Rachel Yehuda: Is Trauma a Disorder or a Survival Skill?

[music] 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, etc. 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, buted 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? >> Well, um, for the person that's living with it, the 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. Um, one of the earliest. debates in the field of psychology, what. launched the field of psychology was. really the question of do we feel um,

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 me. >> Oh, I I must be afraid, [laughter]. right? >> Yeah. >> And to this day, one could argue it both. ways. That was a very famous debate. Um, 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. [music]. This is [music] what now with Trevor. Noah. >> [music]. >> Dr. 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 going to preface it with. that. I came to realize that our. understanding of trauma is 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? Uh that's a good question. I've been. studying the effects of trauma mostly as. they appear in PTSD uh for few decades. now. I'm interested in um why some. people. get PTSD. um 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. Um, that's I guess across the population, but I'm also interested in the fact that. sometimes the effects of trauma also. cross generations. >> Um, so. those are pretty interesting things. And. also, you know, if somebody does have PTSD,

uh, what's the best way to treat that? Um, and when we talk about trauma, we also. talk a lot about resilience. So, what's. the relationship between trauma and. resilience? I mean, some people think, >> well, there's PTSD. That's kind of a. a bad outcome following trauma, mental. health symptoms, very difficult. But the alternative is to be resilient. and not have those symptoms.

increasingly that binary. um doesn't feel true, >> right? >> Um that a lot of resilience is just. about showing up, especially when you. have symptoms and really trying to get. to it a different place. Try and make. >> sense of what happened and try and make. meaning of what happened and and and. >> try to unravel some of the body's. survival mechanisms that haven't shut. off. So, I think that th those questions.

are um what preoccupy me. But I guess. the central idea is that we just don't. respond the same way to things. >> Why is that? >> Yeah. >> And so, you know, 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. >> Yeah. But most of how we respond is. about us which really changes the. conversation and it changes how you. approach this uh for people that are. struggling after they're exposed to. trauma. >> Well, let's let's break this down. because it's so technical and I think. it's so important for us to understand.

in 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 P PTSD. Oh, that gave me. PTSD. >> Even unnecessarily sometimes [laughter]. >> just that gave me PTSD. So So let's. break that down. Post-traumatic stress. disorder. What What does that actually mean? Post-traumatic stress disorder. Like why.

is it a disorder? And and and what are. we actually dealing with versus how. sometimes people might use it? >> 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? Um, 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 happened. It could be an assault. and abuse, combat interpersonal. violence. Um, losing someone I think um. 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. terri you hear even about something. terrible that happens to a loved one and. it just changes the world for you. Um. 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. >> there's no post for you. There's no. there's no free for you. There there's. there's.

>> 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. >> There's an alternate universe where. you're okay. >> Yeah. Where where where you don't have. to worry constantly about um being. threatened. Um, so that that came and complicated. the conversation because in the. beginning PTSD was um going to 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. Mhm. >> Not everyone comes back the same way. It's going to depend a lot on how you. actually were before and what happened. and and what's happening now. Um, but I. think the Vietnam War introduced my. generation to uh PTSD.

>> Um, and a lot of the ways that we. treated Vietnam veterans when they came. home wasn't very good. Um, because the. war was so controversial. >> Yes. >> 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. Um, >> so we all understood that. We understood. I I've spent a lot of time. [clears throat] studying Holocaust.

survivors. Um, that those people were. also um. people that everyone understood. something terrible happened. there was. an acute moment that you could point to. >> or or years but but some change where. and in the Holocaust it was kind of. gradual for the Jews but. >> but at some point you were facing. something just horrific. and how do how do you come down from. that? How do you acclimate. um to that? And then people started.

realizing that they don't have to be. those kinds of events at all. They could. be um everyday events. um somebody who's. subject to interpersonal violence, um who's threatened, who's sexual. violence, um uh assault, crime, um. [clears throat] 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 nervous. >> Yeah. So the question is um what is the. reaction? >> Mhm. >> And how long should it last? [laughter]. 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. Um, 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, hm, something that should have.

happened maybe didn't happen. >> Yeah. >> Um, so that was the original impetus for. 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 you're just changed? And so even in 1980 when the diagnosis. of PTSD came out for the first time even.

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 um a hyperaroused body. you're. going to be um a very hypervigilant and.

on the lookout for danger because your. body has survived and now it is bracing. to have to survive again. you in your work, I think, revolutionized how many people. thought about stress and trauma. And, you know, we we'll we'll go through some. of the the discoveries that you made. because it's it's really it's really. important to see them as events and as. people and then as as things that go. beyond those events and those people and. and we'll get into that later on. But.

when we we think 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, etc. 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, buted 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 [clears throat] that present? >> Well, um, for the person that's living with it, the 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. Um, one of the earliest. debates in the field of psychology, what. launched the field of psychology was. really the question of do we feel um, fear and then our bodies have a fear.

response or do our bodies have a fear. response and we interpret that response. and say. >> fascinating to me. >> Oh, I I must be afraid, right? >> Yeah. >> And to this day, one could argue it both. ways. That was a very famous debate. Um. 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 um. the the threat detector, the amygdala, >> Yeah. >> um is hyper respponsive to reminders of. the trauma, right? [clears throat]. And cause let's say a fear response and. activate a fear reaction. So is that. similar to when like someone has been.

bitten by a dog and then when a dog. barks the is that is that the amydala. that's sort of like respsparking the dog. biting them? Is is it similar to. >> potentially? Yes, it is similar to that. That's a conditioned response. So, but. the question is, is somebody's amygdala. more active because they're afraid or. are there are they afraid still because. of what happened. >> and their 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 becomes less of a disorder. >> Right. >> Right. So, how you phrased it is really. important and I think we don't unpack. these things. We want to encourage. people to go um and seek help when. they've been traumatized or when they. have symptoms. Um but it isn't clear. whether we have we should be. conceptualizing it as. the problem of having symptoms still.

after trauma. Mhm. >> You shouldn't really. You should have. recovered. Or 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. [snorts]. >> 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. You can, you know, people are so complex. >> that um. >> we don't really know. But what seems to. be very important after trauma is to is. to find a place of no trauma is to find. a place where you really can say I'm.

safe now. I have um support. I have. people that care for me and love me and. I. I don't have to be my battle ready self. >> Yeah. um or the person that's afraid of being. attacked again. Um but then the question. is whether that's an internal process. that you tell yourself or how much does. the world have to um work with you to. convince you? >> How much responsibility does the world. bear, >> right? [sighs].

>> This is heavy stuff. [laughter]. >> You're right up our alley. You'll be. there in the morning when we're having. breakfast. [laughter]. >> I like to talk about this before. breakfast. Well, [gasps]. 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. >> Oh, that's fascinating. >> 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. And in our. research, we we have this checklist. When 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. 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. checklist. Um, a lot of people um 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 um. honestly it it makes sense when you. think about um people living at a time. when being children of uh genocide.

survivors where families disappeared and. were fractured. >> Yeah. So the idea of voluntarily. breaking up a family or going through. those motions or the nature was more. traumatizing for them. >> They said it. I mean not all of them but. a few people would tell me that the. breakup of relationships. >> um. was very difficult for them. So I. learned a lot from that. Trauma is in. the eye of the beholder. Um we can give.

suggestions about. >> what we think is more likely to elicit. >> fight or flight. >> Yeah. >> And um sustained. uh PTSD symptoms. And usually those are. big events where you could have died or. you could have gotten injured, school. shootings, the things that are. unfortunately very common. Um. but you have to also give people the. space to [clears throat] tell you what.

it is that is um very very difficult for. them. It could be something that. happened early in life where they felt a. tremendous rejection, bullying, you know, uh uh people being. thrown off their game or feeling that. they're lesser than. All of these things. can impact. And so really um our. research has been trying to. uh make sense of that. >> 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. Yeah. >> When you think about it, >> right? So if 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 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 spark that that makes. you feel proud of yourself or or. >> Exactly. >> or any of that. Yeah, you should you. could be a trauma researcher. That's. great. >> Oh, no, no, no, no. I I'll just ask the. trauma researcher questions, but I. >> Exactly right. I I it's so right what. you're saying and but we don't really. have conversations like that generally. speaking in the field. Um people are.

very um. quick sometimes to say, "Well, I don't. think that's a trauma.". >> Um. I don't think I I would ever say that. Um because. first of all, we were talking about this. before. It takes a long time for. somebody to really tell you what. happened. >> Yeah. >> 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. >> Yeah. >> That that's that's a story that just was. a 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. Um, but you know, trauma is. very uh 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.

>> um to talk about things and even if you. think you know let's 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. I also wonder. you know when when 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, um, one thought that. sprang to mind was a 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, how we met? >> What was that person's name?" And the. other person goes like this, "How could. you not remember their [laughter] name?". It's like, "What were they wearing? How. could you forget what they were. wearing?". >> And you know what I mean? We 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 if I think of it as like a 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. Cuz. 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 aortion that that that trauma. differently now one monkey can stay. behind traumatized on behalf of everyone. and that load gets borne. disproportionately. Is there is there. anything that you know is there anything. in your work that that 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 as a person. >> Oh, I don't think that I don't think. you're saying something ridiculous at. all. What what you're reminding us is. that trauma doesn't just happen to a. person. It happens in community and it.

affects community. Um what you're saying. though reminds me of a book that I read. called Memorial Candles. um I think it. was called that and it was a book by um. 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. what your comment, you know, reminded. me. So there's evidence for something. like that. But it also reminded me that.

how the community um relates to us um is. going to make a tremendous difference in. um how long our suffering lasts. And. that a lot, you know, we we tend to. think about trauma as a personal thing. that happens to an individual and then. they go get therapy with with somebody, >> but really um it affects the 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. um whether. >> um. >> 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 from there. >> 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 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. >> Yeah. [snorts] Um, and somehow people. needed to see that there were changes in.

the brain or changes in the hormones or. or that there were palpable changes in. biology that that this wasn't just in. their head somehow. >> Yeah. >> Um although again that distinction is. 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. >> Yeah. >> 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. >> wait, what what do you mean? Say more on. that. >> Like say for example, you're not coping. with stress at work. >> Then they send you away to a wellness. center maybe for 7 days. Then they will. start volunteering themselves in there. once a month. they go spend a week. >> Okay. So, they they've basically gone. through the program already and then. they'll go and they'll go back they want. to come back.

>> They feel this that's where they feel. like they regulate and they recalibrate. and they go back into the world. And the. funny thing cuz I'm a Yeah. Sorry. >> That's wonderful. I love that that a lot. of veterans do that when veterans that. um. >> they go through their healing process. and the first thing that they think to. themselves is I got to help other. veterans. I got to I got to. >> wow. I gotta help somebody else along. I. know kind of the the dance moves of of. how to go through this process and um.

I'm gonna help somebody else. And that. is that is a form of meaning making. That that's a that's that's a form of. taking your pain and making it. productive for someone else and kind of. giving you giving it some sort of a. purpose. Mhm. >> Um those kind of behaviors change the. brain too, which is what neuroscience is. learning. Um empathy, compassion, all. those all those things. Um because we. are biologic beings, so our states.

change, it's not that shocking, but. >> but the fact that people feel that. [clears throat] urge when they have um. 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 from traumas. >> 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.

ain't 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? >> 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. [sighs]. Um, so there's this intuitive connection.

like I get you, I know there's this that. I see you, I know. >> And um, 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. Um, and you know, that's part of. training to be a therapist really kind.

of. learning how to open yourself up. Um, trying to go through your life events, trying to make those connections, um, so that you can really relate to. somebody else who's struggling with. powerlessness, helplessness, all those. things. It's if you've never felt any of. those things yourself, right? um 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 but by the time you're. starting to work with trauma survivors, >> you're in touch with a lot of the things. um 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. >> H. >> I've seen that. >> Wow. Your your work deals um 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 has thrown off our ability to. actually understand what's going on. Mhm. >> You know, so cortisol, if I ask most. people, and I'll 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. >> Wow. 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. >> Well, we found that in combat. It was my. mentor that found it first, John Mason, Earl Giller. They found it first. I came as a postto.

from the stress field and didn't believe. it like these guys are stressed. Their. cortisol should be high. >> Yeah. So, my wise mentors told me I. should free to replicate it um to try to. replicate it, which I did. And then it. was I knew that it was a real finding. >> Their cortisol was low. >> Their cortisol was low if they had PTSD. Not everyone, but it was um more likely. to be so. And then, you know, that had. me scratching my head, too. Um but on.

the simplest level, if you take a step. back and ask yourself, what does. cortisol do? Mhm. >> It's actually not so it's not so uh. straightforward. Cortisol has a lot of. different functions. It's a very very. important hormone. You need it for. digestion and um mobilizing energy to. the body for cognition of reproduction, thinking um and and stress, right? But.

what does cortisol do in stress? So one. of So we talked a little bit about the. amydala before which is the threat. detector. When your body detects threat, it activates a fight orflight response. So there are a bunch of components to. that response. First you have an. orienting startle response. Get get everything together. >> Right? That's the initial shock moment. >> Initial shock moment. Then you um. 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 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. um, you know, strained your muscle when you. were running, right? >> Cuz you couldn't afford to at that. moment afford to at that time, but later.

you're going to feel it. So, cortisol is. involved in inflammation. It's involved. in all of these um really important um. 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. firemen. 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 in all the mud? [laughter].

>> You don't think of it at the time, please save my cat, you know, but then. you're you're looking at all the damage, right? >> So, you got to clean that up. And I. think that stress hormones help with. that. M. >> 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 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, >> but that's not the only reason. >> 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 a infection, you want to be able to. fight them off. [gasps] So, yes, it.

won't feel pleasant. It won't feel good. 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. >> Yeah. To carry the analogy, you could. think about an autoimmune disease, right? 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 the low cortisol. Um it really led. me away from cortisol, ironically, it. led me to the receptors and the. molecular aspects.

um 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 it was in as a group. people. >> certainly didn't have high cortisol. intended 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 act. >> Oh wow. >> 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 [laughter].

betray us and our bodies. >> do the best they can. And sometimes, you know, it's too much. So, what's. wrong in trauma isn't our bodies, it's 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 cuz we.

need to remember. >> um. you know 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 when PTSD was.

first diagnosed in 1980, the assumption. was that trauma was super rare, but. everyone would get PTSD. It just one of. those rare things. And then when. epidemiologic studies started to ask. people just regular people in the world, you know, have you ever been exposed to. a trauma? It was like, yeah, 70% of. people. And that's an underestimate. You. got to you got to you got to imagine. it's an underestimate. >> Yeah. Absolutely. >> So what what the field of trauma.

realized is, oh man, trauma is really. was really common, but PTSD. doesn't always happen. So that means. we're complicated. Um, and you know, we. we have many different kinds of ways of. responding. Um, but one of them is. certainly PTSD. We're going to continue this. conversation right after this short. break. This episode is brought to you by our. friends at Survey Monkey. You know, Eugene, I don't know if you've ever.

thought of starting a business, but. every time I think about people who. start businesses, I'm like, man, you. need a specific kind of bravery. And by. bravery, I mean terrifying uncertainty. Because think about it, right now, everywhere in the world, there are. people making massive lifealtering. decisions based entirely on a vibe, just. a feeling in their gut. >> That was me when joining the podcast. >> You know what I mean? >> But what if you actually knew the truth. when you started a business? What if you. knew your direct reports weren't just. nodding along, but actually had thoughts.

that they were too polite to tell you? >> Or what if you knew that your best. customers were already halfway out the. door to a competitor? Because let's face. it, we like to say follow your heart, but in business, ignorance is a very. expensive hobby. The good news, Eugene, is that Survey Monkey takes the fear out. of asking and the doubt out of deciding. It's the difference between walking into. a meeting with a hunch and walking in. with 500 validated opinions, which. mathematically is better for your blood. pressure. The truth might hurt for a. second, but it's cheaper than being.

wrong. So, let's get you a survey and. some actual answers. Sign up for an. annual plan at surveymonkey.com/wattnow. and use code whatnow for 2 months free. That's 2 months free with code whatnow. at surveymonkey.com/wattnow. You have any questions? Is it too late. for me to run a survey about who doesn't. like you in the podcast? What do you. mean who doesn't like you? Like like me? >> Like you? Yes. Specifically, the person. in front of me. >> I think surveys are supposed to be. anonymous so that people's feelings. don't get hurt.

>> But I did type anonymous there. >> Well, I mean now I'll know that you. typed it because do do you have a. problem with the working? >> I haven't sent it. >> But you want to make a survey about. >> I haven't sent it yet. >> You can just use the code what now to. get two months free when you do it. >> Still have two months to complain about. you. I feel like this got personal. [music]. when when we talk about the world. letting us down. I wonder if there's any.

um parts of your research that have. looked at whether we are equipped to. deal with the world that we've evolved. for ourselves because you know when. you're talking about trauma I I I I take. us back as humans to a time when. >> fewer things happened. >> Yeah. So, let's say that there let's say. there was a forest fire. Most times it. would be one forest fire and then it's. done and takes a few years maybe before. there's another one. An earthquake is. the same thing. Uh being attacked by a. lion doesn't really happen every day, etc., etc., etc. 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 going to come. into your world or into your mind or. into you get what I'm saying? >> Totally.

>> Like something can just get thrown at. you. And I' I'd love to know if if. that's, you know, part of your work. If. you look at how our environments can. retraumatize us or help us to heal in a. different way, >> I think we become desensitized. >> Yeah. >> Um, so I think we can get very very. upset about trauma, but but then when it. happens for the 200th time, >> Yeah. >> I mean, what was it like when we saw. that first school shooting? It was like, how can somebody shoot in a school?

>> Yeah. And now. I think people really. accept it as a fact of life. It's. horrible. It's tragic. >> People worry about it happening. >> Um. but you sort of adjust to a new baseline. of violence in society. Um, 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 it's just part you just. don't feel like you can escape it. You. you lose the context that it doesn't. have to be this way. that there's that. there is an alternative in a world where. there isn't this level of violence and. that used to be the case, >> right? >> Um 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. >> Yeah. Um, it could also make us feel. very traumatized and helpless, >> right? >> Um, 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. [gasps] Um, maybe I'm missing.

something, but I it's not something that. that I can tell you that it has built. our character or something like that. Um, but many of us have found ways to lead. meaningful lives and and try to do so. And what I found is that that usually. involves helping someone else. >> Um, that is traumatized or that needs to be. helped.

>> It'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, etc. only pushes us to one side of it. So, it's like either we're getting. completely desensitized or we're being. completely traumatized. >> Yeah. >> Well, those are two sides, >> 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 it's such. a it's such a complicated world. I can. see why you have to. >> Well, no. I mean, you could have that.

option. I mean, if people decided. >> that some traumas are in our control. >> and acted to try to um. 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 we live in the in we live. in a world that hasn't prioritized.

having less trauma, >> right? >> We just haven't prioritized it. Um, maybe it would be something to think. about doing. Yeah, there's there's. weapons for mass destruction, but not. many for mass reconstruction. Do you. know what I mean? >> And I often think, do you think that uh there was a time in. our lives where. trauma and violence became. commercialized? >> What do you mean by that? movies that.

were super violent um that show combat. as glamorous and doesn't show you what. after I've never seen a movie for. example that's a blockbuster that shows. what happens after in the wake of a. warlocker there no there are really good. ones the deer hunter I mean there. there's some really good um movies that. I think did make you stop and think. about the cost of war. >> um I don't know if they were. blockbusters or anything like that I saw. them [laughter]. >> I know I saw Yeah, platoon.

>> They won the Oscar, >> not the box office. >> Maybe. Um, >> again, some pe 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. >> Um, COVID 19 was also traumatizing for. many people. >> Um, there are lots of ways to be. traumatized.

So. yeah, >> let's 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. um 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 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. um you know the the the readings or the. findings like can you can you walk us. through that cuz I was so 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 the correct verbiage. >> their their mother's trauma but they. weren't there for that event. Well, I mean I I wouldn't frame it as. that they internalized their mother's. trauma. They had low cortisol. Um. >> so you found that common thread. Yeah. >> 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 um. stressed during pregnancy. that may be able to quote be transmitted. to their um fetus and maybe live on. But. I'm not the one that found that. That.

was a finding that was already quite in. existence um beginning um with the Dutch. hungers in um World War II. >> when the Nazis um surrounded uh the. Netherlands and for like this 9-month. period there was no. >> the restricted food restricted food and. they did very large studies. >> of the effects of that starvation on the. population including in pregnant women. >> and their children and yeah so don't.

give me that don't give me that credit. they um [laughter]. >> they found that um there could be. enormous effects in the offspring who. were born subsequently afterwards and. this spawn um a 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 um.

it started to raise the question of. [snorts] how do you program the stress. response. >> um 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 um the. mother can affect the fetus through the. placenta right. >> so um one of the things that. So that so.

we were kind of mesmerized by the. trimester effect. But all that meant was. that the um exposure to maternal. gluccocortico cortisol maternal cortisol. um 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 um the activity of. that enzyme kind of reduces by the third. trimester because by the third trimester. you're the offspring is preparing to. breathe on their own and they need. maternal cortisol so that their lungs. could mature. This is again cortisol is. not all bad. Nothing is nothing in our. body is all bad. It's just. >> different times, different uses,

different. >> things. So um that is why we probably. had a trimester effect because there. were different stress effects. in the third trimester. But what that. but the reason that finding really. resonated with me was because just a few. years earlier we had published a a paper. showing lower cortisol levels in the. adult children of Holocaust survivors. um 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, >> right? >> 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 um in pregnancy. >> You know what this makes me think of? because we're from South Africa and. obviously we've there's a generation.

called the born freeze the ones that. were born after 1994 after general. elections that were inclusive happened. >> after a partite 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. 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 um. 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? >> Yeah. So what what made me notice this. had nothing to do with biology. I first. noticed behavior. >> uh because adult children of Holocaust. survivors were telling me they were. affected uh by their parents' trauma.

that they had Holocaust related imagery. that they had trouble in relationships. that they um uh had depression and. anxiety. um 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. >> let me look at the hormones. But. cortisol [snorts] 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 um child. Before you go. into that, help us understand what. epigenetics is and and why it's. important. What what is that field of. study actually looking at? >> The field of epigenetics is just the. study of how genes are regulated by. chemical marks that we. are born with that we um can develop.

from the environment. And basically. think about an iPhone that has the. capacity to keep updating its own self. Um, 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 like learn lessons and internalize. information. Um, 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. Um, not all of these were negative. changes. some of them actually were.

adaptive or 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. Um, it's an animal study. that was done that I think I love this. study. Um, 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. [laughter]. But um there was in Brian Diaz and.

Carrie Wrestler. They took um male pups. They fear conditioned them. They exposed. them to the scent of cherry blossom um. 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. Okay. >> So that was associated with epigenetic. changes in brain and sperm. Now, when. those rats were bred with nonstressed. females, the um offspring of those 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. >> Yeah. [sighs]. 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. >> Oh. >> to be afraid. If it took, let's say, 10. for their dad to figure this out. >> Wow. >> They're figuring it out. >> It almost was like a dormant. >> It was like this. It's a preconditioning. in case you encounter this. >> Wow. I'm encoding some information. Um, and. the genes that were um that had the. epigenetic marks had to do with smell. So, um, 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, um, eggs can be another way. uh when sperm. and egg join um 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 it really resonates. the idea isn't that you inherit trauma. you don't inherit trauma you don't. inherit a traumatic memory Mhm. >> You inherit kind of um a bias, a signal. >> Um. and that is. I'm excited cuz. >> cuz you like it. >> Yes. >> Yes. It it it makes sense. >> Go ahead. Sorry. Sorry. I couldn't. contain my excitement. >> No, I I was excited, too. I wish that um.

human work as we call what we do um. could be as clear-cut. It isn't. Um but. we're right there. You know when a Trump. we try to 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. >> but we're seeing the overlap. 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 so 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. [laughter]. >> Keep going. >> Yeah. >> 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's that is awful that terrible. things happen. The fact that we can.

learn from them is magnificent. >> So how much do we have to then think of. trauma or the inherited. elements of the epigenetics? How do 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? >> Yeah. Just just never think about good. or bad because biology isn't about good.

or bad. >> Yeah. It just is [clears throat] or is. >> it's about adaptation and trying to. match what you need with what you got. >> It's could be very difficult. I mean, in. the Holocaust survivors, they developed. um 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 di type two.

diabetes or hypertension, right? Because. now your body doesn't. >> because now your body is wired for. something that was needed in a prior. generation. But biology doesn't know. whether you're whether. >> the offspring's going to be in the in. the same situation as the parent, right? And if not, maybe a a different kind of. adaptation can be made going forward. So. I 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, [laughter]. >> right? >> But that can be tough, too. >> We're going through that in South. Africa. >> Wait, wait, wait. In what way? Say more. on that. Well, I mean, sometimes um it's. not a matter of the fact that your your.

ancestors were victimized. Sometimes. they were the aggressors. And what do. you do with that? So, you know, the. >> as in like that might be passed down or. or the effects of it are passed down or. they. >> if we're saying that if we're saying. that experience. calibrates and and and. some of those lessons are carried. forward. Yeah. >> Then that's all experience. It can be it. can be very traumatic for people. Um.

look, it was a generation ago, but when. I first stud started doing my my um. work, one of the first people that. replicated our low cortisol findings was. in Germany. And I was I was invited to go to. Germany. And you know, I went and the. first thing that everyone was trying to. tell me in that 30 years ago [gasps]. was how difficult it was to be German.

and have this legacy of. of what Germany did, >> right? Of what the Nazis did. >> 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 of with it. And. when we see ourselves kind of hyper. respponding or having reactions that we. don't understand,

>> um we shouldn't just count or ignore. those reactions. We should try to say, I. wonder where that's coming from. I. wonder what is making me so hyper. sensitive to this. Um you know, some. people are very hyper sensitive to. bullying. >> Yeah. >> Um some people are very um they don't. care, right? Yeah, >> that comes from somewhere where. >> I feel 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. >> We're biased. >> We're biased. >> That's not predisposed. >> We're biased. >> We're biased. >> Yeah. The way we see it and and the way. we behave. >> But we can change it. >> 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 offiscate 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. >> Yeah. And I don't have all the answers.

Um I. >> I don't have all the answers, but I know. that trauma is bigger than just one. event to one person. >> Yeah. And I think that's really the only. thing I know for sure. And knowing that. though. should give us some marching orders. >> Um in terms of figuring out how we want. to live our lives, how we want to set up. our societies. Yeah. >> Don't press anything. We've got more.

what now after this. >> [music]. >> 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 but you also really make an effort. to point out that we shouldn't limit it. to those massive events. And we 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 a 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 and the. body? My guess would be that it's that it is.

the same or similar, but it's harder to. study because. the reason that I like to study like. homogeneous groups even in within a. homogeneous group, there's a ton of. heterogeneity. >> Yeah. >> 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 body the biology is. [laughter] busy. >> with what it has to do today. And if. people are I mean things like body. weight um 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 the ways in which. the 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. um 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. um. you are pretty sure that um. people will blame you or 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. Yes. um which can also. compound the effects. So. >> yeah, you ne you never think of it being. community. Yeah, I know. Which I know is. like it's a crazy but I but I've read. stories about how um 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 there's a different there's a. we survived the plane crash or we were. in a plane crash versus I was was in a. plane crash. It it makes it makes me. then wonder. what would what would treatment be like. if we if we thought of these things as. having happened right after the time. like I I've seen in some of your work.

you talk about um cortisol and I think. it was um hydrocortisone that you were. looking at. This this 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. >> It's an example of a theory that really. should work um theoretically and then in. practices [laughter] is good science, you know, doesn't work as well comedy. >> Yeah, you're not wrong. But the idea was. that if cortisol is important in helping. to damp down the adrenaline. um 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. >> Okay. >> Um I don't know the results. We did a. pilot study and there was a small signal. but it wasn't like a oh my god. Um we're. just wrapping up a study that um we've. been in that's been in the works since. CO started which was a great time to. start this right. >> not but um but um I'll let you know I. think that these are very hard studies. to do um to follow people from the.

emergency room and then kind of treat. them in a double blind placeboc. controlled way. >> and also since the time that I thought. that was a good idea. Um I really. changed my mind a lot about um whether. we should be doing interventions. acutely. Um, I think that there I think the kind of. interventions that we need.

>> are what help people naturally. um bring down their sympathetic nervous. system arousal by hugging them, by by. holding them in community, um by showing. them that we care about them, not by. giving them cortisol, >> right? Um 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 um 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 um I think that's. a 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 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, um, you know, my views have really. shifted. I started out kind of very. neuroscience, kind 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 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 um [sighs and gasps]. to live in a certain way um following. their trauma. So, it just gives me pause, you know, I'm.

aed by the complexity of it. I'm not um. it doesn't make me want to not do it. anymore like it's too big a gordion not. to untie but it it should make us really. cautious about being overly simplistic. about any of it. >> 100%. >> and and through it all just. [clears throat] this idea that we are. resilient. >> right let's talk let's talk a little bit. about the psychedelics. you know um over the I would say like. the last sort of twoish years of of.

Biden's presidency there was a lot of. talk around veterans being um prescribed. MDMA therapy and we've seen it growing. around the country, around the world. We've seen um 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. roach pattern. Right. now, maybe I'm I'm completely obtuse and. I I don't know everything about it cuz 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 dut.".

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. insight 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.

>> um I've been um a little surprised by. the lack of reception to psychedelic. therapies. It's not like we have great. solutions right now. Yeah. >> Um 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, um. these um cognitive behavioral therapies. don't do the job for them more often. than not. Um why? Because it's too. 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 uh. history. There's also the issue of maybe.

moral injury. Yeah. >> Um that is very different than uh being. a rape victim. These treatments were. mostly um developed for interpersonal. violence where they work pretty well. But when you have something more. complicated, um 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, >> um you you suspend this like terrible. self- judgment that you carry around.

usually with yourself. >> You know, it's a party drug for a. reason. It it helps with social bonding. So that works in the therapy room with. your therapists. Um you kind of form a. better uh 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." Um, doesn't mean that it's fun. and easy, cuz it is not.

But. if you um 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. It's the psychotherapy is not the way.

that that is a different kind of model. that people will kind of need to learn. Um it's unstructured. which adds a layer of discomfort. People. want to have a structure about how. they're approaching therapy. >> Mhm. >> Um and. >> and is it is it unstructured because you. don't know what the person's going to. experience or Okay. >> Yeah. You're you're you're getting on. their bus. >> Oh yeah. [laughter] You're not you're. not guiding them. They're sort of. guiding you. Yeah.

>> Right. I mean, in in cognitive. behavioral therapy, we decide in advance. what trauma we're going to pro 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. We're going to I'm going to. give you tools to reduce your distress. You know, things like that. Very. structured. >> Yeah. >> Um but this is different. This is like, well, let's see where we go. which a lot. of people um are nervous about because. of the potential that it can um 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 it's 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 um and you know h how to really. make it accessible and how to change. systems so that it can it can happen how. [clears throat] do you integrate it now.

into curricula for people who are. training to be psychiatrists. psychologists and social workers so I. think. the the conversations about oh it used. to be illegal yeah But th those aren't. the kind of things people are really. talking about when they're trying to. figure out how practical. >> Okay, got it. >> How practical it is to do this. Um it's, you know, 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. Oh, and so that's what you mean by labor. intensive is the person takes it, but. now they need extended periods of. supervision. >> Now, now they need to have therapy. Now, now we have to talk about what happened. So, we could talk about it during the. session. That's eight hours with two. therapists. >> Wow. >> 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 can um if I don't have, you. know, a hundred people that need. something. And so really, it's a. question of how we're going to do this. Now, on the on the plus side, once you. have a tremendously good outcome, maybe. your case load will be more like a. revolving door. >> than the same people that are coming to.

therapy all the time. So, you know, I I. think this is a really promising. development. It it does all the things. that I think are important. You don't need to spec talk about your. trauma in advance. You might not even. know what it is. >> Yeah. [snorts]. >> Um it allows you to sort of access. things in parallel, not just serially. >> Um a lot of it isn't verbal. 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 every we can't. put words into everything we feel or. have experienced. Um, 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. Um, I had to do the things that I had to do,

but that does not make me a bad person. I can I can do lots more things now. Um, I can take off my armor. I don't have to. be so um defended. Um, I don't have to. let people take advantage of me. Um, you. know, all these things that could take. maybe years in regular psychotherapy to. really internalize. You could say them. cognitively, >> right? >> But. >> but feeling it, >> feeling it and saying it and knowing it.

>> is really where I think the psychedelic. is just that superpower. >> Yeah. >> 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 [laughter]. did that. Um, neither are any of these. things that turn out. Neither was a. computer that we all wear on our watches. now or in our phones. All of these. things didn't started out to be very. daunting, but once. people see the benefits of it, then we.

find ways. I I I think that's what we're. actually good at as humans. We're good. at taking the impossible and making it. scalable. >> Yeah. >> Um but we can't put so many barriers up. right now. >> Um. again, the studies were criticized. there was. they they they you know they were hard. on those studies. Um but but we're we're.

talking about a schedule one 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. Um there are no barriers. that I see once we develop. um ways of training people, once we. start doing more research where we. figure out the kinds of therapies that. might support this. Um 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 um 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. 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 awaska. >> Oh wow. >> 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. It's very. hard to explain. >> and the amount of healing and what 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. then 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 and but this one here it's a vacation. >> that's that's an extraordinary story. Um, now imagine if you were able to just. really talk about it a lot in therapy. Um, and imagine if there were a lot of. difficulties that you were able to. really process all the things cuz you. remember them. >> vividly. Vividly and you know, imagine. the wonderful opportunity to really. say, I wonder what that meant. Maybe it was.

some a voice that came and talked to. you. Maybe it was an ancestor. Maybe it. was a a realization or a vision. >> Yeah. >> So the question is, is that a luxury or. is that a necessity? >> Yeah. >> And I think that's kind of the debate. that the field is having right now. Um. can we bring this in a group like Iaska. to a bunch of people and and and really. heal in community? Um. again, it's not what mental health is.

like today. >> Yeah. Yeah. So how quickly can we change. how we look at things? Um I mean right. now we're living in a world where things. change rapidly. So. >> maybe. maybe we can change rapidly. I don't. know. But that's kind of the task I. 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 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, "Hey," she said, which translated means, "Damn, white.

people, they're really suffering." And. then I went, "Hm, I mean, okay, can you can you explain more?" And she. and I said, "But there's this black. homeless people as well." And she said. something that really stuck with me and. your your work made me it it triggered. something um 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.". >> Oh, and. >> beautiful. >> 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'd 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 do you see. that in your work? >> 100%. That's the major lesson here that. I mean that that's a beautiful story. >> and it reminds me of a story that my. mother also tells me about how her.

father um who had a grocery store used. to give not only to people that needed. but to wealthy people um who used to be. wealthy but maybe someone had died in. the family and he just suspected. >> oh wow. >> that um. >> 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? >> Yeah. They used to be wealthy.

>> Yeah. Well, they're not other people. And he would say, "Yeah, but it's much. harder when you used to have. everything." Um, and now you don't when. you've always. >> when you've always had, >> you've always had less. And that's the. same thing that your mother was saying. We we know we know how to be resilient. We know how to 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, >> right? >> Um and so, you know, how do we how do we get that. going? Um this is a world where it feels. very polarized. It feels it feels like. we can. have empathy for our own. >> Yeah. >> Um 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 is meaning. making and resilience and it it really. then takes the lessons of trauma and and. just maneuvers them in a completely. different way. >> 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 a people have. experienced and we can and sort of our. jobs to ourselves. Our responsibility to. 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 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 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 [music] out things that. might change your mind. So Dr. Yehuda, thank you so much for joining us today. >> Yeah, thanks for having me. Thank you. for having me. >> Thank you so much for watching the. episode. If you enjoyed it, pass it on. to a friend. If you didn't enjoy it, pass it on to your friend still. let. them suffer for a change. And [music]. don't forget to engage with us in the. comments. Uh if you want to suggest a. guest, maybe there's questions you want,

maybe [music] there's ideas that you. have, you can chat to us. We will read. through the comments and we'll get into. it. Either way, I appreciate you taking. the time. Thank you for hanging [music]. out with us on What Now. And remember, we do this for you, so we would like to. hear from you. [music] Till next time. Thank you.