BioBeats

A long time ago I was a researcher looking at artificial intelligence — that's where I did my first PhD, focused on AI and sound. The idea was to investigate how people improvise. Why do people improvise? What is that behaviour? Why do human beings make things up? I used several different AI techniques — genetic co-evolution, genetic algorithms and so on — to build algorithms that tried to improvise alongside human beings.

But in doing that, I had to look at how human beings respond to emotion, what emotions are made of, the physiology of emotion, and then the neurophysiology of emotion. And the deeper I got into that, the more I realised I was more interested in the cognitive neuroscience than in the artificial intelligence.

In the middle of all this I was running a software company — nothing to do with that study, a much more boring thing — and I had a cardiac arrest at Brussels airport, during a failed bit of exercise, after not taking care of myself for a long time and undergoing a tremendous amount of stress. Not eating. So it was basically starvation and stress. The nurse who woke me up said, literally, your body just gave up. It's not a myocardial infarction, you didn't blow up, there's nothing wrong with you — you just need to eat.

And I thought, this is ridiculous. How can I live above a supermarket and die of starvation? I have enough money to eat — why am I not eating? It wasn't even an eating disorder. I was literally working too hard, forgetting to eat, under too much stress.

So then I thought: of what I know of human emotion and behaviour, and of building technology, could I build a system that would warn somebody this is happening — that their behaviour was heading towards a place where it would become harmful to their body and mind? I started studying that, went back to academia, retrained in research methods in psychology and neuroscience, and started building BioBeats. This was a little while ago, because it took us about six years to get through the main technology. I've raised about six million pounds in venture capital so far, working with insurance companies and all kinds of people like Samsung. It spiralled into something that became MedTech, whereas it was actually supposed to just be a large-scale study on how stress can become traumatic enough — from a chronic perspective — to become disease, to become a paralysing thing.

All I wanted was to reach tens of thousands of people so I could conduct machine learning on the neurophysiology of stress. But doing that in academia is just too slow, so doing it with venture capital works better. That's essentially how it changed from an academic exercise into a company — there was no choice, really. The largest academic project I'd ever been part of was a couple of million in budget, involved several universities and years of research. I needed to do things much more quickly, involving a lot more people.

Yes, it's rubbish. It's a totally misfounded idea. But let's unpack it a little.

First of all, there's nothing wrong with working hard, and any doctor will tell you that you don't often have a choice. The job demands are the job demands. If you don't want to do that job, you find a different job. So it's not often a choice — it comes with the territory that you'll work very, very hard. But the idea that innovation comes from this romantic image of the entrepreneur working 100-hour weeks and sleeping in the office is only partly true. I mean, even we did that — even after having a cardiac arrest from working too hard, I worked too hard for years. It's difficult to avoid, because if you're passionate about anything you become obsessed by it. The more you build it, the more obsessed you get, and the more you're unable to think about anything else. So sometimes it's born out of that.

The problem comes when people do it without that passion — not because they're obsessed, but because they're being made to, or because they feel it's the only way to break through, or the only way to scale the corporate ladder. That's where it becomes toxic. And if it's being done by yourself, towards yourself, it's very hard to spot. You're banging your head against the wall doing something you don't particularly love, just trying to succeed, and it's not making you happy — and the harder you work, the more unhappy you become. That translates into actual physical disorder, not just mental disorder. Trauma is stored in the body, but its expression is corporeal, not mental. The mind can crack on way beyond what the body can endure, so the body will give up for you well before your mind says "I've had enough."

There's an entire culture of that that's become incredibly toxic, and people are starting to wake up from it. In Japan there's even a word for it — karoshi, dying of overwork. How many people have to die of overwork before you come up with a word for it? Maybe our culture isn't as bad as that, but it's really difficult, especially when you take venture capital money and people expect results in six months. No matter how much you explain that yours is a deep-tech shot at building probably the only real-time computational psychiatry platform out there, they'll tell you the reality they have to cope with: they have to go back to their LPs and their funds and show results within a very short timeline. Often myopic timelines that don't allow for deep innovation — unless you've made a lot of money and can show a serious return, in which case they'll throw tons at you.

So it's really important that, no matter how hard you go into something, especially in technology, you remember technology is filled with people who want you to work yourself to death. That's a very moronic idea you can easily unpack by making sure you take care of yourself — sleep eight hours a day, exercise, eat well, don't drink too much, don't indulge in drugs that take your mind apart. And say no a lot. People respect you more, it turns out, when you say no a lot — because then they trust that what you want is very specific. The things you say yes to become really important and respected.

Okay — do you know what the DSM is? The psychiatric book of disorders?

Yeah. It's contentious — loads of people think it's put together partly with some bias for the pharma industry and what they want to make. I'm not particularly sceptical about it; we need some way to classify what we see in disorder, and putting it in one place seems reasonable. But I can see the problems with it.

The one curious thing about it is that the only totally common denominator across the symptoms of mental disorder is a loss of interoceptive signal — a loss of interoception. Interoception is the sense that gives you awareness of body signals like hunger, thirst, your heartbeat. You have perception — what you see, what you hear. You have proprioception — awareness of your movement in the world and the space around you. And then interoception is the awareness of the inside. The interesting thing about it being this common denominator to all mental disorders is that it's essentially the canary in the mine: if your interoception goes, there's a serious problem. But no one's ever looked at it that way. There's been 50 years of research trying to figure out how to even measure interoception — and, not to toot our own horn, we're about to publish a paper showing a new task that appears to be more successful than the rest at measuring it. The reason I wanted to measure it so badly is that if you can measure interoception, and be predictive of its disruption, you could potentially predict mental disorder.

That would be what I set out to do a decade ago — predict the onset of very seriously bad behaviour and its consequence on mind and body, and push the notification I wish I'd had, that says "hey, you're about to conk out, and it's a result of your behaviour, and here are a couple of things you could fix before it happens." And there's another aspect I find even more interesting: if disrupted interoception is a signal that someone is in trouble, could you train interoception to improve the symptoms of mental disorder? Could you look at it the other way around — could training someone to be more aware of internal body signals help them fight the symptoms of generalised anxiety disorder, or panic disorder, or depression? Panic is a special case, so I'd better not go into it, but in general.

So that patent describes a system we built to train somebody to be a better interoceptor. The thesis is: if you're more aware of body signal, you'll be more aware of what happens when a mental disorder rears its head — so you'll be able to stop it, to be more emotionally available, because you'll see the signs coming. One way to do this is to give you your own heartbeat — to sonify it. You make an app that takes your heart rate from the phone camera and gives you your own heartbeat back as a sound. Then you turn that sound into complex music that changes depending on how the autonomic nervous system is behaving. So if you ask people to take a couple of deep breaths and that changes the music successfully, you've just given them a mechanism to fight instant stress. If they learn it well, you'll see a change in heart rate variability — and if the music changes with it, you've given them a game mechanic, a reward for their learned behaviour. That was the purpose of the patent.

We haven't released this yet — I'm working on the prototype now. But we built a really early prototype more than five years ago called Pulse, and released it on the App Store. Actually, we first released it at South by Southwest while it was happening — literally in the streets, getting people to install it and try it in real time. In the end we had around 200,000 people using it. Those beta users taught us a lot about how this could work, but that was a one-time thing — we just wanted to learn whether it was possible, what people found engaging and what they didn't.

Now that we've built this new task that measures interoception, we want to understand what people would do day to day. What would the training look like? Would it even work? We don't know. Most likely, every day you'll be asked to give us five minutes. In those five minutes we'll test how your interoception is today, give you a small training task, then test again — pre and post. The mechanics are being prototyped right now, in terms of what it looks like from a game and user-experience perspective. Ideally you do a little bit every day, and over two weeks you gain a new awareness of what happens in your body. The question is whether it'll also improve your resilience to stress, or things like empathy — constructs that are difficult to measure and even more difficult to change. My hope is that something like that will happen, and that people become more resilient. But we'll see.

They're ultimately related, except mindfulness is a borrowed term — a huge set of appropriations from different cultures. It's not that Western culture hasn't looked inward — there are parts of Christianity that look very much inward, in contemplation of the body — but the ones I've looked at most have been Buddhist and Islamic culture. If you look at Sufi practices, or Buddhist practices, and Indian culture — and this is a total misnomer, because there's no single such thing, but the compound, civilisation-sized set of cultures that embody Indo-Asiatic culture — you have Tibetan practices, yoga practices, all kinds of things in between that have to do with internal signal. For four thousand years people have been experimenting with this.

The problem is understanding what technology could bring to it. Maybe nothing. But if it can bring anything, it'll be the ability to measure in a way that helps people understand progress — better than it can be understood when you're engaging with compassion-focused meditation, or loving-kindness meditation, or heart-focused meditation, as in Sufi practice, where you're quite literally listening to and giving your heart away to what, in religion, people understand as the divine. You can understand it any way you want — for my purposes, what matters is that act of focusing on the internal signal, relaxing into it, and understanding your connection back to your body.

The very simple truth is that whatever trauma you experience will disconnect you from your body, and making that connection again is important. Unfortunately, many aspects of mindfulness today also ask you to divorce yourself from emotion, or from ownership of that emotion — to watch them happen and let them go away. I think that's a humongous mistake, because we're essentially training a whole bunch of people to have sociopathic, even psychopathic tendencies — who aren't aware that it's that suffering that's really the interesting part. That's kind of why this is an extrapolation of all that.

A number of ways. One is going younger in our audience. We've dealt with a lot of middle-aged people in corporate, and at youngest they're in their twenties. I'd really like to look at childhood and adolescence — I'd like schools to teach this kind of meditative practice that's completely secular but also really embodied: looking at how bodies change, why bodies signal what they do, how they relate to the mind. Why we think with our hearts and our guts, not just our brains — why the brain is, in many ways, just a processor — and how to train the gut-brain and heart-brain in a child. That puts them in a totally different position as they grow into adults. I'd love to see the technology used in that kind of teaching.

We're also starting to see how important this is for patient journeys, especially once it becomes predictive at an AI level. Disrupted interoception happens in bariatric surgery, in cardiovascular surgery, in cancer therapy — anywhere the body is severely modified or altered, it changes the person's perception of their body, and that causes enormous suffering, aside from the surgery or its cause. There's a journey there I think we really need to be part of.

The other is a very simple idea: that every wearable in the world is potentially about to save your life, by making sure it attends to your emotional inner life as much as it attends to your heart rhythm, your sleep efficiency, your nutritional diversity. It's the idea of whole-body, holistic medicine — real-time intelligence into that — putting together computational psychiatry and looking at mental disorder not as disorder, but as disruption of something that should be whole-body health.

It is really interesting. There's been so much research into that, and biofeedback has a long tradition — it goes back to the fifties and sixties, and interoception studies go back to the fifties too. Even beyond that: Galen, the Roman physician who was originally Greek, wrote a lot on the dissociation between mind and body. So it goes back a very long time, and the idea of giving that signal back to the person to help them understand what's going on goes back a long way too.

I think the potential now — using game engines and VR environments for better haptic, sonic and visualised experience of internal body signal — is enormous. It's huge. There's stuff we could do that could transform people who are currently suffering. But if we do it early enough in life... you know how children in Scandinavia, up near the Arctic Circle, stare into lamps in winter — you see these pictures of children surrounding a yellow glowing light, because they have to do it every day, otherwise they don't get enough light. I can see that happening in ten years' time, where children learn from environments like that what it's like to be in their bodies. And I suspect that if we do that, we'll see a very serious drop in mental disorder later in life.

There are a number of books. One is When the Body Says No by Gabor Maté. Another is The Body Keeps the Score by Bessel van der Kolk. There are a bunch of others, but those two are major works on why body signal is important, how trauma is stored in the body, and why that matters for neurophysiology — and even for understanding the effect of disease on the mind.

The other is our lab at the University of Oxford, the social cognition lab — one of the groups at the forefront of interoception studies. Going there and looking at what people are writing is a very good point of intersection with the medical sciences. There are other people too — Sarah Garfinkel at Sussex, Hugo Critchley — a number of people looking at this, spread around London and elsewhere. And you can always just write to me — I'm David at BioBeats — I'm happy to talk to anybody about this.