Notes on Resilience

148: Adapting After Trauma, with Dr. Jordan Smoller

• Manya Chylinski • Season 3 • Episode 44

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Resilience isn’t about being unbreakable. 

We sit down with Dr. Jordan Smoller—psychiatrist, epidemiologist, and geneticist at Harvard and Mass General—to discuss resilience as adaptation and explore why naming harm matters, how acknowledgment from leaders reduces isolation, and the real-world steps that transform empathy into trust.

Jordan brings a blend of clinical experience and research leadership to questions many of us have: When does a normal response to trauma become a condition that needs care? How do we balance the language of diagnosis with the need to reduce stigma? 

We dig into the complexity of mental health science, from brain and body to relationships and social context, and tackle the systems-level issues that shape recovery: 

  • access to mental health care, 
  • workforce shortages, 
  • insurance barriers, 
  • and the political currents that complicate meaningful change. 

Jordan argues for two parallel commitments: immediate access to effective support and sustained investment in research that turns innovation into implementation. 

If you’re ready for a grounded, hopeful take on resilience, mental health research, and the power of being seen, this conversation offers perspective and practical insight. 

Subscribe, share with someone who needs it, and leave a review with your answer to one question: what change would make the biggest difference for mental health where you live?

Dr. Jordan Smoller is a psychiatrist, epidemiologist, and geneticist whose research focus has been understanding the genetic and environmental determinants of psychiatric disorders across the lifespan and using big data to advance precision mental health including improved methods to reduce risk and enhance resilience. He is Professor of Psychiatry at Harvard Medical School, Professor in Epidemiology at the Harvard T.H. Chan School of Public Health, and the Jerrold F. Rosenbaum Endowed Chair in Psychiatry and Director of the Center for Precision Psychiatry at  Massachusetts General Hospital, among many other roles. He is also the author of The Other Side of Normal (HarperCollins/William Morrow, 2012).

Go to https://betterhelp.com/resilience or click Notes on Resilience during sign up for 10% off your first month of therapy with my sponsor BetterHelp.

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Jordan Smoller:

Not only are you dealing with the emotional aftermath or physical aftermath of some event, but you're now sort of being turned away as you try to connect with other people or having to bear it or feeling like you have to bear it on your own.

Manya Chylinski:

Hello and welcome to Notes on Resilience. I'm your host, Manya Chylinski. My guest today is Dr. Jordan Smoller, a psychiatrist, epidemiologist, and geneticist, professor at Harvard Medical School, and a professor at the Harvard School of Public Health. And at Mass General Hospital, he's the director of the Center for Precision Psychiatry, among other roles. We talked about resiliency, what it is and isn't, mental health research, and what do we owe each other when we're thinking about mental health and trauma? I think you're really going to enjoy this conversation.

Jordan Smoller:

Thank you, Manya. I'm so excited to be here.

Manya Chylinski:

The first question I ask all my guests before we dig into the topic is what's one thing you have done in any area of your life that you never thought you would do.

Jordan Smoller:

One. There's so many. Practically my whole career is maybe the answer to that. But I don't know, does appearing in a rap video count?

Speaker:

Oh, that totally counts.

Jordan Smoller:

Okay. I'll go with a.

Speaker:

How did that happen?

Jordan Smoller:

This was a while ago. A friend of mine who was directing video, who later became on, went on to become a uh Hollywood director, invited me to participate. We were both uh I was a a rap fan. And uh and yeah, it was it was totally fun.

Manya Chylinski:

Oh, that's great.

Jordan Smoller:

And I played a an uptight record executive.

Manya Chylinski:

Okay, okay, cool. Did that feel like a stretch for you?

Jordan Smoller:

Not really. Uh there was minimal plot.

Manya Chylinski:

So yes, yes. Well, true for a lot of uh music videos, just enough to hold together so it makes sense, potentially makes sense to the listener.

Jordan Smoller:

Right, exactly.

Manya Chylinski:

Interesting. Okay, I never would have pictured that.

Jordan Smoller:

Very good.

Manya Chylinski:

Very interesting. Okay. Well, I wish we could go down that path, but we are actually talking about resilience and research and mental health. So we have to go, we have to go off that a little bit. Let's start by the name of my podcast is Notes on Resilience. You may or may not know that I have a well-documented love-hate relationship with the concept of resilience. But I'm curious when you think about it, what do you mean when you talk about resilience?

Jordan Smoller:

I think to me, the the big sort of distinction to make in terms of how people sometimes think of this and how at least I think of it, and I think many people in the mental health field think, is that it's not the absence of susceptibility to stress. It's not the absence of you know mental health problems or something like that. It's really about adapting in the face of adversity and uh you know trying to return to a an adaptive or even flourishing state, face of adversity. So it's not stealing yourself and just having grit and avoiding any kind of impact of adversity, finding ways to adapt and and to to emerge and to even grow in the face of adversity.

Manya Chylinski:

Okay. I love that you're using the word adapt. Something I myself said, and I know other survivors in other cases have said, we very much say we want to get back to the way things were before. So five minutes before, five days before the thing, whatever it was, happened. And that's not really possible, is it?

Jordan Smoller:

Yeah, I think typically it's not. Because often, if there is a traumatic event, something about the world has changed in a fundamental way. Uh, you are often not the person you were, and the circumstances are not necessarily what they were. And you know, there's a certain degree of in my in my saying, it's about not just avoiding uh susceptibility to stress, it's partly about normalizing the fact that so many people experience substantial adversity and trauma, and difficulties in coping with that or in adapting to it are expectable, and certainly distress is expectable. And finding a you know a path forward in the face of that is often a process that takes some time. Uh, some people are more vulnerable than others to having that process be a very difficult one or even to experiencing stress-related disorders. Other people find for various reasons that they experience a sense of growth. And many people, what we sometimes call post-traumatic growth, but many people find ways to either adapt to the changes that have happened and maybe in a way that is different. The world is different. There's often no denying you're the victim of a natural disaster, for example, and your home has been destroyed and you're not knowing where to go. I mean, the world is a different place. So, yeah.

Manya Chylinski:

One of the things that has shaped my direction after the bombing is the lack of acknowledgement there was for those of us with mental health impacts. And I'm curious, why does that matter? Why does it matter that it's kind of publicly acknowledged or that leaders recognize that this is what's going on with folks who are dealing with the trauma?

Jordan Smoller:

Yeah, that's such an important question. I I think it matters in a couple of ways. It matters for the for those who have been who have experienced the trauma or crisis. I think acknowledgement really, you know, validates the reality that people experience and being able to say, I see what you've lost. This is devastating, or I see how painful this is. It communicates a sense of understanding, dignity, belonging, rather than sort of trying to minimize. Also, I think, you know, from the perspective of those who are trying to help or leaders in organizations, responsibility begins with sort of naming what has happened and acknowledging what has happened in circumstances where there may be something that you know was harmful that was about the environment that perhaps somebody is in, or maybe there's a leader in an organization. I think that you know, that that is an attempt to sort of be, to take responsibility, to be empathic, certainly in the mental health community and mental health providers. I think that is one of the essential things that we aspire to do is to be empathic, to recognize the pain that people may be in and have experienced, not to minimize it, and to meet people where they are.

Manya Chylinski:

As you're talking, I'm thinking that my own experience and those of other folks have shared with me that the mental health community, the social work community, the victim services community, these were where we found support. These were where we found people who understood what was going on. And you use the word expectable. These were folks who expected that this is what was happening and were there and with open arms being supportive. I maybe this is the cynic in me, but I don't see that in the larger community where there is that understanding and that empathy from leaders. And to me, it comes back to responsibility. Again, the cynic in me says, we're not going to acknowledge this because then that means somebody might think we're responsible. Curious your thoughts on that.

Jordan Smoller:

Yeah. I think I've seen what you're describing. And I think that, you know, there are a couple of reasons perhaps. One is people being concerned that they might be held responsible if they acknowledge, you know, that something terrible has happened either under their watch or even if it's peripheral to their uh perceived responsibility. Another is people often feel unprepared to be in a position to respond to people who have gone through something really terrible and extreme. Many people just haven't developed the language or you know, how to express that and maybe worry that they're going to fall short. We think we encounter this in in the world of suicide prevention, where you know there's a real reluctance sometimes to ask people about how they are doing because you're worried if you get the answer that they are having suicidal thoughts, you don't know what to do with it. It can be overwhelming. I think there are many reasons uh that that can happen. I think people unfortunately overestimate the the problems and underestimate the benefits of frankly being empathic, acknowledging somebody's experience. And if you are in a position of leadership in an organization, not only acknowledging and making it clear that you understand what's going on, but actually moving beyond that to say, and here's what we're gonna do about it. You know, here's some concrete change that we're putting in place. When people see that they are seen, when people experience that they're seen, there's some empathy and there's a commitment to do something about it when that's possible. It's not always possible. I think that goes a long way. And people's concerns about we're going to somehow be held responsible underestimate the power of simply connecting with people. It goes a long way to having people not only recover themselves, but to develop trust. And you know, this happens in the medical world too. There used to be a sort of unspoken, perhaps, or even um sometimes maybe spoken, concern that if you acknowledged a mistake, it would greatly raise the legal liability. And even if you if there was no malpractice, essentially. And in fact, it turns out that that, as I understand it at least, that's not only not true, but it raises the liability to minimize mistakes. We'll feel like they are you're not being transparent, or doesn't mean you have to take, you have to say that I'm to blame, because maybe you're not, but that these terrible things happened. Here's here's what happened, and here's what we're gonna do about it, and and even an apology goes a long way.

Manya Chylinski:

Right. I've experienced that in my own life, not a not a medical mistake, but instances where when someone just acknowledged what happened, that's all I needed. Nothing else had to happen, but until they acknowledged it, it was as if they were, I don't know, making it seem like I imagined it or that I had somehow made this thing up. You're like, just admit what happened.

Jordan Smoller:

Right. And it so compounds the burden for those who have experienced these things because not only are you dealing with the the emotional aftermath or physical aftermath of some uh event, but you're now sort of being turned away as you try to connect with other people or having to bear it or feeling like you have to bear it on your own, which we know actually is a detrimental thing. Right.

Manya Chylinski:

In your work, you do a lot of research to try to understand some of these factors that are that contribute to developing PTSD, to all these other things. And that seems like quite a responsibility.

Jordan Smoller:

Well, it is a difficult task for many reasons, actually. One, because of the complexity of understanding things like how our brains and minds and and bodies work, then also finding, trying to find solutions. It's complex because the research world itself is often challenging. People often don't understand how sort of how research happens, both in terms of how it gets funded and what's involved in doing this kind of work. But I will say that I think we have it's sort of a two-sided story of tremendous progress and frustrating difficulty in changing the status quo and actually providing new innovations to uh folks, uh to patients, families, communities. But I always say, as as others often do, that research is hope. This is the the way that we move forward and do better. And that's why for me it's it's feels like maybe the most important thing I can do. I also practicing clinician, so I, you know, I work with people day to day, but the ability to sort of impact the future is a real motivator.

Manya Chylinski:

Right. You're doing both, you're helping people in the moment, and you're working to build a better future. Well, mental health is such a I don't know, it seems so variable because it's so personal and you can't see it, and you have to rely on people either telling you what's happening or being able to interpret some types of behavior to understand. So I just find fascinating the work that you do both as a clinician and as a researcher because of that, because I think it's so difficult to, and even if you find the answer, not everybody's gonna believe that's an answer.

Jordan Smoller:

Right. And it probably isn't an answer for everybody. I mean, in rare cases we we find a basic foundational fact that changes the game. But I think you're right. I mean, one of the particular challenges in mental health and in mental health research and in mental health practice is that it is very much about things like language and relationships and complexity at a level that is not only is, for example, the brain complex, but we we exist in a social situation that's complex. And I think the field is starting to embrace that complexity rather than purely reducing it to something that we can study in one factor at a time. I think that's an important development, but it does make it challenging. Even our diagnostic system, you know, in psychiatry, which people will probably know is kind of best known through the DSM, the Diagnostic and Statistical Manual, which provides criteria for psychiatric disorders, is designed to not focus on causes, I think appropriately in some ways, because we it would have been premature in defining these things to sort of assign what the cause is when we don't know. And in fact, PTSD and substance use disorders are two of the rare examples where a causal factor is actually in the criteria, a traumatic event is in the criteria. That's not true for depression or anxiety or schizophrenia or anything like that. But it's also a consensus of experts. What makes something a disorder? And at what point does it go from being, say, normal variation and in or expectable outcomes to something that we would consider could benefit from treatment and so on? So that in itself makes it difficult. Yeah.

Manya Chylinski:

That's interesting. You you mentioned the concept of disorder. And I have heard arguments that PTSD shouldn't have the D at the end. It shouldn't be post-traumatic stress disorder, that the behaviors that you're seeing from someone are natural response to going through the trauma. I'm curious what you think about that.

Jordan Smoller:

Yeah, I understand that perspective. I think sometimes we attach a lot of importance to words for good reason, but you know, sometimes people will say post-traumatic stress syndrome or simply post-traumatic stress. I think the reason that we think of disorder as having some value in the name is that it corresponds to what we think of in general about defining psychiatric disorder, which is not simply that you have symptoms or distress or even severe symptoms, but that it is really impairing in a consistent way and interfering with life and uh causing you great harm or impairment or disability. And when it crosses that line, which again, of course, is a judgment call for both the person experiencing it and perhaps the mental health provider, that's when we think of disorder in general. But it is true, it's absolutely true what you're saying, which is that it is sort of normative after a traumatic experience. There's nothing unexpectable that people would have stress-related responses, even severe ones, insomnia, hyper-arousal, you know, periods of depression and anxiety, et cetera. And everybody has probably a different time course of how that then moves on from there. And so I think we to some extent overvalue the focus on what how we describe our diagnostic labels. It causes a lot of controversy, but I think in the end, it's about how do we ensure that we are all talking about sort of the same thing. And secondly, when does it become something that requires treatment or somebody wants to seek help for? There's also these sort of prosaic considerations about when does it get reimbursed for treatment? What services become available when you sort of quote cross that line? So it is a complicated sort of sociological phenomenon to define disorders. But I think for me, the the big thing is does this is this interfering substantially with your life in a way that we wouldn't have that first of all, you think is beyond what is tolerable or is impairing, and that we might be able to do something about that's helpful.

Manya Chylinski:

Right. As you were talking, I was thinking of the concept of stigma.

Jordan Smoller:

Yeah, I was thinking about that.

Manya Chylinski:

Not wanting to say something as a disorder. I think there's some fear. I hate that I had PTSD. I all of the normal reasons, but I also hate it because even though I know it wasn't my fault, it still feels like I still feel that stigma about it myself. I don't even want to say it was a disorder because then that means there was, I don't know, that says something about me that I don't like.

Jordan Smoller:

Well, it's interesting. I I think you're right. It also goes back to what you were raising the very beginning about acknowledging. One of the things about acknowledgement and empathy is that it reduces stigma. I mean, I think when people welcoming of other people's experience, that reduces stigma. In this context, it's ironic or or striking that we have the degree of stigma that we have for something that is so mental health conditions as we recognize them or mental health struggles are so almost ubiquitous. Uh, and yet there is this stigma. We don't I would imagine that if you had asthma, which is thought of as a disease, right? You wouldn't have that, it wouldn't, it wouldn't reflect on your person in the same way, or you wouldn't worry that people thought it reflected on your person could and your capabilities as a human being. And that is something I think we need to continue to address. I think there's a lot of progress in some ways. I think there's also some backsliding in some of the ways we talk about mental health in the media, social media, and some corners that I worry about a little bit. But I think overall, and particularly among younger people, I think there is more of a sense of this is not something taboo to talk about.

Manya Chylinski:

I do like that, and I have noticed that, especially among younger people, and I appreciate that. And I'm love that we're moving in that direction and wish we were moving a little faster. What do you think we owe each other after tragedy in terms of people's mental health?

Jordan Smoller:

We being everybody. We being everybody experiencing the tragedy, the people who are not experiencing it directly, but is that what you mean?

Manya Chylinski:

Yeah, I guess that's what I mean. Or uh how do you want to answer the question?

Jordan Smoller:

Who I think we owe each other, first of all, I think we owe each other an empathic approach to other people. We owe each other at a sort of more um structural level. I think we each other access to help. We need we are currently experiencing a tremendous shortage of mental health care. And that's putting aside the problems of reimbursement for care and so on. Um, it's not actually putting aside, it's related to that. Um, but access to help doesn't have to be in a medical setting. We owe a an acknowledgement, I think, of what's happened and not sort of trying to minimize or certainly uh make those who have experienced trauma uh feel excluded in some ways. I think we need to perhaps dispel, certainly dispel stigma. I mean, that's sort of almost goes without saying, but maybe it doesn't go without saying, uh, including the more subtle forms of sort of, well, you know, walk it off, basically. Uh and, you know, it's all about grit and implying in some way that you really should be getting over this at some at some point or something like that. And I think we, again, at a higher social level, owe an examinate, depending on what the the event is, an examination of what are some of the social factors or structural factors or things that may have contributed that we may need to start to address in a different way. You know, this, you know, there's a fierce debate, of course, about guns, firearms. And I don't see that subsiding in the immediate future, but it's a really important one. We know that, you know, firearms are responsible for most are the most you know lethal form of uh for suicide, and we avoid some of the tragedies that we see happening way too often.

Manya Chylinski:

Right. And now we're talking a mix of social factors and all these other things you mentioned, and then add on to it that political layer where people have particular agendas, and sometimes these things can feel intractable.

Jordan Smoller:

We were just having a a conference the other day, and I think the phrase was the the speaker mentioned was, you know, optimism is is maybe the it is a moral choice. That is, even in the face of things that seem intractable, we have to make a moral choice to not give up. Wow.

Manya Chylinski:

Well, we're getting close to the end, but what is one change you would want to see in any way you can think of it that would make the most difference for our mental health and well-being?

Jordan Smoller:

Oh, that's such a huge question. It is. I mean, I think that the I guess I would think of it in in two large areas. So I'm not gonna say one thing, but I could I could maybe reduce it to sort of two big things. Okay. One is, uh, but now I'm thinking of 12 others, but one is immediate response to seriously addressing mental health issues that people have. That the and that is partly an access problem. I think we have not adequately solved that problem of getting people the help or making it available, the help that they may need now. Reducing stigma is a part of that. Um, so I'm throwing in that a little bit. And the other thing, uh, this might sound self-serving, but investment in the future and and research. I mean, things are only gonna stay the way they are if we don't try to learn more, change things. Uh, it's not necessarily biological research. I mean, that also involves research in social determinants of health, research in psychology, psychiatry, uh, what treatments are effective. That is the hope. It really, I really believe that. We absolutely need to invest in it. And the return on that investment is a is a different future.

Manya Chylinski:

Jordan, I could talk to you forever, as you know, as we have in other circumstances. Um, thank you so much for your time. Can you just tell our listeners a little bit about yourself? Of your long list of things that you do.

Jordan Smoller:

What I'm currently doing. Yes. I am uh well, I am um direct, I'm at Mass General Hospital, where uh I direct the psychiatric and neurodevelopmental genetics unit in our Center for Genomic Medicine. I also am the director of the Center for Precision Psychiatry, and I am co-director of the Center for Suicide Research and Prevention, along with my colleague Matthew Knock. And a lot of my work is now focused on using new tools, data-driven approaches to reduce risk and enhance resilience in many different ways. The motto or vision of our center, uh, which has really become a guiding thing for me, is innovation to implementation. How do we focus on those areas where that require research and discovery, but that have a near-term possibility of really helping people with their current massive unmet needs, I think.

Manya Chylinski:

Right. Wow. Okay. Thank you very much, Jordan. It was such a pleasure to talk to you. I appreciate you being here.

Jordan Smoller:

It always is. Pleasure to talk to you.

Manya Chylinski:

And thank you to our listeners, and we will catch you at the next episode.

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Manya Chylinski

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