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

1. 0:00 – 0:51

   Trauma as Biology, Not Just Psychology

   1. TNTrevor Noah0:00

      [upbeat music] I think for most people, you know, when we think of trauma, we think of, like, a bad memory, like a flashback, a nightmare, a story, et cetera. And I think one of the more le- revolutionary ideas that you were part of putting forward was trauma is less of a psychology and more of a biology. And a lot of people, you know, butted up against this. They went, "No, this is, this is all happening only in your brain and it's a thought." And you found that there was something that was actually happening in the body. So, you know, when you talk about trauma as biology, not just psychology, what does that mean for the person who's living with it?

   2. RYDr. Rachel Yehuda0:35

      Mm.

   3. TNTrevor Noah0:36

      How does that present?

   4. RYDr. Rachel Yehuda0:38

      Well, um, for the person that's living with it, the-- it's very hard to separate out psychology and biology, and I don't think that I've been able to separate it out in my mind.

2. 0:51 – 1:37

   The Historic Debate on Fear Responses

   1. TNTrevor Noah0:51

      Oh.

   2. RYDr. Rachel Yehuda0:51

      Um, one of the earliest debates in the field of psychology, what launched the field of psychology, was really the question of, do we feel, um, fear and then our bodies have a fear response?

   3. TNTrevor Noah1:04

      Yeah.

   4. RYDr. Rachel Yehuda1:04

      Or do our bodies have a fear response and we interpret that response and say-

   5. TNTrevor Noah1:08

      That's fascinating

   6. RYDr. Rachel Yehuda1:09

      ... "Oh, I, I must be afraid," [chuckles] right?

   7. TNTrevor Noah1:12

      Yeah, yeah.

   8. RYDr. Rachel Yehuda1:12

      And to this day, one could argue it both ways. That was a very famous debate. Um, what we have found doing neuroscience studies with PTSD, with people that have PTSD, is that you can see traces of their response in their body. [upbeat music]

3. 1:37 – 2:39

   Podcast Introduction and Understanding Trauma

   1. TNTrevor Noah1:37

      This is What Now? With Trevor Noah. Dr. Rachel Yehuda, thank you so much for joining us on the podcast. This is one of those topics that I feel like everybody's interested in and everybody feels like they understand because of how colloquial the word trauma has become. But as I was reading through just s- the research reviews that I could understand, I'm [chuckles] gonna preface it with that, I came to realize that our understanding of trauma is, is flat. You know? It's flat, and it's simplified, and it doesn't fully identify the complexity of the situation we're dealing with. So maybe that's the perfect place to start. Just on the most basic level, help me understand, what is it that you actually specialize in?

4. 2:39 – 3:22

   Dr. Yehuda’s Specialization in PTSD and Trauma Effects

   1. RYDr. Rachel Yehuda2:39

      Uh, that's a good question. I've been studying the effects of trauma, mostly as they appear in PTSD, uh, for a few decades now. I'm interested in, um, why some people get PTSD, um, but the majority don't. Do they get something else, or can trauma sometimes just be something that happens and does not have any mental health effects? So I'm really interested in why we respond so differently. Um, that's, I guess, across the population. But I'm also interested in the fact that sometimes the effects of trauma also cross generations.

   2. TNTrevor Noah3:21

      Hmm.

5. 3:22 – 4:06

   Why Some People Develop PTSD and Intergenerational Impacts

   1. RYDr. Rachel Yehuda3:22

      Um, so those are pretty interesting things. And also, you know, if somebody does have PTSD, uh, what's the best way to treat that? Um, and when we talk about trauma, we also talk a lot about resilience. So what's the relationship between trauma and resilience?

   2. TNTrevor Noah3:44

      Right, right.

   3. RYDr. Rachel Yehuda3:44

      I mean, some people think, well, there's PTSD. That's kind of a, a bad outcome following trauma.

   4. TNTrevor Noah3:52

      Yeah.

   5. RYDr. Rachel Yehuda3:52

      Mental health symptoms, very difficult. But the alternative is to be resilient and not have those symptoms. And increasingly, that binary, um, doesn't feel true.

   6. TNTrevor Noah4:05

      Right.

6. 4:06 – 5:25

   The Relationship Between Trauma and Resilience

   1. RYDr. Rachel Yehuda4:06

      Um, that a lot of resilience is just about showing up, especially when you have symptoms and-

   2. TNTrevor Noah4:12

      Mm-hmm

   3. RYDr. Rachel Yehuda4:12

      ... really trying to get to a, a different place, try and make sense of what happened and try and make meaning of what happened and, and, and try to unravel some of the body's survival mechanisms [chuckles] -

   4. TNTrevor Noah4:26

      Right, right

   5. RYDr. Rachel Yehuda4:26

      ... that haven't shut off. So I think that th- those questions are, um, what preoccupy me. But I guess the central idea is that we just don't respond the same way to things.

   6. TNTrevor Noah4:40

      Hmm.

   7. RYDr. Rachel Yehuda4:40

      Why is that?

   8. TNTrevor Noah4:41

      Yeah.

   9. RYDr. Rachel Yehuda4:42

      And so, you know, there's a whole field of stress, which is where I came from. I was a neuroscientist studying the effects of stress long before I heard [chuckles] about trauma and PTSD. And that field, at least when I started, would have you believe that, okay, th- this thing happens-

   10. TNTrevor Noah4:59

       Hmm

   11. RYDr. Rachel Yehuda5:00

       ... and here's the response. And this other thing happens, and maybe it's a very similar response.

   12. TNTrevor Noah5:05

       Hmm.

   13. RYDr. Rachel Yehuda5:05

       Maybe it's slightly different because of the nature of what happened.

   14. TNTrevor Noah5:09

       Yeah.

   15. RYDr. Rachel Yehuda5:10

       But most of how we respond is about us, which really changes the conversation, and it changes how you approach this, uh, for people that are struggling after they're exposed to trauma.

7. 5:25 – 6:27

   Breaking Down Post-Traumatic Stress Disorder (PTSD)

   1. TNTrevor Noah5:25

      Well, let's, let's break this down because it's so technical, and I think it's so important for us to understand the world that it would be nice for you to hold our hand as we move through the journey of trying to understand many of these complicated ideas. So you say PTSD. Everyone, I think, just casually will use the phrase P- PTSD. "Oh, that gave me PTSD."

   2. RYDr. Rachel Yehuda5:46

      Even unnecessarily sometimes.

   3. TNTrevor Noah5:47

      Yeah, just, "That gave me PTSD."

   4. RYDr. Rachel Yehuda5:49

      Mm-hmm.

   5. TNTrevor Noah5:49

      So, so let's break that down. Post-Traumatic Stress Disorder What, what does that actually mean, post-traumatic stress disorder? What... Like, why is it a disorder and, and, and what are we actually dealing with versus how sometimes people might use it?

   6. RYDr. Rachel Yehuda6:05

      Yeah, so that, I love the way that you asked me that because you're challenging something that many people don't challenge, which is why is this a disorder? Um, and that was really the very first kind of major debate in the field as they were struggling to decide whether this should even be a diagnosis.

8. 6:27 – 7:25

   Debating PTSD as a Disorder

   1. TNTrevor Noah6:27

      Oh, wow.

   2. RYDr. Rachel Yehuda6:28

      We all know what trauma is, right? So trauma is an event that is kind of a watershed. It's big, divides your life, assuming you've had a pretty decent life before and then something happens-

   3. TNTrevor Noah6:41

      Mm.

   4. RYDr. Rachel Yehuda6:41

      And then this was me before, and now this horrific event happened. It could be an assault and abuse, combat, interpersonal violence, um, losing someone, I think. Um, that's a trauma, usually defined as something life-threatening.

   5. TNTrevor Noah7:00

      Okay.

   6. RYDr. Rachel Yehuda7:00

      You could have died. You're watching someone who died or who could have died or something terri- you hear even about something terrible that happens to a loved one, and it just changes the world for you. Um, there's another kind of trauma that's more complicated, and that is that you've always been living under conditions of abuse and neglect.

   7. TNTrevor Noah7:23

      Oh.

   8. RYDr. Rachel Yehuda7:23

      And you can't really-

9. 7:25 – 8:16

   Defining Trauma: Acute vs. Chronic Experiences

   1. TNTrevor Noah7:25

      There's no post for you

   2. RYDr. Rachel Yehuda7:25

      ... there's no, there's no pre for you. There, there, there's-

   3. TNTrevor Noah7:28

      Oh, wow

   4. RYDr. Rachel Yehuda7:28

      ... there's-

   5. TNTrevor Noah7:29

      Living in the-

   6. RYDr. Rachel Yehuda7:30

      There's not a real-

   7. TNTrevor Noah7:31

      Mm

   8. RYDr. Rachel Yehuda7:31

      ... good way to understand that there's an option in life where you're safe and-

   9. TNTrevor Noah7:38

      Wow

   10. RYDr. Rachel Yehuda7:38

       ... and you're not threatened constantly. So-

   11. TNTrevor Noah7:41

       There's an alternate universe where you're okay.

   12. RYDr. Rachel Yehuda7:42

       Yeah. Where, where, where you don't have to worry constantly about, um, being threatened.

   13. TNTrevor Noah7:48

       Mm-hmm.

   14. RYDr. Rachel Yehuda7:49

       Um, so that, that came and complicated the conversation because in the beginning, PTSD was, um, gonna be a great label for people like somebody's coming back from combat. We all understand that.

   15. TNTrevor Noah8:03

       Mm-hmm.

   16. RYDr. Rachel Yehuda8:04

       Um, especially now where we can really see what combat is like-

   17. TNTrevor Noah8:07

       Mm

   18. RYDr. Rachel Yehuda8:07

       ... and we can talk to people who have been through it.

   19. TNTrevor Noah8:10

       Mm-hmm.

   20. RYDr. Rachel Yehuda8:10

       We all get that you're gonna come back different.

   21. TNTrevor Noah8:15

       Mm-hmm.

10. 8:16 – 10:13

    Trauma from War, Holocaust, and Combat Veterans

    1. RYDr. Rachel Yehuda8:16

       Not everyone comes back the same way. It's gonna depend a lot on how you actually were before and what happened and, and what's happening now. Um, but I think the Vietnam War introduced my generation to, uh, PTSD.

    2. TNTrevor Noah8:33

       PTSD. Mm-hmm.

    3. RYDr. Rachel Yehuda8:33

       Um, and a lot of the ways that we treated Vietnam veterans when they came home wasn't very good, um, because the war was so controversial-

    4. TNTrevor Noah8:43

       Yes

    5. RYDr. Rachel Yehuda8:43

       ... that we blamed it on them. We called them baby killers.

    6. TNTrevor Noah8:47

       Yes.

    7. RYDr. Rachel Yehuda8:47

       We did not say thank you for your service-

    8. TNTrevor Noah8:49

       Yes

    9. RYDr. Rachel Yehuda8:49

       ... which is a much better way to greet a veteran that has served their country. Um-

    10. TNTrevor Noah8:54

        Mm.

    11. RYDr. Rachel Yehuda8:55

        So we all understood that. We understood... I s- I've spent a lot of time studying Holocaust survivors, um, that those people were also, um, people that everyone understood something terrible happened.

    12. TNTrevor Noah9:09

        There was an acute moment that you could point to.

    13. RYDr. Rachel Yehuda9:12

        Or, or years.

    14. TNTrevor Noah9:13

        Right.

    15. RYDr. Rachel Yehuda9:13

        But some, but some change-

    16. TNTrevor Noah9:14

        Yeah

    17. RYDr. Rachel Yehuda9:14

        ... where... And, and in the Holocaust, it was kind of gradual for the Jews, but-

    18. TNTrevor Noah9:18

        Right

    19. RYDr. Rachel Yehuda9:18

        ... but at some point, you were facing something just horrific, and how do, how do you come down from that? How do you acclimate, um, to that? And then people started realizing that they don't have to be those kinds of events at all. They could be-

    20. TNTrevor Noah9:36

        Mm

    21. RYDr. Rachel Yehuda9:36

        ... um, everyday events. Um, somebody who's subject to interpersonal violence, um, who's threatened, who's a, a sexual violence, um, uh, assault, crime, um, even something like 9/11 where there you are, boom. I don't know, some people call it terrorism. Some people call it a, a disaster or an accident. But even in a natural disaster, a tsunami-

    22. TNTrevor Noah10:03

        Tsunami

    23. RYDr. Rachel Yehuda10:03

        ... an earthquake, just like-

    24. TNTrevor Noah10:05

        Volcano eruptions. People are never the same.

    25. RYDr. Rachel Yehuda10:07

        Yeah. So the question is, um, what is the reaction?

    26. TNTrevor Noah10:11

        Mm-hmm.

11. 10:13 – 11:03

    Normal Reactions to Trauma and Recovery Expectations

    1. RYDr. Rachel Yehuda10:13

       And how long should it last? [laughs] And then at some point, you know, a reaction that you feel perfectly fine and comfortable with as being normal in the acute aftermath starts to feel like, you know, maybe I should have already gotten over this in some way.

    2. TNTrevor Noah10:32

       Yeah.

    3. RYDr. Rachel Yehuda10:32

       Like, grief is like that, right? When you first hear about-

    4. TNTrevor Noah10:35

       Mm-hmm

    5. RYDr. Rachel Yehuda10:35

       ... a loved one dying, shocking. You're very sad. Um, nobody thinks it's abnormal for people to be in deep grief at a funeral or for days thereafter. But if you would meet somebody two years later and they're still in that grief moment from two years ago, you would think, "Hmm, something that should have happened maybe didn't happen." [laughs]

    6. TNTrevor Noah11:02

       Yeah.

12. 11:03 – 12:09

    When Trauma Responses Persist Beyond the Acute Phase

    1. RYDr. Rachel Yehuda11:03

       Um, so that was the original impetus for, for PTSD, that recovery sh... So people were really debating this. Is it that recovery should have happened, but it didn't? Or is it that when the event is so horrible, you're, you're just changed? And so even in 1980, when the diagnosis of PTSD came out for the first time, even, even then, you would have had experts say... Some would say, "Well, no, most people should recover. This is a disorder"-

    2. TNTrevor Noah11:39

       Yeah. Yeah

    3. RYDr. Rachel Yehuda11:39

       ... to your question. And you'd have other people saying, "Nope, when the event is severe enough, things change, and you're going to have intrusive thoughts."

    4. TNTrevor Noah11:50

       Right.

    5. RYDr. Rachel Yehuda11:50

       "And you are gonna sort of have, um, a hyper-aroused body. You're going to be, um, a b- Very hypervigilant and on the lookout for danger because your body has survived and now it is bracing to have to survive again.

13. 12:09 – 13:20

    Revolutionary Ideas on Trauma’s Biological Impact

    1. TNTrevor Noah12:09

       You, in your work, I think revolutionized how many people thought about stress and trauma and, you know, we, we'll, we'll go through some of the, the, the discoveries that you made because it's, it's really, it's really important to see them as events and as people and then as, as things that go beyond those events and those people.

    2. RYDr. Rachel Yehuda12:29

       Mm-hmm.

    3. TNTrevor Noah12:29

       And, and we'll get into that later on. But when we, we think f- I think for most people, you know, when we think of trauma, we think of, like, a bad memory, like a flashback, a nightmare, a story, et cetera. And I think one of the more l- revolutionary ideas that you were part of putting forward was trauma is less of a psychology and more of a biology. And a lot of people, you know, butted up against this. They went, "No, this is, this is all happening only in your brain and it's a thought." And you found that there was something that was actually happening in the body. So, you know, when you talk about trauma as biology, not just psychology, what does that mean for the person who's living with it?

    4. RYDr. Rachel Yehuda13:04

       Mm.

    5. TNTrevor Noah13:05

       How does that present?

    6. RYDr. Rachel Yehuda13:07

       Well, um, for the person that's living with it, the... It's very hard to separate out psychology and biology, and I don't think that I've been able to separate it out in my mind.

14. 13:20 – 14:18

    The Interplay of Body and Mind in Fear Responses

    1. TNTrevor Noah13:20

       Oh.

    2. RYDr. Rachel Yehuda13:20

       Um, one of the earliest debates in the field of psychology, what launched the field of psychology, was really the question of do we feel, um, fear and then our bodies have a fear response?

    3. TNTrevor Noah13:33

       Oh, yeah

    4. RYDr. Rachel Yehuda13:33

       ... or do our bodies have a fear response and we interpret that response and say-

    5. TNTrevor Noah13:37

       That's fascinating

    6. RYDr. Rachel Yehuda13:38

       ... "Oh, I, I must be afraid." [laughs] Right?

    7. TNTrevor Noah13:41

       Yeah, yeah.

    8. RYDr. Rachel Yehuda13:41

       And to this day, one could argue it both ways. That was a very famous debate. Um, what we have found doing neuroscience studies with PTSD, with people that have PTSD, is that you can see traces of their response in their body, right? So for example, this was not my finding, but one of the most important findings that people hold when they talk about PTSD is that the part of the brain that is, um, the s- the threat detector, the amygdala-

    9. TNTrevor Noah14:17

       Yeah

15. 14:18 – 15:33

    The Amygdala’s Role in PTSD

    1. RYDr. Rachel Yehuda14:18

       ... um, is hyper-responsive to reminders of the trauma.

    2. TNTrevor Noah14:22

       Hmm.

    3. RYDr. Rachel Yehuda14:23

       Right? And cause, let's say, a fear response and activate a fear reaction.

    4. TNTrevor Noah14:28

       So is that similar to when, like, someone has been bitten by a dog, and then when a dog barks, the, is that, is that the amygdala that's sort of, like, resparking the dog biting them? Is, is it similar to that?

    5. RYDr. Rachel Yehuda14:38

       Potentially, yes.

    6. TNTrevor Noah14:39

       Yeah.

    7. RYDr. Rachel Yehuda14:39

       It is similar to that. That's a conditioned response. So but the question is, is somebody's amygdala more active because they're afraid?

    8. TNTrevor Noah14:47

       Oh.

    9. RYDr. Rachel Yehuda14:48

       Or are their, are they afraid still because of what happened and their body is doing what bodies do-

    10. TNTrevor Noah14:56

        It's doing its job

    11. RYDr. Rachel Yehuda14:56

        ... when they're afraid, doing its job.

    12. TNTrevor Noah14:58

        Wow. Yeah.

    13. RYDr. Rachel Yehuda14:58

        And so when you say doing its job-

    14. TNTrevor Noah15:00

        Mm

    15. RYDr. Rachel Yehuda15:00

        ... which increasingly I'm with you 100% on that-

    16. TNTrevor Noah15:04

        Mm

    17. RYDr. Rachel Yehuda15:04

        ... it becomes less of a disorder. [laughs]

    18. TNTrevor Noah15:07

        Right. Yeah.

    19. RYDr. Rachel Yehuda15:07

        Right? So how you phrased it is really important, and I think we don't unpack these things. We want to encourage people to go, um, and seek help when they've been traumatized or when they have symptoms. Um, but it isn't clear whether we have, we should be conceptualizing it as the problem of having symptoms still after trauma.

    20. TNTrevor Noah15:32

        Mm-hmm.

16. 15:33 – 16:59

    Remaining in Survival Mode After Trauma

    1. RYDr. Rachel Yehuda15:33

       You shouldn't really. You should have recovered. Or, or saying, "Well, let's see. Your body is showing signs that you're still very much in survival mode." Maybe the answer isn't only what happened in the past. Maybe the answer is also about what's happening today in your current environment-

    2. TNTrevor Noah15:52

       Yes

    3. RYDr. Rachel Yehuda15:52

       ... that is keeping that, keeping you in survival mode.

    4. TNTrevor Noah15:56

       Right.

    5. RYDr. Rachel Yehuda15:57

       Not letting you kind of say, "Okay, I can stand down." And so I'm fascinated by these questions, mostly 'cause I can't answer them yet, [laughs] right? Because the questions are better than the answers. You can... Y- you know, people are so complex-

    6. TNTrevor Noah16:14

       Yeah

    7. RYDr. Rachel Yehuda16:15

       ... that, um, we don't really know. But what seems to be very important after trauma is to, is to find a place of no trauma [laughs] , is to find a place where you really can say, "I'm safe now. I have, um, support. I have people that care for me and love me, and I, I don't have to be my battle-ready self-

    8. TNTrevor Noah16:42

       Yeah

    9. RYDr. Rachel Yehuda16:43

       ... um, or the person that's afraid of being attacked again." Um, but then the question is whether that's an internal process that you tell yourself, or how much does the world have to, um, work with you-

    10. TNTrevor Noah16:56

        Yeah. How much-

    11. RYDr. Rachel Yehuda16:56

        ... to convince you? [laughs]

    12. TNTrevor Noah16:57

        How much, how much responsibility does the

17. 16:59 – 17:44

    The World’s Role in Healing and Safety

    1. TNTrevor Noah16:59

       world bear?

    2. RYDr. Rachel Yehuda16:59

       Yes. Right.

    3. TNTrevor Noah17:01

       Yeah.

    4. RYDr. Rachel Yehuda17:02

       This is heavy stuff. [laughs]

    5. TNTrevor Noah17:04

       You're right up our alley.

    6. RYDr. Rachel Yehuda17:05

       [laughs]

    7. TNTrevor Noah17:05

       You're gonna be there in the morning when we're having breakfast. [laughs]

    8. RYDr. Rachel Yehuda17:08

       [laughs] I like to talk about this before breakfast.

    9. TNTrevor Noah17:10

       [laughs]

    10. RYDr. Rachel Yehuda17:11

        Yeah.

    11. TNTrevor Noah17:12

        Well, what you said at the beginning about what trauma actually is, is when you made examples of the tsunami or natural disaster or the Holocaust, what's happening in the Sudan, wherever, is people pick the highest level of trauma and make that as if it's the only thing traumatic. So let's say a 16-year-old getting traumatized in a war zone will not be given grace to, as a 40-year-old, to think there's other traumatic things in between their lives that have happened that can be as

18. 17:44 – 19:07

    Misconceptions About “Big” vs. “Small” Traumas

    1. TNTrevor Noah17:44

       equally as damaging. Oh, that's fascinating.

    2. RYDr. Rachel Yehuda17:46

       It is fascinating, and it's so true. We teach people what to say sometimes about how to answer the question of, have you been traumatized? What kind of traumas? We give them a checklist. In, in our research we, we have this checklist. When, when I first started studying intergenerational trauma, I would give my little checklist of things that, you know- Just to see if they had ever been exposed to combat or had interpersonal violence, had their own things. They're, they're telling me that they suffer from the effects of their parents' trauma.

    3. TNTrevor Noah18:18

       Oh.

    4. RYDr. Rachel Yehuda18:18

       And so I'm listening to that, I'm hearing it, but my scientific question is, well, let me first rule out that you haven't had your own traumas.

    5. TNTrevor Noah18:27

       Yes.

    6. RYDr. Rachel Yehuda18:27

       Right? And what I found was that people would tell me that the worst thing that ever happened to him wasn't on those checklists. Um, a lot of people, um, were telling me about how their divorces were the worst thing that had ever happened to them-

    7. TNTrevor Noah18:46

       Wow

    8. RYDr. Rachel Yehuda18:46

       ... even if they had been in combat. Or, um, honestly, it, it makes sense when you think about, um, people living at a time when w- being ch- children of, uh, genocide survivors-

    9. TNTrevor Noah19:03

       Mm

    10. RYDr. Rachel Yehuda19:03

        ... where families disappeared and were fractured.

    11. TNTrevor Noah19:06

        Yeah.

19. 19:07 – 20:36

    Trauma as Subjective and Eye of the Beholder

    1. RYDr. Rachel Yehuda19:07

       So the idea of voluntarily breaking up a family or going through those motions or the need to-

    2. TNTrevor Noah19:14

       That's almost more traumatizing for them

    3. RYDr. Rachel Yehuda19:15

       ... it, well, they said it. I mean, not-

    4. TNTrevor Noah19:17

       Yeah

    5. RYDr. Rachel Yehuda19:17

       ... all of them, but a few people would tell me that the breakup of relationships-

    6. TNTrevor Noah19:22

       Yeah

    7. RYDr. Rachel Yehuda19:23

       ... um, was very difficult for them. So I learned a lot from that. Trauma's in the eye of the beholder. Um-

    8. TNTrevor Noah19:31

       Hmm. That's a good one

    9. RYDr. Rachel Yehuda19:31

       ... we can give suggestions about-

    10. TNTrevor Noah19:33

        Mm-hmm

    11. RYDr. Rachel Yehuda19:34

        ... what we think is more likely to elicit fight or flight-

    12. TNTrevor Noah19:39

        Yeah

    13. RYDr. Rachel Yehuda19:39

        ... and, um, sustained, uh, PTSD symptoms, and usually those are big events where you could have died or you could've gotten injured. School shootings, th- th-

    14. TNTrevor Noah19:51

        Yeah

    15. RYDr. Rachel Yehuda19:51

        ... things that are unfortunately very common. Um, but you have to also give people the space to tell you what it is that is, um, very, very difficult for them. It could be something that happened early in life where they felt r- uh, a tremendous rejection. Bullying [laughs] , you know, uh, uh, people being thrown off their game or feeling that they're lesser than. All of these things can impact. And so really, um, our research has been trying to, uh, make sense of that.

    16. TNTrevor Noah20:29

        You know, it's interesting. When you say that though, I can't help but think of how those are all a form of death-

20. 20:36 – 21:53

    Trauma as Various Forms of “Death”

    1. RYDr. Rachel Yehuda20:36

       Yeah

    2. TNTrevor Noah20:36

       ... when you think about it, right? So if, if I look at your definition and we think about someone suffering or experiencing a near-death experience, whether it's their own or somebody else's or even a death experience-

    3. RYDr. Rachel Yehuda20:49

       Mm

    4. TNTrevor Noah20:49

       ... it is the ending of something. It is the sudden and shocking ending of something. It is a, it is a death of some sort. But if we extend that idea further, we'll come to find that all of these things are deaths. Like, when you get bullied as a kid, that is the death of your-

    5. RYDr. Rachel Yehuda21:03

       Safety

    6. TNTrevor Noah21:04

       ... your safety. It is the death of your ego. It is the death of your self-esteem. It is the death of your-

    7. RYDr. Rachel Yehuda21:08

       It's the little spark that-

    8. TNTrevor Noah21:09

       Yeah, yeah, yeah

    9. RYDr. Rachel Yehuda21:10

       ... that makes you feel proud of yourself or, or-

    10. TNTrevor Noah21:13

        Exactly

    11. RYDr. Rachel Yehuda21:13

        ... or any of that. Yeah. You sh- you could be a trauma researcher. That's great.

    12. TNTrevor Noah21:16

        Oh, no, no, no, no, no.

    13. RYDr. Rachel Yehuda21:17

        Oh, yeah.

    14. TNTrevor Noah21:17

        I'll, I'll just ask the trauma researcher questions. But I, but I genuinely think-

    15. RYDr. Rachel Yehuda21:21

        No, but that's exactly right. I, I...

    16. TNTrevor Noah21:22

        Yeah.

    17. RYDr. Rachel Yehuda21:22

        It's so right what you're saying. And, but we don't really have conversations like that, generally speaking-

    18. TNTrevor Noah21:29

        Yeah

    19. RYDr. Rachel Yehuda21:29

        ... in the field. Um, people are very, um, [tsks] quick sometimes to say, "Well, I don't think that's a trauma."

    20. TNTrevor Noah21:37

        Yeah. Hmm.

    21. RYDr. Rachel Yehuda21:38

        Um, I don't think I, I would ever say that, um, because first of all, we were talking about this before, it takes a long time for somebody to really tell you what happened

21. 21:53 – 23:57

    Unpacking Layers of Trauma in Therapy

    1. RYDr. Rachel Yehuda21:53

       [laughs] .

    2. TNTrevor Noah21:53

       Yeah.

    3. RYDr. Rachel Yehuda21:53

       And so if somebody say, if I say to someone, "What's your most traumatic experience?" And you tell me something, one of the things I can know for sure is that there's way more to that story than you just told me. [laughs]

    4. TNTrevor Noah22:08

       Hmm. Yeah. Hmm.

    5. RYDr. Rachel Yehuda22:08

       That that's, that's a story that just was a s- a, a title or a subtitle, but if we scratch the surface, there would be layers and layers. I mean, you're telling me, you're trying to tell me something. Um, but, you know, trauma's very, uh, deep and personal and intimate. You may, and rightly so, feel that a stranger doesn't get to know really what really affected you deep down in your core, how it made you feel small or worthless or helpless-

    6. TNTrevor Noah22:41

       Mm

    7. RYDr. Rachel Yehuda22:41

       ... or ashamed-

    8. TNTrevor Noah22:42

       Mm-hmm

    9. RYDr. Rachel Yehuda22:42

       ... or any of those things. Those are very private. A lot of people do not disclose very deep traumas to their therapists for years till they've established a better foundation of trust and safety.

    10. TNTrevor Noah22:58

        Right.

    11. RYDr. Rachel Yehuda22:58

        It can take people a long time, um, [tsks] to talk about things. And even if you think you know, let's... School shooting, right? Something happened. It was on the news. I know this happened to you. I saw you on camera.

    12. TNTrevor Noah23:11

        Yeah.

    13. RYDr. Rachel Yehuda23:11

        I know this was bad. You don't know what happened before, and you don't know what's happening now. So you may not have all the details that you need. What you go on is really what the person tells you.

    14. TNTrevor Noah23:26

        I also wonder, you know, when, when, when you talk about it as w- or, or when we think about the framing-

    15. RYDr. Rachel Yehuda23:33

        Yeah

    16. TNTrevor Noah23:33

        ... we'll go disorder, not disorder, get over it, not get over it, when are you supposed to, when are you not supposed to. While you're saying that, I'm thinking of the varied roles that people play in a society, right? So, um, o- one thought that sprang to mind was a, a study that was conducted once where they showed couples who had been together for a long time sort of split the memory load in a relationship.

    17. RYDr. Rachel Yehuda23:56

        [laughs]

22. 23:57 – 25:31

    Shared Trauma and Memory in Communities

    1. TNTrevor Noah23:57

       And so if people were together for a very long time, they may go on the same vacation. One person in the partnership would remember every detail about the food, the other person wouldn't But the other person would remember every detail about the activities. And it's, it's interesting, even when I talk to couples who've been together for a long time, I find it quite, quite fascinating. I'll say, "Tell me the story," and they'll go, "Wait, uh, uh, well-

    2. RYDr. Rachel Yehuda24:18

       Of how we met

    3. TNTrevor Noah24:18

       ... what was that person's name?"

    4. RYDr. Rachel Yehuda24:19

       [laughs]

    5. TNTrevor Noah24:20

       And the other person goes like this, "How could you not remember their name?"

    6. RYDr. Rachel Yehuda24:22

       [laughs]

    7. TNTrevor Noah24:22

       It's like, "Well, what were they wearing? How could you forget what they were wearing?"

    8. RYDr. Rachel Yehuda24:25

       Hmm.

    9. TNTrevor Noah24:25

       And you know what I mean. We, we've seen multiple studies that have shown us that in a community we start to bear the emotional load or the mental load.

    10. RYDr. Rachel Yehuda24:32

        Hmm.

    11. TNTrevor Noah24:32

        And I wonder if the same goes for trauma. You know, i- if, if I think of it as like a, a troop of monkeys, let's say, and they get attacked by a leopard, I would imagine some monkeys would be quicker to get back to their routine than others, but I'm pretty certain the role of one monkey is to stay traumatized-

    12. RYDr. Rachel Yehuda24:51

        Hmm

    13. TNTrevor Noah24:52

        ... to protect the other monkeys. 'Cause imagine if every monkey went back to, "Well, that ended terribly. Goodbye, James, and back to the bananas." Like, that would be a weird thing. But if we, if we sort of apportion that, that, that trauma differently, now one monkey can stay behind traumatized on behalf of everyone, and that load gets borne disproportionately. Is there, is there anything that... You know, is there anything in your work that, that, that considers that? Is that a possibility?

    14. RYDr. Rachel Yehuda25:19

        Hmm.

    15. TNTrevor Noah25:19

        I, I mean, I could just be saying something ridiculous right now, but that's how I think of it as a person.

    16. RYDr. Rachel Yehuda25:23

        Oh, I don't think that... I don't think you're saying something ridiculous at all. What, what you're reminding us is that trauma doesn't just happen to a person. It happens in community.

23. 25:31 – 27:41

    Trauma’s Impact on Ecosystems and Societies

    1. TNTrevor Noah25:31

       Yeah.

    2. RYDr. Rachel Yehuda25:31

       And it affects community. Um, what you're saying, though, reminds me of a book that I read called Memorial Candles. Um, I think it was called that. And it was a book by, um, a child of a Holocaust survivor who argues that within Holocaust families, one child bore the brunt of it-

    3. TNTrevor Noah25:52

       Yeah

    4. RYDr. Rachel Yehuda25:52

       ... a lot more than other people. So that's what, what your comment, you know, reminded me. So there's evidence for something like that. But it also reminded me that how the community, um, relates to us, um, is gonna make a tremendous difference-

    5. TNTrevor Noah26:08

       Right

    6. RYDr. Rachel Yehuda26:08

       ... in, um, how long our suffering lasts and that a lot... You know, we, we tend to think about trauma as a personal thing that happens to an individual, and then they go get therapy-

    7. TNTrevor Noah26:19

       Yeah

    8. RYDr. Rachel Yehuda26:20

       ... with, with somebody. But really, um, it affects the, the entire ecosystem. And so one of the questions we have to ask ourselves is whether we wanna develop societies that are conducive to healing from trauma [laughs] .

    9. TNTrevor Noah26:38

       Yeah.

    10. RYDr. Rachel Yehuda26:38

        Uh-

    11. TNTrevor Noah26:38

        Yes

    12. RYDr. Rachel Yehuda26:38

        ... and whether we know how-

    13. TNTrevor Noah26:39

        Mm-hmm

    14. RYDr. Rachel Yehuda26:39

        ... to treat each other nicely-

    15. TNTrevor Noah26:41

        Yeah, yeah

    16. RYDr. Rachel Yehuda26:41

        ... um, whether, um, whether we wanna be healing places, whether, whether... A- and it's hard to do that in gigantic spaces, you know? It would be nice to start in the unit of a family and [laughs] kind of-

    17. TNTrevor Noah26:54

        And then expand slowly from there

    18. RYDr. Rachel Yehuda26:55

        ... expand slowly from there. But-

    19. TNTrevor Noah26:57

        Hmm

    20. RYDr. Rachel Yehuda26:57

        ... you ... But it's not just your problem. It's not like having a rash, you know? It's like your thing. You just scratch away or whatever. It's, it's a relational issue, and that's... I know I don't sound like a neuroscientist when I say that, but it's because I've done so many neuroscience studies that I know that the neuroscience of trauma only gives you a slice of it.

    21. TNTrevor Noah27:20

        Wow.

    22. RYDr. Rachel Yehuda27:20

        There's more to it than that. The neuroscience really validates it.

    23. TNTrevor Noah27:24

        Yeah.

    24. RYDr. Rachel Yehuda27:25

        Um, and somehow people needed to see that there were changes in the brain or changes in the hormones or t- or that there were palpable changes in biology, that, that this wasn't just in their head somehow.

    25. TNTrevor Noah27:40

        Mm-hmm, mm-hmm. Yeah.

24. 27:41 – 28:51

    Biology Validating Trauma Experiences

    1. RYDr. Rachel Yehuda27:41

       Um, although again, that distinction's interesting, too. But that so much of why your biology changes is being in survival mode, and so much of being in survival mode-

    2. TNTrevor Noah27:53

       Yeah

    3. RYDr. Rachel Yehuda27:53

       ... has to do with whether you're on edge. So much of whether you're on edge has to do with whether people are calming you down or revving you up.

    4. TNTrevor Noah28:02

       Yeah.

    5. RYDr. Rachel Yehuda28:03

       Hmm.

    6. TNTrevor Noah28:03

       I've often heard of professionals who volunteer themselves into wellness centers to go sit with a community of people that feel what they're feeling, that know what they know. And you-

    7. RYDr. Rachel Yehuda28:12

       Wait, what do, what do you mean? Say more on that

    8. TNTrevor Noah28:14

       ... like, say, for example, you're not coping with stress at work.

    9. RYDr. Rachel Yehuda28:17

       Yeah.

    10. TNTrevor Noah28:17

        Then they send you away to a wellness center maybe for seven days. Then they will start volunteering themselves in there. Once a month they'll go spend a week there.

    11. RYDr. Rachel Yehuda28:24

        Oh, okay. So they've, they've basically gone through the program already.

    12. TNTrevor Noah28:27

        Yeah.

    13. RYDr. Rachel Yehuda28:27

        And then they'll go- And then they'll go back ... and they'll go back. They wanna come back.

    14. TNTrevor Noah28:30

        Yeah, 'cause they feel that's, that's where they feel like they regulate, and they recalibrate.

    15. RYDr. Rachel Yehuda28:33

        Oh, wow.

    16. TNTrevor Noah28:33

        Then they go back into the world and... The funny thing, 'cause I'm a... Yeah, sorry.

    17. RYDr. Rachel Yehuda28:37

        That's wonderful.

    18. TNTrevor Noah28:38

        Yeah [laughs] .

    19. RYDr. Rachel Yehuda28:38

        I love that. That a lot of veterans do that when they-

    20. TNTrevor Noah28:40

        Yes, I was about to say, yeah

    21. RYDr. Rachel Yehuda28:41

        ... yeah, veterans, that, um, they go through their healing process.

    22. TNTrevor Noah28:44

        Mm-hmm.

    23. RYDr. Rachel Yehuda28:45

        And the first thing that they think to themselves is, "I gotta help other veterans. I gotta, I gotta-

    24. TNTrevor Noah28:50

        Wow

25. 28:51 – 30:15

    Healing Through Helping Others and Veterans’ Stories

    1. RYDr. Rachel Yehuda28:51

       ... I gotta help somebody else along. I know kind of the, the dance moves of, of how to go through this process, and, um, I'm gonna help somebody else." And that is m- that is a form of meaning-making. That, that's a-

    2. TNTrevor Noah29:06

       Meaning-making

    3. RYDr. Rachel Yehuda29:06

       ... that's, that's a form of taking your pain and making it productive for someone else and kinda giving you, giving it some sort of a purpose.

    4. TNTrevor Noah29:17

       Mm-hmm.

    5. RYDr. Rachel Yehuda29:18

       Um, those kind of behaviors change the brain, too [laughs] uh, w- which is what neuroscience is learning. Um, empathy, compassion, all those, all those things, um, because we are biologic beings.

    6. TNTrevor Noah29:31

       Right.

    7. RYDr. Rachel Yehuda29:31

       So our states change. It's not that shocking. But, but the fact that people feel that urge when they have, um, benefited from something to want to heal others is really kind of the best of humanity. And-

    8. TNTrevor Noah29:46

       Mm-hmm

    9. RYDr. Rachel Yehuda29:46

       ... it is really promising in terms of our ability to heal as a culture from, from traumas.

    10. TNTrevor Noah29:53

        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?

26. 30:15 – 32:13

    The Importance of Shared Trauma Experiences

    1. RYDr. Rachel Yehuda30:15

       Well, what I've seen is that there's a natural fellowship between people that have been [laughs] that, that have had the same experience even if they've never met each other before. Um, so there's this intuitive connection like, "I get you. I know."

    2. TNTrevor Noah30:35

       "I see you."

    3. RYDr. Rachel Yehuda30:35

       There's this-- That, "I see you. I know." And, um, so there's definitely something important to what you're saying. The question is whether if we haven't had those experiences, we can find a way to imagine what they're-- what, what it must have been like. Um, and, you know, that's part of training to be a therapist, really kind of o- o- learning how to open yourself up, um, trying to go through your life events, trying to make those connections, um, so that you can really relate to somebody else who's struggling with p- powerlessness, helplessness, all those things. It's-- If you've never felt any of those things yourself, [laughs] right, um, you may not be able to relate to someone. You don't bring it and start sharing and then making the therapy session about you. I mean, that's why you go through all the training [laughs] and-

    4. TNTrevor Noah31:32

       Right

    5. RYDr. Rachel Yehuda31:32

       ... supervision, you know? But by the-- But by the time you're starting to work with trauma survivors, you're in touch with a lot of the things, um, that they're going through because you explored them in yourself or you tried to. And many, many people become therapists after being traumatized themselves.

    6. TNTrevor Noah31:53

       Hmm.

    7. RYDr. Rachel Yehuda31:53

       I've seen that.

    8. TNTrevor Noah31:54

       Wow. Your, your work deals, um, acutely with cortisol. You know, there, 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-

    9. RYDr. Rachel Yehuda32:09

       Mm

    10. TNTrevor Noah32:09

        ... has, has thrown off our ability to actually understand what's going

27. 32:13 – 33:19

    Misunderstandings About Cortisol and Stress

    1. TNTrevor Noah32:13

       on.

    2. RYDr. Rachel Yehuda32:13

       Mm-hmm.

    3. TNTrevor Noah32:13

       You know? So 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.

    4. RYDr. Rachel Yehuda32:41

       Wow.

    5. TNTrevor Noah32:42

       You found that the opposite was true for people who had come from the most traumatic experiences.

    6. RYDr. Rachel Yehuda32:48

       Wow.

    7. TNTrevor Noah32:48

       Explain to me what you discovered and why that was significant.

    8. RYDr. Rachel Yehuda32:51

       Well, we found that in combat vet- It, it was my mentor that found it first, John Mason and Earl Giller. Uh, they found it first. I came as a post-doc from, from the stress field and didn't believe it. Like, who-- These guys are stressed. Their cortisol should be high. [laughs]

    9. TNTrevor Noah33:06

       Yeah.

    10. RYDr. Rachel Yehuda33:07

        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. Um-

    11. TNTrevor Noah33:18

        Their, their cortisol

28. 33:19 – 34:31

    Discovering Low Cortisol in PTSD Patients

    1. TNTrevor Noah33:19

       was low.

    2. RYDr. Rachel Yehuda33:19

       Their cortisol was low if they had PTSD. Not everyone, but it was, um, more likely to be so. And then, you know, that had me scratching my head, too. Um, but on the simplest level, if you take a step back and ask yourself, what does cortisol do-

    3. TNTrevor Noah33:35

       Mm-hmm

    4. RYDr. Rachel Yehuda33:36

       ... it's actually not so-- it's not so, uh, straightforward. Cortisol has a lot of different functions. It's a very, very important hormone. You need it for digestion and, um, mobilizing energy to the body for cognition, uh, reproduction, thinking, um, and, and stress, right? But what does cortisol do in stress? So one of-- So we talked a little bit about the 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. First, you have an orienting startle response. Get, get everything together. Um-

    5. TNTrevor Noah34:22

       Right. That's the initial shock moment.

    6. RYDr. Rachel Yehuda34:23

       Initial shock moment.

    7. TNTrevor Noah34:24

       Okay.

    8. RYDr. Rachel Yehuda34:24

       Then you, um, activate your sympathetic nervous system to release adrenaline.

    9. TNTrevor Noah34:30

       Okay.

29. 34:31 – 36:14

    Cortisol’s Functions in Stress and Recovery

    1. RYDr. Rachel Yehuda34:31

       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.

    2. TNTrevor Noah34:56

       Mm-hmm.

    3. RYDr. Rachel Yehuda34:56

       So in a way, it kind of begins the process of shutting it down-

    4. TNTrevor Noah35:02

       Mm-hmm

    5. RYDr. Rachel Yehuda35:02

       ... shutting down the stress response when you are in safety, once you've fought-

    6. TNTrevor Noah35:08

       Oh, yeah

    7. RYDr. Rachel Yehuda35:08

       ... once you've fleed-

    8. TNTrevor Noah35:09

       Right

    9. RYDr. Rachel Yehuda35:09

       ... once you did the response you wanna do. And it also protects your body from some of the things that had to happen so that you could do fight or flight.

    10. TNTrevor Noah35:20

        Hmm.

    11. RYDr. Rachel Yehuda35:20

        I mean, you know, you might not feel that you, um, [laughs] you know, strained your muscle when-

    12. TNTrevor Noah35:27

        Yeah

    13. RYDr. Rachel Yehuda35:27

        ... you were running, right?

    14. TNTrevor Noah35:28

        'Cause you couldn't afford to at that moment.

    15. RYDr. Rachel Yehuda35:30

        You couldn't afford to at that time, but later you're gonna feel it. So cortisol's involved in inflammation. It's involved in all of these, um, really important, um, jobs. And the way that I like to explain it very simply is suppose you have a fire in your house and you call the firemen. They do their job. And they leave you with a mess to clean. I mean, they saved your life, but did they really have to break all the windows and track in all the mud? [laughs]

    16. TNTrevor Noah35:59

        [laughs]

    17. RYDr. Rachel Yehuda36:00

        I mean, you don't think of it at the time. [laughs] Right?

    18. TNTrevor Noah36:03

        You just want your house saved.

    19. RYDr. Rachel Yehuda36:03

        Please save my cat, you know?

    20. TNTrevor Noah36:05

        Yes. Yes.

    21. RYDr. Rachel Yehuda36:05

        But then you're, you're looking at all the damage, right?

    22. TNTrevor Noah36:08

        Hmm.

    23. RYDr. Rachel Yehuda36:09

        So you gotta clean that up, and I think that stress hormones help with that.

    24. TNTrevor Noah36:13

        Hmm.

30. 36:14 – 38:43

    Analogies for Cortisol: Firemen and Inflammation

    1. RYDr. Rachel Yehuda36:14

       And if you don't believe that, then the other way you can look at it is think about inflammation, right? When you have an infection and your white blood cell count is high, that doesn't feel good. You get a fever. Nobody likes to have an infection.

    2. TNTrevor Noah36:29

       Yeah.

    3. RYDr. Rachel Yehuda36:29

       But those white blood cells, they're helping you fight The, the foreign intruder.

    4. EUEugene36:33

       Yes.

    5. TNTrevor Noah36:34

       Right.

    6. RYDr. Rachel Yehuda36:34

       So you don't want to say, "Hey, let me kill off those white blood cells."

    7. TNTrevor Noah36:39

       Yeah.

    8. RYDr. Rachel Yehuda36:40

       So I think people have the same feeling about cortisol. It's linked with stress. Stress we don't like.

    9. TNTrevor Noah36:46

       Aha.

    10. EUEugene36:47

        But that's not the only reason it exists.

    11. RYDr. Rachel Yehuda36:48

        But that's not the only reason-

    12. TNTrevor Noah36:49

        Okay

    13. RYDr. Rachel Yehuda36:49

        ... that it exists.

    14. TNTrevor Noah36:50

        Okay.

    15. RYDr. Rachel Yehuda36:50

        And also, if you're going to have stress, you want to be able to have a stress response. If you're going to have a infection, you want to be able to fight them off. So yes, it won't feel pleasant. It won't feel good.

    16. TNTrevor Noah37:04

        So to use that analogy then, could it be that, am I correct in saying that PTSD and its effects on your body and your cortisol levels are that it's an infection that's so big and so bad that the white blood cells sort of diminish and now you don't have enough white blood cells going forward?

    17. RYDr. Rachel Yehuda37:26

        Yeah. To carry the analogy, you could think about an autoimmune disease, right-

    18. TNTrevor Noah37:29

        Yes. Yeah, yeah, yeah

    19. RYDr. Rachel Yehuda37:29

        ... when you start attacking your own healthy tissue.

    20. TNTrevor Noah37:32

        Yeah.

    21. RYDr. Rachel Yehuda37:32

        But yes, I mean, the thing t- about the trauma response is that at some point this was the right thing-

    22. TNTrevor Noah37:39

        Mm

    23. RYDr. Rachel Yehuda37:39

        ... and now it isn't [laughs] , right?

    24. TNTrevor Noah37:41

        Right.

    25. RYDr. Rachel Yehuda37:41

        But I'm still doing it.

    26. TNTrevor Noah37:42

        Right.

    27. RYDr. Rachel Yehuda37:42

        My body's still doing it. This is the way I understand it. It's really, really complicated. And what happened in our early studies is that as I was trying to figure out the why of the, the low cortisol, um, it really led me away from cortisol, ironically. It led me to the receptors and the molecular aspects, um, and into kind of epigenetics and how the system is calibrated. So you can't, like, take a cortisol level on someone and know whether they have PTSD or not.

    28. TNTrevor Noah38:15

        Mm.

    29. RYDr. Rachel Yehuda38:15

        It's a generality.

    30. TNTrevor Noah38:16

        Hmm.
31. 38:43 – 40:26

    Recalibration of the Stress System in Trauma

    1. RYDr. Rachel Yehuda38:43

       That's what I think. All of these are just my opinion. You know, people could have different opinions.

    2. TNTrevor Noah38:47

       Yeah, yeah.

    3. RYDr. Rachel Yehuda38:48

       But this is just how I see it after doing this for decades really.

    4. TNTrevor Noah38:53

       Yeah.

    5. RYDr. Rachel Yehuda38:53

       This is just how I put it together. So I don't think biology betrays us. I think our [laughs] environments betray us-

    6. TNTrevor Noah39:01

       Yeah

    7. RYDr. Rachel Yehuda39:01

       ... and our bodies do the best they can and sometimes, you know, it's too much. So what's wrong in trauma isn't our bodies, it's, it's what happened. And so-

    8. TNTrevor Noah39:17

       Hmm

    9. RYDr. Rachel Yehuda39:18

       ... besides mounting biologic responses that try to adapt-

    10. TNTrevor Noah39:23

        Mm-hmm

    11. RYDr. Rachel Yehuda39:23

        ... but may do so imperfectly, create traumatic memories that aren't good, but we need to have them 'cause we need to remember. Um, you know, how do we minimize the damage done by trauma? By using society as a buffer, by using other people as a buffer, by using community as a buffer, by doing healing things, by treating people well-

    12. TNTrevor Noah39:50

        Yeah

    13. RYDr. Rachel Yehuda39:50

        ... so that all of these things can help us get through it because trauma's a fact of life. When p- 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, you know, "Have you ever been exposed to a trauma?" It was like, yeah, 70% of people, and that's an underestimate.

    14. TNTrevor Noah40:22

        Yeah.

    15. RYDr. Rachel Yehuda40:22

        You gotta, you gotta im- you gotta imagine it's an underestimate.

    16. TNTrevor Noah40:25

        Yeah.

32. 40:26 – 44:47

    Trauma as Common, But PTSD Not Inevitable

    1. TNTrevor Noah40:26

       Absolutely.

    2. RYDr. Rachel Yehuda40:26

       So what, what the field of trauma realized is, oh man, trauma's really com- f- f- was really [laughs] common, but PTSD doesn't always happen. So that means we're complicated. Um, and, you know, we tr- we have many different kinds of ways of responding. Um, but one of them is certainly PTSD. [upbeat music]

    3. TNTrevor Noah40:51

       We're gonna continue this conversation right after this short break. This episode is brought to you by our friends at SurveyMonkey. You know, Eugene, I don't know if you've ever thought of starting a business, but every time I think about people who start businesses, I'm like, "Man, you need a specific kind of bravery." And by bravery, I mean terrifying uncertainty. Because think about it, right now, everywhere in the world, there are people making massive life-altering decisions based entirely on a vibe, just a feeling in their gut.

    4. EUEugene41:21

       That was me when joining the podcast.

    5. TNTrevor Noah41:22

       You know what I mean?

    6. EUEugene41:23

       Mm-hmm.

    7. TNTrevor Noah41:23

       But what if you actually knew the truth when you started a business? What if you knew your direct reports weren't just nodding along, but actually had thoughts that they were too polite to tell you?

    8. EUEugene41:32

       Hmm.

    9. TNTrevor Noah41:32

       Or what if you knew that your best customers were already halfway out the door to a competitor? Because let's face it, we like to say follow your heart, but in business, ignorance is a very expensive hobby. The good news, Eugene, is that SurveyMonkey takes the fear out of asking and the doubt out of deciding. It's the difference between walking into a meeting with a hunch and walking in with 500 validated opinions, which mathematically is better for your blood pressure. The truth might hurt for a second, but it's cheaper than being wrong. So let's get you a survey and some actual answers. Sign up for an annual plan at surveymonkey.com/whatnow and use code WHATNOW for two months free. That's two months free with code WHATNOW at surveymonkey.com/whatnow. Do you have any questions?

    10. EUEugene42:17

        Is it too late for me to run a survey about who doesn't like you in the podcast?

    11. TNTrevor Noah42:21

        What do you mean who doesn't like y- you? Like, like me?

    12. EUEugene42:24

        Like you, yes. Specifically the person in front of me.

    13. TNTrevor Noah42:27

        I think surveys are supposed to be anonymous so that people's feelings don't get hurt.

    14. EUEugene42:30

        But I did type Anonymous there.

    15. TNTrevor Noah42:31

        Well, I mean, now I'll know that you typed it because do, do you have a problem with the working conditions?

    16. EUEugene42:35

        I haven't sent it.

    17. TNTrevor Noah42:36

        But you want to make a survey about-

    18. EUEugene42:37

        I haven't sent it

    19. TNTrevor Noah42:39

        Yet you can just use the code WHATNOW to get two months free when you do it.

    20. EUEugene42:44

        Still have two months to complain about you.

    21. TNTrevor Noah42:46

        I feel like this got personal. [upbeat music] When, when we talk about the world letting us down, I wonder if there's any, um, parts of your research that have looked at whether we are ill-equipped to deal with the world that we've evolved for ourselves. Because, you know, when you're talking about trauma, I, I, I take us back as humans-

    22. EUEugene43:12

        Yeah

    23. TNTrevor Noah43:12

        ... to a time when fewer things happened.

    24. EUEugene43:14

        Yeah.

    25. TNTrevor Noah43:15

        So let's say that there- let's say there was a forest fire. Most times it would be one forest fire, and then it's done, and it takes a few years maybe before there's another one. An earthquake is the same thing. Uh, being attacked by a lion doesn't really happen every day, 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. I could be wrong.

    26. RYDr. Rachel Yehuda43:38

        Mm-hmm.

    27. TNTrevor Noah43:39

        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 gonna come-

    28. RYDr. Rachel Yehuda43:56

        Mm

    29. TNTrevor Noah43:56

        ... into your world or into your mind or into... You, you, you get what I'm saying?

    30. RYDr. Rachel Yehuda43:59

        Yeah.
33. 44:47 – 46:03

    Modern Environments and Repeated Traumas

    1. RYDr. Rachel Yehuda44:48

       but you sort of adjust to a new baseline of violence in society. Um, and when you adjust, it's like the people that live with chronic abuse that we talked about earlier.

    2. TNTrevor Noah45:00

       Mm.

    3. RYDr. Rachel Yehuda45:02

       You just take it as a fact.

    4. TNTrevor Noah45:03

       Hmm.

    5. RYDr. Rachel Yehuda45:04

       Doesn't mean that it affects you more or less, but it's, it's just part... You just don't feel like you can escape it. You, you lose the context that it doesn't have to be this way, that there's, that there's an alternative in a world where there-

    6. TNTrevor Noah45:21

       Yeah

    7. RYDr. Rachel Yehuda45:21

       ... isn't this level of violence, and that used to be the case. [laughs]

    8. TNTrevor Noah45:25

       Right.

    9. RYDr. Rachel Yehuda45:25

       Um, but I think for now, this generation has just grown up with a lot of violence and the potential for a lot of violence. So, you know, it can make us feel desensitized and powerless.

    10. TNTrevor Noah45:42

        Yeah.

    11. RYDr. Rachel Yehuda45:43

        Um, it could also make us feel very traumatized and helpless.

    12. TNTrevor Noah45:46

        Right.

    13. RYDr. Rachel Yehuda45:47

        Um, I don't know if having lots of trauma makes you resilient. I don't see that as a society all this trauma has helped us that much. Um, maybe I'm missing something, but I... It's not

34. 46:03 – 48:39

    Desensitization to Violence in Society

    1. RYDr. Rachel Yehuda46:03

       something that, that I can tell you that it has built our character or something like that. Um, but many of us have found ways to lead meaningful lives-

    2. TNTrevor Noah46:15

       Mm-hmm

    3. RYDr. Rachel Yehuda46:16

       ... and, and try to do so. And what I've found is that that usually involves helping someone else, um, uh, that is traumatized or that needs to be helped.

    4. TNTrevor Noah46:30

       It's an interesting thought.

    5. EUEugene46:31

       Hmm.

    6. TNTrevor Noah46:32

       Just the idea that, like, repeated trauma, especially in today's society, whether we're watching it, seeing it, being informed of it, experiencing, et cetera, o- only pushes us to one side of it. So it's like either we're getting completely desensitized or we're being-

    7. EUEugene46:46

       Incompetent

    8. TNTrevor Noah46:46

       ... completely traumatized.

    9. EUEugene46:47

       Yeah.

    10. RYDr. Rachel Yehuda46:48

        Well, those are two sides.

    11. TNTrevor Noah46:49

        Right. That's what we know. But I'm saying there's that, like, sort of middle part where it's like we would be healing the thing and then trying to... It's, it's such a, it's such a complicated world. I can see why you have to [laughs] heal.

    12. RYDr. Rachel Yehuda46:59

        Well, no, I mean, you could have that option. I mean, if people-

    13. TNTrevor Noah47:02

        Yeah

    14. RYDr. Rachel Yehuda47:02

        ... decided that some traumas are in our control-

    15. TNTrevor Noah47:06

        Mm

    16. RYDr. Rachel Yehuda47:07

        ... and acted to try to, um, not have those traumas, then that would be the third option. I mean... But we live in a world where people feel that we have to solve disputes by war, for example.

    17. TNTrevor Noah47:25

        Yeah.

    18. RYDr. Rachel Yehuda47:25

        Or, you know, we, we live in the, in... We live in a world that hasn't prioritized having less trauma.

    19. TNTrevor Noah47:34

        Right.

    20. RYDr. Rachel Yehuda47:34

        We just haven't prioritized it. Um, maybe it would be something to think about doing.

    21. TNTrevor Noah47:42

        Yeah. There's, there's weapons for mass destruction, but not many for mass reconstruction.

    22. RYDr. Rachel Yehuda47:47

        Hmm.

    23. TNTrevor Noah47:47

        Do you know what I mean?

    24. RYDr. Rachel Yehuda47:47

        Mm-hmm.

    25. EUEugene47:48

        And I often think, do you think that, uh, there was a time in our lives where trauma and violence became commercialized?

    26. RYDr. Rachel Yehuda48:00

        What do you mean by that?

    27. EUEugene48:01

        Movies that were super violent, um, that show combat as glamorous and doesn't show you what the... After, I've never seen a movie, for example, that's a blockbuster that shows what happens after, in the wake of a war. What happens-

    28. RYDr. Rachel Yehuda48:13

        Oh, The Hurt Locker. There are ... No, there are really good ones.

    29. EUEugene48:15

        Yeah.

    30. RYDr. Rachel Yehuda48:15

        The Deer Hunter. I mean, there, there's some really good, um, movies that I think did make you stop and think about-
35. 48:39 – 50:35

    Prioritizing Societies with Less Trauma

    1. RYDr. Rachel Yehuda48:39

       I mean, I think that we live- In a society that has got a lot of trauma. And look, there ... And it's not just violence.

    2. TNTrevor Noah48:48

       Mm-hmm.

    3. RYDr. Rachel Yehuda48:49

       Um, COVID-19 was also traumatizing for many people.

    4. TNTrevor Noah48:54

       Yes.

    5. RYDr. Rachel Yehuda48:54

       Um, there are lots of ways to be traumatized. So, yeah.

    6. TNTrevor Noah49:03

       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.

    7. RYDr. Rachel Yehuda49:27

       Mm.

    8. TNTrevor Noah49:27

       Because I think for a long time, you know, while people evolved, you know, PTSD in the 1980s, and then, you know, we- we're evolving our understanding of trauma, very few people ever thought that trauma was passed on or trauma could exist in somebody who did not experience the initial trauma. When you looked at these mothers who were near the World Trade Center and survived and then had children, and then you looked at their children's, um, you know, the, the, the, the readings or the findings, like, can you, can you walk us through that? 'Cause I, I was so, I was so fascinated and also confused. Like, this is so complicated. How were you able to measure that a child had experienced or had ... Is it internalized? I don't even know the, the, the correct verbiage.

    9. RYDr. Rachel Yehuda50:11

       Yeah.

    10. TNTrevor Noah50:11

        Their, their mother's trauma, but they weren't there for that event.

    11. RYDr. Rachel Yehuda50:16

        Well, I mean, I, I wouldn't frame it as that they internalized their mother's trauma. They had low cortisol. Um-

    12. TNTrevor Noah50:22

        Ah, so you found that common thread.

    13. RYDr. Rachel Yehuda50:23

        So, yeah.

    14. TNTrevor Noah50:23

        Yeah. Mm-hmm.

    15. RYDr. Rachel Yehuda50:24

        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.

36. 50:35 – 52:43

    Intergenerational Trauma and 9/11 Study

    1. RYDr. Rachel Yehuda50:35

       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 s- what happens to a mother who is, um, stressed during pregnancy that may be able to, quote, "be transmitted" to their, um, fetus and maybe live on. But I'm not the one that found that. That was a finding that was already quite in existence, um, beginning, um, with the Dutch hungers in, um, World War II-

    2. TNTrevor Noah51:11

       Hmm

    3. RYDr. Rachel Yehuda51:11

       ... when the Nazis, um, surrounded, uh, the Netherlands and for, like, this nine-month period, there was no-

    4. TNTrevor Noah51:19

       There were restricted food, yeah

    5. RYDr. Rachel Yehuda51:20

       ... there was restricted food. And they did very large studies of the effects of that starvation on the population-

    6. TNTrevor Noah51:26

       Wow

    7. RYDr. Rachel Yehuda51:26

       ... including in pregnant women-

    8. TNTrevor Noah51:29

       Hmm

    9. RYDr. Rachel Yehuda51:29

       ... and their children.

    10. TNTrevor Noah51:30

        Wow.

    11. RYDr. Rachel Yehuda51:30

        And, yeah. So don't give me th- don't give me that credit. They, they-

    12. TNTrevor Noah51:35

        No, no, I mean-

    13. RYDr. Rachel Yehuda51:36

        [laughs] They found that, um, there could be enormous effects in the offspring who were born subsequently afterwards, and this spawned, um, a whole science of developmental programming. But, you know, yeah, it is true, the 9/11 wasn't starvation. That was a psychological trauma.

    14. TNTrevor Noah51:55

        Right. Right.

    15. RYDr. Rachel Yehuda51:55

        So in that sense, that was kind of cool. But what it did was it started to, um, it started to raise the question of how do you program the stress response-

    16. TNTrevor Noah52:08

        Uh-huh

    17. RYDr. Rachel Yehuda52:09

        ... um, of a fetus.

    18. TNTrevor Noah52:11

        Mm-hmm.

    19. RYDr. Rachel Yehuda52:11

        Really. I mean, we're always telling pregnant mothers, "Don't be stressed. Eat this. Do this," right?

    20. TNTrevor Noah52:16

        Mm-hmm.

    21. RYDr. Rachel Yehuda52:16

        Presumably because we know that, um, the m- mother can affect the fetus through the placenta.

    22. TNTrevor Noah52:24

        Right. Right.

    23. RYDr. Rachel Yehuda52:25

        Right? So, um, one of the things that ... So the, so we were kind of mesmerized by the trimester effect, but all that meant was that the, um, exposure to maternal glucocorticoid, cortisol, maternal cortisol, um,

37. 52:43 – 54:26

    Historical Examples: Dutch Hunger Winter

    1. RYDr. Rachel Yehuda52:43

       during the third trimester of pregnancy is very different because in the first two months, the fetus is protected by this chemical maternal sh- shield-

    2. TNTrevor Noah52:54

       Mm-hmm

    3. RYDr. Rachel Yehuda52:54

       ... of an enzyme in the placenta that kind of converts mother's cortisol into an inactive metabolite. But that enzyme ... That's why science is so cool. That enzyme, um, the activity that, that enzyme kind of reduces by the third trimester because by the third trimester, you're pr- the offspring is preparing to breathe on their own, and they need maternal cortisol-

    4. TNTrevor Noah53:20

       Yeah

    5. RYDr. Rachel Yehuda53:20

       ... so that their lungs could-

    6. TNTrevor Noah53:22

       Mm

    7. RYDr. Rachel Yehuda53:22

       ... mature. This is, again, cortisol's not all bad.

    8. TNTrevor Noah53:25

       Yeah, yeah, yeah.

    9. RYDr. Rachel Yehuda53:25

       Nothing is. Nothing in our body is all bad. It's just different times, different uses-

    10. TNTrevor Noah53:30

        Yeah

    11. RYDr. Rachel Yehuda53:30

        ... different things. So, um, that is why we probably had a trimester effect because there were different stress effects in the third trimester. But what that ... But the reason that finding really resonated with me was because just a few years earlier, we had published a f- a paper showing lower cortisol levels in the adult children of Holocaust survivors, um, if the parent had PTSD.

    12. TNTrevor Noah53:59

        Yeah.

    13. RYDr. Rachel Yehuda53:59

        If their parents had PTSD. And 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.

    14. TNTrevor Noah54:11

        Right.

    15. RYDr. Rachel Yehuda54:12

        And what this finding did was it suggested, you know, maybe that's not the only way you get low cortisol. Maybe the origins of low cortisol could be even earlier, um, in pregnancy.

    16. TNTrevor Noah54:25

        Hmm.

38. 54:26 – 56:45

    Trimester Effects in Prenatal Trauma Exposure

    1. TNTrevor Noah54:26

       You know what this makes me think of? 'Cause we're from South Africa, and obviously we've, there's a generation called the Born-Frees, the ones that were born after 1994, after our general elections that were inclusive happened and- After apartheid ended ... after apartheid ended. Yeah. And the generation that's from before always looks at the generation that was born, call them Born-Frees, as different because somehow what you've just said is they don't carry the trauma- Hmm ... that the generation before carried, the way of thinking, the way they behave, and obviously the way they look at their parents and go, "Why are you worried about that?" And their parents go, "You should be worried about that." You know? So I, I think that makes so much sense now when you look at the generational divide. And sometimes it's not that huge. It just depends when the others were born versus when the others were. But actually to, yeah, to Eugene's question How does it show up?

    2. RYDr. Rachel Yehuda55:12

       Mm.

    3. TNTrevor Noah55:13

       You know, like, so we know that somebody who's experienced a trauma-

    4. RYDr. Rachel Yehuda55:17

       Mm

    5. TNTrevor Noah55:17

       ... might have a PTSD, right? And so someone's got that PTSD, they've experienced this trauma. W- uh, we have certain understandings of how it might show up. But I'd love to know whether or not it's just a, a reading, as in, like, someone has low cortisol, or how it actually shows up in their life. Do they, do they take on any of the, um, mannerisms?

    6. RYDr. Rachel Yehuda55:38

       Yeah.

    7. TNTrevor Noah55:38

       Do they have any of the fears? Do they have ... Are those things that we can actually trace or is it now just something that's contained within your biology?

    8. RYDr. Rachel Yehuda55:44

       Yeah. So what, what made me notice this had nothing to do with biology. I first noticed behavior.

    9. TNTrevor Noah55:52

       Mm.

    10. RYDr. Rachel Yehuda55:53

        Uh, because adult children of Holocaust survivors were telling me they were affected, uh, by their parents' trauma, that they had Holocaust-related imagery, that they had trouble in relationships, that they, um, uh, had depression and anxiety. Um, they did kind of blame it on the homes that they were raised in-

    11. TNTrevor Noah56:17

        Yeah

    12. RYDr. Rachel Yehuda56:17

        ... but they absolutely manifested the symptoms.

    13. TNTrevor Noah56:19

        Wow.

    14. RYDr. Rachel Yehuda56:19

        But then I thought, "Okay. Well, let me, 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, um, child.

    15. TNTrevor Noah56:41

        Before you go into that, help us understand what epigenetics is and,

39. 56:45 – 58:20

    How Intergenerational Trauma Shows Up

    1. TNTrevor Noah56:45

       and why it's important. What, what is that field of study actually looking at?

    2. RYDr. Rachel Yehuda56:48

       The field of epigenetics is just the study of how genes are regulated by chemical marks that we are born with, that we, um, can develop from the environment. And basically, think about an iPhone that has the capacity to keep updating its own self. [laughs]

    3. TNTrevor Noah57:10

       Mm.

    4. RYDr. Rachel Yehuda57:10

       Um, epigenetics really is kind of the way in which we internalize information, including from the environment. Some epigenetic changes are wired in. But for stress-related genes, it's a way that we can, like, learn lessons [laughs] and internalize information. Um, people ... Um, nutrition can affect epigenetics-

    5. TNTrevor Noah57:32

       Okay

    6. RYDr. Rachel Yehuda57:32

       ... exercise, a lot of environment, and so can trauma.

    7. TNTrevor Noah57:36

       Mm.

    8. RYDr. Rachel Yehuda57:36

       So one of the- couple of the studies that we did really looked at epigenetic changes in Holocaust offspring and stress-related genes, and we found that in many cases they had changes that were related to different aspects of maternal or paternal exposure. Um, not all of these were negative changes. Some of them actually were adaptive or, or were associated with protective effects.

    9. TNTrevor Noah58:05

       Mm-hmm.

    10. RYDr. Rachel Yehuda58:06

        But it shows up biologically. But the best way that I can explain it is, again, not my work. Um, it's an animal study that was done that I think ... I love this study. Um,

40. 58:20 – 1:00:55

    Explaining Epigenetics and Gene Regulation

    1. RYDr. Rachel Yehuda58:20

       it came out at a ... I didn't know about it when we had our findings. So when I found out about it, I, I felt very validated. [laughs]

    2. TNTrevor Noah58:27

       [laughs]

    3. RYDr. Rachel Yehuda58:28

       But, um, there was in- Brian Dias and Kerry Ressler, they took, um, male pups. They fear-conditioned them. They exposed them to the scent of cherry blossom, um, and gave them a shock so that after a while, just the scent of the cherry blossom could cause-

    4. TNTrevor Noah58:47

       Interesting

    5. RYDr. Rachel Yehuda58:47

       ... a fear response in the animal.

    6. TNTrevor Noah58:48

       Oh, okay.

    7. RYDr. Rachel Yehuda58:49

       Okay. So that was associated with epigenetic changes in brain and sperm. Now, when those rats were bred with non-stressed females, the, um, offspring of those, of that union had a sensitivity to the cherry blossom as well as epigenetic changes in brain and sperm. But this is what I mean by a sensitivity, 'cause this really says it all. [lips smack] They were not born being afraid of the scent of cherry blossoms.

    8. TNTrevor Noah59:22

       Yeah.

    9. RYDr. Rachel Yehuda59:23

       However, if you began to do the same study where you expose them to the smell and then shock them, they would learn, like, in two-

    10. TNTrevor Noah59:33

        Interesting

    11. RYDr. Rachel Yehuda59:33

        ... or three times-

    12. TNTrevor Noah59:35

        Oh, wow

    13. RYDr. Rachel Yehuda59:35

        ... to be afraid. If it took, let's say, 10 for their dad to figure this out-

    14. TNTrevor Noah59:40

        Oh, wow

    15. RYDr. Rachel Yehuda59:40

        ... they're figuring it out in just-

    16. TNTrevor Noah59:42

        It almost was like a torment-

    17. RYDr. Rachel Yehuda59:43

        It was like this-

    18. TNTrevor Noah59:44

        It's preconditioning

    19. RYDr. Rachel Yehuda59:45

        ... born. It's a preconditioning-

    20. TNTrevor Noah59:46

        Mm

    21. RYDr. Rachel Yehuda59:46

        ... in case you encounter this.

    22. TNTrevor Noah59:48

        Wow.

    23. RYDr. Rachel Yehuda59:50

        I'm encoding some information. Um, and the-

    24. TNTrevor Noah59:53

        Mm

    25. RYDr. Rachel Yehuda59:53

        ... genes that were, um, that had the epigenetic marks, uh, had to do with smell. So, um, again, we don't know a lot about how it works. We know that sperm is one of the ways. We know in utero is one of the ways. We know that, um, uh, eggs can be another way. Uh, when sperm and egg join, um, a lot of the sperm genes are regulating the placenta, so father influences don't go away. But all that means is it's really pretty complicated to unpack. But the reason I really like that animal study is 'cause it's so clear, and it, it really resonates. The idea isn't that you inherit trauma. You don't inherit trauma.

    26. TNTrevor Noah1:00:38

        Yeah.

    27. RYDr. Rachel Yehuda1:00:38

        You don't inherit a traumatic memory.

    28. TNTrevor Noah1:00:40

        Mm-hmm.

    29. RYDr. Rachel Yehuda1:00:41

        You inherit kind of, um, a bias, a signal. Um, and that is-

    30. TNTrevor Noah1:00:49

        [laughs] Sorry
41. 1:00:55 – 1:02:13

    Animal Studies on Inherited Fear Sensitivities

    1. TNTrevor Noah1:00:55

       sense

    2. RYDr. Rachel Yehuda1:00:55

       ... totally makes sense. Yes.

    3. TNTrevor Noah1:00:55

       Please go ahead. Sorry. Sorry. I couldn't contain-

    4. RYDr. Rachel Yehuda1:00:57

       Yeah

    5. TNTrevor Noah1:00:57

       ... my excitement.

    6. RYDr. Rachel Yehuda1:00:58

       No. I, I was excited, too. I wish that, um, human work, as we call what we do, um, could be as clear-cut. It isn't. Um, but we're right there. You know, when a trau- We try to, we try to ask the right questions and do the best we can and try to get a signal. If we were only operating without also having animal work I wouldn't be as confident-

    7. EUEugene1:01:22

       Hmm

    8. RYDr. Rachel Yehuda1:01:22

       ... if it was only animal work without our kind of work. Who knows, right?

    9. EUEugene1:01:28

       But, but we're seeing the overlaps.

    10. RYDr. Rachel Yehuda1:01:29

        But when you see the imperfection of both kind of studies coming together, it suggests that something's going on, that these phenomenon are real. But I just want to caution against the fact that the minute we say that the environment can influence our molecular biology and our genes, that just means that that can keep going, and that's why I'm so ... I'm such a fan of healing environments and therapy-

    11. EUEugene1:01:58

        Hmm

    12. RYDr. Rachel Yehuda1:01:58

        ... and healing. Because if it's true that our biology changes in response to the environment, don't stop at trauma. [laughs] Keep going.

    13. EUEugene1:02:09

        Yeah.

    14. RYDr. Rachel Yehuda1:02:10

        Keep going with healing, and then your body should

42. 1:02:13 – 1:03:41

    Inheriting Biases, Not Direct Trauma Memories

    1. RYDr. Rachel Yehuda1:02:13

       be able to adapt because that's the big lesson in all of this-

    2. EUEugene1:02:17

       Yeah

    3. RYDr. Rachel Yehuda1:02:17

       ... that we're not stuck in our bodies. Our bodies r- record lessons, and a lot of them are painful. That's, that is awful, that terrible things happen. The fact that we can learn from them is magnificent.

    4. EUEugene1:02:35

       So how much do we have to then think of trauma or the inherited el- elements of the epigenetics? How, how much do we have to think of that as a scar versus a preparation? Like, should we, should we think of it as good or bad, or should we not even think of it as either? Should we just go-

    5. RYDr. Rachel Yehuda1:02:54

       Just, just-

    6. EUEugene1:02:54

       ... it just is?

    7. RYDr. Rachel Yehuda1:02:55

       Yeah, just, just never think about good or bad because biology isn't about good or bad.

    8. EUEugene1:03:00

       Yeah, it just is or isn't.

    9. RYDr. Rachel Yehuda1:03:01

       It just ... It's about adaptation-

    10. EUEugene1:03:04

        Yeah

    11. RYDr. Rachel Yehuda1:03:04

        ... and trying to match what you need with what you got. It's could be very difficult. I mean, in the Holocaust survivors, they developed, um, changes in enzymes that were responsible for helping them prolong a metabolic fuel during starvation.

    12. EUEugene1:03:22

        Wow.

    13. RYDr. Rachel Yehuda1:03:23

        But if you live in an environment where food is plentiful-

    14. EUEugene1:03:26

        Hmm

    15. RYDr. Rachel Yehuda1:03:27

        ... that might make you more susceptible to metabolic syndrome or di- type 2 diabetes or hypertension-

    16. EUEugene1:03:32

        Yeah

    17. RYDr. Rachel Yehuda1:03:32

        ... right? So-

    18. EUEugene1:03:33

        Because now your body doesn't-

    19. RYDr. Rachel Yehuda1:03:34

        Because now your body-

    20. EUEugene1:03:35

        Yeah

    21. RYDr. Rachel Yehuda1:03:35

        ... is wired for something that was needed in-

    22. EUEugene1:03:38

        Mm-hmm

    23. RYDr. Rachel Yehuda1:03:38

        ... a prior generation. But biology doesn't

43. 1:03:41 – 1:04:27

    Biology’s Adaptability and Healing Environments

    1. RYDr. Rachel Yehuda1:03:41

       know whether you're, whether the f- offspring's gonna be in the, in the same situation as the parent, right? [laughs] And if not, maybe a d- a different kind of adaptation could be made going forward. So I, I would just think, I wouldn't say that it's good or bad, but I would say that it matters because it helps us understand our sensitivities. If we come from legacies of violence where our people were victims or even perpetrators, which is a whole other legacy [laughs] that we never talk about-

    2. EUEugene1:04:17

       Yeah, no one ever talks about that

    3. RYDr. Rachel Yehuda1:04:19

       ... [laughs] right?

    4. EUEugene1:04:20

       Mm-hmm.

    5. RYDr. Rachel Yehuda1:04:20

       But that can be tough, too, right?

    6. EUEugene1:04:22

       We're going through that in South Africa.

    7. RYDr. Rachel Yehuda1:04:23

       Yeah. Mm-hmm.

    8. EUEugene1:04:24

       Wait, wait, wait. In, in, in what way? Say more on that.

    9. RYDr. Rachel Yehuda1:04:26

       Well, I mean, sometimes,

44. 1:04:27 – 1:05:50

    Trauma as Adaptation, Not Good or Bad

    1. RYDr. Rachel Yehuda1:04:27

       um, it's not a matter of the fact that your, your ancestors were victimized. Sometimes they were the aggressors, and what do you do with that? So, you know, these-

    2. EUEugene1:04:41

       As in, like, that might be passed down, or the, or the effects of it are passed down, or the-

    3. RYDr. Rachel Yehuda1:04:44

       If we're saying that, if we're saying that experience calibrates and, and, and some of those lessons are carried forward-

    4. EUEugene1:04:54

       Yeah

    5. RYDr. Rachel Yehuda1:04:57

       ... then that's all experience. It, it could be-

    6. EUEugene1:04:59

       Mm-hmm

    7. RYDr. Rachel Yehuda1:04:59

       ... it can be very traumatic for people. Um, look, it was a generation ago, but when I first start- started doing my, my, um, work, one of the first people that replicated our low cortisol findings was in Germany. And I was, I was invited to go to Germany, and, you know, I went, and the first thing that everyone was trying to tell me in that, 30 years ago, was how difficult it was to be German and have this legacy of, of what Germany did.

    8. EUEugene1:05:37

       Right, of what the Nazis did.

    9. RYDr. Rachel Yehuda1:05:38

       Yes. And that had been something that many people struggled with. So we struggle with our legacies. They matter. And so

45. 1:05:50 – 1:09:11

    Legacies of Perpetrators and Sensitivities

    1. RYDr. Rachel Yehuda1:05:51

       we have to come to terms of- with it. And when we see ourselves kind of hyperresponding-

    2. EUEugene1:05:56

       Yeah

    3. RYDr. Rachel Yehuda1:05:56

       ... or having reactions that we don't understand, um, we shouldn't discount or ignore those reactions.

    4. EUEugene1:06:03

       Yeah.

    5. RYDr. Rachel Yehuda1:06:03

       We should try to say, "I wonder where that's coming from. I wonder what is making me so hypersensitive to this." Um, you know, some people are very hypersensitive to bullying.

    6. EUEugene1:06:13

       Yeah.

    7. RYDr. Rachel Yehuda1:06:14

       Um, some people are very, um, they don't care, [laughs] right?

    8. EUEugene1:06:18

       Yeah.

    9. RYDr. Rachel Yehuda1:06:19

       That comes from somewhere. Where?

    10. EUEugene1:06:21

        I feel like I'm learning so much, and we obviously had a little bit of a conversation before. And I'm thinking there is so much about trauma and how we behave that we are predispositioned to be. Like when you said it's passed down genetically on us-

    11. RYDr. Rachel Yehuda1:06:36

        We're biased

    12. EUEugene1:06:37

        ... we're biased.

    13. RYDr. Rachel Yehuda1:06:37

        That's not predisposed.

    14. EUEugene1:06:38

        We're biased.

    15. RYDr. Rachel Yehuda1:06:40

        We're biased.

    16. EUEugene1:06:41

        Yeah, the way we see it and, and the way we behave.

    17. RYDr. Rachel Yehuda1:06:43

        Yes. But we can change it.

    18. EUEugene1:06:44

        We can change it.

    19. RYDr. Rachel Yehuda1:06:45

        Yes.

    20. EUEugene1:06:45

        And I was having a heated argument with someone the other time when, when I noticed sometimes in South Africa, there's obviously what Black people went through and what the Afrikaners in that country had put Black people through. And 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.

    21. RYDr. Rachel Yehuda1:07:29

        Yeah. And I don't have all the answers. I-

    22. TNTrevor Noah1:07:31

        Absolutely

    23. RYDr. Rachel Yehuda1:07:31

        ... um, I, I don't have all the answers, but I know that trauma is bigger than just one event to one person. [laughs]

    24. TNTrevor Noah1:07:38

        Yeah.

    25. RYDr. Rachel Yehuda1:07:39

        And I think that's really the only thing I know for sure. And knowing that, though, should give us some marching orders-

    26. TNTrevor Noah1:07:49

        Yeah

    27. RYDr. Rachel Yehuda1:07:49

        ... um, in terms of figuring out how we wanna live our lives, how we wanna set up our societies. Yeah. [upbeat music]

    28. TNTrevor Noah1:07:58

        Don't press anything. We've got more What Now? After this. [upbeat music] When I look at some of your work, collective trauma is one of the, you know, the areas that you really focus on. So war, genocide, 9/11. But, but you also really make an effort to point out that we shouldn't limit it to those massive events. And we, we spoke a little bit about this earlier in the conversation, but I wanted to know, does that also show up in the same way? So we know that if somebody, you know, suffered through 9/11, we know, you know, through your work, if it's a Holocaust survivor, if it's a, you know, a Palestinian child, if it's a ... Like, we probably will find all of these things-

    29. RYDr. Rachel Yehuda1:08:47

        Yeah

    30. TNTrevor Noah1:08:47

        ... in their genes. But do we see the same, do we see the same information if somebody was bullied in school?
46. 1:09:11 – 1:10:32

    Trauma Beyond Individual Events

    1. RYDr. Rachel Yehuda1:09:11

       even in, within a homogeneous group, there's a ton of heterogeneity-

    2. TNTrevor Noah1:09:14

       Yeah

    3. RYDr. Rachel Yehuda1:09:15

       ... is that the biology is such a moving target.

    4. TNTrevor Noah1:09:18

       Mm.

    5. RYDr. Rachel Yehuda1:09:18

       I want to study it in relation to an event-

    6. TNTrevor Noah1:09:20

       Okay

    7. RYDr. Rachel Yehuda1:09:20

       ... that was 30 years ago. [laughs]

    8. TNTrevor Noah1:09:21

       Okay. I'll continue with that.

    9. RYDr. Rachel Yehuda1:09:22

       But meanwhile, the body-

    10. TNTrevor Noah1:09:23

        Yeah. [laughs]

    11. RYDr. Rachel Yehuda1:09:23

        ... the biology's busy- [laughs]

    12. TNTrevor Noah1:09:25

        Right

    13. RYDr. Rachel Yehuda1:09:25

        ... with what it has to do today. And if people are d- I mean, things like body weight, um, age, there's just a million factors-

    14. TNTrevor Noah1:09:34

        Mm-hmm, mm-hmm

    15. RYDr. Rachel Yehuda1:09:34

        ... that are influencing today's biology. So if you have ... And again, a lot of people have not replicated the low cortisol finding. But mostly they would do it in a mixed civilian sample because the, the ways in which the, the way that in which people are so different from one another in the sample, the heterogeneity of the sample makes it harder to find any kind of a signal. But theoretically, I don't think that having a trauma alone, um, is materially different. And in some cases, it could be worse because you don't have the community-

    16. TNTrevor Noah1:10:11

        Yeah

    17. RYDr. Rachel Yehuda1:10:11

        ... and you don't have other people.

    18. TNTrevor Noah1:10:13

        That's fascinating. Yeah.

    19. RYDr. Rachel Yehuda1:10:13

        When you are a rape victim, you go home and you probably won't talk about it. Um, you are pretty sure that, um, people will blame you or, or that you're ashamed in some way, or that people won't understand, or they

47. 1:10:32 – 1:12:23

    Collective vs. Individual Trauma Effects

    1. RYDr. Rachel Yehuda1:10:32

       will feel uncomfortable and will distance themselves from you. So sometimes you're suffering from things by yourself without being part of, like, a survivor community-

    2. TNTrevor Noah1:10:43

       Yes

    3. RYDr. Rachel Yehuda1:10:44

       ... um, which can also compound the effects. So.

    4. TNTrevor Noah1:10:50

       Yeah. You nev- you never think of it being community. Yeah.

    5. RYDr. Rachel Yehuda1:10:54

       I know, but it-

    6. TNTrevor Noah1:10:55

       Which I know is like, it's, it's a crazy-

    7. RYDr. Rachel Yehuda1:10:57

       It's really important. Yeah

    8. TNTrevor Noah1:10:57

       ... 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-

    9. RYDr. Rachel Yehuda1:11:06

       Yeah

    10. TNTrevor Noah1:11:06

        ... 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, we were in a plane crash versus I was, was in a plane crash. It, it makes, it makes me then wonder: what would, what would treatment be like if we, if we thought of these things as having happened right after the time? Like, I, I've seen in some of your work you talk about, um, cortisol, and I think it was, um, hydrocortisone that you were looking at. This, this, this really sparked my curiosity because there were some studies where you were looking at whether or not you could affect the levels of cortisol in a person right after they'd experienced a traumatic event, right? And the purpose for that was, if I understand right, to sort of get their body at least back to the place where it was regulated right afterwards so that, so that the trauma didn't have as long-lasting an effect. Talk me through that and the basic principle behind it and whether or not you've made any breakthroughs in, in this, in this work.

    11. RYDr. Rachel Yehuda1:12:07

        It's an example of a theory that really should work, um, theoretically, and then [laughs] in practice, it isn't-

    12. TNTrevor Noah1:12:13

        Good old science

    13. RYDr. Rachel Yehuda1:12:14

        ... does, you know, doesn't work as well.

    14. TNTrevor Noah1:12:15

        Or comedy. [laughs]

    15. RYDr. Rachel Yehuda1:12:16

        But-

    16. TNTrevor Noah1:12:16

        Yeah, you're not wrong. [laughs]

    17. RYDr. Rachel Yehuda1:12:18

        But the idea was that if cortisol is important in helping to damp down the adrenaline,

48. 1:12:23 – 1:13:39

    Community’s Role in Trauma Survival

    1. RYDr. Rachel Yehuda1:12:24

       um, then why don't we just give one big dose of hydrocortisone in case it's low to help us recalibrate the sympathetic nervous system?

    2. TNTrevor Noah1:12:33

       Okay.

    3. RYDr. Rachel Yehuda1:12:35

       Um, I don't know the results. We did a pilot study, and there was a small signal, but it wasn't like a, "Oh my God."

    4. TNTrevor Noah1:12:42

       Mm.

    5. RYDr. Rachel Yehuda1:12:42

       Um, we're just wrapping up a study that, um, we've been in, that's been in the works since COVID started, which was a great time to start this. [laughs]

    6. TNTrevor Noah1:12:51

       Right.

    7. RYDr. Rachel Yehuda1:12:52

       Not. [laughs] But, um, but, um, I'll let you know. I think that these are very hard studies to do, um, to follow people from the emergency room and then kind of-

    8. TNTrevor Noah1:13:04

       Mm

    9. RYDr. Rachel Yehuda1:13:04

       ... treat them-

    10. TNTrevor Noah1:13:05

        Yeah

    11. RYDr. Rachel Yehuda1:13:05

        ... in a d- double-blind, placebo-controlled way. And also, since the time that I thought that was a good idea, um, I've really changed my mind a lot about, um, whether we should be doing interventions acutely. Um, I think that there, I think the kind of interventions that we need Are what help people naturally, uh, bring down their sympathetic nervous system arousal-

    12. TNTrevor Noah1:13:35

        Oh

    13. RYDr. Rachel Yehuda1:13:35

        ... by hugging them, [laughs] by, by holding them in community,

49. 1:13:39 – 1:17:23

    Early Interventions Like Hydrocortisone

    1. RYDr. Rachel Yehuda1:13:39

       um, by showing them that we care about them, not by giving them cortisol.

    2. TNTrevor Noah1:13:44

       Right.

    3. RYDr. Rachel Yehuda1:13:45

       Um, although if it really works well, that would be a great thing for someone to carry around in their Kevlar during a critical incident-

    4. TNTrevor Noah1:13:52

       Yeah

    5. RYDr. Rachel Yehuda1:13:52

       ... because it can't hurt you in any way, um, to prevent PTSD, which is what we said in the grant that got funded. But the other thing that has happened to me since that time is that I've become really interested in psychedelic-assisted therapy-

    6. TNTrevor Noah1:14:09

       Mm

    7. RYDr. Rachel Yehuda1:14:09

       ... for trauma and PTSD. And, um, I think that's a, a better way to kind of help people with their trauma and PTSD because it allows people to access kind of in parallel a lot of, an, a lot of life events, not just focus on one, and also brings in kind of the intergenerational component-

    8. TNTrevor Noah1:14:33

       Yeah

    9. RYDr. Rachel Yehuda1:14:33

       ... because you bring your entire identity with you into kind of the psychedelic work. So, um, you know, my views have really shifted. I started out kind of very neuroscience k- more of in that reductionist frame. I'm gonna find the thing that's broken. We're gonna find drugs that will reverse it. And I'm, I'm not in that same place. I just think that for people, there's too many other things going on. And I've seen people heal, even without any therapy at all, from horrific things if they were embraced in the right way in the community, if they found meaning, if they were able to, um, t- to live in a certain way-

    10. TNTrevor Noah1:15:23

        Yeah

    11. RYDr. Rachel Yehuda1:15:23

        ... um, following their trauma. So it just, it gives me pause. Um, uh, you know, I'm awed by the complexity of it. I'm not, um ... It doesn't make me wanna not do it anymore, like it's too big a Gordian knot to untie. But it, it should make us really cautious about being overly simplistic about-

    12. TNTrevor Noah1:15:45

        Yeah

    13. RYDr. Rachel Yehuda1:15:45

        ... any of it.

    14. TNTrevor Noah1:15:46

        Hundred percent.

    15. RYDr. Rachel Yehuda1:15:46

        And, and through it all-

    16. TNTrevor Noah1:15:48

        Hundred percent

    17. RYDr. Rachel Yehuda1:15:48

        ... just this idea that we are resilient.

    18. TNTrevor Noah1:15:51

        Right. Let's talk a, let's talk a little bit about the psychedelics. You know, um, over the l- I, 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? Now, maybe I'm, I'm c- completely obtuse, and I, I don't know everything about it 'cause I read what I can. It seems to me like some of the resistance to some of these therapies is applied in a way that isn't applied to some other medicine. You know, like, so they'll go, "Oh, we don't know if we could apply these therapies because, you know, it's, it seems like it could be bad in this moment, da, da, da, da, da, da, da, da, da, da, da." But then when you look at many of the medicines that are already out there, we just accept the side effects. And I'm not saying that means we should be dismissive of everything, but, but I wonder, I wonder what some of these therapies do that current medicines don't, and I wonder if you have any 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

50. 1:17:23 – 1:19:14

    Shifting Views to Psychedelic-Assisted Therapy

    1. TNTrevor Noah1:17:23

       on a neurological side? So when it's like MDMA or something like psilocybin.

    2. RYDr. Rachel Yehuda1:17:26

       DMT, mm. Um, I've been, um, a little surprised by the lack of reception to psychedelic therapies. It's not like we have great solutions right now.

    3. TNTrevor Noah1:17:41

       Yeah.

    4. RYDr. Rachel Yehuda1:17:42

       Um, would be different if there were definitely treatments that worked for the majority of people. And we could say there's a lot of risk involved in these approaches, so let's stick to the things we've operationalized that we can deliver quickly and that our workforce knows how to do. But especially for combat veterans, um, these, um, cognitive behavioral therapies don't do the job for them more often than not. Um, why? Because it's too, they're too distressing. It's distressing to really talk about a real trauma, especially if there are multiple ones and also you come in with a, uh, history. There's also the issue of maybe moral injury-

    5. TNTrevor Noah1:18:31

       Yeah

    6. RYDr. Rachel Yehuda1:18:31

       ... um, that is very different than, uh, being a rape victim. These treatments were mostly, um, developed for interpersonal violence, where they work pretty well. But when you have something more complicated, um, I think you need to process it in a certain way, and somehow being in this altered state where it releases a lot of self-compassion.

    7. TNTrevor Noah1:18:55

       Mm.

    8. RYDr. Rachel Yehuda1:18:55

       Um, you, you suspend this, like, terrible self-judgment that you carry around usually with yourself. You know, it's a party drug for a reason. It, it helps with social bonding.

    9. TNTrevor Noah1:19:06

       Hmm.

    10. RYDr. Rachel Yehuda1:19:07

        So that works in the therapy room with your therapists. Um, you kind of form a better, uh, relationship

51. 1:19:14 – 1:23:23

    Resistance to Psychedelics in Medicine

    1. RYDr. Rachel Yehuda1:19:14

       with them. And for some reason, you're open to looking at things that would usually just get you too upset and distressed and would otherwise make you say, "I'm not doing that." Um, doesn't mean that it's fun and, and easy, 'cause it is not. But If you, um, have the right therapists that are well-trained to know how to work with someone in an altered state, and you process it a lot afterwards, you can have an am-amazing outcome. Most people will have an amazing outcome, which is what our study found. So why isn't everyone embracing it? Because it's very labor-intensive. It's-- The psychotherapy is not the way that, that-- is a different kind of model that people will kind of need to learn. Um, it's unstructured, which adds a layer of discomfort. People want to have a structure about how they're approaching therapy.

    2. TNTrevor Noah1:20:17

       Mm-hmm.

    3. RYDr. Rachel Yehuda1:20:18

       Um, and-

    4. TNTrevor Noah1:20:20

       And is it, is it unstructured because you don't know what the person's gonna experience or-

    5. RYDr. Rachel Yehuda1:20:24

       Exactly.

    6. TNTrevor Noah1:20:24

       Okay.

    7. RYDr. Rachel Yehuda1:20:25

       Yeah. You're, you're, you're getting on their bus [laughs] you know?

    8. TNTrevor Noah1:20:27

       Oh, yeah. You're not, you're not guiding them. They're sort of guiding you.

    9. RYDr. Rachel Yehuda1:20:30

       Right.

    10. TNTrevor Noah1:20:30

        Yeah.

    11. RYDr. Rachel Yehuda1:20:31

        Right? I mean, in, in cognitive behavioral therapy, we decide in advance what trauma we're gonna pr-process. You're getting on my bus. Here's-- You're gonna get homework. We're gonna create a hierarchy of things you're afraid of. We're gonna-- I'm gonna give you tools to reduce your distress, you know, things like that. It's very structured.

    12. TNTrevor Noah1:20:49

        Yeah.

    13. RYDr. Rachel Yehuda1:20:49

        Um, but this is different. This is like, "Well, let's see where we go [laughs]

    14. TNTrevor Noah1:20:53

        Yeah.

    15. RYDr. Rachel Yehuda1:20:53

        ... which a lot of people, um, are nervous about because of the potential that it can, um, but it may go to places that are difficult for people that don't really have the experience and training to work in that way.

    16. TNTrevor Noah1:21:09

        Mm-hmm.

    17. RYDr. Rachel Yehuda1:21:09

        So it's hard. It's, it's, it's been a hard one. I don't think that people don't think this works. I think that the question is really about scalability and training-

    18. TNTrevor Noah1:21:21

        Yeah

    19. RYDr. Rachel Yehuda1:21:21

        ... um, and, you know, h-how to really make it accessible and how to change systems so that it can, 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, the conversations about, oh, it used to be illegal, yeah, but th-those aren't the kind of things people are really talking about when they're trying to figure out how practical [laughs]

    20. TNTrevor Noah1:21:51

        Okay, got it

    21. RYDr. Rachel Yehuda1:21:51

        ... how practical it is to do this. Um, it's, you know, hours and hours of psychotherapy in between the medicine sessions, and the medicine sessions themselves can be long. That's with MDMA, which is what is being proposed for PTSD, um-

    22. TNTrevor Noah1:22:09

        Oh, and so that's what you mean by labor-intensive, is the person takes it, but now they need-

    23. RYDr. Rachel Yehuda1:22:14

        Now they need-

    24. TNTrevor Noah1:22:14

        ... extended periods of supervision

    25. RYDr. Rachel Yehuda1:22:16

        ... now, now they need to have therapy. Now, now we have to talk about what happened.

    26. TNTrevor Noah1:22:19

        Right, right, right.

    27. RYDr. Rachel Yehuda1:22:19

        So we can talk about it during the session.

    28. TNTrevor Noah1:22:21

        Yeah.

    29. RYDr. Rachel Yehuda1:22:21

        That's eight hours with two therapists-

    30. TNTrevor Noah1:22:24

        Wow
52. 1:23:23 – 1:26:43

    Labor-Intensive Nature of Psychedelic Therapy

    1. RYDr. Rachel Yehuda1:23:23

       sort of access things in parallel, not just serially. Um, a lot of it isn't verbal. You know, we put a lot of-- we put a premium on being able to explain things. We don't explain. We don't know every-- We can't, uh, put words into everything we feel or have experienced. Um, and just you come out with a sense of forgiveness for yourself-

    2. TNTrevor Noah1:23:46

       Yeah

    3. RYDr. Rachel Yehuda1:23:46

       ... that is really important, and you're not always sure why. But, like, people come out and say, "You know, I'm a good person." Wow, that's big.

    4. TNTrevor Noah1:23:55

       Mm.

    5. RYDr. Rachel Yehuda1:23:55

       That's deep. Um, I had to do the things that I had to do, but that does not make me a bad person. I can, I can do lots more things now. Um, I can take off my armor. I don't have to be so, um, defended. Um, I don't have to let people take advantage of me. Um, you know, all these things that could take maybe years in regular psychotherapy to really internalize. You could say them cognitively.

    6. TNTrevor Noah1:24:25

       Right.

    7. RYDr. Rachel Yehuda1:24:26

       But-

    8. TNTrevor Noah1:24:26

       But feeling it-

    9. RYDr. Rachel Yehuda1:24:27

       Feeling it-

    10. TNTrevor Noah1:24:28

        ... or not

    11. RYDr. Rachel Yehuda1:24:28

        ... and saying it and knowing it is really where I think the psychedelic is just that superpower-

    12. TNTrevor Noah1:24:35

        Yeah

    13. RYDr. Rachel Yehuda1:24:35

        ... because it sort of ties-

    14. TNTrevor Noah1:24:37

        Mm-hmm

    15. RYDr. Rachel Yehuda1:24:37

        ... all of it in together. Practical, it's not. But, you know, again, neither was open heart surgery when people first-

    16. TNTrevor Noah1:24:43

        [laughs]

    17. RYDr. Rachel Yehuda1:24:44

        ... did that. Um, neither are any of these things that turn out-- Neither was a computer that we all wear on our watches now-

    18. TNTrevor Noah1:24:51

        Yeah, yeah

    19. RYDr. Rachel Yehuda1:24:51

        ... or on our phones. All of these things didn't-- started out to be very daunting. But once people see the benefits of it, then we find ways. I, I, I think that's what we're actually good at as humans. We're good at taking the impossible and making it scalable.

    20. TNTrevor Noah1:25:11

        Yeah.

    21. RYDr. Rachel Yehuda1:25:12

        Um, but we can't put so many barriers up right now. Um, again, the studies were criticized. There was... They, they-- You know, they were hard on those studies. Um, but, but we're s- we're talking about a Schedule 1 compound, [laughs] and we're talking about the necessity of psychotherapy. I understand-

    22. TNTrevor Noah1:25:35

        Conflict

    23. RYDr. Rachel Yehuda1:25:35

        ... I understand why they were concerned, but nothing That I've heard is something that can't be resolved

    24. EUEugene1:25:43

        Mm.

    25. RYDr. Rachel Yehuda1:25:44

        There's no reason not to anticipate this in a future. Um, there are no barriers that I see once we develop, um, ways of training people, once we start doing more research where we figure out the kinds of therapies that might support this. Um, and maybe there are some psychedelics that don't need as much therapy. I don't know. People say that. I'm not sure. I need to see some data. But it's promising, and I think that in this world, we need some way to access particularly, you know, compassion, empathy, all those things, forgiveness. And, um, the one thing that absolutely happens to people that have had psychedelic therapy and healed is they turn right around and try to figure out how to help other people get this.

    26. EUEugene1:26:36

        I think what you've just done here amazingly is express in words what I've been struggling to express to other

53. 1:26:43 – 1:28:20

    Scalability and Future of Psychedelic Treatments

    1. EUEugene1:26:43

       people who haven't partaken in something that I've done, which was ayahuasca.

    2. RYDr. Rachel Yehuda1:26:47

       Oh, wow.

    3. EUEugene1:26:48

       And I think I didn't know what I was going through until I went through it, and then until I came out of it. But you're right, the level of compassion and acceptance and reconciling your past with your present so that you can have a better future is something that I couldn't explain in words.

    4. RYDr. Rachel Yehuda1:27:05

       It's very hard to explain. [laughs]

    5. EUEugene1:27:07

       And the amount of healing and what, what I realized coming out of it, and obviously you have a debrief with a shaman afterwards, was the fact that all the versions of myself that I've seen during the ritual is this one I love the most, and it helped me accept the me now than 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 mes, and but this one here, it's a vacation."

    6. RYDr. Rachel Yehuda1:27:34

       That's ex- that's an extraordinary story. Um, now imagine if you were able to just really talk about it a lot in therapy, um, and imagine if there were a lot of difficulties that you were able to really process all the things 'cause you remember them.

    7. EUEugene1:27:50

       Vividly.

    8. RYDr. Rachel Yehuda1:27:51

       Vividly. C- and, you know, imagine the wonderful opportunity to really say, "H- I wonder what that meant." Maybe it was some- a voice that came and talked to you. Maybe it was an ancestor. Maybe it was a, a realization or a vision.

    9. EUEugene1:28:07

       Yeah.

    10. RYDr. Rachel Yehuda1:28:07

        So the question is, is that a luxury or is that a necessity?

    11. EUEugene1:28:11

        Hmm.

    12. RYDr. Rachel Yehuda1:28:12

        And I think that's kind of the debate that the field is having right now. Um, can we bring this in a group like ayahuasca

54. 1:28:20 – 1:30:24

    Personal Ayahuasca Experiences and Healing

    1. RYDr. Rachel Yehuda1:28:20

       to a bunch of people and, and, and really heal in community? Um, again, it's not what mental health is like today.

    2. EUEugene1:28:31

       Yeah. Yeah.

    3. RYDr. Rachel Yehuda1:28:32

       So how quickly can we change how we look at things? Um, I mean, right now we're living in a world where things change rapidly.

    4. EUEugene1:28:42

       Right. Right, right.

    5. RYDr. Rachel Yehuda1:28:42

       So can't ... Maybe, maybe we can change rapidly. I don't know. But that's kind of the task, I think.

    6. TNTrevor Noah1:28:52

       You know what, 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, I still don't know ... I, I thought it was a joke because it was written well, but I don't think she really, like, tells jokes in that way. We were driving through the streets in Johannesburg, and she saw a homeless white person who was begging at the traffic lights, and my mother always has money to give to homeless people. She just drives around like that. And she gave this homeless person money, but the difference was after she gave the guy the money, she turned to me and she said, eh, she said, "Ach, shame. Yaz, abalungu. Oof. Yho, hayi, basokholwa baneni." Which translated means, "Damn, white people, they're really suffering." And then I went, "Hmm. I mean, okay. Uh, uh, can you, can you explain more?" And sh- and I, I said, "But there's these Black homeless people as well." And she said something that really stuck with me, and your, your work made me ... It, it, it triggered something, um, for me in your work. She said, "Yes, I know that Black people are suffering as well." She said, "But these white people, they don't know how to suffer."

    7. RYDr. Rachel Yehuda1:29:55

       Oh.

    8. TNTrevor Noah1:29:56

       And-

    9. RYDr. Rachel Yehuda1:29:56

       Beautiful

    10. TNTrevor Noah1:29:57

        ... what she was saying was interesting. She wasn't assigning suffering to anybody.

    11. RYDr. Rachel Yehuda1:30:01

        Yeah.

    12. TNTrevor Noah1:30:01

        She wasn't saying that suffering belongs to anybody, but she was sort of speaking to something in your work that I would love for you to elaborate on, and she was, in the same way that trauma or the effects of trauma can be inherited, my mom was alluding to something that your work speaks to, and that is that resilience may also be inherited. Do, do you see that in your work?

    13. RYDr. Rachel Yehuda1:30:22

        100%.

    14. TNTrevor Noah1:30:23

        Hmm.

    15. RYDr. Rachel Yehuda1:30:23

        That's the major

55. 1:30:24 – 1:31:29

    Rapid Changes in Mental Health Approaches

    1. RYDr. Rachel Yehuda1:30:24

       lesson here that ... I mean, that, that's a beautiful story, and it reminds me of a story that my mother also tells me about how her father, um, who had a grocery store, used to give not only to people that needed but to wealthy people, um, who used to be wealthy but maybe someone had died in the family, and he just suspected-

    2. TNTrevor Noah1:30:46

       Oh, wow

    3. RYDr. Rachel Yehuda1:30:47

       ... that, um, things were not going well, but perhaps they were too proud to say something. And she would say the same thing that you did, like, "What-"

    4. TNTrevor Noah1:30:58

       Yeah, they used to be wealthy.

    5. EUEugene1:30:59

       Yeah. They didn't know how to suffer.

    6. RYDr. Rachel Yehuda1:31:00

       Yeah. Well, they're not other people. And he would say, "Yeah, but it's much harder when you used to have everything, um, and now you don't than when you've always-

    7. TNTrevor Noah1:31:11

       Shoo

    8. RYDr. Rachel Yehuda1:31:11

       ... when you've always had less."

    9. TNTrevor Noah1:31:12

       When you've always had it.

    10. RYDr. Rachel Yehuda1:31:13

        And that's the same thing that your mother was saying. We, we know how, we know how to be resilient. We know how to, we know how to cope with adversity, but this person may really be flattened by it, and

56. 1:31:29 – 1:33:56

    Stories of Suffering and Inherited Resilience

    1. RYDr. Rachel Yehuda1:31:29

       so I'm gonna help. It's very compassionate. If we lived in a world where everybody thought that, we'd live in a wonderful world.

    2. EUEugene1:31:36

       Right.

    3. RYDr. Rachel Yehuda1:31:37

       Um, and so, you know, how do we How do we get that going? Um, this is a world where w- it feels very polarized. It feels, it feels like we can have empathy for our own.

    4. TNTrevor Noah1:31:54

       Yeah.

    5. RYDr. Rachel Yehuda1:31:55

       Um, but really it's exactly what your mother said, that you have to be able to look at the other and see that pain. And if we do that, then I think that to me is, is meaning-making and resilience, and it c- it really then takes the lessons of trauma and, and just maneuvers them in a completely different way.

    6. TNTrevor Noah1:32:24

       Well, thank you very much because I think what you've left us with is the idea that, you know, not that we didn't think it was, but trauma is real. The intergenerational effects of trauma are very real.

    7. RYDr. Rachel Yehuda1:32:35

       Mm.

    8. TNTrevor Noah1:32:35

       But if I'm hearing you correctly, you've basically told us to remember that trauma isn't a prison. It's not a cage. It's something that a people have experienced, and we can, and sort of our jobs to ourselves, our, our responsibility to, to ourselves is to use it as a tool to inform us in how we heal going forward. Not to dismiss it, but also not to make it seem like that's the fixed, fixed place that we exist within. So thank you. Thank you very much for your work, and I love how candid you are. You know, I, I think that's something a lot of people don't understand about researchers and science and is that your field is, is punctuated with doubt, and that's sort of what it's all about, is doubting, being curious, asking, finding, changing your mind. Uh, when you said that, I was like, "I don't remember the last time I heard someone say, 'I've changed my mind on that.'" And I always think I would rather have somebody involved in science and in research who has the ability to change their mind because that's what researching is all about, finding out things that might change your mind. So Dr. Yehuda, thank you so much for joining us today.

    9. RYDr. Rachel Yehuda1:33:38

       Yeah, thanks for having me. Thank you for having me. [laughs]

    10. TNTrevor Noah1:33:43

        [upbeat music] Thank you so much for watching the episode. If you enjoyed it, pass it on to a friend. If you didn't enjoy it, pass it on to your friend still. Let them suffer for a change. And don't forget to engage with us

57. 1:33:56 – 1:35:10

    Compassion, Meaning-Making, and Final Thoughts

    1. TNTrevor Noah1:33:56

       in the comments. Uh, if you wanna, uh, suggest a guest, maybe there's questions you want, maybe there's ideas that you have, you can chat to us. We will read through the comments, and we'll get into it. Either way, I appreciate you taking the time. Thank you for hanging out with us on What Now? And remember, we do this for you, so we would like to hear from you. Till next time, thank you.

Episode duration: 1:34:17