Transcript: Why Does Mental Illness Run in Families? | Feb 11, 2021

Steve sits in the studio. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a gray suit, white shirt, and gray plaid tie.

A caption on screen reads "Why mental illness runs in families. @spaikin, @theagenda."

Steve says MENTAL ILLNESS CAN OCCUR IN ANY FAMILY BUT IT CAN ALSO SEEM TO RUN IN FAMILIES. WHY? WELL, JOINING US NOW TO EXAMINE WHAT LINKS MENTAL HEALTH ACROSS GENERATIONS WE'RE JOINED IN STOCKBRIDGE, MASSACHUSETTS BY Dr. BESSEL VAN DER KOLK, PSYCHIATRIST AND AUTHOR OF "THE BODY KEEPS THE SCORE: BRAIN, MIND, AND BODY IN THE HEALING OF TRAUMA."

Bessel is in his late fifties, with short gray hair and a trimmed beard. He's wearing glasses and a black sweater.
A picture of his book appears briefly on screen. The cover is blue, with a silhouette of a person surrounded by lights.

Steve continues IN HARLEM, NEW YORK, BIANCA JONES MARLIN, ASSISTANT PROFESSOR OF PSYCHOLOGY AND NEUROSCIENCE AT COLUMBIA UNIVERSITY AND PRINCIPAL INVESTIGATOR AT THE MARLIN LAB.

Bianca is in her thirties, with short-cropped curly dark hair with bleached tips. She's wearing a magenta shirt.

Steve continues IN THE PROMISE, NEW YORK, RACHEL YEHUDA, PROFESSOR OF PSYCHIATRY AND DIRECTOR OF TRAUMATIC STRESS STUDIES AT THE ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI AND DIRECTOR OF MENTAL HEALTH FOR THE U.S. DEPARTMENT OF VETERANS AFFAIRS.

Rachel is in her late fifties, with long wavy blond hair. She's wearing a pearl necklace and a black blazer and blouse.

Steve continues AND AT BATHURST AND DUNDAS, IN THE PROVINCIAL CAPITAL, Dr. ROGER McINTYRE. PROFESSOR OF PSYCHIATRY AND PHARMACOLOGY AT THE UNIVERSITY OF TORONTO AND HEAD OF THE MOOD DISORDERS PSYCHO PHARMACOLOGY UNIT AT THE UNIVERSITY HEALTH NETWORK.

Roger is in his forties, clean-shaven, with short brown hair. He's wearing a black suit and a white shirt.

Steve continues ROGER, IT'S GOOD TO SEE YOU AGAIN. YOU'VE BEEN ON THIS PROGRAM NUMEROUS TIMES AND TO OTHER THREE GUESTS IN THE U.S. WE'RE GLAD TO HAVE YOU ALONG FOR THE FIRST TIME AS WELL. LET'S GET STARTED BY GOING BACK THREE DECADES, SHALL WE? THIS IS A QUOTE FROM A 1991 BOOK ENTITLED "THE NEW GENETICS OF MENTAL ILLNESS." AND HERE'S THE QUOTE...

A quote appears on screen, under the title "Mental illness equals Huntington disease?" The quote reads "Growth in knowledge has occurred at a remarkable rate over the past 20 years following the advent of the so-called 'new genetics' of DNA technology. One of the welcome side effects has been an increased public awareness of the importance of genetics and a new optimism about what the subject has to offer."
Quoted from Peter McGuffin and Robin Murray, "The new genetics of mental illness." 1991.

Steve says OKAY. ROGER, TAKE US BACK TO THE 90s AND THE HUMAN GENOME PROJECT AND HOW WOULD YOU DESCRIBE THE OPTIMISM THAT WAS IN THE AIR AT THAT TIME IN TERMS OF UNDERSTANDING MENTAL ILLNESS BETTER?

The caption changes to "Roger McIntyre. University of Toronto."
Then, it changes again to "The genetic optimism of the 90s."

Roger says PALPABLE. THAT WOULD BE THE ONE WORD THAT COMES TO MIND, STEVE. AT THAT TIME, WE... AND WE KNEW IT FOR DECADES... THAT THERE WAS AN ELEMENT OF THE RISK TO MENTAL ILLNESS BROADLY. SOME CONDITIONS MORE THAN OTHERS. THAT WERE REALLY SUCCESS SERVED BY SOME TYPE OF GENETIC RISK. THIS WAS MORE THAN HINTED AT THROUGH FAMILY STUDIES AND TWIN STUDIES AND A VARIETY OF COMMUNITY-BASED STUDIES ALL PROVIDED THIS VERY COMPELLING STORY THAT THERE WERE GENETICS AT PLAY HERE. AND IT WASN'T JUST FOR THE ACADEMIC. IT WAS FOR THE PERSON WHOSE LIFE COULD POSSIBLY BE AFFECTED BY THIS CONDITION. BECAUSE IN OTHER AREAS OF MEDICINE THERE WAS ALSO TREMENDOUS INTEREST. WE THINK ABOUT BREAST CANCER BUT MANY OTHER EXAMPLES WHERE YOU COULD REALLY, IN BEING IF A, OFFER MORE PRECISION, MORE PERSONALIZED... AND MAYBE EVEN PREVENTIVE APPROACHES TO A CHRONIC DISEASE STATE BY KNOWING THE GENETICS. SO JUST AS THE PROMISE WAS DELIVERED IN OTHER AREAS OF MEDICINE AROUND PREVENTION AND PREEMPTION, WE WERE ECSTATIC ABOUT THAT POSSIBILITY COMING TO US IN THE WORLD OF MENTAL HEALTH.

Steve says RACHEL, PICK UP THE STORY, IF YOU WOULD. WAS THAT PALPABLE IN YOUR JUDGMENT, WAS THAT PALPABLE OPTIMISM OF THE TIME, DID IT PAN OUT OVER THE ENSUING DECADES?

The caption changes to "Rachel Yehuda. Icahn School of Medicine at Mount Sinai."

Rachel says WELL, THERE WAS OPTIMISM. AND THERE WAS A GROWING RECOGNITION THAT MENTAL DISEASES HAD A BIOLOGICAL COMPONENT. SO PEOPLE PEOPLE WHEN THEY THINK ABOUT BIOLOGY, THEY THINK ABOUT GENETICS. THEY DON'T REALLY THINK ABOUT THE CONTRIBUTION OF THE ENVIRONMENT TO BIOLOGY. AND IN THE EARLY 90s, THE THINKING WAS A LITTLE BIT REDUCTIONIST THAT EITHER SOMETHING IS IN YOUR MIND OR IT'S IN YOUR GENES. AND THERE WASN'T A LOT OF IN BETWEEN THERE. BUT, OF COURSE, AS WE GOT TO KNOW DISORDERS SUCH AS POST-TRAUMATIC STRESS DISORDER BETTER. AND AS WE STARTED TO LOOK AT HOW THE ENVIRONMENT CAN IMPACT OUR BIOLOGY AND EVEN OUR GENES, WE BEGAN TO HAVE OTHER OPTIONS BECAUSE THE TRUTH IS THAT MENTAL ILLNESS DOES TEND TO RUN IN FAMILIES. BUT THAT DOESN'T NECESSARILY MAKE IT GENETIC, PER SE.

Steve says ALL RIGHT. LET'S PICK UP ON THAT, THEN WITH BIANCA. WHEN YOU LOOK AT THE PREVALENCE OF MENTAL ILLNESS IN SOME FAMILIES, TO WHAT EXTENT CAN WE SAY "WELL, IT'S IN THE GENES AND, THEREFORE, YOU DIDN'T WIN THE LOTTERY WHEN IT CAME TO GENETIC GOOD LUCK"?

The caption changes to "Bianca Jones Marlin. Columbia University."

Bianca says IT'S SO DIFFICULT TO ANSWER THE QUESTION WHEN IT COMES TO FAMILIES. AND MY CO-SPEAKERS ON THE CALL THEY DO AN AMAZING JOB AT STUDYING THIS IN HUMANS. I LOOK AT MICE. THE REASON WHY I LOOK AT RODENTS TO STUDY THIS IS BECAUSE WE CAN SEPARATE THE OFFSPRING FROM THE KIDS, THE OFFSPRING FROM THE PARENTS AND REALLY DIG INTO THIS QUESTION BIOLOGICALLY. IT'S HARD TO SAY IF YOU'VE GOTTEN YOUR ANXIETY FROM YOUR MOTHER OR YOUR GRANDMOTHER, WHEN THEY'RE SITTING AT THE DINNER TABLE WITH YOU EVERY NIGHT. WHEN THEY'RE RECALLING STORIES OF THEIR TRAUMATIC PAST HOW MUCH OF THAT IS FROM YOUR ENVIRONMENT? OR HOW MUCH OF THAT IS FROM YOUR GENETICS IF YOU HAVE INTERACTED WITH THEM. HOW MUCH OF THAT IS WHEN YOUR ENVIRONMENT ACTUALLY CHANGES YOUR GENES AND BEHAVIOUR. SO I USE MICE TO FOCUS IN ON THAT AND SAY WE CAN SEPARATE THE OFFSPRING FROM THE PARENTS AND REALLY ANSWER THAT QUESTION CLEANLY.

Steve says BESSEL VAN DER KOLKLE, CAN YOU ANSWER THAT AS WELL, HOW MUCH OF IT IS THE GENETIC ROLL OF THE DICE?

The caption changes to "Bessel Van Der Kolk. Author, 'The body keeps the score.'"

Bessel says DESPITE MILLIONS OF DOLLARS OF RESEARCH THERE HAS NOT BEEN A SINGLE GENE TO PREDICT MENTAL ILLNESS. BUT AS RACHEL ALREADY STARTED TO ALLUDE TO, WE'RE DEEPLY INTERPERSONAL CREATURES WHO ARE FORMED BY OUR ENVIRONMENT AND OUR INTERACTIONS TO OUR ENVIRONMENTS. AND THERE MAY BE SOME GENETIC PREDISPOSITION. BUT IN THE END THERE IS A PROFOUND EFFECT ON THE WAY IT'S EXPRESSED. LONGITUDINAL STUDIES OF BOTH MONKEYS AND HUMAN BEINGS SHOW IT'S REALLY THE QUALITY OF THE CARE GIVING RELATIONSHIPS MORE THAN GENES THAT REALLY CAUSES MENTAL ILLNESS.

Steve says IN WHICH CASE, ROGER, LET'S TALK ABOUT TRAUMA. SINCE THE 90s, HOW HAS OUR UNDERSTANDING OF THE EFFECT THAT TRAUMA HAS IN THE ROLL OF MENTAL ILLNESS, HOW HAS IT CHANGED?

The caption changes to "Roger McIntyre. University Health Network."
Then, it changes again to "Trauma leaves its mark on the body."

Roger says I THINK WHAT'S CHANGED IS TO PICK UP ON SOMETHING THAT RACHEL STARTED. I THINK WE'VE MOVED AWAY FROM A REDUCTIONISTIC MODEL, THIS IS JUST IN THE GENETIC ARCHITECTURE TO A MUCH MORE THOUGHTFUL, COMPREHENSIVE AND REALLY, FRANKLY, EVIDENCE-BASED, REALLY CONSIDERATION OF TRAUMA. LET ME GIVE YOU AN EXAMPLE WHERE THIS REALLY HITS HOME. WHEN WE THINK ABOUT GENETIC RISK, YES, IT'S THE RISK TO DECLARING A MENTAL ILLNESS. AND ONE OF THE WAY THAT IS IS MANIFESTED IS THE AGE AT ONSET. AS A GENERAL STATEMENT, DISORDERS THAT HAVE MORE GENETIC RISK AND LOADING TEND TO PRESENT EARLIER IN LIFE RATHER THAN LATER IN LIFE. NOW, MENTAL ILLNESSES ARE DISPARATE, THEY'RE VERY DIFFERENT ACROSS THEIR PATHOGEN PATHOGENESIS. BIPOLAR DISORDER, COMPLEX DISORDER HAS AN ESTIMATED HERITABILITY OF AROUND 70 percent. THAT COMPARES TO MAJOR DEPRESSION AROUND 30 percent. WHAT'S INTERESTING IS THAT IN EUROPE, THE AGE AT ONSET OF BIPOLAR DISORDER ON AVERAGE IS 26. IN THE UNITED STATES, IT'S 13. SO HERE'S A CONDITION WITH 70 percent HERITABILITY WITH A DIFFERENT IN AGE AT ONSET BY 10 YEARS JUST ACROSS THE BOND. AND WHAT'S SO INTERESTING ABOUT THIS INCREDIBLY HERITABLE CONDITION WITH SUCH AN IP CREDIBLY DIFFERENT AGE AT ONSET IS THAT IN THE UNITED STATES THERE ARE TWO THINGS THAT REALLY STAND OUT: A MUCH HIGHER RATE OF REPORTED CHILDHOOD PSYCHO SOCIAL ADVERSITY LIKE TRAUMA, NEGLECT AND OTHER ASPECTS OF INSECURITY. AND SECONDLY, ASSORTATIVE MATING. IN OTHER WORDS, PROCREATING WITH TYPES THAT LOOK LIKE ME. PARENTS OF PEOPLE WITH BIPOLAR DISORDER IN THE U.S. ARE MORE LIKELY TO MATE WITH SOMEONE WHO HAS A MENTAL ILLNESS THAN EUROPE. THERE IS A HIGHER RATE OF TRAUMA WHEN COMPARED TO EUROPE AND YOU ALSO HAVE A HIGHER RATE OF ASSORTATIVE MATING IN THE U.S. IN BIPOLAR DISORDER THAN YOU DO IN EUROPE. IT REALLY INTEGRATES WHAT RACHEL WAS GETTING AT THE DIFFERENT ASPECTS BUT CLEARLY TRAUMA IS CHANGING WHAT WE CALL THE BIOTYPE AND MAYBE WE'LL HEAR FROM THIS FROM THE BOOK THAT WE JUST HEARD ABOUT. IT'S ALL KEPT IN YOUR BODY. BUT CERTAINLY THE CHANGES THE BIOLOGY NOT OF BRAIN BUT ALSO OF BODY AND THAT LIKELY CHANGES RISK AND ALSO CHANGES OTHER TYPES OF ASPECTS, FOR EXAMPLE, OTHER CONCURRENT CONDITIONS THAT PEOPLE MIGHT HAVE MENTAL ILLNESS LIKE OBESITY AND DIABETES WHICH WE ALSO NOW KNOW IS CLOSELY LINKED TO STRESS AND TRAUMA.

The caption changes to "Watch us anytime: tvo.org, Twitter: @theagenda, Facebook Live, YouTube."

Steve says IN WHICH CASE, RACHEL, CAN WE NOW CONCLUSIVELY SAY THAT A BETTER PREDICTER OF MENTAL ILLNESS IS NOT GENETICS BUT, IN FACT, TRAUMA, PARTICULARLY IF IT HAPPENED EARLY IN LIFE?

The caption changes to "Rachel Yehuda, @RachelYehuda."

Rachel says IT'S HARD TO SAY ANYTHING THAT'S REALLY CONCLUSIVE IN THE FIELD OF MENTAL HEALTH RIGHT NOW. THAT'S ONE OF THE PROBLEMS. BUT THERE'S NO QUESTION THAT ENVIRONMENTS MATTER AND WHAT HAPPENS MATTER. AND EVEN WHEN TRAUMA HAPPENS, TO CHILDREN AT A YOUNG AGE, THE ENVIRONMENT IN WHICH THAT TRAUMA OCCURS MATTERS. IF A PERSON IS... IF A YOUNG CHILD IS TRAUMATIZED IN THE CONTEXT OF A NURTURING, CARING, ENVIRONMENT WHERE PEOPLE ARE OUTRAGED ON THE CHILD'S BEHALF, THAT CHILD WILL HAVE A BETTER MENTAL HEALTH OUTCOME THAN SOMEBODY WHO WAS NEGLECTED, WHO LIVES IN A HOME WHERE THEY'RE NOT BEING CARED FOR OR THEY'RE BEING NEGLECTED EVEN ABUSED. SO ENVIRONMENTS ARE IMPORTANT. BUT BIOLOGY IS IMPORTANT, TOO. SO WE HAVEN'T SORTED OUT HOW THAT COMBINATION WORKS TOGETHER. BUT WE KNOW BOTH FACTORS MATTER.

Steve says I DO WANT TO GO, THOUGH, BIANCA A LITTLE FURTHER ON THIS ISSUE OF CHILDHOOD TRAUMA BECAUSE I SUSPECT IF I ASKED ANY OF YOU TO REMEMBER SOMETHING THAT HAPPENED WHEN YOU WERE TWO YEARS OLD NOT FROM OTHER PEOPLE'S RECOLLECTIONS OF IT BUT YOUR OWN WE'D ALL HAVE A HARD TIME DOING THAT. BUT HOW CRUCIAL ARE THOSE YEARS, YEARS ONE, TWO, AND THREE IN TERMS OF PERSONAL TRAUMA LEADING TO POTENTIAL MENTAL HEALTH AFTER EFFECTS?

The caption changes to "Bianca Jones Marlin, @bjmarlin."

Bianca says THOSE ARE THE YEARS WE ESTABLISH SAFETY. WE ESTABLISH RELATIONSHIPS WITH OUR CAREGIVERS. WHEN THOSE ARE BROKEN IT DOES SEEM TO PREDICT THAT IT LEADS TO LONG-LASTING CHANGES. AS RACHEL HAD MENTIONED BEFORE, IF WE'RE IN A SAFE AND WARM, CARING ENVIRONMENT IN WHICH PEOPLE ARE COMING UP AND STANDING UP FOR THOSE WHO ARE ABUSED WE'RE MORE LIKELY TO HAVE A BETTER OUTCOME. IN FACT FOLLOWING THROUGH INTO ADULTHOOD WE'RE MORE LIKELY TO HAVE A BETTER OUTCOME. BUT THESE ARE THE DEVELOPMENTAL YEARS IN WHICH WE'RE UNDERSTANDING WHAT IT MEANS TO TRUST SOMEONE, TO FIND SAFETY IN SOMEONE. AND WHEN THOSE YEARS BECOME PERTURBED, FOR LACK OF BETTER WORDS, IT DOES LEAD TO LONG-LASTING ISSUES. BOTH IN OUR MOUSE STUDIES AND OUR HUMAN STUDIES.

Steve says RIGHT. LET'S DO AN EXCERPT HERE FROM BESSEL'S BOOK, "THE BODY KEEPS SCORE"...

A quote appears on screen, under the title "The life-long impact of trauma." The quote reads "We have learned that trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on mind, brain and body. This imprint has ongoing consequences for how the human organism manages to survive in the present. Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think."
Quoted from Bessel Van Der Kolk, "The body keeps the score." 2015.

Steve says OKAY, BESSEL. SO WHEN IT COMES TO TRAUMA, YOU WRITE: THE BODY KEEPS SCORE. HOW DOES THE BODY KEEP SCORE?

The caption changes to "Trauma leaves its mark on the body."

Bessel says YOUR SURVIVAL PART OF THE BRAIN BECOMES VERY ACTIVATED IF YOU ARE UNDER THREAT. AND YOU CONTINUE TO SECRET STRESS HORMONES AND YOU CONTINUE TO REACT TO YOUR ENVIRONMENT, ANTICIPATING THAT WILL HAPPEN. WHICH ORGANIZES YOUR PERCEPTION AND THE WAY THAT YOUR MIND AND BRAIN FUNCTION, ACTUALLY. SO IN THE EARLIER EXPERIENCE WHAT WE SAID IS HOW YOU PERCEIVE YOURSELF AND THE WORLD AROUND YOU. AND THERE ARE QUITE A FEW LONGITUDINAL STUDIES FOLLOWING KIDS FOR LONG PERIODS OF TIME PARTICULARLY THE MINNESOTA LONGITUDINAL STUDY WHERE YOU TAKE HIGH-RISK KIDS AND IT SHOWS BASICALLY THAT THE QUALITY OF THE CAREGIVING AT THE END TENDS TO COMPENSATE FOR A LOT OF WHAT SEEMS TO BE GENETIC LOADING. THAT IS TO SAY IF A KID FEELS SECURE AND SAFE AND IF THE WORLD IS PREDICTABLE THEY DEVELOP A MIND AND BRAIN THAT CAN ACTUALLY LEARN AND TAKE IN INFORMATION. BUT IF THAT ORGANISM, THAT CREATURE IS FRIGHTENED ALL THE TIME, IT'S JUST SHUT DOWN, CANNOT LEARN VERY MUCH AND GETS STUCK IN THEIR DEVELOPMENT.

Steve says LET'S DO ANOTHER QUOTE HERE. THIS TIME FROM HARVARD MAGAZINE AND I'M GOING TO READ A LITTLE BIT OF AN EXCERPT ABOUT THE WORK OF RESEARCHER ANDREA ROBERTS...

A quote appears on screen, under the title "Intergenerational trauma." The quote reads "Roberts and her colleagues found much higher rates of depression among the children of abuse victims -between 1.5 and 2.5 times higher than children of nonabused mothers.
She surmises that the problem could be behavioral: A mother who experienced abuse in childhood is more likely to be depressed in adulthood, and as a result may be less attuned to her children -a neglect that can sow depression."
Quoted from Karen Brown, Harvard Public Health Magazine. 2016.

Steve says ROGER, START US ON THIS. TO WHAT EXTENT DOES THIS EXPLAIN WHY MENTAL ILLNESS RUNS IN FAMILIES.

The caption changes to "Trauma in the family tree."

Roger says IT CERTAINLY DOES. THERE IS A BIOLOGICAL TRANSMISSION OF THIS WHAT WE CALL BIOSIGNATURE OF STRESS THAT'S PASSED ON TO THE NEXT GENERATION. AND THAT'S ONE, IF YOU WILL, ASPECT. BUT THE OTHER ASPECT WHICH IS CONTEMPORANEOUS IS CLEARLY THE ENVIRONMENT. THERE'S BEEN PLENTY OF WORK NOW TO SHOW THAT WHEN THE PARENTAL EXPERIENCE IS ONE OF DEPRESSION AND EARLY IN THIS TIME NEO-NATE OR EARLY INFANCY, IT REALLY PREDISPOSES A WHOLE ASSORTMENT OF RISKS FOR THAT INFANT LATER IN LIFE OR THREE, FIVE, SIX, SEVEN YEARS OLD WITH BEHAVIOURAL DISORDERS AND MENTAL DISORDERS. WHAT I THINK, THOUGH, STEVE, IS REALLY INTERESTING ABOUT WHERE WE'VE GONE IN PSYCHIATRY, WE STARTED OFF WITH OUR REALLY ENTHUSIASM ABOUT THE GENOMIC PROJECT, HOW THAT WOULD PROCESS. GRAVITY BROUGHT US BACK DOWN-TO-EARTH A LITTLE BIT. I THINK THE OTHER PART THAT WE'VE REALLY BEEN SOMEWHAT ASYMMETRIC WE'VE FOCUSED A LOT ON RISK BUT WE'VE FOCUSED LESSON RESILIENCY. WHAT IS AS INTERESTING IS THE OFFSPRING OF MOM WHO MAY HAVE BEEN TRAUMATIZED HERSELF WHO GOES UP TO HAVE A HIGHLY ADAPTIVE FUNCTIONAL LIFE, WHAT IS IT ABOUT THAT INDIVIDUAL AND THAT INDIVIDUAL'S ENVIRONMENT THAT THAT INDIVIDUAL MAY HAVE CREATED THROUGH A DEGREE OF SELF-REFUGE, IF YOU WILL, THAT PUT THAT PERSON ON A MORE VIRTUOUS TRAJECTORY RATHER THAN A MORE VICIOUS TRAJECTORY? AND THAT PART IS EXTREMELY INTERESTING.

Steve says BIANCA I SEE YOU NODDING YOUR HEAD.

Bianca says I'M SO HAPPY THAT RESILIENCE HAS COME INTO PLAY YOU WANT TO FOCUS NOT JUST ON THE NEGATIVE BUT THE POSITIVE. BIOLOGY IS NOT HERE TO RUIN US. WHEN WE'RE SET UP FOR AN AREA OF SURVIVAL WE NEED TO BE CONSTANTLY ALERT FOR OUR SAFETY BUT THAT DANGER HAS BEEN REMOVED THAT'S WHEN WE HAVE THESE ISSUES. THAT'S WHEN PTSD, FOR EXAMPLE, BECOMES AN ISSUE. WHEN ANXIETY BECOMES AN ISSUE. BECAUSE WE'RE PREPARED TO FIGHT. WE'RE PREPARED TO FLEE. BUT THERE'S NO DANGER PRESENT. IT'S BIOLOGY REALLY SETTING US UP TO SURVIVE BUT WHAT THE DANGER IS REMOVED THAT'S WHEN WE HAVE THESE ISSUES.

Steve says RACHEL, I WONDER IF YOU COULD PICK UP THE STORY FROM THIS STANDPOINT: DO YOU THINK THE "IT'S ALL IN THE GENES" VIEW OF WHY MENTAL ILLNESS RUNS IN FAMILIES COULD BE AN OBSTACLE TO CONSIDER THE ROLE THAT TRAUMA MAY PLAY IN THEIR MENTAL ILLNESS?

The caption changes to "Subscribe to The Agenda Podcast: tvo.org/theagenda."

Rachel says IT CAN BE AN OBSTACLE. SOME PEOPLE FIND IT VALIDATING. THERE'S NOT A LOT OF EVIDENCE FOR IT, THAT'S THE PROBLEM. AND THERE'S A LOT MORE EVIDENCE FOR THE FACT THAT ENVIRONMENT AND EVEN INTERGENERATIONAL ENVIRONMENTS CAN PACK MORE OF A PUNCH. AND REALLY HAVE MORE OF AN INFLUENCE. AND AROUND THE CONVERSATION OF RESILIENCE OR VULNERABILITY, I DON'T ACTUALLY MAKE THAT DISTINCTION. WHEN PARENTS MAYBE PASS ON, FOR EXAMPLE, AN EPI GENETIC CHANGE TO THEIR OFFSPRING, MAYBE IT'S IN MIND TO HELP THEM COPE BETTER WITH THEIR ENVIRONMENTS. WE DON'T REALLY SEE A CORRELATION BETWEEN AN EPIGENETIC CHANGE AND OFFSPRING OF CHRONIC SURVIVORS AND THEIR PATHOLOGY PER SE. IT'S PRETTY COMPLICATED. IF YOU ARE EXPOSED TO A VERY DANGEROUS SITUATION, YOUR BODY LEARNS FROM IT. IT CARRIES A SCAR FROM IT, ALSO. BUT IT ALSO CARRY AS MEMORY TO DO BETTER NEXT TIME. AND SO WHAT WE MIGHT TRANSMIT DOWN THE LINE IS AN ANCESTRAL MEMORY THAT HELPS US COPE AND SURVIVE. SO WE HAVE TO BE REALLY CAREFUL ABOUT LOOKING A ANY BIOLOGIC ASPECT FOLLOWING TRAUMA AND CLAIMING THAT MUST BE BE SOMETHING BAD. TRAUMA MIGHT BE SOMETHING WE WANT TO AVOID. BUT THE BODY'S RESPONSE TO TRAUMA IS REALLY MEANT TO HELP. SOMETIMES THE TRAUMA IS OVERWHELMING OR THE ONGOING CIRCUMSTANCE PREVENTS THAT KIND OF HELP. BUT THESE ARE REALLY COMPLICATED. WHAT IT BOILS DOWN TO IN THE END IS IF WE CAN MAKE OUR ENVIRONMENTS BETTER, WE CAN OVERRIDE NEGATIVE IMPACTS OF VULNERABILITY AND OTHER KINDS OF EXPERIENCES. WE CAN'T CHANGE OUR GENES. GENES ARE ONLY GOING TO ACCOUNT FOR A VERY SMALL PROPORTION OF THE PROBLEM. WE CAN MAKE MASSIVE CHANGES IN OUR ENVIRONMENTS AND OUR POLICIES AND THAT'S GOING TO BE THE ROAD TO PROVIDING BETTER MENTAL HEALTH FOR PEOPLE.

Steve says LET ME PICK UP ON THAT WITH BESSEL. I WOULD IMAGINE RIGHT NOW THERE ARE PEOPLE WATCHING US OR LISTENING TO US WHO HAVE A PARENT WHO HAS SUFFERED THROUGH EPISODES OF MENTAL ILLNESS. AND IF THEY, THEMSELVES ARE WONDERING HOW DO I MAKE SURE THAT DOESN'T HAPPEN TO ME OR WHAT ARE MY CHANCES OF THAT HAPPENING TO ME, WHAT ADVICE WOULD YOU GIVE THEM RIGHT NOW?

Bessel says IT DOESN'T GET PASSED ON. YOU KNOW, WE'RE EXTREMELY FLEXIBLE HUMAN BEINGS. AND EVEN IF YOU ARE REALLY SCARED AND INSECURE TYPES SIX-YEAR-OLDS, IF YOU ARE LUCKY ENOUGH AT AGE 16 TO GET A BOYFRIEND OR GIRLFRIEND WHO REALLY LOVES YOU, YOU CAN STILL CHANGE AND PICK UP NEW EXPERIENCES THAT REALLY RESHAPE YOU. WE'RE CONTINUOUSLY BEING RESHAPED. AND SO IT'S NOT LIKE WHAT HAPPENS TO YOU AT AGE 3 IS GOING TO PREDICT EVERYTHING THAT WILL HAPPEN BECAUSE WE'RE CONTINUOUSLY EVOLVING AND NEW RELATIONSHIPS, SKILLS AND CAPACITIES CAN BUILD ON TOP OF THAT. AND WE'RE FLEXIBLE HUMAN BEINGS. AND WE EVOLVE IN THE VARIOUS DIRECTIONS DEPENDING ON LIFE EXPERIENCES AND ON AN ONGOING BASIS. WHAT'S ALSO STRIKING IS THAT PSYCHIATRY HAS LARGELY RELIED ON DRUGS TO CHANGE PEOPLE. AND THAT'S A TERRIBLE DIRECTION FOR PSYCHIATRY TO GO INTO. OH, IF SOMETHING IS WRONG YOU MUST BE GIVEN THE RIGHT DRUG FOR IT. AND SO PSYCHIATRY BECAME A SERVANT OF THE DRUG INDUSTRY. BUT A NEW TREATMENT LIKE NEUROFEEDBACK OR PSYCHEDELICS ALL THOSE THINGS, BARELY GET EXPLORED AND THERE IS HARDLY ANY MONEY TO DO RESEARCH TO LEARN HOW TO REALLY CHANGE PEOPLE TO LIVE IN BODIES AND BRAINS THAT FEEL SECURE AND SAFE.

The caption changes to "Nurture changes nature."

Steve says ALL RIGHT. LET'S GET INTO SOME DISCUSSION NOW ABOUT NATURE AND HOW IT MIGHT... EXCUSE ME, HOW NURTURE MIGHT CHANGE NATURE. AND WE TOUCHED ON THIS EARLIER BUT WE WANT TO GO A LITTLE DEEPER AND THAT'S EPIGENETICS... HOW YOU ARE INFLUENCED BY YOUR ENVIRONMENT. WE WANT TO START BY SHOWING A SNIPPET OF A PIECE. AND I THINK BIANCA YOU ARE FEATURED IN THIS IN SOME OF THE WORK YOU DO. SO LET'S LOOK AT THIS. SHELDON, IF YOU WOULD.

A clip plays on screen with the caption "Breakthrough: The trauma tracer. 2020."

Black and white pictures show emaciated men, women and children, and healthcare workers tending to undernourished people.

Bianca says AT THE END OF WORLD WAR II AN EXPERIENCE WITH HUNGER WAS EXPERIENCED IN THE NETHERLANDS. THEIR CHILDREN AND THEIR GRANDCHILDREN WERE OBSERVED TO SUFFER FROM INCREASED RATES OF METABOLIC ISSUES. FOR EXAMPLE, DIABETES, HIGH BLOOD PRESSURE AND EVEN SCHIZOPHRENIA.

Bianca sits inside a lab. Her hair is long, blond, in braids.

She continues IT WASN'T JUST CHILDREN THAT WERE CONCEIVED DURING THE FAMINE. BUT CHILDREN THAT WERE CONCEIVED AFTERWARDS. AS IF THE SEX CELLS, THE SPERM CELLS AND THE EGG CELLS HAD A MEMORY OF THAT TRAUMA AND THAT STRESS WELL BEYOND THE YEARS OF FAMINE. IT REALLY DID SPARK QUESTIONS IN THE SCIENTIFIC COMMUNITY OF HOW CAN A MEMORY, A MESSAGE LIVE ON FROM AN EGG AND HOW IT IS BEING PASSED DOWN.

The clip ends.

Steve says THAT IS JUST A STUNNING REVELATION. AND IN YOUR LAB, I GATHER, YOU HAVE BEEN ABLE TO DEMONSTRATE HOW TRAUMATIC MEMORY CAN BE PASSED DOWN EVEN THROUGH MICE. EXPLAIN, IF YOU WOULD.

Bianca says YES, WE'RE DIGGING THROUGH THIS VERY HEAVY QUESTION OF HOW SEX CELLS, SPERM CELLS AND EGG CELLS CAN SOME HOW ENCAPSULATE THIS MEMORY AND THIS MEMORY MAY BE ENCAPSULATED THROUGH THE EPIGENETIC COMPONENT THAT WE'RE TALKING ABOUT. CERTAIN MARKER THAT IS CAN CHANGE THE WAY OUR MARKERS ARE READ AND HOW THAT CAN BE PASSED ON. AND NOT ONLY PASSED ON IN HOW THE MOUSE, QUOTE-UNQUOTE, FEELS BUT CHANGES IN THE BRAIN, HOW NEURONS IN THE BRAIN ACTUALLY FIRE AND GROW AND, THEREFORE, HOW IT CHANGES THEIR BEHAVIOUR.

Steve says AMAZING. RACHEL, LET ME ASK YOU TO PICK UP THE STORY BECAUSE I KNOW YOU'VE DONE RESEARCH AS WELL ON DESCENDANTS OF HOLOCAUST SURVIVORS FROM WORLD WAR II. WHAT CAN YOU TELL US ABOUT THAT?

Rachel says WELL, WHAT I CAN TELL YOU IS THAT THERE ARE EPIGENETIC CHANGES IN THE OFFSPRING BUT IT'S REALLY COMPLICATED. I CANNOT TELL YOU THAT ALL OF THOSE EPIGENETIC CHANGES ARE ASSOCIATED WITH VULNERABILITY. SOME SEEM TO BE ASSOCIATED WITH HAVING LESS ANXIETY AS AN ADULT. AND WHAT SEEMS TO MATTER IN TERMS OF THE EFFECT THAT WE SEE IN OFFSPRING HAS TO DO WITH NOT ONLY WHAT HAPPENED TO THE PARENT BUT THE GENDER OF THE PARENT AND ALSO THE TIME AND DEVELOPMENT THAT IT HAPPENED. SO YOU SEE A VERY DIFFERENT PROFILE IN OFFSPRING WHOSE MOTHER, FOR EXAMPLE, WAS YOUNGER DURING THE HOLOCAUST THAN A MOTHER WHO'S OLDER. SO IT'S REALLY, REALLY COMPLICATED. WHAT'S VERY IMPORTANT WHEN YOU TALK ABOUT, LIKE, THE LEGACY OF SOMETHING LIKE THE HOLOCAUST IS TO UNDERSTAND THAT IT WASN'T JUST A MOMENT IN TIME. THERE WERE THINGS THAT HAPPENED AFTERWARDS. AND AS BESSEL SAID SO CORRECTLY, YOU KEEP HAVING EXPERIENCES. SO IF EXPERIENCE CHANGES THE WAY YOUR GENES FUNCTION, IT DOESN'T JUST HAPPEN ONCE AND THEN YOU'RE STUCK WITH IT. IT'S A VERY FLUID AND DEVELOPMENTAL THING. SO FOR MANY PEOPLE WHO ARE TRAUMA-EXPOSED, WHEN IT WAS OVER, THEY WERE EMBRACED. AND THEN IT REALLY WAS OVER FOR THEM. AND FOR OTHER PEOPLE, THEY CONTINUE TO STRUGGLE. SO REALLY, I THINK, THIS IS, AGAIN, BACK TO A VERY IMPORTANT POINT. PEOPLE GET A LITTLE NERVOUS WHEN THEY HEAR ABOUT GENETICS AND EPIGENETICS AND THE BODY KEEPS SCORE. THESE ARE MESSAGES THAT SOMETIMES MAKE PEOPLE THINK THAT THEY'RE DOOMED. BUT ACTUALLY, THE MESSAGE IS JUST THE OPPOSITE. THE MESSAGE IS THAT YOUR BODY WILL INCORPORATE A POSITIVE CHANGE JUST AS IT INCORPORATES NEGATIVE CHANGE. SO IF A NEGATIVE EVENT OR A TRAUMA HAS THE BODY TO CHANGE YOU, A POSITIVE EVENT HAS THE POTENTIAL TO CHANGE YOU, TOO. AND THAT'S WHAT WE SHOULD BE LEARNING FROM ALL OF THIS. WITH GENETICS, THOSE ARE YOUR GENES. AND YOU ARE GOING TO HAVE THOSE GENES FOR THE REST OF YOUR LIFE. AND THE WAY THAT THROWS GENES LOOK IS NOT GOING TO CHANGE. BUT YOU CAN MAKE DRAMATIC CHANGES IN THE WAY YOU FUNCTION BECAUSE OF THE THINGS THAT HAPPEN TO YOU. AND THAT'S REALLY THE IMPORTANT MESSAGE, THINK, OF NEUROSCIENCE RIGHT NOW AND APPLYING STUDIES OF STRESS TO PEOPLE THAT CHANGE IS REALLY POSSIBLE. EVEN THOUGH IRONICALLY, EXPERIENCES ARE CARRIED WITH US. SO LET'S JUST HAVE MORE POSITIVE EXPERIENCES AND MAKE SURE THAT WE HELP PEOPLE WHO HAVE HAD NEGATIVE EXPERIENCES HAVE THE COUNTERVAILING POSITIVE EXPERIENCES THAT WILL MITIGATE AGAINST MENTAL ILLNESS.

Steve says BIANCA, THAT'S A HUGELY IMPORTANT FACTOR I GUESS TO GET ON THE RECORD HERE. BECAUSE I GUESS, OF COURSE, MEDIA TEND TO FOCUS A LOT ON THE NEGATIVE. AND I GUESS WE SHOULD GIVE EQUAL TIME TO THE NOTION... AND I PRESUME YOU'LL AGREE WITH IT THAT POSITIVE EXPERIENCES CAN ALSO BE PASSED DOWN THROUGH THE GENERATIONS, IS THAT RIGHT?

The caption changes to "A more optimistic picture?"

Bianca says YES, AND I WOULD UNDERSTAND FOCUSING ON THE NEGATIVE BECAUSE THE NEGATIVE IS THE SURVIVAL ASPECT. THIS IS WHETHER OR NOT YOU WILL LIVE TO THE NEXT GENERATION. AND WHAT THE WORK CLEARLY STATES IS THAT FOR SOME PEOPLE, THIS WAS THE MOMENT IN TIME IN WHICH THEY COULD NOW FIND SAFETY AND FOR OTHERS IT SURVIVED LONGER. WE SEE THOSE METABOLIC CHANGE THAT IS OCCURRED OVER A LONGER PERIOD OF TIME BUT NOT IN EVERYONE. THERE ARE OTHER POPULATIONS, FOR EXAMPLE, HERE IN THE UNITED STATES, AMERICAN DESCENDANTS OF SLAVES WHO FOR MANY YEARS SUFFERED STARVATION AND TRAUMA. AND SO HOW MUCH OF THAT PERIOD OF TIME DO WE NEED OF POSITIVITY TO REFLECT THE CHANGES WE SEE AND METABOLIC ISSUES SUCH AS HYPERTENSION, DIABETES, HIGH BLOOD PRESSURE, DEPRESSION, ET CETERA. SO IT'S ESSENTIAL TO FOCUS ON THE POSITIVE AS WELL. NOT IGNORING THAT THE NEGATIVE IS WHAT WE NEED FOR SURVIVAL AND THEN THE POSITIVE CAN BE ADDED ON TOP.

Steve says YOU ASKED A GOOD QUESTION THERE: DO YOU KNOW THE ANSWER? HOW MANY GENERATION IT IS DOES TAKE FOR POSITIVE TO KICK IN?

Bianca says I STUDY MICE AND NOT HUMANS. HOPEFULLY I KNOW THE ANSWER SOON.

Steve says GO AHEAD, PLEASE.

Rachel says THAT'S SUCH A IMPORTANT THING THAT YOU JUST SAID. FOR SOMEBODY THAT IS KNOWN TO HAVE METABOLIC ILLNESS, IT'S PARTICULARLY IMPORTANT TO MAKE SURE THAT A GOOD DIET IS AVAILABLE TO THEM BECAUSE THAT IS GOING TO BE SOMETHING THAT WILL HELP REVERSE WHATEVER THE PREDISPOSITION IS FOR METABOLIC SYNDROME. BECAUSE WE KNOW THAT METABOLIC SYNDROME, EVEN IF YOU HAVE IT IN REAL-TIME, IS SOMETHING THAT CAN BE GREATLY IMPROVED BY MAKING THE CORRECT DIETARY CHOICES. SO WHAT WE HAVE TO DO WHEN WE UNDERSTAND THAT THERE IS A VULNERABILITY IS TAKE CORRECTIVE ACTIONS SO THAT WE CAN REDUCE THE NUMBER OF GENERATIONS THAT ARE AFFECTED. THE ANSWER TO THAT QUESTION, THOUGH, IS TO REALLY PROVE THAT SOMETHING TRULY PASSES THROUGH THE SEX CELLS IT REQUIRES FOUR GENERATIONS. BECAUSE THE IN UTERO EFFECT THAT OCCUR BECAUSE OF A SPERM OR AN EGG EPIGENETIC EFFECT CAN AFFECT THE MOTHER. IT CAN AFFECT THE FETUS. AND, OF COURSE, IT CAN AFFECT THE FEE TUESDAY'S GERM CELL. SO IN ORDER TO HAVE AN EFFECT BEYOND THAT YOU HAVE TO LOOK AT THE FOURTH GENERATION WHICH IS WHY THESE ISSUES ARE REALLY COMPLICATED. PARTICULARLY IN PEOPLE.

Steve says INDEED. SO ROGER, DO WE NEED TO SIMPLY JUST GET RID OF THIS WHOLE NATURE VERSUS NURTURE DEBATE TO BEGIN WITH?

The caption changes to "Watch us anytime: tvo.org, Twitter: @theagenda, Facebook Live, YouTube."

Roger says SHORT ANSWER IS YES. THAT'S BEEN STALE DATED FOR SUCH A LONG TIME. YOU KNOW, STEVE, THE ENTIRE PLANET IS WITNESSING A TRAUMA AT THE CURRENT TIME CALLED COVID-19. AND THIS IS A TRIPLE THREAT. THIS ISN'T JUST A PUBLIC HEALTH CRISIS, THIS IS AN ECONOMIC CRISIS, THIS IS A MENTAL HEALTH CRISIS. IN WHAT WALKED INTO THIS PANDEMIC A PANDEMIC OF LONELINESS. ONE OF THE KEY FACTORS. WE TALK ABOUT A POSITIVE EXPERIENCE. IN SOME WAY IT IS FEELS LIKE JUST SAY NO TO DRUGS. A LITTLE EASIER TO SAY THAN IT IS TO DO. AND WHEN WE TALK ABOUT CREATE A POSITIVE EXPERIENCE, THAT'S INTRIGUING. HOW DOES THE INDIVIDUAL CREATE A VIRTUOUS WORLD FOR THEMSELVES? THROUGH REFUGE AND FINDING AREAS OF SAFETY, CREATING AN ENVIRONMENT WHERE THEY CAN ACCRUE SOCIALLY VALUED CREDENTIALS, DEGREES AND ECONOMICALLY MAKE YOURSELF SECURE. WHAT'S BEEN LAID BARE AND EXACERBATED BY COVID-19 IS SOCIAL DETERMINANTS AND HOW THEY, IN FACT, ARE DIFFERENT ACROSS OUR POPULATION. AND IN OUR SOCIETY AROUND THE WORLD, HIGH AND LOW INCOME COUNTRIES SOME PEOPLE ARE ESPECIALLY TRAUMATIZED RIGHT NOW. AND WHAT'S REALLY REPLICATED IS TWO FACTORS: LONELINESS AND LACK OF SOCIAL ENGAGEMENT. AND SECONDLY, SOME OF THESE SOCIAL DETERMINANTS OF ECONOMIC SECURITY AND REALLY, YOU KNOW, AND HOUSING SECURITY. SO ABSOLUTELY WE HAVE TO CREATE THE POSITIVE ENVIRONMENT. BUT WE ALREADY HAVE WONDERFUL DATA, UNFORTUNATELY FOR THIS TRAGEDY OF COVID-19, THAT'S SUBSTANTIATED THE POWER OF THE SOCIAL DETERMINANTS AND MIXED WITH INDIVIDUAL FACTORS. AND A FACTOR WE SAY SO LITTLE ABOUT... LONELINESS... AND THE IMPORTANCE OF SOCIAL ENGAGEMENT AND COHESION AS THE ULTIMATE VACCINATION AGAINST SOME OF THE RISK WE'RE TALKING ABOUT.

Steve says DON'T FORGET TO ZOOM YOUR FRIENDS EVERYBODY WHO'S WATCHING THIS. BESSEL, YOU WANTED TO ADD?

The caption changes to "tvo.org/theagenda; agendaconnect@tvo.org."

Bessel says I WAS ONE OF THE KIDS YOU SAW IN THE MOVIE. THAT WAS MY GENERATION. THOUSANDS OF KIDS OF MY GENERATION DIED AND I WAS A VERY SICKLY CHILD AND I HAVE THE MEMORY STILL IN MY BODY OF STARTING OFF LIKE THAT. AND MUCH OF MY RESEARCH, ACTUALLY, IS BASED ON HOW DO YOU HELP PEOPLE LIKE THAT WHO I ONCE WAS, TO OVERCOME THAT? AND WHAT IS DISTRESSING IN OUR FIELD IS THAT OUR RESOURCES GO INTO HIGH-TECH SOLUTIONS. AND WE REALLY DON'T EXPLORE VERY CAREFULLY WHAT CAN BEST HELP PEOPLE. FOR EXAMPLE I DID A FUNDED STUDY ON YOGA FOR PTSD. IT TURNED OUT THAT YOGA IS VERY EFFECTIVE. WORKING WITH YOUR BODY AND FEELING SAFE IN YOUR BODY IS VERY IMPORTANT. I HAVE NOT SEEN A SINGLE PSYCHIATRY DEPARTMENT INCORPORATE A YOGA PROGRAM IN... OR AS A SUBSTITUTE FOR PSYCHO PHARMACOLOGY. SO WE KEEP PARKING UNDER ONE TREE. BUT WE'RE REALLY NOT LOOKING CAREFULLY AND HOW CAN WE REPAIR AND UNDO THE DAMAGE. WE'RE MUCH MORE INTERESTED IN FINDING THE UNDERLYING BIOCHEMICAL RESPONSES THAN WHAT CAN WE ACTUALLY DO TO REPAIR THE DAMAGE THAT'S BEEN DONE. AND INCLUDING THE DAMAGE TO BIOLOGICAL SYSTEMS.

Steve says BESSEL WE'RE DOWN TO OUR LAST MINUTE, UP. BUT I'M SO CURIOUS TO FOLLOW UP ON WHAT YOU JUST SAID. GIVEN YOUR BACKGROUND, HOW DID YOU TURN OUT SO WELL?

Bessel says LUCK.

[LAUGHTER]

Steve says GOT TO BE MORE THAN THAT.

Bessel says MOST PEOPLE I GREW UP WITH HAVE DONE EXTREMELY WELL. FOR ONE THING, THE THE NETHERLANDS IS A PRETTY REASONABLE COUNTRY WITH VERY GOOD SOCIAL PROVISIONS. SO THERE IS MUCH LESS INCOME INEQUALITY THERE AND MANY MORE SUPPORTS FOR YOUNG MOTHERS AND FAMILIES TO RAISE THEIR CHILDREN. SO I WENT ACTUALLY THROUGH A WONDERFUL SCHOOL SYSTEM WHERE WE PLAYED AND WE HAD ANIMALS. YOU KNOW, SO MUCH OF THE EARLY ENVIRONMENT THAT REALLY NURTURES CHILDREN, ALLOWS CHILDREN TO PLAY AND TO GROW AND TO BE CREATIVE. THAT IS WHAT MAKES A DIFFERENCE. IT'S NICE TO FIND THE DOPAMINE FACTORS WONDERFUL I'M ALL FOR IT BUT WHAT REALLY HELPS PEOPLE IS THE REAL QUESTION.

The caption changes to "Producer: Eric Bombicino, @ebombicino."

Steve says I WANT TO THANK ALL FOUR OF YOU FOR COMING ON TO TVO TONIGHT AND SHARING YOUR VIEWS. THAT WAS AN ABSOLUTELY ILLUMINATING AND OUTSTANDING CONVERSATION. BIANCA JONES MARLIN, RACHEL YEHUDA, BESSEL VAN DER KOLK, ROGER McINTYRE. STAY SAFE OUT THERE EVERYBODY. AND AGAIN, MANY THANKS FOR SPENDING SO MUCH TIME WITH US ON TVO TONIGHT.

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