- [Announcer] "Your Fantastic Mind", brought to you in part by Sarah and Jim Kennedy.

(dramatic theme music) (dramatic theme music continues) - Welcome to "Your Fantastic Mind".

I'm Jaye Watson.

Most of us know what a physician is and most of us know what a scientist is, but there is a small percentage of people in the United States who are both physician scientist.

It's a unique role that requires juggling two demanding identities, being a physician and treating patients in the here and now, and being a scientist working to change the future.

To show you what that life and career looks like, meet neurosurgeon Dr. Kimberly Hoang.

- [Kimberly] We're doing a craniotomy to remove a benign brain tumor.

- [Jaye] Dr. Kimberly Hoang is an Emory neurosurgeon who specializes in brain and spinal cord tumors.

- Yeah, that's good.

Your anterior to it.

- [Jaye] Hoang tackled the seven-year residency after med school- - [Kimberly] Gary, can you switch over for some tack-ups?

- [Jaye] Regarded as the most challenging in medicine.

- It can be very dangerous.

- [Kimberly] Today, she is a leader in her field- - I have a strong suspicion there's gonna be some radiation involved in this situation.

- [Jaye] Surgically treating people with life-threatening and terminal diagnoses.

- [Kimberly] It's right on the edge there, so we should have encountered the tumor pretty quick.

- [Jaye] It's a massive job.

- Be super careful though by the vein.

- [Jaye] It's not her only job.

- Yeah, correct.

- [Azadeh] We had a news release at Georgia Tech about these tiny robots that can move.

They weren't really doing anything.

They were just moving around.

- [Kimberly] All right, Tony, so you can go ahead and run the video.

- [Azadeh] She saw the news release.

- Right.

- And then she contacted me, sent me an email.

And I was like, oh, a neurosurgeon!

(laughs) - [Jaye] A neurosurgeon who majored in chemical engineering in college, who grew up in Detroit, Michigan working on cars with her father and thought she would become an engineer like him.

Watching her mother go through breast cancer piqued Hoang's interest in medicine.

And this young woman who was always good with her hands, including competitive piano, found her calling in neurosurgery- - I did the rotation, and it caught me by surprise how much I loved it.

- [Jaye] Joining the 6% of female neurosurgeons in the country.

- So microbotics or, are tiny little robots, basically, and that's our area of expertise for this project.

- Radiant and field.

- And we haven't even taken into account yet the divergence.

- [Jaye] It's been four years now since Hoang forged a collaboration at Georgia Tech- - [Kimberly] Yes.

- Get rid of the CT scan.

- [Jaye] With electrical engineer, Dr. Azadeh Ansari- - I think this is already very complicated.

(chuckles) - [Jaye] And PhD student, Tony Wang- - Oh, it's through cities.

- [Jaye] Combining her clinical knowledge treating patients with tumors- - [Tony] That we have a coil for the extraction.

- [Jaye] With their engineering expertise and her engineering background.

Their goal, to bring microrobotics to neurosurgery.

- Oh, she's great.

She knows.

She gets all the details because, I think, of the engineering background.

- [Tony] Do you see a small line here and a small line here?

- [Jaye] Mm-hmm.

- [Tony] Those are our robots.

- [Jaye] Smaller than a millimeter, about the size of a particle of dust, these microrobots have the potential to do biopsies, microsurgeries, carry microsensors, and deliver targeted drugs, such as chemotherapy, to deep regions of the brain.

- [Tony] What you see right here is the screw structure that's 3D printed.

- [Jaye] Right now, tumor patients usually take a pill or receive chemo intravenously.

- The trouble with that, as we know, is that there's this thing called the blood-brain barrier which prevents bad things from getting to our brain.

So that's great for our brain, but also, it prevents things like chemotherapy that we want to get to the brain from really being effective.

And that's why surgery and radiation have been the mainstays of brain therapy, tumor therapy for so long.

- [Jaye] With the microrobot, drugs would be delivered directly to the tumor via a hydrogel backpack that is part of the robot.

- Once they're, the microbots get to the tumor or the desired area, there is a change in pH.

And so that hydrogel backpack responds to the change in the pH, swells, and releases, in our case, these tiny nanoparticles that have the drug associated with them.

- [Jaye] Hoang and the team give a demonstration of these untethered steerable robots magnetically controlled that can travel over the uneven surface of the brain, drill through brain tissue, and swim within the fluid-filled ventricles.

- Underneath the microscope, we can see how the microrobot is moving.

And this is controlled, actually, via a joystick that the surgeon is controlling.

And you can see how complex the trajectories we can do with our microbot and how much control we have.

Here we're spelling out GT for Georgia Tech.

- [Jaye] As with all research, success is not a straight line.

- We can use our controller or joystick to program unique magnetic fields inside our coil system to control our robot to go wherever that it wants to.

The failures, I had to gradually reshape my mindset from seeing them as failures and more as, like, ways to learn and continue to improve my project.

- [Nurse] Yes, do you want the- - [Jaye] This is life as a physician scientist, treating patients and pursuing scientific discovery to improve that treatment.

- I think the ability to help more than just that patient in front of you is a good reason to think about being a clinician and a scientist.

- [Jaye] The Association of American Medical Colleges reports that 14% of all physicians do research.

In academic institutions like Emory, 24% of physicians are scientists.

Women make up a third of that.

- And then you can ask, like, well, why not just be one or the other?

Why try to bring it together?

And that is challenging because obviously, those are two, can be two full-time jobs in and of themselves.

And so you're sort of splitting your attention, so it's hard to be good at both, and that's a challenge for all clinician scientists.

- [Jaye] Also a challenge, the several weeks each year Dr. Hoang spends writing grants.

- Writing a grant is like a very large book report.

- [Jaye] Physician scientists need to fund their research.

Writing grants, explaining their findings and their goals is how they compete for funding from various entities, including the government.

- I'm implementing a new algorithm.

- [Jaye] Hoang and her collaborators have been awarded three grants.

- So I think surgery went well.

- [Jaye] Dr. Wong hopes within five years that these microrobots may be able to begin helping the humans she treats every day.

- I definitely want to keep doing engineering and bring that marriage between engineering and medicine together to make better devices for patients and new discoveries.

People ask me, "Am I putting myself out of business?"

And I always say I hope I am the person to put myself out of business.

- Tonight, we're bringing you an update many of you have been eager to hear.

It's about Tyler Hajjar, the young man who struggled with depression and suicidality for a decade.

When we first introduced you to him, Tyler had tried everything available without success.

Then came an offer, an experimental surgery involving deep brain stimulation, something undertaken by only a few dozen people across the United States.

We followed Tyler's journey several months post-surgery, and the results were astounding.

He was no longer depressed.

It's been five years since we met Tyler and much has changed both in the realm of research and in Tyler's own life.

- All right.

- [Jaye] Tyler Hajjar helps his dad change a headlight on his truck, an ordinary task that is extraordinary when you consider where Tyler was when we first met him five years ago.

- I am, I'm fighting kind of inside.

When I wake up every day, I sit there and I go, "Why can't you just get up?

Get up, get up."

I pray to God sometimes to the point where I'm in tears.

Just get up, just get up, just get up.

- [Jaye] This was Tyler 10 years into his struggle with depression.

He had exhausted his treatment options and lived daily with thoughts of suicide.

- This is allowed.

This is welcome.

We'll be checking in.

- We'll be sending updates during the day.

We're doing this, we're doing that.

It's a long day.

- [Jaye] Tyler became the 38th person at Emory to undergo deep brain stimulation surgery for depression.

- I love you, buddy.

- I love you too, dad.

- You're gonna be fine.

This is gonna work.

You're really the perfect candidate.

- Tell all our family I said I love them.

- [Pete] I will.

- Okay?

- Yeah.

- Right there.

- [Jaye] Dr. Helen Mayberg is a pioneer in the field, and for Tyler's surgery, collaborated with neurosurgeon Robert Gross- - Right side, lateral.

- [Jaye] And psychiatrist Patricio Riva-Posse, the Director of Emory's Treatment Resistant Depression Clinic.

- Each lead has four contacts per hemisphere.

Tyler was part of a study that we did here at Emory in which we were implanting a new experimental battery that not only delivered stimulation, but allowed us to record the brain signal from the lead that is in the brain, in the subcallosal cingulate in each hemisphere, - [Jaye] The cameras captured when the contact connected in a precise spot in Tyler's brain, a life-altering moment.

- Even before he said the name, I felt lighter.

I felt physically lighter.

I mean, just all over, shoulders, neck, head, back.

I mean, just everything felt lighter.

- [Helen] Does it feel, is it a good feeling?

- Yeah.

- [Helen] How easy would it be to actually get yourself out of bed?

- It seems like it would be a lot easier.

- So how is your anxiety right now?

- I don't really, I don't feel it.

- Okay, rate the heaviness, zero to seven.

- Um, I'd give it a one.

- [Helen] Okay, rate the anxiety, zero to seven.

- Yeah, I'd call it a one.

Now it's just kind of gratefulness, like a lot of gratefulness.

- [Helen] So feelings feel more real?

- Yeah.

- So with how you're feeling right now, is this the best you've been during our time here?

- I'd say so.

I remember looking at them and feeling the way I felt.

It was that weight off the shoulders, just like, wow, I haven't felt like this.

I can't remember the last time I felt like this.

It was amazing.

- That felt like we had our son back, at that moment.

And when I watch it, I always get emotional.

When I get to that part, and you hear me choking a little bit right now, I get emotional because you want the best for your kids and you, the worst thing, I think, as a parent is to see your child suffer.

- So I'm gonna ask you to put this over your battery.

- [Jaye] After the surgery, brain activity started being recorded, and a month later, stimulation began.

This protocol included nine other patients.

What was discovered in these recordings is groundbreaking.

Using artificial intelligence to interpret these brain recordings, a neural code emerged showing how neural activity changed between a state of depression and of wellness.

It's a biomarker, a measurable indicator of disease that gives clinicians a tool.

Similar to a blood glucose test for diabetes, it's a readout of the disease state at any given time.

And something else, what was happening in the brain tracked what researchers saw when interviewing the patients in a clinical setting.

Simply put, the inside matched the outside.

The team's research also confirmed the longstanding observation by psychiatrists, that as patients' brains change and their depression eases, their facial expressions also change.

The team's AI tools identified patterns in individual facial expressions from weekly recorded interviews that corresponded with the transition from a state of illness to stable recovery.

- We also did structured interviews each time that the patient came, and the signal of the brain also tracks with the changes in the patient's face.

- I'm well.

I'm- - So if we can have a very strong correlation between the brain and the face, we might be able to then just use facial data to tell us how the patient's brain is doing.

- [Jaye] These patterns proved more reliable than current clinical rating scales and could eventually have broad use in the field.

The study was published in the journal "Nature" in 2023.

After six months of DBS therapy, nine of the 10 patients showed significant improvement in their depression, and seven no longer met the criteria for depression.

One of those seven is Tyler.

- I mean, comparatively to what it was like in 2019 to now, it's night and day.

- [Jaye] The house is filled with photos of Tyler since surgery, smiling, out of the house, at family events.

- I can get up in the morning, and I look forward to getting up in the morning.

And I work part-time at a drug and alcohol rehab facility.

So I get to hang with the guys and cheer 'em up, be goofy a little bit, things I used to do a lot.

- [Jaye] The biggest change is this.

- You haven't had a suicidal thought since surgery.

- That is accurate.

- That's the miracle.

- It's my favorite question to answer when I'm doing those scales.

'cause they have to ask, "Have you had any suicidal thoughts or ideations or any plans?"

And I go, "No."

And every time I do it, I kind of get a little smile on my face, not 'cause it's, like, it's a funny subject but because I'm, like, happy.

I'm so grateful.

- He's one of 50 people in America that has this gift.

- [Jaye] But that number will now grow.

One of the DBS manufacturing companies not involved in Tyler's surgery has obtained a breakthrough designation from the FDA, and a new multi-site clinical trial will be launched at the end of 2024.

This surgical treatment could one day be a real possibility for some of the three million people who suffer from treatment-resistant depression.

There are no more days in bed.

There are days helping dad find the right tool to change a headlight.

And there are still times when they are overwhelmed, remembering all they've been through in order to get here.

- Don't give up before the miracle happens.

I was ready to do that.

And I am so grateful to God, and my family, my parents, my friends that supported me and helped me hang on for one more day.

You never know what the next day's gonna bring.

One day, I'm sitting there going, "The end is near.

Goodbye, cruel world" type stuff, and then the next, I'm getting a call about this radical surgery that could save my life.

And at that point, I was willing to do anything.

And I waited, and it came true.

My miracle came true.

This is my miracle.

I'd hate for someone else to lose out on that opportunity.

So just, if anything, just one more day.

That's what he told me for years.

He'd come into my room, check on me and he'd say, "Tyler, I'm proud of you, buddy.

We're gonna get this taken care of.

We're gonna get you fixed.

We're gonna get this fixed.

Just hang in there one more day, just for the rest of the day, just one more day."

I did that one more day for years, and it, it worked.

(bright music) - There has been a lot of research that suggests the zip code where you spent your childhood can somewhat predict your success in life, but there is other research that looks at where people live and how those places can influence mental health, in this case, psychosis.

This is a story that may make you see your own neighborhood through new eyes.

Most people wouldn't pay much attention driving through a typical neighborhood on a rainy day.

- From all of these studies that have conducted- - [Jaye] But psychiatrist and researcher, Benson Ku- - It's characterized by a high socioeconomic disadvantage.

- [Jaye] Knows how consequential it is where we live and whether we have connections or not.

- [Benson] To really identify mechanism- - [Jaye] Ku treats patients who've had their first episode of psychosis.

- Psychosis is a symptom in which individuals may experience a disconnect from reality.

So some of the things that they may be experiencing are hearing voices when no one's around, what we call auditory hallucinations, or they may have disorganized thoughts where their thoughts are pretty jumbled, and they may be talking and they're not quite making sense.

- [Jaye] Psychosis that goes on for longer than six months with a significant decline in the ability to function is deemed schizophrenia.

Schizophrenia impacts around 1% of the adult population.

It's estimated 60 to 80% is inherited.

And onset for men is in their late teens to early 20s, and for women, in their late 20s and early 30s.

Emory University was one of nine sites across the country to take part in the North American Prodrome Longitudinal Study whose goal was to better identify young people at risk of developing psychosis and better understand why some people develop psychosis and others do not.

- A lot of other investigators have looked into neuroimaging markers, genetic markers, inflammatory markers, and seeing, and they've even developed a calculator, a risk calculator.

These are the three neighborhood characteristics.

- [Jaye] Ku had a different idea.

- I said, what about their neighborhoods?

And what about their neighborhoods during childhood?

- [Jaye] The origins of this idea go all the way back to Ku's childhood.

- I lived in Elmhurst, Queens, and I grew up under the poverty line.

And I just remember going to a huge classroom, 40 kids, one teacher sitting in the back, really not engaged.

And I didn't do well in school initially.

I almost failed third grade.

And I struggled a lot with school, had to switch schools many times.

- [Jaye] The new neighborhood was life-changing.

- It was much better.

I started improving.

I, like, I had confidence.

I, like, ran for school president even though I didn't make it, but I started believing in myself a little bit more.

In the new neighborhood, it was a magic shop.

It might sound a little silly, but I volunteered at that magic shop.

I felt, like, a sense of belonging there.

That particular measure- - [Jaye] Ku was also in the Boys' Club of New York.

All of these connections changed his life trajectory, leading him to psychiatry.

- I could not have imagined being a doctor.

- [Jaye] In 1939, researchers in Chicago shared key neighborhood factors, poverty, residential instability, and lower levels of ethnoracial density were associated with a higher prevalence of schizophrenia.

- The rates have been pretty flat in those that- - [Jaye] Part of Ku's research today involves aggregating publicly available data.

In researching census tracts in Atlanta, areas with 4,000 people, Ku looks at those three things, residential instability, ethnic density, and poverty.

One thing he found in the research stood out the most.

(horn honks) It's something he experienced in his own childhood, that first neighborhood with people moving all the time, - Places with high turnover, this residential instability indexed by what we now know as called the social fragmentation index, during childhood predicts future conversion to psychosis.

- [Jaye] Ku also found that people at risk of psychosis who reported not adapting to their school environment eventually declined, but not until young adulthood.

People at risk living in greater poverty had reduced hippocampal volume.

Their hippocampus were smaller.

The hippocampus is important for memory, learning, and emotion, and is highly vulnerable to environmental stressors, which may lead to higher levels of cortisol, a hormone produced when we are stressed.

- So this is what- - [Jaye] Ku's research also showed something positive for those at risk for psychosis, that connection can be protective.

- If that individual at clinical high risk is connected to an organization, church, made new friends, different indices of social engagement, the impact of neighborhood on their brain actually is no longer that significant.

- [Jaye] Ku and his team found that living in an area of greater ethnoracial diversity is associated with reduced psychotic symptoms, with people reporting experiencing less discrimination.

- If you look at their childhood environment by going back to this area level factor, if they live in an area with greater proportion of also ethnoracial minorities, that led to, that predicted remission of psychotic symptoms.

- [Jaye] This is the neighborhood where Ku works.

- Asking about my patients' neighborhoods and walking around in these neighborhoods have helped me get a better appreciation and understanding of what may be going on triggering these symptoms.

- [Jaye] It has high poverty, lots of residential instability, and is diverse.

There is also high crime and drug use, and Ku says his patients sometimes tell him they don't feel safe.

This area in Atlanta is not impoverished.

- It was in somewhere lower Midtown.

So that is a place where it's relatively not as disadvantaged, so it's a lot of working class young folks living there, but it's highly unstable, as you can imagine, with a lot of apartments there.

I've actually lived in that neighborhood when I first moved to Atlanta.

- [Jaye] And the third place Ku singled out is Clarkston.

- [Benson] It's a huge immigrant community.

- [Jaye] 10 miles from downtown Atlanta, the area is home to immigrants from around the world, representing more than 150 ethnic groups and speaking 60 languages.

Despite high poverty rates, it's also stable, with 90% reporting living there more than a year.

- Members of the community feel connected.

They feel like they have an easier way of transitioning to lifestyle here because of that community.

It's also pretty stable.

(children laugh) - [Jaye] The broader takeaway is that living in a stable area during childhood is probably beneficial to all of us.

But for those at risk of psychosis, these findings could point toward greater treatments, even prevention.

- There are not a lot of great treatments to clinically treat this population to prevent the onset.

- [Jaye] Ku's childhood still resonates and inspires his research.

- I think back to that magic shop I was telling you earlier about and how much things like that, the social connections that I made in those spaces have been so important to me.

(soft music) - As we close our show this week, we wanna take you on tour.

- It's talking about working together, being one, unity.

That's what this is all about.

- The Mobilize Recovery Across Georgia bus tour kicked off at the capitol in Atlanta.

Spearheaded by the Overdose Response Network at the Clinton Foundation, the tour went across the state, holding rallies in different towns every day, celebrating the 800,000 Georgians living in long-term recovery from substance use.

Local, government and faith leaders took part, and organizers handed out overdose aid kits that included the overdose reversing drug, Narcan.

28 million people in the United States are living in long-term recovery, and the tour was to celebrate that and to remind people it's possible.

That's gonna do it for us this week.

See you next time on "Your Fantastic Mind".

(dramatic theme music) (dramatic theme music continues) - [Announcer] "Your Fantastic Mind", brought to you in part by Sarah and Jim Kennedy.