In this episode Dr. Katy Peters talks with Dr. Joel Salinas, a neurologist, clinical assistant professor at NYU Grossman School of Medicine, and chief medical officer of Isaac Health in New York. Dr. Salinas explains what it’s like to experience synesthesia, a rare neurologic phenomenon in which the brain processes several senses at once.

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Episode Transcript

Dr. Daniel Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa.

Dr. Katy Peters:
And I am Dr. Katy Peters. And this is the Brain & Life podcast.

Dr. Daniel Correa:
Now let's do something a little different. Close your eyes, notice all the sounds around you. Do you also notice the different sensations on your skin, on your clothes, maybe a passing breeze or even just the sensation of your breath on your nose? Imagine if when you saw certain colors or numbers or letters that had also triggered one of these different sensations. For some, this is a regular aspect of their day as they live with something called synesthesia.
Katy, you discussed this in much deeper detail with Dr. Joel Salinas. What did you learn?

Dr. Katy Peters:
Well, Daniel, it was fascinating to learn about this sensory phenomenon and how it can really have truly so many different representations in the terms of the different senses, whether it's touch, emotion, actually seeing something or hearing something. Honestly, I wish that I could have the same experiences that our friends with synesthesia have since I've had my wonderful conversation with Dr. Salinas.

Dr. Daniel Correa:
This is a part of some of our episodes where we feature the brain wonders, all the amazing things that our brain does, and we hope you enjoy it.
In the coming weeks, we will also be joined by Abby Romeo and her mother Christine, to talk about her experience growing up and living with autism spectrum disorder. You'll likely remember both of them from the Netflix series, Love on the Spectrum. I really hope you enjoyed this episode.

Dr. Katy Peters:
Today we are delving into brain wonders, and this is a series that focuses on brain wonders and how the brain is able to process and function in unique and complex ways and welcomes variations on how people experience sound, movement, touch feelings, emotions, and even colors. And the brain wonder for today makes me think of a tongue twister. We will be sharing the secrets about synesthesia with Dr. Salinas.
Dr. Joel Salinas is a neurologist and clinical assistant professor at the NYU Grossman School of Medicine. He cares for people with cognitive decline and impairment due to neurodegenerative diseases such as Alzheimer's and frontotemporal dementia. He and a team of psychiatrists, neuropsychologists, physical and occupational and speech therapists, work in the Pearl L. Barlow Center for Memory and Evaluation and Treatment. Through Isaac Health, he improves access to this kind of specialized care by providing it via telehealth to more patients and more families who need it from the comfort and privacy of their homes. When making treatment recommendations for his patients, he balances evidence-based guidelines with holistic lifestyle interventions such as exercise and a healthy diet.
His research is fascinating as it explores the importance of social isolation and loneliness in social networks as risk factors for dementia. While his expertise is on dementia, he is not here to discuss this today, but rather he'll be discussing the phenomenon of synesthesia, which is a fairly rare neurologic phenomenon in which the brain processes data in several senses at once. One sense activates another unrelated sense, and they are experienced simultaneously. That's amazing. And in fact, he wrote a book on this topic and it is entitled, "Mirror Touch: A Memoir of Synesthesia and the Secret Life of the Brain."
Welcome, Dr. Salinas.

Dr. Joel Salinas:
Thank you. Thank you for the invitation. I'm so excited for the conversation.

Dr. Katy Peters:
Wonderful, and I think our listeners will definitely find this a true brain wonder, but before we start discussing synesthesia, just tell me a little bit more about yourself and what brought you to specialize in neurology, including your subspecialty of dementia.

Dr. Joel Salinas:
Yeah, so I am born and raised in Miami, Florida. My family is originally from Nicaragua. They fled during the Nicaragua Revolution in the early 80s and were able to come to the US under political asylum. I grew up in a pretty low income household, so I'm very familiar with the experience of coming from a community that's really underserved. So it's really driven my passion for helping to improve access to high quality healthcare throughout my life.
And one of the things that really drove me to specialize in neurology is just the brain is just incredible, right? It's this motherboard of reality and I felt that whatever we can do to help to improve someone's brain functioning, even if only a little bit, really translates to helping to improve someone's entire reality, their whole universe. And that just felt so precious and so powerful.
And specifically within the area of behavioral neurology, which specializes in people who have cognitive and behavioral issues in particular with dementia, that just feels like it really targets that specific element. And when we get older, our brains are at higher risk for developing all sorts of conditions. And so I wanted to be in the best position possible to be able to help to prevent these conditions and help to guide people through it as much as possible so that way when we intervene early, we might be able to have a greater impact on the long-term trajectory of their health and their happiness and their wellbeing and their ability to enjoy life with the people that they love.

Dr. Katy Peters:
That's great. And I love the idea of intervening early and intervening with not just the tools that we use in medicine, but also the exercise and healthy diet. We're all about brain health here.
So with brain health, it becomes sort of brain wonders, and I loved your terminology, it's sort of the motherboard of what's going on. So one of our brain wonders, you're going to teach us all about synesthesia today. So can you share with us those secrets of synesthesia?

Dr. Joel Salinas:
It is a very challenging word to grapple with, synesthesia, but if you break it down, sin means together, anesthesia means to sense, and together it means to bring together the senses. So synesthesia to kind of explain earlier, and of in general, it's really the experience of receiving information in one sense, like sight, touch, smell, taste, and then translating that in your brain and experiencing as more than one.
So somebody with synesthesia can experience things like what's called grapheme-color synesthesia, where letters and colors are linked together. So I have that form of anesthesia. So my letter A is red, B is orange, C is black, D is light brown, and so on and so on. There's something called chromesthesia or sound-to-color synesthesia, which is very common among musicians. Imagine the sound of a violin evokes a violet color or a G flat may come off as green in your brain and there's many, many different combinations and it's all experienced differently and people may have more than one type of synesthesia, but what anchors it all is connections in the brain that trigger more than one experience at the same time.

Dr. Katy Peters:
That is truly fascinating and you and I talked about it as sort of a phenomenon and for our listeners, a lot of our listeners may have a neurologic illness or a disorder, or they may have a loved one that has it, and when they go to see their neurologist, they don't often describe phenomenon, but how is this different from a sign or symptom in neurology?

Dr. Joel Salinas:
The term phenomenon, you can also call it a trait, really is just something that happens in the brain and using terms like symptom or sign implies some kind of a disorder or dysfunction or disease that's going on. Everybody experiences the world differently based off of how their brain is wired and programmed together. And the language that one chooses to use really depends on what kind of an impact it has on their life. So if we were to use a term like condition, it's slightly more neutral. If we use a term like disorder that implies that there's some negative impact or some kind of impairment going on in your social or occupational functioning. And if we use a term like disease, it really relates to there being some kind of pathology or some abnormality going on underneath. And so it really depends on the beholder in terms of what terminology you use in terms of what a positive or negative impact it has on your life.

Dr. Katy Peters:
For you, you just mentioned that you have synesthesia or you experience the letters you experienced through color also, when did you first become aware of this?

Dr. Joel Salinas:
The experience of synesthesia is one that I've always had, and I can think back to my childhood. I was always very specific about the crayons that I used to color my letters and my numbers. There's another form of synesthesia that I have called ordinal linguistic personification, which essentially means that certain words, numbers and letters also have personality traits, so they might be more masculine or feminine traits or quirky. But basically I remember having all this as a kid, but it was only until I was in my first year of medical school where I was on a medical trip in Gujarat, India and everybody was sitting around enjoying some chai and talking about different aspects of neuroscience, which definitely caught my attention. And a friend of mine who has a background in neuroscience, he mentioned, "Oh, did you all know that there are these people who have this experience that's a lot like an acid trip where they experience sounds with color and colors with sound."
And when he said that, it really caught my attention, not because of how bizarre it was, but because of how normal it seemed, and I was just struck by why would he mention that if everybody experiences that. So later that night I came up to him and I said, "Hey, you mentioned this thing about people who experience colors with letters and sounds and things. Why would you even bother mentioning that? Everybody has that." And he just looked at me and said, "No, that's definitely not normal." And that's what set me off on this long journey to really learn about synesthesia is to learn more about my brain and its experiences and how it all comes together.

Dr. Katy Peters:
I would maybe just say that this is really a variation of how we experience more than calling it an abnormality. So now that you sort of have this experience and you experience letters and colors in different ways, how do you recognize that in your patient population?

Dr. Joel Salinas:
More than anything, it's helped me be a lot more open about atypical complaints or symptoms specific that somebody mentions. So if somebody says that they are feeling something ambiguous or using terminology that doesn't fit the textbook, rather than just saying, "Oh, that's not something relevant," I'll be a little bit more curious and open to their experience, and I'll ask them, "Can you say a little bit more? Can you use other words to describe what you're going through? How important is this in your life? How is it impacting you? Why does it matter and why are you sharing it with me now?"
We all are born with these very strange bodies that we have and we don't have a manual that tells us what a feeling is or isn't. And I think it's important to just be as open-minded to really letting people express what that is. And then as a physician, I'm then the person who takes that information, makes a decision about whether it really ends up being tied to a disease or a disorder of some sort or whether it's just a part of somebody's experience.

Dr. Katy Peters:
Absolutely. I know that there's some children's movies that have really tapped in to sort of describing different emotions and using color to describe those emotions, and I think this is a way for us to at least to show those differences in that sensory experience. Now, are there neurologic conditions associated with synesthesia? Are there certain types of people that are more apt to experience this phenomenon?

Dr. Joel Salinas:
Yeah, so synesthesia is actually something that we all are born with and it's something that typically goes away at about age two or so, as our brain starts to prune access connections that it has to increase efficiency. So it's like closing side rows so you can bring in some highways so the information gets to where it needs to get to more quickly, and there are some people that are more likely to retain those connections. At least that's one of the theories behind it.
And there's been some genetic work done looking at families where a lot of people have the chromesthesia, which is the sound color synesthesia, and they have found a couple of gene variants there in particular one that is important for something called axonal morphogenesis, which is a mouthful, but really what it means is brain cells moving through and shaping through the brain, so it relates to development. In looking at research of people who have synesthesia, their brains generally are different from people who don't have synesthesia because they have an increase of physical and electrical connectivity between brain areas, in particular those brain areas that are relevant to the combined experiences that they have.
So for someone who has sound color synesthesia, you would expect to see more brain connections between the parts of the brain that receive sound and the color areas of their brain. Similarly, people who have grapheme-color synesthesia, the part of their brain called the fusiform face area, that's important for recognizing faces, but also numbers and letters connects a lot more with its area of the brain called the V4 area, which is where we really perceive color. So you can see that a lot of it has to do with connectivity, which is why the in conditions that people are more likely to have differences in brain connectivity like autism spectrum disorders or in ADHD and obsessive compulsive disorders. These people may also be more likely to have synesthesia as well.

Dr. Katy Peters:
Fascinating. That is so interesting. So could you actually test someone for synesthesia? You mentioned that there's been some really fascinating research about those connecting pathways, but could you actually give someone a test to see if they're experiencing this?

Dr. Joel Salinas:
Typically, when somebody is curious about whether they have synesthesia or not, the best way to really approach that is there are researchers who study this phenomenon and they're usually the experts in figuring out what kinds of tests could be done. Oftentimes, it's really to see how strong the associations are. So one way that could be tested, for example, going back to the example of grapheme-color synesthesia, they essentially give you a color wheel and they say, "Okay, now what's the color of this letter and that letter," and they present the letters to multiple times, and the more precise and consistent that color association on that very big color wheel your color is, the more likely it is that you have synesthesia. And they do this for all sorts of other combinations. The more it involves studies when they're really trying to understand brain biology of it involves doing functional MRI scans or functional conductivity MRI scans really to visualize how the brain connections are increased in those specific areas.

Dr. Katy Peters:
I can say that I don't appreciate that certain letters have different colors associated with them, but how would you sort of describe it to someone? If you were trying to describe your experience, what kind of language would you use?

Dr. Joel Salinas:
There are some aspects that are synesthesia that are common across all people, and this is more into the conversation around why it even evolved in humans to exist. And some of it comes down to maybe it had some function around helping us communicate with each other.
So for example, using terms like sharp cheddar or a loud tie. These are things that we typically associate with poetry, but there's a synesthetic aspect to it, right? Why is a flavor actually sharp or why is a color like loud? There's also certain things that we tend to associate broadly across everybody, so high-pitched sounds typically are related with lighter colors and smaller objects and low pitch sounds are typically associated with darker colors and larger objects, and so there's some really interesting evolutionary things there, but in general, it's just that interesting cross-wiring that we all have, but turned up to 100.

Dr. Katy Peters:
Thank you for explaining that because I feel that with the loud clothing or a high-pitched sound, I get it now, I get it. I get the synesthesia, so I appreciate it.
Now, you mentioned your experience in India. I guess it was sort of your synesthesia awakening. What sort of inspired you to write your book, "Mirror Touch: A Memoir of Synesthesia and the Secret Life of the Brain"?

Dr. Joel Salinas:
I was always really shy about sharing a bit about my synesthesia with folks that I wasn't really close with or people that didn't have some background in neurology and were open to talking about it. I mean, there's so much research in this area and there's a lot of evidence there. It's just very well published, but when you first describe it to somebody, they may react in a way that's like, "Oh, this person's weird," or "What's going on here?" And it was only until a journalist reached out to me who had learned of me through one of the scientists that was studying me. She was like, "Hey, your experience is really unique and it could be really powerful for other people to learn about it." And so I decided to open up a bit more about it. In particular, one form of synesthesia that I have is called mirror touch synesthesia, which is like the experience of empathy that people have, but again, turned up to 100, where seeing other people be touched or experience pain or pleasure, I feel it in my own body as well as if it were happening to me.
And once the journalist published the article about it, I just had so many people reach out saying, "I'm so glad you talked about it. I was really scared to mention my own experience as well." I had one person say, "I always had this experience. I knew that there was something different about me compared to others, and now that I have a name for it, I feel so much less alone."
I felt it was just so important to share about what makes us different and also what makes us connected at the same time. And if it gives an opportunity for people to learn more about their brain and their selves and can really open up their mind to the diversity of human experience, all the better.

Dr. Katy Peters:
That is wonderful. Thank you for opening our minds. This is just a great segment, and thank you again, Dr. Salinas for sharing the secrets of synesthesia and for joining us on the Brain & Life podcast. A reminder to our listeners to check out Dr. Salinas's book, "Mirror Touch: A Memoir of Synesthesia and the Secret Life of the Brain" on more insights on synesthesia.
If you'd like to learn more about himself and his work, check out his website, joelsalinasmd.com, and thank you to our listeners.

Dr. Daniel Correa:
Thank you again for joining us today on the Brain & Life podcast. Follow and subscribe to this podcast so you don't miss our weekly episodes. You can also sign up to receive the Brain & Life magazine for free at brainandlife.org. Don't forget about Brain & Life en Español.

Dr. Katy Peters:
Also for each episode, you can find out how to connect with our team and our guests along with great resources in our show notes. We love it when we hear your ideas or questions. You can send these in an email to blpodcast@brainandlife.org and leave us a message at 612-928-6206.

Dr. Daniel Correa:
You can also find that information in our show notes, and you can follow Katy and me and the Brain & Life magazine on many of your preferred social media channels.

Dr. Katy Peters:
And these episodes would not be possible without the Brain & Life podcast team.

Dr. Daniel Correa:
Including Nicole Lucier, our Senior Manager of Public Engagement.

Dr. Katy Peters:
Rachel Robertson, our Public Engagement Coordinator, and Twin Cities Sound, our audio editing partner.

Dr. Daniel Correa:
We are your hosts, Dr. Daniel Correa, connecting with you from New York City and online @NeuroDrCorrea.

Dr. Katy Peters:
And Dr. Katy Peters joining you from Durham, North Carolina and online @Katy PetersMDPHD.

Dr. Daniel Correa:
Most importantly, thank you and all of our community members that trust us with their health and everyone living with neurologic conditions.

Dr. Katy Peters:
We hope together we can take steps to better brain health and each thrive with our own abilities every day.

Dr. Daniel Correa:
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See you next week.

 

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