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Melissa Harris-Perry: Thanks for being with us. I'm Melissa Harris-Perry and this is The Takeaway.

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Melissa Harris-Perry: Take just a moment and contemplate your own astonishing brain. Now, if you're a regular Takeaway listener, your brain has recognized our introductory theme and maybe perceived the familiar auditory patterns of my voice. All the while, your brain has kept your lungs filling and your heart beating. Most likely, all this was happening while you were occupied with other tasks. Maybe driving a car, making a meal, or taking a walk.

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Melissa Harris-Perry: Faster and more powerful than a supercomputer with enough electricity to power a light bulb, our brains have more than 86 billion tiny neurons all coordinated with one another by a fast web of electrical and chemical signals, but the intricacies of our minds also render them vulnerable. Microscopic molecules can disrupt our personalities, shift our perception of reality, and dramatically alter our ability to think and reason. Indeed, something as simple as the chemical element, mercury.

Dr. Sara Manning Peskin: Mercury is a mesmerizing element. It flows like water at room temperature and atmospheric pressure, a trick no other metal in the periodic table can perform.

Melissa Harris-Perry: This is Dr. Sara Manning Peskin, assistant professor of clinical neurology at the University of Pennsylvania.

Dr. Sara Manning Peskin: If you separate a bit of mercury from the rest, it feeds up in tantalizing mounds. With a nudge, it rolls along a flat surface like a drop of water. Gold and platinum are beautiful in static form, but Mercury's mystique lies in its dynamism. In a way, it makes people question the laws of physics.

Melissa Harris-Perry: Professor Peskin is reading here from her new book, A Molecule Away from Madness: The Hijacked Brain. She's revealing here, the almost ethereal properties of mercury, an element that is poisonous to humans. It's not the beautiful or dangerous characteristics of the chemical elements that occupy Peskin in this book. Instead, she's interested in our minds and the ways that tiny molecules can have enormous effects on our brains and on ourselves.

Dr. Sara Manning Peskin: Molecules can be as small as water. We think of water as H2O. That's actually the molecular description. It's two hydrogens and an oxygen. Then there are giant molecules like DNA, which is the biggest molecule in our body. What the book talks about is molecules of all different sizes that can essentially take down our identities.

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Melissa Harris-Perry: In the 19th century, mercury was an active ingredient in a commonly-prescribed medicine called "blue mass." Historical evidence points to the likelihood that in the years before becoming America's 16th president, Abraham Lincoln took blue mass to address symptoms of physical and emotional distress.

Dr. Sara Manning Peskin: This is a theory that was devised by a well-known infectious disease doctor named Norbert Hirschhorn. He uncovered that Lincoln had some unusual behaviors before he became president. We think of him as this really easygoing, thoughtful, measured guy and a controlled guy. Actually, before he became president, there are some cases of him being flying off the handle.

At one of the famous Lincoln-Douglas debates, he almost strangled someone on the podium. In the last trial that he worked on, he almost attacked the judge in the middle of the trial. What Norbert Hirschhorn actually figured out is that there's lots of evidence to suggest that Lincoln was using a medication called "blue mass" at the time. The main ingredient in blue mass is actually mercury. We know now that mercury can cause people to be extremely volatile.

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Melissa Harris-Perry: Today, we understand the effects of mercury toxicity: tremors, insomnia, memory loss, and dramatic behavioral and cognitive changes. Peskin writes that, "Mercury convinces neurons to carry out a massive act of cellular suicide, tricking the nervous system into sabotaging itself." Norbert Hirschhorn and his colleagues discovered a recipe for the pills Lincoln may have taken and learned they contained more than 30 times what we know now to be the safe limit of mercury. His work remains controversial because it's impossible to test tissue samples from the late president, but even the possibility that Hirschhorn's work raises is provocative.

Dr. Sara Manning Peskin: It raises this question of, and we think of Lincoln as being one of the greatest presidents in American history, is it possible that his acumen was almost lost to a medication side effect?

Melissa Harris-Perry: This tenuous grasp on our own minds and personalities, the fragility of our various selves, is what I found most disruptive and sometimes upsetting in Professor Peskin's book. After all, doctors and parents used mercury thermometers when I was a kid. It wasn't until my adulthood, I learned some of my favorite seafood was laden with mercury. I tried to quell my own panic as I read, but I wanted to know if Professor Peskin wrote the book as a warning.

Dr. Sara Manning Peskin: You could think of it as this scary thing of, "Oh, my gosh, we're all so vulnerable," but a lot of what the book is about is how we've actually had these incredible advances in science. Most of these diseases are now preventable or curable.

Melissa Harris-Perry: Indeed, a molecule away from madness is not written to terrify. Instead, it's a history of ideas, a celebration of discovery, and a reminder of our resilience even in the midst of our vulnerability.

Dr. Sara Manning Peskin: I think we often think of the brain as this scientifically-studied object and the mind as the more personality-driven, identity-driven word, but the reality is it's all the same thing. There are these molecules, which you think of as brain-based and scientific, but really, that's what makes up your personality. That's what defines who you are.

Melissa Harris-Perry: I think many of us would like to believe that our personalities, our identity, the thing we think of as ourself is relatively stable. I also suppose we tend to like to believe that we have a significant control over how our minds manifest in the world.

Dr. Sara Manning Peskin: Yes, I think we all have this idea of, "I'm an easygoing person, I'm an outgoing person." One of the diseases I write about in the book is a story about a guy, Danny Goodman, who was a outgoing, extraordinarily successful entrepreneur who, in his 50s, started a online wine company that became a huge success. He brought his son on board in the company.

About six months later, his personality changed. He used to hug his son every morning. He stopped hugging his son. He used to be very fastidious and responsive and he wouldn't answer the phone, started asking strange questions where they showed him the financial statement for February. He asked where's the 29th and the 30th, or he started peppering the listings online with exclamation points. He bought tons of the same DVDs. He'd buy six or eight copies of the same DVD or eat tons of pizza.

He became just very disinhibited, a completely different person. All the people around him said, "Maybe it's back pain, maybe it's depression." Eventually, he gets to a neurologist, who says, "It's none of those things. This is a molecular problem. This is a mutation in your DNA that's causing these personality changes." It's exactly that example of where we think that we're totally in control over who we are. In reality, we can be overthrown. We can have different identities because of the effects of these small molecules.

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Melissa Harris-Perry: Stories like Danny Goodman's are tragic and appalling because of their mysterious suddenness. Without warning, Danny's personality transformed into something so profoundly different. Professor Peskin also recounts experiences where the drastic change of a person's mind is not unforeseen. Instead, it's long-anticipated and dreaded.

Dr. Sara Manning Peskin: Huntington's disease is a condition that causes changes both in the mind and in thinking and also in movements. It causes people to have what's called chorea, which is these rising dance-like movements. If you can imagine what it would look like to have a fluctuating electrical current going through your limbs. Then it causes people to have a dementia. They can also have a lot of agitation. They can get into habits that they wouldn't have otherwise gotten into.

One of the stories I write about in the book is actually about the discovery of the gene that causes Huntington's disease. It's this remarkable story about an incredibly brilliant woman named Nancy Wexler. She was a Harvard graduate and a Fulbright scholar. She planned to go to graduate school in psychology. She's about to start and her dad calls and says, "Could you come home for my birthday?" She's very intuitive. She says, "My dad's not the kind of guy who tells people to come home for an event like that if something is up."

Sure enough, she gets home. Her sisters come in town also. They sit down on the couch in her dad's living room. He says their mom has Huntington's disease and it's a genetic disease. "There's a 50% chance that you each inherited the gene that causes it." Wexler relatively, quickly decides that she's going to try to find a cure. The first step to find a cure is to find the gene that causes the disease.

She basically overthrows her entire career, her entire life plans. Instead, she does her thesis at her graduate work on Huntington's disease. She and her father started creating these workshops where they bring together scientists from different disciplines. They have all these rules like you can't have slides and only a certain number of people in the conference. The goal really is to get people to think out of the box, to get people out of their comfort zones. Out of one of those workshops comes what turns out to be the solution.

It's through her work that they ended up finding the gene that causes Huntington's disease and finding the mutation or finding the change in the gene that causes Huntington's disease. From that, we now can test people for the gene that causes Huntington's disease. People who have no symptoms can actually get tested and we can figure out whether they're essentially going to develop the disease. Wexler herself actually never ended up taking the test. She basically decided that she had more to lose than to gain. Eventually, she actually developed the syndrome and develop the disease. Her sister didn't.

Melissa Harris-Perry: It's the profoundly human stories like Nancy Wexler's that distinguish Peskin's approach to exploring the science of the mind. I wondered about the ways that public perception of neurological disorders has changed over time. After all, many of the conditions that are now treatable are ailments for which people were, until very recently, institutionalized.

Dr. Sara Manning Peskin: One of my favorite stories in the book is about a young woman who grew up in adverse circumstances and ended up excelling academically. She goes to this elite university, comes home after graduation in the summer of 2016. She starts binge-watching The Walking Dead.

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Dr. Sara Manning Peskin: She wakes up one morning and she just seems to have difficulty with memory. She keeps asking her mom the same question over and over again. She starts stumbling, she gets a fever, she goes to the hospital. In the middle of talking to the doctor, she basically becomes acutely psychotic. She throws the doctor on the ground, throws a nurse on the ground. They need nine security officers to restrain her. She starts calling people by means of characters from The Walking Dead.

It's actually a security guard who figures out, "You must have known about The Walking Dead," and figured out what was going on and put it together. She gets admitted to the hospital. No one can figure out what's going on. Her mom actually reads an article about this recently-discovered disease that causes young women to become psychotic. She eventually convinces these doctors to transfer her daughter to another hospital where they very promptly diagnose this disease.

It turns out it's a autoimmune disease that essentially acts like PCP. It's as if she was on a constant drip of PCP. Because it's an autoimmune disease, if you quiet down her immune system, if we get rid of the initial cause of it, she actually eventually was cured. She's now back living in the community and back to her life. That's a disease that was only discovered in the mid-2000s. 20 years earlier, she would have ended up in an institution for the rest of her life.

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Dr. Sara Manning Peskin: Part of the point of the book is to really argue that, neurologically, we actually have been very successful in finding cures to diseases. It's just some of these big Goliaths like Alzheimer's disease. We haven't gotten there yet. Actually, in other conditions, we've been very, very successful.

Melissa Harris-Perry: That barely begins to describe how Alzheimer's disease has confounded medical experts and scientists for more than a century. Now, Alzheimer's was first diagnosed as a particular condition in the early 20th century. Since then, researchers have learned a great deal, but still made little progress towards a cure.

Roughly six and a half million Americans over the age of 65 are currently living with Alzheimer's. That's a number projected to more than double by 2050. The devastation wrought by the disease is something numbers can't quite capture. The gradual onset of memory loss, confusion, a change in personality and behavior with Alzheimer's. You lose your loved one not just once, but over and over again. It is the long goodbye.

Dr. Sara Manning Peskin: You're exactly right about this ambiguous loss with Alzheimer's. That's part of what makes it so hard to study because it changes so slowly. You can imagine, if you want to see if a drug is making a difference, if the disease itself progresses so slowly, it takes a long time to figure out if the disease is progressing differently than usual. In terms of where are we now, we're very good at diagnosing Alzheimer's disease.

We're much better than when we were before. The original Alzheimer's, he met a 51-year-old woman who had memory loss. He was surprised because she was so young. He waited for her to pass away. He looked at her brain under a microscope and he saw these two structures. One was called plaques. It looks like a spot of spray paint. The other is called tangles. It looks like pieces of spaghetti inside of neurons.

We now know years later that the plaques are made of a protein called amyloid and the tangles are made of a protein called tau. That's what defines Alzheimer's disease. When we give someone a diagnosis of Alzheimer's disease, what we're really saying is if I took a piece of your brain out and I looked at it under a microscope, I think I would see amyloid and tau. We've now become very, very good at diagnosing Alzheimer's disease. By and large, drug trials for the condition make you want to participate.

You have to prove you have amyloid and potentially amyloid and tau protein buildup. We can do that in people who are moving with a relatively non-invasive test. They come in, we give them a injection of, essentially, a tag that sticks to amyloid or a tag that sticks to tau. They sit around for a little bit. The tag circulates in their brain and then we take a picture of their brain. We can see, do they have elevated amyloid? Do they have elevated tau?

We can really specifically and very quickly, essentially give a molecular diagnosis of Alzheimer's disease. Up until now, the bulk of Alzheimer's treatment trials have focused on amyloid. The reason for that, there are multiple reasons, but amyloid tends to build up about 10 to 15 years before symptoms. It's thought to be one of the earliest changes if there are some gene mutations that cause unusual types of Alzheimer's disease and those are all related to amyloid.

The general thought is if we can get rid of amyloid or if we can prevent amyloid from building up, maybe we can stop the disease. You spent enormous amounts of money developing drugs that tried to do that. Thus far, they haven't really worked. Then we came on this drug, aducanumab, which was made by a company called Biogen. It was one of the more powerful drugs in terms of cleaning up amyloid.

There was a very, very controversial approval by the FDA. Ultimately, Medicare decided they're not going to cover the medication. Ultimately, where we are is that we don't know if it works. There will be another trial with that medication. There's two other trials with the other medications that work similarly that are very, very powerful. They're Alzheimer's cleansers or amyloid cleansers.

Those are going to read out next year. If those work, that will change the landscape of Alzheimer's disease. That will be the way that we treat the disease. If they don't work, the entire field, I think, will move away from the amyloid hypothesis. We're going to stop trying to cure Alzheimer's disease by getting rid of amyloid and we're going to turn towards other ideas.

Melissa Harris-Perry: You also care for patients with dementia, is that right?

Dr. Sara Manning Peskin: Yes, that's my day job. Exactly. I'm in cognitive neurology, so most of what I do is seeing patients with Alzheimer's disease and also with more rare causes of dementia.

Melissa Harris-Perry: Talk to me about how this scientific knowledge of, apparently, your side gig of writing research impacts your work in terms of caring for patients. How do you approach whether talking with your patients or with their families about these central issues?

Dr. Sara Manning Peskin: I think writing about these diseases completely changed the way that I talk to patients about it. It changes the way I talk to them about diagnoses. It makes me a lot more conscious of not using jargon. I think I had no idea till I wrote the book, how many words we use that we learned in medical school but are not accessible to the people we're talking to.

Also, I try to give patients a little bit of history about their disease because I think a lot of us, we get these diagnoses and we think that the diagnosis has always existed for time immemorial. Actually, it's helpful to know someone discovered this disease at some point. There's been research and this is what's happened. This is what we've learned over time and this is where we're trying to go and put it into context.

I think it also goes the other way. Very much, my practice informs my writing. Dementia, it's not a broken arm. It's a disease that happens in a social context. It happens to couples and families and communities and those relationships very much. That's what sustains me in terms of the practice. That's what I think makes me more motivated to write about these things, is the human side, and the fact that these diseases affect relationships and that they change how people interact with each other.

Melissa Harris-Perry: Let's pause. When we return, Professor Peskin offers some advice for keeping our brains healthy. It's The Takeaway.

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Melissa Harris-Perry: Welcome back to The Takeaway. I'm Melissa Harris-Perry. We've been talking to Sara Manning Peskin, assistant professor of clinical neurology at the University of Pennsylvania, about the mysterious and miraculous ways our minds work. She writes about it in her book, A Molecule Away from Madness: The Hijacked Brain. After reading some of the stories in our book, you might be tempting to run out and buy up a year's supply of vitamins and supplements, at least it was for me. That human desire to control what we can't see or predict, whew, that is real.

Dr. Sara Manning Peskin: For once, you don't have to do any of the supplements. By and large, you get what you need in your diet in the vast majority of cases.

Melissa Harris-Perry: What can you do, if anything, to care for the health of your brain?

Dr. Sara Manning Peskin: One is exercise. The data behind exercise is extraordinary. This is repeated in study after study after study. Aerobic exercise seems to have most of the benefit, so like stretching and yoga doesn't seem to do it. A brisk walk or a bike ride, running, swimming, all of that has an incredible effect in slowing down cognitive loss, both in people who just have normal aging and in people who have dementia.

We generally tell patients of something like 30 to 40 minutes a day, 3 to 4 days a week of something aerobic, and then social engagement. There have been studies back to the '80s. There was a study where they gave people points for each of their social connections. The more connections you have, the slower people declined. Then the other piece is intellectual engagement. There's nothing specific that people should be doing. Essentially, what we tell people is if it's not TV, it's probably helpful. Whether it's reading a book, listening to a show, anything is useful. Just the idea is to be a continuous learner. In neurology, those are really the particular things that are very good for slowing down cognitive loss.

Melissa Harris-Perry: Do we have a sense of the mechanism of why-- Pretty much anything but TV, right? Our social engagement and our intellectual engagement, learning new things, why that is helpful?

Dr. Sara Manning Peskin: There's the "use it or lose it" idea with neurons. Basically, even if you're working, if you've done the same thing for 40 years and it's rote and it doesn't involve any actual intellectual reasoning, that's probably less helpful than picking up a new hobby. In the sense that when we spend most of our days not doing any thinking, those neurons that would help us do that, the connections get lost.

Melissa Harris-Perry: If Peskin's advice doesn't give you some peace of mind, maybe this will. Our brains may be complex and mysterious, but the puzzle pieces are slowly and remarkably coming together.

Dr. Sara Manning Peskin: We're better able to define these diseases molecularly than we've ever been before. We just made huge, huge strides even though you could say from 50,000 feet, we haven't cured Alzheimer's disease. That's the holy grail. That's true, but we've just made extraordinary strides in treating other diseases and in defining Alzheimer's disease.

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Melissa Harris-Perry: Our thanks to Dr. Sara Manning Peskin, author of A Molecule Away from Madness: Tales of the Hijacked Brain.

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