TEDxCaltech
Thomas Insel: Toward a new understanding of mental illness
Tomas Insel (Thomas Insel): U susret novom razumevanju mentalnih bolesti
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Zahvaljujući ranom otkrivanju bolesti, za razliku od samo nekoliko decenija ranije, danas je smanjena smrtnost srčanih bolesti za 63%. Tomas Insel, direktor Nacionalnog istituta za mentalno zdravlje se pita: da li bismo jednako mogli tretirati i depresiju i šizofreniju? Prvi korak na ovom novom putu istraživanja je, kaže, ključno preformulisanje: da prestanemo da mislimo o "mentalnim poremećajima" i da ih počnemo razumevati 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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Započnimo nekim dobrim vestima,
00:15
and the good news has to do with what do we know
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a dobre vesti se odnose na to -
šta mi znamo
šta mi znamo
00:17
based on biomedical research
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o biomedicinskim istraživanjima
00:20
that actually has changed the outcomes
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koja su zapravo promenila rezultate
00:23
for many very serious diseases?
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mnogih veoma ozbiljnih bolesti?
00:26
Let's start with leukemia,
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Započnimo s leukemijom,
00:28
acute lymphoblastic leukemia, ALL,
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akutnom limfoblastnom leukemijom, ALL,
00:31
the most common cancer of children.
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najčešćim oblikom raka kod dece.
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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stopa smrtnosti je bila 95 procenata.
00:39
Today, some 25, 30 years later, we're talking about
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Danas, nekih 25-30 godina kasnije,
govorimo o
govorimo o
00:42
a mortality rate that's reduced by 85 percent.
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smrtnosti smanjenoj za 85 procenata.
00:46
Six thousand children each year
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Svake godine se izleči šest hiljada dece,
00:49
who would have previously died of this disease are cured.
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koja bi ranije umrla od ove bolesti.
00:53
If you want the really big numbers,
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Ako želite zaista visoke brojke,
00:55
look at these numbers for heart disease.
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pogledajte ove brojke za bolesti srca.
00:57
Heart disease used to be the biggest killer,
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Srčane bolesti su nekada bile
najveći uzročnik smrti
najveći uzročnik smrti
00:59
particularly for men in their 40s.
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pogotovo za muškarce u
40-im godinama starosti.
40-im godinama starosti.
01:01
Today, we've seen a 63-percent reduction in mortality
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Danas smo svedoci 63-procentnom
smanjenju smrtnosti
smanjenju smrtnosti
01:04
from heart disease --
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od srčanih bolesti -
01:06
remarkably, 1.1 million deaths averted every year.
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izvanredno, više od milion smrtnih
slučajeva se izbegne svake godine.
slučajeva se izbegne svake godine.
01:11
AIDS, incredibly, has just been named,
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Neverovatno, SIDA je upravo prošlog
meseca proglašena
meseca proglašena
01:14
in the past month, a chronic disease,
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hroničnom bolešću,
01:16
meaning that a 20-year-old who becomes infected with HIV
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što znači da se za dvadesetogodišnjaka
zaraženog HIV-om
zaraženog HIV-om
01:19
is expected not to live weeks, months, or a couple of years,
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očekivalo da neće živeti nedeljama,
mesecima, godinama
mesecima, godinama
01:23
as we said only a decade ago,
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kako smo govorili pre samo 10 godina,
01:25
but is thought to live decades,
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već da će živeti decenijama
01:28
probably to die in his '60s or '70s from other causes altogether.
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i da će verovatno umreti u starosti od
60 ili 70 godina od nekog drugog uzročnika.
60 ili 70 godina od nekog drugog uzročnika.
01:32
These are just remarkable, remarkable changes
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To su zaista izuzetno značajne,
izvanredne promene
izvanredne promene
01:35
in the outlook for some of the biggest killers.
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u prognozi kod nekih od najvećih
uzročnika smrti.
uzročnika smrti.
01:38
And one in particular
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Posebno kod moždane kapi,
01:40
that you probably wouldn't know about, stroke,
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za koju možda ne znate
01:42
which has been, along with heart disease,
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da je bila jednako kao i srčane bolesti
01:44
one of the biggest killers in this country,
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jedan od najvećih uzročnika smrti
u ovoj zemlji.
u ovoj zemlji.
01:46
is a disease in which now we know
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To je bolest o kojoj sada znamo
01:48
that if you can get people into the emergency room
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da ako nastradalog možete da
odvedete do hitne pomoći
odvedete do hitne pomoći
01:50
within three hours of the onset,
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u roku od 3 sata od nastanka,
01:53
some 30 percent of them will be able to leave the hospital
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bolnicu će napustiti njih oko 30 procenata
01:55
without any disability whatsoever.
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bez bilo kakvog invaliditeta.
01:58
Remarkable stories,
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To su izvanredne priče,
02:01
good-news stories,
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dobre novosti,
02:03
all of which boil down to understanding
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koje dovode do razumevanja
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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da rano otkrivamo i da rano intervenišemo.
02:12
Early detection, early intervention,
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Rano otkrivanje, rana intervencija,
02:15
that's the story for these successes.
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to je priča o tim uspesima.
02:18
Unfortunately, the news is not all good.
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Nažalost, ta vest nije u svemu dobra.
02:20
Let's talk about one other story
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Pređimo na jednu drugu priču
02:23
which has to do with suicide.
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u vezi sa samoubistvima.
02:24
Now this is, of course, not a disease, per se.
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To, naravno, nije bolest sama po sebi.
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 dovodi do smrti.
02:32
What you may not realize is just how prevalent it is.
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Ne znate možda koliko je raširena.
02:35
There are 38,000 suicides each year in the United States.
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U SAD je svake godine 38.000 samoubistava.
02:39
That means one about every 15 minutes.
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To znači jedno u približno
svakih 15 minuta.
svakih 15 minuta.
02:42
Third most common cause of death amongst people
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Treći najčešći uzrok smrti
02:45
between the ages of 15 and 25.
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u starosti između 15 i 25 godina.
02:48
It's kind of an extraordinary story when you realize
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To je neobična priča kada shvatite
02:50
that this is twice as common as homicide
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da je dvaput češća od ubistava
02:52
and actually more common as a source of death
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i u stvari, češći uzrok smrti
02:55
than traffic fatalities in this country.
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od saobraćajnih udesa,
u ovoj zemlji.
u ovoj zemlji.
02:58
Now, when we talk about suicide,
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Kada govorimo o samoubistvima,
03:01
there is also a medical contribution here,
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ovde postoji i doprinos medicine,
03:04
because 90 percent of suicides
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pošto je 90 procenata samoubistava
03:06
are related to a mental illness:
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vezano za mentalne bolesti:
03:08
depression, bipolar disorder, schizophrenia,
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depresiju, bipolarni poremećaj,
šizofreniju,
šizofreniju,
03:11
anorexia, borderline personality. There's a long list
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anoreksiju, graničnu ličnost.
Postoji dugačak spisak
Postoji dugačak spisak
03:14
of disorders that contribute,
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poremećaja koji tome doprinose
03:16
and as I mentioned before, often early in life.
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i kao što sam ranije spomenuo
česta su u ranom životu.
česta su u ranom životu.
03:20
But it's not just the mortality from these disorders.
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Ali kod tih poremećaja se ne radi
samo o smrtnosti.
samo o smrtnosti.
03:24
It's also morbidity.
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Radi se i o morbiditetu.
03:25
If you look at disability,
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Ako pogledate na invalidnost,
03:28
as measured by the World Health Organization
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koju meri Svetska zdravstvena organizacija,
03:30
with something they call the Disability Adjusted Life Years,
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s nečim što nazivaju DALY
(Godine života podešene prema invalidnosti),
(Godine života podešene prema invalidnosti),
03:33
it's kind of a metric that nobody would think of
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to je vrsta mere o kojoj niko
ne bi ni pomislio
ne bi ni pomislio
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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osim toga to je jedan način kojim se
pokušava uloviti izgubljeno
pokušava uloviti izgubljeno
03:40
in terms of disability from medical causes,
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zbog invalidnosti iz zdravstvenih razloga,
03:43
and as you can see, virtually 30 percent
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i kao što možete videti, skoro 30 procenata
03:46
of all disability from all medical causes
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od svih zdravstvenih invalidnosti
03:48
can be attributed to mental disorders,
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može se pripisati mentalnim poremećajima,
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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Verovatno mislite da to
nema nikakvog smisla.
nema nikakvog smisla.
03:56
I mean, cancer seems far more serious.
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Mislim, rak deluje mnogo ozbiljnije.
03:58
Heart disease seems far more serious.
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Bolesti srca deluju mnogo ozbiljnije.
04:01
But you can see actually they are further down this list,
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Ali one su zapravo niže na listi,
kao što vidite,
kao što vidite,
04:04
and that's because we're talking here about disability.
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i to je zbog toga što ovde govorimo
o invalidnosti.
o invalidnosti.
04:07
What drives the disability for these disorders
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Šta je pokretač invalidnosti
kod tih poremećaja
kod tih poremećaja
04:09
like schizophrenia and bipolar and depression?
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kao što su šizofrenija, bipolarni poremećaj
i depresija?
i depresija?
04:13
Why are they number one here?
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Zašto su one ovde na prvom mestu?
04:16
Well, there are probably three reasons.
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Verovatno postoje tri razloga.
04:18
One is that they're highly prevalent.
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Jedan je da su veoma raširene.
04:20
About one in five people will suffer from one of these disorders
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Otprilike jedan od pet ljudi oboleće od
jedne vrste tih poremećaja
jedne vrste tih poremećaja
04:23
in the course of their lifetime.
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u toku svog života.
04:26
A second, of course, is that, for some people,
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Drugo je, da neke ljude
04:28
these become truly disabling,
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to, naravno, zaista ohromi,
04:29
and it's about four to five percent, perhaps one in 20.
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što se dešava u 4-5 procenata,
možda jednom u 20.
možda jednom u 20.
04:33
But what really drives these numbers, this high morbidity,
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Ali ono što zaista utiče na te brojke,
na taj visok morbiditet
na taj visok morbiditet
04:37
and to some extent the high mortality,
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i do neke mere visoku smrtnost
04:39
is the fact that these start very early in life.
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to je činjenica da one nastaju
vrlo rano u životu.
vrlo rano u životu.
04:43
Fifty percent will have onset by age 14,
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Kod polovine će se pojaviti
do 14. godine,
do 14. godine,
04:46
75 percent by age 24,
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kod 75 procenata do 24. godine,
04:49
a picture that is very different than what one would see
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što daje sasvim drugačiju sliku
od one koja se vidi
od one koja se vidi
04:53
if you're talking about cancer or heart disease,
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ako je reč o raku ili o bolestima srca,
04:55
diabetes, hypertension -- most of the major illnesses
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dijabetesu, hipertenziji -
od većine glavnih bolesti
od većine glavnih bolesti
04:59
that we think about as being sources of morbidity and mortality.
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za koje mislimo da su izvori
morbiditeta i smrtnosti.
morbiditeta i smrtnosti.
05:03
These are, indeed, the chronic disorders of young people.
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To su u stvari hronični
poremećaji mladih ljudi.
poremećaji mladih ljudi.
05:09
Now, I started by telling you that there were some good-news stories.
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Obratio sam vam se sa rečima
da imam neke dobre vesti.
da imam neke dobre vesti.
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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Ovaj deo je možda najteži
05:16
and in a sense this is a kind of confession for me.
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i na neki način je jedna
vrsta ispovesti za mene.
vrsta ispovesti za mene.
05:19
My job is to actually make sure that we make progress
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Moj posao se sastoji iz toga da zapravo
osiguramo napredak
osiguramo napredak
05:24
on all of these disorders.
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kod svih tih poremećaja.
05:26
I work for the federal government.
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Ja radim za saveznu vladu.
05:28
Actually, I work for you. You pay my salary.
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Zapravo radim za vas,
vi mi dajete platu.
vi mi dajete platu.
05:30
And maybe at this point, when you know what I do,
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I možda ćete sada,
kada znate šta radim
kada znate šta radim
05:33
or maybe what I've failed to do,
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ili možda šta sam propustio da uradim,
05:35
you'll think that I probably ought to be fired,
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pomisliti da bi trebalo da me otpuste
05:37
and I could certainly understand that.
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i ja bih to sigurno mogao da razumem.
05:39
But what I want to suggest, and the reason I'm here
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Ali ono što želim da sugerišem i
razlog zbog čega sam ovde,
razlog zbog čega sam ovde,
05:41
is to tell you that I think we're about to be
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to je da vam kažem da mislim da smo
skoro zašli
skoro zašli
05:45
in a very different world as we think about these illnesses.
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u sasvim drugačiji svet ako
razmišljamo o tim bolestima.
razmišljamo o tim bolestima.
05:49
What I've been talking to you about so far is mental disorders,
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Ono o čemu sam vam do sada govorio
su mentalni poremećaji,
su mentalni poremećaji,
05:52
diseases of the mind.
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bolesti uma.
05:54
That's actually becoming a rather unpopular term these days,
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To, zapravo postaje prilično nepopularan
izraz ovih dana
izraz ovih dana
05:58
and people feel that, for whatever reason,
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i ljudi osećaju, iz bilo kog razloga,
06:00
it's politically better to use the term behavioral disorders
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da je politički bolje da se koristi izraz
poremećaji ponašanja
poremećaji ponašanja
06:03
and to talk about these as disorders of behavior.
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i da se o tome govori
kao o poremećajima u ponašanju.
kao o poremećajima u ponašanju.
06:07
Fair enough. They are disorders of behavior,
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Pošteno. To jesu poremećaji ponašanja
06:09
and they are disorders of the mind.
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i jesu poremećaji uma.
06:11
But what I want to suggest to you
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Ali ono što bih voleo da predložim
06:14
is that both of those terms,
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to je da su oba ova pojma,
06:15
which have been in play for a century or more,
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koja su u igri sto godina ili više,
06:18
are actually now impediments to progress,
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sada u stvari prepreke za
ostvarivanje napretka,
ostvarivanje napretka,
06:21
that what we need conceptually to make progress here
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a napredak koji treba
ovde idejno da napravimo
ovde idejno da napravimo
06:26
is to rethink these disorders as brain disorders.
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je da ponovno premislimo o tim
poremećajima kao o moždanim poremećajima.
poremećajima kao o moždanim poremećajima.
06:31
Now, for some of you, you're going to say,
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Neki od vas će sada reći:
06:33
"Oh my goodness, here we go again.
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"O bože, evo nas opet.
06:35
We're going to hear about a biochemical imbalance
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sada ćemo slušati o
biohemijskoj neravnoteži
biohemijskoj neravnoteži
06:38
or we're going to hear about drugs
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ili ćemo slušati o lekovima
06:39
or we're going to hear about some very simplistic notion
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ili ćemo čuti vrlo uprošćenu misao
06:44
that will take our subjective experience
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koja će naše subjektivno iskustvo
06:47
and turn it into molecules, or maybe into some sort of
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pretvoriti u molekule ili
možda u neke vrste
možda u neke vrste
06:53
very flat, unidimensional understanding
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veoma jednostranog razumevanja
06:56
of what it is to have depression or schizophrenia.
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o tome šta to znači imati depresiju
ili šizofreniju."
ili šizofreniju."
07:00
When we talk about the brain, it is anything but
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Kada govorimo o mozgu,
to može biti sve drugo
to može biti sve drugo
07:05
unidimensional or simplistic or reductionistic.
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samo ne može biti jednostrano,
ni uprošćeno, ni redukovano.
ni uprošćeno, ni redukovano.
07:08
It depends, of course, on what scale
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Zavisi, naravno, na kom nivou
07:11
or what scope you want to think about,
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ili u kom obimu želite da razmišljate,
07:13
but this is an organ of surreal complexity,
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ali to je organ nadrealističke složenosti
07:20
and we are just beginning to understand
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i mi smo tek na početku razumevanja
07:23
how to even study it, whether you're thinking about
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čak i toga kako da ga proučavamo,
da li kao
da li kao
07:25
the 100 billion neurons that are in the cortex
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100 milijardi neurona smeštenih u korteksu
07:28
or the 100 trillion synapses
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ili 100 biliona sinapsi
07:30
that make up all the connections.
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koje čine sve spojeve.
07:32
We have just begun to try to figure out
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Tek smo započeli da odgonetamo
07:36
how do we take this very complex machine
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kako da se latimo ove veoma složene mašine
07:40
that does extraordinary kinds of information processing
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koja obrađuje informacije na
izvanredne načine
izvanredne načine
07:42
and use our own minds to understand
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i koristi naše sopstvene umove da razume
07:45
this very complex brain that supports our own minds.
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taj zapleteni mozak koji je potpora našim
sopstvenim mislima.
sopstvenim mislima.
07:49
It's actually a kind of cruel trick of evolution
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To je zapravo vrsta okrutnog
evolucijskog trika
evolucijskog trika
07:51
that we simply don't have a brain
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da jednostavno nemamo mozak
07:55
that seems to be wired well enough to understand itself.
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koji bi bio dovoljno dobro spojen
da bi se sam razumeo.
da bi se sam razumeo.
07:58
In a sense, it actually makes you feel that
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Na neki način vas on zapravo nagoni,
08:00
when you're in the safe zone of studying behavior or cognition,
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da, kada ste na sigurnom području proučavanja
ponašanja ili saznanja,
ponašanja ili saznanja,
08:03
something you can observe,
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nečega što možete da promatrate,
08:04
that in a way feels more simplistic and reductionistic
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da se to na neki način čini jednostavnijim
i redukovanijim,
i redukovanijim,
08:07
than trying to engage this very complex, mysterious organ
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nego pokušavanje da se bavite ovim
veoma složenim, tajanstvenim organom
veoma složenim, tajanstvenim organom
08:12
that we're beginning to try to understand.
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koji počinjemo da
pokušavamo da razumemo.
pokušavamo da razumemo.
08:15
Now, already in the case of the brain disorders
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Dakle, u slučaju moždanih poremećaja
08:18
that I've been talking to you about,
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o kojima sam vam već pričao,
08:20
depression, obsessive compulsive disorder,
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depresiji, opsesivno kompulsivnom
poremećaju,
poremećaju,
08:22
post-traumatic stress disorder,
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posttraumatskom stresnom poremećaju,
08:25
while we don't have an in-depth understanding
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iako nemamo produbljeno,
suštinsko razumevanje
suštinsko razumevanje
08:27
of how they are abnormally processed
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kako se oni nenormalno obrađuju
08:31
or what the brain is doing in these illnesses,
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ili šta mozak radi kod tih bolesti,
08:33
we have been able to already identify
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uspeli smo već da identifikujemo
08:36
some of the connectional differences, or some of the ways
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neke razlike u spojevima ili neke načine
08:39
in which the circuitry is different
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na koje su tokovi različiti
08:41
for people who have these disorders.
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kod ljudi s tim poremećajima.
08:43
We call this the human connectome,
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Mi to nazivamo ljudski konektom
08:45
and you can think about the connectome
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i možete ga zamisliti
08:47
sort of as the wiring diagram of the brain.
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kao neku vrstu šeme za povezivanje mozga.
08:49
You'll hear more about this in a few minutes.
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Čućete više o tome za nekoliko minuta.
08:51
The important piece here is that as you begin to look
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Ovde je važan deo da kada
počnete da posmatrate
počnete da posmatrate
08:54
at people who have these disorders, the one in five of us
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ljude s ovim poremećajima,
jednog od nas petoro
jednog od nas petoro
08:58
who struggle in some way,
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koji se na neki način bori,
09:00
you find that there's a lot of variation
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otkrivate da postoje mnoge varijacije
09:02
in the way that the brain is wired,
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u načinu na koji je mozak povezan,
09:06
but there are some predictable patterns, and those patterns
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ali da postoje i predvidljivi
uzorci i oni
uzorci i oni
09:08
are risk factors for developing one of these disorders.
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faktori rizika za razvoj
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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To je malo drugačije od načina mišljenja
o poremećajima mozga
o poremećajima mozga
09:15
like Huntington's or Parkinson's or Alzheimer's disease
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kao što su Hantingtonova ili
Parkinsonova ili Alchajmerova bolest
Parkinsonova ili Alchajmerova bolest
09:18
where you have a bombed-out part of your cortex.
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gde imate porušeni deo vaše moždane kore.
09:20
Here we're talking about traffic jams, or sometimes detours,
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Ovde je reč o zastoju u saobraćaju ili
ponekad o zaobilaznicama
ponekad o zaobilaznicama
09:23
or sometimes problems with just the way that things are connected
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ili je ponekad problem samo u
načinu kako su stvari povezane
načinu kako su stvari povezane
09:26
and the way that the brain functions.
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i načinu na koji mozak funkcioniše.
09:27
You could, if you want, compare this to,
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Mogli biste to uporediti, ako želite,
09:31
on the one hand, a myocardial infarction, a heart attack,
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s infarktom miokarda, srčanim udarom,
na jednoj strani,
na jednoj strani,
09:34
where you have dead tissue in the heart,
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gde imate odumrlo tkivo u srcu,
09:35
versus an arrhythmia, where the organ simply isn't functioning
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naspram aritmije,
gde organ jednostavno ne funkcioniše
gde organ jednostavno ne funkcioniše
09:39
because of the communication problems within it.
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zbog unutrašnjih komunikacijskih problema.
09:41
Either one would kill you; in only one of them
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U oba slučaja biste mogli umreti;
a samo u jednom od njih
a samo u jednom od njih
09:43
will you find a major lesion.
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naći ćete veliko oštećenje.
09:46
As we think about this, probably it's better to actually go
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Kada razmišljamo o tome,
možda je bolje da se, u stvari,
možda je bolje da se, u stvari,
09:49
a little deeper into one particular disorder, and that would be schizophrenia,
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malo udubimo u jedan određeni poremećaj,
u šizofreniju,
u šizofreniju,
09:52
because I think that's a good case
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jer mislim da je to dobar primer
koji doprinosi razumevanju
koji doprinosi razumevanju
09:54
for helping to understand why thinking of this as a brain disorder matters.
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zašto je bitno da se razmišlja
o tome kao o moždanom poremećaju.
o tome kao o moždanom poremećaju.
09:58
These are scans from Judy Rapoport and her colleagues
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Ovo su snimci skenera Džudi Rapoport
i njenih kolega
i njenih kolega
10:02
at the National Institute of Mental Health
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na Nacionalnom institutu za
mentalno zdravlje
mentalno zdravlje
10:04
in which they studied children with very early onset schizophrenia,
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na kojima su proučavali decu s veoma ranom
pojavom šizofrenije,
pojavom šizofrenije,
10:07
and you can see already in the top
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i već možete videti u gornjem delu
10:09
there's areas that are red or orange, yellow,
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područja koja su crvena ili
narandžasta, žuta,
narandžasta, žuta,
10:11
are places where there's less gray matter,
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to su mesta u kojima je manje sivih ćelija,
10:14
and as they followed them over five years,
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i kako su ih pratili u periodu od 5 godina,
10:15
comparing them to age match controls,
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upoređivali ih s odgovarajućim kontrolnim
starosnim uzorcima,
starosnim uzorcima,
10:17
you can see that, particularly in areas like
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možete videti da posebno u predelima kao
10:19
the dorsolateral prefrontal cortex
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što je dorzolateralni prefrontalni
deo korteksa
deo korteksa
10:21
or the superior temporal gyrus, there's a profound loss of gray matter.
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ili superiorni temporalni girus postoji
temeljan gubitak sivih ćelija.
temeljan gubitak sivih ćelija.
10:26
And it's important, if you try to model this,
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I to je važno, ako pokušate
da ovo modelirate,
da ovo modelirate,
10:27
you can think about normal development
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možete da razmišljate o normalnom razvoju
10:29
as a loss of cortical mass, loss of cortical gray matter,
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kao o procesu u kome se gubi masa
moždane kore, sive ćelije korteksa,
moždane kore, sive ćelije korteksa,
10:33
and what's happening in schizophrenia is that you overshoot that mark,
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i šta se dešava kod šizofrenije je to da
preskačete normalne granice
preskačete normalne granice
10:36
and at some point, when you overshoot,
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i u nekoj tački, kada preskočite
10:38
you cross a threshold, and it's that threshold
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prelazite prag, a prag je taj
10:41
where we say, this is a person who has this disease,
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gde kažemo, ovo je osoba
koja ima tu bolest,
koja ima tu bolest,
10:44
because they have the behavioral symptoms
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zato što oni imaju simptome u ponašanju,
10:47
of hallucinations and delusions.
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halucinacije i privide.
10:49
That's something we can observe.
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To je nešto što 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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Ako pogledate izbliza i možete videti da su
zapravo prešli različite pragove.
zapravo prešli različite pragove.
10:56
They've crossed a brain threshold much earlier,
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Oni su prešli moždani prag mnogo ranije
10:59
that perhaps not at age 22 or 20,
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možda ne u starosti od 22 ili 20 godina
11:02
but even by age 15 or 16 you can begin to see
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nego već u starosti od 15 ili 16 počinjete
da uočavate
da uočavate
11:05
the trajectory for development is quite different
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da je razvojna putanja sasvim različita
11:07
at the level of the brain, not at the level of behavior.
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na nivou mozga, ali ne i
na nivou ponašanja.
na nivou ponašanja.
11:11
Why does this matter? Well first because,
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Zbog čega je to važno?
Prvo zbog toga što,
Prvo zbog toga što,
11:13
for brain disorders, behavior is the last thing to change.
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kod moždanih poremećaja, ponašanje
je poslednja stvar koja se promeni.
je poslednja stvar koja se promeni.
11:16
We know that for Alzheimer's, for Parkinson's, for Huntington's.
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Mi to znamo za Alchajmerovu, Parkinsonovu,
Hantingtonovu bolest.
Hantingtonovu bolest.
11:19
There are changes in the brain a decade or more
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Promene u mozgu postoje deceniju ili više
11:21
before you see the first signs of a behavioral change.
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pre nego što se primete prvi znaci
promena u ponašanju.
promena u ponašanju.
11:26
The tools that we have now allow us to detect
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Instrumenti koje sada imamo
dozvoljavaju nam da otkrijemo
dozvoljavaju nam da otkrijemo
11:29
these brain changes much earlier, long before the symptoms emerge.
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ove moždane promene mnogo ranije,
mnogo pre nego što se simptomi pojave.
mnogo pre nego što se simptomi pojave.
11:34
But most important, go back to where we started.
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Ali, za ono što je najvažnije,
vratimo se na početak.
vratimo se na početak.
11:37
The good-news stories in medicine
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Dobre vesti iz medicine su
11:40
are early detection, early intervention.
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rana otkrića, rane intervencije.
11:43
If we waited until the heart attack,
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Da smo čekali do srčanog udara,
11:47
we would be sacrificing 1.1 million lives
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svake godine bi u ovoj zemlji stradalo
11:51
every year in this country to heart disease.
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više od milion života od bolesti srca.
11:53
That is precisely what we do today
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To je tačno to što radimo danas
11:56
when we decide that everybody with one of these brain disorders,
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kada se odlučujemo da svaki oboleli
od jednog od tih moždanih poremećaja,
od jednog od tih moždanih poremećaja,
12:00
brain circuit disorders, has a behavioral disorder.
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poremećaja moždanog toka,
ima poremećaj ponašanja.
ima poremećaj ponašanja.
12:03
We wait until the behavior becomes manifest.
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Mi čekamo dok se ponašanje ne ispolji.
12:06
That's not early detection. That's not early intervention.
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To nije rano otkrivanje.
To nije rana intervencija.
To nije rana intervencija.
12:11
Now to be clear, we're not quite ready to do this.
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Sada da razjasnim, mi još nismo
sasvim spremni da to radimo.
sasvim spremni da to radimo.
12:13
We don't have all the facts. We don't actually even know
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Nemamo sve činjenice.
Zapravo još ne znamo ni
Zapravo još ne znamo ni
12:16
what the tools will be,
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kakvi će biti instrumenti,
12:19
nor what to precisely look for in every case to be able
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niti tačno šta da tražimo
u svakom primeru da bismo mogli
u svakom primeru da bismo mogli
12:23
to get there before the behavior emerges as different.
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dopreti tamo pre nego što se pojave
promene u ponašanju.
promene u ponašanju.
12:27
But this tells us how we need to think about it,
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Ali ovo nam govori koliko je nužno
da o tome razmišljamo
da o tome razmišljamo
12:30
and where we need to go.
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i gde treba da idemo.
12:31
Are we going to be there soon?
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Da li ćemo uskoro u tome biti?
12:33
I think that this is something that will happen
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Mislim da je to nešto što će se dogoditi
12:35
over the course of the next few years, but I'd like to finish
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za sledećih par godina,
ali bih voleo da završim
ali bih voleo da završim
12:38
with a quote about trying to predict how this will happen
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citatom o pokušaju predviđanja
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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nekoga ko je mnogo razmišljao
12:43
in concepts and changes in technology.
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o idejnim i tehnološkim promenama:
12:45
"We always overestimate the change that will occur
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"Mi uvek precenjujemo promene
koje će se dogoditi
koje će se dogoditi
12:48
in the next two years and underestimate
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u sledeće dve godine i potcenjujemo
12:50
the change that will occur in the next 10." -- Bill Gates.
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promene koje će se dogoditi u sledećih 10."
- Bil Gejts
- Bil Gejts
12:54
Thanks very much.
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Mnogo vam hvala.
12:55
(Applause)
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(Aplauz)
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