|Dr Kent Berridge|
|Dr Thupten Jinpa|
Day 2 AM - Kent Berridge
Brain Generators of Intense Wanting and Liking
Dr Berridge started by expressing some of the conclusions that they are reaching as a result of the research being done in his lab. The first conclusion is that suffering is not craving, and craving is not suffering. It is possible for these two to exist independently. This means that by curing the suffering, we may not cure the craving. Similarly pleasure may lead to craving and may be the object of craving, but it may simply be the key to unlocking the craving. It is therefore possible to have craving without even the hope of future pleasure.
What is craving? The laboratory is saying that there is a special state and that this may, together with imagining create a craving.
Dr Berridge stated that desires have a life and mechanism of their own. The outline for his talk is:
- The desiring brain is a large system that generates intense "wanting" through the dopamine system.
- Pleasure or liking is a different and fragile system. It is a smaller system in the brain.
- Craving may require no pleasure object - we can "want" even though the object of desire is unrewarding.
- The craving brain system can generate both "wanting" and "fear" - this is a shared system. These may cycle, they may or may not converge.
Dr Berridge explained the similarities between the rodent and human brain in terms of the "craving" system. He explained the hypothesis that the same brain systems are turned on for all states of sensory pleasure - whether food, sex, well-being or drugs. He continued to explain the paradox of dopamine - that the same neurotransmitter can be responsible both for the "stimulate and go" mechanisms when acting on the D1 receptors as well as the "suppress and stop" mechanisms when acting on the D2 receptors.
Incentive salience adds urgency urgency to conscious desires, but it can also lead to a "grasping" at unconscious levels. This is a deep brain system, and the question is how can we bring this into the level of awareness. The discussion moved towards the differences between the dream state and the conscious state, and how these are achieved through shared systems - they are essentially very efficient systems.
Dr Berridge then spoke of his and Terry Robinson's incentive-sensitization theory of addiction. He used a graph to explain how incentive value may increase while subjective pleasure may decrease. Dopamine sensitization may account for this - the system becomes more reactive to the drug or related things.
Dr Berridge explained how they conduct experiments on rats using optogenic laser stimulation of the amygdala to focus "wanting" on a single reward above others. He explained how a virus carries a gene for a photoreceptor molecule, and this can be injected into the brain neurons. This makes it possible to use a painless light to make the neurons fire. Dr Berridge showed a video of how this works and explained how an intense wanting can be produced by firing an amygdala laser while feeding the rat a sugar pellet. The combination of the laser in the brain and the sugar pellet, makes the sugar pellet particularly desirable.
Dr Berridge showed how human babies and rats react to water when thirsty, when it get sugar water and when it gets a bitter taste. This is a video from his lab:
Dr Berridge explained how we can make the rat "want" things, even if they don't like them more. The brain system can make things immensely more attractive than they are.
He then went on to explain how we have seen similar reactions in humans were deep brain stimulation has been used to treat depression. In case one a woman became euphoric, developed flight of ideas and fell instantly in love with the neurologists. She later went shopping and spent money on unnecessary items of clothing. She had impulsive desires whether happy or tense. Two other cases were also discussed.
Dr Berridge explained that this was all about 'wants' or 'desires' without 'pleasure'. He went on to say that the system for pleasure was much smaller, and pleasure was indeed fleeting and required the entire 'pleasure' system to be activated, and was therefore unstable.
Dr Berridge then went on to show we can 'want' something that is not 'liked'. The experiment uses saline water, which rates do not want. They are programed to not like this, and there can be no expectation of 'future liking' - it avoids that taste. By administering a drug that creates a salt appetite, the rat will go towards the salt drink. With the combination with the cue, there is a dopamine activation, and this can create a desire for something that is not liked. In the addict, this means that 'wanting' can be present without 'liking' or the expectation of 'liking'.
HH wondered if there was a disconnect between the 'wanting' and the understanding of future consequence. Dr Davidson pointed out that there often exists a disparity between cognitive understanding and bodily experience.
Dr Berridge made a very interesting point by stating his belief that there needs to be no positive memory of something for it to become the object of desire.
Dr Berridge then went on to briefly explain how the same inhibitory drug can produce both intense desire and active fear. This is a similar illustration to the one Berrdige used:
This shows how three micro-injections in different contexts or environments can produce different results. So the same system can 'flip' producing different results.
In conclusion Dr Berridge said:
- deep brain 'wanting' gives a grasping quality to desires and that individuals differ in propensity for dopamine activation.
- Wanting can occur without distress or need, so relieving withdrawal distress will not eliminate the addictive grasp
- Wanting can occur without pleasure. Liking is not needed as a trigger, and expectation of 'liking' is not needed.
- 'Wanting' mechanism can flip to fear
- What is shared by opposite emotions?
- Can unconscious wanting be brought into awareness?
- Can awareness techniques gain better control of intense 'wants'?
Day 2 PM - Thupten Jinpa
Psychology of Desire: A Buddhist Perspective
Dr Jinpa started by giving a brief overview of what had been discussed to date. His initial point was to point out that if we viewed addiction from a reductionist disease model point of view, then Buddhist thinking or psychology has little to offer to the understanding of addiction. If we expand our view to consider the underpinnings of addiction, then there is a lot to add, especially considering the importance of craving in the Buddhist context. He also made the valid the point that if we view addiction purely as a disease then many people would not identify themselves with this, whereas the majority of people do have a problem with craving, especially when living in a Western consumerist society.
Dr Jinpa believes that in all of us there is some form of addiction potential, and by bringing together multiple fields we can perhaps gain a better understanding of craving and addiction. He suggested that while Kent Berridge went into the brain, he would go into the mind.
Dr Jinpa started by referring to some of the key metaphors of early Buddhist texts:
- Drowning in a mire of sensual desire
- Being swept by currents of craving
- The thirst of craving
- Caught by the noose of craving
- Bound by the long rope of craving
Dr Jinpa then brought to attention the early Buddhist text showing the process of craving:
"Conditioned by contact feeling/experience arises; conditioned by feeling, craving arises; conditioned by craving grasping arises; conditioned by grasping becoming arises......"In other words, when you come into contact with something there is an effective response. So it is not the object that results in the craving, but rather the feeling. And from this arises grasping, which can be seen as a level beyond craving. The becoming is the act of fulfillment. He then goes on to expand upon each of these themes from the view of one of the Buddhist scholars and describe the Buddhist representations of the phases as related to the wheel of life.
Dr Jinpa explained the complexity of the terms 'attachment' and 'craving'. Craving is more future focused and attachment more in the present liking. There are 3 types of craving - existential craving, craving as in desire and craving borne of fear. Craving can also be seen as craving for future objects, craving as attachment through not wanting to be separated and craving in the form of love for continued existence.
Attachment is seen as inappropriate current joining with the object of desire, while craving is more about the future - it is seen as inflictive. He then explained the cycle of craving:
The Buddhists would suggest that we require "imagining" or "inappropriate mentation" to keep this cycle moving. To quote Vasubhandu (4th Century): "One has not abandoned the proclivities; and the objects [of temptations] remain nearby; so with inappropriate mentation, the conditions [for the arising] of afflictions are complete."
Dr Jinpa also spoke of the role of habituation and reduced the process into a simple 4-stage cycle:
He spoke about how habitation creates a kind of short-cut. This how Buddhism explains the cycle, and it expands each stage by focusing on causation so that we can get a deeper understanding of the processes involved.
He explained that he was presenting more the theory of the Buddhist view, while Matthieu Ricard will talk about the application. The concluding points were:
- Craving is about the experioence not the object
- Inappropriate mentation plays a role
- Something about the experience of sensory gratification makes it addictive
- Addiction may be understood as an extreme end of a spectrum within the family of desire, wanting, attachment and craving
- Temporal distinction between craving and grasping - differences in degree, or progressive loss of agency.
- Habituation/sensitization is a key to perpetuating the cycle of craving, grasping and action
- Key links in the chain of causation suggests different stages for interventions that could break the cycle
Dr Jinpa then spoke about the possibilities of active interventions:
- Mindfulness when fantasizing process begins
- awareness when craving arises
- applying specific antidotes to craving
- conscious awareness when craving does lead to action
- consciously connecting to resolve not to repeat the act
Dr Davidson started the discussion by pointing out that there are many sources of commonality and certainly there seems to be common themes in he presentations of Dr Lewis and Dr Berridge. He spoke about the environmental cues and the role of the hippocampus. There is neurogenesis in the hippocampus, but this may be affected by those with addictive disorders. Dr Volkow spoke how the hippocampus is essential for remembering where things are. She raised the importance of the orbital frontal cortex and its role in salience, as well as the role in craving and context. She asked if there was such a thing as positive craving in the Buddhist context. Dr Jinpa spoke about the narrow and compulsive focus to it, which is perhaps not healthy.
This brought the discussion to romantic relationships, and this could be seen as the seed of these behaviours. There was the potential for toxicity - this is something that interests me in the light of seeing addiction as a "pathological relationship". This was later built on by Dr Zajonc in relation to how much art is driven by romanticism, and the progress to the modern interpretation of love: “I hold this to be the highest task of a bond between two people: that each should stand guard over the solitude of the other.” ― Rainer Maria Rilke
Dr Lewis spoke of reinforcement through relief, and spoke about the role of trauma in addiction - and this could be the glue that holds the cycle together. Dr Volkow spoke about how some craving in a biological context could be positive, such as between mother and child. This, Dr Zajonc expressed that this could be hijacked for addictive purpose.
Dr Ricard said that we sometimes lacked the words to clearly define the meaning of what we are saying, and that each word we are using has nuances. He spoke of how compassion can have an anesthetic effect on pain, he spoke about how the concept of "hedonic" and "compassionate" pleasure are different and can have different effects. This them was expanded upon. This conversation at around 1:25:00 into the video is dense with ideas and possibilities.
This was then framed within the context of social setting and Dr Asmussen Frank spoke of how we could be "distracted" from the cycle of addiction by the community. They spoke about how the environment for learning new skills is important.
Dr Ricard and Dr Jinpa spoke about care and compassion without attachment and other negative projections, and it takes training to develop this kind of attachment. Dr Bowen asked how we could create awareness of the distinct processes taking place. HH said that the key of awareness was a knowledge of the pros and cons - this would agree with the motivational approaches that have good evidence.
The Session came to a close after a final comment by Kent Berridge.
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