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The human mind can be a confusing and overwhelming place. Despite incredible leaps in human progress, many of us still struggle to make our peace with our thoughts. The roots of this are complex and multifaceted. To find explanations for the global mental health epidemic, one can tap into neuroscience, psychology, evolutionary biology, or simply observe the meaningless systems that dominate our modern-day world.
This is not only the context of our reality but also that of the critically-acclaimed Netflix series, Maniac. Psychological dark comedy meets science fiction, Maniac is a retro, futuristic, and hallucinatory trip that is filled with hidden symbols. Directed by Cary Joji Fukunaga, the series tells the story of two strangers who decide to participate in the final stage of a “groundbreaking” pharmaceutical trial—one that combines novel pharmaceuticals with artificial intelligence, and promises to make their emotional pain go away.
Naturally, things don’t go according to plan.
From exams used for testing defense mechanisms to techniques such as cognitive behavioral therapy, the narrative infuses genuine psychological science. As perplexing as the series may be to some viewers, many of the tools depicted actually have a strong grounding in current technological advancements.
Catalysts for Alleviating Suffering
In the therapy of Maniac, participants undergo a three-day trial wherein they ingest three pills and appear to connect their consciousness to a superintelligent AI. Each participant is hurled into the traumatic experiences imprinted in their subconscious and forced to cope with them in a series of hallucinatory and dream-like experiences.
Perhaps the most recognizable parallel that can be drawn is with the latest advancements in psychedelic therapy. Psychedelics are a class of drugs that alter the experience of consciousness, and often cause radical changes in perception and cognitive processes.
Through a process known as transient hypofrontality, the executive “over-thinking” parts of our brains get a rest, and deeper areas become more active. This experience, combined with the breakdown of the ego, is often correlated with feelings of timelessness, peacefulness, presence, unity, and above all, transcendence.
Despite being not addictive and extremely difficult to overdose on, regulators looked down on the use of psychedelics for decades and many continue to dismiss them as “party drugs.” But in the last few years, all of this began to change.
Earlier this summer, the FDA granted breakthrough therapy designation to MDMA for the treatment of PTSD, after several phases of successful trails. Similar research has discovered that Psilocybin (also known as magic mushrooms) combined with therapy is far more effective than traditional forms of treatment to treat depression and anxiety. Today, there is a growing and overwhelming body of research that proves that not only are psychedelics such as LSD, MDMA, or Psylicybin effective catalysts to alleviate suffering and enhance the human condition, but they are potentially the most effective tools out there.
It’s important to realize that these substances are not solutions on their own, but rather catalysts for more effective therapy. They can be groundbreaking, but only in the right context and setting.
In Maniac, the medication-assisted therapy is guided by what appears to be a super-intelligent form of artificial intelligence called the GRTA, nicknamed Gertie. Gertie, who is a “guide” in machine form, accesses the minds of the participants through what appears to be a futuristic brain-scanning technology and curates customized hallucinatory experiences with the goal of accelerating the healing process.
Such a powerful form of brain-scanning technology is not unheard of. Current levels of scanning technology are already allowing us to decipher dreams and connect three human brains, and are only growing exponentially. Though they are nowhere as advanced as Gertie (we have a long way to go before we get to this kind of general AI), we are also seeing early signs of AI therapy bots, chatbots that listen, think, and communicate with users like a therapist would.
The parallels between current advancements in mental health therapy and the methods in Maniac can be startling, and are a testament to how science fiction and the arts can be used to explore the existential implications of technology.
Not Necessarily a Dystopia
While there are many ingenious similarities between the technology in Maniac and the state of mental health therapy, it’s important to recognize the stark differences. Like many other blockbuster science fiction productions, Maniac tells a fundamentally dystopian tale.
The series tells the story of the 73rd iteration of a controversial drug trial, one that has experienced many failures and even led to various participants being braindead. The scientists appear to be evil, secretive, and driven by their own superficial agendas and deep unresolved emotional issues.
In contrast, clinicians and researchers are not only required to file an “investigational new drug application” with the FDA (and get approval) but also update the agency with safety and progress reports throughout the trial.
Furthermore, many of today’s researchers are driven by a strong desire to contribute to the well-being and progress of our species. Even more, the results of decades of research by organizations like MAPS have been exceptionally promising and aligned with positive values. While Maniac is entertaining and thought-provoking, viewers must not forget the positive potential of such advancements in mental health therapy.
Science, technology, and psychology aside, Maniac is a deep commentary on the human condition and the often disorienting states that pain us all. Within any human lifetime, suffering is inevitable. It is the disproportionate, debilitating, and unjust levels of suffering that we ought to tackle as a society. Ultimately, Maniac explores whether advancements in science and technology can help us live not a life devoid of suffering, but one where it is balanced with fulfillment.
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As if stand-alone technologies weren’t advancing fast enough, we’re in age where we must study the intersection points of these technologies. How is what’s happening in robotics influenced by what’s happening in 3D printing? What could be made possible by applying the latest advances in quantum computing to nanotechnology?
Along these lines, one crucial tech intersection is that of artificial intelligence and genomics. Each field is seeing constant progress, but Jamie Metzl believes it’s their convergence that will really push us into uncharted territory, beyond even what we’ve imagined in science fiction. “There’s going to be this push and pull, this competition between the reality of our biology with its built-in limitations and the scope of our aspirations,” he said.
Metzl is a senior fellow at the Atlantic Council and author of the upcoming book Hacking Darwin: Genetic Engineering and the Future of Humanity. At Singularity University’s Exponential Medicine conference last week, he shared his insights on genomics and AI, and where their convergence could take us.
Life As We Know It
Metzl explained how genomics as a field evolved slowly—and then quickly. In 1953, James Watson and Francis Crick identified the double helix structure of DNA, and realized that the order of the base pairs held a treasure trove of genetic information. There was such a thing as a book of life, and we’d found it.
In 2003, when the Human Genome Project was completed (after 13 years and $2.7 billion), we learned the order of the genome’s 3 billion base pairs, and the location of specific genes on our chromosomes. Not only did a book of life exist, we figured out how to read it.
Jamie Metzl at Exponential Medicine
Fifteen years after that, it’s 2018 and precision gene editing in plants, animals, and humans is changing everything, and quickly pushing us into an entirely new frontier. Forget reading the book of life—we’re now learning how to write it.
“Readable, writable, and hackable, what’s clear is that human beings are recognizing that we are another form of information technology, and just like our IT has entered this exponential curve of discovery, we will have that with ourselves,” Metzl said. “And it’s intersecting with the AI revolution.”
Learning About Life Meets Machine Learning
In 2016, DeepMind’s AlphaGo program outsmarted the world’s top Go player. In 2017 AlphaGo Zero was created: unlike AlphaGo, AlphaGo Zero wasn’t trained using previous human games of Go, but was simply given the rules of Go—and in four days it defeated the AlphaGo program.
Our own biology is, of course, vastly more complex than the game of Go, and that, Metzl said, is our starting point. “The system of our own biology that we are trying to understand is massively, but very importantly not infinitely, complex,” he added.
Getting a standardized set of rules for our biology—and, eventually, maybe even outsmarting our biology—will require genomic data. Lots of it.
Multiple countries already starting to produce this data. The UK’s National Health Service recently announced a plan to sequence the genomes of five million Britons over the next five years. In the US the All of Us Research Program will sequence a million Americans. China is the most aggressive in sequencing its population, with a goal of sequencing half of all newborns by 2020.
“We’re going to get these massive pools of sequenced genomic data,” Metzl said. “The real gold will come from comparing people’s sequenced genomes to their electronic health records, and ultimately their life records.” Getting people comfortable with allowing open access to their data will be another matter; Metzl mentioned that Luna DNA and others have strategies to help people get comfortable with giving consent to their private information. But this is where China’s lack of privacy protection could end up being a significant advantage.
To compare genotypes and phenotypes at scale—first millions, then hundreds of millions, then eventually billions, Metzl said—we’re going to need AI and big data analytic tools, and algorithms far beyond what we have now. These tools will let us move from precision medicine to predictive medicine, knowing precisely when and where different diseases are going to occur and shutting them down before they start.
But, Metzl said, “As we unlock the genetics of ourselves, it’s not going to be about just healthcare. It’s ultimately going to be about who and what we are as humans. It’s going to be about identity.”
Designer Babies, and Their Babies
In Metzl’s mind, the most serious application of our genomic knowledge will be in embryo selection.
Currently, in-vitro fertilization (IVF) procedures can extract around 15 eggs, fertilize them, then do pre-implantation genetic testing; right now what’s knowable is single-gene mutation diseases and simple traits like hair color and eye color. As we get to the millions and then billions of people with sequences, we’ll have information about how these genetics work, and we’re going to be able to make much more informed choices,” Metzl said.
Imagine going to a fertility clinic in 2023. You give a skin graft or a blood sample, and using in-vitro gametogenesis (IVG)—infertility be damned—your skin or blood cells are induced to become eggs or sperm, which are then combined to create embryos. The dozens or hundreds of embryos created from artificial gametes each have a few cells extracted from them, and these cells are sequenced. The sequences will tell you the likelihood of specific traits and disease states were that embryo to be implanted and taken to full term. “With really anything that has a genetic foundation, we’ll be able to predict with increasing levels of accuracy how that potential child will be realized as a human being,” Metzl said.
This, he added, could lead to some wild and frightening possibilities: if you have 1,000 eggs and you pick one based on its optimal genetic sequence, you could then mate your embryo with somebody else who has done the same thing in a different genetic line. “Your five-day-old embryo and their five-day-old embryo could have a child using the same IVG process,” Metzl said. “Then that child could have a child with another five-day-old embryo from another genetic line, and you could go on and on down the line.”
Sounds insane, right? But wait, there’s more: as Jason Pontin reported earlier this year in Wired, “Gene-editing technologies such as Crispr-Cas9 would make it relatively easy to repair, add, or remove genes during the IVG process, eliminating diseases or conferring advantages that would ripple through a child’s genome. This all may sound like science fiction, but to those following the research, the combination of IVG and gene editing appears highly likely, if not inevitable.”
From Crazy to Commonplace?
It’s a slippery slope from gene editing and embryo-mating to a dystopian race to build the most perfect humans possible. If somebody’s investing so much time and energy in selecting their embryo, Metzl asked, how will they think about the mating choices of their children? IVG could quickly leave the realm of healthcare and enter that of evolution.
“We all need to be part of an inclusive, integrated, global dialogue on the future of our species,” Metzl said. “Healthcare professionals are essential nodes in this.” Not least among this dialogue should be the question of access to tech like IVG; are there steps we can take to keep it from becoming a tool for a wealthy minority, and thereby perpetuating inequality and further polarizing societies?
As Pontin points out, at its inception 40 years ago IVF also sparked fear, confusion, and resistance—and now it’s as normal and common as could be, with millions of healthy babies conceived using the technology.
The disruption that genomics, AI, and IVG will bring to reproduction could follow a similar story cycle—if we’re smart about it. As Metzl put it, “This must be regulated, because it is life.”
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