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

28:39Dr. Kathryn Paige Harden:Like you are on fortune's razor's edge and you still have to move forward and you still have to proceed in relationship with your child. So you're both absolved of blame, but then to the extent that you're absolved of blame, you maybe are more aware of the risk and uncertainty. So there's no having it all, unfortunately, I think, to make motherhood, to make it safe. I don't think motherhood is safe.

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32:33Dr. Kathryn Paige Harden:Yeah. Whereas conduct disorder, I think will ultimately be impossible to entirely take moral stigma out of it because it's hurting another person, right? The core of it strikes to the heart of what we think it means to be a morally regulated person, which is not harming other people. And yet it is also biological. It is also clearly influenced by our genes, by environmental insults to preterm brain development, to experiences of trauma and abuse that we also know changed brain development. So there isn't in our body some some sequestered area where moral behaviors are somehow immune to our biology unlike all of like all of our behavior is ultimately affected by our biology moral or not but I think the idea of thinking of children with conduct disorder who who often grow up to be adults with substance use problems who engage in antisocial behavior our instinct is to think of them as bad kids to turn into bad people.

33:48Dr. Kathryn Paige Harden:And as soon as we're thinking about it in those terms, I think it strips us of the motivation. It doesn't even occur to us as a scientific community to be like, but what drugs would help these children? What are the pharmacological treatments?

34:05Aliza Pressman:Shift the trajectory. And then the environment doesn't give them the feedback that kind of grows that violence.

34:11Dr. Kathryn Paige Harden:Yes, exactly. So, I mean, I think the data that we're seeing with Ozempic and other GLP-1 agonists that they don't just eliminate some of your appetite for food, but that they also reduce cravings for alcohol amongst people who have substance use disorders. It's fascinating. It's so interesting, right? Because we have forever thought of sobriety as a matter of willpower of your moral fiber and this is a peptide that you inject that makes you not crave alcohol that makes you more likely to remain sober i think that really messes with this binary that many of us have between the biological and the moral so it is horrifying to contemplate that you might have a child that might develop a disorder that you don't have as many good treatments for.

35:11Dr. Kathryn Paige Harden:That doesn't mean there's nothing to be done and we can come back to that. But I also think recognizing the horror of that and not pushing it away is one of the first steps towards getting our act together as a scientific community and being like, well, what are we doing?

35:26Aliza Pressman:So to come back to it, just for the relief of the listener.

35:31Dr. Kathryn Paige Harden:Yes, there are things to be done. Yes. So I would say, I think the best evidence on what parenting in particular is most effective for children who are most at risk for conduct problems and substance use problems, basically problems with harmful disinhibition. So doing disinhibited things that harm themselves or others without really like regard to the consequences. One way you can think about that is like, these are children and adults who are punishment insensitive. So some, you know, some people, they have one bad thing happen from their action and they're like, you know, they overlearn for punishment.

36:14Dr. Kathryn Paige Harden:They're like, I'm never doing that again. Like, you know, they're more on the fearful, inhibited side. Whereas one way we can think about conduct problems, and I think many substance use problems, is a little bit like a learning disability, like an inability to learn from punishment. And that could be because, I mean, that could be for lots of reasons. So some of the best research on this, I think, comes from adoption studies where you have children whose parents, biological parents, are known to have serious antisocial behavior problems or substance use problems. So bio dad has been arrested for a violent crime.

36:55Dr. Kathryn Paige Harden:Bio mom was using many substances, maybe also has a history of incarceration and then gives the child up for adoption. A lot of this work is done. There are American adoption studies, but a lot of this work is done in Scandinavian countries where they have these hugely elaborate medical registries linking parents' medical histories, adoptive parents' medical histories, kids' ultimate developmental outcomes. And what you see is that bio parents, you know, substance use problems and histories of violence do predict the risk of their adopted away offsprings also showing these behaviors. That the prevalence of these problems in the adopted away offspring are much lower.

37:45Dr. Kathryn Paige Harden:so there's something about getting out of that intergenerational cycle of chaos and substance use and violence that in and of itself is very very helpful and that the the behaviors that are most predictive of good outcomes and those offspring are warmth like consistent positive regard by parents i like you i care about you i'm affectionate to you and not using harsh discipline in. The one of the cycles that most predicts the escalation of conduct problems is kid acts out, parents are obviously angry, dysregulated, scared because they're doing that, you know, playing the highlight reel of terrible things in the future.

38:32Dr. Kathryn Paige Harden:And then they escalate the punitiveness of their punishment behaviors. This could be spanking, this could be berating, this could be, you know really harsh restrictions and that is something that is incredibly intuitive to do there's older studies from the 90s where they have children with conduct disorder interact with other women who were recruited as volunteers who are not their moms and you see even these these you know women who were naive to the kid like they've never interacted with them be pulled into a cycle of harshness and conflict escalation. And so it is a difficult thing to do, but it is the thing that predicts the growth of those conduct problems the most is that harsh discipline.

39:23So in some ways, it's like, that's the parenting advice you would give to everyone,

39:29Dr. Kathryn Paige Harden:right? Like what are the things you want? You want firmness without harshness, you want high warmth right like that's across the board i think what you see with children who are temperamentally genetically at risk is that they are more vulnerable to the parents not doing those and are and are particularly benefited when the parents are good at that so in the in the book i talk about this about like you know this isn't just kids like any dog owner also knows this like there are dogs where like parents are the dog owners are very lazy like they're very bad at

40:06Aliza Pressman:training and the dog is like you know very permissive dog mom by the way and my dog's fine she's delights because she's just came out that way she you know and it's a passive low energy

40:17Dr. Kathryn Paige Harden:dog and it's small and it's like whatever you know I adopted a great Pyrenees Rottweiler Great Dane Sharpay mix from the, you know, a side of the road in Bastrop, Texas. And I had to invest a lot of time into being a dog owner.

40:36Aliza Pressman:Yeah. I mean, that dog were it mine would be very dangerous. Right.

40:43Dr. Kathryn Paige Harden:So I got this puppy and then I genotyped him because I'm a geneticist. And then I was like, I have a mix of the world's guard dogs. And so what does this dog, by virtue of its size, by virtue of its temperament, by virtue of its, you know, what it's carrying and its DNA, it's going to need more effort and more skill on my part than if I had gotten like a little toy poodle or something. And I think that children are that way too, that some of them do need more skill and consistency on the part of parents, whereas others like, you know, are a little bit more, sometimes psychologists talk about like the orchids and the sunflowers or the orchids and the dandelions.

41:26Dr. Kathryn Paige Harden:Like some kids are, are dandelions, like they're going to be fine. But I think that children who are, for whatever reason, you know, environmental insults or genetically at risk for this, this inhibition and are very insensitive to punishment are going to need a lot more consistency and skill and very consistent warmth. That's, you know, that's the other predictor. And then I would say, like, I think all of parenting, no matter who your kid is, actually, I'm going to expand this. I'm going to say all relationships. I think all marriages are like this too, which is breaking up with the fantasy that you had of who this person was going to be in order to appreciate the relationship with the person that you have, who they really are.

42:12Dr. Kathryn Paige Harden:And I think when you have very outlying kids in whatever direction, but this might be in the disinhibited direction, or it might be in the vaguely psychopathic direction. I mean, when you say my, my, the back of the hairs on the back of my neck stand up, like that's kind of classic. That's right.

42:27Aliza Pressman:That was the saying that I meant.

42:29Dr. Kathryn Paige Harden:Yeah. Like that's a very classic animal. That's like something old that we kind of experience in response to someone not displaying moral emotions in the way that we're used to. Or if you have, to go back to the earlier part of our conversation, your kid is an MIT graduate student, but now they've had a psychotic break. When kids are very outlying, you're going to have to do more work to break up with a fantasy of who you thought or who you hoped that they were gonna be. And that's a grief, you know, and that might be a grief process that lasts for a long time.

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44:45Aliza Pressman:So we're deep into the new year and I think we've all got our, I mean, I didn't do New Year's resolutions. But one thing that I do like to do is just get all my nutrients. And I do check in at the beginning of the year. And one of the things that you can do quite easily is have cachava. So basically, cachava is another drink that you can have that covers any missing nutrients that you think that you might need. There are just two scoops and you get 25 grams of protein. And I know, I know you're hearing so much about protein, but that's because turns out protein is really important and it's hard to get a ton of it.

45:33Aliza Pressman:There's also fiber, which is super important, greens, adaptogens, and so on. And so many flavors, chocolate, vanilla, chai, matcha, coconut, acai, and strawberry. I am a chocolate person or a vanilla person. I keep it simple. Try cachava risk-free with their love it guarantee. So you can stick to whatever your wellness goals of protein are. Doesn't everybody have protein goals at this point? Go to cachava.com and use the code humans for 15 % off. That's cachava, K-A-C-H-A-V-A.com, code humans. So Paige, I think you just, this is like a longer conversation. Maybe we need to have a part two, but the MIT kid who has a psychotic break and thinking about like, that's a totally different situation than some of the things where you saw these early signs and we're talking about conduct disorder and we're talking about antisocial behavior and maybe impulsivity.

46:36Aliza Pressman:There's this other kind of orchid I'm thinking about where like things are going as you hope and dream for them to go. There's this other version of this that I just want to touch on, which is generally speaking, the outlier kid where you're, they're just an outlier. Like I'm thinking of that MIT kid that you talked about, like the nature of the fact that they're at MIT, they're an outlier. but maybe we weren't looking at that child as an orchid or as an outlier because they were doing all the things and they were really good at doing all the things and maybe they're disinhibited and maybe they're the opposite of the scary kid to raise but we still need to think about that puppy that you adopted versus the dandelion dog that I have, who's, by the way, you described exactly, she's like 12 pounds and like kind of ridiculous.

47:44Aliza Pressman:But I do think there's a different kind of susceptibility that we don't necessarily notice because it's not as overtly, like morally

47:58Dr. Kathryn Paige Harden:complicated yes i mean i think that we have as humans been equipped by millions of years of evolution to detect and be highly sensitive to potential threats to cooperation like if you think about why are we the most at this point successful in terms of propagating in every environment species on the planet we have these big brains that we use cooperatively we develop language in order to communicate with one another and even when we go back in our evolutionary lineage at every point in the evolution of life on this planet is the evolution of cooperation which includes mechanisms for detecting failures to cooperate and enforcing cooperation.

48:57Dr. Kathryn Paige Harden:So when we see a child who, as you say, makes the hairs on the back of your neck stand up, that is, I think, an old part of your brain being like, alert, alert, alert. Like this person is, for whatever reason not manifesting overtly in their emotions the guilt or the shame or the remorse or the other concern that we think of as really foundational to being part of a tribe being part of a community i don't think that we have those same really baked in alerts for some other problems because they might not be seen as threats to cooperation right away they might be actually like over socialized to cooperate so much for this you know to the detriment of themselves and so we don't have the same spidey sense because it's more novel and it's not it's not coming on the backs of this really deeply embedded mechanism.

50:07Dr. Kathryn Paige Harden:So I think seeing the teenager who is especially anxious and very sensitive to the news and to comparisons on social media, but that just makes her, you know, get up, get up that much earlier and work out that much more diligently and perform that well in school. I think it's harder for parents to see that again, because we were not equipped in the same way to detect that as we have been equipped to detect people who don't show moral emotions. That's a pretty basic thing about being human that sets off our alert system. So I agree with you. I think there's out, I mean, in some ways, I think people are so complicated and so spiky that everyone's an outlier with regards to one thing like it's it's it's there's gonna be something it's just what is that something gonna be and

51:10Aliza Pressman:how outlying is it gonna be which is why to go back to what you said in the beginning we don't know the person or the listening or the child that they're raising and there's just There's no way, though it would be amazing, to prescribe much more than warmth and limits. Yeah. I mean, it's a tough thing, which I wish I could say the secret is XYZ.

51:42Dr. Kathryn Paige Harden:You know, I really wish I could say that. And there are, you know, there are people that point to, well, maybe there's, you know, omega-3 deficits in children with ADHD and conduct disorder, and you should make sure that they're getting all of their fatty acids. Like, I do that with my kids. Like, that research convinced me enough to give them those supplements. But there's no magic bullet. You know, there's no, there's no, and, and also part of the reason that there's so little concrete advice is because I think the science is so behind on this particular problem. Like we write fewer scientific articles about conduct disorder than any other psychiatric disorder.

52:22Dr. Kathryn Paige Harden:there's fewer grants that are given out for it when i was a graduate student i applied for a grant from the national institute for mental health and it was going to be specifically on delinquency and violence in in adolescence and nmh told me that's not mental health problems really that's not mental health work work in a drug use angle and you can be funded by nida which is the National Institute on Drug Abuse, but conduct disorder isn't part of our priorities. And that's astounding.

52:55Aliza Pressman:Again, like that's crazy because it's so predictive of so many of society,

53:01Dr. Kathryn Paige Harden:like that doesn't make sense to you. Yeah. If you have conduct disorder, you're 12 times more likely to also have ADHD. You're up to 75 % of them will have a substance use disorder in adulthood. It's estimated that a child with conduct disorder costs his family an extra$70 ,000 on average in extra medical treatment and legal costs. Like it is an extremely costly disorder. It is in some of its subtypes as heritable as schizophrenia and our NIH is saying it's not a mental health problem. How could that be? And again, this is what I wrote my book about is I think it is because we again have this binary between there's bad behaviors, which are immoral and there's biological things that which are could be the subject of science and it's so overtly bad when you're when you're really harming someone or like torturing the family cat that we have not been able as a community to wrap our minds around this is also an appropriate object of scientific study that really that really needs to be done is it different in the united

54:11Aliza Pressman:States versus other cultures?

54:14Dr. Kathryn Paige Harden:That's an interesting question. So I will say that the biggest, some of the biggest research on antisocial behavior and conduct problems from a genetic perspective has been done by researchers in Northern Europe. Right. How much of that is like, they also have all the data, to be honest, like, you know, is a little bit unclear. I think there's a long history. I mean, I get into this in my book and it might be too far to wade into for your audience, but America was founded by Christians and a very particular brand of Christians. Our legal system and our political system are really shaped by the fact that we were founded by people who were Protestant and had this reformed theology.

55:06Dr. Kathryn Paige Harden:And that might seem like, what is that theology? What are these old Christian ideas? What are pure, like literal puritanical ideas? Like what did the Puritans think about sin? Like why does that matter? And it's because I had a very particular conception of the relationship between what you inherit in the body and what you're damnable for, what you're morally condemnable for. And I think those attitudes can persist in our subconscious, even if we're not overtly religious or Christian or we're raised in that tradition ourselves. And science can be challenging because it challenges these deeply rooted assumptions to say you could inherit something that predisposes you to bad behavior, but that doesn't mean you're inherently bad, but it does mean that harshly punishing you is probably not going to work, but we do still hold each other accountable.

56:09Dr. Kathryn Paige Harden:Like those are a lot of things that might be seeming contradictory to ask people to hold in their heads at the same time. And I think it's absolutely necessary to do that if we're going to make any progress in how do we serve families whose kids are experiencing these problems? How do we help them?

56:27Aliza Pressman:This is probably like an extreme other side of this, because you could see a world where, you know, corporal punishment and being super strict and saying like, we've got, we got to like military school, the daylights of this kid, right? like clearly might backfire terribly. But then you can also see a parent who's dealing with this going, okay, so my warmth, my sensitivity, my presence, I'm going to work really hard on that. And then they get into a cycle of permissiveness and shame because it's so hard to find even when you're not thinking about all of our deep-rooted, like, subconscious ideas, I think it's really hard to find a way to be warm and loving and patient and set limits without confusing those limits as punitive in a way that's harmful.

57:35Aliza Pressman:And so you get two extreme responses that are the two worst responses you could have on either end of the continuum to the kind of kid that needs that support. So that doesn't make anybody feel better. But I just, just to say, I can see it being, I mean, we have like a gentle parenting trend right now, maybe that feels, and I don't even know what that is defined as, because I don't think it's rooted originally in science, but I could see that being on the other side of it, a feeling like I'm going to gentle my way into this, or I'm afraid to, you know, I'm afraid to go on the other side of the harsh punishment.

58:17Aliza Pressman:And I don't even know, like one of the ways I think we can ask ourselves the question is like, am I changing my limits because of their, you know, whatever they're throwing back at me in a way that's unreasonable or that goes against my values or whatever. But I think that's a very big challenge for parents right now on the side of well-meaning, well-educated. Like, I think there's a different conversation to be had.

58:48Dr. Kathryn Paige Harden:I think that's a huge challenge. I mean, that's a challenge that I have. Me too. I mean, I have three kids. I have a 13-year-old, an 11-year-old, and a three-year-old. So I have three kids that are in three different developmental stages that are pulling me in different directions. and I also tend to conflate harshness and firmness and I also tend to conflate warmth and permissiveness and thinking about these are my limits these are my boundaries this is what I am and I'm not going to do and I am the grown-up and also how do I say that how do I enforce that limit I think the fact that we struggle with that it's not just me it's not just you it's probably many of your listeners I think it's you know millennial gen x parents across the board what is that I mean I'm just really curious about what does that tell us about our culture yeah it's so hard for us to even have the practical and moral imagination yeah to in the moment especially when we're emotionally dysregulated especially when my daughter you know my daughter last night she's three and she wanted to watch bluey and i turned bluey off and she's never done this before but she just pulled off and she just bonked me in the nose and i was like what just happened here and in that moment like what is the holding the limit and not being harsh but you know in and so it was like okay I'm not gonna let you hit me like verbalizing that taking her to a chair and saying I need a break from you I'm going to leave you here I'm gonna walk into a different room and then she just crumpled in the chair and I was and then I was like oh it's not like she's she's defiant she's also overwhelmed and just is so dysregulated for my response and then me going in there and saying I did not like when you hit me I I made me feel bad it's not nice and she was like uh you it wasn't nice that you turned off bluey or something and I was like I told you I was gonna turn off bluey we're gonna have dinner I'm not really ready to to have dinner with you right now because my face still hurts and it really hurts me that you did this and she sat in the chair and I was like am I doing this right what are we doing and then maybe five minutes later she comes in and she's like mommy I'm sorry I hit you and the whole thing was so much better than if I had been like you know you're like if I had spanked her or if I Like the whole time I was like, am I doing this right?

1:01:48Dr. Kathryn Paige Harden:And was this the right response? Like I didn't know in that moment. And I think it speaks to something about how we are as a generation reinventing a way to relate to our children that is different than how many of us were related to when we were kids. And if you're making something up, there's a little bit of an improv element to it where you're like, I am figuring out the contours, the texture of what this means in real time, in real time. And that's not a definitive answer. That's just like, I'm identifying with the challenge. And I think it says something about the cultural evolution we're going through right now.

1:02:30Aliza Pressman:For sure. And I can see, I can imagine a world, also just you're thinking about it. Like you are conscious, you're making a decision in the moment, even when you've just, you know, like, Like, yeah, a person would be like, all bets are off. I'm losing it right now. And and also, if that happened, you you have enough of a experience and relationship that you obviously came back together and repaired. But what I think is interesting is there there are plenty of people for whom they would be afraid that they were shaming their child. Like, again, on the flip side of it, the other side of the dream.

1:03:06Aliza Pressman:and so on one side it's it's like you you would get so angry at her you might hit her back because you're so mad that she hit you and that feels obviously counterintuitive and problematic and then on the other side of it what if you had pretended that that was you know kids will be kids they do these things and we just move on and she didn't get a cue that like I don't like how it feels to hit my mom. Like that did not feel. So there's some moral like development that's happening in the rudder. Yeah. Yeah. Yeah. Did some feedback from you to know that like, I can love you and not want to sit with you right now because you just hit me.

1:03:46Aliza Pressman:And I think that was all that was happening, but to then layer on top of that, there's no, this isn't the same as how like we haven't really we're reckoning with a time in in parenting that feels very like did I do this right did I not do this right and so it's just interesting

1:04:06Dr. Kathryn Paige Harden:that's my long wind yeah I do think it's interesting I this is I tangentially related but I think related is there's so I briefly mentioned this in my book that when the when Puritan settlers first came to the United States they talked about child development and child discipline in a way that I think would still be very recognizable today so they talked about like you know children sort of being naturally rebellious and needing firmness and needing you know physical punishment in order to be if they didn't have those those physical consequences for misbehavior how could they ever learn to not do it and there's many of us that don't parent that way but we know people who do we maybe experience it ourselves it definitely it would it would be familiar and they encountered indigenous american communities and they were totally freaking mystified by how some of these indigenous communities parented their children they wrote letters home and being like they never spank their kids they never whip their kids they treat them always with warmth and love and yet their kids grow up to be part of these communities and know they're, you know, have a place in them and cooperate well.

1:05:31Dr. Kathryn Paige Harden:And they're, they're not running off. They're not, they don't seem to be wild out of control children. And yet the indigenous Americans are never spanking them. They literally couldn't understand what was happening. How does it work? And I think that failure of imagination is still with us where we think we just like we've heard reports that this is possible and we're really trying to figure out how it works in real time but we didn't grow up in communities where consistent warmth and firmness without harshness was the norm and so we're like artists trying to you know recreate a medium having only kind of heard reports of it but without having to like we weren't if we especially we weren't parents that way ourselves like for me the journey in this book was accountability doesn't mean punishment like those are not the same thing blame doesn't mean response like responsibility doesn't necessarily mean blame and like I think that says something about me but also I think it says something about the culture in which I was raised that it's very hard.

1:06:45Dr. Kathryn Paige Harden:It was very hard for me to pull apart those ideas. And parenting is the crucible in which you really have to pull those ideas apart.

1:07:14Aliza Pressman:indirect financial interest in products or services referred to in this episode.