Speaker 1: I'm bartun Day Thurston and this is Spit and I
Speaker 1: Heart Radio podcast with twenty three and me. This is
Speaker 1: the podcast that explores how DNA is changing our lives
Speaker 1: and the world around us. In today's episode, we're going
Speaker 1: deep on mental health. We want to know why is
Speaker 1: it so hard for us to talk about mental illness
Speaker 1: as a society and how do we move beyond this
Speaker 1: stigma and began addressing mental health treatment in the same
Speaker 1: way we talk about any other medical condition. Three D
Speaker 1: Thirty two million people around the world are living with depression.
Speaker 1: That's just about the entire population of the United States.
Speaker 1: And here in our country, eight percent of us some
Speaker 1: forty million people suffer from anxiety disorders, the leading cause
Speaker 1: of disability in terms of years lost to disease. One
Speaker 1: and four of us will suffer some type of mental
Speaker 1: illness in our lifetime, yet only two thirds will seek treatment.
Speaker 1: Why is that? With suicide rates climbing to the tenth
Speaker 1: leading cause of death in the US and the second
Speaker 1: leading cause of death among young adults, we need to
Speaker 1: be having more conversations to help remove the stigma surrounding
Speaker 1: mental health. Mental health is just health, though we may
Speaker 1: not show it on the outside. Just about everyone is
Speaker 1: fighting some sort of battle on the inside. Truth be told,
Speaker 1: I've had my own challenges with mental health. I've even
Speaker 1: helped to bury a close friend who from the outside
Speaker 1: no one would ever have expected to take his own life. Today,
Speaker 1: we're discussing this very important issue with the trio of
Speaker 1: folks who are working every day to combat the stigma
Speaker 1: and discrimination associated with mental illness, and who are using
Speaker 1: their platforms to drive a deeper understanding, some through science
Speaker 1: and research, and some through stories, advocacy, and the healing
Speaker 1: power of music. In Part one of this episode, we
Speaker 1: have a deep and moving conversation with musician, songwriter and
Speaker 1: mental health advocate Mike Shinodah alongside Dr Gail Salt, clinical
Speaker 1: Associate Professor of Psychiatry at the New York Presbyterian Hospital,
Speaker 1: Wild Cornell Medical College and the psychoanalyst with the New
Speaker 1: York Psychoanalytic Institute. I've been learning about it as things
Speaker 1: go along, but what I do know from my own
Speaker 1: personal experience watching my friend is that it was always
Speaker 1: a roller coaster, like you just wouldn't know he'd come in,
Speaker 1: and you wouldn't know if today was a good day
Speaker 1: or our bad day. Genetics do play a role. And
Speaker 1: the reason we know that is that studies that have
Speaker 1: looked at, for example, identical twins or first degree relative
Speaker 1: show there's a much higher incidence of anxiety disorders. And
Speaker 1: actually it's interesting even the specific anxiety disorder like panic
Speaker 1: disorder or phobias. After this conversation, we decided to go
Speaker 1: deeper deeper into the brain, deeper into the research, and
Speaker 1: deeper into the future in terms of advancements and treatment.
Speaker 1: So after Mike and Gale's conversation, stay tuned for part
Speaker 1: two with Dr Ahmad Harreri, a professor of psychology and
Speaker 1: neuroscience at Duke University, who tells us the role of
Speaker 1: jeans play and who's channeling learnings from his lady research
Speaker 1: to help provide more treatment to more people. When we
Speaker 1: have those large numbers of individuals in these studies, I
Speaker 1: think what we're going to find is that there is
Speaker 1: variation all over the genome, across hundreds of genes, if
Speaker 1: not thousands of genes that collectively work together in ways
Speaker 1: that are going to be even more complex to shape
Speaker 1: the kind of what we strive for an understanding an
Speaker 1: individual's kind of genetic risk or familial risk for mental illness.
Speaker 1: I've got to say this is a truly revelatory episode
Speaker 1: and I am so excited for us to go on
Speaker 1: this journey together. We begin in Charlotte, North Carolina, backstage
Speaker 1: with Mike and Gail as his crew prepares for that
Speaker 1: evening show. Mike, Gail, welcome. Thank you both for being here.
Speaker 1: Um and I just want to acknowledge that we have
Speaker 1: sounds going on in the background because we are back age.
Speaker 1: Mike is about to do a big show and we've
Speaker 1: got crews dragging things. Phones are ringing. Rock music is
Speaker 1: about to happen. Rap music is about to happen, Real
Speaker 1: music about to happen. So thank you Mike for letting us.
Speaker 1: Thank you, and thanks to your patients with the noise. So,
Speaker 1: Dr Saws, I'd like to start with some of the
Speaker 1: science and start with you, as the degree holder in
Speaker 1: these matters. What are anxiety disorders within this class of
Speaker 1: mental illness and what's happening in our brains when we
Speaker 1: talk about this. So anxiety disorders are basically our brain
Speaker 1: using the normal danger alarm system that we all have.
Speaker 1: So if you see a bear, I'm definitely alarmed. Your alarmed.
Speaker 1: And what happens in your in your mind and your
Speaker 1: brain is it registers that it says, I have to
Speaker 1: turn on my sympathetic nervous system, I have to release
Speaker 1: certain neurotransmitters, and those ner transmitters are going to enable
Speaker 1: me to either flee or fight. Right the flight or
Speaker 1: fight response and normal fighting a bear just normal response.
Speaker 1: So I think fleas a good choice. But people who
Speaker 1: have anxiety disorders have an overreactive amygdala and hippocampus, those
Speaker 1: of the areas that process fear. And because it's over active,
Speaker 1: lots of things that are either just in their mind
Speaker 1: and actually not even real, or things that are real
Speaker 1: but wouldn't make other people anxious signal that same alarm
Speaker 1: to them. And it's happening much of the day, every
Speaker 1: day for an extended period of time. So they get
Speaker 1: both the psychological thought of how can I flee or
Speaker 1: fight or do something in this situation, the worry that
Speaker 1: comes with that all the time, what if this happens,
Speaker 1: what if that happens, and the physiological response. So some people,
Speaker 1: for example, a panic which is a kind of anxiety disorder,
Speaker 1: have the shortness of breath, the tingly feeling in their body,
Speaker 1: the rapid heartbeat as though they have to hurry up
Speaker 1: and flee or fight. And when you have that for
Speaker 1: an extended period of time, it compromises your ability need
Speaker 1: to function at work. You can't concentrate, right, You're kind
Speaker 1: of miserable all the time, and it affects your ability
Speaker 1: to have relationships. And when you've reached that point that
Speaker 1: it's affection your functioning, you have an anxiety disorder. So
Speaker 1: anxiety normal, sometimes even useful, helpful. Right, Hopefully we're all
Speaker 1: a little anxious right now because that makes us perform better.
Speaker 1: There's a sweet spot beyond which it compromises your belity
Speaker 1: to function. Now you have a disorder. That was the
Speaker 1: clearest explanation of anything I've ever heard. Thank you, I'm serious, dope.
Speaker 1: We've talked in this series so much about genetics, and
Speaker 1: I'm curious to what degree do our genes play a
Speaker 1: role in our likelihood of experiencing anxiety disorders? Is there
Speaker 1: an anxiety gene or or a depression gene. So the
Speaker 1: answer is genetics do play a role. And the reason
Speaker 1: we know that is that studies that have looked at
Speaker 1: for example, identical twins or first degree relative show there's
Speaker 1: a much higher incidence of anxiety disorders. And actually it's
Speaker 1: interesting even the specific anxiety disorder like panic disorder or phobias,
Speaker 1: like if I had a phobia to a dog, it
Speaker 1: would be much more likely that my children would also
Speaker 1: phobias specifically to a dog. So there depression runs in families,
Speaker 1: anxiety disorders running families, Bipolar disorder runs in families. But
Speaker 1: there is not a gene. In other words, it's not
Speaker 1: passed on in an autosomal dominant way like I have
Speaker 1: the gene, now you have the gene. You get it.
Speaker 1: It's we don't know it's it's some sort of complicated
Speaker 1: combination probably of genes and environmental factors. So what's important
Speaker 1: to understand is that when you are born with a
Speaker 1: set of genes, those don't stay your set of genes.
Speaker 1: Environmental issues turn your genes on and off as we age,
Speaker 1: and so what's happening to you could turn off a
Speaker 1: gene like say you do some things to try to
Speaker 1: treat yourself early on to essentially avoid developing one of
Speaker 1: these issues, because you know that this is something that
Speaker 1: you're predisposed to that could help you not have it. Possibly. Ever,
Speaker 1: on the other hand, let's say you're predisposed and you
Speaker 1: have difficult things happen, traumatic events that might not even
Speaker 1: be in your control that might queue you up to
Speaker 1: be more likely to have it. So it's not at
Speaker 1: all or nothing thing. It's complicated, but it is valuable
Speaker 1: to know if these issues run in your family. You
Speaker 1: are making me think of the two people you're talking
Speaker 1: to in terms of the environments that we're in. We've
Speaker 1: got a musician Mike myself, I've done a lot of
Speaker 1: comedy over the years. Are we putting ourselves in an
Speaker 1: environment that's going to activate those those genes more likely
Speaker 1: than not? Or do the arts help you process and
Speaker 1: work through some of those Well, what's fascinating actually about
Speaker 1: the arts, um and this is this is actually related
Speaker 1: to the most recent book that I just did called
Speaker 1: The Power of Different The Link between Disorder and Genius.
Speaker 1: It is the neuroscience behind the fact that people who
Speaker 1: are highly creative like the two of you, and particularly
Speaker 1: successful in it in the word not just creative internally,
Speaker 1: but productive with their creativity, that potential and the use
Speaker 1: of that potential is hardwired to the very things that often,
Speaker 1: unfortunately make one suffer from a mental health issue. So
Speaker 1: we know it's not that you can't be let's say,
Speaker 1: a person who has none of these issues and be creative,
Speaker 1: but we know you're you're lucked out. You lucked out, Okay,
Speaker 1: But we actually do know that people who are particularly creative,
Speaker 1: you know, on the higher end of that spectrum, are
Speaker 1: far more likely to have some of these particular mental
Speaker 1: health issues, and that their part and parcel treat you
Speaker 1: still should treat them, because treating them doesn't take away
Speaker 1: the potential, but you should be looking for your potential,
Speaker 1: and so there is this intense connection and living out
Speaker 1: your creativity actually is useful. It's often therapeutic. One may
Speaker 1: express things that one is having as an internal struggle
Speaker 1: and find it very therapeutic. So it's not dramatic. The
Speaker 1: trauma or the difficulties tend to be earlier in life.
Speaker 1: Things that you know, your parents divorced, um, you had
Speaker 1: a particular loss, you weren't taught, you were helicoptered so much,
Speaker 1: you didn't learn any coping skills, any resilience. Your parents
Speaker 1: never let you fall down or fail in anyway. So
Speaker 1: then when you're faced that you're older, you have a
Speaker 1: more difficult time when bertle you start using substances. That's
Speaker 1: also a risk factor for developing some of these things.
Speaker 1: So there are many things along the way that could
Speaker 1: make it more likely. But being in a field where
Speaker 1: you can produce and be productive, generally speaking, no, unless
Speaker 1: the field where everybody around you is using and abusing substances,
Speaker 1: that can make it more difficult. So for me, just
Speaker 1: to give a little background for listeners who may not
Speaker 1: be as familiar, I grew up drawing and painting. I
Speaker 1: grew up making music. I was doing classical piano for
Speaker 1: ten years when I was I don't know, I probably
Speaker 1: started when I was like three or four, but I
Speaker 1: always thought I was going to be a painter. That
Speaker 1: was my really what my focus was. And then music
Speaker 1: was a hobby and I went to school for visual
Speaker 1: arts at Art Center College Design in Pasadena. I was
Speaker 1: looking to get into illustration or like I wanted to paint,
Speaker 1: to do album covers. I wanted to do movie posters,
Speaker 1: maybe even get into um animation or or video game
Speaker 1: art um and then the music took off chester my
Speaker 1: like we were like the two singers of the band.
Speaker 1: We were the dual focus of the band. I started
Speaker 1: the band, and once we found him, it was like
Speaker 1: he was like the missing piece. And we didn't know
Speaker 1: each other very well in the beginning, but as we
Speaker 1: got to know one another, it was like this inseparable thing,
Speaker 1: and he was very I came from a very like
Speaker 1: secure kind of family system, a very you know, my
Speaker 1: parents are still married. Uh. They took great care of us,
Speaker 1: and I feel like I had a good upbringing and
Speaker 1: Chester kind of had a very dysfunctional home system that
Speaker 1: he grew up in. And one of the things that
Speaker 1: made are not only our our friendship really strong, but
Speaker 1: also are you know it played into the music was
Speaker 1: the fact that it was peanut butter and jelly, Like
Speaker 1: we were so different and we I had a way of,
Speaker 1: as he would describe it, like saying that like writing
Speaker 1: the things that were on his mind. I would come
Speaker 1: to him with songs and lyric ideas and things, and
Speaker 1: he would help me understand where I was getting it,
Speaker 1: where I was like hitting the bull's eye, and where
Speaker 1: he felt like something was not quite right. You know
Speaker 1: what's so cool about that is actually, in the most
Speaker 1: creative people, it is a combination of what I would
Speaker 1: call like a messy brain and an organized brain. But
Speaker 1: like this yin and yang of you have to have
Speaker 1: both in order to produce something. So like, if your
Speaker 1: brain is messy, it has a space for innovation and
Speaker 1: the production of like whatever he was saying telling you about,
Speaker 1: but then it has to have some organization to take
Speaker 1: that and bring it to fruition, right, and so peanut butter.
Speaker 1: And there's also another lane that we would look at things,
Speaker 1: which was, you know, your political brain and your creative brain.
Speaker 1: He was much more on the creative side. He had
Speaker 1: trouble organizing things. I was even with both, and that
Speaker 1: was actually unusual. Even when I was in art school,
Speaker 1: I'd have most of that. I mean, you know, if
Speaker 1: you've ever been to an art school that only does
Speaker 1: you know design school for example, like cal Arts or
Speaker 1: Otis or Risdi or Art Center, but you find that
Speaker 1: the school population is introverted. People are very creative, but
Speaker 1: not very organized. And I was, you know, it was
Speaker 1: one of those rare situations where I'm kind of a
Speaker 1: little more outgoing and organized, so that you know, in
Speaker 1: terms of our relationship, that's kind of like how it
Speaker 1: worked in a sense Chester died by suicide about almost
Speaker 1: a year and a half ago. Some people ask me,
Speaker 1: you know, the obvious things like well, what happened? Did
Speaker 1: you know where their signs? All of these things right?
Speaker 1: And the answer is, really, of course there were. Of course,
Speaker 1: he was the same guy. In essence, he was always
Speaker 1: the same guy. It Without those things, I don't think
Speaker 1: we would have made the music that we made. It
Speaker 1: was the type of music that I've always been drawn to,
Speaker 1: the type of lyrics that I've always been drawn to,
Speaker 1: but I didn't live it the way he lived it.
Speaker 1: And when we put all those things together, that's kind
Speaker 1: of how the DNA of the band was formed, and
Speaker 1: that's the reason the music sound of the way it
Speaker 1: does now. Truth be told some of the lyrics that
Speaker 1: they point to, and they said, oh, he was calling
Speaker 1: out for help, Like I wrote a hundred percent of
Speaker 1: some of those songs so lyrically, so I was writing
Speaker 1: them to be sung by him because I knew they
Speaker 1: were true for him. But the assumption was like, we
Speaker 1: don't know, you know, The assumpting that it it was all
Speaker 1: coming from him and stuff made things very confusing for
Speaker 1: other people. I've also been thrust into this club that
Speaker 1: I never wanted to be a part of, and in
Speaker 1: doing so, these conversations like the one we're having today
Speaker 1: have been happening. And so for me understanding this, you know,
Speaker 1: I don't have any academic background in this stuff. I've
Speaker 1: been learning about it as things go along. But what
Speaker 1: I do know from my own personal experience it's watching
Speaker 1: my friend, is that it was always a roller coaster,
Speaker 1: Like you just wouldn't know. He'd come in and you
Speaker 1: wouldn't know if today was a good day or a
Speaker 1: bad day. And it could be bad could mean very
Speaker 1: depressed and everything was down and enterings negative, or he
Speaker 1: could be just very angry, or he could actually be
Speaker 1: just like kind of unhinged and like he could be manic.
Speaker 1: Basically it could be like, Okay, he's seemingly in a
Speaker 1: good mood, but like, I don't know where this could go,
Speaker 1: Like he's there's a chicken and an egg scenario with
Speaker 1: him and drug use in which he had talked about
Speaker 1: a time. All that said, you know the things you
Speaker 1: were just talking about in terms of triggers of things, um,
Speaker 1: how they manifest, how they come out over time, and
Speaker 1: like what people can do to fight them. That's not
Speaker 1: only something that I've been intimately familiar with, watching and
Speaker 1: trying to help my friend for years and years and years,
Speaker 1: but now in you know, in this year, we've seen
Speaker 1: a lot of other artists pass away from both suicide
Speaker 1: and drug use. A lot of drug use, a lot
Speaker 1: of artists, a lot of managers, a lot of touring entities.
Speaker 1: People in the industry are really starting to ask themselves
Speaker 1: and one another, is there more we can do? And
Speaker 1: if so, how It's a good question. First of all,
Speaker 1: once you layer drugs or substances of any sort on
Speaker 1: top of another psychiatric issue, the rate of suicide goes
Speaker 1: way up. The ability to treat the underlying issue goes
Speaker 1: way down. Um, so that really is always the first
Speaker 1: order of business. That's why it's always sort of like
Speaker 1: go to rehab and you have to get because the
Speaker 1: frontal lobe of the brain is altered by substance use
Speaker 1: such that the part that's used for learning is really impaired,
Speaker 1: and so the learning that you would do for treatment
Speaker 1: isn't possible. You can't see the mistakes you might be
Speaker 1: making and correct or learn from them exactly kind of
Speaker 1: you're inhibiting yourself and it also impacts their confidence in
Speaker 1: a large way. I heard this Ted talk from almost
Speaker 1: ten years ago talking about how people now think of
Speaker 1: someone who creates something great as a genius. They go, oh,
Speaker 1: that person made something so great is there? But back
Speaker 1: in ancient I think it was ancient Greece and Rome,
Speaker 1: they actually thought the person was a vessel and the
Speaker 1: genius came from the gods. So it was either the
Speaker 1: gods gave you the idea and lucky you you were
Speaker 1: the person that God cares it out, and if you
Speaker 1: didn't perform the thing, if you didn't you know, make
Speaker 1: the art or whatever, then the genius would move on
Speaker 1: and show it to somebody else. And what I thought
Speaker 1: was cool, I mean, which she pointed out, and I
Speaker 1: thought was cool about that? That That maybe applies now? Is
Speaker 1: that somebody, I mean, let's just bring it right to
Speaker 1: current times, somebody like Kanye West, who clearly many people
Speaker 1: go he's creatively like, what a genius, but also personally
Speaker 1: falling apart and the guy is unhinged at all times.
Speaker 1: And there's this element of from my perspective as an artist,
Speaker 1: I feel like I'm watching a man who's got far
Speaker 1: too much pressure he's got pressure of the world on
Speaker 1: him saying like, keep making great things or else we're
Speaker 1: going to abandon you, and then pressure on himself saying
Speaker 1: I've loved a lot of the things I've made. I
Speaker 1: need to hold myself to this high level of productivity,
Speaker 1: of creativity, to the standard of craftsmanship, etcetera. And if
Speaker 1: I can't do that, then it's over, or it's I'm
Speaker 1: depressed or whatever. It is, right, And maybe I'm projecting
Speaker 1: a lot on him, but I think it's a definitely,
Speaker 1: it's safe to say it's a very common thing that
Speaker 1: happens to a lot of artists, a lot of them.
Speaker 1: They're one of the reasons why they go to substances
Speaker 1: is because I actually have at a handful of friends
Speaker 1: who don't like to create stuff unless they're high, and
Speaker 1: they do it because, well, the last time I got
Speaker 1: high and made something, I made some pretty dope ship.
Speaker 1: Now it's like a link and it's like, well, I
Speaker 1: got high and I made this song. The song was dope.
Speaker 1: I made another song I wasn't high. Doing it from
Speaker 1: a place of fear. They they don't believe they can
Speaker 1: do it. They believe they got to be an alter
Speaker 1: place to do it, and the drug is the damon
Speaker 1: they're trying. It's either that or it's a key like
Speaker 1: it helps like lubricate the situation and it makes it
Speaker 1: easier to get in touch with that thing, whatever it is.
Speaker 1: It's certainly like disinhibited. So there's something to that. But
Speaker 1: there are other ways to disinhibit your mind. There are
Speaker 1: actually other way something that is listening. What would you say,
Speaker 1: what's another way they could go about it? I would
Speaker 1: say there are states of mindfulness and meditation that allow
Speaker 1: you to disinhibit your mind. Actually, that's a good point.
Speaker 1: I have a couple of friends who write incredible lyrics
Speaker 1: while they're running because their brain, your brain goes somewhere else,
Speaker 1: or you're running and getting to a state of flow. Right,
Speaker 1: So flow is the key to creativity, to be where
Speaker 1: your mind can be messy and then later organized. But
Speaker 1: messy is disinhibited and disinhibit You can do that by
Speaker 1: sometimes getting into an exercise zone and anybody and artists
Speaker 1: can do something like that without having to use a
Speaker 1: substance to disinhibit be cause, of course the substances have
Speaker 1: a double edged sword, right. There are other problems that
Speaker 1: come with that, but it's coming from that place of fear,
Speaker 1: like you're saying the need like maybe I haven't really
Speaker 1: got it. How will I get it? How will I
Speaker 1: keep it? If I don't keep it, I'll be a
Speaker 1: band and I'll be lost. These are also psychotherapeutic issues
Speaker 1: that treatment can help someone quite a bit with, especially
Speaker 1: somebody who's already has this tendency as you're explaining Chester
Speaker 1: did to feel more negative, or more worthless or more
Speaker 1: hopeless about things. So I have a question moving away
Speaker 1: from the artists themselves. So I know that you know
Speaker 1: the complexities of the artist and the situation, especially as
Speaker 1: you get into you know, you have a fan base.
Speaker 1: There are expectations or whatever. We touched on that. Now,
Speaker 1: what I think a lot of the teams around the
Speaker 1: artist are wondering if there's something that they can do
Speaker 1: because they see I've seen fans criticize the teams around
Speaker 1: people that are going through maybe they go to rehab,
Speaker 1: maybe they go to maybe they have a breakdown, and
Speaker 1: then fans are saying, well, why didn't anybody else around
Speaker 1: this person help them? Right? What do you think about that?
Speaker 1: Because there there are I've heard some things lately from
Speaker 1: people in our organization, like our production manager Jim, who's saying,
Speaker 1: being on tour shows every night are very exciting. There.
Speaker 1: It's like you get a super super big high and
Speaker 1: then when it's over, for some people it's a really
Speaker 1: low low, and the artists can feel that, but actually
Speaker 1: the crews can feel that too, And he was wondering,
Speaker 1: how you know, kind of out loud with me, is
Speaker 1: there I wonder if there's anything we could do to
Speaker 1: kind of help out. Well, first of all, let me
Speaker 1: just say it's really unfair to blame anyone. Even a psychiatrist,
Speaker 1: even if chester we're sitting in my office, might not
Speaker 1: be able to tell that that person eminently is going
Speaker 1: to kill themselves, certainly without saying are you thinking of
Speaker 1: killing yourself? Do you have a plan? What is the plan?
Speaker 1: Do you have access to that plan? Now? If you
Speaker 1: get affirmatives to all that, as a person you are,
Speaker 1: you know you you can know something about But people
Speaker 1: high things, they guard things, they write so and most
Speaker 1: people aren't asking those questions. But short of that, there
Speaker 1: is no surefire way to know. But there are particular
Speaker 1: red flags. And the reason I say it's unfair to
Speaker 1: blame people is you know, everybody's already struggling with this
Speaker 1: ripple effect of this loss. Adding to that with blame
Speaker 1: and guilt is not a helpful thing. So to be specific, though,
Speaker 1: I'm wondering or on behalf of on behalf of those
Speaker 1: people who I know maybe listening they were going to say, well,
Speaker 1: is there something I can do? Yes? So drivers of
Speaker 1: suicide that people don't think our drivers aren't just sadness depression.
Speaker 1: They are particulars like shame, shame, humiliation. So when you say,
Speaker 1: you know, where's my next big hit and will people
Speaker 1: leave me? Shame and the fear of that no, I
Speaker 1: didn't make it this time, where this one's stunk is
Speaker 1: actually a particular driver of suicide. So if you hear
Speaker 1: things about someone expressing shame or seeming to be feeling shame,
Speaker 1: if you see them starting to dispense with like let
Speaker 1: me bequeath in any sort of way this to you
Speaker 1: as though, and even look like they're starting to feel
Speaker 1: better in the face of doing that, that is a
Speaker 1: big red flag. High anger and irritability a big red flag.
Speaker 1: Men especially experienced depression and symptomatically reflect depression by being
Speaker 1: highly irritable and angry males are often not recognized as
Speaker 1: having depression. They're just thought to be jerks, and that's
Speaker 1: a real problem. That's why men are undertreated in this
Speaker 1: country for depression. So that anger that is there gets
Speaker 1: turned inward and you take yourself out. That is a
Speaker 1: big red flag. So knowing very specific red flags that
Speaker 1: have combinations that aren't just like I'm up, I'm down,
Speaker 1: it's a bad day, and basically you know, taking that
Speaker 1: person by the arm and saying I see this, I
Speaker 1: know this is this is in there. I'm going to
Speaker 1: go with you to somebody now. So it does have
Speaker 1: to be a now kind of thing. People who are
Speaker 1: in that state often can't organize themselves to find an
Speaker 1: appropriate person, therapy, intervention, therapy, intervention. What I've just heard
Speaker 1: you describe is more on that edge case of someone
Speaker 1: who may be contemplating suicide, but in terms of trying
Speaker 1: to move earlier in the chain to try to maintain
Speaker 1: a healthier mental state for all these team members involved
Speaker 1: prevent getting further down that road. Are there things that
Speaker 1: we can be doing to be more supportive kind of
Speaker 1: on the front end before those red flags start to
Speaker 1: to appear. We're at the yellow and re flag state. YEA, Well,
Speaker 1: we are a nation woefully unaware of preventive mental health care,
Speaker 1: like we have preventive cardiac care and diabetic care and
Speaker 1: all these things we spend lots of money on and
Speaker 1: lots of awareness on and time on doing. But nobody
Speaker 1: thinks about preventive mental healthcare. And that is a real thing,
Speaker 1: and it's very important to some degree. We would be
Speaker 1: doing a better job of knowing what those things are
Speaker 1: by doing more research, but we do know certain things.
Speaker 1: So there are things such as which are probably not
Speaker 1: very condusive to a a band lifestyle, but aerobic activity
Speaker 1: for times a week, even more intense aerobic activity actually
Speaker 1: goes head to head with medication from mild to moderate
Speaker 1: depression and for anxiety sustaining. That makes the likelihood of
Speaker 1: dipping into one of those situations far less likely. Sleep
Speaker 1: is hugely important. I know, everybody wants to sleep, so
Speaker 1: for instance, lack of sleep can tip off a depression
Speaker 1: or a manic episode. Um, if you have a propensity
Speaker 1: in any of those directions, so a regular amount you know,
Speaker 1: seven to nine hours with some sort of regular those
Speaker 1: things actually make a difference. Being able to have a
Speaker 1: support system of people you can talk to. It doesn't
Speaker 1: have to be a therapist. It could be other people
Speaker 1: in your life, but they have to be people that
Speaker 1: you trust and that you have a certain level of
Speaker 1: intimacy with. Because people that you have to uphold a
Speaker 1: veneer with it tends to make people feel worse, even
Speaker 1: worse than not having spoken to them at all. They
Speaker 1: feel like a fake and a phony, and they're you know,
Speaker 1: they're further and further trapped in themselves. Not a use
Speaker 1: of social media, um, you know. I mean, it's that
Speaker 1: can be used here and there for like the connection
Speaker 1: when you can't make any connection otherwise. But we're we're
Speaker 1: lacking real related nous with facial expression, with body language,
Speaker 1: and those kinds of connections that will create intimacy and loneliness,
Speaker 1: which is the feeling you get when you're texting someone
Speaker 1: and you don't see what's going on, and that's the
Speaker 1: only kind of connection you have that spurs depression anxiety.
Speaker 1: I actually I love that part because it is so
Speaker 1: at this point so universal. There's a couple of pieces
Speaker 1: to that that I love to remind at least our fans,
Speaker 1: my fans, which is that Number one you've got a
Speaker 1: power in your hands with your attention. And when you're
Speaker 1: just always on social media, just kind of flitting in
Speaker 1: a way, you're giving away that currency. I mean, you're
Speaker 1: giving it to whoever whatever shows up in your timeline.
Speaker 1: And by the way, a lot of times we're not
Speaker 1: conscious enough of what we're looking at to say to ourselves,
Speaker 1: does this thing deserve my attention? You're just giving it
Speaker 1: to the worst headlines, the worst articles. You're clicking on
Speaker 1: crazy things because that part of your brain goes, well,
Speaker 1: that's I'm curious about that. Let's click on that. And
Speaker 1: to be fair, they've also designed the systems that people
Speaker 1: who control these optimal platforms, they know how our minds work,
Speaker 1: they know the emotional lures and triggers, and they bake
Speaker 1: those in. So they're measuring your attention and that currency
Speaker 1: as you describe in a sense. They can make a
Speaker 1: great argument for like that optimizing your experience and making
Speaker 1: more fun for you, but fun for that, they're gauging
Speaker 1: that in terms of interaction and activity, not in terms
Speaker 1: of is it making you depressed? So they're calling it fun.
Speaker 1: I would call it compulsion where it's it's it's a
Speaker 1: feedback loop. You get some sort of positive feeling and
Speaker 1: that makes you your brain go, let's do it again,
Speaker 1: because that felt good, I gotta do it again. And
Speaker 1: once that's baked in, even when you go, wow, that
Speaker 1: did not feel good, you now already have the compulsion.
Speaker 1: But most people don't stop and say wow, that didn't
Speaker 1: feel good. They turn right around to somebody else text
Speaker 1: or talk and say, man, did you read this headline? Oh?
Speaker 1: Did you hear what's so and so? Did we infect
Speaker 1: each other with that? Yeah? And it's and then it's
Speaker 1: just it is infection, right. So one thing that I
Speaker 1: talked about a lot is just be really aware of
Speaker 1: your your like take your temperature and your mental health
Speaker 1: temperature more often, like when you wake up, I tell fans,
Speaker 1: when you wake up in the morning, you may check
Speaker 1: in with your body and say, well, my back hurts,
Speaker 1: I should take it easy today. If it's worse, oh,
Speaker 1: I should see a doctor or maybe any medication you know,
Speaker 1: so on. But you don't do that for your brain.
Speaker 1: And that's a place where you can make a change.
Speaker 1: We say, and waking up in the morning and body
Speaker 1: feels fine, but my brain feel like I don't feel
Speaker 1: that good today, And do I need to stay home?
Speaker 1: Do I need to take it easy? Should I not
Speaker 1: be on Twitter and Instagram today? Should I not? You know,
Speaker 1: do I actually need to not go into work and
Speaker 1: I need to go see a doctor? To carry a
Speaker 1: heavy emotional burden at Yeah, like you can control if
Speaker 1: you've got friends texting you about something a favor, an
Speaker 1: emotional favor or something that they need help with or whatever,
Speaker 1: that you aren't the only human being in the world
Speaker 1: that could help them with that thing. Maybe they could
Speaker 1: get that help somewhere else, opt out. I mean, that's
Speaker 1: really a mental health if you've already if you've already
Speaker 1: checked them with yourself and you said, man, I'm just
Speaker 1: feeling like a scale one to ten, I'm at like
Speaker 1: a five today, and then somebody else puts their junk
Speaker 1: on you, like you're just not the best person to
Speaker 1: deal with it that day. Self observation, which is what
Speaker 1: you're describing, is one of the first points of therapy
Speaker 1: in the words, So sometimes people just get better, like
Speaker 1: something's going on, and you, as a therapist, I tell
Speaker 1: them I want you to go home, and I want
Speaker 1: you to keep a journal, and I want you to
Speaker 1: take your temperature on whatever it is. We're looking at
Speaker 1: how often you worry, how often you would and just
Speaker 1: the self observation and recording actually makes it diminish, so
Speaker 1: that that's actually a great thing to do. And as
Speaker 1: you said, also could cuse someone in, Okay, I need
Speaker 1: something more. Maybe if it's not diminishing, if it's a problem,
Speaker 1: and you can even apply it, you can even make
Speaker 1: it a part of your routine at work or at school.
Speaker 1: In my band, we actually have done this. We did
Speaker 1: this years ago where before we had a band meeting,
Speaker 1: we always did a check in first, how is everybody doing?
Speaker 1: Because once in a while you get you know, you
Speaker 1: most days you come in, these things are going on.
Speaker 1: We kind of know what each going on in each
Speaker 1: other's lives. But once in a while you get somebody
Speaker 1: coming in and saying, I'm just really not you guys
Speaker 1: didn't know this, but this is going on in my life.
Speaker 1: I'm a little bit stressed out, or I'm a little
Speaker 1: bit down, or I'm it's hard right now for me.
Speaker 1: So then you see, once you have that, you've given
Speaker 1: that piece of information everybody else that you wouldn't have
Speaker 1: otherwise given them. You've just otherwise you would have just
Speaker 1: jumped in the meeting, let's talk about these things. But
Speaker 1: all of a sudden, you know that this one person
Speaker 1: is like maybe they're a little sensitive to certain topics today,
Speaker 1: and you'll be so much more empathic. Yes, empathic, and
Speaker 1: you'r it sounds as well. You know, there can be
Speaker 1: a really high burden to quote unquote ask for help,
Speaker 1: But what you've just described is a step short of that.
Speaker 1: It's just gonna declaring where you are and allowing others
Speaker 1: around you to help in a more implicit or passive way.
Speaker 1: So it's not like I think, because of the shame
Speaker 1: aspect that you talked about, Dr there's a fear of
Speaker 1: looking weak, of being judged as incapable, and I can't
Speaker 1: carry this load. So you're not going that far. You're
Speaker 1: just saying this is where I'm at, and then your friends,
Speaker 1: your co workers, your family members can step up, and
Speaker 1: we do, if we're really connected to each other, tend
Speaker 1: to adjust for each other. It is like stoking empathy. Yeah,
Speaker 1: you know, doing much of that, but really we should
Speaker 1: be teaching children and teaching adults how valuable and important
Speaker 1: empathy is. And empathy which is you know I can
Speaker 1: stand in your shoes. Well, if you don't know where
Speaker 1: your shoes are, I can't stand in them. So you're
Speaker 1: you're giving them that information and that's super valuable. It's
Speaker 1: important to be able to be both empathic which also
Speaker 1: feels good as well as received the empathy. These are
Speaker 1: the kinds of things that I would even say preventively.
Speaker 1: In terms of preventive, are we learning coping skills that
Speaker 1: work for ourselves? Are we doing things to think about
Speaker 1: our resilience and like, how what are tools for us
Speaker 1: to bounce back from things? Do we have like a
Speaker 1: toolbox assembled for ourselves? Empathy, I think is one of
Speaker 1: those things I would give your band another homework ascidle homework.
Speaker 1: Another useful thing to do, believe it or not, is
Speaker 1: to gratefulness actually really boost mood. You look like you
Speaker 1: maybe already have done this one, but like coming together
Speaker 1: and saying at the end of the day to yourself
Speaker 1: or to your bandmates, three things for which you're really
Speaker 1: And they could be like little things like I had
Speaker 1: a great cup of tea this afternoon. You know, they
Speaker 1: could be small or they could be bigger. But shifting
Speaker 1: the focus that it shows even after a couple of
Speaker 1: weeks of doing that really does improve mood. One of
Speaker 1: the things that does not improve mood and can inhibit
Speaker 1: some of what we've just been talking about is the
Speaker 1: stigma around expressions of mental health concerns, mental illness, symptoms.
Speaker 1: And I'm curious for you, Mike and for you dr
Speaker 1: how you've experienced this which you've observed in your own journey,
Speaker 1: around people's judgment and people's fears of expressing their even
Speaker 1: their concerns with social media in real life, the combination.
Speaker 1: But where does stigma stand and where do you stand
Speaker 1: on it? I mean, I think the good news is,
Speaker 1: at least in my experience, is a little bit of
Speaker 1: the stigma and the I feel like there's a tendency
Speaker 1: in Americans in particular that I've experienced at least my
Speaker 1: experience has been you know, we're tough, we can handle it,
Speaker 1: like we don't you know, so for example, so yeah,
Speaker 1: suck it up. Like for example, Pole, can you imagine
Speaker 1: waking up in the morning and going like, Wow, I've
Speaker 1: I've had a really bad week. All this stuff is
Speaker 1: going on, and I just feel depressed and calling into
Speaker 1: work and telling your boss like, look, I need a
Speaker 1: day off. Your boss would be like, you're fired, right,
Speaker 1: They're not going to They're not going to stand for that.
Speaker 1: They're gonna say, look, I've got all these other people.
Speaker 1: Nobody else is complaining. Oh, come on, it's all in
Speaker 1: your head. Pull yourself up by your bootstraps. You know,
Speaker 1: that's just not understanding the biology of these issues. These
Speaker 1: are Your brain is an organ If you have a
Speaker 1: neurotransmitter imbalance, which has to do with what's going on
Speaker 1: in your day and how you've been feeling. The brain
Speaker 1: talks to itself through neurotransmitters. Feelings are neurotransmitters. All of
Speaker 1: the psychology biology exactly, that is how the brain works.
Speaker 1: And so when something is happening in the brain, if
Speaker 1: you called in and said I'm having chest pain, I
Speaker 1: think I might be having a heart attack, I don't
Speaker 1: think your boss would say, well you're fired. Um, you know,
Speaker 1: and we have to start understanding it that way, as
Speaker 1: opposed to like you could just suck it up. We
Speaker 1: have to. And this is actually where I think you
Speaker 1: people like you actually have a much bigger impact than
Speaker 1: people like me. Is the author of six books, But no, really,
Speaker 1: I'm much impact on stigma because it's people needing to
Speaker 1: understand how ubiquitous these issues are, that they happen to
Speaker 1: the most successful and the least success they happened to everybody.
Speaker 1: It cuts every swath and people don't want to be
Speaker 1: associated with someone who was, you know, in the eighteen
Speaker 1: hundreds chained to a wall because they were quote crazy.
Speaker 1: But they do want to feel like, well, yeah, I
Speaker 1: could be that basketball player or that musician or that whatever,
Speaker 1: and I'm struggling, but that doesn't mean I'm not intelligent, able,
Speaker 1: I don't have good stuff going on. So it's the
Speaker 1: people who are able to do and yet able to
Speaker 1: reveal their story that makes a huge difference. Able to
Speaker 1: reveal the they got treatment and the treatment helped them,
Speaker 1: and that was important. Able to and you know, I
Speaker 1: hate to be so bottom line here, but the reality
Speaker 1: is that mental health receives the least dollars by a
Speaker 1: large margin than any other health issue for research for
Speaker 1: clinical care, and if we don't learn more, we're not
Speaker 1: going to have better treatments. If we don't support clinical treatment,
Speaker 1: then in lots of parts of the country where people
Speaker 1: can't afford it out of pocket, they're not going to
Speaker 1: get it, and so it's people like you who will
Speaker 1: motivate those movements that will raise dollars for research. That's
Speaker 1: just a reality. Yeah. How would both of you say
Speaker 1: you like us as a society and individuals within it
Speaker 1: to be talking about mental health and mental illness in
Speaker 1: five years in a way that's better than we do today.
Speaker 1: I think the thing that I learned this year that
Speaker 1: was when I heard it, it was like, oh, that's
Speaker 1: something that we've kind of been accident generally doing in
Speaker 1: a sense, but you can do it much more intentionally.
Speaker 1: Is to make a routine out of it. To create
Speaker 1: little routines, either for yourself or for your communities, whatever
Speaker 1: they are, your family unit, your your work community, your
Speaker 1: school community, whatever it is, just to create little routines
Speaker 1: out of it. Since we're not yet doing it naturally,
Speaker 1: I think we need to create schedule out of it
Speaker 1: in order to do it. What about you? Um? That
Speaker 1: makes great sense to me. Um. I think that we
Speaker 1: have to be more aware of them. Many times we're
Speaker 1: still talking so pejoratively about mental health issues. Throw out
Speaker 1: the word crazy nuts media, you know, TV shows, movies,
Speaker 1: that this is a stuff where people unfortunately learn their
Speaker 1: medical information often say deprecating terrible things essentially about someone
Speaker 1: with mental illness or for that matter, people who treat
Speaker 1: mental illness. Psychiatrists are never portrayed well in the media.
Speaker 1: Let me just say, but, um so, I think that
Speaker 1: if we could, you know, shift our mind's eye to
Speaker 1: the idea that you know, things can be you can
Speaker 1: be differently wired in your brain, which many people are
Speaker 1: close to all of half of all Americans at some
Speaker 1: point or another, we'll struggle with this, which means the
Speaker 1: other half have somebody in that group they love, So
Speaker 1: we're all going to be touched. If we could recognize
Speaker 1: the ubiquitous nous, recognize these are sometimes disease states that
Speaker 1: need treatment like any other kind of disease states, and
Speaker 1: probably even more so because if your mind is not well,
Speaker 1: it's really hard for your body to even be well,
Speaker 1: so nothing's well. This should take more of a front
Speaker 1: and center people sharing their stories most definitely much more openly,
Speaker 1: and hopefully all of that, in my mind, leads to,
Speaker 1: because you know, I am a physician, that we put
Speaker 1: more effort into frankly researching this area and providing better
Speaker 1: treatments because this area lags behind others in many ways.
Speaker 1: Um we need better, more specific, defined treatments for the
Speaker 1: wiring issue than a row transmitter issue that's going on,
Speaker 1: and I think that it can be gotten. But we
Speaker 1: have to have a very different way of digesting all
Speaker 1: of this and seeing that there's another side, that there
Speaker 1: are real strengths and pluses in people who struggle with
Speaker 1: these issues. So we have to start talking to our
Speaker 1: children about mental health, how to build a plan, how
Speaker 1: to not be ashamed, how to seek help, and how
Speaker 1: to find their potential, how to find their strength as
Speaker 1: a result and be their best selves. I'm feeling so
Speaker 1: inspired right now. If there's anything related to this topic
Speaker 1: that you feel like, I wanted to say this, I
Speaker 1: gotta get this off my chest. I mean, I guess
Speaker 1: for me, the only thing that we didn't touch on,
Speaker 1: I'm proud of my wife. I'm proud of Chester's wife
Speaker 1: to Lenda. They've both been involved with an organization called
Speaker 1: um well to Lenda's arm of it is called three
Speaker 1: twenty Changes. Direction Change Direction is a great organization and
Speaker 1: if you're curious about this stuff, then you can go
Speaker 1: check them out and support them. And also people should
Speaker 1: check out your album post traumatic and support. You appreciate that, yes,
Speaker 1: And there's also this single make it Up as I Go.
Speaker 1: That's really a cential theme, not only to the record,
Speaker 1: but to kind of everything that I'm doing right now.
Speaker 1: There's an element of you know, when you feel like
Speaker 1: you have options, when you feel like you are um
Speaker 1: have some control over things, even if that means control
Speaker 1: in choosing to improvise right, that can really empower you,
Speaker 1: make you feel good. So the new song is all
Speaker 1: about that, the video is about that, and I'd say,
Speaker 1: you know, in in like a more of a philosophical
Speaker 1: kind of way, that the whole tour is about that
Speaker 1: post traumatic just disorder by the way which many people
Speaker 1: suffer after a suicide of somebody close to them. A
Speaker 1: suicide of a child increases likelihood of suicide of a
Speaker 1: parent and vice versa. I mean, the ripple effect of
Speaker 1: suicide is quite significant, and people often do struggle with
Speaker 1: literally post traumatic of events following, and they have to
Speaker 1: take care of themselves too. That's really important. Since we
Speaker 1: are here in the venue, I'm going to go out
Speaker 1: and do a sound check after this. UM. One of
Speaker 1: the nice things about a show like this, which if
Speaker 1: you guys stick around you'll be a part of is
Speaker 1: that it is more about the post part than the
Speaker 1: traumatic part. This is a very cathartic and heartwarming and
Speaker 1: by the way, energetic and fun show. You know, I
Speaker 1: don't think it's do entirely to my role in it,
Speaker 1: although I'm kind of em seeing it. I'm running, you know,
Speaker 1: directing traffic. But I've found that, you know, these fans
Speaker 1: who come to this show, they've lost somebody, They've you know,
Speaker 1: they've admired Chester for many years. Some of them have
Speaker 1: many of them have tattoos of the band, of my art,
Speaker 1: of his face, of our lyrics on their bodies. And
Speaker 1: so they come and I would never want to give
Speaker 1: them a night that was sad and depressing and dark,
Speaker 1: like I want to. I want them to have a
Speaker 1: great night. So these shows have been. Every night, they've
Speaker 1: been this wonderful, healing and super super fun experience. I
Speaker 1: want to take a page out of the newly written
Speaker 1: playbook that Dr Saltz has offered us and express gratitude
Speaker 1: deeply to both of you. Mike, you said that showing
Speaker 1: emotional intelligence is not a sign of weakness. It is
Speaker 1: very powerful new lyric that you just doesn't have a
Speaker 1: matching set yet, but you can work on that and
Speaker 1: post and and Dr Salts. You gave us a number
Speaker 1: of steps, both on warning signs of people at the edge,
Speaker 1: around giving away things that are close to them, around
Speaker 1: expressing some sense of shame, and around being jerks or
Speaker 1: super angry that might be masking a deeper depression and
Speaker 1: even more useful to more of us, I think, how
Speaker 1: to create the community that we want to be living in.
Speaker 1: That's one of exercise and sleep and having that circle
Speaker 1: of trust around us uh an expression of gratitude within
Speaker 1: that circle. So I will close by saying to you
Speaker 1: and to all listening, mental illness is just illness, and
Speaker 1: mental health is simply health, and those who live with
Speaker 1: it are not crazy people, thank you, Dr. They're just people.
Speaker 1: We all need help from time to time, whether it
Speaker 1: be with a broken leg or a broken heart or
Speaker 1: a broken mind, and especially in the realm of mental illness,
Speaker 1: a little compassion goes along way. Remember, as we say
Speaker 1: often in this show, we are all connected, we are
Speaker 1: all human, So let's be mindful of what those around
Speaker 1: us are going through, even when our minds are full.
Speaker 1: If you are someone you know needs help. You can
Speaker 1: call the National Suicide Prevention Lifeline. That phone number is
Speaker 1: one eight hundred to seven three eight two. Again, that's
Speaker 1: one to seven three two, or just call. I want
Speaker 1: to thank you both for being here, Mike Shinoda, Dr
Speaker 1: Gail Salts. I've learned and I've grown, and I think
Speaker 1: our listening as well as well. So thanks for being
Speaker 1: so generous. Thank you. In the wake of that emotional
Speaker 1: and eye opening conversation, I was inspired to learn even
Speaker 1: more about the science that underpins the experience and the
Speaker 1: explainers of mental health. So I got on the phone
Speaker 1: with Dr Ahmad Harriary to talk about what the latest
Speaker 1: research tells us is going on in our brains, what
Speaker 1: role our genes play, and how to channel these learnings
Speaker 1: into providing more treatment for more people. All right, good morning,
Speaker 1: Dr Harrary, Thanks for making time. I'm sorry we couldn't
Speaker 1: be face to face. Yes, and please feel free to
Speaker 1: call me a mod a mod Yes, we're already in
Speaker 1: the first and we'll feel free to call me Mr Thurston.
Speaker 1: I want to talk with you about biology and the
Speaker 1: brain and its relationship to mental health, particularly anxiety and depression.
Speaker 1: I want to get into the research that you've done
Speaker 1: with twenty three in me and I want to talk
Speaker 1: about where that research can help take the larger cultural
Speaker 1: conversation around mental health. Do those three sort of areas
Speaker 1: sound like that makes sense? That's fair? Is there's something
Speaker 1: else that you're like, we have to get to this though, No, no, no,
Speaker 1: that's that's more than fair of our toin. I just
Speaker 1: you know, if we have several months to do this
Speaker 1: again and again, maybe we'll cover it all satisfactorily. But
Speaker 1: what I'm promised to do my best. Okay, thank you,
Speaker 1: Thank you, professor. You're you're used to explaining complex concepts,
Speaker 1: so we're gonna take advantage of your official skills. Great. Great.
Speaker 1: One of the things that we understand is that there
Speaker 1: can be a layered reasoning for mental health. That is
Speaker 1: their biological explainers, they're also environmental explainers. And because of
Speaker 1: your work as a professor of psychology and neuroscience, I'd
Speaker 1: like you to take us inside the brain and talk
Speaker 1: about the biology and and the neuroscience of where anxiety, depression,
Speaker 1: other forms of mental health live absolutely bour toin day.
Speaker 1: And I think your your conceptualization of mental illness is
Speaker 1: consisting of layers is very apt in terms of what
Speaker 1: we've begun to learn about the brain in the context
Speaker 1: of depression and anxiety. It's increasingly clear that there may
Speaker 1: be differences in how individuals brains react to their experiences
Speaker 1: and kind of produce different responses to challenges that we
Speaker 1: really all face in our daily lives, and it's really
Speaker 1: at that interface of an individual's brain and how it's
Speaker 1: processing information, how it's processing their experiences, and those experiences
Speaker 1: that we think ultimately can shape and give rise to
Speaker 1: the experience of depression or anxiety. In other words, it's
Speaker 1: differences in an individual's brain interacting with their environments, with
Speaker 1: their own um experiences and trajectories in life that ultimately
Speaker 1: will help determine who is it greater or lesser risk
Speaker 1: for experiencing depression or in anxiety. Rather than there being
Speaker 1: simply a difference in the brain that is absolutely going
Speaker 1: to be expressed as depression or anxiety, it's become much
Speaker 1: more clear that it really is an interaction between an
Speaker 1: individual's brain and that associated biology and their experiences through
Speaker 1: life that we we have to understand both sides of
Speaker 1: that equation in order to really make headway in the
Speaker 1: treatment and what we all hope will ultimately be the
Speaker 1: prevention of depression and anxiety. That's so, so what I'm hearing,
Speaker 1: I'm gonna try to be a good student here and
Speaker 1: play back when I heard the professor share. First of all,
Speaker 1: it's complicated, right, It actually sounds like it's about the relationship.
Speaker 1: So they're there these three parts, right, there's the brain,
Speaker 1: they're the experiences, and then there's the interaction of the
Speaker 1: brain with those experiences. And so if we're thinking about
Speaker 1: different people, we all have different brains, we all have
Speaker 1: different experiences and their relationship. That interaction between the brain
Speaker 1: and those experiences is of course it's self going to
Speaker 1: be different. So how am I doing absolutely a plus
Speaker 1: baritone day? Yeah, it's you know, biology is not in
Speaker 1: this context, is not deterministic. The brain not only has
Speaker 1: a remarkable capacity to change and this concept of plasticity,
Speaker 1: but it has a way of shaping both our experiences
Speaker 1: and then being shaped by those experiences. So to say
Speaker 1: that it's complicated, I think is more than fair. But
Speaker 1: we are we are starting to develop some at least
Speaker 1: rudimentary understanding of specific features of an individual's brain that
Speaker 1: can make them more or less sensitive to particularly uh
Speaker 1: negative experiences in their lives, like stress, whether it be
Speaker 1: common daily stressors or very significant traumatic experiences in their lives,
Speaker 1: for example, those who lived through hurricanes or who live
Speaker 1: through other, you know, natural disasters. We're starting to make
Speaker 1: some headway in appreciating how the differences in their brains
Speaker 1: will help us better understand their relative sensitivity to these
Speaker 1: kinds of experiences. So I would love for there to
Speaker 1: just be fewer worse experiences. Yes, less stress, fewer hurricanes,
Speaker 1: fewer acts of violence, fewer emails right and tweets and
Speaker 1: exactly anything that that causes stress, turn turn it down.
Speaker 1: I'm assuming your research isn't focused on changing the entire world,
Speaker 1: but rather understanding our brains and how it interacts with
Speaker 1: that world. So, so can you describe the nature of
Speaker 1: your research and with twenty three and me in particular,
Speaker 1: and what are you looking at and what are you finding? Sure,
Speaker 1: let me start with some of the understanding that we've
Speaker 1: developed over the years about the brain. I think fundamentally,
Speaker 1: what we're starting to observe is that there are core
Speaker 1: aspects their course circuits. I like to describe them in
Speaker 1: the brain that our response sable for kind of doing
Speaker 1: different things. For us in our daily lives, there's a
Speaker 1: circuit that is really there to help us respond to
Speaker 1: danger and avoid danger and overcome danger. Then there's another
Speaker 1: circuit in the brain that is really there to help
Speaker 1: motivate us to pursue good things. The first one is
Speaker 1: to avoid bad things in our lives, and the second
Speaker 1: one is to pursue good things to develop motivation, and
Speaker 1: through that motivation develop actions that help us achieve rewards
Speaker 1: and experience pleasure. And then above those two circuits, the
Speaker 1: danger circuit and the reward circuit, if you will, there
Speaker 1: is a much more recently evolved control circuit. And what
Speaker 1: we're starting to understand is that if there's a balance
Speaker 1: between your sensitivity to danger, your eagerness to pursue rewards,
Speaker 1: and your ability to control these two drives is ultimately
Speaker 1: the most adaptive condition for an individual's brain. You want
Speaker 1: to have balance across these and whenever we see imbalance,
Speaker 1: in particular, when we see poor control or poor ability
Speaker 1: to regulate our responses to danger or reward, that's when
Speaker 1: we start to see manifestations of abnormal behavior or features
Speaker 1: of mental illness like depression or anxiety. Those are the
Speaker 1: kind of the elements that we study. As you very
Speaker 1: eloquently stated bartin day, we're not going to be able to,
Speaker 1: despite our our greatest wishes and intentions, were not going
Speaker 1: to be able to protect everyone from having bad experiences
Speaker 1: is literally part of living. One of the things that
Speaker 1: we want to do is by understanding a person's brain
Speaker 1: and in the balance between these three circuits in their brain,
Speaker 1: we want to be able to basically identify people who
Speaker 1: may be more in need of the limited services and
Speaker 1: support the society can provide in order to protect them
Speaker 1: from stressors that would otherwise lead them to experience anxiety
Speaker 1: and depression. We essentially want to develop what we call
Speaker 1: bio markers or measures of an individual's brain that can
Speaker 1: help us identify their relative risk and in doing so,
Speaker 1: allow us to direct the very limited resources that we have,
Speaker 1: unfortunately and sadly, to that person and not to people
Speaker 1: who may be otherwise resilient to those same negative experiences.
Speaker 1: That's really where our work kind of lives now. With
Speaker 1: twenty three and me, what we've really been excited about
Speaker 1: is the opportunity to take these these aspects of an
Speaker 1: individual's brain, this balance between these three systems or circuits
Speaker 1: in the brain and represent them at the level of
Speaker 1: their d N A. You know, we know that that
Speaker 1: variation and an individual's DNA and their genomes is very
Speaker 1: important for the development of the brain and how their
Speaker 1: brain and these circuits operate. So if we can, working
Speaker 1: with twenty three and me and really extending the work
Speaker 1: too population levels of research, meaning hundreds of thousands of people,
Speaker 1: we ultimately would love to be able to essentially develop
Speaker 1: what I call a genomic or or a d N
Speaker 1: A signature for an individual that tells us about these
Speaker 1: aspects of their brain function. And I think it's at
Speaker 1: that level that we can really start to talk in
Speaker 1: an important way and in a powerful way about prevention,
Speaker 1: because if we have those genomic signatures, sadly we don't,
Speaker 1: and we're likely still quite a ways from them, but
Speaker 1: that's where we want to be. We can identify those
Speaker 1: genomic signatures really at the moment of birth and through
Speaker 1: that be able to start to consider an individual's relative
Speaker 1: risk or resilience and sculpt the support systems for those
Speaker 1: individuals in a way that would help protect them from
Speaker 1: developing conditions like depression or anxiety. Does that make sense.
Speaker 1: It actually does. Um, I think you're either a great
Speaker 1: teacher or maybe maybe I'm a great student, but I
Speaker 1: think that's so. And you answered many questions that I
Speaker 1: would have naturally asked. So I'll shift it a little
Speaker 1: to say, I get the idea of these three circuits right.
Speaker 1: You have control of the balance between reward and danger
Speaker 1: and balance. You know, I'm thinking yin and yang, I'm
Speaker 1: thinking the force right. Balance is always something that we
Speaker 1: want just to be able to literally move in the world.
Speaker 1: Balance is important, and some of us have more difficulty
Speaker 1: balancing than others. You got it? That that makes sense. Also,
Speaker 1: what makes sense that there would be something encoded in
Speaker 1: us that might reveal our likelihood or our our probability
Speaker 1: of having challenges with control, and that that the bio
Speaker 1: markers you're referring to, these genetic markers, that that somewhere
Speaker 1: in our DNA we could find people who are more
Speaker 1: likely to experience this or not. And you've also explained
Speaker 1: that we're not there yet, so we don't know the
Speaker 1: exact markers and maybe how many. And so by comparison,
Speaker 1: is there a field of genetics that is sort of
Speaker 1: your role model where you say Oh, we do know
Speaker 1: the bio markers here, there's these many this is how
Speaker 1: they show up. We can screen for it. And I
Speaker 1: would love for this field of mental health study and
Speaker 1: brain study to be on the level with that other
Speaker 1: genetic research. Who who's the who's the bigger sibling that
Speaker 1: is biomarker genetic research that we could look up to. Yeah,
Speaker 1: that's a great question and one that's not easily addressed
Speaker 1: because there is really nothing else out there in terms
Speaker 1: of a disease state or maladaptive state of being that
Speaker 1: compares to the mind and compares to mental illness. It's
Speaker 1: so much more complex than, for example, heart disease or
Speaker 1: even forms of cancer, where there are breakthroughs in terms
Speaker 1: of genomic signatures that may help actually direct specific treats
Speaker 1: for cancer. I actually think we're starting to make headway
Speaker 1: within our own field. The example that came to my
Speaker 1: mind bar today when you asked the question was actually
Speaker 1: the genetics of height. It looks superficially so simple, right,
Speaker 1: if you have tall parents, then you're going to be
Speaker 1: a tall kid, and so forth and so on. But
Speaker 1: when we started to look at the actual variation in
Speaker 1: our DNA, that explained height. It was very hard to find,
Speaker 1: and it wasn't until we had literally hundreds of thousands
Speaker 1: of participants of individuals whose height was measured and for
Speaker 1: whom we had DNA that we started to explicitly account
Speaker 1: for the genetic drive on height, which we know is
Speaker 1: hugely important. What basically we found is that it's a
Speaker 1: lot of genes and a lot of variation and a
Speaker 1: lot of genes across our genome, across all of our
Speaker 1: DNA that ultimately helps us account for the heritability that
Speaker 1: the kind of the family nature of high eight. We're
Speaker 1: seeing the same thing in with regards to mental illness.
Speaker 1: Although mental illness you know, depression, anxiety, schizophrenia, bipolar disorder,
Speaker 1: these are so much more complex than even height. But
Speaker 1: we need to really have one very large data sets,
Speaker 1: which a company like twenty three and me is already
Speaker 1: developing through their customers and is poised to advance by
Speaker 1: collaboration with other large studies across the world. And when
Speaker 1: we have those large numbers of individuals in these studies,
Speaker 1: I think what we're going to find is that there's
Speaker 1: variation all over the genome across hundreds of genes, if
Speaker 1: not thousands, of genes that collectively work together in ways
Speaker 1: that are going to be even more complex to shape
Speaker 1: the kind of what we strive for an understanding an
Speaker 1: individual's kind of genetic risk or familial risk for mental illness.
Speaker 1: So more data is absolutely paramount, and then we need
Speaker 1: to marry the quantity of data with the quality of data.
Speaker 1: So one of the one of the movements in psychiatry
Speaker 1: and the study of mental illness has been to shift
Speaker 1: away from these categories, these bins where someone's depressed, someone's anxious,
Speaker 1: someone's bipolar, someone schizophrenic. It's very clear from those in
Speaker 1: the practice of of studying and treating mental illness that
Speaker 1: those categories are largely artificial and they bleed across each other,
Speaker 1: and so it's moved to this more dimensional perspective on
Speaker 1: mental illness. Let's consider symptoms that may be shared across
Speaker 1: multiple categories of mental illness. You know, to feel depressed
Speaker 1: is not unique to someone who's been diagnosed with depression,
Speaker 1: but it's president in someone with an anxiety disorder, is
Speaker 1: present in someone with psychosis, bipolar disorder, you know, schizophrenia,
Speaker 1: obsessive compulsive disorder. So I think marrying this increase in
Speaker 1: the in the quantity of data, with the quality of
Speaker 1: how we're measuring mental illness and the specific symptoms that
Speaker 1: people are experiencing. That's ultimately going to get us closer
Speaker 1: to a genomic signature, genomic bio marker of those conditions,
Speaker 1: which then subsequently we can leverage to hopefully begin to
Speaker 1: address risk in a way that will prevent the emergence
Speaker 1: of illness altogether. Because the other thing that we know
Speaker 1: is that treating illness, be it a medical illness or
Speaker 1: a psychiatric illness, is always an uphill battle, and we
Speaker 1: really never can get people back to wellness. We can
Speaker 1: get them to feel better than they may have felt,
Speaker 1: but it's a tremendously a sad kind of observation that's
Speaker 1: been made over time that people really don't return to
Speaker 1: being well after they've developed mental illness. What's the ideal,
Speaker 1: what's the dream case? When you think about a successful path,
Speaker 1: we get the quantity of data, we get the increased
Speaker 1: quality of how we interpret that data able to identify
Speaker 1: people who have more control challenges than others and more
Speaker 1: susceptible to mental health, and so then we target better
Speaker 1: therapeutic treatment. Better pharmaceutical treatment, do we talk about mental
Speaker 1: illness differently because of these insights with the dream state here, Yeah,
Speaker 1: I mean you you've you've actually captured it quite well already.
Speaker 1: But for me, ultimately, we would want to be able
Speaker 1: to use a relatively simple, a relatively easily collected measure
Speaker 1: of an individual. And you know, this podcast is called spit,
Speaker 1: and spit is about as easy as as can be.
Speaker 1: Let's collect some spit. Let's look at the d n
Speaker 1: A and basically identify a genomic signature, a genomic bio
Speaker 1: marker of risk that doesn't just tell us whether there's
Speaker 1: high or low risk, but actually tells us where the
Speaker 1: risk is manifest in the brain. In other words, we
Speaker 1: might have a genomic signature that's associated it. And this
Speaker 1: is the this is the fantasy. Remember I don't want
Speaker 1: to suggest that we're ready to do this now, because
Speaker 1: we're not. But the fantasy is, yes, I'm dreaming big.
Speaker 1: We would have a genomic signature, for example, for an
Speaker 1: individual who has relatively high danger sensitivity or threat sensitivity
Speaker 1: as we say, and relatively low reward drive but you know,
Speaker 1: normal control. So in the case of that individual, we
Speaker 1: would we would try to address the relative risk by
Speaker 1: managing their their kind of pursuit of rewards, their motivation
Speaker 1: to pursue experiences that bring them joy that they find rewarding,
Speaker 1: and and try and kind of normalize or achieve that
Speaker 1: balance through that specific pathway. Then you may have a
Speaker 1: genomic signature for someone who has basically a kind of
Speaker 1: a typical threat and reward response but poor control. You know.
Speaker 1: The analogy that I like to use is if you are,
Speaker 1: you know, just an ordinary driver, and then all of
Speaker 1: a sudden you find yourself behind the wheel of a
Speaker 1: Formula one race car. That's not going to go well
Speaker 1: for anybody. So these risk signatures in my mind, and
Speaker 1: people find it surprising to hear this from me because
Speaker 1: I am a biologist. I really think that the best
Speaker 1: way to help protect people from developing mental illness, depression,
Speaker 1: anxiety is in particular, is to allow them and to
Speaker 1: afford them opportunities to exercise and develop control, which is
Speaker 1: essentially what psychotherapy is. Cognitive behavioral therapy and the various
Speaker 1: derivatives of psychotherapy ultimately work to empower the individual to
Speaker 1: better control their experiences. So, rather than a magic pill
Speaker 1: that we would give to individuals based on a genomic signature.
Speaker 1: What I dream of is based on those genomic signatures,
Speaker 1: making particular resources available to those individuals like therapists or
Speaker 1: counselors or other individuals educators in their lives that can
Speaker 1: really help encourage and cultivate better control. You know, like
Speaker 1: so many things, it's something that we should all have, right,
Speaker 1: We should all we should all strive for this. We
Speaker 1: should all have the opportunity to develop control. But we don't.
Speaker 1: And I for one, don't want to wait for a
Speaker 1: utopian society where everyone can have access to this. I
Speaker 1: would rather move ahead more quickly and be able to
Speaker 1: target individuals who more need this and make this available
Speaker 1: to them to ultimately help them as they develop throughout
Speaker 1: their lives and really are able to then successfully navigate
Speaker 1: the challenges that we're all going to face. You've given
Speaker 1: me so much hope right now, I think my my reward. Yes,
Speaker 1: a circuit is lighting up because it's something to look
Speaker 1: forward to, and it's it's you're appealing to something, You're
Speaker 1: describing something very universal, yeah, which is empowering of people
Speaker 1: and of individuals, and but also recognizing in the real
Speaker 1: world not everyone has access to that, and so in
Speaker 1: your dream future, which I'm I'm signing up for it.
Speaker 1: Now that's two of us. Man, Then then we could
Speaker 1: target these resources and better distribute them. We've all probably
Speaker 1: known people in our lives who have more resources to
Speaker 1: address problems more objective, like a financial problem, a little
Speaker 1: less complicated than neuroscience and genetic bio markers, um. And
Speaker 1: so this is uh. I like this view. I like
Speaker 1: this picture that you've painted. Yeah, and I think through
Speaker 1: a biological lens, perhaps people can be more committed to
Speaker 1: developing these resources and distributing these resources in a way
Speaker 1: that that's most helpful to individuals. That's where the biology
Speaker 1: and our deepening understanding of the brain and genetics associated
Speaker 1: with mental illness can help kind of drive us forward.
Speaker 1: For me, for example, it's so strange to hear anyone
Speaker 1: talk about mental illness or the mind or behavior as
Speaker 1: distinct from the brain, because that's just not where I
Speaker 1: come from. You know, that's not my pedigree. But it's
Speaker 1: still the case. And I think mental illness still is stigmatized,
Speaker 1: And you know, the initial hope that by simply identifying
Speaker 1: that mental illness is rooted in biology is going to
Speaker 1: lift this stigma it's not happened. It's as we said
Speaker 1: at the beginning of our conversation, it's complicated. But I
Speaker 1: do believe that continuing to drive forward our biological understanding
Speaker 1: of these phenomena will help us educate individuals as to
Speaker 1: their importance and liberate the people suffering from these conditions
Speaker 1: from kind of prejudice from being targeted, thus allow them
Speaker 1: to receive these resources that they need. We don't have
Speaker 1: these extended families that take care of each other anymore,
Speaker 1: especially in the West. We're we're kind of more fractured
Speaker 1: and we're more isolated, and that places greater responsibility on
Speaker 1: society as a whole to provide the resources that that
Speaker 1: individuals need. What why do you think that the stigma
Speaker 1: has persisted despite our deepening understanding that there are some
Speaker 1: biological i e. Uncontrollable underpinnings for people's experience of mental
Speaker 1: health challenges and disorders. Yeah, you know, it's a great question,
Speaker 1: and I feel like perhaps we as biologists haven't done
Speaker 1: enough to articulate our findings and to make them accessible
Speaker 1: to individuals to really promote the view of of mental
Speaker 1: illness as any kind of illness, as an illness that's
Speaker 1: borne out of problems in our biology and how our
Speaker 1: bodies are are working and operating. I would love to
Speaker 1: engage in a larger discussion with you and others who
Speaker 1: are kind of engaged with policy and social and cultural
Speaker 1: kind of shifts to try and make more headway, because again,
Speaker 1: to me, it's just pardon the pun, it's mind boggling
Speaker 1: to think of them as being anything but manifestations of
Speaker 1: our biology. I really just don't understand it. I think
Speaker 1: maybe perhaps it's because we don't have, you know, a scan.
Speaker 1: We don't have a blood test where a doctor can
Speaker 1: definitively say, well, you know, I'm sorry, you know, Mr Smith,
Speaker 1: but you have depression and here's your scan. We don't
Speaker 1: have those kinds of diagnostic tools. I'm not sure we
Speaker 1: ever will. But you know, again, these genomic signatures, if
Speaker 1: they're if they're identified and established with kind of confidence
Speaker 1: and great predictive value, those could be the type of
Speaker 1: diagnostic tools or tests that other aspects of healthcare have
Speaker 1: had that we can use to promote and to further
Speaker 1: kind of educate the public and individuals about the real
Speaker 1: nature of mental illness. I look forward to some more
Speaker 1: of those diagnostic tools to empower all of us, because
Speaker 1: I think we all, whether we're suffering or close to
Speaker 1: people who are, we're carrying an unnecessary burden. Yes, I
Speaker 1: think this will be my my last question as we
Speaker 1: wrap up Classy, and it's it's for you to summarize
Speaker 1: the key learnings from the research so far. Sure, I
Speaker 1: think the key learning and the key kind of observations
Speaker 1: that we have developed in our own research and and
Speaker 1: the research of many colleagues is that imbalance between in
Speaker 1: particular and individual sensitivity to threat and danger and they're
Speaker 1: kind of drive to achieve rewards and to experience pleasure.
Speaker 1: When there's imbalanced there, we oftentimes see that associated with
Speaker 1: higher sensitivity to stress because you have the draw the
Speaker 1: danger signal and you don't have that kind of buffering
Speaker 1: of positive emotion and reward. That's a particularly problematic imbalance,
Speaker 1: and that in the face of this imbalance, it becomes
Speaker 1: much more important and much more critical to have a
Speaker 1: very strong control circuit. So that's where that third circuit
Speaker 1: comes in. If you have and if you are allowed
Speaker 1: to develop and exercise and practice control over your behavior,
Speaker 1: in particular over your response to danger and your ability
Speaker 1: to pursue rewards. Then that imbalance at the level of
Speaker 1: the other two circuits is not going to be expressed
Speaker 1: as depression or anxiety. This is kind of a trite word,
Speaker 1: but we have to have a more holistic appreciation of
Speaker 1: how the brain is operating. And we've been guilty of
Speaker 1: this as well. We've long focused on one circuit while
Speaker 1: ignoring others, and that's partly due to the limitations of
Speaker 1: conducting research. But as we move forward collectively, we really
Speaker 1: have to think about how these three circuits are dynamically
Speaker 1: interacting to hopefully achieve balance in a person's behavior and experiences,
Speaker 1: and then what kind of imbalance is present within an
Speaker 1: individual that may be associated with with depression, anxiety, or
Speaker 1: other forms of mental illness. One of the things that
Speaker 1: we often say to the public, those of us who
Speaker 1: have access you know, if you're experiencing depressive state or challenges,
Speaker 1: if your loved one or something you're close to, is
Speaker 1: call the number. Right There's there's a number for suicide
Speaker 1: prevention that you should call, but there's more than that
Speaker 1: available to us. What else would you suggest for people
Speaker 1: who are experiencing a mental health moment or someone that
Speaker 1: they're close to our How else should we be thinking
Speaker 1: about what we can do in response before all the
Speaker 1: great research and resource allocation comes to be real. Sure,
Speaker 1: I think one of the biggest challenges for someone who
Speaker 1: is experiencing depression or anxiety is the feeling of isolation.
Speaker 1: Rather than to look immediately for a clinical outlet like
Speaker 1: a hotline or or admitting oneself to an emergency room
Speaker 1: or a hospital, is to hopefully reach out to family
Speaker 1: or friends and to be able to just talk about
Speaker 1: the experiences. I think is hugely beneficial. And then to
Speaker 1: and probably is really hard to do for a lot
Speaker 1: of people, is just to talk openly about their experiences
Speaker 1: and allow our social support networks to do their job.
Speaker 1: Don't just think of them as there for fun and
Speaker 1: for good times, but they're much more important when we're struggling.
Speaker 1: We have to help people reach out to those who
Speaker 1: they know, who they're comfortable with, who they trust, who
Speaker 1: they're closest to first, and then those people can't ignore
Speaker 1: what they may be seeing in their friends and loved ones.
Speaker 1: You know, if you're seeing a person's mood change, their
Speaker 1: behavior change in a kind of a drastic way, in
Speaker 1: a persistent way, I think it's paramount to approach them
Speaker 1: to you know, initiate a conversation with them and not
Speaker 1: not allow them to be isolated. I think that is
Speaker 1: absolutely critical in helping someone initially and protecting them from
Speaker 1: more harm and and kind of a deterioration into further
Speaker 1: kind of isolation and deepening symptoms. And then from that point,
Speaker 1: I think that social support network can help get them
Speaker 1: into a clinic, uh, you know, meeting with a psychiatrist
Speaker 1: or psychologist and to develop kind of a more structured
Speaker 1: approach to ultimately kind of relieving this kind of state
Speaker 1: of anxiety or depression. Thank you again. Sure, I've learned
Speaker 1: so much and I am going to consider enrolling in
Speaker 1: your class and change my heart. You know what. You
Speaker 1: I will save a seat for you always. You are
Speaker 1: very welcome to come down here and I think we
Speaker 1: would have a great time if you did. All right,
Speaker 1: I want to dig in more on today's topics and guests.
Speaker 1: Check our show notes and if you enjoyed the episod,
Speaker 1: so share it with a friend, all your friends, and
Speaker 1: be sure to leave a review. If you want to
Speaker 1: hear more surprising stories about how we're all related, search
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Speaker 1: podcast with twenty three and me. I'm Barraitune Day Thurston.
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