TRY NOT TO BLINK

Some experiences don’t seem important when they happen. They don’t arrive with dramatic music or flashing lights. They simply lodge themselves somewhere in the back of your mind, refusing to leave. Years pass. Careers happen. You forget about them entirely until one day they quietly reappear, looking exactly as they did the first time, only now they’re asking a much larger question.

Mine began in 1997.

During a psychopharmacology course, my professor wheeled a television into the classroom, dimmed the lights, and announced we were watching a documentary about Tourette syndrome. Like most of my classmates, I was certain I already knew what Tourette syndrome was. It was the disorder where people uncontrollably shouted obscenities, right?¹ Medical school would later teach me that involuntary swearing, or coprolalia, affects only a minority of people with Tourette syndrome. At 34 years old, however, I possessed the kind of confidence that only genuine ignorance can produce.

I don’t remember the documentary’s title. I don’t remember who made it, where it was filmed, or even what network aired it. What I remember, more than forty years later, is one interview.

The interviewer had Tourette syndrome. So did the two children sitting across from him.

At first nothing seemed unusual. The interviewer asked a question while sitting almost perfectly still. One of the children answered just as calmly. Then something strange happened. As soon as the child began speaking, the interviewer started blinking, shrugging, grimacing, and making the small involuntary sounds characteristic of Tourette syndrome. When the child finished, the interviewer became quiet again, and the child immediately resumed ticcing. The conversation continued that way for several minutes. Whoever was listening displayed the tics. Whoever was speaking seemed, at least temporarily, to lose them. It looked as though the symptoms themselves had impeccable manners, politely waiting for one person to finish before interrupting the next.

The entire classroom laughed.

Not because anyone was mocking the children. We laughed because the timing was so absurdly perfect that it almost looked rehearsed. Even the interviewer seemed amused. Then the lights came back on, the television was rolled out of the room, and we all wandered off to our next classes, convinced we’d just watched an interesting documentary about a rare neurological disorder.

I hadn’t.

I’d watched the opening scene of a mystery that would quietly follow me for the next three decades.

Years later, medical school supplied part of the answer. Patients with Tourette syndrome often describe an uncomfortable sensation that builds until a tic finally occurs, producing a brief sense of relief. One patient explained it to me in a sentence I’ve never forgotten.

“It’s like trying not to sneeze.”

Everyone understands that feeling. You can postpone a sneeze for a while. You can distract yourself. You can fight it with sheer determination. Ironically, the harder you try not to sneeze, the more your attention becomes consumed by the effort. Eventually, the sneeze wins.

That explained why someone speaking might temporarily tic less. Concentrating on a conversation could redirect attention away from the mounting urge. But it still didn’t explain what I had seen. The interviewer hadn’t stopped having Tourette syndrome while he was talking. The children hadn’t recovered whenever they answered. Something else had happened in that room, something I couldn’t explain.

For years I assumed it would remain one of those small medical curiosities that never quite finds an answer. Instead, it kept showing up.

Sometimes it appeared in a patient whose symptoms refused to follow the rules. Sometimes it emerged from a neurology journal or a psychology textbook. Eventually it led me into the Salem witch trials, false memories, mass psychogenic illness, and an emerging branch of neuroscience that argued something almost heretical: the brain isn’t simply observing the world. Much of the time, it’s predicting it.

At first those subjects seemed to have nothing in common. One involved tics, another witches, another courtroom testimony, another mysterious epidemics. Yet every time I stumbled across one of them, I found myself thinking back to that classroom in 1997.

The question itself slowly changed. It was no longer, “Why did those three people seem to exchange their tics?” It became something much larger. How much of what we experience comes directly from the world and how much comes from the story our nervous systems have already begun telling about it?

As Oliver Sacks wrote, “To restore the human subject at the center, we must deepen a case history into a narrative.”² Looking back now, I think that’s exactly what happened to me. I thought I was watching a documentary about Tourette syndrome.

Instead, I was watching the first chapter of a forty-year lesson in how the human mind makes sense of reality.

The Brain Never Stops Explaining

For years I assumed the mystery from that Tourette documentary would eventually be solved by neuroscience. Somewhere, I imagined, there had to be a paper explaining exactly what I’d seen. Perhaps it involved dopamine, the basal ganglia, or some elegant neural circuit nobody had yet explained to me. Medicine has a reassuring habit of believing that every mystery has a mechanism if we’re patient enough to find it.

Then I became a psychiatrist.

Psychiatry has a way of humbling that kind of confidence. Every patient arrives with symptoms, but almost every patient also arrives with an explanation. The teenager who couldn’t finish homework believed he was lazy. The executive who misplaced a familiar name was convinced she had Alzheimer’s disease. The college student whose first panic attack struck in a shopping mall was certain he was dying of a heart attack. Before I ever met them, their minds had already connected the dots into a story that felt perfectly logical.

One family taught me just how misleading those stories can be. They described a boy who, they insisted, “couldn’t pay attention to anything.” Homework was a nightly battle, he never brushed his teeth, rarely bathed, chores never got finished, and dinner required constant reminders to stay seated. Then, almost as an afterthought, they mentioned that he’d recently spent an entire Saturday building a Lego city that covered the family room floor. He hadn’t needed encouragement, hadn’t wandered away, and hadn’t even noticed the time passing.

The problem wasn’t that he couldn’t pay attention. It was that he couldn’t decide what deserved his attention. That distinction changed everything.

As William James observed more than a century ago, “My experience is what I agree to attend to.”³ The longer I practiced, the more that sentence explained. Attention doesn’t merely determine what we notice. It shapes what we remember, what we fear, and eventually what we believe.

The same lesson kept appearing elsewhere. Patients with Parkinson’s disease who froze in empty hallways sometimes walked normally once simple lines were placed on the floor. People who stutter in conversation often sing fluently. Individuals with ADHD who can’t survive ten minutes of homework may spend an entire afternoon happily absorbed in something they love.⁴⁻⁶

• Many people with ADHD demonstrate extraordinary concentration when an activity is genuinely rewarding.⁴
• Visual cues can significantly improve walking in some patients with Parkinson’s disease.⁵
• People who stutter often sing far more fluently than they speak.⁶

The longer I practiced psychiatry, the less interested I became in symptoms themselves and the more interested I became in the explanations surrounding them. It slowly dawned on me that the mind isn’t content to experience the world. It insists on explaining it, often long before all the evidence has arrived.

That didn’t solve the mystery from 1997. It made it bigger.

Because if one mind can build a convincing explanation from incomplete information, what happens when an entire community does the same thing?

When Stories Become Contagious

The question that began with three people in a Tourette documentary eventually led me somewhere I never expected to go.

Salem.

Not because I had a particular interest in colonial America, and certainly not because I believed in witches. I went there because I was looking for another example of intelligent people witnessing the same unexplained events and arriving at conclusions that, centuries later, seem almost impossible to understand.

It’s comforting to imagine we would have been the skeptics. We picture ourselves quietly rolling our eyes while neighbors accused one another of witchcraft, wondering how otherwise sensible people could believe something so extraordinary. Some of us blamed the patriarchy. Some of us blamed ergot poisoning.

History is rarely that generous.

The Salem witch trials didn’t begin with executions. They began with uncertainty. A handful of young girls developed disturbing behaviors that no one could explain. Physicians reportedly found no obvious medical illness. Ministers, parents, and neighbors searched desperately for an answer, and in a deeply religious Puritan community one explanation already existed, waiting to be used.

Witchcraft.

Once that explanation took hold, every strange behavior became another piece of evidence. Every accusation reinforced the last one. Every denial sounded suspicious. Looking back, it’s tempting to ask how so many people could have believed something so implausible. The better question may be how difficult it would have been not to believe it once everyone around you accepted it as reality.

As Voltaire wrote, “Those who can make you believe absurdities can make you commit atrocities.”⁷ Our minds dislike uncertainty. An unanswered question is psychologically uncomfortable. A convincing explanation, even a wrong one, offers relief.

• More than 200 people were accused during the Salem witch trials.⁸
• Twenty people were executed before the panic subsided.⁸
• No credible physical evidence of witchcraft was ever produced.⁸

What fascinates me about Salem isn’t the superstition. It’s the humanity. These weren’t comic-book villains roaming the countryside looking for innocent victims. They were frightened parents, ministers, physicians, judges, and neighbors trying to understand events that made no sense. Surrounded by the same conversations, fears, and assumptions, I suspect most of us would have reached remarkably similar conclusions.

Psychiatry has made me much less confident that I would have been the lone skeptic.

I’ve watched families quietly become convinced that one child is “the problem,” until every forgotten chore, every sarcastic remark, and every slammed door becomes fresh confirmation. I’ve seen workplaces decide one employee is impossible to work with, after which every interaction is interpreted through that single conclusion. Once a shared explanation takes hold, new information rarely arrives as neutral evidence. It arrives already shaped by the story everyone believes.

The Salem witch trials stopped looking to me like an embarrassing historical curiosity. They started looking like a very human one. And that raised another unsettling possibility. If stories can reshape how communities interpret events, could they also reshape what people remember?

The Memories We Build

If Salem taught me that groups can come to believe extraordinary things, another chapter of American history forced me to ask an even more uncomfortable question. What if they could sincerely remember things that never happened?

For most of my life, I thought memory worked something like a filing cabinet. Experiences went in, the brain stored them, and years later we pulled them back out more or less intact. Sure, we forgot details. Dates got fuzzy. Names disappeared. But I assumed the basic event itself stayed put. Psychologists eventually demonstrated just how wrong that assumption was.

Beginning in the 1970s and accelerating through the 1980s and 1990s, researchers like Elizabeth Loftus repeatedly showed that memory is surprisingly easy to reshape. Ask leading questions, repeat a suggestion often enough, mix imagination with genuine recollection, and perfectly intelligent people can become deeply confident about events that never occurred. The memories aren’t lies. They’re experienced as completely real because, to the person remembering them, they are.⁹

That discovery arrived at almost the same moment America became consumed by one of its strangest moral panics.

The McMartin Preschool trial began with allegations that children had been abused at a daycare center in California. As investigators searched for answers, the accusations became increasingly extraordinary. Tunnels beneath the school. Secret rituals. Flights in hot-air balloons. Animal sacrifices. Thousands of alleged victims. Yet after years of investigations, enormous expense, and the longest criminal trial in American history at the time, no physical evidence supporting those claims was ever found.¹⁰

Looking back, it’s easy to laugh at the absurdity. People didn’t laugh then.

Parents were terrified. Investigators believed they were protecting children. Therapists believed they were uncovering hidden trauma. Reporters believed they were exposing a vast conspiracy. Almost everyone involved thought they were doing the right thing. The tragedy wasn’t that evil people fooled everyone else. It was that ordinary people, acting with good intentions, gradually reinforced one another’s certainty until doubt became almost impossible.

• The McMartin Preschool case lasted nearly seven years.¹⁰
• It became the longest and most expensive criminal trial in American history at that time.¹⁰
• No convictions were ever obtained.¹⁰

The more I read about McMartin, the less it resembled an isolated legal disaster. It looked remarkably similar to Salem. Different century. Different vocabulary. Same human machinery. Faced with uncertainty, people searched for an explanation. Once that explanation took hold, every new piece of information was interpreted through it.

That realization changed the way I thought about memory. Remembering isn’t like opening a filing cabinet. It’s more like telling yourself a story over and over again. Each retelling preserves most of the plot, but it also quietly edits the details. New information slips in. Old details fade. Certainty grows even as accuracy sometimes declines.

As Arthur Miller, whose The Crucible transformed Salem into a warning about every era, understood so well, societies don’t simply pass stories from one generation to the next. They also teach us which stories we’re expected to believe.⁵. By now, the question that had begun with Tourette syndrome had changed once again. Maybe the most remarkable thing about the mind isn’t that it remembers. Maybe it’s that it rewrites.

When the Body Believes the Story

By the time I finished reading about the McMartin Preschool case, the question that had begun with that Tourette documentary had changed yet again. If attention can be shaped, and memories can be reshaped, where does the process stop? My instinctive answer was the body.

Surely memories could be wrong while muscles, lungs, skin, and nerves remained stubbornly honest. Then I stumbled across mass psychogenic illness.

I almost skipped the chapter. The name sounded terrible, conjuring images of people pretending to be sick or doctors dismissing suffering with the phrase, “It’s all in your head.” Instead, I found researchers describing something far more interesting. The symptoms were entirely real. The headaches, dizziness, nausea, tremors, weakness, even paralysis were genuine. What wasn’t real was the danger people believed had caused them.

As Robert Bartholomew, one of the leading researchers in the field, wrote, “Mass psychogenic illness is a normal response to abnormal stress.”¹¹ I love that definition because it removes the blame. These aren’t irrational people. They’re ordinary nervous systems doing exactly what evolution encouraged them to do. When the choice is between overreacting to a possible threat and ignoring a real one, evolution has generally favored false alarms.

The medical literature is filled with stories that sound almost fictional. Workers smell an unfamiliar odor, and dozens become ill before investigators discover there was no toxic chemical. Students begin coughing or fainting, and the symptoms spread through an entire school despite exhaustive testing finding no infection. Buildings are evacuated. Emergency rooms fill. Investigators search for poisons, viruses, or gas leaks and find...nothing.

• More than 2,000 outbreaks of mass psychogenic illness have been described in the medical literature.¹¹
• Cases have occurred on every inhabited continent over several centuries.¹¹
• The symptoms are genuine even when no toxin or infectious disease is ever identified.¹¹

One outbreak, however, stayed with me. In 1962, at a girls’ boarding school in what is now Tanzania, three students began laughing. Then more students laughed. Soon neighboring schools were affected. Some girls laughed for hours, others for days. Schools closed, thousands of people were eventually involved, and the epidemic slowly faded away as mysteriously as it had begun.¹²

The first time I read that story, I laughed myself. Not because it was funny. Because it sounded impossible. Then I thought back to that classroom in 1997. Maybe impossible wasn’t the right word.

The saying usually attributed to Mark Twain came to mind: “It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.” Whether Twain actually said those words is almost beside the point. Medicine has taught me that certainty is often far more dangerous than curiosity.

Somewhere along the way, I’d stopped asking whether the mind could influence the body. It clearly could. The real mystery had become how a lifetime of expectations, attention, and experience could quietly shape what the body itself was capable of feeling. That question would eventually lead me to one of the most surprising ideas in modern neuroscience.

The Brain’s Best Guess

By this point, the question that had started in a college classroom had led me through neurology, psychiatry, colonial history, courtroom testimony, and public health. Everywhere I looked, the same pattern kept reappearing. Attention influenced experience. Shared narratives influenced belief. Memory wasn’t nearly as permanent as I’d imagined. Even the body seemed capable of responding to expectations in ways that felt almost unbelievable. It was as though I had spent years collecting pieces from different puzzles, only to discover they all belonged in the same box.

The final piece came from neuroscience.

Like most people, I’d always assumed perception worked in the obvious direction. Light entered the eyes, sound entered the ears, and the brain patiently assembled those raw materials into an accurate picture of reality. It seemed so self-evident that I never thought to question it. After all, that’s how cameras work.

Modern neuroscience suggests our nervous systems do something much stranger.

Rather than waiting passively for information to arrive, the brain is constantly making predictions about what it’s about to see, hear, and feel. Incoming sensory information is enormously important, but instead of creating perception from scratch, it continually updates those predictions, correcting them whenever the outside world disagrees. In other words, perception is less like reading a book one word at a time and more like finishing another person’s sentences. Most of the time we’re right. Occasionally we’re spectacularly wrong.

When I first encountered that idea, I hated it. Not because the evidence was weak, but because it overturned something I’d never realized I believed. I had always assumed my experience of the world began with reality itself. These researchers were arguing that experience begins with a prediction, and reality spends the next fraction of a second negotiating with it.

As neuroscientist Anil Seth likes to say, “We don’t just perceive the world. We actively generate it.”¹³ He has also described perception as a “controlled hallucination,” a phrase that sounds outrageous until you see the evidence. Consider the famous rubber hand illusion. A volunteer hides one hand while an artificial rubber hand is placed on the table in front of them. Both hands are stroked in exactly the same way, and within minutes many people begin to experience the fake hand as their own. Threaten it with a hammer and they flinch. Their heart rate rises. Some instinctively pull away. Intellectually they know it isn’t their hand. Their nervous system has simply reached a different conclusion.

The same thing happens after amputations. People often continue feeling an itch in a foot that’s no longer there or pain in fingers that were lost years earlier. The missing limb hasn’t changed. The brain’s internal map of the body hasn’t caught up yet. Expectations, it turns out, can outlive anatomy.

• Many amputees continue experiencing vivid sensations in missing limbs.¹⁴
• The rubber hand illusion can temporarily convince healthy volunteers that an artificial hand belongs to them.¹⁵
• Placebos and nocebos demonstrate that expectations alone can measurably influence pain, nausea, movement, and many other physical symptoms.¹⁶

The placebo effect has always amused me because it’s probably the best-known phenomenon in medicine and one of the least understood. We often talk about placebos as though they prove symptoms were imaginary all along. In reality, they demonstrate exactly the opposite. Give someone a sugar pill while convincingly describing it as a powerful pain medication, and measurable changes occur in the nervous system. Endorphins are released, pain-processing circuits become less active, and many people genuinely feel better. The nocebo effect simply tells the same story in reverse. Warn people to expect side effects, and they’re substantially more likely to experience them, even when the pill itself is completely inert. Expectations don’t create fake symptoms. They can create real biology.

Reading all of this, I found myself thinking once again about those three people in the Tourette documentary. I’d spent decades assuming the mystery was how their symptoms seemed to take turns appearing. Now I wondered whether I’d been looking at the wrong mystery all along. Perhaps the remarkable thing wasn’t that the nervous system could be influenced by attention, expectation, and context. Perhaps the remarkable thing was that I’d ever assumed it couldn’t.

That realization changed the way I thought about far more than Tourette syndrome. It changed the way I thought about Salem, McMartin, the laughter epidemic in Tanzania, placebo effects, anxiety disorders, trauma, and countless patients I’d seen over the years. They no longer looked like unrelated curiosities. They looked like different windows into the same extraordinary organ, one that spends every waking moment making its best guess about the world and then quietly revising that guess as new information arrives.

Once I saw that pattern, I couldn’t stop seeing it. And then the pandemic arrived.

The World’s Largest Psychology Experiment

If someone had asked me ten years ago whether billions of people could experience the same event and emerge with their nervous systems subtly changed, I probably would have smiled politely and changed the subject.

Then came COVID-19.

I’m not talking about whether the virus was real. It was devastatingly real. Millions of people died. Intensive care units overflowed. Some hospitals parked refrigerated trucks outside because there simply wasn’t enough room for the dead. Families said goodbye through iPads while physicians, nurses, respiratory therapists, and countless others carried burdens that few people outside healthcare will ever fully understand. None of what follows diminishes that tragedy.

What fascinated me, both as a psychiatrist and someone trained in public health, was something else. I watched the world’s largest prediction machine suddenly lose its ability to predict.

Almost overnight, daily life became a series of unanswered questions. Was it safe to buy groceries? Could you hug your parents? Would masks help? Were the vaccines working? Was that cough allergies, a cold, or the beginning of something much worse? Every phone buzzed with another alert. Every television featured another panel of experts. People who had never given epidemiology a second thought suddenly found themselves discussing viral transmission, exponential growth, and R numbers over dinner.

As Daniel Kahneman observed, “Nothing in life is as important as you think it is while you are thinking about it.”¹⁷ For months, then years, nearly everyone on Earth was thinking about the same thing. Am I safe?

Brains become better at whatever they practice. Pianists practice scales. Basketball players practice free throws. During the pandemic, billions of nervous systems spent day after day practicing vigilance. Every headline invited us to search for danger. Every conversation encouraged us to imagine the next possible threat. Every uncertainty demanded another prediction.

As Mike Tyson famously said, “Everybody has a plan until they get punched in the mouth.” COVID punched the entire planet in the mouth. Once survival became the priority, our nervous systems responded exactly as evolution had prepared them to respond: they became exquisitely sensitive to anything that might signal danger.

• Anxiety and depressive disorders increased dramatically around the world.¹⁸
• Children and adolescents experienced some of the largest increases in anxiety, depression, and social isolation.¹⁸
• Loneliness, sleep disruption, and psychological distress rose across nearly every age group.¹⁸

What interested me most, however, happened after the worst of the pandemic had passed. Patients gradually stopped talking about COVID itself, but they didn’t stop talking about danger. Artificial intelligence replaced variants. Climate change replaced case counts. Inflation replaced hospitalization rates. School shootings, politics, war, and the economy each took their turn. The subjects changed, but the emotional rhythm of the conversations barely changed at all. Many patients described a persistent feeling that they simply couldn’t relax anymore, as though lowering their guard for even a moment might allow the next catastrophe to slip past unnoticed.

I’d heard that feeling before. Combat veterans sometimes continue scanning rooftops years after returning home. Survivors of abusive relationships may startle at sounds nobody else notices. Parents whose child was once critically ill often continue checking on them in the middle of the night long after the crisis has passed. None of these people are irrational. Their nervous systems learned a lesson that was extraordinarily useful at the time.

The difficulty is that nervous systems don’t automatically recognize when the lesson is over.

Seen this way, the pandemic wasn’t simply one of the largest public health crises in modern history. It also became one of the largest psychological experiments in history. Never before had billions of people spent years rehearsing uncertainty while connected by twenty-four-hour news cycles and social media algorithms that rewarded fear, outrage, and constant vigilance. We learned an enormous amount about viruses and vaccines. We also learned something about ourselves.

If experience can teach the brain to expect danger, experience can also teach it something else.

Changing the Story

One of the most hopeful discoveries in modern neuroscience is also one of the least dramatic: the adult brain never really stops changing. Today we hear the word neuroplasticity so often that it’s almost become background noise, but when I was in medical school many of us were still taught that, by adulthood, the brain was essentially finished wiring itself. Children learned. Adults simply lived with whatever circuitry they had managed to build.

Everything I’d been reading suggested otherwise.

The Tourette documentary, the Salem witch trials, the McMartin Preschool case, mass psychogenic illness, predictive processing, placebo effects, even the lingering hypervigilance left behind by the pandemic were no longer separate stories. They all described the same remarkable ability from different angles. The nervous system is constantly learning from experience. Most of the time that’s exactly what keeps us alive. The difficulty comes when yesterday’s successful adaptations quietly become today’s unnecessary suffering.

That realization changed the way I think about psychiatry. Patients often arrive convinced that anxiety, depression, obsessive thinking, or trauma have become permanent parts of who they are. I understand why. Depression whispers that nothing will ever improve. Anxiety insists the danger isn’t over. Trauma has an extraordinary ability to convince the nervous system that yesterday is still happening today. But if experience can strengthen those pathways, experience can strengthen different ones as well.

I often think of the process as walking through a forest. The first time you cross the woods, you leave almost no trace. Walk the same route every day for years and eventually a path appears. Keep using it and the trail becomes easier to follow than the surrounding underbrush. Before long, you stop choosing the path because the path has begun choosing you. The encouraging part is that forests don’t stay frozen forever. New trails can be made. At first they feel awkward and inefficient. Therapy feels unnatural. Meditation feels frustrating. Exercise feels exhausting. Reaching out to another person instead of withdrawing can feel almost impossible. That’s exactly what we’d expect. The old trail has been reinforced thousands of times. The new one is only beginning.

As Victor Borge observed, “Laughter is the shortest distance between two people.” I’ve always liked that quotation because it reminds me that brains don’t change in isolation. Every meaningful relationship leaves fingerprints on the nervous system. Good therapists, patient teachers, loving parents, trusted friends, and supportive partners are all quietly helping another human being build new pathways, often without realizing they’re doing anything extraordinary.

• London taxi drivers develop measurable enlargement of brain regions involved in spatial navigation after years of memorizing the city’s streets.¹⁹
• Cognitive behavioral therapy produces measurable changes in brain activity as symptoms improve.²⁰
• Mindfulness, regular exercise, and healthy sleep are all associated with measurable changes in brain structure and function.²¹

One of the great privileges of psychiatry is watching those new trails slowly emerge. I’ve seen children who couldn’t remain seated long enough to finish a classroom lesson grow into successful engineers. I’ve watched patients whose panic attacks once kept them trapped at home eventually board airplanes, give public lectures, get married, raise children, and forget there was ever a time they believed those things were impossible. None of those people changed overnight, and none succeeded because someone persuaded them simply to “think positive.” They changed because their nervous systems kept doing what healthy nervous systems have always done. They practiced. They adapted. They learned.

Looking back now, I no longer think that documentary in 1997 was really about Tourette syndrome. It was about something much larger, although it took me four decades to recognize it. The most hopeful lesson in all of neuroscience isn’t that the brain can change. It’s that it never completely stops.

The Story We Tell Ourselves

Every article eventually reaches the point where the author has to admit what he’s really been writing about. This is that point.

When I first watched that documentary, I thought I was learning about Tourette syndrome. Then I became convinced it was really about attention. A few years later I thought it was about memory. Then came Salem, McMartin, mass psychogenic illness, predictive processing, placebo effects, and the pandemic. For a long time, those subjects seemed only loosely connected, as though I were wandering through different wings of the same museum without realizing they all belonged to a single exhibit.

Looking back, I think they were all asking the same question.

How much of what we experience comes directly from the outside world, and how much is shaped by the remarkable organ trying to make sense of it?

The answer, I suspect, is both. Reality exists independent of us. Viruses don’t care whether we believe in them. Gravity doesn’t consult our opinions before we fall. Trauma is real. Joy is real. Love is real. Yet none of us encounters those realities directly. Every sight, sound, memory, fear, hope, and relationship passes through a nervous system that has spent a lifetime learning what matters, what is dangerous, what can be ignored, and what deserves immediate attention. Most of the time that system serves us astonishingly well. It allows us to navigate a world that contains far more information than we could ever consciously process. Occasionally, however, it fills in the blanks a little too quickly or clings to yesterday’s lessons long after the world has changed.

That, more than anything else, has changed the way I practice psychiatry. Diagnoses matter. Medications matter. Neuroscience matters. But beneath all of them is a quieter question that I find myself asking almost every day: What else might be true? Sometimes the answer changes a diagnosis. Sometimes it changes a marriage. Sometimes it changes the way someone understands themselves after carrying the same painful explanation for decades.

As David Foster Wallace said in his famous commencement address, “Learning how to think really means learning how to exercise some control over how and what you think.” He wasn’t talking about predictive processing, but he understood something every psychiatrist eventually learns. Our first interpretation isn’t always our best one. Curiosity is often a better guide than certainty.

• The nervous system is constantly updating its internal model of the world as new information arrives.¹³
• Attention, memory, emotion, and expectation all shape what we consciously experience.¹³⁻²¹
• Because those systems remain plastic throughout life, our interpretations can continue changing too.¹⁹⁻²¹

I still think about those three people with Tourette syndrome from time to time. I can still picture the interviewer, the two children, and an entire college classroom laughing because the timing of their tics seemed too perfect to be real. At the time, I thought I’d witnessed a strange neurological curiosity. It never occurred to me that the real mystery wasn’t sitting in front of the camera.

It was sitting in the audience.

For more than forty years, that brief documentary quietly sent me from neurology to psychiatry, from colonial Massachusetts to modern courtrooms, from public health to neuroscience, asking versions of the same question over and over again. I never found a single elegant answer, and I’m no longer sure one exists. Instead, I found something I think is more interesting: a growing appreciation for just how creative, adaptable, resilient, and occasionally misleading the human mind can be.

We spend our lives believing we’re simply observing the world. Perhaps we’re doing something far more remarkable. Perhaps, moment by moment, we’re learning how to understand it.

If you enjoyed this article, I’d really appreciate it if you’d click Subscribe, share it with someone who enjoys asking uncomfortable questions, and leave a comment below. Every subscription, share, and conversation helps these ideas reach more people. After all, if our minds are constantly learning from the stories we tell ourselves, maybe it’s worth making sure we’re telling better ones.

Notes & Sources

1. Leckman JF, Bloch MH, King RA, Scahill L. Phenomenology of Tics and Natural History of Tic Disorders. Advances in Neurology. 2006.

2. Sacks O. An Anthropologist on Mars. Alfred A. Knopf; 1995.

3. James W. The Principles of Psychology. Henry Holt; 1890.

4. Barkley RA. Taking Charge of Adult ADHD. Guilford Press; 2010.

5. Morris ME. Movement Disorders in People With Parkinson Disease: A Model for Physical Therapy. Physical Therapy. 2000.

6. Alm PA. Stuttering in Relation to Anxiety, Temperament, and Personality. International Journal of Language & Communication Disorders. 2014.

7. Voltaire. The Philosophical Dictionary. 1764.

8. Boyer P, Nissenbaum S. Salem Possessed: The Social Origins of Witchcraft. Harvard University Press; 1974.

9. Loftus EF, Ketcham K. Witness for the Defense. St. Martin’s Press; 1991.

10. Nathan D, Snedeker M. Satan’s Silence: Ritual Abuse and the Making of a Modern American Witch Hunt. Basic Books; 1995.

11. Bartholomew RE, Wessely S. “Protean Nature of Mass Sociogenic Illness.” British Journal of Psychiatry. 2002; Bartholomew RE, Radford B. Mysteries of Mass Hysteria. Prometheus Books; 2012.

12. Rankin AM, Philip PJ. “The Tanganyika Laughter Epidemic.” Central African Journal of Medicine. 1963.

13. Seth A. Being You: A New Science of Consciousness. Dutton; 2021.

14. Ramachandran VS, Blakeslee S. Phantoms in the Brain. William Morrow; 1998.

15. Botvinick M, Cohen J. “Rubber Hands ‘Feel’ Touch That Eyes See.” Nature. 1998;391:756.

16. Benedetti F. Placebo Effects. Oxford University Press; 2014.

17. Kahneman D. Thinking, Fast and Slow. Farrar, Straus and Giroux; 2011.

18. World Health Organization. Mental Health and COVID-19: Early Evidence of the Pandemic’s Impact. 2022.

19. Woollett K, Maguire EA. “Acquiring ‘The Knowledge’ of London’s Layout Drives Structural Brain Changes.” Current Biology. 2011.

20. DeRubeis RJ, Siegle GJ, Hollon SD. “Cognitive Therapy versus Medication for Depression: Brain Mechanisms and Clinical Outcomes.” Nature Reviews Neuroscience.

21. Davidson RJ, Goleman D. Altered Traits: Science Reveals How Meditation Changes Your Mind, Brain, and Body. Avery; 2017.

Quotations

• Oliver Sacks — An Anthropologist on Mars.

• William James — The Principles of Psychology.

• Voltaire — The Philosophical Dictionary.

• Mark Twain (quotation commonly attributed; attribution disputed): “It ain’t what you don’t know that gets you into trouble...”

• Robert Bartholomew — Protean Nature of Mass Sociogenic Illness.

• Anil Seth — Being You.

• Daniel Kahneman — Thinking, Fast and Slow.

• Mike Tyson — “Everybody has a plan until they get punched in the mouth.”

• Victor Borge — “Laughter is the shortest distance between two people.”

• David Foster Wallace — This Is Water commencement address.