November 9, 2017
Rachel Yehuda
How Trauma and Resilience Cross Generations

The new field of epigenetics sees that genes can be turned on and off and expressed differently through changes in environment and behavior. 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 has studied the children of Holocaust survivors and 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.

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is professor of psychiatry and neuroscience and the director of the Traumatic Stress Studies Division at the Mount Sinai School of Medicine. She’s also director of the Mental Health Patient Care Center at the James J. Peters VA Medical Center in New York City.

Transcript

[music: “Seven League Boots” by Zoë 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’s 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 Zoë Keating]

Ms. Tippett: Rachel Yehuda is a 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. I spoke with her in 2015.

Ms. Tippett: The way I start all of my conversations, whoever I’m talking to, is just wondering about how you would describe — 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.?

Dr. Yehuda: This was my Ph.D.

Ms. Tippett: Ph.D. in psychology or neuroscience — that this young field was really just coming into its own. And so I just — I wonder how you would start to tell the story of — in your lifetime, the emergence of — the difference between what you thought you were going into when you, I guess, decided, maybe — what was it? — that you wanted to study psychiatry, and how you’ve watched that develop; what’s been fascinating to you to be part of, about that.

Dr. Yehuda: Well, it was fascinating from the very beginning. My work in graduate school was focused on stress hormones, and there was a great deal of interest in understanding the biologic response to stress. And then, in the ’70s…

Ms. Tippett: Was this 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. 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, 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 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 all the things we associate with the brain. And that was new?

Dr. Yehuda: 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 that 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, of that work, 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 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. And it was a surprising observation, because cortisol levels, as you may know, are associated with stress responses, 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 almost a crisis in the field, 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.” 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 — 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 VAs 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, trans-generationally. One helpful way, to me, that you’ve talked about epigenetics is, you said, “Think about genetics as the computer and epigenetics as the software, the app, the program.” [laughs]

Dr. Yehuda: Yes. [laughs]

Ms. Tippett: So again, in these old ways, some of these old ways we’re unlearning, 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. 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? 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 and 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 that would affect the children. But what you are showing is that while that is true, 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, because you’ve just said a lot of different things. [laughs]

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

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

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, what can be inherited, passed on?

Dr. Yehuda: Well, let me go back to why we started looking at this in the first place. 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; 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 their lives meaning. They had difficulty in any kind of a separation circumstance — divorce; those kinds of things. And they described, essentially, this problem in separating from their parents.

At 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. 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.

Ms. Tippett: So in their lifetime, they were more vulnerable to post-traumatic stress in whatever experiences came their way

Dr. Yehuda: Right, but not “whatever experiences came their way.” What was very, very interesting was that there were some experiences that didn’t register that much, but all traumatic experiences that involved some kind of an interpersonal component was very difficult; was more likely to be difficult. Holocaust offspring also showed a lot of resilience-related qualities, but in terms of this idea of being more vulnerable to depression or anxiety, that was real.

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 — because again, I think the Holocaust is such a singularly massive event — so tell me, did you have 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. Part of why it’s such an overwhelming trauma is because it happened on such a large scale. 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. 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.

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. And 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. 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. 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 Yellow Horse Brave Heart did on the Pine Ridge Reservation, 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 think 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. Who would you rather be in a war zone with — somebody that’s had previous adversity, knows how to defend themselves, or somebody that has never had to fight for anything, but might be very advantaged in many other social and cultural ways?

Ms. Tippett: Right. So you’re saying that our — that there’s an intelligence in our bodies, behind this adaptation?

Dr. Yehuda: Oh, yes. 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 — 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 — The California Endowment is doing all this work on healthy communities and putting the notion of trauma, 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 think that how we think about legacy trauma changes — if you want, 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 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.

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 what it means to have a greater repertoire of behavior. We have a concept about being optimized to your environment. 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 — 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 what you just described about how Judaism, in particular, and, I think, religious ritual — there’s always been this innate wisdom to that, 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 is so with us now, of this legacy in African-American communities, of all — layers of trauma across history. It seems to me that one of the things this science is saying is that 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’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 can be empowering and not disempowering. 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, 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 — really, a long time. I think 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. 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. 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.

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. 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 see it terms of chemistry, is also there in spiritual text. 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 — just 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. 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: So let me ask a question this way, because it seems to me 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. 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 their parents are with them.

So if I, as a parent, had a traumatic experience — 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, to work with that inheritance factor, knowing that it’s there? You know what I’m asking? 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. 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. 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. 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. [laughs] 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, you — 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 don’t know, there are all kinds of things, and that — depression can feel like a form of trauma, in its way.

Dr. Yehuda: Oh, absolutely. Depression is horrible, 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 could never happen to you,” 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 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: 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. And ironically and interestingly, usually we have our religious leaders do a lot of this communal trauma work…

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

Dr. Yehuda: Because you don’t have a mental health professional up there in front of many families, praying because something bad has just happened. 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 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, you know what I mean? [laughs] — 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 — [laughs] 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, 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 you now have is, in fact, it did. It changed people with genetic force, and it can…

Dr. Yehuda: Epigenetic.

Ms. Tippett: Epigenetic force…

Dr. Yehuda: [laughs] OK.

Ms. Tippett: And that 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 — that 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. 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 un-stressful, 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 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 — an important church there. And he said that one of the most important, transformative things that this mayor had done that young people in his community had said this to him — was to sit with their grief.

Dr. Yehuda: Beautiful.

Ms. Tippett: To be — to dwell with the — and they may have used the word “trauma,” but just to let that be in the room.

Dr. Yehuda: Feel it. Feel it, instead of running to someone to give you a sleeping pill. Feel it. 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?” 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 —the fact that you’re not OK, that something terrible really has happened, and letting that be — letting that also be true.

Dr. Yehuda: Well, the second stage is saying “No,” when you’re not.

Ms. Tippett: “No.” [laughs] Right, right.

Dr. Yehuda: [laughs] But that’s a different problem altogether. 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 reflexively.

Dr. Yehuda: “How are you?” has become a pleasantry that is devoid of all meaning. But just really 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.

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 there 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. [laughs]

Ms. Tippett: [laughs] Right.

Dr. Yehuda: So it becomes — [laughs] it becomes very interesting, when you think about it that way, but I think it’s true.

[music: “Dusk to Dawn” by Emancipator]

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’s also director of the Mental Health Patient Care Center at the James J. Peters VA Medical Center in New York City.

[music: “Dusk to Dawn” by Emancipator]

Staff: On Being is: Trent Gilliss, Chris Heagle, Lily Percy, Mariah Helgeson, Maia Tarrell, Marie Sambilay, Bethanie Mann, Selena Carlson, Malka Fenyvesi, Erinn Farrell, Jill Gnos, Laurén Dørdal, and Gisell Calderón.

Ms. Tippett: Our lovely theme music is provided and composed by Zoë Keating. And the last voice that you hear singing our final credits in each show is hip-hop artist Lizzo.

On Being was created at American Public Media. Our funding partners include:

The John Templeton Foundation, supporting academic research and civil dialogue on the deepest and most perplexing questions facing humankind: Who are we? Why are we here? And Where are we going? To learn more, visit templeton.org.

The Fetzer Institute, helping to build the spiritual foundation for a loving world. Find them at fetzer.org.

Kalliopeia Foundation, working to create a future where universal spiritual values form the foundation of how we care for our common home.

The Henry Luce Foundation, in support of Public Theology Reimagined.

The Osprey Foundation, a catalyst for empowered, healthy, and fulfilled lives.

And the Lilly Endowment, an Indianapolis-based, private family foundation dedicated to its founders’ interests in religion, community development, and education.

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Artist: Zoe Keating
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  • Gabby

    I am not familiar with the underlying research, but what one might do in an empirical study is to identify an ample sample of children of Holocaust survivors, collect data for each not only on the final “outcome” variables (indicators of stress and PTSD) but also their answers to questions about parenting, and then effectively factor out the effect of parenting style (“control for”). Such a strategy allows the researcher to see whether an effect remains once parenting style is taken into account. It is a little more complicated than this, but this is basically how two possible “cause” variables are disentangled empirically.

    • blacksheep

      i disagree with your suggested control. a survey/questionairre by design can not serve as a screening for a control group due to additional potential bias in wording, test/questionnaire phrasing and the like.
      As with most social psych research, establishing an adequate, neutral control is almost impossible due to the number of variables that come to bear. Parenting, schooling and socio-economic enviroment are just a few of the possible variables that would have to controlled in some fashion.

      • Gabby

        One of the important things to realize about empirical research is that one can, in fact, learn a great deal from sound research technique while acknowledging that there are potential sources of error.
        One needn’t give up on understanding something that involves events of the past because one was not there to observe the past. Well designed surveys can be a very useful tool.
        In social science people study and implement what are called “quasi-experimental designs,” because one cannot rely on laboratory controls the way one can in physical science. Identifying sources of error but also the likely degree of error is part of scholarly empirical work in these fields.

  • somethingtosay

    I enjoyed this discussion very much. I work in a small Oregon coastal community with community health. It has brought me to awareness of the studies of epigenetics, Dr. Van der Kolk, the ACE’s study (Adverse Childhood Experiences). This discussion adds more information with regard to the broader study of epigenetics that I find so directly impacting our world and healthcare outcomes so much on our minds today. This compassionate work so beautifully explained by Dr. Yehuda is magnificent. All I am learning about mind and body and collective study and thoughts pulling together to finally acknowledge human beings are affected by trauma. How we could let the VA decide years ago that PTSD is not a big deal still astounds me. It took more assaults on the USA to start new approaches. When will we also acknowledge the impact (stress/ trauma) of all the killings is a health crisis now? I am grateful for your program.

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  • berthe42

    Every human being of reasonable age should listen to this discussion. It has reinforced a notion that some friend and I share: most immigrants ( regardless of their social standing in the county they live behind) have suffered a great trauma abut most manage to pull through and resign themselves to adapt to their new reality. However, most find that their children have less resilience, more quick to seek the solution to their problems in a pill , or take other drastic measures with their lives. So, I feel that although our genetics may be modified by our traumatic experiences, our offspring may not be as strong as we have become. In fact, they may see us as being too though when we voice our criticism, when we call someone a wuss for feeling that the sky fell on their head become something minor happened to them. Ms Tippett, I think you should have a televised town hall on a major network about this topic. Our society needs it! I always look forward to listening to your program! Thank you!

    • Bernadette Swider

      I am a child of post WWII European immigrants and have often felt “other.” Until I became exposed to the study of trauma, did I understand my own trauma in observing my German father and Polish mother reconcile with their histories. Until he died, my father proclaimed, he loved everyone and he wasn’t a “bad” German. I wish I could contact Dr. Yehuda for more information on support for the children of parent’s who passed on their trauma.

  • 2PenniesMore

    Thank you for another very interesting episode and its key comment from your guest that “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… “.

    The laudable effort of epigenetics to understand the genetic impact of trauma and to knit models of its trans-generational transmission provides indeed a great relief from the current ideological hype about mechanistic genetics. I can only hope that it is the prelude of a breakthrough similar to what happened when quantum physics shattered the arrogance of the the mechanistic Newtonian models of the universe.

    Based on the findings of epigenetics, one can therefore also presume that a good psychotherapy also reverses or otherwise changes the way our genes function. In which case, epigenetics is another window on the fluid process called « life », but it offers little or no leverage on the process itself.

    It would have been worthwhile mentioning that the study of trans-generational trauma did not start with epigenetics but has gone through a long list of breakthroughs like the pioneering work of Anne Ancelin Schützenberger on the “Ancestor Syndrome” in trans-generational psychotherapy and that of Dan Bar-On the “Other within us” and his demonstration of a similar impact of the
    Holocaust in three generations of families of Jewish victims AND of families of Nazi perpetrators. The entire movement of “Adult Children of Alcoholics” is also rooted in the recognition that trauma is the “anchor” that holds the trans-generational chain that shackles successive generations of “adult children” until that chain is broken through one or several of the multiple modalities of psychotherapy, including the participation in self-help/mutual aid groups.

    It was a great relief that, after all that genetic science, the interview ended with the recognition that compassion is the irreplaceable agent of healing summed up by the expression “to sit with their grief”. As your guest put it, the casual “How are you?” “has become a pleasantry that is devoid of all meaning. But just really 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”. “Probably” indeed, since such a casual inquiry happens to be a harmonic of “What ails thee?”, the very question that reveals the healing power of the Holy Grail in the Arthurian legend.

    Besides the intellectual pleasure of having the impression that one is deciphering how trauma is recorded at the molecular level, I conclude from that episode that genetics, be it « epi », « para » or otherwise, instead of being the source of hubris it too often is, should be another incentive for us to be humble.

    Thank you for On-Being.

  • Terry Fortman

    There is not enough information here to judge the quality of the science. If we’re talking about the after effects of trauma and how they affect behavior, maybe it does not really matter whether such effects are producing genetic effects or environmental effects. This is because we’re going to do whatever is ameliorative in a manner independent of cause anyway.

    • Helen

      I like this particular episode, but I am also a little disappointed about the light science. I wonder whether that is because I am a biologist, and I want some more mechanistic information, and that perhaps the same thing happens when astrophysicists hear shows featuring someone in their area, but I am just too ignorant of astrophysics to notice!

      There are some very interesting observations about stress, PTSD, and intergenerational transmission, and then of course there is some great spiritual wisdom about traumatic memory, adaptation, stress response. I would have loved to have a molecular mechanism that can begin to explain this. I’ve looked at Yehuda’s work, and she does address this. Of course she addresses a small piece of what will be a very large puzzle-and that is as expected. However, that information really didn’t make its way into the interview, which is too bad.

      She mentioned something very compelling at the beginning-the early observation that Viet Nam vets with PTSD (a controversial diagnosis at the time) had low cortisol levels threw the field into a crisis. I was in grad school at that time, and while not in neuroscience, I can tell you that the unidirectional linear way she describes the thinking at that time (the brain barking orders to the periphery, the master regulator, blah blah) was dominant, and therefore her finding would have in fact been truly shocking because it did not fulfill the simplistic expectation-stress hormone will be high in chronic stress. I wish she had spent more time on explaining how we understand that now, how it is both adaptive and perilous, and then mechanistically, how this is transmitted into the net generation, how that can explain observed behavior, both under adverse and normal conditions, and what coping skills were being effective.

      A lot of this was there, or hinted at, but unfortunately too scattered to create the narrative I would have liked to hear.

  • Caro

    Wonderful, simply wonderful. I would love to be able to contact her

  • Angela

    This conversation resonates with my own experience with trauma and PTSD. Although I have no desire for or thoughts about a future, it was a true relief to understand i am not alone in wanting to heal the whole self. Thank you so much. Rachel and Krista.

  • rbarks

    I have no doubt this is true. My trauma too was a mass shooting/gun violence- done by a young man with 2 semi-automatic handguns shooting 49 students and faculty at Virginia Tech in 2007/10 years ago. 32 young adults, professors and grad students died, 17 were shot multiple times and lived and the shooter committed suicide that April 16th Monday morning. My daughter was 20yo at the time and especially grieved the trauma of 2 friends killed and one friend injured. (She was arriving on campus for classes to the “wailing” of law enforcement vehicles.)

    I am a psychotherapist myself and was teaching here in NC about couple therapy when I received calls about what was happening for my daughter. So I was simply a “ripple effect” Mom who dropped being a professional and rushed to Blacksburg to offer basic support students and families in that community that week. I continued to worry intensely about my daughter and friends in Blacksburg, VA, for many months. I awoke 11 months after that mass shooting suffering paresis (semi-paralysis/muscle weakness) with a Transverse Myelitis (which showed on MRI as lesions on my brain consistent with MS/perhaps a predisposition to MS manifesting with this trauma). I have no doubt those conditions evolved from that trauma. I know of other friends who succumbed to reoccurrence of breast cancer and other illnesses following that gun violent incident and who died of their illnesses within a couple of years. I am grateful that my own daughter, in different ways & at different times accepted support in working through her experience.

    • Gabby

      Blessings to you for what you have done, what you have tried to do, and what you continue to do.

  • Dg

    I loved this episode. But I wonder if the opposite has been evaluated i.e. can truly wonderful situations / experiences exert an effect?

  • When I was 16 years old, during an expended period of stress and trauma, I experienced a bizarre feeling that I can only describe as a “shift” happen inside my body. Within minutes the very first wave of depression and anxiety occurred. Your program reminded me of that time and answered some questions I’ve had for decades. I was touched deeply. Thank you.

  • Jacqueline Strachan Laughlin

    I receive this post on Thursday in advance of it airing on my local public radio station on Sunday. I glanced at in on Thursday quickly scanning the article noting how “relevant” it was to my “work” professionally and personally as I share time with Veterans struggling with Trauma & Brilliant Resilience of all sorts. It is not lost on me that I receive so much more than give them when I offer words of hope, encouragement and resilience I can share they will get better and that it is often in listening to stories about their families and caregivers that they truly experience possibilities/ From generation to generation, some families just figure it out. Little did I know the prophetic words would carry me through the week as ON BEING often does. Yesterday, I sat in the emergency room with my daughter and 6 year old grandson as the sweetest nurses and doctors reattached the tip of his right middle finger after a tussle with a door at school. We were all hurt but the story that lifted him the most was hearing that his grandpa pop pop Jerome had a similar story at school, probably more than 30 years ago… he was a teacher, not the student, and he lost the tip of his finger, but after a slow & steady recovery he too was doing well and had all sorts of special powers that allowed him to do everything he once had albeit differently and do his work as a sculptor maybe in spite or because of his special finger and hand. He sent a quick photo of the healed hand through the phone. And the grandson not having remembered ever seeing his grandfather’s hand before smiled with delight and said I will be fine, I will be like my grand pop and told the doctor she did a very good job. Generational BLESSINGS

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  • Kimberly Noble Piper

    if this topic interests you, I encourage you to not only search evidence-based, peer-reviewed articles on epigenetics and trauma informed care, but also Life Course Theory and Adverse Childhood Events (ACEs) theory. We are far more than our DNA, and our actions and environment cross generations.

  • Stephen Kuttner

    The following quote describes me to the T…especially since my Father’s death last year (a survivor of the Holocaust through the Kindertransport) before the election; “Trauma lodges in our bodies and can transmit effects at a cellular level, across generations. 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. 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.” -Dr. Yehuda

    Attached is a link to a writing on my Facebook wall about my Father and him warning me about another Hitler coming to being:
    https://www.facebook.com/stephen.kuttner/posts/10210708346721127?notif_id=1510982737543695&notif_t=like

  • Early

    Because this interview specifically describes my family’s experience and my own over a period of decades, I will make a personal comment elsewhere. However, your question is relevant and well put, as are those of Helen and others.

    To get a bit more specific with respect to the portion of genetic science involved with epigenetics, you might wish to check the beginnings of epigenetics which, as I understand, began with Scandinavian studies of family histories and initially concentrated on the endocrine system as well as related disease such as diabetes.

    Scandinavian families tend – or at least in times past tended – to keep detailed family histories over many generations. In centuries past this involved extensive oral histories, but in Iceland, Greenland, Finland, Sweden, Norway, Denmark much information was available.

    One common experience over the centuries in these countries was starvation. These family histories and later detailed family genetic studies revealed that disease histories tended to follow a pattern where the grandchildren revealed disease histories that tracked starvation events which occurred in the grandparents lifetime but may not have appeared in parents. After much testing and development of new science techniques, it was shown that certain such traumatic experiences could “flip” the operational switches of particular genes in such a way that the “impossible” – experience – could demonstrably influence the operation of particular genes.

    I apologize for not being able to offer citations to the literature, but Nova has run one or two programs on this topic and I am sure that you will be able to use a search engine to track the “history of epigenetics” or some similar search topic to get more detail.

    Your question is quite reasonable and well taken. Nevertheless, the operation of specific systems and the resultant effect on well understood systems such as endocrine glands, in addition to the developing science of genetic transmission of diabetes and so forth, provided a sound basis for the start of this field.

    And, if you go back to someone with a very strong biological science background, as well as anthropology and medicine, such as Gregory Bateson, you will find that he was writing about epigenetics in a conceptual way several decades before the detailed science was available to provide the documentation. It is, in fact, a very well detailed body of science. Put another way, epigenetics and PTSD are not affects or a product of feeling, an attitude problem or the symptoms of a malcontent. They are effects.