The Checkup with Doctor Mike - Are We Overusing The Word "Trauma" & Critique Of The Body Keeps The Score

Episode Date: January 19, 2024

Professor George Bonanno is a world-renowned expert on Trauma and has spent decades teaching at Columbia University in NYC. His opinions on the subject have gotten him in some hot water online too, as he believes our cultural understanding of trauma is incomplete and often incorrect. Buy Professor George Bonanno's book "The End Of Trauma" here: https://www.amazon.com/End-Trauma-Science-Resilience-Changing/dp/1541674367 Follow Professor Bonanno here: Twitter/X: https://twitter.com/giorgiobee Instagram: https://www.instagram.com/giorgiobee/ Linked In: https://www.linkedin.com/in/george-bonanno-610a0a22a/ 00:00 Intro 1:20 Are You Really Traumatized? 16:37 What’s Wrong WIth Psychology Today? 20:44 How To Overcome Trauma 26:00 Repressing Memories 29:05 Emotional Trauma Causing Physical Symptoms / Psychosomatic Stress 47:52 Getting Over Breakups / Coping Mechanisms 54:23 Addressing His Controversy 57:55 Resiliency 1:05:20 Post-Traumatic Growth 1:11:30 Addressing His Controversy Pt. 2 1:15:27 PTSD 1:20:15 Fixing Modern Psychology 1:25:03 My Trauma 1:28:25 Social Media Executive Producer and Host: Doctor Mike Varshavski Produced by Dan Owens and Sam Bowers Art by Caroline Weigum

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Visit RBC.com slash Ion Cards. Td Bank knows that running a small business is a journey, from startup to growing and managing your business. That's why they have a dedicated small business advice hub on their website to provide tips and insights on business banking to entrepreneurs. No matter the stage of business you're in, visit td.com slash small business advice to find out more or to match with a TD small business banking account manager. I went through some childhood trauma stuff that I never really talked about on social media, but I was always under the impression that that was somehow going to impact me to this day negatively.

And it didn't. And I always felt like I was doing something wrong because it didn't affect me negatively, as if I should have been traumatized, but I'm not, that means I must be repressing it. What you went through is actually the empirical norm in a way, that you went through something untoward in your childhood and it didn't cause destroy your life right and that's resilience and that is the norm not i don't mean to take away anything from you yeah but so that's what we need to know that please welcome professor george bonanno to the checkup podcast he actually came across my radar when one of his students from columbia university sent me an email saying

that the professor actually debunks a lot of the misconceptions that exist in popcorn culture surrounding trauma. I was immediately interested and read the entire book, The End of Trauma, written by Professor George Bonano. And it was a fascinating read. There's so many things that we get wrong about trauma, so many misconceptions. I'm excited to talk to him about trauma, grief, resilience. Hope you enjoy the conversation as much as I did. Let's get started. I frequently talk about the intersection of physical and mental health on my YouTube channel because I've seen a pattern emerge within my patients where their mental health contributes to some of the physical symptoms they experience. And that is something that was not

talked about in their education. So they oftentimes either push back on it, push back on it from disbelief, from feeling like maybe I'm not taking them seriously and saying it's all in their head, which is the exact opposite of what I'm truly trying to say. And in talking about that, I mentioned a book called The Body Keeps the Score, very popular, very cult-like following these days. And one of your students, I believe he's a master's student, reached out, asked me to not use his name on the email, and recommended that I read your book, The End of Trauma. I've recently went through it, finished the book, great read, a lot of valuable insight, so I have to congratulate you on a job well done there.

Thanks so much. And obviously highly recommend it to the viewers as well so that they can check it out. My question to you is, first and foremost, what is trauma? Trauma is, well, there is a very clear definition of trauma that the DSM uses a diagnostic and statistical manual, which is the Bible of mental disorders, which is, well, they used to use a better definition, in a violent or life-threatening event outside the range of normal human experience something, you know, extraordinary. And then I add to it in my mind, my own personal understanding of it, something that will

activate the deepest kind of primitive stress response we have, something that sets off all the alarms in our brains and you are in big trouble. And how has that changed now that you said, like before it used to be more accurate, now it's less accurate. Okay. Let me qualify this also real quickly. That's a potentially traumatic event, I just. described, not a trauma. I misspoke there when I said that. So the whole idea of trauma

is complicated because of the way it's defined in the DSM, the way PTSD is defined. It's defined as requiring an event and then a certain collection of symptoms. The event itself is what I think confuses the world so much. So initially that event was defined as I just mentioned. Then it expanded to include more subjective reactions. The idea that, well, these people didn't have an event like this, but they look traumatized. They look they have PTSD. So we need a broader definition.

So it kept expanding out to include subjective experiences. And that was like a Pandora's box. Once you open it, you can't close that up again. Sure. And we're still struggling with it. This reminds me, and we spoke earlier about this off camera, of Jonathan Heights's work, where he talks about the concept creep phenomenon where the concept of trauma started there and started expanding further and further.

Do you feel the concept of trauma is now including events or feelings or symptoms that may not be true trauma? Professionally, to some extent, socially, culturally, immensely so. Right now, culturally we have just expanded, you know, the kind of colloquial, you know, everyday lay person's definition of it is expanded so broadly it's it's almost impossible to even use the term anymore what what problems arise from the overuse of the word trauma um people think the slightest things are traumatic now and they this is in our language you can't control language right language does what it wants but the you know you you find people talking about being traumatized by things that are merely upsetting and i think on the surface that might seem harmless, but I don't think it is because it's led to,

it's part of a broader cultural trend, I think, to see difficulties as major life crises, to self-diagnosed, to see common struggles as signs of psychopathology. And the idea that trauma could be almost anything fits right in there. So if you're a person who lost a family member, went through a breakup, maybe was someone said something negative to them at the store. How does one define if they have trauma or experienced a true traumatic event? Well, so there's a bit, I used a term only exclusively. I use the term potentially traumatic events, and the acronym PTE. And I've forced myself to do that 10, 15 years ago. And it took some effort because trauma's in our cultural language now. But a potentially traumatic event

is different. That's an event that's potentially traumatic, meaning potentially you could be harmed very seriously. You could be, you know, deeply wounded psychologically. So potentially traumatic event happens and then a trauma is when essentially you can't get over that event. That's a traumatic experience. So for these PTEs, potentially traumatic events, what barometer do you use for it to reach the PTE stage? I don't worry about that a whole lot because I don't particularly have a need for that. That's more of, I think, a diagnostic issue. You know, I haven't seen patients in a number of years.

It's really, and diagnoses are more for, typically for insurance purposes. But, you know, I think we would, I would consider events that most people could agree on are outside the range of normal human experience, violent, life-threatening, you know, the kind of events that don't come across. your life very often, and those would be potentially traumatic events. That said, though, I'll look at something like divorce, loss, going in the hospital for major surgery. Those things can be scary, and they could be potentially traumatic to some people. So, you know, keep that idea a little bit open. And in my own work, I look at events one at a time. So I'll think, all right, let's look at what,

we have done this looking at what having a heart attack is like, right? And so we take that event at face value, we know that it does cause in some people PTSD and it's scary because it's life-threatening, right? So that would qualify, you know, in that broader set. Since

it's more broad of what things fit in, is there anything specific that we potentially think of traumatic events, that you would view that this is going too far in calling these potentially traumatic events? Well, it's a little hard for me to answer that because I'm around, because I teach at a university, so I'm around wide range of young adults to adults.

And I hear the term all the time being used to describe even an exam or, you know, being yelled at by somebody, you know. So I hear it used for those terms, you know, those sort of more everyday situations. And in those everyday situations, what's the harm of labeling them as potentially traumatic events? It potentially makes them sound like you will develop serious psychological problems from them. It undermines the word itself. There are some people who are seriously traumatized and can't get over those events and those people often need help. And in a sense, puts them in the same category. And so basically undermines the category. You know, it does a lot of different things.

I think it also falls into part of this idea that it takes the responsibility away from how we feel and how we react in life. If a traumatic event, if everything is a traumatic event, it's not my fault if I am upset to it. It's not my fault if I can't function right now. And I see this, you know, I don't know be too critical or too cynical here, but I do see it in younger students, that there is a sense of, I can't do what's asked of me. because I'm traumatized right now. And therefore, I have no responsibility.

That's what I'm so interested in how this connects to the broader scheme of things. Thinking outside of the specifics of trauma, grief, resilience, more so let's talk about something in my primary care space, obesity. The American Medical Association has classified obesity as a disease. The culture is moving into saying that being obese, is not a choice. And we've medicalized obesity, very much so, by creating medications.

OZempic is very popular in the news right now. And people are taking OZempik and seeing weight loss as a result as a psychoactive medication because it's driving behavior change more than anything. It's not that it's doing something metabolically to help you lose weight, it's just discouraging you from eating more, so it's changing your behavior.

And I'm curious where you land on the topic certain things being a choice or being our fault or us having control over our body functions. Where do you land on that? Don't miss Swiped, a new movie inspired by the provocative real life story of the visionary founder of online dating platform, Bumble. Played by Lily James, Swiped introduces recent college grad Whitney Wolf as she uses grit and ingenuity to break into the male-dominated tech industry to become the youngest female self-made billionaire. An official selection of the Toronto International Film Festival, the Hulu

original film Swiped, is now streaming only on Disney Plus. Reading, playing, learning. Stellist lenses do more than just correct your child's vision. They slow down the progression of myopia. So your child can continue to discover all the world has to offer through their own eyes. Light the path to a brighter future with stellar lenses for myopia control. Learn more at SLOR. and ask your family eye care professional for SLOR Stellis Lenses at your child's next visit. I don't know if I could make a general statement, but I think if pressed, I would probably put myself much more on the end of the continuum that we have a lot more responsibility than

we like to acknowledge. Because we can control our lives. We can control our lives. And we can improve our lot and we can deal with problems, I think, a lot better than we realize. This is what a lot of my research is about and where my research is going also and how people do that. So I think we have that capacity and we lead richer lives when we do. And, you know, struggle is difficult. Struggle is, you know, struggle to stress are unpleasant, but those things also arise in part because we have the equipment to deal with them. You know, we have a stress response system. And the stress response system needs stress to be activated. So, you know, I think we're capable of those, of, of, you know, moving through these difficulties

in our lives. And I think it harms us. It minimizes what we can get out of life when we assume we have no control. We have no agency. It's interesting. When I look at it from a primary care perspective, I see some patients that do very well feeling like they have control of a condition, of a symptom, over their life in general, basically. And then there's some patients that do very well that say, maybe on a spiritual level or religious level, that they're not in control, that God has a plan for them. And because of that, it takes some pressure off their shoulders and they feel that they're able to function more optimally. Do you see both sides of that, or do you feel like perhaps it's much better to always have a choice?

I think there are definitely two sides to it, sure. And I don't know what the distribution of, you know, who's on which side. And I do know that there are always individual variations in everything. That's one of the things we focus on in my research, you know, mapping those variations. So there are people perhaps who it's much better for them to have a sense that this is going to be taken care of for me. or, you know, and as you said, God will do it. We even actually, we did a study of the pandemic in Israel. One of the things I do in my research is we map different patterns of outcome,

different individual variations in outcome. And we've been looking at how people cope with the pandemic over time. And in Israel, we did a study. We did a study in Poland, Israel, the U.S., a couple other places. And we found that there was the, as we always do find, a large group of people who coped quite well, it turned out one of the things that predicted being in that group was religious fundamentalism, orthodoxy.

And I've never seen that in any other studies. So I asked my Israeli colleagues what's going on there. And their answer was that for this group, this is God's work. God, you know, this goes way back to the beginning of the Old Testament, that, you know, God is always messing with us and throwing pandemics and, you know, frogs coming out of the sky and all those things, pestilence. And so this is just God doing it, and you don't have to get too upset about it. And I think he left out the part that that group also didn't observe the lockdown.

So they made more money than other groups during the pandemic. But, you know, that that was a really interesting insight. That there was a time and place also for that as well. I think in some situations, it might be really much more valuable to just assume somebody else is going to take care of it. Sure. So it sounds like you're saying there's a continuum and it's going to be different for different parties, which is like most medicine. We have generalized guidance and then we have to individualize it for the person that we're treating.

We individualize it for sure. But I do think on the whole, taking control of one's life and taking responsibility and trying to adapt yourself to the problem is the healthiest route, but it doesn't always work for everybody, and I would say in every situation. Like right now, what do you think is leading the pendulum to perhaps swing in the opposite direction away from that personal responsibility or personal choice? That's a very good question. I've thought about it a lot. I think a number of different factors have come into play. I blame the Internet for a lot of things. I would blame the internet for some of it because we're constantly bombarded with information.

You know, we're kind of wired, I think it's fair to say, I don't like to use the word wired because it doesn't, it's not really apt, but I'll use it here. We're kind of wired to see threat. You know, we're wired to, we have a lot, pretty good neurobiology set up to protect, to pick up, to perceive danger. A negativity bias. A negativity biased, as you could say that, you know, to, I'm looking around your room, your studio right now and thinking, okay, what could I see that,

dangerous. And if I see anything remotely, there's some wires, could it be a snake that could trigger, you know, an amygdala response, that, you know, fast and crude response. So we're wired for that. And right now, you know, and I think that the media, newspapers, websites, whatever, know this to some extent. They, disturbing things get clicks. But right now with the internet, it's everywhere. It's constant. You can have it all day long. You can have it in your sleep. You can have it before bed. You know, you can have it on the subway. You can hear it. You can see it. So I think there's a lot of bombardment with some of these stimuli that make us feel like it's, we don't have control, like we're overwhelmed. Like it's, you know, we can't handle it. What about from a

psychological perspective, has there been any work in the field that you feel perhaps can be doing a disservice to the general public? Because, you know, we have movements. We have things that get trendy within the psych space, you know, 90s self-esteem movement or maybe even before that. Do you feel like now we're currently in the movement of trauma? Oh, definitely. And I think a lot of, I would say, less than healthy or less than wise practices have been instigated. For example, some of the government agencies, they're very much promoting native trauma-informed care. And this is something I actually had to ask my daughter. about this, who was a teenager. What is trauma-informed care? She knew, I didn't know, initially.

Can you describe what trauma-informed care? Well, what I've seen, I've looked it up, is that it's, it's advising anybody who works with really anybody who could be exposed to potential trauma, which is essentially the entire world, to be aware that that person may have experienced traumas in their past that they don't want to talk about or they don't know about. And to me, that's an extremely dangerous idea. Because it's like it's if you and I were talking right now and I was thinking to myself, you may have had a traumatic event that you don't know about or you don't want to talk about. So I should be very careful on how I speak. The idea that you don't want to talk about a trauma is a little strange. There are some stigmatized traumas, things like

sexual abuse. People don't like to talk about that for obvious reasons because it makes other people uncomfortable. But there are lots of other types of traumatic events that that you can mention. And I think people who've generally been traumatized want to talk about their traumas because they want them, they want them gone, right? They want to get over them. The idea that people have traumatic events that they don't know about, I think, is wrong. And I think it's a very dangerous idea because it leads to the idea that we have these hidden things lurking in our mental past or in our mental apparatus. So are you saying that there is no world where we sort of put things in the back of our minds and try to not think about them because they cause us pain and

that doesn't happen? No, we can try not to think about things. It's not. Like repression. Yeah, well, repression I don't think actually exists. We can suppress ideas, but suppression is suppressing ideas and thoughts is not very effective. It's not very easy to do that. We can try to keep things off our minds for a while. We can distract ourselves and we do that. We can't do that quite effectively and there are times when we want to do that. But this gets back to the mixing up of the idea of a traumatic event and a trauma reaction. So most people have been exposed to the really good epidemiological research, large-scale survey research, showing that most people have been exposed to a violent or life-threatening event

at least once and often multiple times in their lives. And often we forget about those things because we, we, we, We moved on, we moved bast them. We move beyond them. So they recede into the past. We certainly can remember them if we're reminded of them, but we don't need to think about them. Those are the kind of events that if we consider those traumas, and I don't consider them traumas are potentially traumatic events.

And the research shows most people are not traumatized by even the worst events. That's very strong research showing that. So if we have an event in the past that would qualify as a potential trauma, and then, but we're not thinking about it, and then somebody comes along and says, you know, I'm trying to understand why you're struggling, and then I learn of this event, and then that, then I frame it for you, that's a trauma that you had in the past, and this is a hidden trauma reaction, and this does happen. And I think the idea of trauma-informed care does lead to this kind of idea that we all, we have these things, you know, that ready to erupt in us.

And I think it makes people feel completely like they don't have control. in their lives. In your research and something you've talked about in your book, The End of Trauma, is the concept of resilience and how folks bounce back and overcome these potentially traumatic events. And many of us, in fact, it's fair to say all of us have one of these traumatic events or potentially traumatic events. And yet most of us get past them. It seems like you have these unique curves that you've discussed in your work of how certain populations will either bounce back right away or with period of time. And then there's potentially those who develop PTSD don't bounce back or maybe have recurring events of these traumatic symptoms or trauma reactions.

Can you talk a bit about that? Yeah, I mean, I refer to them as trajectories, basically. And what we do there is we recruit large groups of people who've had an event recently, so we try to peg it to that event, and we follow them over time. And we do, initially I did this by hand. Now I do it with all kinds of computational tools. And we find that there are a handful of prototypical patterns. The most common pattern is what we call the resilience trajectory. And it's essentially a stable pattern of mental health after exposure to even the worst events.

Excuse me, we always see this. And we always see it literally in the majority. I think over 100 studies have been done using this approach. And resilience is always at least around two-thirds, this pattern. And when we have resilience being two-thirds, is it not valuable to talk about the one-third, which is a very significant minority of people who don't have the, you know, resilient, stable mental health trajectory? Yeah, it's absolutely essential.

So two-thirds show the resilient trajectory, and then one-thirds show one-thirds show one-thirds show one of the other patterns. Some of those people show what we call chronic symptom levels, chronic elevations and symptoms. So if somebody has PTSD, they would be in that pattern, right, that chronically high symptoms. And that's a painful experience, at least a couple of years of high levels of symptoms and distress, usually longer. There's another group then that shows, we call acute symptoms, high levels of symptoms and distress after the event, and then they begin to improve after a few months, and it takes

a year or two, and they get sort of back to where they were. Then another group might be struggling moderate level of symptoms. They're able to function, they're going to work to do what they need to do, but then they gradually get worse. You don't always know why that is. It could be there's something else happens. It could be that they get a little depressed because they're not getting better. It could be that they were injured and the injury is causing them trouble and then their life is becoming harder and harder, but they get worse over time. And then we see sometimes other patterns as well. And we see these patterns very consistently. This is what humans do.

Would you feel that over the last 30 years that prior to this new wave of talking about trauma openly and saying that everyone has experienced it in trauma-informed care, prior to that trauma was written off for many people, or you don't feel that that was the case? Trauma was, I'm not sure what you mean by written off. Well, I'll explain this way, where it was the mentality was if you got injured or you experienced something terrible, it was rub some dirt in it, get up, you're good, and you're going to be resilient. Yeah.

I guess it was, the word resilient wasn't really used much back in the day, except for physical things. Somebody gave me a gift of a box from the 20s of resilient springs. So springs are resilient. But really, I think the world did its best to keep the idea of trauma at bay for a long time. And even when it was painfully obvious, like World War I, World War II, you know, becoming really apparent that people are coming back psychologically scarred. Finally, it was the Vietnam War, the U.S. involvement in the war in Vietnam, that broke the camel's back, essentially. Is that the right metaphor? I think so. Yeah, okay. The straw that broke the camel's back. Because I think that war was a not, was a, was a very unpopular war. It caused a lot of psychological casualties. It was a,

it was by conscription. So people were drafted. And it was televised. And it was in people's homes. And veterans came back. Clearly, a lot of veterans came back really broken from that war. So that brought it home, and that brought it into our lives that this thing exists, this thing called PTSD exists. So do you find that as a win for the field of trauma, that we're talking about it more openly? It seemed like a win at the time, and I still think it was essential because it is real. Some people are traumatized, and so this was a way to get them treatment. In a culture where medicine is an enormous enterprise and it needs to be paid for and regulated some way, and so you need diagnoses.

So this diagnosis allowed people to say, okay, I'm going to say this person, person X has this diagnosis, so it can now therefore treat that person. Then we can study that and find out what's the best treatment for that particular thing, and that's exactly what happened. I don't think anybody realized at the time that it would kind of take on a life of its own, which it did, but the idea is essential. Bouncing back before we move on from this point to the segment that we mentioned about repression, how you believe that it's almost impossible to fully repress traumatic events. I have patients that say lines like, before I was 10 years old, I don't remember anything, or they'll describe an event that was very traumatic and they say they have no. memory of it anymore and they can't even remember it and if they do they break down and have a perhaps a panic attack or panic-like attack what are those people saying or what are they doing or what are they experiencing if they're not repressing well memory is our memories are not perfect

and memory is an organic thing right memory is we tend to think of memory as as a is you know like plastic you know you you stick memories in you know where the brain's a toy and you stick memories in or photographs or whatever we, you know, and these actual objects and they're in there or, you know, until we take them out. But memory is organic. It's created by neural pathways, right? Neuro pathways are organic. So when you re-remember something, you automatically, you reactivate that memory. So you have the organic pathways, again, active. Maybe not all of it, maybe some of it. And then it can change. So we can change memories very easily. It's been, you know, very easy to demonstrate this.

And sometimes memories just recede into the background. And there's pruning at different times in life. I think the first pruning happens around two years old or something because we make enormous numbers of neural connections. We also have just an unfathomable number of neurons in our brain more than any other species on Earth, if I'm not mistaken. So all those neurons connected to all those other neurons. And at different periods in our life,

there's sort of a house cleaning happens. And neuropathways, pathways that aren't. used or aren't important, are kind of pruned away. So there's a lot going on in our brains, and we don't have the capacity to access memories at very early ages, because we basically just don't have a route to those memories. You said that when we don't use those neuronal pathways, we can prune those memories. That does happen sometimes, yeah. Is that not repression? If you don't think about the traumatic things that happen to you throughout childhood, you don't use those pathways and then they get pruned, would that be a form of repression?

Well, very little can, as I'm understanding, very little can be remembered up to a certain age for any kind of memory. But if something is traumatic, we do tend to remember it, even from a younger point in our lives, although we may not remember it the same way we'd remember as an adult, right? It's a very different experience. And repression is always thought to be a very active process. Like we are actively repressing something, which is very different than a neural pathway just sort of receding into the distance, right, because if it's not being used. But there's no known mechanism that I'm aware of that can cause something like repressed memory, where we can deliberately, you know, remove something from our memory.

Are you familiar with the work of Dr. John Sarno from NYU? He's a physiatrist, actually, a P.M.R. doctor. I'm sorry, I'm not. I'll kind of give you a brief overview, and you'll tell me what you think of the concept in general. He is a physical medicine rehabilitation doctor, so he's not a psychologist or in the field of mental health. But he postulated in his work, and this was quite common, in his work surrounding pain, which is probably the number one reason people come to see me as a family medicine doctor, physical pain. And he talked about how adverse childhood experiences impact

our pain and actually create symptoms of pain, actually create medical diagnosable conditions, carpal tunnel, acid reflux. And he talked about how those traumatic instances actually yielded physical outcomes in terms of pain, symptomatology, function. Do you believe that that could be a factor from your work? It sounded like tiny bits of that could be true. The broader idea, I don't understand what the mechanism would be. He, he, to his credit, and I'm probably not giving enough credit, he said that that is unknown yet. And he did start doing some trials showing when someone was going through a negative mental state, they would see decreased circulation to certain muscles, increasing spasm and issues

with those muscles. So he tried to create a biomechanical model for what he was describing. But it never fully panned out, and some of it was actually disproven. But that yields me into the conversation of how much of our mental health contributes to physical symptoms, because that's a question I would love to get better answered for my patients. And what have you seen in the research panning out that way? Well, there's a broad way that our mental health can impact our physical health. And this is, I think, widely understood at this point.

Maybe not widely understood, but it's well documented. with empirical research and, you know, which is that stress, chronic stress causes a dysregulation of a lot of biophysical symptoms, right? So we have a very powerful stress response system that can, that works extremely well in the short term, is what it's designed for. When it's, when we're experiencing stress over a long period of time, let's say a month is a nice juicy, you know, time period, that things begin to not function so well anymore. And that this, we have many different systems operating at the same time, you know, we're very complicated

physically, physiologically, we're very complicated. And those systems are finally tuned with each other, and they begin to fall out of sync. And so the, a great example is cortisol. So when we're feeling a lot of stress, we have elevated cortisol, right? And cortisol is a great, is the HPA axis, a great stress response axis, slower, more powerful, more enduring stress response. Cortisol suppresses the immune system because the immune system has its own response to stress. And I know I'm speaking to a doctor and I'm not a doctor. So please take a with a grain of salt, everything I'm saying. All in line with everything.

That's correct. So the immune system is suppressed because the immune system, which largely responds to physical invaders, but it can respond to stress as well, causes what is called illness behavior. So immune messengers will go to the brain and cause us to be fatigued and cause us to not want to be around other people, which is mind-blowing in its own right. It's an amazing feature of our immune system. So cortisol will suppress that because it's typically cortisol's elevated, you know,

immediately elevated when we're facing great dangers, right? So when you're facing great dangers, you don't want to be sleepy. You don't want to be hiding away from other people. You want to be focused and clear and maybe recruiting other people. You want energy. But if after about a month that if cortisol stays in a kind of elevated state for about a month, the immune system begins to habituate to cortisol and it no longer allows it to be suppressed. So now you have the immune system sort of now kind of going out of control,

elevated cortisol, which causes all kinds of other problems, and you begin to get rapid physical breakdown. And you get what I've know them as mups, medically unexplained symptoms, which are simply physical manifestations of that breakdown. So skeletal muscular problems, vision problems, whatever it might be, skin problems. It's interesting that you call them mups when you're giving such a good explanation for why they happen. Well, the reason they're called medically unexplained symptoms is because you can't pinpoint them to an event and you can't say, oh, this is happening, I'm now having digestive problems because I saw that automobile accident last month. But because stress is an ongoing problem

that we, and it's not linked to any one event. It could be linked to, like, you know, say I moved, I took a new job and I'm beside myself with stress. But you can't pinpoint it. any one moment in the job, so you can just kind of say in general stress. But I might have a reaction that's digestive. Another person in the same stress might have skeletal muscular problems, you know? So that's why it's not, there's no real clear sense this kind of stress causes, X kind of stress causes Y kind of symptoms. It's a diagnosis of exclusion where you can exclude physical causes of that pain. You can look with a camera and see no gastritis. You can look at the muscle and see that there's no injury, no tear.

But then the symptoms are still there. You can sort of start leaning in that direction. And then there is the psychological reality of suggestion. And I think we know, we still know very little bit about this. You know, when Freud began to see people in the 19th century, there was not, there was very little understanding of any of these processes. So his patients had all kinds of strange and wacky physical problems that we don't see today. One of my favorites is glove amnesia.

people would have amnesia, say, up to about this point in their forearm, and then not afterwards. And there's no particular biological explanation for why you would have that. So it has to do in part with suggestion, you know, the way we see things. And we know that placebos work even when people are told that they're placebo's, right? So our minds can do a lot. So there's a lot that we don't understand here yet. for sure how does this play out from we're talking about it more in the acute or present setting where you're going through some stressor right now on a chronic level what about stressors

that you underwent or traumatic or potentially traumatic events that you underwent years ago leading to symptoms today well there are because that kind of goes into the body keeps the score yeah there are some well yeah and the body keeps the score is an entire other conversation which because so much of what's in that book, I think doesn't have a scientific reality to it. It's kind of, there are a lot of, there are a lot of science, there are a lot of neuroscience and psychology words

that don't quite match the way those terms are used in the research world. I was just going to ask about that specific point you made. Is it a problem when we make metaphors that don't have a good, definition, but explain the concept well to people who are non-scientific. That's a great question, and I've thought about it a lot because I teach a large class about trauma every year. And the students tend to come, a couple hundred. The students tend to

come in the class completely having drank the Kool-Aid essentially of the body keeps the score, and they're really surprised when I tell them that I don't believe a lot of what's said in that book. What specifically, so the audience can... Yeah, well, so, you know, the book's well written, and Vandercold writes well, and he seems like a nice man, you know, and he seems like a good therapist, so I give him all that, but there's a, there is the idea of hidden trauma. There is the idea of that trauma memories are stored outside the brain, they're stored in the body. He talks sometimes of subcortical systems, but there isn't really any mechanisms that I know that can store trauma memories. He talks

about implicit trauma memories. And in psychology, implicit memories exist, but implicit memories do not have narrative to them. An implicit memory, you know, this green bottle, you know, may imagine has a strange label, and then you see it briefly because it's in my hand. And then two days later, a week later, you see the bottle again, you have a memory of that bottle, but you can't remember where you saw it. That's an implicit memory. Right. So you can't Yeah, but as far as I know, there's no way that a traumatic event can be remembered implicitly because that trauma is a story, basically. So, you know, those are the kind of things that are at the center of the idea that it's in your body

and you have hidden memories that I think are dangerous because there's no anatomical reason that they would happen. So in those who have undergone chronic traumas in the past moments of their lives, There are some changes, like you mentioned, whether it's cortisol changes, neuroendocrine changes, and isn't that representative of keeping the score? People have asked me about that, and that's an interesting point. You could say, well, it's, I guess I'd have to say, what is the score then? Because what those events are, what those bodily reactions are, is they're basically,

basically changing slightly the way our stress response system works. So the responses I know about most clearly are epigenetic changes, right? So changes in gene expression. Sure. And this is all, you know, all of this, the science is still being done here. So some of it may be less robust than we think. If a person is exposed to a long series of stressful events, you know, potentially traumatic events, a very difficult time, a caustic environment for some period of time. That can result in epigenetic changes in their stress response system. So they're either hyporeactive, they're reacting too much, I'm sorry, they're reacting not enough, which is what tends to be a risk for PTSD or hyperactive, they're responding too much.

So those are epigenetic changes resulting from experience, but those are pretty extreme experiences. So you don't need anybody keeping that score because you know it happened. If the score is severe enough to cause those epigenetic changes, it's not hidden, right? So the body is reflecting basically this sort of chronic averse state. When we say hidden, are we saying hidden from the person experiencing them because they may not be aware that trauma can cause that in them? Because I would say most people, if I take my patients as an example, and I tell them that you know by experiencing these really terrible situations some of my patients have it the worst childhoods ever the things that they experience no one should experience and they had multiple

episodes of those things they are not aware of the epigenetic changes that can happen that can drive them to be hypoactive or hyper reactive so isn't it hidden from them in that sense it's it would be hidden from them in the sense that they don't know about that mechanism yeah absolutely but they and that's because they wouldn't have the medical knowledge and few people do I barely do, right? I'm talking about it, but I barely know about this stuff. But they do know what happened to them. And I think the assumption, I think explicit in the whole idea of the body keeps the score is that there are things happen to us that we don't even characterize as traumatic, but they actually were. They don't characterize it as traumatic, or we don't remember them.

Or we don't even, yeah, we don't even know that they're doing these things to us and they're not on our radar in a sense. And that, to me, is fairly rare. I mean, people that have gone through pretty bad events, events severe enough to cause, you know, a change in their physical being, they're very aware of those experiences, right? That's really interesting. Because we're both seeing the same work

and we're interpreting it slightly differently where I'm seeing it as a patient, a layperson who doesn't have the medical background, and to them it's hidden because they're like, why do I feel this way now or why is my body acting this way now? So to them it's hidden, versus from a more researched, well-knowledgeable perspective, you're like, it's not hidden.

You would know that these things happen to you traumatically. The question is, would they connect it? They wouldn't necessarily connect it, absolutely. So that's, but that's not a novel idea. That's really what all psychosomatic medicine is. The question is, though, do patients believe in psychosomatic research, even though it is so well-documented? I don't know. In fact, there's a society called American Psychosomatic Society, and they publish a journal called Psychosomatic Stress. And they told me, one of the people involved in that

organization told me they were thinking of changing the name because it got made fun of on one of the talk shows, the whole idea of psychosomatic stress. But I think, you know, it's, it's a thing that if you read, you find it in the New York Times or, you know, other places, not always, you know, fully fleshed out, but the idea that I think it's becoming more widely understood that stress and physical problems can influence your physical health, right? And psychological problems can influence your physical health. And that's, I think, you know, that broad idea is gaining a lot of currency. The idea, the part I keep coming back to that I find dangerous. that goes to the body, keeps the score on other books of that nature is the assumption that

you can have a traumatic experience and then kind of maybe forget about it, not even realize it was a traumatic experience, but it's causing these things that happen in your life. And I don't think that's too probable, you know, because there's no mechanism, and you would know, right? You'd know this happened, and you might not connect them as the source of it, but you know that these things happen. That's an important distinction to make. Yeah, I think before the book, I think while there was knowledge on a general level from patients that stress can impact your health, there was a disbelief that it could happen to them

where they're like, yeah, I know stress can, but there's no way this is caused by my mental health. Yeah, that's true. And that connection was missing. So while I do see your criticism of the book, I think there was so much value in creating a cultural norm of how mental health is stored in your body. Now, you're stored because it's not really stored. Yeah. But its effects are still felt after the fact.

Right. Well, and it's actually not stored in the, well, it's stored in the brain. Sure. And one of my friends and brilliant. I know what you're going to say. Lisa. Yes. She says the body's the scorecard.

Yes. Lisa Feldman. actually says the body the brain is this the the brain keeps the score the body is the scorecard and and that's i think the best way to think about it i mean it may not mean anything to to the lay public but it's it's really it's it's about what's going on in your brain that it influences your body which is how you think about things yeah i at the same time while that's an important principle and the body keeps the score has important principles i think it's adequate to to to show the criticism of how our interpretation can go too far

of it and actually cause harm because anything in medicine when it's thrown out of homeostasis out of that balance that our body's trying to keep there's going to be a problem so while we need to talk about potentially traumatic events we need to talk about how traumatic events

impact our physical symptoms we can't then assume everything is traumatic we all have had traumatic instances that we may have forgotten like you've pointed out I think those are important nuances to talk about these books so that we can continue building upon that understanding.

Yeah, and I would add to that, which I think we may have already said, that a psychological experience has to be very strong and very long-lasting, very long-lasting, very enduring in order to change the way the body works. You know, you can have stress for a period of time, a couple weeks or a month that will affect your health. You can live a life of stress that will lead to cardiovascular problems, but to have to see this or epigenetic changes and these other things we've talked about

that really requires a lot right so it's not an everyday experience a lot and would you say it's less than a lot if you're in your formidable developmental years Ontario the weight is over the gold standard of online casinos

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I mean, I would say, yes, sure. I don't know enough about that to really comment intelligently, but yeah, definitely. Yeah. Just because I think about the negative things that have happened to my patients as children, and I don't feel like it needed to go on for years for it to have lasting impact. Well, development's complicated, and at different phases of development, there are different factors that will or will not cause harm to different proportions. So, yeah, it's a complicated set of circumstances that I don't know enough about to really sound intelligent about it.

Got it. What about on a practical level? So someone's going through a breakup. I'm going through a breakup. I feel terrible. How do I distinguish if this is a potentially traumatic event? Is this going to affect me down the line? Should I even bother thinking about that?

Yeah, I wouldn't worry too much about whether it's a potentially traumatic event or not. it probably isn't because it's not life-threatening, but it's still a highly stressful event. It can be a very disturbing event can make people feel like the worst they've ever felt. So what we call it is kind of point. It doesn't really matter when a person's going through it, and we know they're going through this event.

We don't need to particularly categorize it. Well, should they, like for example, if they're experiencing this, and then they start experiencing physical symptoms. Do they start blaming those physical symptoms on that potentially traumatic event? Or they should say, this is stressful, this shouldn't be causing it. It's not life-threatening. Well, I think once we know the general idea that stress over a period of time, and again, I'll just say arbitrarily a month, is going to start leading to its own problems of its own.

Once we know that, then we should expect that. right? And we should try to address it as best we can. You know, I feel guilty of this because I lead a fairly stressful life. You know, I'm a productive academic. I travel a lot. And I, you know, I raise a family in New York City. I do things, you know, I'm busy. And I'll allow myself to be stressed out for a couple of weeks, because that, which is, and then I maybe stretch it even a little further now that I know it's about a month. Okay, I'll give myself three weeks. Then I'll chill out, right? And that's a bad habit. But, you know, we can say a person's feeling has been divorced, as you suggested, and they're

feeling terrible, and it's been going on now. They've been feeling terrible for three weeks. They can't stop feeling terrible necessarily. They can't undo the divorce, if they could try to reduce stress in their life. They could try to, you know, do whatever it is that they make, try to make arrangements with close friends to go out and just relax a little bit, get a massage, watch, you know, a series of bad movies, get drunk, you know, whatever it is that a person, and I'm serious when I say get drunk, whatever it is that a person can do to just reduce

the stress a little bit, give themselves a break, they're not going to solve the other problems, but that's a problem that needs addressing. And it's a more concrete problem in a sense, stop feeling stress right now, get it off my mind for a little bit. So distraction is a form of decreasing stress. Yeah, I mean, a lot of what I do in my work now, I talk about it in the book is what I call regulatory flexibility. It's our ability to adapt to the circumstances at hand. And we essentially, there's a series of steps I describe in the book, but it involves identifying the problem, one of the problems you have right before you and just dealing with that. So you can't, you know, undo the divorce. You can't stop feeling terrible about it. But you can

try to just give yourself a break temporarily. And even though that doesn't solve the problem, you know, you could say, somebody could say, well, that doesn't solve the problem. No, it doesn't solve the larger problem, but it does solve this problem. I'm having, I'm being overwhelmed by the stress of it, and I need to just simply get some equilibrium back. And I coined a phrase a number of years ago called coping ugly, which is basically the idea that sometimes we do things that we don't even think are healthy, but they might work in this moment to help us out. And that's where I bring up again getting drunk or, you know, doing something impulsive or watching, I watched, I remember once six months ago, and whenever I was feeling really bad, and I watched Godzilla.

Now, no offense to whoever made Godzilla, you know, but it's not a movie I would normally watch, but I just thought, I just want to watch this movie and just let myself, you know, I'll get some chips and some beer and watch Godzilla, you know, and it was effective. It just changes the pictures in your head a little bit. Sure. So we can do those kind of things. I worry about recommending coping ugly as a general principle because it's so easy, especially this day and age in our society,

to cope ugly permanently and make it a long-term habit. Your point is very well taken. We don't, coping ugly does not mean continuing. So, for example, Edward Slingerhand, I believe his name, has wrote a wonderful book called Drunk. He is a described himself as a, an evolutionary philosopher, but he looked at the history of alcohol, and the history of alcohol is basically every society that's ever lived on earth has used alcohol. And alcohol uses,

tends to form into rituals. It does, we use it in a lot of different ways, but it has these, it's poison, basically. But it has all these benefits, like it relaxes us, it makes it more creative. It's a kind of a social lubricant. It does a lot of things. And so once in a while, drinking with friends doing these kind of things, even drinking me a little too much once in a while, is perfectly okay. I think it goes without saying if we drink a lot for an extended period of time, it has very bad consequences because it's dangerous stuff. The once in a while needs to be underwent. Yeah, really underscored. Yeah, very much so, yeah. Yeah, because it's almost like a theory I heard the other day. I don't know how proven this is

that in the winter, why we love holiday eating, we often say we gain weight because of Christmas, Thanksgiving, holiday parties, but partially it's something to do with the fact that there's less light, you have less neurotransmitters, and when you eat, you make up for that, so is it that you're gaining weight due to trying to fix your neurotransmitter balance?

And I can't know if that's 100% true or not, but logically, I could see that being the case, especially across the world, as we become more anxious as a society with information constantly thrown at us about tragedy, conflict, new diseases, what have you, that eating is a way out of it because eating releases all those feel-good neurotransmitters. I guess it does, yeah. And eating, I mean, eating in the wintertime also, I always think of the simple explanation

that it just, we need a little extra weight in the wintertime. We used to anyway, you know, to fend off the cold a little bit better. For sure, that's very true. you mentioned your stress and I want to talk about one of the specific aspects of your stress where you get a lot of criticism thrown your way when you talk about trauma or maybe the body keeps the score can you tell me some of about some of that criticism oh that's well that's interesting yeah I don't know what propelled me I do know what propelled me but I've been doing this about 30 years when I first began to talk about resilience I was talking about resilience to

loss and at that time that was not well received at all You know, and people thought at that time, the assumptions were that when people lose a loved one, everybody is devastated for a long period of time and requires help. And that's simply not true. Losing a loved one is very painful. It's not fun for anybody. It can be painful for years, but the simple fact is, and our research has shown this over and over, that most people cope really well.

Most people are able to get out with their lives. And when I say that, I mean they're able to function, to concentrate, to have loving relationships and connect with other people. So I began my career, you know, saying those kind of things. You began your career destroying the lovely notion of if I lose you, I can't go on. Yes, exactly. Well, I mean, yeah, I just, you know, that you could just say, well, look at the data. I guess I don't know.

So if your partner tells you, baby, I can't live without you. You have to say the data says otherwise. Sorry, yes, you can. Yeah. You know, so, I mean, I've been doing. doing that for a long time. And it just happened by a kind of weird quirk of circumstances that I was trained in, trained to really understand and critique research methodology and to focus on data and how we use data. And I was trained in clinical psychology. And I shifted my focus

and I had an opportunity to do something different in San Francisco at the very beginning my career, I just got married to study bereavement. I had no idea really about bereavement. I wasn't interested, but I looked at the literature and I thought, well, this literature is really out of date. And all I really did was to use a lot of the modern methodological tools that I had learned as a doctoral student and applied them to bereavement. And we found almost right away that, well, there's lots of evidence for resilience. And I've kept doing that with trauma and other things. So it initially, I don't know if I would say it was stressful, I was ignored more than anything else. I didn't get a lot of pushback as much as I was just ignored in the beginning.

And then as the work caught on and I continued to pile up the research, then I started getting more of vociferous pushback. But then 9-11 happened. And oddly, 9-11 changed the way people think about. I shouldn't say oddly. It makes sense, actually. 9-11 changed the way people think about trauma. And it opened up the world's eyes in a sense to the idea that people could actually be resilient because that's what happened after 9-11. There was a lot of resilience in New York and elsewhere. And then it's shifted.

It's come and gone. And as we know now, it's sort of shifted back a little bit. New Yorkers are probably trying to take credit for that and say we're resilient because we're New Yorkers. Oh, I think people did plenty of that. Yeah. Yeah, I mean, I think that's generalizable if that was anywhere. Oh, totally. It's absolutely generalizable.

Well, the research has been now shown all of the world. Most people are resilient. As a viewer, knowing that most people are resilient, what practical takeaway does that give you? Well, first of all, it means that it's possible. It's common and it's possible. What I've been trying to do is understand how it is that most people are resilient. What do most people do? and what most people do is adapt.

They're flexible and they adapt. And it turns out from our research, we find that most people can do that. I would say a few things to take home with that. Most people are resilient. Our bodies and brains are wired for flexibility. We have the longest period of development in the animal kingdom 25 years.

That gives us the largest number of cortical neurons. And that also means our brains are more adaptable for that reason. That's our evolutionary strategy as human beings. is to adapt. And we have great capacity for that. So we have the tools to adapt to the difficulties that we're confronted with, and we can do that. And, you know, people have different lives. People have different circumstances, as we've talked about. And sometimes it's a little harder for some people than others because of the circumstances they've been confronted

with. But they can do it too. It may be a little bit more work. So they have the ingredients and the tools, what are the actions that they should practice to get this flexibility? Well, the flexibility, I look at it in some detail, but it's got two basic parts. One part has about motivation, and the other part is sort of the mechanism, the nuts and bolts of it, which I call the flexibility sequence. The motivational part is simply really a mindset, a way, I call it the flexibility mindset. It's a way of thinking where we basically prime ourselves to realize that we can adapt. It will be okay. We get through things. You know, many, many, many bad things have happened in the past and we're still here. You know,

and for many people in their lives, you can think about things in one's life that a person went through. And then, you know, in the future, it was okay. That happened in the past. So it's sort of optimism, something called challenge appraisal, where you focus on what's happening right now. And what do I need to do? I didn't. want this to happen, but I need to move on with my life and get past it. I don't want to suffer forever. What do I need to do? Like a practical optimism. It's sort of practical. Optimism is kind of, you know, more emotional. It has a little bit of a hope feel to it, you know, like it'll be okay. I'll get better. I believe it'll be okay. We have to do that to

some extent in order to get ourselves to really just face these events, you know, the kind of events that we're talking about, potentially traumatic events, they're painful and scary, and we don't want to think about them. But we could just wallow in that and wait for time to heal, but time could take a long time. It's interesting how in the past,

if I would have told my girlfriend, it will be okay, it would be viewed with, that you're not helping. Yeah. But it's actually helpful. Well, it's helpful to think it yourself. I'm not, I'm thinking about this,

not whether how helpful it is for someone to tell you, it'll be okay. That may not be helpful because... It needs, like, motivational interview. Yeah, it needs to come from yourself. And so, you know, there's a variety of self-talk that I suggest using, which is you tell yourself, it'll be okay. You know, so if somebody else tells you, it'll be okay,

they're kind of minimizing it. Don't worry, it'll be okay. But if you tell yourself, it'll be okay. I'll get through this. You know, and most of us, when we try to do that, we hear a little bit of voice, another voice saying, are you sure about that? You know, and you have to kind of, you know, you can't conclusively ever say,

no, it's absolutely fine. You know, because we know it, that's not true. But, you know, we have to be kind of, the idea is that we have to have the conviction we'll get through it. You know, and however we get that conviction, people get it by accomplishing things in their lives, people get it by, you know, doing things they didn't know they could do or just even looking back at their lives and seeing that things were okay in the and that they didn't think would ever be okay.

You know, I always think of when I was a kid. I did so many stupid things when I was growing up. It would really fill your show. But once I had a golf club, and I decided to take a swing in the house. And I broke a hanging lamp that my parents valued greatly. And I remember at that moment, the world was ending, right? And I think of that often because I was okay, right?

I got through that event somehow. I think I told them the truth, which very much helped. But you know, you get through these things. And basically we need a way to just get ourselves to focus on what's happening to us at the moment. And then we get into what I call the flexibility sequence. And that involves really taking stock, like saying, what is happening right now? And in some of the examples we've talked about, like say, you know, I've gone through this major event that I can't undo, and it's going to cause, it's causing me a lot of pain

and it's going to cause me a lot of pain for some time probably. But what's happening right now is that it's starting to seep into other areas in my life and I need that to stop. That's the problem right before me. We look at the problem that's right before us. And that problem then we say,

what do I need to do? And we kind of set a goal or I need to find a way to feel less stress or I need to find a way to get a good night's sleep or I need to find a way to get this off my mind. Then we dip into the next part of this flexibility model, the flexibility sequence is what I call repertoire. What tools do we have at our disposal? Everybody has some tools. It's a good idea to think about those tools

when you're not in a stressful situation because you're more able to think clearly when you're not in a stressful situation. What are the things I've done in the past? What am I good at doing? And we try something. Then the third part... What's an example of a tool? Oh, so I might try to put it off my mind. I might try to talk. I might need to sit down make myself some space to think about it, think it through. I might need to tell something. Like a coping strategy. Yeah, coping strategies. Yeah, coping strategies. I might depend on my resources. Maybe I'll buy something.

Or maybe I'll, you know, hire somebody to do something for me if I have the money to do that. Or maybe I'll, you know, just want to be with my friends. It's some of social resources. You know, it's all of those things that are in our repertoire of tools. Then we try something. And the third part, which is absolutely crucial, has had received very little attention outside of this kind of work is that we ask ourselves, did it work? Is it working? And if it's not working, we try something else. I think that's super important. The reevaluation. Yeah, because I think there's a general sense people have. Often you hear this from therapists. Somebody tries to cope with something. It didn't work, and they just tell

themselves, I can't cope with this. I just can't. But in fact, even the most, the healthiest human beings cope by trial and error. We never know. exactly what's happening. We try something. If it doesn't work, we try something else. And if that doesn't work, we try something else. And after a little while, if we're still not getting, and we have to sort of back up a little bit and rethink the situation, what's happening and now? What am I actually trying to do? What's the goal? That process seems to be what people do, what resilient people do, what we've seen anyway. So we're trying to understand that now. Is practical optimism a belief in post-traumatic growth?

no what's the difference between the time oh now you want to know the difference okay no um so post-traumatic growth is a very elusive idea it's the idea that somehow you've become a better person for having gone through something in theory i think that's that's real but we don't know very much about it and all the research i know about it is is is not very good research um and i think it's probably over-emphasized because bad things are bad things. And I think most of the time when we get through something we really didn't want to happen and really hope we never have to go through again, we just, we're lucky just or we're happy just to come out and it's over. We don't have to grow. And I think post-traumatic growth almost puts pressure on people to become better people

because of something they went through. And I think a lot of it comes from, it's almost like retrospective appraisal of re-appraisal. Like, I suffered, so I must have grown. But in fact, I think often we just, you know, we just keep moving instead of growing. This episode is brought to you by Square. You're not just running a restaurant. You're building something big.

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In your three steps that you discussed in getting over, and being resilient. The flexibility sequence. Well, before the flexibility sequence, you said that your tools and thinking about the belief that it will get better. Yeah. And you say one of the big drivers of that belief is thinking about experiences or traumas you've had before and how you've come out ahead. Isn't that coming out ahead thing, an example of post-traumatic growth? You could say that.

I mean, well, I don't think post-traumatic growth doesn't exist, but I think it's overblown in terms of how that every time it doesn't happen. I think, I mean, we grow as human beings through the course of our lives, and as we learn to cope with adversities, we then maybe get more confident, or we maybe broaden our repertoire of things we can do. we might maybe get a different conception of ourselves in the world we try and I suppose it can go the opposite way too well that's the PTSD right well or or even in a just a lesser sense you know

bad things always happen to me why do bad things always happen to me we could tell ourselves that too I would never advise anyone doing that but we can do that and PTSD is an extreme uh response yeah so I mean there is research that has followed people over years and and looked at the occurrence of potentially traumatic events. And the occurrence of those events by themselves doesn't predict that somebody will get PTSD. The only thing that does is PTSD. People go through an event and they develop a lasting trauma reaction that tends to put people a little bit at risk in the future because they've suffered and they now know that they can suffer. It doesn't condemn them to have PTSD. It just puts them more at risk. So to summarize, patients need to have the belief

that it'll get better. They need to initiate the flexibility sequence where they find any kind of coping strategy, something that worked in the past. They try and tackle the problem immediately in front of them. And step three is most importantly that they reevaluate. Yeah, that they reevaluate. And if it didn't work, go back to step two. Try something again. Yeah, absolutely. But the belief always has to be there. The belief, I don't know if it always has to be there. It certainly helps because we need to be motivated to do it. It's painful, right? So we can have all the tools in the world, but if we're just not willing to face something. And face something is a vague word, but I think, you know, we have to think about the event a little bit. We have to, you know,

we can't simply wait for our minds to do these things. And we do these things somewhat automatically already, because they're highly over-learned, right? We learn as we grow up, we learn these things. but we do need to be willing to think about the horrible thing that just happened and look at our emotional reactions to it when people have these traumatic events that have happened to them throughout their lives if they specifically not necessarily repressed but actively distract themselves from thinking about it because it causes them so much pain is that an unhealthy or a healthy coping mechanism in your eyes i think it's it's unhealthy to do that regularly it's unhealthy to do anything all the time, any kind of coping mechanism. That's rigidity, not flexibility. So the

distraction is extremely useful sometimes in some moments, in some situations, but it's not useful if it's done all the time. Then we don't learn anything. Then we don't face anything. But in a given situation, so part of the art of being flexible is thinking about, again, what's happening to me and what's going to work in this moment. That's why sometimes it is valuable in patients who don't want to think about their childhood, always block it off. And then if we discuss it, you're saying that it's a value because now they're being more flexible. Well, discussing childhood is a different kind of a situation.

I think, I mean, if there's a reason to talk about their childhood, right, if their childhood is causing them lasting emotional harm or, you know, it's a lasting preoccupation, I'm not, I think discussing the childhood at least sometime, some is important to get it on the table. But then the problem is not their childhood anymore. The problem is how they're feeling right now. Sure.

And then what do you do now? That's the problem. How do you make yourself feel better? How do you get yourself unstuck from that? How do you find fulfillment? It's tricky because patients don't come in saying that, hey, I had this childhood trauma and this is why I feel this way. Yeah.

They come in with an elbow pain that we ruled out and everything physical. And we talk about their current stressors and they're minimal, but there's this piece of their childhood that they refuse to talk about, they refused to think about, they blocked it off, and then we discuss it. And how can I know if that's causing their symptoms or potentially tied to their symptoms

or their mental health in general, unless we explore it? Is that fair to say? That's very fair to say, yeah, yeah. We kind of moved off the topic of your stressors and your criticism. You were talking about the criticism you got for resilience. And then recently there's been an up

in some of the criticism when you talk about trauma. I want to talk about a little bit of that. Yeah. I've seen you tweet about it. Yeah, and it's a, yeah, and I did put something on Twitter that got a lot of positive responses, but some very negative responses too. And, you know, my books generate 5% negative responses,

which isn't bad. Everything on Amazon is 5% negative. Somebody, there's 5% of the world. Of course. You buy, you know, the sharpest knife, the best chef knife in the world. And 5% of those people say it broke in my hands or something. But so, but the 5% of people who don't like my book really, really don't like my book. And don't like me either.

And, you know, they don't know who I am as far as I can tell. But, you know, so there's a passionate pushback. What is the pushback surrounding? I think it's because I'm suggesting or I'm saying there are these different patterns of outcome. Typically, that's one of the problems and one of the flashpoints. There are different patterns of outcome. Most people are resilient. And people who are suffering and can't get over events, they really don't believe that.

They think it's not true. I've had therapists also tell me it's not true. What's not true? That resilience isn't true? That people are as resilient as I say they are. But does it help a patient to know when they're clearly not exhibiting the course of resilience to say that, hey, most humans are. And they're like, yeah, but I'm not.

I don't think it helps for them to hear that. And I don't tell them that. I just, I write a book, right? Or I teach a course. I don't teach a course for traumatized people. I teach a course for students who want to learn about trauma. So I wouldn't advise telling people who are really suffering, hey, you know, most people are resilient.

I wouldn't do that. And so I think it goes back to, I was a big fan, which some people may find odd. I was a big fan of Frank Zappa when I was younger. And Frank Zappa used to say, he used to describe his music as optional entertainment. You don't have to listen to it. But if you want to listen to it, here it is. And I think these ideas are, this is science.

And I wrote the book for the general public, not assuming that every single person must know this. And if you're suffering, you must read this and know that you're only in this. The book was for people who want to understand what we know. about these events. Yeah, to your credit, you talk about the majority of the population being resilient because that's less talked about these days, more so a focus on the portion of the population that is traumatized or experiencing those symptoms. And in maybe those critics' eyes, they're looking at your book and they're saying, you're talking about this population, and that book is talking about the one-third of the population that doesn't experience resilience, and you're critical

of that book, they feel attacked by it. Is that a fair? I don't know. The one point I often make is that just as you had said that a person, their physical problems that they don't understand may have something to do with their child,

so they need to at least look there. I think that we can't understand PTSD, we can't understand serious psychological problems unless we understand what most people are doing. Most people are resilient, and if we just can't say, okay, but I don't want to hear about that and maybe you're wrong, we need to look. We need to basically understand that most people are coping pretty well.

They hurt as well, and they struggle for a time afterwards, but they basically are able to cope as well. Why? What are they doing? We need to understand that so we can also help people who are not coping well. That's, I think, the fundamental reason to look at it this way. How does a person know or what is a person to do? they feel they have PTSD? First, the PTSD diagnosis isn't really possible until about a month. Again, the magic month.

A month of experiencing this? A month after the event has happened. Yeah, I mean, and the reason is because there's a lot of fluctuation in PTSD symptoms in the first month. What's an example for people who might not know? Well, nightmares, or you can't get it off your mind. And we call these symptoms, they're not, symptoms are just problems. When you have a lot of them, they form what's a diagnostic category, but they're just problems, basically.

And they tend to hang together a little bit. They're similar. But I think a lot of the things that ultimately end up being part of PTSD, initially they're adaptive. We tend to replay really dangerous events in our minds because we need to learn from them. We need to learn, what did I just do that could have got me harmed. And I need to understand why did I let that happen or how did it come about? Is there anything I can do to forest all that from happening again? We tend to feel on edge and aroused

because we could still be in danger. We need to maybe be on the lookout. We maybe have nightmares for the same reason. We're trying to understand what happened. And I think all of those reactions typically they drift away with time. So people, because PTSD is such a, it's become such a kind of a common phrase. Even my mother, who was unfortunately just passed on, but she lived to be 100.

She knew what PTSD was. You know, it's just a household word now. And because of that, when people have these, I think, normal reactions to unusual, unusually horrific events, they worry they have PTSD. and that causes another layer of anxiety that didn't exist, you know, 20, 30 years ago. So after about a month, to answer your question, if it doesn't go away with time, say a month or six weeks or something, then maybe it's time to begin to consider that something's not good here. Maybe I need some help. And professional help is generally always there.

And what are the treatment modalities that are successful here? There are different modalities. The most common modality, not the most common, what seems to be the most successful is called exposure therapy where people re they they they they it's a time limited it's usually eight weeks or so could be longer could be short but usually about eight weeks with a therapist trained in exposure therapy prolonged exposure and they the therapist will tell them what they can expect you know kind of lay it out for them the therapist controls the sessions very closely and will ask the person to tell them in detail everything they can remember about the event, the potentially traumatic event. And that seems to be very helpful. And then they do other

exercises. They do like, you know, setting, they listen to it over and over in their private life, you know, a tape recording of it. But often when we've been through something extremely scary and difficult, we have these kind of bits and pieces that we remember. Even though we can, we can tell the whole story, but we don't. We just get, we have these fleeting pieces and we want them out of our minds. So we don't actually put the whole thing together and think about it. So sitting down and telling the entire story is a little bit like what I was describing with flexibility, that you're kind of looking at what's actually happened here. This even works with loss, with bereavement, when people can't get over a loss. Initially, it didn't seem like

this would work, but it seems to. And for the same reason that people who can't get over a loss often have, for lack of a better word, irrational thoughts about it, like it was my fault, or I should have done something else, I should have seen it coming, I was mean, and now I regret it. And then when they actually think through everything that happened, they realize it's probably not true that it was their fault, you know, that helps people get a little more realistic or say user-friendly idea of what went on. So it's almost like a mini-CBT within the exposure therapy. And in CBT, there's been some research that's

suggest that you get exposure, and then CBT is a really nice combination, because you get all the information in a sense. So there's that. I mean, some other treatments are really just like things like relaxation training, which just helps people reduce the stress. So they get a little bit more calm, can think a little more clearly, and feel safer. That's another treatment that works. It works pretty well, and it's a lot more user-friendly, in a sense.

if I gave you a magic wand and I say with this magic wand you could fix one problem in modern psychology what would you fix in modern psychology so I can't do anything more than that okay I was thinking global no no no it has to be modern psychology um I would say it would be a greater this is going to sound like the ultimate nerd thing to say I would say a greater um that that that that all psychologists would have a greater appreciation for evidence and the ability to critique ideas and, you know, to really take critical, use critical thinking about the concepts we use in our field. Because you feel that a lot of concepts are non-replicatable?

Just not necessarily about replication, but there's just a lot of ideas that don't get thought through very well. Can you give me one? Well, we talked about post-traumatic growth. I think post-traumatic growth, there's something, there's truth in some of that, but I think it's not nearly as pervasive as people assume it is. Another one was the idea that was so popular for so long about the stages of grief. There's never been any evidence for that, and it actually doesn't really capture what

most people go through, and it just caused problems for some people, right? And just a little bit of critical thinking around that idea. really help. How should we go through the stages, or if there are no stages, how should we think about grief? Well, grief is a very painful experience that gradually goes away. And we know a lot about what happens. So, for example, we know we have sadness. Sadness is this emotion that's very functional. And there's a lot of research and theory about the functional nature of emotion. Emotions do things. That's why we have them. Not everybody agrees with that 100%. But But basically sadness, you can show this in very nice, elegant research study, sadness

when we're made to feel sad or when we feel so we turn inward and we kind of take stock. And when we lose a loved one, our brains need to be recalibrated. We expect that person to be in the world. And you get these great anecdotes of, you know, a person hears the footsteps to the front door and the keys jangle and they assume that's their husband coming home. no, they're dead. Or we hallucinate people in public. We see someone fleetingly that looks like the person we lost, and it's not that person because they're dead, and unfortunately we can't have them back, but our brains think they're still in the world. So there's a painful process we must go through

where our brains kind of recalibrate and, you know, reorient to a world without that person. We have our memories, we have our connection to a person, but they're not physically in the world. Sadness helps us do that. It says sadness is very functional in that regard. At the same time, we're being sad, we're turning inward. And you can show this empirically. People are more accurate, they're more realistic when they're sad. It's a kind of a sadder but wiser kind of, I think, has been described.

At the same time, we're turning inward. We've developed these cultural rituals around taking care of people because they're turned inward. We also, at the same time, we show sadness. in our face. We didn't have to do that. We didn't have to evolve that, but we did. And that expression tells other people, I'm turned inward and I'm not paying attention. And we automatically feel sympathy for people who show the sad face, and we want to take care of them. So we've got all these built-in mechanisms. We create together a kind of a mildly idealized version of the

lost loved one. There are lots of culture rituals that do that. But there's, there's, and empirical evidence showing that we actually do that across the board. Everybody takes what they know of the deceased person and they clean it up a little bit. It's something you can carry with you, carry forward. You create a person, you summarize a person's life. They're gone, but they're in your life and you're going to remember them. And this is the memory you have. And there's research showing that everybody seems to do this, just a little bit, but about the same amount. So there are all these things we know, this painful process, but we have the tools to get through it. And I think if you think about these kinds of events, I realize the human species has been going through things

like this forever, and we're still here, and we're still thriving. If we don't do ourselves in, we're going to keep, we're going to be here. And that's because we have evolved the tools to deal with these kind of things that happen to us. So what does it mean to grief properly? Or there is no such thing. I don't know if there's a such thing. I think it's very idiosyncratic. It's just painful and people find whatever. This is where flexibility comes in again. People find the way to do it that works for them. It's not always what other people would do. And I think we're generally willing to cut people some slack when they're grieving. That makes sense. The one takeaway that I really got from your book that spoke to me personally was

I went through some childhood trauma stuff that I never really talked about on social media, but I was always under the impression that that was somehow going to impact me to this day negatively. And it didn't. And I always felt like I was doing something wrong because it didn't affect me negatively, as if I should have been traumatized, but I'm not, that means I must be repressing it or I'm suppressing it or something. And then as I did therapy, and we talked about those instances,

with my therapist, it seemed like I processed it well. And it was okay that I was being resilient. Yeah. But it was interesting that I actually had to seek therapy to confer that it is okay that I was being resilient. Yeah, yeah. So that actually fits in a sense of what I've been just going on about, that it's what you went through is actually the empirical norm in a way,

that you went through something untoward in your childhood. and it didn't cause, destroy your life, right? And that's resilience. And that is the norm. I don't mean to take away anything from you. Yeah. But so that's what, we need to know that. And it's like a simple empirical fact that this is what the norm is.

And it doesn't mean everybody's fine. It doesn't mean that there's no problems, but it does mean that if a person is coping okay with something, then they're coping okay with something. And that's where you get into the stages idea I mentioned earlier that people would think the stages were real, they're essential, and if I'm not doing that, there must be something wrong with me. Yeah, I think the important point that you're making with this topic of resilience, and in general, everything you talk about and the end of trauma is twofold. one by thinking about the majority of people having resilience will a potentially decrease some of the anxiety that we feel surrounding traumatic events or potentially traumatic events because then we're not worried that oh my god is this going to be that thing well no odds are it's not going to be this PTSD model because that happens in in rare cases so that already should lower some anxiety second it prevents people from feeling terrible for feeling good right yeah because that's almost what i was doing I felt okay despite those traumatic events,

and yet I was viewing myself as doing something wrong. So I felt negativity by experiencing what seemed to be the norm. Yeah, I can't imagine anything worse than an idea that makes people feel bad for feeling good. Yeah. It's definitely something that is not talked about. So I applaud you for talking about it despite the criticism, and I thank you for that. So that was my big takeaway of the reading that I did. My last point that I want to discuss with you is about social media.

You said how it's problematic in many ways. What are you seeing specifically surrounding social media that you dislike? I don't mean social media per se. I think the internet is problematic in some ways. It's a wonderful tool for everything, but we all spend too much time on it. And we can be inundated with uneasiness. from the internet. Doom scrolling, as people call it. But social media as well. I'm involved

in some studies of social media use in youth, in adolescence. And the results are showing pretty clearly that internet use, I should say internet use more broadly, it depends on the person and what they're, so people with existing problems are a little more vulnerable online. It's not internet use per se, it's not social media per se. It's all the different options. Yeah, so if you're using it passively versus actively, like if you're just scrolling as a bystander versus participating in a community online. There are those factors. There are the types of media use. You can use entertainment.

You can use educational things. You can use social media. If you have, if you're having psychological problems, social media tends to, people with psychological problems tend to not do as well with social media. It's more than more vulnerable. but again it's not there aren't any one-to-one prescriptions it's kind of complex that we we were seeing profiles of both people and usage but it you know because there are also so many good things about the internet there's information there's connection social connection right yeah this people are listening to us right now and yeah so it's it's it's more complicated than that

I do think that apart from from youth that I see this more for adults, but even for youth that we all have to learn, I think, to live with the internet. I think a lot of problems today that we're struggling with, you know, you hear often people say, this is the worst time in history or things are never this bad, the world's going to hell in a handbasket. I mean, I think that's probably been said every 50 years since people could say it. But right now, the particular problems we have have a lot to do with the internet, you know, fake news, and politicians have learned to manipulate the internet, and we get anxious because of all the things that we can see.

We have to grow up about the internet. And I don't mean any particular person. I mean the entire human race. And we haven't done that yet. And I think we will eventually. We'll begin to realize that we can't just simply look at it all the time. And we can't just simply follow the little things that click up on the sides of whatever we're reading and go down rabbit holes.

That we'll eventually figure that out. But I think that's a real... Yeah, I think it's an evolutionary process. I've warned my medical colleagues pre-pendemic that villainizing social media through and through, just all out, is not going to be a valuable tool because people are still going to use it and then we're not doing the research to find out

where it is valuable and how we can use this tool to reach millions of people. Had I villainized social media before this started, three billion people wouldn't have watched the videos about medical education. Like that's a huge loss that would have happened if we simply villainized. So I think that there is definitely

pros and cons just again is everything in health care there's pros and cons to talking about trauma and there's pros and cons to being on social media yeah the thing that makes it tricky i think in my eyes is social media is so unnatural to how we've evolved as humans in the sense of complete connectedness of all times being connected 24-7 to a large group of people i think that is new to us as a human species where before we would have an in-group or an out-group or culture or community, now that it's evolved to be global, and that's always on and always available. That's new.

And the second part of it is everyone sort of become their own content creator of sorts, even if they're not getting paid for it. They're still putting out content to the world. And we're not used to ever being able to handle a million eyes on us at once, where that becomes difficult to quantify and qualify. Yeah, well, I don't have a million eyes on me at once, I can tell you that. Every time you post something on social media, the possibility of something having a million eyes on it is very high. Yeah.

And you never know and don't have the control over when that would happen. Yeah, and that things do happen. That is true. I think, yeah, I mean, social media is also evolving and becoming a different beast as, you know, as we speak. So it's evolving with us. And there are different ways we can look at it. Individually, we can look at it culturally. Europeans are doing something a little bit different than what's happening in the U.S.

They're trying to regulate it more. You know, advertising is, you know, ubiquitous and tailored advertising, and that's not going to go away either, probably. And I think the more we're educated about it, the more it helps, you know, the more we understand how it works. You know, there was some wonderful research by Dave Dunning and some others showing that the people are more likely to believe fake news if they don't understand how journalism works. They're more likely to believe fake stories, fake scientific evidence if they don't know how science works. So learning how science works, how journalism works, how the Internet works is very useful.

Yeah, I believe firmly that education can be the antidote to many of those. the trouble I run into is how does education get shaped by social media, whereas you're saying if you understand how science works, you're less likely to believe misinformation. But what if now your science curriculum is corrupted by social media? Well, and we're about to enter a brave new world in education with, you know, I'm in higher education with AI because people can, you know, can invent their own writing and, you know, and many other aspects.

They can get information that's less than accurate. It's not curated. And those are all problems we'll simply have to solve, you know. And we will. I mean, we'll work it out, and then there'll be some other problems after that. Yeah, that's true. Well, I had a great conversation. Thank you so much for making the time, for writing such great work,

doing such great research through the years, and I hope to continue seeing your work published. Thank you so much, Dr. Mark. Mark, it was really nice talking with you. Awesome.