TEDxCaltech
Thomas Insel: Toward a new understanding of mental illness
Thomas Insel: K novom razumijevanju mentalnih bolesti
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Zahvaljujući boljoj ranoj dijagnostici, danas su srčane bolesti uzrok 63% manje smrtnih slučajeva, no što je to bilo prije samo nekoliko desetljeća. Thomas Insel, direktor Nacionalnog instituta za mentalno zdravlje, pita se: Možemo li isto učiniti i u slučaju depresije i shizofrenije? Prvi korak u ovom novom polju istraživanja, misaoni je zaokret: prestanimo misliti o njima kao o "mentalnim poremećajima" i počnimo ih doživljavati kao "moždane poremećaje" (Snimljeno na TEDxCaltech.)
Thomas Insel - Neuroscientist and psychiatrist
The Director of the National Institute of Mental Health, Thomas Insel supports research that will help us understand, treat and even prevent mental disorders. Full bio
The Director of the National Institute of Mental Health, Thomas Insel supports research that will help us understand, treat and even prevent mental disorders. Full bio
Double-click the English transcript below to play the video.
00:12
So let's start with some good news,
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Počnimo s dobrim vijestima...
00:15
and the good news has to do with what do we know
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Dobra vijest ima veze s time što,
00:17
based on biomedical research
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na temelju biomedicinskih istraživanja,
00:20
that actually has changed the outcomes
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znamo o onome što je promijenilo ishode
00:23
for many very serious diseases?
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mnogih ozbiljnih bolesti?
00:26
Let's start with leukemia,
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Počnimo s leukemijom...
00:28
acute lymphoblastic leukemia, ALL,
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Akutna limfoblastična leukemija, ALL,
00:31
the most common cancer of children.
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najčešći je rak u djece.
00:33
When I was a student,
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Kada sam bio student,
00:35
the mortality rate was about 95 percent.
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stupanj smrtnosti bio je oko 95%.
00:39
Today, some 25, 30 years later, we're talking about
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Danas, nekih 25-30 godina kasnije, govorimo o
00:42
a mortality rate that's reduced by 85 percent.
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stupnju smrtnosti koji je smanjen za 85%.
00:46
Six thousand children each year
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Svake se godine šest tisuća djece
00:49
who would have previously died of this disease are cured.
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koja bi prije umrla od ove bolesti - izliječi.
00:53
If you want the really big numbers,
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Ako želite stvarno velike brojeve,
00:55
look at these numbers for heart disease.
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pogledajte brojeve u vezi s bolestima srca.
00:57
Heart disease used to be the biggest killer,
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Srčane bolesti bile su najveći ubojica,
00:59
particularly for men in their 40s.
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posebno muškaraca u njihovim 40-ima.
01:01
Today, we've seen a 63-percent reduction in mortality
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Danas vidimo 63%-tno smanjenje smrtnosti
01:04
from heart disease --
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uslijed srčanih bolesti.
01:06
remarkably, 1.1 million deaths averted every year.
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Izvanredno! 1,1 milijun smrtnih slučajeva
izbjegnutih svake godine.
izbjegnutih svake godine.
01:11
AIDS, incredibly, has just been named,
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AIDS je, nevjerojatno, tek prošlog mjeseca
01:14
in the past month, a chronic disease,
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nazvan kroničnom bolesti,
01:16
meaning that a 20-year-old who becomes infected with HIV
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što znači da se ne očekuje da će 20-godišnjak
koji se zarazi HIV-om
koji se zarazi HIV-om
01:19
is expected not to live weeks, months, or a couple of years,
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živjeti tjednima, mjesecima ili par godina,
01:23
as we said only a decade ago,
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kao što smo rekli prije samo jednog desetljeća,
01:25
but is thought to live decades,
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već se pretpostavlja da će živjeti desetljećima
01:28
probably to die in his '60s or '70s from other causes altogether.
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te vjerojatno umrijeti u svojim 60-ima ili 70-ima
iz posve drugih razloga.
iz posve drugih razloga.
01:32
These are just remarkable, remarkable changes
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To su jednostavno izvanredne,
izvanredne promjene
izvanredne promjene
01:35
in the outlook for some of the biggest killers.
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u izgledima u slučaju nekih od najvećih ubojica.
01:38
And one in particular
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A jedan poseban,
01:40
that you probably wouldn't know about, stroke,
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za kojeg vjerojatno ne znate - moždani udar -
01:42
which has been, along with heart disease,
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koji je, zajedno sa srčanim udarom,
01:44
one of the biggest killers in this country,
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jedan od najvećih ubojica u ovoj zemlji,
01:46
is a disease in which now we know
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bolest je za koju danas znamo da,
01:48
that if you can get people into the emergency room
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dovedete li osobu do hitne službe
01:50
within three hours of the onset,
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unutar tri sata od početka napada,
01:53
some 30 percent of them will be able to leave the hospital
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oko 30% njih moći će napustiti bolnicu
01:55
without any disability whatsoever.
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bez ikakvih posljedica.
01:58
Remarkable stories,
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Izvanredne priče,
02:01
good-news stories,
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one sa sretnim završecima,
02:03
all of which boil down to understanding
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sve se svode na razumijevanje
02:06
something about the diseases that has allowed us
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nečega o bolestima, što nam je omogućilo
02:09
to detect early and intervene early.
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njihovo ranije otkrivanje i ranije djelovanje.
02:12
Early detection, early intervention,
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Ranije otkrivanje, ranije djelovanje -
02:15
that's the story for these successes.
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to je bilanca ovih uspjeha.
02:18
Unfortunately, the news is not all good.
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Nažalost, vijesti nisu u potpunosti dobre.
02:20
Let's talk about one other story
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Porazgovarajmo o jednoj drugoj priči,
02:23
which has to do with suicide.
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onoj vezanoj uz samoubojstvo.
02:24
Now this is, of course, not a disease, per se.
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Ono, naravno, samo po sebi nije bolest.
02:27
It's a condition, or it's a situation
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To je stanje, ili situacija
02:30
that leads to mortality.
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koja vodi k smrti.
02:32
What you may not realize is just how prevalent it is.
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Ono čega možda niste svjesni jest
koliko su ona rasprostranjena.
koliko su ona rasprostranjena.
02:35
There are 38,000 suicides each year in the United States.
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Svake se godine u SAD-u dogodi
38.000 samoubojstava.
38.000 samoubojstava.
02:39
That means one about every 15 minutes.
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Znači, jedno samoubojstvo svakih 15 minuta.
02:42
Third most common cause of death amongst people
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Treći najčešći uzrok smrti ljudi
02:45
between the ages of 15 and 25.
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u dobi od 15 do 25 godina.
02:48
It's kind of an extraordinary story when you realize
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Nevjerojatna je to priča kad shvatite
02:50
that this is twice as common as homicide
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da je to dvaput češće od ubojstva
02:52
and actually more common as a source of death
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i, zapravo, puno češći uzrok smrti
02:55
than traffic fatalities in this country.
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no što su to prometne nesreće u ovoj zemlji.
02:58
Now, when we talk about suicide,
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Kada govorimo o samoubojstvima,
03:01
there is also a medical contribution here,
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njima doprinose i medicinski razlozi,
03:04
because 90 percent of suicides
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jer 90% samoubojstava
03:06
are related to a mental illness:
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povezano je s duševnim bolestima:
03:08
depression, bipolar disorder, schizophrenia,
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depresijom, bipolarnim poremećajem,
shizofrenijom,
shizofrenijom,
03:11
anorexia, borderline personality. There's a long list
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anoreksijom, graničnim poremećajem osobnosti.
Dug je popis
Dug je popis
03:14
of disorders that contribute,
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poremećaja koji doprinose,
03:16
and as I mentioned before, often early in life.
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kao što sam ranije spomenuo,
često i u mlađoj dobi.
često i u mlađoj dobi.
03:20
But it's not just the mortality from these disorders.
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Ali, ne radi se samo o smrtnosti
uslijed ovih poremećaja.
uslijed ovih poremećaja.
03:24
It's also morbidity.
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Radi se i o pobolijevanju.
03:25
If you look at disability,
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Razmotrimo invalidnost
03:28
as measured by the World Health Organization
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koju Svjetska zdravstvena organizacija mjeri
03:30
with something they call the Disability Adjusted Life Years,
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nečime što oni nazivaju
"Stopom izgubljenih godina zdravoga života".
"Stopom izgubljenih godina zdravoga života".
03:33
it's kind of a metric that nobody would think of
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To je vrsta mjerenja kakvog se nitko ne bi dosjetio
03:35
except an economist,
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osim ekonomista,
03:37
except it's one way of trying to capture what is lost
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samo što je ovo jedan od načina
da se otkrije što je izgubljeno
da se otkrije što je izgubljeno
03:40
in terms of disability from medical causes,
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u smislu medicinski uzrokovane invalidnosti.
03:43
and as you can see, virtually 30 percent
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Kao što vidite, gotovo 30%
03:46
of all disability from all medical causes
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svih invalidnosti uzrokovanih
svim medicinskim uzrocima
svim medicinskim uzrocima
03:48
can be attributed to mental disorders,
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može se pripisati psihičkim bolestima,
03:51
neuropsychiatric syndromes.
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neuropsihijatrijskim sindromima.
03:53
You're probably thinking that doesn't make any sense.
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Vjerojatno mislite kako to nema smisla.
03:56
I mean, cancer seems far more serious.
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Mislim, rak izgleda puno ozbiljnije...
03:58
Heart disease seems far more serious.
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Srčane bolesti čine se puno ozbiljnijima...
04:01
But you can see actually they are further down this list,
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No, možete vidjeti da su
one niže na ovom popisu,
one niže na ovom popisu,
04:04
and that's because we're talking here about disability.
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što je razlog tome
da ovdje govorimo o invaliditetima.
da ovdje govorimo o invaliditetima.
04:07
What drives the disability for these disorders
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Što je uzrok invaliditeta kod bolesti
04:09
like schizophrenia and bipolar and depression?
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poput shizofrenije, bipolarnosti i depresije?
04:13
Why are they number one here?
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Zašto su one prve na ovom popisu?
04:16
Well, there are probably three reasons.
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Vjerojatno postoje tri razloga...
04:18
One is that they're highly prevalent.
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Kao prvo, vrlo su raširene.
04:20
About one in five people will suffer from one of these disorders
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Otprilike svaka peta osoba bolovat će
od jednog od ovih poremećaja
od jednog od ovih poremećaja
04:23
in the course of their lifetime.
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tijekom svog života.
04:26
A second, of course, is that, for some people,
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Drugi je razlog, naravno, taj što neke ljude
04:28
these become truly disabling,
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ove bolesti istinski onesposobljuju,
04:29
and it's about four to five percent, perhaps one in 20.
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i to iznosi oko 4-5%, možda 1 od 20.
04:33
But what really drives these numbers, this high morbidity,
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Međutim, ono što uistinu potiče ovakve razmjere,
ovako visoko pobolijevanje,
ovako visoko pobolijevanje,
04:37
and to some extent the high mortality,
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a donekle i visoku smrtnost,
04:39
is the fact that these start very early in life.
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činjenica je da se te bolesti
očituju vrlo rano u životu.
očituju vrlo rano u životu.
04:43
Fifty percent will have onset by age 14,
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Bolest će se u 50% slučajeva
pojaviti prije 14. godine,
pojaviti prije 14. godine,
04:46
75 percent by age 24,
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u 75% slučajeva prije 24. godine...
04:49
a picture that is very different than what one would see
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Poprilično različito od onoga što mislimo
04:53
if you're talking about cancer or heart disease,
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kada govorimo o raku ili o bolestima srca,
04:55
diabetes, hypertension -- most of the major illnesses
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o dijabetesu, visokom krvnom tlaku –
o većini bolesti
o većini bolesti
04:59
that we think about as being sources of morbidity and mortality.
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koje smatramo glavnim izvorima
pobolijevanja i smrtnosti.
pobolijevanja i smrtnosti.
05:03
These are, indeed, the chronic disorders of young people.
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One su doista kronični poremećaji u mladih ljudi.
05:09
Now, I started by telling you that there were some good-news stories.
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Započeo sam rekavši vam da postoje dobre vijesti.
05:12
This is obviously not one of them.
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Ovo očito nije jedna od njih.
05:13
This is the part of it that is perhaps most difficult,
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Ovo je možda najteži dio,
05:16
and in a sense this is a kind of confession for me.
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i, na neki način, moje priznanje.
05:19
My job is to actually make sure that we make progress
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Moj posao je, zapravo, osigurati napredak
05:24
on all of these disorders.
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u vezi sa svim ovim poremećajima.
05:26
I work for the federal government.
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Radim za federalnu vladu.
05:28
Actually, I work for you. You pay my salary.
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Zapravo, radim za vas. Vi me plaćate.
05:30
And maybe at this point, when you know what I do,
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Možda ćete u ovom trenutku,
kada znate što radim,
kada znate što radim,
05:33
or maybe what I've failed to do,
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ili možda ono što nisam uspio učiniti,
05:35
you'll think that I probably ought to be fired,
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pomisliti da bih vjerojatno trebao dobiti otkaz.
05:37
and I could certainly understand that.
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To svakako mogu razumjeti.
05:39
But what I want to suggest, and the reason I'm here
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Ali, ono što želim predložiti,
i razlog zašto sam ovdje jest
i razlog zašto sam ovdje jest
05:41
is to tell you that I think we're about to be
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reći vam da mislim da ćemo uskoro biti
05:45
in a very different world as we think about these illnesses.
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u veoma drugačijem svijetu,
što se ovih bolesti tiče.
što se ovih bolesti tiče.
05:49
What I've been talking to you about so far is mental disorders,
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Dosad sam vam govorio o mentalnim poremećajima,
05:52
diseases of the mind.
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o bolestima uma.
05:54
That's actually becoming a rather unpopular term these days,
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Danas to, zapravo, postaje
prilično nepopularan izraz
prilično nepopularan izraz
05:58
and people feel that, for whatever reason,
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i ljudi misle da je, iz kojeg god razloga,
06:00
it's politically better to use the term behavioral disorders
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politički korektnije koristiti izraz
"ponašajni poremećaji"
"ponašajni poremećaji"
06:03
and to talk about these as disorders of behavior.
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i govoriti o njima kao o poremećajima ponašanja.
06:07
Fair enough. They are disorders of behavior,
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Pošteno.
Oni jesu poremećaji ponašanja,
Oni jesu poremećaji ponašanja,
06:09
and they are disorders of the mind.
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i oni jesu poremećaji uma.
06:11
But what I want to suggest to you
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Međutim, ono što vam želim predložiti je
06:14
is that both of those terms,
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to da oba ova izraza,
06:15
which have been in play for a century or more,
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koja koristimo i dulje od stoljeća,
06:18
are actually now impediments to progress,
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zapravo danas priječe napredak.
06:21
that what we need conceptually to make progress here
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Ono što moramo pojmovno učiniti
da bismo uznapredovali jest
da bismo uznapredovali jest
06:26
is to rethink these disorders as brain disorders.
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promisliti o ovim poremećajima
kao o poremećajima mozga.
kao o poremećajima mozga.
06:31
Now, for some of you, you're going to say,
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Neki od vas će reći:
06:33
"Oh my goodness, here we go again.
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„O moj Bože, evo ga opet.
06:35
We're going to hear about a biochemical imbalance
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Slušat ćemo o biokemijskoj neravnoteži,
06:38
or we're going to hear about drugs
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ili o lijekovima,
06:39
or we're going to hear about some very simplistic notion
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ili o veoma pojednostavljenom shvaćanju
06:44
that will take our subjective experience
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koje će pretvoriti naše subjektivno iskustvo
06:47
and turn it into molecules, or maybe into some sort of
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u molekule, ili možda u neku vrstu
06:53
very flat, unidimensional understanding
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vrlo plošnog, jednodimenzionalnog shvaćanja
06:56
of what it is to have depression or schizophrenia.
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što znači imati depresiju ili shizofreniju.
07:00
When we talk about the brain, it is anything but
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Kada govorimo o mozgu, on je sve samo ne
07:05
unidimensional or simplistic or reductionistic.
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jednodimenzionalan, pojednostavljen ili redukcionistički.
07:08
It depends, of course, on what scale
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Ovisi, naravno, o tome na kojoj razini
07:11
or what scope you want to think about,
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ili u kolikom opsegu želite razmišljati...
07:13
but this is an organ of surreal complexity,
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No, mozak je organ nadrealne složenosti.
07:20
and we are just beginning to understand
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Tek počinjemo shvaćati
07:23
how to even study it, whether you're thinking about
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kako ga uopće proučavati,
bilo da mislimo o
bilo da mislimo o
07:25
the 100 billion neurons that are in the cortex
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100 milijardi neurona u kori velikog mozga,
07:28
or the 100 trillion synapses
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ili o 100 bilijuna sinapsi
07:30
that make up all the connections.
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koje sve povezuju.
07:32
We have just begun to try to figure out
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Tek smo počeli pokušavati iznaći načine
07:36
how do we take this very complex machine
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kako razumjeti taj veoma složeni stroj
07:40
that does extraordinary kinds of information processing
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koji na izvanredne načine procesira informacije,
07:42
and use our own minds to understand
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i kako upotrijebiti naš um da bismo razumjeli
07:45
this very complex brain that supports our own minds.
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taj vrlo složeni mozak
koji podržava naše vlastite misli.
koji podržava naše vlastite misli.
07:49
It's actually a kind of cruel trick of evolution
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Doista je okrutan evolucijski trik
07:51
that we simply don't have a brain
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što jednostavno nemamo mozak
07:55
that seems to be wired well enough to understand itself.
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udešen dovoljno dobro da bi razumio samoga sebe.
07:58
In a sense, it actually makes you feel that
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Na neki način, čini se da
08:00
when you're in the safe zone of studying behavior or cognition,
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kada ste u sigurnoj zoni proučavanja
ponašanja ili spoznavanja,
ponašanja ili spoznavanja,
08:03
something you can observe,
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nečega što možete promatrati,
08:04
that in a way feels more simplistic and reductionistic
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to se na neki način čini
pojednostavljenijim i reduciranijim
pojednostavljenijim i reduciranijim
08:07
than trying to engage this very complex, mysterious organ
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od pokušaja da se pozabavimo
ovim vrlo složenim, zagonetnim organom
ovim vrlo složenim, zagonetnim organom
08:12
that we're beginning to try to understand.
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kojega tek započinjemo pokušavati shvaćati.
08:15
Now, already in the case of the brain disorders
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U slučaju moždanih poremećaja
08:18
that I've been talking to you about,
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o kojima sam vam govorio -
08:20
depression, obsessive compulsive disorder,
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depresije, opsesivno-kompulzivnog poremećaja,
08:22
post-traumatic stress disorder,
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posttraumatskog stresnog poremećaja -
08:25
while we don't have an in-depth understanding
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iako ne razumijemo u potpunosti
08:27
of how they are abnormally processed
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o kakvim se abnormalnim procesima radi,
08:31
or what the brain is doing in these illnesses,
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ili kako se mozak ponaša kod ovih bolesti,
08:33
we have been able to already identify
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uspjeli smo dosad identificirati
08:36
some of the connectional differences, or some of the ways
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neke od razlika u poveznicama,
ili neke od oblika
ili neke od oblika
08:39
in which the circuitry is different
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po kojima se razlikuju "sklopovlja"
08:41
for people who have these disorders.
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kod ljudi s takvim poremećajima.
08:43
We call this the human connectome,
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To zovemo ljudski konektom...
08:45
and you can think about the connectome
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Možete ga zamisliti
08:47
sort of as the wiring diagram of the brain.
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kao živčani dijagram mozga.
08:49
You'll hear more about this in a few minutes.
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Čut ćete više o tome za nekoliko minuta...
08:51
The important piece here is that as you begin to look
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Ovdje je važno da kada počnete promatrati
08:54
at people who have these disorders, the one in five of us
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ljude s ovakvim poremećajima -
svakog petog među nama
svakog petog među nama
08:58
who struggle in some way,
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koji na neki način pati -
09:00
you find that there's a lot of variation
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otkrit ćete mnogo raznolikosti
09:02
in the way that the brain is wired,
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u strukturi mozga.
09:06
but there are some predictable patterns, and those patterns
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No, postoje neki predvidljivi uzorci,
i ti su uzorci
i ti su uzorci
09:08
are risk factors for developing one of these disorders.
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rizični čimbenici u razvitku
jednog od ovih poremećaja.
jednog od ovih poremećaja.
09:12
It's a little different than the way we think about brain disorders
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Ovo se malo razlikuje od toga kako
zamišljamo moždane poremećaje
zamišljamo moždane poremećaje
09:15
like Huntington's or Parkinson's or Alzheimer's disease
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poput Huntingtonove, Parkinsonove
ili Alzheimerove bolesti,
ili Alzheimerove bolesti,
09:18
where you have a bombed-out part of your cortex.
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kod kojih je uništen dio moždane kore.
09:20
Here we're talking about traffic jams, or sometimes detours,
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Ovdje govorimo o prometnim gužvama,
ponekad i o obilaženjima,
ponekad i o obilaženjima,
09:23
or sometimes problems with just the way that things are connected
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a ponekad o problemima zbog toga
kako su neke stvari povezane,
kako su neke stvari povezane,
09:26
and the way that the brain functions.
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i toga kako mozak funkcionira.
09:27
You could, if you want, compare this to,
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Ako želite, možete to usporediti,
09:31
on the one hand, a myocardial infarction, a heart attack,
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s infarktom miokarda, srčanim udarom,
09:34
where you have dead tissue in the heart,
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kod kojega je dio srčanog tkiva mrtav,
09:35
versus an arrhythmia, where the organ simply isn't functioning
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naspram aritmije, kod koje organ
jednostavno ne funkcionira
jednostavno ne funkcionira
09:39
because of the communication problems within it.
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zbog komunikacijskih problema unutar njega.
09:41
Either one would kill you; in only one of them
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I jedan i drugi će vas ubiti,
no samo u jednom
no samo u jednom
09:43
will you find a major lesion.
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pronaći ćete veliku leziju.
09:46
As we think about this, probably it's better to actually go
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Dok razmišljamo o ovome,
vjerojatno je, zapravo, bolje
vjerojatno je, zapravo, bolje
09:49
a little deeper into one particular disorder, and that would be schizophrenia,
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zadubiti se malo u određeni poremećaj,
recimo, u shizofreniju.
recimo, u shizofreniju.
09:52
because I think that's a good case
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Mislim da je ona dobar primjer
09:54
for helping to understand why thinking of this as a brain disorder matters.
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koji će nam pomoći razumjeti zašto je važno
smatrati je moždanim poremećajem.
smatrati je moždanim poremećajem.
09:58
These are scans from Judy Rapoport and her colleagues
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Ovo su snimke Judy Rapoport i njezinih kolega
10:02
at the National Institute of Mental Health
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iz Nacionalnog instituta za mentalno zdravlje,
10:04
in which they studied children with very early onset schizophrenia,
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na kojima su proučavali djecu s vrlo rano
manifestiranom shizofrenijom.
manifestiranom shizofrenijom.
10:07
and you can see already in the top
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Na samom vrhu možete uočiti
10:09
there's areas that are red or orange, yellow,
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područja koja su crvena, narančasta, žuta...
10:11
are places where there's less gray matter,
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Na tim mjestima manjka sive tvari.
10:14
and as they followed them over five years,
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Pratili su ih tijekom 5 godina i
10:15
comparing them to age match controls,
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uspoređivali s kontrolnom dobnom skupinom.
10:17
you can see that, particularly in areas like
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Možete vidjeti, posebno u područjima poput
10:19
the dorsolateral prefrontal cortex
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dorzolateralnog prefrontalnog korteksa
10:21
or the superior temporal gyrus, there's a profound loss of gray matter.
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ili gornjeg temporalnog girusa...
Popriličan je gubitak sive tvari!
Popriličan je gubitak sive tvari!
10:26
And it's important, if you try to model this,
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I važno je, pokušate li ovo nekako uobličiti,
10:27
you can think about normal development
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zamislite normalan razvoj
10:29
as a loss of cortical mass, loss of cortical gray matter,
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kao gubitak moždane mase,
gubitak sive tvari...
gubitak sive tvari...
10:33
and what's happening in schizophrenia is that you overshoot that mark,
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Ono što se kod shizofrenije zbiva
jest prevelik gubitak.
jest prevelik gubitak.
10:36
and at some point, when you overshoot,
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I jednom, kad previše tvari propadne,
10:38
you cross a threshold, and it's that threshold
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prijeđete granicu, a radi se o pragu
10:41
where we say, this is a person who has this disease,
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na kojemu kažemo da je osoba oboljela,
10:44
because they have the behavioral symptoms
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jer pokazuje ponašajne simptome
10:47
of hallucinations and delusions.
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poput halucinacija i deluzija.
10:49
That's something we can observe.
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To možemo promatrati.
10:50
But look at this closely and you can see that actually they've crossed a different threshold.
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Međutim, pažljivije pogledajte i
vidjet ćete da su prešli različite pragove.
vidjet ćete da su prešli različite pragove.
10:56
They've crossed a brain threshold much earlier,
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Prešli su moždani prag mnogo ranije,
10:59
that perhaps not at age 22 or 20,
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ne u 22. ili 20. godini,
11:02
but even by age 15 or 16 you can begin to see
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već i u 15. ili 16. može se zamijetiti
11:05
the trajectory for development is quite different
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da je razvojni tok poprilično različit
11:07
at the level of the brain, not at the level of behavior.
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na razini mozga, ne na razini ponašanja.
11:11
Why does this matter? Well first because,
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Zašto je to važno?
Pa, najprije zato što je
Pa, najprije zato što je
11:13
for brain disorders, behavior is the last thing to change.
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kod moždanih poremećaja
ponašanje zadnje koje se mijenja.
ponašanje zadnje koje se mijenja.
11:16
We know that for Alzheimer's, for Parkinson's, for Huntington's.
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To nam je poznato kod Alzheimerove,
Parkinsonove i Huntingtonove bolesti.
Parkinsonove i Huntingtonove bolesti.
11:19
There are changes in the brain a decade or more
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U mozgu se promjene zbivaju
i više od desetljeća
i više od desetljeća
11:21
before you see the first signs of a behavioral change.
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prije no što zamijetite prve znakove
promjena u ponašanju.
promjena u ponašanju.
11:26
The tools that we have now allow us to detect
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Današnja nam tehnologija dopušta da otkrijemo
11:29
these brain changes much earlier, long before the symptoms emerge.
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te moždane promjene puno ranije,
puno prije no što se simptomi pojave.
puno prije no što se simptomi pojave.
11:34
But most important, go back to where we started.
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Ali najvažnije, vratimo se na početak.
11:37
The good-news stories in medicine
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Dobre su vijesti u medicini
11:40
are early detection, early intervention.
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rana dijagnostika, rano djelovanje.
11:43
If we waited until the heart attack,
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Kad bismo čekali sve do srčanog udara,
11:47
we would be sacrificing 1.1 million lives
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žrtvovali bismo 1,1 milijun života
11:51
every year in this country to heart disease.
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svake godine u ovoj zemlji.
11:53
That is precisely what we do today
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Upravo to činimo danas
11:56
when we decide that everybody with one of these brain disorders,
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kad odlučimo da svatko s jednim
od ovih moždanih poremećaja,
od ovih moždanih poremećaja,
12:00
brain circuit disorders, has a behavioral disorder.
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poremećaja moždanih sklopova,
ima poremećaj ponašanja.
ima poremećaj ponašanja.
12:03
We wait until the behavior becomes manifest.
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Čekamo da se ponašanje manifestira.
12:06
That's not early detection. That's not early intervention.
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To nije rana dijagnostika. To nije rano djelovanje.
12:11
Now to be clear, we're not quite ready to do this.
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Da raščistimo - nismo još uvijek
posve spremni za ovo.
posve spremni za ovo.
12:13
We don't have all the facts. We don't actually even know
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Ne raspolažemo svim činjenicama.
Ne znamo čak ni
Ne znamo čak ni
12:16
what the tools will be,
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kakve ćemo alate koristiti,
12:19
nor what to precisely look for in every case to be able
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niti što ćemo točno svaki put tražiti
12:23
to get there before the behavior emerges as different.
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kako bismo djelovali prije no što se
ponašanje promijeni.
ponašanje promijeni.
12:27
But this tells us how we need to think about it,
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Ali, ovo nam govori kako trebamo razmišljati,
12:30
and where we need to go.
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i kamo bismo trebali krenuti.
12:31
Are we going to be there soon?
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Hoćemo li uskoro stići onamo?
12:33
I think that this is something that will happen
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Mislim da će se to dogoditi
12:35
over the course of the next few years, but I'd like to finish
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tijekom sljedećih nekoliko godina...
Ali, želio bih završiti
Ali, želio bih završiti
12:38
with a quote about trying to predict how this will happen
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s citatom o nastojanju da se predvidi
kako će se to dogoditi,
kako će se to dogoditi,
12:41
by somebody who's thought a lot about changes
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mišlju nekoga tko je puno razmišljao o promjenama
12:43
in concepts and changes in technology.
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u pojmovima i u promjenama u tehnologijama.
12:45
"We always overestimate the change that will occur
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„Uvijek precjenjujemo promjenu koja će se dogoditi
12:48
in the next two years and underestimate
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u sljedeće dvije godine, a podcjenjujemo
12:50
the change that will occur in the next 10." -- Bill Gates.
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promjenu koja će se dogoditi u sljedećih deset.“
(Bill Gates)
(Bill Gates)
12:54
Thanks very much.
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Puno hvala.
12:55
(Applause)
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(Pljesak)
ABOUT THE SPEAKER
Thomas Insel - Neuroscientist and psychiatristThe Director of the National Institute of Mental Health, Thomas Insel supports research that will help us understand, treat and even prevent mental disorders.
Why you should listen
Thomas Insel has seen many advances in the understanding of mental disorders since becoming the Director of the National Institute of Mental Health (NIMH) in 2002. During his tenure, major breakthroughs have been made in the areas of practical clinical trials, autism research and the role of genetics in mental illnesses.
Prior to his appointment at the NIMH, Insel was a professor of psychiatry at Emory University, studying the neurobiology of complex social behaviors. While there, he was the founding director of the NSF Center for Behavioral Neuroscience and director of the NIH-funded Center for Autism Research. He has published over 250 scientific articles and four books and has served on numerous academic, scientific, and professional committees and boards. He is a member of the Institute of Medicine, a fellow of the American College of Neuropsychopharmacology, and a recipient of the Outstanding Service Award from the U.S. Public Health Service and the 2010 La Fondation IPSEN Neuronal Plasticity Prize.
Thomas Insel | Speaker | TED.com