HealthyGamerGG - Let's Talk About Trauma (Deep Dive)

Episode Date: May 13, 2023

🎙️ Dr. K dives deep into trauma, revealing its pervasive impact on our lives. Trauma masquerades as chronic depression, impulsivity, repeated mistakes, and somatic problems, affecting up to 60% of the population. Through therapy and understanding, we can integrate emotions and transform our lives. 🌟 Don't miss this powerful podcast episode on healing from trauma! 🎧 Learn more about your ad choices. Visit megaphone.fm/adchoices

We're going to be doing a deep dive today into understanding trauma. Why are we doing a deep dive about this? It's because trauma manifests as so many problems. And it's the kind of thing where trauma is sort of a whole brain or whole person effect. And so you can't slice it up into one piece. Because trauma sort of affects every aspect of who we are, how our brain functions, how we form relationships. So it's the one topic that it's been really hard for me to try to chop up into pieces. What does this mean for you?

What this means for you is that a lot of what I'm going to teach today may not fit right at the beginning. Because what I'm trying to do is paint a picture of how trauma affects a human being. And so I ask you all to bear with me and stay through to the end. And hopefully what we can do is help things click. So what is trauma and how does trauma men? manifest. And this is where, in my experience as a psychiatrist, trauma is the great chameleon of mental illness. And what do we mean by that? That means that trauma looks like all kinds of other stuff. So what I've sort of found working with people

over and over and over again is that they come in with a particular problem, like a lack of motivation, or even things like I keep on making the mistake, the same mistake over and over again. or I have chronic depression. I've been depressed my whole life. And it turns out even things like addictions, all of these are trauma masquerading as something else. And so this may sound kind of surprising, but let's actually look at some of the manifestations of trauma. Okay. So let's start with this.

So trauma is the great chameleon. And what that means is that trauma looks like other things. So here's a list of things that trauma masquerades as. chronic depression. So what does this mean? This means that there are some people out there who say, I've been depressed my whole life. So in psychiatry, we understand that mood disorders, like major depressive disorder and bipolar disorder, are episodic.

So they come and go. But there are some people out there who have been depressed their whole life. Okay. It turns out this is more likely to be due to something like trauma. There's also other interesting evidence to support this. For example, there was recently a meta-analysis that came out that challenged or made a very strong argument that depression is not caused by a serotonin imbalance in the brain. And if you ask them, okay, if it's not caused by a serotonin imbalance in the brain, what is it caused by? And they basically said trauma.

Okay. So if you've been depressed your whole life or for extended periods of time, could be trauma-related. Second thing, impulsivity or a lack of unifying direction. And how are these two things related? Well, I live my life kind of in an impulsive way. So I don't have any sort of direction. I just kind of do what I feel like in the moment. Sound familiar?

Okay. Next up. Vulnerability to repeated mistakes. What does that mean? This means you make the same damn mistakes over and over and over again. Sound familiar? Turns out there's data that that's related to trauma. The inability to take risks. Afford to take risks. Turns out related to trauma. Number five. Being a people pleaser. I am a people pleaser. I don't know how to stop. Turns out, could be related to trauma.

This is another one. Okay? Really important room. Something called the paralysis of initiation. What does this mean? This means that sometimes we can't bring ourselves to start stuff. We essentially live life in a reactive manner. If something happens to me, then I can respond to it.

if I have some sort of external stimulus I can act, but I can't initiate things on my own. Turns out it's related to trauma. Number seven, can't moderate relationships. What do you mean by can't moderate relationships or maybe can't engage in moderate relationships? So the relationships that I engage in are super extreme. So it's like, either it's like we're BFFs or we're enemies or I'm a doormat and this person like treats me however they want to. I always call them. They don't call me, right?

It's like there isn't balance in relationships. Okay. Next thing, really, really, really common is. somatic problems. And what does this mean? That means problems with your body. And then you may say, but Dr. K, if you have problems with your body, isn't that a medical illness? Sort of.

So if there is a diagnosable medical illness, then it is a diagnosable medical illness. If you do something like a biopsy and you have inflammatory bowel disease and we understand that there is a pathophysiology to your physical problems, right? you have an illness, then it's an illness. But what we see in people with trauma is that they have all kinds of physical problems, which if you go to a medical doctor, they're going to tell you to see a psychiatrist. These are things like IBS, chronic fatigue syndrome, fibromyalgia, pots, postural orthostatic, hypotensive syndrome.

There's all kinds of weird. So if there's something weird going on with, your body that a doctor's like, eh, I don't know what's wrong with you. Chances are, it's related to trauma. So if y'all are looking at this and you're saying, but Dr. K, this sounds like really common stuff. But I thought trauma was like pretty rare. And maybe you're listening to this and you're kind of thinking like, wait a second,

like I wasn't abused or anything like that or maybe unfortunately you were. But this sounds like really common stuff that everyone deals with. And you are correct. This is really common stuff that everyone deals with, and it turns out that it's related to trauma. So let's do a quick analysis of some statistics. Okay. So remember when I said that major depressive disorder may not be caused by serotonin imbalance, but could be related to things called adverse childhood experiences or ACEs.

The percentage of the population that has had adverse childhood experiences could be up to 60%. Now, what we've sort of discovered about, trauma is that there are things called post-traumatic stress disorder, which requires you to have like five out of nine of these very discrete things, like hypervigilance and like re-experiencing and nightmares and stuff like that. But it turns out that the mechanisms of trauma, like all of us basically have some kind of traumatic experience in life, right, because our parents aren't perfect, schools aren't perfect, kids aren't perfect. And as we have these kinds of traumatic experiences, we don't have to have five out of nine. It can manifest as like one out of nine. So even if

you're not diagnosed with a trauma-related illness because your function is not impaired, you can have this common crap and you can have like two of them. And it turns out that we understand the mechanism of this stuff relates to trauma. Trauma is sort of a unique illness. And the reason it's so common is because trauma is not a pathology of the brain or the mind. It is an a normal adaptation to a traumatic circumstance or experience. So this is something that we have to understand. When we look at mental illness, we assume that mental illness is something in the mind that is not working the way that it's supposed to. It's a pathology.

So if you look at like autoimmune illness, okay? So this is when our immune system attacks us. That is not what the immune system was designed for. The immune system was designed to attack things that are not us. Okay? So this is what we call a pathology. It's a part of my body that is malfunctioning. When we look at something like, let's say, bipolar disorder, we're not, and if we look at a manic episode and bipolar disorder or psychosis, right?

So in a manic episode, we don't sleep and we hallucinate. So the brain is not supposed to not sleep. It's a normal thing to sleep every day. It is also a normal thing for the things you see to actually be there. Right? Like, our eyes are supposed to perceive things that are there, not things that are made up. Bipolar disorder is a pathology. It is a malfunction of the brain.

But trauma is different. Trauma is not a malfunction. It is an adaptation to a circumstance. Okay? So this is part of the other reason why it's so common and why it can masquerade as so many different things. Because really what trauma is is our brain. attempt or our whole body's beings attempt to deal with crappy circumstances. It's a survival mechanism, right? It's an adaptation. This is something that really needs to be

understood. So if you have some kind of trauma and you're kind of screwed up as a result, you're not actually screwed up. And this is why I think there's a lot of hope for people with trauma. Even though their problems seem really, really insurmountable, it's actually very surmountable because there's not actually anything busted with you. it's just your body or brain's attempt to adapt to a bad circumstance. Okay, so the circuitry actually works, and we'll get into that, all right? What is like the mechanism through which the mind adapts to stuff? Okay.

This is where I'm going to draw a little bit on Eastern psychology, because I think they explain it really, really well. So as we go through life, we have experiences. Okay, so something happens out there. And if, let's say someone, I'm at the playground and someone throws a ball at the back of my head and it hits me in the back of the head. So there are some kind of sensory experiences that happen. There are emotions that come with that sensory experience because what is an emotion? An emotion is a very, very rapid way to present information to my mind. So I don't have time for analysis.

So instead, what my mind is going to do is it's a very, it's going to make me feel angry. And anger is a way that I know how to respond rapidly in a situation. So anger is like when we don't have time to sit down and think about what's going on, our body has these scripts that it's like, okay, activate anger. Now that we're activating anger, like I know how to respond immediately within the situation. So anytime there are experiences, there are emotions that come with those experiences. Then what happens is those emotions either get processed and digested properly,

or they don't. And if they don't get processed and digested properly, they sink into us. Then what happens if we face that circumstance again, like we see the kid who threw the ball, then those emotions arise back up. Okay? So they come back up. And now all that has to happen is I have to see the kid and I feel pissed off, even though nothing has happened. So our mind stores that emotion, recognizes some kind of pattern. The emotions arise again. And this is a trigger. Okay? Now, as we go into the science of trauma, what we kind of discover is that there are five major domains that trauma affects within a person. Okay? The first thing it affects is our affect, which means our emotions. So it changes the way that we relate to our emotions. And

specifically, it does a lot of stuff with anger and also self-destructive behavior. You may wonder, wait, what does that have to do with emotions? So if you think about, like, a lot of the self-destructive behaviors we engage in, everything from cutting or self-harm to even things like addictive or shooting ourselves in the foot or procrastination, all has to do with affect dysregulation. Trauma dysregulates the way that we manage our emotions. Second thing that affects is our sense, our consciousness and attention. So what do I mean by consciousness?

So our ability to focus, our ability to go to sleep or be mentally checked in, right? So we'll start to check out mentally. Third domain that it affects is self-perception or identity. As we go through traumatic experience and we'll go into all the detail, okay? It changes the way that we view ourselves. Fourth thing it affects is relationships. The reason it affects relationships is because trauma is almost always inflicted by another human being. And so when other human beings inflict trauma on us, it changes the way that we view relationships. Okay. And so we carry certain important learnings, oh, like watering hole crocodile. We start to be

scared of any body of water. Okay? The fifth thing that it affects is our somatic self. So what we sort of know is that there's tons of research that starts with even Freud who notice that people who have traumatic upbringings have changes to their body and they have lots of somatic complaints. Okay. So these are five domains that trauma affects. So what does it take for something to be traumatic? The most important element is coercive control, an environment of coercive control. Now, this is what's kind of confusing for people because people think, okay, hold on a second. So isn't sexual assault traumatic? And the answer is, it can be. And then some people may say, but hold on, what about things like genocide? Isn't genocide traumatic? And this is where like literally according to the data,

the answer is that it can be. So if you look at a population that is affected by like a genocidal war, right? And hopefully some of them escape, which is why they're still alive. What we discover is not everyone develops PTSD. Not everyone who's in a prisoner of war camp experiences PTSD. Not everyone who is sexually assaulted experiences PTSD. So what trauma research has sort of figured out is that a key aspect is coercive control. And what does that mean? That means that you grow up in an environment where someone is coercing you and controlling you. So what people sort of figure out, is, and this is what's really interesting, you can look at trauma research, and what you actually figure out is when researchers look at, like, guards from concentration camps and abusive parents,

what they figure out is everyone uses the same techniques. And so human beings intrinsically know how to control other human beings. It doesn't have to be taught. It's discovered. So here's kind of what happens in the mind of an abuser. What they want to try to do is destroy your autonomy. And so the way that they destroy your autonomy is by imposing certain kinds of limits. But this is what's really important. So it makes some sort of petty or arbitrary rule. The rule doesn't have like much function, right? It doesn't really matter if I put my jacket away or put my shoes away.

But the abuser is like, you, you do it in this order because I told you so. And so what they're doing in that moment is destroying your autonomy. This is key. key part of traumatic people, abusers, is that what they want to do is if they treat you unfairly all the time, then you're going to mentally check out because there's like this person is unreasonable. They're like the weather. There is nothing I can do to control them.

But the moment the person starts doing nice stuff to you, now suddenly you know, okay, I can get the nasty parent or I can get the nasty parent or I can get the good parent. And so the way that they chip away your autonomy is by actually creating an environment where the person who is traumatized feels like they are in control by like not pissing this other person off. So they know that this person is capable of kindness. And so if I behave properly, then this person will be nice to me.

It engenders a dependence on the abuser. for all things good and all things bad, right? Because that's the only way it's going to happen. So I become dependent on this person because this is the person that brings me the treats and this is the person that brings me the punishment. But if I ever get the treats from one person and the punishment from another person,

then I'm going to become independent. Because I'm going to say, F, this person. So in the abusive relationship, what they actually do is they're very careful. We sort of see this. We'll call it love bombing, right? like this person is nasty me and then they love on me. What happens in the mind of the abused person is that this abuser becomes God.

This is the bestower of health and happiness. This is the bestower of being able to go to bed at night without bruises on my body. And so when this happens and this is what people will intentionally do, they'll create petty rules, right? Things that are not justifiable. and there's a lot of unpredictability. Because if there's unpredictability, then the person kind of engages in the behavior. We sort of see this with loot boxes,

where when there's a random reinforcement schedule, we play the game over and over and over again. And so if I know that sometimes if I behave myself, if I get a chocolate cake, I'm going to keep playing the game over and over and over again. Traumatic abusers were the original loot box. Lutebox 1.0. Okay?

And so over time, what this person will do is engender dependence on the person who has been traumatized. As we become dependent on the abuser, a couple of things start to happen. The first is that independent action becomes insubordination. And when independent action becomes insubordination, what does that do to your sense of autonomy? destroys it. If your sense of autonomy is destroyed, how can you initiate actions? You can't, because you were taught that independent action is insubordination. Second thing is that in traumatic relationships, there is no room for trial and error, because if I talk back, I'm going to get beat. I can't test boundaries. It's about survival. No Impala or Gazelle. No Impala or Gazelle,

goes up to the edge of the water and debates the crocodile. It's insane. We debate people in places like video games where there's no real consequence. We do not debate crocodiles. I mean, jabate crocodiles. We also don't debate crocodiles. So this is where we see another aspect of the paralysis of initiation for people who are traumatized, which is that if I have learned that trial and error is absolutely a mistake,

I can't try anything. What that means, if I can't try anything, it has to be a perfect success. And until I can get it to a perfect success, I cannot start. So if you are someone who looks for perfection before you get started, could be a trauma response. So what we discover in research on people who've been traumatized is they have emotion-focused coping. So if I'm hurt, I focus on fixing my emotions because I can't control anything. outside of me. So I can't stop my parents from being abusive. I can't stop the prisoner, I mean, the guards from hitting me. All I can do is focus on my internal emotional state because I fundamentally do not have control around me. So then my brain learns when I am

suffering, don't change anything out there because changing stuff out there is futile. What I need to fix is in here. So I'm going to do what? I'm a dissociate. Or I'm going to use. I'm going to use drugs, right? So there's very high correlation between substance use and people who have been traumatized. Because fundamentally, the way that you learn how to fix problems is within, because I can't control anything outside. Then you carry that learning with you. So now, when my professor says, your paper was due today, and I did not receive a paper. So I have to doc you 10 points, but give it to me by the end of the weekend, and you can still get a beat. This is a problem. And how do we deal with problems? We deal with them using emotionally focused

coping. So how do I fix this problem? I get smashed. Because this hurts. And what do I do when things hurt on the inside? Can I fix things on the outside? No, no, no, no. I cannot fix them on the outside, so I have to fix it on the inside. So when I have problems, problems are fixed by fixing emotions. And in order to fix our emotions, we're going to do stuff like get addicted to substances. And now we begin to see like why this sort of becomes an addiction, because instead of fixing the problem itself, all I know how to do is use substances to fix the emotions, because that's the strategy that worked. And if I'm fixing the emotions

and that's the strategy that worked and I'm getting drunk, let's say, or smashed, then Monday rolls around. My paper is even later and now I get a C. And now I get a C, what am I going to do? I'm going to drink more. And so it becomes a cycle

of increasing problems, followed by worsening emotions, followed by increased problematic behaviors. So this is what's bizarre is there's so many different things going on. There's relationships. There's identity. There's even the inability to concentrate.

There is emotional suppression. There is inability to think about the future. There is living life reactively. There is focused on emotional coping instead of actually fixing your problems. All of this is related to trauma. And it manifests as so many different things. So many different things. Right?

Our big list of chronic depression. I can't stop watching porn. I'm living my life like an NPC. If someone comes up to me and initiates, I can do stuff. But I can't have direction. What do you want? I want an amalgamation of what other people want. No, what do you want?

I don't know what I want. Why don't you know what I want? I don't know who I am. Why don't you know who you are? Well, because my brain, when I was growing up, adaptively fractured different parts, created problems like hemiscus. lateralization, and we're not even touching on things like cortisol and all this kind of crap.

And since I dissociate from my emotions and I have no upward momentum in life, all of this negative energy and anger is going to start manifesting in weird ways in my body. Now, asking the important questions, can you change? Answer is, absolutely. remember that our brain is fragmented, but it isn't broken. So I've had a ton of very positive experiences as a psychiatrist in helping people with trauma. People think that things like borderline personality disorder or narcissism are permanent because this is the way I was wired, right?

Thankfully, not correct. You can put all these pieces together. You can absolutely wind up here. like this again. Absolutely. And the data even supports this. Ninety-one percent of people who have borderline personality disorder will be in remission at the 10-year mark. The natural history of the human body and mind is to heal. That is the natural history of the human body in mind. That's what's super cool about it. Don't give up hope. Because remember, you're not actually broken. Nothing is, I mean, it's pathology, but it's not a malfunction of some fundamental circuit, right?

It's not like you've got like a lysosomal storage disease where there's some like neurotransmitter or some receptor that's just coded incorrectly and you're like SOL. Not like that at all. We just have to put the pieces back together. How do we do that? Number one, safety and stabilization is like high cortisol, high stress, high emotion, leads to dissociation, leads to fragmented identity, right?

So the first thing you've got to do is be safe. Very hard to heal trauma if you are actively getting traumatized. A simple way to put it is you can't learn how to swim if you're drowning. The right way to learn how to swim is get out of the water, catch your breath, and then go in slowly. So this is where I hate to say this. And I wish that we lived in a world where you could just listen to this lecture, wake up tomorrow, and by force of will, fix yourself. But it starts by fixing your environment.

Now, what is fixing your environment look like? Thankfully, it's, so I would say strive for independence or limitations around the toxic people. So this is where you don't have to fix everything. Watch out for your mind. that's like what it does with that, right? So look at the reactions of your mind. Sometimes it's as simple as seeing a therapist for one hour a week. That can be enough of a platform for you to rest on and start to branch out in the rest of your life.

But safety and stabilization is the most important thing. The second thing is we need to deal with anxiety and emotional coping. We need to, the foundation of a lot of this stuff is the disinternation. of our emotions. That doesn't mean the absence of emotions. That means literally the disintegration. So this is why things like DBT or dialectical behavioral therapy are so effective. We also have things like EMDR. It works somewhat differently. These are two evidence-based treatments. But we also know that things like meditation, exercise, et cetera, can all work for this kind of stuff. Very practically, what this means is that if you are experiencing some kind of

negative emotion, the most important thing to do is don't go towards the emotional coping mechanism. Okay? So here's what happens. When I have negative emotion, there's emotional coping, which reduces negative emotion. And now what I've done is I've taken that right hemisphere and I've shut it off. But the whole point is we need that emotion. We literally need the emotion. It's a part of the integration. So we've got to stop doing this. Now, this is what's super cool. When we do something like psychotherapy, what we do is we help this person take that emotion, go over to Broca's area, and put it into language. Now, if I'm about to say something, that I do not expect many of y'all to believe.

But it is true. Language can substitute for action. Biggest misunderstanding in society today is that if you have a problem, you have to fix the problem. Literally, Freud came up with this concept and it has been tested. Language can substitute for action.

100%. We see it time and time again in our coaching program. We see it in psychotherapy. A lot of people don't sign up for this stuff because they're like, I don't understand how talking about it makes any difference. The problem still exists. And literally what I hope I have done at this point is when you articulate there is integration. When there is integration, there is flow state. and when there is flow state, there is improvement. Because here's the problem. So here's the other thing to remember. The frontal lobes are here too.

These are the parts of your brain that plan and execute tasks. But as long as this corpus callosum is severed, that emotion you cannot use to fuel you. So literally, this is what we've seen. There are people who have been traumatized and they will go to psychotherapy. We will teach them how to integrate their emotions and they turn their life around.

You know how to find a job. You know how to build a resume. You know how to Google that crap. You know how to ask GPT to do it for you. The problem is not in not knowing how to do it. The problem is that your brain doesn't do what it's supposed to do. Why does your brain not do what it's supposed to do? Because it's split into a million pieces.

It's not a brain. It is a thousand different friends. fragments that are all dissociated from each other and can't actually do anything. Language is a substitute for action. Crazy. But true. And we kind of know this, right? So there's like stuff about cognitive dissonance, just to give you all a random example.

If you get someone to say that they're going to do something or believe that they're going to do something, it makes them more likely to do it. You know what I mean? So like that cognitive, like once you say something, you're like, it's hard for you. you to not do it. There's all kinds of connections, like literally in your fucking brain. Broca's area where we articulate things and the frontal lobes where we plan and execute action, especially on the left side of the brain, are connected. And we sort of know that like, if we look at things like motivational interviewing and coaching and stuff like that, our

methodologies, we don't teach people anything. We just get them to articulate it. And you can't articulate something unless you understand it. Once you understand it, I'm not talking about information. I'm talking about understanding. Then you start doing it. And what do you do when you start doing it? What is the thought that you have? Oh, crap, this was actually way easier than I thought. This is the value of understanding. Understanding comes from integration. Integration comes from articulating your emotions. So articulate your emotions. The last thing. I'm going to teach you all a meditation. Iq tatva abjas.

Ektvyaas, literally take 10 minutes a day, 15 minutes a day, and just do one thing. I'm not even saying make it productive. If it's hard to do productive things, you don't have to do productive things. Put this away when you eat. When you're taking a poop. poop completely. Grab a cup of tea and drink it completely. When we do ektatva abyas,

put your full attention into the one thing. It can even be a breath. For one moment, do it with me now. Close your eyes. Feel the breath. That's it. And for a moment, think about nothing else. Chop wood, carry water.

Focus on one thing at a time. that's it. If you look at trauma treatments, they're very, very complicated. But I hope today that if you all have, hopefully, I don't know how to do this, but I tried to explain what trauma is. So don't give up hope

because actually the majority of evidence suggests that you will get better. There are things that you can do to accelerate it. And the cool thing is that no matter which of these problems you have, and maybe the reason that you don't have a diagnosis because you don't have all of them. Because remember, in mental illness, we need the majority of it. But what I found time and time again is whether people are like directionless in life,

living life on autopilot, can't concentrate, keep on running away to emotional coping mechanisms. This is a trauma is the gold mind to transform your life. Because it is the fundamental way that our brain works and the way that we interact with the world, the way we find direction, the way we execute tasks, the way we form. relationships, all of it can be found in trauma, which is why it is the great chameleon, because it looks like a thousand different problems, but it's all one problem. And that problem has to do with the way that your brain works. And if you can conquer this one thing, and honestly, it's not that hard, you can start,

I mean, it's really hard, but it's very doable. And start with simple things like don't run away from your emotions, articulate your emotions. The real tragedy of this stuff is that the reason we saw. suffer. The Buddha says that the reason we suffer is avidia ignorance, which really confuses a lot of people. But this is why. If you play a game and you don't understand the rules, it's going to be painful. But once you understand the rules, okay, item timings, rotations, the flow of the map, you can play the game well. And if there's one thing you want to learn about how to play the game of life well, understand trauma.