Good Life Project - Understanding Trauma & How to Heal From It | Paul Conti, MD

Episode Date: May 19, 2022

If you google the word “Trauma” you’ll find the top search results arrive in some form of the question “What is trauma?” This then begs the next question: what are we really talking about when we’re talking about trauma? In today’s episode, Dr. Paul Conti and I unpack what trauma is, what it means to have experienced trauma, and what makes trauma so hard to resolve. What I found so fascinating in this conversation was the idea that there are 4 types of trauma we can experience and how, if we can create safe spaces to talk about our trauma and support one another, we can more readily recognize who we were before the trauma occurred and who we want to be after. A graduate of Stanford University School of Medicine, Paul completed his psychiatry training at Stanford and Harvard. Now living in Portland, OR and founding his own clinic, he serves patients and clients throughout the United States and internationally, including the executive leadership of large corporations. He is the author of TRAUMA: The Invisible Epidemic: How Trauma Works and How We Can Heal From It. Thing is, Paul talks about trauma - not just as an academic pursuit but from a personal perspective and experience - having lost his brother to suicide when Paul was just 25 years old. As a result of his training and experience, Paul urges us to remember that we are all in this together and shared humanity is more important now than ever for our healing to begin - and around the 53-minute mark, Paul gives us two prescriptions to take action on - 1 as societal prescription and the other for us individually. Quick note before diving in. As noted above, trauma & suicide are discussed in this conversation, with the lens of care and compassion, still we understand these topics are sensitive and may be triggering to some, so please take care when choosing to listen and honor your own personal sensitivities and needs.You can find Paul at: WebsiteIf you LOVED this episode you’ll also love the conversations we had with Bessel van der Kolk about his embodied approach to integrating trauma.Check out our offerings & partners: My New Book SparkedMy New Podcast SPARKED. Visit Our Sponsor Page For Great Resources & Discount Codes Hosted on Acast. See acast.com/privacy for more information.

As I went to medical school and became a psychiatrist, I saw that we weren't addressing the real sea changes that happened in people after trauma, and that often then the person who suffered the trauma wasn't aware of it and had a completely changed life trajectory or conception of self without any awareness of that having happened. So if you Google the word trauma, you'll likely find that the top search results arrive in some form of the question, what is trauma? And'll likely find that the top search results arrive in some form of the question, what is trauma? And this then begs the next question, well, what are we really talking about when we're talking about trauma? In today's episode, Dr. Paul Conti and I unpack what trauma

is, what it means to have experienced trauma, and what makes trauma so hard to resolve. We don't stop there, though. What I found fascinating in this conversation was the idea that there are actually these four types of trauma he describes that we can experience and how if we create safe spaces to talk about and support one another through this, we can more readily recognize who we were before trauma occurred and who we want to be after and get to that place. So a graduate of Stanford University School of Medicine, Paul completed his psychiatry training at Stanford and Harvard and now living in Portland, Oregon and founding his own clinic. He serves patients and clinics throughout the United States internationally, including the executive leadership of large organizations.

And he's the author of Trauma, the Invisible Epidemic, How Trauma Works, and How We Can Heal From It. The thing is, Paul talks about trauma not just as an academic pursuit, but also from a personal perspective and experience, having lost his brother to suicide when Paul was just 25 years old. And as a result of his training and experience, Paul really urges us to remember that we're all in this together, and shared humanity is more important now than ever for our healing to begin. And at around the 53-ish minute mark, Paul gives us two prescriptions to take action on. One as a societal prescription, and the other for us individually. So quick note, if it's not evident from what I've already shared before diving in, trauma and suicide are discussed in this conversation with the lens of care and

compassion. And still we understand these topics are sensitive and may be triggering to some. So please take care when choosing to listen and honor your own personal sensitivities and needs. So excited to share this conversation with you. I'm Jonathan Fields, and this is Good Life Project. If you're at a point in life when you're ready to lead with purpose, we can get you there. The University of Victoria's MBA in Sustainable Innovation is not like other MBA programs. It's for true change makers who want to think differently and solve the world's most pressing challenges. From healthcare and the environment to energy, government, and technology, it's your path to meaningful leadership in all sectors. For details, visit uvic.ca slash future MBA. That's uvic.ca slash future MBA.

Mayday, mayday. We've been compromised. The pilot's a hitman. I knew you were going to be fun. On January 24th. Tell me how to fly this thing. Mark Wahlberg. You know what the difference between me and you is? You're going to die. Don't shoot him. We need him. Y'all need a pilot.

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The Apple Watch Series 10. Available for the first time in glossy jet black aluminum. Compared to previous generations, iPhone XS or later required, charge time and actual results will vary. So as we have this conversation, you are a mental health professional, went to Stanford, Harvard, degree in psychiatry, and have really seems like devoted so much of your adult life to the world of mental illness and particularly trauma. For you, this is not an academic pursuit. For you, this is personal, starting really with your family. Tell me a bit about the, you know, the experience that you've had in your family

and what you've discovered, I guess, in a more broad notion about your family that really sort of inspired, lit the fire, became the inciting incident for your devotion. Well, I was so struck by how trauma changed so much inside each person in the family, and then also how we were all together as a family, that there was no way of me understanding in advance what the impact would be and how far reaching it would be. And I think the surprise of that and the shock of that and the awareness of change, including awareness of change in myself, that it's not just that there's grief afterwardsated or a scary place to be avoided and whether it held opportunity or it held malice, that there was a whole shift towards really feeling beleaguered and feeling under threat and incapable and incompetent and all of these really profoundly negative things that just weren't in me before. And I think because I was already, I was a young adult, right? And I'd come through so a significant part of life without major trauma.

I was struck by just how much everything changed and that there weren't, there wasn't an understanding of that around me. You know, that even in getting help from other people, you know, there wasn't this framing that like, oh, like, okay, everything is different for you now. So we've got to help you like anchor to what, you know, was true, that still is true, even though, you know, you don't have that awareness in you at the moment that there wasn't that conception of it. So even the helping resources, it had those limitations, which I saw then, you know, in the mental health field, as I went to medical school and became a psychiatrist, I saw that we weren't addressing the real sea changes that happened in people after trauma. And that often then the person who suffered the trauma wasn't aware of it and had a completely

changed life trajectory or conception of self without any awareness of that having happened. Tell me what actually happened. So you're referencing something that happens in your life that traumatizes you and your family. What actually unfolds? The event was the suicide of my youngest brother. My brother, Jonathan, committed suicide when he was 20 years old. And at the time, I was 25 years old and had gotten through a lot of life without major trauma. And then everything really changed at that point in ways that were kind of scary. And I could see that if, you know, without a course correction, that, you know, things could have gone to a place that really would not have been okay for me. When that happens in your life, I know so often the question is, you know, why did this happen?

What, you know, like there's, I think so often we try and create a rational overlay for experiences like that, for something that is profoundly irrational and try to understand what happened here. But also, you know, it marks us, you know, and whether it is an experience that is as awful as what you and your family experienced or anything that really leaves a dent in us in so many different ways. I'm curious though, trauma and grief seem to be deeply related, but not the same. And I'm curious how you would tease out the distinction between them or maybe how they actually relate and are also different. So trauma, whether it's an acute trauma or it's a chronic trauma or even a trauma we experience through someone else, right? It gives us cause for grief, right? For sadness, right? For a sense of loss, for people or feelings or sensations that are missing inside of us that

we need to come to terms with in order to move forward with life. But trauma also creates in us the very mechanisms that prevent us from experiencing and processing grief. So for example, we can't process grief. So experience, I feel sadness, I feel lost, you know, my world is rocked, right? And I need to let myself experience that and let myself feel sad and let myself feel despairing while still moving forward with life and attending to the things that are important to me, right? The people, the goals, the drives inside of us, right? We need to do all of that. That's the navigation, the experience and navigation of grief. But we can't do that if we're, for example, feeling guilty and responsible, right? You know,

it blocks any forward movement of grief. So the fact that trauma in the vast majority of cases creates a reflexive shame inside of us, right? And, you know, that shame comes with a sense of responsibility, feelings of guilt, feelings of being cursed or, you know or marked for unhappiness. And that stops us from experiencing and processing grief, which can then stay with us over years and years in ways that really further and perpetuate that change. Because we're grieving, but we're stuck almost in a suspended animation of the misery of grief without being able to move forward and through it if we're held back by, in the most common case, a sense of guilt and shame about the trauma. And I was very much struck by that. Even further along in my career, as I would see over and over again and then reflect

back on my own life, how trauma brings grief and it also brings the guilt and shame that prevent us from navigating grief. If you think about trauma and grief also, I wonder if the circumstance for trauma or if the circumstance for grief, if it is possible to get to that place without actually having trauma be a part of the equation, like, can you actually separate the two? In which case, every time you would have an experience that would lead to the possibility of grief, trauma, it seems like, I'm trying to imagine even a scenario where trauma would not be a part of the circumstance

that would lead to that, which creates this confounding variable, which makes the whole thing so much harder to actually be with and move through and process. Right, right. So anything that would give, I think, would give us cause for grief, right, is, I think, almost like by definition traumatic, right? Even if we're grieving over, you know, the deaths in the world around us, right? The impact of the pandemic. I mean, even if we're grieving in that way, and it's not,

say, personalized, it's not that a person knows someone who's been lost. We're grieving for something that's vicariously happened in the world around us. We feel that. So even in a scenario like that, we're grieving even though we're not personally impacted. We're still impacted by something traumatic. So, you know, that's where even in the case of vicarious trauma, something that doesn't directly happen to a person, right? You still need the trauma to evoke the grief, even if the grief is for others or for others that we don't know. So I think anything that brings grief is arising from trauma. And as you said, we have that, you know, that almost that catch-22, right? That if it's making the need for grieving and navigating through grief, there's the danger of all the things that trauma raises in us, you know, shame and all of the accomplices of shame that then prevent us from navigating through the grief without us knowing

it. So there's something, you know, very, it's ironic in a menacing way that I think is the reason why, you know, I see people over and over again who are suffering through the immediacy of trauma that happened many, many years ago. And you think, well, how can that be the case that there hasn't been any progression through the impact of grief? And then it's always the same answer that the other consequences of trauma prevent that navigation. And there's sort of a suspended animation of then misery that plays out over time. And then, of course, can lead to so many other problems. So, you know, one being the appeal of in the short term of soothing with substances, right? It's so much of a go to in the society around us, because it's there to soothe us. And the more

that we're stuck in grief in the suspended animation of misery, the more the appeal of unhealthy things that can soothe us in the moment, but lead us towards disaster in our lives. The more at risk we are for depression, the more at risk we are for panic attacks and sleep disturbance and the kind of things that make us turn away from life. So we've used the word trauma a whole bunch in just the first few minutes here. And it occurs to me, it probably makes sense for us to actually talk about what are we actually talking about when we're talking about trauma? What is this thing called trauma?

The trauma is anything that overwhelms our coping skills, and it overwhelms us, and then it makes change in us that stays with us as we move forward, which doesn't mean that we can't work through that and make things better, but that would be the default of it, right? That it overwhelms us, it impacts us, and then there's no sort of automatic resolution to it, right? It's not like a bruise where you just keep going through life and okay, that bruise will heal, right? It's something inside of us that then takes on the life of its own and isn't healed by any natural process inside of us, which of course raises the risk that it festers inside of us and that it then gets worse over time or leads to a cascade effect or a

domino effect, which is why you can see that trauma changes a person's mood for the worst, changes their anxiety in a way that makes it higher, impacts their sleep negatively. And now the person is engaging in life in a different way and they're not as attentive to the people in the world around them or to their ambition or their career choice. world can change, right? And it changes as a result of being overwhelmed, being impacted that way, and then not having the means or the resources or the knowledge or understanding or help around us in order to course correct back to where we were or who we were before the trauma. When you describe it this way, part of me is wondering if something happens, which in the blink of an eye or a sustained experience causes this level of disruption. The question that keeps lingering for me is why can't we readily rewrite that script? Is there

something literally physiological that changes in us? Is it psychological? Is it a belief set? Is there wiring that gets rewired in a radically short period of time that then becomes profoundly hard to unwire or wire differently? What happens during this experience that makes it so hard, that makes it different from a bruise that just over time resolves itself? We have an incredible treasure trove of scientific knowledge about this. So not that long ago, a lot of this was conjectural, right? We could see changes in people. We could see that they persisted over time, but we couldn't link all of that to its sort of neurobiological underpinnings, right? It's psychological underpinnings. And now we can, right? The magic

in the brain, right, is in its connectivity, right? And what we see are these profound connectivity shifts where, for example, the parts of our brain that are about vigilance, right, that are about threat perception, become so dialed up that we then notice the world differently around us, right? So, you know, one example being what lights up in our brain if we see a stranger approach, right? A stranger who looks benign, right? Do we respond with interest, right? Or do we respond with fear that makes us want to avoid, right? And creates a whole cascade of other changes inside of us. And we can see the difference in people who are carrying trauma with them and how their brains respond, for example, even to just the appearance of on the scene of another person, right? And we know that trauma

can change how our genes are expressed, right? So is a gene active or not active, right? This is the field of epigenetics right which is not just what what are our genetic predeterminants right what are the genes inside of us right but more importantly are they active or not active right because if you have a gene and it's turned off or it's passed along in a way where it's either on or off in a way that's different right then we've changed the expression of the genetic code within us. And we know that that can happen, not just in the person who suffered the trauma, but that it can be passed along years later. So it can be passed along to children who not only weren't

born, but weren't even thought of yet, you know, are years, you know, come years after the trauma. So the fact that this changes us, and it changes, you know, on the deepest levels, the functioning of our brain, our interface with the world, and even how our genetics manifest themselves, is really now an incredibly powerful scientific underpinning of what trauma is and what it does to us. The way you described the epigenetic side also, when I think about generational trauma, trauma that appears to be passed from generation to generation, I guess my earlier understanding was that very often that was because somebody either witnessed it, like it was vicarious, which became embodied, and then it gets passed on. Maybe they were in a household with

three generations where they saw trauma in one generation, and then people were literally around if it was violent or whatever that caused this. But what you're saying is something different, which is not a this or, but a yes and. Yes and, trauma can literally alter the epigenetic state or the expression of certain genes in an individual. And that state is heritable through multiple generations. So we can literally, through the process of genetics, pass trauma on to kids who may not even be, like within our immediate worldview

in any meaningful way, shape, or form. And I would imagine that that then gets passed on through multiple generations beyond that. Yes. Yes. And that's, I think we need a scientific underpinning in order to realize the immensity of the impact upon us. I mean, I think we can look at the world around us and we can see that, but it is nonetheless extremely powerful to have that scientific underpinning, right? To realize the truth of what you just said, right? Which is so different from, you know, the idea that, oh, people should pick themselves up and move on, right? Like, you know, we hear so much of, even at times in a well-meaning way, right, of a real minimization, right, of the impact of trauma on us. And it's part of why I wrote about trauma. I mean, I didn't set out to write about trauma, but in doing the work that I

do, I would see over and over and over and over again, right? How trauma had changed someone and how that change was moving forward with them through life, how it was impacting the people around them and how it would change an entire life trajectory in a way that you could just look ahead and see would be generational, right? Without the kind of interventions to course correct.

And it's that realization that there's something going on here that we don't understand that is changing us as we move forward. And we're not aware of the change, right? And then, you know, in mapping that too, and understanding more and more, well, what was going on in me after some of the traumas in my own life, because they happened before I had any medical training, right? And to see with this sort of new clarity, what the impact had been on me, and how difficult it was over the years to try and navigate back to where I was before, it was a huge part of the impetus to write about trauma. Because I think in many ways,

you know, in a way similar to, you know, the invasion of the body snatchers, right? You know, the movie, right, where people fall asleep, and then they're different afterwards. And they're like, and no one else can know that, right? Because they look the same on the outside, that, you know, this idea of how insidious that is, right? You know, how terrifying that is, right? That's why the invasion of the body snatchers is a horror movie, right? That, you know, there's this process that's happening that we are very often inflicting upon one another, right? That rises to that level of, you know, of horror of what's happening in us and our lack of awareness so often of what's happening in us that, you know, it struck me in a way that little else in life has in terms of like learning something about life and learning like this is how

this is working. And I know this because I'm just seeing this play out over and over again in people from all different walks of life, all different socioeconomic strata, right? Like it became so clear that this is profoundly a human problem. When somebody is experiencing like that level of trauma, and as you described, you look the same on the outside, but behaviorally you're different and you're going to relate to people differently and they're going to relate to you differently. But it sounds like one of the things that is also a quality of being in a state of trauma is that you're not necessarily entirely aware of how you are different, of how you're moving through the world differently. You're probably, I would guess, aware of the fact that people are responding to you differently. The world is responding to you differently. You may

be struggling relationally. And as you shared earlier, it sounds like shame is something that tends to touch down on a fairly regular basis. So I'm curious how someone would experience the demise of so much of the way that they were in the world and then the quality and the depth and nature of their relationships and the weight of shame dropping into the world, yet be unaware of the fact that there is something deeper that shifted within them that actually it underlies all of this. Right. When a person has awareness, that awareness is so often through the lens of shame, right? It's my fault, or I'm just a terrible person, or nobody likes me and why should they, right? The fact that trauma evokes in us or arouses in us,

technically what is called affect, technically is aroused in us, meaning it's created without our choice, right? And trauma arouses shame. And shame leads us to create stories that are stories of self-blame, right? They're stories of why we're not good enough, of why we're cursed, why we can't make our way in the world.

And the reflection then of like, why are things not going as well for me, right? Is it comes often through the lens of, well, because it's my fault. And that then perpetuates the original story of trauma, right? You know, in a sense, validates why the trauma happened, right? It happened because I'm a bad person, which is borne out or validated by the bad things that happen after trauma, right? And like, that's a very, very dangerous and self-referential, right, story, right, that then often moves forward, right? And that's in cases when a person

is aware, right? Now, sometimes there's a mixed awareness, right? Sometimes there's not an awareness because trauma, it changes our memories, right? So our memories are enlivened by the emotion that we attach to our memories. And if the memories are now associated with a different kind of emotion, it changes our understanding of what that memory means. So the example I'll give at times was, you know, of a person who, you know, won an award at some point earlier in life, that was really a grounding, you know, event for them of excitement and happiness and feeling good and hopeful that the person could do good things in the world, right?

And then after trauma, the memory now has a very negative emotion attached to it, even though the trauma happened years after the memory, because now the person feels guilty, they feel ashamed of themselves. And when they remember that, they attach a different emotion to it. And it might be an emotion of, oh, someone just gave me that, or there's literature around, you know, the turn from the 19th to the 20th century was, you know, and into the early 20th century was writing about how events in the present can change the past, right? Because if it changes our view of the past and our beliefs of the past, then we are changed retrospectively. And that's often what we see is a combination of those two things where the old memories are now changed because of the negative emotion. So that takes away the ability to see and understand the change. And now the person feels bad about themselves through that lens of shame and guilt. And now they're attributing so much of the negativity to what's bad about themselves, right? And now you can see how

we have a very slippery slope towards what often is life disaster, right? Like I see that this leads to people dying. I see things that lead up to that, right? Where it changes, you know, a person suffers from depression more and their life trajectory sort of levels out. I mean, we see all sorts of bad things, but up to and including death and this all having a sort of final common pathway at times that leads to misery and ultimately to death is not uncommon. And that also struck me of how often that happened and wasn't understood, right? You know, the idea that, oh, that person's cause of death was a car accident. That person's cause of death was an overdose, right? And then I would see, okay, I understand that's the actual cause of physical death, but that's not the important factor here, right? You know, what was the actual cause of

death was so often trauma and then that cascade of consequences of trauma. Yeah. You got to trace it back up the chain. Whether you're in your running era, Pilates era, or yoga era, dive into Peloton workouts that work with you. From meditating at your kid's game to mastering a strength program, they've got everything you need to keep knocking down your goals. No pressure to be who you're not. Just workouts and classes to strengthen who you are.

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iPhone XS or later required. Charge time and actual results will vary. Mayday, mayday. We've been compromised. The pilot's a hitman. I knew you were going to be fun. On January 24th. Tell me how to fly this thing. Mark Wahlberg.

You know what the difference between me and you is? You're going to die. Don't shoot him, we need him. Y'all need a pilot. Flight risk. When you talk about trauma also, I think when most people hear that word, they probably think, well, you know, it is one particular incident that happens to you as an individual in a moment in time. You actually deconstruct it into sort of like different types.

I think there are four different types that you describe. Walk me through how they're different and why that's important to understand. So the primary types of trauma are acute, chronic, and vicarious, right? And acute trauma is of course the easiest to understand. And our interest in trauma societally really comes through the lens of trauma in military situations and combat situations. So something acutely happens, right? Someone is injured. Someone witnesses people being hurt or killed in battle, right? So we often see trauma through the lens of acute incidents, which of course makes sense. I mean, much of trauma happens acutely, an assault, an accident,

an illness, the death of someone. But trauma can also be chronic. So for an example of, so chronic denigration over time, right? So a person who say through either a socioeconomic lens or an ethnic lens or a religious lens is seen by the immediate world around them as less than, right? And it then has to navigate life under the weight of that, right? Under the impact of being seen in this different way, which then of course often leads to internalization of that negativity, right? Of feeling that way about themselves or feeling beleaguered by the world around them, feeling vulnerable and assailed by the world around them. And there's a chronic process there, the process of disenfranchisement, right, the process of being denigrated by the

world around us that produces the same effect in us. So it's less dramatic, right? And therefore, it calls our attention less, but it can be no less impactful. So there's acute trauma, there's chronic trauma. And then vicarious trauma really arises from, you know, this wonderful fact about us, which is that we have empathy, right? And we can feel other people's pain and suffering, which can lead us to help them and them to help us, right? Like this is rooted in something that's very good, but it means that other people's pain and suffering can impact us in some cases, as if it were our own. We lose the boundary between self and other, which again, part of that can be the beauty of empathy or the beauty

of sympathy, right? But in losing that barrier, we can be impacted by what other people are suffering. And we see this very classically in say first responders, right? To disaster situations. So there's one way that that's obvious and clear, but so much of that is pervading our world and accessible, say, through social media, right? Where, you know, one can look at trauma-inducing images or listen to trauma-inducing words 24 hours a day. And often people do too much of that, not because we're trying to hurt ourselves, right? But because we feel insecure, we feel vulnerable, and we want to learn more in order to try and reassure ourselves and get some sense of safety in the world. And then inadvertently, what we do

is sort of fill ourselves with the trauma in the world around us, right? And it creates fear and vulnerability in us. And that's a way in which we can become vicariously traumatized. I mean, we know this is true because it looks the same in the brain when it happens. You can look at the brain through that neurobiological lens of trauma, and it's not like there's a marker for, oh, that's an acute trauma that happened in combat. Oh, that is a chronic trauma that that person suffered over time because of their sexual orientation. Or, oh, that's vicarious trauma because of too much news or because of it being a first. No, it looks all the same in the brain, which I believe is the proof of that concept. That's fascinating. So literally like all three variations, when you look at how they actually land,

like what is the actual net effect in somebody's brain and somebody's body, you can't distinguish between them, even though from the outside looking in, I would imagine if you ask the average person, you know, would the effect of an acute trauma be the same as this sort of like chronic low grade thing that you're living with for months or years? I would imagine most people would kind of almost write off the latter and like clearly acknowledge the impact of the former. I wonder in your practice, if you've seen over the years also, do people tend to struggle more with acknowledging the fact that chronic trauma or vicarious trauma can affect them on the same level that something that they would imagine to be more acute would? Yes. I mean, I see people struggling with acknowledgement and validation of

their trauma across the board, right? Because even say a tremendous acute trauma, you would think, okay, that person can understand, gosh, that terrible thing happened to me. But often because of the magnitude of the trauma, the magnitude of guilt and shame is so high, right? So therein go the self-blaming and all those mechanisms. So I see it across the board, but absolutely, you know, a person who's suffering from chronic trauma is often so ready to discount that, right? It makes it easier to invalidate the self. You know, an example of a person who didn't have trauma based on, say, race, religion, and then moves to a place where now the person is suffering from that. And that's played out over years of a change in the person's sense of safety in the world around them. And they're

feeling that they are welcome in the world, that they can be themselves, they can move their lives forward, that where all of that has shifted, right? And I can see that it's shifted. But the person is very resistant to acknowledging that because it becomes easy for them to minimize it, right? But it has to be acknowledged because, well, in order for the person to be healthier, right? Because in acknowledging it, then the person can regain access to how they felt about themselves before these changes, the hopefulness they felt, the sense of belonging they felt, the lack of a sense of vulnerability and alienation. So the chronic traumas have to be acknowledged just as much as the acute traumas in order for us to, in a sense, get our arms around it and move

forward, which we can do. I mean, a very hopeful message of my book is that we can make this better. I mean, in many ways, it's incredibly complicated, right? The processes that happen in the brain and the epigenetic processes, but in the ways that are most practically important, right? We don't have to understand that are most practically important, right? We don't have to understand every aspect of brain functioning, right? Which we probably never will as human beings. It's so complicated. We don't have to in order to help each other, right?

We can ground to these basic principles of, for example, a safe place to talk about trauma, to talk about how we feel, to talk about the things that frighten us, the changes we see in ourselves, right? To re-anchor ourselves to who we knew we were before trauma or who we aspire to be after trauma. This is not rocket science in that it's not incredibly complicated to do that, but we often don't do it anyway. In fact, our healthcare systems are set up to look for quick fixes. So, oh, your mood is lower, right? Okay, well, let's give you a medicine to improve your mood a little bit. And, you know, instead of looking at, well,

why is your mood lower, right? What is going on in you, right? What is your history? When did your mood become lower, right? What are your life experiences that can impact that? We, you know, we we don't look deep enough. We scratch the surface, address symptoms and then know, the political infighting that prevents us from saying, how about we start with as many of us as possible not dying, right? And then we can have our political infighting, right? But, you know, the infighting comes first, right? And like how we're doing this to ourselves, I believe, because we have an accumulated and accumulating weight of trauma that is evident as we look at our behavior in the world around us and how it's impacting us as a society. what ails us, and certainly the last few years have piled onto that in almost every imaginable way. What is going on in the world of medicine, in the world of healthcare that is stopping? What's going on in the world, in the industry, in the educational side, that's sort of like setting this up in a way where instead of saying, oh, there's trauma here, let's go deeper and try and figure out how do we actually deal with the trauma that underlies this thing?

That it seems like the dominant approach is let's treat what's happening on the surface and not actually even ask the question. If we track this back, are we talking about is there a much bigger gap that needs to be addressed in terms of sort of like the fundamental way that paradigm of medicine and the educational system are set up? Yeah, I would argue that we have developed a culture of rapid and, if possible, immediate gratification, right? That we develop a very short-term view of ourselves and of our health, right? So we then approach problems in a way that is extremely narrow in focus. So you think about, you know, how much money we spend on healthcare in the United States and how, you know, you could look at any of many, many metrics of like, are we doing a good job? And the answer is no, right? You know, we are good at addressing acute, highly sophisticated problems, right? Complex surgeries, right? You know, molecular

advancements in certain treatments. We're very good at that. But when it comes to the big picture of are we taking care of ourselves, right? We have gotten farther and farther away from that. So one example being there are countries, I believe, the Netherlands is one that use about 20% as much medicines, as many medicines as we do, right? Because there's a holistic focus of, you know, if you don't feel healthy and, you know, your cholesterol is too high, like looking at how are you taking care of yourself? What is your lifestyle? Are you exercising or utilizing diet, right? There's a whole sense of looking at a person longitudinally in terms of their health, whereas we have a reflex of like fix that problem now. Okay, so your cholesterol is high. We will give you a medicine to lower your cholesterol.

Done, right? And that is a way of polishing the hood when there's a problem in the engine. And sure, that looks good for a little bit, but it's not an answer to the question. And, you know, we have a for-profit healthcare system that, that, you know, is so in many ways, so fragmented, right? That the systems that are providing the healthcare have a strong incentive to just look at the short term, right? People aren't staying with insurers over time. They're, you know're switching from one insurer to another. So you look at like what needs to be done now and how do we do that as inexpensively as possible? So that decreases human time, right? It increases the use of medicines and really the end goal then becomes throughput

and profit and not health. And I just don't think there's any way, and firmly, I believe in the capitalist system. I think that capitalism is done as a great deal of good and can continue to do so. But we have a system now that just isn't working. So I'm not saying let's socialize medicine, everything will be great, right? But to step back and look at what choices are we making? How are we spending the money, the resources that we have in our healthcare system? How are we using, for example, the people in the healthcare system? I think that it is egregious. And I would go as far as to really feel this way, heartbreaking to see how people are treated who are working in the healthcare system, doctors and nurses and technicians and respiratory therapists and people who are working in these systems who are so overburdened by systems that aren't taking care of the people getting the care or the people giving the care.

And then this term arises of a burnout, right? People in the healthcare system are getting burnout. I mean, you know, when I was younger, burnout was an insult to say to somebody, right? Like that was, you get in a fight saying somebody's a burnout, right? It's saying, well, that person can't do it. That person can't cope, right? Instead of saying, how about people who are stuck in a system that is treating them sadistically as they're trying to what? Take care of the rest of us i mean by any metric of stepping back and looking at it we have a broken system and that broken system isn't looking at even the

basics of how we're taking care of our our weight our diet or exercise right how is that system going to actually look at trauma right it's something that requires human attention and human attention across time so you know we don't go to the root cause of problems. And we know that well over 50% of medical problems, general medical problems people present with come from mental health reasons. So instead of psychiatry or mental health being a specialty, this idea of the pyramid of medicine, I think the pyramid of medicine should rest on a foundation of mental health that then wraps around that pyramid in a way that would improve our health physically and

mentally, decrease our need for care within the physical health system, and start looking at the root cause of many of our problems. But again, we don't do that. And we operate within this broken system that is always looking at today, right? You know, what are we doing today? How are we getting everybody through today? We're not looking at the long term of like, are we taking care of ourselves? Or are we driving ourselves into a spiral that is going to perhaps end in a place where we don't even have a functioning society anymore. And I don't think that that's alarmist or unreasonable to say. I think it's an unavoidable observation of just looking at the world around us.

Completely agree from the outside looking in, you know, you have a very different perspective. But just when you look at the state of the world, when you have this state of the way that healthcare workers seem to be and the way that patients, you know, like are showing up for the same thing over and over and over again. And I think also, you know, it sounds like what you're saying is, yes, we have a paradigmatic problem here. Yes. And it's not, it's very hard to say, well, like this person or entity is to blame. It's like, we all play a role in this system. Like when I show up as somebody who's suffering and I say, give me the pill. And that is all that I want right now. And you know, like the provider knows there's actually something, if we really want to resolve

this, there's something deeper that we need to explore. We're both doing, you know, like we're doing this dance where everybody sort of like has, has a role to play. I wonder if what's gone on over the last two years, if the depth and the pervasiveness of suffering my sense is it is leading so many people to re-examine their relationship with themselves, with their wellbeing, with their mental health. And I think mental health has become so much more a focus of conversation and something that is a focus of conversation without the level of stigma that we had even five, 10 years ago, that I wonder if there's an opening that we have right now. I'm curious how you feel about the possibility of

the moment that we happen to be in right now to make change. Yeah, I think we're really at a fork in the road, right? I think we are really at a fork in the road, right? I think we are really at a fork in the road where our suffering as a planet, certainly as a nation over the last couple of years, can lead us to examine anew how we are interacting with one another, how we are taking care of ourselves. And part of the message that I very much hope to spread is that we're all in this together. We all have our traumas spread is that we're all in this together. We all have our traumas to deal with. We all have our vulnerabilities.

We're living on this planet that we all have to live on together if we're going to stay alive, right? And can we look at that in the context of the shared trauma of the last couple of years and without the stigma that leads people to not acknowledge what is going on in ourselves, right? Can we get around that and sort of approach from trying to find consensus and collaboration to make things better, right? Going back to the first principles of what we're doing or not doing to take care of ourselves. Can we get over that hurdle through the shared experience of trauma? And instead of it dividing us, it brings us together. And then with a common sense view, we stand back and we look at what's going on. And we think about ways to make it better. Like that's a possible outcome of this. But the other branch in the other fork in the road is a possibility to where the

trauma of the last couple of years is in many ways dividing us more and more. So you think of the decline of rational political discourse, where like, how often do you see two people where they've diametrically opposed views and are being respectful to one another, right? I mean, the trauma polarizes us too, where people feel afraid and feel vulnerable and feel disempowered. And then there becomes an assertion of self. And we're at the point where we often can't even agree on what truth is. So something very as obvious as one plus one is two, people will be expressing disagreement about. Now that's not about whether one doesn't understand that one plus one is two, right?

It's a matter of, are we going to be grounded to truth and to facts, or are we just so beleaguered that we just want to assert ourselves, right? Which would say, if we're arguing about something, I really don't care if you're right or I'm right, right? I just want to be mad at you because I feel impotent and angry. And how much of this do we have going on in the world around us that threatens to make us more and more and more callous of other people's suffering. And I do think that we've seen that over the last several years where, oh, it was another shooting and, you know, okay, let's make that a gun control argument and move forward. Like, what about the people who lost people? You know, what about the cascade effect on the people

around them? Like, there's so much that goes on that we just cast aside and move forward instead of thinking of the real human toll. You know, even the thought of how we spend our resources and even how many people are there suffering after being 9-11 responders, right? Could we take care of them better? Like even we're going back, you know, we're going back years now to a group of people that we all agreed did something heroic for all of us, right? And are we optimally taking care of them? Are we helping take care of their children if they're now disabled, either physically or emotionally and can't work, right? I mean, it's just, to me, it's such a salient example of something that I think is worth our time, attention, resources, right? But, you know, we can skip over that and how many thousands of other, you know, tragic events since then, where we just move forward instead of stopping and thinking, what are we doing here as this cascade of trauma spreads and spreads and spreads and spreads to the point where now I believe it's spread through our whole society. And we're going to have to decide together through a process of discourse, are we going to take the

branch where we realize, hey, enough is enough. Let's look at how we're taking care of ourselves, including how we're speaking to one another and what we have in our minds about one another. If a person isn't in complete agreement with everything I think and feel, like, are we going to go that way, you know, in a way that's divisive? Or are we going to overcome that and think again that, hey, we're all here together. And if we're not going to, you know, drown or burn the entire planet or, you know, destroy each other, you know, individually, right, we better make some changes. I mean, I think that is so starkly in front of us now completely agree the apple watch series 10 is here it has the biggest display ever it's also the thinnest

apple watch ever making it even more comfortable on your wrist whether you're running swimming or sleeping and it's the fastest charging apple watch getting you eight hours of charge in just 15 We'll be right back. so we're sitting in this moment right now. You have a prescription, Pat, and you can write two scripts, one for individuals who are experiencing trauma and one for society. Let's take them one at a time. You're writing the script for society at this moment in time. What goes on that prescription, Pat? What are we talking about? What are the things that really, really are important for us to be thinking about and doing? Well, for society, the prescription would, I think, would say to take a step back and look at everything that's not about you, right? Because we tend, I think, more and more to see society through the lens of ourselves. What do I want? And it takes us away from the truth that like, that's what society means is more than one person. And, you know, maybe on that prescription would be, you know, go find somebody that your reflex is to think, you know, you can't stand it as nothing like you. Go find somebody who looks different from you, dresses differently from you, has a sexual orientation or a gender perspective that's different from yours, right? Go find somebody who you feel is different, right?

And find the shared humanity, right? That's when we begin to overcome our societal differences instead of just looking at how's that person different from me, how they look, what they believe, what they eat, you know, where they worship. We look so much for differences. And can we go out and find similarities? And I think if we can think beyond ourselves and challenge ourselves, what we find is shared humanity. That's why people love these stories, right, where you see, oh, somebody dialed the wrong number and, you know, on Thanksgiving day and it was somebody, then you see a picture and like the people are totally different, right? And like, wait, okay, they're totally different from the outside, but they're not totally different on the inside, right?

And like, that's why that's such a heartwarming story. And, you know, why can't we have millions of stories like that, right? Why can't we all go do that and remind ourselves that we live in a society together and we've become so much more sensitized to looking for differences? How am I not like you? accept and grow and be enriched by people who are vastly different in so many ways. Like, that's a wonderful thing. And maybe we could celebrate that a little bit more in ways that aren't just theoretical, but can be very, very practical in how we approach the world around us and the other people that are in it with us. So that's what's on our society prescription. Let's take it down to the level of the individual, whether somebody has experienced acute direct trauma, whether it's chronic, whether it's vicarious, which I would have to imagine there are probably more people walking around having experienced some level of vicarious trauma given the last few years than not at this point. When we look at, okay, so what do we do with that? What should we start to be thinking about? I'll give a much more concise prescription that you could probably write actually on the prescription pad. I'd say less news, reflect on what is going on inside of you and talk to somebody about it and be nice to someone else today.

That would be the prescription for each individual person. I think we could all benefit from less news, which doesn't mean I think we should be uninformed, but I see the constant clicking of the, you know, the news feed and what's, what's new, what's changed, really doing a lot of damage in people. So less news reflect upon what's going on inside of you. So, so many of us, we don't reflect on our inner dialogue. What are we saying over and over and over again inside of our minds, right? To take stock of what's going on inside of us and to communicate about it. That's a start in taking stock of ourselves, even if there's not the weight of trauma there. But very often, some aspect of that taking stock

of ourselves reveals or speaks to the trauma inside of us. And then we can communicate with trusted people around us. And now we have a start towards understanding ourselves and moving forward in ways that maybe we weren't going to be able to before. And just being nice to someone around us. I mean, in many ways, that may sound kind of trite, but it makes a difference. It makes a difference to the person we're kind to, and it feels good, right? It shows us that we're not impotent, right? You know, we aren't just vulnerable and afraid and powerless to change the world around us, right? If we can do something for someone else, it reminds us of the good and

the power inside of us. So I would write a very brief and hopefully more concise prescription that way, because I think that benefits all of us. And then that, of else, like, do you like that? Well, of course that we should have easy access to that. But to actually muster up the energy, the will to just let that guard down, be kind for a heartbeat on the surface. It sounds like, well, sure, everybody can like do something kind, but for somebody who's in the grips of trauma, this is actually probably a pretty heavy lift. I would imagine. Yeah, absolutely. Yes. I think you're pointing out, there's such a great point. You're pointing out something so important, which is to be nice to somebody doesn't imply like, we're all going around like being actively mean to people, right? But often, being nice to someone is an act of vulnerability on the part of the person doing it that, yeah, I've got to feel that I've got something to offer. I've got to expose myself and be a little bit vulnerable to be kind to somebody and hope that the smile or the kind word is reciprocated.

That there has to be some faith in ourselves to do that, right? That we have something to offer, that we can have a human connection, even if it's for a couple of seconds. And so many people, as you pointed out, that is very heavy lifting. And you think about how that cultivates depression in a person, right? They feel so isolated that I don't feel there's enough goodness in me to go out into the world and to do something kind. I mean, a lot of us labor under that. And I've labored under that at different points of my life. And it's a hard way to live. And it predisposes us to all sorts of unhappiness, whether it's the short-term soothing of drugs or alcohol, or it's the weight of depression or sleep disturbance, or just progressive social isolation, right? That it makes a big

difference. And if we can be vulnerable enough to connect with each other even a little bit, then we're starting the needle moving then in the right direction, which is a direction that of course links back to the truth of the person, right? I mean, nobody comes out of the womb thinking that they have nothing to offer to anyone else or that they're useless and worthless. Like that's not built into us. So if we feel afraid and beleaguered and ashamed of ourselves, or if we feel angry and aggressive and we don't even know why, I mean, these are things that come into us artificially over time.

And my thesis, and I believe the world around us shows us this writ large, is that that change, those changes that happen in us happen through trauma and that we can understand them and we do not have to be guided by it, right? Like the idea that trauma is driving the car not have to be guided by it, right? Like the idea that trauma is driving the car and we're in the back seat, right? As the trauma is, you know, yanking us all over the place and threatening to drive us off the road and kill us. Like we, it doesn't have to be that way. And we can start one small step at a time to understand ourselves, anchor ourselves to the things that we know or that we knew, right, are true about us that we can access

again, and be in the world in ways that are much more consistent with what we choose, right, with how we want to be in the world. It's a process of being reflective and intentional, but it's also a process of simplifying, right? Good mental health is always consistent with simplicity and simple principles. Once things become too complicated, we're straying away from good mental health. So part of the goal here is to anchor back to some of those first principles of just being healthy in ourselves and being healthy in the world around us. And the notion of being aware and intentional also, I guess that's really the question that pops up around that for me is how do you actually know? So you can be aggressive. You can be anxious. You can feel depressed. You can feel like you're low

energy. You can feel shame. You can feel all of these different things related to trauma or for completely different reasons. If you are in the grips of trauma, and part of that is that it affects your level of self-awareness, how do we actually know? How do we recognize if the thing that's happening underneath us, that is a part of the way that we're feeling and moving into the world, is trauma, and then start to address it as such, or, or if it's something else, like how do we actually plant that seed of awareness where we can say, oh, this other thing is happening. And now I can start to take steps that are more aligned with how to address that.

Right. I mean, it can, it may sound overly simplified, but, but, but it's not right. That the first step is just to decide to look in ourselves and observe ourselves, which we so often don't do. So I'll give you an example of a person who was really underperforming in many, many roles, right? Occupationally, romantically, right? You think, why isn't this person's life better? And in trying to help the person in the early stages of our work, I started asking, what's going on inside? Like, what are you thinking inside? You know,

what are you talking about inside? And, you know, there's like a lot of us, we're not trained to do that. It's like, what do you mean? I'm this way, I'm that way. But no, no, what's the dialogue going on inside of you? And then what we learn is this person was saying over and over and over and over again, how worthless they are. And we were doing it hundreds and hundreds of times a day. And that was like a surprise. And it often is a surprise. Like, wait, this is going on inside of me, right?

Or like every time something doesn't go perfectly, I say to myself, like, what an idiot. And we don't know that unless we look inside. And we say, well, are there these patterns inside of me? What am I saying to myself? How am I treating myself? And then how is that impacting me? The idea that when I was a kid, people would say that the soup that you're swimming in, what's the soup that we're swimming in, right?

What's the environment I'm creating in myself? Is my life going to get any better if I'm saying to myself like several thousand times a day that I'm worthless, right? Or that I can't do anything right. And so day that I'm worthless, right? Or that I can't do anything right. And so where's that coming from, right? So it's just one example that the first step is to self-observe. Like what is actually going on inside of me? What's my internal dialogue like, right? What's my belief system about myself in the world? And then once we start doing that, we can generate curiosity, right, about ourselves. Like, oh, that's interesting. Like,

you know, the person I'm telling you about was very interested and hadn't thought before that he was saying this to himself over and over and over and over again. Then we were able to look at the roots of that. And the roots of that were childhood trauma. And we were able to go back to, well, is that really the person's belief? Do they really believe that they're worthless and hopeless because what other people hurt them when they were a kid? Is that really the truth? Is that what they would feel and say to someone else? And then the person is able to ground to a sense of self that is actually a true sense of self. That is how they really feel about themselves because they're anchoring to themselves before the trauma. And then life, you know, in this specific case,

and in many others like it, moves ahead in a way that's very, very different, right? Like that person's life is tremendously better now than it was before. So it's just, it's one example, but it shows, I think the answer to the question is to first look inside, right? It's as if there was a room in your house that was very scary and had many, many scary things in it. And you know what to do about it? Well, the first step is to like, okay, open the door and look at it. What's actually in there? There's nothing going on inside of us that we can't look at. It's too frightening to look at. And that's what keeps us really under the yoke of trauma is that we don't open that door, look inside, shine the light around and take stock of what's there. Why? Because we feel too guilty, too ashamed.

Oh, if we look at that, we'll start crying and we'll never stop. Or if we tell anyone, they'll be so ashamed of us, they'll never talk to us again, right? Like these are the lies of trauma that trauma loves, right? Because it keeps it secret inside of us, right? And guilt and shame and anger and resentment and despair then fester inside of us. And if we start looking inside, we see, okay, there may be work to do, but there's nothing that we need to be afraid of. And that's a huge, that can create an absolute sea change in us. And I've seen that happen more times than I can count, right?

The positive change that comes from looking inside of ourselves and ultimately not all of the time, but I think most of the time, the end result of that process is looking at trauma, processing trauma, being able to deal with the grief going back to the beginning of our conversation, right? That comes along with trauma. And then life seems is simpler, right? Clear, and better. And it's the opposite of all the chaos and fear and hiding and guilt and shame that so many of us are laboring under. And I know because I just see this day in, day out in my work over the last 20 years, in all aspects of my life, personal and professional, I see how this plays out in us, and how it's not that hard to make really significant inroads of improvement.

So powerful. And it really, it does start from that moment of just asking the question, you know, rather than gaining the ability to just be, you know, a heartbeat curious about what's actually happening under the hood. Yes. Going inside. And I agree. I think, you know, we are in a moment where a lot of people are asking questions like that. And I hope it's a moment of inflection and change. So it feels like a good place for us to come full circle in our conversation as well. So sitting in this container of good life project, if I offer up the phrase to live a good life, What comes out? Be nice to ourselves. Think about ourselves. Be nice to other people. Think about them too. Ground ourselves to some of the simple truths

we knew when we were younger that it's so easy to forget as we move through life and its struggles, trauma-related or not. Ground to the good things we learned and knew were true. And for most of us, we're fortunate enough to know those things when we were younger. And if we don't, we can learn that we can help one another no matter what's going on inside of us or how bad we may feel. There's goodness to anchor to. Thank you. You're welcome. Thank you. I so appreciate you having me on. Thank you. Hey, before you leave, if you really enjoyed and benefited from this episode, You're welcome. Thank you. I so appreciate you having me on. Thank you. already done so, go ahead and follow Good Life Project in your favorite listening app. And if you appreciate the work that we've been doing here on Good Life Project, go check out my new book, Sparked. It'll reveal some incredibly eye-opening things about maybe one of your favorite subjects,

you, and then show you how to tap these insights to reimagine and reinvent work as a source of meaning, purpose, and joy. You'll find a link in the show notes, or you can also find it at your favorite bookseller now. Until next time, I'm Jonathan Fields, signing off for Good Life Project. The Apple Watch Series 10 is here. It has the biggest display ever. It's also the thinnest Apple Watch ever, making it even more comfortable on your wrist, whether you're running, swimming, or sleeping.

And it's the fastest-charging Apple Watch, getting you 8 hours of charge in just 15 minutes. The Apple Watch Series X. Available for the first time in glossy jet black aluminum. Compared to previous generations, iPhone XS or later required, charge time and actual results will vary. Mayday, mayday.

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