Transcript for Rachel Yehuda — How Trauma and

Resilience Cross Generations

July 30, 2015

[music: “Seven League Boots” by Zoe Keating]

Rachel Yehuda: We're just starting to understand that just because you're born with a
certain set of genes, you're not in a biologic prison as a result of those genes. That changes
can be made to how those genes function that can help. The idea is a very simple idea. And
you hear it from people all the time. People say, when something cataclysmic happens to
them, “I'm not the same person. I've been changed. I am not the same person that I was.”
And epigenetics gives us the language and the science to be able to start unpacking that.

Krista Tippett, host: Genetics describes DNA sequencing, but the new field of epigenetics
sees that genes can be turned on and off and expressed differently through changes in
environment and behavior. And Rachel Yehuda is a pioneer in understanding how the
effects of stress and trauma can transmit biologically, beyond cataclysmic events, to the
next generation. She studied the children of Holocaust survivors and the children of
pregnant women who survived the 9/11 attacks. But her science is a form of power for
flourishing beyond the traumas — large and small — that mark each of our lives and those
of our families and communities.
I’m Krista Tippett, and this is On Being.

[music: “Seven League Boots” by Zoe Keating]

Ms. Tippett: Rachel Yehuda is Professor of Psychiatry and Neuroscience and the Director
of the Traumatic Stress Studies Division at the Mount Sinai School of Medicine. She grew
up in a neighborhood in Cleveland that was heavily populated with Holocaust survivors — a
fact she didn’t register so much as a child, but which later became pivotal to the discoveries
she has helped make.

Ms. Tippett: The way I start all of my conversations, whoever I'm talking to, is just
wondering about the spiritual background. Wondering if there was a — how you would start
to describe the religious or spiritual background of your childhood. However you would
describe that now.

Dr. Yehuda: I had a very strong spiritual background. I was raised in an observant Jewish
community. I went to a Jewish day school. My father was a rabbi. So there was a lot of
Jewish study and Jewish culture and Jewish religion in our home and also at school. So I
was surrounded by — actually immersed in the bubble of observant Judaism.

Ms. Tippett: Right. So, you told me that you were the first graduating class where you were
given the option of getting — was this your Ph.D.? In...

Dr. Yehuda: This was my Ph.D.

Ms. Tippett: Ph.D. in...

Dr. Yehuda: Yes.

Ms. Tippett: ...psychology or neuroscience that...

Dr. Yehuda: Yes.

Ms. Tippett: ...this young field was really just coming into its own and so I wonder how you
would start to tell the story of, you know, in your lifetime, the emergence of the difference
between what you thought you were going into — when you decided maybe that you
wanted to study psychiatry and how you've watched that develop. What's been fascinating
to you to be part of that?

Dr. Yehuda: What was fascinating from the very beginning — my work in graduate school
was focused on stress hormones.

Ms. Tippett: OK.

Dr. Yehuda: And it was a great deal of interest in understanding the biologic response to
stress. And then in the...

Ms. Tippett: Was this like around the time that stress was becoming this word that was in
the culture?

Dr. Yehuda: Yeah, I think stress, as a word, was in the culture really in the '40s and '50s,
also. But it wasn't until around that time that there was a biology associated with stress.

Ms. Tippett: Right.

Dr. Yehuda: And people were very interested in it. And they were very interested in this
idea that something that happens to you generates a biologic response. And people knew a
lot about stress hormones from the adrenals.

Ms. Tippett: Yeah.

Dr. Yehuda: But what started happening in the '70s and the '80s was a recognition that
there were stress hormone receptors in the brain. And what that meant was that the brain
wasn't just barking orders at peripheral tissue like the adrenal gland. There was a dialogue
going on. It wasn't — it wasn't just the brain regulating everything. It was an ability of stress
hormones to circle back, and influence how the brain functioned. And even in the '80s, as a
graduate student, I was awed by that concept.

Ms. Tippett: So that meant that things were lodging in our bodies, and that things were
happening at a physiological level and affecting our brain and that was new?

Dr. Yehuda: I think it was new — I think it was new because everything was new.

Ms. Tippett: Yeah. Right. [laughs]

Dr. Yehuda: But it was certainly new to me. And the work that I did in graduate school was
really following up a series of findings that suggested that when you remove adrenal glands
in infant rodent pups, the brain begins to develop much more than usual. And you get an
adult rodent that has a brain that is 15% larger than if you hadn't removed the adrenal
glands. And that was really interesting, because what it meant was that stress hormones
play a really critical role in how the brain develops and how behavior develops.

Ms. Tippett: Wow. So, my understanding is that you wanted to look at this connection in
people, and I know I'm simplifying this, but at some point you went back to your old
neighborhood in Cleveland, and you started studying Holocaust survivors. And I don't know
if you were studying the children of Holocaust survivors at that point, and you found a
similar cortisol profile in them that one would find in veterans who had PTSD.
Dr. Yehuda: What happened was that I was having trouble understanding the relevance to
humans...

Ms. Tippett: OK.

Dr. Yehuda: ...of that work.

Ms. Tippett: Yeah.

Dr. Yehuda: And it was very important for me to be involved with something that was
directly clinically relevant. I asked to do some projects in people. And one thing led to
another and I found myself at the Veteran's Administration, just a few years after the official
diagnosis of post-traumatic stress disorder...

Ms. Tippett: Right. Right.

Dr. Yehuda: ... became known in the DSM. And we were really among the first people, that
group, to look at the biology of post-traumatic stress disorder. And the observation that we
made, which was really very hard to understand at that time, was that the combat Vietnam
veterans showed lower cortisol levels.

Ms. Tippett: Right.

Dr. Yehuda: And it was a surprising observation, because cortisol levels, as you may know,
are associated with stress responses.

Ms. Tippett: Right. Right.

Dr. Yehuda: And people that have depression and other kinds of mental illnesses and
symptoms often show high cortisol levels. So, this idea that combat veterans had low
cortisol levels was really kind of almost a crisis in the field...

Ms. Tippett: Yeah.

Dr. Yehuda: ...and it was a crisis because the diagnosis of PTSD itself was controversial.
And one day I said to my advisor, Dr. Earl Giller at Yale, I said, "I don't know, maybe you’ve
just got to pack it up around this post-traumatic stress disorder thing. I grew up in a
neighborhood of Holocaust survivors, and they're nothing like the patients here at the VA."

Ms. Tippett: Huh.

Dr. Yehuda: And he looked at me and he said, "That, Rachel, is a testable hypothesis."
[laughs] And, then it went from there. We decided to drive to Cleveland, a bunch of us, and
test the hypothesis that Holocaust survivors were similar to Vietnam veterans. And
essentially what we found is that there were a lot more similarities than we would have ever
dreamed of.

Ms. Tippett: And that they also had these low cortisol levels. Some of the same chemical
markers were there, biological markers.

Dr. Yehuda: Well, that is what we observed. And in terms of the fact that Holocaust
survivors notoriously were not treatment-seeking in mental health.

Ms. Tippett: Yeah, yeah.

Dr. Yehuda: We asked Holocaust survivors about that, we asked them about the symptoms
of post-traumatic stress disorder. We asked about nightmares. We asked about flashbacks.
We asked about those things. They had been suffering many of them for decades with
these symptoms. And when we asked, “well, did it ever occur to you to go and seek help?”
Many of them said, “Who could understand what we had gone through?” One woman said
to me, "You know, Dr. Yehuda, we don't have VA's like your veterans do." [laughs]

Ms. Tippett: [laughs] Gosh.

Dr. Yehuda: I thought to myself, whoa. And went home and within two weeks, we
established a Holocaust clinic for Holocaust survivors at Mount Sinai.

Ms. Tippett: And the field that you — again, very new, young, even younger field that you
have not only stepped onto, but helped — are helping to shape, is this world of epigenetics.
Which is the idea that not only do experiences lodge physiologically, but that physiological
changes can actually be passed on to the next generation, transmitted generationally,
transgenerationally. One helpful way to me that you've talked about epigenetics, is that you
said, think about genetics as the computer and epigenetics as the software, the app, the
program. [laughs]

Dr. Yehuda: Yes.

Ms. Tippett: So again, in these old ways — some of these old ways where I'm learning we
think about — we would think about biological change between generations as being
evolutionary, as something that would take time. But what you're learning is that epigenetics
— it's a mechanism for short-term adaptation, that even genetic mutation can happen
quickly and it's all around this trauma. So that trauma itself gets inherited.

Dr. Yehuda: Yeah. It's not a genetic change, per se, but it's a change to the program. And
we're just starting to understand that just because you're born with a certain set of genes,
you're not in a biologic prison as a result of those genes. That changes can be made to how
those genes function that can help.

Ms. Tippett: Yeah.

Dr. Yehuda: And maybe some changes are more likely to occur than others, and some
genes are more flexible than other genes. But the idea is a very simple idea. And you hear
it from people all the time. People say when something cataclysmic happens to them, I'm
not the same person.

I've been changed. I am not the same person that I was. And we have to start asking
ourselves well, what do they mean by that? Of course they're the same person. They have
the same DNA, don't they?

Ms. Tippett: Right.

Dr. Yehuda: They do. And what I think it means is that the environmental influence has
been so overwhelming that it has forced a major constitutional change, an enduring
transformation. And epigenetics gives us the language and the science to be able to start
unpacking that.

[music: “Rein” by Gustavo Santaolalla]

Ms. Tippett: I'm Krista Tippett and this is On Being. Today with neuroscientist and
epigeneticist Rachel Yehuda. She’s a pioneer in understanding how environmental and
behavioral experiences can transmit effects at a cellular level across generations.

[music: “Rein” by Gustavo Santaolalla]

Ms. Tippett: So, it makes sense to us, I think, that parents who are traumatized in whatever
way, would exhibit things around their children, right? That would affect the children. But
what you are showing is that while that is true, there's also something — children who, in
this sense inherit trauma actually are born with less of a capacity — some of them, born
with less of a capacity to metabolize stress. And is that an actual genetic change?

Dr. Yehuda: Well, let's unpack what you've said...

Ms. Tippett: OK...

Dr. Yehuda: ...because you’ve said. [laughs]

Ms. Tippett: ...and please keep correcting me.

Dr. Yehuda: Well, I’m just going to clarify, not so much correct.

Ms. Tippett: Yeah, yeah, yeah.

Dr. Yehuda: There are two ways to influence the next generation at least. One way is to
directly transmit something that you have and you transmit it in the form that you have it. So
let's say a change has been made onto your DNA, an epigenetic mark now sits on a
promoter region of your gene, for example. And through the magic of myosis that mark gets
transmitted through the act of reproduction. The cell divides, there's reproduction, and the
change sticks. And it's present in the next generation. That's one thing. That's a transmitted
change.

Ms. Tippett: OK.

Dr. Yehuda: There's another kind of change that involves giving your child — either at
conception, or in utero, or post conception a set of circumstances — and the child is forced
to make an adaptation to those circumstances.

Ms. Tippett: Right. And how would you talk about what the insights of this epigenetics adds
into our understanding of those dynamics and what can be inherited, passed on.

Dr. Yehuda: Well, let me go back to why we started looking at this in the first place.

Ms. Tippett: Yeah.

Dr. Yehuda: We established a clinic for Holocaust survivors and what we found was that
our phone did ring, but it was mostly children of Holocaust survivors who called us. And
what we began to see quite clearly was that offspring were reporting that they had been
affected by the Holocaust in many different kinds of ways, but in a very coherent and
cohesive pattern. They talked about feeling traumatized by witnessing the symptoms of
their parents. And they talked about the expectations, being traumatized by some of the
expectations that the Holocaust had placed on them, such as that they are the reason their
parents survived...

Ms. Tippett: Right.

Dr. Yehuda: ...and therefore there was a whole set of things that they [laughs] would now
have to accomplish so that all the people that died would — they could give...

Ms. Tippett: Yeah.

Dr. Yehuda: ...their lives meaning. They had difficulty in any kind of a separation
circumstance — divorce and those kinds of things. And they described essentially this
problem in separating from their parents. I mean, the time we started to treat Holocaust
survivor offspring, most of them were in their late 30s or 40s or 50s, and their mindset was
to describe themselves based on who their parents were. And most people at that age are
someone's parent or someone's spouse....

Ms. Tippett: Yeah.

Dr. Yehuda: ...they're not — very few people at that age are describing themselves in terms
of who their parents were. And I thought that in itself was very interesting.
Ms. Tippett: And what did you learn that was surprising and new?

Dr. Yehuda: Oh, well, first of all, this idea that they felt more vulnerable. That could be
supported by fact and it turned out that Holocaust offspring were three times more likely to
develop post-traumatic stress disorder if they were exposed to a traumatic event than
demographically similar Jewish persons whose parents did not survive the Holocaust. That
was real.

Dr. Yehuda: We also found — and this really was very surprising to us, that Holocaust
offspring had the same neuroendocrine or hormonal abnormalities that we were viewing in
Holocaust survivors and persons with post-traumatic stress disorder. And later on we
refined that even more so that we realized that the specific risk for certain things, like post-
traumatic stress disorder was associated with having a mother that had post-traumatic
stress disorder.

Ms. Tippett: You have also taken this inquiry to other populations. You've studied the
children of women who survived the 9/11 attacks and were at certain points of pregnancy at
that moment. Is that right?

Dr. Yehuda: Yes.

Ms. Tippett: And so, how — so because again, I think the Holocaust is such a singularly
massive event. Tell me, did you find the same kind of a similar — did you have kind of
similar findings with the post-9/11?

Dr. Yehuda: We did. We weren't able to do as extensive a workup. But I want to get back to
something you said that's really very important about the Holocaust being this
overwhelming trauma.

Ms. Tippett: Yeah.

Dr. Yehuda: I mean, part of why it's such an overwhelming trauma is because it happened
on such a large scale.

Ms. Tippett: Yeah.

Dr. Yehuda: But what we have to realize is that individuals who are traumatized maybe in a
very private way are devastated by the things that happened to them, they're just not as
public. They may not be as prolonged, they may not be as great. But for somebody to be
pregnant and in the World Trade Center while those buildings are coming down, that's your
own personal Holocaust.

Dr. Yehuda: And I think we can understand people a lot better if we take the time to
understand the impact that these events have on them personally. Just what we look for
when we study the impact of a trauma is how big the event is compared to what usually
goes on for a person.

Ms. Tippett: OK.

Dr. Yehuda: It's this idea of this overwhelming change that is what I think resets and
recalibrates multiple biologic systems in an enduring way. So, we have to be able to
visualize that in order to understand why the body makes such major and drastic changes,
because of course what we've been taught in school is that you have a stress response and
after a few minutes, everything gets back to normal.

Ms. Tippett: Right.

Dr. Yehuda: We call it homeostasis. The body sort of bounces back like a rubber band and
that happens with respect to extremely circumscribed systems, but not with respect to the
entire person.

[music: “Summary of the Article” by Ryan Teague]

Ms. Tippett: You can listen again and share this conversation with Rachel Yehuda through
our website, OnBeing.org.

I’m Krista Tippett. On Being continues in a moment.

[music: “Summary of the Article” by Ryan Teague]

Ms. Tippett: I'm Krista Tippett and this is On Being. Today: in conversation with
neuroscientist Rachel Yehuda. The young field in which she works, epigenetics, explores
how genes can be turned on and off and expressed differently through changes in
environment and behavior. She has pioneered studies with the children of trauma survivors,
and helped demonstrate how experiences can transmit a biological vulnerability to stress in
future generations.

Ms. Tippett: It seems — and I think this comes through not just in what you're saying, but
how you're saying it, that this knowledge that we're gaining about ourselves is a form of
power. And that it holds lots of promise and also very practical applications now. So we will
talk about that. This science also makes it possible to talk about things that are hard for us
to talk about.

I mean, this whole notion of generationally transmitted trauma, it gives a kind of a chemical
basis for talking about what happens to populations of refugees. Or African Americans in
this country who have this history of generational trauma. Or aboriginal peoples in Australia
or — I was reading about some work in generational trauma that Maria Yellowhorse
Braveheart did…
Dr. Yehuda: Mm-hmm.

Ms. Tippett: ... on the Pine Ridge Reservation. You know, using the term of the soul
wounds, the wounding of the Native American soul, this is science that is putting something
to that phenomenon that seems to me to be quite new. It's a more holistic way of describing
what happens to human beings.

Dr. Yehuda: Yes, but it doesn't all have to be negative. I mean...

Ms. Tippett: Right.

Dr. Yehuda: ...the purpose of epigenetic changes, I think, is simply to increase the
repertoire of possible responses. I don't think it's meant to damage or not damage people. It
just, it expands the range of biologic responses, and that can be a very positive thing when
that's needed. I mean, who would you rather be in a warzone with? Somebody that's had
previous adversity, knows how to defend themselves? Or somebody that has never had to
fight for anything?

Ms. Tippett: Right. So, you're saying...

Dr. Yehuda: It might be very advantaged in many other social and cultural ways.

Ms. Tippett: ...so you're saying that our — that there's an intelligence in our bodies, behind
this adaptation.

Dr. Yehuda: Oh, yes.

Ms. Tippett: Is that — yes. Right. Right.

Dr. Yehuda: There is a wisdom in our body. For sure.

Ms. Tippett: But do you know what I mean about saying that it opens up some
conversations to be able to talk about this in terms of science and in terms of physiology? It
opens up a new vocabulary for talking about things that are very difficult.

Dr. Yehuda: Yes. I think that's right. I think that in general the concept of post-traumatic
stress disorder has allowed us to acknowledge that trauma effects last. They endure. They
don't all go away. And now, epigenetics allows us to extend it to generational.

Ms. Tippett: Yeah. I'm just suddenly aware of a lot of work going — and I know you're so
much more in the middle of this, but just as an outsider, I'm aware of this discussion and
these approaches finding their way. I was in California last year with — the California
Endowment is doing all this work on healthy communities, and putting the notion of trauma
— the children being traumatized, in a much more expansive understanding of what that
means based on a lot of this science and trying to acknowledge that and treat that or help
the children themselves become more self-aware and to modulate themselves, rather than
just punishing them for bad behavior.

Dr. Yehuda: Yeah, I mean, I think that how we think about legacy trauma changes, if you
want.

Ms. Tippett: Yeah.

Dr. Yehuda: Historical trauma — I've given that a lot of thought. In the Jewish religion, we
do memorialize trauma. We have many days, we even have a Holocaust Remembrance
Day. We have fast days that commemorate the destruction of the temple. We have, on an
individual level, we memorialize the date of death of loved ones. We say yizkor, which is a
memorial service. But what's very interesting about that is that these days occur on a
specified time on the calendar. They start at a certain time. They end at a certain time and
then so too the effects end.

So you set aside a certain part of your life to remember and acknowledge, but it doesn't
own you. When you're able to put something in a context, you carry it with you, but you
carry it with you in a way that promotes more reflection, in a way that gives you more of a
context, in a way that shows you where you've come from, in a way that honors your past.
But not in a way that overtakes your past and makes a future predetermined, or impossible.
So, I think that we have to be very careful about how we talk about generational effects. A
lot of people want to say generational scars, but they're merely effects.

Ms. Tippett: Yeah.

Dr. Yehuda: You cannot run from your past. But maybe you would run farther if you carried
your past with you as long as you can control it. And I think that that is really what we want
to understand. We want to understand...

Ms. Tippett: Yeah.

Dr. Yehuda: …what it means to have a greater repertoire of behavior. What it means to be
— we have a concept about being optimized to your environment. Right?

Ms. Tippett: Right.

Dr. Yehuda: So let's say, for some reason, your parents transmitted to you biologic
changes that are very appropriate to starvation, but you don't live in a culture where food is
not plentiful.

Ms. Tippett: Yeah.

Dr. Yehuda: You're just not optimized, but I think that if we develop an awareness of what
the biologic changes from stress and trauma are meant to do, then I think we can develop a
better way of explaining to ourselves what our true capabilities and potentials are.

Ms. Tippett: Yeah, I'm so with you. And I mean, what you just described about how
Judaism in particular and I think religious ritual, there's always been this innate wisdom to
that, kind of creating a container where the pain and the trauma is acknowledged, but not
allowed to — that it has its place. But it's challenging for us culturally to — it also says that
when we have this whole issue of race that is so with us now, of this legacy in African
American communities, of all kind of layers of trauma across history. It seems to me that
one of the things this science is saying is that we, somehow, in the process of healing and
addressing that in a new way, there is kind of a need to create that container of
acknowledgement. I don't know. I mean, I'm just thinking out loud. I just wonder if you think
about this kind of implication of this work you're doing.

Dr. Yehuda: I think about it quite frequently, because I'm very challenged by thinking how
this information could be empowering and not disempowering.

Ms. Tippett: Yeah.

Dr. Yehuda: And one of the studies that we published, maybe a year ago, showed that
some epigenetic changes occur in response to psychotherapy. If we're saying that
environmental circumstances can create one kind of change, a different environmental
circumstance creates another kind of change.

Ms. Tippett: Yeah.

Dr. Yehuda: That's very empowering.

Ms. Tippett: Yeah. That healing also is transmitted.

Dr. Yehuda: Exactly. And I've been talking in some way or another to survivors of extreme
trauma for, I don't know, more than 25 years now. I mean, really a long time. I think...

Ms. Tippett: Yeah.

Dr. Yehuda: ...I've spoken to certainly hundreds, but probably closer to more than a
thousand trauma survivors. And I think the message of how you take your trauma forward
and use it positively is something that a lot of people really resonate with. I mean, there was
a brief moment in our field where many scientists thought that if they could obliterate the
memory for the trauma that would be a cure for PTSD.

Ms. Tippett: Yeah.

Dr. Yehuda: But I don't think that for most people it would be a cure for PTSD. I don't think
most people don't want to remember what happened to them. They want to not be
tormented by that memory, and they want to be able to take all that suffering and convert it
into something positive.

Ms. Tippett: Yeah.

Dr. Yehuda: And that's why you see a lot of trauma survivors engaged in social justice, and
trying to help prevent future tragedies. I think that the podium of suffering provides an
unparalleled opportunity, not to mention the fact that what trauma does sometimes for
people is that it really focuses them on the past. They have a lot of trouble staying in the
present. And there's virtually nothing left for thinking about the future.

Ms. Tippett: Right.

Dr. Yehuda: And really, it's very important that although you can't change what has
happened to you in the past, there's this whole future that you might be able to do
something about.

[music: “There is a Number of Small Things” by múm]

Ms. Tippett: I'm Krista Tippett and this is On Being. Today with neuroscientist and
epigeneticist Rachel Yehuda. She’s a pioneer in understanding how trauma lodges in our
bodies and can transmit effects at a cellular level across generations.

[music: “There is a Number of Small Things” by múm]

Ms. Tippett: I do keep being intrigued by how some of this insight, which is human and now
it also turns out that we can kind of see it terms of chemistry, is also there in spiritual text. I
mean, you quoted this passage from Ezekiel, “the fathers ate sour grapes and the children's
teeth were set on edge.”

Dr. Yehuda: Right, in the Bible, it's rhetorical. But, the idea is that it's a hard thing to
imagine that if your father ate sour grapes, the children's teeth will be rotted. And yet,
[laughs] science is teaching us exactly that.

Ms. Tippett: Yeah, and I do think it's important to keep underlining the fact that what you're
learning and what you're working on is opening up so much new insight and possibility. But
it's — as you said, there was skepticism about PTSD. This kind of idea still has a ways to
go before it's really settled in our midst.

Dr. Yehuda: I think that's right. I think that what throws us off and why these ideas are often
challenged is because there isn't a uniform response to stress or trauma. And it throws
things off when the world isn't that ordered.
Ms. Tippett: Yeah.

Dr. Yehuda: It throws things off when people respond differently to events. So, it's very
hard to have somebody say, “this event derailed me,” when somebody else who
experienced the same event wasn't derailed by the event. We have to appreciate that there
is quite a lot of variability and diversity in the way that we respond. And some have argued
that the diagnosis of PTSD is too limiting, and some have argued that it's too expansive. But
one thing is for certain, post-traumatic stress disorder is one kind of response to trauma,
and there are probably many others, including resilience.

Ms. Tippett: Mm-hmm. So let me ask a question this way, because it seems to me, you
know, what you're doing is you're contributing to this whole sense of how complicated we
are and it's always a dance between what comes to us physiologically and also how we
behave. I mean, it's not — I think, what you're saying is that parents who’ve experienced
trauma, do pass that on in ways that have genetic biological force, but there also are
experiences their children are having that are about how how their parents are with them,
right?

Dr. Yehuda: Mm-hmm. Yes.

Ms. Tippett: So, if I as a parent had a traumatic experience, I mean, if you were working
with, say, a mother who had been in a second or third trimester on 9/11, as you say, people
who you've worked with. What can a parent do to transmute that, to work with that
inheritance factor, knowing that it's there? You know what I'm asking? What — how do
you...

Dr. Yehuda: Yeah, and I'm really glad that you brought up the 9/11 study, because we sort
of didn't finish the loop on talking about it.

Ms. Tippett: Yeah.

Dr. Yehuda: The reason that that study was so pivotal, even though we weren't able to do
as comprehensive a biologic assessment as we had been able to do in adults, was that
what we learned was that there was a trimester effect on cortisol levels in the babies. And
that was really huge for us. And it opened a lot of doors for us.

Because we began to understand that some of the differences between maternal and
paternal trauma and risk might have to do with the very special in utero changes or in utero
contributions to what we call developmental programming, which is really about changing
the stress system so that it can have this greater repertoire. So you asked me a concrete
question of what I would say to a second or third trimester mother.

Ms. Tippett: Yeah.

Dr. Yehuda: What I generally say to people that have a lot more to overcome, because
their biology has given their condition a firmer reality is that you have to work harder or you
have to understand that a lot of what you have is biologically driven. And I find that just this
information...

Ms. Tippett: Just the information, just naming it.

Dr. Yehuda: ...just the information.

Ms. Tippett: Yeah.

Dr. Yehuda: There was one time in one of the Holocaust groups — one of the women was
talking about something stressful that had happened at work. It was in a group
psychotherapy, and it was a terrible story. But then she stopped and she said, “...and then I
remembered that Dr. Yehuda said, I have poor shock absorbers and I should just let it pass
[laughs] because my biology is going to have extreme responses before it calms down. And
then I did and it really worked.” Now, I didn't say that.

Ms. Tippett: [laughs] OK.

Dr. Yehuda: I wasn't that clever. But what was so interesting was how she had internalized
the information that her stress system was more responsive and had used it to actually
calm down all by herself in response to a stressful situation. So I pointed that out, of course,
because it had nothing to do with me. But it's just the power of information.

Ms. Tippett: It's that knowledge as a form of power, just the knowledge itself.

Dr. Yehuda: Exactly, and I think if we know what's going on in our bodies, then it just takes
a lot of the confusion and the panic away from it, especially if we have this idea that this is a
step on the way to having an equilibration of some sort.

Ms. Tippett: Does what you're learning also hold for parents who, let's say — I'll just be
personal here — I've struggled with depression at times and I think when you have
something like that, of course we know that genetically there can be predispositions for
these things. But it also feels like it's in this category of something that you worry about
passing onto your children in every possible way. I mean, I don't know, I'm just — and that
depression does — can feel like a form of trauma in its way.

Dr. Yehuda: Oh, absolutely. Depression is horrible.

Ms. Tippett: Yeah.

Dr. Yehuda: And it does pass to children. But I think one of the things that can be very
empowering is to pass along coping strategies. Instead of saying things like, “Well I have
depression, but that can never happen to you.”
Ms. Tippett: [laughs] Yeah.

Dr. Yehuda: You say things like, “I worry sometimes that you might get scared when you're
down.” And when I'm down, it's awful. But I can reflect back on it and know it's an illness.
Or something that can be, again, a tool. So the worst thing that you can probably do when
you have depression is to not name it. And to make a lot of attributions that are not valid
about your character [laughs] or...

Ms. Tippett: Yeah.

Dr. Yehuda: ...about other things or that you're not trying hard enough. The thing to do
when you feel your depression is what you would do when you feel any illness, and that is
have it treated. And of course, not every illness is treated very easily. But you deal with it for
what it is. So, teaching somebody how they might deal with something that you might pass
on is probably the thing that I would recommend.

Ms. Tippett: And we've talked about how this research speaks to the whole idea about
generationally transmitted trauma speaks to also groups of people. Do you work at all in
communities? Is this science being brought into — to the communal level like this, or is it
useful at that level?

Dr. Yehuda: I don't know. I'm not really dealing with things in that manner.

Ms. Tippett: Yeah.

Dr. Yehuda: And ironically and interestingly, we have our religious leaders do a lot of this
communal trauma work.

Ms. Tippett: That communal [laughs] — yeah, that's right.

Dr. Yehuda: And — because you don't have a mental health professional up there in front
of, you know, many families, praying because something bad has just happened.

Ms. Tippett: Yeah.

Dr. Yehuda: So, I think that we charge our spiritual leaders with doing a lot of this work.

Ms. Tippett: Well, what you said a little while ago though is that the spiritual traditions have
actually created these containers for doing the naming, right? And putting ritual around it so
that it has its place? But it also has boundaries, and also I just think there's language like —
there's the language of Lamentations [laughs] you know what I mean? That we don't...

Dr. Yehuda: Mm-hmm. Yeah.

Ms. Tippett: ...that we don't have culturally, but it's so necessary to the reality of —
Dr. Yehuda: Well, Jewish tradition believes that the same person who wrote Lamentations
also wrote the Song of Songs, so... [laughs]

Ms. Tippett: Yeah.

Dr. Yehuda: ...so it's — can't verify it for you, but the idea is that this is a moment, it's an
expression. It's a time of your life. It's not necessarily defining you always. People can have
periods of good functioning and periods of bad functioning and it can be quite uneven.
There could be triggers that make things worse. There could be good environmental
circumstances that make things better. There could just be a natural cycle. Time can make
things better or make things worse. So, there are just a lot of different ways of really
approaching this.

Ms. Tippett: I have to say, I'm so struck, kind of, coming back to what you said to me at the
beginning about the fact that we hear people say something traumatic happened to them,
and it could be a veteran who came back from war, it could be rape, it could be a violent
accident or a criminal attack and they say “it changed me.” And your — this knowledge that
have you now is that, in fact, it did. It changed people with genetic force, and it can...

Dr. Yehuda: Epigenetic.

Ms. Tippett: ...epigenetic force that it can be passed...

Dr. Yehuda: [laughs] OK.

Ms. Tippett: ...it can be passed on. Also, I'm so struck by the fact that this knowledge itself,
just acknowledging the force of what has happened to us, that the force of trauma itself is a
piece of knowledge that, I don't know if you want to say it's healing, but that it helps. That
it's kind of a — it's a building block to healing.

Dr. Yehuda: I think it's a necessary prerequisite for healing. You have to do more than just
recognize it. But you have to recognize it.

Ms. Tippett: Right.

Dr. Yehuda: We have a culture that goes to two extremes. They either completely dismiss
something as nothing happened, don't worry, or they get very hysterical about what might
have happened. And really what we have to do is give ourselves a little time after an
adverse event to kind of take stock and not be so hard on ourselves, or not set expectations
and just listen to our bodies and give ourselves the space to be quiet and to heal and to
see. To ascertain what has been damaged. And try to counteract that by putting ourselves
in the most unstressful, healing environment that we possibly can have to counteract some
of that and promote a biological and molecular healing process that might forestall some of
the epigenetic and molecular changes.
Ms. Tippett: I keep having this memory of some — an experience I had a couple months
ago. I was in the city of Louisville, where they're working on — from the mayor to the chief
of police to the school system, they're trying to figure out what it would be to be a
compassionate city. And they're actually using some science in this. They're bringing some
contemplative methods into schools. It's very interesting and very holistic. And there was an
— actually a pastor, an African American leader, who leads one of the important churches
there. And he said that one of the most important transformative things that that this mayor
had done — that young people in his community had said this to him, was to sit with their
grief...

Dr. Yehuda: Mm-hmm. Beautiful.

Ms. Tippett: ...to be — to dwell with the — and they may have used the word trauma. Just
to let that be in the room.

Dr. Yehuda: Feel it.

Ms. Tippett: Yeah.

Dr. Yehuda: Feel it instead of running to someone to give you a sleeping pill.

Ms. Tippett: Yeah.

Dr. Yehuda: Feel it. I mean, if you want to have that kind of a culture, it boils down to two
words. It boils down to being able to ask someone, "You OK?" You know, just the idea that
you are acknowledging the possibility that something bad has just happened to someone
and inquiring about them is really, really at the heart of how military cultures really check up
on each other and in other healing cultures, you really hear a lot of people saying, "Hey, you
OK?"

Ms. Tippett: And if you're not OK — I mean, the fact that you're not OK, right? That
something terrible really has happened, and letting that be — letting that also be true.

Dr. Yehuda: Well, the second stage is saying “no...”

Ms. Tippett: “No.” [laughs]

Dr. Yehuda: ...when you're not. But that's...

Ms. Tippett: Right.

Dr. Yehuda: …that's a different problem altogether.

Ms. Tippett: Yeah.

Dr. Yehuda: But just the idea of creating this space for that to be a possibility instead of
having the assumption in our lives we just assume everything is OK.

Ms. Tippett: Yeah. “How are you?” “Great.” Right? We do that...

Dr. Yehuda: Right.

Ms. Tippett: ...reflexively.

Dr. Yehuda: “How are you?” has become a pleasantry that is devoid of all meaning. But
just really kind of taking a second to inquire in a real way about how someone is doing. And
even if they don't tell you, and even if they lie to you, it will probably have a beneficial effect.
I mean, what I hear from trauma survivors — what I'm always struck with is how upsetting it
is when other people don't help, or don't acknowledge, or respond very poorly to needs or
distress. I'm very struck by that. And I'm very struck by how many Holocaust survivors got
through, because it was one person that became the focus of their survival. Or they were
the focus of that person's survival. So how we behave towards one another individually and
in society, I think can really make a very big difference in — honestly, the effects of
environmental events on our molecular biology...

Ms. Tippett: [laughs] Right.

Dr. Yehuda: ...so it [laughs] it becomes — it becomes very interesting when you think about
it that way. But I think it's true.