Subscribe
Share
Share
Embed
How can a deeper understanding of mental health help us see our world, and ourselves, differently? Hosted by therapist Kurt White and journalist Mary Wilson, each episode of Unravelling explores a complex mental health topic with insights from both professionals and people with lived experience. Whether you're trying to make sense of the world or just the slice of it inside of your head, Unravelling is here to foster a more compassionate and informed perspective on life.
The content of this podcast is for informational purposes only and should not be considered medical advice. Always consult with a qualified health care professional for any health concerns. Take care of yourself out there. Welcome to Unraveling, a podcast that sees the world through the lens of mental health. I'm Curt White, a social worker and psychotherapist.
Mary:And I'm Mary Wilson, a journalist. Wow, Curt. Our past three episodes, we've really covered a lot of ground exploring what makes us who we are, how memory, development, and diagnosis all shape the self.
Kurt:And we hope people go back and listen to those episodes because they all stand on their own. You don't don't need to listen to them to understand and appreciate today's conversation. But I think we do wanna try to tie some things together today in maybe a way that is a a little bit different from our usual format.
Mary:Yeah. We're going to pull some clips from our previous interviews, but we have a fourth interview today, and we think that it really ties all of these ideas together.
Kurt:That's right. And there's a a big question that runs through all of these that I'd like to ask you now.
Mary:Okay.
Kurt:When something is a problem, what do we even mean by that?
Mary:Yeah. That's a deceptively simple question, but it can actually be quite complex. It means that something isn't working in your life. Right?
Kurt:Yeah. It does mean that, and it also opens up all of these social and philosophical and biological complexities. Right? Is it a do we mean is it a mind or a brain problem? Is it a diagnosis like we've talked about?
Kurt:Nature, nurture, or adaptation? Did it come out of development? You know, this has really been, I think, at the heart of this series that we've been doing. Trauma is a good example. We talked about how the same kind of experience can actually cause a number of different diagnoses or problems.
Kurt:They're they're just sort of labeled, but also experienced differently.
Mary:And this is something that we heard about from doctor Randy Frost who helped us understand how complicated it can be to establish diagnoses in mental health and how a diagnosis can change.
Dr. Frost:In a sense, we are trying to understand some entity, but it's an entity we can't physically measure. It's some kind of human behavior that's abnormal. And Mhmm. And so it's not like having a broken bone because you can see a broken bone. It is in a way, what we refer to as a hypothetical construct.
Mary:But he also pointed out some challenges with this way of defining problems.
Dr. Frost:This categorical approach doesn't quite fit with with nature.
Kurt:So when we talk about nature, we're getting at some sort of appeal to an understanding that has a validity beyond description alone. What does something really look like? And a lot of times in medicine, actually, that's an appeal that goes into the the world of biology. Can you see it on a brain scan? Can you see it in a pathology test?
Kurt:Can you see it in genetics? Can you see it in something that we can observe in development, for example. Right? But often, people with similar experiences, even very similar genetics, qualify for several different diagnostic labels and and treatments at the at the biological level. You know, medicines, for example, often act on the very same systems in the brain.
Kurt:There's an old joke that a psychiatrist in Chicago told me that we've moved from the four humors to the four receptors. You know? It's sort of like there's a a whole bunch of treatments that really do work, but they seem to work for a lot of different things, which which brings up the validity of, like, how do we know what's really underneath it even when there is a biological cause? And doctor Golda Lynn pointed out this dilemma in our episode about development.
Dr. Dolen:What does PTSD have to do with addiction? What does addiction have to do with depression? You know, how is it that one class of drugs, which seems to be working through different receptors, how are they all doing the same thing?
Mary:Doctor Dolan also gave us a framework for thinking about this developmentally, introducing the concept of critical periods, times when our minds are especially open or plastic to developing and changing.
Dr. Dolen:Really, I think that the critical period explanation does a good job of accounting for this diversity of diseases because if you think about it, every single one of them is a disorder that has a a learning component to it. Right? We've learned some set of behaviors that was adaptive at the time of, say, if it was PTSD, you know, was adaptive during the the moment to survive the injury, but over time are less and less adaptive.
Kurt:And these critical periods are are an excellent example of what we're talking about. The the mind on a biochemical level is always trying to adapt. Everything is exists in dependence on something else. Right? We have our biology, but then we have the environmental stressor.
Kurt:Sometimes even an old understanding or version of this is called the stress diathesis model, right? That you have some proclivity toward developing a problem, but then stressors in the environment cause the problem to actually develop. So you get things like even folks with identical genetics, like identical twins, will only have problems like schizophrenia fifty percent of the time. Right? So it's highly heritable, but it's not universally heritable.
Kurt:So what's going on there? Right? There's there's definitely something happening.
Dr. Dolen:You know, the reason that we have critical periods is because there aren't enough genes in the genome to encode every single behavior. Instead, what gets encoded in the genome is the ability to learn from your environment. And this ability to learn, it has a progression. Right? So you can't learn everything all at once.
Dr. Dolen:Instead, you have to first, have to learn to walk and then or crawl and then walk and then run. Right? And so those windows of time seem to be developmentally constrained to the appropriate window for that learning progression. But it also means that it enables humans and other animals who have these critical periods a huge amount of behavioral flexibility that wouldn't be available if they were trying to use genes to encode these behaviors. So instead of having 7,000 possible languages, we would all speak only one.
Dr. Dolen:Right? And so this is an advantage, but also a constraint that is imposed by setting the the brain up like this.
Mary:So because we need to have our genes respond to what happens as we grow and live our lives, we stagger our development and let it respond to what is needed. And there's a name for this. You might have heard of it. It's epigenetics. It's the idea that ties together everything we've been talking about, how our biology, environment, and experiences are constantly shaping one another.
Kurt:On this episode, we want to tie all these things together by asking, what if our experiences don't just live in our minds, but leave lasting marks in our bodies even at the genetic biochemical level? And epigenetics explores exactly that, how stress, trauma, and environment can influence how our genes are expressed, sometimes across generations.
Mary:Yeah. And to help us understand this concept of epigenetics more in-depth, I spoke with doctor Tess Mirsha, an endowed chair and professor at Cincinnati Children's Hospital Medical Center specializing in genetics and epigenetics. His research explores how genetics and environmental factors interact to influence diseases with a particular focus on asthma and allergic conditions. His lab develops innovative tools to study genetic ancestry, racial disparities, and personalized medicine with the goal of translating research into real world clinical applications. His work has been widely published in top scientific journals, and he's received numerous awards for his contributions to genetic research.
Dr. Mersha:Thank you for the opportunity, Mary. I appreciate doing this with you. Thank you.
Mary:Epigenetics is one of those words I feel gets tossed around a lot, but is a bit mysterious to pin down. It's not genetics, but it is based on genetics.
Dr. Mersha:Scientists recognize that genes or genetics in Earth science from family parents are not the only cause of variation. And they call it epigenetic. Epi means on top of genetics. So, something laying over genetics. So, your gene is still there.
Dr. Mersha:Epigenetics is basically a study of inheritance that changes in gene expression, but doesn't involve the DNA sequence itself.
Mary:So your DNA stays the same through your life, but the way your genes are expressed, whether they're turned on or off, can change based on things like environment, stress, or experience.
Dr. Mersha:Yes. A good example in this case is you can consider epigenetics as a software that runs on the hardware. The hardware is your genome, your genetic background, but the software that you load on is epigenetics. This is a really interesting way of looking at our genes.
Kurt:You know, when I was in college in the nineties, the human genome project was all the rage. And I I knew some people that that that's what they did. Actually, they graduated college and went to graduate school and and worked in in places that that were trying to decode the human genome. And and we we thought that was gonna answer a lot of questions for us, and and it has answered some. But, you know, cataloging the 20,000 genes in our system also left a lot of questions unanswered because it it seemed like once we got through all of that, that it it's more complicated than that, that this code is influenced by the environment even at the biochemical level and in ways that we don't always know exactly how it's being influenced.
Kurt:These are metaphors, locks and keys. And but how how is it really, working? You know? How how can we shed some light on this topic?
Mary:Oh, funny you should mention light. Doctor. Mirsha offered another example of how this relationship works, comparing epigenetics to a light switch.
Dr. Mersha:So you can turn it on, turn it off the switch, and you can see light or not, but still the wire is the same. So that means the genes, the background remains the same, but that's the change that you see as a result of perturbation. Especially in this case, something environment. For example, you are turning on and off. You are, like, serve as an environment.
Dr. Mersha:If somebody is exposed to pollution, the pollution is the environment that changes the gene expression, ultimately affect the outcome.
Mary:So environment and experience, especially in childhood, play a major role in how epigenetics unfolds.
Dr. Mersha:So, your genes try to upregulate or downregulate to offset the effect of the environment. By doing that, that upregulation creates unnecessary overexpression, which is potentially not helpful to your health. So it's a change in your expression as a result of the environment that you are exposed.
Mary:As I understand it, in this context, upregulation just refers to how much the gene is working at any one time, how much of a protein a particular gene or gene sequence is producing. And it turns out that factors like stress can contribute not only to this regulation, but the ways that diagnoses and problems can develop later on in life.
Dr. Mersha:So I think early life stress trauma can trigger a number of epigenetic modification. That modification obviously will affect your cortisol level and that change can heighten the stress sensitivity, risk to anxiety, depression, and PTSD, and obviously later in life. So there's this cascade of event that childhood trauma or childhood stress can lead to adulthood.
Mary:So that means experiences, especially early ones, can shape how our genes function for years, even decades. Stress in childhood isn't just emotional, it leaves a biological footprint.
Kurt:So much for the blueprint of the human genome. I have I have mixed feelings around all of this, actually. On the one hand, it'd be nice to have a total blueprint. Right? But, on the other, if if we get one, I I suppose, then it really means that our genes are our destinies in a in a complicated way, isn't it?
Kurt:But if we don't have that kind of blueprint, or at least if it's not quite as blue as the blueprint would suggest, if there's more wiggle room and flexibility in it, then perhaps there's a hopefulness in that, even though there's a little bit more uncertainty. Maybe that some problems that we thought were more destiny, you know, actually turn out to be only potential pathways for us.
Mary:Yeah. That's exactly what doctor Mirshu was saying, that there is this idea of reversibility.
Dr. Mersha:It can be reversed, you know, with appropriate, for example, exercise or diet, the effect can be reversed. Most genetic changes are permanent, but epigenetics has a way, plasticity, that you can reverse depending what outcome you are looking for. And that would be a very good target in, you know, pharmacogenomics or whatever you have in a precision medicine arena. So it's a very good target in the field.
Kurt:Now I find that really quite amazing to think about, that the joy in our lives and the connection to others and the reduction of stresses might help genes express themselves in the best possible ways and even reverse past expression that might have led to some problems.
Mary:Yeah. That's the power of epigenetics. Unlike genetic mutations, which are fixed, epigenetic changes can often be altered.
Dr. Mersha:When stress happen, there are some genes that may be turned on, off, or expression changes dramatically. The same holds true when you are in joy, and there are genes that, you know, extremely positively express. Although, as human geneticists and disease geneticists, we focus mostly on the bad side of the effect of stress or the effect of epigenetic in terms of stress, And definitely, it could apply both ways.
Mary:With epigenetic mapping, we might eventually identify the exact gene involved and find a way to dial it down, even if the environment doesn't change. That's the frontier of precision medicine. Doctor.
Dr. Mersha:You know, we have over 20,000 genes in our genome, and it's very hard to know which is which. But if we identify through this epigenetics, genome wide epigenetic methylation, we can target specific genes that are correlated to a given stress. For example, let's say you are exposed to environmental exposure like air pollution, And you become asthmatic as a result of environmental exposure. So you can associate air pollution with asthma. But in order to target a specific biomarker, you need to focus on your biology so that what are the genes that are mostly associated or insulted by air pollution, for example.
Dr. Mersha:Then out of this 20,000 genes, you would say gene X is associated to air pollution. Then the next step is, okay, what to do? Is it gene overexpressed or underexpressed? Then the overexpression of gene X is associated to air pollution. Because of its overexpressed, it leads to asthma.
Dr. Mersha:Now the next step is how to adjust using CRISPR or other technique to down regulate that gene so that it wouldn't be affected by that stress. So it gives you a way to target. Although you may have to live in that environment, your body will adjust as a result of your genes are regulated not to up regulated, up expressed.
Kurt:So in a way, both Doctor. Mirsha with epigenetics and Doctor. Dolan with critical periods are talking about a similar thing, aren't they? Bringing some flexibility to a process that was closed up tight to facilitate a kind of adaptation, a kind of healing. It strikes me that this is actually what psychotherapy is trying to do.
Kurt:I mean, I'm always putting a plug for it, you know, to try to turn something rigid and fixed into something more flexible, filled with play, filled with possibility. That's where the other interview in our series comes in. You you had talked about this very idea with doctor Bremner, didn't you, in your interview on trauma and memory?
Mary:Yeah. That's right. Doctor Bremner also talked about how complicated it is when there are these disruptions in early life that can contribute to problems like PTSD and dissociation, for example, problems that therapists often see in their work.
Dr. Bremner:The most common cause of PTSD in women is early childhood sexual abuse, and a lot of the DID patients are people with early childhood sexual abuse experiences, and so that's probably one of the more common scenarios is that early trauma. You know, I haven't really seen it in people with adult trauma like, you know, train accidents or combat veterans. It's mainly in women who have early repeated chronic childhood sexual abuse. You know, the the kind of the deviations in the different alteration altered identities, it'd be like the same thing, like, for amnesia or depersonalization that minor stressors or traumatic reminders could trigger those.
Mary:So just like doctor Mirsha and doctor Dolan have said about our bodies, the effects of events and the environment on our mental health depend on a lot more than just our genes. But even in extreme environments, psychotherapy can be helpful.
Dr. Bremner:I think, you know, most therapists would say that the role of therapy is reintegration. You know? So, if there are traumatic memories that, are sealed off in consciousness, if you will, or not, you know, part of the normal daily thoughts, then it may be that I mean, and those and those will be painful memories, and they may be things that a therapist would have to help people, you know, moderate their anxiety as they recall these traumatic memories, and, you know, there's cognitive behavioral therapy techniques that can help people to reduce anxiety and and whatnot. And so that would be the goal of long term psychotherapy, would be to reduce the anxiety associated with specific memories, and sort of maybe cognitively help people reintegrate and have a better perspective as an adult on certain pathways of thought that children may have that, you know, blame themselves or, you know, etcetera, that, if they can cognitively restructure it, may be able to, you know, reintegrate those memories into the main core themselves and come up with a a new narrative that can incorporate those past traumas, but, you know, also help someone kind of move forward and and heal.
Kurt:And I think what he's saying here is very powerful, actually, because he's drawing attention to how the biological world and the social world is not actually so separate after all, right? Of course, our something like a kind of a social, a talking cure, a therapy intervention like this, also has biological correlates, right? We're helping people to regulate the nervous system, regulate brain functioning through the work that we're doing when we do things like psychotherapy. But it can be a slow process, especially with some of the, you know, really significant and hard to treat problems like he's discussing, dissociation or early childhood trauma. And it it involves a lot of work, a lot of courage on the part of our clients.
Kurt:And it's also a problem that there really hasn't been that much new in the field of mental health treatment for, I don't know, really decades. I mean, there've been gradual interventions, and we shouldn't poo poo that. I mean, lot of medicine, a lot of a lot of a lot of things are actually just sort of very gradual movements forward. But sometimes it's a little disheartening in the field of mental health to see other fields like cancer treatment get whole new kinds of therapies like immunotherapy or, you know, you can't spend ten seconds on network television without seeing a monoclonal antibody commercial. You know, they're the ones that all end in mab.
Kurt:You know, they treat all kinds of different problems. Where are our new treatments?
Dr. Frost:Our efficacy in treating OCD hasn't improved very much in the last thirty years. It's still it's pretty good, and it's better than, say, medication for OCD. It's the first line treatment for OCD, and it has been for thirty years. But it hasn't improved since then. And it's not perfect.
Dr. Frost:You know, there are there are people who don't get better with it and don't improve very much.
Kurt:It would be wonderful to have something like psychotherapy, but that kind of jump started the process and got it going faster. You know, we've never been sure if there really is exactly such a thing. You know, if you combine some of the medicines that we have now with psychotherapy, you get a better effect than either one alone a lot of the time. But it's a kind of, again, a kind of a modest or gradual effect that still can be complicated and take a long time. And for a long time, really nobody thought this was possible, even those working on it, like doctor Dallettin, for example.
Dr. Dolen:You know, people have been looking for these master keys. And honestly, when I was a graduate student, I poo pooed the idea. I I was very skeptical that we would ever get to a master key because based on what we knew about the mechanisms relating to inhibitory excitatory balance, extracellular matrix remodeling, metaplasticity, I thought anything that could do this, any any drug or manipulation that could be a master key for unlocking critical periods would dramatically interfere with the ability of the brain to, you know, not have seizures or it would, you know, cause amnesia or it would cause, you know, structural instability to the brain. And so I I was very, very skeptical of the idea that we might ever find a master key.
Mary:Doctor Dolan's research is now pointing to being able to reopen those healing periods and let our brains readapt to the current environment. It's really exciting work, and you'll have to go back to our episode with doctor Goldilen for more information on that.
Kurt:It's such fascinating research. Some of the most exciting that I think is being done right now anywhere in the world. And doctor Mirsha, who's at the front of a a similar kind of thing in epigenetics, is equally excited about its potential for understanding how it can carefully target, carefully anything that we describe or consider to be a problem.
Dr. Mersha:I think the good thing with epigenetics is that you can control as much as possible. Know, as a family, let's say you have a certain stress and you know that stress affects your epigenetic profile, and you can learn how to adjust those immediate action and reverse the effect. So if you have this, all your information and also your lifestyle and your diet system. And pretty much knowing about profiling and cataloging about you will help the physician to prescribe you in a more tailored way. And then you and I get a different treatment, even if we feel the same disease or the same outcome.
Dr. Mersha:So that's kind of moving, the field is moving that way. So how can be precise, and instead of providing all our, you know, one size or a fit system?
Mary:All of these things together, the understanding of how our environment impacts us, the mechanisms our bodies and brains use to adapt and remold themselves, and how we can reintegrate those things together, all of that is really helpful when you look at it together. Because the fact that we can understand problems and sometimes reopen our adaptive capacity means there's a chance to go back to relearn and rewire. And that brings us back to healing because if our bodies and brains can adapt, maybe trauma isn't destiny.
Kurt:So we started this special episode with a deceptively simple question. What does it mean to have a problem? And where we've landed is that it's a lot more complex than we thought, but also maybe a bit more hopeful that this is all leading us is a really interesting frontier.
Mary:Yeah. We've learned that what is often labeled as problems in mental health diagnoses like PTSD or depression are not fixed categories but dynamic patterns, patterns that emerge as the mind and body adapt to the environments we grew up in, the stresses we face, and even the meetings we assign to our experiences.
Kurt:And that word adaptation has been a key linking point in all of this, right? Whether we're talking about traumatic experiences like dissociation or shifts in gene expression shaped by our early life stress, the through line really is that the mind and body are always trying to adapt. And sometimes these adaptations can outlive their usefulness. What once helped us survive can later show up as suffering.
Mary:Epigenetics gives us language and tools to explore this process at the molecular level, how the environment interacts with our biology, and how these interactions can change over time.
Kurt:All that together gives us something powerful, possibility, the idea that experience, especially healing experiences, can leave just as much of a mark as the harmful ones, that biology isn't destiny, that psychotherapy, medicine, and social support might help reopen critical periods or shift long held patterns so that there can be combination therapies of medicines and and other interventions that synergistically work together to help so much more than we ever thought possible.
Mary:And while we may inherit vulnerabilities, biological or social, we also inherit the capacity to adapt. And if problems are part of that adaptive story, maybe healing is too.
Kurt:Thank you for listening to Unraveling today. It wraps up our series on exploring these layers of identity, development, and diagnosis, though I'm sure we'll return to many of these topics. They're really complicated. But we hope you go back and listen to the other episodes too. It's just some really interesting standalone stuff with a lot more detail from doctor Galdo Lend, doctor Randy Frost, and doctor Doug Bremner.
Mary:And a very special thank you to doctor Tess Mirsha, who really helped us tie everything together today in this special episode. We hope you join us next time.
Kurt:Unraveling is brought to you by Brattleboro Retreat. Our producers at Charts and Leisure are Andrew Adkin, Hans Buteau, and Jason Oberholzer.
Mary:And you can find us on social media by searching Brattleboro Retreat. Brattleboro Retreat is committed to exploring diverse perspectives on mental health. While we invite hosts and guests to share their insights, the views expressed are their own and do not necessarily reflect the policies or positions of the hospital or its staff.