WEBVTT - Bonus: In Conversation with Dr. Rachel Yehuda 0:00:00.200 --> 0:00:10.840 Family Secrets is a production of I Heart Radio. It 0:00:11.039 --> 0:00:13.960 is my honor and pleasure to present the special bonus 0:00:14.040 --> 0:00:17.279 episode of Family Secrets, the first in a two part 0:00:17.360 --> 0:00:23.520 conversation with Dr Rachel Yehuda, Professor of psychiatry and Neuroscience 0:00:23.880 --> 0:00:27.200 and Director of the Traumatic Stress Studies Division at the 0:00:27.240 --> 0:00:31.080 Mount Sinai School of Medicine in New York City. Dr 0:00:31.160 --> 0:00:34.440 Yehuda is one of our nation's foremost experts on the 0:00:34.479 --> 0:00:38.680 intergenerational effects of trauma. This is one of my favorite 0:00:38.680 --> 0:00:48.760 conversations ever. Could you begin by telling me how you 0:00:49.080 --> 0:00:54.560 ended up studying trauma and its effects At the beginning, yes, 0:00:54.680 --> 0:00:56.920 it was a little bit of an accident. Um. I 0:00:57.080 --> 0:01:00.720 was a graduate student in the late nineteen eighties and 0:01:01.080 --> 0:01:06.000 I was studying the effects of stress on beIN development. 0:01:06.160 --> 0:01:09.640 I was doing so in laboratory RAPS. I was a 0:01:09.680 --> 0:01:14.640 student of neuroscience, and I found the idea that stress 0:01:14.680 --> 0:01:18.440 can affect brain development really very fascinating. But I did 0:01:18.440 --> 0:01:23.000 not find RAPS very fascinating, and I really the whole 0:01:23.040 --> 0:01:25.319 time I was in graduate school wondered if there would 0:01:25.360 --> 0:01:29.679 be any way that I could possibly pivot towards working 0:01:29.840 --> 0:01:35.520 with people, and I ended up meeting somebody in my 0:01:35.680 --> 0:01:41.679 graduate school who was very interested in studying psychosis proneness, 0:01:42.520 --> 0:01:45.199 which is really the idea of being able to look 0:01:45.280 --> 0:01:48.760 to see if college students are at risk for the 0:01:49.000 --> 0:01:53.520 later development of mental illness. And he had developed a 0:01:53.640 --> 0:01:58.960 screening tool. But this was the emerging era of biological psychiatry, 0:01:59.080 --> 0:02:02.400 and so we met casually one time, and I was 0:02:02.440 --> 0:02:04.840 a student of neuroscides. He said, I wonder if there 0:02:04.920 --> 0:02:09.880 is a test that could be used to biologically validate 0:02:10.200 --> 0:02:15.240 my UM questionnaire. And I looked in the literature and 0:02:15.280 --> 0:02:19.280 I found that indeed, people were starting to talk about 0:02:19.880 --> 0:02:24.079 UM risk for developing psychosis in terms of a biological 0:02:24.120 --> 0:02:28.640 alteration in a in an enzyme called monoamine oxidase. And 0:02:28.760 --> 0:02:32.239 so I thought to myself, I wonder if this could 0:02:32.280 --> 0:02:35.440 be measured, and learned that it can be measured in 0:02:35.480 --> 0:02:39.520 plate lists. So it was so organic. I said to him, 0:02:39.560 --> 0:02:41.760 you know what, I bet I could figure out how 0:02:41.800 --> 0:02:46.200 to measure this enzyme in plate lits. And my advisor 0:02:46.440 --> 0:02:51.280 wasn't that happy about this whole new development, but I 0:02:51.320 --> 0:02:55.600 promised him I would finish my dissertation in the rats um. 0:02:55.639 --> 0:02:58.080 And this is such a challenge for me to figure 0:02:58.080 --> 0:03:00.960 this out. But I did figure it out, and we 0:03:01.120 --> 0:03:06.000 did find UM that the enzyme levels were associated with 0:03:06.080 --> 0:03:11.000 his test. And after that, I just really wanted to 0:03:11.040 --> 0:03:15.880 do clinical work and it wasn't necessarily important for me 0:03:15.960 --> 0:03:18.800 to do it in trauma. About what happened was this 0:03:18.880 --> 0:03:23.320 professor's name was Dr William Addell, moved to Yale and 0:03:23.520 --> 0:03:26.359 UM asked me to come with him, and I ended 0:03:26.440 --> 0:03:29.640 up doing a post doctoral fellowship at Yale Medical School 0:03:30.320 --> 0:03:34.000 UM starting looking for people that knew about this enzyme, 0:03:34.600 --> 0:03:39.120 monoman oxidase, and ending up at the v A UM 0:03:39.280 --> 0:03:42.880 at the West Haven v A where UM somebody had 0:03:42.920 --> 0:03:45.600 actually done work with this enzyme but had now moved 0:03:45.640 --> 0:03:50.360 towards studying post traumatic stress disorder. And I thought that 0:03:50.440 --> 0:03:53.200 was magnificent. I hadn't heard of it before, but I've 0:03:53.240 --> 0:03:57.440 been studying the effects of stress in rats for so 0:03:57.480 --> 0:04:02.280 long that I thought, oh, this is perfect. So how 0:04:02.320 --> 0:04:05.880 long had post traumatic stress disorder had a name and 0:04:05.960 --> 0:04:09.000 been been something that was in maybe not the popular 0:04:09.080 --> 0:04:13.200 lexicon but the medical Yeah, that's a really good question. 0:04:13.280 --> 0:04:16.920 It had only been a diagnosis for seven years by 0:04:16.920 --> 0:04:20.960 the time that I began my post doc um which 0:04:21.000 --> 0:04:25.520 is seven and PTSD was first described in the d 0:04:25.640 --> 0:04:31.799 s M three in Night, so there was very little 0:04:31.839 --> 0:04:35.120 known about the disorder. That disorder itself was kind of 0:04:35.160 --> 0:04:39.680 controversial when it first came out, and in fact, my 0:04:39.760 --> 0:04:42.960 mentors at Yale that I ended up working with, doctors 0:04:43.040 --> 0:04:48.320 Earl Giller and Dr John Mason Um had just published 0:04:48.440 --> 0:04:53.400 what was the first biologic study in PTSD, and they 0:04:53.440 --> 0:04:59.400 showed very counterintuitive findings. One paper they published showed that 0:05:00.120 --> 0:05:04.159 adrenaline levels were higher in Vietnam veterans compared to other 0:05:05.080 --> 0:05:09.560 veterans with other psychiatric conditions. But another paper that they 0:05:09.600 --> 0:05:13.600 published showed that levels of the stress hormone cortisol or 0:05:13.760 --> 0:05:18.080 lower in Vietnam veterans with post traumatic stress disorder compared 0:05:18.480 --> 0:05:23.560 the patients with depression and schizophrenia and other conditions. And 0:05:23.640 --> 0:05:27.440 this lower cortisol level than a stress disorder had everybody 0:05:27.480 --> 0:05:31.159 really baffled. And when I heard about it had just 0:05:31.200 --> 0:05:35.400 been published, it had me baffled because everybody knew that 0:05:35.720 --> 0:05:40.800 stress related conditions were associated with elevated stress hormone levels, 0:05:41.839 --> 0:05:45.120 and against the backdrop of the fact that people were 0:05:45.160 --> 0:05:48.000 having a hard time in the field of psychiatry wrapping 0:05:48.000 --> 0:05:51.560 their heads around post traumatic stress disorder. You know, this 0:05:52.080 --> 0:05:55.520 was sort of an inconvenient truth in a way, because 0:05:55.560 --> 0:05:58.960 it would have been better had the initial study found 0:05:59.080 --> 0:06:02.800 high stress formal levels. Then you could say, see, I 0:06:02.839 --> 0:06:05.360 told you they still are under stress. But this seemed 0:06:05.400 --> 0:06:11.119 to be a very challenging initial observation. So the first 0:06:11.200 --> 0:06:14.120 study that I ever did in the field of PTSD 0:06:14.360 --> 0:06:18.440 was to try to replicate this observation, and I was 0:06:18.480 --> 0:06:22.480 astonished when I actually found the same thing, low cortisal 0:06:22.560 --> 0:06:28.000 levels in combat Vietnam veterans with PTSD compared to combat 0:06:28.040 --> 0:06:31.840 veterans without PTSD. And what did you make of that? 0:06:31.920 --> 0:06:34.960 I mean, what what? And over time? What have you 0:06:35.000 --> 0:06:37.560 made of that? It must be you know, I'm not 0:06:37.600 --> 0:06:41.040 a scientist. It must be so sort of provocative in 0:06:41.040 --> 0:06:44.279 a way as a scientist when you know the results 0:06:44.279 --> 0:06:47.800 are there and they're irrefutable, and yet they're not. They're 0:06:47.800 --> 0:06:50.960 frustrating because they're complicated or confusing or not not what 0:06:51.120 --> 0:06:55.239 was expected or creates I guess, create new challenges. Yeah, 0:06:55.480 --> 0:06:59.920 so irrefutable is a big word, because um, no stud 0:07:00.040 --> 0:07:03.240 these a refutable. What what people like me do when 0:07:03.360 --> 0:07:06.320 when we do a study is we try very hard 0:07:06.760 --> 0:07:11.520 to minimize the kind of confounds that might contribute to 0:07:11.600 --> 0:07:15.800 having false results UM. And so you always wonder when 0:07:15.800 --> 0:07:19.160 you do a study, is this really right? Did I 0:07:19.200 --> 0:07:24.360 minimize all the things that could contribute to something that 0:07:24.520 --> 0:07:27.400 might give me a distorted readout? And so what most 0:07:27.440 --> 0:07:31.560 people do is think I better retreat the study. And 0:07:32.040 --> 0:07:36.720 since the results really were so counterintuitive, but by this 0:07:36.760 --> 0:07:40.040 time it was the second finding, because I was replicating 0:07:40.040 --> 0:07:44.760 a finding already. But still the results are so counterintuitive 0:07:45.240 --> 0:07:47.040 that I thought I had to replicate them. And then 0:07:47.040 --> 0:07:50.120 I wondered if there had been something special about Vietnam 0:07:50.240 --> 0:07:54.200 veterans who were at the v a UM that might 0:07:54.240 --> 0:07:59.440 not be prototypic of other kinds of trauma survivors. And 0:08:00.280 --> 0:08:05.560 for my replication I chose to study Holocaust survivors UM 0:08:05.680 --> 0:08:09.200 because I thought, well, you know, Holocaust survivors have also 0:08:09.280 --> 0:08:13.880 suffered extreme trauma. I grew up in a Jewish community 0:08:13.920 --> 0:08:17.560 where there were a lot of Holocaust survivors, and to me, 0:08:18.160 --> 0:08:22.000 they seemed initially like they might be different from Vietnam 0:08:22.080 --> 0:08:25.560 veterans who were at the v a UM. But that 0:08:25.640 --> 0:08:29.520 was a false first impression. But in any event, I thought, look, 0:08:29.760 --> 0:08:33.679 I'm going to go and find out if cortisol levels 0:08:34.280 --> 0:08:39.120 are lower in Holocaust survivors and adrenaline levels are higher 0:08:39.720 --> 0:08:45.040 also in Holocaust survivors within without PTSD, And in kind 0:08:45.040 --> 0:08:50.120 of putting that study together, UM, I learned that first 0:08:50.200 --> 0:08:53.640 of all, yes, we were able to replicate the finding 0:08:53.679 --> 0:08:58.960 of lower cortisol levels and increased levels of adrenaline in 0:08:59.000 --> 0:09:03.320 Holocaust survivors PTSD. But the thing that gave me the 0:09:03.360 --> 0:09:09.240 biggest jolt was how many Holocaust survivors had PTSD even 0:09:09.360 --> 0:09:15.200 fifty years after the Holocaust, and how infrequently this has 0:09:15.280 --> 0:09:18.440 been talked about, how they didn't have a name for it, 0:09:19.200 --> 0:09:22.200 how they hadn't sought treatment for it, and how how 0:09:22.320 --> 0:09:24.360 many of them were people that I had grown up 0:09:24.360 --> 0:09:28.840 with and never suspected we're suffering. We'll be right back. 0:09:34.800 --> 0:09:37.920 I think it would be so helpful um to listeners, 0:09:38.480 --> 0:09:41.880 even though it's really so basic for you to actually 0:09:42.360 --> 0:09:48.480 define PTSD in regard to its symptoms, because I know 0:09:48.600 --> 0:09:52.560 it can take on many different shapes and forms, but 0:09:52.679 --> 0:09:55.679 it is it is diagnosable in terms of symptoms as 0:09:55.720 --> 0:09:58.880 well as in terms of the science of the cortisol levels. 0:09:59.640 --> 0:10:04.760 It's a it's a good point PTSD, as as it 0:10:04.880 --> 0:10:10.679 was defined then, was a condition that occurs following exposure 0:10:10.720 --> 0:10:14.600 to an extremely traumatic event, generally a life threatening event 0:10:15.480 --> 0:10:18.640 UM and at that time there were three symptom clusters 0:10:18.679 --> 0:10:22.800 associated with PTSD. There are now four, but they are 0:10:23.040 --> 0:10:29.600 UM having intrusive distressing recollections of the trauma, either because um, 0:10:29.679 --> 0:10:33.199 you get reminded of what happened, or just out of 0:10:33.240 --> 0:10:37.280 the blue, you know, you're just minding your own business 0:10:37.360 --> 0:10:41.160 and you have an intrusive recollection of something horrible, or 0:10:41.200 --> 0:10:43.720 the memory comes to you in the form of a nightmare. 0:10:44.559 --> 0:10:46.920 And one of the things that happens when you do 0:10:47.000 --> 0:10:50.040 get triggered or you do have a memory, is you 0:10:50.120 --> 0:10:53.800 become very, very distressed. So it's easy enough to ask 0:10:53.880 --> 0:10:58.320 people about whether they have UM distressing recollections of a 0:10:58.360 --> 0:11:01.400 trauma that they've been exposed to you. And the second 0:11:01.559 --> 0:11:05.720 category of symptoms have to do with avoidance. That is 0:11:05.840 --> 0:11:11.920 that trauma survivors with PTSD tried desperately to do whatever 0:11:11.960 --> 0:11:15.880 they can do to not think about the trauma or 0:11:15.920 --> 0:11:20.000 not get triggered by the trauma. And this involves not 0:11:20.160 --> 0:11:23.640 dealing with people that might remind them of what happened 0:11:23.720 --> 0:11:28.160 or going to places where the trauma occurred, and it 0:11:28.200 --> 0:11:32.160 could be a real barrier in therapy because if you 0:11:32.240 --> 0:11:37.120 have an illness or condition where you one of the 0:11:37.200 --> 0:11:41.160 symptoms is that you want to avoid thinking about what happened. 0:11:41.200 --> 0:11:44.480 You're reluctant to talk about what happened, and healing from 0:11:44.559 --> 0:11:48.360 trauma often involves that. But you can ask people about 0:11:48.400 --> 0:11:53.120 their avoidance behavior. And the third UM symptom cluster with 0:11:53.240 --> 0:11:57.440 hyper arousal, and these are the real physiological symptoms that 0:11:57.440 --> 0:12:00.680 are probably a function of the higher address all levels. 0:12:01.200 --> 0:12:06.280 But there's a difficulty sleeping and difficulty concentrating UM. There's 0:12:06.559 --> 0:12:09.680 something we call hyper vigilance, which is scanning the environment 0:12:09.760 --> 0:12:13.120 just sort of sort of being in a new place 0:12:13.160 --> 0:12:16.240 and feeling like it might be unsafe, looking for the exits, 0:12:16.600 --> 0:12:20.880 making sure that um, you know where the doors are UM, 0:12:20.960 --> 0:12:26.160 and having a startle response um uh to loud noises. 0:12:26.640 --> 0:12:29.959 One of the one of the hyperreusal symptoms are also 0:12:30.040 --> 0:12:33.560 being very irritable and angry. And this is something that 0:12:33.600 --> 0:12:37.560 many trauma survivors just cannot understand why they're so irritable 0:12:38.240 --> 0:12:40.600 and why little things make them so angry. But it's 0:12:40.640 --> 0:12:44.040 part of a physiological complex, and now in the d 0:12:44.280 --> 0:12:47.679 s M five there's a new symptom cluster that is 0:12:47.720 --> 0:12:52.120 really reflecting changes in mood and changes in cognition, which 0:12:52.160 --> 0:12:55.560 simply means that you think about the world differently. You 0:12:55.679 --> 0:12:57.800 just don't see the world the same way as a 0:12:57.880 --> 0:13:00.360 result of trauma as you used to see it. And 0:13:00.720 --> 0:13:03.120 for people who have been exposed to trauma early on, 0:13:03.520 --> 0:13:06.280 so it's really confusing because they don't remember there before. 0:13:07.080 --> 0:13:09.560 They just know that they don't feel safe and that 0:13:09.640 --> 0:13:12.480 the world is a dangerous place and that you can't 0:13:12.520 --> 0:13:16.640 trust strangers, or they may feel that they are incompetent 0:13:16.720 --> 0:13:20.320 to deal with what life has to offer them. And 0:13:20.360 --> 0:13:23.439 the mood disturbances are such that you feel pretty sad 0:13:23.800 --> 0:13:28.880 most of the time, sometimes anxious, sometimes hopeless. In that sense, 0:13:29.520 --> 0:13:33.720 um PTSD can often be confused with depression, or sometimes 0:13:33.720 --> 0:13:37.880 it just can co occur with it. It's so interesting 0:13:37.960 --> 0:13:44.360 too and complex that the person suffering may and I 0:13:44.360 --> 0:13:48.479 guess that goes to the fourth cluster, may not actually 0:13:49.400 --> 0:13:53.079 consciously be able to identify what the source of the 0:13:53.120 --> 0:13:58.000 suffering is. That there's a kind of dissociative way of 0:13:58.040 --> 0:14:02.240 sort of distancing avoiding. Does that make sense? Completely and 0:14:02.240 --> 0:14:04.720 that and that that's what I found in the Holocaust 0:14:04.800 --> 0:14:08.240 survivor is that they knew they were distressed. They thought 0:14:08.240 --> 0:14:11.720 it was their lot in life. Um. They never gave 0:14:11.960 --> 0:14:16.679 their own symptoms that much consideration because they were, after all, 0:14:16.720 --> 0:14:20.160 the survivors, and compared to the fact that so many 0:14:20.240 --> 0:14:25.560 people had died. Um, they didn't even feel perhaps entitled 0:14:26.160 --> 0:14:30.520 to complain about the symptoms that they did have. And 0:14:30.600 --> 0:14:33.680 certainly there wasn't this idea that anyone could do anything 0:14:33.720 --> 0:14:37.160 for them. Um. As one woman put it to me, 0:14:37.280 --> 0:14:40.400 what is somebody going to do take back the Holocaust? 0:14:41.440 --> 0:14:43.680 Make it like I didn't go through what I went through. 0:14:43.720 --> 0:14:47.280 So there there really was this feeling that they were 0:14:47.320 --> 0:14:50.360 as marked as the tattoo on their arm, that this 0:14:50.440 --> 0:14:52.280 is something that they were going to just have to 0:14:52.280 --> 0:14:56.520 live with. Um. And they didn't think about it as 0:14:56.600 --> 0:15:00.640 a cluster of symptoms that might be able to be treated, 0:15:01.240 --> 0:15:04.360 or that even the things that they now thought as 0:15:04.360 --> 0:15:09.440 a result of the trauma might be revisited or contemplated 0:15:09.560 --> 0:15:12.760 or discussed in therapy so that you could get a 0:15:12.760 --> 0:15:16.120 different idea about them, which is actually one of the 0:15:16.160 --> 0:15:20.880 main purposes of psychotherapy. So to me, it was just 0:15:21.120 --> 0:15:26.120 striking to see what something looks like when you don't 0:15:26.120 --> 0:15:29.280 deal with it for so long. Now, of course, many 0:15:29.320 --> 0:15:33.720 Holocaust survivors had primary care doctors, and many primary care 0:15:33.760 --> 0:15:37.840 doctors saw the anxiety and prescribe things for insomnia and 0:15:37.920 --> 0:15:40.640 for anxiety. But that's not really the same thing as 0:15:40.800 --> 0:15:45.520 naming something that happened as a result of a terrible 0:15:45.560 --> 0:15:51.040 traumatic experience, and maybe even something that UM might not 0:15:51.760 --> 0:15:54.440 need to exist in its current form. If you can 0:15:55.400 --> 0:15:59.000 work yourself around what has happened and what it means, 0:16:00.240 --> 0:16:03.080 some of those symptoms will go away. I mean that 0:16:03.280 --> 0:16:07.520 that's so much what the you know, thematic material of 0:16:07.560 --> 0:16:12.040 this podcast has been over the course of four seasons, UM, 0:16:12.600 --> 0:16:17.360 because you know, we talk about my you know, my guests, 0:16:17.360 --> 0:16:20.360 and I talked about secrets, all different kinds of secrets. 0:16:20.360 --> 0:16:22.160 I mean that the tagline is the secrets that are 0:16:22.200 --> 0:16:24.040 kept from us, the secrets we keep from others, and 0:16:24.080 --> 0:16:28.400 the secrets we keep from ourselves. And UM, I find 0:16:29.080 --> 0:16:33.080 most poignant and distressing in a way the secrets we 0:16:33.160 --> 0:16:36.680 keep from ourselves. But there's you know, where they're like 0:16:36.720 --> 0:16:39.000 if I were going to draw a Van diagram, like 0:16:39.080 --> 0:16:46.560 where there is the intersection between secrecy and silence, UM, 0:16:46.840 --> 0:16:53.480 silence and shame UM the places where those three sort 0:16:53.480 --> 0:16:58.480 of states intersect. And you know, you're you're talking about 0:16:59.040 --> 0:17:04.600 UM studying the Holocaust survivors in Cleveland, where you grew up, 0:17:04.640 --> 0:17:09.359 and and I remember that that is when you came 0:17:09.400 --> 0:17:13.399 across my radar for the first time. UM was when 0:17:13.440 --> 0:17:17.439 I was deep, deep, deep into the research and the 0:17:17.480 --> 0:17:22.880 experience of having discovered a family secret that was so 0:17:22.960 --> 0:17:25.720 deep and so powerful that I could never have actually 0:17:26.359 --> 0:17:29.520 consciously imagined it, which was that I was the family 0:17:29.600 --> 0:17:32.960 secret that my dad had not been my biological father. 0:17:33.080 --> 0:17:37.240 And I had never consciously entertained that thought consciously being 0:17:37.480 --> 0:17:40.640 you know the key word. And and I had grown 0:17:40.720 --> 0:17:44.040 up in New Jersey, in a neighborhood that was filled 0:17:44.040 --> 0:17:47.119 with Holocaust survivors, and I felt like I knew the 0:17:47.160 --> 0:17:50.200 people you were talking about. And for the most part, 0:17:50.400 --> 0:17:52.600 because I you know, I can't say it to the person. 0:17:52.680 --> 0:17:55.560 But wouldn't have sought therapy. I mean, it would have 0:17:55.600 --> 0:17:57.919 been like the last thing that they would have And 0:17:58.000 --> 0:18:01.440 they very often didn't speak of it UM or it 0:18:01.480 --> 0:18:03.800 would leak out sideways, or they wouldn't speak of it 0:18:04.080 --> 0:18:05.600 with their children or there. You know, it was like 0:18:05.640 --> 0:18:10.840 you shouldn't know from that, and so they carried it. 0:18:10.880 --> 0:18:16.600 But carrying something without speaking it has such a profound cost, 0:18:17.080 --> 0:18:19.960 which I think is what I've been learning in a 0:18:20.000 --> 0:18:22.560 way as a student of all this um for the 0:18:22.640 --> 0:18:25.479 last number of years, is what the cost of that is. 0:18:25.520 --> 0:18:29.480 It doesn't go away because you wanted to. It doesn't 0:18:29.480 --> 0:18:33.679 go away because you wanted to, And keeping and not 0:18:33.840 --> 0:18:36.520 using your words to talk about it doesn't mean you're 0:18:36.520 --> 0:18:42.840 not conveying the narrative in some nonverbal way, and that 0:18:43.000 --> 0:18:46.119 I think is a lot of the information that we 0:18:46.200 --> 0:18:51.200 do get sometimes from our parents is nonverbal. I mean 0:18:51.520 --> 0:18:55.879 we internalize the information even if it isn't spoken in words. 0:18:56.840 --> 0:19:01.320 Um So, but that trilogy of silence, change, secrecy, I 0:19:01.359 --> 0:19:07.679 think is something that really unites many trauma survivors because 0:19:07.720 --> 0:19:13.080 I think you're exactly right about those three aspects of 0:19:13.119 --> 0:19:18.760 the problem. And also, when you seek treatment UM you 0:19:18.840 --> 0:19:22.600 have to feel in some way that you're entitled to it, 0:19:22.880 --> 0:19:26.040 which many trauma survivors don't. And in fact that many 0:19:26.080 --> 0:19:31.120 trauma survivors end up in therapy because someone that they 0:19:31.160 --> 0:19:34.399 live with or someone that they love tells them that 0:19:34.440 --> 0:19:39.440 they should go to therapy because they're not able to 0:19:39.440 --> 0:19:44.000 tolerate some of the manifestations of trauma UM that either 0:19:44.119 --> 0:19:47.240 they do or don't recognize as manifestations of trauma. But 0:19:47.320 --> 0:19:52.119 sometimes trauma survivors go for therapy without even understanding that 0:19:52.160 --> 0:19:56.720 they're there to process the trauma UM, which is very 0:19:56.800 --> 0:20:00.600 interesting but is not at all unusual. No, that doesn't 0:20:00.800 --> 0:20:05.679 that doesn't surprise me. I but why the sense of 0:20:05.920 --> 0:20:10.240 undeserving or and I'm sure that there are many different 0:20:10.240 --> 0:20:16.119 reasons for different individuals. But is it because um, because 0:20:16.119 --> 0:20:21.560 it's really a sense of minimizing the trauma or kind 0:20:21.560 --> 0:20:26.119 of erasing the trauma, or is it the shame or 0:20:26.320 --> 0:20:29.240 sort of shame based feeling of like I don't deserve 0:20:29.320 --> 0:20:32.040 to feel better or I don't deserve to be better. 0:20:32.880 --> 0:20:34.879 I think a lot of it is shame based UM, 0:20:35.560 --> 0:20:39.359 certainly depending on the trauma of a lot of people 0:20:39.440 --> 0:20:43.240 that are exposed to sexual violence or sexual trauma, particularly 0:20:43.440 --> 0:20:47.919 early on, are convinced that they somehow provoked it, and 0:20:47.960 --> 0:20:52.439 they feel very ashamed about that. And even if they 0:20:52.480 --> 0:20:55.560 don't feel that they provoked it, many people feel very 0:20:55.600 --> 0:20:59.960 ashamed that they couldn't stop it. UM. And I heard 0:21:00.040 --> 0:21:04.280 this also from Holocaust survivors, just the they could really 0:21:04.320 --> 0:21:08.040 do nothing, and yet there was the shame of being 0:21:08.640 --> 0:21:14.879 so degraded and so humiliated by the circumstance. So I 0:21:14.920 --> 0:21:21.280 think that that shame is connected to feeling undeserving in 0:21:21.359 --> 0:21:26.040 some way. And it's very complicated for combat veterans. We 0:21:26.160 --> 0:21:30.240 talked now a lot about moral injury and people being 0:21:31.880 --> 0:21:33.840 very ashamed of some of the things that might have 0:21:33.880 --> 0:21:38.960 happened in combat. So again, combat is an pretty uncontrollable 0:21:39.000 --> 0:21:43.960 situation most of it, and um, people are going to 0:21:44.520 --> 0:21:47.880 often second guess themselves. Even after nine eleven, so many 0:21:47.920 --> 0:21:52.120 people talked about what they could have done, what they 0:21:52.160 --> 0:21:56.040 didn't do. Kind of a lot of recriminations of running 0:21:56.040 --> 0:21:59.200 down the stairs instead of helping other people down the stairs. 0:22:00.680 --> 0:22:04.840 Anywhere you go in a traumatic situation, there's room to 0:22:04.920 --> 0:22:07.960 second guess yourself. We refer to it in the field 0:22:08.000 --> 0:22:13.320 as the basis of developing negative cognition. So you start 0:22:13.359 --> 0:22:15.200 to wonder why you didn't do this, that or the 0:22:15.280 --> 0:22:18.680 other thing, and then you develop an answer for that, Well, 0:22:18.720 --> 0:22:20.760 it must be I'm a bad person, it must be 0:22:20.800 --> 0:22:24.800 I'm incompetent, alright, So it feeds into the same thing. 0:22:25.200 --> 0:22:28.080 The reality is that when you're under a fight or 0:22:28.080 --> 0:22:32.119 flight response, you're not really thinking that much. Your body 0:22:32.400 --> 0:22:35.879 is doing what it is evolutionarily designed to do, which 0:22:35.960 --> 0:22:39.520 is save those genes that they can be cassed. And 0:22:39.680 --> 0:22:43.000 so you don't go into an entire analysis of what 0:22:43.040 --> 0:22:46.679 should I be doing at this moment. You just do 0:22:46.840 --> 0:22:50.560 it at this moment what your genes are programmed to 0:22:50.600 --> 0:22:54.440 help you do, which is survived by any means necessary. 0:22:56.160 --> 0:22:58.680 We'll be back in a moment with more family secrets. 0:23:03.800 --> 0:23:11.400 Are certain people's genes programmed more toward one of those 0:23:12.359 --> 0:23:16.920 evolutionary responses In other words, I mean I recently came 0:23:17.000 --> 0:23:20.080 to be aware that you know that the freeze response 0:23:20.160 --> 0:23:23.720 is part of that like it's it's and so it's 0:23:23.720 --> 0:23:26.520 like this trio of I came to realize it because 0:23:26.560 --> 0:23:29.320 I'm a freezer. I'm not a fighter, I'm not a 0:23:29.320 --> 0:23:32.920 flear I'm a freezer. I go into like just I'm 0:23:32.920 --> 0:23:35.840 going to be as still as possible and maybe this 0:23:35.920 --> 0:23:41.439 will pass. UM. I'm just wondering whether that's is that 0:23:41.560 --> 0:23:47.880 genetic or is that circumstantial. It's probably got features of both. Um, 0:23:48.040 --> 0:23:53.000 but sometimes the body makes different decisions based on what's happening, 0:23:53.119 --> 0:23:57.200 So freeze might be exactly the right response under some circumstances. 0:23:57.800 --> 0:24:01.800 Don't move over, else something bad will happen. Sometimes fleeing 0:24:01.880 --> 0:24:06.040 is the best and wisest response, and sometimes fighting is. 0:24:06.600 --> 0:24:10.600 You know, So I think that I actually think that 0:24:10.640 --> 0:24:14.600 we might have I think we have the capacity to 0:24:14.640 --> 0:24:19.200 do all of those things under different circumstances. But that 0:24:19.520 --> 0:24:23.199 you make the best choice you can given how you 0:24:23.320 --> 0:24:28.280 size up a situation at the moment. So I think 0:24:28.280 --> 0:24:30.920 that that I think we all do that when when 0:24:30.920 --> 0:24:34.399 a trauma occurs when you're younger, it's probably the most 0:24:34.440 --> 0:24:38.879 adaptive thing to just freeze through it, because you're not 0:24:38.920 --> 0:24:41.119 going to be able to fight, and maybe you're not 0:24:41.160 --> 0:24:45.399 even going to be able to flee, So just breathe 0:24:45.440 --> 0:24:48.760 through this and let's see where it goes. Do you 0:24:48.800 --> 0:24:52.920 think some of that then becomes learned and ingrained, so 0:24:53.040 --> 0:24:58.680 that if when we were younger we learned that freezing 0:24:59.040 --> 0:25:01.879 was what was going in too get us out of this, 0:25:02.080 --> 0:25:05.280 or or or be the best recourse, maybe we've become 0:25:05.440 --> 0:25:08.600 more freezers as adults, or or any of the any 0:25:08.600 --> 0:25:11.879 of the responses. Maybe maybe we did flee or maybe 0:25:11.880 --> 0:25:14.119 we did fight, or is it as you say that, 0:25:14.200 --> 0:25:17.480 it really does depend on the circumstances. No, no, no, 0:25:17.560 --> 0:25:20.240 that's exactly right. I mean one of the most important 0:25:20.280 --> 0:25:24.480 things that happens when you're in a situation of extreme 0:25:24.640 --> 0:25:29.200 stress is that the body's release of stress hormones, among 0:25:29.320 --> 0:25:33.879 other things, helps you remember what has happened, presumably for 0:25:33.960 --> 0:25:36.840 the purpose of allowing you to have a better response 0:25:36.920 --> 0:25:42.320 next time. So, yes, our responses to trauma very much 0:25:42.400 --> 0:25:45.199 depend on what has happened to us before that moment, 0:25:45.920 --> 0:25:48.399 which is why when you're responding to a trauma in 0:25:48.440 --> 0:25:51.399 the here and now, if you're also responding to a 0:25:51.480 --> 0:25:54.360 lot of things that have happened in the past. And 0:25:54.400 --> 0:25:56.119 this is why we start to get a lot of 0:25:56.160 --> 0:26:00.560 individual differences in the way people respond to events, because 0:26:00.600 --> 0:26:04.080 so much of what you're doing in the moment, Sure 0:26:04.200 --> 0:26:08.919 it's biologically conserved and your program to save yourself, but 0:26:09.000 --> 0:26:13.920 a lot of the decision making about how to respond 0:26:13.960 --> 0:26:16.119 to trauma does have to do not only with what 0:26:16.280 --> 0:26:19.560 happened in the past, but what the outcomes of those 0:26:19.600 --> 0:26:23.959 decisions were. That makes so much sense. So let's go 0:26:24.040 --> 0:26:29.000 back for a moment to Cleveland and the Holocaust survivors. 0:26:29.240 --> 0:26:35.840 And was this the beginning of your exploration of or 0:26:35.960 --> 0:26:41.360 sort of identification of epigenetics in the intergenerational effects of trauma. 0:26:41.560 --> 0:26:43.600 Oh no, no, no, no, that didn't happen for a 0:26:43.680 --> 0:26:47.720 really long time. Interesting. Yeah, no, no, no, I didn't 0:26:47.720 --> 0:26:50.440 know the word every genetics when I first started studying 0:26:50.480 --> 0:26:53.639 Holocaust survivors. It wasn't a word that was used in 0:26:53.680 --> 0:26:58.240 neuroscience or matl health or psychiatry. And it wasn't even 0:26:58.240 --> 0:27:01.119 a concept that was available to me, which is what 0:27:01.280 --> 0:27:07.440 makes the whole story so much more um interesting, because 0:27:08.000 --> 0:27:11.160 what I was thinking to myself, Well, what happened was 0:27:12.280 --> 0:27:15.720 we study, we did a study on Holocaust survivors. We 0:27:15.720 --> 0:27:21.520 were able to replicate the hormonal findings, which to me 0:27:21.520 --> 0:27:25.880 meant this is real and worth pursuing because I got 0:27:25.880 --> 0:27:30.040 to find out what is it that is resulting in 0:27:30.359 --> 0:27:34.720 lower cordisol levels and people that have had a trauma 0:27:35.000 --> 0:27:38.760 so long ago and now have PTSD, Like, what's that about? 0:27:39.400 --> 0:27:43.680