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What Now? with Trevor Noah
Rachel Yehuda: The Biology of What We Carry
01:32:23
In this episode, Trevor and Eugene unpack intergenerational trauma with psychiatrist Rachel Yehuda. Turns out, trauma is inherited, passed down through generations, but don’t fear! The three turn the heavy science of PTSD into a profound conversation about meaning-making and we learn that where trauma can be passed-down, so can resilience.
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- [00:04]
A
I think for most people, you know, when we think of trauma, we think of, like, a bad memory, like a flashback, a nightmare, a story, et cetera. And I think one of the more revolutionary ideas that you were part of putting forward was trauma is less of a psychology and more of a biology. And a lot of people, you know, butted up against this. They went, no, this is all happening only in your brain, and it's a thought. And you found that there was something that was actually happening in the body. So, you know, when you talk about trauma as biology, not just psychology, what does that mean for the person who's living with it? How does that present.
- [00:38]
B
Well, for the person that's living with it, it's very hard to separate out psychology and biology. And I don't think that I've been able to separate it out in my mind. One of the earliest debates in the field of psychology, what launched the field of psychology was really the question of, do we feel and then our bodies have a fear response, or do our bodies have a fear response and we interpret that response and say, oh, I must be afraid. Right. And to this day, one could argue it both ways. That was a very famous debate. What we have found, doing neuroscience studies with ptsd, with people that have ptsd, is that you can see traces of their response in their body.
- [01:38]
A
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- [02:46]
C
And then you don't know where it.
- [02:47]
A
Is, and then you're like, what do I do? Well, if your phone is connected to your card and your card is connected to your phone, you know what's going on. The best thing about having the Apple card connected to your phone is, you know what every transaction is. You know, like, sometimes you're like, what did I spend this month? The Apple card will show you one month. I had spent an obscene amount of money ordering videos online.
- [03:05]
C
Just videos?
- [03:06]
A
They were just videos.
- [03:07]
C
What kind of videos?
- [03:08]
A
That's not the point. The point is, I knew that I didn't want to order those videos anymore because I'd spent too much money on was videos on how to not spend money online.
- [03:19]
C
I felt like I'd been duped.
- [03:21]
A
Point is, Apple showed me what I was spending my money on, and I was able to change my spending habits. And you can do it, too. I earn up to 3% daily cash back on every purchase with my Apple card. That's unlimited daily cash back no matter where I shop. Apply for Apple card in the Wallet app on your iPhone. Subject to credit approval. Apple card issued by Goldman Sachs Bank USA, Salt Lake City branch terms and more@applecard.com. Doctor Rachel Yehuda, thank you so much for joining us on the podcast. This is one of those topics that I feel like everybody's interested in and everybody feels like they understand because of how colloquial the word trauma has become. But as I was reading through just the research of yours that I could understand, I'm gonna preface it with that. I came to realize that our understanding of trauma is flat. You know, it's flat and it's simplified and it doesn't fully identify the complexity of the situation we're dealing with. So maybe that's the perfect place to start. Just on the most basic level, help me understand, what is it that you actually specialize in?
- [04:37]
B
That's a good question. I've been studying the effects of trauma, mostly as they appear in ptsd, for a few decades now. I'm interested in why some people get ptsd, but the majority don't. Do they get something else? Or can trauma sometimes just be something that happens and does not have any mental health effects? So I'm really interested in why we respond so differently. That's, I guess, across the population. But I'm also interested in the fact that sometimes the effects of trauma also cross generations. So those are pretty interesting things. And also, you know, if somebody does have ptsd, what's the best way to treat that? And when we talk about trauma, we also talk a lot about resilience. So what's the relationship between trauma and resilience? Some people think, well, there's ptsd. That's kind of a bad outcome. Following trauma, mental health symptoms, very difficult. But the alternative is to be resilient and not have those symptoms. And increasingly, that binary doesn't feel true, that a lot of resilience is just about showing up, especially when you have symptoms and really trying to get to a different place, try and make sense of what happened and try and make meaning of what happened, and try to unravel some of the body's survival mechanisms that haven't shut off. So I think that those questions are what preoccupy me. But I guess the central idea is that we just don't respond the same way to things. Why is that? And so there's a whole field of stress, which is where I came from. I was a neuroscientist studying the effects of stress long before I heard about trauma and ptsd. And that field, at least when I started, would have you believe that, okay, this thing happens, and here's the response, and this other thing happens, and maybe it's a very similar response. Maybe it's slightly different because of the nature of what happened. But most of how we respond is about us, which really changes the conversation, and it changes how you approach this for people that are struggling after they're exposed to trauma.
- [07:23]
A
Well, let's. Let's break this down because it's so technical, and I think it's so important for us to understand the world that it would be nice for you to hold our hand as we move through the journey of trying to understand many of these complicated ideas. So you say ptsd. Everyone, I think, just casually will use the phrase ptsd. Oh, that gave me ptsd.
- [07:44]
C
Even unnecessarily.
- [07:44]
A
Yeah. Just. That gave me ptsd. So. So let's break that down. Post traumatic stress disorder. What does that actually mean? Post traumatic stress disorder. Like, why is it a disorder? And what are we actually dealing with versus how sometimes people might use it?
- [08:03]
B
Yeah. So that. I love the way that you asked me that. Because you're challenging something that many people don't challenge, which is, why is this a disorder? And that was really the very first kind of major debate in the field as they were struggling to decide whether this should even be a diagnosis. Oh, wow. We all know what trauma is, right? So trauma is an event that is kind of a watershed. It's big, divides your life, assuming you've had a pretty decent life before, and then something happens, and then this was me before, and now this horrific event happen. It could be an assault, an Abuse, combat, interpersonal violence, losing someone. I think that's a trauma usually defined as something life threatening. You could have died. You're watching someone who died or who could have died or something terrible. You hear even about something terrible that happens to a loved one and it just changes the world for you. There's another kind of trauma that's more complicated, and that is that you've always been living under conditions of abuse and neglect, and you can't really.
- [09:22]
C
There's no post for you.
- [09:24]
B
There's no pre for you. There's not a real good way to understand that there's an option in life where you're safe and. And you're not threatened constantly.
- [09:38]
C
There's an alternate universe where you're okay.
- [09:40]
B
Yeah. Where you don't have to worry constantly about being threatened. So that came and complicated the conversation because in the beginning, PTSD was gonna be a great label for people, like, somebody's coming back from combat. We all understand that. Especially now, where we can really see what combat is like and we can talk to people who have been through it. We all get that you're going to come back different. Not everyone comes back the same way. It's going to depend a lot on how you actually were before and what happened and what's happening now. But I think the Vietnam War introduced my generation to ptsd. And a lot of the ways that we treated Vietnam veterans when they came home wasn't very good because the war was so controversial that we blamed it on them. We called them baby killers. We did not say thank you for your service, which is a much better way to greet a veteran that has served their country. So we all understood that. We understood. I spent a lot of time studying Holocaust survivors, that those people were also people that everyone understood. Something terrible happened.
- [11:07]
A
There was an acute moment that you.
- [11:08]
B
Could point to or years, but some change where. And in the Holocaust, it was kind of gradual for the Jews, but at some point you were facing something just horrific. And how do you come down from that? How do you acclimate to that? And then people started realizing that they don't have to be those kinds of events at all. They could be everyday events. Somebody who's subject to interpersonal violence, who's threatened, who's sexual violence, assault, crime, even something like 9, 11, where there you are, boom. I don't know. Some people call it terrorism, some people call it a disaster or an accident. But even in a natural disaster, a tsunami, an earthquake, volcano eruptions, people are never the same. Yeah. So the question is, what Is the reaction and how long should it last? And then at some point, you know, a reaction that you feel perfectly fine and comfortable with as being normal in the acute aftermath starts to feel like, you know, maybe I should have already gotten over this in some way. Like grief is like that, right? When you first hear about a loved one dying, shocking. You're very sad. Nobody thinks it's abnormal for people to be in deep grief at a funeral or for days thereafter. But if you would meet somebody two years later and they're still in that grief moment from two years ago, you would think, hmm, something that should have happened, maybe didn't happen. So that was the original impetus for ptsd, that recovery. So people were really debating this, is it that recovery should have happened, but it didn't. Or is it that when the event is so horrible, you're just changed? And so even in 1980, when the diagnosis of PTSD came out for the first time, even then you would have had experts say, some would say, well, no, most people should recover. This is a disorder to your question. And you'd have other people saying, nope, when the event is severe enough, things change, and you're going to have intrusive thoughts and you are going to sort of have a hyper aroused body. You're going to be very hypervigilant and on the lookout for danger because your body has survived. And now it is bracing to have to survive again.
- [14:07]
A
You, in your work, I think, revolutionized how many people thought about stress and trauma. And, you know, we'll go through some of the discoveries that you made because it's really important to see them as events and as people and then as things that go beyond those events and those people. And we'll get into that later on. But when we think, I think for most people know, when we think of trauma, we think of like a bad memory, like a flashback, a nightmare, a story, et cetera. And I think one of the more revolutionary ideas that you were part of putting forward was trauma is less of a psychology and more of a biology. And a lot of people, you know, buttered up against this. They went, no, this is, this is all happening only in your brain and it's a thought. And you found that there was something that was actually happening in the body. So, you know, when you talk about trauma as biology, not just psychology, what does that mean for the person who's living with it? How does that present?
- [15:05]
B
Well, for the person that's living with it, it's very hard to separate out psychology and biology. And I don't think that I've been able to separate it out in my mind. One of the earliest debates in the field of psychology, what launched the field of psychology was really the question of do we feel fear and then our bodies have a fear response, or do our bodies have a fear response and we interpret that response and say, that's fascinating to us. Oh, I must be afraid. Right. And to this day, one could argue it both ways. That was a very famous debate. What we have found doing neuroscience studies with PTSD with people that have ptsd, is that you can see traces of their response in their body. Right. So, for example, this was not my finding, but one of the most important findings that people hold when they talk about PTSD is that the part of the brain that is the threat detector, the amygdala, is hyper responsive to reminders of the trauma. Right. And cause, let's say, a fear response and activate a fear reaction.
- [16:26]
A
So is that similar to when like someone has been bitten by a dog and then when a dog barks, is that the amygdala that's sort of like re sparking the dog biting them? Is it similar to that?
- [16:36]
B
Potentially, yes, it is similar to that. That's a conditioned response. But the question is, is somebody's amygdala more active because they're afraid or are they afraid still because of what happened? And they're body is doing what bodies do when they're afraid, doing its job. And so when you say doing its job, which increasingly I'm with you 100% on that, it feels less of a disorder.
- [17:04]
A
Right.
- [17:06]
B
So how you phrased it is really important. And I think we don't unpack these things. We want to encourage people to go and seek help when they've been traumatized or when they have symptoms. But it isn't clear whether we should be conceptualizing it as the problem of having symptoms. Still after trauma, you shouldn't really should have recovered or saying, well, let's see, your body is showing signs that you're still very much in survival mode. Maybe the answer isn't only what happened in the past. Maybe the answer is also about what's happening today in your current environment. That is keeping that, keeping you in survival mode, not letting you kind of say, okay, I can stand down. And so I'm fascinated by these questions, mostly because I can't answer them yet. Right. Because the questions are better than the answers. People are so complex that we don't really know. But what seems to be very important after trauma is to find a Place of no trauma is to find a place where you really can say I'm safe now, I have support, I have people that care for me and love me and I don't have to be my battle ready self or the person that's afraid of being attacked again. But then the question is whether that's an internal process that you tell yourself or how much does the world have to work with you to convince you?
- [18:55]
A
How much responsibility does the world bear?
- [18:57]
B
Right. This is heavy stuff.
- [19:01]
C
You're right up our alley. Should be there in the morning when we're having breakfast.
- [19:06]
B
I like to talk about this before breakfast.
- [19:10]
C
Well, what you said at the beginning about what trauma actually is is when you made examples of the tsunami or natural disaster or the Holocaust, what's happening in the Sudan, wherever is, people pick the highest level of trauma and make that as if it's the only thing traumatic. So let's say a 16 year old getting traumatized in a war zone will not be given grace to as a 40 year old to think there's other traumatic things in between their lives that have happened that can be as equally as damaging.
- [19:42]
A
Oh, that's fascinating.
- [19:43]
B
It is fascinating and it's so true. We teach people what to say sometimes about how to answer the question of have you been traumatized? What kind of traumas? We give them a checklist. In our research we have this checklist. When I first started studying intergenerational trauma, I would give my little checklist of things that you know, just to see if they had ever been exposed to combat or had interpersonal violence, had their own things. They're telling me that they suffer from the effects of their parents trauma. And so I'm listening to that, I'm hearing it. But my scientific question is, well, let me first rule out that you haven't had your own traumas. Right. And what I found was that people would tell me that the worst thing that ever happened to him wasn't on those checklists. A lot of people were telling me about how their divorces were the worst thing that had ever happened to them. Even if they had been in combat or. Honestly, it makes sense when you think about people living at a time when being children of genocide survivors, where families disappeared and were fractured.
- [21:04]
A
Yeah.
- [21:05]
B
So the idea of voluntarily breaking up a family or going through those motions.
- [21:11]
A
Or the nature, what's more traumatizing for them?
- [21:14]
B
They said it. I mean, not all of them, but a few people would tell me that the breakup of relationships was very difficult for them. So I learned a lot from that trauma's in the eye of the beholder. We can give suggestions about what we think is more likely to elicit fight or flight and sustained PTSD symptoms. And usually those are big events where you could have died or you could have gotten injured, school shootings, things that are unfortunately very common. But you have to also give people the space to tell you what it is that is very, very difficult for them. It could be something that happened early in life where they felt a tremendous rejection, bullying, you know, people being thrown off their game or feeling that they're lesser than all of these things can impact. And so really our research has been trying to make sense of that.
- [22:27]
A
You know, it's interesting when you say that though I can't help but think of how those are all a form of death when you think about it. Right, so if I look at your definition and we think about someone suffering or experiencing a near death experience, whether it's their own or somebody else's, or even a death experience, it is the ending of something. It is the sudden and shocking ending of something. It is a death of some sort. But if we extend that idea further, we'll come to find that all of these things are deaths. Like when you get bullied as a kid. That is the death of your safety, it is the death of your ego, it is the death of your self esteem, it is the death of your.
- [23:07]
B
Little spark that makes you feel proud of yourself or any of that. Yeah, you could be a trauma researcher. That's great.
- [23:14]
A
Oh no, no, no, no, no. I'll just ask trauma researcher questions. But I genuinely think.
- [23:19]
B
No, you're exactly right. It's so right what you're saying. But we don't really have conversations like that. Generally speaking in the field, people are very quick sometimes to say, well, I don't think that's a trauma. I don't think I would ever say that. Because first of all, we were talking about this before. It takes a long time for somebody to really tell you what happened. And so if somebody is saying. If I say to someone, what's your most traumatic experience? And you tell me something, one of the things I can know for sure is that there's way more to that story than you just told me. That's a story that just was a title or a subtitle. But if we scratched the surface, there would be layers and layers. I mean, you're telling me, you're trying to tell me something, but you know, trauma is very deep and personal and intimate. You may, and rightly so, Feel that a stranger doesn't get to know really what really affected you deep down in your core, how it made you feel small or worthless or helpless or ashamed or any of those things. Those are very private. A lot of people do not disclose very deep traumas to their therapists for years till they've established a better foundation of trust and safety. It can take people a long time to talk about things. And even if you think, you know, school shooting, right? Something happened, it was on the news. I know this happened to you. I saw you on camera. I know this was bad. You don't know what happened before, and you don't know what's happening now. So you may not have all the details that you need. What you go on is really what the person tells you.
- [25:24]
A
I also wonder, you know, when you talk about it as. Or when we think about the framing, we'll go, disorder, not disorder. Get over it. Not get over it. When are you supposed to? When are you not supposed to? While you're saying that, I'm thinking of the varied roles that people play in a society, right? So one thought that sprang to mind was a study that was conducted once where they showed couples who had been together for a long time sort of split the memory load in a relationship. And so if people were together for a very long time, they may go on the same vacation. One person in the partnership would remember every detail about the food. The other person wouldn't, but the other person would remember every detail about the activities. And it's. It's interesting. Even when I talk to couples who've been together for a long time, I find it quite, quite fascinating. I'll say, tell me the story. And they'll go, wait, of how we met. What was that person's name? And the other person goes like this. How could you not remember their name? It's like, what were they wearing? How could you forget what they were wearing? And you know what I mean? We've seen multiple studies that have shown us that in a community, we start to bear the emotional load or the mental load. And I wonder if the same goes for trauma. You know, if I think of it as like a troop of monkeys, let's say, and they get attacked by a leopard. I would imagine some monkeys would be quicker to get back to their routine than others. But I'm pretty certain the role of one monkey is to stay traumatized, to protect the other monkeys. Cause imagine if every monkey went back to. Well, that ended terribly. Goodbye, James, and back to the bananas. Like that would be a Weird thing. But if we. If we sort of apportion that, that. That trauma differently now, one monkey can stay behind, traumatized on behalf of everyone, and that load gets born disproportionately. Is there. Is there anything that, you know, is there anything in your work that.
- [27:15]
B
That.
- [27:15]
A
That considers that? Is that a possibility? I. I mean, I could just be saying something ridiculous right now, but that's how I think of it.
- [27:22]
B
I don't think you're saying something ridiculous at all. What you're reminding us is that trauma doesn't just happen to a person. It happens in community and it affects community. What you're saying, though, reminds me of a book that I read called Memorial Candles. I think it was called that. And it was a book by a child of a Holocaust survivor who argues that within Holocaust families, one child bore the brunt of it a lot more than other people. So that's what your comment, you know, reminded me. So there's evidence for something like that. But it also reminded me that how the community relates to us is going to make a tremendous difference in how long our suffering lasts. And that a lot. You know, we tend to think about trauma as a personal thing that happens to an individual and then they go get therapy with somebody, but really it affects the entire ecosystem. And so one of the questions we have to ask ourselves is whether we want to develop societies that are conducive to healing from trauma and whether we know how to treat each other nicely, whether. Whether we want to be healing places, whether, whether. And it's hard to do that in gigantic spaces. You know, it would be nice to start in the unit of a family and kind of. And then expand slowly, expand slowly from there. But you. But it's not just your problem. It's not like having a rash, you know, it's like your thing you just scratch away or whatever. It's a relational issue. And that's. I know I don't sound like a neuroscientist when I say that, but it's because I've done so many neuroscience studies that I know that the neuroscience of trauma only gives you a slice of it. Wow. There's more to it than that. The neuroscience really validates it. And somehow people needed to see that there were changes in the brain or changes in the hormones, or that there were palpable changes in biology, that this wasn't just in their head somehow. Although, again, that distinction's interesting, too. But that so much of why your biology changes is being in survival mode and so much of being in survival mode has to do with whether you're on edge. So much of whether you're on edge has to do with whether people are calming you down or revving you up.
- [30:00]
A
Yeah.
- [30:01]
C
I've often heard of professionals who volunteer themselves into wellness centers to go sit with a community of people that feel what they're feeling, that know what they know, and.
- [30:10]
A
Wait, what do you mean? Say more on that.
- [30:11]
C
Like, say, for example, you're not coping with stress at work.
- [30:15]
A
Yeah.
- [30:15]
C
Then they send you away to a wellness center, maybe for seven days. Then they will start volunteering themselves in there once a month. They'll go spend a week.
- [30:22]
A
Okay.
- [30:23]
B
So they've.
- [30:23]
A
They've basically gone through the program already. Yeah. And then they'll go through and they'll go back. They want to come back.
- [30:28]
C
They feel that that's where they feel like they regulate and they recalibrate and they go back into the world. And the funny thing, because I'm a. Yeah, sorry.
- [30:35]
B
That's wonderful. Yeah. I love that. That a lot of veterans do that.
- [30:38]
C
Yes.
- [30:39]
B
I was about to say veterans that they go through their healing process, and the first thing that they think to themselves is, I gotta help other veterans. I gotta. I gotta. I gotta help somebody else along. I know kind of the dance moves of how to go through this process, and I'm going to help somebody else. And that is a form of meaning making. That's a form of taking your pain and making it productive for someone else and kind of giving it some sort of a purpose. Those kind of behaviors change the brain, too, which is what neuroscience is learning. Empathy, compassion, all those things. Because we are biologic beings, so our states change. It's not that shocking. But the fact that people feel that urge when they have benefited from something to want to heal others is really kind of the best of humanity. And it is really promising in terms of our ability to heal as a culture from traumas.
- [31:51]
C
There's a very famous phrase that Vietnam vets are very famous for whenever people criticize them about being part of the war, and that was you and there, man. Is it important for someone who has been through tremendous amounts of trauma to be able to speak to someone who was at the scene of a particular or similar kind of trauma.
- [32:13]
B
Well, what I've seen is that there's a natural fellowship between people that have been. That have had the same experience, even if they've never met each other before. Um, so there's this intuitive connection, like, I get you. I know there's this. I see you. I know and so there's definitely something important to what you're saying. The question is whether if we haven't had those experiences, we can find a way to imagine what they're. What. What it must have been like. And, you know, that's part of training to be a therapist, really kind of learning how to open yourself up, trying to go through your life events, trying to make those connections so that you can really relate to somebody else who's struggling with powerlessness, helplessness, all those things. If you've never felt any of those things yourself, right. You may not be able to relate to someone. You don't bring it and start sharing and then making the therapy session about you. I mean, that's why you go through all the training and supervision, you know? But by the time you're starting to work with trauma survivors, you're in touch with a lot of the things that they're going through because you explored them in yourself or you tried to. And many, many people become therapists after being traumatized themselves.
- [33:51]
C
Hmm.
- [33:51]
B
I've seen that.
- [33:52]
C
Wow.
- [33:54]
A
Your work deals acutely with cortisol. You know, there's a lot of work that I've read of yours where you're talking about cortisol. And I was thinking, again, to the colloquial understanding of some of these things, has thrown off our ability to actually understand what's going on, you know, so cortisol, if I ask most people, and I would say it's become more and more prominent over the past maybe decade or so, people go like, oh, cortisol, that's the stress hormone. You don't want cortisol in you. There's too much cortisol. That's the thing that makes you stressed out. And I was really fascinated to read in your work about how, like, when you were working with Vietnam veterans, you realized there was a misunderstanding that we had of cortisol, because we assume that somebody who's been through a very traumatic experience would have high levels of cortisol, as in, they would have high levels of stress.
- [34:39]
C
Wow.
- [34:40]
A
You found that the opposite was true for people who had come from the most traumatic experiences. Explain to me what you discovered and why that was significant.
- [34:49]
B
Well, we found that in combat. It was my mentor that found it first, John Mason and Earl Giller. They found. At first, I came as a postdoc from the stress field and didn't believe it. Like, these guys are stressed. Their cortisol should be high. So my wise mentors told me I should free to replicate it, to try to replicate It. Which I did, and then it was. I knew that it was a real finding.
- [35:16]
A
Their cortisol was low.
- [35:17]
B
Their cortisol was low. If they had ptsd, not everyone, but it was more likely to be so. And then, you know, that had me scratching my head, too. But on the simplest level, if you take a step back and ask yourself, what does cortisol do? It's actually not so. It's not so straightforward. Cortisol has a lot of different functions. It's a very, very important hormone. You need it for digestion and mobilizing energy to the body for cognition, reproduction, thinking, and stress. Right. But what does cortisol do in stress? So we talked a little bit about the amygdala before, which is the threat detector. When your body detects threat, it activates a fight or flight response. So there are a bunch of components to that response. First, you have an orienting startle response. Get everything together, right?
- [36:20]
A
That's the initial shock moment.
- [36:21]
B
The initial shock moment. Then you activate your sympathetic nervous system to release adrenaline. Okay? Your parasympathetic system kind of slows down a bit. I mean, you can digest your lunch later. Right now, we need all of our energy to be in fight or flight. But you also activate cortisol. The hypothalamus activates the pituitary, which activates the adrenal to release cortisol. Cortisol is really important to the stress response, but one of the things that it also does is it contains the adrenaline levels. So in a way, it kind of begins the process of shutting it down, shutting down the stress response. When you are in safety, once you've fought, once you've flee, once you did the response you want to do. And it also protects your body from some of the things that had to happen so that you could do fight or flight. I mean, you know, you might not feel that you strained your muscle when you were running, right?
- [37:26]
A
Because you couldn't afford to at that moment.
- [37:27]
B
You could afford to at that time, but later you're going to feel it. So cortisol's involved in inflammation. It's involved in all of these really important jobs. And the way that I like to explain it very simply is suppose you have a fire in your house, and you call the fireman, they do their job, and they leave you with a mess to clean. I mean, they saved your life, but did they really have to break all the windows and track it?
- [37:55]
C
All the money.
- [37:58]
B
You don't think of it at the time, please save my cat. But then you're looking at all the damage, Right. So you gotta clean that up. And I think that stress hormones help with that. And if you don't believe that, then the other way you can look at it is think about inflammation. Right. When you have an infection and your white blood cell count is high, that doesn't feel good, you get a fever. Nobody likes to have an infection. But those white blood cells, they're helping you fight the foreign intruder, Right? So you don't want to say, hey, let me kill off those white blood cells. So I think people have the same feeling about cortisol. It's linked with stress. Stress we don't like.
- [38:45]
A
But that's not the only reason that exists.
- [38:46]
B
That's not the only reason that it exists. And also, if you're going to have stress, you want to be able to have a stress response. If you're going to have infection, you want to be able to fight them off. So, yes, it won't feel pleasant, it won't feel good.
- [39:02]
A
So to use that analogy, then, could it be that. Am I correct in saying that PTSD and its effects on your body and your cortisol levels are that it's an infection that's so big and so bad that the white blood cells sort of diminish and now you don't have enough white blood cells going forward?
- [39:23]
B
Yeah. To carry the analogy, you could think about an autoimmune disease when you start attacking your own healthy tissue. But yes, I mean, the thing about the trauma response is that at some point this was the right thing, and now it isn't right. But I'm still doing it. My body's still doing it. This is the way I understand it. It's really, really complicated. And what happened in our early studies is that as I was trying to figure out the why of the low cortisol, it really led me away from cortisol. Ironically, it led me to the receptors and the molecular aspects and into kind of epigenetics and how the system is calibrated. So you can't, like, take a cortisol level on someone and know whether they have PTSD or not. It's a generality. It was in as a group, people certainly didn't have high cortisol and tended even to have lower cortisol. When we researched it, we realized it was just a matter of that the system had recalibrated, and it had recalibrated to have low stress hormones. Why? Because if you need to respond to stress again, you're better off starting out low so that you can actually.
- [40:40]
A
Oh, wow.
- [40:41]
B
That's what I think. All of these are just my opinion. You know, people could have different opinions, but this is just how I see it. After doing this for decades, really, this is just how I put it together. So I don't think biology betrays us. I think our environments betray us and our bodies do the best they can. And sometimes it's too much. So what's wrong in trauma isn't our bodies. It's what happened. And so besides mounting biologic responses that try to adapt but may do so imperfectly, create traumatic memories that aren't good, but we need to have them because we need to remember. How do we minimize the damage done by trauma? By using society as a buffer, by using other people as a buffer, by using community as a buffer, by doing healing things, by treating people well so that all of these things can help us get through it. Because trauma is a fact of life. When PTSD was first diagnosed in 1980, the assumption was that trauma was super rare, but everyone would get ptsd. It was just one of those rare things. And then when epidemiologic studies started to ask people, just regular people in the world, have you ever been exposed to a trauma? It was like, yeah, 70% of people. And that's an underestimate. You gotta imagine it's an underestimate.
- [42:23]
A
Yeah, absolutely.
- [42:24]
B
So what the field of trauma realized is. Oh, man. Trauma is really common, but PTSD doesn't always happen. So that means we're complicated and we. We have many different kinds of ways of responding, but one of them is certainly ptsd.
- [42:48]
A
We're gonna continue this conversation right after this short break. Hey, everybody, it's Rob Lowe here.
- [42:56]
B
If you haven't heard, I have a.
- [42:59]
A
Podcast that's called Literally with Rob Lowe. And basically it's conversations I've had that really make you feel like you're pulling up a chair at an intimate dinner between myself and people that I admire, like Aaron Sorkin or Tiffany Haddish, Demi Moore, Chris Pratt, Michael J. Fox. There are new episodes out every Thursday, so subscribe, please, and listen wherever you get your podcasts.
- [43:29]
B
Hey, it's Olivia from Ollie. Getting better sleep this year is totally doable, but skip the lettuce tea in the mouth tape. These sleep trends are getting unhinged. Ollie sleep gummies help you fall asleep, stay asleep, and wake up refreshed. Just melatonin, L theanine, and botanical extracts. No weird wet salad aftertaste. Better sleep can start tonight. Go to O l l y.com to choose your snooze. These statements have not been evaluated by.
- [43:54]
A
The Food and Drug Administration.
- [43:55]
B
This product is not intended to diagnose, treat, cure or prevent any disease. Hi, I'm Angie Hicks, co founder of angie. When you use Angie for your home projects, you know all your jobs will be done well. Roof repair, done well. Kitchen sink install, done well. Deck upgrades, done well. Electrical upgrade, done well. Angie's been connecting homeowners with skilled pros for nearly 30 years. So we know the difference between done and done well. Hire high quality pros@angie.com.
- [44:35]
A
When we talk about the world letting us down, I wonder if there's any parts of your research that have looked at whether we are ill equipped to deal with the world that we've evolved for ourselves. Because, you know, when you're talking about trauma, I take us back as humans to a time when fewer things happened. So let's say there was a forest fire. Most times it would be one forest fire and then it's done. And it takes a few years maybe before there's another one. An earthquake is the same thing. Being attacked by a lion doesn't really happen every day, et cetera, et cetera, et cetera. And so when you live in those communities and you're in a smaller world, I could imagine that you would have fewer things that could traumatize you. I could be wrong, but I wonder if, like, some of the work has looked at what it means to live in a world where now our traumas could either be imposed upon us or even reignited by a world that shows us things. So you open your phone any given day, you have no way of knowing what's gonna come into your world or into your mind or into. You get what I'm saying?
- [45:39]
B
Totally.
- [45:39]
A
Like, something can just get thrown at you. And I'd love to know if that's, you know, part of your work. If you look at how our environments can re traumatize us or help us to heal in a different way, I.
- [45:51]
B
Think we become desensitized. Yeah. So I think we can get very, very upset about trauma. But then when it happens for the 200th time, I mean, what was it like when we saw that first school shooting was like, how can somebody shoot in a school? And now I think people really accept it as a fact of life. It's horrible, it's tragic. People worry about it happening, but you sort of adjust to a new baseline of violence in society. And when you adjust, it's like the people that live with chronic abuse that we talked about earlier. You just take it as a fact. Doesn't mean that it affects you more or less, but it's just part of. You just don't feel like you can escape it. You lose the context that it doesn't have to be this way, that there is an alternative in a world where there isn't this level of violence. And that used to be the case, but I think for now, this generation has just grown up with a lot of violence and the potential for a lot of violence. So, you know, it can make us feel desensitized and powerless. It could also make us feel very traumatized and helpless.
- [47:25]
A
Right.
- [47:29]
B
I don't know if having lots of trauma makes you resilient. I don't see that as a society. All this trauma has helped us that much. Maybe I'm missing something, but it's not something that. That I can tell you that it has built our character or something like that. But many of us have found ways to lead meaningful lives and try to do so. And what I've found is that that usually involves helping someone else that is traumatized or that needs to be helped.
- [48:09]
A
That's an interesting thought. Just the idea that, like, repeated trauma, especially in today's society, whether we're watching it, seeing it, being informed of it, experiencing, et cetera, only pushes us to one side of it. So it's like either we are getting completely desensitized or we're being completely traumatized.
- [48:27]
B
Yeah, well, those are two sides.
- [48:28]
A
Right? That's what. No, but I'm saying there's that, like, sort of middle part where it's like we would be healing the thing and then trying to. It's such a complicated world. I can see why you have to.
- [48:38]
B
Well, no, I mean, you could have that option. I mean, if. If people decided that some traumas are in our control and acted to try to not have those traumas, then that would be the third option. I mean, but we live in a world where people feel that we have to solve disputes by war, for example, or, you know, we live in. We live in a world that hasn't prioritized having less trauma.
- [49:13]
A
Right.
- [49:13]
B
We just haven't prioritized it. Maybe it would be something to think about doing.
- [49:21]
A
Yeah. There's weapons for mass destruction, but not many for mass reconstruction. Do you know what I mean?
- [49:27]
C
And I often think. Do you think that there was a time in our lives where trauma and violence became commercialized?
- [49:39]
B
What do you mean by that?
- [49:40]
C
Movies that were super violent, that show combat as glamorous and doesn't show you what? I've never seen a movie, for example, that's a blockbuster that shows what happens after in the wake of a war.
- [49:52]
B
Hurt Locker? No, there are really good ones. The Deer Hunter. I mean, there's some really good movies that I think did make you stop and think about the cost of war. I don't know if they were blockbusters or anything like that. I saw them. I know I saw them.
- [50:10]
C
Platoon.
- [50:10]
A
They won the Oscar. Not the box office.
- [50:13]
B
Maybe again, some people, I don't know. I mean, I think that we live in a society that has got a lot of trauma. And look there, it's not just violence. COVID 19 was also traumatizing for many people. There are lots of ways to be traumatized.
- [50:39]
A
So, yeah, let's talk a little bit about the work that has, I guess, sort of brought your name back to prominence in a different light still in and around the same field. And that's been how trauma shows itself intergenerationally. After 9 11, you studied 38 pregnant women who were near the World Trade center, and your findings were nothing short of revolutionary. Because I think for a long time, you know, while people evolved, you know, PTSD in the 1980s, and then, you know, we're evolving our understanding of trauma, very few people ever thought that trauma was passed on or trauma could exist in somebody who did not experience the initial trauma. When you looked at these mothers who were near the World Trade center and survived and then had children, and then you looked at their children's, you know, the readings or the findings, like, can you. Can you walk us through that? Because I was so fascinated and also confused. Like, this is so complicated. How were you able to measure that a child had experienced or had. Is it internalized? I don't even know the correct verbiage. Their mother's trauma, but they weren't there for that event.
- [51:55]
B
Well, I mean, I wouldn't frame it as that. They internalized their mother's trauma. They had low cortisol.
- [52:01]
A
Ah, so you found that common thread. Yeah.
- [52:03]
B
So we measured salivary cortisol in mothers and their babies. They were correlated. If the mothers had ptsd, they tended to have lower cortisol levels. So did their babies. But what we really found was something very interesting, which was a trimester effect. And that is what gave us the biggest clue that there is something about what happens to a mother who is stressed during pregnancy that may be able to, quote, be transmitted to their fetus and maybe live on. But I'm not the one that found that that was a finding that was already quite in existence, beginning with the Dutch hungers in World War II when the Nazis surrounded the Netherlands. And for like this nine month period, there was no restricted food. Yeah, restricted food. And they did very large studies of the effects of that starvation on the population, including in pregnant women and their children. Yeah, so don't give me that credit. No, no, no. I mean, they found that there could be enormous effects in the offspring who were born subsequently afterwards. And this spawned whole science of developmental programming. But, you know. Yeah, it is true. The 911 wasn't starvation, that was a psychological trauma. So in that sense that was kind of cool. But what it did was it started to raise the question of how do you program the stress response of a fetus? Really? I mean, we're always telling pregnant mothers, don't be stressed, eat this, do this. Right. Presumably because we know that the mother can affect the fetus through the placenta. Right. So one of the things that. So we were kind of mesmerized by the trimester effect, but all that meant was that the exposure to maternal glucocorticoid cortisol, maternal cortisol, during the third trimester of pregnancy is very different because in the first two months, the fetus is protected by this chemical maternal shield of an enzyme in the placenta that kind of converts mother's cortisol into an inactive metabolite. But that enzyme, that's why science is so cool, that enzyme, the activity of that enzyme kind of reduces by the third trimester, because by the third trimester, the offspring is preparing to breathe on their own and they need. Need maternal cortisol so that their lungs could mature. This is again, cortisol's not all bad.
- [55:04]
A
Nothing is.
- [55:04]
B
Nothing in our body is all bad. It's just different times, different uses, different things. So that is why we probably had a trimester effect, because there were different stress effects in the third trimester. But the reason that finding really resonated with me was because just a few years earlier we had published a paper showing lower cortisol levels in the adult children of Holocaust survivors. If the parent had ptsd, if their parents had ptsd. And so what we were wondering about was why would their cortisol levels low? Was it because of the parenting behavior? Which is what everyone said.
- [55:50]
A
Right.
- [55:52]
B
And what this finding did was it suggested, you know, maybe that's not the only way you get low cortisol. Maybe the origins of low cortisol could be even earlier in pregnancy.
- [56:05]
C
You know what this makes me think of because we are from South Africa. And obviously there's a generation called the born freeze. The ones that were born after 1994, after our general elections, that were inclusive, happened after apartheid ended. After apartheid ended. And the generation that's from before always looks at the generation that was born, call them born freeze as different. Because somehow what you've just said is they don't carry the trauma that the generation before carried. The way of thinking, the way they behave, and obviously the way they look at their parents and go, why are you worried about that? And their parents go, you should be worried about that. You know, So I think that makes so much sense now when you look at the generational divide, and sometimes it's not that huge. It just depends when the others were born versus when the others were.
- [56:48]
A
But actually to. Yeah, to Eugene's question. How does it show up? You know, like, so we know that somebody who's experienced a trauma might have a ptsd, right? And so someone's got that ptsd, they've experienced this trauma. We have certain understandings of how it might show up. But I'd love to know whether or not it's just a reading, as in like someone has low cortisol or how it actually shows up in their life. Do they. Do they take on any of the mannerisms? Do they have any of the fears? Do they have. Are those things that we can actually trace, or is it now just something that's contained within your biology?
- [57:24]
B
Yeah. So what made me notice this had nothing to do with biology. I first noticed behavior because adult children of Holocaust survivors were telling me they were affected by their parents trauma, that they had Holocaust related imagery, that they had trouble in relationships, that they had depression and anxiety. They did kind of blame it on the homes that they were raised in, but they absolutely manifested the symptoms. But then I thought, okay, well, let me look at the hormones. But cortisol isn't really the main issue, because cortisol was just what led us to understand that how it showed up could also be in terms of epigenetic changes that were present in both the parent and the child.
- [58:20]
A
Before you go into that, help us understand what epigenetics is and why it's important. What is that field of study actually looking at?
- [58:27]
B
The field of epigenetics is just the study of how genes are regulated by chemical marks that we are born with that we can develop from the environment. And basically think about an iPhone that has the capacity to keep updating its own self. Epigenetics really is kind of the way in which we internalize information, including from the environment. Some epigenetic changes are wired in, but for stress related genes, it's a way that we can learn lessons and internalize information. People nutrition can affect epigenetics, exercise, a lot of environment, and so can trauma. So one of the couple of the studies that we did really looked at epigenetic changes in holocaust offspring and stress related genes. And we found that in many cases they had changes that were related to different aspects of maternal or paternal exposure. Not all of these were negative changes. Some of them actually were adaptive or were associated with protective effects. But it shows up biologically. But the best way that I can explain it is again, not my work. It's an animal study that was done that I think I love this study. It came out at a. I didn't know about it when we had our findings. So when I found out about it, I felt very validated. But there was Brian Diaz and Carrie Ressler. They took male pups, they fear, conditioned them, they exposed them to the scent of cherry blossom and gave them a shock. So that after a while, just the scent of the cherry blossom could cause a fear response in the animal. Okay, so that was associated with epigenetic changes in brain and sperm. Now, when those rats were bred with non stressed females, the offspring of that union had a sensitivity to the cherry blossom as well as epigenetic changes in brain and sperm. But this is what I mean by a sensitivity, because this really says it all. They were not born being afraid of the scent of cherry blossoms. However, if you began to do the same study where you expose them to the smell and then shock them, they would learn like in two or three times to be afraid. If it took, let's say 10 for their dad to figure this out. Wow, they're figuring it out.
- [61:21]
C
It almost was like a dormant.
- [61:23]
B
It was like this. It's a preconditioning. In case you encounter this. Wow, I'm encoding some information. And the genes that had the epigenetic marks had to do with smell. So again, we don't know a lot about how it works. We know that sperm is one of the ways we know in utero is one of the ways we know that eggs can be another way. When sperm and egg join, a lot of the sperm genes are regulating the placenta. So father influences don't go away. But all that means is really pretty complicated to unpack. But the reason I really like that animal study is because it's so clear and it really resonates the idea Isn't that you inherit trauma, you don't inherit trauma, you don't inherit a traumatic, you inherit kind of a bias, a signal. And that is.
- [62:29]
C
I'm excited because.
- [62:30]
B
Because you like it. Yes, yes.
- [62:33]
C
It makes so much sense. Please go ahead. Sorry. Sorry. I couldn't contain my excitement.
- [62:37]
B
No, I was excited too. I wish that human work, as we call what we do, could be as clear cut. It isn't, but we're right there. We try to ask the right questions and do the best we can and try to get a signal. If we were only operating without also having animal work, I wouldn't be as confident if it was only animal work without our kind of work, who knows, right?
- [63:07]
A
But we're seeing the overlaps.
- [63:08]
B
But when you see the imperfection of both kind of studies coming together, it suggests that something's going on, that these phenomenon are real. But I just want to caution against the fact that the minute we say that the environment can influence our molecular biology and our genes, that just means that that can keep going. And that's why I'm such a fan of healing environments and therapy and healing. Because if it's true that our biology changes in response to the environment, don't stop at trauma, keep going, keep going with healing. And then your body should be able to adapt. Because that's the big lesson in all of this, that we're not stuck in our bodies. Our bodies record lessons and a lot of them are painful. That is awful. That terrible things happen. The fact that we can learn from them is magnificent.
- [64:14]
A
So how much do we have to then think of trauma or the inherited elements of the epigenetics? How much do we have to think of that as a scar versus a preparation? Like should we, should we think of it as good or bad? Or should we not even think of it as either? Should we just go, it just is.
- [64:34]
B
Yeah, just. Just never think about good or bad. Because biology isn't about good or bad.
- [64:40]
A
Yeah, it just is. Or is.
- [64:41]
B
It's about adaptation and trying to match what you need with what you got. It could be very difficult. I mean, in the Holocaust survivors, they developed changes in enzymes that were responsible for helping them prolong metabolic fuel during starvation. Wow. But if you live in an environment where food is plentiful, that might make you more susceptible to metabolic syndrome or type 2 diabetes or hypertension. Right.
- [65:12]
A
Because now your body doesn't.
- [65:13]
B
Because now your body is wired for something that was needed in a prior generation. But biology doesn't know whether the offspring's going to be in the same situation as the parent. Right. And if not, maybe a different kind of adaptation could be made going forward. So I would just think, I wouldn't say that it's good or bad, but I would say that it matters because it helps us understand our sensitivities. If we come from legacies of violence where our people were victims or even perpetrators, which is a whole other legacy that we never talk about.
- [65:57]
A
Oh, wow, that's right.
- [65:59]
B
But that can be tough too.
- [66:01]
C
We're going through that in South Africa.
- [66:02]
A
Wait, wait, in what way? Say more on that.
- [66:05]
B
Well, I mean, sometimes it's not a matter of the fact that your ancestors were victimized, sometimes they were the aggressors and what do you do with that?
- [66:18]
A
So you know, as in like that might be passed down or the effects of it are passed down, or they're.
- [66:24]
B
Saying that if we're saying that experience calibrates and some of those lessons are carried forward, then that's all experience. It can be very traumatic for people. Look, it was a generation ago, but when I first started doing my work, one of the first people that replicated our low cortisol findings was in Germany. And I was invited to go to Germany and I went. And the first thing that everyone was trying to tell me in that 30 years ago was how difficult it was to be German and have this legacy of what Germany did.
- [67:16]
A
Right. Of what the Nazis did.
- [67:18]
B
Yes. And that had been something that many people struggled with. So we struggle with our legacies. They matter. And so we have to come to terms with it. And when we see ourselves kind of hyper responding or having reactions that we don't understand, we shouldn't discount or ignore those reactions. We should try to say, I wonder where that's coming from. I wonder what is making me so hypersensitive to this. You know, some people are very hypersensitive to bullying. Yeah, some people are very. They don't care. Right, yeah. That comes from somewhere where I feel.
- [68:00]
C
Like I'm learning so much. And we obviously had a little bit of a conversation before and I'm thinking there is so much about trauma and how we behave that we are predisposition to be like when you said it's passed down genetically on us.
- [68:15]
B
Biased.
- [68:16]
C
We're biased.
- [68:17]
B
That's not predisposed.
- [68:18]
C
We're biased.
- [68:19]
B
We're biased.
- [68:20]
C
Yeah. The way we see it and, and the way we behave.
- [68:23]
B
But we can change.
- [68:23]
C
We can change it. And I was having a heated argument with someone the other time when, when I noticed sometimes in South Africa there's obviously what black people went through and what the Africanas in that country had put black people through. And even after all these years, there's certain things that you'll notice that an Africana person would say that a black person would never say. And then you think to yourself, after all these years, we all grew up in the same environment. Surely you see that what you're saying is inappropriate for the time now. But like you said, it's about where they're from and what they go through. And we sometimes obfuscate that responsibility and make it about culture and the environment that they find themselves in. But sometimes, from the looks of the research that you've done, it goes way deeper than that.
- [69:08]
B
Yeah. And I don't have all the answers. I don't have all the answers, but I know that trauma is bigger than just one event to one person. And I think that's really the only thing I know for sure. And knowing that, though, should give us some marching orders in terms of figuring out how we want to live our lives, how we want to set up our societies. Yeah.
- [69:38]
A
Don't press anything. We've got more. What now? After this.
- [69:44]
B
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A
Angel stuff for your tushy.
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B
It's made by Angels Soft and strong. Budget friendly. The choice is simple. Pick up a pack today. Angel soft. Soft and strong. Simple. Hey, it's Olivia from Ollie. Getting better sleep this year is totally doable. But skip the lettuce tea and the mouth tape. These sleep trends are getting unhinged. Ollie Sleep gummies help you fall asleep, stay asleep, and wake up refreshed. Just melatonin, L theanine and botanical extracts. No weird wet salad aftertaste. Better sleep can start tonight. Go to o l l y.com to choose your snooze. These statements are have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
- [71:07]
A
When I look at some of your work, collective trauma is one of the, you know, the areas that you really focus on. So war, genocide, 9, 11. But you also really make an effort to point out that we shouldn't limit it to those massive events. And we spoke a little bit about this earlier in the conversation, but I wanted to know, does that also show up in the same way? So we know that if somebody, you know, suffered through 9 11, we know, you know, through your work, if it's a Holocaust survivor, if it's a, you know, a Palestinian child, if it's like, we probably will find all of these things in their genes, but do we see the same. Do we see the same information? If somebody was bullied in school, do we see the same. Is it the same level in their bodies, or is that where there's a disconnect between the mind in the body?
- [71:54]
B
My guess would be that it is the same or similar, but it's harder to study because the reason that I like to study homogeneous groups, even within a homogeneous group, there's a ton of heterogeneity, is that the biology is such a moving target. I want to study it in relation to an event that was 30 years ago. But meanwhile, the biology is busy with what it has to do today. And if people are, I mean, things like body weight, age, there's just a million factors that are influencing today's biology. So if you have. And again, a lot of people have not replicated the low cortisol finding, but mostly they would do it in a mixed civilian sample because the way that. In which people are so different from one another in the sample, the heterogeneity of the sample makes it harder to find any kind of a signal. But theoretically, I don't think that having a trauma alone is materially different. And in some cases it could be worse because you don't have the community and you don't have other people. When you are a rape victim, you go home and you probably won't talk about it. You are pretty sure that people will blame you or that you're ashamed in some way, or that people won't understand or they will feel uncomfortable and will distance themselves from you. So sometimes you're suffering from things by yourself without being part of, like a survivor community, which can also compound the effects.
- [73:44]
A
So, yeah, you never think of it being community.
- [73:48]
B
I know, but it's.
- [73:49]
A
Which I know is like.
- [73:50]
B
It's a crazy.
- [73:51]
A
But I've read stories about how, you know, people who were lucky enough to survive a plane crash, if they survived it collectively, have a different experience of it than if they were like the sole survivor. There's a Different. There's a, we survived the plane crash or we were in a plane crash versus I was in a plane crash. It makes me then wonder. What would treatment be like if we thought of these things as having happened right after the time. Like I've seen in some of your work, you talk about cortisol and I think it was hydrocortisone that you were looking at. This really sparked my curiosity because there were some studies where you were looking at whether or not you could affect the levels of cortisol in a person right after they'd experienced a traumatic event. Right. And the purpose for that was, if I understand right, to sort of get their body at least back to the place where it was regulated right afterwards so that. So that the trauma didn't have as long lasting an effect. Talk me through that and the basic principle behind it and whether or not you've made any breakthroughs in, in this, in this work.
- [75:01]
B
It's an example of a third theory that really should work theoretically, and then in practice.
- [75:07]
A
This is good old science.
- [75:09]
B
Doesn't work at all.
- [75:09]
C
Comedy.
- [75:11]
A
Yeah, you're not wrong.
- [75:12]
B
But the idea was that if cortisol is important in helping to damp down the adrenaline, then why don't we just give one big dose of hydrocortisone in case it's low, to help us recalibrate the sympathetic nervous system?
- [75:28]
A
Okay.
- [75:30]
B
I don't know the results. We did a pilot study and there was a small signal, but it wasn't like, oh, my God, we're just wrapping up a study that's been in the works since COVID started, which was a great time to start this. Not. But I'll let you know, I think that these are very hard studies to do to follow people from the emergency room and then kind of treat them in a double blind, placebo controlled way. And also, since the time that I thought that was a good idea, I really changed my mind a lot about whether we should be doing interventions. Acutely. I think the kind of interventions that we need are what help people naturally bring down their sympathetic nervous system. Arousal. By hugging them, by holding them in community, by showing them that we care about them, not by giving them cortisol. Although if it really works well, that would be a great thing for someone to carry around in their Kevlar during a critical incident, because it can't hurt you in any way to prevent ptsd, which is what we said in the grant that got funded. But the other thing that has happened to me since that time is that I've become really interested in psychedelic assisted therapy for trauma and ptsd. And I think that's a better way to kind of help people with their trauma and ptsd, because it allows people to access kind of in parallel a lot of life events, not just focus on one, and also brings in kind of the intergenerational component because you bring your entire identity with you into kind of the psychedelic work. So, you know, my views have really shifted. I started out kind of very neuroscience, more of in that reductionist frame. I'm going to find the thing that's broken. We're going to find drugs that will reverse it. And I'm not in that same place. I just think that for people there's too many other things going on. And I've seen people heal, even without any therapy at all from horrific things, if they were embraced in the right way in the community, if they found meaning, if they were able to live in a certain way following their trauma. So it just gives me pause. I'm awed by the complexity of. Doesn't make me want to not do it anymore. Like, it's too big a Gordian not to untie. But it's. It should make us really cautious about being overly simplistic about any of it, 100%. And through it all, just this idea that we are resilient.
- [78:45]
A
Right. Let's talk a little bit about the psychedelics. You know, over the. I would say, like the last sort of 2ish years of Biden's presidency, there was a lot of talk around veterans being prescribed MDMA therapy. And we've seen it growing around the country, around the world. We've seen ketamine therapy growing. We've seen some people do therapies using psilocybin or mushrooms. And one of the things people report is the ability to do work that they couldn't otherwise do because it interrupts their brain's ability to either make an assumption or jump to a preconceived conclusion or basically fall into its rote pattern. Right now maybe I'm. I'm completely obtuse and I. I don't know everything about it because I read what I can. It seems to me like some of the resistance to some of these therapies is applied in a way that isn't applied to some other medicine. You know, like, so they'll go, oh, we don't know if we could apply these therapies because, you know, it's. It seems like it could be bad in this moment. But then when you look at many of the medicines that are already out there. We just accept the side effects. And I'm not saying that means we should be dismissive of everything, but. But I wonder, I wonder what some of these therapies do that current medicines don't. And I wonder if you have any insights into whether, you know, the medical field is resistant to them because they've been seen as party drugs, or is there another reason that we don't know as the general public that we're not seeing on a neurological side. So when it's like MDMA or something like psilocybin dmt.
- [80:25]
B
I've been a little surprised by the lack of reception to psychedelic therapies. It's not like we have great solutions right now. It would be different if there were definitely treatments that worked for the majority of people and we could say there's a lot of risk involved in these approaches. So let's stick to the things we've operationalized that we can deliver quickly and that our workforce knows how to do. But especially for combat veterans, these cognitive behavioral therapies don't do the job for them more often than not. Why? Because they're too distressing. It's distressing to really talk about a real trauma, especially if there are multiple ones and also you come in with a history. There's also the issue of maybe moral injury that is very different than being a rape victim. These treatments were mostly developed for interpersonal violence where they work pretty well. But when you have something more complicated, I think you need to process it in a certain way. And somehow being in this altered state where it releases a lot of self compassion, you suspend this terrible self judgment that you carry around, usually with yourself. It's a party drug for a reason. It helps with social bonding. So that works in the therapy room with your therapists. You kind of form a better relationship with them. And for some reason you're open to looking at things that would usually just get you too upset and distressed and would otherwise make you say, I'm not doing that. Doesn't mean that it's fun and easy because it is not. But if you have the right therapists that are well trained to know how to work with someone in an altered state and you process it a lot afterwards, you can have an amazing outcome. Most people will have an amazing outcome, which is what our study found. So why isn't everyone embracing it? Because it's very labor intensive. The psychotherapy is not the way. That is a different kind of model that people will kind of need to learn. It's unstructured which adds a layer of discomfort. People want to have a structure about how they are approaching therapy.
- [83:14]
A
And is it unstructured because you don't know what the person's going to experience.
- [83:18]
B
Or okay, yeah, you're getting on their bus.
- [83:22]
A
Oh, yeah. You're not guiding them. They're sort of guiding you.
- [83:24]
B
Yeah, right. I mean, in cognitive behavioral therapy, we decide in advance what trauma we're going to process. You're getting on my bus. Here's you're going to get homework. We're going to create a hierarchy of things you're afraid of. I'm going to give you tools to reduce your distress. You know, things like that. It's very structured, but this is different. This is like, well, let's see where we go. Which a lot of people are nervous about because of the potential that it can. But it may go to places that are difficult for people that don't really have the experience and training to work in that way. So it's hard. It's been a hard one. I don't think that people don't think this works. I think that the question is really about scalability and training and how to really make it accessible and how to change systems so that it can happen. How do you integrate it now into curricula for people who are training to be psychiatrists, psychologists, and social workers? So I think the conversations about, oh, it used to be illegal. Yeah, but those aren't the kind of things people are really talking about when they're trying to figure out how practical.
- [84:45]
A
Okay, got it.
- [84:46]
B
How practical it is to do this. It's hours and hours of psychotherapy in between the medicine sessions. And the medicine sessions themselves can be long. That's with mdma, which is what is being proposed for ptsd.
- [85:03]
A
Oh, and so that's what you mean by labor intensive is the person takes it, but now they need extended periods.
- [85:09]
B
Of supervision, now they need to have therapy. Now we have to talk about what happens.
- [85:13]
A
Right, right.
- [85:14]
B
We can talk about it during the session. That's eight hours with two therapists.
- [85:18]
A
Wow.
- [85:19]
B
Just for one session. So we're going to talk about it. We're going to talk about it for three sessions before, three sessions after, and then again, and before you know it, you've had a lot of therapy. So that's good. If I don't have 100 people that need something. And so really, it's a question of how we're going to do this. Now, on the plus side, once you have a tremendously good outcome, maybe your caseload will be more like a revolving door than the same people that are coming to therapy all the time. So, you know, I think this is a really promising development. It does all the things that I think are important. You don't need to talk about your trauma in advance. You might not even know what it is. It allows you to sort of access things in parallel, not just serially. A lot of it is inferbal. You know, we put a lot of. We put a premium on being able to explain things. We don't explain. We don't know everything. We can't put words into everything we feel or have experienced. And just you come out with a sense of forgiveness for yourself. That is really important. And you're not always sure why. But like, people come out and say, you know, I'm a good person. Wow, that's big. That's deep. I had to do the things that I had to do, but that does not make me a bad person. I can do lots more things now. I can take off my armor. I don't have to be so defended. I don't have to let people take advantage of me. All these things that could take maybe years in regular psychotherapy to really internalize. You could say them cognitively.
- [87:19]
A
Right?
- [87:20]
B
But feeling it, feeling it and saying it and knowing it is really where I think the psychedelic is. Just that superpower, because it sort of ties all of it in together. Practical, it's not. But, you know, again, neither was open heart surgery when people first did that. Neither are any of these things that turn out. Neither was a computer that we all wear on our watches now or on our phones. All of these things started out to be very daunting. But once people see the benefits of it, then we find ways. I think that's what we're actually good at as humans. We're good at taking the impossible and making it scalable. But we can't put so many barriers up right now. Again, the studies were criticized. There was. They, they, you know, they were hard on those studies. But. But we're. We're talking about a Schedule 1 compound and we're talking about the necessity of psychotherapy. I understand conflict, I understand why they were concerned, but nothing that I've heard is something that can't be resolved. There's no reason not to anticipate this in a future. There are no barriers that I see. Once we develop ways of training people, once we start doing more research where we figure out the kinds of therapies that might support this, and maybe there are some psychedelics that don't need as much therapy. I don't know. People say that. I'm not sure. I need to see some data, but it's promising. And I think that in this world we need some way to access particularly, you know, compassion, empathy, all those things, forgiveness. And the one thing that absolutely happens to people that have had psychedelic therapy and healed is they turn right around and try to figure out how to help other people get this.
- [89:31]
C
I think what you've just done here, amazingly, is express in words what I've been struggling to express to other people who haven't partaken in something that I've done, which was ayahuasca.
- [89:41]
B
Oh, wow.
- [89:42]
C
And I think I didn't know what I was going through until I went through it and then until I came out of it. But you're right, the level of compassion and acceptance and reconciling your past with your present so that you can have a better future is something that I couldn't explain in words.
- [90:00]
B
It's very hard to explain.
- [90:01]
C
And the amount of healing and what I realized coming out of it, and obviously you have a debrief with a shaman afterwards, was the fact that all the versions of myself that I've seen during the ritual is this one I love the most. And it helped me accept the me now than anguish about what the future is going to be like or what my past growing up was like. I was like, there's decades and hundreds and thousands of years of me's. And about this one here, it's a vacation.
- [90:29]
B
That's an extraordinary story. Now imagine if you were able to just really talk about it a lot in therapy. And imagine if there were a lot of difficulties that you were able to really process all the things because you remember them vividly, vividly. And you know, imagine the wonderful opportunity to really say, I wonder what that meant. Maybe it was a voice that came and talked to. Maybe it was an ancestor, maybe it was a realization or a vision. So the question is, is that a luxury or is that a necessity? And I think that's kind of the debate that the field is having right now. Can we bring this in a group like ayahuasca to a bunch of people and really heal in community? Again, it's not what mental health is like today. So how quickly can we change how we look at things? I mean, right now we're living in a world where things change rapidly. So maybe we can change rapidly. I don't know, but. But that's kind of the task, I.
- [91:45]
A
Think, you know, as I was looking through all of the work and the things you say, I couldn't help but think to something my mom said to me, which I still don't know. I thought it was a joke because it was written well, but I don't think she really like tells jokes in that way. We were driving through the streets in Johannesburg, and she saw a homeless white person who was begging at the traffic lights. And my mother always has money to give to homeless people. She just drives around like that. And she gave this homeless person money. But the difference was, after she gave the guy the money, she turned to me and she said. She said, which translated means, damn white people, they're really suffering. And then I went, I mean, okay, can you explain more? And she. And I said, but there's this black homeless people as well. And she says something that really stuck with me and your work made me. It triggered something for me in your work. She said, yes, I know that black people are suffering as well. She said, but these white people, they don't know how to suffer.
- [92:51]
B
Beautiful.
- [92:52]
A
What she was saying was interesting. She wasn't assigning suffering to anybody. She wasn't saying that suffering belongs to anybody. But she was sort of speaking to something in your work that I would love for you to elaborate on. And she was. In the same way that trauma or the effects of trauma can be inherited, My mom was alluding to something that your work speaks to, and that is that resilience may also be inherited. Do you see that in your work?
- [93:16]
B
100%. That's the major lesson here. That. I mean, that's a beautiful story. And it reminds me of a story that my mother also tells me about how her father, who had a grocery store, used to give not only to people that needed, but to wealthy people who used to be wealthy. But maybe someone had died in the family and he just suspected that things were not going well. But perhaps they were too proud to say something. And she would say the same thing that you did. Like what?
- [93:52]
A
Yeah, they used to be wealthy.
- [93:54]
B
Yeah, they're not other people. And he would say, yeah, but. But it's much harder when you used to have everything and now you don't, than when you've always. When you've always had it, you've always had less. And that's the same thing that your mother was saying. We know how to be resilient. We know how to cope with adversity, but this person may really be flattened by it. And so I'm going to help. It's very compassionate if we lived in a world where everybody thought that we'd live in a wonderful world.
- [94:30]
A
Right.
- [94:32]
B
And so, you know, how do we get that going? This is a world where it feels very polarized. It feels like we can have empathy for our own. But really, it's exactly what your mother said, that you have to be able to look at the other and see that pain. And if we do that, then I think that to me is meaning making and resilience. And it really then takes the lessons of trauma and just maneuvers them in a completely different way.
- [95:18]
A
Well, thank you very much, because I think what you've left us with is the idea that, you know, not that we didn't think it was, but trauma is real. The intergenerational effects of trauma are very real. But if I'm hearing you correctly, you've basically told us to remember that trauma isn't a prison. It's not a cage. It's something that people have experienced and we can. And sort of our jobs to ourselves, our responsibility to ourselves, is to use it as a tool to inform us and how we heal going forward. Not to dismiss it, but also not to make it seem like that's the fixed place that we exist within. So thank you. Thank you very much for your work. And I love how candid you are. You know, I think that's something a lot of people don't understand about researchers and science and is that your field is. Is punctuated with doubt. And that's sort of what it's all about, is doubting, being curious, asking, finding, changing your mind. When you said that, I was like, I don't remember the last time I heard someone say, I've changed my mind on that. And I always think I would rather have somebody involved in science and in research who has the ability to change their mind, because that's what researching is all about, finding out things that might change your mind. So, Dr. Yehuda, thank you so much for joining us today.
- [96:32]
B
Thanks for having me. Thank you for having me.
- [96:40]
A
What now with Trevor Noah is produced by Day Zero Productions in partnership with Sirius xm. The show is executive produced by Trevor Noah, Sanaz Yamin and Jess Hackle. Rebecca Chain is our producer. Our development researcher is Marcia Robiou. Music mixing and mastering by Hannis Brown. Random other stuff by Ra. Ryan Hardu. Thank you so much for listening. Join me next week for another episode of what Now.
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B
Hey, everybody. Ted Danson here to tell you about my podcast with my longtime friend and sometimes co host Woody Harrelson. It's called Where Everybody Knows your name and we're back for another season. I'm so excited to be joined this season by friends like John Mulaney, David Spade, Sarah Silverman, Ed Helms, and many more. You don't want to miss it. Listen to where everybody knows your name with me, Ted Danson and Woody Harrelson. Sometimes. Wherever you get your podcasts, the new.
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