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Are We Getting Better? Mental Health Through History
Episode 110th January 2023 • So Curious! • The Franklin Institute
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To kick off the season, Kirsten and Bey sit down with Penn State professor Dr. Greg Eghigian to learn all about the history of mental health. Find out how it was perceived throughout time, how treatment has developed, and how our modern understanding of mental health has emerged. Plus, we’ll learn what the vagus nerve is and learn a mindfulness technique to reset it from Marguerite Nicosia of the Shanthi project.

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Hello. Hello and welcome to so curious.

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We are your hosts.

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I'm Kirsten Michelle Silver.

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And I'm the Bull Bay.

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So Curious is a podcast presented by the

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Franklin Institute, a science museum in Philadelphia focused on celebrating human

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sciences and technology, which is exactly what this show is all about.

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We're so excited to be back for season three of So Curious.

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Last season, we looked into the science behind sex, dating, and relationships,

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talking about things like hookup, culture, ghosting, and compatibility.

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And this season, we're talking all about mental health.

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But before we get into all that, we should probably introduce ourselves.

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My name is Abo Bay.

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I'm a Philadelphia based hip hop artist.

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And for proof, you could just play my song right here.

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Yeah, I'm still not west.

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Yeah, I'm about to get a check.

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Yeah, I'm back at it again.

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And what about you, Kirsten?

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Who are you?

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Okay, Kirsten.

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Here I am.

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Philadelphia's token terminally ill stand up comic.

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I was born and raised in the city of brotherly Love.

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I have cystic fibrosis, and because of

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that, I've been working as an advocate for the CF Foundation.

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I've been doing stand up professionally

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for six years, and I split my time between telling jokes.

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I can't imagine having to care about a future in general.

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You know, like, I don't have a savings account.

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I don't wear sunscreen.

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I love burning bridges socially and

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yelling gobarts unprompted any chance I get.

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So, Bay, this season is all about mental health.

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So what is mental health to you?

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Mental health to me is, I guess, a part of your overall health.

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Right. And making sure that you are well and

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functional and really just able to kind of connect with the world around you, whether

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it be your environment or people and whatever gets in the way of that.

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My motto is mental health is health.

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I think mental health is kind of like the final, most important science that not

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that many people treat as science yet, and it so very much is.

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Right. And I'm excited to get to talk about the

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facts and figures and data behind it and that there's so much more than just, like,

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I feel happy, I feel sad, and all the actual things that go into it.

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Right?

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So we've got some amazing conversations about mental health for this season.

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One question I have is how did mental health become a thing?

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So our first guest, Dr.

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Greg Agigian, is a historian of science

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and medicine specializing in the history of social deviance.

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So let's welcome him now to hear his insights on the history of mental health.

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Greg, can you introduce yourself?

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Tell us a little bit about what it is that you do.

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Sure. My name is Greg Egymia.

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I'm professor of History at Penn State University.

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I'm a historian of science and medicine,

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but I've probably spent most of my time doing research on the history of madness,

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the history of mental health, the history of psychiatry.

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Wow.

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Can you talk to us about how people thought about mental health in the past?

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How was that perceived and conceptualized? Yeah.

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Well, it always depends upon what period

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of time you're looking at and, of course, where you're looking.

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But what's clear is that throughout most of history, it's fair to say that every

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society has recognized that there can be states of mind and states of agitation and

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distress that we today would call mental illness.

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It's not gone by that rubric.

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It's not always been understood as

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something that falls under that sort of banner of something that you want to talk

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about as being akin to other kinds of diseases.

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For much of its history, particularly in the Western world, it's also been largely

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understood as something that affected one's soul, one's spirit, and so it

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oftentimes had very kind of religious and spiritual dimensions to it.

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Yeah.

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Can I ask, in your study, do you find that the discussion of mental health and the

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way that we treat mental health, do you find that it has gone in a linear

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progression, like it's only getting better?

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Yeah, I think as a historian, I would say

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that I don't think history tends to work in any linear fashion.

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And I think the history of mental health treatment and understandings

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of mental health have zigbed and zagged and taken one step forward and three steps

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back and then another three steps forward multiple times.

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And it always depends on what we're talking about.

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Are we talking about our understanding of

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what makes people tick and why it is that people suffer from certain things?

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Or are we talking about how, say, policies towards people with mental illnesses have

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evolved, or are we talking about treatments?

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I think it's fair to say that in large

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measure, there have been periods of time in which, by any measure, you'd have to

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say they've been very grisly, very dismal times.

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And those times have not always been the times that I think a lot of people sort of

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strikes them in their minds about when that would be.

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I think many people would think, oh, it must been in the Middle Ages that people

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with mental illnesses were treated in a specially brutal manner.

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And that's really not the case.

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Like, now it's 2020. Yeah.

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The Middle Ages gave us the concept of the hospital, a place where people who were

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vulnerable, who had no other place to go, could, at the very least, receive a kind

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of basic care in the sense of being given shelter, given a place to sleep, given

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food, and looked after it's in the 20th century.

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I think you can make a good argument that

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we see the most horrible things that have ever been done.

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It's the period it gives a birth to the concept of eugenics.

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It's the period of time in which hundreds of thousands of people were sterilized

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against their will because they had a mental illness, and it was thought that

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this would make for a better society or a better race.

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And of course, the 20th century, the Nazis

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embarked on a project to kill 200,000 psychiatric patients in one fell swoop.

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So I think we can definitely find

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inspiration at different periods of times in different moments.

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But there's going to be other times when

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we're going to, I think, have to admit things took a very dark path.

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How would you define our modern understanding of mental health?

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And when do you think the current

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understanding we're in right now began in society?

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I'd say that the way I think about it in my terms as a historian who's looked at

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this from the ancient world up to the present.

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Our contemporary conception of mental illness and mental health, I think has a

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strong foundation in a kind of biological understanding of human beings that we are

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hardwired in a certain way with certain processes and certain chemicals working

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inside us and that we are made up of certain genetic material.

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That kind of vision of who we are, to me, is something that I think really starts to

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first take shape in the 17th and 18th centuries.

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Starting in the late 19th century, then into the 20th century, has come overlaid

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and superimposed on top of that, an awareness, in a sense that, however,

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there's all sorts of social and psychological stressors that can affect

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one's life and that can have an impact on that physiology.

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And those two things together, I think,

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are the things that still shape our way today and our contemporary lives, still

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shapes the way we think about mental health and mental illness.

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And can you bring up any time period,

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specifically in the past and some of those treatments?

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What were the conversations?

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What drugs were used?

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What did that look like?

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So if you look back and say the ancient

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medieval worlds, the ways in which you would have particularly medical people

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intervening in these areas would be to because they believed that what was wrong

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with not just people who suffered from what we would today call mental illness.

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But when you had almost any kind of health

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problem, they believed it was an imbalance of humors that were in the body.

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So the key way you would try to help

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somebody and alleviate their symptoms is balance those humors.

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And you would do that through various means.

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It might mean prescribing.

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Somebody should get lots of sea air, or

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you might be told to drink some water, or you might be told not to drink water.

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You might be given certain kinds of herbal

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treatments of various kinds, and these could come in multiple forms.

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Some would be in the form of suppositories.

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You might be given things that would make

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you vomit in order to get rid of the toxins, things like that.

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When you start to get into the 19th century and the 20th century, that's when

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you see the emergence of the use, particularly of chemistry.

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And that's when you start to see first the use of sedatives of various kinds,

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primarily used to calm people who were agitated or people who couldn't sleep.

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And then over the course of the 20th century, you start to see other kinds of

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things, ranging from malaria fever therapy, which was a therapy used in the

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early 20th century to give somebody malaria, actually to promote, to put them

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into basically a long sort of prolonged set of seizures and fevers.

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But you also have the development of

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lombotomy in the middle part of the 20th century, the idea of choring parts of the

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brain in order to sever certain connections.

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And of course, the development at the same time around then is electric shock

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treatment, ECT, which was also sort of operated on a similar kind of logic.

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And so we've seen over time lots of different options, but they tended to be

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sort of clustered around certain periods of time.

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I wanted to focus on institutionalization treatment sites.

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When did we start using that as a tool and

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talk about how that looks across the globe?

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Because I know it looks different in

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different countries and in different cultures.

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Yeah, no, that's a good area.

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A lot of research has been conducted on this topic.

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So one of the things we have to remember is that basically until you get to, I'd

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say the beginning of the 19th century, so for the vast length of time, people with

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mental disorders were not put into any kind of institution.

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They were cared for at home.

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And if they couldn't be cared for at home,

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or nobody could look after them, they were basically left to their own devices.

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And that might mean wandering the streets.

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It might be walking out into the

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countryside and living in a wooded area or something like that.

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You only start to see the beginnings of some sort of semblance of a place where

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some of these folks might go with the birth of the medieval hospital.

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But the hospital was never intended to be medical.

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It was not a place for incarcerating or

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putting people in custodial facilities for any length of time.

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It's only in the 19th century that we get the invention of the asylum.

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That is a place solely dedicated to the

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treatment of people with severe mental disorders.

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And it's so stigmatized.

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Did it always have that stigmatization?

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Or how did it become this thing that when we hear we're like, oh.

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An asylum, the asylum did not have that kind of stigma attached to it?

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And one of the things when I teach about

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this and write about this, is that I make an argument that the asylum is one of the

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most misunderstood objects in modern history.

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It's surrounded by, if you watch TV.

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American Horse, I was going to say, I'm a huge base pointing at me.

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I'm a huge horror fan, horror movie, everything.

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And so much stuff is around asylum's

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institutions and usually around that time period you just discussed, right?

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Yeah, and abandoned ones that sometimes be turned into haunted houses.

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The asylum was the solution to a serious

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problem and it was seen as a great reform at the time.

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We have to remember that you have the introduction of industrialization,

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urbanization, a massive increase in population that takes place.

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And so the old way, the way in which people had done business for thousands of

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years was no longer tenable, leaving people to their own devices.

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Stories of people who were literally like

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you would with a dog, putting a stake in the ground and tying a rope to it and

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having their family member out in the backyard because they didn't know what

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else to do with them or people being kept in basements.

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So the asylum was seen and stole to people.

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As we are going to create an institution

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that is friendly, that is warm, that is safe, and doesn't impose unduly on family

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members and provides a space for people to recover and recuperate.

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And these asylums, they were remarkable places, if you take a look seriously at

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the way they were built, how they were designed.

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Beautiful gardens, big airy spaces, rooms,

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they had bowling alleys, they had places you could go out for hikes, they had

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places where dances could be held, reading rooms.

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So the asylum only begins to really become this place.

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We associate with these more egregious

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kinds of problems when we really get to about the early 20th century, when they

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become overcrowded, when they become warehouses.

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But for most of the early period, for a good 30 to 50 years, they are really

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places in which I think most people would look proudly and said, you see, we're

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finally doing something right about this issue.

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Think about that term asylum. What does it mean?

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Well, we know as we associate with it today, people seeking asylum are people

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who are desperate, need to find a safe haven.

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And that's what asylum meant.

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So in your writing, you specifically note the problems with retroactive diagnosis.

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Can you explain what retroactive diagnosis is and your thoughts on it?

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Yeah.

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So retroactive diagnosis is something that gets engaged in a lot.

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Some historians do it, but I think the

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general public does it as well and journalists do it.

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And namely that is applying a diagnosis

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that we have today to people or a group of people in the past.

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Right.

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So it's to sit there and say that, oh, you know what?

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I think Napoleon's problem is that he had ADHD and that explains why this, that and

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the other thing, it's a real problem, I think, on a couple of levels.

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One is, I think, an issue that any historian or most historians would agree

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with, which is that we call it anachronisms.

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Right.

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When we apply certain sets of terms from one period to another period.

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When you do that, we know as historians that it's not just a sloppy practice, but

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it means you're sort of imposing certain other standards on another society.

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It probably means you're also going to miss things, you're going to misinterpret

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things, you're going to misunderstand the meaning of texts.

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And so on one hand, it's problematic.

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Historically, clinically, it's also problematic.

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It's extremely difficult to sort of bring our categories from today and transport

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them backward in time and think that they're going to mean the same thing.

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So that's my skepticism about that.

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Well, before we go, sometimes on a day to

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day walking through cities and communities, you do encounter folks.

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How do you process their conditions?

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And maybe even if you wanted to do something, what can we do and how can we

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better understand people that we encounter day to day who might be dealing with some?

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Yeah, day to day.

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I mean, one can only do so much, and maybe that's true of just about every

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intractable health and social problem that exists in the world.

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I'm a big proponent of the idea that to my mind, the history of madness and mental

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illness shows that the most effective and the most helpful things that one can do

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involve lots of different people being involved on lots of different levels.

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But especially locally, it means helping shelters, right?

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It means when a ballot initiative comes up in your local election about funding and

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resources for social services for people, it means saying, yes,

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okay, take that hit, agree to pay more taxes, to invest in these kinds of things.

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And then when you see certain kinds of

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facilities out there that are doing this outreach for people, maybe it's

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transitional housing for people, things like that, that means providing aid for

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them and whether that's volunteering or maybe some financial help as well.

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So to my mind, what's required and has

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always been needed has been support networks.

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This, I think, has been shown time and time again in history is that oftentimes

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people with mental illnesses lack the kinds of resources, the support resources

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that maybe other people have, or that even if they have those things, they need more,

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they need additional supplementation to that.

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So I think providing people with multiple levels of assistance for all the different

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challenges they face, this, to me, is the thing that I think is most needed.

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In addition to trying to do your best to

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avoid stigmatizing and isolating people who need your help.

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That's great. That's a great place to leave it.

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We love being able to end on action items like that.

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So that's really awesome.

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Yeah, we can a lot we can do local good vote.

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Yeah, exactly. Thank you so much.

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Thanks very much. Thank you guys.

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I appreciate it. All right.

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Thank you so much to Dr.

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Giggian for coming on to talk with us.

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I feel like I learned so much.

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Yeah, mental health is one of those things

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you never really think about as having a full history behind it.

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It's kind of an exhaustive topic right now.

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You hear it all over the place.

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But really we're at the precipice of new

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understanding and new science and new studies about mental health because the

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history of it, people were kind of just figuring it out and it was all very new

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and wasn't a lot of like, updated science things.

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It's like when we interviewed the

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historian on marriage last season when we talked about sex, love and relationships.

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And I was like, yeah, I guess marriage

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does have a history like love and mental health.

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And they had that back then and that's crazy.

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I thought we invented that.

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Yeah, 100%.

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Well, now that we know some background

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info, I think we're set up nicely for the rest of this season.

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And in this season, we also have a new segment to share with you all.

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We are joined here by Marguerite Nicosia from the Shanti Project to teach us some

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mindfulness exercises and explain the science behind how they work.

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Yeah, but before we start, could you

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introduce yourself and explain what The Shanti Project does?

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I'd love to. Thank you guys.

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Shanti Project is a nonprofit based in Lehigh Valley, Pennsylvania.

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We have been doing work in our community for ten years.

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We began teaching yoga in the prison

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system and had such great success with that.

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Seven years ago launched programming to teach mindfulness in public schools.

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It's called calm, kind and focused.

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And recently, Shanti Project has published a research paper.

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In April of 2021, it was published in the

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Journal of Child and Family Studies and that's available on our website.

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But basically the research shows that mindfulness intervention programs teach

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children how to manage their emotions better.

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It's part of their social emotional learning and it's increased positive

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behaviors and decreased problem behaviors in the classroom.

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Teachers have seen kindness shown to each other.

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The teachers benefit from the mindfulness programming as well.

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So it's pretty wonderful the results that they get.

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And I'm very, very honored to be working there.

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Awesome. So I have a question, it's a bit of a

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callback question to season one of So Curious podcast.

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The theme of it was Human 2.0. And just

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like body hacking, wearable technology, pills and different things like that.

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But something simple as breathing can slow

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down your posts, your heart rate, your cardiovascular system.

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Can you talk more about what that might do to the brain?

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So the simplest way to explain it is that breathing calms your nervous system.

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And the science of that is there's

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something called the autonomic nervous system.

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It's broken into two parts.

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So one part is the sympathetic nervous

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system and the parasympathetic nervous system.

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The sympathetic nervous system is what

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happens when the part of your brain, the amygdala.

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When we talk to kids, we talk about the amygdala being the watchdog.

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It's part of our survival instinct.

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It's what senses danger or when you are

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faced with stress, your amygdala will activate.

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And since that nervous system goes kind of

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on high alert and what happens in the brain is there are other parts of the

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brain that govern thinking, which is the prefrontal cortex.

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So thinking and learning.

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And then the other part of the brain, the

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hippocampus, which governs remembering and storing information.

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When the amygdala is activated, those

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other two parts of the brain kind of go offline.

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So the way we explain it in kids

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programming is when your watchdog goes off and alerts you, the prefrontal cortex,

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which is we refer to it as the thinker goes offline hippocampus.

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We refer to that as the librarian.

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Your librarian goes offline and your watchdog is in charge.

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So what happens is by naming an emotion,

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just the simple act of naming the emotion that you're experiencing creates a pause.

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And then the breathing that you do brings

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those other two parts of the brain back online.

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So that's the brain science part of it,

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but the physical body part of it is involved as well.

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And there's something called the vagus nerve.

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It's a cranial nerve.

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So it begins in the back of your neck and it goes all the way through your torso.

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Let's all do it right now.

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Let's do this together because this is cool.

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Absolutely.

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Go ahead and take your hands and just put them on either side of your ribs.

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And now what you're going to do is when

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you breathe, you're going to feel your ribs expanding side to side.

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So you're really going to take a nice full breath.

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So just go ahead and breathe in

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and expand your ribs and then breathe out nice and long and slow.

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And so that simple act of taking a deep

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breath and in fact, if you take three in a row, it's the perfect reset for your

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nervous system because what that does is you are massaging that vagus nerve inside

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your body by taking those deep they're called diaphragmatic breaths.

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And basically, you are just filling your

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torso, not just your lungs and your upper chest, and not just your belly.

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You're filling your entire ribcage.

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And that's considered diaphragmatic breathing.

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And so you've actually like, kind of massaged that vagus nerve.

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And three breasts in a row is the magic number.

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I love that. Yeah, it's awful.

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It's very cool. Awesome.

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And how can we find out more about the Shanty project?

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Well, it's Shantyproject.org, and by the

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way, Shanti is a Sanskrit word that means peace.

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And I love telling people that because I

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just think it's the coolest thing in the world.

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So, Shantyproject.org, we've got a beautiful website.

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We have a YouTube presence or on

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SoundCloud, so you can find meditations on our website.

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It's really, really a great resource. Awesome.

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And I'm just going to spell Shanti real quick so everybody on line can look us up.

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So it's Shanti shanthi project. Yes.

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And next week we are going to be learning all about emotions.

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Where do they come from?

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Why do we feel the things that we feel?

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How do we deal with them?

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Like almost anything else we express or.

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Identify or do, it has to do with whether we've practiced it and whether.

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It'S been role modeled.

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All that and much more.

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And don't forget to subscribe to this podcast wherever you listen.

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We have new episodes coming at you every Tuesday this winter.

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This podcast is made in partnership with Radio Kismet.

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Radio Kismet is Philadelphia's premier podcast production studio.

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If you are thinking about integrating

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podcasts into your personal brand or business, check us out@radiokismet.com.

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This podcast is produced by Amy Carson and Emily Cherish of Radio Kismet.

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This podcast is also produced by Joy

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Matafusko, Joshua Das and Aaron Armstrong of the Franklin Institute.

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Head of operations is Christopher Plant, our assistant producer is Seneca White,

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our mixed engineer is Justin Burger and our audio editor is Lauren DeLuca.

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Our graphic designer is Emma Seager. I'm Kirsten.

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Michelle sills. And I'm the Bull Bay.