Holistic Psychiatry Podcast

Over the years, a number of practitioners have reached out, sometimes with specific questions, but more often to ask how they can learn more about root cause psychiatry. The amount of information can feel overwhelming:

* One condition, such as depression, can be caused by different roots.

* One root, such as copper overload, can cause a range of symptoms, including anxiety, hyperactivity, inattention, depression, and insomnia.

* One root, such as mold toxicity, can contribute to other roots, in fact, to almost all of them.

* A seemingly psychological root such as attachment disruption, trauma, or chronic stress, can lead to limbic and autonomic nervous system dysfunction, but also drive inflammation and high pyrroles.

Most people will have more than one root at play.

After thinking about what would have been a helpful starting place for me, I put together one page of what I see as the most common roots, each with a few of its more prominent symptoms and traits. Simply a place to start.

Though this was written for practitioners, anyone is welcome to download it.

Common Root Causes of Brain Symptoms Checklist

You’ll notice the checklist asks for your email. That’s because I’m creating a separate email list for practitioners, so I can send resources meant for clinical work without filling everyone’s inbox. This includes an upcoming free 4-week course for practitioners (described below). If you’re not a practitioner but interested in a potential course for individuals and families, you can share your interest here.

Coming soon for practitioners

On Monday, October 26, I’m starting a free 4-week pilot course for practitioners and those in training. We’ll go deeper into recognizing these roots and how they’re evaluated. You’ll find the invitation right after you download the checklist, but I’ll also share more here next week.

Until next time,

Courtney

Courtney Snyder MD is a holistic, functional, and environmental psychiatrist for children and adults. Find her at courtneysnydermd.com and on the Holistic Psychiatry Podcast on all major platforms.

Medical Disclaimer

This newsletter is for educational purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Consult your own physician for any medical issues you may be having.

If you’ve been working very hard to heal and still feel stuck, I made this episode for you. I also made it for practitioners who wonder whether they’re overwhelming some patients with too much information, too many protocols, and too many steps. I share my own story of perfectionism during my illness, who tends to be vulnerable to this pattern, how it affects the whole family, and the tools that help the body and mind feel safe enough to heal.

Chapters

* 01:56 My experience with perfectionism

* 04:28 Who is vulnerable?

* 06:46 The risks and benefits of research

* 10:51 The impacts on family, spouses, partners, and children

* 13:27 Practitioners can be perfectionistic too

* 14:57 Healing requires safety

* 17:24 What helps?

* 20:41 Advice for the practitioner

* 21:53 My own turning point

* 24:57 Resources

If you’d like to help get this information out into the world, please consider liking, sharing, or commenting.

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Until next time,CourtneyCourtney Snyder MD

Dr. Courtney Snyder MD is a holistic and functional child and adult psychiatrist and host of the Holistic Psychiatry Podcast and can be found at courtneysnydermd.com

Resources mentioned:

* High Sensitivity Through 3 Lenses: The Highly Sensitive Person, Pyrrole Disorder & RCCX Theory — https://www.courtneysnydermd.com/blog/high-sensitivity-hsp-pyrrole-disorder-rccx-theory

* Limbic System Dysfunction & What We Can Do About It — https://courtneysnydermd.substack.com/p/limbic-system-dysfunction-and-what

* The Vagus Nerve: Your New Ancient Best Friend — https://www.courtneysnydermd.com/blog/the-vagus-nerve-your-new-ancient-best-friend

* Complex Illness, Brain Symptoms & Paths to Healing with Neil Nathan, MD — https://www.courtneysnydermd.com/blog/complex-illness-brain-symptoms-paths-to-healing-with-neil-nathan-md

Medical Disclaimer

This podcast is for educational purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Consult your own physician for any medical issues you may be having.

In this episode, I have the pleasure of speaking with Dr. Neil Nathan about the intersection between brain symptoms and complex illness. Dr. Nathan has practiced medicine for over 50 years. He is one of the leading experts in complex chronic illness and mold toxicity — author of the bestselling Toxic: Heal Your Body from Mold Toxicity, Lyme Disease, Multiple Chemical Sensitivity, and Chronic Environmental Illness and The Sensitive Patient's Healing Guide.

I am grateful to call Dr. Nathan a mentor and colleague. His pioneering work has been responsible for my healing from chronic illness, as well as that of many patients I've treated. Together, we co-lead a small peer group (within the larger mentoring group he provides with Marie Matheson, ND), supporting practitioners who treat those with complex chronic illness.

In this episode we discuss:

03:43 – Dr. Nathan’s path to understanding complex illness11:20 – Why complex illness is rising and underrecognized19:30 – Why new medical ideas take decades to reach patients23:15 – Mold, Lyme, and long-COVID: the “big three” root causes25:58 – The limbic-vagal-mast cell “trifecta”30:31 – Are some people born more vulnerable?44:39 – The risk in “just do limbic retraining” advice

47:35 - Biochemical contributors49:26 – Structural root: jaw and cervical instability53:58 – Differentiating Between Mold, Lyme & Long-COVID58:49 – A message of hope, and where to learn more

Full Transcript below

You can find Dr. Nathan’s books, consultations and mentoring program through his website at neilnathanmd.com.

If you’d like to help get this information out into the world, please consider liking, sharing, or commenting.

Until next time,CourtneyCourtney Snyder MD

Dr. Courtney Snyder MD is a holistic and functional child and adult psychiatrist and host of the Holistic Psychiatry Podcast and can be found at courtneysnydermd.com

Medical Disclaimer

This podcast is for educational purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Consult your own physician for any medical issues you may be having.

Full Transcript

Dr. Nathan’s Path to Understanding Complex Illness

03:43

Courtney: I’m so glad we’re doing this, and I feel like it’s long overdue. As you know, in the mental health space in psychiatry, there’s a lot of recognition of a dysregulated nervous system, threat response in the body, but oftentimes that’s attributed to external forces or trauma, and not necessarily internal threats that we see, obviously, in complex chronic illness, which we’ll be talking about. There’s also not the recognition of the relationship between physical symptoms and brain-related symptoms. So I know you’re going to help us connect a lot of these dots. As we sort of just lay the groundwork for what complex chronic illness is — when in your path did you start to recognize the distinction, when was the beginning of your work and appreciation of complex health issues?

Neil: Okay, there are two answers to that question. First, when I went to medical school, my hope was to become a healer. And I was very disappointed that when I got there, I realized they weren’t going to teach me to be a healer. And back then I used to question my professors at medical school — why do you do it this way, and how is that? And I kept feeling in all of our interactions that we were missing something. And my professors would go, “Okay, Mr. Wise Guy, smart guy, what are we missing?” And I’d go, “I don’t know, I just know we’re missing something.” Later I would come to recognize that we were missing the emotional and spiritual component to whatever was affecting people in their illnesses. And I have language for it now — I didn’t then. The person in medical school who influenced me the most was Elisabeth Kübler-Ross, who I view as my main mentor in medical school. She, unlike anyone else, had a one-and-a-half-hour seminar once a week. Back then there weren’t video cameras — you were in a small confined room with a two-way mirror, and you’re sitting there watching someone do this. And she would simply interview one of her patients. She was a psychiatrist, but she was the only one in medical school who demonstrated how to really listen to people, how to really communicate with them, and not have this standard review of systems — here’s my questions, here’s your answers, and that’s what I do, and this is what I write up. She was really listening. She was trying to really take in, okay, what happened to you, and what’s going on with you? So I would want to give her credit as a role model to change how I learn to listen. Okay, that was step one.

I’m going to fast forward to the early 1980s. And I am, at that point, the medical director of a regional pain clinic. And we are starting to see a whole bunch of patients who had this complicated process of fatigue, unrefreshed sleep, irritable bowel syndrome, and pain migrating all over their body. And back then we called it fibrositis. Now we call this fibromyalgia. And so whenever medicine encounters a thing that they don’t know what they’re looking at, it’s psychological until proven otherwise. And people would get therapy, and they would take antidepressants and anti-anxiety agents. Didn’t help much. And so it became clear to me that we didn’t understand what this was at all. It was not psychological. Something was going on in their bodies — now I recognize it as an inflammatory process. Back then there was no concept of that at all. And then, slowly, in the early nineties, we began to find pieces of the puzzle to understand what was triggering fibromyalgia. I was working back then with Jacob Teitelbaum, who did a lot of work with chronic fatigue and fibromyalgia, and we both independently came up with an understanding that a deficiency of magnesium, DHEA, adrenal issues, thyroid issues, sex hormone deficiencies, GI dysbiosis, and food allergy — if we looked at those and treated those, the majority of people with fibromyalgia got cured. It was different for different patients. It was not like there was one thing that caused it. And as time evolved, we began to realize that there was lots of other biochemical imbalances in the body that would contribute to this kind of a process that represented chronic fatigue and fibromyalgia.

We discovered that Lyme disease and coinfections was a huge piece of that. And later still we discovered that mold toxicity was a huge piece of that. And so my understanding of the complexity — and it’s not really confined to chronic fatigue and fibromyalgia at this point, we’re really talking about almost all chronic illness — with a huge psychological component to that. So we’ve begun to understand this as essentially some version of inflammation. And if we start to really dig into what are the potential causes of that inflammation, we can make a huge impact for them. So this is a multi-year evolving understanding of how a person’s genetics, biochemistry, physiology impacts their whole being in every way. And that inflammation extends to the nervous system, contributing greatly, if not causing directly, a large number of what are now called psychiatric diagnoses.

Courtney: Right. So even among those patients that you were seeing — you were seeing, I’m assuming, depression, anxiety, brain fog?

Neil: Yeah, the vast majority of our patients with mold toxicity have brain fog and anxiety, depression, OCD behaviors, mood swings, depersonalization, derealization. I mean, all of that is super common in our patients.

Complex Illness Is Rising — and Underrecognized

11:20

Courtney: Do you feel like this is more recognized now — or do you feel like the number of people being hit with these complex health issues is increasing — or both?

Neil: Both. I would love to say that the medical profession is increasingly recognizing all of this as important, but that recognition is coming very, very slowly. The majority of folks out there, if they were to list the symptoms that they had, their doctors would basically look at them like, “I have no idea what’s causing it, so this must be in your head.” And that is the message they’re getting from their physicians at this point. So many patients are being gaslighted, so many patients are being told it’s in your head. And the repercussions of that are the family is hearing that same message, and the families become less supportive of those people, because they’re saying, “This is not real, so why would I support you? This is still in your head, go get your head fixed.” And they’re wrong, and it’s really a travesty. But so yes, very slowly, this awareness is growing. There are now more medical meetings that I’m aware of where psychiatrists can learn more about this than there were ten, fifteen years ago, for sure. But not enough — it’s still not enough.

The other part of that is some of the main triggers for this inflammatory process are increasing. So we’re seeing more and more mold toxicity, we’re seeing more and more Lyme and coinfections, partly because the environment that we are all exposed to has gotten extremely increasingly toxic. So it’s now known, for example, that there are 350,000 new chemicals in our environment than existed 70 years ago. The vast majority of those have never been tested for safety in human beings. So human beings have a tremendous amount of chemical exposure that they never had before. Human beings have a tremendous amount of EMF, electromagnetic exposures that they never had before in the history of the human race. So these exposures are cumulative. Our major organs, like our liver and our kidney, that have to deal with toxicity, are overloaded. And so, yes, we are seeing an epidemic of a whole bunch of these conditions. In children, we are aware that autism has skyrocketed — it went from one in several thousand kids to one in thirty kids in many states now have autism. And forgive me, but the pediatric profession is not taking this seriously. It’s like, “Yeah, that’s sad, it’s unfortunate.” It’s like — really, you don’t want to look at this? This means one in every three kids born are getting autism — does that not concern you? But, forgive me, the medical profession is very slow to embrace new information, and that is really to the detriment.

We’re seeing an epidemic of Alzheimer’s, Parkinson’s, ALS, all of which involve neuroinflammation. We’ve seen already an epidemic of chronic fatigue and fibromyalgia. And all of these things are interrelated, because — yes, I’m supposed to be an expert on mold toxicity, and I probably am — but mold toxicity doesn’t exist in a vacuum. You have mold toxicity as one of multiple environmental toxins we’re being exposed to. It is simply one of the most common, the easiest one to diagnose, because we have tests for it. We don’t have tests for the hundreds of thousands of chemicals out there. We’re just beginning to be able to have some tests that will tell us what’s in someone’s body that might be making them sick.

Courtney: Right, right. And I would imagine that this typical medical model of looking for one cause to autism, one cause to dementia — it’s a completely different way of thinking. When you get away from that and you look at complexity of the human body, that way of thinking holds back the research, it holds back any progress.

Neil: What I think is helpful for people to look at is: we are all uniquely, biochemically, genetically different. And so the same inflammation in one person could trigger cardiovascular disease, and another person could trigger Alzheimer’s, and another person could trigger chronic fatigue. So we need to take a step back and go, okay — and this is not a brand new idea. For the last ten years, there are many papers in the medical journals that are saying chronic illness is almost certainly an inflammatory process. Now, it hasn’t really integrated into what people are being taught in medical school or in their residency program. But this is not a brand new idea, and there’s tons of medical research documenting that.

What behooves us as physicians is to look at every human being and go, “Okay, this is your named chronic condition — what are the triggers for you?” We have to kind of be like a medical detective and dig in and go, okay, what’s triggering your inflammation, so I can treat the cause — not put a band-aid on it, which is, forgive me, in the psychiatric field, taking antidepressants and benzodiazepines. That’s a band-aid. It’s a helpful band-aid, it could be a very important band-aid, help someone to function. But you really need to be looking at, okay, I have this great band-aid, but wouldn’t it be nice to actually cure this? And I think that would be, for me, to your audience, Courtney, my take-home message — which is always look for the root cause, because it is possible that we will find that root cause, and you won’t have whatever name you’ve been given, depression, anxiety, OCD, for the rest of your earthly life. Maybe.

And I’ve treated thousands of people successfully here. So this is not — I’ve had one or two successes here — we’re talking thousands of people that have responded to this way of practicing medicine, with fabulous results. People who’ve been literally bedridden, incapacitated by their illness, are now out there working again and being with their family and living full lives. So that’s the take-home message.

Courtney: Right. Which makes it so satisfying to treat. And I mean, I can speak to that, having experienced it personally. But at the same time, you do get pushback from other areas of medicine that don’t give it necessarily credibility, even though people, on the other side, are thriving and healing, and it’s really amazing.

New Medical Ideas & Research Take Decades to Reach Patients

19:30

Neil: You know, the history of all science, including medicine, is: new technology, new drugs are fast-tracked to get into our lives. Ideas, not so much. Typically it takes a generation — twenty, twenty-five years — for a new idea to come into acceptance. And the first reaction of any science, medicine included, is to get into denial, which is, “There isn’t enough data to support this concept, and I can’t be perceived as practicing bad medicine by embracing a concept that isn’t proven yet.” But that means that all of their patients are going to have to wait twenty years — until suffering — until that person goes, “Now there’s enough evidence, now I can learn how to do this, and now I’ll begin to help you.” I’m not wired that way. I’m wired that if I have a suffering person, and I have something that I can offer them that might help, I’m going to try it. I’m going to do it in the safest way I know how, but I can’t leave someone dangling for twenty years and say, “I’m sorry, I have to wait until my profession figures out what to do.” That’s not me.

I worked at the medical school at the University of Minnesota Duluth for eleven years. And I was not only on the faculty, but I was on the committee that determined what new information was put into the curriculum. For example, AIDS was just coming into vogue at that particular point, and it was obvious that we needed to have courses on AIDS for the medical students, because this was big. What a lot of people wouldn’t understand is that each department in a medical school fiercely guards its time allotment. Everyone gets a certain number of hours, and they’re not open to adding new things or giving up any of their time slots for anything new. And so what I would watch is, as new information came into the medical school, each department fiercely refused to add any new lectures in their department, or give up any of the time that they had to anybody else to add that information. So we’re talking about university politics now — this is not even medicine, this is people guarding their turf. And I don’t even think that would occur to any consumers, that that would happen like that — well, certainly, why would that happen in a medical school? Well, it’s because human beings are responsible for each department, and they guard their own turf. So it’s a kind of an insidious process about how new information isn’t embraced by the profession, to go into the medical school curriculum.

Mold, Lyme, and Long-COVID: The “Big Three”

23:15

Courtney: I want to come back to what you were saying about inflammation being at the core of chronic illness and complex chronic illness. And when it comes to complex chronic illness, whether it’s SIRS or mast cell activation from mold or Lyme, we talk about multiple systems being affected — the central nervous system, gastrointestinal tract, endocrine, skin, just you name it. If the inflammation then is from a source of oxidative stress or a major insult — would you say that mold toxicity is the most common, or would you put Lyme or now even COVID on a par with that, as far as the deepest roots causing the inflammation? Not that the chemicals, metals, and everything else we’re being exposed to aren’t at play.

Neil: In my experience, those three are the biggies — mold toxicity, Lyme with its co-infections, and long-haul COVID. Those are the three most common. Of those, in my experience, mold is the most common, and the one that has to be treated first if you have some or all of them. So, for example, in people who have long-haul COVID or Lyme, often their body will not respond to that treatment optimally until you first get the mold out. So there’s a little hierarchy of what we do, in what order. And then within that hierarchy, there’s also an order in which we do things for people to respond optimally. So, for example, mold toxicity will trigger — and Lyme and Bartonella will do the same thing — limbic dysfunction, vagal nerve dysfunction, and mast cell activation in most of our patients. Not all, but in most. And the longer they have it, the more likely those things are going to get triggered. Once somebody does not feel safe — and the systems that we have in our body to monitor that safety and to keep us safe are the limbic system, the vagal system, and mast cell activation — we have to get the body safer, or it will not be able to take what you need to take to treat mold or Lyme or long-haul COVID. People will literally shut down — their limbic system will essentially go, “Mm, I see what you’re trying to do there, and I can’t let you do it, because I’m not sure that’s safe.” And it will literally not allow people to do it.

The Limbic-Vagal-Mast Cell “Trifecta”

25:58

Courtney: So with one of those, or a combination of those, on board, these threat mechanisms would be kicked up — mast cell activation, limbic system dysfunction, autonomic nervous system dysfunction. If they look similar, or a timeline isn’t easily helping parse out what might be primary, how able do you feel to make the distinction — versus if mold is present, starting there?

Neil: If we look at our patient’s symptoms, they will point us clearly to whether there’s a limbic or vagal or mast cell piece, to be specific. The limbic system’s job involves primarily monitoring and regulating and keeping emotion and sensitivity in check. So any symptoms that involve those two things are limbic almost by definition. So on the sensitivity side, if someone describes an increased sensitivity to light, sound, touch, smell, chemicals, EMFs, food — they’re already telling me my limbic system is dysfunctional. In some ways it doesn’t matter what the cause is; if someone has this increased sensitivity, regardless of the cause, I know we have to treat their limbic system first.

On the vagal side, the symptoms would primarily run into symptoms that involve the autonomic nervous system, which would involve things like temperature dysregulation, palpitations, insomnia, POTS, blood pressure dysregulation, or symptoms that involve the gastrointestinal tract, because the vagus nerve controls almost the entire intestinal tract. So any GI symptoms — gas, bloating, distension, reflux, diarrhea, constipation, abdominal pain — again, that would lead me to go, the vagus is involved here. So by listening to my patient’s symptoms, I can immediately know what’s dysregulated here, and what my first treatment arm will be — to get the limbic and vagal systems back up and running again at a safer level, because otherwise our patients aren’t going anywhere. They can do binders and antifungals and antibiotics for Lyme, and they will get worse. Their body will basically go, “I know I might need that, but why are you doing that? I can’t even get to a place of safety to respond. I’m on self-preservation mode here.”

And in the mast cell category — again, all of the same symptoms that could be mold or Lyme or long-haul COVID could also be mast cell. Again, it’s a multi-systemic process. A tip-off, which I find very helpful, is if someone describes a symptom that comes on immediately after eating, sometimes while eating. Nothing causes that kind of reaction that fast except mast cell activation. Allergy — and most people, if they do have some symptom that comes after eating, they’re going to be thinking, “It must be what I ate, what did I just eat?” But it’s not food allergy, it’s mast cell activation. In that context, many of our patients have already observed that they can eat a particular food one day and have a very strong reaction, and the next day, same food, nothing. And they’ll go, “That doesn’t make sense — if this was allergy, I ought to react the same way every time.” And so that is classical mast cell activation, which fluctuates. So — for the first part of your question — that’s what I’m looking for. When I take a history, when I talk with patients, I’m going to really dig into: are they already manifesting symptoms that clearly tell me what we need to do first, to get them safer, so that now they can respond properly to the treatment that will really get at their root cause.

Are Some People Born More Vulnerable?

30:31

Courtney: I know you take deep timelines when you meet with someone, so you’re really accounting for a lot. But one of the things that I think about a lot is: who is most vulnerable? Do some of us come into the world already with a vulnerability similar to Elaine Aron’s highly sensitive person model? And then maybe there’s trauma, early attachment disruption — and already vulnerabilities — but then the toxic load that we’re all experiencing. But then something like mold or Lyme then hits. And then, all the years and all the patients you’ve seen — I’m curious how many you feel already had sort of a vulnerability. Not that they ever had to really become sick necessarily, but already had a vulnerability.

Neil: Honestly, I would say most. Our limbic system evolves from the time we were in our mother’s uterus, so that almost no one has had a perfect childhood. And so whatever someone has had to deal with in childhood — it could be recurrent ear infections or throat infections, or it could be a surgical procedure, or it could be parents, both of whom worked and they didn’t get enough time, or they could be abusive parents, sexually, physically, verbally abusive — whatever someone has been exposed to, that forces their limbic system to have to deal with it. Because that’s the job of the limbic system, is to keep you safe. So your limbic system is basically going, “Okay, I’m just a little thing here, what do I need to do to cope with this?” And so their limbic system slowly, inexorably, becomes more and more hypervigilant to protect them. Let’s say someone had an alcoholic parent, and they would come home, and you were never sure what their status would be — and so you’d kind of hold yourself back from that, which is, “I’ve got to see what this person is showing me, is it safe for me to come up and give them a hug, or do I want to hang out in my room for a bit until whatever this is settles down?” That’s the beginning of this limbic hypervigilance process. And then it just goes on through life. So that if you’ve had difficult relationships, or surgeries, or severe infections, or anything in the physical or emotional or spiritual plane, a betrayal of some type — the limbic system becomes slowly more and more and more hypervigilant, when the straw hits the camel’s back. And that straw could be COVID, or Lyme, or mold toxicity, or another infection of some type — that’s the straw that breaks the camel’s back. At that point the limbic system goes into shutdown, which — we know the vagal system goes into shutdown, literally, that’s something the vagal system is trained to do. It’s “okay, we are so unsafe that I’m shutting down my systems here.” And so that predisposes to illness. But I want to tie that back to inflammation, which — a lot of people don’t understand that the vagus nerve, for example, controls inflammation in the body also. There are branches of the vagus that go to the spleen, to the gut-associated lymphoid tissue, and to the thymus, all of which are major immune organs. And if the vagus is dysfunctional, inflammation can rage out of control. So again, this comes back to understanding this complexity of inflammation, and how we need to both understand it and know where it is we want to look to get at that inflammation. So there is a profound interconnected limbic-vagal-mast cell piece. Each totally connects to the other. There’s an interaction between the thousand biochemical mediators that mast cells make and the nervous system itself. So I call this interconnection the trifecta, which is: you can’t just treat the limbic system in a vacuum, because if you’re not also looking at the vagal and mast cell system, your treatment may be a little bit helpful, or it might not even work at all, until you combine all three — so that you really understand this is a package deal here, in terms of how we work with it.

There was one more piece I wanted to add, Courtney, to understanding the inflammation piece: whether or not someone gets mold toxicity or Lyme or COVID depends on how robust their immune system is. So you could have a family living in a moldy environment — one person is really sick, several are a little bit sick, and one is not sick at all. And the one who’s not sick at all can easily go, “I’m not sure what’s wrong with you all, but I’m fine in this environment, it can’t be my environment because I’m fine.” And what they’re not understanding is: yes, they are fine, as long as their immune system stays robust. For the others, they were at risk for all of these conditions because their immune system took a hit. And for many people who were living in a moldy environment, during COVID, for example, when we isolated and people were spending twenty-four hours in their home rather than the eight hours out, they were many now being exposed to more mold at home than they were before. I don’t think people began to think about that or look at that. So in that environment, whether or not they were affected depends on the hit they took. Now, the things that will hit an immune system to weaken it, and allow whatever’s there to manifest, are: COVID was a biggie, any severe infection, a surgical procedure, childbirth, menopause, or any emotional upheaval will weaken that immune system, and then the immune system loses containment, and now we are off to the races. So what I try to convince people who are living in a moldy environment who are well is that they’re living with a ticking time bomb. Should they take an immune hit, they will be just as sick as their family member who they’re kind of lording it over, which is, “I’m not sick, what’s wrong with you?” You’ll be right there yourself if you take that hit — to try to help them understand, yeah, you’re okay for now, but once your immune system weakens. So I’m trying to tie together the immune system, its ability to regulate inflammation, and this whole process here.

Courtney: Right, right. Which I guess is why we call it complex, complex illness.

Neil: It is the way human beings are. We’re not making up a new word of complex illness — illness was always complex. We’re just beginning to understand how complex it always has been.

The Limits of Treating Symptoms Alone

44:39

Courtney: Right, so there’s communities out there addressing mast cell activation. There’s communities out there addressing POTS and dysautonomia. Communities out there addressing OCD and more obvious limbic-type issues. And then there’s the whole mental health field. And the dots aren’t getting connected. I mean, I’ve yet to see someone with OCD — I think it’s like eighty to ninety-five percent have mold toxicity as part of the picture.

Neil: You know, an example — and I won’t name names — is there’s an eminent pediatric physician who is very well known for his work in autism, who thought he was ADD his whole life until he recognized that he had mold toxicity and started taking antifungals, and all of a sudden his brain went online and he doesn’t have it anymore. So that’s just a very clear example of what you’re talking about. And what we are talking about is: it’s absolutely essential that all people who work in the medical field, all healthcare providers, embrace this complexity, because if you’re only working on a piece of it, you will help some people to a certain extent, but you will not help people optimally. I mean, that is the absolute bottom line.

The understanding that mast cell activation was huge came in 2016, when Larry Afrin wrote his book, Never Bet Against Occam. It was a huge game changer. When I read his book, it was like, “My goodness, I’ve been missing this in my patients.” And the whole world embraced this information, so that every medical center in the country now has a mast cell activation clinic. However, they’re looking at it as a single thing with a label to it, and they’re treating it just that way. They have not recognized that if they don’t add limbic and vagal work to it, their treatment is not going to be adequate. And so, yes, they’re helping people, but absolutely not optimally. And to make it worse, very few of those clinics have recognized that what’s causing mast cell activation, which absolutely needs to be treated, is mold toxicity and Lyme. So people go to these clinics and get a certain amount of help, but they’re not being treated comprehensively, which is a pet peeve of mine — which is, come on, if you’re going to have a clinic, understand the whole interactions of whatever name it is you’re working with. If you’re going to be an ENT specialist, understand everything that impacts that area. If you’re going to be a cardiologist, understand everything that impacts it. And we just don’t see that. We see people kind of in their little box — “No, no, I’ve learned this, this is what I do, this is how I work” — and it’s just unfortunate that they’re not looking at the bigger picture.

Courtney: Right, I think add to that PANS and PANDAS, because in psychiatry, people feel like they’re deep diving because they’re getting to PANS and PANDAS. It’s like, okay, you’ve got to go deeper than that, because even those conferences, they talk about the need for treating relapse, and it’s just going to keep reoccurring.

Neil: I mean, they’re using IVIG to help. That’s nice, but they’re not getting to cause. And we know when PANS and PANDAS first emerged on the scene, it was all about strep, and that was the focus for a long time. But as time emerged, it was very clear that this was a neurological inflammation triggered — here we go, broken record — Lyme, mold, other infectious agents had to be looked for. And if we treated those, you could cure PANS. It wasn’t something that needed IVIG for the rest of your earthly life.

Courtney: Even among those, would you say very often mold is underlying the mycoplasma, the candida?

Neil: I think mold is one of the most missed components to illness that I can think of. If I have a goal in life, it would be to raise the consciousness of our profession as to the importance of mold toxicity, how common it is. We’re talking millions and millions of people who are not diagnosed, because their doctors don’t know about it, and therefore are not making the diagnosis. I’d love to see the consciousness get to the point that someone would present with these complicated stories and a doctor would say, “Why don’t we think about mold toxicity?” That would be the most important thing I would have done in my career.

Courtney: Yeah, well, you’re certainly raising awareness.

Neil: I’m working — it is slow. As we said, I’m working on a twenty-year generational issue here.

Courtney: You’ve mentioned that the underlying source needs to be addressed, but the nervous system and immune systems need to be addressed. So one of the things that comes up with limbic system retraining is: I’ve had people hear the message that if they just address their limbic and autonomic nervous system, then they wouldn’t need to address what I see as an ongoing threat, such as a mold toxin. So I’m hoping you can speak to that, and the importance of these programs, despite that.

Neil: Sure. A couple of the better-known limbic retraining programs, the coaches get a little bit zealous about — “limbic retraining is so important, this is all you need to do alone, don’t even do anything else, just do limbic retraining.” And I suspect that there are a handful, very few, but a handful of people who’ve gotten well just doing limbic retraining. If, for example, if you had mold toxicity, if it was relatively new, if you had not colonized, and you moved out of your mold exposure soon, it is possible that the limbic retraining would help reboot it to the point that your immune system rebooted itself and you’d be fine. I believe there are a few people like that. The vast majority of people who have limbic dysfunction — you need to do limbic retraining and vagal retraining. You may also need to do mast cell retraining, and please look for the cause of that. Those are downstream effects, those are not named diagnoses that you treat alone and it fixes it. Please look for at least mold and Lyme, which are the two most common things that are triggering this at this point. And people are getting the wrong message if they think they need to do it in a vacuum. To make it worse, they’re being told, “No, no, just do limbic retraining, that’s all you need.” And the truth is, no, you need to combine limbic retraining and vagal rebooting and mast cell activation most of the time. And of course you’ve got to get back to cause.

Courtney: Right, I mean I try to liken it to — if they were in an abusive relationship or toxic relationship, they wouldn’t just limbic-system their way out of that, if there was an external threat.

Biochemical Contributors

47:35

Neil: No, you’ve got to fix what’s primary here. I want to add to this discussion — we’re focusing on inflammation from toxins and infections, but there are also other biochemical issues, some of them downstream, that need to be looked for and addressed in order for people to recover completely. So, for example, Lyme and mold will trigger kryptopyrrole issues, or imbalances in the ratio between zinc and copper, or they’ll trigger methylation issues super commonly. And I just wanted to expand this discussion — I know it’s complicated enough, but I don’t want to oversimplify it either — that there are other biochemical things that we want to be looking for, because they’re treatable, and they will help people to heal faster, if we’re also addressing methylation, the need for zinc, the need for magnesium or B6 — those are common components of this whole process here. And so I just want to kind of tie that all together for a moment.

Courtney: No, I’m glad you did, because those are topics that I talk about here, so it’s important to connect those. The other thing I see, because I integrate the Walsh approaches with treating people that have complex health issues, is zinc seems so amazing when it comes to mast cell activation — making sure that’s optimized. As well as connective tissue — and that was something else I wanted to ask you about — is structural issues that can be impacting the autonomic nervous system. I just see a lot of people — I inquire about it because I had it myself — but who have upper cervical instability as part of this whole picture.

Structural Contributors

49:26

Neil: Again, all of these things are interrelated, and the physical structure can prevent people from moving forward in several different ways. One is the structure of the jaw and the face — the body puts a priority on teeth occluding properly. And if the teeth don’t meet just quite right, and the jaw is a little bit out of structure, people often talk about TMJ — the body basically freaks out, it goes into sympathetic overdrive. And for some patients — it’s not common, but I’ve seen several dozen — where the jaw had to be realigned by a combination of dentists specially trained in this work, working with osteopathic physicians, to realign the jaw. Often in those patients, they couldn’t respond to the limbic and vagal treatment until their jaw got realigned.

Same thing is true with what you’re talking about, as cervical cranial instability, which is basically a weakening of the ligaments at the base of the skull, where it attaches to the first cervical vertebra. Now, these are all again intertwined — for example, it begs the question of what weakens those ligaments. And the answer is: if you have mast cell activation, some of the materials that the mast cell makes weakens the ligaments. So the ligaments get weak, and where the skull attaches to the first cervical vertebra, instead of being pulled apart, like ligaments do, it collapses. And that influences the blood flow to the brain, the nerve flow to the brain. And again, the body recognizes that as a priority, and often you can’t get that better — you can’t get limbic and vagal response until that gets fixed.

So there are a bunch of structural issues that also need to be looked at, when people become overly sensitive and are not responding properly. And there’s more in that area. So, for example, there’s a chapter by Tasha Turzo, who’s an expert on the jaw structure. There’s a chapter in there by Andy Maxwell on cervical cranial instability. So that book would give people a really good overview of how complicated things are, and they might, chapter by chapter, get a clue of, “I haven’t looked at this piece yet.” I mean, we haven’t talked about oxalate or salicylate imbalances, which can add to that. So I just think that is a resource for folks that could really help them understand how they’ve gotten where they are, and understand the path out.

Courtney: Right, right, because not everyone has all of these areas, but certainly could be held back or have a unique something that they could be getting relief from early on in the process. So I think it’s both, to the degree that people are able to learn, and your book Toxic, too — it’s like an encyclopedia, even if someone doesn’t read straight through it, they can go to the mast cell section, or they can go to the Bartonella section.

Neil: It was intended to be a readable way to understand this complexity, because it basically will talk about almost everything we’ve talked about today, and help people to get better understanding. I mean, we’ve talked about the bigger picture today. We didn’t talk about, okay, how do you diagnose Lyme, how do you diagnose mold toxicity, how do you diagnose long-haul COVID, and most important, because this is very complicated, how do you decide which of those is the biggest player that you want to address first?

Distinguishing Between Mold, Lyme & Long-COVID

53:58

Courtney: Right, I have shared resources on diagnosing mold toxicity. Would you comment on your last point — how do you recognize, are you using specific testing that you want to reference, the RealTime?

Neil: I do. But I would emphasize, we’re taught in medical school that if you really listen to patients, ninety-five percent of the time you will make the diagnosis by history alone. And I don’t want to get too focused on testing, because listening to the patient and having them describe in detail what they’re going through will really give you the little pieces you need to tease it apart to a certain degree. That’s only possible to a certain degree, because there’s a huge overlap between the symptoms of Lyme and Bartonella and mold and long-haul COVID and mast cell activation. Huge overlap. So there’s little teeny pieces that will tend to lean more in one way than another. And honestly, that’s what’s required from all of us, literally years of study, to really get a handle on — someone will say something, okay, that’s much more of a mold symptom than it is a Lyme symptom, something else. So I do encourage people, if they think they might have mold, to get a urine mycotoxin test. That has revolutionized our ability to make these diagnoses.

Courtney: Would you still set RealTime as the preferred? That’s what I’ve communicated to this audience.

Neil: I would. Any test can help make the diagnosis, but for follow-up testing, the only one that’s been really consistent is RealTime. And you want a follow-up test, so you want to know what your baseline starting is, and then you want to know, okay, am I getting these toxins out of my body? From my perspective, you know that you’re done treating it when that RealTime comes back reading not present in every category. We have better tests now for Lyme than we’ve had in the past. Years ago, our tests were inadequate to say the least. And the CDC recognized years ago that the tests were so inadequate that it was basically a diagnosis made by a physician by examining all of the history and information that you had. That was enough — you didn’t need a lab report to make the diagnosis of Lyme disease. A new test that I’m particularly fond of is Bruce Patterson’s fourteen-panel cytokine test. This is a test that measures cytokines, which are the molecules of inflammation — cytokines are made by your immune system to deal with, or fight, different inflammational causes. And so what Dr. Patterson has discovered is there’s a pattern of cytokines that we see with long-haul COVID, which is different than the pattern we see for Lyme. And I’m working with him now on the pattern for mold. So we can literally look at that test and look at, okay, what is inflaming this person primarily now, because I’m looking at that inflammational pattern, and I can literally read that. Some of my patients will have all of those on a particular test, or only one, but it really helps tease apart what is — I call it public enemy number one for my patient, what do I need to address as root cause right now. So our science is improving as we go here.

A Message of Hope — and Where to Learn More

58:49

Courtney: And that’s huge. Before we go — I think all of your books, but I’m thinking specifically about Toxic and The Sensitive Patient — all the information you generously share gives people a lot of hope who’ve been struggling out there. And I think your mentoring and teaching so many of us helps extend some of that reach. Is there anything you’d want to convey to people out there in the throes of chronic illness who are feeling hopeless and not getting the feedback from their doctors that this is something they can get beyond?

Neil: Sure. My take-home message is always: everything we talked about today is treatable. Is there hope in there? You bet there is. But if you are not getting the help you need from whoever you are seeing, find someone who understands these things. For example, I do have on my website a list of physicians that I’ve trained over the years that I’m comfortable that they really know what they’re doing — it’s a growing list. There’s someone like Courtney, who’s been trained for years to do this, she’s good at it. Find someone who knows what they’re talking about, so that you can get someone who does embrace this complexity, and will look at it in its entirety, and then get you moving in the right direction, doing the right things in the right order. To me, this can be done. I mean, I have personally helped to cure four or five thousand people with mold toxicity, and an equal number of people with Lyme disease. So we can help the vast majority of people that we’re seeing. So, regardless of how long you’ve been sick, if you haven’t been properly diagnosed and you haven’t gotten the right treatment, you can be helped.

Courtney: Right, right, that’s great. And for physicians out there who are interested in learning more about complex chronic illness — are there resources you would point to? I’ll be sharing your books, because I think those are great references — but also how people can find what you’re doing currently.

Neil: Sure, my books — particularly with this discussion, Toxic and The Sensitive Patient’s Healing Guide would be the two most appropriate. I would add that I have just finished writing a book on this whole subject of inflammation. It’s currently being edited, I hope it’ll be out by early next year. So if you stay tuned to my website, I’ll let people know when that’s going to be available. And I think, Courtney, what you’re referring to is: I do have a mentorship program for healthcare providers. We now have three hundred and fifty-plus people in the mentorship program, it keeps growing. You were in one of the first groups — we started with eight, and then people kept wanting to get in on it. So we welcome people to join. If you go to my website, which is simply neilnathanmd.com, there’s a whole thing which talks about the mentorship and how to sign up for it. So I certainly welcome people who want to learn more.

Courtney: And then you offer consultations and professional consultations also?

Neil: I do. My consultations — I am, at this point, since I’m semi-retired, not seeing people directly. But I do offer consultations with a patient and their primary treating physician — so we all get on a Zoom together, and we will go over the details of that person’s history and their lab work, and I will help outline a treatment program that looks to me like it will get people well. And actually, Courtney, I actually do a lot of that — I’m not really retired, my wife will tell you. I stay pretty busy. I love helping people. I love being able to take this complicated information and tease it apart, so that I can help people to understand what they need to do, in what order, in order to get better.

Courtney: And we’re all grateful — grateful that you’ve followed your path, because so many people have benefited personally and professionally. So thank you for bringing your wisdom and expertise, really appreciate it.

Neil: You’re very welcome, happy to do that.

You can find Dr. Nathan’s information, consultations, and mentoring program through his website at neilnathanmd.com.

If you’d like to help get this information out into the world, please consider liking, sharing, or commenting.

Until next time,CourtneyCourtney Snyder MD

Dr. Courtney Snyder MD is a holistic, functional, and environmental psychiatrist for children and adults. Find her at courtneysnydermd.com and on the Holistic Psychiatry Podcast on all major platforms.

Medical Disclaimer

This podcast is for educational purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Consult your own physician for any medical issues you may be having.

In this episode, I have the pleasure of speaking with Andy Mort. I think you will appreciate his wisdom, poetic way with words and sense of humor. Andy is a UK-based songwriter and musician whose work as a creativity coach explores the intersection of high sensitivity, creativity, and the influence of culture.

Aside from sharing some of our own experiences with high sensitivity and gentle rebellion, we discuss various ways those of us with high sensitivity (as described by Elaine Aaron) might better align with our nature. We also discuss:

* 00:00 — High Sensitivity and Its Misconceptions

* 01:54 — The Concept of Differential Susceptibility and Environmental Impact

* 03:47 — Andy Mort’s Journey Into Understanding Temperament and Sensitivity

* 07:05 — The Discovery of the Highly Sensitive Person Trait and Its Biological Roots

* 09:58 — The Idea of Being a Gentle Rebel and Leading With Authenticity

* 14:51 — The Importance of Creating Supportive Environments for Sensitive People

* 19:47 — Creativity as a Form of Self-Expression and Nervous System Regulation

* 25:07 — The Role of Sensitivity in Leadership and Group Dynamics

* 29:58 — The Challenges and Opportunities of Sharing Creative Work

* 34:46 — The Societal Narratives Around Sensitivity and Self-Acceptance

* 39:57 — The Importance of Community and Support for Sensitive Individuals

* 45:06 — The Concept of Gentle Rebellion and Aligning With One’s Nature

* 49:45 — Closing Thoughts on Sensitivity, Creativity, and Leadership

Full transcript included below

Where to find Andy Mort:

* 🔗 Website: andymort.com

* 🏡 The Haven (his coaching community for gentle rebels): the-haven.co

* 🎧 The Gentle Rebel Podcast on Apple Podcasts: listen here

* 📺 The Gentle Rebel Podcast on YouTube: watch here

As always, I welcome your thoughts and questions.

Until next time,Courtney

Dr. Courtney Snyder MD is a holistic and functional psychiatrist for children and adults. Find her at courtneysnydermd.com and on the Holistic Psychiatry Podcast on all major platforms and on YouTube.

Medical Disclaimer: This newsletter is for educational purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Consult your own physician for any medical issues you may be having.

Full Transcript

Introduction to High Sensitivity and Its Misconceptions

00:00

Courtney: I was just reading on your website, how nicely you ask, “ What drew you here.” And you say — “you might have been told you’d solve your innate sensitivity by toughening up and squeezing yourself into a shape and rhythm you don’t belong to. But sensitivity is not a problem to fix. Working with it may require a creative way of understanding yourself, and of building environments and rhythms that support you.” Seems fitting with what we’re gonna talk about.

Andy Mort: Yeah, that’s good — it all, it all fits, it all relates together, yeah.

Courtney: It does. I should tell you too, the last podcast was on high sensitivity in children — helping parents sort of create environments for highly sensitive children to thrive. But this is more about how we can create our own lives. I think we’ll see where our conversation evolves, but how — how can we as adults do that?

The Concept of Differential Susceptibility and Environmental Impact

01:54

Andy Mort: Yeah, I think those two things are two sides of the same coin. And in the, I guess, the context of environmental sensitivity — I don’t know if you talked about sort of differential susceptibility, and that research that’s shown how the more sensitive you are, the more affected you are by your environment. And so for children — those early years’ environments are really important, in terms of, for better or worse, a sensitive child is impacted by their environment, and they will thrive and flourish if it’s nurturing and supportive, and vice versa if it’s not. But as we will, I think, talk about — that is not the end of the story. It’s not that there’s this sort of deterministic element that means you will forever be screwed as a sensitive person if you grow up in a non-supportive environment.

Courtney: Yeah.

Andy Mort: And there are things that we can get in place around us today that actually start to heal that stuff —

Courtney: Right.

Andy Mort: — if it’s gone wrong.

Courtney: Yeah, a lot of what I try to share is how people can lower that physiologic stress response — whether it’s related to toxins, trauma, early attachment. But included in that, and which I have never until recently spent time on, is how not being in alignment with our temperament would be creating a chronic physiologic stress response. You’ve been teaching, talking about high sensitivity — is it twelve years now, or is that really when your community started?

Andy Mort’s Journey Into Understanding Temperament and Sensitivity

03:47

Andy Mort: Yeah, the community started twelve years ago, 2014. And for a few years before that, I was exploring it really out of, I guess, the background was my music, as a songwriter and as a performer. I was exploring aspects of temperament and personality as it came up — as it was relevant, really, because I’ve found myself struggling with certain elements of going out on tour, being — yeah — both on the road and also at shows themselves, where it’s like, man, my energy is just depleted at certain points. And I’m finding myself energized by other things that don’t make a whole lot of sense when I speak to other people, who are like, how can you get on stage and perform? It’s like, well, that’s the part I love, that’s where I’m in my happy place. It’s the navigating to the venues, working out what am I going to eat, where am I — like, all of that sort of the details around it, like that. That was the stress for me. And so, started hearing or reading — there was articles about introversion, the first time I’d heard about introverts and extroverts at that point — and that just took me, I guess, down a rabbit hole that ended up with me talking about it, and then people responding to it, saying, that sounds like me, that’s similar to this situation I have at work. And it just all — yeah, I guess — kind of moved together, and ended up with me somewhat accidentally creating the community, but as a place for people to just gather and share those sorts of experiences, and for me to workshop things and stuff as well. Yeah, was never an intention — which is a theme in my life.

But then I kept seeing this term, highly sensitive person, coming up, and dismissed it over and over, because it didn’t feel particularly relevant. I think it was — as I’ve reflected on it, sort of in the years since — it’s the word “highly” rather than “sensitive” that I have a bit of a resistance to, because, like, to me, “highly” is associated with, like, being very highly strung, or, like, high — it’s like very high frequency, like the opposite of me, because I’m quite chilled out and calm —

Courtney: Right. Mm-hmm.

Andy Mort: — in situations and things like that. So yeah, highly sensitive was like — yeah, that combo doesn’t work.

The Discovery of the Highly Sensitive Person Trait and Its Biological Roots

07:05

Andy Mort: But then I just clicked through on one of these articles at some point, and landed on Elaine Aron’s initial self-test list. And for so many of the things, I was like — yeah. All but about three or four of them sounded right. And that made so much more sense as an underlying biological trait, rather than a personality type — because that allows for —

Courtney: Mm-hmm. Right.

Andy Mort: — like, all sorts of personalities, and preferences, and tastes, and all of that sort of stuff. It’s like, that’s more freeing, rather than what I kept seeing in these Myers-Briggs profiles, was — I’m being pushed into a box here, where the question is, do I rebel against that, or do I try and conform to how I’m supposed to be, given that I’ve got this label that I’m, you know, is defining me in some way. Yes.

Courtney: Right. And so this idea of there being just diversity within high sensitivity — I hesitate to categorize people, and at the same time, the language helps people to make sense of their experience, and how they might make choices for themselves. Your podcast — has that been in parallel?

Andy Mort: Yeah, I mean, that’s been in parallel with my own journey. It’s morphed — when I first did it, it was called Sheep Dressed Like Wolves, which I come back to now and, like, I quite like that title — because it was just this idea of, yeah, like, what we’re pushed to be when we’re pushed to be sort of hyper-individualistic. And it was like a play on “a wolf in sheep’s clothing,” the wolf that goes in and takes over the herd — but actually, to flip it around, and to think about how, actually, no, we are social creatures, but we’re forced to dress up like wolves. And what if — what if there was, yeah, another approach? But anyway, I let go of that, because I think I got lost in the metaphor, and then changed it to the Gentle Rebel Podcast — because that term just captured it better.

That was in 2014 as well, when I started the community. And I think it just captured the essence of what I kept seeing in people who were identifying with this trait of high sensitivity, and how there’s a nonconformity to the expectations that the world has for people, when it comes to actually navigating the world with a highly sensitive temperament — you need to do things differently. And there’s also a part of us that wants to do things differently, a lot of the time — and you kind of see, like, when you’re sort of noticing thing patterns, noticing subtleties, noticing the effect that things might be having, whether it’s individual people or culture more widely.

Courtney: Mm-hmm.

The Idea of Being a Gentle Rebel and Leading With Authenticity

09:58

Andy Mort: But the gentle part was, I think, as important as the rebel part, because there’s a reluctance to it, in a way, and a paradox that I felt — this contradiction at the heart of it, where, yeah, I am a rebel, but I hate being the center of attention, and I don’t really like being seen by people in many ways. But there’s this overriding sense of, like, you know, I care about justice —

Courtney: Mm.

Andy Mort: — and fairness, and all these things that I just can’t keep quiet when it comes to certain things when I see it happening. And so, yeah, those two things come together, and gentleness, I would define very much as a strength, rather than a soft — like a soft weakness. It’s actually — being able to use the terminology, I think Brené Brown —

Courtney: Mm.

Andy Mort: — coined it, but this sort of firm back and soft front idea.

Courtney: Right.

Andy Mort: Actually, no — you stand firm, you hold your shape, but you’re open to what comes. And I just really like that as an image of gentleness, because it’s not just sort of rolling over and letting things happen to you, but it’s also not being brittle in the face of other people. Yeah, I think it’s that — I did a lot of studying of stoicism a number of years ago, and it was like, there was elements of that philosophy that felt — you know, the idea of accepting things as they are, rather than wishing they were different, if you have no influence over them. It’s like classic, classic —

Courtney: Mm-hmm.

Andy Mort: — stuff. But I was interested in how to then integrate that into a philosophy of gentleness, really, and how, yeah, that is at the heart of that. Okay, this is how things are, this is how I am, and I’m gonna stand firm, but I’m also open to, yeah, the flexibility of how we might move forward, and address things, or change things, or whatever.

Courtney: Right, as opposed to trying to do it in the way that culture appears to promote — louder, more —

Andy Mort: Yeah, exactly.

Courtney: — forceful.

When you were talking about that, I was remembering how I found you, because I had searched on YouTube. I was grappling with Mel Robbins, having listened to part of her book, and I thought, something doesn’t feel right here — surely someone else is talking about this. So I got on there, and there you were, talking about it —

Andy Mort: Ha ha ha.

Courtney: — in a gentle and rebellious way, of just sort of laying out the information — not in an attacking way, but, these are the details of what appear to have happened. And it was just so refreshing, seeing somebody share their experience, their wisdom, their knowledge, in a way that was so different than what is typically online. So then I went to your website — who is this? And then discovered you had coaching, which I was so happy to see, and which I have continued to benefit from.

Andy Mort: That’s a great example of what I was just saying earlier, the thing that catches me. I think this is, again, something I’ve seen with many highly sensitive people — I love this term, “noticing what you notice.” Noticing the thing that catches your attention, like a thorn that catches your sleeve and just won’t let you go. That whole story was an example of that. I’d seen a couple of reels in passing from Mel Robbins’ posts in the past, but then I saw this post questioning the timeline of the “Let Them” theory. And I thought, I wonder what that’s about, and clicked through on it. If that’s true, I thought, that doesn’t sound okay. There was this poem that pre-existed the book, with a very similar cadence and feel, and no acknowledgement of it — even though it had gone viral in its own right. So I fell right down a rabbit hole digging into it. There’s a massive part of me that’s like, what are you doing, you don’t have time for this, why are you getting pulled into this story — but there was this other part that was like, this is too important not to speak about. That’s a real example of gentle rebellion, I think, from the past year.

Courtney: And — did any of it feel like sort of standing up for the highly sensitive — the original offering, the original creation, was seemingly co-opted by someone who knew how to put it out there —

Andy Mort: I — yeah, exactly. Yeah.

Courtney: — more loudly.

Andy Mort: Yeah, and I think there was this big difference as well between motivations. And this was a really interesting thing that I noticed in comments, because there were people who would say, well, Cassie Phillips is just not as good at promoting herself, or promoting the idea. Like, Mel’s taken advantage of her marketing expertise, and she’s won. And it was like — yeah, but I don’t think that Cassie has the same motivations underpinning the whole thing in the first place. And, you know, it’s something I spoke about over and over — Cassie herself said, you know, I wrote this poem, and it came from an experience of sort of making sense of domestic violence, and her marriage that she’d got out of, and everything. And it was, basically, a gift to other people who are in similar situations. That’s what people latched onto, and that’s why people then started getting these tattoos with “let them” on them — which, again, Mel Robbins took the credit for later on. But it was coming from a totally different place, and that felt — as your question implies — aligned with a creative philosophy, and also this sense of, like, this is sensitivity as it flourishes in life, and it’s being overridden by this completely insensitive other way of just co-opting and overpowering and trying to control something that was freely available to everyone. It’s trying to take it and hoard it back to a single person. Even as Mel Robbins would be talking about how it’s her community of millions of people benefiting from it — the underlying energy within it, I think, is a totally different story to where it came from.

The Importance of Creating Supportive Environments for Sensitive People

14:51

Courtney: And to even — I guess — try to copyright it, and pin it down in that way.

Andy Mort: Yeah, exactly. Yeah. Like trademarking the term. Yeah. There’s all those things that basically undermined a lot of the — people who were trying to defend Mel and saying, you know, this is an idea that’s been around for centuries, the Stoic philosophers talked about this, and it’s from Buddhism, and all of this stuff. It’s like, well, okay, that’s fine, but why is she trying to trademark it? Should I control it?

Courtney: Right.

Andy Mort: Like, yeah, that flies in the face of all of that.

Courtney: Yeah, yeah. In terms of, like, this idea of being a gentle rebel, or having that spirit with which one leads their life — it seems like it does hit on creativity. Just decisions about daily life for people that I work with, even that have chronic health issues, like the rebelliousness of just self-care and rest, quiet simplicity. But since we’re talking about creativity — how do you feel like that intersects? Because it seems like we’re in a world where if you create something, it’s to produce a product that’s to be seen and sold. Like, everything’s been put towards artists and entertainers, and the creative process seems to have become lost as far as the human experience.

Creativity as a Form of Self-Expression and Nervous System Regulation

19:47

Andy Mort: Yeah, there’s that large commodification of creativity, as you say — what are you doing it for, what are you going to end up with and be able to sell, what’s it going to say about your identity, all of this outcome stuff attached to it. It’s been a big part of my own personal life. I just shared a short film I created — I was at an HSP Association gathering in Finland last week, or the week before — documenting my own relationship with songwriting and music, as it relates to my sensitivity and my understanding of myself and other people. It was a really cathartic exercise, just going and creating it, because it took me back to really early childhood, where I’d use music to process stuff. Back in 2018, after the unexpected end of my marriage, I almost instinctively sat at the piano in my parents’ garage and started playing and singing, just throwing it all out. That eventually turned into something — six songs came out of it, over about a two-week process — not with the intention of writing songs, just letting the wastewater of what I’d been through flow through creative pipes. And that turned the pain into something eventually. Creativity has been such a part of that for me throughout my life, and it’s led to albums and songs that have taken tangible form, that I’ve been able to share with people. But that’s not where it started for me. I think there’s probably a rebelliousness in creating for creativity’s sake — it’s a way to discover who you are. There’s the Flannery O’Connor quote, “I write because I don’t know what I think until I read what I say.” I’ve always loved that, because it turns something outwards — whether it’s through writing or through music — and as you engage with what’s come out of you, you get a sense of what’s going on within you, what it’s telling you about your thoughts and feelings, how you’re perceiving a situation. So many positive benefits to creative practice — but you can’t contrive them.

Courtney: Mm-hmm. Like — but the way you describe it is almost like a window into the unconscious. I think for me, it’s been sort of learning that — trusting the process. Do you know, like, you don’t know where it’s going, but I feel like that’s — I’ve really learned that through art, that I couldn’t learn through this very linear planning, goal orientation — but art taught me, you don’t have to know where you’re going.

Andy Mort: Absolutely, yeah.

Courtney: I feel like it’s a — you know, we always hear about, like, nervous system regulation — creativity should be included in that. Not to make it clinical, but as people are thinking about tools to regulate their nervous system — just a creative act.

Andy Mort: 100%. Yeah. Yeah. And I think that the danger is you instrumentalize it, and you turn it into that kind of — it’s got to have this purpose to it, or it’s got to be useful. And that’s where we have to hold these kinds of things with a sense of both-and-ness, I suppose. ‘Cause, you know, you think — why have people written songs and sung together for as long as we’ve been probably around as humans, and shared stories around the campfire — that’s been a really important part of both knowledge sharing, but also of building trust and building safety within the community. And I think the offshoot of that is within that individual nervous system as well, is, yeah, the connection that is created through that shared experience of creativity. And I think that has always been the case, hasn’t it? And maybe we’re just sort —

Courtney: Yeah.

The Role of Sensitivity in Leadership and Group Dynamics

25:07

Andy Mort: — of catching up. And, yeah, you could use creativity for nervous system regulation. It’s like, yeah, absolutely — I think it’s absolutely core to it. Yeah.

Courtney: Mm-hmm. Right, just part of what our human condition should be. But when you say about creativity as the form of connection — I feel people who are highly sensitive very often are creative. But then the high sensitivity could be part of why they may not share, or use it as a means of connecting, because of shame, fear of criticism, vulnerability, perfectionism. What are your thoughts on that? I’m thinking about something we’ve talked about — my own tension around wanting to share information through social media, and how do I do that in a way that’s — not who — I’m not the celebrity doctor or the performer, but how do I do it in a way that feels true to my nature, comfortable, and do it — as opposed to, I think, what many of us can do, is to either not do it, or try so hard to do it in a way that’s not who we are, that it just doesn’t work, or it’s stressful.

Andy Mort: Yeah, I think that’s an amazing question, because the disconnect, as you say, with the highly sensitive person — the creativity just sort of flowing through many of us. And then that susceptibility to the potential harm of the critical response, or the words that can just land as a story within us, maybe, in those early years, where we’ve been told we’re not creative, or there’s certain stories that may have been absorbed even when they weren’t directed at us — when you hear somebody, like, sat around watching television, and —

Courtney: Mm-hmm.

Andy Mort: — somebody says something about someone on the TV, who do they think they are, look at that person, they look ridiculous doing whatever it is. Those kinds of stories can resurface when you take that vulnerable step of sharing something you’ve created — or it might just be that felt sense that it’s unsafe. Think of the highly sensitive person as a gluey part of the social order: the safety of the whole is based on people being okay, and we’re looking out for whether our people are okay, so I’m okay if they’re okay. That can shut us down, as we start to think, I want to do that, but who do I think I am, or I need to grow up, or whatever the story is that’s landed there. It’s also worth saying that sharing stuff is genuinely risky — not just a mindset thing. If you’re thinking about sharing your creativity with the world, you probably will get backlash. You just have to look on social media to see the vitriol thrown around without a second thought, and that could potentially derail you. So for me, one of the important parts is the safety of the environment you’re creating within — having, if possible, people around you who give you that support network, unconditional, not competitive. And when the hard experiences happen, they’re safe to go and talk about, and laugh about. Humor is another component I find so —

Courtney: Mm-hmm.

Andy Mort: — important, when it comes to finding a shock absorber, for those moments where the wind’s been taken out of your sails by a comment, or that experience was awful. And now I need to be able to laugh about it, not in a dismissive, belittling way, but in a way that makes it as light as it needs to be, so you can carry on moving forwards.

Courtney: Right, and I guess feeling understood too, by both.

The Challenges and Opportunities of Sharing Creative Work

29:58

Andy Mort: Yeah, yeah.

Courtney: Which the Haven is an opportunity for that.

Andy Mort: That’s what I’d aim to make that sort of space for people. Yeah. I am aware, saying that — a lot of us don’t have that around us, and that’s the problem. It’s growing up with people who maybe haven’t encouraged those aspects of who we are — maybe they’ve reinforced that story of, you’re too sensitive, you need to thicken your skin and grow up, or whatever it might be. And it’s not something you can just magic up, like, I need a group of people who are going to support me. That’s part of what my vision with the Haven is — to just be that place that is an unconditionally accepting environment where you’re —

Courtney: Yeah.

Andy Mort: — not feeling like you’re competing with everybody, and that kind of thing.

The Societal Narratives Around Sensitivity and Self-Acceptance

34:46

Courtney: I think the recognition of high sensitivity also takes away some of the narratives that I think people create around some of the discomfort. Certainly our experiences can add to it, but without recognizing high sensitivity, it’s easy to go down these narratives around shame, and around why I might be taking this especially hard, relative to someone else — when, if there’s a recognition of a baseline nature of high sensitivity, then —

Andy Mort: Yeah.

Courtney: — then, you know, sometimes that can be liberating for people, of —

Andy Mort: Hmm.

Courtney: — this is just how I’m wired, and other people are as well, and I don’t need to maybe do endless work, other than figuring out how to create a life that aligns with this.

Andy Mort: Exactly. Yeah. I think that’s a really good point, ‘cause it is so easy to get sucked into knowledge hoarding, or trying to figure out why am I like this, what particular experience made this happen. Maybe it’s just the sensitivity, it’s the fact that this is all more finely attuned, closer to the surface. And that can, even in itself, especially when you’re with other highly sensitive people, become something you find humor in, and joke about, the experiences that you —

Courtney: Right.

Andy Mort: — have inside. I know that’s my sensitivity, and it doesn’t —

Courtney: Mm-hmm.

Andy Mort: — stop it from hurting, or landing in particular ways — but when you have that outlet, or that ability to share it and talk about it, or process it creatively, it just lets it settle in a different way, to holding —

Courtney: Right.

Andy Mort: — it, and feeling completely isolated in your sensitivity, thinking I’ve got no one who understands me, there’s nowhere I can turn with this, and it feels like I am flawed. And I think that’s the fundamental part of a lot of why I want people to feel — it’s not a flaw, it’s just a natural part of who you are, and how we’ve evolved as human beings. It’s a trait that works, but it doesn’t necessarily work in the systems and institutions we’ve created over the past couple hundred years, certainly in the West, that actually make it more difficult to be sensitive. And how’s that working out for us? How’s it working out for us, to have these systems that just dismiss sensitivity, and the highly sensitive people within the institutions and organizations that we run? I don’t think it’s going all that well, but I don’t know.

The Importance of Community and Support for Sensitive Individuals

39:57

Courtney: Right. It makes me think about a conversation we had recently, about there actually can be, or is, a role for the highly sensitive person within a group dynamic, as opposed to not fitting in — if that’s honored by the person. I don’t know that it has to be honored by the group, but there’s an important role to be had, to be potentially the person in the group who’s able to see what’s happening, tuned in to the energies of the people in the group, in a way that other people without high sensitivity — that wouldn’t be a strength they’d bring to the group, they’d bring other strengths. And I say that as someone who had a terrible time speaking up, even though I had a lot of thoughts and ideas, in group settings. And to just sort of make that shift — it’s not just that it’s okay, but that there’s actually a role, in the bigger natural order of things, for highly sensitive people, even in the context of groups. Without making it sound like it’s on them to be up against a system that’s not necessarily built for them.

Andy Mort: Yeah, I think that’s absolutely right. It’s not on the highly sensitive person to speak up — it’s recognizing that sort of collective, the melting pot of all the different things that make us an effective social species. It’s not a competition between the sensitive and the less sensitive. It’s great that we have people who are less sensitive. One of the mechanisms in a lot of highly sensitive people is this pause to check — we’re more likely, before taking action, to just take a moment to pause, to assess the environment, to check for signs of safety and threat. It can take us longer to move into a new situation. And the less sensitive person may just go full-on into that situation and figure it out once they jump in. There could be anything in there, there could be sharks in there. And —

Courtney: Right.

Andy Mort: — actually, having all of that is really useful. It’s more on the environments and the systems to understand the importance of sensitivity, than it is for sensitive people to push themselves into those situations, ‘cause if that’s how we’re going to do it, it will never happen. Coming back to that differential susceptibility piece — sometimes the conversation moves into accommodations for highly sensitive people, changing the organization so it’s a nicer place for them to be —

Courtney: Mm-hmm.

Andy Mort: — in. It’s more than that — it’s creating a place that actually allows people of all levels of sensitivity to explore their potential, and to be the best that they can possibly be. We’re restricting our potential as humans if we’re not making places conducive for people on all areas of that continuum. That mindset of “we should include everyone” — I think that’s missing the point, because —

Courtney: Right.

Andy Mort: — we’re just failing ourselves if we’re not seeing the importance of sensitivity. And when we look around the world right now, we’re sorely missing some elements of what could help us as a species, and what could have helped us prepare for and avoid certain things that have come to pass over time.

The Concept of Gentle Rebellion and Aligning With One’s Nature

45:06

Courtney: My daughter, who’s twenty-one, is highly sensitive, and really interested in leadership. She wanted me to ask you about highly sensitive people in leadership roles. I think people might naturally think you have to have a certain temperament — I’m curious your thoughts there, not just on people having the opportunity to speak up and be heard and create, but to lead.

Andy Mort: Yeah, the more highly sensitive leaders we can have, the better. Maybe encourage your daughter to find role models — other people who appear to be sensitive leaders — and notice what they do differently. Is there a difference in the way that a highly sensitive person leads?

Courtney: Mm-hmm, yeah.

Andy Mort: In my experience, I’ve probably seen more of a collaborative approach, a filling in — not being completely egocentric in the leadership. There’s been this trend — I remember, maybe twenty years ago, it felt like we were moving towards more relational, more empathetic models of leadership. And then it just got sideswiped, and we got —

Courtney: Mm-hmm.

Andy Mort: — the sort of, yeah, the ultra —

Courtney: Hierarchy.

Andy Mort: — yeah. The person at the top, it all being about this single figure —

Courtney: Mm.

Andy Mort: — maybe that sort of Steve Jobs role, you’ve got the figurehead of the organization, and everyone’s aspiring to get to that position. But when I’ve seen effective leadership done by more sensitive people, it’s recognizing — okay, I have these weaknesses, I know where my strengths lie, and I want to bring everyone with me. This is a collective endeavor, leading a cause with a central purpose, vision, and mission — and how can we most effectively serve that, rather than how can I most effectively harness as much power as possible, which seems to be the question on the minds of a lot of leaders today. It’s an interesting question, how you operate within systems that have rewarded the egotistical leader, and whether you end up reshaped from your sensitivity into that, either to get into the position, or once you’re there.

Courtney: Right.

Andy Mort: Something to be aware of. Yeah, I don’t know.

Courtney: Right. Which — sort of the cost of not honoring our nature, whatever that nature is — I’d imagine people are more likely to get burned out, to not enjoy their work.

Andy Mort: Yeah, that’s definitely a whole other part of it — if you’re trying to squeeze yourself into the way people do these roles. That’s one of the issues, going back to what we were talking about with rest as rebellion, self-care as an act of rebellion. It’s really difficult, especially at a time when people are facing real uncertainty and financial precariousness, and all of that makes hustling, being on all the time, trying to make a living any way you can, feel like a life-or-death thing in a lot of situations. And we have the online world, which doesn’t switch off. There’s nothing telling us to stop, other than the moment your body breaks and you hit burnout, and by then it’s too late. I don’t know what the answer is to that, because I feel that pressure at times, like, I should be doing more, I can’t just sit here and rest —

Courtney: Right.

Andy Mort: — I could be making social media posts, trying to make a living.

Courtney: People listening may struggle with brain symptoms or chronic health issues, and for many people that can take them off the path of hustle culture and busyness, by necessity, because they just can’t do what they used to do. I’m thinking, some of gentle rebellion, or honoring our nature, can be a whole lifestyle shift. When I got sick with chronic illness and had mold toxicity, it almost gave me permission — even though I had all the health issues going on — it gave me permission, in a way, to say no to social obligations, to get rid of a lot of things, and, because of the purging with mold toxicity, to really drill down into a simplicity of life I wouldn’t have chosen otherwise.

Andy Mort: So, like an enforced —

Courtney: Like it sort of —

Andy Mort: — permission. Yeah. People often talk about wake-up calls, don’t they — like when someone has a heart attack, realizes they’ve been working themselves into the ground, and changes their life from there. But this has a — maybe a gentler tone to it, because it’s almost an invitation to align —

Courtney: Yeah. Right.

Andy Mort: — with your nature, to come into rhythm with who you are, and align with it more. Rhythms — that’s a word we’ve used a few times before — the importance of that —

Courtney: Right.

Andy Mort: — like the seasons. We’re sort of in a post-seasonal age, when it comes to the things that used to happen traditionally through the year — this is the time for this, and then the season changes, and you put that down, and the next thing happens. Instead there’s this constant pressure to be doing everything, all the time. But if you have that enforced permission, it’s almost like you can relax into — my body literally can’t do what I’m telling myself I ought to do, or have been told I ought to do. It just can’t. So now I’ve got to make some decisions about what actually matters, and how I want to approach things.

Closing Thoughts on Sensitivity, Creativity, and Leadership

49:45

Courtney: But I feel like your term, “gentle rebel,” just resonates and sinks in as that kind of permission — it’s very grounding.

Andy Mort: That’s nice to hear. And I hope it’s an invitation to bring your own story into it, rather than — what do I need to do in order to be a gentle rebel. It’s not an identity in that sense — there isn’t a set of characteristics to tick off. It’s kind of counter to that, in many ways.

Courtney: No, no. Thank you so much — there’s so much I’d like to talk to you about.

Andy Mort: Maybe we’ll do it again. I love talking about this stuff.

Courtney: Likewise.

Andy Mort: I could talk about it all day.

Courtney: Great. Thank you, I really appreciate it.

Andy Mort: Absolute pleasure. Thank you.

Where to find Andy Mort:

* 🔗 Website: andymort.com

* 🏡 The Haven (his coaching community for gentle rebels): the-haven.co

* 🎧 The Gentle Rebel Podcast on Apple Podcasts: listen here

* 📺 The Gentle Rebel Podcast on YouTube: watch here

Medical Disclaimer: This newsletter is for educational purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Consult your own physician for any medical issues you may be having.

With it being back to school season, this topic feels especially timely. In this episode, I have the pleasure of speaking with family advocate Tracy Spiaggia, founder of Slingshot Health Coaching, about recognizing high sensitivity in children and how to support sensitive children and their parents.

We discuss the core traits of the Highly Sensitive Person (HSP) trait, Tracy’s great “power strip” analogy for sensory overload, and why the tripping of the power strip (the stress response) can look different in different children (fight, flight, freeze, or shutdown). We talk about challenges that may point to high sensitivity — school behavior problems, breakfast refusal, perfectionism, somatic complaints — and the practical framework Tracy uses with families to sort the “immovables” in their lives from what can actually be changed.

We each share our own experience growing up as highly sensitive children, and how we each began our parenting journey largely unaware of this trait. We address the importance of awareness and self-compassion for parents. And, we close with commenting on the value of identifying and addressing pyrrole disorder- a fairly common biochemical imbalance in those with highly sensitive who are struggling with brain and physical symptoms.

Timestamps:

0:00 Introduction to high sensitivity and its importance2:04 Recognizing high sensitivity in children and adults3:58 Parental support strategies for sensitive children5:52 Stress response styles and their impact7:56 The physiology of high sensitivity and overstimulation9:59 Creating modifiable environments for thriving12:06 The evolutionary purpose of high sensitivity14:04 Practical tips for supporting sensitive children in school and home15:58 The importance of self-awareness and compassion in parenting18:04 The role of nutrition and physical activity in sensitivity management20:02 Supporting adult highly sensitive persons22:11 The power of community and shared experiences24:04 Overcoming shame and embracing sensitivity as a strength25:59 Practical steps for creating supportive environments28:00 The importance of ongoing learning and adaptation29:53 Closing thoughts and resources for further support

Introductions (0:00)

Dr. Courtney Snyder

Welcome to the Holistic Psychiatry Podcast. I’m Dr. Courtney Snyder, a physician and holistic child and adult psychiatrist. In this episode, I have the pleasure of having a conversation with Tracy Spiaggia, who is an experienced health coach who works with families. Using Elaine Aron’s term of the highly sensitive person, HSP, Tracy and I will discuss high sensitivity in children. This trait, as Tracy will mention, occurs in about 20% of the population. Tracy and I both consider ourselves to be highly sensitive, so in addition to sharing our professional experience, we’ll also share insights from our own childhoods, as well as insights from parenting highly sensitive children. Tracy is currently a candidate for a PhD in what will be Whole Health Leadership. She’s a Functional Nutrition and Lifestyle Practitioner, Certified Integrative Attachment Theory Coach, Brain Health Specialist, National Board Certified Health and Wellness Coach, and the author of the book From “Chained to Changed. Break Mental Strongholds and Transform Your Life Through Faith.”

Courtney

We have so many intersections in terms of what we care about and are interested in — nutrition, functional medicine, attachment, families.

Tracy

Why I hang on every word you put out.

Courtney

Thank you. Thank you.

Courtney

One of the things that I was thinking about is how much people do to support children that have all these different issues, but there’s not a lot of recognition of high sensitivity in children, nor what their unique needs are. They’re living in a world that’s not designed for high sensitivity. As we talk, we can help raise awareness about what that looks like — how to recognize when a child is highly sensitive, and not in a symptomatic, pathologic frame, but really, that’s who they uniquely are. And then we’ll move into how to help people make choices to support these children so that they can thrive, and also recognize the situations where they’re probably not going to thrive as easily.

Tracy

Correct. And then how, as a mom and dad, can I modify my expectations on the child and give them a lived experience that best aligns with their sensitive nature — so that they can become who they’re supposed to be, not vicariously living through the child, especially if you’re a non-sensitive parent.

Courtney

We should talk about both — when the parent is also sensitive, and then when they’re not necessarily, ‘cause there’s different dynamics that would come up.

Tracy

Yes, yes, yes, absolutely. Especially if the sensitive parent never knew — hello, never knew anything about HSP. And so you’re raising your children, and then when you come to find out, like, your whole brain just explodes in. And then I just kind of really became a completely different parent, almost on a dime, finding this work. And I felt the most free I’ve ever felt in my life when I came across the work. So yeah, we’ll talk about that too.

Growing Up Without an Awareness of the HSP Trait(3:21)

Courtney

I know — I think like you, I look back and there’s things I would have done differently. Now having a daughter who’s twenty-one, certainly learning when I did has helped her, and this information helps her even make her own choices at this point. When I thought about parenting, it also made me think about being a highly sensitive person, and my own experience as a child, because there certainly wasn’t language back in the sixties and seventies.

Tracy

Here’s a great example. I’m going to make it personal instead of hypothetical. My parents — we came from a household where my dad was a police officer, my mom stayed home, four kids, money was super tight. And so the summer would come, and I now, as a seasoned mother, I can only imagine how she’d be like, almost dreading it — like, “oh my gosh, they’re all here.” So we would have to go to swim team ‘cause it was free from the town. We’d have to go to the town pool. We’d have a choice — we weren’t asked, “you’re going to swim team.” And if my memory serves, it started super early, maybe seven, eight o’clock in the morning. Back then I was just a bag of bones, I was so thin, and that water was freezing. I had no idea why I was so terrified to perform in front of others, but that’s part of the HSP. Like I shared earlier — when I came across this work and all of the questions that were asked to see if you fall on the spectrum of HSP, I’m like, yep, yep, yep, yep, yep.

But when it was my turn to compete, I would nine out of ten times not show up on my block. I would hide in the bathroom. I’d even get good at climbing up on top of the toilet with the door closed, so if my mom came in — you know, you can’t see feet. So I would hear my name being called, like, “McMurray, block three,” and I wouldn’t show up the vast majority of the time, because I’d rather the punishment on the back end than have to endure a public display of competing in swim team.

So I give that as an example — if a parent were skilled, the first time I don’t show up for my competition, there should be some really safe but powerful questions being asked, like, “hey, what’s going on for you? I noticed you weren’t there, you didn’t show up.” Obviously you’re not doing that to — the parent should be able to say, “obviously you’re not doing that just to irritate me,” but we take it all so personally as exhausted parents. But if they were skilled, they could ask questions, and I’d be able to say to them, “this is really scary for me, I don’t want to do this, I don’t like getting into the pool at seven in the morning, I’m freezing, I’d be blue, I don’t like this, I don’t want to do this.” And then they’d say, “my goodness, okay, you don’t have to do this anymore, you can come and stay home and we can figure out what you enjoy.” I didn’t grow up like that.

So that’s an example of a rule I made up to the game of life — if something is bringing you to the brink of sheer terror, just don’t show up for it, go hide somewhere. That’s one example of how I started to cobble together rules of the game of life so that I could survive it.

Courtney

And that’s so interesting, because in my own early life, I think I cobbled the rule of “you just do it no matter what.” That has its own problems, because you don’t even become aware — you just persist through what’s quite uncomfortable. Whether that’s sporting events, public speaking, which for me was a complete nightmare — anticipating, many months in advance, a book report or something like that. And I think, even looking back, I could say, “I had anxiety as a child.” But when you think about high sensitivity, and you think about the context with which one is trying to navigate — which is highly stressful, chronic, and in some cases severe stress — that doesn’t have to even be anxiety. It could just be a severely, chronically stressful situation, trying to be in a world of extroverts. In my family I was the youngest of four, and I was the only one that was highly sensitive.

It’s Not Anxiety. It’s Physiology. (7:53)

Tracy

As you describe that, I don’t hear an anxious child. I hear a physiology. I hear the brilliant design of the physical body, that your alert system was working perfectly well — trying to say you’re living a life that’s antithetical to who you are, but you’re kind of being forced along for the ride. If there’s a lot of children, those at the tail end just kind of get bolted on, as opposed to being seen — not all the time, but most of the time — because parents are just human beings with finite resources and probably very little skill, and are just trying to seriously survive the day.

Courtney

Yeah, exactly.

Tracy

Trying to survive the day. So the kids just get bolted on, but it’s the meaning that we make out of just being bolted on, or being told what you’re doing. And so I don’t hear anxiety — I hear a physiology that’s working beautifully, because your body continuously alerted you to the reality of having to show up in a world where you’re not asked, you’re told what you’re going to be doing, but it goes against the nature you were given.

And this is why — I really do have a moral conundrum with just jumping straight into pharmaceutical prescription, because the body’s brilliant. It’s not broken. So if we have chronic depressive episodes, if we have peaking anxiety, there’s something to hear. There is something to be listened to before we go trying to dull and mute all of those sensory, dashboard-like signals. There’s something there. And so I feel like those states have been kind of villainized — “get rid of it at all costs” — where it’s like, if we can stay in the uncomfortability while we remain super curious and highly supported, you’re going to be able to have that body communicate to you where you’re living out of order. Could even be a diet that’s out of order. If your relationships are okay, and you scratch your head like, “hmm, I feel great with my family, my parents hear me, they see me, I feel heard and seen, I don’t feel judged, I’m doing the things I like, I’m not being forced to do things I don’t like” — then it’s time to say, okay, maybe there’s certain foods that I am or am not eating that the body is trying to alert you to, to give you your best life.

Courtney

Right — and it can be an alignment of all of those factors.

Tracy

Of course. And it’s like a snowball at the top of a mountain that builds to this ginormous thing by the end, because it just collects and builds momentum as it goes down. That’s what I try to help parents see — either for themselves, beginning in childhood, or what’s going on for their own child, especially the non-sensitive parent coming in with the sensitive child, saying “I don’t know what’s wrong with him or her, fix—” And it’s like, no, no, no, no. You’re the most important person on planet Earth. It’s me helping you relate to your child in a way that will turn those signals down, because they finally feel seen, heard, understood, unconditionally accepted. And then you will move to create an environment that lets the body relax.

The Traits I Look For — and the Power Strip (11:08)

Courtney

Yeah. So let’s talk about HSP first in adults, and then how that translates to children — because the reality too is that chronic stress in childhood has different implications. The pillars that I think about — and a lot of this is abilities as well as potential liabilities — ability to process a lot of information, being a deep thinker, feeling things deeply, problems with stress tolerance, and then sensory sensitivity, whether that’s picking up on the emotions in a room or sensitivity to bright light, loud noises, textures. People don’t have to have all of these to fall on the spectrum. Being empathic, tuned into other people’s feelings, maybe even being more emotionally reactive.

Tracy

I wonder how you’ll feel about the way I try to explain it to the clients I work with, because it is — when you’re not interested, you and I could geek out on this for a whole week straight with no naps. But you have to really capture the essence of what we’re trying to share with people so it can change the way they live and operate and relate to other people.

So the way I offer it in a layperson’s framework: I point to a particular outlet on the wall, with one lamp plugged into it. An electrician, when they wire a house, the same number of volts is going to come out of each outlet — the lamp is the only device plugged into that one outlet, drawing its 120 volts, and it lights the lamp, and the lamp is fine. But over here by my desk, there’s still only one outlet, but I need many, many things to operate off that 120 volts. So I have a power strip, and in that same 120-volt outlet, I have the power strip with five things plugged in. And it has a mechanism — this is the whole purpose of the power strip — to shut down when I’m trying to draw too much energy out of that same outlet.

We have the same thing built into our nervous system. When the world is tugging and pulling at a highly sensitive nervous system — through forced clothing that has seams, a rough turtleneck — I’ll talk from personal experience, like being in a wet, sandy bathing suit on a hot beach. I just wanted to be dead. It was so overstimulating for me. I am the power strip, and life is plugging in without my permission — stealing bandwidth, stealing nervous system resiliency from me. So then when I’m left with the last thing to be plugged in, which is like, “hey, come for dinner,” and it’s something I don’t like — that could trip my whole nervous system. And the uninformed family members: “you’re always the problem, it’s always you.” And it’s like, no, you don’t understand all the things that were plugged in before that, stealing all of that nervous system bandwidth from me. This last thing is what you observe, but that was what tripped the nervous system.

My stress response style, by nature, is fighter — so that trip will manifest in your preferred stress response style. For me it’s combative. For other people it could be complete shutdown, or “I’m getting out of here” and they flee. Other people, they dissociate — they just kind of freeze, they’re there but they’re not there, nobody’s home. That’s where that innate preferred stress response style shows up when the power strip trips. And then what we do is we assign — “that’s their personality.” And it’s not their personality, this is their stress response style. You have to get curious about each person — how much bandwidth do you have before you trip, how much is stealing from you? Some people could wear a wet bathing suit and just lay there, nothing plugged into their strip. Me — “when do we get to go back and take a shower? Please, can I leave?”

So that’s the analogy I use: examine yourself, then consider your child. Do you believe they’re a one-outlet person, where life is good and nothing else is going to get into that outlet? Or are they a power-strip person, where there’s all kinds of opportunity to plug into that same voltage, causing that person to go into a sympathetic-dominant state.

Courtney

Right, right, right, that’s great. Really helpful — you and I are good examples from our own experience, because I was more the shutdown-and-comply kid. So less obvious — I think both are struggling in different ways. Some children it might be more externalized, and others it might not be at all.

Tracy

Yeah, and then not at all — unfortunately, parents can easily miss that and say, “you’re such a good girl, you’re such a good boy.” They’re actually in shutdown. They have no voice.

Courtney

Exactly. Right — or having headaches and stomachaches, somatic-type symptoms.

Tracy

Absolutely, absolutely. See that all the time — I’m sure you do too.

What Families May Notice First (17:16)

Courtney

So we should talk about what types of problems people might notice before they actually notice the sensitivity itself — whether that’s meltdowns, withdrawing from activities. What would you say are common things families come to you with that relate to this?

Tracy

The most common would be problematic behaviors in school. Being woken out of a dead sleep, refusing breakfast because you’re so high-stress, under-rested — it’s almost like a nauseous feeling. So unknowingly, they send their child into an incredibly stressful environment, undernourished, without any nutrition on board to blunt the effects of all that myriad stress — all those plugs going into that power strip. A lot of parents will bring their child in — mothers, let’s just say it’s almost always moms — “help me, they’re not allowing my child to come into the mainstream class.” And I’m like, has anybody, including the school counselor, gotten curious around energy reserves, the status of stress, the nutrition that’s on board? If the child is refusing to eat, we need to really look at that, because there is stress that has got to be pruned from this child’s life, so their biochemistry normalizes to the degree where they can tolerate a small breakfast to start.

That’s not normal human behavior, to break your fast upon waking and have a nauseous reaction to food. You have to understand that body is communicating, once again, brilliantly — it’s deprioritizing nourishment and digestion and prioritizing stress response. People don’t understand that. So I’d say one of the most common is just combativeness or non-compliance in these domains of life, in school, or when I tell them to do such and such at home. And listen — there’s going to be some non-pathological defiance. That’s normal, progressive development for a child. They test the boundaries, depending on their temperament, because they’re always on a trajectory to individuate. Once they get to around eight, nine years old, and that nervous system’s cement has kind of cured a little bit, now they’re looking out into the world to figure out, “who am I, I want to separate a little bit from this family of origin and figure myself out.” That may look like being difficult or combative, but they’re trying to individuate.

Sometimes when I hear myself talk, Courtney, I feel badly for the child, but I also feel badly for us parents, because we’re calling parents higher and higher to awareness and education when they’re so exhausted trying to pay the bills, keeping the lights on, food in the fridge — who lost their job, who’s getting a divorce, who has an incurable disease. And at the same time I’m trying to call you higher with your parental skills so you can better attune to your child. I know how that lands on a tired parent, because I was hurt too. But we have to understand that the reason we’d have that type of response to this information is because nobody supported us when we were little. So we just learned “this is life, buck up and deal with it,” and we live from those rules we cobbled together as a kid — “I guess I just have to figure it out on my own.” And a parent, unknowingly, is doing the same thing — telling this struggling little child, “figure it out, man, I’m spent, I’m tired, I can’t.”

Courtney

I mean, ultimately this should make parents’ lives easier if they can understand what the needs are of the child, so there’s not meltdowns at school in the cafeteria where it’s so loud, or on the school bus — there would be just peace overall for everybody.

Tracy

You’re a hundred percent right, and that is the critical message. If there’s any takeaway from this conversation for your listeners, it’s — it will get a little worse before it gets better. And that’s true with any healing journey. You broke a bone, okay, it’s gonna hurt, I have to reset the bone. It gets worse before it gets better. But when you come alongside professionals like you and I, we have a path, a strategy to bring you along — we’ll hold you really well during the worse part, but then you will be liberated into not just a future, but potentially a legacy that you can completely change. You can leave this mark as a patient person, a considerate person, a forgiving person, a compassionate person — all of the beautiful traits of the highly sensitive get to just flourish unabated if we create an environment for it.

Self-Compassion and the Family Timeline (24:27)

Courtney

So it can be meltdowns, or children withdrawing from activities. It could be perfectionism almost, or self-consciousness — being so in tune and observant that they might assume everyone else is as observant, and be highly self-conscious or perfectionistic about themselves or even others. Is that something you see in the families you work with?

Tracy

Just as much. The perfectionism, the overachievement, the over-giving. These kids need to be able to look to us when they’re in crisis — “I’m freaking out, but you’re steady, you’re the rock I can cling to.” So if we freak out when they freak out — and listen, a lot of what I’m sharing are insights after I’ve made the mistakes. I would give anything to know then what I know now, but I can’t go back. So I did a lot of things right, but I did some things not so great. And now I repackage and repurpose the mistakes into something we can offer to the world — “moms, dads, you don’t have to make the same mistakes I did, you can learn from me.” And I believe God will honor that, and even allow forgiveness and grace and mercy to flow in my children towards me for the things I didn’t do well.

Courtney

I think those are really valuable conversations to have — one, for parents to be able to apologize and teach their children the value in that, but also just this own self-compassion, that we’re all doing the best we can. And it leads into this idea of — if you’re a highly sensitive parent with a highly sensitive child, which would have been my experience — there are a lot of both gifts in terms of recognizing their needs, and also a lot of challenges in terms of not wanting to project too much onto them what their needs might be. I think there were times when my own concern about how the world operates in relation to sensitive people was almost problematic, and other times where I was sort of going along with the culture. I think it can go both ways, and the main thing is just to be conscious of it if you’re a sensitive parent.

Sort the Immovable From the Modifiable (30:36)

Courtney

Which actually leads us to this idea of what types of choices might parents make that would help support a child who is highly sensitive — whether that’s in the home, at school (there’s not always a lot of choice in terms of school options), or activities. I think that’s worth grappling with — the real practicalities of, within a home, how might things be different if someone’s going with the flow versus recognizing, “I have a child that’s highly sensitive.”

Tracy

Yeah, I think it’s important — I don’t think we stated it — if there are listeners new to the concept, only about twenty percent of the population is thought to have this trait, and that trait lives on a spectrum. So if you’re in the twenty percent, we have to explore how full you are on that spectrum. This journey is very unique and individualized — you have to study each individual child and each parent separately to know exactly what you’re working with. I think the next step would be to make a two-column list: these are the immovable, unmodifiable realities in our lives. “This is where we live, we’re a two-income household, I’m a single-parent house, I have to go to work, you have to go to public school, I don’t have resources otherwise” — okay, that’s an immovable reality, put it in that column, because it is what it is, and that doesn’t set you up for a worse outcome. We have to start appreciating that none of us are a victim, we’re all victors — if we just do the work of taking inventory of the reality of our lives and create a schematic of sorts, we all will be given the same opportunity for thriving and flourishing. Nobody’s at some gross disadvantage — I know some people might think I’m talking financially, but I’m really talking about inner resources.

Courtney

I was just going to say — even if a child is in a public-school setting, there are still ways to create some downtime in their life, versus going from school to activity to activity to lots of stimulation.

Tracy

A hundred percent. Even within the school experience, you can ask for certain accommodations — and we do this all the time. If you have a profoundly highly sensitive child who’s being flooded with fluorescent lights, sitting in hard chairs amongst peers who are loud — if it turns out the mom and dad say, “you know what, I think it’d be really helpful if they could just get a 10-minute snack break, high protein, moderate fat, not sugar,” and maybe 10 minutes with the school counselor to recharge that battery — exactly. So you might have public school as an immovable, but that doesn’t mean it’s not modifiable. You can still branch it over to the modifiable and figure out what aspects of that day are draining the nervous system resilience and causing chronic stress, and what’s modifiable there. Schools have really embraced their role in improving mental health outcomes, by and large. So as long as you advocate for your child in a respectful and reasonable way, there are aspects of this immovable reality that can be modified to give some resilience back to the child. But the most influence is obviously going to come from their home environment and experiences.

Courtney

Just thinking through this lens can impact what choices are available to people.

Tracy

People by and large have no understanding — again, because they’re not interested in this sphere of learning and knowing. They have very little understanding and appreciation of all of the modifiable factors of their daily lives. It’s like removing one plug from a really burdened power strip — that’s what we try to do, remove some of the plugs we can, proactively, to give some of that bandwidth back to the child. That’s what makes this work very customized, very individualized. I do groups — I don’t know if you do groups — so it’s more affordable and accessible, and I’m saying the same thing to larger groups of people, and they can begin to process the information and create their own customized strategy.

Courtney

Yeah — and in the groups, they can hear each other, and there’s some degree of support, because that’s the other huge part — however people can find like-minded people and families, and it sounds like your group is a way to do that.

Tracy

Yeah, it normalizes your experience — and don’t we all, frankly, want that as adults and parents, but even more so a child wants to be normalized. There’s nothing wrong with you that you get really overstimulated on the beach, in the sun, in a wet sandy bathing suit for eight hours straight with very little food. There’s nothing wrong with you — there’s something profoundly wrong with that experience. So it takes the shame off, and if we can throw off the shame, the body feels liberated to start to migrate its way back to parasympathetic — maybe we can actually take a deep breath, because we’re not in imminent danger.

It’s Not a Flaw — It’s a Design (36:34)

Courtney

Right. So things like being mindful of downtime, opportunities to be in less stimulating environments. Routine can be important too, as far as anticipating and knowing something’s not going to come out of left field and derail things.

Tracy

Critically important, I think.

Courtney

And I think about it even with this idea of “they’re going to have to live in the real world” — many adults wouldn’t choose for themselves to be in situations with a lot of people and a lot of loud noise. Working adults are better able to recognize a preference for certain types of work, depending on what’s practical for them. But we expect children to do what every other child is doing, and expect them to thrive in that way. Most adults aren’t living in “the real world” like that.

Tracy

Especially today, with remote working, where you could be a grown adult making a wonderful salary right from the comfort of your own living room — at least for my generation, there was obviously no such thing.

Courtney

And we haven’t talked about how many strengths come with this, and how many strengths and abilities can be lost trying to navigate or fit into a world that’s largely not built around high sensitivity. As the research shows, this is evolutionarily here for a reason — everyone should want people with high sensitivity to be thriving, and want the children to have the opportunity to thrive.

Tracy

Absolutely. Another really helpful point for your listeners: when Dr. Aron discovered the trait, researchers have continued to discover it in over 100 species of animals and insects, and that work continues. This is something innate in all creatures, and it’s brilliant — not too many of us, but just enough of us to sound the alarm for dangers that the non-sensitive can’t see coming. We can see the headlights of the train where these people are oblivious, standing on the tracks. So to live in a world without people with these fine, highly tuned senses to alert the masses — it’s kind of like the carbon monoxide detector in a home. You probably don’t pay much mind, but let me tell you, when it goes off, it’s saving your life. We are the carbon monoxide detectors. We are the ones alerting you long before you’re aware there’s danger afoot. It’s a gorgeous trait — I wouldn’t trade it for anything.

Courtney

Yeah.

Tracy

I really wouldn’t. It fills me with so much purpose and passion, and I’m able to move through this world and feel so deeply — really high highs, yes, really low lows, but I feel alive. I don’t feel kind of in that middle of “meh.” I’m never meh, that’s never me. I think it’s a beautiful thing if people can get over the stigma the world would probably want to attach to it.

Pyrrole Disorder

Courtney

Right, right, right. And I’ll just mention too, for people who are highly sensitive and struggling maybe with mental health or physical health issues, in part because of chronic stress — the issue around pyrrole disorder, which is more common in those of us who are highly sensitive, results in specific nutrient imbalances that are not difficult to treat. That doesn’t apply to everyone we’re talking about, but some people dipping into more severe issues could really benefit from that kind of information.

Where to Find Tracy (41:04)

Tracy

My goodness — to me that’s almost the lowest-hanging fruit. That’s why I love functional nutrition — trying to repair a familial relationship is hard work, but elevating your zinc and B6 levels, that’s pretty low-hanging fruit.

Courtney

I know, right, right. Tell everyone how they can find you, the work that you do — do you have an active group right now that you’re working with?

Tracy

No, we’ll kick off the next group — I run them in the fall and in the spring, so the next group will kick off, I believe, mid-September. They can find me — my practice is called Slingshot Health Coaching, after the David and Goliath story in scripture. Slingshot Health Coaching on Facebook and Instagram — I’m not a huge social media person, but there’s a presence there. Website is just slingshothc.com. Anybody can book a complimentary call to explore — you have to meet the person, make sure the chemistry is good, that I’m actually the right practitioner for you. That’s available to anybody, and you can certainly subscribe — I send out a fair amount of content by email, and I run a lot of complimentary studies and things people can do for free, to build community.

Courtney

Great. Thank you so much.

I hope you enjoyed our conversation. As always, I welcome your thoughts and questions.

Until next time,CourtneyCourtney Snyder MD

Resources:

* Tracy Spiaggia at Slingshot Health Coaching

* High Sensitivity Through 3 Lenses (HSP, Pyrrole Disorder & RCCX Theory)→

* Elaine Aaron - The Highly Sensitive Person (website)

Dr. Courtney Snyder MD is a holistic, functional, and environmental psychiatrist for children and adults. Find her at courtneysnydermd.com and on the Holistic Psychiatry Podcast on all major platforms.

Medical Disclaimer: This newsletter is for educational purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Consult your own physician for any medical issues you may be having.

Are you someone who at times has great productivity and hyperfocus, but at other times can barely focus and get things done?

Do you have problems focusing and getting things done unless you’re under pressure? Do you tend to procrastinate?

Do you, after periods of high-intensity work — whether that’s physical or mental — crash and burn out afterward?

Do you feel that you dive deeply into an interest, but then lose interest and don’t know what just happened? Do you have serial interests, or even serial relationships?

Do you feel you have great abilities — you’re a quick learner, you go deep when you’re pursuing something you’re interested in, perhaps you’re even gifted — but then feel unable to harness those abilities and gifts, and feel like you’re on a roller coaster between hyperproductivity and an inability to focus and have motivation?

These are common patterns that I see in my practice, and they relate to arousal. I’m not referring to sexual arousal or emotional arousal, but arousal as far as our neurophysiology being in a place where we can ideally act — where we have focus, motivation, and energy — and not low arousal, where you can’t focus, and have low motivation, and low energy, nor hyper arousal, where we’re excessively focused in a physiologic stressed state. Many people find themselves fluctuating between both ends and having problems finding that sweet spot in the middle that allows them to sustain their interests, sustain the goals they’ve set for themselves, and harness their greatest gifts. Many of these individuals are extremely gifted — deep divers, can even be obsessive about their interests. But it can take that depth for people to function at a high level.

This newsletter and podcast are for educational purposes and aren’t a substitute for professional medical advice, diagnosis, or treatment. Please talk with your own doctor about any medical or psychiatric concerns.

What You’ll Learn

* (0:00) Recognizing the pattern of hyperfocus and burnout

* (3:43) What arousal actually means, physiologically

* (4:26) The RCCX connection

* (7:03) The crash, and why it happens

* (10:11) Finding our sweet spot — practical tools that help

Recognizing the Pattern

There’s a sweet spot of arousal where we have focus, motivation, and energy. On one side of it is low arousal — brain fog, low motivation, low energy, something that can look a lot like ADD in both children and adults. On the other side is hyper-arousal — when we have excessive focus and drive, often accompanied by physiological stress.

Many of the people I see fluctuate between both ends and struggle to find that middle place. They tend to have deep interests. They can dive deeply into something, even obsessive about it, and can have difficulty disengaging. When there is not enough stimulation, they tend to get bored. They often don’t enjoy small talk.

What Arousal Means Physiologically

When we talk about what can be happening here — when we are stressed, and again, when I’m talking about arousal, that’s a degree of stress, and we’re aiming for an optimal level of stress where we get things done and can enjoy what we’re doing.

What impacts arousal? One is cortisol. If we have adequate levels of cortisol, that gives us adequate energy. Along with cortisol, catecholamines fluctuate — things like norepinephrine, which gives us motivation, and dopamine, which helps us focus. Think of these three as moving up and down together for the most part. There are other things that can impact them separately, but generally they’re increasing together, and they can be decreased or low at the same time as well.

The RCCX Connection

The best explanation I’ve found for why some of us find ourselves at either end of the arousal spectrum and not easily in the middle sweet spot, is RCCX theory, developed by Dr. Sharon Meglathery. This is a theory I’ve described in previous newsletters and podcasts — it makes the connection between a gene for hypermobility, a gene for 21-hydroxylase (an enzyme in the hormone pathway that produces cortisol), and another gene that relates to autoimmunity. People don’t have to have all of these genes affected, but I’d say the most important one, from a psychiatric and brain-symptom perspective, is 21-hydroxylase, needed for the production of cortisol.

If we have a weakness on this gene — and it appears that likely 20% of people do — that could give us a baseline low cortisol level. It’s not as if we can pin this down to a single variant; there are likely a number of places on that gene that could be affected, and it’s not something that can currently be measured through genetic testing except in research settings. But if we have that weakness, we could still make adequate cortisol under stress — until we push it too far. Say, on one of these hyperproductive days, we push too far, and then we overwhelm that enzyme, and we don’t have enough cortisol.

So why would people who struggle with this already tend to be deep divers? It appears that a vulnerability in that enzyme, 21-hydroxylase, could have affected brain development in utero and in early life — causing higher androgens and spiking cortisol that can affect particular parts of the brain, including the amygdala, which senses threat and can contribute to this high-intensity difficulty putting on the brakes once we’re under stress. So these individuals, when they’re working on something, may have difficulty stopping — and then when they’re not able to keep producing the cortisol to meet the demands they’re placing on their physiology, they hit a wall.

The Crash — and Why It Happens

When the enzyme can no longer keep up with the demand, cortisol and those neurotransmitters drop — that’s the crash: low energy, poor focus, no motivation. For some people, hitting that wall can also trigger mast cell activation, through another mechanism I’ve talked about in a previous episode. There’s a hormone in the brain, corticotropin-releasing hormone (CRH), that tells the adrenal glands we need more cortisol. When that happens, CRH can bind to mast cells — inflammatory cells in the body — which release histamine and inflammatory mediators that can cause physical symptoms, and worsen fatigue and brain fog. Not everyone has this happen; most people with mast cell activation have something else going on too, like a biotoxin exposure.

This isn’t only about a single hard day. Zoom out, and I’ve seen people who were high-functioning — even hyper-functioning — for years, doing remarkable things across work, family, and adventure, before hitting a wall they never fully recovered from. Often there’s something else quietly using up their stress capacity underneath it all: mold or biotoxin exposure, mitochondrial dysfunction, a chronically stressful relationship, early attachment disruption, or even codependent relationship patterns that keep someone chronically stressed.

Once someone hits that wall, it’s common to unconsciously reach for something to bump cortisol and those neurotransmitters back up — compulsive eating, carbs, seeking stimulation online, risk-taking, or calling the one person who reliably stirs up drama. Beyond the physical crash, there’s a bigger cost: most people aren’t recognizing this as their neurophysiology. They’re experiencing it as being inconsistent, self-defeating, self-sabotaging, or a self-esteem problem, rather than recognizing it as a very common physiologic pattern involving our stress hormone pathways and neurotransmitters — and the bigger loss is all the abilities and gifts people aren’t able to harness because they’re on this roller coaster.

Finding the Sweet Spot

The first thing is to notice. Notice when you feel in that hypo-arousal state, when you’re having difficulty getting things done, and then recognize what you’re reaching for — is it carbs, is it eating, is it substances, is it the internet, is it risk-taking, is it the dramatic friend who stirs up trouble?

Notice

Also notice when you’re in a state of hyperarousal — doing an activity, powering through without being able to stop, unable to take breaks. If you’re observant enough, you’ll notice your muscles tightening around your neck and shoulders, and simply not being able to relax. When we notice which state of arousal we’re in, we know what tools we have access to, to help modulate it.

For High Arousal

When you’re in a state of hyperproductivity, the last thing you want to do is take a break. But to sustain a degree of productivity, it can require putting that intensity aside and taking a break, so the wall isn’t hit. Another approach is to alternate high-intensity work with low-intensity work — step away and move if the work is on a computer. It can help to chunk activities: set goals, and after reaching them, stop and take a break, rather than letting a project sprawl deeper and deeper. It’s also important to assess your stressors — stressors aren’t all negative, but if we’re not pacing, if we’re not setting aside time to calm our nervous system, we can still hit that wall. It’s really important to set an intention before starting — how it’s going to be broken up, setting a timer for how long before a break — to really be intentional.

For Low Arousal

Just recognizing that low baseline arousal can already have us thinking creatively about how to increase it. Do we need to change the setting where we’re working? Do we need to find a way to make what we’re doing more interesting — what is the why? Make it more creative. When we have that low arousal, instead of reaching for food or surfing the internet, we could instead have a creative outlet that’s stimulating and raises our arousal without being harmful to us. Movement is a way to raise arousal — getting up and moving around can help. It can also help to chunk activities and put a timer on; sometimes the challenge of getting something done in a certain amount of time will raise arousal on its own.

Everyone’s approach to this, and what works for them, will be different. But I do feel like this understanding can help us all recognize how we function best, recognize when we’re in that under-arousal or hyper-arousal state, and modulate — all with the intention of not being on that roller coaster, and instead finding that place in the middle where we can be in a state of flow, enjoying what we’re doing, finding meaning and purpose in it.

I’d love to hear your thoughts and experience. Have you found things that help you find your own sweet spot?

Until next time, take care.

Courtney

Courtney Snyder MD is a Holistic and Functional Child and Adult Psychiatrist who offers non-patient consultations to individuals and practitioners nationally and internationally in addition to her treatment practice serving FL, IN, KY, OH. Her educational content, shared through her website, Substack Newsletter, the Holistic Psychiatry Podcast and her YouTube Channel reaches readers and listeners in over 160 countries.

Resources

* RCCX Theory & Psychiatry. Dr. Sharon Meglathery

* RCCX Theory: Hypermobility, RCCX Theory, Mental Health & Complex Chronic Illness

* Recent newsletter on Hypersensitivity: High Sensitivity Through 3 Lenses (HSP, Pyrrole Disorder & RCCX Theory)

I recently joined Annika Taylor on The Wellness Rebel Podcast to talk about mold toxicity, and how it can cause not only physical symptoms, but also brain symptoms such as anxiety, depression, OCD, brain fog, mood swings, and in more severe cases, psychosis.

Watch the full conversation above. Below is a recap of our conversation, along with the resources we discussed along the way.

Chapters:0:00 Introduction to Mold and Mental Health1:47 Understanding Mold Exposure and Illness5:13 Personal Journey with Mold Illness8:40 Sources of Mold Exposure12:12 Physical Symptoms of Mold Toxicity18:54 Mental Health Impacts of Mold Exposure25:32 Identifying Mold in the Environment32:28 Treatment Options for Mold Toxicity

I. What Is Mold-Related Illness?

Mold-related illness can be broken down into three distinct categories that often get lumped together: mold allergy, mold toxicity, and mold colonization. Mold allergy, which most people are familiar with, is a reaction to outdoor or indoor mold spores. Mold toxicity is different: it happens when mycotoxins actually accumulate in the body, something that appears to affect roughly 25% of people who can't effectively remove the toxins on their own. This explains why one family member in a home with mold can get seriously ill while another in the same house is fine. Third is the lesser-known mold colonization, where mold spores take hold directly in the sinuses or even the GI tract. That means a person can be out of a moldy environment for years and still have an internal source of toxicity.

II. My Own Mold Story

My interest in mold began around 10 years ago when I was diagnosed with mold toxicity. For years prior, I had been dealing with chronic fatigue, symptoms of fibromyalgia, and vague neurological symptoms that neither my doctors nor I could explain. My daughter was also having complex chronic health issues that initially looked like developmental regression. Understanding the microbiome and dietary changes were helpful to both of us, as were the Walsh Research Institute's nutrient-based interventions, but the real turning point came when the topic of mold toxicity came across my radar in 2016.

Mycotoxin testing and testing of our home and my office confirmed that we had significant exposure and toxicity, which we were treated for and benefited significantly from.

III. When a Partner Isn't on Board: How Mold Treatment Affects the Whole Family

One thing that doesn't get talked about enough is how difficult it can be for someone to get out of or address an exposure if their spouse or partner is not on board. In my own case, I was fortunate — my then-husband was agreeable, especially when he realized how much clarity, decisiveness, and even sense of urgency I had. We'd dealt with significant health issues for a long time, and I didn't want something irreversible to emerge that would leave me in regret for not acting sooner. We acted on that instinct.

We were very lucky to find that we were eligible for insurance coverage, which covered an extended-stay hotel while we had our home remediated. For a lot of families, that's not the reality. If a partner isn't on the same page, it can become one of the biggest reasons someone doesn't end up leaving a house with mold — whether that obstacle gets talked about openly or not. There are those who don't believe mold toxicity is real, and those who don't want to believe it's real (consciously or unconsciously). Education, input from those with expertise, or even seeking couples therapy can be necessary.

It is important to remember that part of the treatment, namely addressing mold in the home, impacts the whole family.

IV. Where Mold Hides: Common Sources of Exposure

For most people who test positive for mold toxicity, the primary exposure is likely environmental, as opposed to mold in food. Leaks under sinks, problems around windows, roof leaks, chimney flashing, damp basements, and high ambient humidity are all common culprits. High humidity left unaddressed can be a big problem. Estimates of the percentage of homes that mold have crept up over the years, from 50% to 75% to, as some consultants now say, essentially every building to some degree. I've seen a couple of children with developmental issues who had mold in their mattresses from bedwetting.

V. The Physical Symptoms of Mold Toxicity

Mold toxicity often shows up as sinus issues (especially with colonization), asthma, and — notably in young children — recurring croup (spasmodic croup) and ear infections.

Many people with mold toxicity also develop mast cell activation, which triggers an exaggerated immune response affecting the skin, respiratory tract, GI tract, and/or bladder. Racing heart, air hunger, and stomach pain can occur. Neurological complaints can include electric "jolt" sensations, numbness and tingling, headaches, light sensitivity, and temperature dysregulation.

Many of these symptoms overlap with Lyme disease, EMF sensitivity, and other chronic conditions. The immune dysregulation caused by mold toxicity can contribute to a vulnerability to Lyme and its coinfections, Candida, SIBO, PANS, PANDAS, and more.

VI. The Brain and Mental Health Symptoms of Mold

Brain Fog, Fatigue, Anxiety, OCD, Psychosis, Mood Swings, Developmental Delays & Cognitive Decline

I don't know what psychiatric symptom mold toxicity can't cause. Brain fog and fatigue are especially common, as is anxiety. For some, mold toxicity can contribute to psychosis and/or dramatic mood swings. In children, mold toxicity can look like ADHD, anxiety, or developmental delays.

I see mold toxicity as something that aligns with — and amplifies — someone's existing genetic vulnerabilities rather than acting alone. Most of the patients I see with severe conditions like schizophrenia, bipolar disorder, or severe OCD have mold toxicity as a contributing factor, though, again, rarely the only factor.

The Neurotransmitter Connection

Mold toxicity can drive up pyrrole levels, which in turn depletes zinc and B6 — two nutrients essential for neurotransmitter functioning. It can also worsen copper-zinc imbalances through oxidative stress and interfere with methylation, both of which also impact neurotransmitter functioning.

A Client's Story: OCD and a Hidden Leak

Annika recalls when she became interested in helping those with mold toxicity. She shares the story of a friend whose severe, debilitating OCD — along with episodes of derealization and out-of-body sensations — turned out to trace back to black mold discovered behind a washing machine, the result of an old water leak. Once they addressed the mold, the connection became clear in hindsight.

VII. Mold Toxins Can Create a Threat Response in the Body & Brain

While we can have threats on the outside, mold toxicity is a threat we can have on the inside. When we are under threat, three systems tend to get activated: the immune system (as discussed with mast cell activation), the limbic system, and the autonomic nervous system. The limbic system puts the body into a vigilant, threat-scanning state — and for some people, that vigilance surfaces as OCD (an unconscious attempt to "make things right" when the body senses something is wrong), health anxiety, or a diffuse sense that something isn't okay.

The autonomic nervous system, meanwhile, can get stuck in fight-or-flight or shutdown mode instead of rest-and-digest. Annika is careful to frame this not something to fear, but something to understand — the goal isn't panic, it's empowerment.

VIII. Testing for Mold: Home and Body

Testing Your Environment

If there's visible water damage or visible mold, extensive testing usually isn't necessary. Generally, where there is water damage or water retained in a space, there will be mold growth. The priority becomes proper containment, and remediation. If there is no known issue and someone has mold toxicity (which could be from an old exposure), I recommend the ERMI-style dust test (I use Mycometrics), which measures water-damage-associated spore counts against outdoor spore counts from a simple cloth dust sample.

I caution against relying solely on air sampling from a home inspector, which I and many of my patients have found unreliable by itself — surface or dust testing gives a clearer picture. Petri-dish testing (I use Immunolytics) can help pinpoint which room is affected, though it misses a couple of important mold species.

Testing Your Body

For testing mycotoxins in the body, I use RealTime Labs, an at-home urine test that screens for five toxin families. Annika discusses her experience with another company, which showed false negatives — a patient with a "no mold" result went untreated for years while ongoing exposure continued.

To improve the accuracy of the test, I sometimes have patients do a sauna session or take glutathione in the days leading up to testing, to help mobilize toxins — though this isn't appropriate for everyone, particularly more sensitive patients.

IX. Treatment: Binders, Antifungals, and Diet

Environment:

Once someone has a positive test and a known or suspected source, I recommend having a consultant (separate from the remediation company, to avoid conflicts of interest) create a remediation plan — ideally with proper containment so the remediation process itself doesn't spread spores further. After remediation, a retest should be done to confirm the space is actually clean, ideally at the remediation company's expense if it isn't.

Binders:

On the body side, treatment typically starts with binders — chosen based on which toxins showed up on testing — such as bentonite clay, activated charcoal, chlorella, or cholestyramine (a prescription option that binds ochratoxin particularly well). I start sensitive patients low and slow, since mobilizing toxins can temporarily worsen symptoms.

Antifungals When Appropriate:

Depending on the response and whether colonization is present, treatment may progress to nasal or systemic antifungals.

Diet:

Because colonization is so common, minimizing sugar and refined carbs is very important, since these feed Candida and mold colonization directly. Foods with higher trace mold content — corn, peanuts, dried fruit, aged meats and cheeses, coffee, and non-shelled nuts — are also worth limiting, along with high-histamine foods for those who are histamine-reactive.

X. Where to Learn More

As Annika emphasizes: this isn't about fearing every corner of your home — it's about being empowered with the right information.

And as always, I welcome your thoughts, experience and questions.

Until next time,

Courtney

Courtney Snyder MD is a Holistic and Functional Child and Adult Psychiatrist who offers non-patient consultations to individuals and practitioners nationally and internationally in addition to her treatment practice serving FL, IN, KY, OH. Her educational content, shared through her website, Substack Newsletter, the Holistic Psychiatry Podcast and her YouTube Channel reaches readers and listeners in over 160 countries.

Resources

* Dr. Courtney Snyder's blog: How Mold Toxicity Impacts the Brain

* Home mold test (dust sample / ERMI-style)

* RealTime Labs mycotoxin urine testing

* Mold Symptom Questionnaire (Dr. Jill Crista)

* Mold Clean-Up Guide (Dr. Jill Carnahan)

* Finding mold consultants & remediation professionals (ISEAI)

* Annika Taylor’s website: Nourished by Nature

Medical Disclaimer:

This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your own physician for any medical issues that you may be having.

As a holistic and functional psychiatrist, I see many people who are highly sensitive. Most are deep divers into information and able to connect a lot of dots. Many are gifted. Many struggle with overwhelm and low stress tolerance. Some struggled with anxiety, inner tension, or feeling “too much” for as long as they can remember. Some feel different - that they don’t fit in.

As a holistic and functional psychiatrist with over twenty years in practice, I've worked with thousands of highly sensitive adults and children. Most are deep divers into information, able to connect a lot of dots — many are gifted. And yet many struggle with overwhelm, low stress tolerance, anxiety, or inner tension that has been there for as long as they can remember. Many feel different, like they don't quite fit in. What I've found is that sensitivity itself is rarely the problem — it’s the seeming vulnerability to brain-related or physical conditions.

Over the years I’ve found three different models to be especially useful in explaining some of the vulnerabilities and the strengths of those of us who are highly sensitive: Dr. Elaine Aron’s work on the Highly Sensitive Person (HSP), the nutritional medicine concept of Pyrrole Disorder, and Dr. Sharon Meglathery’s RCCX Theory. Each looks at a similar group of traits through a different lens — psychological, biochemical, and genetic, respectively.

Before I start, I want to emphasize that sensitivity is not a pathology or a diagnosis. It is actually a trait that has existed across human history for a reason. My goal is not to pathologize it, but to understand it — and to offer tools to those who have these traits but who are struggling with a condition more prevalent in those with these traits. As I go through these three frameworks, the overlap will be obvious and I’ll highlight what each of these has to offer that the others don’t.

What You'll Learn

* The HSP model provides validation and a language for sensitive individuals.

* Pyrrole Disorder involves an overproduction of pyrroles, leading to nutrient depletion of nutrients critical for neurotransmitter functioning.

* Pyrrole Disorder is common in brain-related conditions.

* RCCX Theory connects genetic vulnerabilities to sensitivity and chronic illness.

* Stress amplifies the experiences of highly sensitive individuals.

* Understanding these models can lead to effective treatment options.

* There are meaningful paths forward for those who are highly sensitive.

Chapters

* 00:00 Understanding High Sensitivity

* 02:26 The Highly Sensitive Person (HSP) Model

* 10:23 Exploring Pyrrole Disorder

* 18:18 RCCX Theory Explained

* 30:11 Intersecting Models: HSP, Pyrrole Disorder & RCCX Theory

* 34:40 Conclusion and Path Forward

I. THE HIGHLY SENSITIVE PERSON

In the early 1990s, psychologist Dr. Elaine Aron identified a personality trait she called Sensory Processing Sensitivity (SPS) — and the people who score high in it she called Highly Sensitive Persons, or HSPs.

This is not a diagnosis. It is a trait, present in roughly 15–20% of the population. It has been found across more than 100 species — from fruit flies to primates. This tells us it is evolutionarily conserved — it confers survival advantages. In any social group, having members who are wired to notice subtle cues, process information deeply, and detect threats before others do is extremely valuable. Fitting with this, many of these individuals, who also struggle with complex chronic health issues are considered the “canaries in the coal mine” since their bodies react to environmental triggers (environmental toxins, chemicals, or stressors) long before the rest of the population.

Dr. Aron captured the core features of this trait in an acronym she called DOES:

D — Depth of processing: HSPs think deeply, reflect before acting, and notice subtleties that others miss.

O — Overstimulation: Because they process so thoroughly, HSPs reach their threshold more quickly in high-stimulation environments.

E — Emotional reactivity and Empathy: HSPs feel emotions intensely and are highly attuned to the emotions of those around them.

S — Sensitivity to subtle stimuli: They pick up on things — in their environment, in social dynamics, in the body — that others simply don’t register.

As you can see, traits that are super powers, can become liabilities. The deep diver who loses sight of the big picture. The empath who absorbs everyone else’s energy as their own energy becomes depleted. The person who withdraws from the world because the stimulation has simply become too much.

HSP Research

Beyond the clinical observations, there is now a growing body of neuroscience and genetic research supporting this trait. There is evidence that the brains of sensitive people are doing more, processing more and feeling more.

fMRI studies (Acevedo, Aron et al., 2014) have shown that when HSPs view emotional images — particularly photos of loved ones expressing happiness or sadness — their brains show significantly greater activation in regions associated with awareness, empathy, and sensory integration.

Twin studies show that Sensory Processing Sensitivity (SPS) as defined by Dr. Aron is approximately 47% heritable. Small studies as opposed to large genome wide studies have focused on genetic variants involving dopamine and serotonin systems, such as a serotonin transport gene, a dopamine receptor gene, and COMT, which codes for the enzyme that metabolizes dopamine and norepinephrine.

While this hints at a biochemical dimension, the HSP framework doesn’t address this as directly as the other two models I’ll discuss, nor does it explain the higher prevalence of physical health conditions in those who are highly sensitive.

Research published in 2026 (Matsuzawa et al.) found that individuals high in SPS had substantially higher rates of depression (13.8%), anxiety disorder (10.5%), and developmental disorders, such as ADHD and ASD, compared to the general population.

Despite this overlap with developmental disorders: unlike, ADHD, HSPs typically have excellent concentration in quiet environments. And unlike the social deficits described in ASD, HSPs tend to have heightened social attunement. They often feel too much of what’s happening in social situations, not too little, even if they respond awkwardly at times.

Research shows that high sensory processing sensitivity is associated with more frequent physical symptoms — back pain, fatigue, digestive issues, frequent illness.

What This Framework Offers

The HSP model has given millions of people validation and a language for these traits that has allowed them to shift from “what is wrong with me” to “this is how I am wired.”

It also offers an evolutionary reframe. High sensitivity is not a mistake and is not pathologic. It is a feature of the human population that has served us.

What it doesn’t offer is a biological explanation for why some sensitive people suffer so acutely — or a path toward biochemical intervention.

II. PYRROLE DISORDER

Pyrrole disorder is a biochemical imbalance that has been recognized for decades, though it remains largely unknown in mainstream psychiatry. It involves an overproduction of pyrroles — metabolic byproducts that, on their own, are not a problem. When they are high, however, they can result in a depletion of zinc, B6 and a few other nutrients.

First identified in the 1950s and first treated with zinc and B6 in the 1980s, pyrrole disorder is one of the most common nutrient imbalances found in brain-related conditions — and one of the most treatable. Yet most people who have it have never heard of it. I learned about pyrroles in 2014 when I first trained with the Walsh Research Institute.

The Importance of Zinc, B6 & Magnesium

Vitamin B6 is required to synthesize dopamine, serotonin, and GABA — three of the most critical neurotransmitters for mood regulation, anxiety, and stress response. Zinc plays a profound role in the central nervous system, the immune system, gastrointestinal tract (which we now know has its own significant influence on brain health) and connective tissue (joints and skin).

Pyrrole Disorder Traits & Symptoms

The most consistent feature is low stress tolerance. People with elevated pyrroles are often described as those for whom life seems harder than it should be, every transition can be destabilizing and every large group or new environment feels like too much.

The overlap with the HSP profile is striking, but here, we start to see not only traits, but symptoms.

- Socially anxious, shy, or fearful since childhood, with severe inner tension

- Sensitive to bright light, loud noises, textures, and odors

- Avoids crowds, strangers, and new situations

- History of reading difficulty

- Poor short-term memory

- Underachievement

- Irritability, mood swings, bouts of depression

- Tends to stay up late; little or no dream recall; morning nausea

- White spots on fingernails; very dry skin; stretch marks; poor wound healing

- Joint pain

- Frequent infections or autoimmune tendencies

Most people with pyrrole disorder don’t have all of these symptoms — but the inner tension, the high sensitivity, and low stress intolerance are very common.

What the Data Shows

The Walsh Research Institute has collected data on over 30,000 patients. Elevated pyrroles were found in:

* 18% of those with ADHD

* 24% of those with depression

* 28% of those with behavioral disorders

* 35% of those with autism

* 35% of those with bipolar disorder

* 30% of those with schizophrenia

* 12% of those with PTSD

And in only 8% of healthy controls — meaning those with no psychiatric diagnosis.

What Causes Pyrrole Disorder?

For many, there appears to be a genetic component, but for others, pyrroles appear to have increased due to high physiologic or emotional stress. Examples include candida overgrowth or other forms of gut microbial imbalances, mold toxicity, heavy metals, chemical exposures, illness, emotional trauma, major life transitions or even growth spurts in children.

What This Framework Brings Us

Relative to the HSP framework, an understanding of pyrroles gives a specific, treatable biological mechanism. When zinc, B6, Magnesium and other nutrients are depleted, we know how the brain’s neurotransmitter functioning is affected — and we know what to do about it.

Treatment from a Walsh Research Institute trained practitioner typically involves a nutrient protocol of zinc (based on zinc and copper testing), B6 or its active form P5P, and other nutrients for pyrrole disorder and other nutrient imbalances identified. For many patients, a lifetime of chronic inner tension and fearfulness begins to shift within days to a couple of weeks of starting the nutrients.

Treatment doesn’t change one’s personality, but it can improve social discomfort, overwhelm, the anxiety, the depression that has been layered on top of that sensitivity.

Where zinc deficiency can impact a lot of the physical conditions that appear to be more common in those who are hypersensitive, it doesn’t fully explain the significant hormonal, inflammatory, connective tissue symptoms and autoimmunity we see in many who are hypersensitive.

III. RCCX THEORY

RCCX theory has been proposed by Dr. Sharon Meglathery, MD — a psychiatrist and internist whose own complex health history (which is very similar to my own) led her to one of the most compelling explanations I’ve encountered for why hypersensitivity, neurodivergence, psychiatric conditions, MCAS (Mast Cell Activation Syndrome), EDS (Ehlers Danlos Syndrome), POTS (Postural Orthostatic Tachycardia Syndrome), CIRS (Chronic Inflammatory Response Syndrome) and/or CFS (Chronic Fatigue Syndrome) and autoimmunity tend to cluster together in certain individuals and families.

RCCX refers to a module of four genes on chromosome 6. Three of them appear to be particularly important to our health, and two of those have very high rates of mutation.

The Three Key Genes

(1) TNXB codes for a protein involved in connective tissue. Variants range from subtle joint hypermobility to Ehlers-Danlos Syndrome. But connective tissue isn’t just about joints — it’s also about the permeability of the gut-blood barrier, the blood-brain barrier, and vulnerability to upper cervical (neck) instability, which can put tension on the vagus nerve and affect the entire autonomic nervous system.

(2) CYP21A2 is the most important gene in the module when it comes to psychiatric conditions. It codes for 21-hydroxylase, an enzyme needed to convert 17-hydroxyprogesterone into cortisol. When there is a mutation — and there can be many, of varying degrees — the body may struggle to meet the demand for cortisol under stress. A weakness on this gene could have two primary effects:

First — The theory holds that many people with CYP21A2 mutations, even without hypermobility, may develop what Dr. Meglathery calls a “brain wired for danger” — essentially, a nervous system calibrated toward threat detection from early in life, with minimal trauma required. A mutation on CYP21A2 may essentially result in relatively higher androgens impacting the amygdala — the brain’s fear and emotional center. Studies have found that hypermobile individuals (who often carry TNXB mutations) have a larger-than-normal amygdala.

Second — because of this mutation, the body may not be able to keep up with the body’s need for cortisol (especially when under stress). This deficit causes the brain to release corticotropin releasing hormone (CRH) to signal the adrenal glands to produce more cortisol. CRH binds to mast cells and activates the immune system — leading to secondary brain inflammation. This is the inflammatory pathway that can result in a number of secondary health issues including MCAS, CIRS, POTS, CFS and more.

(3) C4 is involved in immune response and autoimmunity, and has been linked to schizophrenia. This gene variant is not as common as the first two referenced, though I do see a number of families who also have autoimmunity impacting multiple family members.

The CAPS Psychological Profile

Dr. Meglathery uses the term CAPS — CYP21A2 Mutation Associated Neuropsychiatric Spectrum — to describe the psychological profile she has observed in people with this genetic vulnerability. These traits can exist long before any formal psychiatric diagnosis, and they are not inherently pathological.

- Anxiety and over-arousal during times of stress — high adrenaline, insomnia, sometimes manic-like characteristics

- Under-arousal during low-stress periods — leading to ADD presentations, compulsive behaviors, or thrill-seeking to raise arousal

- High emotionality, sensitivity, and reactivity to environmental stimuli

- Sensory processing difficulties — typically over-stimulation in loud or chaotic environments

- A strong ability to read emotions in others, paired with social awkwardness in response

- Easily affected by events others would consider minor — an offhand comment, a disturbing movie

- A tendency toward nonconformity

- Special abilities: gifted musicians, scientists, creatives, systems thinkers

- Hyper-focus and obsession with areas of deep interest, often leading to remarkable accomplishments

- High tenacity and determination, when not derailed by overstimulation or past trauma

- Strong emotions — positive or negative — that can manifest as obsessional worrying, harm avoidance, OCD tendencies, or very high standards for self and others

Dr. Meglathery also notes — and I have observed this clinically — that people with this profile tend to find each other through friendships, partnerships and marriage. They are drawn together by shared sensitivities, emotional depth, and intellectual gifts. This means children are likely to receive a tendency towards CAPS from both sides.

Women who are appear to have CYP21A2 mutations often have a male-pattern finger length ratio — the ring finger longer than the index finger — a possible marker of androgen exposure during development.

What RCCX Offers

RCCX theory offers the broadest biological framework we have for understanding why sensitivity, psychiatric vulnerability, and complex chronic illness so often travel together in the same people and families. It connects the nervous system, the immune system, the hormonal system, and connective tissue under one genetic umbrella.

It also points toward specific interventions: nervous system regulation (limbic retraining, vagal work), mast cell management, and addressing the downstream biochemical consequences of cortisol dysregulation.

The limitation is that genetic testing for variants on the gene for 21-hydroxylase is not yet widely available, which is why this isn’t a gene that you’ll see referenced when it comes to HSP, though I would argue it is likely the most prevalent. RCCX remains a clinical theory — but one that explains the constellation of traits and symptoms of most of the people that I in my practice

IV. WHERE THESE MODELS INTERSECT

Where Might Pyrrole Disorder and RCCX Theory Meet?

The symptom overlap is almost complete: poor stress tolerance, sensory sensitivities, anxiety, inner tension, connective tissue symptoms, frequent infections, autoimmune tendencies. Relatively low zinc would impact most of these shared symptoms, but there may be a potentially deeper connection.

21-hydroxylase contains a pyrrole-like structure — heme — within it. Could a mutation resulting in abnormal 21-hydroxylase lead to a buildup of abnormal heme-like compounds, contributing directly to pyrrole disorder? This is not proven, but in an exchange about this with Dr. Meglathery, she indicated that she also believes there is a strong association, and the biochemical logic is compelling.

This matters, because we know what helps pyrrole disorder. We have a treatment — treatment that can complement what RCCX theory makes evident — that the stress response has to be addressed.

Stress (again from any cause - physiologic or emotional) is the great amplifier across all three models. Stress worsens the HSP experience, and tips the CYP21A2 mutation from manageable to destabilizing (through the hormonal consequences and the inflammatory cascade) and yes, it even causes pyrroles to increase.

BRINGING IT TOGETHER

For someone who is highly sensitive, and struggling with brain related or physical symptoms or conditions, pyrrole disorder and even RCCX theory are worth considering because they offer tools and start to answer, “What Can We Do About It?”

The three frameworks work together:

The HSP model offers validation and language. It shifts the frame from deficit to difference. It reminds us that sensitivity is not pathology — it is a trait with evolutionary value, and it comes with great strengths.

The Pyrrole model offers a treatable nutrient imbalance. It explains, at the neurotransmitter level, why stress hits harder for these individuals. Treatment doesn’t take away the sensitivity; it lifts the weight that has accumulated on top of it.

The RCCX model offers the broadest systems view. It connects the dots between what the body is doing — the immune activation, the hormonal dysregulation, the connective tissue involvement — and the psychiatric and psychological profile that tends to accompany it. It also provides additional tools: nervous system regulation, mast cell support, hormonal awareness.

If any of this resonates — the sensitivity, the inner tension, the feeling of always being at the edge of overwhelm — please know that there are roots to explore and meaningful paths forward.

If you are looking for someone trained by the Walsh Research Institute knowledgeable in assessing for and treating pyrrole disorder (and other common nutrient imbalances impacting brain health), or learning more about Dr. Aron’s work on HSP and Dr. Meglathery’s RCCX theory, I am providing those links below.

And as always, I welcome your thoughts, experience and questions.

Until next time,

Courtney

About the Author

Dr. Courtney Snyder MD is a Holistic and Functional Child and Adult Psychiatrist who offers non-patient consultations to individuals and practitioners nationally and internationally in addition to her treatment practice serving FL, IN, KY, OH. Her educational content, shared through her website, Substack Newsletter, the Holistic Psychiatry Podcast and YouTube Channel reaches readers and listeners in over 160 countries.

Resources

Walsh Research Institute: walshinstitute.org

RCCX Theory — Dr. Sharon Meglathery: rccxandillness.com

Dr. Elaine Aron — The Highly Sensitive Person: hsperson.com

Other Sources: Acevedo et al. 2014, “The Highly Sensitive Brain,” Brain & Behavior | Matsuzawa et al. 2026, Psychiatry & Clinical Neurosciences Reports

Medical Disclaimer:

This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having.

In this episode, Dr. Courtney Snyder, a Holistic Child and Adult Psychiatrist discusses:

- The research into Adverse Childhood Events (ACEs) and health outcomes (at a population level)

- How early adversity can impact our physiology, biochemistry and thus neurotransmitter functioning

- Why ACEs scores are less meaningful at an individual level

- The role of Positive Childhood Experiences (PCEs) on mitigating the effects of adversity in childhood

- The gift of neuroplasticity and resources to help teach/train/rewire our nervous system to feel safe.

Chapters

00:00 Introduction to Holistic Psychiatry

01:25 Understanding Adverse Childhood Experiences (ACEs)

07:07 Impact of Early Stress on Physiology and Biochemistry

16:27 The Role of Positive Childhood Experiences

21:01 Vulnerability to Trauma and Genetic Factors

22:05 The Power of Positive Experiences in Healing

Positive Adaptive Childhood Experiences Study 2019 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6747474/

To learn more visit:

CourtneySnyderMD.com

Medical Disclaimer:

This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having.

It is increasingly understood that our brain health is dependent on our having healthy nutrient levels. But how do nutrients actually impact our neurotransmitters.

We might assume that certain nutrient levels would cause certain symptoms or conditions. Instead, what we find are biotypes - one condition is often associated with a small handful of imbalances. For example, the biotypes of depression from the Walsh Research Institute, included undermethylation, overmethylation, pyrrole disorder, copper overload and metal toxicity. And reversely, one nutrient imbalance can contribute to a range of brain symptoms. Copper overload, for example, can be a factor in ADHD for one person, but for another contribute to panic or insomnia and still another rage or tantrums. There are some conditions, however, that have a very strong associations with specific nutrient imbalances. In this newsletter, I will address:

* 5 Ways Nutrients Impact Neurotransmitter Functioning

* Psychiatric Conditions That Can Almost Predict a Specific Nutrient Imbalance

The data comes from the Walsh Research Institute.

Nutrient Imbalances Can Be Due to Too Much or Too Little

I use the term nutrient imbalances, because it’s not just about deficiencies of certain nutrients. Specific nutrient overloads can impact brain health as well. This biochemical diversity means we don’t all have the same needs when it comes to diet and supplementation. Some of us, for example, can benefit from folate, but for others with excess folate, supplementation could worsen depression and anxiety. Those with copper overload can similarly have worsening of symptoms with copper supplementation, while others will have a need for copper.

What Causes Nutrient Imbalances

While it might seem that this is all about our intake of nutrients, we can come by these imbalances genetically. We can also acquire deficiencies and even overloads through high oxidative stress. This is when our body (including our brain) is dealing with too many insults, resulting in a depletion of our inherent antioxidants leaving us vulnerable to DNA and thus cell damage, inflammation and their consequences). Copper zinc imbalances and elevated pyrroles, which results in relatively low zinc and B6, are signs of oxidative stress.

Often an imbalance appears to have multiple causes. For example a woman with high copper causing high anxiety, could have a family history of high copper conditions (post partum depression, ADHD, angry outbursts) and thus have a likely genetic vulnerability. She may also, be taking a multivitamin with copper, eating a lot of chocolate (high in copper) dealing with high oxidative stress and not the least, be on an oral contraceptive (added estrogen can make copper go up).

5 Ways Nutrients Can Impact Neurotransmitter Functioning

Nutrients often function as co-factors, helping certain enzymes do their job. Specific nutrients are needed:

* For production of neurotransmitters. Vitamin B6, for example is needed to make serotonin, dopamine and GABA. B6 can be low in pyrrole disorder and thus contribute to a range of symptoms.

* To convert one neurotransmitter to another. Copper is needed to turn dopamine into norepinephrine (think adrenaline). If we are high in copper, we could have relatively low dopamine and high adrenaline states, which is what is seen in ADHD.

* To support enzymes involved in the breakdown of neurotransmitters. For example MAOA is an enzyme that needs Vitamin B2 to do its job breaking down serotonin, dopamine and norepinephrine. If these aren’t broken down, there could be problems with activation and anxiety.

* To help receptors do their job. Receptors are what neurotransmitters bind to, resulting in a impulse being sent down the nerve cell. Zinc and magnesium help regulate the NMDA receptor. If not well regulated, there can be high activity, which can look like thoughts getting stuck - ruminations, obsessions in OCD, cravings in addiction, and even delusions in psychosis.

* Regulate the expression of genes for serotonin reuptake receptors. Folate causes an increase in the expression of these genes (and thus production of these receptors). This results in more serotonin being picked up and less available between nerve cells. This could be a problem for someone who already has low serotonin symptoms. SAMe, on the other hand, does the opposite and it can function like an SSRI.

Why One Diagnosis Isn’t Always Associated With One Imbalance

* Psychiatric conditions appear to have various causes. If someone comes to me with a diagnosis of depression, for example, that only tells me what type of symptoms they likely have. It doesn’t tell me if those symptoms are related to high copper, a methylation imbalance, elevated pyrroles, candida, a misaligned upper cervical spine , mast cell activation, mold toxicity, metal toxicity, hormone imbalances or a combination of any of these…….or something else.

* More often multiple factors appear to be aligning. It is not uncommon, for example, to have candida or mold causing high pyrroles causing low zinc, leading to high copper, and as an aside also be undermethylated.

* One “root cause” can contribute to a range of conditions and symptoms. Some people with high copper are diagnosed with depression or anxiety and others with ADHD. Some people who are undermethylated have OCD, others depression and still other schizophrenia. Very often, people will be have multiple diagnoses fitting with an imbalance. “Comorbidities” in psychiatry are the norm, rather than the exception.

Despite all of this, there are certain nutrient imbalances that occur so commonly in certain psychiatric conditions that they can almost be predicted .

Data From Walsh Research Institute

Simply knowing someone has a mental health condition makes it more likely that they will have a methylation imbalance - more often undermethylation.

The Walsh Research Institute has looked at the methylation status of 30,000 over 40 year and found that 70% of those with mental illness exhibit a methylation imbalance (undermethylation and overmethylation). This is relative to the general population, in which 30% had a methylation imbalance.

Other Data From the Walsh Research Institute:

* History of Postpartum Depression - 95% have copper overload

* ADHD - 68% have a copper zinc imbalance

* Autism Spectrum Disorder - 98% undermethylation, 98% low zinc

* Antisocial Personality Disorder - 95% undermethylation, 95% pyrrole disorder, 95% low zinc

* Oppositional Defiant Disorder - 85% undermethylation

* Schizoaffective Disorder - 90% undermethylation

* Anorexia - 82% undermethylation

* Schizophrenia - 70% undermethylation

* Violent behavior - 78% high copper

Evaluation & Labs Are Still Important

None of these are 100%. And, again, there is rarely one contributing factor, so a comprehensive evaluation and lab testing are still important. Even if I am fairly confident that someone is low in zinc, I don’t recommend starting zinc without checking zinc and copper levels. Starting zinc too rapidly can mobilize high copper and worsen symptoms. If copper is low, zinc can cause a further decrease.

Also, there are occasions when it can be difficult to address an imbalance, without addressing another contributing issue first. For example, I see some patients who are unable to tolerate treatment of undermethylation until they begin treatment for candida or mold.

There is always so much more data to share, when it comes to the Walsh Research Institute. I look forward to discussing biotypes of depression, ADHD and schizophrenia

in a future episode.

As always, I welcome your comments and questions.

Until next time,

Courtney

To learn more about my discovery calls, non-patient consultations, and treatment practice, visit:

CourtneySnyderMD.com

Medical Disclaimer:

This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having.