18. How much does love weigh?

Hi friends,

Welcome to the eighteenth dispatch of How Humans Flourish, a research-informed newsletter on how humans thrive.

The last few weeks have been an absolute whirlwind, and I have so much exciting science to share with you!

But first, a quick aside. 

After spending April deep in the world of Blue Zones, I’d planned for us to read Dr. Lisa Mosconi’s book Brain Food: The Surprising Science of Eating for Cognitive Power for the month of May. 

Dr. Mosconi is both a neuroscientist and integrative nutritionist, as well as, Weill Cornell’s Associate Director of the Alzheimer’s Prevention Clinic (Weill Cornell is the teaching hospital for Cornell University). “Brain Food” would have been a great compliment to the information we learned last month, but alas, something happened last week that changed everything.  

Last Wednesday I hopped on a plane and arrived in rainy Boston to attend the Annual Boston International Trauma Conference, hosted by Dr. Bessel van der Kolk. Dr. Bessel’s book, “The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma,” is a seminal piece of literature within mental health research. Not only does the book have a 4.8 rating on Amazon… but that rating represents the aggregate of over 74,000 reviews. It charted the New York Times bestseller list for over 254 consecutive weeks, and though originally published in 2014, the book continues to provide language for individuals around the world. If you’re interested, but too busy to read the book yourself, I wrote about it in February. You can read newsletters one, two, three, and four here. 

The main premise of his book is profound: that trauma constitutes a distinct form of memory, one separate from the memory used to remember where we stored our keys or whether we switched off the oven. These ordinary, banal memories are ephemeral and will fade over the course of ordinary life. But trauma acts as a literal mental ambush that collapses the past and present, and when the brain is triggered (consciously or subconsciously) it produces physiological effects whether or not the traumatic event is even consciously remembered. This means while the mind may not remember, the body registers and stays on alert, constantly reliving the threat of a now-nonexistent danger. 

Quite simply, the body keeps the score.

And so, after landing in Boston, I didn’t know what to expect. The schedule showed workshops ranging from ancestral embodiment to the latest in psychedelic research coming out of John Hopkins Center for Psychedelic & Consciousness Research. 

It turned out to be four days of mind-bending content where I sat and learned from people who consistently contemplate the breadth and depth of the human experience. Some days I felt like a student at Xavier’s School for Gifted Healers, other days I felt like I was in an advanced neuroscience college elective.

I sort of fit in… and sort of didn’t.

On the one hand, at break*through, we’ve spent an inordinate amount of time building AI wellness champions trained on data sets developed by prolific wellbeing coaches and cognitive behavioral health therapists. They are sophisticated digital coaches that guide primary healthcare patients through transformative virtual support groups to adopt healthier habits. 

But, I realized something pretty quickly. Because populations most at risk for chronic health problems also tend to be individuals from marginalized communities, in order to help people make healthier decisions, we also have to understand the trauma complexities affecting them. For example: how do you encourage someone used to losing loved ones from gun violence to care about their nutrition or sexual health when they do not believe they will survive past 30?

We’re by no means treating trauma, but our AI is trauma-informed, providing healing tools to help patients along their wellbeing journey.

And while I have deep respect for clinical mental health practitioners, during the conference it wasn’t lost on me how building “therapy adjacent” technology may feel distasteful for actual clinicians. It’d be reminiscent of Brian Chesky, the CEO of Airbnb, attending hotel conferences during the startup's early days. It’s a bold move.

Personally, I know that therapy chatbots or therapy adjacent technologies will not replace practitioners, the same way Airbnb has not replaced hotels. But, I do recognize it will disrupt the status quo and ask all of us– clinicians and non-clinicians– to re-contemplate our assumptions.

This came up clearly during one conversation with a clinician who argued: in order for something to be trauma-informed, it inherently requires subjectivity. It requires the ability to observe what is happening with the traumatized person and respond moment by moment to the energy and presence they bring. Subjectivity inherently requires consciousness, and considering that AI is not conscious, it cannot be trauma-informed.

I offered back: if it’s true that only objects with consciousness can provide trauma-informed interventions, then the United States (if not the world) is in quite a crunch.

There are 56,536 practicing psychiatrists in the United States. 106,000 licensed psychologists. This includes practitioners that are excellent at their jobs, and practitioners that are terrible. It includes practitioners who charge $1500 a session, and those who charge on a sliding scale. 

Meanwhile, population surveys conducted with over 68,000 respondents found over 70% of the participants had experienced a traumatic event (30.5% reported being exposed to four or more traumatic events). Across studies, trauma exposure is more common in men, but men are less likely to get help. In fact, a study published by the University of Virginia and Harvard in 2014, found most men would rather shock themselves than be alone with their thoughts.

My point, I stressed to the clinician, is access. People need access to tools and interventions in ways that resonate with them. Some of which will be therapy, some of which will not be therapy. The beauty of technological tools are that they are scalable… they can reach more people in accessible ways.

The clinician was neither impressed nor swayed.

Curious on how to push the conversation further, I decided to bring the feedback to the Godfather himself. 

Fortunately, in the very next workshop I attended, Dr. Bessel was also present. He sat at the back of the room, and as soon as the session adjourned for a break, I walked quickly to the back and sat down next to him. 

I shook his hand and delved straight into my question.

“Hello Dr. Bessel, my name is Melissa Kiguwa and I’m the founder of break*through. We increase health literacy for primary healthcare patients through gamified, AI virtual support groups. We do consider ourselves to be trauma-informed, with a focus on at risk patients, but I’m open to being challenged on this. A clinician today said we can’t possibly be trauma-informed without subjectivity which would require AI with consciousness. Obviously we don’t have that, so I’m curious to hear your thoughts.”

He leaned his head toward me, still looking toward the front of the room, and replied contemplatively, “Interesting.”

He then leaned closer to me and said in his thick Dutch accent, “You have to admit… there’s something to this. Me and you here. There is something biologically happening to the both of us that would not happen over a zoom call. Here.. together… you speak, I intuit. I respond, you sense. Neurologically, there is something happening between us.”

I catch his drift. “Sure, in person we can leave a biological impression on one another. Perhaps I delight you by the way I laugh. Perhaps I gesture like someone you know. You are affected by my presence.”

He shakes his head, “It’s more than that. It’s somatic. It’s in the body. But most importantly, it’s in the brain. That’s what you need to research. You need to take a cohort through your break*through experience in person, put them through a functional MRI scan and see what in the brain lights up. Then take a cohort through the break*through experience with your AI coaches and see what lights up… or doesn’t. Then quantify it. Calculate the significance of the human to human connection. What do we lose from the virtual… and how much of it? Perhaps you can in your own parlance ‘hack it’ once you know the difference…perhaps not.”

I leaned back. Damn. Godfather, indeed.

Ever the founder, I responded, “Brilliant, great suggestion. I’m not a neuroscientist and I don’t have scanning machines though…so, are we doing this together?”

He laughed, “Lucky for you, my team and I have been asking these very questions. I’m interested.”

…Now, will Dr. Bessel follow-up? Perhaps. I’ll stay on him.

But, regardless, his questions offer a series of interesting questions those of us building technology are being asked, but have no answers to: 

What is the quantitative significance of human to human contact? 

How do humans transmit feelings? 

And can we replicate it virtually?

These are big heady questions that will have my brain turning for a while. These questions are also why instead of reading “Brain Food” for the month of May, we are reading, Attached: The New Science of Adult Attachment and How it Can Help you Find and Keep Love. 

Until next week, friends.

With gratitude,