The Childhood Trauma Doctor: Your Childhood Trauma Changes The Shape Of Your Brain & Causes Parkinson’s! How Not To Ruin Your Kids! Dr. Paul Conti

0:00:04 >> Trauma is like a virus, and it gets passed along to your children, even if their children
0:00:10 are not born until years later, because trauma can change the expression of our genes.
0:00:14 So we need to understand whether trauma is afflicting us, how it’s afflicting us, and
0:00:16 how we can treat it if it’s there.
0:00:17 >> Dr. Paul Conte.
0:00:20 >> Psychiatrist, expert in treating trauma.
0:00:22 >> He’s worked with Kim Kardashian.
0:00:23 >> And saved Lady Gaga’s life.
0:00:26 >> And been in clinical practice for over two decades.
0:00:28 >> How many people have some form of trauma?
0:00:33 >> Well, over half the population, and trauma can change us in very negative ways.
0:00:37 For example, the odds of traumatic brain changes are very, very high.
0:00:43 We know trauma makes us age faster than our calendar age, and we know that ultimately the
0:00:48 root of depression, addiction, Parkinson’s disease is from trauma.
0:00:50 Modern science knows this, but we’ll give them pills.
0:00:55 With the idea that pills are gonna fix everything, and then we’re surprised that tens of thousands
0:00:58 of people die each year from prescribed pills.
0:00:59 You know, we’ve let that happen.
0:01:01 >> What should we be doing instead?
0:01:03 >> The key to all of this is curiosity.
0:01:05 So for example, let’s say someone is addicted to their phone.
0:01:10 Oftentimes, addictive behavior is meant as an escape from something, or even to self-punish.
0:01:14 But when you scratch the surface of that, you might learn about an episode of sexual abuse
0:01:16 that happened when the person was a child.
0:01:19 This is not uncommon.
0:01:22 >> What are the tell-tale signs that I am traumatized?
0:01:26 What can I do to alleviate the trauma, and then can you completely get rid of a trauma?
0:01:29 The answer is based in hard science.
0:01:30 So
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0:02:14 Dr. Paul Conti, on the front of your book, it says trauma, the invisible epidemic.
0:02:17 Why did you use those two words, invisible and epidemic?
0:02:25 >> Well, as a practicing psychiatrist, what I started seeing over and over and over again
0:02:32 is that the root cause of the vast majority of what I was treating, whether it was depression
0:02:40 or addiction or panic, that ultimately the root of it was trauma, that if we traced back,
0:02:44 what we would learn is that there was something that had happened in that person’s life.
0:02:49 It could have been acute or it could have been chronic over time, but that changed their
0:02:50 brain.
0:02:55 So the brain is then different going forward, and that is the root of the problem.
0:03:00 So from that sense, I could see there’s an epidemic because this is behind what is ailing
0:03:01 us.
0:03:08 The 50% or more of complaints to general medical doctors are coming from mental health.
0:03:11 These are general physical medical medicine doctors.
0:03:17 So you imagine how much of what is going on inside of us is affecting our health.
0:03:23 So the epidemic of trauma is touching us in so many ways, but we’re not identifying it.
0:03:28 We’re identifying different illnesses, for example, like, “Oh, that person has depression,
0:03:31 that person has cardiovascular disease and had a heart attack,” but those things may
0:03:37 be linked, including autoimmune diseases, all aspects of mental and physical health,
0:03:44 but we’re not seeing that at the heart of it is the trauma that then changes us and
0:03:47 our brains and our bodies are different as we move forward.
0:03:52 So to start seeing this commonality that this is everywhere and we’re not identifying it
0:03:57 because one of the impacts of trauma is to make a reflexive sense of guilt and shame
0:03:58 in us.
0:04:04 So then we sort of hide things away, so we’re changed, made less healthier, and the very
0:04:09 trauma itself leads us to have a tendency to keep it inside, to not share, to not get
0:04:14 help, to not do the kinds of things that would lead us to recognize the epidemic.
0:04:17 How many people have some form of trauma?
0:04:21 Because when we think of trauma, sometimes people think of PTSD soldiers coming back
0:04:26 from war, so how many people does this subject speak to in some way?
0:04:31 The numbers and estimates vary, but it’d be hard to imagine you wouldn’t have roughly
0:04:32 one in five.
0:04:39 I mean, likely you have more than that, but if you look at data across demographics and
0:04:45 data for occurrences of traumatic events and the impacts we see downstream of these brain
0:04:50 changes, we’re talking about a very significant portion of the population, and then if you
0:04:56 think of people who are either experiencing the post trauma effects themselves, the changes
0:05:01 to themselves, or experiencing those changes through someone close to them, through someone
0:05:07 they love, a parent, a child, a significant other, right now we’re well over half the
0:05:14 population that will experience a significant and negative life impact from something that
0:05:19 either was, with high likelihood, avoidable or treatable.
0:05:25 In other words, change for the worse that doesn’t have to be that way.
0:05:29 It’s not just as if just mental health, we’re saying something small, I mean, mental health
0:05:33 is how we interface with the world, but it’s our bodies too.
0:05:34 Is that person going to get lupus?
0:05:37 Is that person going to have a heart attack or a stroke?
0:05:40 How rapidly is that person aging?
0:05:45 We know that trauma by this definition that changes us because our coping mechanisms are
0:05:51 overwhelmed makes us age faster than our calendar age.
0:05:56 So you can say, well, that person is 40 years old by the calendar, but they’re really 46.
0:05:59 That person is 65, but really 73.
0:06:06 If you look at the aging that occurs in us as a result of trauma, I say this in part to
0:06:10 really speak to how concrete and real this is.
0:06:15 So something that happens and changes you so that you are actually older than your calendar
0:06:22 age, closer to death than the calendar might suggest is so real and so tangible.
0:06:25 And this is the effect of trauma upon us.
0:06:30 And modern science knows this, modern neurobiology, modern psychiatry.
0:06:34 The research around us tells us this, but the things that we know aren’t always at the
0:06:38 forefront of our consciousness in society, which is a reason I think it’s so important
0:06:40 to spread the word about it.
0:06:43 Why does this matter so much to you?
0:06:49 I had a youngest brother who died by suicide when he was 20 years old.
0:06:57 I was in my mid-20s, which had just a terrible effect upon the family structure and upon
0:06:58 me.
0:07:03 And I felt the reflexive sense of guilt and shame without really being aware of it.
0:07:05 I hadn’t felt that before.
0:07:09 I hadn’t felt like I couldn’t be in the world or make my way forward in the world.
0:07:13 And I started feeling very, very different about myself and I started behaving in ways
0:07:14 that weren’t healthy.
0:07:18 You know, they were very unhealthy, drinking too much, unhealthy friendships and relationships
0:07:27 and real change in me that I was fortunate to be able to get help for that really brought
0:07:30 to the surface how much had changed after the trauma that I felt very different about
0:07:31 myself in the world.
0:07:32 It’s a curse.
0:07:37 And maybe our family was cursed and I couldn’t make my way forward and bad things were always
0:07:38 going to happen.
0:07:42 It was the realization that I’m really different and this is not okay.
0:07:48 And it wasn’t just grief in the sense that sadness and loss of course were a huge part
0:07:56 of that, but realizing also I am different and that had a very big effect on me, both
0:08:00 the depression and the issues in him that weren’t seen and addressed that led to his
0:08:04 suicide and then the downstream effect on the rest of us.
0:08:05 That led me to leave.
0:08:09 I had a business career and I went back to college and took some pre-med classes and
0:08:14 went to medical school and then became very interested in psychiatry and brain function,
0:08:21 both the psychology of how we think and the brain biology that underpins how we think
0:08:24 and have been very much fascinated ever since.
0:08:31 Did you process or deal with the loss of your younger brother Jonathan by suicide at the
0:08:32 time?
0:08:33 No.
0:08:34 No.
0:08:37 At the time, I just went inside.
0:08:41 People didn’t talk about it and were overwhelmed and became less healthy and felt different
0:08:45 about the world, but there wasn’t an outlet for talking about it.
0:08:47 It just wasn’t how I had grown up.
0:08:49 There wasn’t a way people would say, “Let’s check in.
0:08:50 How are you doing?”
0:08:56 And maybe you should see someone like it didn’t happen and it took until I realized I’m
0:08:57 kind of in trouble here.
0:09:01 I need to get some help to then, you know, I had an insurance card and to look on the
0:09:03 bag and say, “Oh, maybe I should go talk to someone.”
0:09:07 But that was a stretch for me and I felt even embarrassed about doing that.
0:09:13 I really didn’t understand neither what had happened nor how to help myself.
0:09:18 And then I went to someone and I just remember just how amazing it was to just have her tell
0:09:24 me that, you know, I wasn’t sick or crazy or not going to be okay because I felt this
0:09:25 way.
0:09:29 She helped normalize what I was feeling and helped me put some of it into perspective
0:09:34 and I realized, like, well, that was very basic, what was just done for me.
0:09:38 And you know, many, many, many people do not get that and I almost didn’t have it myself.
0:09:43 And I was very struck by it and by how much of a difference it made to have a better understanding
0:09:44 and get some help.
0:09:49 The impact it had on the rest of your family, I was reading that your mother was depressed
0:09:54 for the rest of her life almost because of, potentially because of that incident.
0:10:00 Yeah, I think she was clearly different afterwards too and was much more isolated.
0:10:07 Again, in hindsight, it’s so clear to see, but I think the guilt and shame that she felt
0:10:12 was overwhelming and she was not able to get help, you know, no matter how much encouragement.
0:10:16 You know, at some point, I was actually a psychiatrist and I still couldn’t, you know,
0:10:22 couldn’t get her to get help because I think she was just felt so ashamed and felt that
0:10:27 help was inaccessible or that getting help was even more shameful and, you know, the
0:10:28 patterns change.
0:10:34 I mean, there were still some happy times in her life, but the whole tenor changed and
0:10:39 changed towards progressively more depression and again, it didn’t have to be that way either,
0:10:45 but there weren’t support resources for, you know, mothers who lose a child to suicide.
0:10:50 And my father, who was more extroverted, you know, then just had more natural support mechanisms
0:10:54 and that’s what you see sometimes, that it shouldn’t be that one person does better
0:10:58 than the other because they just happen to have different proclivities, you know.
0:11:02 But when we’re not really paying attention to this and we’re just kind of running forward,
0:11:05 you know, and trampling people, then maybe the person who’s a little more introverted
0:11:10 in a situation like that, a little more inclined to be self-blaming, you know, like that’s
0:11:14 the person who doesn’t do okay and, you know, and my mother didn’t and died, I think, much
0:11:20 younger than she should have of cancer, but this kind of trauma predisposes to the immune
0:11:24 system not functioning as it should, and I can’t say that this trauma caused her early
0:11:31 death by cancer, but certainly there are a lot of scientific reasons to think that it
0:11:37 was likely a factor in it and, again, unless we’re aware of what trauma is and what it’s
0:11:43 doing to us, that we can prevent it, we can identify it and treat it, these changes to
0:11:47 us don’t have to stay the same, like the person who’s blaming themselves and ashamed
0:11:52 and depressed doesn’t have to stay that way, the person who’s abusing a substance to try
0:11:57 and cope or to try and kill themselves because they feel so bad, it doesn’t have to be living
0:12:01 like that, like we really and truly can make change, the person who has an autoimmune disease
0:12:06 or heart disease or rheumatoid arthritis that’s inflamed after the trauma, like everything
0:12:11 is worse after the trauma, it doesn’t have to be medically ill like that, like the message
0:12:17 I’m bringing is one based in hard science and it’s one that has a real message of change,
0:12:22 that it’s not an esoteric principle, what we can and should be healthier, even you think
0:12:28 about more than 50% of complaints brought to physical medicine doctors come from a mental
0:12:33 health perspective, and how much of that is based in trauma, it’s the majority of what
0:12:37 is ailing us and the numbers actually do tell us that.
0:12:40 At the top of this conversation you referred to ageing and the impact that trauma has on
0:12:42 ageing, how does that work?
0:12:46 So trauma makes me older.
0:12:52 There’s cellular mechanisms in us, people often talk about telomeres which is one aspect
0:12:56 that change as we grow older because we’re very interested in figuring out why do we
0:13:03 grow older, so there are processes in us that sort of mark time and that change across the
0:13:08 ageing process of humans, now we don’t understand everything about this, if we did we could change
0:13:13 it and live much, much, much longer, but we’re trying to understand about it and I think
0:13:18 science has made a lot of very significant headway in understanding and part of that
0:13:26 understanding is the biological age of a person is different from the calendar age, so an
0:13:31 example would be if you took two identical twins at birth and one of them is able to
0:13:36 live in pretty good circumstances and free of trauma and has a pretty good life going
0:13:43 and the other person lives in a way that has privation and a lot of trauma, maybe direct
0:13:48 physical assaults are seen as less than denigrated by society, it’s a theoretical example, but
0:13:55 the idea would be you go follow them 30, 40, 50 years later and you find two people who
0:14:00 are not the same age anymore, the person who had the better life if they’re 40, well they’re
0:14:05 40 and if you match up cellular ageing mechanisms and again we don’t know how close a person
0:14:08 is to death, but the ageing mechanisms are telling us how far along our path we are so
0:14:13 to speak, they say okay that kind of matches with being that person’s age, but then you
0:14:17 see the person who has been through so much trauma, the presumption here of being there,
0:14:22 the brain changes of trauma, there’s a post trauma syndrome, that person is going to actually
0:14:28 be older in terms of how far they have traversed down that path of the machinery in them running
0:14:32 itself forward than what the calendar tells you.
0:14:37 Trying to figure out why and how that’s happening, what is the mechanism that’s causing them
0:14:40 to apparently accelerate in age?
0:14:44 So the less healthy environment within the person, so some of that is likely say the
0:14:50 signaling molecules that we talked about, it’s just not as the bloodstream isn’t as clean
0:14:56 and healthy and running in as lockstep fashion as we might want, but there are inflammatory
0:15:01 signaling markers and that impacts cellular function and cells are more likely to die
0:15:06 earlier than they might otherwise and elements of neurotransmission and anxiety and tension
0:15:11 states within us, it’s really environmental.
0:15:15 One set of aging machinery is in a healthy environment and the other isn’t, so it’s going
0:15:20 to deteriorate more quickly, I mean it’s one way of kind of trying to capture that, the
0:15:28 environment is very different in those two people, so what is functioning in that environment
0:15:34 ages is going to change, like having a car maybe in a nice warm dry environment versus
0:15:39 having a car where there’s snow in nice six months of the year and then it’s terribly
0:15:44 hot the other six months, it’s going to be different, it’s going to age differently so
0:15:49 to speak, if you go look at those two cars 10 years later and to some extent it’s like
0:15:51 that in us too.
0:15:56 Death, disease and trauma, a 2021 study by the British Medical Journal found that adults
0:16:02 who experience sexual abuse by the age of 16 have 2.6 times the chance of dying in middle
0:16:09 age than those who didn’t experience it, it’s not commonly believed that trauma can result
0:16:14 in disease, like physical disease directly, but you argue that it can and you also talk
0:16:24 about how it can result in autoimmune disorders, things like arthritis, Crohn’s disease.
0:16:28 Crohn’s disease, ulcerative colitis, Parkinson’s disease probably has an autoimmune component
0:16:32 when we’re learning that much, much more is autoimmune.
0:16:37 So do you believe that trauma is the underlying reason behind many diseases that lead to early
0:16:38 death?
0:16:42 Absolutely, and thinking about what you just read, can we take a look at that again, like
0:16:46 I think what you just read is absolutely momentous.
0:16:54 So think about that, sexual assault in the teen years leads to a two and a half fold
0:16:58 increase in death risk that’s staggering.
0:17:00 What’s causing that?
0:17:04 The whole cascade from the biological to the behavioral.
0:17:09 So gene transcription has changed, healthier genes are more likely to be off, unhealthier
0:17:14 genes are more likely to be on, that’s not good for our blood vessels, that’s not good
0:17:19 for heart disease or possibility of having a stroke and the immune system is more activated
0:17:24 and more likely to attack itself and some of the mechanisms within us that are protective
0:17:27 against cancers for example are less likely to function.
0:17:33 All of those things change biologically, neurotransmission, endocrine function, signaling markers in the
0:17:38 bloodstream, all of that is changing and at the same time behaviors are changing, higher
0:17:45 risks of depression, higher risks of addiction, higher risks of impulsive behaviors, risk-taking
0:17:51 behaviors, you have to put a lot of things together before you get a death risk that
0:17:56 is two and a half times higher but that’s how we get there because it does put a lot
0:18:02 of things together from the genes all the way through to complex risky behavioral taking.
0:18:08 Do you think there’s anything killing more people than trauma fundamentally?
0:18:13 Not if we look for root cause, I’ve seen many, many things that killed people and I wrote
0:18:21 about this in the book of people that I was taking care of who at times died and I was
0:18:28 so we so struck by what the death certificate said versus why they had really died.
0:18:33 So the death certificate might have said car accident, okay I understand that but why was
0:18:38 that person driving 120 miles an hour in bad conditions or why were they being so reckless,
0:18:43 why they had five car accidents, I know that’s the trauma, right, well it’s a heart attack,
0:18:49 why did that person have a heart attack when they were 62, they didn’t have huge risk factors
0:18:55 from other, anyway except the trauma and its impact and so if we’re looking at root cause
0:19:01 analysis of what is hurting us, what is hurting our quality of life, what is hurting the quality
0:19:07 of life of people that we love and what is killing us, I think that need we know more
0:19:12 than even just that and there’s so much we could pile the information a mile high that
0:19:16 supports that piece of information which I think is quite staggering.
0:19:20 What are the different types of trauma, are there different categorizations of trauma
0:19:23 from like small to big or?
0:19:28 If we’re using the definition that trauma is anything that overwhelms our coping mechanisms
0:19:34 so there are changes in the brain when our coping mechanisms are overwhelmed and on the
0:19:39 other side of that our brains are different, so that’s the biological definition then we
0:19:45 would look at well how do we get there, right and it breaks down into three categories then
0:19:52 of acute, chronic or vicarious, so the acute trauma is how we’ve traditionally seen trauma,
0:19:55 so if you think about the idea that people were shell shocked after World War I, right
0:20:01 that was acute trauma, combat trauma, so our traditions of looking at trauma come from
0:20:05 acute trauma and it’s just more evident you know after someone dies or there’s an injury
0:20:10 or there’s a car accident like you know we can see that oh okay gosh that could what
0:20:14 makes some difference in the person like we can kind of get that and sometimes we can
0:20:21 see the change in the person from before and after, so we have tended to equate trauma and
0:20:25 post trauma syndromes like what happens to us after those changes in the brain are now
0:20:31 with us to acute trauma but again it’s not a soft definition, it’s based on do those
0:20:36 changes in the brain happen in other ways and the answer to that is yes, that if a person
0:20:44 is seen as less than for example in a society for whatever reason across time or even within
0:20:49 a household, a person is being abused in a household, a child is being neglected or a
0:20:54 child is being emotionally or physically abused, bullied at school, sure bullied at
0:21:02 school absolutely right this over it so nothing happens all at once right but that brain changes
0:21:10 just the same so it’s a scientific definition of traumatic change and it is true in situations
0:21:15 of chronic trauma just as it is in acute trauma, now it doesn’t mean all acute traumas or all
0:21:19 chronic traumas make these changes in the brain and then vicarious so the third category
0:21:25 there would be vicarious trauma which means human beings are empathic right I mean thank
0:21:28 goodness right that’s how all goodness comes in the world through our ability to have empathic
0:21:34 connection but that also means that our trauma can communicate from one to another and again
0:21:40 it’s not a soft concept so people who are very much involved in other people’s trauma
0:21:47 so in healthcare settings sometimes in journalism settings just in intimate home settings in
0:21:54 just spending a lot of time with the news right can become traumatized and have the
0:21:58 changes in the brain that look the same as the person who lost two family members in
0:22:05 the car accident so it is true that vicarious trauma can change us in just the same way
0:22:10 the modern field acknowledges that if it’s in the context of professional endeavors
0:22:13 which really makes no sense right like what we’re talking about are brain changes and
0:22:19 brain changes can come through acute trauma chronic trauma or vicarious trauma because
0:22:24 of our ability to have empathic connection and compassion with other humans I want to
0:22:27 make sure that I’ve nailed this before we move on so the acute trauma I get it it’s
0:22:33 the big events it’s the going to war it’s the car accident big events that happen typically
0:22:39 in an instant typically chronic trauma this is things like racism sexism bullying that
0:22:45 happen over a long period of time gradually that make you often feel less than right than
0:22:50 other people and the vicarious trauma is the trauma that as you say you get from empathy
0:22:55 so feeling someone else’s pain feeling someone else’s trauma and it becomes your own yes
0:23:01 okay yes and they can all lead us to the same brain changes but people have different levels
0:23:08 of susceptibility right so one person may have three big acute traumas and that person’s
0:23:13 brain is still doing okay right it’s not changed towards greater vigilance right it’s not
0:23:18 changed towards greater inflammation in their blood vessels then you know another person
0:23:24 could have one incident that might seem more mild than the other three the person and that
0:23:30 person can then have brain changes so probably who are we genetically how are we built what
0:23:34 kind of life experience have we had especially early life experience how susceptible are
0:23:40 we to one thing versus another and then this idea of the multiple hit hypothesis that I
0:23:45 could have a number of traumas and then on a certain trauma that might be even mild compared
0:23:49 to ones that came before it now it makes the changes what is that hypothesis so that multiple
0:23:55 hit which which which says that this idea that what what doesn’t kill us makes us stronger
0:24:00 is completely wrong I mean it absolutely every way what what doesn’t kill us often makes
0:24:04 us weaker right and that’s why we have to be attentive to what hurts us but doesn’t kill
0:24:08 us so that we don’t get weaker we get stronger but what can happen is we can become more
0:24:15 susceptible to the more likely that the next trauma if we experience one will then create
0:24:21 the brain changes as I often wondered I’m the youngest of four kids we all grew up in
0:24:26 the same household we experienced a variety of different traumas in my opinion much of
0:24:29 it was chronic but again being the only black family in the Norway area all these kinds
0:24:34 of things but I think I’ve always reflected on is for some reason I think I experienced
0:24:39 it much more the trauma of that then my oldest siblings yes and I pondered whether that’s
0:24:44 because of the timeline being the youngest it was worse in the later years so I think
0:24:48 my hypothesis has been that I experienced it more than my siblings and I think I’ve embodied
0:24:53 the shame a lot more than my siblings have yet we both went through the same thing so
0:24:59 for whatever reason I’m like really like I’m a workaholic and I’m exceptionally driven
0:25:03 not that my siblings are but I’m obsessed in a way that’s probably not completely healthy
0:25:06 and I look at my siblings and I go they’re not fucked up in the same way that I am but
0:25:11 we will went through the same thing part of what you’re pointing out is that the variables
0:25:16 of life matter right so circumstances are different say for one child in formative years
0:25:21 and for another those children could be affected differently like economic circumstances so
0:25:27 some of it maybe and probably is impacted by the things that you’re saying but they’re
0:25:32 probably are almost surely other factors to this kind of nature and nurture that people
0:25:37 have what sometimes gets called different levels of attunement of the emotional compass
0:25:42 so you know some people are very sensitive and sensitized to things and very aware of
0:25:46 what’s going on around them and aware of their own feeling states and you know and other
0:25:50 people can kind of go through life and you know emotionally buffeting things can happen
0:25:54 but they kind of keep going you know and then look their pros and cons to both of those
0:25:59 ways of being but the person with the sort of more finely attuned emotional compass is
0:26:05 the person who’s likely to register more things that are negative like things like subtle
0:26:10 expressions of prejudice right that someone with a less attuned compass may just you know
0:26:16 kind of not see that or just he doesn’t make it you know into their conscious awareness
0:26:21 where someone else who be very attuned might see a lot of those things so it’s this part
0:26:25 like what is the nature like who is the person right and then what is the nurture meaning
0:26:30 like what are the variables you know that that that seed sort of falls into as we go
0:26:31 through life.
0:26:35 You must have seen this a lot in your practice where an individual went through a really
0:26:40 traumatic early event and you’ve got the person in your practice set in front of you
0:26:45 that is an alcoholic they are experiencing sort of suicidal thoughts but then when you
0:26:50 look at the rest of the family the family are just doing fine to some whatever that means
0:26:51 fine but.
0:26:55 Like well one if to look at is the rest of the family doing fine because sometimes what
0:27:01 it seems like on the outside is not true on the inside and then we do think about genetics
0:27:06 especially around alcoholism there are we don’t understand all of it of course but but
0:27:12 there are genetic factors that can be very impactful then we’ll look at personality structure
0:27:17 you know is that person built to sort of internalize or externalize blame you know so why alcohol
0:27:20 for this person and not for someone else how much is nature or nurture and how much may
0:27:26 be formative it may be that for example that person was in social circumstances just real
0:27:32 example that happens with some frequencies they mid to late teens where alcohol was accepted
0:27:37 as a way of coping right and and maybe other people in the family weren’t this circumstances
0:27:40 were just different where they went to school was different and and they didn’t have it
0:27:45 modeled for them that this is how they cope so maybe their genetic factors that that push
0:27:51 more towards alcoholism maybe there are social factors right that it was modeled for that
0:27:56 person so you know put can put those things together and which is why we follow patterns
0:28:01 and there’s a science underlying all of this but we have to look at who is that person right
0:28:06 because you have to look at you know the family history so the genetics that may have been
0:28:10 passed on and what does that seem like may be the case in the person how can you be informed
0:28:15 by that and what were the formative life experiences and you know you start we start to build a
0:28:19 picture of what’s going on inside of us so that we can understand and change by looking
0:28:23 at our history which is why mental health doesn’t often do this you know it takes an
0:28:28 inventory of your symptoms now to reflexively prescribe a medicine right so we need to understand
0:28:32 ourselves if we’re going to understand whether trauma is afflicting us how it’s afflicting
0:28:37 us how we can prevent it how we can treat it if it’s there and and I think that means
0:28:42 accepting that this is real and this is real science which which actually when you were
0:28:47 talking it made me think of an example so if I say an example to the science of it one
0:28:52 of the earlier studies and I forget exactly how many years ago this was but 15 or 20 years
0:28:58 maybe was looking at immigrants and I believe they were immigrants from Somalia to Holland
0:29:02 I think I’m remembering that correctly and and so the incidence of schizophrenia in the
0:29:08 human population is about one percent across the human population but when stressors are
0:29:14 higher right they can predispose people to having to coming down to having the syndrome
0:29:19 of schizophrenia so it’s about one percent of the population but it’s not evenly distributed
0:29:23 if there are you know people in sort of pressure cooker environments so to speak become more
0:29:30 susceptible and so they looked at at immigrants who integrated into the community in Holland
0:29:37 versus immigrants who lived in primarily immigrant communities and the incidence of schizophrenia
0:29:43 was higher in the people who had integrated right so the thought is and again there’ve
0:29:46 been subsequent studies and we don’t know for sure but the the when you kind of look
0:29:52 at that so what what is that is the feeling of otherness right is is different trying
0:29:56 to integrate into a society that was looking at you know not everyone in that society of
0:30:01 course but there was a much more pervasive sense of otherness when people were integrating
0:30:06 than then when they were living in the communities where food and dress and like the day to day
0:30:13 of life was normalized what’s otherness and what’s the sort of cost of otherness you think
0:30:18 otherness in the way I’m defining is a sense of difference in a way that’s not good right
0:30:25 a sense of difference in a way that involves either being seen as less than and again sometimes
0:30:29 it can be over prejudice but it can be also stratification of opportunity you know just
0:30:33 seeing that okay like in some way I’m not on an equal I don’t feel on an equal footing
0:30:38 here right and then that there’s a there’s can be a sense of isolation there that that
0:30:44 builds the sense of otherness then say building tension inside the person right the person
0:30:48 doesn’t feel quite as safe right it doesn’t feel quite as validated because you know we’re
0:30:52 especially when we’re young we look around us to see what’s normal and if you know people
0:30:57 are looking talking dressing like us like we just feel validated in ways that we might
0:31:02 not feel if we see that we are different especially if the difference isn’t embraced right and
0:31:09 we see this across immigrant communities who at some point integrate right but initially
0:31:13 people will tend more to stay together because there’s there’s a sense of validation in the
0:31:18 community so then the children often then will integrate right which is why it’s such
0:31:24 an interesting study to look at people who were first generation immigrants who would
0:31:28 be likely to feel very strongly you know whether they were integrated or whether they were
0:31:32 somewhere different because they weren’t the subsequent generations right they’re the generation
0:31:38 that just come from the home culture that either they could still sort of live in or
0:31:43 live in a new culture and not that everyone felt a pervasive sense of otherness but there’s
0:31:50 more of that sense of otherness and the fact that that would change susceptibility to an
0:31:57 illness that otherwise is it distributes itself across the population I think is a very profound
0:32:03 you know marker of scientific proof upon the things we don’t pay attention to as much
0:32:08 you know subtle prejudices discriminations whatever they may be that are in our society
0:32:14 that we kind of look the other way and don’t see we’re really harming people who then can
0:32:21 come to the come to the adult phase of life in a place where we have marginalized them
0:32:25 and we’ve we’ve made things different inside of them that makes it harder to make their
0:32:30 way in the world and I think we overlook very much whether it’s bullying there’s many many
0:32:34 things that can be based upon what can make people feel less than but the effect of it
0:32:40 is is seen in actual brain biology and like we know this we’ve known this for a long time
0:32:46 but in some ways I see that we’re more fragmented and pushing more towards these experiences
0:32:51 of otherness or experiences of vulnerability and lack of safety that push people towards
0:32:57 the the the chronic aspects of traumatic brain change when we think about trauma we often
0:33:01 focus on childhood but what you’re saying now with this study of the Somalians that immigrated
0:33:08 to Europe and presumably those adults yes so the the highest incidence of schizophrenia
0:33:12 is in people who are in young adulthood so so we’re not seeing changes in people who
0:33:16 are already deep into adulthood but the but the the changes that we’re seeing is in the
0:33:23 sort of transition to it to adulthood which honors both that yes we are much more impressionable
0:33:27 in all sorts of ways including how our brains are forming when we are younger so these are
0:33:31 people still their brains still have enough formative ideas the thought would be they
0:33:37 have enough formative processes going on in their brains that the brains can be changed
0:33:42 by the trauma but when we talk about these three types of trauma the acute chronic and
0:33:49 vicarious can you experience these types of trauma in any age phase chapter of life yes
0:33:56 the earlier in the lifespan the more impactful okay yes absolutely which is why childhood
0:34:03 trauma is so important my in the book I interview Darren Richard who’s a psychiatrist at Sanford
0:34:08 and Stephanie von Gutenberg who’s a child wellness advocate because we’re talking about trauma
0:34:14 from both ends of the spectrum so that the chapter that’s the interview with Stephanie
0:34:21 von Gutenberg talks about how childhood trauma so deeply impacts the the sense of self of
0:34:26 the child like things that we know but I dedicate a chapter to it because childhood trauma is
0:34:34 so tremendously impactful and again we don’t pay enough attention to helping children who
0:34:40 are traumatized and to to projecting ahead to the increased burdens of illness and decreased
0:34:46 role performance and all the awful things that happen so so childhood trauma is one thing
0:34:51 on the other end of the spectrum Dr. Richard’s work has highlighted the fact that when people
0:34:58 are traumatized they are changed in ways that changes subsequent generations so for talking
0:35:04 about childhood trauma we can talk about traumatized children we can also talk about traumatized
0:35:11 adults whose trauma changes their children even if their children are not born until
0:35:18 years later so think about this so so the and part of Dr. Richard’s work was around
0:35:24 war crimes so the idea of rape for example as used in war that was seen primarily through
0:35:29 a criminal lens like that was something wrong and criminal that was done in a way that very
0:35:35 much circumscribed it and part of what his work has really brought to the fore is not
0:35:40 only is that not a circumscribed crime that is going to affect that person for the rest
0:35:46 of their lives because the odds of traumatic brain changes are very very high and if that
0:35:51 happens which is likely then the unborn children that could be years and years down the road
0:35:58 are also affected think about that is I think as dramatic as any evidence can be that yes
0:36:03 we need to think about children if we’re thinking about childhood trauma but we also need to
0:36:08 think about adults who are changed by trauma and then their children are changed greater
0:36:14 genetic expression of anxiety pathways of pathways that are about hyper vigilance and
0:36:20 again it’s just a sense of lack of safety and this can come years after the trauma changes
0:36:28 the brain of the parent how do we know that trauma can and is being passed on what is
0:36:33 the best evidence we have to support that so the field of epigenetics which has come
0:36:40 to the so so epigenetics will come to the forefront in the last two to three decades
0:36:48 which is the understanding that our life experiences can change the expression of our genes so
0:36:56 so you or I may have a gene that is active now because we inherited an active gene for
0:37:00 example and then maybe that gene is producing something it’s just helping us in some way
0:37:06 bolstering mood decreasing anxiety then something can happen something can change in us that
0:37:12 turns off the expression of that gene or turns on the expression of another gene so then
0:37:17 even though you have that gene you don’t have the benefit of it because the gene has been
0:37:24 turned off and this is a very it’s a very revolutionary understanding that it’s not
0:37:27 just what your genes are your genes you know we could look when sperm and egg come together
0:37:32 well that’s telling us what’s going on if we could understand that fully we would see
0:37:36 oh here’s the array of genes that are active in the array of genes that are not active
0:37:43 but that’s not the story right that’s just part of the story the story continues that
0:37:49 one’s experiences of life changes how those genes function which ones are on which ones
0:37:55 are off and how they get passed along so if the parent is not traumatized the parent may
0:38:01 pass along the active gene for something positive say to the child if the child then is traumatized
0:38:07 the child may pass on that gene without it being expressed so it’s as if the gene isn’t
0:38:13 passed on so if you think about that it’s just amazing that our genetics in the sense
0:38:18 of what’s actually going on in us is not just the nature of what genes did we get it’s the
0:38:26 nurture how has what has happened to us affected the expression of those genes there’s one
0:38:31 study that I read about which says scientists at Emory University in Atlanta trained male
0:38:36 mice to fear the smell of cherry blossom shocking them whenever they smelled it so the mice
0:38:40 got to the point where they shuddered when they smelled it even when they weren’t even
0:38:47 being shocked and I’m guessing the children then had that the same reaction I guess that’s
0:38:52 what the study concludes but also the the children of holocaust survivors are another
0:38:56 example of how trauma can be passed on because yes it’s hard to think of a much more traumatic
0:39:01 event than being involved in the holocaust right and for a long time the thought was
0:39:07 that the the reason that the children of holocaust survivors had higher levels of anxiety and
0:39:13 of anxiety spectrum illnesses was because of anxious parenting that understandably the
0:39:20 parents had a much more sense of vulnerability you know so so across the population they
0:39:24 were they were more anxious and they were raising the children with more anxiety and
0:39:30 what we have learned is that that the experiential aspect is part of it but that exactly what
0:39:35 you and I are talking about is part of it too because the experience of what they went
0:39:42 through changed genetic expression in the children so that’s that’s just a sea change
0:39:48 in understanding that the the genes of the parents the genetic expression of the parents
0:39:52 and the genetic expression that they pass along to their children is changed by the
0:39:59 holocaust experience itself with this understanding of epigenetics do you in your practice then
0:40:04 consider deeply what someone’s parents went through in their life and how that might have
0:40:08 changed someone’s sort of genetic expression that sat in front of you in your practice
0:40:15 sure sure I think we all deserve so to speak to to think about our life narrative right
0:40:19 and then so many of us don’t I think if we’re trying to help ourselves you know whether
0:40:23 someone listening to this like feels that they’re depressed or that they they don’t
0:40:26 have any mental health issue but they want to understand themselves better is like think
0:40:31 about a narrative of okay where let me start like where have I come from and like who came
0:40:36 before me and and then wait this happened and then that happened and then when we build
0:40:41 a narrative it’s remarkable how much we can come to understand about ourselves because
0:40:46 often we don’t do that we have isolated pieces of information about ourselves but we don’t
0:40:52 knit it all together and and it’s really remarkable what can happen what can be elucidated by
0:40:58 doing that so absolutely yes just for the general understanding of the person and also to understand
0:41:03 what did the parents go through you know what what experiences did they have how might that
0:41:08 impact this person and you might then ask questions of let’s say that family situation
0:41:14 changed you know between say older siblings and younger siblings right then by learning
0:41:18 about that history and learning about older siblings versus younger siblings and the parents
0:41:24 I mean how much you learn then not just about the person’s experiences growing up but but
0:41:28 just about the the biological aspects of how are the parents functioning how did it impact
0:41:32 the children and what were the situations how are the children similar or different there’s
0:41:38 so much we can learn from that you like in trauma to a virus it’s a very interesting
0:41:42 way for us to start thinking about trauma because we seem to think of it at least I did as being
0:41:47 sort of isolated to the person but the idea that it’s somewhat has a contagion to it and
0:41:53 that we can spread it vicariously to other people that are around us but also down through
0:41:59 the family tree via our epigenetics and via our genes makes you kind of understand both
0:42:03 the importance of treating it but I’ve just never heard anyone describe it as a virus
0:42:12 before yeah because there’s a reflexive guilt and shame to trauma and our society doesn’t
0:42:18 recognize it it often gets hidden inside the person right but when it’s hidden inside
0:42:24 the person it’s still spinning off symptoms so I think the best analogy to use here is
0:42:31 of an abscess in the body so an abscess is a walled off area of infection in the body
0:42:35 and it’s good that the infection is walled off because if it weren’t it could be fatal
0:42:40 right so it’s good that it’s walled off but the body is still aware that it’s there and
0:42:45 it’s still spinning off symptoms because it’s there so for example a person might have an
0:42:50 intermittent low grade fever or just feel kind of jittery or you know they’re sweating and
0:42:54 they’re not sleeping well right so they’re pervasive symptoms that are impacting this
0:43:01 person but it’s not obvious that the abscess is there right so what often happens in general
0:43:05 medicine is a person is having nonspecific symptoms you know people go looking scan they
0:43:10 say oh there’s an abscess there right once we know that then we might have an understanding
0:43:15 for why that person this never feels good right they always feel lethargic or they never
0:43:20 feel comfortable we know there’s something there now and we can go in and fix it right
0:43:24 and it involves you know there’s a surgical process right so something has to happen that’s
0:43:29 not a fun thing right if you go through surgery and recovery now the abscess is gone so I think
0:43:36 the the example of the abscess in the body is a very good way to understand what trauma
0:43:41 does to us in the mind so if we shove it down inside of us there’s reflexive guilt and shame
0:43:46 society isn’t helping us take a look at it now it’s there inside of us it’s going to
0:43:51 spin off symptoms and those symptoms aren’t always symptoms that makes a one person hurtful
0:43:57 to another they may not that person may be very very vigilant and and just kind as can
0:44:03 be to someone else but across the population those symptoms inside of us are not good so
0:44:09 they give us shorter tempers right we’re more likely we’re more anxious so we may be more
0:44:15 quick to anger or we’re less functional in the world around us because of depression
0:44:21 anxiety sleep problems right we can be more impulsive like it works against us being in
0:44:26 the world as best we can be and is that what you refer to as post trauma syndromes is that
0:44:31 similar thing yeah yes post trauma syndromes are ways in which we can recognize the changes
0:44:38 in ourselves so higher levels of anxiety for example lower levels of mood right different
0:44:46 changes in sleep physical health changes and then changes in just how comfortable we feel
0:44:51 in the world right so what we’ll see is changes in behaviors that are driven by just feeling
0:44:55 differently in the world so we have it we’re in a different self states we have different
0:45:00 behaviors the syndromes can do all sorts of different things to us for mood anxiety sleep
0:45:05 behavioral change so someone who might want to find a relationship partner you know stops
0:45:09 going to places where they could meet someone right so we change our behaviors this is what
0:45:16 shows us that there is a post trauma syndrome that’s how we know we’re traumatized effectively
0:45:19 because that’s why I’m trying to figure out how people be listening to this now and hearing
0:45:23 you talk about these different types of trauma what are the sort of telltale signs I’m assuming
0:45:29 it’s this that I am traumatized right yeah this is what we’re looking for right so someone
0:45:33 might present with that person is depressed now and they weren’t before that person is
0:45:38 having panic attacks and they weren’t before that person is using alcohol to soothe and
0:45:42 they weren’t before because in medicine we look at just the surface right what we want
0:45:46 to look at is like oh why are you here oh you’re here because you’re drinking too much
0:45:49 let’s talk about how you can drink less you’re here because you’re depressed what can we
0:45:54 give you a depression medicine right so then we’re not looking at like why right why are
0:45:59 you depressed I mean some people biologically will become depressed you know no matter what
0:46:03 even when things are going very very well but this isn’t the majority right most most
0:46:08 of us if we’re depressed there are likely factors like so we should be curious why
0:46:12 is that person depressed why is that person having panic attacks why is that person change
0:46:18 their behaviors right and so now if we get curious we get curious about the person then
0:46:22 we’re going to figure we’re going to figure out things we wouldn’t have before right so
0:46:27 if a person gets depressed because everyone in their family gets depressed every nine to
0:46:31 twelve months no matter what like okay let’s let’s come at that biologically we don’t that
0:46:35 doesn’t necessarily map to trauma right but but if we start looking at that person being
0:46:40 depressed do we see that you know they kind of started getting depressed you know a couple
0:46:46 of years ago around the time their sleep started being a little bit different and you know
0:46:49 they started behaving differently and they you know they didn’t spend as much time with
0:46:54 family or and then you start getting more curious and and you start learning oh you know
0:46:58 if it’s something something happened then right again with acute traumas it’s easiest
0:47:03 to see but when you look for the whole picture of like might there be a post trauma syndrome
0:47:07 going on here you know maybe that person who’s depressed and is drinking too much started
0:47:12 drinking too much when their mood started decreasing after the trauma or maybe they started drinking
0:47:17 after the trauma and it’s driving their mood down like and it’s not always this but we’re
0:47:23 never going to know and understand unless we’re curious like this is how we trace to the roots
0:47:29 of it and this is how we get back to the narrative right of of what is going on inside of me
0:47:34 and have I changed right and the idea we started talking about how the changes in behavior of
0:47:39 the post trauma syndrome are the changes that that make trauma like like a virus because
0:47:46 we start behaving differently and for some people that is the their mood is as good and
0:47:50 it’s not as healthy to be raised by a parent who’s depressed right so that can be a way
0:47:56 in which the virus of trauma gets passed along to the next generation or maybe that person
0:48:01 is drinking or using a drug to cope and that doesn’t make for the best parenting that’s
0:48:07 how the virus of trauma gets passed down to the next generation or there are times when
0:48:13 when a reaction to trauma to the feeling of disempowerment can be aggression and envious
0:48:18 aggressive behavior so so not all abuse of children comes through the lens of trauma but
0:48:23 a lot of it does I’m interested as well in the subtle symptoms of trauma you know we’ve
0:48:26 talked about some of the big picture stuff which is like suicidality you know becoming
0:48:30 an alcoholic or all those kinds of things but the subtle ways that trauma shows up in
0:48:37 everyday life I was some of them I was hypothesizing over things like phone addiction being addicted
0:48:42 to your phone or video game addictions these kind of things that I think maybe originate
0:48:49 from the sort of more chronic traumas but are less easy to spot right right yeah I think
0:48:53 the key to all of this is curiosity right so let’s say someone is like say addicted
0:48:58 to their phone okay maybe that’s because phones are addictive and the person has just spent
0:49:05 too much time on their phone maybe right but addiction mechanisms in human beings are similar
0:49:11 like it’s the same machinery across addictions and oftentimes addictive behavior is meant
0:49:17 as an escape from something or to soothe against something or even to self-punish because
0:49:22 of something so addictive behaviors that’s similar brain machinery whether it’s cocaine
0:49:27 it’s alcohol it’s brownies it’s a telephone it’s sex it’s exercise I mean there are things
0:49:34 that people do in addictive ways as routes of unhealthy coping so so if we get curious
0:49:40 why they get why the drug why the phone addiction why the things that might seem more subtle
0:49:46 um and maybe are more subtle but we should scratch on the surface of them to try and
0:49:51 understand if they mean something is that phone addiction the 14th addictive behavior
0:49:56 in a row right because that person has sort of particularly adept addictive machinery
0:50:00 inside of them and they’re trying to escape from something like that doesn’t happen all
0:50:05 the time but it is not untrue that when you scratch the surface of that you might learn
0:50:09 about an episode of sexual abuse that happened when the person was a child like these are
0:50:14 real examples right and that the person isn’t built to run from things through addiction
0:50:17 and maybe they’re saying things about their own character that’s negative they’re saying
0:50:21 negative things about themselves they feel disempowered and they’re disempowering themselves
0:50:26 but if you go look at that narrative you know that that person that might have a dialogue
0:50:29 running over and over again in their head of shame about something that happened 30 40
0:50:35 years ago like this is not uncommon so we need to be curious and we need to scratch on the
0:50:40 surface of things whether they’re really big things or they’re subtle things like which
0:50:45 is why life narrative is so important if you think about changes like after trauma that
0:50:51 changes the brain we respond differently when we see a new face so so without the trauma
0:50:56 is I’m simplifying a little bit but you see a new face we might be curious like oh you
0:51:00 know could could you be a friend or if someone’s romantically interested like oh my that person
0:51:05 like me or I might like people are interested and curious whereas after trauma there’s there’s
0:51:09 a difference of feeling a little bit on the back foot so people tend less to look up and
0:51:14 engage and more to look away or more of negative thoughts so you don’t that person doesn’t
0:51:19 like me you know instead of something that might be more constructive how do they test
0:51:24 for this is there tests that are able to be done to see if someone after trauma has like
0:51:30 a different set of sunglasses that they view the world with yes yeah there’s a test from
0:51:37 from the brain biology all the way through to to very clever psychological experiments
0:51:42 like we can see all of this and it’s these these signs we should be looking for in ourselves
0:51:46 right because it is very obvious if someone who always was an extrovert now won’t leave
0:51:50 the house right like we can tell something’s wrong and someone’s probably going to come
0:51:54 ask something right but if we just change in these more subtle ways where we’re just
0:51:58 less interactive and you know people notice their friends a little bit different and less
0:52:02 outgoing you know it’s these things that as you’re saying the subtle ones the subtle
0:52:09 signs and the nuances are often very impactful and indicative of other things going on under
0:52:14 the surface you know that can bring even greater problems on this subject of soothing that
0:52:17 you’re talking about a second ago there’s this quote that you say in your book trauma
0:52:21 promotes pain pain increases suffering and suffering makes us desperate to soothe our
0:52:27 pain whatever form it takes sadly we’re seeing the terrible cycle play out on a larger societal
0:52:35 level with the opiate epidemic yes this idea of soothing we will find ways to soothe ourselves
0:52:40 and some of those ways that we find to soothe ourselves become destructive in and of themselves
0:52:45 and it almost makes me think that like our sometimes our attempt we think of like alcoholism
0:52:52 typically as people that are self-destructing but when you understand the soothing component
0:52:59 of drinking alcohol it actually is them trying to not self-destruct not destroy themselves
0:53:05 but to take care of themselves right in a weird way if we’re under huge amounts of distress
0:53:10 our perspective of the world narrows right very very dramatically means is an elephant
0:53:14 standing on my foot I only have one thing I’m guessing I would think about which is
0:53:20 the elephant not standing on my foot anymore right so when we’re under tremendous stress
0:53:26 and strain right something that soothes us in the short term right becomes acceptable
0:53:31 because there’s a desperation in us that has us focused on the short term like I know
0:53:35 that man no that’s not good in the long term but I’m just trying to get through today right
0:53:41 and and it’s this lack of perspective in the world and the society around us that if we’re
0:53:47 not recognizing what trauma does to us can it that it can drive us to places of desperation
0:53:53 that is it any wonder that short term soothing will have a big appeal to us and that could
0:53:57 be soothed soothing to excess eating and now you know that person is overweight and has
0:54:02 diabetes and wants to be healthier but like doesn’t really feel that they can stop and
0:54:06 ping pong is back on different diets and you know what they’re really doing is they learned
0:54:11 self soothing with food in a way that that was you know in the context of really feeling
0:54:17 some sense of despair or desperation the same way that person may have learned that oh alcohol
0:54:21 soothes now again there’s their genetic factors and there are all sorts of factors that come
0:54:27 into play too but unhealthy coping mechanisms are beckoning to us all the time which is
0:54:34 why you know I did a lot of treatment of of opiates and opiate dependence over a number
0:54:39 of years and you know it’s just outrageous to me that these these are the most powerful
0:54:46 psychoactive medicines on earth right opiates like they soothe psychic distress like you
0:54:53 know feeling not good mentally inside of us very very rapidly and effectively and almost
0:54:59 immediately start building tolerance and danger right but I had no education and training around
0:55:07 opiates as psychoactive medicines so so here we are in a society that so is under appreciating
0:55:13 trauma and and where people are are at in a sense of isolation or otherness or desperation
0:55:19 in so many facets of our society and then we start handing them the most powerful short
0:55:26 term soothing mechanism with the absolute highest risk of long-term danger and death
0:55:31 and then we’re surprised that how many tens of thousands of people die each year from
0:55:38 prescribed opiates what kind of opiates of people beings prescribed so how the opiate
0:55:45 epidemic really began was with opiates in pill form so so that they would be prescribed
0:55:52 say for for conditions of pain but conditions of pain that were more chronic conditions
0:55:56 or conditions not so amenable to opiate so if you come out of surgery an opiate is a
0:56:01 great idea right like there’s a lot of pain that needs medicine to soothe that pain until
0:56:08 the pain decreases but it’s judicious use of a very powerful medicine in high QT circumstances
0:56:12 what we started trying to do and part of this was you know we know there’s a whole story
0:56:17 behind the politics in the business of this was to say well people shouldn’t be in pain
0:56:21 so there’s a short term solution right no one should be in pain we’ll give them pills
0:56:27 right and opiates do not work in those situations they soothe a lot early on but they rapidly
0:56:36 build tolerance addiction they suppress breathing drive so so we started doling out opiate pills
0:56:42 with the idea that we’re treating pain and isn’t that good but with an absolute inattention
0:56:48 to the immense risks of that and I think it fits with the short term view of you know
0:56:52 of relieving all pain like we’re human beings we can’t relieve all of our pain right sometimes
0:56:59 what there is to do is to work hard to mitigate pain and that might be pain you know from
0:57:03 a mental health perspective might be pain from a physical health perspective this idea
0:57:07 that a pill is going to fix everything and now everyone has pain pills and won’t be in
0:57:13 pain you know has resulted in hundreds of thousands of deaths in this country alone
0:57:20 from prescribed opiates you know let alone illicit opiates so there’s the short term
0:57:28 thinking on the part of our society that then almost lures people into the seduction of the
0:57:33 short term soothing right you feel miserable and you want things to be better take this
0:57:39 pill now you’re seduced and addicted and at huge risk and you know we’ve let that happen
0:57:44 for us to know how to treat trauma we have to understand the physiological consequences
0:57:49 of it how does trauma change our brain when we look at brain scans what do we see in a
0:57:56 traumatized person brain scan data is more complicated and harder to interpret you can
0:58:01 see different patterns in the brain we’re not at the point where brain scan science
0:58:08 can really can pinpoint right but what we do see is parts of the brain that are sort
0:58:14 of inflamed so to speak by trauma so so the amygdala and pathways around the amygdala
0:58:18 which is a part of the brain that gets called sometimes grand central station for negative
0:58:25 emotion right we see that pathways involving this part of the brain become more prominent
0:58:31 right so we see changes in brain connectivity because how our brains function is by communicating
0:58:37 from one place to another if they function through connectivity and which pathways are
0:58:42 more prominent so what we see then is pathways that are involved in trust say and feeling
0:58:48 a sense of safety are less prominent pathways that are more activated when we feel less
0:58:53 safe and more vigilant are more activated and then we see the climate so to speak in
0:58:59 the brain change in a way that’s less healthy and you may also see specific aspects of a
0:59:05 post trauma syndrome so so mood regulation areas are not functioning as well because
0:59:11 now there’s depression intruding so we see patterns in the brain that show us this change
0:59:16 although the science hasn’t come far enough to pinpoint like at some point we’ll be able
0:59:20 to do with much greater accuracy and I’ve heard you talk about how that creates cognitive
0:59:25 blind spots of blind spots in our brain following a traumatic event what do you mean by cognitive
0:59:30 blind spots and what’s the the harm or risk of that right so a cognitive blind spot can
0:59:38 occur when we take a lesson inside of us that is a lesson of trauma not a lesson of truth
0:59:45 and then it changes how we may think about things so so for example a real and sadly
0:59:49 many examples of this site that I can bring to mind and people’s faces who come to mind
0:59:53 as I say it but someone who felt pretty good about themselves and able to navigate the
1:00:01 world and striving for a better job and doing fun things who then is assaulted and after
1:00:10 that assault the person is much less present in the world and internalizes a bunch of different
1:00:14 thoughts about themselves of I don’t really like being out I like being at home better
1:00:18 or it never goes well I don’t get along with other people like they think about themselves
1:00:27 differently so there’s a cognitive blind spot which makes it very very difficult to think
1:00:32 with accuracy about say possibilities so that person may have say been striving for a better
1:00:36 job right but if they think of themselves differently I’m not the kind of person who
1:00:40 can get ahead and people don’t really like me then they don’t strive for a better job
1:00:44 they just take for granted that they can’t get it it won’t go well they’ll fail at it
1:00:49 but they never thought that before is this what you kind of see when people refer to
1:00:55 someone having daddy issues and I was thinking as you were saying that that my dad so say
1:01:02 my dad left when I was four and I internalize this idea that men don’t love me for example
1:01:06 right and then I go through life being an avoidant person in romantic situations or
1:01:10 self-sabotaging or going for people that are unavailable to avoid the rejection is that
1:01:14 somewhat similar like I’ve created a cognitive blind spot and now I’m living out that as
1:01:21 an instruction manual for my life yes absolutely yes and the earlier in life the more powerful
1:01:27 the lesson is and the brain doesn’t go back and revisit those lessons so I think this is
1:01:33 just so amazing and surprising to me that our brains are so incredibly complex right
1:01:39 more complex than the greatest supercomputer right yet our brains don’t do some very basic
1:01:43 things like we don’t reboot and see is there a patch or is there something to fix right
1:01:49 we don’t go back and look at these earlier lessons so if you learn at age four oh men
1:01:55 don’t love me that’s a hard lesson to unlearn because it gets solidified at an early age
1:02:00 and then once those lessons are there there’s an internalized danger to go revisit them if
1:02:06 you go revisit that lesson could you be disappointed right because that’s the way it is and that’s
1:02:09 the way it’s going to be like that’s kind of what we tell ourselves inside the trauma
1:02:13 kind of walls it off and then we don’t just go back and look and say is that really true
1:02:19 like here I am I’m an adult now and no did I just carry forward something when I was
1:02:23 four years old that wasn’t about me is it really about the four year old right or is
1:02:27 it about the adult like we learn all these things but we don’t go back and revisit the
1:02:34 lesson and then yes there’s a person who could be very very avoidant in ways that that lesson
1:02:39 that quote unquote truth that is not true can change that person’s life and that’s why if
1:02:44 we go back and look at that life can really change and go back and look at why do you
1:02:49 feel that it’s interesting to feel that let’s let’s think about it and you know what’s the
1:02:54 story behind it and we can get to a place where that can be undone and say oh I took
1:03:00 that lesson inside because someone else made a choice that was about them and not me no
1:03:05 four year old is responsible for a parent leaving but I took something in that was different
1:03:09 and it’s really affected me and I kind of feel differently about myself it’s not that
1:03:15 everything instantaneously changes but boy the world is different then.
1:03:20 On that subject as well of say the father leaving at four years old and me thinking that men
1:03:25 were was that let’s say I was four years old and my father was violent what you sometimes
1:03:32 see is people then are attracted to the familiar when they grow up so although it wasn’t healthy
1:03:36 they have a sort of bias towards being attracted to something that was familiar even if it
1:03:37 wasn’t healthy.
1:03:43 Right that gets complicated what sometimes people will talk about is repetition compulsions
1:03:49 are quite complicated often what a person is doing then is trying to gain a sense of
1:03:56 mastery over a situation in which they had no control so you will see this in abusive
1:04:01 relationships where you know sometimes a person will come and say okay I’m coming to see you
1:04:05 but I know you can’t help me but at my last like eight relationships have been just awful
1:04:10 so how can you possibly help me and then I might say something like if you can tell me
1:04:15 how you had eight different relationships that didn’t go well maybe I’ll believe you
1:04:19 but you’re going to tell me about the same relationship eight times over right something
1:04:25 along those lines because we repeat things that don’t go well in an effort to gain a
1:04:32 sense of control so what often is the case in that kind of situation is whether it’s
1:04:36 repeating an abuse cycle or just someone who is an attentive or isn’t interested the person
1:04:43 is trying to feel better about something from the past so if the father was inattentive and
1:04:49 that person has a romantic interest in men that person may choose men who are inattentive
1:04:55 with a desire to make them inattentive to fix the to soothe the pain of the past because
1:05:00 the emotion systems in our brain don’t care about the clock in the calendar so you can
1:05:05 solve the past in the present as far as the emotion systems are concerned and if the trauma
1:05:11 is very strong in us the emotion systems will rule the day so they said the father was violent
1:05:17 then maybe that person chooses a violent significant other right and then that relationship goes
1:05:21 away and the person chooses another violent significant other and then sometimes the thought
1:05:29 is the person is choosing that because that’s what they’re comfortable with but no the person
1:05:34 is trying to make sense of something and there’s some desperation inside to feel better about
1:05:40 themselves and to fix and heal something whereas if we can intercede there and say the problem
1:05:47 is if you want someone who’s attentive choose someone who’s attentive right as opposed to
1:05:50 choose someone who’s not attentive and try and make them attentive.
1:05:52 Can we become addicted to our victimhood?
1:06:00 Sure there’s no internalized victim without an internalized persecutor so if someone is
1:06:05 victimized in the sense of the law right someone has done something bad to that person that
1:06:09 doesn’t mean that person takes inside of them that they are a victim right but trauma can
1:06:14 make us feel like victims after the loss of my brother when I felt like maybe we’re cursed
1:06:19 and I’m not I can’t really get anywhere in the world like there’s a black magic to that
1:06:22 right then I should feel like I’m a victim of something I don’t I’m behind the eight
1:06:28 ball I then I have a sense of otherness right and and now I’ve taken something inside of
1:06:32 myself where we don’t need a persecutor anymore I feel like I’m less than so how’s that gonna
1:06:39 go well right so what we end up doing is we take inside of us sometimes this sense of
1:06:47 victimness but that also takes inside of us the idea that we are less than that there
1:06:54 is something magical that is bad and negative and what we need to strive against is exactly
1:06:58 that that something may have happened that we might okay that person is a victim in the
1:07:02 eyes of the law they were assaulted right but that doesn’t mean that person has to take
1:07:07 victimness inside guilt and shame how many people have I seen who are assaulted and they
1:07:13 talk about how they’re ashamed of it and it’s their fault someone else attacked them right
1:07:18 but the reflexive guilt and shame of trauma can lead us to feel less than then we start
1:07:24 feeling like victims then we feel less than we embrace this and we don’t need someone
1:07:31 to persecute us anymore the limbic system we’re talking about the brain here what is
1:07:38 the limbic system and what role is it playing in cementing our trauma so the limbic system
1:07:42 is the name for the emotion systems in the brain so we’re simplifying a little bit but
1:07:47 the idea that they’re logic systems and emotion systems the emotion systems are limbic those
1:07:53 are the limbic systems and they never lose when they come face to face with logic right
1:07:59 like the limbic the emotional always rules the logic if the two come head to head which
1:08:05 is why if the emotion of trauma the fear of being less than the need to repair something
1:08:11 that was unfair in the past if that is driving us logic will not have it say you know logic
1:08:18 would say if you’ve dated six people who’ve all kind of seen the same at the outset and
1:08:23 then all behaved in the same negative way don’t choose a seventh like that right logic
1:08:27 very logic was saying that at the second person that let alone the third the fourth the fifth
1:08:34 why do we see repetition of unhealthy relationships because the limbic system if it needs to feel
1:08:39 different it needs so to speak to solve that trauma by gaining mastery it’s going to go
1:08:44 look for the seventh person who’s just like the first six but once we take the energy
1:08:50 we lance the abscess so to speak of the trauma then logic can have it say and that person
1:08:54 who says you can’t help me because the last eight relationships were all awful sees oh
1:08:59 I did the same things chose the same person last eight relationships that’s one paradigm
1:09:04 and I’m changing it now and then things are different when they thought they couldn’t
1:09:09 be because they can see now what they couldn’t see before the limbic system isn’t ruling
1:09:14 the day anymore there’s a whole balanced brain that has an understanding of self and uses
1:09:19 that understanding to move forward in life it seems like the limbic system is against
1:09:24 us but there must be some sort of evolutionary reason or rationale or purpose of that limbic
1:09:29 system that is I don’t know malfunctioning in the modern world oh sure the limbic system
1:09:33 isn’t against us like all these parts of our brain none of them hate us they’re all part
1:09:37 of they’re all parts of us and some of the research and observations through the psychedelic
1:09:42 sciences are really telling us that much more that there aren’t parts of our brain that
1:09:49 hate us they may work against us because as you’re commenting they’re not built for the
1:09:54 modern world so you know if you think about the limbic system and the negative information
1:09:59 like something bad happened when you were four or five like take that in and whatever
1:10:04 lesson that is never questioned it or change it right then this is based upon survival
1:10:08 mechanisms the example I give is you know imagine for most of human history and peoples
1:10:13 of hunting and gathering and living in small groups and and like having enough food was
1:10:19 very important for humans across human evolution if you find a new food that it looks good
1:10:22 looks like something else that was good and you and you eat it and it tastes good and
1:10:27 it’s nourishing like it’s good to remember that right but if you eat it and you get very
1:10:32 very sick you better remember that forever right so that the negative has much more salience
1:10:37 in us and makes these lessons never go near that thing again never go near that person
1:10:42 again never do this again they’re designed to keep us alive but we’re trying to do more
1:10:47 than that right we’re trying to do more than stay alive and these systems in us that evolve
1:10:53 to keep us safe then can very much work against us the person who’s traumatized because someone
1:10:58 attacks them and that system gives them panic attacks if they leave the front door I mean
1:11:05 that’s that person’s brain trying to keep them safe use the word shame a lot when we’re
1:11:12 talking about trauma in the same way that I asked is the limbic system against us what
1:11:17 is the use of shame why do we experience shame can’t we just program ourselves to get rid
1:11:23 of shame and then we’ll all be fine exactly the same with the limbic question no we kind
1:11:29 of need shame but we need shame for good reason right so so these primary affects that that
1:11:37 are very primordial in us anger fear love shame these are things that are just aroused
1:11:41 in us like they can become other things once we start thinking about them but their states
1:11:48 that that that are very deep within us they all have a survival adaptation so love feeling
1:11:53 love is you know being more than one you know if we love someone now you are two and you
1:11:57 and you’re there with one another and that’s going to help you survive make your way forward
1:12:02 in life love is adaptive right fear can be very adaptive that now you’re in a fight or
1:12:06 flight stage you’re trying to survive and get through life shame is the same way the
1:12:11 things that people do that bring shame that change behavior shame changes behavior a lot
1:12:16 because it feels so bad so you know I give the example if I imagine that you know in
1:12:21 the old days you know someone who you know peas on the food in the cave instead of going
1:12:26 outside you know and like now puts the whole tribe at risk or people and then like there’s
1:12:30 a sense of shame that comes to that person like you can’t do that anymore and the person
1:12:34 feels bad and never does that again and it’s adaptive for the group right it’s just one
1:12:38 example of how shame can alter behavior so to keep us alive in that context right to
1:12:43 keep us alive like now you feel shame you will not forget to not do that anymore right
1:12:46 like it’s going to have an impression is going to change you because you feel so much shame
1:12:52 which we would think should be the case in the modern world too right we there are things
1:12:56 people do that are shameful that are worth feeling shame about I mean sometimes the problem
1:13:00 is we don’t have enough shame where we should but we have a lot of new modern problems don’t
1:13:07 we with I was thinking about bullying right example like I imagine back in the days of
1:13:13 our tribes there wasn’t internet like obviously not but there wasn’t like mass internet bullying
1:13:19 where a huge group of strangers could just pepper you with insults and maybe our modern
1:13:24 brain still has the same old mechanisms of kind of perceiving that as our tribe are going
1:13:28 to kick us off the island here right to the brain malfunctions and experience the shame
1:13:31 which causes all the things you described and then even in the context of like sexual
1:13:37 assault I was trying to rationalize that how the shame of sexual assault can make you feel
1:13:42 shame when really it was someone else’s right behavior but how does that make that you know
1:13:49 that woman feel that guy feel shame about themselves when they were attacked right because it doesn’t
1:13:53 start with the thought of it because you’re right because what you’re saying I think is
1:13:58 basically it makes no logical sense why would you feel ashamed of yourself if someone else
1:14:01 came up behind you and jumped you and did something awful to you why would you feel ashamed of
1:14:06 yourself right but but the person doesn’t get there by thought right I didn’t get to
1:14:11 feeling ashamed of myself after losing my brother by suicide by thinking that is a shameful
1:14:16 thing I should feel ashamed no no the shame is aroused in us it’s created in us because
1:14:22 its behavior modifying there’s there’s the adaptive something bad has happened feel something
1:14:27 inside that creates a version the shame is created in us and then we make the meaning
1:14:32 of it I feel ashamed the shame inside me and then we make the meaning of right because
1:14:36 I shouldn’t have been there when that happened and then then we make a story around it it
1:14:41 starts with the limbic system with the affect and then we build a story around it which is
1:14:47 why we can build a different story where for example shame goes where it makes sense to
1:14:51 go like that’s very very effective of processing through so okay so this thing happened you
1:14:55 can process through with someone how they felt and you know what was going on inside of them
1:14:59 maybe they’re in an ambulance or a hospital they’re filled with shames they realize what
1:15:05 has happened to them and you know and then that was a terrible state to be in but then
1:15:08 they start put it they start making trying to make meaning of that state and we can go
1:15:16 back to oh that’s a that’s a natural completely understanding human state to be in after this
1:15:24 happened but now you get to decide what that means so in the context of our ancestors I’m
1:15:32 walking through the I don’t know Serengeti with my with my big spear and I’m walking and a lion
1:15:39 jumps out at me out of the blue I managed to survive it although I’ve been attacked I the
1:15:45 shame is created in me because as a response to make sure my behavior changes so it doesn’t
1:15:49 happen again and then I write a story about that when I get back to the cave and tell myself like
1:15:54 in the story could be that I shouldn’t have been walking out at night in the Serengeti alone
1:16:00 when that lion attacked me and that’s adaptive and useful because it stops me from doing that in the
1:16:04 future it’s like a so I’m trying to think of it through maybe it’s a little different if you were
1:16:09 out okay let’s say you’re out and you’re actually like you’re hunting a lion in the service of
1:16:14 everyone else and then you are attacked and hurt that it’s that’s different because you’re doing
1:16:21 something then to feel proud of yeah right so so that is is different we’re that’s a situation where
1:16:26 the person is approaching the trauma on the front foot and then when you return back the
1:16:30 thought would be you’d be respected and cared for like you know you went out to do something for
1:16:37 everyone and got hurt that is very different than how people normally would would experience their
1:16:44 trauma which is when there is in a sense of pride and self-sacrifice behind it so so if the person
1:16:48 let’s say you’re walking out in the Serengeti at night and you shouldn’t be then you should feel
1:16:52 bad about that right then the thought would be yeah I shouldn’t have been doing that and how
1:16:57 bad you feel about it will make you not do it again so you’re not going to get killed right and
1:17:00 then you’re going to come back and talk about that or people are going to go what were you doing and
1:17:04 well you shouldn’t have been out there and like they may feel bad that you got hurt but like
1:17:09 there’s there’s then an experience that is a deterrent to others doing that too right so
1:17:13 this is something really interesting about how we treat people who’ve been through a trauma
1:17:18 right the did lose the difference in the United States between veterans coming back from World War
1:17:25 II and veterans coming back from Vietnam there was far more post trauma syndromes post-traumatic
1:17:30 stress disorder after Vietnam because people were not coming home to a hero’s welcome the thought
1:17:35 the thought there would be they had gone out like the person who goes out into the Serengeti to hunt
1:17:40 the lioness to save everybody else is that’s what was going on when people went to fight in World War
1:17:45 II and when when people went to fight in Vietnam but when people came back from World War II and
1:17:51 they’d been hurt they were treated as heroes they were treated with respect and and that
1:17:57 allows a person to shoulder that trauma without the brain changes happening when people came back
1:18:01 from Vietnam and were treated differently which didn’t happen to everyone but it happened as a
1:18:07 societal phenomenon that was that was a terrible thing for the veterans who came back you saw
1:18:12 much greater rates of post-traumatic stress I mean that’s that I think captures very clearly
1:18:18 what the impressions and perspectives of the people around us mean there may be a reflexive
1:18:25 guilt and shame from trauma but that doesn’t have to win the day but it was much more likely to win
1:18:30 the day if there’s a sense of otherness because now we’re you know we’re talking about the same
1:18:36 thing of feeling less than chronically by society for some reason makes that person more susceptible
1:18:40 so that person who’s been through combat trauma and then comes back and does not receive a hero’s
1:18:46 welcome is put at much much greater risk for the brain changes of post trauma syndromes
1:18:51 what role does vulnerability and being open with others about how we’re feeling play in
1:18:58 alleviating our shame well sure it plays it plays in for most of us in most cases it plays
1:19:05 a very big role because the reflex to the trauma is guilt and shame and the reflex to the guilt and
1:19:12 shame is to hide it inside what we are doing is cutting ourselves off from the human contact that
1:19:20 we need in order to process what has gone on with us so very many times over 25 years of being a
1:19:27 psychiatrist I’ve sat with someone who is putting words to their trauma for the first time you know
1:19:34 when I was five years old I was assaulted in that way this coach did this to me when I was a certain
1:19:40 age I was hurt this way and I’m the only one who survived and my two buddies died these are real
1:19:48 things that I have that I have heard people say and then be shocked that I the other human in the
1:19:58 room don’t recoil from that because they’ve held so long inside of them that it is shameful that
1:20:04 they were assaulted it is shameful that they survived that that it’s so dangerous to even
1:20:09 utter it the fear of how person will react that someone is surprised like wow you could hear that
1:20:15 or they they say it in ways and kind of step back a little bit because there’s such an expectation
1:20:20 of rejection where’s what the person is telling me is something that from any reasonable human
1:20:27 being would only elicit compassion now that person who’s telling me would only ever be compassionate
1:20:33 to someone saying that but they’re not compassionate to themselves is shame really
1:20:38 the cause of what we kind of think of as these trauma cycles because someone experiences a trauma
1:20:45 they suppress it which changes how they behave which means that they’re more likely to experience
1:20:50 more trauma in some way or at least perceive it as a trauma via shame and then they kind of their
1:20:54 life gets more and more full of different types of trauma does that make sense because I’m wondering
1:20:59 if like trauma can be quite a self-fulfilling thing where you get into a cycle of trauma in your
1:21:05 life well it can be I mean in the case of the person who now finally puts words to something
1:21:09 they’ve held inside of them that they would know is not shameful to anyone else but they hold
1:21:15 this shameful for them what is going on inside of them may or may not have caused further trauma
1:21:20 right I mean it’s caused suffering right there’s no doubt about that when a person is is is saying
1:21:24 that and they’re they’re putting words to something that’s so important has been inside of them
1:21:29 has caused them suffering so they haven’t been as happy as they could be enjoyed life as much
1:21:34 as they could be been as outgoing as they can be been depressed when maybe they didn’t have to be
1:21:40 depressed so so the trauma is impacting them because they’ve hit it down inside right if you
1:21:45 can talk about it and bring light to it let’s say after that thing that happened when the person
1:21:50 was assaulted at five years old or survived an accident others didn’t if someone did trauma work
1:21:54 with them of hey you’re what are you feeling now okay let’s get to the fact that person is feeling
1:21:58 guilt and shame and the naturalness that they are but it doesn’t tell them truth right it’s just
1:22:03 telling them how they feel and in fact it comes from compassionate places inside of us we can help
1:22:11 to unwind that before it becomes a thing inside the person that yes may make life less enjoyable
1:22:17 or it may also in a way that’s worse push towards repeated trauma so the the trauma of choosing the
1:22:23 same unhealthy partner or the same abusive partner over and over is an example of what you’re
1:22:27 saying if a person doesn’t look at the trauma and like why am i doing this what am i trying to solve
1:22:33 here right i’m trying to solve something maybe from childhood that was somebody else’s shortcoming
1:22:38 or fault or someone else’s okay i can stop doing that then the person can stop with repeating the
1:22:44 behavior so the answer to all i think the answer to what you’re asking is absolutely yes and if
1:22:49 we’re curious and we strive for understanding ourselves and we know that there are routes to
1:22:55 change this is how we heal from trauma that ultimately invisible epidemic is a message of
1:23:00 warning but it’s not a negative or a pessimistic message it’s a positive message this is if we
1:23:06 understand this and we look at it we’ll guess what happens is we get better we prevent trauma
1:23:10 we take care of the trauma in ourselves and others and we get healthier like i see this play out in
1:23:17 25 years of doing this like this is what happens but we only get there if we have the curiosity
1:23:23 we we you know we’re interested we know enough to go looking and thinking and making a narrative and
1:23:27 you’re talking about ourselves wanting things to be different and knowing that they can be
1:23:32 so it’s a message of hope because when we do that we really see change so clinically when
1:23:37 doing this work you see a lot of difference in people and that’s part of what’s been so heartening
1:23:42 and led me to write the book is it’s not just a message of oh this is what’s going on with us
1:23:46 let’s take a look at it this is what’s going on with us and if we look at it
1:23:49 absolutely we make life better i want to talk about some of the ways that trauma
1:23:54 impacts us that are less obvious one of them i’m interested in is sleep a lot of people are
1:24:00 struggling with sleep these days is there a link between sleep issues and trauma yes and how strong
1:24:08 is that link yes so so sleep is one of the symptoms of a post trauma syndrome it’s not an all post
1:24:13 trauma syndrome so higher anxiety lower mood behavioral changes sleep is one of these factors
1:24:20 and sleep is very often negatively impacted by trauma so the changes you had asked about in the
1:24:25 brain and then we talk about how they go more towards vigilance more towards activation they
1:24:32 make it harder for the brain to settle down and be in a restorative state so sometimes we get what
1:24:37 was called ruminative where there’s just thought loops going on inside of us and the brain doesn’t
1:24:42 want to quiet down to a place where we can get restorative sleep so people have more fragmented
1:24:46 sleep they have shallower less restorative sleep more time until they can fall asleep earlier
1:24:54 awakenings so this is very very bad for us across the board i mean talk about the union of physical
1:25:01 and mental health sleeping very poorly is terrible for us from head to toe and very often after trauma
1:25:07 if there is a post trauma syndrome which is not uncommon sleep patterns are dramatically changed
1:25:13 and and sleep restorative function is changed what happens is we’re in higher states of arousal
1:25:19 and neurobiologically this is about sexual arousal it’s it’s just state of alertness right so we’re
1:25:24 in too high a state of arousal too high a state of alertness and then the brain systems inside of us
1:25:30 that need to really simmer down in order to restore aren’t able to fully do that i guess there must
1:25:34 be some kind of link there as well because if i’m in that if i’m less comfortable with being
1:25:40 with my own thoughts because they’re ruminative that i’m overthinking all the time i’m then also
1:25:45 more likely when i’m trying to settle down to be trying to stimulate myself like a lot of people
1:25:50 aren’t comfortable with just being sitting in a room alone with their thoughts especially if they’re
1:25:54 you know an overthinker so then they might grab their phone they might sure be you know doing
1:25:59 things to stimulate themselves at a later hour of night but it all comes back to the trauma
1:26:04 absolutely yes as in you’re describing how the downstream effects of all of this are
1:26:11 tremendous so absolutely yes so so we’re saying getting less sleep is just bad for us from head
1:26:17 to toe okay and also there’s all the things that you’re talking about so if you know you’re going
1:26:22 to try and sleep and it’s going to be just going over and over again in your head and it might be
1:26:26 i’m not safe or i’m going to get fired or i’m going to get hurt or it may just be
1:26:30 something that’s simple and negative that you don’t even relate to trauma like oh this is awful
1:26:33 or like i mean these are things that go over and over again in people’s heads when they’re trying
1:26:38 to sleep like i’m not okay what’s going to happen and it’s going over and over again so of course
1:26:43 you’re going to want to distract from that and you because the way we’ve kind of framed it there
1:26:48 is that you’re aware and conscious of that but can that be taking place in like the back room of
1:26:52 your mind where you sure sure sometimes people are aware and sometimes they are nuts that’s to
1:26:57 ask a personal why why aren’t you sleeping while the last four months which seems like a good question
1:27:01 to ask instead of just giving the person a sleeping medicine but in modern medicine sometimes the
1:27:06 question doesn’t get asked but you know maybe the answer is it’s just some really different
1:27:10 trying to fall asleep and like i just don’t feel peaceful anymore but but the person has not thought
1:27:16 of that until you ask them then what’s the logical next question why right what happened when anything
1:27:21 changed around then and a lot of times you get an answer and that person is a trauma problem
1:27:26 not a sleep problem you can probably pound the sleep system to sleep with medicine but now we’re
1:27:32 doing something that ultimately is harmful for the person so yes and also when you know when you
1:27:36 talk about avoidance behaviors of sleep this is also why the person can avoid avoid avoid and then
1:27:43 have three or four drinks to get to sleep right so there’s so much that is unhealthy that then
1:27:50 perpetuates being unhealthy and it spreads and this is part of the epidemic aspect of this and
1:27:58 I mean people often don’t know why things are different in their sleep but a lot of the time
1:28:02 if you stop and you think and you talk about what’s going on inside of them they will tell you
1:28:06 and it may be that for the first time they’re telling themselves which is why
1:28:10 we should ask ourselves this question you said to rich roll amongst the conditions I’ve seen
1:28:15 treated the absolute worst in mental health treatment and indeed in general medical treatment
1:28:26 are sleep problems why is sleep underlies so much and because we when we we have a lot of
1:28:32 havers in medicine so we see a lot of nails so if someone is not sleeping the reflex in medicine
1:28:37 and not everyone does this and I’m not trying to say they’re all physicians or practitioners are
1:28:42 not behaving in the right way but we we work in systems that are high volume and designed for
1:28:46 throughput so they’re designed for symptom identification so what we say is okay you’re
1:28:53 not sleeping so we’ll give you sleeping medicine like that simple but the reasons people are not
1:28:59 sleeping are very very often not related to their sleep systems they’re related to these
1:29:06 vigilance and activation systems inside of us so if if that’s what’s going on in me and I’m
1:29:11 agitated and have this highly aroused state after trauma and maybe it’s been going on for two weeks
1:29:16 or maybe it’s been going on but getting worse for two years but this is what’s going on and I can’t
1:29:21 settle down and my sleep system can’t overcome it you know if you give me a sleeping medicine for
1:29:25 that I’m probably gonna need a lot of it right because we’re trying to make the sleep system
1:29:31 overcome the distress I’m more likely to get addicted to it I mean there’s a lot of bad we do
1:29:36 to people and I never have an opportunity to address my problem what should we be doing instead
1:29:42 we should be asking why why is it that you are not sleeping and maybe it came out of the blue
1:29:48 maybe maybe your sleep system every now then fails you but when we start asking those questions
1:29:54 we get answers and more often than not those answers are in the realm of trauma then that person does
1:30:00 not get a trauma medicine they may get a different medicine that in the short term can quiet the
1:30:06 vigilant systems this we do this a lot where the person has a sleeping problem we learn the trauma
1:30:11 history we use a short course of a medicine that calms the vigilant systems there’s nothing to do
1:30:16 with making the person sleep and then they start sleeping well and maybe this is true they might
1:30:22 not have slept well with five six ten sleeping medicines but that is not the medicine that they
1:30:28 need right they need a medicine to calm these distress systems inside of us so that the sleep
1:30:34 system which is not damaged can go and do its thing and and while we realize this we can start
1:30:39 talking about the trauma and maybe the person can process some of the trauma now the sleep problem
1:30:42 is gone everything is better the person is not going to be on a sleep medicine for the next 20
1:30:49 years it’s healthier it’s safer but we have to be more than reflexive right there are a lot of
1:30:57 reasons people don’t sleep what about a link between weight and trauma i’ve heard i’ve tired
1:31:03 a ton of studies over the years about how various people who are obese have high levels of sort of
1:31:10 traceable trauma is there any truth to this yes so there are probably or almost surely a couple
1:31:17 of factors one is look it’s hard enough to take care of ourselves you know even when things are
1:31:23 going really well right i mean life is so busy and so stressful so it’s hard to take care of oneself
1:31:29 if a person adds trauma to the mix it becomes harder to take care of oneself and one way we
1:31:33 cannot take care of ourselves is you know what we’re eating and whether we’re exercising so
1:31:38 the trauma makes it harder to take care of ourselves and predisposes to poor self-care
1:31:42 now we have no person who’s overweight and then maybe pushing towards diabetes or heart disease
1:31:48 or cardiovascular or cerebral vascular disease and also just like we talked about epigenetics and
1:31:55 changes in gene transcription what genes are active in us trauma puts us in a place where we
1:32:03 are more inflammatory within us like there are more inflammatory markers in our blood vessels so
1:32:09 it’s not as clean and clear as we would like it to be we’re not as healthy and this works against
1:32:15 the health of our blood vessels and the health of our immune system so the soup we swim in so to speak
1:32:23 is changed by the trauma and then those higher levels of inflammatory markers for example that
1:32:28 are circulating in our bloodstream can make it harder to lose weight the body starts holding on
1:32:34 to more calories and it makes it harder for our blood vessels to stay healthy and then we get less
1:32:40 and less healthy and part of that is the biological effect of trauma just like the epigenetics
1:32:47 and part of it is the changes psychologically and the changes in self-care how do you convince
1:32:51 someone that comes into your practice and tells you that they can’t change they don’t believe they
1:32:56 can change how do you convince them that they can well i’m a huge believer in the power of knowledge
1:33:01 and the power of information which i think goes back to how powerless i felt as a kid
1:33:06 when we couldn’t understand medical information it’s like i want to know i want to understand
1:33:11 and i think i think a lot of people are like this i think we as humans don’t get enough credit
1:33:16 that we want to understand and i think so much in our society is reflexive like you know what you
1:33:20 know and you feel how you feel and then you know we have a whole set of beliefs about the world because
1:33:26 we affiliate with some group or another right i think that’s a reaction to feeling so disempowered
1:33:30 and that what we really want is knowledge and i think that’s a reason why for example knowledge
1:33:35 imparting podcasts are so valued because you’re not trying to tell people what to do or how to
1:33:42 think but you’re giving them bringing them knowledge and and that’s what i try and do of like i know
1:33:46 that’s not true now it may be that if you’re a science-based or a rational person or you’re an
1:33:50 engineer or an accountant it’s like i might try and get at you through this through the science
1:33:54 right i might get try and get at you through that article right this is something that can like let
1:34:00 you see that or i might try and get at it through examples of hey here’s like people do change like
1:34:05 here’s kind of really what the state of the art is now and like can i get excited about that give me
1:34:12 an example there are a lot i could cite but the one that comes to mind is the one story in in my
1:34:22 book that is just an amazing story of a person who had had a trauma in her life that had just changed
1:34:30 everything mood anxiety behavior choices in the world i mean so much had gone in a way that was
1:34:37 not how this woman was built to live her life or how she was living her life and it was so striking
1:34:45 her telling me about who she was at some point in the past and contrasting that to how she was
1:34:50 living and how she thought about herself and it was really a night and day difference and it became
1:34:57 clear there was a very abrupt change at this at the time of this trauma like a night and day change
1:35:05 towards dysfunction poor health poor social function misery and she had no thought or idea
1:35:11 that she could be like she was before because all she knew was that things had changed and now
1:35:18 she was like this and this was not okay and never going to change but she was willing to see the
1:35:24 starkness of the change and to hear my observations and examples like look i i see something here
1:35:30 that’s looking from the outside that’s really striking and and that’s we could think about and
1:35:37 talk about and understand and and like changed her entire life and it really is true that 10 years
1:35:44 later she looked 10 years younger absolutely is this a one hit wonder though or is it a training
1:35:48 process like me being in the gym and picking up weights over and over again am i having to retrain
1:35:56 my mind to view that situation differently yes yes we are creatures of neuronal habit so if you
1:36:01 think the example i give usually uses let’s say you and i just picked a word random word we said
1:36:06 it 500 times right we need to be saying it this evening let’s say we say 2000 times you know
1:36:11 give it a couple days it’s still there on the mind why even when we know it’s a silly example
1:36:16 why would it still stay with us because when we say that word so many times we’re strengthening
1:36:21 memory connections that word comes to mind word stronger within us and then the only way it goes
1:36:26 away is it atrophies over time you know as you can’t just make that go away after you said it a
1:36:31 couple thousand times it’ll go away meaning it gets less and less powerful over time so if you
1:36:36 don’t keep saying that word you know comes to mind maybe 10 times the next day five the second day
1:36:43 three times then not again but this is how processes of change work inside of us so someone who has
1:36:48 for example had self-talk in them said oh it’ll never work out for me or like i suck no one likes
1:36:53 me or you know i’m terrible or how could you idiot or you know things like i had a shadow
1:36:57 voice saying these things to me for years like that doesn’t want to go away at once because it’s
1:37:04 just habituated inside of us so we have to realize look that is not real and true i don’t that is not
1:37:08 what i think or what i want to say to myself so i want to know when it’s there i want to
1:37:13 realize i’m saying this to myself and i don’t believe it then we make it less strong right we
1:37:17 make it less strong every time we say something that’s a negative lie to ourselves like no one
1:37:22 will ever love me right people say that to themselves over and over we make that more powerful as if
1:37:27 it were true and if it’s as if it were true is it true our brain can’t tell the difference
1:37:33 now so if we understand that and now we want to change it like i know why i said that because
1:37:38 when i was growing up that parent a person always said that to me over and over and over and then
1:37:41 you know i chose bad relationships so i didn’t think i was worth anything better and they didn’t
1:37:46 go well and it reinforced that to me like a person really understands that we bring that
1:37:52 understanding to bear in a way that you speak against that when it comes into your mind because
1:37:56 we can’t make it not come into your mind it can atrophy mean this process of slowly over time
1:38:01 it goes away but we have to say have the whole me i thought what the judge in the middle of all the
1:38:05 opinions has to say okay no i’m saying this to myself right but do i believe that or not
1:38:09 can you really completely get rid of a trauma can you take a trauma to zero
1:38:17 well we won’t lose the memory of it something bad has happened we’re not going to entirely
1:38:22 forget it that means it can trigger us again in the future well the the question is how much
1:38:29 does it trigger right how much does it trigger the idea is to attenuate the response to it so if
1:38:34 if it was a car accident and every time the person looks at a car they have a panic attack
1:38:39 right it’s probably it’s probably not going to happen that someday they look at a car and
1:38:44 don’t even remember right but they can look at a car and like they know they had a car accident
1:38:48 they’re trying to hide it from themselves like oh my god i can’t see a car i had a car accident
1:38:52 it triggers me like i’m trying i’m understanding that i understand the naturalness of the responses
1:38:57 in me and how they got maybe were perpetuated by the fear that i felt and that i wasn’t working
1:39:01 through it or working through the loss that happened now that i’m understanding that more
1:39:04 i don’t have to be afraid of this so i see a car in this it makes me kind of uncomfortable but
1:39:09 it’s okay a lot of people beat themselves up because they’ve done a lot of work right and
1:39:13 this trauma still remains i think i’m one of those people where there’s certain traumatic
1:39:18 things for my childhood done a lot of work i logically know that it’s not true like that that
1:39:23 belief i had is not true yeah i’m still prone to be triggered on a bad day about that particular
1:39:31 thing right right look that’s that’s that’s how it goes when a person is navigating through trauma
1:39:36 and really getting through like getting over a lot of difficult things and getting to a much
1:39:42 better place but responds to the triggering in a way that inadvertently reinforces the trauma
1:39:46 so i would say if you’re having a bad day and you have a memory of something that you kind of
1:39:51 know you got over but then it if raises the same set of thoughts or feelings that aren’t good right
1:39:54 instead of my guess is that you’re feeling bad about that like i did all this work and i didn’t
1:40:01 get over it right to say look isn’t it interesting like how strong this imprints us that this is
1:40:05 still going to come to my head today’s going to come into my head like so i’m having a bad day or
1:40:09 i drop something in the morning and i don’t feel great about myself this stuff is very very powerful
1:40:13 but still not telling me truth you know that shoulder shrug about it okay it’s going to come
1:40:18 into your head it was neuronally reinforced and sometimes you’ll be having a bad day and it’ll
1:40:23 come in it doesn’t mean anything lady gargar sits at the very top of your book and she’s written
1:40:31 the forward in your book there’s this wonderful quote inside there that says i can now say with
1:40:39 certainty that this man saved my life he made life worth living but most importantly he empowered
1:40:48 me to find and reclaim myself again that is an incredible thing for anyone to say to anyone
1:40:54 else thank you my first thought is she’s eloquent and generous of spirit and i and i so appreciate
1:41:01 that she wrote such lovely words and i and i so so appreciate that thank you why did she say that
1:41:10 you know as she has talked about there’s trauma in her life and to gain an understanding or much
1:41:16 better understanding and be able to ground to the things about her that are wonderful and she’s a
1:41:21 wonderful person there’s wonderful there’s wonderfulness in us no matter who we are and
1:41:28 i think from the perspective of her on such a big world stage acknowledging the trauma and the
1:41:37 humanness in her and that like anyone else she needed some understanding she needed some help
1:41:41 forward in different pathways of thought about self like the kind of thing any of us need
1:41:48 after trauma and she had the the bravery the fortitude to take chances to be different you
1:41:52 know just like someone would say i can’t be any different we can all feel that when we have a lot
1:41:57 of trauma inside of us and it’s hard to think i’m going to really try and be different i’m going to
1:42:04 take that chance but you know in order to change our lives we have to do that and and and she also
1:42:10 did that it’s a it’s a very very human story in i think a deeply feeling person who then wants to
1:42:16 bring that message forward to others that we can change trauma and i’m so grateful she wrote the
1:42:21 forward to my book but part of that is she’s she believes in that message that trauma does not have
1:42:25 to control us we can understand it we can get our arms around it and i think that’s what she is
1:42:29 you know it’s what she’s communicating in that quote that’s the part of that quote that’s important
1:42:33 the part that’s about everyone reading it and the and the capacity for change
1:42:38 you have some incredible celebrities um on the book inside the book that have given you
1:42:43 quotes for the book people like kim Kardashian tommy hill figure etc etc lady gargar as i mentioned
1:42:50 i’m guessing these these people at some point came to you without sort of disclosing client
1:42:54 confidentiality issues i’m just wondering how you find yourself in a position as a
1:43:00 psychiatrist that the this caliber of people are seeking out your support
1:43:07 well and does that ever feel a bit surreal yeah i think i think it does mean i like to
1:43:14 think of myself as a diligent person who wants to continue working at things and moving them forward
1:43:23 and and uh seeing where they can go and and i think at some point in time i realized i had
1:43:28 the capacity to perhaps reach people who reach a lot of other people right and and there’s been
1:43:33 a real joy i i think that people who have who are public facing i mean there are a lot of
1:43:38 stresses to that you know people can think oh it seems so wonderful from the outside but there’s
1:43:44 a lot of extra stress to that from the inside so to be able to address some of the extra complexity
1:43:51 of that and to be able to help people who have a big impact on the world around them uh was um
1:43:56 that’s sort of a joy to pursue we have a closing tradition on this podcast where the last guest
1:44:00 leaves a question for the next guest not knowing who they’re going to be leaving it for and the
1:44:04 question that’s been left for you feels quite fitting and very interesting i really like this one
1:44:09 it just says it’s not even written as a question it just says
1:44:21 erase one regret from your life dot dot dot wow you know i think i should have paid more attention
1:44:32 to the world around me when i was younger and more lost in trying to feel good enough at the
1:44:40 moment and i think that it made it harder to sort of find my path and i think it made me harder i
1:44:47 think my brother hadn’t found his path and i think there was a lot of frantic anxiety or fear driven
1:44:53 forward movement without pausing and circumspection and it may be that we just talked about and we’ve
1:44:56 talked about his suicide and we’ve talked about that in this podcast so it’s kind of at the
1:45:02 forefront of my memory but when i think back then i probably knew well enough to be more
1:45:08 circumspect including about what might have been going on in him or in me and um i’m happy i got
1:45:14 myself on a path that’s led to places that feel good and then i think are generative and productive
1:45:20 i wish i had more attention to the bigger picture when i was significantly younger why
1:45:26 well i think i would have made better decisions i think i would have seen pathways that led away
1:45:31 from health and happiness and maybe seen that in others too um because some you’re talking about
1:45:35 jonathan and others where where where was born and raised i think there were a lot of good people
1:45:41 in a lot of forward movement but um we maybe could have looked around ourselves a little bit more and
1:45:45 there’d be several people maybe still here as opposed to not being here and people being healthier
1:45:52 and um i think i probably had it in me to look around myself more than i did at that time and i
1:46:00 do sometimes feel i will feel regrets about that well i have to say dr polkanti the work you’ve
1:46:03 committed your life to and the understanding you’ve committed your life to spreading
1:46:10 is going to save many many many many many many people’s lives thank you and not just save their
1:46:15 lives but sometimes it’s not always about saving a life it’s about improving the standard of someone’s
1:46:20 life which i think can have a generational impact if that person is to stay alive and they are to
1:46:25 you know if we look through the lens of epigenetics or just about the how internalized shame and guilt
1:46:32 and all of this can be passed on through vicarious forms of trauma that the kids might feel and whatever
1:46:40 you know your work and your your future work i deeply believe is going to save and improve
1:46:44 thousands and thousands and tens of thousands hundreds of thousands of people’s lives
1:46:49 and that is an unbelievably remarkable thing to commit one’s life to thank you there’s no words
1:46:53 that i could say in the 30 seconds i have now that would would express the extent of the good
1:46:59 that that’s going to do in the world and i i you know i can’t imagine those people that are here
1:47:08 and not here how proud they would be an art of you thank you for turning your trauma into such a
1:47:13 wonderful healing important thing so on behalf of all of those people that you’ll never get to
1:47:17 meet that you’ve helped with your work i want to say thank you so much well you’re very welcome and
1:47:33 thank you for those kind words which i take to heart and thank you for having me on i appreciate it
1:47:35 you
1:47:47 you