Love Conquers Alz

DR. SCOTT SMALL - Director of the Alzheimer's Disease Research Center Columbia Uni.; Author of FORGETTING: THE BENEFITS OF NOT REMEMBERING

January 13, 2022 Dr. Scott Small, Susie Singer Carter and Don Priess Season 4 Episode 50
Love Conquers Alz
DR. SCOTT SMALL - Director of the Alzheimer's Disease Research Center Columbia Uni.; Author of FORGETTING: THE BENEFITS OF NOT REMEMBERING
Show Notes Transcript

 I literally panic every time I can’t remember a word or a someone's name.  And If you're caring or have cared for someone living with dementia or Alzheimer’s, like me, you probably experience similar anxiety when it comes to forgetting.  It's terrifying.  Well, Don and I are kicking off SEASON 4/EPISODE 50 with a very special guest, the distinguished memory researcher,  Dr. Scott Small,  who is going to share some new scientific findings that are going to give you some welcomed peace of mind in terms of normal forgetting and he also shared some GROUNDBREAKING DEVELOPMENTS ABOUT ALZHEIMER'S DISEASE.

 Scott is Director of the Alzheimer's Disease Research Center Columbia University, is a neurologist and neuroscientist known for his work in Alzheimer's disease and normal cognitive aging. His research focuses on the hippocampus, a circuit in the brain targeted by Alzheimer's disease and aging. He is also the author of author of the 2021 book, Forgetting: The Benefits of Not Remembering, published by Crown/Penguin Random House.  

Until recently, most everyone--memory scientists included--believed that forgetting served no purpose. But new research in psychology, neurobiology, medicine, and computer science tells a different story. Forgetting is not a failure of our minds. It's not even a benign glitch. It is, in fact, good for us--and, alongside memory, it is a required function for our minds to work best.

Scott’s book includes a wide variety of studies that include pigmy chimpanzees in the wild, visits with the iconic painter Jasper Johns, as well as the renowned decision-making expert Daniel Kahneman, looking across disciplines to put new scientific findings regarding forgetting into illuminating context.

These studies revealed that forgetting benefits our cognitive and creative abilities, emotional well-being, and even our personal and societal health.  As frustrating as a typical lapse can be, it's precisely what opens up our minds to making better decisions, experiencing joy and relationships, and flourishing artistically. 

So, the next time you forget where you left your keys,  remind yourself that a little forgetting does a lot of good!

Love.
Susie and Don xoxo 

Support the show (https://www.buymeacoffee.com/sscarter)
Don Priess:

When the world has gotcha, and Alzheimer's sucks. It's an equal opportunity disease that chips away at everything we hold dear. And to date, there's no cure. So until there is we continue to fight with the most powerful tool in our arsenal. Love. This is Love Conquers Alz is a real and really positive podcast that takes a deep dive into everything Alzheimer's, The Good, the Bad, and everything in between. And now, here are your hosts Susie Singer, Carter, and me, Don Priess.

Susie Singer Carter:

Hello, everybody. I'm Susie singer Carter.

Don Priess:

And I'm Don Priess. And this is Love Conquers Alz. Hello, Susan.

Susie Singer Carter:

Hi, Donald. I'm so excited today. How are you?

Don Priess:

Well, I'm fine.

Susie Singer Carter:

I know - plattitudes.

Don Priess:

A new New Year and a new beginning. And let's just let's just hope that this one, you know, maybe heads in a better direction than last one. So Right. Yeah, you know, today may kick us off right in that direction.

Susie Singer Carter:

I think so we have the greatest guest ever. I'm so excited. So that's why I'm like jumping. I'm doing leaps over overall plattitudes. Yeah. Yeah. Well, first of all, you know, let me just quickly put a plug in for I Love Lucifer, our other podcast, which is now a finalist for four finalists in the Audio Verse Awards. And we're not asking you to do anything, but just send good vibes. So we're excited about that. And you guys know, it's a Comedy, Horror and it's fantastic and it stars Adam Levy. From the Witcher and HBOs industry.

Adam Levy:

Her eyes are literally burning with an outrageous color of red. My fearless daughter moves into Fanta kiss the Porsche and it just to hold her away Tanya's lips have a inches from horses from the heat from her eyes, don't be daft now. In the grip of the....

Susie Singer Carter:

So you guys if you're a caregiver, and you have someone that you're caring for with dementia, or Alzheimer's, you probably are experience anxiety on a daily basis about forgetting. I mean, I do. I know I do. Every time I can't think of a word or I'm writing a night and a simple word doesn't count. I literally get pa nicked Don like, my heart starts beating

Don Priess:

I know I'm very well aware of it.

Susie Singer Carter:

I do and but I was I found I listened to this guest our guest on Anderson Cooper and it rocked my world. It changed how I thought about it and it gave me a peace of mind. Because I do have a good memory. You know and and like my daughter's always say, Mom, we can't remember words all the time. Right? So...

Don Priess:

Let's get to it. Today, our guest is Scott Small. And Scott is a distinguished memory researcher, the director of the Alzheimer's Disease Research Center at Columbia University, and the author of a fascinating not to mention practical book and titled Forgetting: The Benefits of Not Remembering, in which he explains why forgetfulness is not only normal, but also favorable. Until recently, most everyone memory scientists included believe that forgetting serves no purpose. But new research in psychology, neurobiology, medicine and computer science tells a very different story. Forgetting is not a failure of our minds. It's not even a benign glitch, it is in fact, good for us. And alongside memory, it is a required function for our minds to work best. Scott's book includes a wide variety of studies that include pygmy chimpanzees in the wild visits with the iconic painter Jasper Johns as well as the renowned decision making expert Daniel Kahneman, looking across disciplines to put new scientific findings regarding forgetting into illuminating context, while also revealing groundbreaking developments about Alzheimer's disease. And that's what we're very excited about talking about tody.

Susie Singer Carter:

And just to put it in layman's terms, the next time you forget your keys, just remember that forgetting is good for you. So please welcome our exciting guest, Scott S mall.

Scott Small:

Hi, guys, thank you so much for inviting me. Thanks for the very exuberant intro. I will start off by saying that although I'm optimistic in my personal world, I am like most trained physician scientists ever skeptical not necessarily optimistic. But Don, if you do mention the new year, a new year perhaps ringing in with hope. There's a lot of hope coming out of the the laboratories of Alzheimer's and it's translating practically there are new drugs there's new hope and I can easily articulate cautious optimism.

Don Priess:

Wow.

Susie Singer Carter:

It's amazing.

Don Priess:

It's funny because on - whenever we hear about a new drug, and it's always Wait, does it does it? You know, reverse it? Does it stop it where it is? Does it prevent it? And is it is it in all those areas?

Scott Small:

Well, you know, if if we could start from the beginning, perhaps the beginning is the mechanics cliche, you can't fix something unless you know what's fundamentally broken. And it turns out, and there are many ways in which I apologize to my patient, patients for the slowness in us really isolating the root cause of Alzheimer's. But there's a sense that we're finally there. And you know, the only silver lining of COVID, once you identify the target, the biomedical enterprise is endowed with such wonderful tools that you can genuinely realistically be hopeful that effective drugs can be developed.

Susie Singer Carter:

And I think it stems from kind of what in your book, when you talk about the the mechanism, the the molecular mechanism that you discovered, you always knew there was a mechanism for memory. But you didn't, but there wasn't a mechanism identified for actually forgetting. And so there's two mechanisms - is that right?

Scott Small:

That's exactly right. And quickly, let me let me just clarify, I've been involved like most of the world and finding mechanisms that regulate memory and pathological forgetting. So we've all been working away for decades, trying to understand the mechanisms of memory, which have been

Susie Singer Carter:

Which I want to get into, like, what illuminated by my mentor, Eric Condell, and many so many over the course of decades. And that and the belief was always well, you know, forgetting is just a glitch. It's just memory gone what actually identifies the difference between pathological bad. But the research in the last 10 years has clarified that that's not the case, there is a completely separate group of mechanisms that are dedicated to active, normal forgetting. And if I may quickly insert because we this needs to be clarified. In a very simplistic sense, one can think of pathological and which we all want to know. That's the big question, isn't forgetting what happens to us when we develop Alzheimer's, perhaps when we age, worsening from our own baseline versus normal, forgetting the forgetting we're born with the forgetting that all of us have, yet everyone, including everyone who sits next to me at a dinner party says, Oh, you're a memory Doctor, let me tell you about my forgetting. And it turns out to it? Like, where where's that line when it becomes normal and be normal forgetting. And so the book is really written in contrast to the pathological form. There's nothing nothing good about that. But there's a lot good about the normal form or forgetting pathological? I mean, I saw it in my mother. And I could only say, from my experience, what I how I identified it. And you

Scott Small:

That's it Susie, that's it. That's the distinction. And first of all, let me just say in this very know, and it's interesting, because not everybody, not engaging conversation, and not to put my neurology colleagues out of business, ultimately, if you really want to know if it's pathological, go see your doctor. And, and Los Angeles has wonderful, wonderful neurologists, the the the but you, you you hit on it the different the real way to, for everybody is attuned to it, because I was kept telling my your own self, or for your family members to know if it's pathological. If it's worsening from someone's baseline, so you know, sounds like your mother's lucky or she's very close to you, her daughter, so you detected something worsening from her from her baseline. The problem is, is that it's often family members, something's wrong with mom and neighbor, very subtle, and we all forget, and the kind of forgetting you're asking about can actually be the same as just any of us forgetting our keys. So it's really not so much about the kind of forgetting early on later in the disease. It's like, You're overreacting. That's normal. You know, she's clear, but at the earliest transition from normal to pathological forgetting, it could be subtle. But the critical point is, is it's worsening about a compared to someone's own baseline. And as in the case, sadly with your mother. So Alzheimer's is a progressing disorder. It starts

Don Priess:

And does that come out...sometimes? I mean, can you can you relate it to not just forgetting but behavior, as fine. I, we don't notice anything. And I was saying, but first, and it incubates in an area of the brain that really is opposed to just, "Oh, I forgot that." But now it's affecting dedicated primarily to memory and that's why if you think their behavior. Is that a sign? back, I don't know where your mother is right now, Susie, but if you know anyone with Alzheimer's and just think how it's different. it progressed over time, and that progression is not just a worsening in one area of the brain, it's a spreading across other areas of the brain. And so Don, when you ask about behavior, you know, that's a, that's a fuzzy word. But often when people really have behavioral problems with Alzheimer's, which could be the most devastating to the patient and to the family, that tells me the neurologist that the disease has already spread out of the air out of the area of the brain where memory alone functions.

Susie Singer Carter:

I think it's interesting, I just had a text conversation with a cop with a friend of mine whose father in law is 92 and experiencing dementia, not in a particularly Alzheimer's, but probably some combination thereof. And he had a fall and and they luckily, I guess he had internal bleeding, but it stopped. And he's now exhibiting like, incredibly violent behavior. And, you know, and I said, That's not.... You know, she was just lamenting about the fact that it may be, you know, I can't believe how bad you know, Alzheimer's, you know, if it brings him to this point, I said, I don't know if that is Alzheimer's, if it could be medication they put him on, it could be that whatever damage he had on his, you know, when he fell, is affecting him. If it's that quick of a change of personality, it doesn't seem like

Scott Small:

I think I think you're showing great clinical skills. Susie, that would be my first worry. And the good news about that, if it is medication, and it is a bleed in a part of the brain that can affect behavior, those are fixable, potentially, right. Alzheimer's, sadly, until now, isn't. The only nuance there is that often when people describe something that happens suddenly acutely, which is not the way Alzheimer's progresses? If you dig deeper, actually, oh, yeah, maybe there was some aggression before maybe there was some and so this just accelerated that. And you know, this is the problem is that we're relying on a history a narrative. And as your filmmakers, so you know, better than I that narratives aren't always faithful to the truth.

Susie Singer Carter:

That is, right. And, you know, I noticed even when my mom early on, when I was detecting, like some of the changes in her memory, I detected a change in her personality. Well, you know, the way that she related to me there was, there was an edge to it that wasn't there before. And I can't I you know, I couldn't really articulate it, or would probably sound very pandering to myself, but I felt it, I knew it was there. And it was real. So and that was really what tipped me off, and was like, my mom's not...

Scott Small:

if you think about you know, so it's, it's easy for us brain scientists to compartmentalize different parts of the brain and to think of discrete regions. But of course, if any of you, either of you were to have a fun night partying, and then the morning, after you're a little bit groggy a little bit out of it, you're out of sorts, you might also be and it's only because your memory is not great, you also might be a little bit grumpy, or a little bit. So and that's really, I have to tell you, it leads to an interesting pointabout what we do clinically, maybe we'll get to the cautious optimism about how we can really be physicians, and that by which I may intervene meaningfully, but I, but most of my patients who I spent often hours with are thankful. And I say, Well, why you're thanking me, I've done nothing. They said, well, and the patient's saying this, they're saying, well, at least I now know, it's not my fault. I at least I now know that I'm, you know, that my spouse who's thinking that I'm just being absent minded. It's not just me not caring. And so there's a certain amount of gratitude that comes from knowledge, even if it's not, sadly at this point, actionable,

Susie Singer Carter:

That's beautiful. Yeah, that's, that's so it is important. And I learned that the hard way because I always say I made the every miss my mom's habit for 16 years, just so I can frame it for you. And I so I learned the hard way by making a lot of mistakes, and then learning you know, what works and what doesn't work and, and putting myself in her, you know, being the most empathetic I could be to, to try to wrap my head around it, and realizing, you know, now and I used to say to her once I got the hang of it that you know, I could see her searching for a word, and I know how frustrating it is for me if I can't find a word or I'd and as it progressed, I could see her searching for the whole statement she wanted to say and then I could see it pass out of her head, and I could see her give up. I could

Scott Small:

And maybe blame herself and maybe be ashamed. Yes, all things that we have to try to eradicate from the...

Don Priess:

And she knew I mean, Susie found a diary of hers from before she even was diagnosed with Alzheimer's in her late 60s, writing, she says I better write this down now or I'm not gonna remember. She knew.

Susie Singer Carter:

And she also says, she also said something very poignant in that in those few pages. She said, You know, I can I can barely, you know, I have to, I have to, as Don said, write quickly she goes, In she goes, but there's something to be said about forgetting. She said, It's because I don't have to remember all the bad things.

Scott Small:

Well, that's really and you know, it is ultimately philosophical. It's not philosophical, hard to understand. It's philosophical, because it's about our society, in our families. That's I consider philosophical. And that's a really perceptive point on your mother's part. And one of the things my patients have taught me and I think I included in the book is that we tend to over index memory. And it's not Yes, God forbid, saying that it's a good thing necessarily. But we live in an information heavy world, we all want to be the person who can quote, we all want to be we all want to learn fast, more so than previous generations. And what my patients have taught me, particularly in the early stages, I'm not talking about the late stage. But in the early stage when someone is forgetful, profoundly forgetful, rarely are they profoundly despondent if they understand it's not their fault. And what they've taught me is that you don't need your memory to engage in the joys of life in art and beauty, and in family, love, and that that's a profound philosophical lesson that I I'm thankful to my patients for teaching me. I certainly live in a life where, you know, it's all about who can quote the who can you know, it's arguments it's in you want to know the right paper to counter argue, but at some point in our lives, it's actually not that important. The other stuff is more important.

Susie Singer Carter:

Oh, my God, you you are you're like my, I love you so much. I mean, I got this, this perspective from another a woman who was a she said she she has a method called the Dawn method with which is she talks about living with dignity and and she really takes the importance off of memory. And and I actually started a clubhouse where people meet called and the club is called M.A.S.Y., which is Memories Are So Yesterday, basically like it. They're not that important, right?

Scott Small:

Yeah, but I completely agree. I love I love the acronym, but try telling it to a kid who's sitting down for the SATs Or try tried some? And I Could I just say quickly, the book even in the normal forgetting is not saying memory is bad. It's saying we need our forgetting to balance our memories. So it's balanced.

Susie Singer Carter:

Yeah, for sure. No, I'm just saying that when you compare it to, you know, someone who was disabled. So I consider it a disability, right, of course, it's a disability. However, that doesn't mean you can't live life, and enjoy life.

Scott Small:

And as I tell my patients, and it's always difficult, and you have to be sensitive about this, because you never want to minimize anything when you're talking to a patient. But there are many chronically progressive disorders that we live with, right? Diabetes, guess what diabetes, if you live long enough, you'll have a lot of pain, you might lose sight, you might lose your limbs, you could really suffer. Forgetting, it may be a form of suffering for many of us, but as you pointed out for your mother's wonderful insight, and as most many of my patients tell me, if it's just forgetting it, the suffering is actually not that bad. What the real suffering is, again, to minimize is that you're basically giving someone a diagnosis that you can maybe convince them that right now and for the maybe foreseeable future, you won't suffer except for lack of memory, but it's a time bomb and the the end of Alzheimer's is not a pretty picture. We should not whitewash that.

Susie Singer Carter:

Yeah, absolutely. I agree. It but but it you know, it's, it's that thing that we as caregivers grapple with is, you know, and I had the issue from the from the get go, which is quality of life over quantity of life. So, you know, and, and, and, you know, our medical system is set up to prolong life as the physical life as opposed to, you know, really valuing the quality over the quantity. And so, and that's where I had issues because when my mom was in her full, you know, in her best of mother, she would you know, when we would visit certain people that were maybe like my grandpa who was in a skilled nursing, and she said, and she was fantastic with people in there, whereas how I learned to have my bedside manner and she'd walk out and say, "Susie, me, never! Ah, don't like, I've had a great life. Thank you. Okay. So you know what she's saying, and I, you know, but as it happens, you're like, that's, yeah, I can't fulfill that for you. However, I what I can do is make whatever time you have here, whatever whatever skills you still have the best they could...

Scott Small:

Yea, that's spot on.

Don Priess:

You say there's there's emotional and non emotional memories and how they how do they relate to the idea of forgive and forget PTSD? Are they both in? Are they the types... Are they important to forget I mean, in order to, to move on.

Scott Small:

Yeah, and in some ways as you as you nicely summarized on at the beginning, the book has many chapters that all cohere around this idea that forgetting is good. Some of the chapters are a little less intuitive, some a little bit more, I think, I think when it comes to emotional forgetting, I think that's more intuitive. We all know that we phrase we need to forget to forgive. We all know that there's a problem with PTSD. That is, by definition, by definition, a disorder of too little emotional forgetting. We all know in our daily lives, that if we were separate over our painful memories, we might become difficult people and suffer ourselves. So when it comes to the emotional part of memories, I think it's very, those were easier chapters to articulate why we need to balance our emotional memories with forgetting to live an emotionally balanced life. What was new, though, is that this all comes out, as you mentioned, Susie, from the new science of normal forgetting that only emerged in the last 10 years, and I wouldn't have written this book, just as a feel good book, if it is one. Without that hardcore science. I am a scientist after all, and again, most of that science was not done by me. But my by a universe of colleagues.

Don Priess:

I mean, it's funny, we talk about forgetting to forget to forgive, which can sometimes lead to people getting remarried, after they've divorced, I don't know how healthy that is. But it's something otherwise we just, but that you do that you forget, literally you could have a horrible...

Scott Small:

Right. And that's why I think that, Don, I think the balance analogy, the teetering balance is a good one. You don't want to forget everything. You don't want to forget all emotions, you don't want to forget the bad part. But what you want to do is defang the memory from preventing you from living a better and happier life. That balance means that occasionally you're going to be balanced, you're going to be swinging one way or the other, you might make mistakes because of too much memory or too much forgiving of forgetting. But it's factually true that you need to balance out your memory with your forgetting whether it's emotional, or informational.

Don Priess:

But we don't do that purposefully. I mean, the bot the brain does that for us. Is that correct?

Scott Small:

Yes. There. You know, it's interesting. Soin as I've been talking about the book to public audiences, often I worry that I won't convince people of the fact that we need our forgetting to balance our memories. I seem to convince people so much that often the questions at the in the q&a is okay, Doc, your doc, you've been working on how to fix pathological forgetting too much, you know, bad memory. If I have problems with my normal forgetting, how could I fix that? Right? Doctors are mechanics, I try to fix things. And and the one thing I learned again, I learned a lot, I work a lot on this book to make sure that it was sort of compelling and correct. And so in every chapter, I sort of have a guide, as you mentioned, Jasper for creativity, Danny Kahneman for decision making Eric and Dell for memory. In this case, I had a guide who's the PTSD expert at Columbia. And we were talking about PTSD and what parts of the brain and you know, how it taps into this new forgetting. And we're then talking about why is it that two people come home from a wartime experience? I experiencing the identical traumas, emotional traumas, right? One person could forget that enough, not the details, not completely, but enough to not develop a psycho pathology, whereas that other person can't write. And you should know that in the field of PTSD, they are trying to tap into the new science of forgetting. There are various drugs we can talk about. But what I found most interesting is it turns out that the most important factor is if you're exposed to trauma is to surround your life with love, laughter and happiness. And even now, I slightly giggle when I say that because I'm a hardcore you know, molecular guy. That seems a little bit namby pamby but it's actually factually true.

Susie Singer Carter:

Oh man, you're speaking my language!

Don Priess:

It's the basis of our show...

Susie Singer Carter:

Yeah, I mean Love Conquers Alz, doesn't

Scott Small:

And by the way, just to illustrate how a basic it?. scientists like me can reduce even love, love, ad absurdum. And I'm now self spoofing, but it is anchored in the science. One of the things that love does is it releases in our brain something called oxytocin. Maybe people have heard about it. One of the things that maybe the most profound thing that oxytocin does, is it relaxes the area of our brain that stores fear memories. And so in some ways, this is a simplification, I hope you do not edit this out.. Because it is, but it is not inconceivable to say that one of the things one of the reasons we're able to love is only when you're able to relax your fears. Think about a kid who goes to school, right? Kindergarten, it's not neurotic to say that that five year old is worried is fearful. And if that kid can overcome their fears, they're going to live a lonely life. It's only when you relax your fears. Relaxation is another colloquialism for forgetting your fears, at least temporarily. Do you open your heart to love and then it becomes a vicious cycle or as I say, a pas de deux because vicious cycle sounds vicious.

Susie Singer Carter:

So you also talked about humor? And it's in you know, that that things that that do increase your oxytocin. Right. And is that includes sex? I'm sure it does. But I'm

Scott Small:

Tt completely does. And I some somewhat, you know, I just can't help but let my personality creeping into a book. You know, I and that's just sort of pinching my sanctimonious maybe to religious friends. If, if oxytocin is good, if it's part of love, clearly, everyone will agree with that. But be careful, careful, what you wish for. Because too much oxytocin breaks the holy matrimony, of one on one fidelity. Bonobos, bonobos prove that. So, you know, you can't you have to be careful about what you pray for, I would say in this case.

Susie Singer Carter:

That sounds good. But you know, with my mother, I always say that there's, you know, I have certain tricks that I use to get to open the door when I visit her, and it's, you know, gets harder and harder and harder and harder and harder, right. My mother was, was a musician. She was the most amazing singer. I have her recordings from, you know, from the from Capitol Records, we play and sing them all the time, those open the doors, I make her laugh now, because she had, she has tremendous wit. So you know, and that when I can make her laugh, she suddenly and this comes back to that.

Scott Small:

And that just comes back to the closing of the loop the pas de deux, because when you make her laugh, she feels better. But it also shows how she still has her humor. And she still has her chops and her music. You know, I don't know if you saw that with Tony Bennett. I mean, absolutely incredible. And I know because I have a friend who knows him well, and he is no secret. He has Alzheimer's pretty advanced, but you put them you put him on a stage, it helps to be on the stage with Lady Gaga, of course. But you put him on a stage. And he remembers the full songbook. And even to me, and I know this phenomenon. So it's really, really profound about how memories pockets of memories can be preserved.

Susie Singer Carter:

My mother...It's just only within the last year and I blame it on COVID because she's been isolated too much. And even though we've been Zooming, Zoomi is not the greatest thing as we all know, for you know, to connect. So we but we've done the best we can, but she's lost her ability to to sing along. And that was the last thing to leave. And she knew the words better than we did.

Scott Small:

One, one of the things that worry me about COVID. And besides everything else, is the social problem of COVID. Think about it. It's a double whammy where isolate we were isolating ourselves because we have to for our bodily health. But in doing that we're worsening the trauma that many people experience the emotional trauma of COVID. And you're absolutely right. You mentioned the gecko that you have dogs so do we. One of the classic papers that was published in our one of our most prestigious journals is showing that not just us with ourselves and our family and our friends but us with our dogs. When we look deep into our dog's eyes. They release oxytocin. (Susie's dog barks) There he is! He's is a genius.

Susie Singer Carter:

That's my dog, right on cue.

Scott Small:

Yeah, he's immediately admitted to Columbia, I can tell you that. And, and so they release oxytocin, we release oxytocin and that oxytocin creates this social bonding. And it's it's real, it again, might sound soft, but it's not that is hardcore as hardcore as science can be. And you can't get that through zoom, you just don't, and you can't thank you. And you cannot get that from zoom. It's so interesting. And so maybe we get a little bit of that, but there's nothing it there's something about, you know, the brain is clever, just like the brain of most dogs can't look at a screen and see something our brain deep down, cannot recognize that I'm looking into your eyes right now. And so there's probably very little oxytocin.

Susie Singer Carter:

Exactly. Oh, I agree with you. 1,000%. That's why I would never online date.

Don Priess:

So you've heard stories of, you know, veterans who came back from World War Two. Yeah. And they never, they it's like, they never talked about it. And over, they never, you know, it was their way of coping with it. And, and then other people talk about it all the time. And as far as really getting rid of those memories, you know, it's what it feels like, Okay, if I talk about it, then it becomes part of my reality. And then I'm going to continue to memory maybe if I don't talk about it, it'll disappear. What? What are the effects of both?

Scott Small:

Yeah, well, I, again, I'm not prescribing a treatment here. I'm actually not a psychiatrist, so long pointed in psychiatry at Columbia, as well as neurology, but it's simply do what works for you. Right? So for someone who's not talking about it, that seems to not kind of shake, shake up all the memories. Maybe that works. But I think the simple answer is often if you don't talk about something, if you don't let, if you don't air it out, then it can fester. And it could start becoming worse and talk therapy of all kinds, not just with professionals, but talk. But talk therapy among friends and family is a great way to air out memories. And then at the least at the very least, not to forget the memories, we should never forget the day right? We should never forget 911. But we don't want to fester. Because that's going to then give the enemy too much power, it's then going to not kill you. At the battlefield, it's going to slowly kill your mind later your psychological mind.

Don Priess:

And that's what anything that's any upset in your life.

Scott Small:

Any any any upset. And that's where I think therapists you know, talk therapy, again, of all kinds, I think is is a true therapy. And most therapists do this. I was talking to a friend of mine who is a therapist, and I'm saying, you know, basically what you're doing is you're accelerating the forgetting process. And he generally agrees with it. I mean, if you think about formally, more formally, obsessive compulsive disorders, phobias, right, the way we treat that the most effective way is to have repeated exposures to the phobia in a in a benign setting, that's tapping into forgetting mechanisms, period, there's just no doubt about that.

Susie Singer Carter:

It feels like to me it feels like what I'm getting is that it the mechanism works on on, like, in a high level way, I'm going to say it really, you know, crudely, but it takes away those emotional or it takes away all the excess of what you don't need in that memory and leaves you with what you do need to make good choices. So and I'm going to bring it back to a plain like an easy to understand example , like a divorce.

Scott Small:

Yes. Let's talk about divorce. I'll tell you what, what couples therapy is used to accelerate forgetting. Now we know this in retrospect, before it became a banned substance, but yeah, let's talk about divorce.

Susie Singer Carter:

I know it's your I know what you're gonna say. Okay, I just Okay, so let me let me preface this, you guys. So I went through a horrible divorce. And it was really, really hard on me. And it was my second one. And the first one was not easy, but it was better. This one was just chaotic--

Don Priess:

It was harder on me.

Susie Singer Carter:

And I literally had just, yeah, well, Don's been my best friend forever poor God bless him. But um, you know that and I had seen the movie, The Eternal Sunshine of the Spotless Mind, right? And I was like, "Yes, I want that. I want that I need to go and have somebody erase this loop that keeps going through my head and making me cry". And so I went to a hypnotherapist, and I said, I want to get rid of just these memories and keep the good ones. Can you do that for me? She said, she said yes, of course she didn't, because I can't be hypnotized anyway. So that didn't work at all. Whether or not it does work, you would you could probably tell me that. But is there a way that we can accelerate getting rid of those because now it's taken me 10 years. And now I can actually look at it with a, you know, an objective frame and go, "This person? Not good for me and not cry.

Scott Small:

Well, you've, you've used the very natural gift of forgetting and that's time, right? But you're asking, Why do I have to wait 10 years suffering? Can I have accelerated it again, back to a legitimate question to ask a practitioner, a doctor. And I can't condone or critique hypnosis. I don't know enough about it. My hunch is that it can't just go in and like find that one little pocket and delete that. But essentially, good psychotherapy does that coupled with drugs and drugs, accelerate forgetting. And that's why often it's a common tutorial. What I was going to talk about actually is not the suffering after a horrible divorce, I'm sorry, you had experienced that Susie, but I was talking about is couples therapy -- therapists who try to preserve a friendship or a marriage. And, this is, this is a while ago, when I would lecture on you know, how I'm trying to develop memory pills for Alzheimer's disease. I got this question a number of times from therapy couples therapists as well. That's great, Dr. Small, but when you find a drug for forgetting, please let me know because it's gonna it's gonna allow my couples therapy to, to thrive because in essence, sounds like you had, you know, you've had a bad marriage, but many marriages falter on too much memory, too much baggage, right, letting go, letting go. Letting go is another of the many colloquialisms of forgetting. Letting go. How do you let go? And what they were using until it was banned is something that we know exactly what it does. And that's MDMA or ecstasy, it actually does accelerate the forgetting areas of our brain. And you might know, Don, back, we were talking about PTSD, it is now shown and currently tested more formally, as a therapy for PTSD to relax those brain areas that are just burning with too many memories burning hot and burning our minds.

Susie Singer Carter:

Does it target that molecular mechanism for targets?

Scott Small:

Yep. So so when you say, when you talk to a neurologist to talk about mechanisms, you first think again, back to the car mechanic analogy. He first asked where and then you ask what the where is clearly this region in our brain called the amygdala, where fear memories are actually stored. That's relatively new people always knew the amygdala was part of the story. But beautiful research out of Stanford has shown that it's really that's the storage of if your memories and you can turn it up and turn it down, at least in our model systems, what ecstasy, MDMA does a lot. But clearly what it does is it turns down that area that's burning too hot, no, no question about that. And I will say, since we all love, love, it sounds like, think about it's actually interesting to pore through the papers that have it back in the early days, tried to understand what ecstasy does, why does it make people feel so good. And so they've collected all the common

Don Priess:

That continues through through life. I mean, words to describe the experience. And it's all about connections and love and feeling a sense of well being. That apparently is such a great feeling that it's ecstatic and that's what's called ecstasy. And so, fear memories are important. Let's not forget, if we have no fear memories, we probably wouldn't make it out of kindergarten, right? We don't We no longer live in a jungle, but speak to a junior high schooler. It's a social jungle. It's a junk you want to know how to manage that. You don't want to just be you know, I'm Ollie optimist, I'm happy I don't care. You have to care you have get the life is Junior High. I mean, I just continues. to not get hurt. And that's why your fear memories are

Scott Small:

That's so true. All the lessons we learned in junior high still are apply in any sandbox. It's so interesting. We important. Let's come back to the balance idea. But you can't think we become wiser as we age we do, but not when it comes to let that go. Yeah, you can't let that tilt your balance and then social dynamics. The sad thing about Junior High's what gets say I'm not going to school or I'm just going to stay home and imprinted in junior high is our humiliation and that is hard to play video games. That's not going to work right. shake. And so when you see...that's what brought me in. And I was just watching a movie with with my wife where, you know, it was about high schoolers. And in the current age of social media, I have no idea how they manage that. I mean, I remember how ruthless we all were with no junior high schoolers. It would I mean, revenge and, and, and acting out all that kind of stuff that you might be sorry for later. But guess what? You can't delete that video. You can't delete that comment. It's out there. It's horrible. I feel bad for my friends who have young kids.

Don Priess:

Yeah, and it's beyond high school now. All social media at the bullying at all level? Yeah. Is Yeah, it's...

Scott Small:

Yeah,Humiliation,

Susie Singer Carter:

And I'm too sensitive...,

Scott Small:

Humiliation is an example par excellance of a form of memory that has to be relaxed. And it's easier said than done. Whatever we're talking about here is never easy.

Susie Singer Carter:

One of the things that you talked about in the book, which I found, you know, ironic, because which was, which was a way to accelerate forgetting the good kind of forgetting, yes, sleep. Right. So that sleep is that is the function of and and, and, you know, ironically, when you're upset when you're going through something traumatic like a divorce and your mother's moving in with you with Alzheimer's, and and the your life is imploding, and you're a sandwich generation with a young daughter, and you go and but guess what, sleep goes out the window, I didn't sleep well. I literally slept two hours a night for a year.

Scott Small:

You know, it is actually Fascinating, isn't it, that we spend something if we're lucky, a third of our lives, doing - sleeping, and we do it in a in a position of complete vulnerability to the world, right. And so you would think on first approximation, there's no way that mother nature would design us because we need to survive in the jungle. And it is one of the core requirements to live people who are forced to be sleep deprived by not a few hours, but true sleep deprivation will lead to death. And we do it. Our mammalian brothers and sisters do it meaning all dogs, mice, etc. Flies do it. We all need to sleep at least a third of our lives. And it's always been a great mystery. Unlike why we need to drink water or to eat food which we can explain easily. We intuitively understand what's up with sleep, why? And it's one of the most fascinating questions. And one of the answers, which is now gaining traction was proposed by Francis Crick. So Francis Crick is one of the great Nobel Prize winners, there are a lot of great Nobel Prize winners, he's up there. And he's the guy who first cracked the genetic code in the 1960s. And that is probably the most important finding in biology at least. And he said, Okay, well, that's easy. Let me figure out two things, consciousness and sleep. And then he went to the great Institute Salk at UCSD just south of you. And he spent the rest of his career trying to figure out sleep and consciousness. For sleep, he was the first one to propose formally. And it's a proposal that was so out of left field that if I would have proposed, no one would have listened. But because it's Francis Crick, they did, he formally proposed that we sleep in order to forget that sleep is a form of smart forgetting. And it took a long time to really test rigorously in the way we need in a lab. But he spawned a whole group of graduate students are now luminaries in their own right, who have finally shown that one of the things we do when we sleep is that we sort of we forget we we organize our mind, we get rid of extraneous matter, matter, information. Remember, your brain is not exactly your, your your portable camera device. But it effectively is memory happy. It always is trying anything that you were being exposed to within your waking day, your brain is saying I'm going to try to remember this, I'm going to try to remember this and then ends up remembering way too much information to the point that if you don't sleep, and I've had the experience of not sleeping for three days, you become

Don Priess:

But it's not a passive experience. Not a psychotic with too much information. So what sleep does passive experience because then you go and especially for is it neatly trims down your memories so that you get rid of someone like Susie who remembers every second of every dream she the extraneous stuff, but it also topiary, like, accentuates has. I do not. She she has a whole nother world that goes on the important memories. It doesn't just delete all memories. when she goes to sleep. I know I dream too. I just don't know, but she's Yeah, as an input hire, so it's not passive. It's

Susie Singer Carter:

Yeah, I wanted to ask you about that Dr. not passive. I don't know what to ask you about that. Small because I do have a whole other life in my dreams with other locations that I go back to that aren't in my real life. People that don't live in my life that I know, cars and places and, and, you know, like malls that I go to. And and it's it's, it's actually exhausting.

Scott Small:

I doubt I am going to clarify a lot in this call, but I'm certainly not going to clarify the transmigration of souls. So don't ask me to go there. If that's what you're suggesting, you have perhaps a separate parallel life. You might, you really might. I love that in literature. It's called the metaverse the meta universe.

Don Priess:

No, but but she dreams stuff. And she, she'll say to me, she says, What do you think this means? Like? What do you mean it's, it's exactly what you're experiencing in your in your wake day.

Scott Small:

So I can't, I can't I'm not sure I bring that back to forgetting. But what I can say is that we don't most of our sleeping time is not engaged in dreams, dreams probably play out certain things. And in playing them out. They're not playing other things. And so they're part of the topiary sculpting. But the what really was interesting to me there and I have to say, again, I I learned a lot in reading for the book, and talking to experts and reading stuff that's a slightly out of my natural home base, which is Alzheimer's. And it, there's just no question that we need to sleep, to forget to be more creative people. That is a really interesting punch line. And it took me a while to convince myself that I can even say that and because others have said it in different ways. And basically, the idea there is that it's always hard to pin down complicated terms. But in psychology, they pin down creativity in a way that I think makes sense to most of us. Creativity is not something out of the blue. It's not that you're Rica, that suddenly you know, you see something, most creative people, whether they're scientists or artists or in any walk of life, if we you know what a creative person, that person is being creative. Because they do two things. They expose their brains to a lot of information. So visual artists, visual information, musicians, music, scientists, maybe scientific information, so you need the memory part. But you need the forgetting part. This is what's so interesting. People have really exceptional memories will not necessarily be creative, almost the opposite. You need the forgetting part, to keep those associations in your brain loose and playful. It's that playfulness that creates the alchemy of forgetting of creativity. And that's really interesting. Emerson had this quote, and I'm loving people are sending me from around the world quotes, you know, artists, thank you very much. Well, I insist they call me Scott, but sometimes they they they flub and they call me Dr. Small Thank you very much Dr. Small for for the illuminating book, but you know that artists X, Y and Z writer, philosopher, poet, XY and Z figured this out a long time ago. And I actually talk about that in book in the book, how artists figure out how the brain works before we do. But Emerson has this great quote, where he says that....morning is the imagination of our minds. Evening is when it's burdened with memories and it's really just incredible because he's he sends that I think you speak to most speak maybe you Susie or your mother back in the day, most artists feel that they need a good refreshing night's sleep, to be able to really be creative for that alchemy to happen most likely.

Susie Singer Carter:

You know, a lot of creative people can do can have a lot of stimulation going on. And I love a lot of stimulation. I'm like, I'm like a hyper girl give me coffee, I would take I'd take a Coffee Drip. I'm good on that. But But when I'm creating I'm especially when I'm writing, I don't like any distraction. I can't because I already ...

Scott Small:

So all the information is there. If if you were one way - we ewant to be careful with oversimplifications. Again, my typical refrain, but people who have really, really good memory have all that information, but it's just stapled with steel. They can't be playful. They can't engage in creativity. That's what creativity is. And in some ways, it's my favorite chapter because of the importance of creativity in our lives.

Don Priess:

Is that what causes writers block? I was wondering when you writer's block, is there something that's going on you just thinking about other things? Or?

Scott Small:

That's a really interesting question, don't I? You know, I guess I would imagine there a lot of forms of writer's block. But that's a really interesting question. Might I forgetting bill? Help writer's block. It's not maybe a complete coincidence that drugs like alcohol have been used by many famous writers to unblock the writing. Again, I'm not a doctor of hot pot. I'm not. I'm not. I'm not condoning all that or prescribing any of that. But in this general discussion, that that would on first approximation, at least make some sense.

Don Priess:

And hallucinogenics, too

Susie Singer Carter:

many, many. Yeah, I was gonna say many a movie, and many a movie has been written on hallucinogenics. But yeah,

Scott Small:

Yeah. hallucinogenics I think are a little bit different. I think they what they do is they they're an active process, but and they might open up a pocket, that kind of thing. I'm not sure that and I know a lot about these recreational drugs. I'm not sure that and I'm all all in on on Jonathan Pollard's book, you know, micro dosing again, not as a doctor if but, but on the forgetting part. I think it's more the drugs like alcohol like ecstasy. That relax the forgetting that allow that kind of sleeping, that allowed that kind of creativity.

Susie Singer Carter:

I'm really always going on 13 years old in my head. So no wonder I'm just a playful girl!

Scott Small:

Honestly, Susie, playfulness is exactly the buzz word. Playfulness. I try to sign off I run a center at Columbia, I run a center for schizophrenia. I work with a lot of technocratic li driven, really smart people and we bang away at science. I try to end every zoom or meeting with the playful play, stay playful, stay fit, keep it fun. Otherwise, what's the point? I respect that? 100% I thought of this. To me. It's so fascinating. Do you know anything about dreams and Alzheimer's? Do because it's dreams come from a different part of the brain? Do you feel that people with Alzheimer's may dream? That's an interesting question anything. So if I can rephrase it, at least in a way that I think I can answer is, do our dreams. dreamscapes change as we develop Alzheimer's actually don't know that. That's an interesting question. One thing I should say that dream that's sleeping seems to be beneficial for Alzheimer's. That's a complicated story. And so I'm not sure it's related to anything I've been saying. But it's I don't know if the dreamscape actually changes, it probably does a hard to tell at some point, it'd be hard to tell. But if you look at artists and I talk about de Kooning write it together with Jasper. At some point, it definitely influences your creativity and your output. The question with de Kooning was whether impactful it impacted his later years to the point that it should not be showed in public. But when they decided to show it at the Museum of Modern Art, I think in 1997, it was they excluded some of the art that they thought was maybe subpar, but most of it is just the genius of a late stage.... Giant. So it's all interesting.

Don Priess:

Wow. I mean, could they do they monitor? Could will monitoring brainwaves say if you're dreaming or not?

Scott Small:

It'll say if you're dreaming or not, but it won't tell you I think what you're asking to me the more interesting question you're dreaming. But are you dreaming more or less? Are you dreaming? Like Susie? Are you dreaming? Like you wouldn't be Don, boring?

Don Priess:

Or just dreaming like you did? Dreaming like you did as well before Alzheimer's or dreaming? You know, is there a different type? Obviously, there's no way to you know, we can't record dreams yet.

Susie Singer Carter:

What are these ground breaking developments on Alzheimer's that you are talking about?

Scott Small:

Without going into the science because that might take a little bit more time? What we now know is what is, in medicine, we think not just neurology, we think of what goes wrong in the cell and the brain that would be neurons. And cells have 1000s of molecules. I think people know that. But we organize those molecules into Pathways, so like a blueprint of a complicated machine. And so we think of pathways and the pathway that used to be thought to be the cause is now probably not, that's one reasons why all the clinical trials that have been testing are generally disappointing. But the upswing is in parallel with the old ideas losing traction, the true pathways that seems to be playing the dominant role, and Alzheimer's has been clarified. And once you have that clarity, then the biotech industry can start developing drugs and that's happening as we speak.

Don Priess:

Fabuloius.

Susie Singer Carter:

Wow. How, what is the timeframe? Do you have a proximate timeframe for something?

Scott Small:

Well, the timeframes doctors have always gotten to trouble with timeframes because we sort of borrowed from Stalin on the Soviet five year promise, we always say five years, somehow that seems right. Medicine, biology doesn't work in years. I think the better analogy maybe is if in the past, we were swinging in the wrong playing field lights off, now we're in the right playing field lights are completely on and illuminated. And so the homerun will be hit soon. Whether that's a year two or five, it's hard for me to say. But again, the only silver lining of COVID is that it's shown us that once we're sure we the collective, we are sure of the cause of something. There's a lot of new tools that we just didn't have a few years ago, that can quickly mobilize to find meaningful drugs. And that's why there's cautious optimism and and some of the drug companies that I work with, they're not by nature. You know, overselling, but they truly believe in the next few years meaningful drugs where we'll come out of this new effort,

Susie Singer Carter:

Real quick, will anything ever reverse it?

Scott Small:

We have to bite off what we can chew. I think most of my patients, maybe your mother 16 years ago, if I told her I can arrest it, that would be maybe good enough, a little bit of forgetting and that's fine. That's our goal right now are meaningfully slowing. But But now that we have these these insights, there is some reason if you catch it early enough, much like cancer, you might be able to reverse it but let's not engender false optimism. Let's focus on what we think we can do.

Susie Singer Carter:

Understood.

Don Priess:

Well, we can't thank you enough for being here today. I mean, with this is your your fasc, everything about this is so fascinating. I we encourage everyone to go out and get your

book Forgetting:

The Benefits of Not Remembering.

Susie Singer Carter:

We really thank you so much for taking the time. You're such a mensch, as they say in French. And, Don, what do we always say?

Don Priess:

Well, as we always say, Love is powerful. Love is contagious, and love conquers all. And we thank you all for listening, and we'll see you next time. Take care