Peter Sterling, a professor at the University of Pennsylvania, is a well-known neuroscientist, having co-authored a popular text, Principles of Neural Design. He is a lifelong political activist, and historians of psychiatry may remember his public criticisms of psychiatric treatments in the 1970s, most notably of electroshock and antipsychotics.
He could also be described as an ethnographer, as his travels among the indigenous people of Panama, where he now lives part-time, influenced his understanding of how the human brain was shaped in response to the demands of early hunter-gatherer societies.
He is the author of a recent book titled What is Health: Allostasis and the Evolution of Human Design. His book raises this provocative question: What does our species require for a healthy life? And can we achieve this with drugs?
The transcript below has been edited for length and clarity. Listen to the audio of the interview here.
Robert Whitaker: I thought it would be helpful to start with your history of political activism, as it was activism that led to a “discovery” that ultimately led to your writing What is Health. Plus, you were raised by parents who were communists, and thus you grew up as a Red Diaper Baby, which is not a heritage that many speak about today.
Peter Sterling: I was born in 1940. My parents, in the 1930s and the 1940s until about 1955, were members of the Communist Party of the United States of America. What people don’t realize now, because it has been 60 years of vilification of the communists, is that it was a political movement, which was fairly popular in many ways. They ran candidates for President, for Congress, for city councils. They were organizers of unions. The UAW was very dependent, in its early age, the mid-1930s, on the energy of communists.
But there was a systematic persecution of communists. My sister mentioned to me the other day in an email that my father would wake up in the middle of the night muttering, “I have nothing to say, I have nothing to say,” because he would be stopped on the street in New York City on his way to work by FBI people.
So on the one hand there was this tense environment which my parents and their friends and their kids and I grew up with. There was also the excitement of actually working for the NAACP, trying to stop lynchings, the executions of black men . . . the standard sort of thing that was going on.
So there was a social commitment and the idea was, as Marx noted in his Communist Manifesto, “From each according to his ability, to each according to his need.” That’s what I was raised with and that’s what I believe, and that has motivated me to investigate social problems.
Whitaker: When you were an undergraduate at Cornell, you signed up to go on the Freedom Rides in 1961.
Sterling: The Freedom Rides started in Washington DC. Two buses were sent by the Congress of Racial Equality (CORE) to test two Supreme Court decisions that ruled against interstate Jim Crow laws. If you were traveling interstate, you should have facilities of lunchrooms, bathrooms, and so on, and they were not to be segregated. The Freedom Rides initially were a test to see whether the law would be enforced. And everything went fine until somewhere in South Carolina, John Lewis, the late John Lewis, was beaten when the bus stopped. Then, when they crossed into Alabama, that’s when all hell broke loose, the bus was bombed, the riders were almost burned to death, they got out from this burning bus and then they had the crap beaten out of them.
By mid-May, there had been such a catastrophically violent series of events that CORE and the Student Nonviolent Coordinating Committee, SNCC, decided to do a massive resistance and they called for buses to converge on Jackson, Mississippi, and fill the jails.
Whitaker: You went down there expecting to be arrested, to fill the jails of Jackson, Mississippi?
Sterling: That was the idea. We drove down with New York State license plates. We knew we would be stopped as we went through the South, and so when we crossed into Mississippi, we installed as the driver one of our companions who was from Texas who had a wonderful Texas drawl. When we were stopped by the State Police, saying, “Are you boys going to make trouble?” he said, “No, no, we’re just going to visit my mammy and my pappy,” and so we made it to New Orleans.
There we were trained in nonviolent resistance in case we were attacked. We were then sent by train to Jackson, because the FBI had intelligence that there was a mob waiting at the Mississippi state line to intercept a bus, and that we would be safer by train.
The police were waiting for us, they arrested us immediately. The charge was, “breach of the peace.” And we were sent off to jail in segregated paddy wagons, singing “We Shall Overcome.”
Whitaker: Jim Crow laws had been around for a long time. Four years after that summer of 1961, the country had a Voting Rights Act. Did this make you optimistic that social change could happen?
Sterling: That’s a very good point. The Freedom Rides started in mid-May in 1961. And it only took 400 riders, half of whom were whites from the north, and the rest were largely southern blacks, and by the end of November, the Interstate Commerce Commission had ruled against segregation in interstate commerce. Imagine 400 students achieving this in a few months.
Then, in 1964, there was the Mississippi Summer, where the southern Student Nonviolent Coordinating Committee registered voters in Mississippi. By 1965, there is a Voting Rights Act and this was a huge, rapid change.
Whitaker: You were at Case Western Reserve University in 1965, studying to become a neuroscientist. But it’s political work that sparked your rethinking of how the brain works.
Sterling: In 1965, I was several years into my PhD research, which was on the connections between the motor cortex and the spinal cord and the brain stem. But I was still active in CORE and I was canvassing in this central area of Cleveland, very poor, totally black population. I would knock on doors and people would come to the door, and I could see that often their faces were sagging, and they were limping, their speech would be slurred. I had never seen this in the white middle-class community where I grew up. So I asked my professor, who was a neurologist, and he said it’s due to hypertension, chronic hypertension.
People at that time said, oh, we don’t know what causes hypertension. Gosh, it’s maybe because you eat too much salt, or black people have bad genes, all kinds of mysterious explanations which are still given in medical textbooks.
Well, this was the ghetto where my grandfather had been confined when it was a Jewish ghetto. And my grandfather had had a stroke, an early stroke and hypertension. I thought, well maybe this is social tension that is related to hypertension.
Whitaker: Our normal conception of hypertension is that it’s an abnormality that occurs within the individual. You are raising a different thought here, that something physical has happened in response to an environment that’s very stressful.
Sterling: That’s right. And the question is, if social tension is the cause in some way of hypertension, it must act through the brain. There must be pathways from our perceptions, and our experience of life, to the parts of the body which control blood pressure.
I went on from Cleveland to Boston to Harvard Medical School, where I did three years of post-doctoral study in the visual system. Then I got a job as Assistant Professor at the University of Pennsylvania and I established my own laboratory studying vision. But I began to read more about social tension and causes of high blood pressure, and I began to systematically read about the nerves that connected to the kidney and connected to the pancreas and connected to the blood vessels. It became more and more apparent that the brain controls every cell in the body.
I wrote about this with Joe Eyer. We published a paper in 1977, then in 1981 about how social conditions — including stresses, including divorce, bereavement, segregation, and so on — affect various brain systems that affect blood pressure.
Whitaker: So if a person is in a stressful environment, is hypertension actually adaptive to that stress?
Sterling: Right. As I later came to understand, the whole purpose of the brain is to predict what we need as an individual organism. And to find a way to make sure that our body has just enough resources, just in time. When we are in an emergency state, our brain raises our level of alertness and our body activities.
For example, it does that by raising the heart rate, telling the kidney, “we are going to need some more blood supply here, so pump in some salt water,” and that we need to save salt water by constricting the blood vessels to raise the pressure. These mechanisms are a normal part of our regulation, it goes up, it goes down.
The problem is that if you live under conditions where you’re required to be alert, every second of your life, for something scary to happen, then the body adapts. The brain comes to predict that you’re going to need high blood pressure. It tells the kidney, “pump in more salt water,” it tells the blood vessels to constrict and the heart rate to go up. This becomes your way of life.
Eventually, it’s just like lifting weights. If you lift weights, your muscles thicken. If you raise your blood pressure chronically, your blood vessels thicken, they have muscles in them and they thicken. So it becomes an adaptation.
Whitaker: If you look at the Adverse Childhood Experiences Study, which tells of how adverse events early in life — parents divorcing, physical abuse, and so forth — you see poor health down the line, mental and physical. It seems that your story about hypertension would be a model for explaining trauma and its long-term effects; the child is always on high alert.
Sterling: It’s not even an analogy. It’s part of the same thing. It’s about prediction.
Whitaker: In the 1970s, you got involved with psychiatry. Why?
Sterling: Well, somebody who visited our house brought a copy of the New York Post, and said, “Did you see this? They are doing brain surgery on children to cure their behavior.” I said, “Nah, come on.” But I looked it up and I found the article, and I found a gazillion references to the fact that this was happening on children and adults and drug addicts, and on prisoners in jails and that this psychosurgery was still being done by leading surgeons at Harvard Medical School and Yale and Columbia.
My first effort was to understand whether there was something good here. Is there some value in this? Because if there is, I will be quiet. But if there isn’t, I had to speak up. And you know this — removing your frontal lobe or amygdala or your cingulate gyrus is a disaster.
Then I thought, what about the drugs? Antipsychotics at the time — mainly chlorpromazine and related drugs — were causing their own sort of brain damage, tardive dyskinesia. And then I found the same thing is true for electric shock, and I began to testify about that.
Whitaker: Testify before Congress?
Sterling: I testified at several state hearings about electric shock treatment, that it was brain-damaging.
One more place I testified was related to antipsychotics. Mental patients in the New Jersey State Hospital had a lawyer advocate who sued the State of New Jersey for the right to refuse neuroleptic drugs, because they said the drug “makes us feel terrible and it causes brain damage.”
This was in Federal District Court in New Jersey. I testified on behalf of the plaintiffs, saying, “Look, it does damage. And that’s a rationale for refusing the treatment.” The judge, this is in 1979, ruled in favor of the plaintiffs. I wrote an article for the New Republic at that time titled “Psychiatry’s Drug Addiction.”
The case was then appealed in Federal Appeals Court in Philadelphia, and the judges said, “No, we cannot accept this” and they kicked it out. They said they cannot be the final arbiter of who is going to get medicine.
Whitaker: What was the name of the New Jersey case?
Sterling: Rennie v. Klein.
Whitaker: That was a famous case on the right to refuse treatment. I didn’t realize you were one of the expert witnesses. Let’s go back to the question you ask in What is Health? What does our species require for a healthy life? Maybe you can start with telling us about the brain of a worm.
Sterling: The worm brain was the first brain of a multicellular bilateral organism. And the worm and the earliest brains have a special circuit that drives an animal, or a human, to search, to move. We look for food, we look for shelter, we look for comfort. The worm was looking for the right acidity, the right water temperature, salinity, mates. And the rule was, when you find something good that you need, there is a circuit that releases a special chemical that says, okay, relax, you found it. Chill, you know this is where you need to be. The chemical is called dopamine, and this circuit, both the searching circuit and the reward circuit, was preserved for half a billion years.
And the thing about dopamine is that it rewards us for all kinds of activities. We were looking for food, we didn’t really know what to expect, but here we find some, and we get just a tiny little drop of dopamine. Then we go onto the next activity. This circuit, which goes back to the worm, drives us to seek and to find little surprises. Our whole behavior, our whole selfhood, is really organized around these frequent small surprises. And if we don’t find them, we get very uncomfortable, we get agitated.
Whitaker: Now let’s go to a second feature that made homo sapiens so successful . . . our big brain. You write that our brain has 200 circuits and that they “specialize” in different tasks, which leads to a variation in behavior and skills among individuals.
Sterling: The first point is that you have a brain that can beat a supercomputer in many respects. A supercomputer occupies a room, it requires megawatts of electricity. Our brain fits in the space of a milk carton, and it operates with less electricity than a refrigerator light bulb. So it has an amazing efficiency for computation.
However, once you have the human skull filled with brain and 200 circuits, you are stuck because that’s all you can compute as an individual. And you can’t make the brain very much larger because you would have to re-engineer the whole body. The strategy that we evolved as human beings was to specialize between individuals.
While individuals may have roughly 200 brain circuits, they are not the same for all people. Some people are very alert at tracking and hunting, but they can’t really recognize other people’s faces. Other people never forget a face, those are the people who become politicians, social people. But they need to cooperate with hunters and so on . . . some people make tools, some people know how to build a boat. You have musicians, storytellers, and comedians, and in that way you generate a small community with individuals who start out with different innate talents.
Whitaker: Let’s turn to the DSM. In 1980, when the American Psychiatric Association published the third edition of its Diagnostic and Statistical Manual, it adopted what it called a “medical model” of mental disorders. According to this manual, if you have certain behaviors or feelings that impair your functioning, that’s a psychiatric disorder. It draws a line that says, on one side of this line are people who are “normal,” and on the other are those who are “abnormal.” Does that fit with your understanding of us as a species?
Sterling: First, in some cases, there are things that I would accept as a disease. For example, childhood diabetes. For some reason, your immune system attacks your pancreatic Beta cells and wipes them out. You have no source of insulin. I accept this as a disease and that a treatment that replaces the missing insulin is a rational treatment. What I want to make clear is that I’m not a denier of neurological and mental illness.
But there are many other behavioral issues and experiences that I think are really not diseases, but rather behavioral traits. And by behavioral trait, I mean this: let’s say if you’re tall, being tall is a trait. It’s controlled by hundreds of genes. And if you get a hundred genes for tall and a few genes for short, you’re going to be very tall, way out on the spectrum of distribution of height.
Now take the traits that would be described as ADHD. Tom Sawyer was a character in American literature who is full of energy, imagination, devilment. He is always in trouble in school, he pays no attention to authority, and yet, we would be bereft without this character in American literature. But if Tom Sawyer were in a classroom today of 30 children, he would definitely be identified as somebody who had this disorder.
This behavior is a trait and so if you move a little to the left of the average person, they are less impulsive, they are better at waiting till the teacher calls on them, and so on. And if you go to the right, you have children who simply cannot sit still in the classroom and really shouldn’t be in a classroom, they should be doing something outside.
Whitaker: You write about “deaths of despair” rising in the United States in recent times. What do you attribute this to?
Sterling: For many generations, going back to our early days as a species, we found interesting work to do throughout our whole lifecycle. At about age 20, we learned to begin to feed ourselves. It takes a very long time to learn how to hunt, what animals to follow, when to give up, when to keep going, and same thing for gathering foods. And there was a lifetime of learning and contributing to the community.
Now we have two problems. Many jobs can be learned in five minutes. They are just routine things, stamping a passport, scanning a barcode, and God knows what. These do not occupy a brain that is as magnificent as ours. People with that type of work really sort of slowly go mad.
The other thing is that we used to find food and comfort in something of a random way, and we would get a little drop of dopamine when we did. Now when you are in the supermarket, you know what you are going to find on aisle seven, and so there is not very much dopamine to get from that. But you can get that from eating richer foods, or alcohol or drugs, because they release dopamine.
So on the one hand, we have really crappy work and on the other, we have a destroyed community where there very is very little interconnection. We have people who are isolated and the only way they can become comfortable with themselves and their isolation is by taking drugs that release surges of dopamine. The problem is that the brain is designed to adapt to these large levels of dopamine by reducing the dopamine receptors and then you need more of this release. So we become addicted to the rich food, to the drugs, to the alcohol, and all of the other things. That’s what I think is the source of the despair. It’s poor work, social isolation, and reliance on these other sources [for dopamine release].
Whitaker: I guess you could say we don’t have an environment that feeds our worm-inherited brain. Can we fix this with drugs?
Sterling: No, of course not. This is a delusion that you can fix it this way. If you have a specific loss, as I was suggesting for insulin, there is a certain logic to replacing the substance with an artificial drug that in some way addresses this specific deficit. But if you are talking about human despair, that involves the whole brain with many complex circuits.
If you raise somebody’s mood by giving them a pro-dopamine drug, then you also affect the protein receptors on nerve cells that are binding these drugs. And those change other signaling systems and you rearrange basically all of the neuro-circuits in ways that we really have no idea about.
If you do it for a little while, it may be okay, but if you do it for a long period of time, it’s just like everything else, the brain adapts profoundly. And to get somebody off of one of these drugs or multiple drugs, you have to do it very slowly, very carefully to let the brain sort of readapt, but it’s a very long, difficult process.
Whitaker: So then, what is health?
Sterling: I think it is paying attention to the human lifecycle as it was as we evolved. Of course, we are not going to go back to being hunter-gatherers, but I think we need to understand better what we need to preserve in that life.
That means making sure that we have activities that attract adults to continue their own education, which is what the hunter-gatherers did. We need a spiritual life — you cannot expect to have the human interior life just be stimulated by a screen and pushing buttons on a screen. It involves participatory activities, playing music together, singing together, and a sexual life.
And children need attention from multiple parents and generations. You can’t just stick children off in a corner and expect them to be okay.
Whitaker: Last question. You are the Mental Health Czar for the United States. You’re responsible for creating an environment that would lead to better mental health. What would you do?
Sterling: I’ll start with a question: What does Europe know that the U.S. doesn’t? The first is that Europe has four to six weeks paid vacation for every adult. Europe has support for public medicine, so you don’t have to worry about where your medicine is coming from, or your children’s education and childcare. If you had the social supports that advanced modern societies have, this would have a huge effect for American’s mental health.
Two, if we were to pay attention to the actual condition of children, then we would make sure that children wouldn’t have to worry about being evicted, where they are going to sleep . . . Children should not be anxious about whether they can be provided for materially. You have to make stronger families and that would happen if there was guaranteed support for families.
And when you get to the classroom . . . the model of a classroom we have of putting 30 kids in a room and telling them to shut up for hours, all day, is crazy. We need to reform the schools to better match the distribution of capabilities of children in the population. If there is a musical child, who can’t sit still, get him out of there, stick an instrument in their hands and let them work on that. It would be pretty easy to reorganize U.S. education along the lines of developing people’s talents instead of compressing them into this mold, which is really intolerable.
Whitaker: How about the need for play among kids?
Sterling: Of course, this is a way that children learn. Children growing up in pre-modern societies spent enormous amount of time with each other, across the range of ages, so that young children learn from older children. In our farm, where we are now in Panama, there is a range of kids from cradle to those in their 20s, and they play soccer together. And of course, the little kids aren’t as good as the big kids, but if the big kids just crushed them, it wouldn’t be any fun. So the teams are mixed up and people have a good time playing, and winning is not the main thing. There are no referees and kids learn to apply the rules. The older kids teach the younger kids.
Whitaker: Thank you, Peter, for joining us today. It’s been a fascinating interview.
Interviewer’s note: This interview initially stated that Peter Sterling had retired from the University of Pennsylvania. Although he closed his lab in 2009, he continues to have an appointment as a professor at the university.
MIA Reports are supported, in part, by a grant from the Open Society Foundations