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tv   Charlie Rose  PBS  September 26, 2015 12:00am-1:01am PDT

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>> rose: welcome to the program. it is the end of summer and we're looking back at some of our favorite moments from the past year. resentation, we take a look at some of the moments and some of the insights from our brain series. >> this program could not be better timed because, as you pointed out, we're going to ight actually be helpful toweout society in this way. >> in humans, particularly, understanding the role of parenting behavior and the biology of parenting behavior is very important. >> it's unfortunate society often considers transsexuality to be a mental illness or an immoral choice, and because of this, transgender people are often denied even basic human rights. they're often subject to violence. >> rose: insights into the brain, when we continue.
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>> rose: funding for "charlie rose" has been provided by: american express. >> rose: additional funding provided by: >> and by bloomberg, a provider of multimedia news and information services worldwide. captioning sponsored by rose communications from our studios in new york city, this is charlie rose. now, in all these discussions, we're going to come back and forth to certain brain regions and four regions are particularly important. the pre-frontal cortex, the migd leand a hypothalamus. the pre-frontal cortex is in executive function and character information. and defects in the pre-frontal
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cortex often can lead to aggression. the ventral strightum is involved in certain kinds of aggression. the amygdala is the org administrator of emotion both positive and negative and influences several brain systems particularly the hypothalamus. the hypothalamus has many functions. we'll focus in particular its role in aggression and sexuality. >> so, charlie, we're basic neuroscientists in my lab and we want to understand the most fundamental questions about aggression. how is aggression which is an evolutionary ancient behavior, you see it throughout the animal kingdom, how is that hard wired into the brain? where is aggression in the brain? and we've studied this problem in flies and mice and we're particularly interested in the relationship of the parts of the brain which control aggression
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and mating because they're closely related behaviors and, in nature, you often find periods of aggression are at their highest when animals are mating and these behaviors reinforce each other, but, at the same time, they're mutually exclusive. so a male will direct mating towards a female of species, aggression towards another male. so there is a paradox, how can these behaviors be mutually exclusive but also reinforce each other in some way? so we've begun by trying to pinpoint the neurons that control aggressive behavior and we've started by looking in a very evolutionary ancient region of the brain which eric brought up called the hypothalamus. so we begin by trying to measure the electrical activity of cells that were active during aggression or mating in a tiny region of the hypothalamus and we found something quite surprising and that is, within this very small region of the
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brain, we found a mixture of neurons, some of which were active, turned on when the animals were fighting, this is done in males, some of which were turned on when the animals were mating with a female and, interestingly, some of these neurons were active during both fighting and mating, about 25% of them overlap. so that was a very interesting observation. it was a correlation and we really wanted to understand the function of these neurons. so we began by using very modern techniques, now, called optogenetics to activate and inhibit these neurons and we can pinpoint this activation with a high level of accuracy directly to specific cells in the brain that are active during aggression and turn them on and turn them off with a time resolution of milliseconds. so i'm going to show you a video of what happens to a male mouse when you activate these aggression neurons in the brain. i should say before we show the
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video some of your viewers might find the image a bit disturbing but what we're doing doesn't hurt the mouse and these are all protocols approved by the institutional animal use and care committee and are n.i.h. approved. so you will see the mouse in the cage with an inanimate object. when the light comes on we're stimulating the aggression neurons in the mouse. so we can actually trigger the mouse to attack a rubber glove. of course, if there were another mouse there, he would attack the other mouse as well. so we wanted to ask are these neurons actually necessary for normal aggression? so mice will normally fight with each other, for example, if you introduce an intruder mouse into a cage where a male mouse lives. very shortly thereafter the resident mouse will attack the intruder, he doesn't like somebody impinging on his territory. so we ask if we shut the neurons off can we stop a fight dead in
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its tracks? the next video will show you it's possible to do that. the mice are fighting naturally. when the light comes on, we inhibit the neurons and suddenly the fight stops. we'll show you in slow motion. you can see the mice are fighting. sund through light comes on. boom, we stopped the attack dead in its tracks. >> rose: i don't understand thousand neurons know to respond to light. >> the way that we do this is we genetically implant in these neurons deep in the brain a protein that comes from a light-sensitive algae, and that protein makes an ion channel through the membrane of the neuron that turns the neuron on only when light activates that channel. so we can convert these are neurons into light sensitive neurons. so that shows us that these neurons are necessary and sufficient for aggression. >> different kinds, those that activate the neurons and those
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that shut it off, and he can do either. >> so we discovered as we were manipulating the conditions for turning these neurons on something very surprising, and that is that you needed tensity stimulation wouldowto promote mating whaifer. so the mouse would try to mate with low intensity stimulation, whether male or female mouse. and we could switch the behavior of the same animal from attempted mounting to a mixture of mounting and attack just by increasing the intensity of light. so that tells us that, in this tiny region of the brain, this is a mixture of neurons that are controlling both the mating instijt and the fighting instinct and perhaps that will or may account for the tension between the sex drive and the aggressive drive. >> rose: extraordinary.
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iit's extraordinary. it also explains why aggression can lead to sexual aggression. is it an amazing set of findings. >> a lot of people think aggression is important in people with mental illness. the fact is mental illness on its own does not increase the aggression. it may depend on other factors like substance abuse and prior aggression. everyone gets concerned when mass shootings happen this, person must be psychotic, mentally unfit, and those are very individual situations. when you look across large epidemiological studies, it just doesn't pan out. there is multiple forms of aggression. socially sanctioned aggression such as fighting in war. metal aggression. but the two big ones are impulse aggression and premeditated
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aggression. and impulse aggression is not exactly spontaneous. people perceive a threat or a frustration and their threshold to blow up is just very low. so they just blow up and experience or display a temper tantrum or physical aggression. primitive aggression which can happen in anybody is -- premeditated aggression is thought out. the people who do that are more likely to be psychopaths. and the number of psychopaths are maybe 1% of the population. but people have intermittent explosive disorder, more like 3% to 6%, so that's much more the case as far as that's concerned. and those important distinctions to put forth because we have an idea how to treat impulsive aggression. we're not quite sure how to treat premeditated aggression. we'll say more about that. >> rose: what do we see at the neurobiological level?
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>> what we see in people with aggression is very similar to what we're hearing at this table. dr. tremblay talked about 4% of boys being aggressive. we see the same things biologically, problems with serotonin function, where usually serotonin function is diminished. we see evidence of highent other nerve transmitters to facilitate aggression. in terms of systems, we see problems in the frontal area, the amygdala and other aspects of that. when we present these kids who are angry or threatening, the amygdala will overreact to that stimulus compared to healthy volunteers and that correlates with how aggressive these people have been over the course of their lives. now, an important thing going along with this is se serotoninn the amygdala has to do with the tendency to be aggressive, but
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what makes you aggressive in the here and now has to do with how you interpret social signals. so people who are aggressive and it may well be because they had aggression as a child tend to have social information processing. so they don't take in enough information about what's going on and make a hostile inference as to what the other person is doing. so you can have a situation where your threshold may be high or low and where you're coming into the day is that you're primed to think that somebody brushing up against you or looking at you funny is threatening to you or frustrating to you. you have an overactive amygdala, a serotonin system and the frontal lobe is not working well, the brakes are bad, high accelerator and the brakes are bad, you're going to have a crash. >> it's interesting when charlie and i did a study on depression, depression is often designed type crease serotonin.
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is there increased in aggression and people with low levels of serotonin. >> interestingly, not necessarily. the early studies i did were interesting in that we saw this problem in individuals who didn't have a primary mood disorder and what we think is going on is that ther their bran systems involved in activation are not working well and will make a suicide attempt because that's going on. low serotonin is bad brakes. >> rose: adrian, let me talk to you about certain individuals who can not control their impulses. >> yes, emil has been talking about people in a hospital context. what we do is work with people likely at the straight level, people who are violent psychopaths, even killers. >> rose: what does psychopath mean? >> it's an individual who lacks conscience, lacks remorse, lacks guilt and because of that lack of normal emotional feelings,
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they do outrains things and they're stimulation seekers, impulsive. >> there is the cold, calculating callous type and have many of the and thety social lifestyles, doing horrible things to other people. they have been studying brain imaging to look to see what part of the brain might not be working right, what part of the brain might be physically different. what we find in normal people, of course, is their prefrontal corps text is working well as you see there in the green. if we can have the next slide, this is where we see murderers. the murderers are impulsive, very hot blooded in terms of their homicide, and what we see there on the left is poorer functioning in that very frontal region of the brain. so why is it that that part of the brain can predispose to
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aggression? it's the part of the brain that's involved in checking on impulsive behavior. we all get angry at times, don't we? what stops us? we have a good frontal corps text working well to regulate and control our aggressive behavior. so those are hot-blooded murderers, but what about the cold-blooded murderers? when we study them, they have pretty good frontal functioning which makes sense because these are the killers who premeditate their homicide and plan ahead and they have the wherewithal to do that. the interesting question is what is it that's producing them to be violent in a predatory fashion? so let's turn to the next slide where we'll look at another brain region and this is the amygdala. on the left you can see where it's located in the brain. what we find when we study cold-blooded offenders, psychopaths, they have a
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shrinkage, a physical shrinkage in the amygdala, reduced in size by 18%, and on the right you can see the areas within the amygdala covered in blue that are physically deformed. the the amygdala is very important in generating emotions, as eric said to begin with. if there is a shrinkage in the amigd larks that will reduce fear. what stops a lot of us breaking if law of the land? we're frightened about the punishment we would get if we were caught. but if you lack the fear and have the impairment to the amygdala that normally produces this anticipated fear that stops us from committing crime, well, you're more likely to commit offenses in a cold-blooded fashion. there is more to it than that, however. there is yet another brain region called the ventral striatum. on the left you can see where it's located in the brain.
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on the right you can see there is greater activity in psychopaths when they are anticipating rewards. so we have the idea that psychopaths are reward driven. they want the good. exactly just like an addiction. >> rose: so that's a stimulation to the brain? >> the idea is an ant pays rewards that part of the brain that gets hooked on reward is firing up a lot more. maybe that's why psychopaths are more likely to pursue rewards and gains that they want. they've got the drive to do that and they don't have the emotional amygdala to hold them back in a way to give them that anticipatory fear that would normally result. >> this is a spectacular series of findings we're discussing here, charlie, because when i was a medical student, none of these imaging techniques were available and you had very little insight of what was going on in the living brain of people. we now have insights into the biological substratum of
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different kinds ofsi of -- ofsin dropples that's remarkable. we can see how much we've learned, different categories -- >> even affecting the size of the amygdala. >> rose: the question is because of your reference to imaging, can you look at imaging and decide who is most likely to be aggressively violent? >> that's a great question and we are beginning to get some clues about who may be more likely to be violent in the future. for example, myself and colleagues brain scanned just males in the community. those individuals with a smaller volume to the amygdala were more cold-blooded, so to speak. they were four times more likely to commit a violent act in the next three years and that's prediction over and above prior history of violence, prior history of psychopathy. so it's not perfect prediction
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by any manner of means but we are beginning to get added value by imaging to try towns who are at risk of becoming the next generation of offender. >> rose: are we seeing this kind of research used in criminal trials? >> the key question here is if a psychopath is -- i mean, first of all, what's causing the amygdala shrinkage? it could be genetic or how the brain diverged, but we also know trauma reduces the size of the amygdala in children. neglect reduces the size of the amygdala. for whatever reason, i don't think psychopaths have to be born with an amygdala that's three sizes too small. if that brain impairment predisposes them, raises the odds of them doing the terrible things they do, the fascinating question is to what extent do we hold them fully responsible for that action? >> this is not dna evidence. this is not like saying i'm
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responsible, david is not, definitively. this is a problemistic statement and that is imperfect in front of the law. >> so it needs to get bert. when the amygdala is associated with this abnormality, that means danger, and when associated with another abnormality it's unrelated, then we'll be in a better position. >> human parents naturally die young and these behaviors are essential for the proper development of the child. in addition, parenting is one of the strongest and most enduring social bonds in human societies. remarkably, parental behavior is widely conserved in the animal kingdom. in animals, females lactate and, therefore, take primary responsibility of the parenting care, as can be seen in these very nice slide, these female
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chimpanzee is watching over the first step of her child. so females are very maternal and not only in mammals but some species of birds, frogs, reptiles, insects. what about fathers? well, the contribution of the males in parenting is very vairable. in some species, for example in this silverback gorilla playing with the infants, in some speeshts male are paternal and nurture their i don't think and in other species sometimes attack the children and kill them. i'm a neurobiologist and my group used the laboratory mice to try to understand the basic biology of parenting behavior. we would like to identify the brain areas involved in driving parental behavior and would like to understand how the brain areas are regulated.
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in order to have animals that are parenting and some animals that are neglecting their infants. now, in females, mothers as well as non-mothers are spontaneously maternal, which means that when they are put in the presence of pup, they will make a nest, groom them and cuddle with them for long periods. in contrast, males will readily attack the pups and kill them. however, males that have access to the females become paternal three weeks after mating with the female which correspond exactly to the gestation time in nice. in other words, men who become fathers also become paternal. so we took advantage of this extremely interest paradigm and differences in behavior between males and females and fathers and infanticide males to try
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towns what are the brain areas involved in those behaviors. the first question we ask are what are the neurons that drive parental behavior? and in the first set of experiments we identify a specific set of cells in the hypothalamus that are activated during parental behavior. we then ask are the neurons required for the parental drive? in the subsequent experiment we obliterated these neurons in parental males and females. remarkably, none of the animals negligent or attack the infants. so this experiment suggestion that the neurons are required for parental behavior. in the next experiment, we ask whether the activity of these neurons was sufficient to drive parental behavior. this time we artificially
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stimulated these nurturing neurons. amazingly, these aggressive males stopped attacking the pups and instead groomed their infants. what the experiment says is the activity of the neuron is sufficient to drive parental care. in another experiment, we identify a set of cells in the different area of the hypothalamus that is activated when aggressive males attack their infants, so we call these the parental neglect neurons. in another experiment, we activate these neurons in females and found these neurons now, these females, instead of caring of their infants, now neglect or attack them. so overall, what these experiments suggest is that brain has two components, a set of cells in the hypothalamus that drives parental behavior and another set of cells that
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drive parental neglect. we are very excited by these results because it opens new opportunity to understand the control of parental behavior and possibly why some animals are parental and some animals are neglecting or attacking these infants. now, parental behavior is widely observed among animals and these raise the possibility that the function and the regulation of these cells is widely conserved across the animal kingdom. >> rose: how do you stimulate the neurons to make the aggressive males more nurturing? >> we use modern methods in neuroscience called optogenetics that enable to shine light on neurons that have been genetically modified and have an ion channel that is light activated. so, in other words, we drive the activity of genetically defined population of neurons. >> rose: fascinating.
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sususanne, talk about how it evolved, parenting behavior. >> parenting behavior is conserved across animals, and not just conserved but varies. so there are some similarities between species that aren't very closely related and there are difference between closely related species, and what our work is trying to do is to understand the evolutionary basis for some of these parenting behaviors and why is it you have some parenting that's very similar and some that's very different. as we can see in this video, this is a video of a gorilla mother and her infant. there are a lot of similarities in the behavior of how this mother interact with her babies and how humans interact with her babies. we want to understand what is it that's similar about humans in our care giving and parental behavior and other animals. and the biology of mammals,
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females, means that there are hormones that are very, very important in determining lactation, so driving the production of milk and driving the let-down reflex, and these hormones also can be very important in regulating the behavior of mothers and their infant. two of these hormones are oxy tosin an and prolactin. attend of pregnancy, the brain produces oxytocin which is primarily important physiologically in the production of milk and lactation. however, it's also important in driving maternal behavior. so oxytocin have the secondary impact on the brain so when the hormones are raised the females bond with babies and the hormone is important in driving the
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offspring relationship. prolactin produced in pregnancy is also important in the production of milk but also has consequences for maternal offspring bonding. and i think that's really interesting because we have this biology that allows females to produce milk, but they also are incredibly important in driving the relationship between mothers and their offspring. and these hormones are important in driving social bonding in general with other animals. seems like one of the basic relationships between two individuals for animals are the mother offspring bond. but also these hormones are important in determining bonding between males and females and more widely in social relationships. there has been fascinating work done by teams understanding the evolution of parenting behavior and understanding the evolution especially of parent bonding
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between males and females. it's a very nice system where some vol species are monogamous. some are very nurturing toward their young. what has been found in this system is that not only are there higher levels of oxytocin but, in the males, there is a similar hormone that's produced by the hypothalamus which seems to be very important in determining both paternal and parabonding behavior. in the m monogamous species thee are higher levels of repressers. hormones drive --
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>> and insulin. they did a fascinating series of experiments determining both how oxytocin impacts some female maternal behavior and valdpersson for male bonding behavior. >> rose: is it higher levels of oxytocin that produce the monogamy or vice versa? >> oxytocin is primarily involved with the maternal behavior. some of the same teams who worked on how valsupressin has shown you can take vol species that are mott monogamous and change the hormones and that changes their behavior.
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our research is looking at what blj is similar and different to other primates. humans have a very large brain and exceptionally long juvenile and infancy periods. because we're born so helpless and unable to take care of ourselves, parenting becomes exceptionally important, and human babies are pretty much totally defenseless and even throughout the juvenile period, they need much more investment by their parents than similar species that are closely related to us and i think that tells us that in humans, particularly, understanding the role of parenting behavior and the biology of bharntin parenting br are important. >> rose: turn to what happens to children who are deprived of parenting. >> this infant and mother are having a wonderful conversation. you can see the mother is clearly in love with this baby.
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this is what we want to see in all infants and mothers. under conditions of profound deprivation all of that is missing. we have a pair of twins interacting. but now we have institutional care. a couple of things to notice, the sheer number of babies sitting in these institutions, the lack of caregivers. as you look through here, there's one you can see in the back. you can see there is a very low investment in these children, unlike the video clips we saw in the beginning. the lack of social interaction we think plays a fundamental role in building the brain. so what we started to observe was, in this study, what happens to the developing brain in kids growing up in institutional care? we actually formed a manipulation in which we saw a large number of children abandoned to institutions in romania and after studying extensively, some were placed in high quality foster care and some remained in the institution. i want to show you a video of what a child around the age of
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two looks like. this is an outing of a bunch of little kids in an institution. the girl who is rolling over, 22 months of age, i.q. below 50 at this point in time, been in the institution close to the time of birth. the other little girl is rock and off camera three, four other kids are all rocking, stereotypical of kids who grow up in institutions. the questions becomes what happens to the brain. in the next slide i'll show you the beginning of this journey to understand the brain. we recorded the brain's electrical activity or the e.e.g., by placing sensors on the top of the head. the billions of neurons generate electrical activity we can pick up and then from that electrical activity basically infer the power that the brain is producing, how much electrical activity is there. we can color code that, that indicates more or less power. on the right side you see an image of a never institutionalized brain. you're looking at this from the
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top down. the distribution of electrical activity is portrayed here to reflect much more brain activity in red sitting really over the frontal lobe. but if you look on the left panel, that's the institutionalized group. you can see the brain of the kids in the institution are basically underpowered, so you can use the analogy instead of a 100-watt light bulb it's 40. at that point we became concerned about what's making the brain produce less electrical activity. when children were eight to ten we fer formed mris to look at the detailed anatomy of the brain. on the right, we're showing the grey matter that represents the cell godys and appendages of neurons that sit on the corticol surface and do the computations and calculations the brain does whereas white matter does the communication of the brain and shows up whitish and grey matter shows up greyish. on the far right you see the
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amount of grey matter in the never institutionalized kids, these are the children who grew up in families in bucharest, romania. children on the far left is less reduced, showing less grey matter as do the kids in foster care. what this is showing us is the brain has much less brain matter by a function of being in an institution. in the next slide, we show the same reduction in white matter, this communication pathway. what's scary is it's almost suggesting that we know there is a smaller brain as a function of being in an institution. >> the reason this is so important because before chuck did these studies, people knew that deprivation or a lack of parental action was bad for cognitive development of children. one didn't know what affected the brain directly. one thought this was likely to be the case. this was the first evidence showing dramatic changes occurring in the brain. >> rose: would bit different
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if there was some kind of activity with the kids in the institutions produced from outside? >> yes. in a moment we'll talk about what happens when you put kids in families. your question is can you improve an institution. >> charlie is asking another question. does it have to be parents, could there be parental substitutes? >> we know it has to be tin investment the caregivers make. it doesn't have to be the parents but it has to be caregivers who care about the child. in institutions, you don't have that. >> rose: is it&your brain will develop if you feel there is contact that somebody knows who you are and recognizes you and there's an act of affection for you? >> yes. i think it's the social interaction that really is what's stimulating brain development and it's the lack of social interaction. so a kid's in an institution who got cognitive and linguistic stimulation but no care giving, they would be just as poorly off as the kids that we see. now the question is how much
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recovery is there. so in this study we place half the kids into high-quality foster care. in the beginning of the video, once again we'll see the little girl when she's 22 months of age, i.q. below 50 in an institution, very atypical motor behavior. after this we put her in foster care, and eight months later her i.q. is in the mid 60s, this is her interacting with her foster care mother. it's clear they have this loving relationship. this is merely eight months of foster care. in this clip, she's now about four years of age. she's spend intent half her life in foster care and look at the interaction she's having. this is the same little girl we saw in the beginning who is crawling backwards, rolling over, had no language and an i.q. in the 80s. this tremendous improvement seems to be regulated by a critical period which means
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placement before two years of age leads to better outcome, but after two years of age leads to less desirable outcome. in the next slide, the e.e.g. to remind us on the right is the brain to have the never institutionalized child. more red is more activity. left is the institutionalized child. we see the critical period on the left. after age two, notice the brain looks identical to the institutionalized brain. the child was in a family but not till old than two. in the next slide you can see that the children placed before two have brain activity who look just like the kids who have never been in an institution. you see this in other domains as well. you see this inflection and development. removal from an institution and placed in a good family before two lead to better outcomes to children placed after two. >> rose: timing is everything and if you don't have it, it puts a certain ceiling on how
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much you can produce. >> exactly, the window for opportunity is reduced. >> what we bring on this subject is not only a deep discussion of the psychological and sociological issues but the biological underpinnings. when we begin to speak about the biological underpinnings, we want to distinguish two different concepts, an atom cal sex and gender identity. anatomical sex is the body parts associated with sexuality and reprouction. gender identity is the more subtle complex image that is a sense o of one's self as a maler female. anatomical sex is determined not surprisingly by our genes. genes are arranged in chromosomes and we have 23 pair of chromosomes, we get half from our father, one pair from our father and one pair from our mother.
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22 are called otosomes and the different between the father and mother contributions are real but modest. but the sex chromosomes, the difference is really quite profound. women are xx and men are xy. the chromosomes are really quite different than the o autosomes d they have a very important function in determining sex. let's begin with the y y chromoe there, it has a region in it which is called the sex determining region of y that contains the gene that activates the dirchiatio differentiation e
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gonad that develops into male. the testes develop within the first seven weeks in utero. if the test matures as a result of the sex determining region of y, the testes release a massive amount of testosterone comparable to puberty and adult and that is responsible for giving you the male body form, the brain characteristic of male functioning as well as having actions on every aspect of your being. if the sex-determining region of y is not there, if you have xx, you have development of the ovary. the ovary, in turn, secretes estrogen and progesterone and gives you the female body form and changes in the brain. so, clearly, these are extremely important changes, and that's
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the easy part. this is the anna tommicle part. the more subtle part is the gender identity. >> rose: let me begin with ben. tell me the experience that you went through. share with us as much as you can cision, how you carriedur forward and the impact it's had on your life. >> sure. i think in many ways my experience is probably typical. for other transgender people, i think i was only about four or five years old when i started having strong feelings that i felt more like a boy. i was born as a girl, barbara. but i played like a boy, felt like a boy, played with boys' toys. i wished i could be in the boy scout. every halloween i dressed as an army man or football player. this seemed normal to me. i felt like a boy. middle school and early teen years, i did start to feel more and more uncomfortable with this. i didn't feel i should have
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breasts. i didn't feel comfortable at all wearing dresses, makeup, jewelry, and it became increasingly uncomfortable when i got into high school. you know, i started to be teds more by kids. you know, i just had a lot of confusion about my gender and i felt very ashamed of it. i never spoke with friends or family about it at all, ever once. >> rose: no one? no. i just felt very ashamed and very confused. don't forget this is the days before the internet, so there wasn't a lot of information about this sort of thing. so as i got into my 20s, i was doing well about my gender and in my career and medical and research training, but i was increasingly uncomfortable and like in trans people i thought about suicide a lot.
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this is a picture of me when i was barbara. i was a bride maid at my sister's wedding. i can still feel the agony putting on the dress, wearing jewelry and makeup and i still remember that. anyway, i did complete my training and began my job at stanford 20 years ago when i was age 40. about two years into that i actually developed breast cancer. i was still very confused about my gender identity but i knew i didn't like to have breasts, so when the doctor said he needed to do a mas ticketly to remove the cancer which fortunately was picked up early and i was cured of, i said, while you're there please take off the other breast. he was quite horrified by this. perhaps he's the first one i shared my feels about gender identity, but since the cancer runs in my family he agreed to remove the other breast.
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i can't tell you how therapeutic that was. i felt so relieve to have those breasts removed. i recognized that was a very different response than my mom when she had her mastectomy. she saw this as a huge blow to her femininity. after the surgery the doctor talked to me about reconstructing the breasts. i was hoe horrified. i said there is no way you're putting those things back observon me.that was a clue to s something different about my gender. a year later i was reading the san francisco chronicle where i read about james greene an opening female to male person in the bay area and realized there were other people that experienced the same sort of gender confusion, other people like me and i might be transgender. so i went to see a sex change pioneer at stanford and he ran a gender clinic. after ty evaluated me, they
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told me they thought i was transgender and offered me the possibility of changing my sex which was immediately irresistible to me and quickly within weeks i decided to change sex. i already had the ma ma sect ma. i didn't want the lower surgeries. all i needed was the testosterone. it's powerful stuff. one of the most powerful things was, to my great surprise, it became much harder for me to cry. male-to-females report it becomes much easier for them to cry so that was perhaps a prizing experience. but i think the main experience i had was after i changed sex, it's hard to describe the intense relief that i felt just like this weight lifted off of my back and i have been so much happier since. i've never had another suicidal thought, and i have to say that at the time i decided to do
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this, i had been a scientist at stanford several years and was very worried changing sex would harm my career. this was 20 years ago. but all my colleagues, friend and family were immediately supportive and i have been very fortunate to have my career continue and to have lots of wonderful students and so forth. >> i want to show you a very powerful example of identical twins who, in this case, one of the male twins -- and we have proven these twins are indeed absolutely identical and born male -- but one of them at age 3 started to say everything about being a girl and, in fact, if there was any issue that came up, she turned it into an issue of gender, and she did some of
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those things that we consider hallmarks, like preferring to wear female underwear and female pajamas, et cetera. and by the age of 7, the family decided, with the help of a counselor, to change her name to a female name and to have the child assume a female role. so here is twin sister with twin brother at the age of just about 9 to 10 years of age. >> rose: fourth grade. so they were fourth grade. what i want to point out is if i switched all the attachments to them -- the earrings, the clothing, the hairstyle, the shoes -- you could basically switch one for the other. the fact of the matter is that kids with their clothes on are virtually interchangeable
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prepuberty and, actually, their hormonal levels are virtually, at that particular point, interchangeable. so everything happens, really, at puberty. so here they are at age 14. now, because it is so difficult to live in a gender different from your biologic sex, when you have the toxics effects of your genetically hormone-driven puberty which would basically make twin sister look exactly like twin brother, and you can see that she looks still almost like a nine or ten-year-old and there is a good reason for it, she's had her puberty suppressed. the next slide shows the level of sex hormones across the human life span. look at the blue line which is the male level of testosterone,
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the hormone ben was receiving and some of us make, but that during fetal life, especially in the mid trimester, the level of testosterone in a fetus rises to a level close to the full adult range, and then it falls, and then there is another blip up right after birth, a kind of second puberty, and then things go completely dormant. if they didn't go dormant, we would have a whole bunch of puberty-looking fifth graders because everything is suppressed. >> when we think about possible causes for transgender, and ben and i spoke about it before, wouldn't it be possible if there is some abberation in testosterone or estgin secretion during intrauterine development or shortly thereafter that could contribute? >> certainly possible.
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it's a very dynamic stage. we still don't know what the second bump is right after birth or what roll it plays or whether boys who are born without testes but are otherwise normal show any differences as a result of that. the problem, eric, is that when we want to look at a hormone, west to get it out and measure it. well, you can't get it out of the brain. the other problem is sometimes it isn't the hormone level that's important but the affinity of the receptor for the hormone, and it's very, very difficult to measue such things. >> it's really defining a really fascinating problem to see what is the biological underpinning of transgender identity. as you pointed out, it's so important because kids who are in the wrong sex, their incidence of suicide attempt is very serious. >> it's one of the highest risks
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of any. >> and this is really something we need to understand. >> and the pubital process, the whole system awakens again. the system that had been awakened in utero comes back in which hypotha hypothalmic hormoe the release of the sex steroid hormones which are testosterone and estgin, mainly, and those things produce the differences between the body of the male and the female associated with puberty. so we have been able to probably since the 1980s, we have been be able to block the release of the hormone from the hypothalamus to the pituitary, and once you do that so far upstream, everything downstream goes down to zero, and we have a record of this medication being
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completely successful in shutting them down until the appropriate time and, also, the fact that it's completely reversible. look how revealing this is, because the twin sister affirms the female identity, and the puberty is blocked for two years, two years to get more time for counseling without the pressure of body change. that's very important because if we're going to give her estrogen, that's going to have permanent effects. so take a look at what would happen to her if she hadn't been given this blockade, she would look exactly like twin brother, and he's in early puberty for a 14-year-old, but so would she have been because they're identical. now here are the twins at age 17. at age 14, just after that picture was taken, she began estrogen, while, at the same time, having her male hormones blocked. with that, our patients don't
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need breast surgery when they feminize because it is so effective. and she is now, in that picture, entering junior high school as is her brother and she's absolutely fabulous. this past october, the dutch who taught us this reported the first follow-up of patients, the 55 of whom whose puberty was blocked and for whom sex was switched, they had surgery at age 13 and their total uncomfortableness with their gender disappeared and the dutch found the kids treated this way are psychosocially functioning as well or better than the controlled group of non-transgender kids they're compared to. >> rose: a powerful argument for surgery? >> for able surgery at the right
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time for the right people. >> also, i think one of the nice things about the dutch approach is that it delays puberty. once puberty sets in, you have, as i just pointed out, physical can changes that make it much more difficult to reverse, so you prevent the physical changes of the other occurring. in addition to the biological changes that it delays, it allows the child to think through whether this is the course they want to be on because some people say, i'm in the wrong body, i want to be a man, when they're a woman, but change their mind after a few months. i think this is the wrong course. this delay allows not only the physiological process to be handled in a more satisfactory way but the psychological evaluation to see whether this is the way the kid actually feels which is only a temporary decision in their minds. >> so the dutch gave me their protocol in 2006, and we started
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using it in boston children's hospital, in fact at which time we were the only major medical center to do so, but there aren't that many years since 2006 and there are over 40 programs. so it's now programming the standard of care. >> rose: for more about this program and earlier episodes, visit us online at and captioning sponsored by rose communications captioned by media access group at wgbh
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