At least half of what presents to all physical health doctors arises from a mental health condition. So much of the time it is trauma. Trauma negatively impacts all of us. My guest for this exploration into trauma is Dr. Paul Conti. Trauma is something that leaves the brain different going forward. A psychiatrist and expert in treating trauma, Dr. Conti is also the author of "Trauma: The Invisible Epidemic: How Trauma Works and How We Can Heal From It" If we keep it inside of us, it is very, very toxic, because we are doing the exact opposite of what we need to do in order to heal. This conversation ranks, at least to my mind, among the more important in the history of the show. The whole foundational aspect of who we are and how we see ourselves becomes different. Please click that pesky subscribe button. And with that out of the way, please enjoy. (pensive music) Super nice to meet you. I'm honored to meet you Thank you.
and to be able to share this time and space with you this afternoon. I've been over the many, you know, kind of years endeavoring to understand how trauma has played a crucial role, surprisingly, in my many pathologies. And it's been instrumental in informing how I've grappled with my own healing. And the more, and I know you'll agree with me on this, the more that I kind of learn and discover what trauma is, what it's about, the more convinced I personally have become that it really does lay at the root of so much mental and emotional pathology. So...
Yes. You know, it's really great to be able to kind of seize this opportunity to discuss what I think is, you know, not only a crucial aspect of what it means to live an examined life, but a piece that unfortunately is really all too often overlooked, the "invisible epidemic," as you call it. Yes. You know, because I think trauma is something that we've all experienced to some degree. I think it lives on a spectrum, much like addiction. Yes.
But the extent to which, and the manner in which trauma impacts our lives downstream is absolutely monumental. Right? Agree completely.
So in thinking about how to kind of enter into this conversation, in my mind, I'm sort of thinking of it in three parts, the first part being, defining what we mean about trauma, when we talk about trauma. Second, the many ways in which trauma manifests itself in our lives. And then third, the means by which we can effectively process, heal, and even prevent trauma and those downstream effects.
Yes. So why don't we start with defining our terms here? Like what is trauma? That term gets thrown around pretty cavalierly, right?
Right. So I think it's important that we understand what we're talking about. Right, no, I agree. I think we have to define it to have a meaningful conversation about it, absolutely. And I think for purposes of the book that I wrote and for conversations about trauma, what I'm really interested in is trauma in the sense that something happens, which could be acute or could occur over time, that overwhelms our coping mechanisms and then leaves us different as we move forward. And that difference is rooted in brain biology. It's not a soft concept of, "Oh, I'm impacted by that because I remember it," or, I mean, all those things can be true, but there's actually a change in the brain, right? And that change pushes some things that we know about ourselves, or know about the world, out of our mind. Like we forget things that we knew and we then ground to the world in a different way, in a way that comes more through the lens of vulnerability and vigilance. And we often do not know that those changes have happened inside of us. So there are brain changes, there's psychological changes. They're real, they're identifiable. And the reason, as you talked about, there can be so much downstream effect is if it's impacting us so deeply and we don't know it, then how do we stave off the sort of domino effect of consequences? Yeah, in trying to differentiate or distinguish between a difficult experience or a painful experience and something that would be categorized as trauma, there seems to be a concretized narrative that ensues, right? There's a storytelling piece that gets kind of instilled within us that becomes very difficult to break, like a looping that then kind of drives behavior. Right, it's a change in life narrative. So life narrative, and like, what do I think about myself, and what do I think about my life history? So it's retroactive, right? So the change in life narrative is not just going forward, right? But it's going forward as linked to the past. And it very often changes what we've thought about ourselves. So the whole foundational aspect of who we are and how we see ourselves becomes different. Yeah, talk a little bit more about that, how the timeline, it pervades the timeline in both directions, and actually, as a result, prevents us from actually being present in what is truly real. Right, right. I think the best example I can give of this, which I write about to some degree in the book, is the loss of my youngest brother to suicide. And, you know, it was a much earlier stage in my life, long before I went to medical school, and my whole view of myself, and of life, and what the world could hold for me was different. Now, at some point in time, I became aware of it, right? But it was a whole point, a whole space of time where I wasn't, that instead of feeling like, look, I'm a pretty smart guy, and I work hard, and I think I can make my way in the world, and like, I've achieved some things, which kind of tells me that I can achieve more things, even though in one's early twenties, it can be so daunting, right? Like, how am I gonna get where I want to go? But I have faith in myself because I've gotten places. And there's a whole conception of self as being able to navigate the world. And after that, I thought of myself very differently in a way that was, oh, like I'm cursed, right? Or my family's cursed, and like nothing really ever works out, right? And like, you know, you can try and you can work hard, but like, what does it really get you, you know? And then I felt very defensive, and beleaguered, and vulnerable, and there was a whole change in habits, or like, my mood was different, my level of anxiety was different. My choices about who to spend time with were different, whether it's friends or dating, like it was a shift towards the unhealthy, right? Without a realization like, hey, you don't actually think this way about yourself in the world, or at least you didn't before. And it was very much a shock to me to have that realization that like, oh, like this made everything different, not just going forward, but going backwards, too. Hm. What was the journey towards that self-realization like? Like there was a period of time in which you didn't have the awareness to understand that you were operating under, you know, the sort of downstream implications of this trauma, you were just living your life, and then something changed where you were able to see it and evaluate it more objectively. Yeah, a couple of different factors. You know, one was I was aware of how I was sort of miserable in ways that weren't just related to the loss of my brother. Like, you know, there was that sort of hanging over me, but, you know, I was drinking too much and hanging out with unhealthy people, and not thinking ahead to like what I wanted next, right? And so realizing that like, oh, I'm pretty miserable, right? Like I'm not sleeping as well, my mood is low, I have a negative view of everything. Like, oh, like here's some new project at work. I had a different career at the time, and instead of thinking like, oh, I can do this well, I'm like, where's that gonna lead? I was like, oh, what's gonna go wrong, you know? Yeah.
And it was very clear the change in myself, which was a change towards limitation and misery, right? And then I also got a little bit of psychotherapy, you know, I'd come from a place, so to speak, where people didn't get psychotherapy, right? And it was thought that, oh, if you're getting mental health care, like, that was for people who were really sick, right? So I didn't have this understanding that no, this is a tool that we can use to make our lives so much better. And I accessed just like 10 sessions or so through my insurance through work, and they were so elucidating, you know, to sit with somebody who then was able to say like, "Right, you lost your brother, and that's a problem, of course, but there's all these other problems now that are in you," right? And that really opened, I mean, it did really open my eyes. And in looking back at that experience, do you have a sense of how much of your reaction to your brother's suicide was driven by just your internal mechanisms? Or was there a piece where the way that you were parented through that had an implication as well? I mean, I want to get into kind of generational aspects of this later, but in looking at like, how did your parents weather that experience, and how did they communicate to you about that at the time, and did that have some implications in terms of how you responded? Yeah. I think we all, just in a sense, slotted into what was the societal norm then, which was not talking about it, not processing it, right? Not communicating about really deep changes, right? The idea that, well, what good would that do, right? Like, all that's gonna do is make things worse, which of course the opposite is true, right? So I think that my parents and the people around me who wished, of course, to help me and themselves, didn't understand that our reaction to trauma, so the reflexive guilt and shame, plus the brain changes, which is all kind of part and parcel of the same thing, drives us inside. And the way we often reflexively handle it, well, this is something to be ashamed of. I mean, so the thought that, well, like I'm cursed, or my family's cursed, and like nothing good can come of it, that's not something people generally feel proud of, right? So you wanna hide that inside. And then, you know, so many people were suffering, but in ways that were isolated, and isolated from one another. And I think that that took a very big toll. I think it took a very big toll, for example, on my mother, who then, I think, was depressed much of the rest of her life, which I think predisposed to some very bad health outcomes. Like, I think where that goes, if we don't revisit that, if guilt, shame, fear drives us inside of ourselves and we live that new reality, that that often is the story, that it's like, oh, it's years of suffering and then an early death. Like, I think that that often is the outcome of it, or it might not be years of suffering, 'cause people might accelerate themselves towards an early death, but like, that's the truth of it. If we keep it inside of us, it is very, very toxic, because we are doing literally the exact opposite of what we need to do in order to heal. Sure, so this is the major key in the whole thing, and why this is such an invisible epidemic, because, and I know you talked about this with our mutual friend, Dr. Huberman. Yes.
But the natural inclination when we suffer through or survive a traumatic experience is to compartmentalize it, to repress it. And, you know, Dr. Huberman characterized that as maladaptive, but it's really a survival mechanism. For some reason or another, this is our instinct in how to best weather these experiences. So talk a little bit about that and how that kind of drives these negative outcomes over time. Right. And certainly I'm not an expert on psychological anthropology, so to speak, but I think if we look at what human history was like throughout most of human history, it makes sense, right? The response in us to compartmentalize and to hide something away with us probably makes sense in a time period where we just didn't live that long, right? So, you know, if you're out on a hunt and like you have to get some food, right? And there's a bad outcome and somebody in the party is killed in front of you, right? Well, you still have to find food, right? I mean, there's a survival advantage to being able to compartmentalize in the short term, in the service of immediate needs, right? Which doesn't fit at all with how we live our lives in the modern world, where like where we go and what we do is much more based upon our conception of self, right? And we're not, you know, we're not living lives that are limited into, hey, if you can get to your early twenties and reproduce, like we call that good, and if you make it further than that, you become an elder, right?
Right. I mean, if it's not like that, then these reflexive mechanisms in us designed to keep us going, right, they're not adaptive anymore, because we're not just looking at a short-term survival picture, but we're looking at a long-term picture of like, how are you gonna live your life? How are you gonna thrive? How are you gonna strive? And that's very, very different because it must be in us this strongly because of something adaptive, right? Like the reflex of guilt and shame and hiding it, it can't be from nowhere. It must serve an adaptive evolutionary purpose. Right. But that doesn't mean that it serves a purpose in the world we live in now. Right. In other words, in an era in which we weren't expected to live past 30 and all we're here to do is reproduce, push it down, survive, get through the next day, reproduce, and then who cares what happens? Yeah, and that would predispose to a tremendous salience to the negative, right? So the example I'll give sometime is, imagine if in the hunter-gatherer era of humankind, if you're hungry and you're looking for something to eat, and you find a berry and it looks like it might be good, and it actually is, and it's nutritious and it's helpful. It's good to remember that, right? But if you find a berry and you get deathly ill, you better not forget that. So the salience of the negative also has a survival advantage, but we build stories around that in the way we live modern life that just shut us down. So the example, I mean, it's so sad, I can't possibly count how many times I've talked to someone in my clinical work who's been, say, a victim of a sexual assault, has been maybe attacked somewhere, and then takes away from that the lessons of guilt, and shame, and vulnerability, and like, I'm not safe out in the world. And now that that person doesn't wanna leave their house, or they don't wanna go out and live their lives, because there's something that tells them that, hey, you shouldn't do that, it's not safe to do that, and look, you couldn't keep yourself safe. And then all the guilt and shame comes around that. And it's so shockingly maladaptive, but the person can't see that if they're sort of in the throes of the reflexive survival urges. It tells them, right, blaming yourself and never leaving the house sounds like the best way to survive, right? But it's not.
Yeah, the, the fear and the sense that the world is an unsafe place seem like self-evident ideas. The guilt and the shame, however, are a little bit more challenging to understand. Like if somebody has suffered, you know, is victimized by some act of violence, it does strike one as unusual that that person would then feel ashamed of that or guilty, but these two emotions, and I'd like you to distinguish between the two, seem to go hand in hand with trauma and the kind of attempt to survive it. Right, I think the guilt and shame part is much more surprising, right? And as I came to realize over years of just doing clinical work, like, wait a second, like I'm seeing this writ large, across the vast majority of problems. So the vast majority of problems that I'm seeing and treating, and the vast majority of problems in myself, are being driven by trauma and the power of the reflexive guilt and shame, which doesn't make the obvious sense that fear does. And again, we don't know why that is, but my thought about that is, you know, neurobiologically, there are different parsed out definitions, right, and the idea that affect is something that's aroused in us, that's created in us without our choice, and affects very powerfully modulate our behavior. So like an affect of fear, you know, starts blood coursing through the body, and our heart's racing more and we're ready for fight or flight, and then we know it, right, because it's much more important to prepare the mind and body than it is to have conscious awareness of it. So aroused affects drive us very strongly, and shame seems to be among the strongest modulators of behavior. You know, imagine as an adult, where, you know, I try to avoid this assiduously because it feels so bad, but where I do something that I feel ashamed of. It's like the worst feeling, right? It's, at least, I think for me, and a lot of people, I think, describe this, like, it's worse than being angry. It's worse than being afraid. Like, it's this shame in me that like, I've done something and it feels so bad. And I think it's such a strong behavior modulator that if you add shame to fear or to anger, then you have a very powerful behavioral modulator against, you know, the breadth of perspective that's exactly what we want to thrive in the world. It says shut down your life, shut down your perspective. And so that's my thought about it. And again, I can't know for sure, but I think that's why shame is so powerfully in the picture. Shame seems to be one of the most powerful drivers of unhealthy human behavior in so many ways. And I tend to look at things like this through the lens of addiction and sobriety, like we were chatting before the podcast, you live in Portland. Portland is where my sober journey began. I was in a treatment center there for quite some time in the late 90s. And that was the inception of me confronting my own shame of my addictive behaviors and the secrets that I was keeping. And over many years and, you know, thousands of AA meetings, one of the key kind of things that I've learned, that I've taken to heart through this experience of being sober, is the extent to which 12-step and AA are able to normalize trauma to eradicate that shame association, because you're sort of compelled to get up in front of a group of people and share your story, warts and all. And the liberating impact of seeing somebody else do that, who can own their past without that shame instinct, gives another person permission to, you know, walk that same path. Yes.
And there's something about freeing yourself from that association that then opens up unlimited possibilities for healing and growth,
Yes. but it's so difficult. We're so locked up. We create these prisons around these secrets that we hold.
Yes. Yes, and I think what you're describing is that it becomes then permissive to share and to say like, this is my truth, this is my reality, but I think that's retrospective too, right? That it becomes permissive to have had things happen or to have done things that have aroused shame, right? It ceases then to be this internal litmus test on am I a good person, am I a worthwhile person? You know, so much of that I think comes from the shame that's aroused in the moments over things we do that we don't feel great about. And it makes a story inside of us that says like, look, that's not okay and you're not okay, right? So to have it be permissive to be validated, like, look, this stuff can have happened, and it's not a litmus test on who I am, right? I can define who I am now going forward. And I think that's why when AA and 12-step works really well, I think among its most powerful, if not maybe its most powerful, impact is anti-shame. Yeah, I think of the opposite, or the antidote, to shame being vulnerability, and a close cousin of that is courage, because it requires courage to be vulnerable. The adage "shame can't survive the light" is very true. But in order to move towards that light, you have to summon the courage to be vulnerable. And in the sharing of that, there is this unbelievable release that's, quite frankly, astonishing. It's like having a two ton weight lifted off your shoulders.
Yes, yes. And then in the wake of that, realizing, like why did I, you know, haul that thing around for so long? Yes, yes. I agree completely. I think shame is so toxic and when we sort of set that down inside of us, we start making like immutable judgements about ourselves and they take away our sense of agency, our autonomy, our free will, right? So, you know, at times I've thought or said in clinical settings that, you know, in some sense, feeling so ashamed and feeling like, oh, you're, you know, can't do or achieve anything, you're just a bad person. It sets you free from the risks of striving, right? And it's the risks of striving where, as you said, we allow vulnerability, we show courage, right? We're really living. And I think, having done a lot of substance work in my career, you know, when something happens to a person that triggers a lot of shame, that's the time of greatest risk for the person, because it's just so tempting to fit one story into some neat, little, entirely false premise, right? Like I'm a bad person, I can't do good, now something else happens again, I feel ashamed of myself, look, I'm gonna go do the same behaviors I did before, and in some self-abasing way, prove it all to myself. And it's the most dangerous thing that can happen. It's the opposite of looking at the truth in ourselves, you know, good, bad and otherwise, right? Like, okay, this is it, right? And if I look at that and I see it, then I can take stock of it all, and I can determine what comes next for me, right? I maintain, I keep, and I, in fact, foster my sense of agency by looking honestly at everything, good, bad, and otherwise. Yeah, shame being this kind of arbiter of worthlessness that then becomes a predictor of life outcomes
Yes. for the course of an entire lifetime and then getting passed on to the loved ones with whom you associate. Yes. Yes, and that when a person is driven with guilt, shame, anger, fear, how could we possibly stop that from a cascade effect that impacts the people around us? I mean, it colors the lens through which we see everything, right? So are we gonna say something really encouraging to someone who's down and feels bad about themselves and needs the encouragement? Or are we gonna say right, you know, that's life and that always sucks. So like, where are we gonna go with that? And we-
But that encouragement falls on deaf ears to the person who's unwilling to hear it or to confront, you know, that trauma. Right, true. But the thought would be inside of us, where are we going?
Oh, right. What are we saying to someone, 'cause that other person may have ears for that, right? They have may have ears for whatever we say, right? Maybe it's a good friend or it's someone who respects us, it's a child, right? You know, what we say can fall on fertile ground for the seeds of what we communicate to take root. So it matters what we say, right? It matters if we just look at everything through a negative lens and like, right, that's right, because nothing ever goes well. Like, is that what we're communicating out into the world around us and to people who trust us and respect us, or are we communicating like, right, things can happen that make us feel a certain way, and it's valid how we feel, but that does not tell us if there are intrinsic limitations in us. There's not a limitation to our sense of agency. 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Give me a sense of how pervasive this epidemic of trauma is, because I think a lot of people, when you say the word trauma, it conjures, you know, an image of being sexually abused or being, you know, victimized by some very violent act, when in fact there's a broader definition at play here. I just know that my kind of introduction to these ideas came at the hands of Gabor Mate. We had a podcast and he did what he does, which is he flips it and it becomes like a session. We started talking about my upbringing, and I grew up, you know, my parents took care of it, everything was pretty good. I have nothing that I can point to in my past that would ring a bell and say that was a traumatic experience. But the more I've kind of excavated that, the more I realized that, you know, I did suffer some. My parents are good people and they're well intentioned, but there were some traumatic experiences there. And it's really reframed how I think about trauma in terms of how it lies on a spectrum. So, you know, talk a little bit about that. Sure. So remember, going back to the very first aspect of this conversation, right? Like trauma is something that leaves the brain different going forward, right? So it's not just anything negative that happens, 'cause people say, what about post-trauma resilience? Well, yes, if we define trauma differently, right? Something that really hurts us inside, isn't something we're built to be resilient to, right? Something that doesn't do that, that strikes us as well, oh, that was negative, we can respond to with resilience, right. But what you are talking about, and how we're framing this is like there's a neurobiological anchoring to trauma, in that it overwhelms us, and then we are different going forward, right? And nowhere is it written that like, oh, that only happens if you're in a terrible accident or if a loved one dies, or if someone assaults you, right? Those brain changes can happen in other situations as well. We know that to be true. So for example, chronic trauma. So if we could break it down into there are acute traumas, chronic traumas, and vicarious traumas. The acute, of course, more easy to understand, but the chronic traumas of, so for example, being framed as less than in the world, whether that's because of sexuality, or socioeconomic status, or immigration status, whatever it may be that often is imposed upon people, where there's just a constant message that says you're less than, right? Or, of course, there's equality, but then there's a wink that says, but not for you, right? Because you're this whatever the minority characteristic is that the majority is looking down upon and stigmatizing. And it's just so clear that if you sit with people who've been subject to that for a long time, not all of them, but a significant subset have the same kind of clinically evident brain changes as people who've had the acute trauma. The world is not a safe place, and you don't quite really believe anything positive, and even if it seems like everything is positive, it's still gonna go against you, right? And then all this is internalized. Why, because that chronic trauma can change the brain the same as acute trauma. And sometimes it can even be things that are seen as positive. So the idea of, you know, the quote, unquote, "special child," who's like, wow, you're so good, and you're so smart, and like, you're gonna go so far and like, there's all these expectations, right? And then it becomes very hard to shoulder when there are disappointments. And there are things, so then a little bit of shame becomes a lot of shame, right? And then the thought of like, oh, I've been less than perfect, or I messed something up, or whatever there may be, can be intolerable to a person, right? And I think that was part of my problem, having been like a firstborn child of a firstborn child, and then having been pretty successful in school and the thought was like, oh, you're just gonna do great things. Like, everything's gonna be great, right? Well, everything, wasn't great, right? And I needed to realize like, look, everything can not be great, and I can still go make a good life for myself, right? So I think it's part of why some of the things that happened to me made those changes, because I was sort of set up to be intolerant of anything less than perfection in myself, which came from a good loving place, you know, in the people who nurtured me, but nonetheless set me up to be very intolerant of anything that was less than how I thought it should be. So yes, the chronic traumas can come from lots of places. And we know that this can happen through vicarious trauma, you know, thank goodness we have empathy as humans so we can feel for one another, and it's part of why we wanna help one another, right? But empathy also means we can feel, sometimes in very deep ways, other people's trauma, you know, which is why in the last, I don't know, 5 to 10 years or so, I've found myself, and I think a lot of clinicians have found themselves much more saying to a person, like, look, my prescription to you is no more news, right? Or check the news so that you learn what's new, right? But why, you know, why is the person checking, and rechecking, and rechecking, and rechecking, because there are all these messages that tell us we are not safe. And then the parent is reading over and over again the story of the parent who lost a child in a school shooting, things that are immensely difficult to shoulder, right? And they're out there, and we become fascinated because we wanna think inside like, look, I could survive something like that, right? So we're fascinated with it and, you know, and find it to be so abhorrent and unimaginable, but drawn to it in a way that if we can have more of an understanding, maybe there could be some sense of like, right, if awful things happen to me, I can survive them. But inadvertently what we often do is just bring more, and more, and more trauma, and more, and more, and more lessons, so to speak, that say, hey, you just can't keep yourself safe in this world. Yeah, I mean, there is a neurochemical allure to that type of behavior, right? Like the doom scrolling,
Yes. Yes.
and you just can't put it down, or you can't turn off the news in the background, it's gotta be on all the time. And even intellectually understanding that this is not good for you and it's making you progressively more and more unhappy, there is an inability to course correct that behavior. Right, absolutely. The same way this happens in a lot of people, where if there's something a person's really worried about, the person keeps themselves thinking about it, right? And we do that because there's a superstition sort of built into the species that says, if I'm really worried about something, but I'm thinking about it, and I'm being vigilant about it in my thoughts, it's likely to stave it off, right? If there's a cancer I'm really worried about, because my goodness, a couple people in my family have had the cancer, then somewhere, it occurs to me that if I think about that, it's not gonna sneak up and get me, right? And like, that's a human reflex that probably comes from way back when, of like, if you're worried about something, think about it, it'll help keep you safe. But it doesn't serve us anymore. And then that's kind of the neurobiological function that's served by the doom scrolling or the, you know, always have the news on in the background, of like, I'm being vigilant, I'm aware, not just in terms of what is the news, but I'm like, it's in my mind every moment. And like, somehow that's gonna keep me safe. And it doesn't keep us safe. I mean, it does quite the opposite to us. Yeah, there's something about it that's wed to an illusion of being able to control outcomes in the future. But there's another piece that I think is important, which is about rewriting the past, right? If you have suffered some event in the past, that kind of obsession, the looping mind on the facts of that scenario is an attempt to reconcile that event and perhaps, you know, figure out how to make it different, or could it have been different had I done X, Y, or Z? Yes. It's great that you're bringing that up, because I think that's absolutely true. And it is so poorly served by just having it go over and over again in our minds, right? We rarely figure out something new, right? If you've been ruminating about something bad in the past over, and over, and over, and over again, what are the chances of thinking something new? Which is why sometimes a person will come in and they're willing to talk about trauma they haven't talked about before, and maybe I know this, like it's been telegraphed, but I haven't seen the person before, we haven't talked about the trauma before, and then they'll start talking about it. And sometimes I say almost nothing, right? I'm just, I'm a listening presence, and I'm reassuring, and encouraging, and whatever, you know, "mm-hm," or whatever sounds I may make, and then the person at the end will think, "Oh my God, that was, I can't believe it. I can't believe how much better I feel." It's like, I didn't do anything, right? But the person put words to it, said it out loud to another person, and therefore was able to think about it in a different way. So the thousands of times it goes over in the brain, we very rarely learn something new. But if we put words to it, there are different parts of our brain that come online. There's a part of our brain called the ventromedial prefrontal cortex that's involved in reversal learning, so unlearning things we've learned that are wrong, for example. And we bring that much more online in the spoken word and with a witness, somebody hearing our words. So I think what you're saying is so important, but it's hard to achieve that when it's just running over and over again in our minds, 'cause it just becomes often the same oppressive self narrative. Yeah, yeah. It's its own living pernicious entity, right? Yes.
Like we all know people who walk around with a rain cloud over their head and, you know, I'm fat, I'm ugly, I always get fired, and no matter what you say
Yes. to that person, it's impossible to kind of trigger them out of that mindset, which isn't rooted in reality, but obviously, you know, basically predicts all their life outcomes, because that's the way they're navigating the world, that's the way that they're interacting with other people, and of course that's gonna provoke the result that they seem not to desire, but which they continue to manifest time and time again. Right, the enaction, like E-N, not I-N, right, the enaction of a self-fulfilling prophecy is used as evidence that the prophecy was unavoidable. And boy, that's hard to get out of, but we can get out of it. And I know it was the sort of third topic of like, how do we get better, right? But, looking ahead a little bit to that is like how we get better is we stop the cycles that run over, and over, and over again in our minds by doing something different, by putting words to something, whether that's writing, it's speaking to someone trusted, it's going to psychotherapy, it's the thought of like, look this, you know, this over, and over, and over, and over again, that all it does is spin off misery and spin off negative symptoms and impacts us in mind and body, right? It impacts our immune system. It impacts our cardiovascular health. So all of this negativity, if we see all that's going on in me is just spinning that off, then like it's time for me to do something different, right? That's when, not just like, oh, things can get better, but things can get dramatically better, and sometimes dramatically better much more quickly than one might imagine, which kind of does make sense, 'cause now something different is happening that actually serves a solution state to the problems that have just been running over and over again and spinning off symptoms. I wanna go back to the chronic trauma piece that you were talking about a few minutes ago. In immersing myself in your world, it's left me very reflective on kind of my own upbringing. And I'm gonna resist the temptation to make this too much about a personal, (laughs) session with you. But I do wanna share this one thing, 'cause I think it's a illustrative of the many points that you're underscoring here, which is that I grew up with a mother who suffered at least two pretty acute traumas that I can point my finger to, one being the passing of her father when she was quite young in college. And by all accounts, he was an amazing human. He died before I was born. I'm named after him. He was a very important figure in her life. And then subsequently her brother passing away tragically in a car accident when she must have been,
Oh my goodness. 30, late thirties, maybe 40, something like that. And I have a vivid memory as a very young person experiencing her grief and trauma as a result of that. But she's also somebody who didn't grow up in an environment where therapy and these modalities were kind of something that you do, right? So she repressed these experiences, compartmentalized them, and then just did her best to move on. And over time, as my sister and I kind of grew up, it became very clear, and I wasn't aware of this until many, many years later, the extent to which we were raised in an environment where we were told in no uncertain terms that the world is unsafe, and it's scary, and risk is unacceptable, and you need to do the secure thing. And there was a sort of pressure associated with that. Like the way to be safe and secure is to excel in education or to kind of distinguish yourself and perform. And then, you know, thereafter pursue a career that is very safe, right?
Yes. And so it was an environment of fear, of catastrophizing, of the shoe is about to drop, it's right around the corner, and we should all be very afraid. And you know, in kind of recognizing this, I've experienced a roller coaster of emotions over the years. Anger, mostly resentment. Like why couldn't she have gotten help? What would've happened had she gotten the help that she needed? And I have to practice a tremendous amount of contrary action to forgive her, to forgive myself for the behaviors and the decisions that I made as a result of that upbringing, and to practice loving kindness. Because in truth, those traumas led her to become a person who was from her own heart center, you know, love for her children, was just trying to protect her kids. Like she was doing what she thought was in our best interest because she didn't want that to happen to us. Yes.
But the extent to which that kind of metastasized and led to outcomes that none of us wanted is severe. And I would have to imagine, you know, in talking about the pervasiveness of trauma, that this is a very garden variety story that is relatable to a lot of people, and I'm not trying to, you know, shove my mom under the bus or anything. I love my parents, they're fantastic. And like all of us, we are all doing our best. And I think what I wanna kind of land on here is that I've had to literally, you know, move emotional and mental mountains over many years to transcend these behavior patterns, to make peace with all of this, and find new strategies and models for living, and I've succeeded in doing that. And yet, as a parent of four kids, I will still find myself, like so much of my parenting is in opposition to that, right? Almost too much to the other direction. And yet, in less conscious moments, I'll find myself repeating those behavior patterns. And it's my wife who's like, "You're doing that thing again." And she catches me, then I catch myself. So it's this autopilot that is so entrenched. Yes.
Over many, many, many years, that even myself being someone who really wants to excavate all of this and overcome it, it still persists. It's still there, it's an ongoing thing. Yes. I think the story you just told is, it's so powerful an example, precisely because of its, essentially, its normalcy, right? I mean, you think about how someone might just tell your mother's history of like, well she lost a parent early and lost a brother in a car accident. Like we kind of like gloss over these things, like, oh, that's part of that person's history, right? But we don't stop and think like, wait, what? Like what do those things do to a person? What can those things do to a person? So there's a lot of us people in the world who've lost someone, right? In the way you're not describing it was like three standard deviations from the mean trauma in your mother, right? You're describing things that happen and they happen and they get carried forward because if we don't look at them, then we don't stop and think, and of course you said the world around your mother wasn't stopping saying, "Hey, what, what happened? How is this affecting you?" It's like life just runs along forward, and then there are these massive changes in people and they're just, they're not revisited. And you can see how that can come across generations. I mean, you're describing some of the impact that it had on you and then how vigilant you have to be now in your own parenting, right? But there's an awareness of it that says, hey, we don't wanna keep carrying this forward, right? And I think it's almost, in many ways, the inevitability of it, you know, what family system that in people who are parents, where there aren't some traumas? I mean, they're not there all the time, but the story you described is not an outlying story to happen to a human, right? And then the fact that there's a cascade of effect, I think, speaks to like, right, this is what trauma does to us. And there are real neurobiological correlates that probably after the loss of her brother, you know, if you looked at like, what's the connectivity among the parts of your mother's brain and with the vulnerability parts, and how prominent are they? You would see like, oh, whoa, there's a change there. And that change then determines, you know, sense of vulnerability, and fear, and behavioral choices, and conception of the world, and what's communicated to children. And it doesn't have to be like that, but we've gotta stop and be aware, and help people be aware so that they don't just run along from it, and then there's a cascade of negative. And I think another thing to say there is, of course, as you're describing the story, if I understood right, you and your sister were already, had been born already, right?
Yeah. But isn't it amazing, I mean, just amazing that when a person is traumatized in the ways we're discussing, that their children can be impacted biologically, right? Not through oh, the parenting style, but purely biologically.
Epigenetically. Right, epigenetically, years down the road. So if you think about, sometimes a criticism of this can be like, oh, it seems so soft, and like, everybody has trauma, and it's not that, right? It's saying, hey, there's like, there's the science of epigenetics says that changes how genes are passed on, whether they're active or not years later. So it's so clear that there's a deep neurobiological and neurochemical effect in us through these epigenetic principles. And so if that's the case, then of course there's psychological impacts, too, that follow from all of that. So I just see that as among the strongest aspects of validation of how all this works, both the drama of the epigenetic changes years down the road, and then also, really, the commonality of some aspects of your story and some aspects of mine that this stuff happens in the world, and just because it's common doesn't mean that the impact of it is not dramatic. Yeah, yeah. Thank you for that. I wanna double-click on one piece, which is the fear, and I know it's related to shame and, you know, and what we just talked about, but you know, in thinking about certain personality types, there is such a resistance to looking at it, right? Like, that is absolutely terrifying. And they would rather live in a chronic state of low grade dysfunction or misery than risk the experience of unpacking something out of, I don't know, like what is that? Is it that they think it will dismantle their lives? Or the terror associated with actually looking inward and trying to, you know, excavate what is actually going on is so difficult for so many people. I mean, I know that in my own case pain drove the changes that I've made and maybe they haven't reached a point where it's acute enough where they're willing to, you know, conquer that fear, but talk a little bit about how you get somebody into a mindset where they feel safe and comfortable enough to do this kind of work. Yeah. Often you have to speak directly to the threat of doing it, right? Because if something generates shame and generates fear, well, it tells us to hide that thing, right? I mean, if something is creating fear in me, I don't wanna go poke that bear, right? And people will say things like, I hear this all the time, right, "I'll just start crying and I'll never stop." Or, "I'll just curl up into a fetal position and cry until I die." Like, absolutely people will say that, right? And of course, shame, which comes along with it, it's like, why would I wanna, I'm gonna tell somebody else about something I'm so ashamed of? I can remember telling the therapist way back when about my losing my brother to suicide and feeling such shame, as if, you know, she was gonna be like, "Oh my God, you're a terrible person. How could you have not known it was coming?" Like you know, I had a whole set of expectations of how she might react to it, right? And it leads us then to keep it inside, you know, because there's like the reflexive leap from what we're feeling inside to then what quote, unquote, "logic" tells us, right? But like, but it's a false leap. Like if I feel ashamed of it, I should keep it inside, right? If I'm afraid and it's making me feel bad, I must keep it inside, 'cause if I let it out, I'll feel worse, right? And then we make these conclusions, but they're not true, right? And you can see how the reflexes in us, the fear, the shame, the guilt, have us keep something inside, and then we build up such fear around the idea of exposing it, right? And you know, you see this in movies, like it's a human theme where like something that someone is so, so, so, so, so, so afraid of, and then, oh, they go look at that thing and like, it's okay, they can navigate it, they can figure it out. I think even like "The Lord of the Rings" with no one can say "Mordor," right? And it's like, there's a place of oblivion, you know, but by marshaling their resources, what's really going on here, how can entities be and work together? Like they can go defeat that, right? So it's a human theme, right? And we need to come directly at it and gently, but firmly challenge it, of like, well, is it really true? Like you think if you talk about it you'll fall apart, but is that true? And then you can start talking about how in the vast, vast majority of people, probably all people, if it's done right, it is the opposite. And then the person feels emboldened, because you take away the negatives of like the, of course I can't do that, to like, well, wait a second. Can I do that? In fact, is that the right thing? Is it the best thing to do? And sometimes people will say, including in very dramatic situations, you know, I can think of a man who talked about sexual abuse for the first time. It must have been 25, 30 years ago that it had happened, and just immense relief, and the rapid succession of positive changes, who was in a serious but joking way saying like, "I can't believe this," you know, like, "I hid this away in me for so long." And then that decision, that leap of faith in a secure environment and with a trusted person to start talking about it, and like almost immediately, things are better, you know? And there can be like a real shock to that, but I think it speaks to how strongly those mechanisms are, and the mechanisms of stigma in the world around us, which we might say, oh, it's so much different now than in the 50s or in the 70s, and I'm not so sure it's that much different in terms of the societal mechanisms in us that tell us, hey, if there's something you feel bad about, keep that inside. Yeah, yeah. (mellow music) Let's focus a little bit now on this second part, which is how trauma shows up in our lives. Obviously it's something that if untreated ends up disrupting, you know, all manner of mental and emotional processes, but let's start with addiction, because that's, you know, again, like kind of where my interest lies. Sure.
As a starting point. You know, Gabor was among the people who began to speak about the tremendous impact that trauma, particularly childhood trauma, has on, you know, addiction
Yes. Yes.
that we see later in life. So what is your perspective on the relationship between addiction and trauma? Yeah, I think it's very much along the lines of his, and I'm, in part, impacted by his thought and by my own experience throughout life, you know, clinical and in my personal life, of just seeing how strongly trauma, and the earlier and the more severe the trauma is, the more it promotes abusive substances and addiction. And I think that is in a way that actually makes sense, right? If you think about the idea of short term soothing, right? If there's thought to be no hope of things getting better, then it makes sense to soothe for the short term, right? Like there really is then no better option, right? And under that conception that the trauma is hidden away in someone, or the person doesn't even know it's there, or if they know, it's in fleeting ways that they're ashamed of, right? So what it really does is pose for the person an unsolvable dilemma, which is like, you feel terrible and you're not gonna feel better, right? And if that's true, which it isn't, but if the conception is that it's true, then the appeal of substances becomes much, much, much higher, right? The appeal of soothing in the short term, because there then appears to be no better answer, right? And I think the way to come at trauma and addiction is to hold forth the truth, and the hopeful truth, that no, there is something way better than short term soothing. In fact, there are ways of coming at it that takes away, can take away the desperation that makes the short term soothing at some points irresistible. Does that make, does that sound reasonable?
No, it does, it does. I'm trying to, you know, understand the relationship between confronting this unresolved trauma and how that plays out in terms of building a foundation of long term sobriety. And, you know, I repeat this often on the show, but I'm, you know, I got sober in 12-step, I'm very much a traditionalist in that modality and that kind of toolbox and how, you know, that modality relates to a psychiatric modality that is related to trauma, like where those things intersect and where perhaps they're divergent. Yeah. So maybe one way of coming at that is actually approaching and addressing trauma can take away one of the most miserable and destructive conditions humans can be in, which is a damned if you, do damned if you don't, right? Like I feel awful. I feel terrible. I wanna feel better, and there's no way out of this. So I can go try and do something about it, but all the things I do about it, which might sometimes be the use of substances, make things worse, but there's no other, there's nothing else to do about it. There's no other way to make it better, right? And when we have what sometimes is called a central conflict, or a damned if you do, damned if you don't, we can't stand that as human beings, right? We feel we're confronted with helplessness and hopelessness. And the idea is then to come at that therapeutically, in a way, like, put words to that in a way that takes away the dilemma, right? It's not damned if you do, damned if you don't, there's a third path, there's a route through it, right? In some ways, I don't know if you're familiar, there's a psychiatrist named Lance Dodes who's at Harvard, who wrote a book called "The Heart of Addiction," and he is basically writing how traumatic circumstances promoted relapse to addictive behaviors. And I think it was a long time ago that he wrote that book, and I think it captures the concept that even if a person, say, has gotten themselves back into a healthier state, unless they've resolved that central conflict, something can happen that makes them feel again like they felt before. It's not really a resolution to the state, so they can go back to the state, and that that was telegraphing so many of the relapses that he would see in his practice. And I think that there's an immense truth to that. I mean, on the one hand, addiction is a neurobiological illness, right? There are receptors that are operating in divergent manners and they're, you know, they're firing in ways that sort of demand reinforcement. And there's all sorts of things going on there, but that doesn't mean that that's necessarily at the heart of it. Like we can get to the point of that neurobiological state, but it arises, often, from a psychological dilemma, and the psychological dilemma that arises from trauma. Does that? Yeah, no, it makes a lot of sense. It makes a lot of sense. In healing, confronting, healing, that historic trauma, I see a path forward towards building that foundation of sobriety, but I feel like it's just one, there are many other tools that still come into play. Sure.
Like it's not as simplistic as deal with the trauma, then you're good. Right, it's-
And I, sorry, that's the one thing that I kind of like bristle back at, because it's not a binary.
Oh, sure. Absolutely. We want everything that we can have in our favor, to be healthy and happy in our favor, right? So addressing trauma, and understanding that comes through trauma that can resolve those damned if you do, damned if you don't dilemmas is important, but it's just one part of a structure that a person can put around themselves to engender health, you know, self-awareness, well-informed life choices, reflectiveness, choices about the who, what, when, where of self-care. There's so much more to it, but a central heuristic to understanding it and navigating it would say you can't expect a person to do that, and to have the odds in their favor of doing it successfully, if there's a central conflict inside of them that is still spinning off a damned if you do, damned if you don't,
Sure. or all the reflexes we were talking about the trauma, of like, "Oh, nothing will ever go right for me," or "It's never gonna be okay in the long run." Like, how do you build that structure around you with that core belief? So we wanna come, we wanna make sure there is no core belief like that when the person is then building the healthy structure around them. Yeah, no, that makes a lot of sense. That makes a lot of sense. What are some of the other ways beyond addiction that trauma manifests? Sure. So if we think about the hallmarks of a post-trauma syndrome, which often gets called PTSD, but like the word trauma, PTSD gets thrown around a lot, right?
Yeah. And I think there are limitations. I mean, it's a DSM definition, right? And the DSM is a book of taxonomy, right? It doesn't tell you, it doesn't say what truth is, right? So for example, PTSD can be vicarious if it's occupational, but not if it's not occupational. Like that doesn't make sense to the truth of the brain, setting something so arbitrary, right? So if we look at it and we say, what actually goes on in human beings when there's a change in the brain, and that change is a consequence of trauma? Right? And a lot of it is very similar. You know, it tracks along with PTSD criteria, right? So there's exposure to something, whether it's acute, or chronic, or vicarious. It is then re-experienced, meaning that there are intrusive thoughts about it. There are recurrent thoughts about it. It's on the person's mind. It gets mapped to things they see in the world around them. You know, someone who is in an accident who sees the car go by and imagines the car hits something next, right? So it becomes ingrained in the person in a way that is a lot of re-experience to it. Then there's a shift towards brain mechanisms that are more about fear, and vulnerability, and vigilance, right? So people then become more vigilant and want to maybe take less opportunities. You know, the idea of like, you know what, I wanna be safe. The best way I can be safe is to not leave the house, ergo, I'm not leaving the house, right? And then like, look at how much of life is cut off, right? So the shift in us towards vigilance is negative. Then there can be shifts that raise baseline anxiety and tension inside of us, that lower mood, that impact sleep, and that lead to behavioral changes. So the idea would be, that's what we're looking for, right? Because those are the manifestations of a change that has happened in the brain that's not a healthy change that we wanna recognize, right? Whether it's a clinician recognizing, or someone who's being reflective about themselves, or someone else in their life. We wanna recognize, hey, like, that's a real change. And it warrants going in and looking at that and trying to fix it, right? Trying to change that back to how it was before. The sleep impingement one is super interesting, right? Yes.
I think a lot of people believe, or they're operating under this idea that they have a sleep disorder or some form of insomnia, when in reality, they're just looping these thoughts that are activating their brain
Yes. and their neurochemistry in a way that's just getting in the way of sleep, right? Yes.
It's sort of like these patterns that, you know,
Yes. are sort of hard to overcome or repress. I cannot say a strong enough "yes" to that. And over the years, amongst the conditions I have seen treated the absolute worst in mental health treatment, and indeed, in general medical treatment, are sleep problems, because, you know, we're living in an era of rapid fire throughput medicine, right? And as I often will describe it as like, polish the hood if there's a problem in the engine, right? Then things look better for a little bit and we can call it good and shuffle the person on down the road. And we see that so strongly with sleep, where we're like, anyone who has a sleep problem is, well, they're not sleeping, so they need a sleeping medicine, right? And it's like, it's so overly simplistic, and it doesn't honor at all that there are things that can be in our mind in ways that are ruminative, right? These deep distress systems in our brains that feel so unsafe that they just have us ruminating, going over and over. And I cannot tell you how many times I have seen a person who quote, unquote, "can't sleep." And, oh, they've been on 4, 6, 10 sleeping medicines. Oh, my goodness, like they can't sleep. And it's like, right, they don't have a sleeping system problem, right? They have a trauma problem. They have a rumination problem. And if we look at it through that lens, which is the lens of truth, of what's actually going on in them, we can resolve that problem. Whereas you'll never resolve that problem with a sleeping medicine, because that's not where the problem is. But in a system of reflexive medicine and overburdened physicians, especially the primary care physicians, where people are just overburdened, so of course they're looking for like, okay, like what, you're not sleeping? Let me give you sleeping medicine. Because they have 11 minutes with the person, right? And how else are they gonna do it? And I think we, there's so much misery and sometimes death in people. So much needless suffering and so much needless cost because our healthcare system has become focused on throughput, not thinking. And then we impose that upon the people who are working in the system. And we impose that upon all of us who are trying to get healthier within the system. And how can we be surprised that we often end up with dumbed down answers that don't work?
Yeah. Yeah, yeah, yeah. Yeah, I would venture to imagine that the rumination factor is at root in the vast majority of people who would claim to have sleep disorders. I believe that to be true as well, to the best of my knowledge, there's no data about it. I don't know if there ever will be, but it's just so, what I say, clinically evident, right? Something where you just sit with a person, you just know what that is. Then you have the proof of concept, right? You come at it not by giving them the ninth sleep medicine, but by coming at the reasons behind the rumination, and sometimes coming at that pharmacologically, right? So you try and shut down the rumination while then working with words to solve the problems, or you just come at it with the words, and you see, oh, that made that better. So there's the proof of concept, which is obvious when a person presents with that kind of rumination. Like, they don't say like, "Oh, I just can't sleep," or, "Well, I'm tired, but I can't." No, they're telling you what's going on in their brain and it's scary, and miserable, and vulnerable. And it comes to the fore around bedtime, right? Like it's just part of how our brains start relaxing a little bit that lets more of this in, because we're less thinking about other things. And in many cases it's just so obvious and predictable, but the system doesn't identify it. Yeah. In my mind that that serves as sort of a micro example of these autopilot behaviors that we're semi-unconscious of, but a very common, you know, more macro pattern would be the example of the person who is in an abusive romantic relationship. That relationship ends, they're in another relationship, the same pattern emerges again, and again, and again. And you know, they vary in the extent to which they're even aware that they're repeating this pattern, and there's a sense of powerlessness. Like you're continuing to seek out, because of something that happened to you a long, long time ago, you're recreating this situation in your life. Yes, yes. I find it like really amazing how often this happens in us, in human beings. It gets called a repetition compulsion. Like we can put whatever words we want to it, but it's rooted in this, like, I think amazing fact that, like, for the vast majority of my life, I wasn't aware of, which is that, okay, there are logic systems in our brain and there are affective, or emotion systems, what's called the limbic system in our brain. So there's logic and there's emotion, basically. And emotion overrides logic like all the time, right? If emotion feels strongly about something, it always overrides logic. But we're not aware of that. And we're also not aware that those emotion systems in our brain do not care about the clock and the calendar. Because people say, well, why, you know, if you've had four relationships that have been, say, basically the same abusive relationship, but the person just had a different name, basically the same person. Why would you do that again? Why would you think you could fix the past by doing that same thing in the future and gaining some mastery? It's the wrong question to ask, because that part of the brain isn't discerning past from present, right? It's all immediate and the brain wants to solve it. It wants to release itself from the fear and the trauma of what happened in the past to correct it by what happens in the present, because it's not making those, it's not distinguishing like that. Which is why people will say, well, how could that be true? Like everybody knows you're not gonna fix something in the past. That's not true. The logical parts of our brain know that, but when there's highly charged emotion, the logical parts of our brain don't matter. And unless we honor that in us, how are we going to stop repeating the same cycles, whether they're individual and psychological, or they're aggregate and sociological? People say, "Oh, history repeats itself." Right, history repeats itself, 'cause if we're not aware, then we do the same things on aggregate scales that we do in our own individual lives. And we engage in this repetition compulsion and you know, everything else that we see out play on bigger historical stages. So I think what we're talking about now is actually intrinsic to the survival of the species. And it might be, I know it's a strong thing to say, but I really do believe that. You know, I think that culture is the sociological equivalent of free will. Like if we know ourselves and understand ourselves as best we can, we exercise free will as best we can. But we also establish a culture around us. Is it a culture of helping and supporting people? Is it a culture of repeating traumatic distress over, and over, and over again? Like we establish the culture, and then the culture, I believe, determines whether or not we engage in these big repetition compulsions. You know, repetition compulsions of war and of lack of self-care to the environment around us. And as things get bigger and bigger, and we're truly on a world stage, for example, with climate change, we run the risk that we keep repeating those cycles, and you know, we blow ourselves up with nuclear weapons or we drive the planet into inhabitability. Right, that is the ultimate macro example of all of this, right?
Yes. But to extend the example of the person in the abusive relationship. Ostensibly, what you're saying is, let's say that person grew up with a father who was abusive. So unconsciously, they seek out partners that mimic their father's behavior. Yes. Because what they're attempting to do, without their free will or awareness, is to fix the past. Like if I get into this relationship with someone similar to my father and I can make it a healthy relationship, that will rewrite how I feel about what happened when I was a child.
Yes. Yes, yes.
Yeah. That one, I understand. The one that's harder to understand is the sort of converse example of the person who suffered, let's say a young boy was sexually molested as a young person. That person quite often grows up to be somebody who then perpetrates that same abuse on other people. So what is that person unconsciously or consciously attempting to do? Like why did those people end up becoming the perpetrators of the harm that was so traumatic? Right. So again, great question. And so there are different ways that our brains will try and solve the things that terrify us, right? Those central conflicts. I must have a good, I must have a romantic relationship with someone who loves me, right? But I can't, because I wasn't even loved by my father, right? And then, okay, well the solution state is the repetition, right? That's one aspect. That's one way that we can come at it. Another way can be identification with the aggressor, right? That being the recipient of sexual abuse is terrifying. And when people talk about it, there are sensations, and thoughts, and feelings that are so inappropriate to the age and the situation that they're wildly confusing and frightening, right? So there's such a strong sense of helplessness that the person then sometimes identifies with feeling powerful and feeling safe. It would be safer to feel like the abuser than the person who is being abused. And there's a there's a truism that I believe, I think this goes back like over a hundred years in the field, but I believe it to be absolutely true, which is there's no internal victim without an internal persecutor. So if someone internalizes being victimized, you know, not like, oh, someone did something to me and I was victimized under the eyes of the law, right? But like, I am a victim. I'm someone who people can do awful things to, right? Like that's me, I'm a victim. People also internalize the persecutor. And very often what they're doing then is persecuting themselves, right? So they're internalizing that person who told them they were worthless, is still telling them they're worthless 'cause they took that person into themselves. But another way or direction that can go is internalizing the persecutor and identifying with the persecutor in order to feel safer, which is what can then lead to perpetrating the same crime that was perpetrated upon that person. So that person then goes out and tells other people they're worthless. The person who was told they were worthless then repeats that pattern by trying to, you know,
Right. basically becoming the perpetrator as a way of reconciling the victimhood. Yeah, and often not in a way of saying, oh, I'll, either unconsciously or consciously, I'll feel better about myself by making someone else feel the way I felt. It's generally not that. It's if I'm doing this, basically if I'm perpetrating crime, then I'm safe. I feel powerful, right? I have a relief from the terror and the fear inside of me of, you know, the ruminative distress of the memories and the feelings of having been abused. Usually it's in the service of the person feeling safe, right? Now, there may be a whole set of cognition around that that involve knowing that someone else is being hurt, you know, of course that's why there's culpability and you know, legal culpability for it. But ultimately, psychologically, you know, people are trying to find safety, right? They're trying to find some peace and some safety. And we can go about that in some ways that can be incredibly damaging and hurtful to ourselves and/or others, if we don't understand that that's what we're trying to achieve in the world. The sense of safety, of relief of fear and vulnerability. And if we look at that, and we wanna understand it and shine the light everywhere instead of running from it and hiding from it in guilt, and shame, and fear, then we navigate that in ways that are so much healthier for ourselves, and for everyone else too. You mentioned PTSD earlier. That's a term that is cavalierly kind of tossed about. The more that I think about trauma, the more I'm confused why this term even exists. Like isn't there just trauma and our response to trauma? What, if anything, is different about something that would be clinically described or diagnosed as PTSD, versus somebody else's, you know, downstream response to a traumatic event? Well, it's a big question and I'll try and speak to it kind of concisely. That, you know, there need to be criteria for diagnoses in order to identify them and to communicate between clinicians and to enact treatment paradigms, right? But what I believe so strongly has happened in the field is that mental health, or psychiatry, if we're thinking about medicine, wants to be like the rest of medicine, where it's like very clear, do you have a pneumonia or not? We can tell that, right? Because we're gonna get a chest x-ray and we're gonna do blood draws. And like, we know you either have a pneumonia or you don't, right? So we then want these, we want a taxonomy that tells us what something is and what something isn't. And then we do what I think human beings often do, is we glorify the taxonomy as if the taxonomy is the answer, right? Instead of saying, look, people can have trauma in all sorts of ways. And on the other side of that trauma, there can be a whole set of problems, right? And the problems often look like this. Now, they don't always look like this, right? But they often look like this. And they come from these changes in us that promote these problems. That's why you can see mood changes, and anxiety changes, and sleep changes, because there are all these brain changes. But that's less absolute, right? Why, because it's real, right? It's true. It's less absolute than saying, look, there's either PTSD or not PTSD, and you have to have X criteria in this category and Y in that criteria, and it's like, it's false, right? But we look at it in a way that glorifies the taxonomy. I can remember years ago, training a resident who went and saw someone who so clearly had a diagnosis that, you know, you could have told a middle schooler about like, hey, here's a criteria. That person has it, but they didn't have, they only had like two from one category instead of three. So the person comes back like, "I have no idea what's going on." Because we are dumbing down the whole system. And then the whole understanding in the broader community and world around us and in the training processes, where people will call the DSM a bible. Right, I was just gonna say, this DSM being considered biblical, and in its edicts- Terrible.
Yeah. (laughs) It's just, it's terrible, because it leads to, it perpetuates an overly rigid form of ignorance that is not grounded to what's actually happening in people. So if we think, hey, here's this truth, that if things happen to us that overwhelm our coping skills, our brains and bodies can be so different that we can pass on our genes in a different way years down the road. So very clearly then, the communication and the prioritization of different parts of our brain informing how we feel and what we decide can certainly be impacted. And we wanna be cognizant of that. And we wanna be cognizant that that can occur in like anyone who presents. That doesn't mean it's in everyone, but I wanna think about that. I wanna think, has that thing happened that's changed the person? That is so, it's so much more of an application of judiciousness and intelligence than it is to say like, okay, you've presented to me, I don't know who you are, but like, I'm gonna check some boxes. Do you have this, do you have this, do you have this? And then at the end of it, I get to the checklist and I tell you what's wrong with you or not, right? It's just fake. And it's a product of a healthcare system that prioritizes throughput and decreasing costs by minimizing human interaction and throwing way too much medicines at people. Why, 'cause it's cheaper to throw medicines at people than it is to sit with them and try and understand them. You know, and then we have over, and over, and over again, problems that aren't solved because we're not putting in the human time, which might cost, say, in the realm of like, I'm just making it up, like several thousand dollars, right? But instead of that, the healthcare system will spend hundreds of thousands of dollars when that person shows up again, and again, and again in an emergency room. And then, which is so terrible, but I've seen this so many times, so many times, then sometimes there's a person in that position and then they die. And that's the end of that story. There's no learning or reflectiveness, like how many people are dying needlessly? Right? Because we're so shortsighted. You know, the same way I think often we're looking at, you know, corporate profits in a, you know, end of the month or end of the quarter, right? Like there's so much in our world around us that focuses on the short term, not that everyone is doing that in business or in medicine, but there's so much of that, that we don't extrapolate forward to like what are we doing to ourselves as a society? And I think this is true of the downstream effect of trauma. Like, you know, every time I see it, there's another mass shooting, right? Of course, I think about like the horror of the lives that were lost, but then I think, oh my God, like how many dominoes are now tipped over? And how many people who knew these people or knew people who knew these people, or they're still alive and they're trying to cope with life, or they're somewhere identifying with the terror those people feel. And we just, don't, it's very easy for us as a society, just, eh, you know, we just polish the hood and we move forward and we don't even, we don't provide enough resources to really take care of well, people who lost someone in the September 11th attacks. It's like, oh, do we have enough resources, we really, how much are we gonna really help them? Like, why are we not as a society saying, look, there's a clear group of people, for goodness' sakes, can't we really take care of them, right? Even in situations like that that are so unambiguous, you know, there's limited resources, right? Because I think we waste a lot of resources, and we don't look at the vulnerability of us all as individuals and as a population and see ourselves as stewards of the world around us, of our own health, of the health of people we love, certainly of our children and the next generation, in a way that has us stop and really think outside of a, wait, what's the bottom line now? Or what can I consume now to make me feel a little bit better? And as a society, I mean, I think it's hard to take stock of our society and feel a sense of pride in where we're at. Yeah, it's a, you know, it's a dire indictment of how we think about and care for our brothers and sisters. And I often despair of our capacity to, you know, sort of overhaul our systems and create a more compassionate, holistic means by which to care for people. Because I think it requires, on a practical level, a complete change in the incentive structure, a total overhaul in how we think about healthcare, from, you know, diagnose and prescribe, to this holistic approach to wellbeing more broadly. And this is something that you're, you know, not only endeavoring to do, but succeeding at your clinic, and, you know, hopefully it's a model
Thank you. for more of this kind of thing, but the entrenched
Thank you. infrastructure in which healthcare operates systemically is utterly broken, and incremental changes within it aren't going to really shift the equation very much. And then on top of that, without a revolution of consciousness, I don't know how we solve these problems, because it requires not only a higher plane of thinking, but you know, a higher plane of awareness that really values compassion and, you know, loving kindness, and these more kind of Eastern strains of thought and perspective that lead to creating systems and institutions and infrastructures that are value driven in the manner in which you just described. Yes, I agree with you completely. If there's anything I see as positive or hopeful, it's that what you just described comes through a grounding really, to common sense, to what we just see so obviously in front of us, right? The lessons that history tell us, the lessons that early childhood education tell us, the lessons that even the basics of religious values tell us say, come on, let's look at this for what's really going on. Can we just stop and look and just see with new eyes, with common sense eyes? And I think so often that's where the answers lie, right? And I sometimes will think, and I really kind of mean this, I'm exaggerating a little bit, maybe not, that, you know, we should have a bunch of like really smart middle schoolers look at our healthcare system and come up with like, what principles would you make? What would you do, what would you change to make this better? Because by the time you're often at the level of adults, there are too many entrenched interests, right? There are too many, oh, I can only see it the way I've seen it. And then we can't see what's obvious. And I think the biggest example of this, which I, it just makes so much anger in me, is the term burnout, for physicians who just can't navigate in the system, right? I'm in my early fifties, but when I grew up, like the term burnout was an insult, right? That was someone who wasn't going anywhere, wasn't trying, like, it was absolutely an insult. And now we apply this to physicians who find themselves unable to function in sick systems, right? We don't say, you know, that person actually is on the receiving end of the sadism of a system that looks at them like a thing, and says, oh, you know, you're gonna see now four patients an hour. So you're a primary care physician, you're trying to figure out out what's going on with people. You're gonna see four patients an hour, and you're the person on call today in case there's a walk-in, so you might have five. I mean, how is that person supposed to function? As a person who's taken care of a lot of doctors throughout my career, you know what I see the vast majority of times are good people who are trying, but this is not what they signed up for. They didn't sign up for denigration, right? They didn't sign up for it being literally impossible to care for the people, the number of people in the range of acuity that's on their panel, right? And then the system's labeled 'em, oh, well, they're burnt out. I mean, I just think that, that that to me is the focal point, and I find it be, it outrages me. And because of course I feel for those physicians, but then also on the other side of it, how about the people, which is all of us, who could come in the door to be taken care of by someone who doesn't have the time or the means, you know, or even the freedom inside their own mind to actually take care of us. So then how do you begin to make reparations for this? Like, what is the path forward? Like if you found yourself in the position of, you know, running a massive healthcare organization, or perhaps you get appointed to be surgeon general, like, what are the policies that you would like to see put forth and foster? Like what do we do? Right. I don't wanna pretend like I have all the answers, but I'll tell you this for sure, is I'd come back to first principles. Like, okay, what is this system about? It's about taking care of people, right? It's about health and happiness over the long term. Okay. Much of which presents to healthcare systems either is, or has the capacity to be chronic, right? Or has its roots in things that are often chronic. So, okay, so let's look at that and look at how we're dealing with it. How often are we polishing the hood instead of looking into the engine, right? How do we look into the engine? What's at the root of dysfunction? If you think about how many medical costs come from mental health issues, right? It's well understood that at least half of what presents to all physical health doctors arises from a mental health condition. Like we know that, it's clear. When you look at the studies, they're all saying half or it's more than half, right? So, wow, that's fascinating, right? Because that's a lot of morbidity, mortality, cost, that's coming from that. So can we look and say, well, what is that that's at the heart of it? And look, so much of the time it is trauma, right? That is why that person's not taking care of themselves. And now, oh, guess what? They're 40 pounds overweight. Now they have diabetes and they have high blood pressure, and we wanna throw this medicine, that medicine, instead of saying like, why? Where is this coming from? Can we help you to diffuse this? Can we help you to take care of yourself? When we actually look at it that way, we do help people be to be healthier. And ultimately, in addition to helping people be healthier and happier, we decrease costs within the system. But how often? I mean, it's maddening, and like, I worry sometimes there's a thought of like, that I must be exaggerating, but like people who operate in the systems, you just see this all the time where, you know, something that would be so simple or so easy is not provided, right? And then you see the hundreds of thousands of dollars of medical costs that you see that come of that. Or you see the morbidity and mortality. I write about in the book of a, you know, person with clear mental health, bad mental health condition, right? No help, no help, no help, no help. Dead kids, right? And then what does society wanna say? What a bad person. Instead of saying, we set up all of that to happen because every step of the way, we looked at that person in that situation in the most shortsighted way. And then there's the revolving door in and out of the emergency room, in and out of the hospital, until something catastrophic happens. And it's not that hard, if we go back to first principles, to make that better. What's hard is deciding, hey, this isn't working and we need to go back to first principles. Yeah, well, you're successful in the clinic that you've created. And there are other, you know, there are many examples out there of integrative medicine, functional medicine practitioners, clinics large and small. And this is, you know, an ecosystem that seems to be growing, you know, even compared to 5 or 10 years ago. And I think the more of these entities are successful, it shows young doctors and healthcare practitioners who are coming up, that there is a new and different way. So that is my kind of silver lining of hope in all of this. Yes, yes. And I do agree. I see that. I think the shift has to be where what sort of private clinics or places are doing that are providing, hey, how would you provide really good care to someone, shifts over into the standard systems, right? Because people are often paying out of pocket for, they're paying for the really good care, and true if that's how it is in order to get really good care, like, I understand that, and I'm a provider of that, right? But I lament that, I think, in many ways we're moving towards a bifurcated system where it's like, well, if you have the knowledge, and the savvy, and the resources to go get that, you can, but if you're operating through insurance, hey, there's only so much you're gonna get. And I think that that is wrong, right? And part of how I feel morally and ethically that what I do, I feel good about, right? And I think part of it is, yes, we can do things at a sliding scale or discount, like we can choose to do that. And we're also showing that, hey, ultimately, this is better, right? That if you look across time, people are happier, they're more productive, they have better lives, they're spending less on their healthcare. That it's not just a model for wealth, right? That it could be a model that the insurance systems run from too, that then can really change our society and how our society is functioning. But it's not clear to me that we're gonna make that leap. I hope we are, and I wish for us to. And it's part of why I wrote the book and it's part of why I'm here talking about it, because I think we need to shift our whole system in that way. And if we don't, again, I do think we're in trouble. Yeah, yeah. I would agree with that. (mellow upbeat music) Let's turn our attention to healing, right? How do we think about and pursue a healthy modality of grappling with, you know, our past and possible traumas? I'm just imagining the person who's listening or watching, who's saying, "Oh my God, I've never thought of this sort of thing in this way. I'm realizing that perhaps I have some things to look at. How do I do that?" Yeah. I think this will be more positive than maybe some of what
Yeah. We went down a dark alley.
I've been saying recently. But I can't it because, right.
We're bringing it back. Because I think there's a truth to the dark parts of it that it's hard to say, but I think important. Sorry to interrupt.
Yeah, yeah. But like, that whole thing that we just, to me, I look at that and I say, all of this can be tracked back to certain traumas. Like what's happening, the tectonic plates of culture, politics, economics, so much of where I think we're losing our way can be, you know, identified and rooted in certain individual and kind of institutional traumas that get played out
Yes. and create these systems that seem to be going haywire. Yes. And that's why this is a great topic to have as the final topic, right? Because it's legitimately exciting, empowering, optimistic, right? And I believe that, it's not just that I wanna finish with something optimistic. And I wrote the last section of my book is about the same theme. Like how do we get better? And I think it's not just the search for being optimistic. It's the truth that if we come at trauma, we do the opposite of what it tells us to do, right? We do the opposite of, I feel guilty, I feel ashamed. I'm hiding it inside of me. I'm gonna do the opposite to that, right? I am gonna let myself put words to it. I'm gonna let myself write about it, communicate to it, think about it in new ways. What is it telling me? If it's telling me "You should be ashamed." I remember the words going in my head of like, "Well, you should be ashamed. You didn't know how ill your brother was until you lost him to suicide, and right, you should feel ashamed." And then thinking, can it really be true? That like, if I didn't see it, was it there so evidently for me to see? Like, what's going on inside of me? When you really confront what makes shame in us, it tells us something different, which is like, hey, that seems pretty punitive and pretty negative, and like, what was really going on then? And I think, right, that, you know, like sadness and confusion, really for both of us. And I didn't see what was going on in him. Like, you come to a more benign perspective, not in the service of it being benign, but it's also true, right? And if we go against the grain of what guilt, and shame, and fear, and often anger tell us to do, it's remarkable how quickly we can start doing better. And as you said, if the bigger questions have their roots in the impact of trauma upon individuals, and we can readily get at that by going against the grain of what the society around us and our own internal mechanisms tell us to do, then that's very, very hopeful. Yeah, not only in terms of, or in the context of that individual's lives and the generations that spawn from that individual, but in a macro sense in talking about like, how do we elevate consciousness? Like this is a very practical way and doable way of doing it.
Yes. Just imagine, you know, scaling up everything that you're talking about, such that everybody can get the treatment that they need, and people's heads are inured around these healing modalities, where they're welcoming it as opposed to recoiling from it. How does that impact society at large as a macro organism? Yeah, I mean, I think what you just described is a very foundational level upon which so much else is built. So if that is impacted in the positive way you described, I would expect that we would see remarkably positive effect on the structures that are built upon it. We would say, whoa, healthcare costs are becoming much less, not just in mental health, in physical health, too, right? People are communicating better. People are being more civil. People are functioning more adaptively in the world around us. Productivity goes up. I think we would just see so much, because that's about as deep as one can get, I think, foundationally, right into the sub-structure that we build so many individual and societal constructs upon. So let's get back to the idea of what to do, right? There are plenty of modalities out there. Not everybody is gonna be able to come and see you, but talk a little bit about the variety of, you know, therapeutics available for people who are willing to begin grappling with their own trauma. Sure, and I always say, it makes sense to say that, look, if a person is having very severe depressive symptoms, you know, they can't see the positive in anything, or thoughts of not wanting to be alive, or thoughts of suicide, then we need to get professional help. And even if you have to be very persistent about that, or, you know, you insist, you've gotta see someone, or you go to this ER, and if that doesn't work, I go to another one, right? There are things, symptoms, that mean we really need professional help, but in many cases, that's not it. What we need to do really is just take stock of ourselves, right? Like what is my self talk inside? What's my narrative of life? Is there something going on that I know, but don't wanna know is going on? Have I been really different since something or other, right? Has someone I know been really different? If I know you really well, and I know kind of something happened like 9 months ago or 10 months ago, and like, you seem different to me, can I just put some words to that? Whether it's me or it's another person, can I put some words, like, what might that be? And can they be like plain, simple, honest words, right? And if that's not what's running around inside of us, what are the emotions attached to them? Is it guilt, is it shame, is it frustration, is it anxiety, is it anger, is it fear? Because what that's gonna tell me is don't look at that. But exactly what I need to do is to look at that. And if I start looking at it, what do I have to say about it? What do I have to write about it, right? Do I start saying new things in my mind? Sometimes that happens, but it's easier to say new things if we know someone well. If I say, "Hey, you know, can I just talk to you for a little bit?" You know, friend, family, clergy, whatever it may be. Then we start to open that up, much the way the parallel here is a medical abscess, right? It's like, if there's an abscess, it's a walled off infection inside of a person, and it's occult, it can be difficult to identify, but it spins off, often, symptoms, right? A little fatigue, lethargy, fever, right? And if we go and treat that, then those symptoms don't get spun off anymore. And if we see it kind of that way of, I don't wanna be afraid of what's going on inside of me. I don't have to be, right? I can look at it, I can put words to it, I can talk about it, I can get help about it. I don't have to be afraid. That reflex of fear, guilt, shame, we come by it honestly, right? But we can identify that and make sure that it is not what drives us. And how important is it to be able to talk to another person about it? There's a sense, and I know that I've experienced this myself, that I'm gonna solve this in my mind. The mind that created this problem is gonna somehow miraculously solve it. Because I'm so afraid of raising my hand and asking for help, or the prospect of sharing these secrets with another person, even if it's in a therapeutic setting where it's confidential, et cetera, is still too terrifying. So I will convince myself like, I'll just fix it. I just listened to this podcast. I'm gonna read Paul's book. I'm gonna think about these things. And I will resolve it somehow, mysteriously, and you know, mystically within myself. I would say maybe, but that's not usually how it works. So if we accept that there is a truth of how humans change inside, and thinking about it over and over again is very rarely the answer to that. And that is in large part neurobiologically driven, that these mechanisms in us that are, for example, error checking mechanisms, mechanisms of reversal learning, right? They don't come online if it's just going over and over again inside of us. So hopefully, like listening to this podcast, or reading the book, or whatever it may be, the change that it can engender in someone is a change that fights against the fear and the unacceptableness of putting words to it. And so like, is that really true? And the start of putting words to it can be in writing. Sometimes even in the spoken word, out loud. So it's a way of putting words, because then it comes out of us, right? And it comes down onto the paper, or the computer. Can one put words to it that way, right? I mean, it's pretty safe, right? Like you could delete it afterwards if you don't, you know, if you don't like it, right? Can we start to do that and start to confront the given that like, hey, this is shameful and it's not safe to talk about. Like, that's often, that's a given. Well let's question the given, right? 'Cause there are a lot of givens in life that don't actually hold water once we go and look at them. Within that, is there a particular strain of therapy that is more effective than others? I think that varies a lot. You know, there are a lot of nuances about that we could talk about. But I think what I'd wanna say about that is they're vastly different mechanisms of psychotherapy, and sometimes one is really called for over another, and that may be the case, but the greatest predictor of the ability to help someone in therapy is establishing rapport, right? Another way of looking at that is there's more than one way to skin a cat, right? But you have to have an alliance at first, right? And then you can go about that however way a person is trained to go about it. But what's most important is someone that a person can trust and relate to. So people ask me about this and I wrote about it in the book. It's just like really, again, the basics of common sense. Is someone paying attention to me? Do you seem interested in me? Are you making eye contact with me? Do I feel safe with you? Do you remember this week what I said last week? Like it's just the basics of human, you know, of humanness, right? In interacting and in building trust. And very often, if someone is like that, they can establish rapport like that, then they're likely to have the undergirding skills to be of some help. So I think the establishment of rapport and the assessment of, is this a person I can sit with and trust who seems interested in me, has benign positive regard for me, you know, wants to listen to me, that's, we do that, we're over the majority of the hurdles. Yeah, that's very empowering, because it's not a sense of like, oh, you need to find this person who's expert in this specific modality and short of that, you're out of luck. And there's only a few of them. The idea that it's trust and somebody who's validating you, listening to you, making eye contact with you, is like getting you all the way to the 20 yard line or whatever on the whole thing. Yes, yes, absolutely. What is your sense of the appropriateness or efficacy of pharmaceutical interventions, SSRIs, things like that in the context of trauma? Yeah, pharmaceutical interventions can be helpful. But we have to look at, what are we treating with them? And what are they in the service of? Like, meaning like SSRIs don't fix, quote, unquote, "trauma," right? But sometimes SSRIs can improve distress tolerance, decrease anxiety a little bit, and make it easier thereby for the person to confront the trauma, right? Same thing if you're not sleeping and you're ruminative. I mean, if we don't get good restorative sleep, we're not solving way out of a paper bag. I mean, that's just true of us as human beings, right? So if that's going on, is there a medicine we can bring to bear so that person can sleep and they can be at their best again? And they can face this from that perspective. So there are a lot of ways that medicines can help in a lot of circumstances, but we cannot mistake them for answers to the problems. And they should be prescribed with a very clear understanding of what are they in the service of. So if you come and see me and we're talking about trauma and I think, hey, look, you could really benefit from an anti-ruminative at bedtime, and you could really benefit from an anti-anxiety medicine because you're having seven panic attacks a day, and it's so hard to live and solve one's problems then, then I should talk to you about that. Like here's what's going on. Here's what we would try and treat with these medicines. Here's the risks and benefits and side effects. And here's why they're temporary in nature, we expect, in the service of helping you do what you need to do so that you don't need them anymore. Right, so they're not specific to treating the trauma. They're about getting you into a place where you can be receptive to therapy, right? Therapeutic interventions. Right, which is really an enaction of common sense in the provider of saying, hey, if you're coming to me, then I'm gonna say, well, I have seven medicines I use for trauma. Like, I don't know who you are yet, right?
Right. So you come and tell me what's going on with you. If I see, hey, there's a couple of things going on in you that are number one, making you miserable, and number two, making it really hard to process your trauma, well, let's talk about that. And let's decide, like, does that sound reasonable to you? Like, can I talk about it in a way that you can understand well enough? If not, I'm not doing a good enough job of it, right? And then ultimately it's you who makes that decision. Yeah, I'm gonna serve my own cause with this, or these medicines, but I understand what they can do for me and what they can't. It's just the common sense use of medicines in the service of the greater good, instead of medicines as mystery, right? And how many people, I mean, how many people say they go and they see someone who's like not making eye contact, not make much eye contact, not talking to them about it, and then is writing prescriptions for them? I mean, how can that go well? There's no empowerment in that. There's no collaboration in that. Like, we need to know what are medicines in the service of. And then we track along in a data driven way. If we think we're gonna start two medicines because there are two significant problems you've told me about that are standing in your way, well, then we're gonna track along. Like, is that actually helping you? If it's not, we gotta do something different. If it's helping you, but causing some other problem, we know we need to do something different. There's just like a common sense collaboration to it that makes the use of medicine so much more judicious and effective.
Right. And what is your sense of the emerging science that's coming out around the use of psychedelics, specifically with respect to PTSD and addiction? I mean, there does seem to be a growing consensus and, you know, body of understanding that there are efficacious use cases for these things, although we are in the early phases of really understanding this. Yes, yes. The information that's out there, both in terms of academic data and also in terms of the of history of these substances, tell us that they can be incredibly powerful tools in the service of health and happiness. Now as with any powerful tool, it needs to be used judiciously, right? And we're figuring out, okay, how do we do this in ways that are judicious in terms of application, where we can track along how these tools are helping people, right? How do we utilize them in the service of health and happiness? So we're learning that, but what we're learning is very, very promising. It's interesting, and it's encouraging. I think, you know, part of my, and look, I'm just a lay person here, but part of my thinking around this is caution, it's sort of coming from a place of caution, because there does seem to be a narrative out there that this is like a cure-all panacea. Like all you need is this, and, you know, don't worry about what we've been talking about for the last two hours, because the answers that you seek lie in this mind-altering substance, and you're gonna be just fine. So how do you think about that? Oh, I agree with you completely, right. There's a temptation to quick solutions, right? But isn't that what we're talking against in everything we're talking about today. Like the quick solution isn't someone who promises us politically, someone's gonna make everything better for me, right? The quick solution isn't in the Western medicines, right? The quick solution isn't in anything, right? And the more powerful something is, the more respectful we need to be of it, right? Powerful tools can also do powerful harm. So if we're respectful of what the tools we have at our disposal can do, what we know they can do, what we don't know yet about them, Then we will employ them, no matter what they are, judiciously in the service of the actual process, which is a process of human understanding, right? It's a process of looking at that thing inside of us, that guilt and shame and fear that may have told us to look away from, and like it's all the things we've been talking about, like that's what it's all in the service of. Are there ways that we can help ourselves that are external tools? Yes, but we need to be diligent, circumspect, respectful of those tools. Hm. To kind of close this out, and thank you for being so generous with your time. You're so welcome, thank you. Perhaps a few words for the person that we've kind of walked to the edge of the cliff here. You know, I'm thinking of the person who hadn't really thought too deeply about these issues and now is in a place of thinking, "Maybe there's something I need to look at here? How do I begin to do that?" Perhaps some encouragement and maybe a few really basic tools to help that person wrap their arms around, you know, the fantastic journey to come. Yeah. You know, I would say you don't have to be afraid of what's inside of you. And we often get very afraid of what's inside of us, especially after trauma, when the trauma itself makes fear and can make shame, that we become very afraid as if there's something magical just off, I can't see in my peripheral vision. And if I like really look at that, that's the, "I'll start crying and never stop," or "I'll stop functioning." And it's just not how it works. It's just not how we work. That if we're careful about it, we don't wanna say just go talk to everyone about it, right? But we're thoughtful. What's going on inside of me, can I put words to it, could I talk to someone, right? And running current to like the strength of what says, no, you can't do that, right? Everyone will be ashamed. No one will look at you in the same way. You won't be able to function. Like, you know, as we talked about much earlier on, it's in the service of survival, right? But that's through an aspect of human evolution that's not applying now in the ways that we're talking about. So if we honor and validate that that's in us, but also recognize that it's not actually true, that confronting the thing that makes shame or fear is gonna make us fall apart. And in fact, quite the opposite, I mean, there's so much data and clinical experience telling us the exact opposite, that we don't have to be afraid of it, and we don't have to rush headlong, that we can be careful and judicious. And, you know, you can talk to somebody a little bit, or you can write a little bit, you know, that we don't have to be afraid of it, you know. It's not some mystery that makes us deer in the headlights and then we can't function. It's just, we can approach it like anything else, you know, judiciously, carefully, reflectively. That's how we make ourselves healthier. Yeah. It's a very hopeful message. And you know, not for nothing. I just wouldn't be sitting here had I not embraced everything that you just said. Like, I remember all too well, and in quite vivid technicolor, what it's like to live in the prison of shame and guilt, and the fear of confronting that uncomfortable truth and secret that lived with inside myself, until I was in so much pain that I really was deprived of any other choices and was kind of compelled to confront it, and kind of begrudgingly, you know, entered a world that made me feel safe and encouraged me to slowly, like you said, drip by drip, start to, you know, let go of my attachment to that fear and share a little bit at a time, a little bit at a time. And, you know, over a very long, extended period of time, that has resulted in not only healing beyond anything I could have imagined, but also in helping create a foundation for wholeness, so that I could be in happy, successful relationships, and professionally be somebody who could be relied upon and who could build something of meaning. And I credit my entire life to, you know, the courage of facing things that I really didn't wanna face. So for anybody out there who feels stuck, who feels alone, who feels hopeless, I'm here to tell you, and Paul is here to tell you, that there is help and there is hope, and it begins with raising your hand, asking for help. And it doesn't have to be a dramatic gesture. It can be a quiet, private gesture. But to anyone listening, I encourage you to take that first step, because that first step could lead you on a fantastic adventure beyond anything that you could imagine. And I can't imagine a more heartening and encouraging truth than what you just said. Thank you. As I said at the outset, I really think that the work you're doing is incredibly profound. Thank you.
And I can't overstate how important it is. And I really think that this invisible epidemic is at the root of so much of what ails us, not just as individuals, but as a society and as a global community. And I think that it's so important to get this message out, Thank you.
and I'm at your service, if there's anything I can do to help further your work. Thank you.
I'm here for you and for everybody else listening. Thank you for listening. Please pick up Paul's book, "Trauma: The Invisible Epidemic." It's a must read to kind of extend the conversation that we've had today. And that's it, that's my big speech. (laughs) Thank you, thanks for having me on. I so appreciate it. Thank you.
I appreciate you as well. Is there anywhere else you wanna direct people who wanna learn more about your work and your world? There's a website, it's just dr, and then my name, Paul Conti, and it has links to some of the podcasts and has links to purchase the book, if someone chooses. That's it, I think that we're trying to help open the door, right? And I think listening to podcasts like this or reading the book is, it just helps open the door. And once a person opens the door, the possibilities are endless. Yeah, absolutely. Well, hopefully we can extend this conversation. I'd love to have you back.
Yes. Thank you.
I think there's, you know, 50 other things in my outline that we didn't even get to today. So I feel like we just scratched the surface of what we could potentially talk about. Thank you.
All right. So to be continued. Yes. Peace. Plants. (mellow music)
