Rachel Yehuda: The Biology of What We Carry

31:15Then they will start volunteering themselves in there once a month. They'll go spend a week there. Okay, so they've basically gone through the program already. Yeah. And then they'll go back. They want to come back. Yeah, because that's where they feel like they regulate and they recalibrate. Oh, wow. Then they go back into the world. And the funny thing, because I'm a, yeah, sorry. That's wonderful. I love that. A lot of veterans do that. Yes, I was about to say, yeah. Veterans that they go through their healing process and the first thing that they think to themselves is I got to help other veterans.

31:44I got to help somebody else along. I know kind of the dance moves of how to go through this process and I'm going to help somebody else. and that is a form of meaning making. That's a form of taking your pain and making it productive for someone else and kind of giving it some sort of a purpose. Those kind of behaviors change the brain too, which is what neuroscience is learning. Empathy, compassion, all those things because we are biologic beings. So our state's change is not that shocking. But the fact that people feel that urge when they have benefited from something to want to heal others is really kind of the best of humanity.

32:40And it is really promising in terms of our ability to heal as a culture from traumas. There's a very famous phrase that Vietnam vets are very famous for whenever people criticize them about being part of the war. And that was, you weren't there, man. Is it important for someone who has been through tremendous amounts of trauma to be able to speak to someone who was at the scene of a particular or similar kind of trauma? Well, what I've seen is that there's a natural fellowship between people that have had the same experience, even if they've never met each other before. So there's this intuitive connection, like, I get you.

33:29I know. I see you. I see you. I know. and so there's definitely something important to what you're saying. The question is whether if we haven't had those experiences, we can find a way to imagine what it must have been like. And that's part of training to be a therapist, really kind of learning how to open yourself up, trying to go through your life events, trying to make those connections so that you can really relate to somebody else who's struggling with powerlessness, helplessness, all those things. If you've never felt any of those things yourself, you may not be able to relate to someone.

34:21You don't bring it and start sharing and then making that therapy session about you. That's why you go through all the training and supervision. But by the time you're starting to work with trauma survivors, you're in touch with a lot of the things that they're going through because you explored them in yourself or you tried to. And many, many people become therapists after being traumatized themselves. I've seen that. Wow. Your work deals acutely with cortisol. There's a lot of work that I've read of yours where you're talking about cortisol. And I was thinking again to the colloquial understanding of some of these things has thrown off our ability to actually understand what's going on.

35:08So cortisol, if I ask most people, and I would say it's become more and more prominent over the past maybe decade or so, people go like, oh, cortisol, that's the stress hormone. You don't want cortisol in you. There's too much cortisol. That's the thing that makes you stressed out. And I was really fascinated to read in your work about how like when you were working with Vietnam veterans, you realized there was a misunderstanding that we had of cortisol because we assume that somebody who's been through a very traumatic experience would have high levels of cortisol as in they would have high levels of stress.

35:36You found that the opposite was true for people who had come from the most traumatic experiences. Explain to me what you discovered and why that was significant. Well, we found that in combat. It was my mentor that found it first, John Mason, Earl Giller. they found it first i came as a postdoc from from the stress field and didn't believe it like these guys are stressed their cortisol should be high yeah so my wise mentors told me i should free to replicate it um to try to replicate it which i did and then it was i knew that it was a real finding their cortisol was low their cortisol was low if they had ptsd not everyone but it was more likely to be so.

36:20And then that had me scratching my head too. But on the simplest level, if you take a step back and ask yourself, what does cortisol do? It's actually not so straightforward. Cortisol has a lot of different functions. It's a very, very important hormone. You need it for digestion and mobilizing energy to the body for cognition, reproduction, thinking, and stress, right? But what does cortisol do in stress? So we talked a little bit about the amygdala before, which is the threat detector. When your body detects threat, it activates a fight or flight response. So there are a bunch of components to that response.

37:11First, you have an orienting startle response. Get everything together. Right. That's the initial shock moment. The initial shock moment. Then you activate your sympathetic nervous system to release adrenaline. Okay. Your parasympathetic system kind of slows down a bit. I mean, you can digest your lunch later. Right now, we need all of our energy to be in fight or flight. But you also activate cortisol. The hypothalamus activates the pituitary, which activates the adrenal to release cortisol. Cortisol is really important to the stress response, but one of the things that it also does is it contains the adrenaline levels.

37:50So in a way, it kind of begins the process of shutting it down, shutting down the stress response when you are in safety, once you've fought, once you've fleed, once you did the response you want to do. And it also protects your body from some of the things that had to happen so that you could do fight or flight. I mean, you might not feel that you strained your muscle when you were running, right? Because you couldn't afford to at that moment. You couldn't afford to at that time, but later you're going to feel it. So cortisol is involved in inflammation. It's involved in all of these really important jobs.

38:36And the way that I like to explain it very simply is, suppose you have a fire in your house and you call the firemen. They do their job. And they leave you with a mess to clean. I mean, they saved your life, but did they really have to break all the windows and track it all the money? I mean, you don't think of it at the time. please save my cat. But then you're looking at all the damage, right? So you got to clean that up. And I think that stress hormones help with that. And if you don't believe that, then the other way you can look at it is think about inflammation, right? When you have an infection and your white blood cell count is high, that doesn't feel good.

39:20You get a fever. Nobody likes to have an infection. But those white blood cells, they're helping you fight the foreign intruder. So you don't want to say, hey, let me kill off those white blood cells. So I think people have the same feeling about cortisol. It's linked with stress. Stress, we don't like. But that's not the only reason it exists. That's not the only reason that it exists. And also, if you're going to have stress, you want to be able to have a stress response. If you're going to have an infection, you want to be able to fight them off. So yes, it won't feel pleasant. It won't feel good.

39:58So to use that analogy then, could it be that, am I correct in saying that PTSD and its effects on your body and your cortisol levels are that it's an infection that's so big and so bad that the white blood cells sort of diminish and now you don't have enough white blood cells going forward. Yeah, to carry the analogy, you could think about an autoimmune disease, right? When you start attacking your own healthy tissue. But yes, I mean, the thing about the trauma response is that at some point this was the right thing and now it isn't, right? But I'm still doing it. My body's still doing it. This is the way I understand it.

40:40It's really, really complicated. And what happened in our early studies is that as I was trying to figure out the why of the low cortisol, it really led me away from cortisol. Ironically, it led me to the receptors and the molecular aspects and into kind of epigenetics and how the system is calibrated. So you can't take a cortisol level on someone and know whether they have PTSD or not. It's a generality. It was as a group, people certainly didn't have high cortisol and tended even to have lower cortisol. When we researched it, we realized it was just a matter that the system had recalibrated.

41:26And it had recalibrated to have low stress hormones. Why? Because if you need to respond to stress again, Again, you're better off starting out low so that you can act. Oh, wow. That's what I think. All of these are just my opinion. People could have different opinions. But this is just how I see it after doing this for decades, really. This is just how I put it together. So I don't think biology betrays us. I think our environments betray us and our bodies do the best they can. And sometimes, you know, it's too much. So what's wrong in trauma isn't our bodies, it's what happened. And so besides mounting biologic responses that try to adapt, but may do so imperfectly, create traumatic memories that aren't good, but we need to have them because we need to remember.

42:28How do we minimize the damage done by trauma by using society as a buffer, by using other people as a buffer, by using community as a buffer, by doing healing things, by treating people well, so that all of these things can help us get through it because trauma is a fact of life. When PTSD was first diagnosed in 1980, the assumption was that trauma was super rare, but everyone would get PTSD. It was just one of those rare things. And then when epidemiologic studies started to ask people, just regular people in the world, have you ever been exposed to a trauma? It was like, yeah, 70 % of people.

43:15And that's an underestimate. You've got to imagine it's an underestimate. So what the field of trauma I realized is, oh man, trauma is really common, but PTSD doesn't always happen. So that means we're complicated. And we have many different kinds of ways of responding, but one of them is certainly PTSD. We're going to continue this conversation right after this short break. If you like YouTube, you'll love YouTube Premium. It's destroying athlete, creator, and YouTube Maxer. YouTube Premium enhances how I use YouTube with awesome features like offline downloads so I can download my favorite training videos before I hit the gym.

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45:25When we talk about the world letting us down, I wonder if there's any parts of your research that have looked at whether we are ill-equipped to deal with the world that we've evolved for ourselves. Because, you know, when you're talking about trauma, I take us back as humans to a time when fewer things happened. So let's say there was a forest fire. Most times it would be one forest fire and then it's done. And it takes a few years maybe before there's another one. An earthquake is the same thing. Being attacked by a lion doesn't really happen every day, et cetera, et cetera, et cetera. And so when you live in those communities and you're in a smaller world, I could imagine that you would have fewer things that could traumatize you.

46:07I could be wrong. But I wonder if like some of the work has looked at what it means to live in a world where now our traumas could either be imposed upon us or even reignited by a world that shows us things. So you open your phone any given day. You have no way of knowing what's going to come into your world or into your mind. You get what I'm saying? Totally. Like something can just get thrown at you. And I'd love to know if that's part of your work, if you look at how our environments can re-traumatize us or help us to heal in a different way. I think we become desensitized. Yeah. So I think we can get very, very upset about trauma, but then when it happens for the 200th time, I mean, what was it like when we saw that first school shooting?

46:56was like, how can somebody shoot in a school? And now I think people really accept it as a fact of life. It's horrible. It's tragic. People worry about it happening. But you sort of adjust to a new baseline of violence in society. and when you adjust, it's like the people that live with chronic abuse that we talked about earlier, you just take it as a fact. Doesn't mean that it affects you more or less, but it's just part. You just don't feel like you can escape it. You lose the context that it doesn't have to be this way, that there's an alternative in a world where there isn't this level of violence, and that used to be the case.

47:54But I think for now, this generation has just grown up with a lot of violence and the potential for a lot of violence. So it can make us feel desensitized and powerless. It could also make us feel very traumatized and helpless.

48:19I don't know if having lots of trauma makes you resilient. I don't see that as a society, all this trauma has helped us that much. Maybe I'm missing something, but it's not something that I can tell you that has built our character or something like that. But many of us have found ways to lead meaningful lives and try to do so. And what I've found is that that usually involves helping someone else that is traumatized or that needs to be helped. It's an interesting thought, just the idea that repeated trauma, especially in today's society, whether we're watching it, seeing it, being informed of it, experiencing, et cetera, only pushes us to one side of it.

49:11So it's like either we're getting completely desensitized or we're being completely traumatized. Well, those are two sides. Right. No, but I'm saying there's that like sort of middle part where it's like we would be healing the thing and then trying to, it's such a complicated world. I can see why you have to. Well, no, I mean, you could have that option. I mean, if people decided that some traumas are in our control and acted to try to not have those traumas, then that would be the third option. I mean, but we live in a world where people feel that we have to solve disputes by war, for example.

49:54Or we live in a world that hasn't prioritized having less trauma. Right. We just haven't prioritized it. Maybe it would be something to think about doing. Yeah, there's weapons for mass destruction, but not many for mass reconstruction. Do you know what I mean? And I often think, do you think that there was a time in our lives where trauma and violence became commercialized? What do you mean by that? Movies that were super violent, that show combat as glamorous and doesn't show you what... I've never seen a movie, for example, that's a blockbuster that shows what happens in the wake of a war. Oh, The Hurt Locker.

50:43No, there were really good ones. The Deer Hunter. I mean, there's some really good movies that I think did make you stop and think about the cost of war. I don't know if they were blockbusters or anything like that. I saw them. I know I saw them. They won the Oscar, not the box office. Maybe.

51:06Again, I don't know. I mean, I think that we live in a society that has got a lot of trauma. And look, it's not just violence. COVID-19 was also traumatizing for many people. There are lots of ways to be traumatized. so yeah let's let's talk a little bit about the work that has i guess sort of brought your name back to prominence in a different light still in and around the same field and that's been how trauma shows itself intergenerationally um after 9-11 you studied 38 pregnant women who were near the world trade center and your findings were nothing short of revolutionary because i think for a long time, you know, while people evolved, you know, PTSD in the 1980s, and then, you know, we're evolving our understanding of trauma.

52:05Very few people ever thought that trauma was passed on or trauma could exist in somebody who did not experience the initial trauma. When you looked at these mothers who were near the World Trade Center and survived and then had children, and then you looked at their children's, you know, the readings or the findings. Like, can you walk us through that? Because I was so fascinated and also confused. Like, this is so complicated. How were you able to measure that a child had experienced or had, is it internalized? I don't even know the correct verbiage, their mother's trauma, but they weren't there for that event.

52:44Well, I mean, I wouldn't frame it as that they internalized their mother's trauma. They had low cortisol. So you found that common thread. Yeah. So we measured salivary cortisol in mothers and their babies. They were correlated. If the mothers had PTSD, they tended to have lower cortisol levels. So did their babies. But what we really found was something very interesting, which was a trimester effect. And that is what gave us the biggest clue that there is something about what happens to a mother who is stressed during pregnancy that may be able to, quote, be transmitted to their fetus and maybe live on.

53:28But I'm not the one that found that. That was a finding that was already quite in existence beginning with the Dutch hungers in World War II when the Nazis surrounded the Netherlands for this nine-month period. There was restricted food. There was restricted food, and they did very large studies of the effects of that starvation on the population, including in pregnant women and their children. Wow. Yeah. So don't give me that credit. No, no, no. They found that there could be enormous effects in the offspring who were born subsequently afterwards. And this spawned a whole science of developmental programming.

54:19But, you know, yeah, it is true. The 9-11 wasn't starvation. That was a psychological trauma. So in that sense, that was kind of cool. But what it did was it started to raise the question of how do you program the stress response of a fetus, really? I mean, we're always telling pregnant mothers, don't be stressed, eat this, do this, right? Presumably because we know that the mother can affect the fetus through the placenta, right? Right. So we were kind of mesmerized by the trimester effect, but all that meant was that the exposure to maternal cortisol during the third trimester of pregnancy is very different because in the first two months, the fetus is protected by this chemical maternal shield of an enzyme in the placenta that kind of converts mother's cortisol into an inactive metabolite.

55:31But that enzyme, that's why science is so cool, that enzyme, the activity of that enzyme kind of reduces by the third trimester because by the third trimester, the offspring is preparing to breathe on their own and they need maternal cortisol so that their lungs could mature. This is, again, cortisol is not all bad. Nothing is. Nothing in our body is all bad. It's just different times, different uses, different things. So that is why we probably had a trimester effect because there were different stress effects in the third trimester. But the reason that finding really resonated with me was because just a few years earlier, we had published a paper showing lower cortisol levels in the adult children of Holocaust survivors if the parent had PTSD, if their parents had PTSD.

56:30And so what we were wondering about was, why were their cortisol levels low? Was it because of the parenting behavior, which is what everyone said? Right. And what this finding did was it suggested, you know, maybe that's not the only way you get low cortisol. maybe the origins of low cortisol could be even earlier in pregnancy. You know what this makes me think of? Because we're from South Africa, and obviously there's a generation called the born-freeze, the ones that were born after 1994, after general elections that were inclusive happened. After apartheid ended. After apartheid ended. And the generation that's from before always looks at the generation that was born, call them born-freeze, as different.

57:14Because somehow what you've just said is they don't carry the trauma that the generation before carried. The way of thinking, the way they behave, and obviously the way they look at their parents and go, why are you worried about that? And their parents go, you should be worried about that. So I think that makes so much sense now when you look at the generational divide. And sometimes it's not that huge. It just depends when the others were born versus when the others were. But actually, to Eugene's question, how does it show up? So we know that somebody who's experienced a trauma might have a PTSD, right?

57:48And so someone's got that PTSD, they've experienced this trauma. We have certain understandings of how it might show up. But I'd love to know whether or not it's just a reading, as in like someone has low cortisol, or how it actually shows up in their life. Do they take on any of the mannerisms? Do they have any of the fears? Are those things that we can actually trace? Or is it now just something that's contained within your biology? Yeah. So what made me notice this had nothing to do with biology. I first noticed behavior because adult children of Holocaust survivors were telling me they were affected by their parents' trauma, that they had Holocaust-related imagery, that they had trouble in relationships, that they had depression and anxiety.

58:42they did kind of blame it on the homes that they were raised in, but they absolutely manifested the symptoms. But then I thought, okay, well, let me look at the hormones. But cortisol isn't really the main issue because cortisol was just what led us to understand that how it showed up could also be in terms of epigenetic changes that were present in both the parent and the child. Before you go into that, help us understand what epigenetics is and why it's important. What is that field of study actually looking at? The field of epigenetics is just the study of how genes are regulated by chemical marks that we are born with, that we can develop from the environment.

59:31And basically, think about an iPhone that has the capacity to keep updating its own self. Epigenetics really is kind of the way in which we internalize information, including from the environment. Some epigenetic changes are wired in, but for stress-related genes, it's a way that we can learn lessons and internalize information. People of nutrition can affect epigenetics, exercise, a lot of environment, and so can trauma. So a couple of the studies that we did really looked at epigenetic changes in Holocaust offspring and stress-related genes. And we found that in many cases, they had changes that were related to different aspects of maternal or paternal exposure.

1:00:26Not all of these were negative changes. Some of them actually were adaptive or were associated with protective effects, but it shows up biologically. But the best way that I can explain it is, again, not my work. It's an animal study that was done that I think, I love this study. It came out at, I didn't know about it when we had our findings. So when I found out about it, I felt very validated. but there was Brian Diaz and Carrie Ressler, they took male pups, they fear conditioned them, they exposed them to the scent of cherry blossom and gave them a shock so that after a while, just the scent of the cherry blossom could cause a fear response in the animal.

1:01:17Okay. So that was associated with epigenetic changes in brain and sperm. Now, when those rats were bred with non-stressed females, the offspring of that union had a sensitivity to the cherry blossom as well as epigenetic changes in brain and sperm. But this is what I mean by sensitivity because this really says it all. They were not born being afraid of the scent of cherry blossoms. However, if you began to do the same study where you expose them to the smell and then shock them, they would learn like two or three times to be afraid. If it took, let's say, 10 for their dad to figure this out, they're figuring it out.

1:02:11It almost was like a dormant. It was like this. It's a preconditioning. It's a preconditioning in case you encounter this. Wow. I'm encoding some information. And the genes that had the epigenetic marks had to do with smell. So again, we don't know a lot about how it works. We know that sperm is one of the ways. We know in utero is one of the ways. We know that eggs can be another way. When sperm and egg join, a lot of the sperm genes are regulating the placenta, so father influences don't go away. But all that means is it's really pretty complicated to unpack. But the reason I really like that animal study is because it's so clear and it really resonates.

1:03:04The idea isn't that you inherit trauma. You don't inherit trauma. You don't inherit a traumatic memory. You inherit kind of a bias, a signal. And that is useful. Sorry, I'm excited because you like it. Yes. Yes. It makes so much sense. It totally makes sense. Please go ahead. Sorry, sorry. I couldn't contain my excitement. No, I was excited too. I wish that human work, as we call what we do, could be as clear cut. It isn't. But we're right there. We try to ask the right questions and do the best we can. and try to get a signal. If we were only operating without also having animal work, I wouldn't be as confident.

1:03:51If it was only animal work without our kind of work, who knows, right? But we're seeing the overlaps. When you see the imperfection of both kinds of studies coming together, it suggests that something's going on, that these phenomenon are real. But I just want to caution against the fact that the minute we say that the environment can influence our molecular biology and our genes, that just means that that can keep going. And that's why I'm such a fan of healing environments and therapy and healing. Because if it's true that our biology changes in response to the environment, don't stop at trauma.

1:04:37Keep going. Yeah. Keep going with healing, and then your body should be able to adapt because that's the big lesson in all of this, that we're not stuck in our bodies. Our bodies record lessons, and a lot of them are painful. And that is awful that terrible things happen. The fact that we can learn from them is magnificent. So how much do we have to then think of trauma or the inherited elements of the epigenetics? How much do we have to think of that as a scar versus a preparation? Like should we think of it as good or bad or should we not even think of it as either? Should we just go, it just is?

1:05:24Yeah, just never think about good or bad because biology isn't about good or bad. Yeah, it just is or isn't. It's about adaptation and trying to match what you need with what you got. It could be very difficult. In the Holocaust survivors, they developed changes in enzymes that were responsible for helping them prolong metabolic fuel during starvation. Wow. But if you live in an environment where food is plentiful, that might make you more susceptible to metabolic syndrome or type 2 diabetes or hypertension, right? Because now your body is wired for something that was needed in a prior generation.

1:06:09But biology doesn't know whether the offspring's going to be in the same situation as the parent, right? And if not, maybe a different kind of adaptation can be made going forward. So I would just think, I wouldn't say that it's good or bad, but I would say that it matters because it helps us understand our sensitivities. If we come from legacies of violence where our people were victims or even perpetrators, which is a whole other legacy that we never talk about. Oh, wow, that's interesting. Right. But that can be tough too. We're going through that in South Africa. Wait, wait, wait. In what way?

1:06:53Say more on that. Well, I mean, sometimes it's not a matter of the fact that your ancestors were victimized. Sometimes they were the aggressors. And what do you do with that? As in like that might be passed down or the effects of it are passed down? If we're saying that experience calibrates and some of those lessons are carried forward, then that's all experience. It can be very traumatic for people. look it was a generation ago but when I first started doing my my work one of the first people that replicated our low cortisol findings was in Germany and I was I was invited to go to Germany and you know I went and the first thing that everyone was trying to tell me in that 30 years ago was how difficult it was to be German and have this legacy of what Germany did.

1:08:06Right, of what the Nazis did. Yes, and that had been something that many people struggled with. So we struggle with our legacies. They matter. And so we have to come to terms with it. And when we see ourselves kind of hyper-responding or having reactions that we don't understand. We shouldn't discount or ignore those reactions. We should try to say, I wonder where that's coming from. I wonder what is making me so hypersensitive to this. Some people are very hypersensitive to bullying. Some people are very, they don't care, right? That comes from somewhere. Where? I feel like I'm learning so much.

1:08:51and obviously we had a little bit of a conversation before, and I'm thinking there is so much about trauma and how we behave that we are predispositioned to be. Like when you said it's passed down genetically on us. We're biased. We're biased. That's not predisposed. We're biased. We're biased. The way we see it and the way we behave. But we can change it. We can change it. And I was having a heated argument with someone the other time when I noticed sometimes in South Africa, there's obviously what Black people went through and what the Afrikaners in that country had put Black people through.

1:09:29And even after all these years, there's certain things that you'll notice that an Afrikaner person would say that a Black person would never say. And then you think to yourself, after all these years, we all grew up in the same environment. Surely you see that what you're saying is inappropriate for the time now. But like you said, it's about where they're from and what they go through. and we sometimes obfuscate that responsibility and make it about culture and the environment that they find themselves in. But sometimes from the looks of the research that you've done, it goes way deeper than that.

1:09:58Yeah, and I don't have all the answers. Absolutely. I don't have all the answers, but I know that trauma is bigger than just one event to one person. Yeah. And I think that's really the only thing I know for sure. And knowing that, though, should give us some marching orders in terms of figuring out how we want to live our lives, how we want to set up our societies. Yeah. Don't press anything. We've got more What Now? after this. If you like YouTube, you'll love YouTube Premium. It's destroying athlete, creator, and YouTube Maxer. YouTube Premium enhances how I use YouTube with awesome features like offline downloads, so I can download my favorite training videos before I hit the gym.

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1:12:07When I look at some of your work, collective trauma is one of the areas that you really focus on. So war, genocide, 9-11. But you also really make an effort to point out that we shouldn't limit it to those massive events. And we spoke a little bit about this earlier in the conversation. But I wanted to know, does that also show up in the same way? So we know that if somebody, you know, suffered through 9-11, we know, you know, through your work, if it's a Holocaust survivor, if it's a, you know, a Palestinian child, if it's like we probably will find all of these things in their genes. But do we see the same information if somebody was bullied in school?

1:12:48Do we see the same? Is it the same level in their bodies or is that where there's a disconnect between the mind and the body? My guess would be that it is the same or similar, but it's harder to study because the reason that I like to study homogeneous groups, even within a homogeneous group, there's a ton of heterogeneity, is that the biology is such a moving target. I want to study it in relation to an event that was 30 years ago. But meanwhile, the biology is busy with what it has to do today. And if people are, I mean, things like body weight, age, there's just a million factors that are influencing today's biology.

1:13:31So if you have, and again, a lot of people have not replicated the low cortisol finding, but mostly they would do it in a mixed civilian sample because the way in which people are so different from one another in the sample, the heterogeneity of the sample makes it harder to find any kind of a signal. But theoretically, I don't think that having a trauma alone is materially different. And in some cases, it could be worse because you don't have the community and you don't have other people. When you are a rape victim, you go home and you probably won't talk about it. You are pretty sure that people will blame you or that you're ashamed in some way or that people won't understand or they will feel uncomfortable and will distance themselves from you.

1:14:31So sometimes you're suffering from things by yourself without being part of a survivor community, which can also compound the effects so yeah you know you never think of it being community i know but which i know is like it's really crazy yeah but i but i've read stories about how um you know people who were lucky enough to survive a plane crash if they survived it collectively yeah have a different experience of it than if they were like the sole survivor there's a there's a different there's a we survived the plane crash or we were in a plane crash versus I was in a plane crash. It makes me then wonder, what would treatment be like if we thought of these things as having happened right after the time?

1:15:24Like I've seen in some of your work, you talk about cortisol and I think it was hydrocortisone that you were looking at. This really sparked my curiosity because there were some studies where you were looking at whether or not you could affect the levels of cortisol in a person right after they'd experienced a traumatic event, right? And the purpose for that was, if I understand right, to sort of get their body at least back to the place where it was regulated right afterwards so that the trauma didn't have as long-lasting an effect. Talk me through that and the basic principle behind it and whether or not you've made any breakthroughs in this work?

1:16:01It's an example of a theory that really should work theoretically and then in practices. Good old science. It doesn't work as well. Or comedy. Yeah, you're not drunk. But the idea was that if cortisol is important in helping to damp down the adrenaline, then why don't we just give one big dose of hydrocortisone in case it's low to help us recalibrate the sympathetic nervous system. I don't know the results. We did a pilot study and there was a small signal, but it wasn't like, oh my God. We're just wrapping up a study that's been in the works since COVID started, which was a great time to start this.

1:16:46Right. Not, but I'll let you know. I think that these are very hard studies to do, to follow people from the emergency room and then kind of treat them in a double-blind placebo-controlled way. And also, since the time that I thought that was a good idea, I really changed my mind a lot about whether we should be doing interventions acutely. I think the kind of interventions that we need are what help people naturally bring down their sympathetic nervous system arousal by hugging them, by holding them in community, by showing them that we care about them, not by giving them cortisol. Although if it really works well, that would be a great thing for someone to carry around in their Kevlar during a critical incident because it can't hurt you in any way to prevent PTSD, which is what we said in the grant that got funded.

1:17:54But the other thing that has happened to me since that time is that I've become really interested in psychedelic assisted therapy for trauma and PTSD. And I think that's a better way to kind of help people with their trauma and PTSD because it allows people to access kind of in parallel a lot of life events, not just focus on one, and also brings in kind of the intergenerational component because you bring your entire identity with you into kind of the psychedelic work. So, you know, my views have really shifted. I started out kind of very neuroscience, more in that reductionist frame. I'm going to find the thing that's broken.

1:18:48We're going to find drugs that will reverse it. And I'm not in that same place. I just think that for people, there's too many other things going on. And I've seen people heal, even without any therapy at all, from horrific things if they were embraced in the right way in the community, if they found meaning, if they were able to live in a certain way following their trauma. So it just gives me pause. I'm awed by the complexity of it. It doesn't make me want to not do it anymore, like it's too big a Gordian knot to untie. But it should make us really cautious about being overly simplistic about any of it.

1:19:40Yeah, 100%. And through it all, just this idea that we are resilient. Right. Let's talk a little bit about the psychedelics. you know um over the i would say like the last sort of two-ish years of of biden's presidency there was a lot of talk around veterans being um prescribed mdma therapy and we've seen it growing around the country around the world we've seen um ketamine therapy growing we've seen some people do therapies using psilocybin or mushrooms and one of the things people report is the ability to do work that they couldn't otherwise do because it interrupts their brain's ability to either make an assumption or jump to a preconceived conclusion or basically fall into its rote pattern, right?

1:20:30Now, maybe I'm completely obtuse and I don't know everything about it because I read what I can. It seems to me like some of the resistance to some of these therapies is applied in a way that isn't applied to some other medicine. You know, like, so they'll go, oh, we don't know if we could apply these therapies because, you know, it seems like it could be bad in this moment. But then when you look at many of the medicines that are already out there, we just accept the side effects. And I'm not saying that means we should be dismissive of everything. But I wonder what some of these therapies do that current medicines don't.

1:21:06And I wonder if you have any insights into whether, you know, the medical field is resistant to them because they've been seen as party drugs. or is there another reason that we don't know as the general public that we're not seeing on a neurological side? So when it's like MDMA or something like psilocybin. DMT.

1:21:25I've been a little surprised by the lack of reception to psychedelic therapies. It's not like we have great solutions right now. It would be different if there were definitely treatments that worked for the majority of people. And we could say there's a lot of risk involved in these approaches, so let's stick to the things we've operationalized that we can deliver quickly and that our workforce knows how to do. But especially for combat veterans, these cognitive behavioral therapies don't do the job for them more often than not. Why? Because it's too distressing. It's distressing to really talk about a real trauma, especially if there are multiple ones.

1:22:17And also you come in with a history. There's also the issue of maybe moral injury that is very different than being a rape victim. These treatments were mostly developed for interpersonal violence where they work pretty well. but when you have something more complicated um i think you need to process it in a certain way and somehow being in this altered state where it releases a lot of self-compassion um you you suspend this like terrible self-judgment that you carry around usually with yourself you know it's a party drug for a reason it helps with social bonding so that works in the therapy room with your therapists.

1:23:04You kind of form a better relationship with them. And for some reason, you're open to looking at things that would usually just get you too upset and distressed and would otherwise make you say, I'm not doing that. Doesn't mean that it's fun and easy because it is not. But if you have the right therapists that are well-trained to know how to work with someone in an altered state and you process it a lot afterwards, you can have an amazing outcome. Most people will have an amazing outcome, which is what our study found. So why isn't everyone embracing it? Because it's very labor intensive. The psychotherapy is not the way that is a different kind of model that people will kind of need to learn.

1:24:03It's unstructured, which adds a layer of discomfort. People want to have a structure about how they're approaching therapy. And is it unstructured because you don't know what the person's going to experience or okay yeah you're you're you're getting on their bus oh yeah you're not you're not guiding them they're sort of guiding you yeah right i mean in cognitive behavioral therapy we decide in advance what trauma we're going to process you're getting on my bus here's you're going to get homework we're going to create a hierarchy of things you're afraid of we're going to i'm going to give you tools to reduce your distress you know things like that is very structured yeah um but this is different this is like well let's see where we go which a lot of people are nervous about because of the potential that it may go to places that are difficult for people that don't really have the experience and training to work in that way.

1:25:04So it's hard. It's been a hard one. I don't think that people don't think this works. I think that the question is really about scalability and training and how to really make it accessible and how to change systems so that it can happen. How do you integrate it now into curricula for people who are training to be psychiatrists, psychologists, and social workers? So I think the conversations about, oh, it used to be illegal. Yeah, but those aren't the kind of things people are really talking about when they're trying to figure out how practical it is to do this. It's hours and hours of psychotherapy in between the medicine sessions, and the medicine sessions themselves can be long.

1:25:58That's with MDMA, which is what is being proposed for PTSD. Oh, and so that's what you mean by labor intensive is the person takes it, but now they need extended periods of supervision. Now they need to have therapy. Now we have to talk about what happened. Right, right, right. We can talk about it during the session. That's eight hours with two therapists. Wow. Just for one session. So we're going to talk about it for three sessions before, three sessions after, and then again. And before you know it, you've had a lot of therapy. So that's good if I don't have 100 people that need something. And so really, it's a question of how we're going to do this.

1:26:42Now, on the plus side, once you have a tremendously good outcome, maybe your caseload will be more like a revolving door than the same people that are coming to therapy all the time. So I think this is a really promising development. It does all the things that I think are important. You don't need to talk about your trauma in advance. You might not even know what it is. It allows you to sort of access things in parallel, not just serially. A lot of it isn't verbal. We put a premium on being able to explain things we don't explain. We can't put words into everything we feel or have experienced.

1:27:36And just you come out with a sense of forgiveness for yourself that is really important. And you're not always sure why, but people come out and say, I'm a good person. Wow, that's big. That's deep. I had to do the things that I had to do, but that does not make me a bad person. I can do lots more things now. I can take off my armor. I don't have to be so defended. I don't have to let people take advantage of me. all these things that could take maybe years in regular psychotherapy to really internalize. You could say them cognitively, but feeling it and saying it and knowing it is really where I think the psychedelic is just that superpower because it sort of ties all of it in together.

1:28:33Practical, it's not. But again, neither was open heart surgery when people first did that. Neither are any of these things that turn out, neither was a computer that we all wear on our watches now or on our phones. All of these things started out to be very daunting, but once people see the benefits of it, then we find ways. I think that's what we're actually good at as humans. We're good at taking the impossible and making it scalable, but we can't put so many barriers up right now. Again, the studies were criticized.

1:29:19They were hard on those studies, but we're talking about a Schedule I compound and we're talking about the necessity of psychotherapy. I understand why they were concerned, but nothing that I've heard is something that can't be resolved. There's no reason not to anticipate this in a future. There are no barriers that I see once we develop ways of training people, once we start doing more research where we figure out the kinds of therapies that might support this. And maybe there are some psychedelics that don't need as much therapy. I don't know. People say that. I'm not sure. I need to see some data.

1:30:05But it's promising. And I think that in this world, we need some way to access particularly compassion, empathy, all those things, forgiveness. And the one thing that absolutely happens to people that have had psychedelic therapy and healed is they turn right around and try to figure out how to help other people get this. I think what you've just done here, amazingly, is express in words what I've been struggling to express to other people who haven't partaken in something that I've done, which was ayahuasca. Oh, wow. And I think I didn't know what I was going through until I went through it and then until I came out of it.

1:30:49But you're right, the level of compassion and acceptance and reconciling your past with your present so that you can have a better future is something that I couldn't explain in words. It's very hard to explain. And the amount of healing and what I realized coming out of it. And obviously you have a debrief with a shaman afterwards was the fact that all the versions of myself that I've seen during the ritual is this one I love the most. And it helped me accept the me now, then anguish about what the future is going to be like or what my past growing up was like. I was like, there's decades and hundreds and thousands of years of me's.

1:31:25And about this one here, it's a vacation. That's an extraordinary story. Now imagine if you were able to just really talk about it a lot in therapy. And imagine if there were a lot of difficulties that you were able to really process all the things because you remember them. Vividly. vividly. And imagine the wonderful opportunity to really say, I wonder what that meant. Maybe it was a voice that came and talked to you. Maybe it was an ancestor. Maybe it was a realization or a vision. So the question is, is that a luxury or is that a necessity? And I think that's kind of the debate that the field is having right now.

1:32:11Can we bring this in a group like Ayahuasca to a bunch of people and really heal in community. Again, it's not what mental health is like today. Yeah. So how quickly can we change how we look at things? I mean, right now we're living in a world where things change rapidly. So maybe we can change rapidly. I don't know. But that's kind of the task, I think. You know, as I was looking through all of the work and the things you say, I couldn't help but think to something my mom said to me, which I still don't know. I thought it was a joke because it was written well, but I don't think she really tells jokes in that way.

1:33:00We were driving through the streets in Johannesburg and she saw a homeless white person who was begging at the traffic lights. And my mother always has money to give to homeless people she just drives around like that and she gave this homeless person money but the difference was after she gave the guy the money she turned to me and she said hey she said ah shame yes which translated means damn white people they're really suffering and then i went hmm i mean okay i can you can you explain more and she and i said but there's this black homeless people as well and she said something that really stuck with me and your work made me it it triggered something for me in your work she said yes I know that black people are suffering as well she said but these white people they don't know how to suffer oh and what she was saying was interesting she wasn't assigning suffering to anybody she wasn't saying that suffering belongs to anybody but she was sort of speaking to something in your work that I'd love for you to elaborate on and she was in the same way that trauma or the effects of trauma can be inherited.

1:34:07My mom was alluding to something that your work speaks to, and that is that resilience may also be inherited. Do you see that in your work? A hundred percent. That's the major lesson here. That's a beautiful story. And it reminds me of a story that my mother also tells me about how her father, who had a grocery store used to give not only to people that needed, but to wealthy people who used to be wealthy, but maybe someone had died in the family, and he just suspected that things were not going well, but perhaps they were too proud to say something. And she would say the same thing that you did.

1:34:52Yeah, they used to be wealthy. Yeah, they're not other people. And he would say, yeah, but it's much harder when you used to have everything. And now you don't then when you've always had less. And that's the same thing that your mother was saying. We know how to be resilient. We know how to cope with adversity, but this person may really be flattened by it. And so I'm going to help. It's very compassionate. If we lived in a world where everybody thought that, we'd live in a wonderful world. Right. And so how do we get that going? This is a world where it feels very polarized. It feels like we can have empathy for our own.

1:35:49Yeah. But really, it's exactly what your mother said, that you have to be able to look at the other and see that pain. And if we do that, then I think that to me is meaning-making and resilience. And it really then takes the lessons of trauma and maneuvers them in a completely different way. Well, thank you very much, because I think what you've left us with is the idea that, you know, not that we didn't think it was with trauma is real. The intergenerational effects of trauma are very real. But if I'm hearing you correctly, you've basically told us to remember that trauma isn't a prison. It's not a cage.

1:36:36It's something that people have experienced. And we can, and sort of our jobs to ourselves, our responsibility to ourselves, is to use it as a tool to inform us and how we heal going forward, not to dismiss it, but also not to make it seem like that's the fixed place that we exist within. So thank you. Thank you very much for your work. And I love how candid you are. You know, I think that's something a lot of people don't understand about researchers and science and is that your field is punctuated with doubt. And that's sort of what it's all about is doubting, being curious, asking, finding, changing your mind.

1:37:12When you said that, I was like, I don't remember the last time I heard someone say, I've changed my mind on that. And I always think I would rather have somebody involved in science and in research who has the ability to change their mind because that's what researching is all about. Finding out things that might change your mind. So, Dr. Yehuda, thank you so much for joining us today. Thanks for having me. Thank you for having me.

1:37:40What Now with Trevor Noah is produced by DayZero Productions in partnership with SiriusXM The show is executive produced by Trevor Noah, Sanaz Yamin and Jess Hackle Rebecca Chain is our producer Our development researcher is Marcia Robiu Music, mixing and mastering by Hannes Brown Random Other Stuff by Ryan Harduth Thank you so much for listening Join me next week for another episode of What Now?

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