Why Don’t We Talk More About Mental Health? With Mike Shinoda, Dr. Gail Saltz and Dr. Ahmad Hariri

Join us for a real, raw and powerful conversation that calls on all of us to do our part in removing the shame and stigma surrounding mental illness. In the United States, anxiety disorders are the most common mental illness, affecting over 40MM adults -- over 18% of the U.S. population. It's the leading cause of disability, judged by years lost to disease, yet only a small percentage of people with the illness receive treatment.  In the latest episode of Spit, host Baratunde Thurston discusses mental health with a trio of folks who are working every day to combat the stigma, using their expertise, their research and their platform to make a difference. In part one of this episode, Baratunde sits down with singer, songwriter and mental health advocate Mike Shinoda and Dr. Gail Saltz, Clinical Associate Professor of Psychiatry at the New York Presbyterian Hospital, Weill-Cornell Medical College and a psychoanalyst with the New York Psychoanalytic Institute. Together they explore what mental illness is; how genetics and your environment together play a factor in triggering anxiety disorders; the importance of checking in with yourself and with those around you; and how we can all foster and create safe and positive spaces at home, at work and in the world. Mike speaks openly about his journey since losing best friend and Linkin Park bandmate Chester Bennington, asking Dr. Saltz, “Is there more we can do? And if so, how?” He also explores the notion that artists create from a place of “genius” and if that genius can ultimately lead to crippling pressures and self-doubt, further increasing the risk of depression and substance use. In part two, we get a deeper understanding of the genetic science behind mental health and the latest research about the brain's role in mental wellness when Baratunde speaks with Dr. Ahmad Hariri, a Professor of Psychology & Neuroscience at Duke University, where he is also the Director of the Laboratory of NeuroGenetics. Dr. Hariri is the author of Looking Inside the Disordered Brain. https://bit.ly/2ySrMa0 Spit is an iHeartRadio podcast with 23andMe. Enjoy this episode and subscribe, rate and review Spit on Apple Podcasts. And be sure to tell your friends all about it. Find out more about our host Baratunde Thurston at Baratunde.com or sign up for his text messages at 202-902-7949. 

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Episode Transcript

Speaker 1 (00:04):
I'm bartun Day Thurston and this is Spit and I
Heart Radio podcast with twenty three and me. This is
the podcast that explores how DNA is changing our lives
and the world around us. In today's episode, we're going
deep on mental health. We want to know why is
it so hard for us to talk about mental illness
as a society and how do we move beyond this

(00:24):
stigma and began addressing mental health treatment in the same
way we talk about any other medical condition. Three D
Thirty two million people around the world are living with depression.
That's just about the entire population of the United States.
And here in our country, eight percent of us some
forty million people suffer from anxiety disorders, the leading cause

(00:45):
of disability in terms of years lost to disease. One
and four of us will suffer some type of mental
illness in our lifetime, yet only two thirds will seek treatment.
Why is that? With suicide rates climbing to the tenth
leading cause of death in the US and the second
leading cause of death among young adults, we need to
be having more conversations to help remove the stigma surrounding

(01:08):
mental health. Mental health is just health, though we may
not show it on the outside. Just about everyone is
fighting some sort of battle on the inside. Truth be told,
I've had my own challenges with mental health. I've even
helped to bury a close friend who from the outside
no one would ever have expected to take his own life. Today,

(01:29):
we're discussing this very important issue with the trio of
folks who are working every day to combat the stigma
and discrimination associated with mental illness, and who are using
their platforms to drive a deeper understanding, some through science
and research, and some through stories, advocacy, and the healing
power of music. In Part one of this episode, we

(01:49):
have a deep and moving conversation with musician, songwriter and
mental health advocate Mike Shinodah alongside Dr Gail Salt, clinical
Associate Professor of Psychiatry at the New York Presbyterian Hospital,
Wild Cornell Medical College and the psychoanalyst with the New
York Psychoanalytic Institute. I've been learning about it as things
go along, but what I do know from my own

(02:11):
personal experience watching my friend is that it was always
a roller coaster, like you just wouldn't know he'd come in,
and you wouldn't know if today was a good day
or our bad day. Genetics do play a role. And
the reason we know that is that studies that have
looked at, for example, identical twins or first degree relative
show there's a much higher incidence of anxiety disorders. And

(02:31):
actually it's interesting even the specific anxiety disorder like panic
disorder or phobias. After this conversation, we decided to go
deeper deeper into the brain, deeper into the research, and
deeper into the future in terms of advancements and treatment.
So after Mike and Gale's conversation, stay tuned for part
two with Dr Ahmad Harreri, a professor of psychology and

(02:53):
neuroscience at Duke University, who tells us the role of
jeans play and who's channeling learnings from his lady research
to help provide more treatment to more people. When we
have those large numbers of individuals in these studies, I
think what we're going to find is that there is
variation all over the genome, across hundreds of genes, if

(03:15):
not thousands of genes that collectively work together in ways
that are going to be even more complex to shape
the kind of what we strive for an understanding an
individual's kind of genetic risk or familial risk for mental illness.
I've got to say this is a truly revelatory episode

(03:35):
and I am so excited for us to go on
this journey together. We begin in Charlotte, North Carolina, backstage
with Mike and Gail as his crew prepares for that
evening show. Mike, Gail, welcome. Thank you both for being here.

(03:55):
Um and I just want to acknowledge that we have
sounds going on in the background because we are back age.
Mike is about to do a big show and we've
got crews dragging things. Phones are ringing. Rock music is
about to happen. Rap music is about to happen, Real
music about to happen. So thank you Mike for letting us.
Thank you, and thanks to your patients with the noise. So,
Dr Saws, I'd like to start with some of the
science and start with you, as the degree holder in

(04:17):
these matters. What are anxiety disorders within this class of
mental illness and what's happening in our brains when we
talk about this. So anxiety disorders are basically our brain
using the normal danger alarm system that we all have.
So if you see a bear, I'm definitely alarmed. Your alarmed.

(04:39):
And what happens in your in your mind and your
brain is it registers that it says, I have to
turn on my sympathetic nervous system, I have to release
certain neurotransmitters, and those ner transmitters are going to enable
me to either flee or fight. Right the flight or
fight response and normal fighting a bear just normal response.
So I think fleas a good choice. But people who

(05:02):
have anxiety disorders have an overreactive amygdala and hippocampus, those
of the areas that process fear. And because it's over active,
lots of things that are either just in their mind
and actually not even real, or things that are real
but wouldn't make other people anxious signal that same alarm
to them. And it's happening much of the day, every

(05:24):
day for an extended period of time. So they get
both the psychological thought of how can I flee or
fight or do something in this situation, the worry that
comes with that all the time, what if this happens,
what if that happens, and the physiological response. So some people,
for example, a panic which is a kind of anxiety disorder,

(05:45):
have the shortness of breath, the tingly feeling in their body,
the rapid heartbeat as though they have to hurry up
and flee or fight. And when you have that for
an extended period of time, it compromises your ability need
to function at work. You can't concentrate, right, You're kind
of miserable all the time, and it affects your ability

(06:06):
to have relationships. And when you've reached that point that
it's affection your functioning, you have an anxiety disorder. So
anxiety normal, sometimes even useful, helpful. Right, Hopefully we're all
a little anxious right now because that makes us perform better.
There's a sweet spot beyond which it compromises your belity
to function. Now you have a disorder. That was the

(06:26):
clearest explanation of anything I've ever heard. Thank you, I'm serious, dope.
We've talked in this series so much about genetics, and
I'm curious to what degree do our genes play a
role in our likelihood of experiencing anxiety disorders? Is there
an anxiety gene or or a depression gene. So the

(06:47):
answer is genetics do play a role. And the reason
we know that is that studies that have looked at
for example, identical twins or first degree relative show there's
a much higher incidence of anxiety disorders. And actually it's
interesting even the specific anxiety disorder like panic disorder or phobias,
like if I had a phobia to a dog, it
would be much more likely that my children would also

(07:09):
phobias specifically to a dog. So there depression runs in families,
anxiety disorders running families, Bipolar disorder runs in families. But
there is not a gene. In other words, it's not
passed on in an autosomal dominant way like I have
the gene, now you have the gene. You get it.
It's we don't know it's it's some sort of complicated
combination probably of genes and environmental factors. So what's important

(07:34):
to understand is that when you are born with a
set of genes, those don't stay your set of genes.
Environmental issues turn your genes on and off as we age,
and so what's happening to you could turn off a
gene like say you do some things to try to
treat yourself early on to essentially avoid developing one of

(07:55):
these issues, because you know that this is something that
you're predisposed to that could help you not have it. Possibly. Ever,
on the other hand, let's say you're predisposed and you
have difficult things happen, traumatic events that might not even
be in your control that might queue you up to
be more likely to have it. So it's not at
all or nothing thing. It's complicated, but it is valuable

(08:18):
to know if these issues run in your family. You
are making me think of the two people you're talking
to in terms of the environments that we're in. We've
got a musician Mike myself, I've done a lot of
comedy over the years. Are we putting ourselves in an
environment that's going to activate those those genes more likely
than not? Or do the arts help you process and

(08:40):
work through some of those Well, what's fascinating actually about
the arts, um and this is this is actually related
to the most recent book that I just did called
The Power of Different The Link between Disorder and Genius.
It is the neuroscience behind the fact that people who
are highly creative like the two of you, and particularly
successful in it in the word not just creative internally,

(09:01):
but productive with their creativity, that potential and the use
of that potential is hardwired to the very things that often,
unfortunately make one suffer from a mental health issue. So
we know it's not that you can't be let's say,
a person who has none of these issues and be creative,
but we know you're you're lucked out. You lucked out, Okay,

(09:23):
But we actually do know that people who are particularly creative,
you know, on the higher end of that spectrum, are
far more likely to have some of these particular mental
health issues, and that their part and parcel treat you
still should treat them, because treating them doesn't take away
the potential, but you should be looking for your potential,

(09:45):
and so there is this intense connection and living out
your creativity actually is useful. It's often therapeutic. One may
express things that one is having as an internal struggle
and find it very therapeutic. So it's not dramatic. The
trauma or the difficulties tend to be earlier in life.

(10:05):
Things that you know, your parents divorced, um, you had
a particular loss, you weren't taught, you were helicoptered so much,
you didn't learn any coping skills, any resilience. Your parents
never let you fall down or fail in anyway. So
then when you're faced that you're older, you have a
more difficult time when bertle you start using substances. That's
also a risk factor for developing some of these things.

(10:27):
So there are many things along the way that could
make it more likely. But being in a field where
you can produce and be productive, generally speaking, no, unless
the field where everybody around you is using and abusing substances,
that can make it more difficult. So for me, just
to give a little background for listeners who may not
be as familiar, I grew up drawing and painting. I

(10:48):
grew up making music. I was doing classical piano for
ten years when I was I don't know, I probably
started when I was like three or four, but I
always thought I was going to be a painter. That
was my really what my focus was. And then music
was a hobby and I went to school for visual
arts at Art Center College Design in Pasadena. I was
looking to get into illustration or like I wanted to paint,

(11:08):
to do album covers. I wanted to do movie posters,
maybe even get into um animation or or video game
art um and then the music took off chester my
like we were like the two singers of the band.
We were the dual focus of the band. I started
the band, and once we found him, it was like
he was like the missing piece. And we didn't know

(11:31):
each other very well in the beginning, but as we
got to know one another, it was like this inseparable thing,
and he was very I came from a very like
secure kind of family system, a very you know, my
parents are still married. Uh. They took great care of us,
and I feel like I had a good upbringing and
Chester kind of had a very dysfunctional home system that

(11:52):
he grew up in. And one of the things that
made are not only our our friendship really strong, but
also are you know it played into the music was
the fact that it was peanut butter and jelly, Like
we were so different and we I had a way of,
as he would describe it, like saying that like writing
the things that were on his mind. I would come
to him with songs and lyric ideas and things, and

(12:14):
he would help me understand where I was getting it,
where I was like hitting the bull's eye, and where
he felt like something was not quite right. You know
what's so cool about that is actually, in the most
creative people, it is a combination of what I would
call like a messy brain and an organized brain. But
like this yin and yang of you have to have

(12:35):
both in order to produce something. So like, if your
brain is messy, it has a space for innovation and
the production of like whatever he was saying telling you about,
but then it has to have some organization to take
that and bring it to fruition, right, and so peanut butter.
And there's also another lane that we would look at things,

(12:58):
which was, you know, your political brain and your creative brain.
He was much more on the creative side. He had
trouble organizing things. I was even with both, and that
was actually unusual. Even when I was in art school,
I'd have most of that. I mean, you know, if
you've ever been to an art school that only does
you know design school for example, like cal Arts or

(13:20):
Otis or Risdi or Art Center, but you find that
the school population is introverted. People are very creative, but
not very organized. And I was, you know, it was
one of those rare situations where I'm kind of a
little more outgoing and organized, so that you know, in
terms of our relationship, that's kind of like how it

(13:41):
worked in a sense Chester died by suicide about almost
a year and a half ago. Some people ask me,
you know, the obvious things like well, what happened? Did
you know where their signs? All of these things right?
And the answer is, really, of course there were. Of course,
he was the same guy. In essence, he was always
the same guy. It Without those things, I don't think

(14:01):
we would have made the music that we made. It
was the type of music that I've always been drawn to,
the type of lyrics that I've always been drawn to,
but I didn't live it the way he lived it.
And when we put all those things together, that's kind
of how the DNA of the band was formed, and
that's the reason the music sound of the way it
does now. Truth be told some of the lyrics that
they point to, and they said, oh, he was calling
out for help, Like I wrote a hundred percent of

(14:22):
some of those songs so lyrically, so I was writing
them to be sung by him because I knew they
were true for him. But the assumption was like, we
don't know, you know, The assumpting that it it was all
coming from him and stuff made things very confusing for
other people. I've also been thrust into this club that
I never wanted to be a part of, and in

(14:44):
doing so, these conversations like the one we're having today
have been happening. And so for me understanding this, you know,
I don't have any academic background in this stuff. I've
been learning about it as things go along. But what
I do know from my own personal experience it's watching
my friend, is that it was always a roller coaster,
Like you just wouldn't know. He'd come in and you

(15:05):
wouldn't know if today was a good day or a
bad day. And it could be bad could mean very
depressed and everything was down and enterings negative, or he
could be just very angry, or he could actually be
just like kind of unhinged and like he could be manic.
Basically it could be like, Okay, he's seemingly in a
good mood, but like, I don't know where this could go,

(15:26):
Like he's there's a chicken and an egg scenario with
him and drug use in which he had talked about
a time. All that said, you know the things you
were just talking about in terms of triggers of things, um,
how they manifest, how they come out over time, and
like what people can do to fight them. That's not
only something that I've been intimately familiar with, watching and

(15:48):
trying to help my friend for years and years and years,
but now in you know, in this year, we've seen
a lot of other artists pass away from both suicide
and drug use. A lot of drug use, a lot
of artists, a lot of managers, a lot of touring entities.
People in the industry are really starting to ask themselves
and one another, is there more we can do? And

(16:10):
if so, how It's a good question. First of all,
once you layer drugs or substances of any sort on
top of another psychiatric issue, the rate of suicide goes
way up. The ability to treat the underlying issue goes
way down. Um, so that really is always the first
order of business. That's why it's always sort of like

(16:31):
go to rehab and you have to get because the
frontal lobe of the brain is altered by substance use
such that the part that's used for learning is really impaired,
and so the learning that you would do for treatment
isn't possible. You can't see the mistakes you might be
making and correct or learn from them exactly kind of
you're inhibiting yourself and it also impacts their confidence in

(16:52):
a large way. I heard this Ted talk from almost
ten years ago talking about how people now think of
someone who creates something great as a genius. They go, oh,
that person made something so great is there? But back
in ancient I think it was ancient Greece and Rome,
they actually thought the person was a vessel and the

(17:14):
genius came from the gods. So it was either the
gods gave you the idea and lucky you you were
the person that God cares it out, and if you
didn't perform the thing, if you didn't you know, make
the art or whatever, then the genius would move on
and show it to somebody else. And what I thought
was cool, I mean, which she pointed out, and I
thought was cool about that? That That maybe applies now? Is
that somebody, I mean, let's just bring it right to

(17:37):
current times, somebody like Kanye West, who clearly many people
go he's creatively like, what a genius, but also personally
falling apart and the guy is unhinged at all times.
And there's this element of from my perspective as an artist,
I feel like I'm watching a man who's got far
too much pressure he's got pressure of the world on

(17:57):
him saying like, keep making great things or else we're
going to abandon you, and then pressure on himself saying
I've loved a lot of the things I've made. I
need to hold myself to this high level of productivity,
of creativity, to the standard of craftsmanship, etcetera. And if
I can't do that, then it's over, or it's I'm
depressed or whatever. It is, right, And maybe I'm projecting

(18:18):
a lot on him, but I think it's a definitely,
it's safe to say it's a very common thing that
happens to a lot of artists, a lot of them.
They're one of the reasons why they go to substances
is because I actually have at a handful of friends
who don't like to create stuff unless they're high, and
they do it because, well, the last time I got
high and made something, I made some pretty dope ship.

(18:40):
Now it's like a link and it's like, well, I
got high and I made this song. The song was dope.
I made another song I wasn't high. Doing it from
a place of fear. They they don't believe they can
do it. They believe they got to be an alter
place to do it, and the drug is the damon
they're trying. It's either that or it's a key like

(19:01):
it helps like lubricate the situation and it makes it
easier to get in touch with that thing, whatever it is.
It's certainly like disinhibited. So there's something to that. But
there are other ways to disinhibit your mind. There are
actually other way something that is listening. What would you say,
what's another way they could go about it? I would
say there are states of mindfulness and meditation that allow

(19:24):
you to disinhibit your mind. Actually, that's a good point.
I have a couple of friends who write incredible lyrics
while they're running because their brain, your brain goes somewhere else,
or you're running and getting to a state of flow. Right,
So flow is the key to creativity, to be where
your mind can be messy and then later organized. But
messy is disinhibited and disinhibit You can do that by

(19:48):
sometimes getting into an exercise zone and anybody and artists
can do something like that without having to use a
substance to disinhibit be cause, of course the substances have
a double edged sword, right. There are other problems that
come with that, but it's coming from that place of fear,
like you're saying the need like maybe I haven't really
got it. How will I get it? How will I
keep it? If I don't keep it, I'll be a

(20:09):
band and I'll be lost. These are also psychotherapeutic issues
that treatment can help someone quite a bit with, especially
somebody who's already has this tendency as you're explaining Chester
did to feel more negative, or more worthless or more
hopeless about things. So I have a question moving away
from the artists themselves. So I know that you know

(20:30):
the complexities of the artist and the situation, especially as
you get into you know, you have a fan base.
There are expectations or whatever. We touched on that. Now,
what I think a lot of the teams around the
artist are wondering if there's something that they can do
because they see I've seen fans criticize the teams around

(20:50):
people that are going through maybe they go to rehab,
maybe they go to maybe they have a breakdown, and
then fans are saying, well, why didn't anybody else around
this person help them? Right? What do you think about that?
Because there there are I've heard some things lately from
people in our organization, like our production manager Jim, who's saying,
being on tour shows every night are very exciting. There.

(21:13):
It's like you get a super super big high and
then when it's over, for some people it's a really
low low, and the artists can feel that, but actually
the crews can feel that too, And he was wondering,
how you know, kind of out loud with me, is
there I wonder if there's anything we could do to
kind of help out. Well, first of all, let me
just say it's really unfair to blame anyone. Even a psychiatrist,

(21:38):
even if chester we're sitting in my office, might not
be able to tell that that person eminently is going
to kill themselves, certainly without saying are you thinking of
killing yourself? Do you have a plan? What is the plan?
Do you have access to that plan? Now? If you
get affirmatives to all that, as a person you are,
you know you you can know something about But people

(21:59):
high things, they guard things, they write so and most
people aren't asking those questions. But short of that, there
is no surefire way to know. But there are particular
red flags. And the reason I say it's unfair to
blame people is you know, everybody's already struggling with this
ripple effect of this loss. Adding to that with blame
and guilt is not a helpful thing. So to be specific, though,

(22:21):
I'm wondering or on behalf of on behalf of those
people who I know maybe listening they were going to say, well,
is there something I can do? Yes? So drivers of
suicide that people don't think our drivers aren't just sadness depression.
They are particulars like shame, shame, humiliation. So when you say,
you know, where's my next big hit and will people

(22:42):
leave me? Shame and the fear of that no, I
didn't make it this time, where this one's stunk is
actually a particular driver of suicide. So if you hear
things about someone expressing shame or seeming to be feeling shame,
if you see them starting to dispense with like let
me bequeath in any sort of way this to you

(23:03):
as though, and even look like they're starting to feel
better in the face of doing that, that is a
big red flag. High anger and irritability a big red flag.
Men especially experienced depression and symptomatically reflect depression by being
highly irritable and angry males are often not recognized as

(23:24):
having depression. They're just thought to be jerks, and that's
a real problem. That's why men are undertreated in this
country for depression. So that anger that is there gets
turned inward and you take yourself out. That is a
big red flag. So knowing very specific red flags that
have combinations that aren't just like I'm up, I'm down,
it's a bad day, and basically you know, taking that

(23:48):
person by the arm and saying I see this, I
know this is this is in there. I'm going to
go with you to somebody now. So it does have
to be a now kind of thing. People who are
in that state often can't organize themselves to find an
appropriate person, therapy, intervention, therapy, intervention. What I've just heard

(24:09):
you describe is more on that edge case of someone
who may be contemplating suicide, but in terms of trying
to move earlier in the chain to try to maintain
a healthier mental state for all these team members involved
prevent getting further down that road. Are there things that
we can be doing to be more supportive kind of

(24:30):
on the front end before those red flags start to
to appear. We're at the yellow and re flag state. YEA, Well,
we are a nation woefully unaware of preventive mental health care,
like we have preventive cardiac care and diabetic care and
all these things we spend lots of money on and
lots of awareness on and time on doing. But nobody
thinks about preventive mental healthcare. And that is a real thing,

(24:52):
and it's very important to some degree. We would be
doing a better job of knowing what those things are
by doing more research, but we do know certain things.
So there are things such as which are probably not
very condusive to a a band lifestyle, but aerobic activity
for times a week, even more intense aerobic activity actually

(25:14):
goes head to head with medication from mild to moderate
depression and for anxiety sustaining. That makes the likelihood of
dipping into one of those situations far less likely. Sleep
is hugely important. I know, everybody wants to sleep, so
for instance, lack of sleep can tip off a depression
or a manic episode. Um, if you have a propensity
in any of those directions, so a regular amount you know,

(25:37):
seven to nine hours with some sort of regular those
things actually make a difference. Being able to have a
support system of people you can talk to. It doesn't
have to be a therapist. It could be other people
in your life, but they have to be people that
you trust and that you have a certain level of
intimacy with. Because people that you have to uphold a

(25:57):
veneer with it tends to make people feel worse, even
worse than not having spoken to them at all. They
feel like a fake and a phony, and they're you know,
they're further and further trapped in themselves. Not a use
of social media, um, you know. I mean, it's that
can be used here and there for like the connection
when you can't make any connection otherwise. But we're we're

(26:18):
lacking real related nous with facial expression, with body language,
and those kinds of connections that will create intimacy and loneliness,
which is the feeling you get when you're texting someone
and you don't see what's going on, and that's the
only kind of connection you have that spurs depression anxiety.

(26:41):
I actually I love that part because it is so
at this point so universal. There's a couple of pieces
to that that I love to remind at least our fans,
my fans, which is that Number one you've got a
power in your hands with your attention. And when you're
just always on social media, just kind of flitting in

(27:02):
a way, you're giving away that currency. I mean, you're
giving it to whoever whatever shows up in your timeline.
And by the way, a lot of times we're not
conscious enough of what we're looking at to say to ourselves,
does this thing deserve my attention? You're just giving it
to the worst headlines, the worst articles. You're clicking on
crazy things because that part of your brain goes, well,
that's I'm curious about that. Let's click on that. And

(27:25):
to be fair, they've also designed the systems that people
who control these optimal platforms, they know how our minds work,
they know the emotional lures and triggers, and they bake
those in. So they're measuring your attention and that currency
as you describe in a sense. They can make a
great argument for like that optimizing your experience and making
more fun for you, but fun for that, they're gauging

(27:45):
that in terms of interaction and activity, not in terms
of is it making you depressed? So they're calling it fun.
I would call it compulsion where it's it's it's a
feedback loop. You get some sort of positive feeling and
that makes you your brain go, let's do it again,
because that felt good, I gotta do it again. And
once that's baked in, even when you go, wow, that

(28:07):
did not feel good, you now already have the compulsion.
But most people don't stop and say wow, that didn't
feel good. They turn right around to somebody else text
or talk and say, man, did you read this headline? Oh?
Did you hear what's so and so? Did we infect
each other with that? Yeah? And it's and then it's
just it is infection, right. So one thing that I
talked about a lot is just be really aware of

(28:27):
your your like take your temperature and your mental health
temperature more often, like when you wake up, I tell fans,
when you wake up in the morning, you may check
in with your body and say, well, my back hurts,
I should take it easy today. If it's worse, oh,
I should see a doctor or maybe any medication you know,
so on. But you don't do that for your brain.
And that's a place where you can make a change.

(28:47):
We say, and waking up in the morning and body
feels fine, but my brain feel like I don't feel
that good today, And do I need to stay home?
Do I need to take it easy? Should I not
be on Twitter and Instagram today? Should I not? You know,
do I actually need to not go into work and
I need to go see a doctor? To carry a
heavy emotional burden at Yeah, like you can control if
you've got friends texting you about something a favor, an

(29:10):
emotional favor or something that they need help with or whatever,
that you aren't the only human being in the world
that could help them with that thing. Maybe they could
get that help somewhere else, opt out. I mean, that's
really a mental health if you've already if you've already
checked them with yourself and you said, man, I'm just
feeling like a scale one to ten, I'm at like
a five today, and then somebody else puts their junk
on you, like you're just not the best person to

(29:31):
deal with it that day. Self observation, which is what
you're describing, is one of the first points of therapy
in the words, So sometimes people just get better, like
something's going on, and you, as a therapist, I tell
them I want you to go home, and I want
you to keep a journal, and I want you to
take your temperature on whatever it is. We're looking at
how often you worry, how often you would and just

(29:52):
the self observation and recording actually makes it diminish, so
that that's actually a great thing to do. And as
you said, also could cuse someone in, Okay, I need
something more. Maybe if it's not diminishing, if it's a problem,
and you can even apply it, you can even make
it a part of your routine at work or at school.
In my band, we actually have done this. We did

(30:12):
this years ago where before we had a band meeting,
we always did a check in first, how is everybody doing?
Because once in a while you get you know, you
most days you come in, these things are going on.
We kind of know what each going on in each
other's lives. But once in a while you get somebody
coming in and saying, I'm just really not you guys
didn't know this, but this is going on in my life.

(30:33):
I'm a little bit stressed out, or I'm a little
bit down, or I'm it's hard right now for me.
So then you see, once you have that, you've given
that piece of information everybody else that you wouldn't have
otherwise given them. You've just otherwise you would have just
jumped in the meeting, let's talk about these things. But
all of a sudden, you know that this one person
is like maybe they're a little sensitive to certain topics today,

(30:55):
and you'll be so much more empathic. Yes, empathic, and
you'r it sounds as well. You know, there can be
a really high burden to quote unquote ask for help,
But what you've just described is a step short of that.
It's just gonna declaring where you are and allowing others
around you to help in a more implicit or passive way.

(31:18):
So it's not like I think, because of the shame
aspect that you talked about, Dr there's a fear of
looking weak, of being judged as incapable, and I can't
carry this load. So you're not going that far. You're
just saying this is where I'm at, and then your friends,
your co workers, your family members can step up, and
we do, if we're really connected to each other, tend

(31:39):
to adjust for each other. It is like stoking empathy. Yeah,
you know, doing much of that, but really we should
be teaching children and teaching adults how valuable and important
empathy is. And empathy which is you know I can
stand in your shoes. Well, if you don't know where
your shoes are, I can't stand in them. So you're

(32:01):
you're giving them that information and that's super valuable. It's
important to be able to be both empathic which also
feels good as well as received the empathy. These are
the kinds of things that I would even say preventively.
In terms of preventive, are we learning coping skills that
work for ourselves? Are we doing things to think about
our resilience and like, how what are tools for us

(32:23):
to bounce back from things? Do we have like a
toolbox assembled for ourselves? Empathy, I think is one of
those things I would give your band another homework ascidle homework.
Another useful thing to do, believe it or not, is
to gratefulness actually really boost mood. You look like you

(32:44):
maybe already have done this one, but like coming together
and saying at the end of the day to yourself
or to your bandmates, three things for which you're really
And they could be like little things like I had
a great cup of tea this afternoon. You know, they
could be small or they could be bigger. But shifting
the focus that it shows even after a couple of
weeks of doing that really does improve mood. One of

(33:08):
the things that does not improve mood and can inhibit
some of what we've just been talking about is the
stigma around expressions of mental health concerns, mental illness, symptoms.
And I'm curious for you, Mike and for you dr
how you've experienced this which you've observed in your own journey,

(33:28):
around people's judgment and people's fears of expressing their even
their concerns with social media in real life, the combination.
But where does stigma stand and where do you stand
on it? I mean, I think the good news is,
at least in my experience, is a little bit of
the stigma and the I feel like there's a tendency
in Americans in particular that I've experienced at least my

(33:53):
experience has been you know, we're tough, we can handle it,
like we don't you know, so for example, so yeah,
suck it up. Like for example, Pole, can you imagine
waking up in the morning and going like, Wow, I've
I've had a really bad week. All this stuff is
going on, and I just feel depressed and calling into
work and telling your boss like, look, I need a
day off. Your boss would be like, you're fired, right,

(34:15):
They're not going to They're not going to stand for that.
They're gonna say, look, I've got all these other people.
Nobody else is complaining. Oh, come on, it's all in
your head. Pull yourself up by your bootstraps. You know,
that's just not understanding the biology of these issues. These
are Your brain is an organ If you have a
neurotransmitter imbalance, which has to do with what's going on

(34:38):
in your day and how you've been feeling. The brain
talks to itself through neurotransmitters. Feelings are neurotransmitters. All of
the psychology biology exactly, that is how the brain works.
And so when something is happening in the brain, if
you called in and said I'm having chest pain, I
think I might be having a heart attack, I don't
think your boss would say, well you're fired. Um, you know,

(35:00):
and we have to start understanding it that way, as
opposed to like you could just suck it up. We
have to. And this is actually where I think you
people like you actually have a much bigger impact than
people like me. Is the author of six books, But no, really,
I'm much impact on stigma because it's people needing to

(35:20):
understand how ubiquitous these issues are, that they happen to
the most successful and the least success they happened to everybody.
It cuts every swath and people don't want to be
associated with someone who was, you know, in the eighteen
hundreds chained to a wall because they were quote crazy.
But they do want to feel like, well, yeah, I

(35:41):
could be that basketball player or that musician or that whatever,
and I'm struggling, but that doesn't mean I'm not intelligent, able,
I don't have good stuff going on. So it's the
people who are able to do and yet able to
reveal their story that makes a huge difference. Able to
reveal the they got treatment and the treatment helped them,

(36:01):
and that was important. Able to and you know, I
hate to be so bottom line here, but the reality
is that mental health receives the least dollars by a
large margin than any other health issue for research for
clinical care, and if we don't learn more, we're not
going to have better treatments. If we don't support clinical treatment,

(36:25):
then in lots of parts of the country where people
can't afford it out of pocket, they're not going to
get it, and so it's people like you who will
motivate those movements that will raise dollars for research. That's
just a reality. Yeah. How would both of you say
you like us as a society and individuals within it

(36:46):
to be talking about mental health and mental illness in
five years in a way that's better than we do today.
I think the thing that I learned this year that
was when I heard it, it was like, oh, that's
something that we've kind of been accident generally doing in
a sense, but you can do it much more intentionally.
Is to make a routine out of it. To create
little routines, either for yourself or for your communities, whatever

(37:11):
they are, your family unit, your your work community, your
school community, whatever it is, just to create little routines
out of it. Since we're not yet doing it naturally,
I think we need to create schedule out of it
in order to do it. What about you? Um? That
makes great sense to me. Um. I think that we
have to be more aware of them. Many times we're

(37:31):
still talking so pejoratively about mental health issues. Throw out
the word crazy nuts media, you know, TV shows, movies,
that this is a stuff where people unfortunately learn their
medical information often say deprecating terrible things essentially about someone
with mental illness or for that matter, people who treat
mental illness. Psychiatrists are never portrayed well in the media.

(37:54):
Let me just say, but, um so, I think that
if we could, you know, shift our mind's eye to
the idea that you know, things can be you can
be differently wired in your brain, which many people are
close to all of half of all Americans at some
point or another, we'll struggle with this, which means the
other half have somebody in that group they love, So
we're all going to be touched. If we could recognize

(38:17):
the ubiquitous nous, recognize these are sometimes disease states that
need treatment like any other kind of disease states, and
probably even more so because if your mind is not well,
it's really hard for your body to even be well,
so nothing's well. This should take more of a front
and center people sharing their stories most definitely much more openly,
and hopefully all of that, in my mind, leads to,

(38:40):
because you know, I am a physician, that we put
more effort into frankly researching this area and providing better
treatments because this area lags behind others in many ways.
Um we need better, more specific, defined treatments for the
wiring issue than a row transmitter issue that's going on,

(39:01):
and I think that it can be gotten. But we
have to have a very different way of digesting all
of this and seeing that there's another side, that there
are real strengths and pluses in people who struggle with
these issues. So we have to start talking to our
children about mental health, how to build a plan, how

(39:22):
to not be ashamed, how to seek help, and how
to find their potential, how to find their strength as
a result and be their best selves. I'm feeling so
inspired right now. If there's anything related to this topic
that you feel like, I wanted to say this, I
gotta get this off my chest. I mean, I guess
for me, the only thing that we didn't touch on,

(39:43):
I'm proud of my wife. I'm proud of Chester's wife
to Lenda. They've both been involved with an organization called
um well to Lenda's arm of it is called three
twenty Changes. Direction Change Direction is a great organization and
if you're curious about this stuff, then you can go
check them out and support them. And also people should
check out your album post traumatic and support. You appreciate that, yes,

(40:06):
And there's also this single make it Up as I Go.
That's really a cential theme, not only to the record,
but to kind of everything that I'm doing right now.
There's an element of you know, when you feel like
you have options, when you feel like you are um
have some control over things, even if that means control
in choosing to improvise right, that can really empower you,

(40:30):
make you feel good. So the new song is all
about that, the video is about that, and I'd say,
you know, in in like a more of a philosophical
kind of way, that the whole tour is about that
post traumatic just disorder by the way which many people
suffer after a suicide of somebody close to them. A
suicide of a child increases likelihood of suicide of a

(40:51):
parent and vice versa. I mean, the ripple effect of
suicide is quite significant, and people often do struggle with
literally post traumatic of events following, and they have to
take care of themselves too. That's really important. Since we
are here in the venue, I'm going to go out
and do a sound check after this. UM. One of
the nice things about a show like this, which if

(41:11):
you guys stick around you'll be a part of is
that it is more about the post part than the
traumatic part. This is a very cathartic and heartwarming and
by the way, energetic and fun show. You know, I
don't think it's do entirely to my role in it,
although I'm kind of em seeing it. I'm running, you know,

(41:32):
directing traffic. But I've found that, you know, these fans
who come to this show, they've lost somebody, They've you know,
they've admired Chester for many years. Some of them have
many of them have tattoos of the band, of my art,
of his face, of our lyrics on their bodies. And
so they come and I would never want to give
them a night that was sad and depressing and dark,

(41:54):
like I want to. I want them to have a
great night. So these shows have been. Every night, they've
been this wonderful, healing and super super fun experience. I
want to take a page out of the newly written
playbook that Dr Saltz has offered us and express gratitude
deeply to both of you. Mike, you said that showing
emotional intelligence is not a sign of weakness. It is

(42:16):
very powerful new lyric that you just doesn't have a
matching set yet, but you can work on that and
post and and Dr Salts. You gave us a number
of steps, both on warning signs of people at the edge,
around giving away things that are close to them, around
expressing some sense of shame, and around being jerks or

(42:39):
super angry that might be masking a deeper depression and
even more useful to more of us, I think, how
to create the community that we want to be living in.
That's one of exercise and sleep and having that circle
of trust around us uh an expression of gratitude within
that circle. So I will close by saying to you

(43:01):
and to all listening, mental illness is just illness, and
mental health is simply health, and those who live with
it are not crazy people, thank you, Dr. They're just people.
We all need help from time to time, whether it
be with a broken leg or a broken heart or
a broken mind, and especially in the realm of mental illness,

(43:22):
a little compassion goes along way. Remember, as we say
often in this show, we are all connected, we are
all human, So let's be mindful of what those around
us are going through, even when our minds are full.
If you are someone you know needs help. You can
call the National Suicide Prevention Lifeline. That phone number is
one eight hundred to seven three eight two. Again, that's

(43:46):
one to seven three two, or just call. I want
to thank you both for being here, Mike Shinoda, Dr
Gail Salts. I've learned and I've grown, and I think
our listening as well as well. So thanks for being
so generous. Thank you. In the wake of that emotional

(44:10):
and eye opening conversation, I was inspired to learn even
more about the science that underpins the experience and the
explainers of mental health. So I got on the phone
with Dr Ahmad Harriary to talk about what the latest
research tells us is going on in our brains, what
role our genes play, and how to channel these learnings

(44:30):
into providing more treatment for more people. All right, good morning,
Dr Harrary, Thanks for making time. I'm sorry we couldn't
be face to face. Yes, and please feel free to
call me a mod a mod Yes, we're already in
the first and we'll feel free to call me Mr Thurston.
I want to talk with you about biology and the

(44:51):
brain and its relationship to mental health, particularly anxiety and depression.
I want to get into the research that you've done
with twenty three in me and I want to talk
about where that research can help take the larger cultural
conversation around mental health. Do those three sort of areas
sound like that makes sense? That's fair? Is there's something
else that you're like, we have to get to this though, No, no, no,

(45:12):
that's that's more than fair of our toin. I just
you know, if we have several months to do this
again and again, maybe we'll cover it all satisfactorily. But
what I'm promised to do my best. Okay, thank you,
Thank you, professor. You're you're used to explaining complex concepts,
so we're gonna take advantage of your official skills. Great. Great.
One of the things that we understand is that there

(45:33):
can be a layered reasoning for mental health. That is
their biological explainers, they're also environmental explainers. And because of
your work as a professor of psychology and neuroscience, I'd
like you to take us inside the brain and talk
about the biology and and the neuroscience of where anxiety, depression,
other forms of mental health live absolutely bour toin day.

(45:55):
And I think your your conceptualization of mental illness is
consisting of layers is very apt in terms of what
we've begun to learn about the brain in the context
of depression and anxiety. It's increasingly clear that there may
be differences in how individuals brains react to their experiences

(46:17):
and kind of produce different responses to challenges that we
really all face in our daily lives, and it's really
at that interface of an individual's brain and how it's
processing information, how it's processing their experiences, and those experiences
that we think ultimately can shape and give rise to

(46:40):
the experience of depression or anxiety. In other words, it's
differences in an individual's brain interacting with their environments, with
their own um experiences and trajectories in life that ultimately
will help determine who is it greater or lesser risk
for experiencing depression or in anxiety. Rather than there being

(47:01):
simply a difference in the brain that is absolutely going
to be expressed as depression or anxiety, it's become much
more clear that it really is an interaction between an
individual's brain and that associated biology and their experiences through
life that we we have to understand both sides of
that equation in order to really make headway in the

(47:23):
treatment and what we all hope will ultimately be the
prevention of depression and anxiety. That's so, so what I'm hearing,
I'm gonna try to be a good student here and
play back when I heard the professor share. First of all,
it's complicated, right, It actually sounds like it's about the relationship.
So they're there these three parts, right, there's the brain,

(47:44):
they're the experiences, and then there's the interaction of the
brain with those experiences. And so if we're thinking about
different people, we all have different brains, we all have
different experiences and their relationship. That interaction between the brain
and those experiences is of course it's self going to
be different. So how am I doing absolutely a plus

(48:04):
baritone day? Yeah, it's you know, biology is not in
this context, is not deterministic. The brain not only has
a remarkable capacity to change and this concept of plasticity,
but it has a way of shaping both our experiences
and then being shaped by those experiences. So to say

(48:25):
that it's complicated, I think is more than fair. But
we are we are starting to develop some at least
rudimentary understanding of specific features of an individual's brain that
can make them more or less sensitive to particularly uh
negative experiences in their lives, like stress, whether it be

(48:45):
common daily stressors or very significant traumatic experiences in their lives,
for example, those who lived through hurricanes or who live
through other, you know, natural disasters. We're starting to make
some headway in appreciating how the differences in their brains
will help us better understand their relative sensitivity to these

(49:08):
kinds of experiences. So I would love for there to
just be fewer worse experiences. Yes, less stress, fewer hurricanes,
fewer acts of violence, fewer emails right and tweets and
exactly anything that that causes stress, turn turn it down.
I'm assuming your research isn't focused on changing the entire world,

(49:32):
but rather understanding our brains and how it interacts with
that world. So, so can you describe the nature of
your research and with twenty three and me in particular,
and what are you looking at and what are you finding? Sure,
let me start with some of the understanding that we've
developed over the years about the brain. I think fundamentally,
what we're starting to observe is that there are core

(49:55):
aspects their course circuits. I like to describe them in
the brain that our response sable for kind of doing
different things. For us in our daily lives, there's a
circuit that is really there to help us respond to
danger and avoid danger and overcome danger. Then there's another
circuit in the brain that is really there to help
motivate us to pursue good things. The first one is

(50:18):
to avoid bad things in our lives, and the second
one is to pursue good things to develop motivation, and
through that motivation develop actions that help us achieve rewards
and experience pleasure. And then above those two circuits, the
danger circuit and the reward circuit, if you will, there
is a much more recently evolved control circuit. And what

(50:41):
we're starting to understand is that if there's a balance
between your sensitivity to danger, your eagerness to pursue rewards,
and your ability to control these two drives is ultimately
the most adaptive condition for an individual's brain. You want

(51:02):
to have balance across these and whenever we see imbalance,
in particular, when we see poor control or poor ability
to regulate our responses to danger or reward, that's when
we start to see manifestations of abnormal behavior or features
of mental illness like depression or anxiety. Those are the

(51:22):
kind of the elements that we study. As you very
eloquently stated bartin day, we're not going to be able to,
despite our our greatest wishes and intentions, were not going
to be able to protect everyone from having bad experiences
is literally part of living. One of the things that
we want to do is by understanding a person's brain

(51:43):
and in the balance between these three circuits in their brain,
we want to be able to basically identify people who
may be more in need of the limited services and
support the society can provide in order to protect them
from stressors that would otherwise lead them to experience anxiety
and depression. We essentially want to develop what we call

(52:05):
bio markers or measures of an individual's brain that can
help us identify their relative risk and in doing so,
allow us to direct the very limited resources that we have,
unfortunately and sadly, to that person and not to people
who may be otherwise resilient to those same negative experiences.

(52:26):
That's really where our work kind of lives now. With
twenty three and me, what we've really been excited about
is the opportunity to take these these aspects of an
individual's brain, this balance between these three systems or circuits
in the brain and represent them at the level of
their d N A. You know, we know that that
variation and an individual's DNA and their genomes is very

(52:49):
important for the development of the brain and how their
brain and these circuits operate. So if we can, working
with twenty three and me and really extending the work
too population levels of research, meaning hundreds of thousands of people,
we ultimately would love to be able to essentially develop

(53:10):
what I call a genomic or or a d N
A signature for an individual that tells us about these
aspects of their brain function. And I think it's at
that level that we can really start to talk in
an important way and in a powerful way about prevention,
because if we have those genomic signatures, sadly we don't,

(53:32):
and we're likely still quite a ways from them, but
that's where we want to be. We can identify those
genomic signatures really at the moment of birth and through
that be able to start to consider an individual's relative
risk or resilience and sculpt the support systems for those

(53:53):
individuals in a way that would help protect them from
developing conditions like depression or anxiety. Does that make sense.
It actually does. Um, I think you're either a great
teacher or maybe maybe I'm a great student, but I
think that's so. And you answered many questions that I
would have naturally asked. So I'll shift it a little

(54:15):
to say, I get the idea of these three circuits right.
You have control of the balance between reward and danger
and balance. You know, I'm thinking yin and yang, I'm
thinking the force right. Balance is always something that we
want just to be able to literally move in the world.
Balance is important, and some of us have more difficulty

(54:37):
balancing than others. You got it? That that makes sense. Also,
what makes sense that there would be something encoded in
us that might reveal our likelihood or our our probability
of having challenges with control, and that that the bio
markers you're referring to, these genetic markers, that that somewhere
in our DNA we could find people who are more
likely to experience this or not. And you've also explained

(54:59):
that we're not there yet, so we don't know the
exact markers and maybe how many. And so by comparison,
is there a field of genetics that is sort of
your role model where you say Oh, we do know
the bio markers here, there's these many this is how
they show up. We can screen for it. And I
would love for this field of mental health study and

(55:20):
brain study to be on the level with that other
genetic research. Who who's the who's the bigger sibling that
is biomarker genetic research that we could look up to. Yeah,
that's a great question and one that's not easily addressed
because there is really nothing else out there in terms
of a disease state or maladaptive state of being that

(55:42):
compares to the mind and compares to mental illness. It's
so much more complex than, for example, heart disease or
even forms of cancer, where there are breakthroughs in terms
of genomic signatures that may help actually direct specific treats
for cancer. I actually think we're starting to make headway

(56:04):
within our own field. The example that came to my
mind bar today when you asked the question was actually
the genetics of height. It looks superficially so simple, right,
if you have tall parents, then you're going to be
a tall kid, and so forth and so on. But
when we started to look at the actual variation in
our DNA, that explained height. It was very hard to find,

(56:26):
and it wasn't until we had literally hundreds of thousands
of participants of individuals whose height was measured and for
whom we had DNA that we started to explicitly account
for the genetic drive on height, which we know is
hugely important. What basically we found is that it's a

(56:47):
lot of genes and a lot of variation and a
lot of genes across our genome, across all of our
DNA that ultimately helps us account for the heritability that
the kind of the family nature of high eight. We're
seeing the same thing in with regards to mental illness.
Although mental illness you know, depression, anxiety, schizophrenia, bipolar disorder,

(57:08):
these are so much more complex than even height. But
we need to really have one very large data sets,
which a company like twenty three and me is already
developing through their customers and is poised to advance by
collaboration with other large studies across the world. And when

(57:30):
we have those large numbers of individuals in these studies,
I think what we're going to find is that there's
variation all over the genome across hundreds of genes, if
not thousands, of genes that collectively work together in ways
that are going to be even more complex to shape
the kind of what we strive for an understanding an

(57:52):
individual's kind of genetic risk or familial risk for mental illness.
So more data is absolutely paramount, and then we need
to marry the quantity of data with the quality of data.
So one of the one of the movements in psychiatry
and the study of mental illness has been to shift
away from these categories, these bins where someone's depressed, someone's anxious,

(58:18):
someone's bipolar, someone schizophrenic. It's very clear from those in
the practice of of studying and treating mental illness that
those categories are largely artificial and they bleed across each other,
and so it's moved to this more dimensional perspective on
mental illness. Let's consider symptoms that may be shared across

(58:38):
multiple categories of mental illness. You know, to feel depressed
is not unique to someone who's been diagnosed with depression,
but it's president in someone with an anxiety disorder, is
present in someone with psychosis, bipolar disorder, you know, schizophrenia,
obsessive compulsive disorder. So I think marrying this increase in
the in the quantity of data, with the quality of

(58:59):
how we're measuring mental illness and the specific symptoms that
people are experiencing. That's ultimately going to get us closer
to a genomic signature, genomic bio marker of those conditions,
which then subsequently we can leverage to hopefully begin to
address risk in a way that will prevent the emergence

(59:21):
of illness altogether. Because the other thing that we know
is that treating illness, be it a medical illness or
a psychiatric illness, is always an uphill battle, and we
really never can get people back to wellness. We can
get them to feel better than they may have felt,
but it's a tremendously a sad kind of observation that's

(59:42):
been made over time that people really don't return to
being well after they've developed mental illness. What's the ideal,
what's the dream case? When you think about a successful path,
we get the quantity of data, we get the increased
quality of how we interpret that data able to identify
people who have more control challenges than others and more

(01:00:05):
susceptible to mental health, and so then we target better
therapeutic treatment. Better pharmaceutical treatment, do we talk about mental
illness differently because of these insights with the dream state here, Yeah,
I mean you you've you've actually captured it quite well already.
But for me, ultimately, we would want to be able
to use a relatively simple, a relatively easily collected measure

(01:00:30):
of an individual. And you know, this podcast is called spit,
and spit is about as easy as as can be.
Let's collect some spit. Let's look at the d n
A and basically identify a genomic signature, a genomic bio
marker of risk that doesn't just tell us whether there's
high or low risk, but actually tells us where the

(01:00:54):
risk is manifest in the brain. In other words, we
might have a genomic signature that's associated it. And this
is the this is the fantasy. Remember I don't want
to suggest that we're ready to do this now, because
we're not. But the fantasy is, yes, I'm dreaming big.
We would have a genomic signature, for example, for an
individual who has relatively high danger sensitivity or threat sensitivity

(01:01:18):
as we say, and relatively low reward drive but you know,
normal control. So in the case of that individual, we
would we would try to address the relative risk by
managing their their kind of pursuit of rewards, their motivation
to pursue experiences that bring them joy that they find rewarding,

(01:01:41):
and and try and kind of normalize or achieve that
balance through that specific pathway. Then you may have a
genomic signature for someone who has basically a kind of
a typical threat and reward response but poor control. You know.
The analogy that I like to use is if you are,
you know, just an ordinary driver, and then all of

(01:02:03):
a sudden you find yourself behind the wheel of a
Formula one race car. That's not going to go well
for anybody. So these risk signatures in my mind, and
people find it surprising to hear this from me because
I am a biologist. I really think that the best
way to help protect people from developing mental illness, depression,
anxiety is in particular, is to allow them and to

(01:02:29):
afford them opportunities to exercise and develop control, which is
essentially what psychotherapy is. Cognitive behavioral therapy and the various
derivatives of psychotherapy ultimately work to empower the individual to
better control their experiences. So, rather than a magic pill
that we would give to individuals based on a genomic signature.

(01:02:51):
What I dream of is based on those genomic signatures,
making particular resources available to those individuals like therapists or
counselors or other individuals educators in their lives that can
really help encourage and cultivate better control. You know, like

(01:03:11):
so many things, it's something that we should all have, right,
We should all we should all strive for this. We
should all have the opportunity to develop control. But we don't.
And I for one, don't want to wait for a
utopian society where everyone can have access to this. I
would rather move ahead more quickly and be able to
target individuals who more need this and make this available

(01:03:35):
to them to ultimately help them as they develop throughout
their lives and really are able to then successfully navigate
the challenges that we're all going to face. You've given
me so much hope right now, I think my my reward. Yes,
a circuit is lighting up because it's something to look

(01:03:55):
forward to, and it's it's you're appealing to something, You're
describing something very universal, yeah, which is empowering of people
and of individuals, and but also recognizing in the real
world not everyone has access to that, and so in
your dream future, which I'm I'm signing up for it.
Now that's two of us. Man, Then then we could

(01:04:16):
target these resources and better distribute them. We've all probably
known people in our lives who have more resources to
address problems more objective, like a financial problem, a little
less complicated than neuroscience and genetic bio markers, um. And
so this is uh. I like this view. I like
this picture that you've painted. Yeah, and I think through

(01:04:37):
a biological lens, perhaps people can be more committed to
developing these resources and distributing these resources in a way
that that's most helpful to individuals. That's where the biology
and our deepening understanding of the brain and genetics associated
with mental illness can help kind of drive us forward.

(01:04:59):
For me, for example, it's so strange to hear anyone
talk about mental illness or the mind or behavior as
distinct from the brain, because that's just not where I
come from. You know, that's not my pedigree. But it's
still the case. And I think mental illness still is stigmatized,
And you know, the initial hope that by simply identifying

(01:05:21):
that mental illness is rooted in biology is going to
lift this stigma it's not happened. It's as we said
at the beginning of our conversation, it's complicated. But I
do believe that continuing to drive forward our biological understanding
of these phenomena will help us educate individuals as to
their importance and liberate the people suffering from these conditions

(01:05:44):
from kind of prejudice from being targeted, thus allow them
to receive these resources that they need. We don't have
these extended families that take care of each other anymore,
especially in the West. We're we're kind of more fractured
and we're more isolated, and that places greater responsibility on
society as a whole to provide the resources that that

(01:06:05):
individuals need. What why do you think that the stigma
has persisted despite our deepening understanding that there are some
biological i e. Uncontrollable underpinnings for people's experience of mental
health challenges and disorders. Yeah, you know, it's a great question,
and I feel like perhaps we as biologists haven't done

(01:06:26):
enough to articulate our findings and to make them accessible
to individuals to really promote the view of of mental
illness as any kind of illness, as an illness that's
borne out of problems in our biology and how our
bodies are are working and operating. I would love to
engage in a larger discussion with you and others who

(01:06:47):
are kind of engaged with policy and social and cultural
kind of shifts to try and make more headway, because again,
to me, it's just pardon the pun, it's mind boggling
to think of them as being anything but manifestations of
our biology. I really just don't understand it. I think
maybe perhaps it's because we don't have, you know, a scan.

(01:07:10):
We don't have a blood test where a doctor can
definitively say, well, you know, I'm sorry, you know, Mr Smith,
but you have depression and here's your scan. We don't
have those kinds of diagnostic tools. I'm not sure we
ever will. But you know, again, these genomic signatures, if
they're if they're identified and established with kind of confidence

(01:07:33):
and great predictive value, those could be the type of
diagnostic tools or tests that other aspects of healthcare have
had that we can use to promote and to further
kind of educate the public and individuals about the real
nature of mental illness. I look forward to some more

(01:07:54):
of those diagnostic tools to empower all of us, because
I think we all, whether we're suffering or close to
people who are, we're carrying an unnecessary burden. Yes, I
think this will be my my last question as we
wrap up Classy, and it's it's for you to summarize
the key learnings from the research so far. Sure, I

(01:08:17):
think the key learning and the key kind of observations
that we have developed in our own research and and
the research of many colleagues is that imbalance between in
particular and individual sensitivity to threat and danger and they're
kind of drive to achieve rewards and to experience pleasure.

(01:08:40):
When there's imbalanced there, we oftentimes see that associated with
higher sensitivity to stress because you have the draw the
danger signal and you don't have that kind of buffering
of positive emotion and reward. That's a particularly problematic imbalance,

(01:09:00):
and that in the face of this imbalance, it becomes
much more important and much more critical to have a
very strong control circuit. So that's where that third circuit
comes in. If you have and if you are allowed
to develop and exercise and practice control over your behavior,
in particular over your response to danger and your ability

(01:09:22):
to pursue rewards. Then that imbalance at the level of
the other two circuits is not going to be expressed
as depression or anxiety. This is kind of a trite word,
but we have to have a more holistic appreciation of
how the brain is operating. And we've been guilty of
this as well. We've long focused on one circuit while

(01:09:43):
ignoring others, and that's partly due to the limitations of
conducting research. But as we move forward collectively, we really
have to think about how these three circuits are dynamically
interacting to hopefully achieve balance in a person's behavior and experiences,
and then what kind of imbalance is present within an

(01:10:05):
individual that may be associated with with depression, anxiety, or
other forms of mental illness. One of the things that
we often say to the public, those of us who
have access you know, if you're experiencing depressive state or challenges,
if your loved one or something you're close to, is
call the number. Right There's there's a number for suicide
prevention that you should call, but there's more than that

(01:10:27):
available to us. What else would you suggest for people
who are experiencing a mental health moment or someone that
they're close to our How else should we be thinking
about what we can do in response before all the
great research and resource allocation comes to be real. Sure,
I think one of the biggest challenges for someone who

(01:10:47):
is experiencing depression or anxiety is the feeling of isolation.
Rather than to look immediately for a clinical outlet like
a hotline or or admitting oneself to an emergency room
or a hospital, is to hopefully reach out to family
or friends and to be able to just talk about

(01:11:08):
the experiences. I think is hugely beneficial. And then to
and probably is really hard to do for a lot
of people, is just to talk openly about their experiences
and allow our social support networks to do their job.
Don't just think of them as there for fun and
for good times, but they're much more important when we're struggling.

(01:11:31):
We have to help people reach out to those who
they know, who they're comfortable with, who they trust, who
they're closest to first, and then those people can't ignore
what they may be seeing in their friends and loved ones.
You know, if you're seeing a person's mood change, their
behavior change in a kind of a drastic way, in

(01:11:53):
a persistent way, I think it's paramount to approach them
to you know, initiate a conversation with them and not
not allow them to be isolated. I think that is
absolutely critical in helping someone initially and protecting them from
more harm and and kind of a deterioration into further

(01:12:13):
kind of isolation and deepening symptoms. And then from that point,
I think that social support network can help get them
into a clinic, uh, you know, meeting with a psychiatrist
or psychologist and to develop kind of a more structured
approach to ultimately kind of relieving this kind of state

(01:12:34):
of anxiety or depression. Thank you again. Sure, I've learned
so much and I am going to consider enrolling in
your class and change my heart. You know what. You
I will save a seat for you always. You are
very welcome to come down here and I think we
would have a great time if you did. All right,

(01:12:54):
I want to dig in more on today's topics and guests.
Check our show notes and if you enjoyed the episod,
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(01:13:17):
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