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The Tim Ferriss Show
#533: Paul Conti, MD How Trauma Works and How to Heal From It
#533: Paul Conti, MD  How Trauma Works and How to Heal From It

#533: Paul Conti, MD How Trauma Works and How to Heal From It

The Tim Ferriss ShowGo to Podcast Page

Paul Conti, Tim Ferriss
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Sep 22, 2021
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5:37
Hello boys and girls, ladies and germs, this is Tim Ferriss and welcome to another episode of the Tim Ferriss show. I am thrilled to have my guest with me today. Paul, Conte MD, Paul, is a graduate of Stanford University, School of Medicine. He completed his Psychiatry training at Stanford and at Harvard, where he was appointed chief resident, and then served on the Medical Faculty before moving to Portland and founding a clinic. Dr. Conte specializes in complex assessment and problem-solving as well as both health and performance.
6:07
Asian serving patients and clients throughout the United States and internationally including the executive leadership of large corporations. His new book is trauma. The invisible epidemic subtitle how trauma works and how we can heal from it. You can find him online at dr. Paul, Conte, cont. I.com, and also at Pacific Premier group.com Paul, so, nice to see you. My friend. Thanks so much for having me. It's great to see you too. I appreciate it. And I have
6:37
I've been looking forward to this conversation in my mind's eye for some time because we've known each other for a while. We met through our mutual friend Peter a TIA and I saw a very early manuscript of trauma the invisible epidemic. We were doing the math beforehand. Before we press record around two and a half or so years ago, and I was so thrilled.
7:07
That you were putting your experiences and your approaches into book form. The fact of the matter is most of the time when I have every friend acquaintances and their cousin, and Grandma telling me they're going to write a book or asking if they should write a book. I spend most of my time dissuading people from writing books a because, I think they'll be just redundant, or not, a great value, add and then, on top of that, I really just don't want to be forced to read them. And
7:37
And my feeling with you is is very much the opposite. You are such a deliberate thoughtful and skilled practitioner. And I also, of course value you as a friend, but I've had a chance and I'm not going to disclose details necessarily, but I've seen you really intervene and quite likely save lives and I can't say that for many people. So it's a real
8:07
Honor to have you on. I've been looking forward to doing this for a very long time. I have the highest opinion of you just to establish that upfront and with all of that. Let's jump in and I would love to hear also because my memory needs refreshing. But for people listening how you ended up in Psychiatry. Thank you, and I want to thank you for your support. When I was really figuring all this out and deciding, I really want to
8:37
Write a book and it's such a leap to take that your support and encouragement about how that would be a worthwhile Endeavor and could could really make a difference with so helpful to me two and a half years ago and before then too. So I'm so appreciative of that and it's sort of part of my circuitous route, you know that I had no pre-medical classes in college and I had a business career and and you know, at some point in time, I realized that what was unified my interests across time was really about
9:07
People. So your I studied history and political science and art and and I was very interested. But ultimately it was really in the people in. This was also feeling my interest in business, was the people I was engaging with what were they like, and how do they have these thoughts? That got them to where they're at and it was that sort of unifying elements that led me to go back to medical school and to go count good to learn about human biology and just learn something about human beings. And it was there that I realized, like, oh, you can take this medical knowledge.
9:37
Knowledge. And you can take the sort of Life knowledge whether its history or politics or sociology just knowledge about human beings and you can put that together with an individual person who's sitting in front of you and talking about them like the specifics of their life and their experience and you can put all that together and really be helpful to people like really make a concrete difference that you can see there's a change and and that was ultimately so appealing to me and I felt like
10:07
Could get that through Psychiatry and I think I found that to be the case. I'm so grateful for the vagaries and the idiosyncrasies, that ultimately led me to be able to see all of this and choose it as a career, many follow-up questions, but we're going to kind of Flash Forward to current day and then we're going to flash backwards. So I want to read a little snippet from the forward in your book. I think you'll recognize this, and then I'm going to ask you to
10:37
Add context. Okay. Why didn't you bring me a real doctor? I asked the nurse Paul replied by saying I'm an Italian from New Jersey. And that's when I decided I was willing to talk to him. My dad is an Italian from New Jersey. So I figured I, at least knew what I was dealing with whose words are these. Those were the words of Stefani germanotta? Who's also Lady Gaga on our first meeting? I think what I would describe as I think our our auspicious first meeting
11:07
So she wrote the forward to trauma the invisible epidemic, of course, you didn't start off with clientele or clients patients, like her. Could you tell us a bit about since we've mentioned the title? A number of times your own personal history with trauma? If you'd be open to sharing in the first part of my life, is it up until around early 20s?
11:37
Yes, I didn't have major trauma in my life. And in some ways I was fortunate to get through the big developmental Milestones without major trauma and it gave me a sort of view of life. That was, then deeply challenged by a sequence of traumas that sort of came in the second part of my life and seeing how they made me feel differently about things because I had the sort of foundation of confidence in myself and also in the predictability of
12:07
World that if I'm engaging and doing the right things are good. Things are going to come back to me and how differently. I fell one after my brother's suicide, which was the first of a series of quite traumatic. Things that unfolded over a number of years, the challenge of that of realizing that I'm trying to figure out my way through this, and like, how to go on with life and how to support my parents and the people around me while I have an awareness that like, I am.
12:37
Different that now I'm seeing the world differently and all of a sudden. I remember I feel a little bit like a, my cursed is my family. Cursed is is anything going to be? Okay? Maybe he's bad, things always happen. I was so off balance, and in a way, kind of impacted impaired, even by all of this, and realizing that we can, I even trust how I'm thinking, because I'm thinking differently, and then I'm trying to use the brain that's thinking differently to figure out what's different and there was something quite scary about.
13:07
That the Jedi could also then I could see when I became a psychiatrist play out in the people. I was trying to guide or advisor, take care of. They also often had thought differently about themselves. They stop seeing that they could make their way in the world that they had good things to offer where that they could even stay safe. And, and that for me, like really caught my attention, that, hey, there's something going on here. That is, that's very deep and also very Insidious.
13:36
Thank you for sharing and I just want to Echo some of what you're saying in my own personal experience with depressive episodes, which I've had as a Mainstay of sorts for most of my life and it can be very terrifying. And certainly disorienting say in the middle of a depressive episode to be aware that you are looking at the world through a distorted.
14:06
Lens, but to have no confidence that you can correct that lends, it can get very terrifying because you feel like you're the prism through which you are looking at reality is broken and you're aware. There's a problem, but you can't look through that broken prism, to fix the broken prism or or so, you might believe and it can be extremely disorienting and sometimes destabilizing for sure. And I wanted to ask
14:36
If you might be willing to speak to some of the other traumatic events and to place Us in time, starting with perhaps your brother. How old were you when your brother committed suicide? So, I was 25 at the time, 25 years old. And are you willing? If you are willing to share, would you be open to mentioning some of the other things that happen to you? And the reason I'm asking about this is not to inflict pain.
15:06
In revisiting these things, but rather to share your personal experiences because there are very likely going to be people listening who will identify with different parts of your story. I understand and I think it is helpful. The context is helpful. And I think it does, it speaks to the impact of repeated traumas that not long, after my brother's death, one of my best friend's a person, I grew up with died died, very unexpectedly, you know, we were in our
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Mid-20s several years down the road. My wife was injured and injured. Quite seriously. I lost another very close friend in under very tragic circumstances. A couple years. After that, there were other traumas that were interspersed, that weren't at that level. So there was this sense of like continued negative things happening. My mother became ill with pancreatic cancer and died. Not that long after Her diagnosis. And that was
16:06
Very painful for very many reasons, including the feeling that my brother's suicide in the impact upon the family had may be predisposed her to getting sick which you know, there may be some truth to that there may not, we can't know the answer but that oppressive feeling of like there's one bad thing after another and I can't control any of it and amidst it. If I'm not really grasping to get to keeping a hold on, my sense of self that I could potentially
16:36
Sensually lose that too or a sense of my place in the world via idea. You described of say, what amounts to learned helplessness says, I eat. Absolutely. I see these bad things. I see what they're doing to better. Don't think I can change any of it that I could. There was a real danger of that throughout that whole period of time. And if we focus on this term, we've used now a number of times trauma. How do you suggest people think about or Define?
17:06
This term now probably do this quite a bit in our conversation, just to ensure that everyone understands the way in which we're using certain terms. But how would you suggest people think about trauma? And if there are subsets or different types of trauma, perhaps what those are? I would describe, trauma is anything that causes us emotional or physical pain, that surpasses, our coping mechanisms, that makes us feel then. Overwhelmed, often overwhelms, our
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Our nervous system, both body and mind. And then really leaves a mark on us, as we move forward, and Trauma can be acute, right? A single traumatic event. In a sold, the car accident in injury and combat. Trauma can be acute. It can also be chronic. So, the, The Chronic impact of say, ongoing abuse or ongoing neglect or even ongoing marginalization, and we see so much of this has come to the Forefront. Whether
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That's gender identity or its racial, how many people are trying to exist in doing their best to not just to thrive, but doing their best to survive, amidst circumstances that are constantly telling them that they're less than, or that they're at special risk. That's chronic trauma. And vicarious. Trauma comes from really, this wonderful fact that we can be empathic and empathically attuned to other people. And we can feel what they're feeling.
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I mean that's a wonderful thing that we can do that for one another but it also makes us so susceptible to other people's suffering and pain and we can lose the boundaries of what is us. And what is them? I mean, I'm not the only physician to say that at times especially in the intensity of the training period would have to really stop and say, okay, wait a second that is happening. What is happening now? Is happening to someone else, not to me because if I don't maintain that boundary I'm too overwhelmed to help them. But if one
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Empathically attuned, which many, many people are. Then we don't bound ourselves from other people's suffering. So there's acute, trauma. Chronic trauma and vicarious, trauma. And of course, an overlap, there can be an overlap between them two. I'd like to, you know, since we're also you and I catching up ourselves as friends, not just doing an interview Red Lotus. She has, it's really, really great to see you and I'd like to share an experience maybe in the last
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Category. I don't want to give it a capital T. But I've had a new experience and I've never passed through this type of shift in myself. I don't think an acquaintance. I don't say friend, but someone I know I had a horrible family tragedy not long ago. His teenage daughter was killed in a head-on collision with a large truck like a Mack truck. And for reasons that I don't think we're necessarily.
20:05
And her car just swerved ever. So slightly into the oncoming Lane and dead on impact. And since that news, I get exposed to tragedies every day. I mean, if you look at the news, you buy the newspaper, man, their tragedy is everywhere. So I don't know why this had such a disproportionate, a disproportionate, but such a large impact, when I'm exposed to tragedy of other types all day long, but I have had
20:35
had extreme anxiety.
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While driving, almost every day, since that happened, right? I can understand that. Yeah, and I don't want to take necessarily an anxiety lytic just to mute the anxiety, or to suppress the symptom. But in a case like this, just because perhaps it's maybe easier to tackle than something like the childhood abuse that I experienced when I was really young.
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How might someone approached this with her without professional help. And maybe this isn't the Forum in which to discuss it, but I'd love to hear any thoughts. You might have because I've never experienced anything like this before, Tim. I think it's a great forum for it because it speaks to a common problem and a general principle in approaching the problem. We have to divert our attention from our instability and the unpredictability.
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Woody of the world around us like a nun, some level like we know that the kind of Anything could happen and we're not safe from moment to moment from tragedy, but we have to sort of set that aside where it's kind of in the periphery of our mind. And that's what lets us be able to go on and like live our lives and things will happen. Sometimes that really resonate with a person. Now here it may be that something makes you really identify.
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If I with this person, even though they're in acquaintances and say, not one of your closest friends, or it just may be that something about the story or even something about your own condition. Right? The fertile ground inside your mind. When you hear the story, that makes it resonates with you. And then in this, like that's a very classic aspect of vicarious trauma, then it resonates and you feel as if like that's happened, you get some shadowing of, like, what that must feel like for that person.
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And then it shakes your sense of stability and predictability and its ability to control the world around you and be safe and that starts making you feel insecure vulnerable. Like it's a natural response. And the thing to do about it is to validate it. That's why the primary point. I would say in response is to validate it because what people most often do is the opposite. It's unpleasant. It feels so bad that the person wants it. So there's something wrong with me. Why am I feeling this way?
23:05
Sway about this like it didn't happen to me. This is one of my someone in my close family like is and we try and to somehow invalidate what you're experiencing instead of saying no, it's understandable. This is reminding. You of something that you do actually know is true but is bringing it to the Forefront of your Consciousness, the vulnerability, the unpredictability difficulty, controlling the world. And if we validate that and realize okay, I'm not learning anything new from this, but I'm feeling something very strongly and I want to honor that I'm feeling
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That and then to be able to put words to it with the someone that you know and trust and to be able to say that helps to pay down some of the anxiety and distress. It often gets worse. If the person is trying to shove it down and invalidate his what's wrong with me? That I'm feeling this way. They just grows that tension inside. Yeah, right? That makes perfect sense to me. I mean you have sort of a catalyzing event and then you have
24:02
So let's just call that one. I hesitate to use this term like one problem. And then if you have a very self-defeating but self critical, judgmental response to it. Now you have another, like I've quite another problem. As I'm thinking about this. I haven't really spoken to anyone about this but
24:23
I recall at the time because you have me wondering like why did I respond to this in this way? And I think that the circumstances temporarily right? The circumstances at the time had a lot to do with it. I think a number of very difficult unexpected things that happened in my life. I then also got the news in a somewhat. I don't want to say frantic but very urgent text from a mutual friend.
24:52
And of this acquaintance and when I called there's some type of help that I was potentially being asked to provide and I couldn't provide it and so see I found it very jarring in that respect. So I wanted to share that as an opportunity for discussion. If I could say back to him that makes him a think about the sense of vulnerability and in the sense of I can't even do anything to help. There's such a sense of vulnerability that then gets reinforced by that and often people.
25:22
You want to help even when like, there is nothing someone can do to help, and then the person feels bad. They can't make anything better make. The person feel better. And that adds to, that sense of Terror, really? If we should validate within ourselves. I'm doing what I can do. Like, I can be here for this person that I can listen. I can let them cry or be upset around me like, that is what there is to do, then that can take away from this sense of desperation, and vulnerability. And I want to help, but I can't because
25:52
Is that critical voice that you referenced is very, very common in people who are conscientious, which is, you know, most people are conscientious people capable of feeling someone else's pain. So that critical voice comes to the fore so readily, it's reflexive right? Which is where the shame comes from and there's a whole Cascade of as you said, secondary problems to the initial negative thing or the initial problem. Thank you for listening and for talking through it. How would you describe?
26:22
The current state of treating successfully or unsuccessfully or anywhere in between trauma. What is the current standard of care? And what do you make of some of the tools in the tool kit? The short answer to the question is by and large abysmal and I think that's not because you're the people into helping rolls don't want to do their jobs or are capable of doing their jobs, but we've evolved a system.
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That pervez Mental Health Care largely without attention to the actual human being and this is a huge problem. If you think about the shortening of visits, I mean, how much can you really talk about who you are, or what's going on in you? In the kind of brief often rushed and infrequent appointments that we have in our health system, and an over-reliance on medicines, which leads to a
27:22
Dime, that just wants to basically take a symptom inventory, rice. It will tell me an inventory of your, of your symptoms. And I used to say this, sometimes when I was teaching where I would give an inventory of symptoms of a person who had a rock in your shoe and then often at the other end of that would be like, what do you think is going on? And and people have to take attention deficit disorder because you know, the person is not paying attention to things or distractible. But if we just take symptoms, like we will get it wrong. Do you?
27:52
Yeah, it will get it wrong, a lot and getting it wrong. Is it benign? It's just it's not that. Oh no. Help is given because we got it wrong. No, it's actually that harm is done and the symptom inventory, you know, make a diagnosis or several diagnosis and then throw by and large medicines that the diagnosis just doesn't work. And what we end up doing is like so much in the American Healthcare System. We spend so much but we are at the bottom in terms of it at industrialized.
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He's of outcomes. And that's because we waste so many Resources by not looking in depth at the actual problems. And I think we do a very poor job at identifying and processing. Trauma, for all of those reasons. Are there any places? This could be a country, a city? It could be specific clinics. That stand out to you as being on the opposite, end of the spectrum.
28:52
Room either highly effective or at the very least, more effective with addressing trauma. I have some information and data about what's going on in some of the European countries, but not enough to comment really, with any Authority. I think that most of what goes on in America ends up being a very low bar in a very formulaic, prevalence of care. There are exceptions. So for example, the bridge to recovery, which is a place in Peter, has talked about and
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I think is a place that really sets an example of how to be different. And of course, it's a residential facility. And not everyone needs to or can go to a residential facility, but that route of approach of really understanding the people and understanding developmental trauma, even if the reason the person is coming to care, isn't specifically the developmental trauma, but realizing that people are, we're all a whole. We're a whole person with our feelings memories that evolved in us over.
29:52
Time. And so they do a wonderful job of looking at the whole person. There's a certainly not the only entity that does that including individual practitioners, but by and large, it is hard to find systems that will treat. Trauma, from a holistic perspective. How do you find the proverbial or metaphorical Rock in the shoe? And by that? I know you were giving an illustration of a of an exercise. When teaching
30:22
But beyond.
30:25
Symptom inventory.
30:28
How do you begin to Unearthed?
30:31
The causes at play with someone what I find. So interesting about this is it's actually not that hard. If you can build a rapport with someone where they feel like, okay, you're not looking to fault me and you're not looking to stigmatize me. You're actually interested in me interested in what's going on in me, so I wouldn't say to everyone. I'm an Italian from, New Jersey.
31:01
At the side of, that's not your opening Salvo. It's not my consistent opening Salvo,
31:06
right? That when someone is, you could tell this in pain and you're thinking, look at is there. Is there a route in which we can connect and Stephanie is an Italian from New York where there's a similarity that can then establish a rapport that can lend lead the person with whom. I'm trying to establish the Rapport to really feel like I can talk to you. I can talk period, right? I can talk openly.
31:31
And it often leads to right where we need to go, because people often are aware of what's going on inside, is and what triggers them what's going on in that, the tape that's playing in their head all the time. How do they feel badly about themselves? What's their internal dialogue about themselves? And when you let people start talking very often, they'll talk about it. Even if they never have before, they might have had treatment for depression in 15 different settings. Never talked about trauma. I mean, by the way, I see this a lot. That's not just
32:01
Radical example because no one's asked about it and been and been open to it and that reinforces the idea of Shame and stigma. No one's asking about this even though we're Sten ssibly, here to talk about my mental health, that reinforces the messaging of stigma and shame. But if you give people an open venue to talk, it's remarkable how it can come to the fore, be processed, or validated or challenge, however, may be, it's just an openness to it, which involves a milieu that allows for that to happen, which is
32:31
Is something other than very, very rushed like, okay, we have 15 minutes. Let me, let me hear a symptom inventory. So, I can write a prescription and then the next person can come in. That's never conducive to openness and sharing, but if we make environments that are open to that really good things happen. I would love to ask a question that that might pop to mind for listeners as well. And
32:53
Is just a backdrop, you know, I've thought a lot about trauma. I'm not wouldn't consider myself a domain and expert, but had experiences of sexual abuse, when I was very small and consistent, regular abuse for several years from two to four at a babysitter's house. And so I thought and read quite a bit related to trauma, but I think it's important to note and please correct me if I'm not getting this, right, but that
33:22
You are not a hammer looking for nails with trauma. In the sense that you cover a very broad spectrum of different conditions issues wants questions with patients and it seems to me that there's probably a potentially damaging just like the symptom inventory is not neutral necessarily, it can result in very bad outcomes. I've done some
33:52
Reading on controversy related to say, suppressed memories, right? So I'm sure there are therapists who actually do a lot of damage by trying to fit a narrative of trauma to every patient that they have in some way. I'd love to just hear you comment on The Good, the Bad and the Ugly within the discipline. Let's just say or skill set of treating trauma. The first thing I would say is I never made a conscious decision.
34:22
Ian to say, hey, I'm going to be a trauma person. All right, right. I mean what I saw was oh this is running through like everything that I'm doing and at the time I really first started seeing it, I added open general practice and I was seeing what are the commonalities across people that I'm seeing socio-economic demographic background diagnosis. What are the commonalities? And of course I saw how often substances were playing into what was
34:52
Going on and I saw even more strongly than that. How often trauma was playing into what was going on. Whether that was depression, or anxiety, or insomnia, or even the evolution of psychosis or the triggering of bipolar episodes. I mean, there was just so so, so much that was keyed to trauma. And that's what really captivated my attention. And then grew my interest in my research and clinical approaches to it. I think it's there and it's
35:22
It's quite pervasive, but it of course, isn't the answer to everything. And yes, if you have the hammer and you want to see all Nails, then that's what we see. And I think we have to be very very careful because we often as human beings, we develop sort of allegorical ways of understanding things and we can do that consciously and also unconsciously. So the idea of recovered memories from the perspective of, oh, that person had no idea that that thing had happened. And now they,
35:52
Is it is happened, is something we just must be skeptical about in a way. That's careful. I don't mean skeptical in a way of trying to invalidate a person but being careful because if a story that's not actually true becomes that person's Touchstone for truth, that is not good for that person and it can be. It can be very damaging for others who then may be falsely, accused of something. For example, right, most of the time and I've been doing this for 20 years and I would say the vast
36:22
Majority of times when someone is now talking about a memory that they haven't talked about before. It is not because they had the not have that memory before it's because it was writing in the sort of boundary being above and below Consciousness, Ray and they they know that that's there but they don't let it into Consciousness or let alone put words to it. And then there's a way in which the memory or the experience. The person is talked about fits with their internal world before it came to the fore.
36:52
Opposed to it. In a sense, kind of coming out of the blue which we just need to be more careful about for the sake, of that person who may have had that come out of the blue because maybe that's true, but maybe that's not and if it's not it's not helpful to them and it's a potentially risky to others if that makes sense. And and the more that we work against stigma, like I, you know, I'm saying this because I believe with all my heart that it's true, that your willingness to talk about your own. Trauma is so powerful.
37:22
It's so powerfully helpful because you're pushing against reflexive stigma because trauma makes reflexive shame and reflexive stigma. And that's what makes people go underground. So to speak with their trauma and that's where confusion comes in misery. Gets compounded, confusion comes in because people are alone with something that's terrifying. Them and there are loan over time and their own brains can evolve in ways that maybe, sometimes you're helpful, but maybe sometimes are not helpful. So, the more that we
37:52
Against stigma and shame and say, look, what is there? That's happened to a person that that person should not be able to talk about with trusted others, rather with the whether that's trusted friends and family or clergy or helping people in helping fields that a person should be able to talk about what's going on inside of them because it's burying those unhealthy seeds. So to speak, that then compounds original trauma into something that can end up being far far worse.
38:22
The whole Cascade of problems could be depression. Could be substances could be self harm, could be an eating disorder. There's so much that gets compounded. When the original trauma gets pushed outside of Consciousness and outside of communication. It brings to mind for me, something. And I'm paraphrasing here that someone named Gabor maté shared on the podcast quite a few years ago. And again, I'm not getting this word for word, but he spent a lot of time working with
38:52
Opiate addicts. Yes, British Columbia and elsewhere and he is fond of saying we shouldn't ask why? The addiction we should ask. Why the pain? Yes, and certainly in my exposure to addiction. My best friend from childhood died of a fentanyl overdose and my brother's best friend from childhood died, in a drunk driving accident, lot of substance abuse where I grew up.
39:22
Up on Eastern Long Island, and my uncle actually recently died of. I'm not laughing, cause it's funny, but alcohol-induced cardiomyopathy, his wife, my aunt died of Percocet, plus, alcohol. So I've seen a lot of addiction and what Gabor says really resonates with me.
39:47
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41:29
I would love to if you're open to exploring some of the tools in the toolkit and I'm not implying that you utilize all these modalities in your practice. But for those people out there who are wondering and we're going to talk about the framework of the book and how you put it together and what people who don't have access to Paul, Conte might expect to learn and be able to apply from the book. But before we get there in the last handful of years,
41:59
As you know, I've been hoovering up a lot as a as an enthusiastic amateur and have found certain things personally very helpful, like ifs internal family systems. I found very helpful and helped fund some studies with different formats of therapy, like CBT or DBT dialectical behavioral therapy. Yes. I'm hoping, I think I've already
42:29
Eddie funded or my Foundation has funded a study involving these acronyms get really tricky after a while, could joint or conjoint something that is conjoint and similar to CP T. But okay, I did maybe. But the idea being that you are using. In this case, therapy mdma-assisted therapy, for not just the individual who experienced trauma, and I think it has case it's veterans, but also the
42:59
Is
43:00
so there are all these different approaches. People may have heard of EMDR, which I don't have much experience with. But all of these various tools in the toolkit are there particular. And this may not be a good question, but I'm curious. So I'll ask are there particular modalities Frameworks tools that you have found to be particularly helpful in working with individuals who have trauma.
43:29
Maya and their background, there are many arrows in the quiver. And CBT is an arrow. In the quiver. DBT is an arrow in the quiver, medicines can be an arrow in the quiver. But where it all has to start is a search for truth, right? Because trauma changes. Our emotions about things are feelings and emotions about things. If then changes what how we think and what our memories mean, so we need to look at
43:59
Is the
43:59
person's narrative about trauma if they're identifying that there's trauma and if not, what is the narrative about self? Because unless we understand that then it's like trying to solve a problem that you're trying to solve a math problem. But you don't know what the equation is. We're not going to pick the right tool. We're not going to get to the right place. So because there's so much reflexive shame and then a Cascade that comes after that and a lot of times that involves like a
44:29
It's enroll performance where now the person doesn't they're not performing their roles. They as a parent or as an employee or as a friend as well. Then the person begins to think of themselves in a different way. And the first thing to get at is what is the person's narrative. So someone who may present and say, I've really got physically hurt in my last relationship. I mean, this is always what happens or it never goes any differently, right? Let's look at the trauma from this thing. That happened to you in your last.
44:59
Relationship, you have to look at. Why is the person approaching the whole question of relationships from a place that says, things won't be. Okay, for me. What are the lessons that that person is learned that are not actually true and you have to go back to why? When did the person start thinking of that? I mean, people don't. I'm saying it for effect, but people don't pop out of the womb, thinking. No one's going to treat me. Well, I don't deserve to be treated. Well by always get hurt in relationships. Where a long did that conception.
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Come into play and how much does that person? Also maybe feel they don't deserve anything better. Where did that come from? And if we go back and we look at the formation of a narrative that then furthers and perpetuates Trauma, then we can get at changing it. But then you have to get at what are the the pain that the person felt, you know, the emotions involved? We have to go to a place that's emotional. But if you go to that place the actual events, the emotions the change in conception of self or conception of the world.
45:59
Then you can come through and say, okay what tools does it make sense for us to apply because there are the arrows in the quiver that you noted and a lot more. The question is knowing. Hey, when does one makes sense versus another and I try and write a lot about strategies antidotes in the book, you know in a sense of their good ideas by, I think they're good ideas, but they're good ideas only if they're applied in the right situation to the right person. So it goes back again to understanding the person what happened to them and how
46:29
Now, what is their Narrative of themselves and what the world can, or can't be for them? Let's get personal and I'll be the one to get personal just as a way of exploring this, as you're open to it. Sure, it's hard. Maybe it's impossible to say I feel X because of why, right? I mean if you were scientific study would be very hard to get to conclusive result. Nonetheless. There are certain events in my life and I do
46:59
This
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experiences and so on that, I think have formed my worldview or informed my worldview. I don't want to put it all on that. There's probably, there must be more to the story. But I'd love to talk about hyper-vigilance for a second. Sure. If this is from your book when people suffer from trauma, however, there are threats sensor becomes hyperactive and hyper-vigilant, convincing them that things are dangerous and wrong. Right now constantly like a threat sensor recognizes.
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Has that it was unable to prevent the initial trauma. And now it's trying to make up for it by being active and Loud all the time. This is how I feel a lot of the time and I've I've approached it from different angles. I've used, heart rate, variability training to kind of start from bottom up. In other words, not starting with the language in the concepts in the stories, but starting to physiology. I found that quite helpful with dr. Leah Lagos. I feel like I've made progress here, but nonetheless.
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I do feel like my threat sensors are turned to high volume most of the time. And so I have these fundamental stories. And since I suppose our stories become filtering mechanisms, for what we notice. And remember, yes, I can point to Long laundry lists of evidence that support what I'm about to say, not saying they're true across the board by any stretch, but okay, the world is
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Fundamentally unsafe, it's unpredictable, people should earn trust but start at a baseline of being distrusted or viewed with some suspicion and these positions that have established for myself. I recognized cause a lot of anxiety anger stress. That is unhelpful in my life. Yes. I rest.
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I'm fully aware of this and I beat myself up with respect to my apparent, inability, to reformat my hard drive. Uh-huh. Uh-huh. Do you have any antidotes for hyper-vigilance? Do you have a way of thinking about it, or approaching it that we could discuss?
49:21
I come back to the first step being to assess and validate, like think about the things that you said, there's fundamental truth to some degree. Mean the world is not an entirely safe place. We can't control everything. So it's sort of like too much of a good thing and that's what hyper-vigilance is because we're not saying we should have, no vigilance mean their threat sensors in all of us, that that are supposed to be kind of firing in the background. You're loud noise. You pay attention supposed to
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In the background. But recognizing that probably what has pushed say. That Vigilant sensor in you up to a much sort of higher place on the scale is the impact of trauma which takes reasonable Concepts and then builds the whole story around the extrapolation of the concept is some end that is unhealthy and maladaptive. So take your driving example, you're prompted. I think from predisposed say from prior trauma.
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Do you have something that kind of hits home, really increase the level of tension and vulnerability inside? So one way of looking at, that is to validate and say, look, I do actually know that it's not completely safe to drive. So I try and they say they have a safe car and drive carefully, right? Like, I know, all of that, but because I hear an example of something really tragic that occurred while driving, then that Vigilant sensor wants to build the whole story around that and wants to say that's going
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to
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Happened to you, the chances of that are happening are so high and now it starts capturing your attention and it starts reinforcing itself. And then if you're thinking on top of that guy what's wrong with me that I keep thinking that that calls attention to a to and further reinforces it? But by validating that hey, I'm an empathic person that heard about a terrible tragedy and the circumstances of that tragedy. We're going to resonate within me and make the hyper vigilance in me attached to that. I know.
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This, I understand this I can step back to say, reality, testing of saying, I do actually know that. If there's some danger to driving, I do actually take precautions, me learning about this tragedy isn't actually making me less safe and maybe it has me reflect as my car is safe. As I want it to be, is there actually something I can take away from it and if I can't, let me feel a sense of grief for this person's loss and feel a sense of sadness, but make a conscious boundary that that is actually not.
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About me or my risk in the world that I didn't learn anything new, and I certainly don't want to then be beating up on myself because I'm what kind of hyper Vigilant from prior trauma and empathically attuned. And that's a place where another example could be were medicines, could be helpful. And again, I'm not saying this because, I don't know, enough of the specifics, but sometimes a little bit of medicine for a short period of time, can help push back, the extra attention and the extra vigilance to the point where things can then go back towards normal. So, there's so many
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Any Psychotherapy and medication tactics that can be used but it starts with what is the truth of this? What is it? Actually telling a person? What does it mean to them? What's the narrative about it? And how do we ground ourselves to the truth of it? As opposed to shame and self-recrimination even feeling bad that you feel bad? Just for clarity. The medicines in this case, say prescription medications could be used to reintroduce my psychology.
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and Physiology to a state of non hyper-vigilance, so I can sort of recalibrate and recognize it as a possible State and that is done without the intention of
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Chronic Administration or never-ending Administration? It is given for a short period of time. Maybe it's short. I don't know. I guess that's relative. Right? But right, pure that, that often is effective and you can go. So to say, top down from brain to body, but you can also go. As you were saying, couple minutes ago. You can go bottom up from body to brain because tension in the brain makes all sorts of problems in the body. And one very strong example of that is the impact of muscle tension. So there
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Be muscle tension, for example, between the ribs. And now the person feels a little bit short of breath or there's muscle tension in the GI system and other person is having IBS symptoms, or muscle tension in the legs, and now there's restless legs symptoms. And if where we can go the other way of looking at the body and ways of trying to relax the body and decrease the tension in the body because that decreases the signaling that goes back to the brain. What we don't want is a cycle where brain is tense, sends those signals to body body gets more tense. Sends those signals to brain, that gets more.
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And you can see we can be in a vicious cycle there. So, you know, we have a Mind Body Connection, whether we choose to pay attention to it or not. It's still there. And often if we're not paying attention to it. It's not that that's neutral either, but that that can be quite negative. So, looking at the whole person. Where do you hold your attention? How do you experience your attention? How much in the way of words? Do you need to put to this? How much in the way to physical interventions? Should you be doing? Should there be any medicines? But again, we're looking at the person like that.
54:39
Becomes very specific to you as it should be, I would love to ask a question that is specific to you. In this might be a bit of a left turn but I think it would be, I'm personally very curious. If we could go back to your brother's suicide and I know it's probably not the easiest thing to talk about but that is a it sounds like it's hard for me to conceive of a larger.
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Event, at least in the vicarious trauma category. What are the things that help to the most, in terms of coming to terms with that or healing from that to the extent that you have?
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I'll start by saying.
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You know, I had no mental health education or experience at the time. So my initial response is like weren't very healthy. I felt like I was my fault, I should have known. I should have been a better brother. I was probably fairly depressed myself and drinking too much. And I mean, all sorts of other things that that I was still like going along with life, but feeling very depressed and feeling oppressed, not just externally, but
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So this idea that trauma changes how we think about ourselves. And then we're trying to recognize as, like, trying looking at the mirror and saying is that me, but you don't really remember what you looked like yesterday, right? Yeah, so, that was very scary, and a lot of the ways in which I handled, it were not helpful or healthy. So ultimately, when I think how did I get through that? It was interconnections with other people were absolutely indispensable that
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There were people around me who cared about me, who were then reflecting back to me. The like know, you're a good person and a terrible tragedy has happened to you, which is a very helpful because they they could see me because they knew me and they knew before the tragedy. It was me who couldn't see me and they were basically communicating this something awful has happened, but you're the same person you were before and that's a capable person and a caring person and that was immensely helpful to me and and some of that
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Was through friends and family. And also, I went and got some Psychotherapy, which people weren't really doing, like, where I grew up, people didn't go to therapy. Where did you grow up outside of Trenton, New Jersey? And it is wasn't in the culture. So for me, going and getting therapy, even was like, something. Do I feel embarrassed about that? Is it healthy people ever do that? Is that just for crazy people like that? You know, that was, that was how it was thought of. So I had to do something that I think did have some bravery to it of saying like K, let me
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I'll be honest with myself. I'm not doing okay. And I'm getting help from people in there, are people who care about me, but there's professional help to and I just found a therapist and she was very very helpful to me in that basic grounding way. So the impact of others was so helpful because otherwise, I think I probably is a good chance. I would have never seen myself the same way again in a way that could have just been worse and worse and worse and that's
57:58
Ultimately what led me to is this kind of come to a full stop and look at how it was handling my life. And look, there's Silver Linings. I do believe if we work hard enough towards them. There can be Silver Linings to anything, no matter how bad it is and a silver lining was, I looked at myself and I, you know, I'd wanted to go to medical school, but I thought I'm too old why? Because I was 25. Like, that's not too old, but I thought it was, or I couldn't leave my job because I was making a good income. And, and if I went to medical school, I'm not going.
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To I'm going to pay and you know, all these things were in my head and people were saying to me, you're too old. You can't walk away from your job and it's going to cost through so many things that I realize that don't matter. I have my life and I'm healthy enough that I can go do what I want to do. Now, go do those things and it was actually quite helpful to me in decided. I'm going to leave my job. And even though I haven't taken a single pre-med course, I'm going to go apply and you know, it led me to feel embolden, but I had to get to a
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Place where I could see myself as a worthwhile and capable person. That's how I saw myself before his suicide, but there was a whole period of time when I didn't see myself that way. And it was really other people, both personally and professionally that the were sort of for me a bridge to a place. I was not going to be able to get on my own and I think that's the case for many of us and when people don't have access to people who care about them people who can help them. Unfortunately, there's a lot of secondary tragedies.
59:28
That come of that because we're interconnected is human beings and we are not kind enough and helpful enough. They are, you know, I write about the compassion community and humanity. And these basic principles did I think we should be following? Because I don't think the rocket science. I think there's simple yet. We don't follow them and they were not there for each other in ways that I think we want to think that we are but we often we're not living that in the world around us. Thank you for sharing and
59:58
Look if turned into one hell of a bridge yourself cell. Thank you. Thank you. That means a lot to me to hear. Yeah, that's it's true. It's true. I would love to hear you because I haven't seen the latest and greatest. I saw V1. I saw a version of one of my manuscript. He's he's all my I read it with great interest and, and gave you probably more more feedback.
1:00:28
Look than any reasonable person would want I needed it. I needed that feedback. It was strong. I'm sure it's grown and developed. What is the format of the book? Could you lay out the basic structure of the book? You were very, very helpful to me. And, and the few people that I asked to look over that original manuscript really guided me in the same two ways, which was towards having more of
1:00:58
Voice that is like they just a natural voice. When I may be talking to someone and I can tend to become a little too academic, right? As opposed to like look. And that's not how I want to be. So I'm trying to write in a way. I've tried to write in a way that is just, it's plain and clear and thereby, hopefully effective. And the other recommendations were about incorporation of Stories of the things in my own life and in my work, which is part of my life that really emphasize the concept.
1:01:28
Steps. And that's what the book is is like it's meant to be read by anyone and everyone who has an interest in the subject material and it's very personalized about me and the examples in the world around me that illustrate the concepts. And with that, in mind, there are four parts to it. So the first is what is trauma and how does it work? So, that's talking about the definition of trauma and the facets of post, trauma syndromes, and how they impact people. So, the Cascade of henchmen
1:01:58
Trauma starting with shame and all of the others that come along with shame. So that's where the first part of the book. The second part is the big picture. So that's the part. That's the sociology of trauma of look at. Look. How is this happening in the world around us, which my goodness is come to a fever pitch with the pandemic and and just a spotlight on systemic racism and race racial Injustice in the world around us. And also on this erosion of faith in our socio-economic foundation. Can you work really hard and get ahead?
1:02:28
How does that work now? Compared to how worked 50 years ago. So that's the second part of it. And in the third part that lets her. It's sort of called and owners. Manual for your brain. We're trying to really look at how does this work in the brain? What's the difference between the logic systems in the limbic or emotional systems in our brain? How do we find meaning in our memories? How do our memories change when our limbic system changes? The emotion tied to Memories? How does trauma Cascade?
1:02:58
You mind and body. So that's the third part of the book. And then the, the fourth is like how we can beat trauma. Because, again, I don't, I do not want this to be esoteric in any way, shape, or form. The idea is that this is, well, grounded in the Practical of like, what can we do and change? Now, which means it has to be there to be things that we can employ, and that we can employ individually and in small groups of people and in larger groups of people, which brings us back to
1:03:28
Some things that what you the majority of it really comes down to like Simplicity and there's a common sense to it that I'm advocating for, in the fourth part of the book, but I'm trying to use the whole book to get us to the place where like these doable. Practical things are really at the Forefront of our minds and the person reading the book in Philly, right? I can do those things that can do them now and I can advocate for them in the world around me. And that's what really brings it. The idea that we're going to wear it up.
1:03:58
College in the knowledge is going to make change. Are there any particular stories in the book? I'm sure there are that we haven't discussed that have resonated with proofreaders and those who have had a chance to read it. Do any come to mind. I'll start with. So my favorite story, my favorite part of the book, maybe my favorite story, ever in my own life, which I shared. I don't know if you remember, it was.
1:04:28
A while ago, but you really did like this and that made me feel good. I believe, I believe it. I believe it, because it's a positive story. Like there are stories that are about how people get to the point where, like really bad things have happened, and that's part of us understanding, but there are stories about overcoming to and, you know, my uncle Rango, who was such a dear beloved person in my life. Is someone whose early life didn't look like things were going to go that. Well, he had a sixth.
1:04:58
Education and not a lot of guidance and support and then was drafted in the second world war and experienced some horrible, horrible things during the war, but through those experiences, develop the sense of self that said, I am a conscientious person. I am a strong person. I'm a person who can do difficult things in, you can do difficult things for reasons that are so strong. That one can't look away.
1:05:28
From them and a person who can do that. Those things should not feel ashamed of themselves. Should feel a sense of Pride, am. It's the recognition of tragedy and even with a sixth grade education and the limits that that kind of lack of exposure to the bigger aspects of of the world. And even of how our minds work was able to really understand that and have a very, very good life. And part of why he had a good life was the silver lining of the trauma that he experienced in the second world war, because he came out,
1:05:58
That was a sense of self that said, you know what, you're not a delinquent loser. You're the opposite of that. You're someone who leads men to safety when they're otherwise likely to be killed who does and I want to give away the story but does something incredibly difficult that haunted him his whole life because in his opinion, I don't understand what else could have been to do, but what he did because that was what was in front of him and he didn't see it as his fault, in a sense. That would have brought him shame if
1:06:28
That makes sense. And that's why I think it's my favorite story. And even before when I was younger, I was able to put all this together. I could see reasons to feel proud and made me see. Hope in that even when I was quite young, his story was very empowering, even though we didn't know the details. He never would tell us the details. But we knew what he had come through, and he was this decorated war hero, and we felt proud of him because he felt a sense of pride in himself. That's right. I do remember, I do remember Uncle Rango.
1:06:58
Do you remember how could one forget, could you speak to more Define selective abstraction? Because this, this is sure thing. That might be worth digging into selective abstraction is when we take one detail from a big picture and we construct the story of that whole big picture around the detail, an example. Probably a common example, but even
1:07:28
In my own life is like I can come to work and I can have a good day at work and feel like I'm doing good things and I'm helping people. I generally can feel good about things but then if I can't find my keys when I'm leaving and says what goes really happened and then you know, I'm frustrated now and I'm frustrated with myself. And when I finally find my keys right get people to help me find my keys. The Narrative that's going on in my head is like, what a loser mean. You can't even find your car keys to drive home. What the hell is wrong with you, right? And, and like, a bat.
1:07:58
The story then I can get home and like, my wife could ask me. How was your day? I'm like, ah, you know, it's a terrible day because I'm incompetent because like I built the story of the whole day around. What the Salient negative, the thing that triggered in me, you know, my own susceptibility to thinking, I'm not good enough. And what I'm doing, is it worthwhile enough and oh, look what's wrong with me? And that's selective abstraction because that was probably 10 minutes of my day, but my brain builds the holster
1:08:28
Ori of the day, which is my story of myself around that negative thing. Selective attention is a hell of a thing, right? You buy a new car and all of a sudden, everyone's driving the same car, but of course, those cars are already out there. Maybe you're just paying more attention now, and that's so big because this is all about salience biases. What are we paying attention to? And Trauma makes us pay attention to the negative. That's why we think the
1:08:58
This less safe of a place or that we're less competent people like this is the danger. We use selective abstraction and salience biases. And attribution bias has wear something negative happens that I'm going to attribute it to me. And I see this all the time where, you know, something- may happen next door. Person had nothing to do with, but they feel that it's their fault because we get enough of this in ourselves and we literally forget who we are or what we're worth, which is why people will stay.
1:09:28
Say in jobs that they hate when they could try something different or they'll stay in abusive relationships, when they could end the abusive relationship and not enter. Another one, where does all that end up? It ends up in learned helplessness and learned helplessness pushes people towards more trauma and very often towards death. Could you say more about that when you say towards death because the accumulation of trauma makes people more and more desperate for ways of
1:09:58
Coping it's like when you had met the you talk about drug addiction, then we talked about the decrease in role performance and the shame that comes along with it and the stigma, nobody decides, you know, I'm going to use drugs because what I want to do is ruin my life. Like no one makes that decision. So if we look at, as you were saying, dr. Mattei was saying is like, look at the pain in the person. Where did that come from? And not always, but a