Readers. [applause] good evening and welcome to the strand rare book room, my name is nancy beth lied and for a little bit of history the store was founded by my grandfather benjamin bass in 1927 and then my dad who passed away, fred bass, it was a part of new yorks famous book row which ran along Fourth Avenue one block away from astro place to union square and there were 48 used bookstores that all kind of competed with one another. All the stores have shattered except for the strand. I want to thank you all, you voracious readers because we are Still Family Owned and still driving, in fact, we are doing 400 events and discussions just like the one tonight and even tonight we have four events. Its really fun. Thank you. And thank you cspan for filming this. Happiness is the best medicine, yet americans will spend 3. 4 billion on medicine and healthcare this year. So, thats largeness to send every family of four a check for 40,000 for their care. We all know that happiness is not a big ticket item. Our guests tonight doctor Kelly Harding will discuss abdr. Kelli harding shes an assistant professor of psychiatry at Columbia UniversityMedical Center and a diplomat to the american board of psychiatric and neurology. Doctor hardings work in the emergency room works at the emergency room at the New York Presbyterian Hospital and as a daughter of a 91yearold ive spent a lot of time near so i have a lot of admiration. She has appeared on today Good Morning America and npr, new york times, medscape and the u. S. News and world report. Doctor harding is here, the author of the rabbit effect. [applause] starting with the story of a nurturing postdocs treatment of rabbits, doctor hardings book discussions the groundbreaking new research that shows how love, friendship, community and environment and our lifes purpose can have a greater impact on our health than anything that happens in a Doctors Office. Joining dr. Kelli harding in conversation is doctor lloyd sutter. He is an adjunct professor at the Columbia School of Public Health and was for 12 years the chief medical officer for the new York State Office of Mental Health. The nations largest state Mental Health agency where it continues there as a distinguished psychiatric advisor. Hes written many books including one we have here tonight. Addiction solution tweeting or dependency on opiates and other drugs. Is also written family guide to Mental Health care and improving Mental Health, for secrets in plain sight. Please welcome me abplease welcome doctors harding and doctor ato the strand for this important discussion. [applause] first of all nancy, thank you so much for having us and that beautiful introduction it is such an honor to be at this famed bookstore. Really, i didnt grow up in new york and the strand has this mystique to it but to actually be sitting here and sitting among these books is just really one of the highlights of my life. Thank you so much. And to be surrounded by so many people that i absolutely love this is just an incredible treat. Im seeing so many faces from so many different periods. Thank you so much. Because this is a book about kindness we also just want to take one second and if you could just say hello to your neighbor and introduce yourself if you dont know them. Good evening. We wanted to get to know you as our guests a little bit more so how many of you are scientists . How many of you are from Mental Health field . Good representation. How many of you are writers . Journalists . Journalists are a special form of writers. How many of you are here tonight because you are a relative of doctor harding . [laughter] how many of you are here tonight because you are her neighbor and you rely on her medical advice . [laughter] is anybody here because they think this is a book about vampires . [laughter] it is not. It must be in one of the other function rooms. Click some of you are also wondering whats the deal with these rabbits. We will talk about that. Lets learn a little bit more about you kelli. We heard you have a pretty busy life as an emergency room doctor you have three children, how in the world did you gather the time and energy to write this book . I have to say, this book is an incredibly Important Message and i know many of you in the room actually know this it became something that felt urgent. I actually got the message out. I know this is something that you also share a passion about and that comes down to Public Health. There is an important story we are not talking about in this country and it affects everything a person sitting in this room. Tell us about the rabbits. The essential characters in this. Before i get to the rabbits, i want to say something. As clinicians, raise your hand if youre a clinician, again. We got a lot of clinicians in the room. As clinicians, there is a lot of mystery when it comes to the mismatch between what we expect when we know about the disease and then what actually transpires in life and in the hospital. Its the patients who have serious diagnosis but on paper they found really not doing well but then you meet them and then they are actually functioning and living their lives fully its also the flipside of that patients who may be when you look at all their labs and imaging and Everything Else its okay but they are not functioning in life. This mystery propelled me through many years of education. Starting in internal medicine, i ended up in Research Fellowship looking at medically unexplained symptoms at columbia and i still didnt really feel i had a full answer until i heard about the rabbits. In effect, this book was part of your discovery of what you had been searching for. Exactly. The rabbits, one of my mentors a lovely fellow named doctor Arthur Barsky whos at harvard told me one day, i think you might want to hear about these rabbit studies. He said, i heard something about them how to social world impacts health but he didnt quite know the details so i searched and searched and finally tracked all these rabbit studies done in the late 1970s early 80s and heres this really cool, the studies were actually done with the intention of looking at heart health and rabbits. At the time it wasnt known if a high fat diet really made a difference to heart health. The genetically identical rabbits were all fed a highfat diet and then look at the results and something was wrong one of the groups of rabbits had far Better Health outcomes and using different markers than the other group of rabbits. abfigure there is something wrong with the protocol. He looked at it again and everything checked out so they looked up and they looked at who is caring for the rabbits and they noticed one of the post docs was a very caring woman who was actually picking up the rabbits she wasnt just giving them kibble she was petting them, loving them talking to them. To their credit because of the time it was a radical idea they went ahead and replicated the study. This time with really tightly controlled conditions and the got the exact same results and they published it in a very prestigious journal of science and i want to take a step back because a lot of the studies are somewhat serendipitous. I think this was an example of one because this is a groundbreaking study it was showing that the social world was having impact but it was just the beginning of a much bigger story. This is the nature of really good sites is when something doesnt make sense, you dont dismiss it, you pursue it. Thats what they did in that log. This is a protective effect in a way, that the nurturance that this colony of rabbits received protected them from disease. Help us understand that. Its a phenomenal thing to discover. First its sort of seeing whats going on that in fact somehow over the social world is changing our physiology. That defies our understanding of how the body works right there. Whats amazing is we now have four decades of science since then that really show, this is all to the field of Public Health that really show how our social world is impacting all of our lives. Everything a person in this room. Everything a person listening on cspan, their lives are impacted the kindness they are giving others in the kindness by receiving and it comes back to so many different factors relating to Mental Health. You describe is as hidden factors. Somebody hide them . Are they there . Are yet to be discovered . I described them as hidden factors edits with the field of Public Health calls social determinants of health or social dimensions of health. Its a bit of a mouthful but i think the thing to keep in mind is that its really all these hidden things in our daytoday relationships. We are talking about what happening in our home, whats happening in our workplaces, whats happening in our schools kibble with happening in our communities, whats happening in our neighborhood, whats happening are broader social environments. It really comes down to how to be to care one another . In this kind of raises the point that if you dont mind him to stop for one second. I wanted to take a second to pick about kindness in your life and my life lets take a second and think about somebody who has shown you kindness recently just for a couple seconds. For me this exercise is very easy because im looking at a sea of people that have done that and sitting next to me. So thank you. I think its those things though that we dont, kindness makes us feel so good but theres actually all this amazing awesome science and its emerging science too. Like really cool stuff about how the body works and how our social world is actually changing who we are. Youre saying these moments of kindness actually are protective. They can make a difference in how we lead our lives how we feel our bodies. It seems like such a readying resource yet you are saying at one thats hardly used. Im curious to your thoughts on it. Why do you think it is so underused . I wont let you get away without answering your own question. I have to say, after i wrote my book, doctor sutter lloyd sent me a book and it covers a lot of the same things. There are all these secrets that are hidden in plain sight basically. Its hard sometimes to take science and actually implement it into the daytoday when you have a certain mindset. The goal of this book, i realized once i crossed the street from Medical Centers, chart of the school of Public Health i realized this is information that needs to be in every Single Person in newsrooms hands they need to recognize actually their actions do matter. It turns out that a bigger predictor of your health by far is your workplace. We think about health usually diet, sleep, exercise occasional trip to the doctor. Were not really thinking about workplaces having such an important impact on our health. Were not necessarily thinking about our neighborhood where we lived access to the food we have, for better or for worse whats that like. Its a conversation we need to talk about because another thing thats a big piece of it is Mental Health. Theres a lot of stigma around Mental Health and he received the first and throughout your career. How is, yet another Public Health problem widely talked about now related namely loneliness. How do you connect loneliness with these problems in health and with reaching each other and kindness. Kindness comes down to really taking care of one another so when we think about it as a society, we are not doing a great job at this. Loneliness is a big piece of this. Smoking 15 cigarettes a day or heavy alcohol use, even high Blood Pressure and the question is how many times does your doctor maybe ask you do you smoke . Do you drink . What are they asking you on the last time you called good friend . Or saw someone you really cared about . If things got rough would you have somebody you could reach out to . It turns out its really critical. Its time we started talking about. Have you gotten a bit of a hard time from colleagues for saying that we are missing the boat . When we are asking about smoking or asking about drinking or asking about ab that we are missing this whole aspect of the relationship parts of our lives, when was the last time a doctor asked about that. I would actually say this. I would love to hear from colleagues in the room about this too. There are record abi was just talking about this with the medical students, there are records number of burnout among physicians that people work in medical care. I think a big piece of that is because our Current System is simply not acknowledging the major determinant of our help. Which actually brings me to a statistic. Medical care probably only accounts for about 10 to 20 of our overall health. Think about that for a second. Yet when it comes to how we spend on healthcare in this country we are spending 95 percent of our dollars on medical care and administrative cost. That being said, its important, access to medical care is absolutely critical but at the same time we have to start looking at a Bigger Picture of health and that includes whats happening in our communities and thinking about our School Systems and thinking about all those other things that typically we somewhat minimized in the glare of the razzledazzle of biomedicine which i love it too am a total science nerd. Is it hard to be kind . What are the barriers . [laughter] what you think . Whats getting in the way . I would say this is my experience writing this book as many of you have seen. Kindness is a practice. Its something you have to absolutely do every day. Because we are human beings we fail at it all the time. I think whats exciting is just recognizing that its something we can continually strive for. Im not talking about like grand measures of kindness where you are donating buildings to various places or things like that. Looking at the person who gives you a cup of coffee in the morning and in the eye and say good morning. We are talking about basic human decency things and thinking about how we are treating other people s kindness different from niceness . [laughter] i think its closely enough related that we could probably put it together. Kindness im using somewhat loosely because when we sort of in the medical world we talk about its happening more in the Public Health world. When the boys down to it for me it was one of the great pleasures of writing this book was actually hearing my wonderful editors debate of how do you talk about this to people who arent necessarily scientists or academics and it came down to kindness. Its really true because thats the golden thread that runs through all of this and its got this amazing Ripple Effect because when someone you know has your back. None of those things make us feel better but not school because we are increasingly getting the science to show it. We got to do more of it. I also want to say i feel lucky because the room is filled with people i know have my back and im just so grateful for you and gratitude is also good for health. An easy way to do this is start with gratitude. When we are thinking about the person that was kind to us were using gratitude and increasingly all the studies that gratitude and mindfulness are all good for our body. Stress is in and out of the blue part of life. I love how you talk about stress in your work and its one of those things we are to think about buffers because we know that stuff comes up and thats a big part of the book is trying to build up our reserves of resilience and also reserves of stress buffers stuff comes up that doesnt knock us on the floor. Part of it is essential to the development of a disease and disability abhow is kindness and anecdote to the inflammatory response . Whats happening here pee dee help us understand this. This for me is i think some of the coolest science. The neuro immune system basically like not understanding how that was working prior. It explains the pay since i was seeing during my Research Fellowship with the patient to just not feeling well but we cant quite find something wrong in our traditional tests. Its probably because our tests arent measuring some of the right things necessarily. I think whats also really cool about it is in this country we tend to celebrate the mind and the body and we do another very physical way when it comes to Mental Health we have separate Mental Health places of care, we dont think of people there is a doctor for every bit of your body and weve gotten super sub specialized. On one hand its helpful but on the other we still need to step back and look at these Bigger Pictures and its these conversations that are going to be happening in bookstores and communities around the country. Are you asked by readers, by friends, to coach them about how to talk to their doctor about the inflammatory response about kindness . About the social factors that determine our health . How do people go about bringing this up with their doctors . Its been really fascinating. Id be curious to hear your experiences but a lot of people are telling me, i have this one doctor that is phenomenal and they are asking these questions. Part of it is our system the way it currently people in healthcare paid to somebody about their social life in a 10 minute very focused visit in 10 minutes is if you are lucky. Feels like opening the lid of pandoras box. I talk about this in the book, raise your hand if youre familiar with aces . Im seeing some hands go up this kind of thing abim so impressed. One of the things is actually thinking about experiences that happen, its sort of like, something present in our environment all the time kind of like smoking used to be back in the 1940s. People didnt really think smoking causes lung cancer it took many years before they figured it out that this is actually causing all kinds of diseases across the board. It turns out, trauma is actually one of those things and its something we are really not talking about and many doctors dont know about it. There is an easy test you can take online its called aces too high so you can see about a history of trauma. The crazy thing is, every other person you pass on the street has some history of trauma in their past. Theres a lot of shame and stigma around it so people dont talk about it necessarily but it actually comes back to the question like what do you do when you encounter somebody whos unkind . We know that hurt people hurt people. Sometimes if somebodys being very unpleasant it can be helpful to keep that in mind that thats actually part of the story because people think kindness is great until suddenly there is like a stressful situation or somebodys yelling at you or somebody cut you off in traffic or whatever it may be. Kindness is actually about conflict resolution. How do we navigate our world and hear other peoples differences in a way that we are able to actually come to some problem solving. Its absolutely no secret we are doing a very good job of that right now and putting people in other camps. I think for our society and frankly for health we need to be having more conversations where we are able to create a bridge. Trauma is a very big concept. What are some examples of the kind of experiences that children have that leave them with this residue perhaps for the rest of their lives of an inflamed neuroendocrine system. The data shows that instances that happened during childhood can have a lifetime consequence when it comes to health. This is first studied in obesity. It was at the time yet again another incidental finding that seemed too curious to let go. Whats interesting about it, things like the loss of a parent, witnessing abuse many of the things that we would sort of think about being very harshly talked to. Things that we might necessarily think about as trauma are on that list but whats really empowering is we actually have some ability using trauma informed therapies that come in all different modalities. Comes in art, it comes in Mental Health, it comes in yoga. Theres all different ways that people are addressing the traumas that theyve had and it actually seems to make a difference for their bodies too which is amazing. These are traumas that can be identified early in a childs life. When that happens, what can be done . What can be done to help spare that child as a persistent problem. A big part of it and a lot of this work is being done in california where its not just whats happening in the clinics. You identify you got some aces and from there a lot of the resources are things in our communities but this isnt necessarily the kind of thing we are supporting with our current healthcare system. A lot of interventions that make a huge difference on health i really actually quite low cost and when i talk about in the book the rabbit effect is actually also these are things you dont necessarily have to have a white coat to have. I would say the vast majority of the programs, you just have to have the Good Intention and theres lots of wonderful Peer Health Educator programs out there and ways to get involved. This is just one example of like hundreds in the book but it blows my mind. It turns out that actually volunteering is good for your health. You live longer. Anything you are interested in, you want to get out there and try to get involved in and heres the other cool thing, it turns out, education is probably abdo we have any teachers in the room . Awesome. It turns out you guys are really in the healthcare business because education saves way more lives than it turns out biomedicine does. The statistic as a physician was absolutely mindboggling. For every one life saved by biomedicine, education saves eight. Think about that. I went to medical school to help people but it turns out you really dont need a white coat to help people. You can help Peoples Health in many ways. You can do a lot with an md and i have some absolutely incredible students in the room so i dont want to minimize that. I want to say that all of you who are sitting here are participating in the health of you, your families, the people in your Community Whether you know it or not. You really want to try to start making a difference in any way you can. I know many of you are all super kind. One thing that has changed in my life at this book, now i am really making a point of trying to reach out to people. When i see somebody in need i dont necessarily just walked by i try to think of something creative i could do or even little things. Thats one ways that this book has changed you, are there other ways that with the writing and all the speaking . I would say actually the biggest changes happening last week. I was sharing earlier with nancy and lloyd i didnt think anybody would show up at the meeting because i actually don will remember, somebody on our tour as we were shopping this idea around, somebody said kindness doesnt sell. But heres the thing, its incredibly heartwarming it turns out that, and falling out of my chair because of it. It turns out people really care a lot about kindness. We are at a critical point in our communities where we are starting to talk about it that its not okay how we are treating each other and its actually time to make an important change and its going to require all of us to really start looking at the problem and start stop bothering people. Anyhow. Thats a very good message to leave us all with. And maybe now there are some comments or questions from our guests. If you have a question if you like to raise your hand we can run a mic to you. Thank you so much for the talk and for convincing us to get many copies of the book for everybody we know. Wonderful. Thank you. And my happiness engineer i do this for a living. Thats awesome my question to you, the response relationship that you notice is there such thing out old being on kindness whether receiving or giving . Actually, that raises an important point. We talked a lot in this country how people are in a lot of pain. They typically have been looking for a pill or a visit to the Doctors Office to solve it but you just have to do a Google Search and look up what comes up when you say, why do i feel so b why do i feel so tired . Why do i feel so alone . Think about that because the antidote to that is not necessarily going to come in a pill that we can overdose on. Thankfully i cant remember a single case in the emergency room of somebody overdoing it on kindness. [laughter] when you see somebody who maybe appears to be mentally ill on the streets, what should you do about that . I actually feel like this is better, i can tell you what i do. Doctor aran Mental Health for new york state for over a decade hes very wellequipped to do this. There are many different things. The first i would start with, obviously your safety comes first but you want to ask if the person asked them their name, say are you okay . You want me to call somebody . Those are some things i typically do then because its often the same people, as a new yorker is like how could it be that we are in this glorious city with these incredible resources but yet there are so many people that are still on the streets . There are so many people still with Mental Illness not getting adequate treatment. Its not even necessarily people with severe elements. People runofthemill depression anxiety are not getting treated. If any of you are interested in getting trained in Mental Health first aid just checking in with people. Training people up to be able to address issues of Mental Health in a more systematic way because its not just a guy on the street, its the kid at school, the guy in the workplace thats having a hard time, its all those people we really need to really be creating a more Inclusive Community with. Is so many of us might be tonguetied at that moment with somebody who is in distress. There was a campaign in australia to script a very simple question for everybody in the country. The campaign was called, are you okay . Which is i think what you are describing. Also, the firstperson experience, we ask somebody, not only are you okay . I was a stranger, whats your name . Yes. It personalizes it brings the Human Element you are describing the kindness. Thats exactly it. I think its getting at that Human Element because its so easy to other people so whatever the circumstance is whether somebody on the street or somebody who doesnt necessarily share the same political views you do, i guess one of the things where its easy to put people in another camp. Its kind of like how we probably survived over time. We also have these incredible brain that can help us overcome that and the key is recognizing these hidden factors and recognizing that your actions are actually having a profound effect. I think some of the most lovely pieces of this sometimes just one action of kindness can make a real difference in somebodys life in a way that you may not ever anticipate. One thing i felt very fortunate as a clinician is sometimes people will come back and say you really made a difference when you do this one thing and i thought, i cant believe it. Because its not always appreciated at the time. By the giver herself. Other comments or questions . We been mostly talking about the kindness therapy or whatever you want to call it with normal folks. Im curious how does the kindness Therapy Training with someone who is psychotic or in the hospital schizophrenic or how do you utilize it and how does that work . Thats a really good question. Its a great question. I think we also have to look at how we are treating people in hospitals. If anyone is ever, raise your hand if youve ever stayed in any sort of hospital or care for somebody in a hospital . I know i have. Hospitals sometimes is very easy to lose the person whos getting the medical care. The human being involved for all the medical care. Part of that is by design but we also have to really be thinking about sort of like a humanistic element of the person getting the care and i think we could do a lot better job. Some of the research actually comes from looking at how is medical care delivered in other countries . I think we are starting to make inroads to it because it used to be that like visiting hours were cut off at certain times but now its much more inclusive because people often do better when their family is by their side. I see lots of headshaking. It makes so much sense. In other countries thats often the norm and now become the norm here. So for westernized medicine just to come back to the big population data, we are really not doing a good job we are spending this huge amount of money but at the same time when you look at our outcomes they are really where they not where they need to be. Across the board we are not doing as well as a lot of other wealthy countries are doing. When it comes to race, obesity, premature death. High Blood Pressure, homicide suicide, all these things we need to acknowledge we are missing a big piece of the puzzle. I think youd asked me earlier how clinicians respond. Im hearing a lot of positive support from clinician because i think they are recognizing, we all went into medicine to help care for people and to really, you can fix the problem but fail the patient if youre not addressing some of this. Hello. Am wondering about the connection between mindfulness and kindness as you are explaining. If youre talking about just taking the time to look someone in the eye and say thank you for the cup of coffee, i think particularly in new york we are in this goal, goal mode and i know a lot of people are talking about mindfulness and think wondering about your thoughts on the connection between that and kindness. Mindfulness, like there probably experts in this room who are far more abthan i am but theres really compelling data now, beyond just sort of niceness there is also, like meditation practices gratitude practices, there is a whole buffet of different mindful practices but you can pick and choose what works for you with your life style. I think the meditation a lot of clinicians i hear a joke its like we all know the data is just overwhelmingly good but to actually sit down and be still for 10 minutes 20 minutes a day its very hard. It takes practice. It takes practice. I would say just bears the data showing its very helpful for health and it probably is because its reducing the stress levels its like this cascade of epigenetic changes there is this really Cool Research around a thats a big word not Everybody Knows that. Used to be like your jeans were your destiny but now there is this really cool science that is showing in fact our genes are much more valuable than we realized and its because of the way they are folding and responding to the environment and these really cool studies where its basically showing that you can make positive changes, even with somebody whos living with an illness based on doing things like mindfulness practices and lowering your risk of recurrent stroke or heart disease. Thats incredible. The data if that came as a pill everybody would take it. The data is so robust. It is because it requires a practice and its not necessarily an easy fix. But its very inexpensive right. Absolutely. Thank you so much. Whats your name . Stephanie. Hey stephanie. This is to that point but there are so many apps out there right now whether, or simple habit or any of those, is there one that you like in particular or any sort of type of way to look at that that you think is good . I would say just do what works for you. The key is the practice element of it. Find one that works for you. Theres some cool ones out there. Ive had lots of friends tell me different ones work but you dont even necessarily even need an app you can just sort of practice even stillness for five minutes. It makes a big difference its really amazing. We are a go go culture. Good evening. Id like to thank you for a lovely last evening in new york. How fabulous. How did you hear about the talk . I was out walking and came in here and its something im probably i was stuck for what to do on my last night so i thought i would invest in a book. [applause] i have an 18 hour train journey tomorrow so this will come in handy. [laughter] am just interested in what you think if there is a correlation between cultural inclusivity when it comes to politics, in britain at the moment were struggling with it disaster thats brexit. Certainly ive seen in my society a Huge Division between people and we have become us and them and a lot of people didnt have the correct information when voting so there was a lot of fear from people and i fear to fear ab even Walking Around certain areas of new york such Cultural Diversity but a lot of it is very affecting us. Im wondering if you think the Public Health services is chewing into that and creating cultural inclusivity as part of the program. With regards to politics. I feel it politicians kind of separate us. I would say this is actually probably topic number one when it comes to Public Health. Some of our med students in the audience will know this but talking about Health Disparities how people are treated differently in the hospital, its pretty unbelievable. Its not always overworked. Its often done with the best of intentions but when you look at the data, in fact, we were just talking the other day about a study that showed surgeons for africanamerican patients versus white patients were like 70 more likely to recommend amputation abthat kind of data even if like theres a margin of error like 20 its totally unacceptable. That is probably a really big area. One of the things i talk about in the book is also like our unconscious biases and its something we probably everybody has got them we talk about in the book some of the ones i discovered taking the ie t which we also have the medical students take. The test is not perfect to show you like you are biased in this way but the idea is to get you thinking but maybe youre doing things like micro aggressions. We have time on two more questions. I havent read the book yet but i look forward to. The impact of . The internet. Right. Because things like apps can be very helpful. If you look for the Younger Generation especially talking about how it such a lonely generation you talk about loneliness and increase of loneliness and the impact it has on Mental Health. Did you look at that at all or think about that . That comes into play particularly theres adapter one of the early chapters is on our onetoone relationships. We are all doing this incredible experiment with our children right now. I think they just called it as Arianna Huffington is calling it generation also. Its our first generation really grown up, my kids age and many other people in the rooms kids age where theyve never not known technology but they are these really interesting wellknown studies looking at your phone and not looking at another human phase has all these downstream consequences and we are doing it pretty much every day to each other. Just next time you are on the subway look around and you will notice how few people are not engaging with one another they are just sitting looking at their phone. You will see a couple meditators what i think is pretty cool. That is something for me that has changed a lot as im trying to be much more intentional about my phone use and its hard because then you end up totally behind on email and not seeing some Important Message. As a society we are grappling with this and i certainly dont have the solutions but i would say lets keep working on it. The facetoface interaction is the most critical thing. I think in lieu of the last question. We have one more question. Hi, im gabrielle. Its an individual trauma as a child undiagnosed, what would be some suggestions you have for them now as an adult and then the second half of that is, if you do see an adult or child in trauma, what are some suggestions as a friend or Family Member we can do for them . What a wonderful question. I would say probably the first step with the adult trauma is to actually dig into some of the resources. Thats actually a good thing to think about seeing a Mental Health professional. Luckily if you live here in new york city there are a lot. They can give you options or give anyone options that are tailored to their needs. The second piece of it is when it comes to childhood actually most innovative clinics are doing things that are involving, its not the doctors responsibility to take care of all this we really need more interdisciplinary teams. Psychiatry has done this for decades. But getting even better and i think its the thing we need to be investing in social work. I know we got expert social work in the room. We have need to be investing in more Peer Health Educators and using things that are more evidencebased. There are some Pretty Amazing studies looking at just the power of writing and how that can make a difference. Writing things for like 15 minutes a day for like three days in a row is actually significantly shown to reduce stress around trouble. Its Pretty Amazing that the interventions are out there but the key thing for us is to Start Talking about them and then start looking for solutions together. Its a big topic its a big book we cover a lot. If its okay the last thing id like to do in closing is just to think also may be what you might do tomorrow morning to offer a little kindness to somebody in a different way that you werent necessarily expecting. If you could turn to your neighbor and offer a little kindness, thank them for coming. World announcer washington journal continues. Host doug wead