateris going to be steeper. how about how cold

versus how unpleasant about the ice water5 seconds, 10 seconds, 15 seconds? >> workshop participant: i think the ice wateris going to be, for me, i would assume it would be much more unpleasant. >> wiser: right. but how ... okay, sorry. >> workshop participant: greater intensity. >> wiser: yes. so let's say five seconds yourate the coldness of five, and the unpleasantness of five. ten seconds, you're going to ratethe coldness of six or seven. where will the unpleasant be with respect to that? that'swhat i'm trying to ask. >> workshop participant: it will increase.

>> wiser: but as much or less than the senseof cold? >> workshop participant: you've got two thingsgoing like this and they'll either stay like this or is one going to go ... >> wiser: right. that's what i'm trying ... thankyou. i often need translators. so what do you think? >> workshop participant: we need the visual. >> wiser: yeah, you need the visual. >> workshop participant: but there's a learnedbehavior at play here too. i know that if i put my hand in the very hot water, it'sgoing to hurt me. it's got to hurt; it's going

to hurt me. >> wiser: yeah, if it's too hot. >> workshop participant: when i take it outit's going to continue to hurt, but i know >> wiser: oh, you wouldn't do it with thathot water. >> workshop participant: ... ice cold water,when i take my hand out, my hand will return to its normal temperature much faster. therewill be no long-term effect. >> wiser: that's true. >> workshop participant: five seconds in boilingwater versus five seconds ... >> wiser: no, i didn't say boiling. theseare classroom experiences, so hot tub temperature.

so you're avoiding the question. [laughs] so in other words what i'm trying to ask iswill the unpleasantness go faster with time than the sense of cold? >> workshop participant: i think it will. >> wiser: it will. yeah, it does. >> workshop participant: because you don'thabituate in that ... >> wiser: because you don't habituate andthe unpleasantness goes faster than the coldness, which shows that's one very basic way in whichto show that pain is a sense of its own and not just the perception of intense stimuli,which is basically i think what's accepted

now. when i was a grad student it was stilla question. what causes pain that you know? again, going back to the good old days wherewomen were told that menstrual cramps were just in their heads, my answer to that, ofcourse it's in your head, where would it be? when you cut your finger, it's also in yourhead. i mean there's the cut on your finger, but the pain is not in your finger. so ofcourse ... okay, so that's one thing, but now people understand the nature of it. ithas to do with, again, hormones related to histamine, et cetera. so not only now we knowit's real, right, because there's a chemical explanation.

i also talk about neuropathic pain, meaningpain that has outlived its purpose and what can and sometimes cannot be done about it. referred pain is interesting. you know thefeeling heart attacks in your elbow? no? left arm or something. and the explanation, doeseverybody know? then i just move on. >> workshop participant: what's the explanation? >> wiser: the explanation that i read is thatembryologically the nerves that signal pain coming from your heart and your arm are linked.and so whether the signal comes from your arm or from your heart, your brain doesn'tknow, so to speak. >> workshop participant: so they link somewheretogether on the neural pathway to the brain.

>> wiser: yes, that's right and then becausewe are more familiar with pain on our left arm than in our heart that's how we experienceit, right? >> workshop participant: are you going totalk about acupuncture? >> wiser: yes. i do. in fact, let's see. letme show you. this is a simplified version of my pain pathways, and there you go - acupuncture. so this the pain detector in your skin andit goes to the spinal cord, and then it goes to various brain areas. one is the pag. ishould have looked that up, the periaqueductal gray, something like that, and then the associationcortex, the limbic system that you know, et cetera. and then the question is how do youexplain pain neurologically this way? and

you can understand a lot. so for example,imagine being at the dentist. what does novocain do? do you know? >> workshop participant: blocks the [unclear] >> wiser: yes, it blocks here, right. so itchanges the electrical conductivity of your nerve and it prevents ... so it's very earlyin the system so the pain signal doesn't even reach the spinal cord. whereas, when you gounder as they say for surgery, that's of course at the upper level. then aspirin and stuff act on inflammationat the locus of where you hurt. i'm not going to do it all, but then acetaminophen ...

>> workshop participant: acetaminophen. >> wiser: thank you [laughs]. i usually callit by its brand name. it's easier but then i'm forgetting that one too. so it also actsin the spinal cord, et cetera. so you can explain, for example, why when you hit yourfinger or your toe, you rub it and that really helps. that's called the gate theory of painand you know that. and then here the pag in the midbrain has a huge role in lots of pain-relatedphenomenon. there are different hypotheses about acupuncture,but one of them is that it stimulates activity in the midbrain. okay, so this is a non-labeledone. one thing the students have to do is put arrows on it. do the messages go downor up? so the pag goes down when it's active

and it blocks activity here so it blocks thepain. i mean, not totally, et cetera, but it inhibits activity here so then the painmessage doesn't make it up. so that's the theory about acupuncture. it stimulates theactivity of an area of the midbrain, which then sends activity down to the spinal cord,which takes care of the pain signals to a greater or lesser degree. similarly that's where endorphins are generatedso the run is high. i'm telling you like the gospel that's what i read and there's goodscientific evidence for it whether it's foolproof. probably, there will be lots of changes. youknow this, right? that's where opiates act as well, and they act on the same receptorsas endorphins. that's also where self-produced

analgesia is, which is this little electricaldevice. when you have intractable pain, again i hear, you can have a little electrical likea pacemaker, at least that's what i imagine, except it stimulates your midbrain. it giveslittle bursts of electrical activity in your midbrain which then does its thing like acupuncture,if you wish. am i making sense? >>voices: uh-huh. >> wiser: and then hypnosis is higher up.the association cortex can, of course, send signal back and that's why that takes careof cultural influences, learning cognitive effects and stuff. that has to come from ahigher arch [sounds like] obviously, et cetera, et cetera.

so anxiety, on the other hand, excites thelimbic system, which excites the neurons in the spinal cord. and then fibromyalgia hasa lot to do ... i mean, there are lots of different theories also about different unwantedsignals are generated when they shouldn't. then i talk about the phantom limb pain. whydoes it hurt? there are also different explanations for that, but essentially the idea is thatthe nerves are still alive and therefore send signals to your brain although they don'toriginate from where they used to originate. that's one thing i use to try to teach studentsthat, as i put it, you are at the mercy of your brain. what that means is that whateverthe reality is, all you have is the activity in your brain. if the activity in your brainsays my hand hurts, your hand hurts. the fact

there is no hand there is irrelevant. yourhand hurts, right? that's not necessarily something they thinkabout on a regular basis. i'm not saying about amputation, but in general is that whatever... that's where my little speech on drugs come in. if you mess up your brain, it mightbe forever, and then that's your reality. you can't choose to see things or hear thingsthe way you used to because your brain is not just your eyes and your skin and yourears, it's also all the parts of your brain that participate in perception and that shape- we're back to that - that shape your perception's experience. if you mess that up, it will changeyour perception in the same way as putting colored glasses, whatever. you see the point.they don't listen, but i believe that very

deeply. stress also acts at the midbrain level.and then i gave you a bunch of things to read should you want to know more. now, i have a third part about touch, buti am not going to do it all. i would like to ask you, is that okay? questions aboutpain? we can always talk later. so why do you need touch? and then i'll show you theslide. >> workshop participant: to develop your brain. >> wiser: to develop your brain. that's alittle vague. [laughs] >> workshop participant: i guess immediatelyabout them like harlow and monkey studies. [unclear] like no touch then not the same.

>> wiser: so it's at least socially, extremelyimportant. >> workshop participant: beware of [unclear]. >> wiser: sorry, i skipped you. yes. absolutely,that's really important and it's not necessarily something students will tell you.>> workshop participant: related to what you were saying, it's just part of the feedbackthat we used to ... >> wiser: okay. anything else? yes. >> workshop participant: about phantom limbs. >> wiser: yes, that's right. >> workshop participant: there's tedtalkson youtube about phantom limbs and a guy who

has severe nerve damage in his existing armto the point where he asked it to be amputated. the arm was cut off and he has the same phantompain which hurts like, okay, i can't cut his arm off because it's already gone. he's gotagonizing pain which won't respond to stuff. so eventually he works at a mirror box inwhich he has a mirror image of the existing normal arm. he has to work the normal armso it looks like both limbs are now operating normally without pain, and cures it. >> workshop participant: vision over ... >> wiser: wow. >> workshop participant: you have to see this.

>> workshop participant: ... there's no feedbackanymore. [unclear] >> wiser: now there is. i wonder if one couldcure tinnitus the same way because tinnitus is also things taking over where they shouldn't.in fact, i hear mine a lot more in quiet settings than when there are other ... and it's notbecause it covers it. it's because if there are noises, real ones, [laughs] it stimulatesthe auditory system, and then the spurious ones don't. the neurons are busy respondingto real things. so i think there is a similarity. yeah. he is one of the pioneer about somatosensorysystems and ... >> workshop participant: who's that? >> wiser: it's ramachandran. he's in californiai think.

okay, what else with touch, anything else?socially, yes. >> workshop participant: i don't know if imissed this, but i just keep thinking of harry harlow and the attachment and [unclear]. >> wiser: yeah. >> workshop participant: sexuality. >> wiser: yes. right. that's what i delicatelyput as social attachment. [laughs] yes, absolutely, from babies to teenagers to ... yeah, absolutely.no. one can venture in it. in fact, the textbook i use, they try to imagine sex without touch.i don't know if you can say that. at college you can, but i don't know if you can say thatin high school. can you?

well, students often think about the socialaspect and rarely ... not necessarily bring up all the role of touch in motor behaviorand try to button your shirt without touch. what i try to explain is when you are verycold and you can't button or unzip or whatever, it's not because your motor neurons are notworking, it's because your sensory neurons are not working. anyway, so it's crucial to any movement. soi make a big deal out of that. sorry, i have to turn this on now. there wego. first of all that's how you swat flies orwhatever that land on your arm even when you don't see them. you're very sensitive andthat's building reflex for good reasons.

information about objects, try to imaginepicking up a tennis ball versus a crystal glass. even if you look at it and think aboutthe role of touch in doing both successfully, so what specifically ... it's probably obviousbut no, the lecture on this ... what kind of information do your hands give your brainessentially so that you successfully pick up the crystal glass without breaking it andthe tennis ball, whatever? what do you think is relevant? >> workshop participant: the weight. >> wiser: the weight, exactly. so one thingis you will lift, you adjust to weight so you lift properly. and in fact there is ... idon't think it's on youtube, it's probably

way too old. but there is a very cute thingwith babies where let's say, one-year-old and you give them something to lift repeatedly.it's really an experiment about piagetian conservation. it's a bar and they lift itand you can see they get used to it. and now they don't go ... whatever. and then you foldthe bar into two, so now it looks half the size. the young babies pick it up and they're,"ow," whatever. they expected a different weight. so how do we know the weight of somethingwithout putting it on the scale obviously? >> workshop participant: we make assumptions[unclear]. >> wiser: there is learning absolutely whichis why it was a trick tennis ball, whatever, but it's more than that.

>> workshop participant: isn't it the pressurethat it exerted back from it? >> wiser: that's part of it, but certainlyand that's why there is the size-weight illusion because more compact things ... >> workshop participant: ... with water inthis, it's pushing down on my hand more than a [unclear]. >> wiser: yes, right. but there is more toit than that. you're right, it's very important. >> workshop participant: it's visual. i mean,that's a huge thing. >> wiser: it's not so huge. >> workshop participant: i don't know. i'mlooking at an empty water bottle and i know

it's going to be light than a full one andi know it's going to ... >> wiser: but if i blindfolded you, you wouldstill very successfully lift both. i considered doing it and then i said ... [laughter]. female: i might feel a little awkward at firstif i'm blindfolded not quite knowing what to expect. >> wiser: yes, at the very first but ... >> workshop participant: after the first millisecond. >> workshop participant: the minute you touchit, like you pick up your cup. if my cup is empty, the minute i pick it up i sense a lotof things about it. right now it's full and

it feels and i sense something so totallydifferent about it in my space, in my body, the whole sense of ... i don't know what theword is. so there's like five or six things that have to be going on for me to do this. >> wiser: look, she's holding it like this,right? and i'm not proving you wrong. you're absolutely right. so what else? what is tellingher that the cup is of a certain weight? >> workshop participant: the pressure thatyou have to put against it, to hold it. >> wiser: so there is slipperiness. so youhave skin detectors that tell you how slippery things are, i mean, how slippage is ... >> workshop participant: how solid it is asopposed to ...

>> wiser: yes, right. so some detectors, somesort of detectors measure how much is pulling down, and then you adjust. other detectorswill tell you how it reacts to ... no, but that's not the end of the story, right, becausethe detectors are not ... they don't have any brain, so what is it with the tennis ballversus ... sorry, i've been ignoring you. >> workshop participant: i'm thinking of abeer stein and a wine glass and you're blindfolded, identical texture. so you're sensing a glass,but you'd be able to tell something about this by, well, how much force it takes todisplace them in space and to move them around. so if i'm using the same identical pressureagainst both glass objects, then i can feel the wine glass tipping and sliding versusthe beer stein is in same place with the same

amount of pressure. >> wiser: so physics is there, too, but let'stalk. so let's say pushing is probably not a good idea to do it fully, so you're pushingthem both, right? >> workshop participant: plenty of space. >> wiser: yeah, plenty of space and blah,blah, blah, and you're blindfolded. what information goes to the brain to tell you about that oneis more massive than the other? >> workshop participant: you're feeling, shape,quantity, texture. when we say the word feeling or touching it's so much more ... >> wiser: right, but my question is ... whati try the students to do is to go beyond that.

yes, we feel all that. how? what is the informationthat goes to your brain so that you experience texture? it's like the apple doesn't go toyour brain. texture doesn't go to your brain either. it's something else, so what is theintermediary? do you see what i mean? so what kind of information is it that allows youto perceive texture or how resistant the two glasses are or whatever else? i mean, it'sa bit different explanation but the general idea is the same. >> workshop participant: are you just lookingfor the fact that it's a neurochemical event? >> wiser: oh no. yeah. you see too many why's.so what i should have said is when you do this to a tennis ball versus a baseball, oryou push two things of different masses, whatever,

your sensors, your touch receptors are respondingto something in the same way. i mean, not in the same way but now the retina receptorsrespond to light, so that's all they do. they are responding to something. and then thenerve signals that come from your touch receptors are exactly the same nerve signals as theones in your optic nerve. i mean, not at the same time, but if you look at the nerve signal,you don't know whether it's about touch or sight or anything, it's just a nerve signal. so what makes you see versus feel is wherein your brain it goes but that's a separate issue. so what is it that they're encodingwith say information processing people? what information do those nerve signals carry?they're just little ... no, not even. they're

all different patterns. so what is it fromthe outside that is encoding in the nerve signals about holding something? >> workshop participant: it's all pressure-related. >> wiser: it's pressure-related, yes. >> workshop participant: i was thinking likepressure and touch and all, but then it's going back to the experiences that as youlearned this, every time you learn different touch and feeling and then checking your brain.your brain is like interpreting that to be that soft, that ... >> wiser: well, you see i don't disagree.experience is usually important. the thing

is, as clumsy as they are, babies do the samething. so there is again a part that's not learned. you have to learn in order to lookat something and know how to handle it more. first of all, and let me ... i want to getto the pride and a daily marathon, because everybody has ... it's terribly written butit's terribly informative. it's about a young man who doesn't have touch. that's for you and the vision. so he seesperfectly well. he could not do anything of the things that we have talked about and heknows. he lived for 20 years with touch but he keeps waiting things. he cannot do anythingat first, but it's really ... i'm getting ahead of myself. so what is it that touch,you know, pressure ... okay.

>> workshop participant: i think what you'redriving at is it's many different types of textures ... >> wiser: but texture is the percept. thequestion is what's the mediator? assuming you're not counting the texture is reallythere, right? >> workshop participant: it's not an illusion. >> wiser: it's not an illusion. and then yourub, you know how in stores ... i don't know if men do it too. when you ... you're alwaysfeeling clothes, right, so corduroy versus blah, blah, blah. >> workshop participant: you mean sensoryneurons?

>> wiser: i'm sorry. >> workshop participant: are you looking forsensory neurons? >> wiser: no. i'm looking for what kind ofinformation ... okay, let me try again and then i'll get to pride and a daily marathonbecause i'm just dragging you into this. [laughter] i often tell the students if you have to builda robot and i do that with cognitive development too. in fact there is a famous paper called"how to build a baby." so, that's the idea. how would you build your robot, not that heor she has the experience of ... that's metaphysics, but that it holds ... there is such a problemwith robots actually, right, so they don't crush what they hold. so what informationdoes the robot have to be sensitive to in

order to hold the glass, throw the ball orwhatever? >> workshop participant: how does supermanknow not to break the wine glass that he's holding? >> wiser: why superman? >> workshop participant: he's the man of steel.he crushes ... >> wiser: true, presumably he had the samesort of sensory system we do, right? >> workshop participant: it's resistance. >> wiser: it's resistance, okay. it's as simpleas that in a way. i'm well aware i didn't ask my questions properly, but certainly idon't think it's necessarily obvious because

like with the apple, it's there. the textureis there. the glass, of course the glass is slippery so it slips. well, the question ishow do you know it's slippery and everything is spatial, temporal patterns of pressure.that's all touch is. so this immense world of being able to walk, being able to hold,to button, to hold the baby, blah, blah, blah is only patterned information about how pressurechanges, how much of it there is and how it changes in time. >> workshop participant: it's all the relativeamount of pressure against the skin surface, and therefore, the receptors fire and ... >> wiser: exactly and that's all they do.now there are four kinds, and they are not

sensitive to the same patterns of pressure- that's what i'm in love with but we won't have time -and how combined, that's your touchworld which is huge. it's all time, space-dependent patterns of pressure. i find, again, thatabsolutely fascinating. anyway, thank you for your patience. so letme get to ian. so you have all of that. so the person inpurple at the back there, i'm sorry i don't know your name. >> wiser: that student, that's okay. to goback to your two glasses, when you push - action and reaction - the thing is pushing back onyou. and your sensory receptors, your touch receptors just say how much pressure thereis on them. i know you can do it. but the

students don't necessarily focus on the objects.they see on the action of the objects on them and that's what is sometimes tough to carry. so pride and a daily marathon, i'm just goingto give you a little taste of it. it was written by either the therapist or the neurologistof this young man who one day literally woke up without the sense of touch. he could feeltemperature. he could feel pain and his muscles were ... i mean, the muscles were intact butthen the question was how to move them. and it happened because of a viral infection thatdestroyed his touch fibers essentially. you don't come back from that. and so the bookis about both the neurophysiology aspect of it, but also his experience. and i don't knowabout you but i knew i needed it for walking

[sounds like] et cetera, but until you readthat, i think you'll realize how deep it goes, how much you need touch in a sense. so he is in his bed, he wakes up and he triesto sit up. he can't. so he tries to remember how one sits up, and he thinks somehow thattensing his stomach muscles has something to do with it. as we know sit ups have somethingto do with it. nothing. he has the same brain he had the day before but he cannot do it.and then he realizes it has to do with gravitational thing. that he has to bend his head forwardto sort of bring his ... it doesn't really matter the specific. so he has to reinventthe simplest of motions. and i want to go back to the first comment that ... what'shis name? yeah, you, sorry, i cannot call

by names because i don't know your name. sothe first thing you said very early on is we need touch to move, did you say? >> workshop participant: just to be awareof our movements. >> wiser: yeah, to be aware of our movements.and that's something that i don't think is that much known is that without touch youcannot decide. even when you look at your arm, you cannot decide to move from here tothere because in order for your brain to do the command to move from here to there, yourbrain has to know where your arm is, not visually, touch-wise. and so without touch, your brainis missing that information, and therefore, cannot generate any controlled movement.

>> workshop participant: that's ian waterman'scase. >> wiser: yes. >> workshop participant: actually, if yousearch for him online and there's a bunch of [unclear]. you can watch him on video clipsand things. you will see he had done an interesting documentary on him that you can watch littleclips of it, but in this case he like retrained himself ... it was all through sight. he hadto do it and if you shut off the lights and they talked about ... >> wiser: he fell. >> workshop participant: ... power went out,he just collapses to the ground.

>> wiser: think of it, if you have no sensation... >> workshop participant: that's because heno longer knows where his body parts are in relation to each one of those. >> wiser: and sometimes his arms would flingout because the brain ... it's not that the brain doesn't give random, as you know, commandsbut no, totally. and so he did retrain himself through sight. he literally crawled and thenwalked and as soon as it's dark ... i think of driving because he got back to driving.now imagine not having proprioception and the car next to you moved. how do you knowit's the other car or you? >> workshop participant: no. you have thatillusion of moving.

>> wiser: yeah, that's the trained sort ofillusion. i mean, the courage, it's fascinating but it's also ... i mean, not everyone cando that. other people who have that condition chose to stay in a wheelchair. i mean, it'sjust too hard. and he lived ... did he die? >> workshop participant: [unclear] i don'tknow. >> wiser: and then he ended up even buildingstone walls and trying to have a normal life. but just a description of what it means tosit up or to hold an apple. and then he becomes a clerk in a company. and talking about thecrystal glass, he has to distribute sheets of paper to different offices. how much pressuredo i put not to crush this paper but still

not have the papers and on and on and on.i think that really brings home even at the

different level the importance of touch. yeah,his name is ian waterman. so i'll stop here. thank you so much for yourinterest and i'd be glad to answer questions. [clapping]