A high school dropout no more . . .

This weekend I returned to Houston for a special engagement. The Monarch School, a place I’ve written about before, decided to give me an honorary high school diploma. There were ten kids in the graduating class, and me. In this shot, we're all lining up for the official photo:





Here I am, with the leadership of the school, as a newly minted graduate:



Each of the kids had done a senior project. One made a park bench for the new campus. Another wrote poetry. Several did art. One did a special education project. One wrote an essay about his mom and her struggles coming to America and raising him. Two kids promised to return to school after graduation and help with programs, like sports.

And one kid, in a wonderful display of Aspergian eccentricity, made a multi-pane display for school yearbooks. As he said, it’s configured to be free-standing, hung from a wall, or used as an ornamental door.

I wished I had a project of my own to tell them about.

It was a remarkable display that showed why Monarch is unique, and shows the benefits of small schools in general. http://www.monarchschool.org/

After graduation, there was time for a trip to the Ship Channel, http://en.wikipedia.org/wiki/Houston_Ship_Channel the highlight of any trip to Houston. The best place to see the channel is east of town, by the Battleship monument. If you go all the way to the end of the road you'll reach the Lynchburg Ferry, which you can ride for free till the service ends at dark.




There are two ferries, which swap sides every 15 minutes or so. I rode the William P Hobby. The photo above shows the Ross S Sterling as we meet mid-channel.


Here are some pictures of the traffic, which I watched till dusk. The towboat Elizabeth Bleiler passed close by, with two barges:









A lone biker rode watched the channel from his hog:






As the sun began to set, the tanker Stolt Creativity headed out to sea. Stolt Creativity is a 37,000 ton tanker that carries specialty petroleum products.








The light was too low to get the name on this one, my last tanker of the evening:



The refineries glittered like gold as the lights winked on at dusk:







After that, I drove back to the Galleria for dinner, where I encountered this van in the garage. The name truly says it all.



They’re online, for real, at http://www.texaslicesquad.com/

I’ve been scratching a bit since dinner.

A visit to the TMS lab, and some questions answered

I’ve started getting quite a few questions about the TMS work I’m participating in at Alvaro Pascual-Leone’s lab in Boston http://www.tmslab.org/ I’m going to answer a few of them here. Feel free to ask your own questions in the comments. I’ll try to answer, and I’ll run any technical or medical questions past Alvaro, Shirley, and the other doctors to make sure I have the facts straight.

What is TMS?

As we think, our brains generate small electrical signals. These signals pass through our nerves to work our muscles, and the pass within our brains to create our thoughts and memories. All our nerves work on electricity – nerves in our eyes, ears, and even our nose generate electrical signals that our brain interprets and processes.

TMS uses the principle of electromagnetic induction to add its own signal to the signals running along our neural pathways. TMS is very precise, so we can aim it at fairly specific paths. For example, we can use TMS to stimulate one finger in the hand. By applying TMS pulses to the part of the brain that controls it, we can make the finger twitch.

These pulses can augment the function of a brain area, or they can inhibit it. So you might say they allow us to “speed up” or “slow down” small parts of the brain. The TMS equipment we’re using in this work focuses on a bit less than 1% of the brain mass.

So how could it help people with autism?

Shirley and Alvaro developed a theory that some parts of the autistic mind are over-active, and those overactive parts sort of overwhelm the other parts. By “slowing down” the over-active areas they hoped to bring about an improvement in overall function.

In this first study, several areas were targeted over four sessions.

So far, my results look very, very promising. Really exciting stuff. We also have positive initial results from a few others in the study. But it’s too soon to say more – we need to analyze the data and run more experiments.

Now, if I may, I’d like to show you what it looks like. Meet Shirley Fecteau, PhD, the leader of this particular study. She’s an instructor at Harvard Medical School and a part of Dr. Pascual-Leone’s team at Beth Israel Deaconess Medical Center.




Shirley is French-Canadian. One of the things I've noticed is that people have come from all over the world to work in these Harvard programs. They really do get the best and the brightest from all over.

In this image you can see me getting TMS to the right front of my brain.





She's holding the coil against the side of my head. The black headband has some targets on it that allow two computer cameras on the wall to track my head so she can keep the coil in the right spot. You’ll notice I have a blank expression. That’s because the TMS induces an almost meditative state in me. The picture you see is not a setup, it’s real TMS.


This next shot shows a bit more of the setup. You can see the cameras on the wall, looking down at the chair. Those cameras feed the computer below, which tells Shirley where to hold the TMS coil. Fellow Aspergian Michael Wilcox is in the chair, and he's going to write about his TMS experience on his own site, which is http://www.mfw.us/ The fellow with the camera is filming is for a Canadian Television documentary based upon Dr. Norman Doidge's book The Brain That Changes Itself. Dr. Doidge and the crew came to see us 2 weeks ago and I took the chance to shoot a bunch of photos.






In this photo, you can see the brain map and the targets for stimulation.





The upper right view has some small colored dots . . . those are the target areas. The pair of cameras on the wall match points on my face with the MRI images to show them where to place the TMS coil.

The crosshairs on the left show the coil (the black) dot with the target area being the X

This shot shows the actual TMS machine:




Here's a better view of the TMS coil, on my son Cubby's head:




The hose coming out of the coil is an air line, to pass air through the coil to cool it. The coil is a figure 8 of wire in the blue plastic casing.

And a few more questions before I go . . .

Does TMS damage or kill brain cells?

In my previous post, I described some pretty dramatic effects from TMS. Someone on the http://www.ageofautism.com/ site asked if those vivid images were produced by "millions of neurons dying off."

TMS does not injure or kill brain cells. In this study, we are using what's called functional MRI imagery to watch brain activity before, after, and even during TMS. We can see areas become less active, or more active, and we see them return to their pre-TMS states. We can say with certainty that TMS is not killing brain cells.

We are able to watch the areas of the brain that we stimulate change and evolve.

In addition, Alvaro and other neuroscientists have observed the effects of TMS during open-brain surgical procedures in patients. TMS alters the signals passed through the neurons. It does not burn them out.

Is TMS like ECT, electro convulsive or shock treatment?

Not really. It's only similar in that they are both electrical processes. To use an analogy, TMS is like touching your fingers across the terminals of a AA battery. ECT is like throwing a cable over a high-tension electric powerline. Needless to say, both are electrical experiences but their effect on the person is drastically differrent.

TMS is a low-energy and highly focused procedure that's aimed at less than 1% of the brain mass. It's painless and in fact induces something of a tranquil state while it's being done. For me, TMS has produced a lasting elevation of mood and made me somewhat calmer overall.

ECT, on the other hand, is a very violent, high energy jolt to the whole brain. It induces seizures and it's so painful that people must be under general anesthesia. As you can see, none of that happens with TMS.

I'm aware that any tool that reaches into the brain and alters the way we think is scary. I guess it's not as scary for me because I have a good understanding of the electronic principles, and I'm seeing it unfold firsthand. And it's also exciting. The results I am seeing are truly like science fiction come to life.

Brain plasticity in action

A few posts back, I told you I was beginning a research collaboration with the neuroscientists at Harvard’s Beth Israel Deaconess Medical Center. In the study, we are focusing magnetic energy into my brain (I am one of several volunteers) in hopes of inducing brain plasticity.

I am still gathering my thoughts on the TMS work, but I will say this . . . the results I have seen are mind-boggling. It’s like science fiction, but for real. I don’t want to say too much more until I have test results to back up my words. But stay tuned . . . I assure you, it will be worth the short wait.

As you wait, keep in mind that I am personally experiencing this. This is not a thirdhand interpretation. Right now, I’d like to quote a letter I recently sent to Dr. Alvaro Pascual-Leone, director of the TMS program, and Shirley Fecteau, PhD, who’s running the current investigation. This experience occurred right after a TMS session:

Dear Alvaro and Shirley,

Today, your TMS gave me back something I did not know I had lost. Suddenly, I can see music again. Let me explain. Over the past 20-some years, I thought music had lost some of its richness; some color, but I accepted that as the gradual decline of my ears with increased age. Kind of crummy, but there it is.

Tonight, driving home, I became bored and switched on my iPod. I've got it loaded with the music I loved best, back when I did music. Most of my songs are original live recordings, the real thing, errors, mistakes, and all. Not the polished stuff that comes out of the studio. I switched it on to Diana Ross, recorded live in Las Vegas. I listened absently for a few minutes, and suddenly realized something was different. I turned up the volume a bit. It took a moment for me to get it, and then it hit me right between the eyes.

I could see the music. Again.

I listened some more, and realized it was true . . . I could “see” the voices, the microphones, the costumes glittering in the light; I could see the backup singers, and I could pick out the instruments out one by one. I heard her hit a triangle, and I could see it in my mind, clear as day, held up by the mike as she rang it. I could hear the emotions in her voice, and I could sense happy and sad and excited and tired.

I saw her in my mind, standing by the stage with me 30 years ago as we watched the band. I could see the instruments and hear them play, individually or within the fabric of the song. I could reach into the songs, and hold the individual bits and pieces in my hand.

Even the little stuff . . . the wind chimes; the bells; and the noises on the stage. I saw them all, just as clear as day, like watching a video. I could hear the echo as the vocals kicked back off the rear walls of the arena and came back into the stage mikes. I could see the crowds below. It was alive, and it kept changing.

A minute later, I listened to Eddie Holman announce his song, Hey There Lonely Girl in a hall in New Jersey, and I could see him speak. I didn't see him, exactly, but I saw my friend Willard Cofield, a prominent black Baptist pastor, who embodies something of his voice and expression. I could hear and feel the joy in his expressions as he shouted into the mike at the end of the song, "thank you for 33 years, three sons, and six grandchildren!"

It felt just like being there, with all the power of the original performance.

As I listened to three black musicians talking between songs, I could see my friends – Bobby Hartsfield and Seabreeze, standing outside my shop by their Harleys, and I saw the same expressions on their faces that I heard from the guys on stage. It’s like I could see the feelings of the guys on stage and link it to the “closest match” in people I knew; in the faces of my friends. An old recording transposed into the setting of Springfield, Massachusetts, yesterday. But not the music. The facial expressions and feelings. Strange, but not strange.

I listened to McFadden & Whitehead sing a song they wrote for Marvin Gaye, and I realized I could pick out the individual keyboard instruments. I could see them in my mind, too, three stacked keyboards with a fourth – a piano – to the side I saw the Korg on top and an old Hammond B3 on the bottom. I could see the keyboard player walking one hand along the Korg and the other on the B3, and then I could switch and follow the bass guitar.

I could pull them out of the music just like being in the studio, when I’d put on the headphones and hit the monitor button on the console. When you’re in a recording studio, making a record, you record every instrument and voice on its own track, so you can control it. That’s what I could do in my mind – pull the individual voices and instruments out of the background. But I did it without electronics. I had a digital processing suite in my mind, 20 years before they were invented.

Words cannot express the richness of the material I could hear. I listened to Tavares come on stage. Tavares is a group of brothers; they played the Boston club circuit when I started out and then made it big when they recorded the soundtrack for Saturday Night Fever with the BeeGees. I could hear them passing the vocal parts back and forth as they opened Penny for Your Thoughts; I “heard” the subtext of the show. Now, that particular recording of Tavares turned to shit on the next song as the PA system picked up an arrhythmic "pop-pop" noise that was totally out of sync with the music.

Yesterday, that "pop" was so objectionable, I'd have skipped their song Heaven, but tonight I played it through. And I found I could lock onto each voice, and the instruments in back, one by one. And I could filter the pop right out with my mind. It was like I had a noise cancellation program running in my head.

These are not new abilities. Do you remember how I said I could see the music when I was young? This is what I saw and felt. It's faded away over the years, and I guess I didn't know it was gone. Until now. Experiencing its return is to say the least, stunning. Will it last? I guess time will tell.

That ability is what took me to the top of the world, making musical electronics, 30 years ago.

A few weeks ago, I said I thought I'd lost many of my old technical abilities as I developed new skills; new paths. You told me you suspected the old abilities I thought were lost were still there, dormant in my mind.

Well, today you woke them up.

The incident with the gun, my brother, our father, and me

In my brother’s new book, A Wolf at the Table, there’s a scene where we have a family fight, and my brother runs into my room. He grabs my gun, hands it to me, and says, “Kill him!”

When a reporter asked me about that scene, I said: It wasn’t as big a deal to me as it was to my brother. I’m eight years older, so my perspective is a lot different. And it was, after all, only a BB gun.

To my enormous distress, people have seized bits of that statement and used it to suggest that the scene, or even the whole book, is exaggerated and made up. It’s not. My brother, my mother, and I all agree on the essential truth of the book. We certainly agree that my father was frighteningly mean when he was drunk. And in those years, he was drunk every night, whenever he was home.

The only time he was sober was when he was at school, so his colleagues and students saw a totally different side of him. Luckily, I too saw that side of him later in life, after he stopped drinking.

The fact that my little brother – a small child at the time – felt the need to grab a gun to defend us says a lot about how life was at that time.

Fights with drunks can get ugly.

The fact that it was a BB gun is irrelevant to the true emotional tale my brother relates: I was holding our father at gunpoint. The fact is, my brother was terrified and thought that was the defense of last resort. So he got it, and gave it to me, because he believed I was his defender. And it worked. Our father went downstairs and things simmered down.

My brother also writes that I warned my father, “I keep the rifle loaded,” which I did. How many of you were proud teenagers with BB guns and air rifles? How many kept them loaded, in case a grizzly bear came through the door? How many of you can remember feeling like that?

As much as I am troubled by the scary stories from my youth, I feel I should share the story of why it was “only” a BB gun. And why we did not have a “real gun” in the house.

I wrote in Look Me in the Eye about how I grew up around guns. Down at my grandparents in Georgia, most every farmer or landowner had guns. Mine were no exception. When we moved to Massachusetts, my grandfather sent my father a gun, too. He sent him a WWII surplus Springfield bolt action rifle. Luckily, he didn’t send shells.

The gun arrived about the time my brother turned three. My father fell into a black depression, and talked of suicide. I wrote about some of those incidents in Look Me in the Eye. Here’s one that didn’t make the book:

My father would get drunk, and sit the gun on the floor, aimed at the ceiling. He’d be in his chair, at the kitchen table, with the old black and white TV in the corner. He’d drink his sherry, rest his head on the end of the barrel, and cock the gun and pull the trigger. Time after time after time. Yesterday, our mother told me she remembered going to sleep to the click of the empty gun. Frightened, she gave it to a friend for safekeeping. I have it today.

So there you have it. That’s the reason there was only a BB gun in our house.

There are a number of other inaccuracies that are being reported. One reporter said, [A Wolf at the Table] claims Robison put a cigarette out on Burroughs' forehead. That’s wrong. That is in my book, in a chapter called The Nightmare Years, and also in my brother's 2003 memoir Dry.

When I wrote that, my mother read it and said, I don’t remember that happening, but I just don’t know . . .

My first wife read it and said, Oh my, when you were seventeen years old you showed me a mark on your chest where he’d burned you with a cigarette. Don’t you remember? It was on you! Thirty some years later, spot has vanished and the memory has faded. So the evidence suggests that both my brother and I may have had cigarettes mashed out on us, and we've repressed the memories. Obviously people can have different and even contradictory memories of bad things. That’s how memory works. Saying we're in disagreement about those points is simply untrue.

After reading this story, I hope you will re-read the epilogue to Look Me in the Eye, where I made peace with my father at the end of his life. Because that’s how I want to remember him today. People do change, and the last half of my father’s life – after we’d left home and he was remarried - shows that.

In closing, let me just affirm I am very disturbed to see my words taken out of context and used to fan the flames of controversy when in fact there is no controversy. My brother and I don’t have any dispute about the content of our books. Augusten and I may interpret the meaning of childhood experiences differently, but we do not disagree about the underlying events themselves. And those are the facts.

Here's a link to order my brother's book:
http://www.amazon.com/Wolf-Table-Memoir-My-Father/dp/0312342020/ref=pd_sim_b_img_6

My brother and I are in the NY Times today with his new book

You can read the story here:
http://www.nytimes.com/2008/04/24/books/24burr.html?_r=1&scp=1&sq=augusten&st=nyt&oref=slogin

No words, but some scenes from Boston this spring afternoon

Train tracks



Street art



Reflection in a Jetta



Approaching streetcar

Standing on the brink

On more than one occasion, I’ve had people ask me, “If you could take a pill and get rid of your Asperger’s, would you do it?” I’ve always said, “No! I’m proud to be Aspergian and I wouldn’t change it for anything.”

Asperger’s is an essential part of who I am. In fact, its how my brain is wired. My brain’s unusual wiring manifests itself in many ways. I say unexpected things. I have weird mannerisms. I come to surprising conclusions when solving problems. To most people, my mind just works in strange ways. When I was younger, that troubled me to no end.

I always knew I could take pills to change the way I act. But my Aspergian impulses are pretty powerful, so I’d need a powerful pill to hammer them into submission. And I shudder to think of the side effects. I still remember seeing my parents in the state hospital, slowly wandering, mindless, and tranquilized into submission. The orderlies even had a name for it. They called it, “doing the Thorazine shuffle.”

Today’s brain pills may not have such dramatic side effects, but the complaints of sexual dysfunction, dry mouth, weight gain, or insomnia are well documented. Pills go in our mouths, dissolve, and affect the whole body. Pills aren’t intelligent. They can’t pick the one part of the brain that’s troubled and fix it. Body-wide dispersion is okay for fighting infection, or lowering fever. But it’s not okay for a pill that affects the working of the mind, at least, not for me.

But I’ve always wondered, What if there was an alternative to pills? If I could pick a part of my mind and change it and make it better, would I do it?

Until now, such questions were merely fantasies. No more. Right now, neuroscientists are working to make that dream a reality. In fact, one of the leading teams is right near me, at Beth Israel Deaconess Medical Center – a part of Harvard Medical School.

A group of researchers led by Dr. Alvaro Pascual-Leone is using focused magnetic fields to deliver energy to small parts of the brain without surgery. This energy can enhance or inhibit the functioning of specific areas of our brains, allowing treatment of small parts of the brain without affecting the whole. This technique is so precise that regions as small as 1 percent of the brain’s total volume can be treated. The process is called Transcranial Magnetic Stimulation, or TMS.

The TMS energy is delivered by electromagnets held alongside the head. It’s clean, noninvasive and painless. The TMS energy causes the brain to form new connections and pathways. It provides the “push” to make the brain change. The brain changes in subtle ways throughout life, but TMS can accelerate and shape that change in a beneficial way.

I was immediately attracted to and comfortable with the idea of TMS, because it uses processes I knew from my time in electronics. When I worked at Candela Laser, we designed high-energy power supplies that were essentially the same as those used in TMS. And I used powerful electromagnets in both audio and laser work. When I began talking about this, some of my friends said, “Aren’t you scared having those magnets by your head?” I’m not scared, because the systems I used before were far more powerful than these. Admittedly, they were not focused into my head, but we engineers have a long history of co-existing with magnetic fields without ill effect.

In addition to my own experimentation, Dr. Pascual-Leone and others have done extensive research to validate the safety of magnetic therapy. It’s also been extensively researched in the context of MRI machines, which generate even more powerful magnetic fields.

All my life, I have worked hard to train and develop my brain. I’ve had good success teaching my strong parts, like logical reasoning, to take the place of weak parts, like social empathy. That has made my life far better, but it has limits. Now, TMS offers the possibility of removing some of those limits by targeting specific roadblocks within my mind, and enhancing or removing them.

The possibilities of TMS are staggering. Right now, the technology is helping restore brain function in stroke survivors. It’s helping chronically depressed people return to happy lives. A Google search reveals many articles and papers on the successful use of TMS in these areas.

The process has been fine tuned over the past twenty years, and it’s now a mainstream therapy for certain conditions in Europe. Based upon that success, Dr. Pascual-Leone’s team has set their sights on using TMS to help the autistic mind here in Boston.

I have decided to join Dr. Pascual-Leone’s team to assist in conducting and shaping this research. We both hope my Aspergian mind will provide insights to move the work ahead. I’ll be in an unusual position, since I’ll be an experimental subject who is at the same time involved in formulating the experiments. And throughout the process, I’ll be writing and telling the story to the wider world.

And so far, my own results look very promising. TMS did not effect any permanent change in me, but it opened my mind and gave a glimpse of what's inside. Remarkable, to say the least.

The prospect is both exciting and scary. It’s exciting because TMS may help my mind develop new abilities, and it may allow me to accomplish things I could not even have dreamt of before. But it’s scary for the same reason . . . I may change in unexpected and even unwanted ways. What if I don’t like the result?

But it’s irresistible too, because the process of shaping and delivering powerful pulses has always fascinated me. In fact, it was one of the things I specialized in when I worked in electronics. The similarities between the equipment in their lab and devices I’d worked with were immediately obvious to me.

As a child, I read a book called Flowers for Algernon. It’s the story of a team of scientists who find a way to make people smarter. As a test subject, they choose a mildly retarded janitor. And he becomes a genius, but it doesn’t last. After a little while, his intelligence fades before his eyes.

Will I suffer the same fate? I sure hope not, and my logical mind tells me such a possibility is extremely small. As always, I prefer to focus on the opportunities life offers. And I’ve got an ace in the hole . . . TMS is not permanent unless it’s reinforced by repeated treatment. Otherwise, the effects of TMS fade with time. That means we pay close attention to our results, and reinforce the beneficial ones while abandoning those that don’t work out.

All my life, I’ve been blind to social cues, facial expressions, and body language that others read instinctively. I can’t look someone in the eyes and know how they feel. Those parts of my brain just don’t work. You might say, those circuits aren’t hooked up.

What if TMS could help my brain make those connections? What would it mean to me, at age fifty? How could I know? It’s like asking a blind person what it might be like to see. Wiring differences like that create big problems for thousands, even millions, of people. What if we could address those problems without changing the essence of who we are?

What if we could remove the anger from a person who suffers from uncontrollable rages? We can do it today, with heavy tranquilizers. Can you imagine using TMS to do it without medication, leaving the essential person unchanged? Existing tools – heavy medication, electroconvulsive therapy, or lobotomy, are like sledgehammers in the mind. Suddenly, there’s the prospect of tiny tweezers to pick out microscopic slivers instead.

The most exciting possibility is that of extending this therapy to more profoundly autistic people. What if we could offer a non verbal person the power of speech? Today that’s a dream, but it may become a reality through techniques pioneered in the Beth Israel Deaconess labs.

Some people read about TMS and the phrase “a cure for autism” comes to mind. I’m aware such talk generates tremendous controversy. Dr. Pascual-Leone is quick to say TMS does not “cure” autism, but that does not stop the gut reaction many people feel. On the one side, we have parents desperate to “fix” their kids. On the other, we have grownups on the spectrum, who say, “We don't want to be fixed, and we have the right to live our lives in peace.” That’s what I’ve always said too, while faced with existing sledgehammer treatment options. Now, with the possibility of gradual growth and change through a process that’s the mental equivalent of physical therapy, I have to rethink that position.

The idea that I can change and hopefully improve my brain in a gentle, progressive, and reversible way is just fascinating, and irresistible. TMS could offer the ability to make our brains work better. I invite you to accompany me on this journey, as we learn some of the implications of fine-tuning the mind. I look forward to sharing the story of our research as we move ahead.


For additional reading:

The lab’s official site
http://www.tmslab.org/

Old brain, new tricks New research on the blind is revealing the brain's ability to adapt - and may lead to new therapies for everything from strokes to chronic pain
Published in the Boston Globe, January 15, 2006

Zap!
Published in the Boston Globe, January 14, 2003

Magnetic Pulse Seen as Boon for Brain Research
Morning Edition, NPR, January 25, 2007
http://www.npr.org/templates/story/story.php?storyId=7015109

Stroke Treatments
New Scientist, June 22, 2002
http://www.newscientist.com/article.ns?id=dn2423

And here are some videos from the Ted site:

http://www.ted.com/index.php/talks/view/id/184 brain segmentations and control

http://www.ted.com/index.php/talks/view/id/229 a doctor studies her stroke

http://www.ted.com/index.php/talks/view/id/236 brain control