Talking About It - Episode 12: Our Community and Mental Health

Talking About It Host Cindy Graziano talks with Dr. Andrew Gerber MD, PhD; President and Medical Director of Silver Hill Hospital in New Canaan, CT.  People have said that Dr, Gerber makes discussing mental health "cool". What is the impact of mental health issues on families and communities? How can we come together a community to help?

The Partnership’s core mission is opening up discussions around behavioral health issues in order to reduce the stigma around these issues and prevent abuse and promote healthy relationships.

Talking About It is produced the New Canaan Abuse Prevention Partnership with support from the New Canaan Community Foundation.

To learn more about the resources mentioned on this podcast, visit our website: TalkingAboutIt.org

© 2020-2023 New Canaan Abuse Prevention Partnership & New Canaan Community Foundation

Transcript

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Hello and welcome to Talking About It, a podcast from Buchanan, Connecticut. I'm your host, Cyndi Graziano. COVID is transforming every aspect of our lives in ways we could have never expected. How can we adapt in healthy ways? This year, the new Canine Abuse Prevention Partnership is dedicating It's talking about it podcast to providing practical tips to manage the stresses of living in this difficult time. The psychological and physical health of everyone is at stake. And one critical takeaway from life during the COVID pandemic is that we must learn new skills to better take care of ourselves and one another. Our goal is to create an educational and open dialog within the McCain and community and beyond. May is Mental Health Awareness Month. So how fitting that in today's podcast, our guest is Dr. Andrew Gerber. Dr. Gerber is president and medical director of Silver Hill Hospital in New Haven, Connecticut. People have said that Dr. Gerber makes mental health cool. His medical degree is from Harvard Medical School. He has a Ph.D. in psychology as well. His undergraduate degree in physics is from Yale University. He remains on the faculty at Columbia, as well as the Yale Child Study Center. Prior to joining Silver Hill in November of 2018, he was the medical director and CEO of the Austin Riggs Center in Stockbridge, Massachusetts. In the last several years, he has opened the door of Silver Hill's extraordinary resources to the people of New Canaan. Welcome, Dr. Gerber. Thank you, Sandy. Thanks for having me. It is our pleasure. I think a good place for us to start Our discussion is just around the language that we use in mental illness and mental health. How do you define mental illness today? So I think it's such an important question you're raising, Cyndi. I think in in many areas of science and medicine, we use very specialized language. And while that can be offputting in some ways, it also helps the the field define its terms well. In the field of psychiatry, in psychology and mental illness, we think it's very important to use language that is accessible to people. However, there is a danger with that, which is we can speak about things that mean one thing to a professional and mean something different for someone who's not a professional. And that can lead to a lot of confusion. So I love that you're starting with this basic question. I think it's important that when we talk about struggles with mental illness, we start really by describing the experience of the individual, because that tells us not only about what they're what they're saying to us, that it encourages us to listen to patients directly, but it also makes us remember that at this stage in the field, we really categorize different difficulties, whether they be depression or anxiety or even to some extent, more severe illnesses like psychosis or mania. We're describing a set of symptoms we would love to be at the point in the field where we were describing the underlying problem in the brain. But frankly, the brain is such a complicated organ that we don't yet have the language to do that. So, for example, I often make the analogy that when we talk about someone having an appendicitis, we're not saying they have belly pain because we all know there's many reasons for pain in one's abdomen. But an appendicitis is a very specific reason for abdominal pain that is different, for example, than gastro enteritis or, for example, some other kind of illness that might cause abdominal pain. At this point, we're still describing symptoms at times. We now switch into a language where we're talking about what do we think is causing those underlying symptoms? Why is a person depressed, depressed, why are they anxious and so on? And as we have the conversation today, I'll point out, when I'm switching from one to the other. It seems that there is so much more talk about mental illness today. Everybody seems to be talking about it. Is there a trend that there is more mental illness today or do we just have better ways of describing the symptoms or the causes? I think the answer is both. There's no question that we are getting better at describing these things. And this is one of the silver linings, one might say, of the last several years, is that for a number of reasons, I think people have gotten more comfortable talking about their own or their family's mental illness. So part of this increased sense of the prevalence of mental illness is indeed, I think, an increased openness to conversation. Some of that's been driven, for example, by celebrities and athletes and leaders who are talking about this in a way that was would have been unthinkable 20 or 30 years ago. But there's no question that that's not the entire story. There's good data now from back in in pre 2020 and post the pandemic to show that the reports of symptoms of mental illness have gone up significantly in almost every area of society. The most dramatic is in adolescence in young adults. And it seems like no coincidence that in those children and adolescents whose lives were most disrupted by COVID back in 2020, all the way through now, there are increased reports of depression and anxiety, and then in the homes, that is, parents and adults who are living with younger people also report higher levels of mental health symptoms. We can obviously speculate about why these have been such stressful years. Some of that is no doubt due due to the direct effects of isolation and and masking and and the direct effects of COVID. But we believe it's not only that it's very hard to show this with the data, but we believe that things going on more widely in society. Some of the divisions in society have also led to some of the symptoms that we're seeing. Couple of questions as it relates to what you're saying. Does the US have more mental illness than other industrialized countries around the world? It's such an interesting question and like most things, the answers are fairly complex. On the one hand, I think the US does a better job identifying mental illness and and naming some of the symptoms. So in that respect, back to your earlier question, I think there is a silver lining in the fact that in the US we have a fairly advanced both mental health services structure as well as more research going on here. But there is also reason to believe that as people move further and further away from their nuclear family and in all industrialized societies, but particularly in the United States, when families are very spread out and less likely to live as part of a type community, that that also seems to lead to higher incidence of mental illness. It's a subtle thing because there have been reports at times that if you go back 50 or 100 or even more years, you say, well, we're we didn't see as much of these certain illnesses. Part of that is because we didn't have the descriptions or the names. It's certainly true that mental illness has existed for as long as humans were writing recorded history. But we also believe that as the societal structure has changed, and particularly around the loss of community and increased isolation, and there nowhere in the world is that is that greater than in the United States or that that also leads to increased rates of illness. It probably is a question that is takes us down an entire path. But is it obvious that social media has impacted that age bracket to the point that it has increased isolation or caused more self-doubt and all of those things? It's that obvious. And what do we do about that? You know, in science, you might say nothing's ever obvious, right? There have been times that we we have we have assumed things that only later look back on and said we were wrong about. But I do think that that the impact of social media on mental illness is probably one of the more clear relationships in recent times. The challenge, of course, is to know, well, how much is the actual social media itself and how much is all the stuff that comes with it going on in society. We can't separate those because this was an experiment done on a massive scale, essentially with all of us, certainly all of our young people. That said, the the folks who have been researching this are fairly convinced that there are specific effects around social media that we can point to. So I'll give you probably the most obvious one, and you've heard many parents say this, but never in the history of technology have young people had as much access to direct comparisons between themselves and an idealized image of others. Remember, what they're seeing on social media is not necessarily an accurate vision of what everybody else is doing in terms of their social lives or their appearance or their successes. But young people now are spending an increasing number of hours feeling inadequate in relation to what they're seeing on social media, and that clearly has a negative effect on self-esteem and it has a negative effect on one's ability to consolidate what I would call a balanced and nuanced identity. Right. Part of maturity, part of of adulthood is being able to describe oneself as a complex person who has strengths, who has vulnerabilities, who's good at some things, not so good in others, and finds a way in the world of both building on one's strengths, but also acknowledged the things one is less good at. That's harder to do in a society when one is constantly comparing oneself and being encouraged to portray one's selves in ways that are more superficial. Well, then it goes to the the epidemic of loneliness that that has been talked about so much. So I'm wondering, does mental illness, the vulnerability around mental illness cause loneliness, or because people are feeling disassociated that's causing mental illness? Is it that clearly defined? I mean, I think that that in many ways and it follows directly on what we were just talking about. Loneliness is a cause of mental illness, probably more than the reverse, meaning that as we as a society get more fractured for a variety of reasons, one is increasingly focused narrowly on oneself and has a less nuanced view of the wider community. And whether we call that loneliness or we call it isolation, or we call that, you know, fracturing or division within society, we believe that has a direct causal relationship that causes some of the other problems, particularly anxiety and depression. Now, there's no question that individuals who are anxious and depressed have a harder time than interacting more broadly and can it can also feed back in terms of a vicious cycle leading to further loneliness. So I wouldn't discount that piece, but but I think what's changed really, I mean, that's always been true about depression and anxiety. What's changed in society is, I think, the way that that our structures are really set up to to create that isolation from the beginning. Perhaps we can talk a little bit about the signs of mental illness for families and the community at large, but what are some of the signs that point toward perhaps a more serious problem than just having a bad day? Right. It's important because this and this goes back to this language question. Right. So much of our daily language is about is about mental states. And so when you come home from work, you say, oh, I'm feeling depressed today, or I'm feeling so anxious about this meeting I have tomorrow. One is not necessarily using those words to suggest I have a mental illness and we wouldn't want to try to constrain people's language. In fact, I think I think the fact that mental language has come into much more wide usage is not necessarily a bad thing as it expresses people's feelings in positive ways. But I would very clearly distinguish those sorts of daily life descriptions, the sort of new normality of one's daily ups and downs from where one is entering. What I would sort of think is a disordered or pathological state, really defined by the lack of the ability to move forward in one's life. Hmm. That is a normal up and down is, quote unquote normal because you can rebound from it because tomorrow is a better day or can be a better day or even if it's more prolonged. And one has something very sad happen. There's a loss in one's family or disappointment in one's life. I don't expect that to only take one day of sadness. But if it takes a few weeks or even a month or two, the fact that one can then ultimately rebound and point to positive steps one is taking to get back on track is all what I would consider part of the normal spectrum where it starts to take on the cast of illness is when things don't rebound or and often these two things go together. It turns into a vicious cycle. Imagine the situation where when somebody is feeling down because of, let's say, loss of a job and that doesn't lead to the ability to rely on one's friends or family or apply for new jobs or to think about one's career. All of those would be positive moves, but instead leads to one staying at home, drinking more heavily, not getting out of bed, becoming more and more depressed to the point that applying for a job becomes impossible. That's where we would start to think about about it being an illness. And I really throughout psychiatry, we think of illness as tied to loss of function. Function can sound like that, like a like a clinical term at times. But what really means is that people pursue the lives that they want to have, and if they feel like they can no longer do that at that point, we think getting some sort of professional intervention is worthwhile. As it relates to that great example. That's true for adolescents as well. Obviously, a teenager who doesn't want to go to school or becomes isolated from friends. But I'd like to explore with you what you mentioned a few weeks or a few months. At what point does a parent or a family unit begin to say, this is more serious, They're going to school, but they're not engaging? At what point does a parent begin to get concerned and need a professional opinion? Well, you're absolutely right to point to adolescence as one of the more complicated situations, because in some respects, adolescence is defined by ups and downs. There's no parent of an adolescent or no one who's ever been an adolescent who doesn't can't point to ways in which as part of normal, healthy adolescent function, there are ups and downs. And, of course, adolescence last years. So one could say, well, does that mean an extended period of years of being anxious or depressed could be, quote unquote, normal? And I think what I would answer is that adolescence does cause us to change our lens slightly, meaning a certain amount of volatility, a certain amount of amount of uncertainty, of exploration is absolutely normal, but it's in the service of healthy development, meaning for adolescents. Those ups and downs lead to a sense of a sense of this is what I'm learning, this is who I'm connecting with. And there's a return to relationships, a return to a quest for meaning and identity, which is in some sense the essence of development. If it's not leading to those things, if the turmoil of adolescence seems to be heading in the wrong direction, meaning greater isolation, less function, less of a sense of of purpose and self, then adolescence could easily be on the wrong track. And that's the point at which I would tell parents to intervene. I also try to suggest to parents that they need to trust their instincts. We were all adolescents. We've all seen adolescence. We have a sense of when things are tricky but going, okay. And when parents no longer feel that, they feel that they really have lost their relationship with their adolescent, that their adolescent isn't pursuing the things that would make him or her ultimately learn from their experiences, then I would encourage the parents to ask for help. I see as relatively little downside to that. Even if the if the answer was your adolescent boy or girl goes and sees a therapist for a couple of times, gets an assessment and they say, you know what, they seem to be doing okay to me, there's very little harm done. I would much rather people air on the side of asking for help than taking the risk of saying, Well, I don't want to overreact. I better not do anything. They'll be upset. And then and then unfortunately, not intervening before things get worse, Right? Well, there's certainly an impact to families with mental illness or any of these depressions or anxiety. There's impact to families. And I think what you're pointing out is that there is hope and there are opportunities. I wonder if you could talk a little bit about abuse and trauma and how that impacts mental health. This is part of the new Canine Abuse Prevention Partnership. So can you talk a little bit about the trauma and abuse and how that impacts mental health? Absolutely. You know, I think one of the things we've learned a lot more about over the last several decades is how universal in some respects in society, trauma is in a very tragic way, in a way that many of us or I would say most of us have never necessarily wanted to admit. And if you go back a certain number of decades when people not only didn't talk about mental illness, but they didn't talk about the rates of trauma in the world, even when it was it was one could look around and see war and famine and and really, I think, conclude that that what we can see was significant. So probably what we couldn't see was even worse. And I mean, sexual trauma, I mean, domestic or intimate partner violence. I mean child abuse, I mean elder abuse. I mean, things that were going on behind closed doors, presumably throughout most of human history. But weren't getting talked about. And I do think that there is a good step in recognizing it, but it's also a painful step because by acknowledging how common trauma is that now calls on us to do something about it. And, you know, certainly in the course of my career, I've seen the medical field take on way more responsibility for identifying trauma in our patients, in ourselves, in our families, and then coming up with systems that don't just paper that over, but actually intervene in ways that decrease the levels. So for me, the the the Abuse Alliance is so crucial in calling out that trauma doesn't only happen in other people's communities, it happens in every community. Now, let me add another piece to this, because I think this can sometimes be a reason that people avoid a conversation or maybe get a little stuck. Being a victim of abuse or trauma doesn't mean that you start it off with a mental illness. And there's a real danger, I think, in pathologizing victimhood, because then the danger becomes that somebody it actually gets turned around and the person who is the victim of trauma is now being blamed and said, well, it must have had something to do with your preexisting condition. Now, they might have had some preexisting condition, but that's not really relevant in many ways to the fact that the trauma that was done to them came after that. And then we certainly know that victims of trauma are more likely to subsequently develop symptoms because of the trauma that they experienced. So I say this because in many ways I want to separate what we need to do as a society in reducing the rates of abuse and trauma from the existence of underlying mental illness. In one case, it's very clear what we need to do. We need to set up systems to prevent that abuse from happening. In the other case, we need to take a wider view of all the different illness that is in society and some of that's in victims, some of that's in perpetrators, some of that's in neither. And get all of those people the appropriate care. So so I think these conversations are important to have, and I think we really need multiple systems to handle all these problems. And it goes a little bit to what you said as well. The stigma of mental illness is now trying to be mitigated. But I'm wondering, how is trauma defined? It's a great question. And in sometimes in my field, people even even separate trauma into two terms, trauma with a little T and trauma with a big T, I. I'm not sure we have to pass it quite that way today, but I would say that that trauma is really defined by the person experiencing what to them feels like a life threatening event. Okay. And truthfully, what an outside observer sees it to be is less important. What matters is the individual experiencing it. Because what is trauma as a child with trauma, as an adolescent was trauma as an adult may be different. And from an external point of view, one may look and say, Well, that wasn't life threatening or that was life threatening. And the truth is, it doesn't matter. What matters is what the individual, him or herself was experiencing. Which which is a great way to look at that. Because one of the things we want to talk a little bit about is how do you get to a point where you reach out if you believe it's trauma or some form of mental illness, as you're saying, you get stuck. How do you begin to reach out? Yeah, it's such an important question and it's such an individual answer, because if different individuals have different obstacles, obviously we wish if we lived in a society and if people that people felt always free as soon as a traumatic event occurred or there was even a risk of a traumatic event to speak up and say this happened to me and to be believed, heard and protected by the rest of society, that's where we want to get. What we know is that for many individuals, that's very hard to do and it's hard to do for a number of reasons. It can be hard to do because they're afraid for their safety that if they were to speak up, they're afraid it would make the trauma worse. That's that's a very common one and very, very scary because it can lead to cycles where one remains in a dangerous situation for a long time. One cannot speak up because one has been told whether it's by one's perpetrator or somebody else that they're at fault and that that they for whatever reason, that may sound completely illogical on the outside, is felt to be true to the individual that they somehow deserve to be treated in this way. A horrible thing to imagine. Yet it's something we hear from individuals who are traumatized. They can be helpless. They can feel like there's nothing anybody can do. The victim can sometimes feel dependent on the very same person who is is causing the trauma to them. And that can be dependency financially. It can be emotionally. People say, how could you ever love somebody who does this to you? But the truth is, we can and our minds work in very complicated ways. And you can both be have loving feelings towards someone who's also treating you really terribly. So all of these things in individual cases can lead to a person not speaking up. You mentioned stigma. That's universal. And again, it leads to a kind of self-criticism about about talking about things. To put it all together, though, what I would say is we need to meet people where they're at, and that means somebody. And whether that's a trained clinician or that somebody in a position of answering a hotline or being a facilitator of some kind needs to be able to hear where that person is and offer them the support that is appropriate to where they are. And sometimes that may just be listening and not asking them to do anything further. It may be giving them a phone number and having that phone number be something they can come back to when they're ready to call it. Not even necessarily call right away. It may mean they're further along and able to go and see somebody or change their situation or work with somebody who can who can help protect them. But but these are each defined stages and as helpers. Our job is not to judge, is not to decide for them what they need, but really to make resources available and to be ready to listen and hear what they need. And I think those are great strategies because, as you say, the idea that someone is struggling, there are options, but many people will reach out to someone, even the neighbor or a friend. And so the idea of listening and meeting them where they are and having resources available to them is one thing we can all do and be there for each other. A couple of questions as it relates to our communities and the idea that we obviously learn from our social learning comes from those around us. Can you talk a little bit about the value and the importance of just role modeling, great behavior, whether you're a parent, neighbor, a colleague, how important that is for our health and well-being and communities? Sure. I mean, listen, I think teachers probably can tell this more than anything, which is students learn by observing. That's what human beings do. We more so than what you say, more so than what's written on the page or on the blackboard or in the textbook. People, whether they're young or adolescent or or older, learn by observing people. And when you see behavior that inspires you, lift you up, shows vulnerability and strength, leadership, courage. All those things can be learned by observing. If we're lucky, we grow up in families where that's all around us, and that's what we're seeing. If we're unlucky, we may have one or more individuals in our family who don't demonstrate that, and we can learn the wrong messages. But fortunately, we don't only learn from our nuclear family. We can also learn from our neighbors, from our grandparents, for our aunts and uncles, from our clergyman, four of our teachers at school from a whole wide range. And when we think about how the human organism was designed, one of the great design elements is that children, adolescents and even adults are good at looking for the positive out there in the world. So there are remarkable situations and sometimes we read about them, you know, on the news or we hear about them in a biography of of individuals who may have grown up in very difficult circumstances and then find that individual in their lives, they could be from almost anywhere who inspires them. So it's not the total number, it's not even the proportion. It's can they find that adult out there who's really going to to be a role model for them? And I think that's true in terms of so much about being kind, about serving others, about finding meaning in one's life, and really about overcoming the challenges that come out of it. That's an inspirational thought in and of itself. A couple of questions as it relates to the the mental illness future. Is mental illness curable? I certainly believe and hope that we can dial back these recent increases, that we can shift the the trajectory that we've had over the last several years towards reducing the rates of mental illness and reducing some of the negative outcomes. Certainly substance use disorders, depression, anxiety, suicidality, etc.. Do I ever think we will eradicate mental illness from society? No, I think I think it is part of the human condition. But for individuals, I absolutely see that we can turn that corner and turn difficult experiences and even what I would call vulnerabilities into strengths. There's almost no vulnerability in the human character that doesn't also have an aspect of it, a flip side of it that contains a strength that takes work, that takes help from others, that takes being part of a community. It takes time. It certainly takes courage. But but I believe that the experience of the individual in doing that is maybe not technically a cure, but in some ways you might even say it's better than a cure because you're turning what was once very something very difficult or even something shameful into something one can be proud of and something one can certainly overcome. And that growth, that ability to see growth and improvement, if you will, or increased health can be very motivating for individuals to act. You've probably heard the old and I hope I don't get the the ethnicity wrong, but but I believe it's a it's a Japanese art form of taking a cracked pot and then repairing it and having it be more beautiful and stronger than it was before. And I think that that's very true about the human character. And I've met so many people in my career who have overcome very difficult things, including mental illness and substance use disorders, who are remarkable people and who in some way wouldn't go back and change what happened to them because it's made them who they are. And just as as you're saying, talking about those things, that people can get better, if you will, can look at their vulnerability and see some strength. And it is is so inspiring. Obviously, the kind of community behavioral health resources and the programs that have been promoted is certainly one avenue for people to take. It's particularly important now based on the fact that you've we've talked about the increase in mental illness and some of them on our abilities. Can you address a little bit about what is available in the behavioral health programs here? Sure. So first of all, I can't tell you how fortunate I feel I am as as a resident medical director of a psychiatric hospital and Silver Hill as an institution is to be in a community like New Canaan. If you go back in history, certainly 100 years or more, the norm was for psychiatric hospitals to be to be banished, to be out in in some very remote area with with often the stated wish of out of sight and out of mind. And to me, one of the inspirations 92 years ago when John Millett and then William Terhune and of Parsons coming to new came in to establish Silver Hill was the exact opposite. They said, We want to be part of a community. It was not a coincidence that they ended up just a couple of miles from the center of town in a community that was already thriving and known to be a welcoming place. They believe, and I still believe, that being part of a larger community is good for the work we do. It's good for the patients who come and live at Silver Hill, and it's good for the community because it to some extent exposes everybody to the aspect of human existence and encourages us to talk to one another. Now, over the years, I think that's gone a little up and down. There have been times when Silver Hill has been has felt a little more remote, but one of the privileges of my tenure over the last four and a half years has been to really reintroduce Silver Helton, who came in and who came into Silver Hill in in a way, COVID helped with that. But even if it hadn't been for COVID, it was something that I really believed in. So this is a bit of a long intro into saying that, you know, only a little over a year ago when the town of New Canaan, really led by Moynihan, a first selectman, and Bethany Zero, our director of Human services, as well as the director of our Community foundation or in Paterson and others, approached me and said we could do something together. I thought that was just a real extraordinary opportunity. And out of that, were those conversations. Sessions We did two things that are linked. One is we built a new Kate New Haven Behavioral Health Alliance, or might even say we reinvigorated because it had existed before. But a group of people who come together regularly from all the different agencies in town, and now we've included neighboring towns and Fairfield County. So we have folks coming from Wilton and from Ridgefield and from Westport and Weston and Darien, and people come together and talk about what we're all doing and how we can better coordinate our services. That's the larger organization. But more specifically within that, the Town of New came and designate some public funds from ARPA to support a a free assessment service to any member of the New Canaan community. Can call a number an easy number or go to a website and within 48 hours have a free and confidential assessment done by expert clinicians, including a psychiatrist who's also trained as a child and adolescent psychiatrist, as well as an expert social worker. And we've been doing those since July of 2022. We just recently crossed the 100 mark, and we're really proud that these very comprehensive, quick free assessments are supporting people's mental health. Our goal for the coming year, as we as we head towards year two, is to include other towns as well. You can continues to be a crucial support, but we have recently gotten a commitment from the town of Weston to join as well. We hope other towns will consider joining and we really see this as a model for a service that is going to make mental health assessment and treatment more accessible to more people. Clear away some of those old obstacles that you'd have to have a co-pay or a deductible or you'd have to wait a long time. We clear all those things away and say, Come and and let's figure out what's going on and let's figure out how we can be helpful to you. And it's obviously been very successful. Were you surprised by the success? I'm not I'm not surprised by the by the demand, because this is my job. Every day I talk to people, people call me and we hear about the difficulties what I'll say that I am delighted by surprise will probably be too strong a term, but delighted by is the warm and and open reception we've received from every different part of the decade in the community. And when I tell you that churches and synagogues and men's groups and women's groups and schools have all reached out to us, not with fear, not with we don't have that problem, but universally welcoming us in and saying, yeah, we need this. Even to the point of people standing up in meetings and saying, I wouldn't got an assessment and it was helpful to me, that blows me away because that suggests to me that this is a real community that is open for change and willing to have these tough conversations about what we need to do to move forward. And certainly, as we said at the beginning, talking about it, having open conversations is certainly one of the critical runways to having some real impact on this issue. So in closing, I wondered if there was just one lesson you would like to leave us with something that you think is a really important statement about mental illness, mental health and the well-being of our community? If I had to boil it down, and certainly certainly these are complex issues, so probably can't be easily, but if I had to boil it down, I would say that human beings are looking for meaning and connection. And the best way I know to get meaning and connection is to be part of a broader community. Communities have to be the right size. They can't be too enormous or one gets lost. They can't be too small or one gets just have enough options. And I believe that the New Canaan community is pretty much the perfect size to create a welcoming group of people who can disagree, can support each other, can keep things private, but can also share, and ultimately we can increase the sense of connection and meaning. So so that's good for all of us. And I think we have to work at it. It's not always easy, but it's a real privilege at Silver Hill to be part of such a great community. Well, and we thank you so much for all your work there and all the efforts that everyone on staff does at Silver Hill. And I think the idea that there are options that you can if you're struggling, there are options, you can reach out and seeing others who are struggling, you have options to provide that listening ear or offering a resource is is a good piece of information for all of us to keep in mind. So we want to thank you, Dr. Gerber, for your time and for all your efforts. And we look forward to hearing more about all the services available. Thanks so much for having me. And talking about it is a community production from New Canaan, Connecticut, created by the New Canaan Abuse Prevention Partnership. Deedee Bartlett, founder and produced by Robert Dorn. It is supported by the New Canaan Community Foundation and many other organizations. If you or someone you suspect is in crisis, call the National Domestic Violence Hotline at 100 7997233 or the suicide prevention hotline at one 800 2738255. The National Suicide Prevention Lifeline is available at 988. To learn more about the subject we discussed today and resources on all our podcast. Please visit our website at talking about it. Board. The series will be broadcast on YouTube talking about it Dawg Major podcast such as Spotify, Apple, Google or wherever you listen to your podcast. And on New Canaan Public Access Channel 79. We'll be back soon with a new episode of talking about it.