Welcome to "Tell Me More."

I'm Kelly Corrigan.

I'm a writer, a podcaster, and a mom.

This season, number 7, is unlike anything you've seen from us before because everyone who works on this show is reading the same headlines.

There is so much unsettling news about how people are actually feeling, so we have recruited the best scientists and researchers to separate fact from fiction and surface a set of practices we can all live by.

Join us for a 10-part conversation on wellness-- how do you get it, and how do you keep it?

We have been able to nearly double the human lifespan in the course of this last century.

Corrigan: That's Atul Gawande.

He wrote one of my favorite books.

It's called "Being Mortal."

It's sold millions of copies.

It's hugely important.

He's also at USAID trying to sort out the toughest public health questions on planet Earth.

You have to stop thinking about genes like they're blueprints for anything because they're really not.

Corrigan: This is Lisa Feldman Barrett.

She is a neuroscientist.

In fact, her work is cited more often than almost any other neuroscientist.

She wrote a great book called "How Emotions Are Made."

Wellbeing is not a one-solution kind of problem.

It's always gonna come down to a wealth of things that need to happen.

Corrigan: And this is Dani Dumitriu.

She works at Columbia.

She's a pediatrician who's trying to figure out where wellbeing begins.

The best I can figure it, as a layperson, there are, like, 3 big feeders into wellbeing.

There's nature-- there's your genetic profile-- there's nurture, and then there's choices or behavior or lifestyle, whatever you want to call that category, so what I'm trying to figure out is, is it the fact that, because there are 3 feeders, you do have some hope of being able to enjoy, like, a decent sense of wellbeing, to be happy in your life, to be happy about your life?

You absolutely have hope.

Does everyone agree?

100%.

There's nothing deterministic about a human body or brain.

It remains plastic well into adulthood and aging.

Not even genes are deterministic.

Not even genes are deterministing, and especially not when it comes to mental health, right?

One of the cool findings to highlight here is, people have done lots of genetically identical twin studies to look at things like heritability of things like depression and, um, schizophrenia.

There is still no more than roughly, you know, 50% heritability in any of these, which means that what happens to you in life and the combination of your actions and the actions of the world probably play a much, much bigger role than genetics.

The hope comes from the fact that we have managed to develop tools to affect all 3 of those, so nature, we have been able to double, nearly double, the human life span in the course of this last century with learning how to make childbirth safe and how to navigate the different phases of life course.

Second, on nurture, we are experiencing much less poverty, much less violent exposure, and more areas of freedom and individual opportunity.

The third is around behavior.

When we tried to address tobacco, the first two decades were spent on smoking cessation.

Why don't you have the willpower to quit smoking?

Well, because it's as addictive as heroin.

That's why we can't get you to stop smoking, and we addressed it through recognizing this is a community change we have to make.

You wouldn't have thought we could get cigarettes out of Boston bars and French cafes, but we did.

I might change your bins a little to be more in line with that beautiful description that you just gave, so what I would say is that you have to stop thinking about genes like they're blueprints for anything because they're really not.

When a baby's born, the brain's not finished.

Brain has to wire itself to that baby's body, has to wire itself to the world that that baby lives in, and so it's-- you can't really separate that from behavior.

There is this idea that, you know, like, when you're 2-- by the time you're 25, you know, your prefrontal cortex will be done.

Like, a little bell will ring.

My daughter says, "I'm about to turn 25.

I'm waiting to hear that bell to tell me--" Even your daughter's got it slightly wrong?

She's just saying it to torture me, but the third piece is actually context.

There's a reason why it's so important to get cigarettes out of bars and out of restaurants, because the context is partly what is driving your behavior.

There's been this really large debate for, like, more than 100 years about how much are you in control of your own behavior, free will, and how much is the context in control of your behavior, and the answer is, that's just the wrong way to think about it.

What is the right way to think about it?

The right way to think about it is that your brain is being nudged by a gazillion little factors, many of which are inside your own body and many of which are in the world, and, just in general, if the context is changed, it will be easier for you to control your behavior, and if the context makes it harder, it will be almost impossible for you.

So if you're talking about wellbeing, it sort of feels like step one is to define it at some level.

Like, what is normal?

What should a reasonable person expect in terms of the duration, frequency, and intensity of what people typically think of as negative emotions?

When it comes to emotion, variation is the norm for everybody.

If you're feeling negative emotion frequently enough that it's starting to interfere with your ability to sleep, with your ability to eat, with your ability to concentrate, that is when things become a problem.

Having a diagnosis helps you understand when things are becoming dysfunctional and of a medical concern, but in day-to-day life, there's gradations, you know, beyond that, as well, and some of the ways that we talk about it in the public-health world is, are they experiencing distress?

Part of the reason why people are suffering so much is because the context sucks.

Has the context gotten a lot worse in the last 30 years?

Because the numbers are getting worse.

Yes.

Well, I want to say yes, too, but I'm also cognizant of this-- There's this research in social psychology which says people always experience the present moment as being worse...

Worst ever.

than the past.

At least in the U.S., you have school shootings that can happen in any moment.

You have economic uncertainty.

You have the existential uncertainty of climate change.

You have, you know, political uncertainty, and then we had COVID.

There are 3 really expensive things that your brain can do.

It can move your body, it can learn something new, or it can deal with persistent uncertainty, but what a stress response simply is, really, is, your brain is believing that it's preparing the body for a big metabolic outlay.

I think there's pretty good evidence now that many of the mental health problems that people are suffering actually has a metabolic basis, and there is a way to understand why adverse experiences in childhood would lead people to be more vulnerable to illnesses in adolescence and adulthood because part of what your brain is doing is, it's wiring itself to the world that you live in, and it's attempting all the time to anticipate the needs of the body and meet those needs before they arise.

That's what stress is.

When your brain is wired to a body in a world that is full of uncertainty and maybe threat, it causes a longer-term kind of metabolic drag, which leaves you really vulnerable to mood-related disorders as well as physical disorders.

The same biological factors that contribute to physical illnesses also contribute to difficulties with mental health.

Mood-related symptoms and other kinds of psychological symptoms, like inability to concentrate and so on, you see these in physical disorders as often as you see them in so-called mental disorders, so I think that metabolism is clearly important in a range of difficulties that people are suffering from.

It's not just the physical ones.

Your stress response and how it gets developmentally sculpted during early periods of life then affects the rest of your health, right, and it affects every organ system in your body, so down to your blood pressure and diabetes and everything else.

What I would argue is that the life expectancy's starting to dip the opposite way is an indication of the mental health crisis that we have.

How is our country doing on mental health?

Like, where do we rate?

What I can tell you is, in general on health, we do poorly.

Our health system leaves a lot of people behind for both mental and physical health.

To get to Lisa's point, it's hard to separate these things.

A major driver of mental health is lack of employment, lack of food, but also lack of health care.

The top 1% of incomes in the United States get to live 87 years on average or more, but the thing that I pay attention to globally is that we have a bunch of countries in the world that outperform their incomes, so usually, your survival, your life expectancy in the world is very tightly tied to how rich your country is, and every increase in income per capita translates into years of life, but there are countries that outperform their incomes and countries that underperform.

The United States underperforms our income.

At our income, we should be closer to, you know, mid 80s of average life expectancy, and we're not there.

If we said, "Oh, well, these are countries where bad things didn't happen to children," that just isn't true, Right.

and they are countries that went through many difficult periods, many, many life stressors, but it's some preventive education, but it's also a contact point outside the family that can make people be pulled into a community where people are not suffering alone.

I think there's a really important thing that you're saying that, I think, even connects down to the individual level, right, so research suggests that children who experience an adverse life event, they deal with that better when they have a single caring adult who can provide support for them.

You know, we are the caretakers of each other's-- not just each other's mental health, but each other's physical health, that we actually as a species, we've evolved to really be the caretakers of each other's nervous systems, to some extent, and there's research to show that people live longer on average when they have healthy, reliable, supportive connections with other people, and they, relatively speaking, live a shorter amount of time, all other things being equal, they live a shorter amount of time when they feel lonely or when they're isolated, so there's the provision of actual physical support, like, you know, "Do you need food?

"Do you need, you know, water, Vaccines.

vaccines," so the things that physically support people, but there's also a very tangible health consequence for being...

Cared for.

cared for and also for caring for other people.

Mm-hmm.

What's your take on the biggest change in the context?

Well, earlier you'd said, "Have things gotten worse in the context in the last 30 years?"

and my answer would be, depends for whom you're talking about, so when we talk about the decline in U.S. life expectancy, the global story has been steady, upward improvement in survival.

COVID, 3 years of COVID, ended up being the first global reduction in life expectancy since World War II.

We have every indication that that is gonna snap back as we recover from the pandemic.

The declines in life expectancy have been concentrated in white, high-school-educated males.

It has not occurred in the Black and Hispanic community, and unpacking that is actually super interesting, and, you know, credit to Anne Case and Angus Deaton at Princeton, who, you know, did this work.

A working-class, white person in the United States, they are highly likely by the age of 50 today to not be living as well as they did with their parents in their childhood.

They're less likely to own a home like their parents', less likely to be stably employed.

That combination also makes them less likely to have married, to have had kids, and if they have kids, to still have that relationship with their children, so while the why didn't that happen to Black and Hispanic people?

Civil rights allowed them to experience things that their parents didn't have.

It appears that the reason why their overall life expectancy has continued to climb until the pandemic was that they were benefiting from a better context in their life.

So that goes to this amazing mind-body connection, which is-- I feel like Vivek Murthy has done such great work with loneliness that has legitimized the study of those sorts of things as health factors, but one of the most curious mind-body connections is, I was in the room with my dad when he died.

He didn't talk for 12 hours.

He didn't move.

He didn't open his eyes.

Everybody left.

I said, "I'm gonna be all right.

You can go."

[Snap] Do you have a theory?

Do you have data?

Do you have research about that choice, that ability to-- like, the will to live and then the readiness to die?

We don't.

What we know about that last stage of the end of life, when people are in an environment where they're surrounded by family, it's a less medicalized experience where they get to prioritize what they want-- in addition to length of life, what the quality of life is and do I have control in my environment.

We experience life as a story.

It has a beginning, a middle, and an end.

Being able to feel that I have brought this story to a close-- I was able to say my good-byes; I was able to address things that mattered to me-- those are also experienced in really meaningful and important ways.

Corrigan: Yeah.

It's just such an interesting example of two of those 3 categories, which is your environment and, like, whatever nurture he felt on that day and then agency, like this somehow that he could--ckh!-- close the door.

And you asked about mind-body connection.

You know, do we have an inclination of what that is?

Not so much, but what we do know is that the mind-body connection is extremely real not only in the direction that I mentioned earlier in terms of the stress response, but also the opposite way, we have the placebo effect, so we know that the brain can actually influence virtually every organ system down to the individual firing rates of neurons in your brain.

What it is, we don't know, but that it is there, we definitely do know.

I think one of the hardest things about this moment in American society and in every family, and with every person you love who's experiencing a dip in wellbeing is that there are so many of those think books with the white covers and the serif font, and there's so many neuro bros with TikTok accounts and podcasts, so, like, how do you know that good science is happening here?

Like, how would you tell a regular Joe how to think about a big headline that says your microbiome is causing your anxiety, for instance?

The first and important principle is, there's never gonna be one solution.

Wellbeing is not a one-solution kind of problem.

It's always gonna come down to, you know, a wealth of things that need to happen, right, so we just highlighted a lot human connection here, but you need the exercise, and you need the good diet, and that also doesn't mean that you have to have everything done perfectly.

You don't have to sleep exactly 8 hours every night, but on average, you should sleep.

But ironically, our brains are looking for shortcuts, and we have these cognitive biases that are driving us to crave certainty over uncertainty, and certainty often comes in a great one-liner that's like, "You sleep 8 hours and eat kale twice a day, you will feel 90% better."

Gawande: I'm the same way, right, and I'm a systems person, and you constantly think, "I have to do everything.

"Otherwise, what's the meaning of doing anything?"

and the reality is, you are constantly tweaking your own system all the time, and anyone who comes and says, "I've got the vitamin.

I've got the pill.

"I've got the food that's gonna solve all your problems," that is clearly not the answer... Not to be trusted.

not to be trusted, but understanding yourself well enough to know, "Where is my best nudge?

"Is it gonna be something that helps me "get a little more exercise "or helps me avoid that can of soda, you know, at lunch every day?"

those are small nudges that can make a big difference.

You really want to pay attention to some of the big ones, right?

Do I get basic amounts of sleep?

Do I have the basic relationships that are the foundation of solid mental health, or do I have to address those, whether it's a bad-boss situation or a bad domestic situation?

Well, the other thing that gets a lot of headlines is medication, and I wonder if you think that we are experiencing a diagnosis inflation.

Yes, and we medicalize a lot of these key experiences, and we have this whole set of weight-loss drugs that have been miraculous in many ways, cutting your desire for eating, reducing heart disease, now indications that it improves your mortality.

It doesn't rescue you from addressing the other parts of your own context.

It, you know, offers you some resistance to the unhealthy parts of your context and environment but can be overdone and isn't the be-all, end-all solution.

Having a diagnosis helps you understand when things are becoming dysfunctional and of a medical concern, but in day-to-day life, there's gradations, you know, beyond that, as well.

Yeah, I think it's so important, what you're saying.

There's this idea that's been around for, really, centuries, millennia probably, that the way something is caused, like an illness or even a feeling, if you just change this one thing, then, you know, the outcome will change.

It's called effective causation.

It's like a billiard ball hits another billiard ball, and it moves.

You see this a lot, actually, that, "Here's the one thing."

"If you just eat enough kale," or, "If you just, you know, "take this one supplement, your whole life will change."

I think the bread analogy works.

You need salt in bread in order for bread to taste like bread, but the bread doesn't taste salty, but if you remove the salt, the bread just tastes weird.

Salt doesn't cause bread.

No.

Salt doesn't cause bread, and here's another thing.

You know what does also influence bread?

Anyone who's a bread baker really knows this-- the temperature of your oven specifically, and the amount of humidity in the air and how much yeast is in the air...

Context, context, context.

but those aren't part of recipes, so really, most causes of health or illness are emergent from all of these pieces.

Now, there are some nudges that really do make a difference, right?

Like, if you were just gonna ever change one thing, just one... Corrigan: See, everyone's leaning in right now.

I swear to God, everyone in America is like, "Shoot.

They're finally gonna get to it."

You'd sleep.

We all have mentioned sleep, so sleep is really important.

That's because so much of the country doesn't sleep... Barrett: Exactly, and that's also-- and it's like not having salt in most bread in the country.

Exactly, exactly.

I probably do prefer sleep over anything at this point, although 30 years ago, it would have been some form of human connection, but now it would be sleep.

Also, when we're metabolically encumbered because, you know, of all the things we've been talking about, what do people do in those moments?

They look for simple, single answers.

Health and wellbeing are systemically caused... And, therefore, systemically solved.

and so anybody who ever tells you-- No matter what their credentials are, anybody who ever tells you, "This is the magic bullet," you just should never believe that ever.

Tell me, what is some good news about the way science is changing such that we could have some reasonable, grounded hope that we will find our way out of this mental health crisis?

I mean, to me, it is such a huge good-news story, right?

We are an unusual species that has figured out how to double our lifespan, and now we're trying to learn, "How do I make that available "to every member of our species everywhere?"

We're all learning, for example, all of those things we've been talking about here, that the body is not separated from the mind, and we're now understanding in most of medicine and in public health that your wellbeing is rooted in things like your childhood experiences, and we're learning about the skill sets we bring to help you overcome and address those, and we are learning about the communities and what we need to build in those communities, including basic primary care linked to basic public health and connections that reach out to people because large portions of the population in every society often become disconnected from schools and from health and health care.

20 years ago, if we were talking about countries with a fraction of American income catching up to American life expectancy, we would have thought...

"Impossible."

"I don't know how we're ever gonna get there."

Now we have many examples, and they are growing, and by the time our kids are middle-aged, I think we'll be in a world where it's quite normal to have an over-90-year life expectancy without major disability and to have good, good quality of life.

Now, you know, we will all think that we're still living in the worst era in history.

That's also the way we're wired.

It's like, "Oh, it was so much better when I was a kid," but, you know, probably not, actually, but to have the world and our whole country take advantage of what we have discovered over the last century in wellbeing and in lifespan, I think we have every indication we can bring that to more and more for all of us.

Corrigan: Here are my takeaways from my conversation with Lisa, Dani, and Atul.

Number one, genes are not blueprints.

There is nothing deterministic about a human body or a human brain.

Number two, people always experience the present moment as worse than the past, but it doesn't mean it is.

Number 3, persistent uncertainty is metabolically expensive.

Number 4, a single caring adult is excellent protection against unwellness.

So is caring for others.

Number 5, beware the charlatans who tell you they have the answer.

Number 6, wellbeing is systematically caused and systematically solved.

Number 7, context drives behavior.

Number 8, life expectancy is a key indicator of mental health, and number 9, the mental health crisis is real, but so are the reasons for hope.

If you'd like us to send you this list, we're happy to do it.

Just send an email to PBS@kellycorrigan.com.

♪ ♪ ♪ ♪