Behavioral Genetics 101: How Genes Shape Mental Health w/ Professor Kathryn Paige Harden

Summary

Podcast Summary: Raising Good Humans

Episode: Behavioral Genetics 101: How Genes Shape Mental Health

Host: Dr. Aliza Pressman
Guest: Professor Kathryn Paige Harden
Date: February 27, 2026

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Episode Overview

This episode explores the role of genetics in shaping mental health and behavior, especially in children, and how this knowledge impacts parenting. Dr. Aliza Pressman sits down with Professor Kathryn Paige Harden, a psychologist specializing in behavioral genetics, to discuss genetic risk, the misconception of deterministic outcomes, the enduring debate over blame in parenting, and the vital balance between nature and nurture in supporting children's mental health.

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Key Discussion Points & Insights

The Limits of Privilege in Mental Health Care

• [01:42] Prof. Harden shares insights from her formative experience training at McLean Hospital, renowned for treating well-resourced, high-achieving patients:
  • Even privilege and resources have limits when it comes to extreme mental health challenges.
  • Families often have to "re-envision what this transition to young adulthood is going to look like," especially after severe diagnoses like a first psychotic break.
  • Quote: "There's no amount of success or high functioning or individual functioning that is going to bootstrap your way out of that diagnosis." (B, 03:37)
  • The experience fostered her appreciation for how families must navigate complex systems, not just individual treatment.

The Science and Mystery of Behavioral Genetics

• [05:54] Harden describes the evolution of psychiatric genetics research:

  • Her focus: How do genes affect risk for psychiatric diagnoses? How can environmental interventions support those at high genetic risk?
  • The field once expected to identify a small set of "depression genes" or "schizophrenia genes." Reality: thousands of variants, each with minuscule effects, many shared across conditions.
  • Quote: "We now know how much we don't know in a way that belies the early optimism of the early 2000s." (B, 09:34)

• [11:02] The hope for genetic diagnosis was similar to a diagnostic COVID test, but the reality is much more complex:

  • Genes don’t map simply to diagnoses; there’s no "autism gene" or "bipolar gene" test.
  • Many risk variants are shared between multiple conditions (e.g., addiction, ADHD, conduct problems).
  • Quote: "The power of science to be wrong and then to admit that it's wrong and... course correct. Our model of the world was way off." (B, 12:30)

Parenting, Instinct, and Advocacy

• [18:17] Harden encourages parents to trust their deep knowledge of their children:
  • "Trusting that you have a deep knowledge of your child and not giving up if you really think there is a problem…" (B, 19:20)
  • She shares her own experience advocating for her son’s speech delays, despite initial reassurances from doctors.
  • Parenting is continuous, a process of getting to know an entirely new person.

Genetics, Blame, and Absolving Parents

• [23:49] The episode delves into how historical blame, particularly of mothers, has intertwined with psychiatric genetics:
  • The “schizophrenogenic mother” and “refrigerator mother” theories for schizophrenia and autism persisted until twin studies upended them, showing strong genetic components.
  • Genetics “rescued” mothers from blame but replaced it with existential anxiety—parents have less control than hoped.
  • Quote: "To the extent that you relinquish the idea of perfect control, you're both absolved of blame. But then there is a kind of existential risk and existential anxiety…" (B, 26:30)
  • Parenting means being “poised on fortune’s razor edge”—there’s always uncertainty and risk.

Conduct Disorder, Morality, and Stigma

• [32:33] Conduct disorder is fraught with moral judgment:

  • Our culture struggles to disentangle biology from morality, especially when behaviors cause harm.
  • Quote: "There isn't in our body some... sequestered area where moral behaviors are somehow immune to our biology. All of our behavior is ultimately affected by biology, moral or not." (B, 32:50)
  • Medical research is hampered by stigma: conduct disorder is under-funded, under-researched.

• [35:32] Relief for parents: "Yes, there are things to be done."

  • Warmth and consistent, non-harsh discipline are crucial, especially for children genetically at risk for conduct or substance use problems.
  • Adoption studies show children at genetic risk do better in warm, structured environments with consistent limits.
  • Quote: "What predicts the growth of those conduct problems the most is harsh discipline." (B, 39:16)

The Challenge of Parenting Outliers

• [40:09] Harden uses a dog training analogy: some "pups" (children) require more care and structure than others, dependent on their genetic temperament.
  • "Some of them do need more skill and consistency on the part of parents, whereas others... are a little bit more... dandelions, they're going to be fine." (B, 41:40)
  • "Breaking up with the fantasy" of the child you imagined and attuning to the person you have is an essential, sometimes painful part of parenting outliers.

Hidden Outliers & Societal Blind Spots

• [48:00] Harden discusses “hidden” outliers: high-achieving kids (the MIT student) may also be vulnerable but elude parental concern because their difficulties don’t set off the same evolutionary “alarm bells” as non-conforming behaviors.
  • Some struggles, like anxiety masked by achievement, are less likely to get noticed or supported.

Practical Parenting Wisdom—and Its Limits

• [51:12] With so much complexity and individuality, there’s no universal parenting formula:

  • Warmth and appropriate limits remain fundamental, but every child and family is different.

  • Research on interventions (e.g. omega-3s for ADHD/conduct disorder) is promising but no “magic bullet.”

  • The field underfunds research for disorders with moral implications (conduct disorder), reflecting societal discomfort with the intersection of biology and bad behavior.

Cultural Roots of Parenting & Discipline

• [54:14] Harden points out the influence of American cultural and religious ideas about inherited sin and blame, which affect how we view discipline and moral accountability.

  • In other cultures (e.g., Indigenous American communities), warmth and non-punitive discipline are the norm and effective.

  • Quote: "Accountability doesn't mean punishment. Blame doesn't mean responsibility..." (B, 66:05)

The Struggle for a New Parenting Paradigm

• [58:48 & 59:56] Modern parents grapple with balancing firmness and warmth, avoiding both harshness and permissiveness, often improvising new ways without the benefit of cultural models.
  • Harden shares a personal story of her daughter hitting her, modeling calm but clear limit-setting followed by repair.
  • "I think it says something about how we are as a generation reinventing a way to relate to our children..." (B, 62:12)
  • Parenting is now “a little bit of an improv,” pulling apart inherited ideas of blame, punishment, accountability, and love, and reassembling them in real time.

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Notable Quotes & Moments

1. The Limit of Diagnosis and Privilege:
"There's no amount of success or high functioning or individual functioning that is going to bootstrap your way out of that diagnosis." (B, 03:37)

2. The Promise and Mystery of Genetics:
"We now know how much we don't know in a way that belies the early optimism of the early 2000s." (B, 09:34)

3. Parental Advocacy:
"Trusting that you have a deep knowledge of your child and not giving up if you really think there is a problem..." (B, 19:20)

4. Blame & Existential Uncertainty:
"To the extent that you relinquish the idea of perfect control, you're both absolved of blame. But then there is a kind of existential risk and existential anxiety..." (B, 26:30)

5. Challenge with Conduct Disorder:
"There isn't in our body some... sequestered area where moral behaviors are somehow immune to our biology. All of our behavior is ultimately affected by biology, moral or not." (B, 32:50)

6. The Power of Warmth & Limits:
"What predicts the growth of those conduct problems the most is harsh discipline." (B, 39:16)

7. Parenting Outliers:
"Some of them do need more skill and consistency on the part of parents, whereas others... are a little bit more... dandelions; they're going to be fine." (B, 41:40)

8. Accountable, But Not Punitive:
"Accountability doesn't mean punishment. Blame doesn't mean responsibility..." (B, 66:05)

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Key Segments & Timestamps

• 01:42 – The limits of privilege in mental health care (McLean Hospital experience)
• 05:54 – The evolution of psychiatric genetics & diagnostic complexity
• 11:02 – Why genetic tests can’t predict mental illness like a COVID test
• 18:17 – The importance of parental intuition and advocacy
• 23:49 – Mothers, blame, and historical paradigms in psychiatry
• 32:33 – Conduct disorder, biology, and moral stigma
• 35:32 – Practical interventions: warmth, boundaries, and what helps at-risk kids
• 40:09 – Analogy of dogs and raising “outlier” children
• 48:00 – The struggle to recognize non-moral vulnerabilities in high achievers
• 51:12 – Warmth, limits, and the absence of a magic parenting strategy
• 54:14 – American religious roots in attitudes towards behavior and discipline
• 58:48 – The challenge of balancing firmness and warmth in modern parenting
• 62:30 – Repair, rupture, and improvisational parenting in real time
• 66:05 – Reimagining accountability and blame in parenting

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Conclusion: Takeaways for Parents

• Genetics shape risk but are far from deterministic; parenting still matters, especially in providing warmth and consistency.
• Parental intuition and advocacy play a crucial role, particularly in the early detection of issues.
• Blame is often misplaced; relinquishing control is both freeing and anxiety-provoking.
• There is no perfect parenting script; all children, especially outliers, require individualized approaches.
• Setting limits with warmth—not harshness or permissiveness—is a continually evolving challenge, both culturally and personally.

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Listeners are left with a nuanced understanding of behavioral genetics—a field that complicates the old debates about nature versus nurture and offers both relief and new questions for parents working to raise good humans.

Transcript

[A]

The following podcast is a Dear Media production. Welcome to Raising Good humans podcast. I'm Dr. Aliza Pressman, and I had such a cool conversation. I'm sharing with you today with Professor Katherine Page Hardin. She's a professor in the Department of Psychology at University of Texas at Austin. She leads the Developmental and Behavioral Genetics lab. She just wrote another book that blew my mind called Original Sin. It's on the genetics of vice, the problem of blame, and the future of forgiveness. A lot of this conversation is really helping us understand behavioral genetics and if our children are at risk for developing psychiatric disorders or, or there are some genetic risks regarding anything that you know, from addiction to psychopathology. And so if that's the case, what you can do about it, and all of our kind of difficult conversations about blame, shame, and absolution, I thought it was a very new and interesting way to think about things. I'm excited to share it with you. And remember to go to my substack, drlisapressman.substack.com to kind of check in every week and get a little summary of our conversations. And of course, if you want to do the monthly zoom, that's really fun. It's small, it's under $5 a month, and I love getting to talk to you individually.

[B]

McLean is an interesting hospital to train in because it's a private hospital and it attracts, you know, it has a kind of storied past. It's this private hospital in the suburbs of Boston. It's where Susanna Kaysen, who wrote Girl Interrupted, that they turned into that Angelina Jolie movie, was set. It is where David Foster Wallace was hospitalized. And so you get a lot of people there who, on paper, don't see, seem like they've had extreme challenges, at least in terms of poverty or racial discrimination. It is the sort of place where, if you're an MIT graduate student who has your first psychotic break, you end up at McLean, or if you are from, like, an old Boston money family and you have a mental health issue. And so a lot of it is the, you know, the best possible world of working in the field of psychiatry because you often are working with patients whose families do have resources, they do have deep ties to the community. And then you see that there is a limit to privilege. There's a limit to how much money can buy, especially when you're talking about the extreme of mental health challenges. And resources always help. Like, resources are always better than no resources. But there is no there is a limit to the level of care you can get there's no magic bullet even for the most advantaged families, even for the most educated families. And I also think for the families at McLean, the gap between what parents expected for their kids lives or their early adulthood and what, what's actually happening and the kind of like now I need to completely re envision what this transition to young adulthood is going to look like for my kid is very poignant because again, a lot of the patients there are extremely high achieving. And so the narrative that the families have had is like, we've worked extraordinarily hard, we've built this life, our kids have worked very hard, our kids have gotten into Harvard or BU or mit. And now this clinician is telling me that, you know, this person has had a psychotic break, they've had a first manic episode and there's no amount of success or high functioning or individual functioning that is going to bootstrap your way out of that diagnosis. And so it's for many families the first time they've come up against, and I think chronic disease does this to many people. It's the first time they've come up an obstacle that they can't high function their way over. And just the outrage that they can feel with like it's dumb, genetic, like, you didn't cause your kid to have schizophrenia, no one caused your kid to have schizophrenia. A lot of the genes that made your kids very imaginative and creative and great at school might have contributed to their risk of schizophrenia. That is a hard pill to swallow for a lot of families. So my internship had this case management aspect of it, which was talking to insurance companies, talking to social workers, trying to line up, where are they going to live when they get out of hospital. And in many ways that was the most valuable part of my training because it was not just one on one treatment. It was how is this person going to interact with all the systems of American healthcare and how are their families now going to have to navigate that system moving forward? So it was a really good experience that was really formative. Even if I don't see patients individually now in my career.

[A]

And when you were doing well, I guess as you're doing continued research and maybe tell everybody what your research focuses on. I'm curious, like when you think back to the schizophrenia or the borderline personality disorder or the things that you saw in your clinical practice then can you make more sense of it now or is it still as frustrating and confusing as ever?

[B]

That's a really great question. I mean there's definitely been progress so to back up a second, my research is in the field of psychiatric and behavioral genetics. So what I'm interested in is how do genes make a difference for people's risk for psychiatric diagnoses? And then there's lots of behaviors of that are interesting and important to people, but they don't meet the definition of clinical psychopathology. So I'm interested in both the formal level of, like, you meet a psychiatrist definition of you meet this diagnosis, but also that's the extreme end of a continuum. And I'm really interested in the whole continuum of individual differences. And so what my lab focuses on is discovering specific genes that are associated with psychopathology. I can get into my kind of subset of psychopathology that we focus on the most in a second. And then once we've discovered those genes, how can that genetic information be applied in ways that help us understand. In many ways that help us understand the environment? So which environments are most important for people at high genetic risk? Are there particular environmental interventions that will serve people who are at this genetic liability for the disorder? And then what are these genes doing over the course of development? Like, especially when we're talking about serious psychopathology, that's often on setting in adolescence or young adulthood. That's a long way from when you first got your genes at conception. So what's happening in that intervening 15, 20, 25 years in terms of brain development, in terms of interactions with caregivers, in terms of peer relationships? Can we start to flesh out this developmental cascade from genes to early development to environment, ultimately to psychopathology? I think what doing clinical work gave me a lifelong appreciation for is how messy diagnoses are and how much is lost when we represent people in numbers. So if we have a case control study and you see that this person's in the schizophrenia bucket and this other person's in the bipolar bucket, according to the data file that we see, that doesn't capture all of the ambiguity and clinical skill and developmental information and change over time that went into figuring out, like, what is the best description of that problem. And there's no diagnosis that is ever going to capture the totality of someone's psychology. So there's a phrase that the qualitative sociologists use a lot, which is called, you know, flesh on the numbers. And I think clinical experience gives you an appreciation of how far the flesh is from the numbers, that you can see patterns, and those patterns are meaningful. And also those patterns are not constitutive of an entire real person's experience, which is so individual. No two patients even who have the same diagnosis, have the same, you know, have the same symptoms, have the same response to treatment, have the same interiority or subjective response to their experiences. So that's. That is what has helped, I think, with clinical experience for me. But. But we have not solved the mystery. Like, we're not like, you know, I think when the Human genome project was first unveiled, when they. When they first sequenced the first human genome, there was this sense that, like, Ned, now we're going to crack the code. Like, genome is going to give up its secrets, and then we're going to discover what schizophrenia really is or what I study conduct disorder, problems in children and adolescents, what conduct disorder really is. And in fact, it's now been 26 years since that. And I think our appreciation for the mystery of the human genome has only deepened. We now know how much we don't know in a way that belies the early optimism of the early 2000s.

[A]

So it used to feel like maybe now we'd be able to look at this picture of what a human being's DNA looks like and point to why and how they're going to be a certain way or have a certain diagnosis, and then how we might be able to prevent or make it a little bit less amplified or do something to change the trajectory of what could be something terrible, but we can't do that.

[B]

Yeah. So a big part of it is that people used to think that There were maybe 10 genes that shaped your risk for any specific form of psychopathology. So Maybe there were 10 genes that made you depressed and another 10 genes that made you anxious, and then maybe another 10 genes that caused autism, and then maybe another 10 or 15 genes that cause schizophrenia. And if that had turned out to be true, then the original plan, which was, okay, well, we'll sequence the genomes, we will sequence the DNA of a lot of people who have a diagnosis of a mental illness, and we will compare it to people who don't have that diagnosis. And then we will be able to discover the genes, and we will know what proteins these genes code for. And then that will give us, you know, information about drugs, and it will give us information about subtypes, and it will solve our diagnostic mysteries because we'll be able to say, you know, you. You have. You definitely have schizophrenia because your genes look like this, and you definitely have bipolar because your genes look like this. So the. The hope would it be. It would be, we're kind of like a COVID test, you know, like, you go into the doctor and you're like, I've got fever and I've got chills and I've got a cough. And your doctor is like, okay, I can give you a test, and on the basis of that, I will let you know you have Covid or you have the flu or you have rsv, and then that's going to direct the treatment. Like, I can give you Tamiflu. I like, I can give you an antibiotic because it's strap. And the hope was that psychiatric genetics was going to work out like that, that it was going to be, go to a doctor, you're having problems, they can read your DNA and said, oh, you've got the autism genes. Like, this is what's going on. And it didn't work out like that at all. I mean, everyone was wrong. I think this is a real. The power of this, of science to be wrong and then to admit that it's wrong and then be like, we have to course correct. Our model of the world was way off. And it turns out that there's not 10 genes that are associated with any mental health condition. There are thousands upon thousands upon thousands of genetic variants, each of which have a tiny effect, many of which reside in portions of the genome that we don't even know what they do, and many of which overlap across conditions. So the same genes are associated with becoming addicted to alcohol, as becoming addicted to opiates, as having conduct problems in childhood, as having adhd. So this crisp diagnostic picture that we were hoping just did not pan out, and instead what we were left with is, okay, well, we have 4,000 variants and they all increase your odds by, like, a hair. How do we put that information together in a way that's clinically useful? And that is not a solved problem. That's something that the field is still struggling with. So it's not that we haven't made progress, but our progress has redefined the problem that we're trying to solve, which is how do we make sense of all that we've discovered about how much of the genome differs between people and how much of the genome that differs between people pushes people down these different life trajectories?

[A]

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[B]

So the first thing I say to parents is like, I am a stranger. I'm a academic psychologist. I don't know you. I don't know your kid. I don't know your family history. And I think there's. There's a role for expertise, but there's also a role for parental deep knowledge of. There's a problem there. I didn't have this around mental health, but I had this around my son when he was very young, which he was a very late talker. And I would go to the doctor and I would say, he's not talking. Like, he's not talking nearly as much. And they all did kind of launched into reassurance. Oh, he's a boy. Oh, he's a late talker. Oh, he'll catch up. And I, you know, I'm. I like to get along. I'm Southern by nature. I don't like to disagree with people. And so I would leave the appointment and I would be like, but wait, like, I'm not actually convinced by this. I still think I'm right. I still think that there's a problem. And it took me being like, I am going to trust my own instincts about the early warning signs that I'm going to see in order to advocate for care. So I just kept going back to speech therapist and going back to a neurologist until someone took me seriously. And then it turns out that I was right. He did have a pretty serious speech disorder, and he did need pretty intensive speech therapy for years around what turned out to be a kind of a more general motor planning problem. And so I think often parents who are attuned to things because they have perhaps a family history can very easily be talked out of that. That warning light that's going off in their head. And I think it's great to put problems in perspective. And I think it's great when a pediatrician can be like, this does not feel abnormal to me. Like, I see a lot of kids and this feels fine to me. But I also think trusting that you have A deep knowledge of your child and not giving up if you really think there is a problem until you kind of feel satisfied that like this, this is being taken seriously. I think that's the first, the first line of advice that's kind of like high level advice that I have. And I think it's related to a more general thing which is like your child. I think with behavior, being a behavior geneticist, the way it's most profoundly shaped my perspective on parenting is I think of my children as things that are not copies of me, but as entirely new people unto themselves whom I am getting to know. And that getting to know process is continual and unfolding. So being attuned to who is this stranger that I've birthed and what do they have to tell me about themselves is the attitude that I bring to my parenting. And I. That's probably the biggest thing, that's the biggest kind of high level perspective that's been informed by being a geneticist.

[A]

You know, it's, it's interesting because you could see parents tensing up if they already bend anxious because they're like, so. There's no so. So if I know that there's some genetic something, it's a soup of some kind that, you know, like the recipe that we've seen before. But there's something potential. Are there things that I should be doing in terms of prevention and support or parents who are like, I'm. This isn't unfolding. We're going to see what happens. Is there any benefit to knowing that there's addiction in the family or to knowing that there's schizophrenia or to knowing like, I guess it's more like. And the truth is, as I asked this question, I think it depends on the parent. Like, what do they need? Right. Like, I probably wouldn't have been great with a super anxious pediatrician because I would have just spun out. But I have friends who are so relaxed that I'm like, you could do with a pediatrician that's paying a little closer attention. But I think there's a separate part of this which is, and you say this so beautifully in the book that I'm going to pull it up. It's so small. But you said blaming and absolving are kind of the two sides of nurture and nature in that conversation. And I think you're totally right. Like, that's the conversation with most parents most of the time and with ourselves is like an, an absolving of sorts because you're kind of born with these goods. And this is what it is going to be or a blaming because you've been just such a shitty parent that in the presence of another family, things might have gone much better. And the weird thing is the people listening to Raising Good Humans podcast are already a self selecting group of people. So given that, how do we talk about all of this?

[B]

I mean, I'm glad you picked up on the theme of blame and blaming the parents and that I'm blaming, let's be honest, most of the blame has been on mothers in particular. Let's keep most of the blame has been mom historically and genetic. The story of psychiatric genetics has intersected with that in really powerful ways. So if we think about schizophrenia, for example, in the middle 20th century, the predominant theory was that schizophrenia was caused by toxic families, that children were caught in double binds. There was something known as the schizophrenic mother. And so if you imagine the situation of trying to get treatment for a child or an adult child, at that time, you're trying to get treatment from an establishment that thinks that your child's problems are entirely your fault. That which is just adding blame to suffering never helps anyone. And that view really began to be challenged with these large twin studies that showed that schizophrenia ran in families. It ran in families in patterns that matched genetic transmission more than cultural or environmental transmission, that the best predictor of having schizophrenia was having an identical twin with schizophrenia. And it really uprooted and challenged in a fundamental way across psychiatric, not just psychiatric research, but psychiatric practice, this model that the best ideological model of a child's problems was always to look at some trauma that the mother had caused. And then you saw a similar story with autism. So autism, autism spectrum disorders were blamed on, quote, unquote, refrigerator mothers. And refrigerator mothers was a concept that grew out of psychiatry ideas of frigidity. So there was the frigid wife who wasn't sexually responsive to her husband, and she became the refrigerator mother who wasn't emotionally available enough to her kid. This incredibly misogynistic and pathologizing profile. And that was what autism spectrum disorders were blamed on. And it really wasn't until the first twin studies of autism started to be published that people thought, maybe it's not mom. Like, maybe this is something that is, you know, a genetic difference in how the brain develops. That if mom acts a little bit aloof with the clinician, it might be because she's one, sick of being blamed. And two, she might also have autistic spectrum features in which she doesn't, like eye contact. And doesn't come across as super chatty with a stranger that's, that's, you know, accusing her of being a bad mother. So genetics has historically played this role of, of in, in many ways rescuing moms from blame. The flip side being that it's, it's rescued moms from blame by highlighting that we are not in perfect control of how our kids turn out. And that can be really scary. I mean, I think in many ways having a child is one of the most risk tolerant things that a person can do with their life. Like I'm going to roll the genetic die. I don't have control over who this person is going to be. I'm going to do my best to be in relationship with this stranger that I've welcomed into my body, into my home. And I am not in perfect control over that process. So I, you know, I think to the extent that you relinquish the idea of perfect control, you're both absolved of blame. But then there is a kind of existential risk and existential anxiety that goes with that that I don't think there's any, I don't think that science can and will ever be able to totally take away. I think there's an unpredictability in producing a human where we can mitigate against risk, but we can't make it perfectly safe. There's no such thing as safe. Perfectly safe Motherhood. Like we're all out here on I, in my book, I quote this line from Oedipus Rex where one of the characters says, remember, you're poised on fortune's razor edge. And I just thought, if that's not motherhood, I don't know what is. Like, you are on razor's, you are on fortune's razor's edge. And you still have to move forward and you still have to proceed in relationship with your child. So you're both absolved of blame. But then to the extent that you're absolved of blame, you maybe are more aware of the risk and uncertainty. So there's, there's no having it all. Unfortunately. I think to make motherhood better, to make it safe, I don't think motherhood is safe.

[A]

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[B]

Yeah. Whereas conduct disorder, I think, will ultimately be impossible to entirely take moral stigma out of it because it's hurting another person. Right. The core of it strikes to the heart of what we think it means to be a moral, a morally regulated person which is not harming other people. And yet it is also biological. It is also clearly influenced by our genes, by environmental insults to preterm brain development, to experiences of trauma and abuse that we also know change brain development. So there. There isn't in our body some. Some sequestered area where moral behaviors are somehow immune to our biology. Unlike all of. Like all of our behavior is ultimately affected by our biology, moral or not. But I think the idea of thinking of children with conduct disorder who, who often grow up to be adults with substance use problems, who engage in antisocial behavior, our instinct is to think of them as bad kids who turn into bad people. And as soon as we're thinking about it in those terms, I think it strips us of the motivation. It doesn't even occur to us as a scientific community to be like, but what drugs would help these children? Right. What are the pharmacological trajectory.

[A]

Trajectory. And then the environment doesn't give them the feedback that kind of grows that violence.

[B]

Yes, exactly. So, I mean, I think the data that we're seeing with ozempic and other GLP1 agonists, that they don't just eliminate some of your appetite for food, but that they also reduce cravings for alcohol amongst people, people who have substance use disorders, is fascinating. It's so interesting, right, because we have forever thought of sobriety as a. As a matter of willpower of your moral fiber. And this is a peptide that you inject that makes you not crave alcohol, that makes you more likely to remain sober. I think that really messes with this binary that many of us have between the biological and the moral. So it is horrifying to contemplate that you might have a child that might develop a disorder that you don't have as many good treatments for. That doesn't mean there's nothing to be done, and we can come back to that. But I also think recognizing the horror of that and not pushing it away is one of the first steps towards getting our act together as a scientific community and being like, well, what are we doing?

[A]

So to come back to it just for the relief of the listener, yes,

[B]

there are things to be done. Yes. So I would say, I think the best evidence on what parenting in particular is most effective for Children who are most at risk for conduct problems and substance use problems, basically problems with harmful disinhibition. So doing disinhibited things that harm themselves or others without really like regard to, to the consequences. One way you can think about that is like, these are children and adults who are punishment insensitive. So some, you know, some people, they have one bad thing happen from their action and they're like, you know, they overlearn for punishment. They're like, I'm never doing that again. Like, you know, they're more on the fearful, inhibited side. Whereas one way we can think about conduct problems, and I think many substance use problems, is a little bit like a learning disability, like an inability to learn from punishment. And that could be because, I mean, that could be for lots of reasons. So some of the best research on this, I think, comes from adoption studies where you have children whose parents, biological parents, are known to have serious antisocial behavior problems or substance use problems. So bio dad has been arrested for a violent crime. Biomom was using many substances, maybe also has a history of incarceration and then gives the child up for adoption. A lot of this work is done, there are American adoption studies, but a lot of this work is done in Scandinavian countries where they have these hugely elaborate medical registries linking parents, medical histories, adoptive parents, medical histories, kids, you know, ultimate developmental outcomes. And what you see is that bio parents, you know, substance use problems and histories of violence do predict the risk of their adopted away offsprings also showing these behaviors that the, the prevalence of these problems in the adopted away offspring are much lower. So there's something about getting out of that intergenerational cycle of chaos and substance use and viol that in and of itself is very, very helpful and that the, the behaviors that are most predictive of good outcomes and those offspring are warmth, like consistent positive regard by parents. I like you, I care about you, I'm affectionate to you. And not using harsh discipline. The one of the cycles that most predicts the escalation of conduct problems is kid acts out. Parents are obviously angry, dysregulated, scared, because they're doing that, you know, playing the highlight reel of terrible things in the future. And then they escalate the punitiveness of their punishment behaviors. This could be spanking, this could be berating, this could be, you know, really harsh restrictions. And that is something that is incredibly intuitive to do. There's older studies from the 90s where they have children with conduct disorder interact with other women who are recruited as volunteers who are not their moms. And you see even these, these, you know, women who were naive to the kid, like they've never interacted with them, be pulled into a cycle of harshness and conflict escalation. And, and so it is, it is a difficult thing to do, but it is the thing that predicts the growth of those conduct problems the most is that harsh discipline. So in some ways it's like that's the parenting advice you would give to everyone, right? Like what are the things you want? You want firmness without harshness, you want high warmth. Right? Like that's across the board. I think what you see with children who are temperamentally, genetically at rest is that they are more vulnerable to the parents not doing those and are, and are particularly benefited when the parents are good at that. So in the, in the book, I talk about this about like, you know, this isn't just kids. Like any dog owner also knows this. Like there are dogs where like parents are, the dog owners are very lazy. Like, they're very bad at training. And the dog is like, you know,

[A]

very permissive dog mom, by the way. And my dog's fine. She's delights because she's just came out that way.

[B]

She, you know, and it's a passive, low energy dog and it's small and it's like whatever, you know. I adopted a Great Pyrenees Rottweiler, Great Dane Shar Pei mix from the, you know, a side of the road in Bastrop, Texas. And I had to invest a lot of time into being a dog owner.

[A]

Yeah, I mean I, that dog were at mine would be very dangerous, right.

[B]

So I got this puppy and then I genotyped him because I'm a geneticist. And then I was like, I have a mix of the world's guard dogs. And so what does this dog, by virtue of its size, by virtue of its temperament, by virtue of its, you know, what it's carrying and its DNA, it's going to need more effort and more skill on my part than if I had gotten like a little toy poodle or something. And I, I think that children are that way too, that some of them do need more skill and consistency on the part of parents, whereas others, like, you know, are a little bit more. Sometimes psychologists talk about like the orchids and the sunflowers or the orchids and the dandelions, like some kids are, are dandelions, like they're going to be fine. But I think that children who are, for whatever reason, you know, environmental insults or genetically at risk for this, this inhibition and are very insensitive to punishment are going to need a lot more consistency and skill and very consistent warmth. That's, you know, that's the other predictor. And then I would say, like, I think all of parenting, no matter who your kid is, actually I'm going to expand this. I'm going to say all relationships, I think all marriages are like this too, which is breaking up with the fantasy that you had of who this person was going to be in order to appreciate the relationship with the person that you have, who they really are. And I think when you have very outlying kids in whatever direction, but this might be in the disinhibited direction or it might be in the vaguely psychopathic direction. When you say my, my, the back of the hairs on the back, my back of my neck stand up. Like that's kind of.

[A]

That was the saying that I meant.

[B]

Yeah, like that's a very class animal. That's like something old that we kind of experience in response to someone not displaying moral emotions in the way that we're used to. Or if you have to go back to the earlier part of our conversation, your kid is an MIT graduate student, but now they've had a psychotic break. When kids are very outlying, you're going to have to do more work to break up with a fantasy of who you thought or who you hoped that they were going to be. And that's a grief, you know, and that might be a grief process that lasts for a long time.

[A]

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[B]

Yes. I mean, I think that we have as humans been equipped by millions of years of evolution to detect and be highly sensitive to potential threats to cooperation. Like, if you think about why are we the most at this point successful in terms of propagating in every environment, species on the planet, we have these big brains that we use cooperatively, we develop language in order to communicate with one another. And even when we go back in our evolutionary lineage, at every point in the evolution of life on this planet is the evolution of cooperation, which includes mechanisms for detecting failures to cooperate and enforcing cooperation. So when we see a child who as you say, makes the hairs on the back of your neck stand up, that is I think, an old part of your brain being like alert, alert, alert. Like this person is for whatever reason not manifesting overtly in their emotions the guilt or the shame or the remorse or the other concern that we think of as really foundational to being part of a tribe, being part of a community. I don't think that we have those same really baked in alerts for some other problems because they might not be seen as threats to cooperation right away. They might be actually like over socialized to cooperate so much for this, you know, to the detriment of themselves. And so we don't have the same spidey sense because it's more novel and it's not, it's not coming on the backs of this really deeply embedded mechanism. So I think seeing the teenager who is especially anxious and very sensitive to the news and to comparisons on social media, but that just makes her, you know, get up, get up that much earlier and work out that much more diligently and perform that well in school. I think it's harder for parents to see that again because they're. We were not equipped in the same way to detect that as we have been equipped to detect people who don't show moral emotions. That's a pretty basic thing about being human that sets off our, our alert system. So I agree with you. I think there's out. And in some ways, I think people are so complicated and so spiky that everyone's an outlier with regards to one thing. Like, it's, it's, it's. There's gonna be something. It's just what is that something going to be? And how outlying is it going to be?

[A]

Which is why to go back to what you said in the beginning, we don't know the person or the listening or the child that they're raising. And there's just no way. Though it would be amazing to prescribe much more than warmth and limits.

[B]

Yeah, I mean, I, it's a tough thing, which I wish I could say. The secret is xyz, you know, I really wish I could say that. And there are, you know, there are people that point to, well, maybe there's, you know, omega 3 deficits in children with ADHD and conduct disorder. And you should make sure that they're getting all of their fatty acids. Like I do that with my kids. Like that research convinced me enough to give them those supplements. But there's no magic bullet. You know, there's no, there's no. And, and also part of the reason that there's so little concrete advice is because I think the science is so behind on this particular problem. Like, we write fewer scientific articles about conduct disorder than any other psychiatric disorder. There's fewer grants that are given out for it. When I was a graduate student, I applied for a grant from the National Institute for Mental Health and it was going to be specifically on delinquency and violence in adolescents. And NIH told me that's not mental health problems.

[A]

Really.

[B]

That's not mental health work. Work in a drug use angle and you can be funded by nida, which is the National Institute on Drug Abuse. But conduct disorder isn't part of our priorities. And that's astounding.

[A]

Again, like, that's easy because it's so predictive of so many of society. Like, that doesn't make sense.

[B]

Yeah, if you have conduct disorder, you're 12 times more likely to also have ADHD. You're up to 75% of them will have a substance use disorder in adulthood. It's estimated that a child with conduct disorder costs his family an extra $70,000 on average in extra medical treatment and legal costs. Like, it is an extremely costly disorder. It is, in some of its subtypes, as heritable as schizophrenia. And our NIH is saying it's not a mental health problem. How could that be? And again, this is what I wrote my book about is. I think it is because we, again, have this binary between there's bad behaviors which are moral and there's biological things that. Which are. Could be the subject of science. And it's so overtly bad when you're. When you're really harming someone or like torturing the family cat that we have not been able as a community to wrap our minds around. This is also an appropriate object of scientific study that really. That really needs to be done.

[A]

Is it different in the United States versus other cultures?

[B]

That's an interesting question. So I will say that the biggest, some of the biggest research on antisocial behavior and conduct problems from a genetic perspective has been done by research researchers in Northern Europe.

[A]

Right.

[B]

How much of that is, like, they also have all the data, to be honest? Like, yeah, you know, is a little bit unclear. I think there's a long history. I mean, I get into this, my book, and it might be, you know, too far to wade into for your. For your audience, but America was. Was founded by Christians and a very particular brand of Christians, you know, they were. It was. Our legal system and our political system are really shaped by the fact that we were founded by people who were Protestant and had this Reformed theology. And that might seem like, what. Like, what is that? What is that theology? What is the. What are these old Christian ideas? What is what a pure, like, literal puritanical idea is like, what is. What did the Puritans think about sin? Like, why does that matter? And it's because I had a very particular conception of the relationship between what you inherit in the body and what you're damnable for, what you're morally condemnable for. And I think those attitudes can persist in our subconscious even if we're not overtly religious or Christian or we're raised in that tradition ourselves. And science can be challenging because it challenges these deeply rooted assumptions to say you could inherit something that predisposes you to bad behavior, but that doesn't mean you're inherently bad, but it does mean that harshly punishing you is probably not going to work, but we do still hold each other accountable. Like, those are a lot of things that Might be seeming contradictory to ask people to hold in their heads at the same time. And I think it's absolutely necessary to do that if we're going to make any progress in how do we serve families whose kids are experiencing these problems? How do we help them?

[A]

This is probably like an extreme other side of this because you could see a world where, you know, corporal punishment and being super strict and saying like we, we gotta like military school, the daylight kid, right, like clearly might backfire terribly. But then you can also see a parent who's dealing with this going, okay, so my, my warmth, my sensitivity, my, my presence, I'm gonna work really hard on that. And then they get into a cycle of permissiveness and shame because it's so hard to find even, even when you're not thinking about all of our deep rooted, like subconscious ideas. I think it's really hard to, to find a way to be warm and loving and patient and set limits without confusing those limits as punitive in a way that's harmful. And so you, you get two extreme responses that are the two worst responses you could have on either end of the continuum to the kind of kid that needs that support. So that doesn't make anybody feel better. But I just, just to say I can see it being a, I mean we have like a gentle parenting trend right now maybe that feels, and I don't even know what that is defined as because I don't think it's rooted originally in science, but I could see that being on the other side of it, a feeling like I'm going to gentle my way into this or I'm afraid to, you know, I'm afraid to go on the other side of the harsh punishment. And I, I don't even know like one of the ways I think we can ask ourselves the question is like, am I changing my limits because of their, you know, whatever they're throwing back at me in a way that's unreasonable or that goes against my values or whatever. But I think that's a very big challenge for parents right now on the side of well meaning, well educated, like, I think there's a different conversation to be had.

[B]

I think that's a huge challenge. I mean, that's a challenge that I have. I, I mean I have three kids. I third, I have a 13 year old, an 11 year old and a three year old. So I have three kids that are in three different developmental stages that are pulling me in different directions. And I also tend to conflate harshness and firmness and I Also tend to conflate warmth and permissiveness. And thinking about, these are my limits, these are my boundaries. This is what I am, and I'm not going to do. And I am the grown up. And also, how do I say that? How do I enforce that limit? I think the fact that we struggle with that. It's not just me. It's not just you. It's probably many of your listeners. I think it's, you know, millennial Gen X parents across the board. What is that? I mean, I'm just really curious about what does that tell us about our culture that it's so hard for us to even have the practical, immoral imagination.

[A]

Yeah.

[B]

To. In the moment. Especially when we're emotionally dysregulated. Especially when my daughter, you know, my daughter last night, she's three, and she wanted to watch Bluey, and I turned Bluey off, and she'd never done this before, but she just hauled off and she just bonked me in the nose. And I was like, what just happened here? And in that moment? Like, what is the. Holding the limit? And not being harsh, but, you know, in. And so it was like, okay, I'm not gonna let you hit me. Like, verbalizing that, taking her to a chair and saying, I need a break from you. I'm going to leave you here. I'm gonna walk into a different room. And then she just crumpled in the chair. And I was. And then I was like, oh, it's not like she's. She's defiant. She's also overwhelmed and just is so dysregulated for my response. And then me going in there and saying, I did not like when you hit me. I. I made me feel bad. It's not nice. And she was like, you. It wasn't nice that you turned off Bluey or something. And I was like, I told you I was gonna turn off Bluey. We're gonna have dinner. I'm not really ready to. To have dinner with you right now because my face still hurts. And it really hurts me that you did this. And she sat in the chair, and I was like, am I doing this right? What are we doing? And then maybe five minutes later, she comes in and she's like, mommy, I'm sorry I hit you. And the whole thing was so much better than if I had been like, you know, you're like, if I had spanked her or if I. Like, the whole time, I was like, am I doing this right? And is this the right response? Like, I didn't know in that moment. And I think it speaks to something about how we are as a generation reinventing a way to relate to our children that is different than how many of us were related to when we were kids. And if you're making something up, there's a little bit of an improv element to it where you're like, I am figuring out the contours, the texture of what this means in real time. In real time. And that. That's not a definitive answer. That's just like, I'm identifying with the challenge. And I think it says something about the cultural evolution we're going through right now, for sure.

[A]

And I can see. I can imagine a world also just. You're thinking about it like, you are conscious. You're making a decision in the moment, even when you've just, you know, like, any person would be like, all bets are off. I'm losing it right now. And. And also, if that happened, you. You have enough of a experience and relationship that you obviously came back together and repaired. But what I think is interesting is there. There are plenty of people for whom they would be afraid that they were shaming their child. Like, again, on the flip side of it, the other side of the dream. And so on one side, it's. It's like you. You would get so angry at her, you might hit her back because you're so mad that she hit you. And that feels obviously counterintuitive and problematic. And then on the other side of it, what if you had pretended that that was, you know, kids will be kids. They do these things, and we just move on. And she didn't get a cue that, like, I don't like how it feels to hit my mom. Like, that did not feel good. So there's some moral, like, development that's happening in the rhetoric.

[B]

Yeah, yeah, yeah.

[A]

That she needed some feedback from you to know that, like, I can love you and not want to sit with you right now because you just hit me. And I think that all that was happening. But to then layer on top of that, there's no. This isn't the same as how, like, we haven't really. We're reckoning with a time in. In parenting that feels very like, did I do this right? Did I not do this right? So it's just interesting. That's my long winded.

[B]

Yeah, I do think it's interesting. I. This is. I tangentially related, but I think related is. There's. So I. I briefly mentioned this in my book that when the. When Puritan settlers first came to The United States. They talked about child development and child discipline in a way that I think would still be very recognizable today. So they talked about, like, you know, children sort of being naturally rebellious and needing firmness and needing, you know, physical punishment in order to be. If they didn't have those. Those physical consequences for misbehavior, how could they ever learn to not do it? And there's many of us that don't parent that way, but we know people who do. We maybe experience it ourselves. It def. It would be. It would be familiar. And they encountered Indigenous American communities, and they were totally freaking mystified by how some of these indigenous communities parented their children. They wrote letters home and being like, they never spank their kids. They never whip their kids. They treat them always with warmth and love. And yet their kids grow up to be part of these communities and know they're, you know, have a place in them and cooperate well. And they're. They're not running. They're not. They don't seem to be wild, out of control children. And yet the Indigenous Americans are never spanking them. They literally couldn't understand what was happening. How does it work? And I think that failure of imagination is still with us where we think it's like, we've heard reports that this is possible, and we're really trying to figure out how it works in real time. But we didn't grow up in communities where consistent warmth and firmness without harshness was the norm. And so we're like artists trying to, you know, recreate an. A medium, having only kind of heard reports of it, but without having to, like, we weren't. If we especially. We weren't parent that way ourselves. Like, for me, the journey in this book was accountability doesn't mean punishment. Like, those are not the same thing. Blame doesn't mean response. Like, responsibility doesn't necessarily mean blame. And like, I think that says something about me, but also I think it says something about the culture in which I was raised, that it's very hard. It was very hard for me to pull apart those ideas. And parenting is the, like, crucible in which you really have to pull those. Those ideas apart.

[A]

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