- Welcome to The Minor Consult where I speak with leaders who are shaping our world in diverse ways. Today, I'm delighted to be joined by Dr. Pria Anand. Pria is an award-winning writer and a practicing neurologist. Her work explores the power of narrative in medicine, the mysteries of the brain, and the ways that neurological conditions can change how we experience ourselves and the world around us. Her most recent book is "The Mind Electric: A Neurologist on the Strangeness and Wonder of Our Brains". It won the 2026 PEN America/E.O. Wilson Literary Science Writing Award, among other honors. Her writing has also appeared in such publications as The New York Times and the LA Review of Books. Pria is an assistant professor of neurology at the Boston University School of Medicine, and she cares for patients at the Boston Medical Center. Pria is also an alumna of the Stanford School of Medicine. Pria, thank you for joining me today.

- Thank you so much for having me, Dean Minor. It's such a pleasure to be here.

- Well, let's start at the beginning. What drew you to medicine as a profession? And why did you choose neurology as a specialty?

- So I'll actually start with the second question because that was something that happened while I was at Stanford. I was just starting my fourth year of medical school and going through all of my different rotations. And I was one of those medical students, I think you have a lot of them at Stanford, who loved every single rotation. So I think my first rotation was transplant surgery and I said, "I'm gonna be a transplant surgeon, this is incredible," and then OB-GYN and medicine. Everything I did, it seemed like a really remarkable way of really kinda being able to intimately become a part of people's lives. And then when I was just at the very beginning of my fourth year of medical school, I still hadn't decided what I was gonna specialize in. I think my academic advisors were all tearing their hair out, telling me that I was gonna have to apply to residency pretty soon. And my grandfather in India, I lived in India when I was younger, my grandfather still lived in Bombay, started to fall sick and I had the chance to go to India to see him. And my grandfather, he was this really larger-than-life figure in my childhood. He made films for the Indian government. He'd spent his whole life in India, but he had in the '40s somehow managed to find his way into an American troop ship and visit Los Angeles and had all these really beautiful stories about meeting movie stars and visiting film sets and just really was this person who was full of stories and life and really shaped my childhood. And he started to fall sick in this really strange and particular way. So he was a really kind of tall, big guy, and he started to vanish, this really larger-than-life person from my childhood started to lose his muscles. His voice, which had always been really commanding, began to disappear. He had always been really extroverted, he stopped leaving his house, and he really seemed like he was withering before my eyes. And I had the chance to go with him to the neurologist. This neurologist, as is the way of good neurologists, undressed him and examined him. And just from laying his hands on my grandfather's body, from seeing how his muscles had started to waste away, from listening to his voice, this neurologist was able to piece together this part of my grandfather's story that I, as his granddaughter who thought I knew all of his stories, didn't know, which was the story of his childhood. He had grown up in a very rural village in North India, dropped out of school as an early teenager to work in a cotton gin factory. And at some point during that childhood, he had contracted polio. He had childhood polio and he had a limp his whole life, but otherwise it was not something he ever talked about or mentioned. It was a really deeply buried part of his story, but polio is a funny thing that is written into your body for your whole life. Doctors who have cared for patients with polio, people with family members who might have experienced it when they were younger know this. And he was suffering from an echo of that childhood infection. And this neurologist could touch my grandfather's body, look at how his muscles were twitching and check his reflexes, and just without even exchanging words could know this really intimate part of my grandfather's story. And I was so moved by that and it spoke to what brought me into medicine in the first place, which was kind of stories and this really, this sense of curiosity about people. I came back from India, got over my jet lag, and the next day I called up the good Dr. Jeffrey Dunn and said, "I think I wanna be a neurologist. Can I do a sub-I with you?" And thankfully he was very generous and welcomed me to his service. But it was really sort of this aha moment that brought me to neurology.

- That's such a wonderful story. You've also said that you wanted to become a writer before you wanted to become a physician. What made you decide to combine these two passions?

- That's a wonderful question that I'm still trying to piece together how my journey has sort of evolved. Before I ever wanted to be a doctor, I was not one of those children who grew up with a stethoscope. There are no doctors in my family. Before I ever wanted to be a doctor, I wanted to be a journalist. And maybe it's because I'm a nosy person, but I loved being able to ask people questions and learn about their lives and then figure out a way to retell that story in a way that might resonate with people more broadly. And so that was what I wanted to do when I started college. And when I was in college, I had this job where I worked actually as a case manager in the prison system. And I took the job because I was really interested in the relationship between the community and kind of the carceral system. And I was interested as a journalist, but I was working as a medical case manager, helping people connect with medical care for their addiction, for their HIV, for all of these different medical conditions they've been struggling with. And I realized that that felt like the most intimate part of people's lives, was their bodies, it felt like a thing that was universal, that unites all of us. Even though I was a college student coming from this very different place, these physical vulnerabilities were kind of true for my clients, the people, everyone else in my life, my family, it felt like something that was very universal. And so I really sort of saw the potential for stories in work that had to do with medicine and illness and bodies. And I have to say, I don't know that I would have been able to honor that interest in stories and writing had I wound up anywhere other than Stanford Medical School. I feel like Stanford has this really special way of elevating, regardless of the way that you wanna make an impact in the world, it's really not a one-size-fits-all place, it has this way of elevating whatever your passion is and centering whatever your passion is, and for me, that was writing. And so when I was in my first year of medical school at Stanford, a lot of my classmates were applying for summer jobs in labs and Stanford funded me to do a writing project. I flew to this island in Colombia. I was interested in language and how language evolves. So I designed this project to travel to this island in Colombia with a very high rate of inherited deafness and collect oral histories and collect, try and understand this sign language that organically evolved on this island. And I can't imagine another place that would have put up with such a circuitous route through medicine, but it really let me honor both of those interests from the very beginning.

- That's wonderful. And you certainly have taken advantage of those opportunities to define your passions, to develop excellence as a writer and as a physician and as a neurologist, and it's something we're all very proud of here at Stanford. And I also wanna congratulate you on "The Mind Electric", it's a wonderful book and I thoroughly enjoyed it. In the book, you explore the gap between the science of the brain and the mysteries of human experience, and you do so by weaving together patient stories, medicine, mythology, literature, and your own experiences. What does narrative allow you to reveal about illness that a more traditional medical account might miss?

- It's an amazing question, and I think probably every doctor and every person living in a body has a version of this. As I said, I didn't start out life wanting to be a physician. And I think I first encountered illness not in medical texts, but in novels and stories. So I think I read about epilepsy in Dostoevsky's books where he kind of immortalizes his own experience of epilepsy before I ever read about it in a medical text or looked in an EEG. And it's so interesting because I think, especially for neurologic illnesses, but for anything, I think that what someone experiences in their body is not always easily captured or rendered with the particular set of pathways or the particular anatomic explanation for what they're experiencing. So something I remember learning about in the sleep clinic when I was a medical student at Stanford was sleep paralysis. And it fascinated me because we understand sleep paralysis, there have been many, many experiments that helped us to understand what sleep paralysis is. It is the phenomenon of the freezing that keeps us from acting on our dreams happening at a moment when someone is awake. So people describe the sensation of being trapped in their bodies. They see this kind of illusory image just beyond their line of sight. They hear phantom noises, they feel a sensation of a weight on their chest. It's a very common experience, some of your listeners may have had it. And it's very, very reliable, so the physiology is the same no matter who you are or where you are. But if you are someone who's ever experienced it, you might look at that anatomic diagram of the cat or the rat with a lesion that gives rise to sleep paralysis and say, that doesn't capture what is so scary and otherworldly about the experience of being trapped in my body with the weight on my chest and seeing kind of a shadow. But every culture has a story that explains this experience of sleep paralysis, and I find that so fascinating. There's a richness to those stories. So there's a witch or a sorcerer. I've heard different things from my patients who've had this experience, who describe, in their sort of folklore tradition, a baby that sits on your chest, different things that capture the embodied, the feeling of sleep paralysis, that subjective feeling. And I think there's a real value in that too, so I think they both have value. Understanding the science is essential, but understanding or being, even if you can't fully understand it, being curious about what it means to exist in a body that's having these experiences is so fascinating to me.

- You begin "The Mind Electric" by describing patients whose symptoms can sound almost fantastical. There's a woman who believes she's been replaced by a changeling, someone who hears the same four chords repeatedly. What can these extraordinary cases tell us about the ordinary workings of the brain?

- I love that question. I think for anyone who is a student who's thinking about neurology, I think it's important to understand that having an interest in neurology is not about being voyeuristic, it's not about looking for things that are weird or out of the norm, it's really about understanding how symptoms and illness can really reveal something universal about how all of our brains work when they're functioning. And that's true of every time that, I think every sort of advance in neurological science really hinges on the experience of people who have experienced sort of a wound that reveals something about how the brain works. So a great example, I think, is language. So much of what we understand about language is profoundly human. Universal human function comes from watching what happens when people experience injuries that rob them of their language. And it turns out that you can lose your language, but still be able to think, you can lose your ability to produce language, but still be able to understand it. So these really kind of specific injuries help us to map out the networks that are happening, operating all of our brains, whether or not our brains are injured. And so as strange as they sound, I think they really are a reflection of all of us and how we're all working when we're well.

- You have a wonderful quote in the book and the quote is that "a neurology diagnosis always hinges on a story." What can a patient's story tell us that an MRI or a neurological exam can't?

- That's an incredibly important question, especially in this era of medicine where often I feel like in the hospital, I feel like it is really hard to hear a story before you see the person's MRI. It's one of the first things that happens when someone walks through the door. So I think it's a really important question that I struggle with a lot and consider a lot. So I'll start by saying that my specialty within neurology is neurologic complications of infectious diseases, and often it is, especially infectious diseases, but neurology in general is so entwined with people's story with how they move through the world. I can think of a patient I had recently who had this meningitis that we couldn't figure out. None of the cultures that we collected would grow anything. And to understand what his diagnosis was, you had to understand his migration journey. So he had this really extensive travel across South and Central America, and the infection that he'd picked up along the way, there was no way to know what it was unless you knew where he had traveled and where he had set foot across the Southern United States. And so it's so interesting because I really cling to those examples of moments where you have a degree of curiosity about another person in order to arrive at a diagnosis. And the nice thing about neurology is it's still just by virtue of the fact that so much neurology cannot be captured by an MRI. There are still diseases of the muscle, there are still diseases of the nerve, there are still diseases of how the brain functions that don't manifest with the physical lesion you can see in an MRI. Epilepsy is a great example that doesn't always show itself physically in an MRI, that you still have to ask someone what they're experiencing in their body. You still have to talk to another human being in order to make a diagnosis. So practically, you still have to rely on the narrative, I think.

- One of the ideas running through the book is that cultural beliefs can shape how people experience and describe illness. How much of what we understand as illness is shaped by the culture around us, and what does that mean for the way physicians listen to patients?

- That's such a fantastic question. I think some of my favorite work in this actually comes from Stanford, from colleagues like Tanya Luhrmann, who's a wonderful anthropologist at Stanford, who studies the experience of hearing voices. And she talks about how the neurobiology, the pathophysiology of diseases like schizophrenia, is reliable across cultures, but how people experience their voices really differs. And so whether they experience voices as intrusive and assaultive, whether they experience voices as familiar, whether the voices they hear are anonymous and the voices they hear are a family member or a deceased relative, that is really, really culturally determined, and that matters for how people do, for how people recover from their illness. The same thing is true of in... I think about things like musical ear syndrome, is something that I see from time to time in my practice, this phenomenon of losing your hearing and your brain constructing a sound that you hear instead. And it turns out that what people hear is really, really reliably grounded in their experience, their culture, whether it's a particular hymn that they grew up with or a beloved song. And so it turns out that how you experience a symptom or how you experience an illness, and even whether you think that it is a problem or damaging or pathologic can have as much to do with culture and with your own story and your own history as it does the actual biology of what you're experiencing. So I think our brains are more open to the world around us than I once thought.

- You also talk about confabulation in the book, and you describe confabulation as the brain unconsciously creating stories to fill in gaps in memory or understanding. What do you think confabulation can teach us about the stories we all construct to make sense of the world? And also, how do you view the relationship between confabulation coming from the brain and AI hallucinations?

- Confabulation is, I think, one of the most strange mysteries in all of neurology. And exactly as you said, there is an element of confabulation in how we all move through the world. So confabulation describes a neurologic symptom where someone's brain unconsciously constructs a story and they experience that story as real. So for example, I will often take care of someone who has lost their memory and I'll ask them, "Have we met before?" And I've heard answers that range from, "We were childhood sweethearts," to, "We met at my high school reunion," to "We played in the big game together." I mean, really specific, really intimate stories that are true for the person who's telling me, but are not grounded in the facts of the world around them. And confabulation, you can lose a lot, you can have a lot of different kinds of brain injuries. You can have injuries to your memory, injuries to your strength, injuries to your vision, that your brain compensates with these confabulations, these stories to make up for the information that you're missing. Some of the really classic descriptions of confabulation come from a Russian neuropsychiatrist who described confabulations in a patient of his who was actually a writer who constructed stories that he had never actually written before he was ill. And I find that so fascinating because it tells us that storytelling is really deeply coded into our brains. We retain the ability to tell stories even when we lose so many other basic functions, whether it's strength or memory or anything else. Stories are really, really hardwired into our brain. And I think we all, to some extent, we all confabulate as we move through the world. We all tell stories to make sense of things that we don't understand. We're all drawn to stories. There's a reason that news travels the way that it does. There's a reason that we relate to one another the way that we do. Our brains are really primed to look for a narrative and to look for a story around us, whether we have any kind of neurologic injury or not. So I've heard some AI developers call AI hallucinations confabulations, which I love because that feels like a really true description of what they are. I think hallucinations describe a perceptual experience, like something that I'm seeing or hearing or touching, and I'm not sure whether AI can have a perceptual experience, but confabulations describe this story to compensate for a sense of, like, the story to make up for what you don't understand or a sense of uncertainty. And I feel like it's so interesting that as we've tried to create new forms of intelligence, it turns out that stories are really maybe a universal part of intelligence maybe. I think they probably arise from a different, mechanistically different, but I have heard that one of the flaws that makes an LLM much more likely to confabulate is if it doesn't feel like it has permission or if it doesn't have permission to confess uncertainty, so it has to give an answer rather than confess uncertainty. And I think that's also a very human, a human quality, especially for doctors. We hate confessing uncertainty, we'd rather tell a story.

- Sure, sure. In "The Mind Electric" and also in your other writing, you explore how profoundly that brain health shapes our quality of life. And as our brains change with age, how do we preserve not just our cognitive longevity, but also what makes life meaningful, our identity, agency, and our connection and our sense of purpose?

- I love that question because I feel like there is this tendency to equate brain health and longevity with sort of a fear of changing, this idea that you don't want your brain to age or change. And I don't think that brain aging is a bad thing at all. The way that our brains develop is that we, you know, the way that our brains develop is in toddlerhood we prune down the number of synapses that we have so our brains have a better ability to pay attention to what matters. And through our lives, we learn more and more about what it is that matters, what we should focus on. And so I think some of the changes in our brain reflect experience and are precious and important. So I love that you framed that question in terms of not just cognitive longevity, but what matters, purpose and identity and connection. And I think it's interesting. I think a recurring theme in a lot of neurologic illnesses is really that connection, it turns out that, I think, connection to other people is as essential as any of the basic human needs, so as essential as sleep and food and hydration and exercise, connection to other people is absolutely essential. And there are all kinds of neurologic consequences of isolation. So some forms of confabulation are much more likely if, for instance, you're an older person living by yourself without any sort of other input. It seems like our brains are actually wired for language, to hear other people talking, to experience other stories, to experience the touch of other people. And when we don't have that kind of connection, our brains will construct it to make up for the things that we're missing. So I think if there's anything to be learned about brain health, that healthy aging has to leave room for change, but also has to prioritize the things that our brains are primed to look for and hungry for. Connection to other people is, I think, the most essential one of those.

- Looking ahead, what questions about the brain and human experience do you think medicine is only beginning to ask? And what do you hope we'll understand differently 20 years from now?

- That is a great question. I wish I had a crystal ball because neurology looks so different now than it did 20 years ago or even five years ago. One thing that we were just chatting about before we started the podcast was just this idea that for the longest time neurology was really, people called it a subspecialty of diagnose and audios. You would spend all this time trying to figure out what someone had and you'd say, "I'm sorry, I have nothing to offer you," and that's not true in neurology anymore. We're entering this new sort of moment of treatments for genetic diseases that we previously thought that's your fate, that's what you're gonna go on to have for strokes, for autoimmune diseases. So we're entering this new moment of treatments. But I think as a neurologist, I still wear my diagnosis hat always. And I think this new era of treatments has really made me feel like diagnosis matters more than ever now, it matters more than ever that we get things right. And looking back at sort of the trend in neurology, it's so interesting how much of our understanding of the nervous system changed in the era of having MRIs or having imaging of the brain. So in the time before where all you had was your exam, and in the time after, diseases like multiple sclerosis that leave really obvious wounds in the brain on an image, but don't always leave lasting scars on the neurologic exam or the body. Those were diseases we really only started to believe in and understand after the advent of MRI. So I'm really interested in what functional imaging, as we start to understand the brain in terms of its activity and its networks and not just its structure. The brain is a living, moving, a functioning organ and not a static moment in time the way that our MRIs show them. I wonder whether there's a whole new set of illnesses that we haven't even begun to comprehend that will start to make sense, maybe disorders of movement that we've struggled to diagnose in the past that suddenly we'll be able to see some of the functional changes in our brains that we've kind of struggled to piece together or understand in the past.

- Well, Pria, this has been a wonderful conversation. And I'd like to end with two questions that I ask all my guests. First, what do you think are the most important qualities for a leader today?

- I should be asking you that question. I'm still trying to figure out how I should think about leadership in my job. So I'm the director of the residency program for neurology, which has been a really interesting, and in some ways it feels like a very weighty role because I think this is a moment watching people go into medicine and choose what kind of doctors they're gonna be, how they're gonna practice medicine, how they're gonna treat their patients, it feels like very high-stakes leadership to me. I think what I've started to value the most is actually the same things that I value in the practice of medicine and in neurology, which is, I think the first of those is humility. I think humility is maybe an undersung virtue in leaders and especially in leaders in medicine where medicine does get things wrong. And I think being able to course-correct and be open to those moments of uncertainty or being able to be open to a moment where you've got the story wrong is really hard, it's incredibly hard and it doesn't get any easier with time, but I think it's really an undersung virtue of great leaders in medicine. And the other one I would say is genuine curiosity. I think being open to sort of where something new might lead, even if you have no, even if it's not something you have a lot of information about to begin with or priors about, I think can really create some incredible opportunities. And I think those are both qualities that you and Stanford kind of expressed in spades and modeled for me when I was a student.

- Well, you certainly exemplify humility and curiosity in your work, both your work as a writer and your work as a neurologist and as a leader of the residency and so many other things. And finally, what gives you hope for the future?

- So like I said, I spend a lot of my time with trainees, with residents and students, and that is a very deliberate choice on my part. I think it's really easy to forget what is remarkable about medicine, what's remarkable about our bodies. And then you spend time with someone who is seeing something for the first time, seeing an exam maneuver for the first time, having the experience of hear a patient share their story for a first time, and you realize, wow, this is a really precious and wonderful thing that we get to do with our lives. And so it really reinvigorates my love of medicine, but it also gives me a tremendous amount of hope and faith. I think people are always sort of bemoaning the future of medicine in this moment of technology and AI, but the trainees that I work with are so, so deeply human and care so deeply about their patients. And I'm on the hospital service now. One of the residents that I'm working with, a patient really struggled with housing, came in from a shelter, and she walked him from the hospital back to a shelter because he had left some of his possessions there. And just that physical, the willingness to meet someone where they are, to hear what's important to them, even if it's not the thing that's in your textbook, I feel like there's a generation of doctors who have that quality and they're gonna bring it to medicine. And I can't wait to see what the next generation of medicine looks like.

- That's fantastic. Pria, thank you so much for joining me today. And it's great to connect again after your graduation from the Stanford School of Medicine. And thank you for listening to The Minor Consult with me, Stanford School of Medicine Dean Lloyd Minor. I hope you enjoyed today's discussion with award-winning author and neurologist, Dr. Pria Anand. Please send your questions by email to TheMinorConsult@TheMinorConsult.com and check out our website, TheMinorConsult.com, for updates, episodes, and more. To get the latest episodes of The Minor Consult, subscribe on Apple Podcasts, Spotify, or wherever you listen. Thank you so much for joining me today. I look forward to our next episode. Until then, stay safe, stay well, and be kind.