Ep. 184: Professor Terrie E Moffitt - Executive Function, Stressful Lives, and Health Decisions

Sucheta Kamath: Welcome back to Full PreFrontal exposing the mysteries of executive function. I'm your host Sucheta Kamath, I believe by tying the findings from neuroscience, psychology, and anthropology, sociology into everyday transformations, a lot can happen to our personal and collective growth. This podcast, as I've shared with you all before, is fueled by three goals, many goals, but here are the top three, to help build a wide lens perspective on human development based on cognitive neuroscience and psychological sciences. Second, is to understand the underlying motivations and beliefs that fuel not just others, but our own decision making. That makes the self-change possible, because Isn't life all about self-change. And lastly, to really help people create a personal playbook for success by learning about the role of executive function in self-control, self-motivation, and self-monitoring over time, and this these days or years of pandemic has taught a lot of a lot about our own executive function and collective executive function of our community. So to me, if you ask me what is executive function it is that capacity or set of skills that allow us to bridge the past experiences with present goals and future plans through the process, including attention, organization, problem solving, mental flexibility and strategic thinking, to help manage work, relationships, change, challenge and stress. So it's great to talk about skills and ideas and and our plants under calm conditions. But what happens to us is really, the rubber meets the road under stressful conditions. And what's so valuable is to really understand what changes or when circumstances and conditions change. And that's why I have a phenomenal researcher. I you know, all of us have some professional crushes. This is mine. So her work and her colleagues work I have been tracking and today we have Dr. Terri Moffitt. She who has expertise in the area of lifelong aging, mental health and longitudinal research, that talk about executive function as somebody who's persistent persisted through passage of time of 40 years to study a cohort of participants. So bravo. She is the Associate Director of the Devlin longitudinal study which follows a 1972 birth cohort in New Zealand. She also founded the environmental risk longitudinal twin study, which is also known as E risk, which follows a 1994 birth cohort in Britain. She is a licensed clinical psychologist, which is one of my favorite perspective she brings because she's not only interested in conditions and observations, but she gives a lot of thought about how to impact people's outcomes and lives, life conditions. She is an elected fellow of the US National Academy of Medicine, British Academy, UK Academy of medicines, medical sciences and association of psychological science. She is the recipient of multiple, multiple awards, and she's a celebrated researcher, to name a few is the Stockholm Prize, the Klaus Jacob Prize, the NARSAD Ruane Prize, and the 2022 Grawemeyer Prize. So I can go on and on about her and her work. She is a prolific author, and she has published many, many, many articles and research papers. And she is an author of multiple books. One of my favorite books is the Origin of You, which I just finished reading last week, and that the time we had scheduled allowed me to do that. So I think thank her for that. And lastly, I want to say in my work of executive function, and implication, the role of executive function and its implication over lifespan. I always quote you, Terrie and your work and it's has such a profound impact on my understanding of how to help people. So welcome to the podcast. Thank you for agreeing to be here.

Professor Terrie E Moffitt: This is terrific. Thank you for that very long introduction.

Sucheta Kamath: Yes, yes, absolute worthy introduction. So I want to kind of start with your, your seminal work. And you know, the definition of executive function is the set of skills essential to appropriately adjust. Our one stop is an actions in accordance with changing environment and challenging times to achieve personal goals. I set the goals for me based on my knowledge of Me for me, so that my future self is secure, but enlightened self interest goals, not selfish ones. And you your longitudinal study with your colleagues was one of the things that I as I mentioned, that those with strong self control over the over 30 years or beyond showed that they had better jobs, higher income, improved health outcomes, stronger relationships, and fewer run ins with the law. I would love to start there. And what are your thoughts about these findings? And as a neuropsychological psychologist and clinical psychologists, what do you make of that?

Professor Terrie E Moffitt: Well, I'm really interested in the role of self control in in people's entire lives. And it does seem to be something that we hit the ground running with, you know, as early as age three, and it has repercussions that reverberate throughout our lives. One of the interesting things that we found from our research following 1000 people for almost five decades now, is that is very changeable. And so when we look at the association between measures of self control taken in childhood and measures of self control taken in adulthood, the same people score differently. So it's possible to change. And that's an exciting thing for us, because so many things that we study in psychology, don't change very much. You know, if you track something like IQ testing, from childhood to adulthood, the correlation is extremely, say, say about level of smart throughout their lives, but their self control is something that responds to their decisions. And they're, they're, as you say, got making goals and plans. So that's that malleability is very interesting.

Sucheta Kamath: And it's so interesting, because your study wasn't to mention study, you were not treating, or offering some help, right, you're measuring and reporting, and tracking changes over time. So that's such a profound observation, very useful, right? To improve life outcomes.

Professor Terrie E Moffitt: That's correct. The study was designed as back in the 1970s, before I even joined it, I joined in the 1980s. But it was originally designed as a study of natural development. So we don't even give the participants feedback when we collect, you know, they come into our clinic for a full day of tests and measures and examinations every couple of years. And we don't give them unless, of course, or something. So their participation is something that happens, you know, without any kind of, of intervention or treatment.

Sucheta Kamath: And so to me, if we intervene and support and, you know, at the, the point of intersection where troubles arise, if we keep supporting individuals, their loved life outcomes can be so much more positive. And that's very reassuring to me, as a speech and language pathologist and somebody who has been in clinical practice myself for last 25 years. So another interesting perspective that you bring is really this recent work, which is, you know, the pandemic has unveiled our collective psyche or psychological patterns of our communities and our nations even. And you have done a lot of thought and reflection about this idea of looking at psychological histories of people and see if there's some some discoveries can be made about those who are vaccine resistant, or might those who carry vaccine resistant mindset, or those who are anti vaccination. So I wanted to take a deep dive into that thought here, which is so relevant. So what made you interested in doing a study of vaccine resistors?

Professor Terrie E Moffitt: Okay, this is kind of a good story for me to tell. Because for a long time, I've been interested in the difference between how we test for executive functions in the laboratory in the psychology laboratory, versus how people use their executive functions out in the real world. So often we bring people into the laboratory, we give them executive function tests. We make sure the room is quiet. There's only one psychologist there working with them, we structure it. So that is Ideal conditions and people score a certain way. World We do that through executive functions. And we find that actually, the same person who scored well on our psychological test doesn't do so well, when they're tired, when they're multitasking when they've had a glass of wine when the children are cranky. So as you said, you know, when under stress, that's when executive functions rubber hits the road. And I don't think we do a good job of testing that in the laboratory. So I was looking around for opportunities to study are 1000 people when all of them were under stress, and then the pandemic arrived, and all of us were under a lot of stress. So that seemed to be a great opportunity for psychology. Now, personally, from a personal angle, I have so many friends and family, who, when the pandemic arrived, said that it was a hoax, and then they would never wear a mask, and that some continued singing, or attended of events. And when the vaccines became available, they refuse to take them. And so this created a lot of stress and conflict in my own life. And I really wanted to understand where people are coming from. So I decided to do this, this piece of research. It was a rapid response project, we started in less than a year ago and have finished it already. So it was really a rapid kind of project that we did to take advantage of this situation.

Sucheta Kamath: And you know, you hit on something that speaks so dearly to me, because executive function is most crucial during transitions and disruptions, conditions of uncertainty, you know, ambiguity, stress, anxiety, and unanticipated roadblocks, and what I found myself in the pandemic, and I'm so glad, no, I'm not glad that pandemic happened. But I'm so glad people actually had a global sense of patterns in people's responses and arrange with which people respond. But it was almost looked at as if we can wait for the pandemic to be over as if it is just one time thing. And but it was much more, you know, we have an opportunity to really kind of take a little internal inventory of what kind of people we are and how we respond to stress, and how do we respond to other people's inability to respond well, to stress? So, for starters, I was wondering if we can start with of these two groups as opposed to those who lean into vaccination. So how do you define vaccine hesitant and vaccinate resistant intentions?

Professor Terrie E Moffitt: Okay, so we had a really great opportunity to do this. And first I need to explain a little bit about how people respond to new technologies. So anytime, when a new technology comes along, whether it's a new phone, or a new kind of vaccine, there will be your first adopters. And those people who love novelty, they love technology, they're always scanning the environment for something new to try. And they get in there first, and everybody else hangs back, hangs back and hesitates. But then as we all go along and have experience with the new product into the and we're left at the end with two groups that are rather small and society. One will be the people who are even after getting all the information, they're still hesitant. They're still confused, they still don't know whether to try this new technology or not. And they still feel unsettled and fearful about it. And then the other group, is the vaccine resistant. And they have taken in all the information and decided it's not for them over their dead body, would they ever do this? You know, digging in their heels and deciding that the vaccine is not for them or any piece of new technology. So what we did was, we had been following these 1000 people since they were born in 1972. And they live in New Zealand and the New Zealand government announced that they would make the vaccines available to everyone on the first of August. So in April, we decided to telephone all of them and ask them what they were going to do. You know, are you when the vaccine becomes available to you in a couple of months? Are you going to take it or not? At that point, this is August. This is the April, May, June, July of 2021. So all the New Zealanders had had the opportunity by then to watch everything about the vaccine unfold overseas. So they had seen everything that happened in Britain and Canada where the vaccine had been enrolled, or had been on social media all year. So they had lots of information. And they were making their final decision at that point. We got 75% of the 1000. People said that they were willing to take the vaccine, 12% said they were still confused and hesitant, and they didn't know what to do. And 13% said they had definitely decided and they were resistant and would not take the vaccine.

Sucheta Kamath: Wow. So is this data surprising to you? Oh, actually, it's so funny. You, are you embedded my next question into your answer already. But I was looking at the parallel between technology and the smartphones, you know, or the evolution of iPhones so to speak. There's all always that early adopters, they don't need any data, they are just curious. And you know, it piques their interest, and they jump into it. But this is, as you mentioned, after a lot of information is made available, and everybody has a chance to scrutinize. So this is a 25% of the population that is hangs back, but also has a strong opinion about it. Do you think it is something that signifies their mental flexibility issues? That is openness to new opportunities? Or is this something more than that?

Professor Terrie E Moffitt: Well, one of the things that I noticed from the surveys that were being done during the pandemic was that they were all one point in time surveys. And so they had contacted people, typically over the internet, sometimes by phone, and ask them about their views about the vaccines. And there's a couple of things wrong with that, that we thought our study could improve on. One thing that's wrong with it is that people who are against vaccination are also against surveys, so they don't respond. So you're not in those kinds of point in time surveys done in 2021. You're not getting the actual responses from the people who are really resistant to vaccines. Another problem with them is that one of the things that we've learned from years of psychology research is that if you ask people, at the time, when they're making a decision, why they're making the decision that everyone has reasonable reasons, it gives the impression that you just now made up your mind right now. So anyone who's resistant to vaccines, you know, it's just because they're poorly informed, or they haven't got the right information. So all of the reasons being talked about were reasons in the here and now. Whereas because we had been following these 1000 people, since they were 22, and doing intensive in depth measures of measurement and interviews of their psychological functioning, learning and cognitive function, all their loss of information right back to primary school, about how they solve problems and how they think about novelty, what their attitudes and values are. So we could ask ourselves, are we using this longitudinal study? Is there anything about their childhood or their adolescence that has fed into how they're now coping with the pandemic? So we took a lifelong view instead of a point in time view?

Sucheta Kamath: Yeah, and I really, I quote, you that I really aligned that struck me it really emotional connection, that, that resistancy a hesitancy and resistance are not merely contemporary misunderstandings, made by uninformed adults. So there's a lot of compassion that you you're expressing, towards the individuals who are, you know, stepping back, they're kind of showing their reluctance. So can we go a little bit into the psychology of that? How do people arrive or become people who are? To me that sounds like a psychological emotion of mistrust?

Professor Terrie E Moffitt: That's right. One of the things that we were able to find is about our let me talk about the resistant group first, so it was that small, absolutely not no vaccine for me. We found that these people had most of them had experienced adverse childhood experiences, which means that during the first 10 to 15 years of their lives, they had experienced sometimes actual abuse and maltreatment. But a lot of parents have mental illness or a lot of substance abuse in the homes where they grew up. And a lot of other kinds of adverse experiences as a small child, they had learned early in life that it doesn't pay to trust the grown ups. And when we interviewed them to ask them over the phone to ask them, Who do they trust for pandemic information? We asked, Do you trust the government? Do you trust the media? Do you trust the social media, your co workers, your family, your friends, your minister, your family doctor, we asked all of those questions, and they didn't trust anyone. So they're coming from a lifelong style of being mistrustful. And that comes from childhood experience. We also found that they report reported in their personality tests, they really valued being a nonconformist, they didn't like to go along with social rules and norms, they wanted to make up their own mind. And we reported a lot of fatalism about their health. And this was when they were 15 years old. So as high school students, they believe that there's nothing they can do about their health. It's called locus of control for health, if they believe that their health was out of their control. It's a matter of fate, you know, since trying to do anything to improve your health, so they had long standing, interesting ways of approaching decision making and approaching health in particular, that were with them from childhood and adolescence. And the other thing they had was a long history of mental health disorders coming and going. So that could have been, you know, ADHD as a child or depression as an adult or substance abuse issues as a young person. So they had been struggling many of them with mental health problems for quite a number of years. Those kinds of mental health problems are the things that that misinterpret health messaging that leads them to be susceptible to conspiracy theories. So these were things that they The important part is that as the these problems had been with them, for most of their lives, so present in our data that were collected when they were secondary school students, and they were not just their own self reports, but also when we had interviewed their teachers and their parents at that age. They also described them in that way.

Sucheta Kamath: Wow. So I would love to unpack this in so many directions. The first thought comes to mind is when you experience adversarial relationship, definitely it is kind of taken a real toll on their their ability to trust people who either are mentors or loving people, people who care for them. And that unless that relationship is healed, you're going into your adulthood, carrying the similar beliefs. I wonder what happens to these individuals with their intimacy, their capacity to develop a meaningful relationships, and have a reciprocal relationship? So that's the first thing that comes to mind. How does that impact their ability to have stable? And how do they become parents, you know, if you're carrying so much mistrust with the environment in which you're operating?

Professor Terrie E Moffitt: Well, we had given the Dunedin study members, personality inventories when they were 18 year olds and 26 year olds, so twice on those occasions, and we had also had their loved ones fill in personality checklists about them. And interesting thing about the people who were very resistant to vaccine, people who were hesitant to use was that they tended to experience a lot of extreme emotions, so they very easily and readily experience fear, anger, and negative emotions like that over time. So they're struggling against this kind of very extreme emotional reactions. And when they and they also reported themselves when they were 18 year olds, that they tended to shut down mentally under stress. So it's a trait called stress reactivity. And it just means that a person is aware that they are the kind of person who under a stressful situation finds it much more difficult to think clearly and systematically so they just tend to go into an emotional response. So this all sounds really bad. But the good part we discovered was that the vaccine resistant group and the vaccine hesitant group, those who were still confused, not different from group on personality traits called Social closeness. Oh, wow. And that means that they, they have a desire for relationships, they have a great capacity for human warmth. They say that they need and want people in their lives. They want intimacy and love. And they have a capacity to experience joy and affection with other people. So on their social closeness aspect of their personalities, they're very healthy. It's just that they want to be loved, and they want to be in love. But there's that mistrust. They fear that other people won't love them or won't be worthy of their trust.

Sucheta Kamath: So that's great. Thank you for unpacking that. It's really helpful to understand the response because we have, I was at a conference, I am at a conference, as I speak to you. And yesterday, I had an encounter with a colleague of mine that I have met a few times. But I don't know her that well. And but she, I presented she was in my session, and she knows me, but she behaved as if she has never seen me. And she was distant. She had a very stern face. It was very putting off ish. And so I don't know what happened to me during lunch break, I had finished my presentation, I saw her she was sitting again with a very stern face in a corner. And she was going through her phone. So I said, Okay, I'm gonna approach her and just say hello, to see if she remembers me. So I went there. And I said, I don't know if you remember me, but I am so and I'm Sucheta, we, she said, I know who you are, again, very stern. And, and I said, I hope you're doing well. And, and you look like you're doing something very interesting. What are you doing? So she said, she proceeds to tell me so she has just remember she has not shown any acknowledgement of I exist. I know her we have volunteered at some place together. I was trying to work on myself. I said, Why am I judging somebody by their face, right? So turns out, she was turning 65. And she was planning a party while she was in this at this conference. And she proceeds to tell me that she was going to have 100 people for her birthday party, and she was doing Oscar Gala, and the dress. And then she proceeded to tell me she's not vaccinated. And she doesn't believe in vaccinations, and she's just over it, and how masks are useless. So she did this whole two sided story of this amazing celebration that she's going to have 100 people at who have RSVP. And she said, 75 RSVP so far so far. But I'm going to fill those second tier people that I have not invited initially, because I have turned 25 spots. I just found this whole encounter so strange and fun and funny for me, because just by and then I did give her feedback. I said, Hey, I don't know if you notice, but your face looks like you're very intent on me to talk to you. She said, No, I love talking to people. But I said your face just didn't wasn't. She said thank you for telling me that because I'm really looking to date. And a lot of men on the street, stop me and say What's wrong with you? Approach her because she's beautiful. And then she they say, Whoa, lady, what's wrong with you, because she just comes across. Anyway, what I'm telling you, this encounter kind of gave me so many perspectives on this one person that I had encountered twice for four hours in a non only professional environment. And I feel we are missing out on knowing people or understanding who they are or what they are all about. Because we may just walk away because they look a little difficult to deal with.

Professor Terrie E Moffitt: That's right. We, we do you know, we want to have all kinds of people in our lives, but it isn't a matter of, you know, executive function for your your listeners to this podcast, to you know, to think about our executive functions, how we use them for self awareness, you know, not just to make plans about what to do for the future and what to do with our loved ones in our social life, but also how we are perceived by other people. That's a very important aspect of executive function. And it's often overlooked, especially by psychology research. Yeah.

Sucheta Kamath: And so the second part I wanted to unpack that you mentioned was very, very interesting, that the personal adversities early life Personal adversities have a tremendous impact on their emotional vulnerability. But there's a second component that your research also shows is the cognitive information processing. And I'm very interested in that because you know, lifelong clinical speech language pathologist, I have worked with people with language based learning disorders, ADHD, dyslexia, autism spectrum, and all of those developmental disorders, as you know, and of course, concussions acquired neurological disorders, but they all affect processing, and processing of information requiring working memory processing of complex and abstract information, requiring to create a conceptual roadmap for yourself are inductive and deductive reasoning requiring you to weigh options or evaluate information. And I found that I wonder if there is some childhood processing disorders that exaggerate on unintegrated intervened, leads to this information processing deficit, which is there's no class for COVID, right, you're just now getting information for various resources. And you are curating material. What if you're a bad curator of material,

Professor Terrie E Moffitt: That's a good direction, that pandemic did declare all of us to do that, because we were constantly bombarded with media and because the media try to compete with each other in the in the field of media success by having more evermore shrill and extreme messages that evoke strong emotions, especially a fear during the pandemic, a lot of the formal media, but also the online social media. And the anti vaccination messages, were also trying to evoke a lot of fear. One of the things that we found in the personality testing for both the hesitant and the resistant group was that they said they were those kinds of the kind of person who shuts down mentally under when they have an intense extreme emotions. But also for the hesitant group, we found that when they were in high school, they quite poor reader, and had difficulty with vocabulary. Now, both of those groups, when they grew up, tended to have slower processing speeds, so they couldn't think as fast under conditions of stress. And when a large amounts of information were coming out them. And as you said, working memory was so important on our test of working memory, both the hesitant and the resistant group scored more poorly than the wheeling group. And working memory is is kind of what people ordinarily think of as multitasking, the ability to hold some large amounts of information in your mind, while you're actively moving it around and comparing it to each other and choosing among different options. So it's sort of mental multitasking. So both are hesitant and resistant group were slow at processing information. And they became easily over amounts of information came at them. Now you add to that, the extreme emotions that happened during the pandemic, and the fear that we all felt in the uncertainty, it was a recipe for trouble, just a recipe for trouble. So I can see then why the hesitant group still felt confused right before they could get the vaccination, they still didn't know whether it was a good thing or not. And then the resistant group just felt like they had dug in their heels and thought I'm not taking part in this. So now after having done this research, I have a lot more understanding and feeling for where they're coming from. I can see their point of view a lot better, it helps me with my own friends and family. But I think we can do better with our health messaging, if we understand that, you know, these these styles of processing information have been with people for decades. This is this is part of their deep seated personality, their approach to the world.

Sucheta Kamath: Yes. And and I think the the really nice thing that you touched upon is this feeling of confusion because that not only these are, you know, circumstances of challenge and stress, but there's a judgment call like people are thinking if you're not a somehow a leaning towards vaccination, you either are not progressive or you are not a worthy citizen. You know, there's a lot of typecasting and and, you know, we need to really listen To the stories and understand that taking time to decide is not a bad thing. And if information can be dispersed in a different way, that is a better way to reach people. And in fact, I was following some stories of physicians, where the vaccination rate was very low, how they were doing kind of one on one talking with with their patients, almost like for four months, before the patient would agree. And now I have had conversations with my husband, who also is a physician and trying to get his, you know, team or his patients, and you know how to incentivize and it's not a monetary incentive that's going to work. It is really psychosocial support, that's going to really change and so that your research actually, to me shows what an amazing way we need to look at humanity and some people through that psychological lens. My next question was going to be about this hot and cool executive function, which you kind of alluded to, Phil Zelazo and group refers to this, this idea of our capacity to take decisions or, you know, an effective challenges, which is psychosocial, emotional challenges, interfering with our capacity to think clearly weigh options and take decisions while pursuing goals versus abstract problem solving under calm conditions. What will you do if when there is no tiger coming at you? And you say, what will you do? A tiger comes to you. You know, there was a great story when I was a child, I don't know if you ever heard this story. It's a folklore. But there was a, there were two friends who go hunting. And I know, bear comes. And so one is a very good swift climber of a tree. So he quickly climbs on the top of the tree, the other one can climb, and he had to quickly decide so he drops to the floor, and pretends to be dead. And so the bear comes and sniffs him, and, and goes away. Because, because he thinks the friend on the floor or on the ground is dead. And so this, always, I mean, there's some punch line about the friend, but he wanted the bear say to you, and he says, Don't trust your friend. But it's a funny story. What I thought about that, what I thought about that story was what a presence of mind to drop dead pretend to drop dread, dead when so that when the bear comes, he will think you're dead and won't attack you. I thought that was a very clever solution. But to think about a clever solution under duress, is the is the heart executive function being what do you think about all those who are behaving this way, their capacity to take decision under duress versus their capacity to take decisions when they're not under stress? Were they before pandemic, when they had these tendencies and traits, were they taking better decisions?

Professor Terrie E Moffitt: You know, we hadn't been able to do in the, in the course of the research, put them all under a stressful situation like this, you know, dress to anybody would drop out of the research project, right. So we always the treat them like the queen of France. And we're always really good to them, when they come in for to take part in the research. So it's very important to us to keep a positive relationship with our research participants over the years and have great goodwill. On the other hand, there have been certain things that have happened to them naturally in the course of their lives, where they've had to make decisions. And I know that some of the people with these same kinds of difficulties with cognitive processing have, they would say, now they're satisfied with how their lives have turned out. So we interviewed them with life satisfaction questions. And you know, we ask questions like, you know, if you had your life to live over, would you do it exactly the same way? Or would you want it to be differently, done differently, and they do say that they feel less satisfied. People in New Zealand feel satisfied their lives when well over 70% It's a fantastic country. But the people who are the most satisfied are the people with the best executive function. So I think you could say that they must have been making life decisions all along the way, whether under stress or not under stress, that now that they're turning 50 they can look back and see that executive function if they had it has really paid off for them.

Sucheta Kamath: Hmm. And, you know, to your point, I think there's areas of research that supports this point that the during that unpredictability, change, setback or loss, people develop tunnel vision, they become risk aversive, they rush to judgment. And they block thinking critically. So, the, but if this pattern persists that it small incidences of your life also invoke a lot of stress for you, then you're constantly in that state. So I can imagine that being very difficult. The other question I had...

Professor Terrie E Moffitt: One wrong decision made might then compound the stress, you know, before the next decision point in life and so it can have a snowball effect of childhood personality. On the other hand, we did find out that people who had scored the childhood did not necessarily score the poorest in adulthood. So a lot of the people that some people have changed over time.

Sucheta Kamath: It's so funny, you know, I a lot of my work has been in mild traumatic brain injury, you know, loss of consciousness was, you know, three minutes, but your executive function got impaired quite a bit. And it always fascinates me to see shows that show amnesia as a central storyline. You know, I recently watched an Australian series, where a man who apparently was a hitman, then had a car accident, his car rolled and completely forgot, including his name, who he is and any historical facts about him, which is not how amnesia works, and and found himself trying to figure out what his life was, and every single thing he had done was a bad decision. And suddenly, every single cognitive ability was destroyed except his insight. So which is so not how executive function or trauma related injuries work, right. So I was so fascinated by storyline written by people who have no idea how things work, but I was just curious, what is your observation about all overall participants insight, as they retrospective as they look back over 30-40 years of their life? Were you asking any questions related? There are two that like, what did they think about their life in terms of, you know, just introspection ability?

Professor Terrie E Moffitt: You know, we have we have something that the Dunedin study is actually quite famous for is our publications on the question of retrospective recall. So we have asked our study members now that they're adults, to report about themselves as children on measures that we took when they were children, or young adults. And what's interesting is, there's a there's a pot. First of all, there's extremely low agreement. People simply do not remember their childhood and adolescent adolescence the way it was. Many people believe themselves to have had ADHD who simply didn't have it. Many people who had severe ADHD now don't remember, Preston, if you ask them about their reading ability, they all believe that they were above average readers, if you ask them about their height, they all believe that they were in high school who are taller than the average student. So you know, we were very poor humans are very poor at retrospective recall. And that's one of the things that didn't need and it's why it's so valuable that we have the archive of measures that have been collected over in childhood.

Sucheta Kamath: That's crazy, right.

Professor Terrie E Moffitt: These findings, though, have some implications for how we think about this, this whole approach to the vaccine. So the public health messaging that has been coming out, the pro vaccine, public health messaging, has obviously not been reaching a good quarter of the population and bought what is, is the anti that aging is it's reaching them because it's completely tailored to their lifestyle. It's the kind of messaging that reinforces themes of mistrust and suspicion and incites fear and anger and alienation and claims that conspiracies are going on it sensationalizes you know, side effects that are actually really rare. It and it tells people you need to be a nonconformist, you need to go against the vaccinated herd and you have to make this personal choice to avoid vaccination. so that you won't be exploited and taking taken advantage of. Now, that is messaging that is totally tailored to their lifelong personality style. First, you incite emotions of fear and anger. And then you bombard people with information telling them that they're being taken advantage. So I think our public health messaging teams can really get a clue by looking at how well the the anti vaccination messaging teams are tailoring their messages. To this to the learning style of the recipients, we need better on the on the public health side. The other point when we're talking about what can be done in early life and childhood, you know, we could do more to educate people in high school health classes about how the the immune system works, and how the epidemiology of viral exposures and epidemics of infection work. So to give everyone as a high school student, much more science, about this, then they're prepared with knowledge so that they're not susceptible to the the extreme messaging and not that they can use to make better decisions and to stay call when everything is uncertain about them. So I think if we can improve people's levels of information and knowledge and certainty about how pandemics work and how their own body works, while they're deficient, I think they'd be better prepared for the next pandemic.

Sucheta Kamath: I love that, there is a next pandemic, we should just understand that. So as we come to an end, I wanted to really hear, let my audience hear your perspective, which is mind blowing about mental health and mental disorders. Your work shows that, almost as I say, 85% of the population in your study had one mental health diagnosis over a lifespan, and you have not followed them for 50 years. What can you tell us a little bit about that? And what is the most amazing information we gleaned from that? Why is that so important to know?

Professor Terrie E Moffitt: I can, you know, just say to to the audience of this podcast, you've probably heard in newspaper coverage, that about 15% of of people will have a mental disorder at any point in time. And the important words to remember there are at any point in time, and that information is is found by either interviewing people about mental health at present, or by interviewing older adults, and asking them to think back over their whole lives about whether they've ever had a mental disorder or not. Now what what you just heard from our studies of the problems with retrospective recall is that everyone remembers their life as having been better than what it really was. And so, we find that most people who have had a mental disorder in the past, now have forgotten it or have, you know, recast it in their mind as really having a lasting, that it's on them, so they don't remember it anymore. What we did that was different, was every time our study members in the Dunedin study have come into our clinic, and that's on 13 different occasions over the years, we've given them a full psychiatric assessment, which they willingly take part in. It's quite a lengthy interview, we diagnose 17 different kinds of mental disorders, everything from OCD, to attention deficit hyperactivity disorder, depression, different kinds of anxiety, PTSD, even schizophrenia and mania, as well as substance dependence dependence on alcohol, cannabis and other drugs. So counting up all of those different mental disorders, over the entire lifetime of the study members as they have accumulated, we can now say that people reach their 50s 85% of them have experienced at least one mental disorder at some time during their lives. And what does that mean? What I think it means is that if you haven't had your turn at mental disorder yet, it's probably coming to you. And so we should all keep in mind if you've made it all the way to age 50 without having any experience of mental disorder whatsoever. You're a real A rare person, that's not normal. So I'm hoping that this information, if we can get it out there to the public, it will help reduce stigma. So that we'll all understand that everybody, you know, sooner or later, everybody has a brush with mental disorder. And that means that there's no room really, for us to feel critical or negative or, or fearful about people who have mental disorders. And actually, a stigma that would be that everybody when they have their mental disorder, feels safe to go and seek treatment. So I'm really hoping that this, if we can get this information out there, that it will help to reduce stigma.

Sucheta Kamath: And it also means I think that it's a psychosocial coping challenge, it either heightened or invoked by challenging circumstances. And that is life, isn't it? That's right. 

Professor Terrie E Moffitt: And it looks as though that you know, mental health is a kind of a river that runs underneath the, the, you know, underground river that runs through the life course. And at times of intense stress, it bubbles up to the surface. And that happens for all of us, for anybody.

Sucheta Kamath: And I myself, as I was, you know, reading your research, I thought to myself, yeah, I would love to deny, you know, my challenges and or proclaim healthy social adjuster. But I know I, my teenage years were very full of angst. And I think I had a great spiritual and religious community that I belong to, I also had the same people in my family that cross checked turned out to be great supporters during the stress once the stress was revealed, which was kind of very annoying and difficult, that you are the source of distress.

Professor Terrie E Moffitt: If only we could choose our families.

Sucheta Kamath: And last thing I was gonna say about that is, I recognize after, after maybe 30 years that that phase, and you're my father particularly was going through his own stressful time, either that was a, you know, midlife crisis, or his own sense of accomplishment or where he stands in life and some of the choices he made, sounded to me that introduced a lot of stress for him, which then translated to stress to us. And, and I understand him far better now. But I never got a chance to talk to him about that. But of course, it's all such a private matter that we rarely talk about these things. But I'm bold enough now as a, you know, order person that I feel, it's okay, because that just shows my humanity and not my weakness.

Professor Terrie E Moffitt: I agree, I agree completely. And if anyone who thinks that only 15% of the population ever has a mental disorder, should just have a party and get all of your friends together, as we often do, and we sit around, you know, and we're having dinner and talking about our thoughts, and our sisters and our brothers in law, who are all completely crazy, as we can realize, just from our own list of our own relations, even if we, as you say, We discreetly leaves ourselves out of the conversation, that the base rate of mental disorder in the population is actually quite high.

Sucheta Kamath: Well, Terrie, you this was such a brilliant conversation, thank you for your incredible insights and, and I deep deep gratitude for the work you have done for us to understand and bring compassionate view for for human struggle, and more importantly, kind of showing away that there's hope for us. And I really think, you know, the kind of work you're doing in public service, I hope it it kind of seeps through all aspects, particularly in education. And we look at children developing minds with same compassion. And their struggles are not compartmentalized into a disability in ability versus ability and thriving, you know, we just recognize the continuum of it. So I truly, genuinely, it's such a momentous moment for our podcast to have you. So thank you for being here.

Professor Terrie E Moffitt: I'm so glad you invited me to chat to this. It means a lot. To follow on from your comment about, you know, the whole process of human development is a dimension and that people I hope people will have a look at that book or did you because that's what that book is about. It's about the the resilience of of children throughout the life course and how they can turn out a lot better than anyone would have thought. So I think it's a kind of an uplifting book and it's written for anyone to read. You don't have to be a psychology professor. But also just to thank you for having a podcast on executive functions. It is so important that everyone understand what these are and make sure that they're using theirs and honing them and strengthening them. So this is like going to the gym. But for your executive functions, I think it's fantastic. So you're doing a great service too.

Sucheta Kamath: Well, I'm now going to be celebrating after this, even though it's just 11 o'clock in the afternoon. I'm in the morning. Well, thank you for joining us. Thank you, listeners for being on this journey with us, Terrie and I and if you love what you're listening, which I'm sure you do, please share, please spread the word. There's the you make it possible for people to be able to access us and know about executive function, and it's important, if you love, do share this episode with your friends and colleagues and your family members. And also if you have a moment, please write us a review that that way people find us and they also know why it's important to listen to the podcast. So once again, thank you, Terrie, deep, deep gratitude for your presence here. And thank you everyone for tuning in. And until then, see you again.