What’s normal anxiety and what’s an anxiety disorder?: Transcript

Dr. Jen Gunter:
Just letting you know, this episode discusses mental illness. Take care while listening.

When I was a kid, it felt like my dad was obsessed with getting to the airport on time. It would start a week ahead of our flight… sometimes even more. On the day of the flight, if the taxi we’d scheduled for 4am -- already 2 hours earlier than needed -- wasn’t there by 3:59, he’d get really agitated. Then we’d always get there so early, that nothing would be open yet. And he’d start screaming at people - the folks who worked there, my mom.

He was clearly in a lot of distress, and when you’d try to talk him down and explain it was ok, he’d brush you off. He was in the right, and we just couldn’t see it. He did other things that felt similar: he’d always worry that he’d left the stove on or that he left the iron on. And my brother and I started checking these things when we were getting ready to go anywhere, in hopes that my dad wouldn’t worry if we took care of it.

But it never helped.

My dad’s anxiety permeated lots of things, and caused a lot chaos. As a kid this was really hard on me. I was embarrassed all the time. Other people thought my family was strange - my friends didn’t want to come over to my house to hang out. It didn’t know anyone else who was like this and it felt like there was something wrong with my family.

Now, I recognize my dad had a severe anxiety disorder.

He never sought treatment for it. In the 1970s, no one talked about mental health. Especially not men’s mental health. And even today, the stigma and silence remains As a doctor, I see this all the time - I regularly have patients who are clearly struggling with anxiety, but don’t know it, or have a hard time accepting that diagnosis. It’s not surprising - our whole lives, we receive messages about how mental illnesses aren’t real illness.

“Why can’t you just stop worrying?! … Don’t be such a snowflake… He’s just so unstable… She’s crazy… What do you need, a trigger warning?… Why can’t she just get it together?”

But I’m here to tell you that anyone with symptoms of mental illness is experiencing something that is as real as high blood pressure. And if you had high blood pressure, no one would tell you to just ignore it, because it’ll go away. That could lead to unnecessary suffering… and perhaps, injury to your heart or your kidneys. With high blood pressure AND with mental health issues, ignoring problems risks making a lot of things worse.

Today, we’re talking about something we all experience from time to time, but can sometimes escalate to a medical condition: Anxiety.

I’m Dr. Jen Gunter. From the TED Audio Collective, this is Body Stuff.

Think about a time when you were feeling really anxious. What was making you feel that way? Maybe a big test, or a serious conversation you had to have with someone important to you, or when you’ve had to drive at night during a rainstorm. How did that anxiety feel in your body? Did your heart start to race? Did you start to sweat? Anxiety isn’t just happening in your mind - it’s full-body reaction. So how does it all work??

I called up Dr. Kali Cyrus. She’s a psychiatrist in Washington DC. I asked her to give me the basics.

Dr. Kali Cyrus:
So anxiety is generally a form of fear or a form of worry. You are afraid that something is going to happen or you are just increasingly worried, maybe apprehensive. You're not sure if something bad is going to happen, you are maybe overly focused on the expectation of some kind of outcome, like you just can't stop thinking about something.

Dr. Jen Gunter:
One thing I sometimes hear from people is, um, is that, Oh, well, you know, you should just, just be less anxious. So just try to be less anxious. But I mean, you know, that in many ways sounds like trying to say to someone why don't you just have less high blood pressure or, you know, why don't you have just less abnormal cells in your uterus?

Dr. Kali Cyrus:
It's exactly the case. It's just that we don't think about feelings and emotions in that way. For some people it's actually part of your genetic makeup, um, or there was something in your environment where you were predisposed to so many circumstances where you were alert. And if you can't control your environment, you certainly can't control your genes. You can't just get rid of your anxiety just like your cells or your high blood pressure.

Dr. Jen Gunter:
Anxiety is a normal emotion that all humans experience, just like happiness, sadness, and anger. It turns out all feelings have purposes. Looking at evolution can give us some insight here.

For example, joy and affection tie families together, to create stronger bonds of support. Anxiety exists to keep us alive. It’s part of our threat response system. And Anxiety and Fear are closely related. Imagine thousands of years ago, you’re out foraging for roots and berries, and there’s a rustling in the tall grass. You need a system in place to help you sort out if it’s just the breeze, or a lioness is on the prowl.

Today, we have fewer lionesses to deal with. But we still have threats, and anxiety helps us predict them, and respond to them. So what’s going on here? We have two main parts of our brains that are involved in anxiety: the limbic system and the cortex.

Dr. Kali Cyrus:
We have the limbic system, which has sort of thought of this old emotional system that helps to sort of, uh, you know, get us ready to fight a tiger

Dr. Jen Gunter:
The limbic system is involved with our emotions and behavior, among other things. Especially when those emotional or behavioral responses have to occur quickly, without applying reasoning or judgement, to keep us alive. Like our fight, flight, or freeze response - which is both a mental and physical reaction to a potential threat.

Dr. Kali Cyrus:
And then we also have the third part, which I'm just going to call our cortex, right? And this, these are some of the more complicated parts of our brain when we think about how we reason or how we plan, where our judgment and where our motivation comes from.

Dr. Jen Gunter:
The brain is complex and interconnected … and what’s going on in one part of the brain is absolutely influencing the other parts.

Dr. Kali Cyrus:
So you're walking down the street and you see somebody walking towards you, maybe it's like a dark alley and your amygdala is probably the first thing that goes off.

Dr. Jen Gunter:
The amygdala is a little almond shaped region in our limbic systems. It’s the main fear processor in our brains

Dr. Kali Cyrus:
Um, which is basically being activated when you see this guy walking towards you, So let's say your, your mind perceives this as fear. So what ends up happening is that your amygdala will start sending signals to other parts of your brain, including the hypothalamus. And what will end up happening, the fight flight or freeze system will get triggered, which will help your body basically run or fight or freeze, or just stand still.

Dr. Jen Gunter:
The amygdala sends out the distress signal, and it’s received by the hypothalamus - another part of your limbic system. Then the hypothalamus relays that signal to the rest of your body.

Dr. Kali Cyrus:
Your blood vessels will constrict so that in case you get cut or stabbed or something like that, that you won't bleed out, your digestive system will shut down because it's not time to pee and poop also is like, it's time to save your glucose so you can fight... your lungs, your bronchials will dilate so that you can let in as much oxygen as you can to get to your muscles in case you need to run. And also your heart rate increases so that you can pump more blood to your muscles.

Dr. Jen Gunter:
So your limbic system is responding to that threat immediately, with the fight flight or freeze system. At the same time your cortex - the part of your brain that applies reason - is also trying to figure out the situation.

Dr. Kali Cyrus:
And then I think about the cortex thinking, well, have you seen a face like this before? It's at nighttime? Should we have we ever encountered a situation with someone who's ever hurt us in a position like that?

Dr. Jen Gunter:
You have two different systems running at the same time. And so much of your experience of anxiety depends on how those two systems work together.

Dr. Kali Cyrus:
And so there are some ways in which the amygdala can take over and you are afraid if you don't get, um, processing from the cortex or some of these higher thinking of reasoning to tell you that you don't need to be afraid.

Dr. Jen Gunter:
So it may not surprise you considering my history that I used to be very anxious about flying. As soon as I booked a ticket, I’d be nervous.I knew it wasn’t rational. I knew that the chance of my plane falling out of the sky was astronomically low. But I couldn’t stop worrying about it. My cortex and my limbic system were at war - but eventually my cortex would rally the troops, and I’d get on that plane. I’d be nervous, it would not be fun, but the whole thing didn’t disrupt my life. But for some people, anxiety can be disruptive. They experience persistent, pervasive anxiety that gets in the way of their daily life or relationships. That’s when it becomes an anxiety disorder.

People who have anxiety disorders find that they will start feeling super anxious out of nowhere, or their anxiety is completely disproportionate to a situation.

Dr. Kali Cyrus:
So you can see that your body starts to respond as if it's fighting a tiger and activating this entire neurochemical response when it doesn't necessarily need to. When someone comes to me and is talking about how maybe the past couple of weeks, they just haven't been able to leave the house. Every time they leave the house, they have a panic attack.

Um, or someone comes to me and says you know, maybe I got COVID in December and I've been afraid to interact with anyone. I like to think that if you are experiencing the symptoms of anxiety, most days of the week for a prolonged time that is interfering with your daily functioning, then that's when it poses, um, a level of being a disorder to me.

Dr. Jen Gunter:
There are many types of anxiety disorders, but Generalized Anxiety Disorder is one of the most common. It’s symptoms can be very unpleasant and disruptive.

Dr. Kali Cyrus:
Someone might be feeling restless or keyed up. They might be tired, you have trouble concentrating. You're also just kind of irritable. Like things bother you. People are moving as fast as they need to. You just don't know why you're kind of cranky muscle tension. So for whatever reason, um, maybe your jaws clench, or you find that your, your teeth are clenched. Um, and then you also usually have some kind of sleep disturbance. So you might have trouble falling asleep or staying asleep

Dr. Jen Gunter:
It can be incapacitating. Researchers have looked at people with anxiety disorders, and found some specific differences in the structure and function of parts of their brains.

Our brains have billions of interconnected neurons It’s like the motherboard of a computer, and it’s incredibly complex. Networks of connected neurons are known as pathways, or circuits. And the more times those pathways fire, the more likely they are to fire again.

Think of these pathways as literal paths in a grassy field. The more often you use one path, the more tamped down the grass is, and the easier it is to walk. When you use one path all the time, what happens to the others? They start to overgrow and get harder to use. So our brains are constantly changing and adapting to the signals we receive. This is known as neuroplasticity.

Dr. Kali Cyrus:
And that's part of like the wonder of the brain, which is that the circuits that get used and used and used, you know, so the amygdala to the hypothalamus or the amygdala to the prefrontal cortex in response to something that you're processing is a pathway that gets strengthened over and over and over again, every time you respond in a certain way.

Dr. Jen Gunter:
So in the brain of a person with Generalized Anxiety Disorder the amygdala becomes hyperresponsive. It might even issue false alarms. Over time, anxiety can cause changes in the brain, essentially strengthening the areas involved with anxiety. This can become a feedback loop that can produce a lasting shift in brain structure and function.

Dr. Kali Cyrus:
And so trying to undo that is just not going to happen that easily. You really have to put in the work to try to break that cycle.

Dr. Jen Gunter:
The good news is that our brains have an astounding ability to change. You know how I said I used to be really anxious about flying? A few years ago, I was on a flight to New Jersey, sitting next to a pilot who was on his way to his next job. We got to talking, and I told him how anxious I was about flying.

Then during the flight, every time there was a bump, I’d turn to him and ask if it was a big deal? Every bump felt HUGE to me. But the pilot would chuckle and say, oh, that’s nothing. He’d explain exactly what was happening. By the time the flight was over, I really understood a lot more of what was going on. And after that, each time I’d start to get anxious about flying, I’d remind myself of that conversation. I’d remember how it felt sitting next to that pilot, how safe he made me feel.

I remembered that conversation again and again and again… every time I planned a trip, every time I got on a plane. After a while, I didn’t have to remember that conversation to feel comfortable flying

I’d created new neural pathways.

After the break, we’re going to talk about how coping with anxiety means understanding it, accepting it, and asking for help. All of that can mean wading through the stigma around mental illness… a stigma that has roots deep in history.
_

I understand why my dad never got help for his anxiety. His generation’s attitude about mental illness was 1 - it’s a sign of weakness, and 2 - it’s a woman’s problem. That stigma’s been around for a long time.

Professor Helen King:
It's one of those ways that men oppress women and have done for a very, very long time.

Professor Helen King is a brilliant classicist in the UK. She studies the history of Western medicine, and has a particular interest in the ways misogyny is all tied up in it.

I find her work totally fascinating! I might actually be her biggest fan.

Dr. Jen Gunter:
If we were in person, I’d have you autograph my copies of “Diseases of Virgins” and “Hippocrates Woman.”

Professor Helen King:
Sorry, had a moment of such excitement there that my microphone fell off!

Dr. Jen Gunter:
Professor King says you can trace the stigma about mental illness to outdated ideas of the female body. Historically, physicians were absolutely obsessed with the womb… or the uterus.

Dr. Jen Gunter:
I'm always fascinated by, you know, reading, you know, older medical textbooks and why a man may have gout and maybe it wouldn't be what we'd accept today, but it fit with the model of the day. And for the woman it's your uterus.

Professor Helen King:
Exactly. It's always a uterus.

Dr. Jen Gunter:
The ancient Greeks blamed A LOT of things on something that seems wacky to us now: the wandering womb.

Professor Helen King:
So men's organs stay roughly in the right place, except, you know, in obvious sexual situations where they move up and down a bit. Plato actually says that it's not even me being rude here, it's Plato. Um, women are different because women have wombs and wombs just wander. And sometimes they're seen almost as animate.

Dr. Jen Gunter:
they're sort of like naughty animals, I guess, kind of wandering the body. Like they're looking for something like they are a creature… it’s described as an animal inside an animal in one Roman text.

Dr. Jen Gunter:
This was also the time when doctors believed that the key to how your body worked was something called the four humours.

I’m not talking about something that makes you laugh… it’s the four fluids that physicians once thought made up the body: yellow bile, black bile, phlegm, and blood. Before anyone knew about germs and genetics, people blamed everything on the humours. Got a cold? or a pain in your hip? Your humors are out of whack.

Professor King says blood was the humour associated with women and their wombs… so most female maladies were blamed on a blood imbalance or her womb wandering around inside her body.

Professor Helen King:
It's all about the blood getting stuck and that can cause disorders anywhere in the body, you know. A man, with a pain in his shoulder, is what have you been recently doing? Lifting and carrying. A woman with a pain in her shoulder? Ooh, your womb got stuck in your shoulder, you know, it's that sort of, it's that sort of level. It's all about the womb and the womb is all about retaining blood, collecting it, pouring it out at the right time or not.

Dr. Jen Gunter:
For much of the history of Western medicine, there wasn’t any distinction between physical and mental health. And when the womb was just a naughty little animal that wandered the body... it was seen as an unstable organ… and the women who had wombs were seen as unstable too.

Professor Helen King:
So because your, because your womb is on the move all the time, you, you know, you just can't really settle to anything. So you're kind of naturally unstable “Oh, she's crazy.” That's got an extremely long history.

Dr. Jen Gunter:
The idea of women as unstable, as made up of weaker stuff… was a very effective way to oppress women. Professor King told me about an example from the 16th century.

A young woman named Anna isn’t well. And her father is concerned - Anna is old enough to get married, and he’s worried that her malady could affect her marriage prospects.

Professor Helen King:
She's pale. She's got palpitations. She's got great difficulty breathing. She's got problems with her eating. Now, I mean, we might say, Oh look, you know, let's look at this as possible anorexia, you know, she's not eating properly. Or we might say, what about these palpitations? Is this some sort of nervous thing.

Dr. Jen Gunter:
Anna’s dad reaches out to a doctor for help. And they begin a correspondence.

Professor Helen King:
As far as they're concerned, it's to do with blood it's because she's still a Virgin. Her blood has got stuck in her body and it can't go out because she's not open at the bottom. This disease is what's called the Virgin's disease. Because she’s a virgin.

Dr. Jen Gunter:
If you look at Anna in context, I see a young girl going through puberty, with a lot of pressure on her about getting married. Maybe she’s anxious about getting married, or not getting married.

Marriage was not exactly a picnic for young women at that time.

Professor Helen King:
Particularly, if you had the experience of other members of your family, women, who've been married and then died in childbirth, which obviously it was a lot more common then than it is now. We don't always factor in when we look at the past, you know, examples from early modern Europe of people, writing letters before, before they go into childbirth, in case they die because it was a real risk.

Dr. Jen Gunter:
Right.

Professor Helen King:
Being a woman was a very dangerous thing to be. You can sort of see that someone like that of the age for marriage, it will be enough to make you pretty anxious.

Dr. Jen Gunter:
But Anna’s doctor makes a very typical diagnosis for the day, with a typical treatment:

Professor Helen King:
The cure ideally is to let the blood out. You can do it with marriage or you can do it with bloodletting. Lots of things that women have wrong with them, the answer is bloodletting, you know, if in doubt, there's always bloodletting.

Dr. Jen Gunter:
Bloodletting--cutting a person open and draining some of their blood--was prescribed liberally—to both men and women—for a very long time. But it was closely associated with female maladies

Professor Helen King:
But then the ultimate bloodletting is actually having a baby. So, not only does your blood form the baby and feed the baby in utero, but then when you give birth, you also lose blood. So that cures you of anything that's been built up for, for a long time in your body. So how often you find in the ancient Greek texts, if she gets pregnant, she will be healthy.

Dr. Jen Gunter:
It’s hard for me to ignore the fact that for Anna, the cure is either performing a painful, traumatic, and potentially dangerous bloodletting, or a possibly equally traumatic marriage and pregnancy.

Professor King has observed in her work that across thousands of years of medical history, over and over, medicine was used to control women… because the idea was they needed to be controlled.

Professor Helen King:
Women are just, you know, completely wild and they have to be under the control of men, or they'll just be; go on being completely wild.

Dr. Jen Gunter:
I think it's this it's if, if you want to stay in power, then the greatest way to stay in power is to tell all your detractors or the people that you want to have power over that they're, you know, they're crazy or stupid or wrong or less intelligent.

That persistent idea that women were crazy, or unstable, or less intelligent? It helped set the stage for a complementary idea to emerge... That mental illness was feminine.

The prime example is hysteria, a diagnosis that came into vogue in the 17th century. Hysteria was an emotional affliction caused by the womb. That’s why it was named after the Greek word for uterus - hystera. It supposedly caused everything from anxiety to sexual deviance to fluid retention.

At the same time, the idea that the mind and body were distinct had started to take root. Which meant medicine was talking about mental illness as something separate from physical illness. And physicians began to think of hysteria as a problem with the brain… rather than just the womb. That opened up the possibility that men could be hysterical too. For a time, some doctors used “male hysteria” as a diagnosis in men who had PTSD-like symptoms after experiencing battle.

Professor Helen King:
It's fascinating. The idea was that the sorts of reactions men with shell shock had were very similar to what they expected a woman with hysteria to have. So they call it male hysteria, but it didn't catch on as a name because you can't use the word hysteria of a man because you know, it's not manly as it. So it became shell shock, which sounds like a manly good, hard consonance shock.

Dr. Jen Gunter:
Wow. That's fascinating.

Professor Helen King:
It is extraordinary. Isn't it? It's basically feminizing them. It's saying that some sorts of bodily reactions are not appropriate to proper men. And if you've been told all the time that you can't possibly have a mental illness, cause that's a feminine thing, you won't seek treatment.

Dr. Jen Gunter:
I think we still see this kind of stigma today. I definitely saw that with my dad. And I want to acknowledge that this isn’t just about misogyny, it’s also about homophobia. And it hurts all of us. It stigmatizes a lot of people who are struggling… and it keeps them from getting help. I think the way around all of this is a deeper understanding of what mental illness is… And since we’re talking about anxiety disorders, lets start there.

It’s true that some people are more vulnerable to anxiety disorders than others, but it has nothing to do with being feminine, or weak. There’s complex biology at play. In the past few decades we’ve come to understand how what happens when we’re kids can affect our health as adults. Researchers have identified a set of Adverse Childhood Experiences - or ACES - that correlate with higher levels of mental illness later in life, and also physical problems like heart disease and diabetes.

Dr. Kali Cyrus:
And so the ACEs, at least that they categorize are things like being physically, sexually or emotionally abused being emotionally or physically neglected.

Dr. Jen Gunter:
That’s Psychiatrist Dr. Kali Cyrus.

Dr. Kali Cyrus:
Having an addicted parent, having a parent who is depressed or had some other kind of mental health condition, having a separation of your parents, uh, having someone who was a parent who was incarcerated.

Dr. Jen Gunter:
ACES can rewire a young person’s brain in the same way that we talked about earlier - the more often a path is walked, the more defined the path becomes. Neurons that fire together, wire together.

So if you were raised in a household where you were frequently exposed to abuse...

Dr. Kali Cyrus:
Your reaction and exposure to these events shaped your brain circuitry. How often you, your amygdala witnesses, something that it signals as fear and how often then your hypothalamus and other parts of your brain activate that fight flight or freeze response, how that over and over and over again for years then impacts you as an adult, as an adult, when your circumstances may have changed and how you can have anxiety because this system is going off constantly

Dr. Jen Gunter:
So when the fight, flight, or freeze response is repeatedly activated, it creates a ripple effect in your body.

Dr. Kali Cyrus:
And so if you think about your heart rate, going up, your bronchioles and your lungs are being expanded to bring in more air, you know, all of these processes happen in your body over time and just sit there. Right? So usually if you're going to fight, you're going to use those resources up. You're going to use that oxygen. You're gonna use that glucose, but imagine if it's just continually gets activated and you don't actually need to fight, right? What that does to your body.

Dr. Jen Gunter:
Over time, all of this can disrupt the development of brain architecture and other organ systems.

There are other legacies of ACES.

Children may also develop behaviors formed in reaction to those adverse experiences. They might use less helpful coping strategies, like shutting down or lashing out when there’s conflict, or working extremely hard to keep people around them calm, in order to avoid any conflict.

Dr. Kali Cyrus:
And you can imagine if you were typically the kind of child who yelled or you shut down, or you tried to please everyone, and that got you out of trouble as a child over and over and over again until you were 18. And then you're out in the world, that's going to be your knee jerk because it worked.

And so how do you undo. You know, something that's been habituated for years and not just, I think behaviorally in terms of like, Oh, if my go-to is to respond in this way, but I mean, also neurochemically those pathways in your brain are solidified, you know, from the moment you started doing that as a child.

Dr. Jen Gunter:
These experiences have long term impacts over a person’s life. An adult who experienced ACES as a child is more likely to have asthma, kidney disease, stroke… they could be even more likely to experience earlier menopause. And these impacts can be magnified over generations. Some things can help prevent ACES from having a long term impact. For example, having a loving, supportive relationship with an important adult can be a buffer. The National Institute of Mental Health says that more than 30 percent of Americans will experience an anxiety disorder at some point in their lives.

So what is the path forward for so many people who live with one? One of the first steps in managing an anxiety disorder is getting diagnosed.

Dr. Kali Cyrus:
So the first thing I will say is, is it's okay. If you have severe anxiety is just acknowledge it. Um, but I think that the main treatments are in terms of medications, but also in terms of therapy and typically, and also the research suggests that doing these things in combination is more effective than doing one or the other.

Dr. Jen Gunter:
Let’s start with talk therapy. One of the kinds of talk therapy that can be extremely effective for anxiety is CBT, or Cognitive Behavioral Therapy.

CBT helps you learn to tamp down your fight, flight, or freeze response

Dr. Kali Cyrus:
You are really just talking through what a patient's personal experiences are in these stressful situations, step by step, and really trying to help them understand how their emotions are connected to their body response and how all of that is stored in our brain.

So that the next time we experience it, we have the same kind of reaction. So how do you intervene? How do you take yourself off of that loop in a way that is actually helpful And so it's really powerful actually that, you know, a talking form of therapy can do all this.

Dr. Jen Gunter:
It can be hard for people to imagine that a problem so overwhelming could be helped by something that seems as inconsequential as talking. But this is a structured process that’s been scientifically proven to help establish and strengthen new pathways in the brain. The stronger those pathways become, the more likely you are to react to triggers in that new, more productive way.

Medications can also be incredibly helpful. Some prescriptions help change the way the neurons in your brain are firing.

Dr. Kali Cyrus:
The pharmacological medications that we think about are the ones that are triggering the neurochemicals that are involved in some of these neuro processes that we've been talking about—You take a medication and it tries to change the, at least the ratios in which they are released will help to signal to the amygdala to tell the hypothalamus to turn on or turn off, or tell the amygdala to turn on or turn off.

Dr. Jen Gunter:
Dr. Cyrus says it can take up to a month for medications like this to start working. But there are also options that help people who need to calm down in a moment of a panic, and they help lots of people. Medications get a bad rap, there’s a lot of stigma and misinformation. But working with a qualified mental health professional you trust is a great way to explore your options.

The basic health things work too: good nutrition, plenty of sleep, and exercise.And many people find meditation helpful as well. Meditation dampens the fight, flight, or freeze system and promotes an alternate relaxation response, slowing down the heart rate and breathing.

There’s an elephant in the room that I want to acknowledge - it can be incredibly hard to access mental health care. It can be hard to find someone who is taking patients, and if you do find someone, it can be prohibitively expensive.

This lack of access, plus the stigma we’ve been talking about… you can understand why people don’t get the care they need. This has to change. Until it does, people will keep suffering.

When I got to medical school and figured out that my dad had an anxiety disorder, it was a relief. It was powerful to have a diagnosis … to learn that my family wasn’t uniquely broken. Sometimes I think about how my life would have been different had my dad gotten a diagnosis earlier, and received help with his anxiety disorder. I think of all the chaos, of the yelling and screaming … maybe it could have all been avoided. And most of all, maybe my dad would have suffered less. This is the point- conversations about mental health are just conversations about health. Period.

Next week on Body Stuff, sometimes your body just needs to be cleaned out with a detox or cleanse….right?

Kaveh Hoda:
No. The only thing these cleanses and detoxes remove from your body is your money.

Jen Gunter:
We take on a myth that’s stuck around for centuries...and introduce you to your most mysterious organ… the liver.

Body Stuff is a member of the TED Audio Collective. It’s hosted by me, Dr. Jen Gunter, and brought to you by TED and Transmitter Media. This episode was produced by Lacy Roberts and edited by Sara Nics. The rest of the team includes Camille Petersen, Alice Wilder, Gretta Cohn, Michelle Quint, Banban Cheng, and Roxanne Hai Lash. Alex Overington is our sound designer and mix engineer. Krystian Aparta and Neeraja Aravindan are our fact checkers.

And special thanks to that sweet old lady in the church choir who has since passed away, who knew my parents were really weird, and took me under her wing.

We’re back next week with more Body Stuff. Make sure you follow Body Stuff in your favorite podcast app so you get every episode delivered straight to your device. And leave us a review! We love hearing from our listeners.

See you next week!