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Fresh Air with Terry Gross

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TERRY GROSS, HOST:

This is FRESH AIR. I'm Terry Gross. What makes the brains of people on the autistic spectrum different from the brains of neuro-typical people? That's one of the questions my guest, neuroscientist Alvaro Pascual-Leone, is trying to answer with his research stimulating parts of the brain with electromagnetic fields to alter targeted parts of the brain's circuitry. It's a procedure known as transcranial magnetic stimulation, or TMS. TMS is already being used to treat certain conditions, including depression, but with autism, it's in the experimental stage.

One of the participants in Dr. Pascual-Leone's study is John Elder Robison, who is also my guest. Robison was initially diagnosed with Asperger's syndrome and is now considered to have Autism Spectrum Disorder. He received weekly TMS treatments for six months, and both he and the research team were surprised by the emotional awakening he experienced. Robison's new memoir, "Switched On," is about his TMS treatments. Robison wrote an earlier memoir about having autism called "Look Me In The Eye." He used to engineer and design effects for rock shows. Then he started a company that sells, services and restores late-model European vehicles.

He's now the neuro-diversity scholar-in-residence at the College of William and Mary and serves on the federal government's Interagency Autism Coordinating Committee. Dr. Pascual-Leone is a professor of neurology at Harvard Medical School and director of the Center for Noninvasive Brain Stimulation at Beth Israel Deaconess Medical Center, which is one of Harvard's teaching hospitals. He wrote the introduction to Robison's book. Dr. Alvaro Pascual-Leone, John Elder Robison, welcome to both of you to FRESH AIR. Doctor, I want to start with you. What is transcranial magnetic stimulation?

ALVARO PASCUAL-LEONE: So transcranial magnetic stimulation is a method - a tool. It allows us to to introduce a small amount of current into specific parts of the brain without having to use surgery to do so - in other words, noninvasively, through the skin and the skull. We use a magnetic field to pass through the skin and the skull painlessly and introduce current in the brain. The reason to do that is because the brain ultimately uses current to do its work, and by introducing current in it, we can probe the function of certain parts of the brain. We can even modify how different parts of the brain work.

GROSS: So what's the theory behind how you're using it with people with autism, stroke, depression, epilepsy, Parkinson's disease?

PASCUAL-LEONE: There are two very different goals in those applications. The first set of goals is to understand better how the brain works in those conditions - in patients that have those diseases. Part of the reason to understand it better is to develop new ways to diagnose the conditions earlier. Another reason to understand it is to be able to develop new treatments. In addition to those diagnostic applications, there are also therapeutic applications. It turns out that by applying transcranial magnetic stimulation to different parts of the brain repeatedly, day after day after day, we can modify the brain activity in those areas. And that can translate into a benefit for patients with different disorders.

Those types of therapeutic applications are now, for example, approved for treatment of patients with medication-refractory depression, the forms of depression that don't respond to treatment. In the case of autism, we are earlier in those applications, and it's premature to use TMS for therapy. But it's a very powerful tool to try to understand better how the brain of people with autism is different from the brain of people that don't have autism.

GROSS: So what do the conditions that we mentioned - autism, stroke, depression, epilepsy, Parkinson's - what do they have in common that make them things that you think might be treatable through TMS?

PASCUAL-LEONE: That's a great question, and perhaps it requires my explaining a little bit how we think of the brain in relationship to these disorders. One can think of any one disorder - depression or autism or Parkinson's - as a label that is applied to people that have certain symptoms. Take, for example, Parkinson's. It's hard to get going. It's hard to move fast enough. It's hard to think thoughts. There is tremor and involuntary movements. Each one of those symptoms maps onto a given circuit of the brain.

The reason why that circuit of the brain is not functioning properly in the case of Parkinson's has to do with the deficit of a certain chemical in the brain. But the point is that if we can identify the circuit that causes the symptoms, we can target that circuit and make it function better with brain stimulation. So in a sense, it's not a treatment for the disorder - for the ultimate cause of the disorder - but it's an intervention that improves how the patient is able to function. It's a more symptomatic treatment rather than a causal treatment.

So what is common across disorders - any number of diseases of the brain as psychiatric and neurological - is that if we can identify the brain circuit that maps onto a given symptom that impairs the patient's life, we can potentially improve the quality of the patient's life by treating those symptoms.

GROSS: So you're basically trying to activate certain pathways in the brain that aren't functioning like they should?

PASCUAL-LEONE: Yeah. You're trying to modify the activities. Sometimes it's activating. Sometimes it's actually deactivating. So it turns out that sometimes a certain pathway in the brain is too active, and it is that excessive activity that causes the symptoms.

GROSS: Now, I have to say it's kind of frightening to think of electrically interfering with the brain. I know that there's been ECT - electroconvulsive therapy - used for years, what used to be called shock therapy. And I know that the dosage that you're using is much lower than that. Still, it just seems, when you're just a layperson like me, there's something just kind of alarming about the idea of shocking the brain. So make it less frightening for me.

PASCUAL-LEONE: So I agree. There is a - it's a different way of thinking of interventions for the brain. And with that comes a certain fear associated with it. But electroconvulsive therapy is by far the best antidepressant treatment that we have. And when applied as it currently is, not as portrayed in movies of the past, but with appropriate protection of the patients with anesthesia and so forth, it actually is rather benign. But it still involves modifying activity throughout the brain.

The difference here is that with TMS, we target a very small area of the brain, the tip of a little finger worth of an area of the brain. So it's a very controlled modulation of activity in a very defined area of the brain of the individual, an area that we know is not functioning properly.

GROSS: And here's another thing I would worry about if I was a patient - that the procedure is so new that you don't really know yet what the short-term let alone the long-term effects are. And then, like, who knows what the long-term effects might be? Does that concern you?

PASCUAL-LEONE: Absolutely. I think that with this as with all other new tools or new developments in medicine, it is important to do the appropriate studies to assess the safety first and then progressively the efficacy. And that's a process that takes years, many years. It's a process that for the use of this tool, TMS, in the treatment of patients that have failed treatment for depression has been completed, and it is now approved by the Food And Drug Administration. Four different devices are approved, and it's being used in clinics throughout the United States.

For the applications in people with autism, it's not there yet. And it is important that they appropriate studies with appropriate safety and, indeed, as you're pointing out, with appropriate information to the patients that they are informed about what the potential risks could be, that that firm consent takes place.

GROSS: I'm speaking with Dr. Alvaro Pascual-Leone, and he is a neurologist who directs the Berenson-Allen Center for Noninvasive Brain Stimulation at Beth Israel Deaconess Medical Center, which is a teaching hospital of Harvard Medical School. And he's a professor of neurology at Harvard Med School. He wrote the introduction to a new book by John Elder Robison who has received the kind of transcranial magnetic stimulation that we've been discussing. And he has autism what was originally diagnosed as Asperger's syndrome and is now considered to be on the autism spectrum.

So he's received a series of about eight of these transcranial magnetic stimulations and has written a new book about it called "Switched On: A Memoir Of Brain Change And Emotional Awakening." And Dr. Pascual-Leone wrote the introduction for the book. John, welcome to you. Before I ask you a question, I just want to say Dr. Pascual-Leone, you mention in the introduction - it's kind of a disclaimer when you say this - that John isn't a patient per se. Your treatments weren't to cure him, per se. What were the treatments for?

PASCUAL-LEONE: Well, I think that the reason why that's important is because the mindset of the physician trying to help a patient or the mindset of a scientist trying to do a research study are necessarily different. Oftentimes, as a physician, obviously what is important is to help the patient whether it is thanks to what we do or despite of what we do, if we help the patient in a sense, we've done our job. And therefore, the focus is on the individual. In science and in clinical trials, oftentimes the focus on the individual is less clear because what we want to do is find the fundamental principles, the truth underlying a given condition.

And I was not his physician, I was a principal investigator of the study. But in addition to that, it's important to emphasize that the studies that John participated in were not clinical trials for therapy. We were using TMS as a tool targeting different brain areas to understand specific aspects of the functioning of the brain in individuals with autism. So it wasn't aimed at improving anything in any kind of lasting way. And I think it is the insight of John that clarified that even a short-term intervention where we learned something about the functioning of the brain can have a profound and lasting impact on the way people live.

GROSS: What parts of John's brain were targeted in the study?

PASCUAL-LEONE: So we targeted different areas in the frontal part of the brain - the frontal lobe - that is right under the forehead, both on the left and the right side. And we targeted those areas because we wanted to understand the role and relationship to empathy, to be able to read emotions in people's eyes. And then in a second series of studies, we targeted the motor areas to try to understand how long the effects would last, how efficient the brain is in terms of its mechanisms of plasticity, its capacity to change.

GROSS: John, why were you willing to participate in this study and what were your hopes?

JOHN ELDER ROBISON: When I learned about this study from one of Alvaro's researchers, I was just immediately captivated by the idea of TMS. I had never heard of TMS before, but I had worked with the underlying electronic technology in my career as an engineer. And I just thought how cool is that, to apply the technologies I used in rock 'n roll sound systems to change the brain? And at the same time, the goal of the study to maybe improve emotional insight, as Alvaro said, that spoke to the heart of something that I felt had disabled me all my life. So I was fascinated and captivated by it.

GROSS: My guests are John Elder Robison, author of the new memoir "Switched On" and Harvard professor of neurology Dr. Alvaro Pascual-Leone. We'll talk more after a break. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: This is FRESH AIR. I have two guests. John Elder Robison has written a memoir called "Switched On" about receiving transcranial magnetic stimulation, TMS, as part of a research study on the use of TMS on people with autism. After the treatments, he experienced empathy for the first time. Dr. Pascual-Leone is the principal researcher on that study and is a professor of neurology at Harvard Med School. John, one of the most profound things that happened to you as a result of the electric stimulation to your brain was your experience of music.

Now, you used to be an engineer working at rock concerts, designing sound systems and flashy things (laughter) for bands like Kiss. And then you became an auto engineer - a car engineer - and have your own shop. So music has really been a part of your life. But after these treatments, you started experiencing music differently. Can you talk about the before and after experience of music?

ROBISON: There were two things that were really profound for me. First, when I work as an engineer in music, I used to hear every little detail of the performance. You know, the guy would hit a note on the bass guitar and I would hear the buzzing of the snares on the bottom of the drum. Or the singer would walk across the stage and I would hear the swishing as he dragged the cable behind him. And to me, those were all clues that things were working or not working. And after I stopped working in music, that kind of rich detail faded away, and I sort of went from hearing music through a wonderful sound system to hearing it like through a cheap transistor radio. And it was a gradual thing over 30 years.

And when I came out of the lab after one stimulation and I turned on the stereo in my car, just the majesty of it and the brilliance and clarity, it was so real and so alive, it made me cry all the way home. And I wrote Alvaro and I told him that when I got home. And the thing is, it wasn't that they created something new, they reactivated something that was, like, so central to my life and it had faded away. And it was like magic.

GROSS: My impression from your book is that you also experienced an emotional quality to the music that you hadn't experienced before.

ROBISON: That took a little while longer for it to sink in for me, but that's absolutely right. What I first heard was all of the technical detail, like I said to you. I never really - in producing music - heard what the songs were about. What I heard were all the details that I had to hear to do a good job of delivering that sound to the audience. But somehow after the stimulation, I heard what the songs meant, you know? That they were love stories or sad stories or stories of hope, and I hadn't heard that part of the message before - as much music as I had done.

PASCUAL-LEONE: Can I raise an issue that we found interesting, Terry?

GROSS: Please.

PASCUAL-LEONE: So, you know, when you apply TMS, you hold a coil - it's like a plastic covered spoon of - you know, like a paddle - over the person's head. And the person doesn't really know exactly what part of the brain you're targeting. They feel a tap, they hear a clicking, but we're aiming it for specific parts of the brain. And we use the fact that the subject doesn't know exactly what part of the brain we're targeting as a way to control the specificity of the effects - targeting different areas as controls, as I was describing.

So the experience that John is describing happened when targeting one very specific part of the brain in this frontal area that I was describing. It did not happen when we targeted other areas. So it wasn't every time that he experienced TMS that he had this experience but only when targeting a given area - an area that we had hypothesized would lead to an increase in emotional connectedness. If we were able to suppress it appropriately - because we had hypothesis - that activity in that area is excessive in the case of autism. And it's excessively suppressing the normal circuitry that allows people without autism to relate to emotions appropriately.

GROSS: Oh, so that's really interesting. I would have thought you were activating that circuitry, but you're actually suppressing it.

PASCUAL-LEONE: Yes.

GROSS: And explain again why for someone with autism, you're suppressing that particular circuitry as opposed to activating it. What's the theory behind that?

PASCUAL-LEONE: So we had hypothesis - it is just, you know, with an experiment to see whether this is true or not. The fact is that individuals with - in the spectrum of autism, spectrum disorders - have difficulties understanding, reading emotions. And that can be shown and tested in a variety of different ways. But for example, you present faces expressing different emotions and individuals with autism don't recognize the emotion as readily or not at all in some instances. And one possibility is that the circuits of the brain that allow those without autism to recognize emotions, that those circuits are not there or are faulty or are damaged in some form.

But another possibility is that circuits of the brain that control those circuits, that those are excessively good at controlling - that there is too much of a suppression of that circuit. The reason why we need those circuits is that in some circumstances, we need to suppress our own emotions to be able to do things, things that make us cringe or that are painful. Think of a physician. When treating a patient, we have to do things to the patient, like draw blood, where we know it may cause some discomfort or some pain. And in order to do that, we need to control our emotional response to that. Well, if you have an excessive control of the emotional responses, you may end up being disabled by a lack of emotional resonance. And that was the hypothesis we had. That's why we were doing the experiments that John was participating in.

GROSS: My guests are Dr. Alvaro Pascual-Leone, a professor of neurology at Harvard Med School and John Elder Robison, author of the memoir "Switched On." After we take a short break, we'll hear how the TMS treatments enabled Robison to experience empathy for the first time. I'm Terry Gross, and this is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: This is FRESH AIR. I'm Terry Gross. We're talking about the experimental use of transcranial magnetic stimulation - TMS - for people with autistic spectrum disorder. TMS uses electromagnetic fields to affect changes in the brain. My guests are John Elder Robison, who has written a memoir called "Switched On" about receiving these experimental treatments - he's on the spectrum - and Dr. Alvaro Pascual-Leone, who's the principal researcher behind the study Robison participated in. Pascual-Leone is a professor of neurology at Harvard Med School and director of the Center for Noninvasive Brain Stimulation at Beth Israel Deaconess Medical Center which is a Harvard Med School teaching hospital. When we left off, John was talking about how the TMS treatments caused him to hear the emotional qualities of music that he had never experienced before.

So, John, in talking about how this electronic stimulation of your brain caused you to experience music in a more emotional way, what about in the rest of your life when that part of your brain was activated - or I should say suppressed - did you experience more emotion in your interactions with people? My impression from your book is your empathy increased. Your ability to read other people's emotions increased.

ROBISON: That's right. I was always possessed of strong emotions. What I wasn't as possessed of was reaction to situations with other people. And, indeed, after another stimulation, when I could look in your eyes and, like, feel like I was just reading your thoughts which was really weird and powerful for me because that had never ever happened in my life. I experienced exactly what Alvaro alluded to. And just a moment ago, where just looking at somebody and having her tell me about putting a water pump on her car, but I would look at her and I would see that she was, you know, worried and frightened and anxious.

And I though, you know, excuse me. I got to go outside and gather myself for a second because I was almost reduced to tears by an ordinary conversation of commerce. And I think that looking back on that time, I now see that having this unregulated ability to read emotion was actually, for me, perhaps more disabling than being oblivious to the emotion because when I was oblivious, I could just listen to her tell me about the water pump leak. And I didn't even notice if she was scared or anxious.

GROSS: Dr. Pascual-Leone, was this empathy component - the ability to have more empathy - did that come from suppressing the same part of the brain circuitry that activated John's ability to experience music in an emotional way?

ROBISON: That was a different stimulation.

GROSS: That was a different stimulation?

ROBISON: It was a subsequent one. But they might've been cumulative in the way they acted on me, at least the way I felt.

GROSS: Doctor, what do you have to say on that? Is that the same part of the experiment?

PASCUAL-LEONE: It was targeting the same area, so it had been - when we targeted the same area - as a control of the initial effects. So in that sense, yes, it must be related to the same phenomenon or it might be. But the striking thing to us was that the effects of brain stimulation the way we were applying it - a short period of time - it normally lasts for 30 minutes at the most. In terms of behavioral effects in what John was experiencing and describing were effects that were much later, much longer-lasting. And so it begs the question of how did it come about? We could demonstrate a certain effect on a computer-based task that we were doing in the laboratory. That effect was then gone. But what he was experiencing then was a change in the way he approached people that appeared to be related to whatever short-lived effect had been there from the TMS.

GROSS: Is it possible that he learned how to read emotions from that brief transformative experience?

PASCUAL-LEONE: I think so. I think what it suggests is that the possibility that a moment of insight, a moment of realizing, oh, wait, when people make this phrase, actually it means something. There is an emotion behind it, that that moment of insight enabled him to continue to focus on it and in doing so become better and better at it.

GROSS: John, does that make sense to you?

ROBISON: I think the same thing. You know, what was really funny is they said to me before we did this that the effects would last 15 minutes or half an hour. And frankly, when I was in the hospital to do this, I didn't feel any different. The things I said to you about being overwhelmed by emotion, that actually happened the next day. So it was like totally out of the range of what I had been led to expect.

As far as the idea of learning it, the way I see it now, I realize that people could tell me for all my life that there's this emotional language you're missing. People - there are stories in people's eyes. There are messages. And, you know, a million words were just a million words. It didn't mean anything to me. But when I actually experienced it, even if the experience was brief, I knew the slight truth inside of me, and it would never leave me. I would always, always know that that was in me and that people can read these emotions. And I always now will conduct my life with the knowledge of that experience. And that is absolutely powerfully transformative...

GROSS: And that sounds very...

ROBISON: ...In a way that words aren't.

GROSS: And that sounds very positive. But there was a very unusual outcome to this as well, which is that your second wife suffered from clinical depression, and you never really understood the sadness of that depression. And she was very helpful to you in helping you read other people's emotions. Once you started to be able to read other people's emotions, your relationship to your wife shifted, including the fact that you were able to read her sadness. And experiencing her sadness sounds like it was just overwhelming for you.

ROBISON: You're right. But it was much more than that. When I volunteered for this study, I had, I guess, this fantasy in my mind. I thought, well, people could say bad things about me, and I've gotten that all my life. And I thought because I was oblivious to these emotional signals that there must be all these messages of beauty and sweetness in life that I was missing. And if only I could get them, things would be wonderful for me.

And when I was able to see emotion, it wasn't just in my marriage, it was in the people all around me. And I saw the world was filled with angst and fear and worry. But, you know, the really hardest thing was seeing people that I had thought had been my friends and realizing that they were laughing at me. And I thought we were all laughing together at jokes, and I was the joke. And that was really, really hard and it even affected my memories. I remembered things that I used to think were funny and in this new illumination, I was like the fool. You know, it was really painful and as much hope as I had for that, I can't remember a single thing that turned beautiful and sweet in my memory. But there's a lot of stuff that turned bad and sad.

GROSS: So you and your second wife subsequently divorced, and you've since remarried.

ROBISON: That's right, yeah.

GROSS: Dr. Pascual-Leone, when you hear the story about how complex it is to actually experience emotions that John hadn't experienced before and the amount of kind of like sadness and regret that came with it because he experienced sadness. He understood other people's depression. He felt he was the butt of the joke. What does that tell you just about human condition and also the brain and your experiments?

PASCUAL-LEONE: It's incredibly interesting and incredibly moving. And it emphasizes the fact that we need to embrace the opportunity that we're giving as researchers of having human subjects that we have the honor to do research on. And we need to embrace the opportunity of actually listening to them and hearing their introspective report. Oftentimes, we don't do this well enough.

When somebody says as eloquent and gifted as John is in the introspection and the willingness to share it, we come to learn things that we often don't even anticipate. And this is one such example. We set up experiments to look for short-lived effects and for effects that are going to happen in the setting of the laboratory. And we anticipate that once that is gone that everything is back to normal, that nothing is lasting. And yet, what John describes is an inexperience that has an impact on subsequent day-to-day life in ways we wouldn't have anticipated.

GROSS: My guests are Dr. Alvaro Pascual-Leone, a professor of neurology at Harvard Medical School and John Elder Robison, author of the memoir "Switched On." We'll talk more after a break. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: This is FRESH AIR. I have two guests. John Elder Robison has written a memoir called "Switched On" about receiving transcranial magnetic stimulation, TMS, as part of a research study on the use of TMS on people with autism. Dr. Alvaro Pascual-Leone is the principal researcher on that study and is a professor of neurology at Harvard Medical School. So, John, can you explain a little bit more how that brief period of insight into emotion, how that became something you could draw on even when the effects of the magnetic stimulation faded?

ROBISON: Yes, I actually now see what I think is a really strikingly clear example. I came to the attention of the Harvard researchers after I wrote my book "Look Me In The Eye," my first book. And in that book, I describe a number of interesting accomplishments, if you will - designing rock 'n' roll sound systems, special effects, working on electronic toys at Milton Bradley, designing other electronic systems and then starting my automobile business and then, ultimately, taking up writing and photography careers. And I did all those things successfully, which makes me, I guess, kind of an outlier for doing those many things. And, you know, I - something, actually - I owe a great debt to Alvaro for that I should mention here. I felt like I did all those different careers because I had failed at them one after the other.

And I now realize that it's because I'm autistic that I could not see my own success. And I felt like I just flitted from one thing to another, and I was just, like, lucky by chance. And it was Alvaro who said to me, no, that can't be true. If it was just chance, you would have failed at everything. He said, whatever it is, you know, even if we don't understand it, there's something in you that allowed you to do that. But when you think about it, those were all solitary accomplishments. I designed a circuit. I made a thing. I did it by myself. And I was actually fired from jobs in corporations because I wasn't a team player and I couldn't fit in.

And now look at what my life - after going through this study five years later. And instead of being fired from a job, I serve on the federal autism committee for the secretary of Health and Human Services, and I work in a bureaucracy of 50 government and public officials. It's like - and they describe me as a unifying force. And I think what a striking change that I've gone from being someone who worked alone to someone who works almost entirely with people in government service, in my teaching now at William and Mary. The idea of me teaching in a college, you would've said that was crazy if you heard that 10 years ago. So that is a powerful, powerful transformation that I can engage groups of people successfully. And never before did I do that in my life.

GROSS: And I want to talk about another effect that the transcranial magnetic stimulation had on you, John. And this is just, like, an odd thing that happened. I think you were in a cafe, and there was an ambulance outside with its siren on. And you started howling with the siren. Would you just describe the experience of that as you recall it?

ROBISON: It was just, like, the weirdest thing. I was sitting in the cafe on the street at Beth Israel. And, you know, it's a crowded street. And an ambulance was at the curb and it just goes (imitating siren), you know, it just, like, blipped its siren for second. And I was just sitting there at the table, and I just howled in return. And it's just like it called me and I answered it. And I guess, even now, I describe it like it's no big deal, you know?

But it was a - kind of a weird thing for all the people around me. Sometimes I guess I would have these - I would have these just weird things that I would feel or do after the TMS experiments. And I would kind of get the sense that it felt perfectly natural, but maybe if I said it to the wrong person, I would end up locked in an observation cage in the basement of the hospital, you know?

GROSS: Doctor, what's your neurological explanation of what happened?

PASCUAL-LEONE: I don't know. I don't think that we...

GROSS: (Laughter).

PASCUAL-LEONE: ...Have very good explanations sometimes. It's - you know, one of the dangers in what we do is that we can always come up with an a posteriori kind of explanation, a hand wavy kind of account of things. I tend to be cautious about doing that because it's easy to then come to believe one's own stories.

So I think that those are the things - those kind of experiences that John had are things that we didn't anticipate, that we didn't predict, that we were not looking for. And so it's a challenge for us to try to now set up experiments to understand them more fully, to figure out how we can learn from him, to design experiments to explore it further.

GROSS: My guests are Dr. Alvaro Pascual-Leone, a professor of neurology at Harvard Med School, and John Elder Robison, author of the memoir "Switched On." We'll talk more after a break. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: This is FRESH AIR. I have two guests. John Elder Robison has written a memoir called "Switched On" about receiving transcranial magnetic stimulation, TMS, as part of a research study on the use of TMS on people with autism. Dr. Alvaro Pascual-Leone is the principal researcher on that study and is a professor of neurology at Harvard Med School. Robison was profoundly affected by the treatments he received. What lasting effect have these experiments had on you? What do you experience now when you hear music? What do you feel when someone is telling you about their sadness?

ROBISON: I feel it now. And what's really funny is I can't go to movies anymore, I can't watch TV. Ten years ago, I could've sat through "The Texas Chain Saw Massacre..."

GROSS: (Laughter).

ROBISON: ...Eating popcorn and stuff and wouldn't have cared. Now it's really upsetting and really stressful to me just to watch the evening news. I can't do it. And I wrote in a draft of my book how I used to make jokes about people who would read a news story about something bad that happened on the other side of the world and they'd be all, you know, crying and wailing about it. And they must be just making a play for attention. But, you know, that happens to me now. I could pick up the newspaper and I could read a story, and it would make me feel like I was going to start crying and I couldn't read it aloud.

GROSS: You know, it makes me wonder - because this kind of empathy is so new to you, you didn't grow up developing the kind of coping skills to deal with all the sadness and pain and anxiety in the world.

ROBISON: It's like I lost a protective shield. All these memories that hurt me because I was, like, the butt of a joke or something, I now realize that I just kind of went through life. And people maybe said mean things about me, but I never knew so it didn't hurt. And now stuff like that, it really hurts a lot. And - but at the same time, I know that my ability to serve, like on these autism committees, I think that's the greatest thing I've ever done in my life. And I'm really proud I can do that, you know? And I think that this made it possible. And so there's pain that I felt from having these emotions come on.

But, you know, I'm just so proud that I could do this thing, you know, that's important to young people and other people with autism and differences. I'm so proud that I can go out and connect with people and do something that really helps people because I did stuff, like, in music. And it was fun to make guitars, and I loved it and it was really neat. But it didn't really help people. And being able to share these ideas and to speak, especially to young people, it really helps people. And I feel like this was a key part of making that possible. And that makes any pain of it worthwhile to me.

GROSS: Now, obviously, I'm hearing a lot of emotion in your voice right now.

ROBISON: Well, it makes me sad to think of the hurt - you know? - the hurt in my life. But I have that pride, too.

GROSS: No, I...

ROBISON: I have that too.

GROSS: I understand that. I'm wondering if I spoke to you 10 years ago before you had this experimental magnetic stimulation of your brain, would you...

ROBISON: Ten years ago, Terry, I wouldn't even have had a conversation like this with you. I couldn't have done it. I - and if we went back 30 years ago, I wouldn't even have talked to you. I'd have started taking apart your radio studio.

GROSS: (Laughter) 'Cause you're an engineer. But do you remember in your past before getting these experimental magnetic stimulations of your brain, do you remember ever tearing up while reflecting on your own experience?

ROBISON: No, things like that never happened to me before TMS. After all this seeing of emotion, though, one thing that I've come away with is the knowledge that I wanted all my life - to be able to read these emotions. But of course, reading emotions just makes me like everyone else. And I think a debt that I could never repay Alvaro and those scientists is that they showed me that my geeky ability to see into machines and see into things, that's my true gift in life too, that nobody else can do that.

GROSS: Right.

PASCUAL-LEONE: Thanks to the way that John has described it in a very simplistic sort of image is learning to drive a car, you apply the right amount of acceleration. But if your car was delivered to you with the handbrake on and you never knew that, then you would think, well, it doesn't drive quite as fast, but so be it. If you now all of the sudden are relieved of that handbrake, you're faced with a completely different challenge as to how to apply your foot onto the gas pedal because all of the sudden, it's sort of flying off from you.

So I think part of the challenges that John is experiencing in coping with emotions may have to do with the fact that this handbrake, as it were - this excessively controlled suppressed circuitry has been relieved of that excessive suppression by the moment of insight and the experience that he had. And we need to learn what the implications of that is and how to appropriately modify activity in those areas if we want to help people without the exposure to potentially negative consequences.

GROSS: Are either of you running into any pushback from the neurodiversity movement?

ROBISON: Absolutely, yes. I think mostly people who haven't really read my book and actually talked to me. They just think, oh, this is crazy, or this is a treatment that's going to be, like, forced upon me to normalize me. And I don't feel that those are real threats. And I guess I think it's kind of a magical thing. I - yes, people are skeptical of something that changes the brain. But I guess it's hard for me to imagine that you'd be feeling like a threat like that after you talking to me now.

GROSS: Doctor, the use of TMS for people on the autism spectrum is still in its experimental phase. What conditions are actually being treated now with transcranial magnetic stimulation?

PASCUAL-LEONE: So the Food and Drug Administration has approved four different devices that apply TMS for the treatment of patients with medication resistant depression by targeting a very specific part in the left frontal area. It's also approved - a different device is approved for the treatment of migraine. And then there are a number of devices approved for diagnostic applications, to map brain areas before surgery to protect them from the surgery and to define the areas that have to do with language or motor movements.

And there are a number of additional applications being explored by different companies with different devices targeting different areas for things like Parkinson's disease and cognitive problems, dementia, Alzheimer's disease as well as recovery from stroke. So there is a number of applications that are approved by the Food and Drug Administration, even covered by insurance - depression, particularly. And there are a number that are quite advanced in the clinical trials and hopefully close to us having the evidence where it really helps and how it best helps and being able to offer it to patients.

GROSS: I want to thank you both so much for talking with us. John Elder Robison, Dr. Alvaro Pascual-Leone, thank you so much.

PASCUAL-LEONE: Thank You.

ROBISON: Well, thank you for having us with you.

GROSS: John Elder Robison is the author of the new book "Switched On," a memoir of brain change and emotional awakening. Dr. Alvaro Pascual-Leone is a professor of neurology at Harvard Medical School and the principal researcher in the TMS study that Robison participated in. We have an extra on the podcast edition of today's show that there wasn't time for in the broadcast in which Robison talks about being the brother of Augusten Burroughs, who's best known for his memoir "Running With Scissors." Robison also talks about how being autistic prevented him from realizing that a man he regarded as a paternal figure was actually a predator.

Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.

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