Why Do People Become Extremists? Behavioral Science and National Security

What do behavioral health, social isolation, stalking, extremism, and national security have in common?

In this episode of At the Boundary, Jim Cardoso sits down with psychiatrist and national security researcher Dr. Jacob Holzer to explore an important but not often discussed aspect of national security.

Dr. Holzer hosted a GNSI Policy Dialogue panel on the topic titled, Behavioral and Mental Health Aspects of National Security: The Invisible Front Lines with guests Mond Mugiya, Director at Control Risks and retired FBI profiler and Ryan Wagoner, MD, is the chair of the Department of Psychiatry and Behavioral Neurosciences at the University of South Florida. The panel will premiere on the GNSI YouTube channel later this week. 

The episode provides a sample of the intriguing panel conversation. The discussion explores the psychology of extremism, the role of social media in shaping beliefs and behaviors, the rise of digital stalking targeting public officials, and emerging research on how individuals become vulnerable to radicalization. Dr. Holzer also examines common traits that appear across insider threats, lone-actor violence, espionage, and other security challenges, while highlighting the opportunities and limitations of identifying risk before violence occurs.

Subscribe to At the Boundary for conversations on national security, defense strategy, intelligence, cybersecurity, emerging technologies, foreign policy, and the issues shaping the future of global security. Supported by discussion of social isolation, radicalization pathways, stalking of public officials, and insider threat research. 

Links from the episode:

Ours to Keep? Diego Garcia, Mauritius, the UK, the US and Security in the Indian Ocean - By Guido Rossi, PhD

How Mental Health and Behavioral Factors Shape National Security - Youtube Link

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At the Boundary  from the Global and National Security Institute at the University of South Florida,  features global and national security issues we’ve found to be insightful, intriguing, fascinating, maybe controversial, but overall just worth talking about.

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Transcript

SUMMARY KEYWORDS

Behavioral mental health, national security, stalking, public officials, social media, digital stalking, extremism, radicalization, sacred values, social inclusion, cognitive flexibility, risk assessment, law enforcement, AI, insider threat.

SPEAKERS

Jim Cardoso, Jacob Holzer, MD

Jim Cardoso  00:00

Dr. Jake Hulser, welcome to At the Boundary. Thank you so much for being here today.

Jacob Holzer, MD  00:05

Yeah, no, thank you for the opportunity to, you know, be included in this.

Jim Cardoso  00:10

I look forward to it. So, first of all, you know, behavioral mental health aspects of national security, I won't call them uncovered, but they're certainly under covered, as compared to fairly typical, you know, topics of national security conversations. How did you gravitate to this field of study? Yeah, so

Jacob Holzer, MD  00:28

you know, thanks for asking about that, probably in a really kind of checkered way, but you know, just in background, I started out many years ago in the Air Force, and my area was totally different. This was before medical training, I was actually in intelligence operations, but had a really positive experience back then. It was sort of afterwards that I came to follow more of a clinical training and career, and got involved in, you know, ultimately psychiatry, and, and sort of through training over the years have done both clinical and forensic psychiatry, but I've always had an interest in areas of, like, political, you know, politics, political science, international relations, and essentially in forensic psychiatry, I mean, I've done court work evaluations in that, but many years ago I developed more of an academic interest, so around doing some research in the relationship of clinical forensic psych and national security, so that was more my own personal interest that evolved into this academic area, and you know, I sort of noticed in reviewing the literature what's out there already, not a lot of people do this work, there's sort of a handful of people that have done research and published, you know, there are people who work within the public sector and the government, consulting with agencies, you know, with intelligence, the intelligence community, military, you know, law enforcement. So, I've had an interest in this, and I'm like taking it more from the academic viewpoint.

Jim Cardoso  02:44

Well, I mean, yeah, I mean, I think that, you know, we did the recent recording for the policy dialogs, and we're going to kind of use that as a baseline for our conversation today, and we'll release that on the 24th of June, as we talked about, as I talked about in the intro, and really, like I said, it's kind of a, it's a conversation we haven't had that often, you know. So I really look forward to continuing that, and kind of giving a little bit of a, a teaser trailer, as you were, for the, for the actual pilot policy dialogs conversation that that you recorded recently. So let's, but with that, let's start big picture. So the video, it's going to be released on the 24th It's going to, it's got three mega themes: the susceptibility to terrorism, stalking, and then the lover-hater framework of extremism. Now, your professional focus is on susceptibility terrorism, so let's briefly touch on the last two first, and then we'll get to that at the end. So, stalking is discussed in the video by USF zone, Dr. Ryan Wagoner, a colleague of yours. It's, and it's by no means a new phenomenon, but the application of stalking to public officials, where this becomes a national security issue, it is. What are some of the goals and mindsets that you see behind stalking a public figure, somebody that the stalker probably has never met.

Jacob Holzer, MD  04:07

Right, right. Well, you know, my view is, and I think Ryan did a fabulous job in reviewing this topic. You know, my view is it's really a vital area to really understand, you know, what the threats are. It does have a clear national security component to it. The complexity is, you know, it's it's pretty varied, so I mean, and I think Ryan really touched on all this, that you know, stalking primarily will involve more of a, you know, sort of lower level of. A, you know, person to person kind of aspect where you know someone may stalk a friend, family member, someone who you know there's some personal connection with that is really not, not much to do with public figures, but it could be someone in an occupation or something, and then there could be like a number of reasons for that, so much of that we never hear about, that's more at a lower level, personal, personal type level, but there are examples where stalking can evolve into the public sector and present us a threat against officials, and it's really important to really look at that to try and understand that phenomenon. What I got out of that talk, you know, what what Ryan presented was just how complex it really is. It, you know, it, it can involve different reasons, you know, that may motivate somebody to stalk, including sort of animosity and threat of violence, but who knows, it could be because of, you know, the person being famous, and the stalker just wants to make some personal connection with that person, as in, you know, maybe a Hollywood star, so you don't, you don't really know the motivation, but it's important to really understand that that's one variable to really look at, that mental illness, psychiatric conditions may play a role in some of these, and may help in understanding, you know, what is going on there, you know, the stalker's intent may be pretty benign again, they may want to, let's say, make a personal connection with a star, but in reality they may present a real threat of violence, and you know the last thing that person needs, you know, the potential victim is to have some stranger, you know, kind of stalking them and presenting this threat. So I don't know if that answered the question. No, no, it

Jim Cardoso  07:45

did. Actually, I mean, it's a good, you know, it's a good overview of the kind of the concept of stalking. I think it's interesting how you say the intentions may be benign, but the activities may not seem benign to the stalk e, and that is becoming more, you know, it's becoming more ubiquitous these days, and we're seeing more, you know, activities in that, and it is affecting public figures, at which could then impact national security. I mean, another aspect of that, you know, you, GNSI, we try to talk about things at what we call the boundary of policy and technology, and technologies has impacted stalking. Stalking has existed for centuries, probably, but digital stalking has really changed quite a bit. Is there any, and you know, a lot of the things we talk about in this area, there's a, there's a, there's a technology aspect to it. Is there any, any trends or areas that you see as concerning when we talk about the digital digital stalking and social media presence and greater social connectivity.

Jacob Holzer, MD  08:49

Yeah, yeah, so that Jim, that's a really critical area. Stalking may be a small part of that, that's important to really understand, but there's a much broader, you know, sort of component to the use of social media in a number of different topics that we're talking about here.

Jim Cardoso  09:18

Yeah,

Jacob Holzer, MD  09:19

and I can get into that, yeah, you know, stalking one on the, you know, on social media is a real growing problem, so you know, one population this affects, you know, could be like adolescents, teenagers who are bullied online, and yeah, and they can be stalked. They may not want to be, you know, people who, you know, sort of focusing on teenagers. Let's say, but, but that's not, that's not exclusively, you know, the only group, but you know, sort of people who use social media, you know, they don't have full control over who can access that, you know, and there can be like mal intent, you can get a, you know, let's say in the, in the case of like adolescent teenagers, where you could have a classmate who has some ill intent and they're going after somebody online, but you know, it probably happens fairly frequently with people who attempt to do, like, let's say, financial scams online, you know, or or are fixated on someone for some other reason, you know, and that can be a real problem, a real threat.

Jim Cardoso  11:07

Yeah, yeah, you know, I think that I mean everybody, even even a lot of national security personalities, have a fairly robust social media presence now. I mean, there's controls, obviously, on how much they can be stalked, but I mean, there's, there's still opportunities, I think, for harassment and for impact as well. You know, it's it's one of those things that it just hasn't been a factor for centuries or for decades, but now, in the recent past, it's becoming more and more, so, so it's affecting, and I think also generations being raised that just lives in this arena of constant social media presence. So, these are the national security leaders of tomorrow, and so how they approach it could be different as well.

Jacob Holzer, MD  11:54

Right? Right? You know, it's a.. it's a fairly new phenomenon. So, there isn't. um, you know, I think it's still at a period of time where these sort of things are happening, and there aren't a lot of breaks on it yet, you know, a lot of like interventions to really secure and safeguard against it, I mean, there are some, but you know, the trying to think of examples of this where you know there's there's the ability to, you know, kind of break into sites with malware, and you know, sort of manipulate information, and I think the whole, the whole arena of AI and developing AI throws yet another variable into this. This comes up, you know, I mean, sort of a really good example. Again, this isn't quite stalking behavior, you know, in the traditional sense, but it's all part of the same context, you know, where this has come up as an issue around campaigning, and it can be, you know, political campaigning at like the local or state or even national level, where somebody may introduce AI into the campaigning, and it can throw things totally off. Some AI is very realistic, so yeah, you know, again, it sort of speaks to the complexity of this issue, but you know, it's not, it's not out of the realm that somebody out there could have some mal intent against a public official, and with the use of AI, and you know, good social media skills really develop a really high risk situation.

Jim Cardoso  14:09

Well, it kind of, you know, it links to what you talked about in the policy dialogs, and some of those susceptibilities to terrorism, some of those mental traits, I guess character traits could be aligned with, you know, with stalkers, as well as some, you know, violent extremism, and some of the things you'll talk about. So, let's, let's turn to that. So, you know, you noted several areas of recent neurobiological research to help determine why people gravitate to extremism and radicalization, and, and listening to the policy dialogs that'll be released soon, there's a key theme that I saw a couple times, which is sacred values versus non-sacred values. Could you explain the difference between those two, and how that impacts how one might be drawn into violent actions?

Jacob Holzer, MD  15:00

Oh, sure, sure, yeah, so really, you know, fascinating research that was done, kind of a handful of studies,

Jim Cardoso  15:11

and we're going to get to some of those a little more in depth too. I got some follow-ons, is that too? So, yeah,

Jacob Holzer, MD  15:16

sure, yeah, no, I'm happy to get into this, but it's really interesting, so you know, one area that, and again, a lot of this stuff is interconnected, but that whole area of extremism and radicalization, and we're sort of not talking about, you know, so I want to clarify that I'm not talking about any specific, let's say ideology or political persuasion, you know, I want to almost leave all that stuff aside, you know, what I'm sort of talking about are people who are, you know, more extremist in thinking compared with people who are like more moderate or centrist in thinking, and you know there's been a handful of studies looking at this in some different areas, a lot of it is done in Europe, European settings, but one of the studies really looked at, as you were describing, looked at this concept of sacred values, and researchers in Spain studied that in a very small subgroup of young men in the Muslim population there, and they looked at a young cohort of people who were willing to fight and die for a sacred cause, and so sacred causes have to do more with spiritual beliefs in God and religion, as opposed to materialistic. materialistic money, right. So one of the, one of the research studies, you know, they, they did some imaging, and, and this, you know, sort of, there's a lot of technical aspects, but they did brain imaging, and they basically, what they did was, they took this small group of people who were willing to fight and die for a sacred cause, and they basically scanned them, they did a brain scan, and then they introduced this game called Cyberball, and I'm not really quite familiar with, so I've read about it. I've never played it, but Cyber Ball is this online game, and it basically elicits strong feelings of either being included or excluded, and so what this research showed was that everybody in the small group who wanted to fight and die for sacred cause, their brain lit up in a certain area in the front, front side, you know, the frontal area of the brain, and the frontal area, frontal and prefrontal cortex of the brain has to do with higher order functions that deal with social interactions, social integration, inclusion in a group, decision making, so a lot of higher order functions, and you know, again, getting back to that group, some people were included in the cyber ball game, and their brains lit up when they wanted to fight and die for sacred cause, but not for money. If they were offered money, the brain did not light up. People who were excluded in the cyber ball game, their brains lit up both for sacred causes and for money. Really fascinating, if you think about this, that you know it had some real world meaning that people who are socially included in a group, supported, included in some group. I'm not talking about a terrorist group, I'm talking about a social group. If they're felt included and integrated in a group, they seem to be better protected from being vulnerable to, you know, committing violence for money,

Jim Cardoso  19:41

yeah.

Jacob Holzer, MD  19:42

Who were excluded, who were isolated, excluded socially, could be bought, paid to commit violence. Really, an important piece of research, you know, from my point of view.

Jim Cardoso  19:59

Yeah, and. Mean, yeah, the inclusion versus social, the inclusion versus exclusion, that's another one of those that is, it seems to flow through that study, and I think you discuss it a couple times as well, that I mean, and look, we've, you know, you hear about people being, oh, they were a lone wolf, and really they didn't seem to have much, so they didn't socialize much. He doesn't have any friends. I mean, it is something we've seen kind of historically, sometimes in stories that rise about people after the fact that have committed some type of, some type of violence or extremist act.

Jacob Holzer, MD  20:32

Right, right, that's actually very true. So, you know, here we're talking about people in the, in the study who never actually committed violence, you know, this is just stuff they were thinking of, you know, they talked about, and it showed some real brain changes.

Jim Cardoso  20:52

Yeah,

Jacob Holzer, MD  20:53

but I mean, practically, you know, there's unfortunately hundreds of cases of individuals who have committed mass violence one way or the other, kind of linked to some belief or ideology, and you're exactly right that you know we can look at traits and patterns, and that many of those people, and that's part of what I've been interested in, you know, that many of those people have had some social disconnection, some sort of level of isolation. Social media plays a major role where, you know, they don't have healthy social outlets, but they spend a lot of time on social media, you know, communicating with other people in chat rooms, and that there's sort of a number of other issues that have to do with, you know, vulnerabilities, clinical issues, you know, that are that are part of the mix, but you're right, you know, some of this we can see, you know, vulnerability in that group.

Jim Cardoso  22:05

Well, and you know that's, you know, a lot. It's interesting because you talk about social media, and you know, social talk about social engagement, inclusion versus exclusion. Sometimes the engagement, if it's over social media, I think we've seen, or at least heard of areas that could be almost, almost harmful in some ways, because it, and you know, we talked about this, you know, offline, but it kind of is driving, and you talk about on the, the policy dialogs video as well, that sort of, there's everything's black and white right now, there's, I mean, everybody's kind of lining up on their sides, and you said earlier in this podcast it's not aligned with a certain political belief or a certain, you know, it's just more aligned with just an extremism, whether it's on one side of the spectrum or the other, and it seems that social media can almost exacerbate that, because you don't, you don't have a conversation, you don't get conflicting views, you just get something that feeds what you already believe, and it can, I guess, you can, for lack of a term, kind of spiral and not really benefit from what true social interaction could be.

Jacob Holzer, MD  23:09

Yeah, yeah. No, that's absolutely true. I mean, part of it is, you know, again, you're taking like an individual who already may have some vulnerability, right? They're they're open to some persuasions to set the, you know, suggestion, they're susceptible to that, and then you know on social media, you know, there's a lot of animate anonymity,

Jim Cardoso  23:37

yep,

Jacob Holzer, MD  23:37

pronouncing that correct, anonymity, but they don't know who they're talking with, and yeah, you know, in that sort of setting, things can spiral out of control, where you know there's people who are encouraging someone to become violent, you know, come on, you can do it, you know, we need you to live up to being a man, show us that you can do it. You know where 99% of the people in the chat room, you know, let's say a chat room has hundreds of people, 99% of them would never commit violence, they're okay at talking the talk, right, but it only takes one vulnerable individual who is susceptible to this stuff, and it could lead, it could be one of the things that crystallizes in that person to then say, you know, I've got to take matters in my own hands and then go on to commit some mass violent offense,

Jim Cardoso  24:41

yeah, yeah, another, another, another study that you talk about, it's a Cambridge study, and it was trying to encapsulate the personally, personality traits of someone potentially prone to gravitating towards extremism, and now one thing, as I was listening, and help me out here, because I noticed there's an apparent dichotomy, because you had. To talk about a caution in decision making and seeking accuracy over speed, as opposed to the tendency to act impulsively once they process the information. Could you walk me in the audience through that relationship and any other notable traits as well with that Cambridge study?

Jacob Holzer, MD  25:19

Yeah, so that Cambridge study, that was pretty interesting, because they stressed there that they looked at again, not not a specific political ideology or persuasion, they looked at people who were more inclined to like the extreme point of view versus moderate, you know, centrist, and they had a number of findings, including kind of a lack of cognitive flexibility, you know, being sort of more rigid, this thing called dogmatic, they, they talked about that as one of the traits, and that they had this one study where they, they did this timed exercise, so everybody knew it was timed. You only had a certain amount of time, and then you would fail if you go over time, and the people who are more extremist disregarded that time frame, and they focused on getting things exactly right, but they ran out of time, and they failed, whereas the people who were more moderate kind of made mistakes, but they wanted to get done before the time limit, so that was that time test where they were at, they wanted, you know, the extremists wanted to be more perfect, but in general they tend to be more risk-taking, impulsive. Um, now you know it, it, it gets tricky, this this area that I'm talking about, and I think you know it's important, maybe to touch on this, that it really is complicated. There's a number of other factors you want to think about with this, because there's, you know, there's certain professions, so let's say you know, and people who are not.. I'm not talking about extremists ideologically, but there's certain professions where you want people to be a little bit more of a risk taker, because if they're not, then they could.. that could inhibit their functioning.

Jim Cardoso  27:40

Yeah,

Jacob Holzer, MD  27:41

see this potential, you know, like first responders that you know by nature they're going to be they're going to have a higher risk tolerance, but you know that doesn't mean they're extremists, no, yeah, so there's more to this conversation, you know, there's more complexity to this. I think the other interesting thing, you know, and I was thinking about this, is that it also depends a little bit on the environment when we talk about extremism versus moderation, you know, and I was when I was trying to process all this stuff with reading these studies, that you know, it really depends on the environment and the definitions of extremism, because I started to think a good example would be, you know this really sad case of Alexi Navalny, who was, you know, sort of really active in running for a democratic stand in Russia until you know he was apprehended and jailed and eventually died in prison, um, but you know, in the US he would be considered a real moderate in thinking, you know, progressive moderate, in Russia he was considered an extremist, um, so again, I'm sort of talking about this because you want to factor in kind of what the environment is, you know, that that it isn't just black and white, there's sort of a number of variables, and that, you know, a person may still, you know, a person may still be extremist, even though they're defined as something different because of that environment.

Jim Cardoso  29:46

Yeah,

Jacob Holzer, MD  29:47

that's

Jim Cardoso  29:48

it. Does, yeah. And actually, it leads to, you know, a follow-on in that it goes to, you know, terrorism, terrorist profiling, and it has historically been focused almost. Singularly on clinical and psychological socio-demographic factors, and kind of what you talk about, you know, it articulates that that those singular factors are not useful. It needs to be a more integrative approach, and that's something you talk about in the policy dialog, and why it needs to be a more integrative approach, so that you know a first responders, and you know, seen as an extremist. It's just there's certain personality traits, but you have to step back and look at it more integrated across various factors. Can you expand a bit on what this integrated approach, what that entails, and why that's so important?

Jacob Holzer, MD  30:39

Uh, sure, yeah, you know, so in the panel discussion, yeah, I did talk about a paper that there was this review article, I don't have the details of who wrote that, but it was sort of an interesting paper where they stressed that if you look at any of these individual very, you know, not variables, but frameworks like social psychology or clinical aspects, you know, or more of a political taking it from a political viewpoint that you're really missing the missing the boat on this, and that really to, to try and grasp this phenomenon, you know, understand that a little bit better. You really need to factor in a number of different areas and think about this, and so you know, in that paper they talk about things like factoring in social psychology and cognitive psychology, you know, sort of neurobiology, but then also factoring in, you know, things like the political environment, you know, there's the concept of like rhetoric that may be calling one politically, how that factors in, you know, again the use of social media, how that may factor into this picture, and I think there's a concept, you know, that that has been described in the area of loan act or terrorism, where you know you want to look at a number of different variables, so we sort of talked about a little bit, you know, vulnerabilities, there may be clinical aspects, there's personality aspects, the sort of political environment and rhetoric, use of social media, weapons, access to, they have, I mean, someone may have the motivation and have little ability to carry something out, but you want to look at that aspect of it, their capacity to engage in violence, and what you need to do is really look at all of these things and how they come together and crystallized in an individual where they then would be at higher risk. If you look at one of those things, like social media alone, you know that doesn't really give you enough information.

Jim Cardoso  33:35

Yeah,

Jacob Holzer, MD  33:35

so yeah, that's the integrative thing.

Jim Cardoso  33:40

I would think that'd be challenging, though, to be able to, I mean, do that successfully. I mean, you've got to have an interdisciplinary approach and a wide variety of expertise to be able to do that evaluation, which I would imagine would be hard to come by.

Jacob Holzer, MD  33:55

So, yeah, it's much easier said than done, so so you know, people can look at this academically, you know, as far as research goes, that's one thing, but I think the challenge is really more practically for people who may potentially be at higher risk of committing violence on and the challenge for like law enforcement to be able to kind of tease through this and identify people who may present as a higher risk, you know, proactively, that's the real challenge.

Jim Cardoso  34:46

Well, and the policy dialogs, and other guests that talks is Manujia, former of FBI profile, and that's kind of his, that's kind of his world. How does, how does the, how do law enforcement, how do the folks that can prevent these sort of things, how do they. Do this inter this this integrated interdisciplinary approach, and be able to hopefully identify risk factors and risk or risk human beings that are out there before, before they take some type of action. It seems it's obviously challenging because people are still doing it. There's still extremist acts happening that are sometimes completely unexpected. You know, you talk about the CEO, the CEO of the healthcare, I mean, that was just out of the blue, and I think that really opened up a lot of people's eyes onto the possibilities that could exist out there in ways we approach who's out there,

Jacob Holzer, MD  35:33

yeah, yeah, no, it's, you know, I can appreciate it's enormously challenging, mind, you know, who was on the panel, the, you know, person who did that work with the behavioral policies program, you know, he talked about that, yeah, the work really involves a collaborative effort, I think, between law enforcement, it could be also mental health professionals, and potentially other professionals who would work as a team in trying to identify people who may be at higher risk, and potentially do something, you know, and it may be, you know, getting someone help one way or the other proactively to really try to reduce that risk, but you know, I think it must be enormously difficult, and you think about it, and I had these discussions, you know, in working with Mons and some other people just around the research part of, in the writing, where, yeah, you know, they would talk about how, you know, on social media, let's say in some platform, you may get, you know, 10,000 people who talk about the need for violence to change something, right? 10,000 people talk about

Jim Cardoso  37:07

it,

Jacob Holzer, MD  37:08

and you know, again, 99% of them talk about it, and they stop, get off social media, and that's the end of it. And how do you identify? I mean, that's sort of an enormous number of false positives, and you know, I mean, there's also the issue of, you know, well, they have the right to talk about it, you can't prevent them from talking about it, but you also want to be able to identify who in that group could go on to present more than just talking about it, but an actual threat, and I'm not sure how exactly that's done, you know, out there on social media, I mean, without violating, like, the First Amendment, I mean, how do you, how do you control for that?

Jim Cardoso  38:05

Yeah, that's well, and that's why we have conversations like this to kind of just kind of walk through that and get people, not that we have all the answers, but give people something to think about, and maybe they listen to this, and they'll listen to and watch the policy dialogs that were released on June 24 and they'll have an opportunity to think more about that. We are getting ready to wrap up this podcast, though. So, one last question, what other.. what are areas are you researching that and pursuing that kind of hit that, that Venn diagram, for lack of a better term, between behavioral mental health and national security?

Jacob Holzer, MD  38:38

Right? Right. No, great question. So, this is really an area I'm really very interested in, and you know, there's sort of a number of groups we actually are working on a new project, the new book that's going to come out, really looking at this more closely, but you know, there's sort of a number of high threat groups that you know sort of touch on the theory of national security risk, um, you know, one area that I'm interested in is the group that deals, you know, that presents a risk of like committing treason and espionage, violating the Espionage Act. There's another category that are individuals that present sort of an insider threat. They may be within an organization, and they may present as a threat financially or through violence to that organization. It sort of turns out really interestingly that you know these are all disparate groups, right? A group, you know, the Treason Espionage Group, Lone Actor Terrorism Group, Insider Threat Group, but there's overlap between these groups, they. All have some common features, and so it's really looking at that some of those common features are really clinically based, you know, that have to do with personality traits, you know, some of their clinical histories, there may be some variables that sort of stand out, so you know those are areas that I'm really interested in.

Jim Cardoso  40:26

Well, you know, we may have some opportunity future to explore them a little bit more, and I look forward to that. But for today, Dr. Jacob Holzer, I really want to thank you for your time today. Really appreciate your insights.

Jacob Holzer, MD  40:38

Yeah, no, thank you. Thanks again for the opportunity to do this.