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Welcome to feel better, live more bite-sized, your weekly dose of positivity and optimism to get you ready for the weekend. Today's clip is from episode 543 of the podcast with Dr Camilla Nord, a neuroscientist and author of The Balanced Brain, The Sight of Mental Health. In this clip, she explains why pleasure is so fundamental to mental well-being and how small consistent actions could help improve our mental health. Regularly doing things that you love makes you more resilient to stress and at the same time chronic work stress makes it harder for you to experience pleasure in those day-to-day things. So, again, this kind of bi-directional relationship. In terms of pleasure, then, if you're someone who is not experiencing pleasure from things that you used to, is there a practical take-home that people can say, oh, well, I used to find this enjoyable, I don't anymore, what can I actually do about it? So I suppose the most practical thing for someone diagnosed with depression is to kind of take that signal as being very important and significant, something that they maybe should seek treatment for, psychological treatment, pharmacological treatment, you know, whatever works for them. But I think a second kind of corollary of that that applies to everyone, irrespective of their diagnosis, is to maybe prioritize pleasure a little bit more than we do. Especially I think people have this kind of this inclination that everything fun is bad for you. And some fun things are bad for you. But actually, when it comes to your mental health, there is a kind of inherent benefit of doing things that you really love, even if some of those things come with small consequences for your health. So I think, you know, it is actually about a balance. If what you do is you deprive yourself of everything you love in pursuit of some kind of optimized health for most people, that will not be the route to best mental health. Okay. I wonder if I can share with you an experience I had with a patient quite a number of years ago now. Your work and your description of pleasure really makes me think about what actually happened with that patient. So are you open to this? If I just share. So I think he was 53 from recollection. He was the CEO of a local company. He came into see me with basically a number of symptoms, including low moods and an inability to get pleasure. He was quite indifferent about his life. And I remember seeing him and spending a bit of time and trying to understand his life. Nothing really excited him. And he definitely had symptoms that you could quite reasonably diagnose him with depression. Okay. And I asked him, do you do anything fun, you know, in your week? Do you have any hobbies? And he said, no, doc, I don't have time for hobbies. And he was basically just saying, I'm too busy. I said, what about the weekend? I'm taking my kids to their clubs and their classes. I don't have time. And yes, I did some blood tests and we did some screening tests and all those sorts of things. But one of the things I said to him, I sort of probed him about hobbies more. I said, well, what did you used to do? Were there things you used to enjoy? He said, yeah, when I was a kid, when I was a teenager, I used to enjoy building train sets. I said, okay, do you have train sets at home? And he said, well, I do, but they were in my loft. I haven't used them for years. I said, okay, what I want you to do this week, I want you to get down from your loft, some of those train sets and start playing around with them. Okay. There were other things as well, but I'm trying to just simplify the story to try and get to the point about pleasure. I didn't see him again for a few months, which is not uncommon. About three months later, I bumped into his wife and she said, Doc, he's like a different person. Ever since he saw you that day, he got the train set down. He started playing with it. He now has subscribed to a monthly magazine. He's going on eBay to buy collectors items. I actually then saw him about three months later for a well man's check. I said, hey, look, you know, how are you getting on? He goes, everything's different now. I'm enjoying my job. I'm closer to my kids. I feel really, really good. His low mood had gone. His indifference had gone. That was so powerful for me, Camilla, because it would be easy. Look, I'm always very holistic minded. I'm always trying to get to the root cause of a patient's problems. I just felt with him, what would happen if we in some ways correct the pleasure deficiency in his life or try and address it? It would seem to me that by engaging in pleasure, and again, I appreciate that everyone can do pleasurable things and feel that pleasure, but he was able to. Yeah, he had something. He had something. He got into it. Everything else in his life came back online, his marriage, his relationship with his kids, his enjoyment of his job. So you're saying that pleasure neurochemically, as a neuroscientist, looking at it through the lens of the brain is very, very important for our mental well-being. Can you hypothesize for me what might have been going on? Yeah, it's remarkable, actually. And I think it's remarkable because of if you draw a line between train sets and mental health, well, that's going to be a very complicated line. I think for many people, it wouldn't have an effect on mental health. For that patient, it did. And I think the reason for that is actually something that is in common with other maybe more expected treatments for mental health. So what some pharmacological drug treatments for mental health do is they help you engage in the world a little bit better, perhaps with a little bit less anxiety, and help you re-access the sorts of, say, social pleasures that you used to get. Or what some psychological treatments for depression do is they help you, for example, take a little bit of a social risk, see some friends you wouldn't normally see, and essentially also give you a route to that pleasure or help you engage with other kinds of activities that you might have previously not. So I think, although trains is unique and special, what it is is it's kind of facilitating that for me, it's a positive prediction error. So in the brain, we have this kind of predictive model of the world. Otherwise, we wouldn't be able to kind of deal with all of the information that we have. So instead, we learn from what we've experienced. We learn to expect what's happening next. And when something deviates from our expectations, say when something is better, we weren't experiencing any pleasure at all, and then all of a sudden, we have a little dose of pleasure. What that is is it becomes a positive prediction error, a surprise that we start, hopefully, integrate into our model of the world and eventually our belief about the very nature of the world can be affected. It can start to become more positive because we've learned that perhaps not 100% of the world is quite so bleak. And then I think it will have helped him feel perhaps some kind of fulfillment or connection, because if he started subscribing to magazines and feeling like this was kind of, you know, maybe he was part of a community that he hadn't been part of before, it also perhaps would have helped him access one of the other ingredients that I think is really essential for mental health, which is motivation. So it maybe will have given him a kind of invigoration for something that he didn't otherwise have. An apathetic state is not a very pleasant one to be in. You feel maybe neutral, but actually it stops you from engaging in things in life. And that, no matter what it is, if it's something that really motivates you, gives you that kind of get up and go, then that is often a really important access to things that could give you pleasure and happiness and so on. Yeah, it's fascinating. I really want to talk about these various ingredients for mental health that you write about and you dedicate separate chapters to pleasure, pain, motivation, learning. Because I think we hear a lot about these things. Dopamine, for example, is the neurochemical of the moment online. Everyone likes talking about dopamine. Do you think some of that would have been mediated through dopamine? Yeah, so that particular learning process, it's not that the train releases dopamine. That's a kind of often a misconception that sort of, if you were to see something you like, that causes some kind of huge rush of dopamine. It's not exactly how it works. It's more that the dopamine is this signal, a signal, perhaps, of significance that means this is something you should learn about. So it helps your brain figure out what an unexpectedly positive event was. And when that event is sort of reasonable within your world, then it can get integrated into your wider model of the world and it begins to affect your future expectations, such that actually eventually then it wouldn't have that same effect because it would be expected. Yeah. You spent a lot of time at the start of this book talking about pain and pleasure. And I love what you've written because it's, you know, there are many symptoms that we look at when trying to diagnose depression, but a loss of pleasure or an inability to gain pleasure is one of those symptoms. So can you talk about pleasure and pain and why you think it's important for us to understand them in the context of our mental well-being? Not everyone knows this, but you don't actually need low mood to be diagnosed with depression. Instead, you could have their second core symptom is just a loss of pleasure or motivation. So that is so fundamental. It is actually at the center of the depression diagnosis. That's probably why I first became interested in it. I thought there is this central system, a symptom, I should say, that is somehow neglected, both culturally, but also to some degree clinically. It's not as well treated by typical treatments like antidepressants. Often that's the kind of symptom that might remain, even if you see improvements in some of your other symptoms. And I thought to myself, but that is so disabling and could actually kind of have this real negative cycle where if you stop getting pleasure from things, stop being motivated to seek out what you use to enjoy, that's just going to self-perpetuate. It's just going to make your symptoms worse because you'll stop experiencing the very things that could have helped you get out of a depressive episode. So I think a lack of pleasure is so central to poor mental health. And in fact, experience of pleasure, in my opinion, is central to mental health. Yeah. So through the lens of the brain as a neuroscientist, what is happening in our brain when we experience pleasure? Or does it depend what we're doing to get that pleasure? In some ways, it doesn't totally depend what we're doing. Those do change where in the brain is kind of interested in it. But there are very pleasure specific regions that become involved no matter what the source of pleasure is. These are sometimes called hedonic hotspots, a phrase from Morten Kringelbach and others who are kind of pleasure neuroscientists. And this means that like volcanoes dotted across the surface of the earth, we have these little hotspots of pleasure dotted in our brain. It's actually not they're not big and they're not that many of them, but they are really essential and kind of quite characteristic of our experience of pleasure. Yeah. And do we know what neurochemicals are being released when we experience pleasure? So they actually have multiple kinds of neurotransmitters involved in them. But one of the best examples is the opioid system. There is actually a nice debate about opioids, whether you exactly feel pleasure from them in and of themselves or whether it kind of depends a lot on the context, which is a fun example of where neuroscientists like to take things quite, quite literally. Let's talk a bit about laughter and laughing with friends, because you've you've been sharing in your book that laughing with friends actually reduces pain. Do we know how it does that? This is a good example of what pleasure can do. So what laughter does is it releases endogenous opioids. Really fun experiment that was done when people were watching comedy videos with friends. So this is a social laughter experience, kind of one of the most pleasurable things, I suppose, that humans can do. And so people engaging in this social laughter, not only did they show opioid release in brain scans, proving that there's this kind of biological, like almost pain killer mechanism, but you can even show that in literal pain killing effects, because people were able to do these sort of uncomfortable wall sits and uncomfortable exercise for longer afterwards. So that is an immediate effect of having experienced this pleasurable thing on a kind of, you know, a reduction or an overcoming, let's say, of painful inputs afterwards. Yeah, it reminds me again of this idea that I end up talking about quite a lot on the podcast these days. This is the idea that we can't really separate psychology from physiology. And what you just said there, that if you are doing wall sits, that sort of like half squat against the wall and seeing how long you can hold it for. You're saying that if you're laughing with friends watching something, you can actually go for longer. So instead of it being, let's say, 30 seconds that you can manage, that might go, it's a 45 seconds or a minute. So your sense of well-being, what you're doing, your laughter, the kind of hormone and neurochemical release from that allows you to do something physically challenging for longer. The fact that we can do something, let's say, pleasurable, right? And it can then change our perception of pain. That's really interesting, isn't it? Yeah, I think that is quite significant. And actually, sometimes when you're in a painful state, as we all have been at some point in our lives, it can feel inescapable. And that's part of what makes it so bad, I think, that it can feel eternal. Do you know if you have even something like a stomachache, if it goes on for long enough, you just start to think too much about it. You start to think, oh, my gosh, this is just the way I am. My stomach is just going to feel like this. This is it. And actually, if you can have even temporary relief from those symptoms, it might not necessarily reduce the kind of pain signals coming from somewhere in your body, but it will definitely change your interpretation of those signals. The moment you start to think of them as less permanent, less all-encompassing, less kind of, this is who I am, then that's where you get the key to kind of overcoming them and making it through despite those symptoms. The body and the brain. Well, I'm giving my perspective and I welcome yours. I think one of the one of the problems when we think about our health in general and let me broaden it out beyond mental health is that we have separated body and brain. We even have these different terms. I understand why we have those different terms. But it's very clear to me, having seen many patients over the course of my career, that sometimes with some patients, let's say with a mental health issue, helping them do things that you would say are helping their body. It's incredible how many times it helps their mental well-being. So I don't know, exercise or sleep, for example, can have transformative effects on some people with mental health problems. Not everyone necessarily, but some people. I share that perspective entirely, but I didn't always actually when I first started doing this kind of neuroscience of mental health research, I like any other neuroscientist was really focused, you know, neck up. And actually it was only maybe a couple of years after my PhD. And I thought to myself, actually, a lot of what the brain is doing is not processing the world around it, but processing the world inside of you, meaning signals from your heart, your gut, your metabolic system all over your body. So that means necessarily that your physical body is consequential to the brain. So consequential, it's constantly receiving information from it. And so I began to kind of, I suppose, delve into body, brain research. That's actually the major focus of my lab now. And I do think that one of the other ways we kind of get mental health wrong is by creating this artificial division between physical and mental health. And I think in the case of mental health, I think that the real sort of missing piece of the puzzle is understanding the brain and the things that the brain does that make us feel better or worse and mentally healthier or mentally less healthy. Yeah. I really, really love because it so aligns with my view on the world that there's no one size fits all for improving our mental health. You make that point at multiple times throughout your book. You know, we said earlier on about all these different things that, you know, our genetics, our social world, our diet, our physical conditions, like depending on what's driving that end product of low mood and anhedonia in the brain, what the treatment is then going to be different depending on what the cause is. Right. Exactly. Which is to say that, you know, that the train intervention that worked so well for that person who needed one source of kind of motivation, one source, perhaps a pleasure, might not have worked for someone else for whom their kind of contributing factors for depression were just different. Yeah. I think one of the most important messages you can take from my book is not the sort of depressing generalization that nothing works for everyone, but actually that I think something works for everyone. And that's something I hope for you. It already exists, but it is possible that that is still in development, that we still need more science to discover that, but it's coming. It's coming quickly. There are huge resources dedicated to developing new, innovative mental health treatments working as we speak. So I think that kind of diversity of treatments is a good thing as well as, you know, sometimes a bad thing. Yeah. Very empowering. And are there two or three kind of general practices that you think actually, whilst you can't say for sure this is going to work for you, these are generally good things to be doing for your mental well-being and your physical well-being, I guess, from your research, you know, where would you go if you were going to recommend some general practices for people? Yeah. The two biggest things I would say, one is obvious, one is less obvious. So one is to focus as much as you can on things like sleep hygiene and also exercising, if you can, these sort of basic things can often be the difference between resilience in the face of great mental health challenges that we all sadly experience at some point in our life and not. So I think focusing on those kind of crucial, fundamental aspects of health, if you can. And then the second thing I would say is pleasure. Even if you feel that a life of austerity is like on a pinnacle, something we all need to be aspiring to, I think actually you need to look at what is pleasurable in your life and don't neglect it. Yeah, I love it. Hope you enjoyed that bite-sized clip. Do spread the love by sharing this episode with your friends and family. And if you want more, why not go back and listen to the original full conversation with my guest? If you enjoyed this episode, I think you will really enjoy my bite-sized Friday email. It's called the Friday 5. And each week I share things that I do not share on social media. It contains five short doses of positivity. Articles or books that I'm reading, quotes that I'm thinking about, exciting research I've come across and so much more. I really think you're going to love it. The goal is for it to be a small, yet powerful dose of feel good to get you ready for the weekend. You can sign up for it free of charge at DrChatterjee.com forward slash Friday 5. Hope you have a wonderful weekend. Make sure you have pressed subscribe and I'll be back next week with my long formed conversation on Wednesday and the latest episode of Bite Science next Friday.
