The Diary Of A CEO with Steven Bartlett - The Childhood Trauma Doctor: Your Childhood Trauma Changes The Shape Of Your Brain & Causes Parkinson's! How Not To Ruin Your Kids! Dr. Paul Conti

Episode Date: March 21, 2024

We are living in an epidemic of trauma, causing disease and death, so why are so few of us ready to face it? Dr. Paul Conti is a general psychiatrist and expert on treating trauma, he is also the founder and CEO of Pacific Premier Group, PC In this conversation Paul and Steven discuss topics such as, our current epidemic of trauma, why trauma is making you age faster, how you inherit trauma, and the ways that trauma can lead to an early death. 00:00 Intro 02:04 The Invisible Epidemic 04:12 What Percentage of the Population Has Traumas? 06:39 Your Brother's Suicide 09:43 Trauma Is Causing All Sorts of Illnesses in Our Bodies 12:35 How Trauma Speeds Up Your Ageing 14:31 How Trauma Affects Us at a Cellular Level 15:49 Trauma Leads to Early Death 18:01 Is There Anything Killing More Than Trauma? 19:15 The Different Types of Trauma 23:46 What Doesn't Kill You Makes You Weaker 26:30 Why Some People Experience Trauma Stronger Than Others 29:07 The Impact of Being Different 31:54 Developing Trauma Later in Life 35:21 How Do We Know If Trauma Is Being Passed On? 38:55 Do We Need to Understand Our Parents' Trauma to Understand Ours? 43:22 Post-Trauma Syndrome 44:11 How to Know If We Are Traumatised? 47:18 Trauma Shows Up as Addiction 50:18 What Tests Can Be Done to See If We Have Trauma? 51:12 Self-Destructive Shooting Methods 54:33 People Are Dying from Prescribed Meds 56:38 How Does Trauma Change Our Brains? 58:17 Trauma Creates Cognitive Blind Spots in Our Brain 01:03:14 We Tend to Seek What Harms Us in Order to Fix It 01:05:49 Becoming Addicted to Our Victimhood 01:07:27 What's the Role of the Limbic System in Our Traumas? 01:10:01 Shame Keeps Us Alive 01:11:57 You Can Build a Different Story Around Your Shame 01:16:08 How You Are Treated Determines Whether a Situation Becomes Traumatic or Not 01:17:46 How to Alleviate Our Shame 01:19:31 How Bringing Up the Trauma Helps 01:22:47 The Link Between Sleep and Trauma 01:24:28 The Importance of Sitting Alone with Your Thoughts 01:25:09 01:26:07 Sleep Problems Need to Be Urgently Addressed 01:27:33 Why You're Not Sleeping 01:28:50 Link Between Weight and Trauma 01:30:45 Advice for People That Think They Can't Change 01:33:40 Training Your Brain 01:36:04 Can You Completely Get Rid of a Trauma? 01:37:03 How to Stop Being Triggered by Trauma 01:38:18 Saving Lady Gaga's Life 01:41:53 Last Guest Question You can purchase Paul’s book, ‘Trauma: The Invisible Epidemic: How Trauma Works and How We Can Heal From It’, here: https://amzn.to/4ceTKhf Watch the episodes on Youtube - https://g2ul0.app.link/3kxINCANKsb My new book! 'The 33 Laws Of Business & Life' is out now - https://smarturl.it/DOACbook Follow me: https://beacons.ai/diaryofaceo Sponsors: Uber: https://p.uber.com/creditsterms Vodafone V-Hub: https://www.vodafone.co.uk/business/sme-business/Steven-Bartlett-Digital-SOS?cid=psoc-ent_li_ebu_/brnd/Stevenbartlett01/aws/11.23/SB Shop the Conversation Cards: https://thediary.com/products/the-cards 

Quick one. Just wanted to say a big thank you to three people very quickly. First people I want to say thank you to is all of you that listen to the show. Never in my wildest dreams is all I can say. Never in my wildest dreams did I think I'd start a podcast in my kitchen and that it would expand all over the world as it has done. And we've now opened our first studio in America, thanks to my very helpful team led by Jack on the production side of things. So thank you to Jack and the team for building out the new American studio. And thirdly to to Amazon Music, who when they heard that we were expanding to the United States, and I'd be recording a lot more over in the States, they put a massive billboard in Times Square for the show. So thank you so much, Amazon Music. Thank you to our team. And

thank you to all of you that listened to this show. Let's continue. Trauma is like a virus, and it gets passed along to your children, even if their children are not born until years later. Because trauma can change the expression of our genes. So we need to understand whether trauma is afflicting us, how it's afflicting us, and how we can treat it if it's there. Dr. Paul Conte. Psychiatrist, expert in treating trauma. He's worked with Kim Kardashian. And saved Lady Gaga's life.

And been in clinical practice for over two decades. How many people have some form of trauma? Well over half the population. And trauma can change us in very negative ways. For example, the odds of traumatic brain changes are very, very high. We know trauma makes us age faster than our calendar age. And we know that ultimately the root of depression, addiction, Parkinson's disease is from trauma. Modern science knows this, but we'll give them pills

with the idea that pill is going to fix everything. And then we're surprised that tens of thousands of people die each year from prescribed pills. We've let that happen. What should we be doing instead? The key to all of this is curiosity. So for example, let's say someone is addicted to their phone. Oftentimes addictive behavior is meant as an escape from something or even to self-punish. But when you scratch the surface of that, you might learn about an episode of sexual abuse that happened when the person was a child. This is not uncommon. What are the tell tell signs that I am traumatized? What can I do to alleviate the trauma? And then can you completely get rid of a trauma? The answer is based in hard science. So...

Quick one, quick favor to ask from you. There is one simple way that you can support our show, and that is by hitting that follow button on this app that you're listening to the show on right now. This year, in 2024, we're trying really, really hard to level up everything we're doing. And the only free thing I'll ever ask from you is to hit that follow button on this app. It helps the show more than I could probably articulate, and it allows us, enables us to keep doing what we're doing here. I appreciate it dearly. On to the show. Dr. Paul Conti, on the front of your book, it says trauma, the invisible epidemic. Why did you use those two words, invisible and epidemic? practicing psychiatrist, what I started seeing over and over and over again is that the root cause of the vast majority of what I was treating, whether it was depression or addiction or panic,

that ultimately the root of it was trauma. That if we traced back, what we would learn is that there was something that had happened in that person's life. It could have been acute or it could have been chronic over time, but that changed their brain. So the brain is then different going forward, and that is the root of the problem. So from that sense, I could see there's an epidemic because this is behind what is ailing us. The 50% or more of complaints to general medical doctors are coming from mental health, right? These are general physical medicine doctors. So you imagine how much of what is going on inside of us is affecting our health. So the epidemic of trauma is touching us in so many ways, but we're not identifying it. We're identifying different illnesses,

for example, like, oh, that person has depression, that person has cardiovascular disease and had a heart attack, right? But those things may be linked, including autoimmune diseases, all aspects of mental and physical health, but we're not seeing that at the heart of it is the trauma that then changes us and our brains and our bodies are different as we move forward. So to start seeing this commonality that this is everywhere and we're not identifying it because one of the impacts of trauma is to make a reflexive sense of guilt and shame in us. So then we sort of hide things away. So we're changed, made less healthier, and the very trauma itself leads us to have a tendency to keep it inside, to not share, to not get help, to not do the kinds of things that would lead us to recognize the epidemic. How many people have some form of trauma? Because when we think of trauma, sometimes people think of PTSD soldiers coming back from war. So how many people does this subject speak to in some way?

The numbers and estimates vary, but it'd be hard to imagine you wouldn't have roughly one in five. I mean, likely you have more than that. But if you look at, you know, data across demographics and data for occurrences of traumatic events and the impacts we see downstream of these brain changes, we're talking about a very significant portion of the population. And then if you think of people who are either experiencing the post-trauma effects themselves, the changes to themselves, or experiencing those changes through someone close to them, through someone they love, a parent, a child, a significant other. Right now we're well over half the population that will experience a significant and negative life impact from

something that either was with high likelihood avoidable or treatable. In other words, change for the worse that doesn't have to be that way. And it's not just as if just mental health, we're saying something small. I mean, mental health is how we interface with the world, but it's our bodies too. Is that person going to get lupus? Is that person going to have a heart attack or a stroke? And how rapidly is that person aging? So we know that trauma by this definition that changes us because our coping mechanisms are overwhelmed makes us age faster than our calendar age. So you could say, well, that person is 40 years old by the calendar, but they're really 46, right? That person is 65, but really 73. If you look at the

aging that occurs in us as a result of trauma. So if, you know, I say this in part to really speak to how like concrete and real this is. So something that happens and changes you so that you are actually older than your calendar age, closer to death, right, than the calendar might suggest is so real and so tangible. And this is the effect of trauma upon us. And modern science knows this, modern neurobiology, modern psychiatry, the research around us tells us this, but the things that we know aren't always at the forefront of our consciousness in society, which is a reason I think it's so important to spread the word about it. Why does this matter so much to you? I had a youngest brother who died by suicide when he was 20 years old. I hadn't felt that before. I hadn't felt like I couldn't be in the world or make my way forward in the world. And I started feeling

very, very different about myself. And I started behaving in ways that weren't healthy, that were very unhealthy, drinking too much, unhealthy friendships and relationships and real change in me that I was fortunate to be able to get help for that really brought to the surface how much had changed after the trauma, that I felt very different about myself in the world. I was cursed and maybe our family was cursed and I couldn't make my way forward and bad things were always going to happen. And it was the realization that like, I'm really different and this is not okay. And it wasn't like just grief, you know, in the sense that sadness and loss, of course, were a huge part of that, but realizing also like I am different and, you know, that had a very big effect on me, both the depression and the issues in him that

weren't seen and addressed that led to his suicide and then the downstream effect on the rest of us. And that led me to leave. I had a business career and I went back to college and took some pre-med classes and went to medical school and then became very interested in psychiatry and brain function, both the psychology of how we think and the brain biology that underpins how we think and have been very much fascinated ever since. Did process and or deal with the loss of your younger brother jonathan by suicide at the time no no at the time i just went inside like people didn't talk about it and were overwhelmed and you know became less healthy and felt different about the world but there wasn't an outlet for talking about it.

It just wasn't how I had grown up. Like there, there wasn't a way people would say, let's check in. Like, how are you doing? And maybe you should see someone like, like it didn't happen. And, and it took, it took until I realized like, I'm kind of in trouble here. I need to get some help to then, you know, I had an insurance card and to look on the back and say, go, maybe I should go talk to someone. But that was a stretch for me. And I felt even embarrassed about doing that. Like I really didn't understand neither what had happened nor how to help myself. And then I went to someone and I just remember just how amazing it was to just have her tell me that, you know, I wasn't like, I wasn't sick or crazy or like not going to be okay because I felt this way that like she

helped normalize what I was feeling and helped me put some of it into perspective and I realized like well that was very basic what was just done for me and you know many many many people do not get that and I almost didn't have it myself and I was I was very struck by it and by how much of a difference it made to have a better understanding and get some help. The impact it had on the rest of your family. I was reading that your mother was depressed for the rest of her life almost because of, potentially because of that incident. I think she was clearly different afterwards too and was much more isolated. Again, in hindsight, it's so clear to see, but I think the guilt and shame that she felt was overwhelming and she was not able to get help, you know, no matter how much encouragement. You know, at some point I, it was actually a psychiatrist and still couldn't, you know, couldn't get her to get help because I think she was just felt so ashamed and felt that help was inaccessible or that getting help was even more shameful.

And, you know, the patterns change. I mean, there was still some happy times in her life, but the whole tenor changed and changed towards progressively more depression. And again, it didn't have to be that way either, but there weren't support resources for, you know, mothers who lose a child to suicide. And my father, who is more extroverted, you know, mothers who lose a child to suicide. And my father, who is more extroverted, you know, then just had more natural support mechanisms. And that's what you see sometimes, that it shouldn't be that one person does better than the other

because they just happen to have different proclivities, you know. But when we're not really paying attention to this and we're just kind of running forward, you know, and trampling people, then maybe the person who's a little more introverted in a situation like that, a little more inclined to be self-blaming, you know, like that's the person who doesn't do okay. And, you know, my mother didn't and died, I think, much younger than she should have of cancer.

But this kind of trauma predisposes to the immune system not functioning as it should. And I can't say that this trauma caused her early death by cancer, but certainly there are a lot of scientific reasons to think that it was likely a factor in it. And again, unless we're aware of like what trauma is and what it's doing to us, that like we can prevent it, we can identify it and treat it. These changes to us don't have to stay the same. Like the person who's blaming themselves and ashamed and depressed doesn't have to stay that way.

The person who's abusing a substance to try and cope or to try and kill themselves because they feel so bad, it doesn't have to be living like that. Like we really and truly can make change. The person who has an autoimmune disease or heart disease or rheumatoid arthritis that's inflamed after the trauma, like everything is worse after the trauma, it doesn't have to be medically ill like that.

Like the message I'm bringing is one based in hard science. And it's one that has a real message of change, that it's not an esoteric principle, what we can and should be healthier. Even you think about more than 50% of complaints brought to physical medicine doctors come from a mental health perspective. And how much of that is based in trauma? It's the majority of what is ailing us and the numbers actually do tell us that.

At the top of this conversation, you referred to aging and the impact that trauma has on aging. How does that work? So trauma makes me older. There are cellular mechanisms in us. You know, people often talk about telomeres, which is one aspect that change as we grow older, because we're very interested in figuring out why do we grow older, right? So there are processes in us that sort of mark time and that change across the aging process of humans. Now, we don't understand

everything about this. If we did, we could change it and live much, much, much longer, but we're trying to understand about it. And I think science has made a lot of very significant headway in understanding. And part of that understanding is the biological age of a person is different from the calendar age. So if you, you know, an example would be if you took two identical twins at birth and, you know, one of them is able to live in pretty good circumstances and free of trauma and, you know, has a pretty good life going. And the other person lives in a way that has privation and a lot of trauma, maybe direct physical assaults seen as less than, denigrated

by society. It's a theoretical example, but the idea would be you go follow them 30, 40, 50 years later, and you find two people who are not the same age anymore, right? The person who had the better life, if they're 40, well, they're 40. And if you match up cellular aging mechanisms, and again, we don't know how close a person is to death, but the aging mechanisms are telling us how far along our path we are, so to speak. And you say, okay, that kind of matches with being that person's age. But then you see the person who has been through so much trauma, the presumption here being there, the brain changes of trauma, there's a post-trauma syndrome, that that person is going to actually be older in terms of how far they have traversed down that

path of the machinery in them running itself forward than what the calendar tells you trying to figure out why and how that's happening what is the mechanism that's causing them to apparently accelerate in age so the less healthy environment within the person so some of that is likely say the signaling molecules that we talked about. The bloodstream isn't as clean and healthy and running in as lockstep a fashion as we might want, but there are inflammatory signaling markers and that impacts cellular function and cells are more likely to die earlier than they might otherwise. And then elements of neurotransmission and anxiety and tension states within us. It's really environmental. One set of aging machinery is in a healthy environment and the other isn't.

So it's going to deteriorate more quickly. I mean, it's one way of kind of trying to capture that. The environment is very different in those two people. So how what is functioning in that environment ages is going to change. Like having a car maybe in a nice warm, dry environment, you know, versus having a car where, you know, there's snow and ice six months of the year, and then it's terribly hot the other six months, you know, that it's going to be different. It's going to age differently, so to speak, right? If you go look at those two cars 10 years later, and to some extent, it's like that in us too. the chance of dying in middle age than those who didn't experience it. It's not commonly believed

that trauma can result in disease, like physical disease directly, but you argue that it can. And you also talk about how it can result in autoimmune disorders, things like arthritis, Crohn's disease. Crohn's disease, ulcerative colitis, Parkinson's disease probably has an autoimmune component. We're learning that much, much more is autoimmune. So do you believe that trauma is the underlying reason behind many diseases that lead to early death? Absolutely. And think about what you just read.

Can we take a look at that again? Like, I think what you just read is absolutely momentous. So think about that. Sexual assault in the teen years leads to a two and a half fold increase in death risk. That's staggering. What's causing that? The whole cascade from the biological to the behavioral. So gene transcription has changed. Healthier genes are more likely to be off. Unhealthier genes are more likely to be on. That's not good for our blood vessels.

That's not good for heart disease or a possibility of having a stroke. And the immune system is more activated and more likely to attack itself. And some of the mechanisms within us that are protective against cancers, for example, are less likely to function. All of those things change biologically. Neurotransmission, endocrine function, signaling markers in the bloodstream, all of that is changing. And at

the same time, behaviors are changing. Higher risks of depression, higher risks of addiction, higher risks of impulsive behaviors, risk-taking behaviors. You have to put a lot of things together before you get a death risk that is two and a half times higher. But that's how we get there because it does put a lot of things together from the genes all the way through

to complex risky behavioral taking. Do you think there's anything killing more people than trauma fundamentally? Not if we look for root cause. I've seen many, many things that kill people. And I wrote about this in the book of people that I was taking care of who at times died. And I was always so struck by what the death certificate said versus why they had really died. So the death certificate might have said car accident. Okay, I understand that, but why was that person driving 120 miles an hour in bad conditions?

Why were they being so reckless? Why did they have five car accidents? I know that's the trauma. Well, it's a heart attack. Why did that person have a heart attack when they were 62? They didn't have huge risk factors from other any way except the trauma and its impact. And so if we're looking at root cause analysis of what is hurting us, what is hurting our quality of life, what is hurting the quality of life of people that we love and what is

killing us, I think that need we know more than even just that. And there's so much we could pile the information a mile high that supports that piece of information, which I think is quite staggering. What are the different types of trauma? Are there sort of different categorizations of trauma from like small to big? If we're using the definition that trauma is anything that overwhelms our coping mechanisms. So there are changes in the brain when our coping mechanisms are overwhelmed. And on the other side of that, our brains are different. So that's the biological

definition. Then we would look at, well, how do we get right? And it breaks down into three categories then of acute, chronic, or vicarious. So the acute trauma is how we've traditionally seen trauma. So if you think about the idea that people were shell-shocked after World War I, right? That was acute trauma, combat trauma. So our traditions of looking at trauma come from acute trauma and it's just more evident.

You know, after someone dies or there's an injury or there's a car accident, like, you know, we can see that, oh, okay, gosh, that could make some difference in the person. Like we can kind of get that. And sometimes we can see the change in the person from before and after. So we have tended to equate trauma and post-trauma syndromes, like what happens to us after those changes in the brain are now with us to acute trauma. But again, it's not a soft definition. It's based on, do those changes in the brain happen in other ways? And the answer to that is yes. That if a person is seen as less than, for example, in a society, for whatever reason, across time, or even within a household, a person is being abused

in a household, a child is being neglected, or a child is being emotionally or physically abused. Bullied at school? Sure. Bullied at school. Absolutely. Right. This over it. So, so nothing happens all at once, right? But that brain changes just the same. So it's a scientific definition of traumatic change. And it is true in situations of chronic trauma, just as it is an acute trauma. Now it doesn't mean all acute traumas or all chronic traumas make these changes in the brain. And then the vicarious, so the third category, there would be vicarious trauma, which means like human beings are empathic, right? I mean, thank goodness, right?

That's how all goodness comes in the world through our ability to have empathic connection. But that also means that our trauma can communicate from one to another. And again, it's not a soft concept. So people who are very much involved in other people's trauma, so in healthcare settings, sometimes in journalism settings, just in intimate home settings, in just spending a lot of time with the news, right, can become traumatized and have the changes in the brain that look the same as the person who can change us in just the same way. The modern field acknowledges that if it's in the context of professional endeavors, which really makes no sense, right? Like what we're talking about are brain changes and brain changes can come through acute trauma, chronic trauma, or vicarious trauma because of our ability to have empathic connection

and compassion with other humans. I want to make sure that I've nailed this before we move on. So the acute trauma, I get it. It's the big events. It's the going to war. It's the car accident, big events that happen typically in an instant, typically. Chronic trauma, this is things like racism, sexism, bullying that happen over a long period of time gradually that make you often feel less than right than other people and the vicarious trauma is the trauma that as you say you get from empathy so feeling someone else's pain feeling someone else's trauma and it becomes your own yes okay yes and they can

all lead us to the same brain changes but people have different levels of susceptibility right so one person may have three big acute traumas and that person's brain is still doing okay, right? It's not changed towards greater vigilance, right? It's not changed towards greater inflammation in their blood vessels. Then, you know, another person could have one incident that might seem more mild than the other three,

and that person can then have brain changes. So part of it is who are we genetically? How are we built? What kind of life experience have we had, especially early life experience? How susceptible are we to one thing versus another? And then this idea of the multiple hit hypothesis that I could have a number of traumas and then on a certain trauma that might be even mild compared to ones that came before it. Now it makes the changes. What is that hypothesis? So that multiple hit, which says that this idea that what doesn't kill us makes us stronger is completely wrong.

I mean, in absolutely every way, what doesn't kill us often makes us weaker. And that's why we have to be attentive to what hurts us but doesn't kill us so that we don't get weaker, we get stronger. But what can happen is we can become more susceptible to the more likely that the next trauma, if we experience one, will then create the brain changes. Because I've often wondered, I'm the youngest of four kids. We all grew up in the same household. We experienced a variety of different traumas, in my opinion. Much of it was chronic, but again, being the only black family in a white area, all these kinds of things. But I think I've always reflected on is for some reason, I think I experienced it much more, the trauma of that, than my older siblings. And I've pondered whether that's because of the timeline. Being the youngest, it was worse in the later years. So I think my

hypothesis has been that I experienced it more than later years. So I think my hypothesis has been that I experienced it more than my siblings. And I think I've embodied the shame a lot more than my siblings have, yet we both went through the same thing. So for whatever reason, I'm like, really, like I'm a workaholic and I'm exceptionally driven. Not that my siblings are, but I'm obsessed in a way that's probably not completely healthy. And I look at my siblings and I go, they're not fucked up in the same way that I am, but we all went through the same thing. Part of what you're pointing out is that the variables of life matter, right?

So if circumstances are different, say for one child in formative years than for another, those children could be affected differently, like economic circumstances. So some of it may be and probably is impacted by the things that you're saying, but there probably are almost surely other factors to this kind of nature and nurture that people have what sometimes gets called different levels of attunement of the emotional compass. So, you know, some people are very sensitive and sensitized to things and very aware of what's going on around them and aware of their own feeling states. And,

you know, and other people can kind of go through life and, you know, emotionally buffeting things can happen, but they kind of keep going, you know, and look, there are pros and cons to both of those ways of being, but the person with the sort of more finely attuned emotional compass is the person who's likely to register more things that are negative, like things like subtle expressions of prejudice, right? That someone with a less attuned compass may just kind of not see that or just doesn't make it into their conscious awareness, whereas someone else who'd be very attuned

might see a lot of those things. So it's this part, like what is the nature? Like who is the person, right? And then what is the nurture? Meaning like what is the nature? Like, who is the person? Right. And then what is the nurture? Meaning like, what are the variables, you know, that seed sort of falls into as we go through life? You must've seen this a lot in your practice where an individual went through a really traumatic early event and you've got the person in your practice sat in front of you that is an alcoholic. They are experiencing sort of suicidal thoughts but then when you look at the rest of the family the family just doing fine to some whatever that means fine but right

well one has to look at is the rest of the family doing fine because sometimes what it seems like on the outside is not true on the inside uh and then we do think about genetics especially around alcoholism there are um we don't understand all of it, of course, but there are genetic factors that can be very impactful. Then we'll look at personality structure, you know, is that person built to sort of internalize or externalize blame, you know, so why alcohol for this person and not for someone else, how much is nature or nurture and how much may be formative. It may be that, for example, that person was in social circumstances. Just real example that happens with some frequencies, they mid to late teens, where alcohol was accepted as a way of coping, right? And maybe other people in the family

weren't. The circumstances were just different, where they went to school was different, and they didn't have it modeled for them that this is how they cope. So maybe there are genetic factors that push more towards alcoholism. Maybe there are social factors, right, that was modeled for that person. So you can put those things together, which is why we follow patterns. And there's a science underlying all of this. But we have to look at who is that person, right? You have to look at the family history, so the genetics that may have been passed on. And what does that seem like may be the case in the person? Right? Because you have to look at, you know, the family history. So the genetics that may have been passed on and what does that seem like may be the case in the person. How can

you be informed by that? And what were their formative life experiences? And, you know, you start, we start to build a picture of what's going on inside of us so that we can understand and change by looking at our history, which is why mental health doesn't often do this. You know, it takes an inventory of your symptoms now to reflexively prescribe a medicine, right? So we need to understand ourselves if we're going to understand whether trauma is afflicting us, how it's afflicting us, how we can prevent it, how we can treat it if it's there.

And I think that means accepting that this is real and this is real science, which actually, when you were talking, it made me think of an example. So if I say an example to the science of it, one of the earlier studies, and I forget exactly how many years ago this was, but 15 or 20 years maybe, was looking at immigrants. And I believe they were immigrants from Somalia to Holland. I think I'm remembering that correctly. And so the incidence of schizophrenia in the human population is about 1% across the human population. But when stressors are higher, they can predispose people to having the syndrome of schizophrenia.

So it's about 1% of the population, but it's not evenly distributed. If there are people in sort of pressure cooker environments, so to speak, become more susceptible. And so they looked at immigrants who integrated into the community in Holland versus immigrants who lived in primarily immigrant communities. And the incidence of schizophrenia was higher in the people who had integrated, right? So the thought is, and again, there've been subsequent studies and we don't know for sure, but when you kind of look at that and say, what is that? Is the feeling of otherness, right, is different trying to integrate into a society that was looking at, you know, not everyone in that society, of course, but there was a much more pervasive sense of otherness when people were integrating

than when they were living in the communities where food and dress and the day-to-day of life was normalized. What's otherness and what's the sort of cost of otherness? I think otherness in the way I'm defining it is a sense of difference in a way that's not good, right? A sense of difference in a way that involves either being seen as less than, and again, sometimes it can be over prejudice, but it can be also stratification of opportunity. You know, just seeing that, okay,

like in some way I'm not on an equal, I don't feel on an equal footing here, right? And then that there's a, there's can be a sense of isolation there that builds the sense of otherness, then say building tension inside the person, right? The person doesn't feel quite as safe, right? It doesn't feel quite as validated

because, you know, especially when we're young, we look around us to see what's normal. And if, you know, people are looking, talking, dressing like us, like we just feel validated in ways that we might not feel if we see that we are different, especially if the difference isn't embraced, right? And we see this across immigrant communities

who at some point integrate, right? But initially people will tend more to stay together because there's a sense of validation in the community. So then the children often then will integrate, right? Which is why it's such an interesting study to look at people who were first generation immigrants who would be likely to feel very strongly, you know, whether they were integrated

or whether they were somewhere different because they weren't the subsequent generations, right? They're the generation that just come from the home culture that either they could still sort of live in or live in a new culture. And not that everyone felt a pervasive sense of otherness, but there's more of that sense of otherness. And the fact that that would change susceptibility to an illness that otherwise distributes itself across the population, I think is a very profound marker of scientific proof upon the things we don't pay attention to as much, you know, subtle prejudices, discriminations,

whatever they may be that are in our society that we kind of look the other way and don't see. We're really harming people who then can come to the, that come to the adult phase of life in a place where we have marginalized them and we've made things different inside of them that makes it harder to make their way in the world. And I think we overlook very much whether it's bullying, there's many, many

things that can be based upon what can make people feel less than, but the effect of it is seen in actual brain biology. And like, we know this, we've known this for a long time, but in some ways I see that we're more fragmented and pushing more towards these experiences of otherness or experiences of vulnerability and lack of safety that push people towards the chronic aspects of traumatic brain change. When we think about trauma, we often focus on childhood. But what you're saying now with the study of the Somalians that emigrated to Europe, presumably those were adults. Yes. So the highest incidence of schizophrenia is in people who are in young adulthood. So we're

not seeing changes in people who are already deep into adulthood, but the changes that we're seeing is in the sort of transition to adulthood, which honors both that, yes, we are much more impressionable in all sorts of ways, including how our brains are forming when we are younger. So these are people still, their brains still have enough formative, the idea is, the thought would be they have enough formative processes

going on in their brains that the brains can be changed by the trauma. But when we talk about these three types of trauma, the acute, chronic, and vicarious, can you experience these types of trauma in any age, phase, chapter of life? Yes. The earlier in the lifespan, the more impactful. Okay. Yes, absolutely. Which is why childhood trauma is so important. In the book, I interview Darren Richerter, who's a psychiatrist at Stanford and Stephanie von Gutenberg, who's a

child wellness advocate, because we're talking about trauma from both ends of the spectrum. So the chapter that's the interview with Stephanie von Gutenberg talks about how childhood trauma so deeply impacts the sense of self of the child, like things that we know, but I dedicate a chapter to it because childhood trauma is so tremendously impactful. And again, we don't pay enough attention to helping children who are traumatized and to projecting ahead to the increased burdens of illness and decreased role performance and all the awful things that happen. So childhood trauma is one thing. On the other end of the spectrum, Dr. Richarder's work has highlighted the fact that when people are traumatized, they are changed in ways that changes subsequent generations. So if we're talking about childhood trauma, we can talk about traumatized children, we can also talk about traumatized adults whose trauma changes

their children, even if their children are not born until years later. So think about this. And part of Dr. Richard's work was around war crimes. So the idea of rape, for example, as used in war that was seen primarily through a criminal lens. Like that was something wrong and criminal that was done in a way that very much circumscribed it. And part of what his work has really brought to the fore is not only is that not a circumscribed crime, that is going to affect that person for the rest of their lives because the odds of traumatic brain changes are very, very high. And if that happens, which is likely, then the unborn children that could be years and years down the road are

also affected. Think about that is, I think, as dramatic as any evidence can be that, yes, we need to think about children if we're thinking about childhood trauma, but we also need to think about adults who are changed by trauma and then their children are changed. Greater genetic expression of anxiety pathways, of pathways that are about hypervigilance. And again, it's just a sense of lack of safety. And this can come years after the trauma

changes the brain of the parent. How do we know that trauma can and is being passed on? What is the best evidence we have to support that? So the field of epigenetics, which has really come to the... So epigenetics really come to the forefront in the last two to three decades, which is the understanding that our life experiences can change the expression of our genes. So you or I may have a gene that is active now because we inherited an active gene, for example, and then maybe that gene is producing something. It's helping us in some way,

bolstering mood, decreasing anxiety. then something can happen. Something can change in us that turns off the expression of that gene or turns on the expression of another gene. So then even though you have that gene, you don't have the benefit of it because the gene has been turned off. And this is a very, I mean, it's a very revolutionary understanding that it's not just, well, your genes are your genes. You know, we could look when sperm and egg come together. Well, that's telling us what's going on. And if we could understand that fully, we would see, oh, here's the array of genes that are active in the array of genes that are not active. But like, that's not the story, right? That's just part of the story. The story continues that

one's experiences of life changes how those genes function, which ones are on, which ones are off, and how they get passed along. So if the parent is not traumatized, the parent may pass along the active gene for something positive, say, to the child. If the child then is traumatized, the child may pass on that gene without it being expressed. So it's as if the gene isn't passed on. So if you think about that, it's just amazing that our genetics in the sense of what's actually going on in us is not just the nature of what genes did we get, it's the nurture. How has what has happened to us affected the expression of those genes? There's one study that I read about which says scientists at Emory University in Atlanta trained male mice to fear the smell of cherry blossoms,

shocking them whenever they smelled it. So the mice got to the point where they shuddered when they smelled it, even when they weren't even being shocked. And I'm guessing the children then had the same reaction. I guess that's what the study concludes. But also the children of Holocaust survivors are another example of how trauma can be passed on because it's hard to think of a much more traumatic event than being involved in the Holocaust. And for a long time, the thought was that the reason that children of Holocaust survivors had higher levels of anxiety

and of anxiety spectrum illnesses was because of anxious parenting. That understandably, the parents had a much more sense of vulnerability. So across the population, they were more anxious and they were raising the children with more anxiety. And what we have learned is that the experiential aspect is part of it, but that exactly what you and I are talking about is part of it too. Because the experience of what they went through changed genetic expression in the children. So that's just a sea change in understanding that the genes of the parents, the genetic expression of the parents and the genetic expression that they pass along to their children is changed by the Holocaust experience itself. With this understanding of epigenetics, do you in your practice then consider deeply what someone's parents went through in their life and how that might have changed someone's sort of genetic expression that sat in front of you in your practice? Sure. Sure. I think we all deserve, so to speak, to think about our life narrative,

right? And so many of us don't. I think if we're trying to help ourselves, you know, whether someone listening to this feels that they're depressed or that they don't have any mental health issue, but they want to understand themselves better. It's like, think about a narrative of, okay, where, let me start with like, where have I come from? And like, who came before me? And then wait, this happened and then that happened. And when we build a narrative, it's remarkable how much we can come to understand about ourselves

because often we don't do that. Like we have isolated pieces of information about ourselves, but we don't do that like we have isolated pieces of information about ourselves but we don't knit it all together and and it's really remarkable what can happen what can be elucidated by doing that so absolutely yes just for the general understanding of the person and also to understand what did the parents go through you know what what experiences did they have how might that impact this person and you might then ask questions of, let's say the family situation changed, you know, between say older siblings and younger siblings, right? Then by learning about that history and learning about older siblings versus younger siblings and the parents, I mean, think about how much you learned then, not just about the person's experiences growing up, but just about the biological aspects

of how are the parents functioning? How did it impact the children? And what were the situations? How are the children similar or different? There's so much we can learn from that. You liken trauma to a virus. It's a very interesting way for us to start thinking about trauma because we seem to think of it, at least I did, as being sort of isolated to the person. But the idea that it somewhat has a contagion to it and that we can spread it vicariously to other people that are around us but also down through the family tree via our epigenetics and via our genes makes you kind of understand both the importance of treating it but i've just never heard anyone describe it as a virus before.

Yeah, because there's a reflexive guilt and shame to trauma and our society doesn't recognize it, it often gets hidden inside the person, right? But when it's hidden inside the person, it's still spinning off symptoms. So I think the best analogy to use here is of an abscess in the body. So an abscess is a walled off area of infection in the body. And it's good that the infection is walled off because if it weren't, it could be fatal, right? So it's good that it's walled off, but the body is still aware that it's there and it's still spinning off symptoms because it's there. So for example, a person might have an intermittent low-grade fever or just feel kind of jittery or they're sweating and they're not sleeping well, right? So there are pervasive symptoms that are impacting this person,

but it's not obvious that the abscess is there, right? So what often happens in general medicine is a person is having nonspecific symptoms. You know, people go looking, scan, they see, oh, there's an abscess there, right? Once we know that, then we might have an understanding for why that person never feels good, right? They always feel lethargic or they never feel comfortable. We know there's something there now and we can go in and fix it, right? And it involves, you know, there's a surgical process, right? So something has to happen that's not a fun thing, right? If you go through surgery and recovery, now the abscess is gone.

So I think the example of the abscess in the body is a very good way to understand what trauma does to us in the mind. So if we shove it down inside of us, there's reflexive guilt and shame. Society isn't helping us take a look at it. Now it's there inside of us. It's going to spin off symptoms. And those symptoms aren't always symptoms that makes a one person hurtful to another. They may not, but that person may be very, very vigilant and just kind as can be to someone else. But across the population, those symptoms inside of us are not good. So they give us shorter tempers, right? We're more likely, we're more anxious. So we may be more quick to anger or we're less functional in the

world around us because of depression, anxiety, sleep problems, right? We can be more impulsive. Like it works against us being in the world as best we can be. Is that what you refer to as post-trauma syndromes? Is that a similar thing? Yeah, post-trauma syndromes are ways in which we can recognize the changes in ourselves. So higher levels of anxiety, for example, lower levels of mood, right? Different changes in sleep, physical health changes, and then changes in just how comfortable we feel in the world, right? So what we'll see is changes in behaviors that are driven by just feeling differently in the world. So we're in a different self states.

We have different behaviors. The syndromes can do all sorts of different things to us from mood, anxiety, sleep, behavioral change. So someone who might want to find a relationship partner, you know, stops going to places where they could meet someone, right? So we change our behaviors. This is what shows us that there is a post-trauma syndrome. That's how we know we're traumatized, effectively. Because that's what I'm trying to figure out. People will be listening to this now and hearing you talk about these different types of trauma. What are the sort of telltale signs, I'm assuming it's this, that I am traumatized? Right. Yeah, this is what we're looking for, right? So someone might present with,

that person is depressed now and they weren't before. That person is having panic attacks and they weren't before. That person is using alcohol to soothe and they weren't before. Because in medicine, we look at just the surface, right? What we want to look at is like, oh, why are you here? Oh, you're here because you're drinking too much. Let's talk about how you can drink less. You're here because you're depressed. What can we give you a depression medicine, right? So then we're not looking at like, why, right?

Why are you depressed? I mean, some people biologically will become depressed, you know, no matter what, even when things are going very, very well. But this isn't the majority, right? Most of us, if we're depressed, there are likely factors. So we should be curious. Why is that person depressed? Why is that person having panic attacks? Why has that person changed their behaviors, right? And so now if we get curious,

we get curious about the person, then we're going to figure out things we wouldn't have before, right? So if a person gets depressed because everyone in their family gets depressed every nine to 12 months, no matter what, like, okay, let's come at that biologically. That doesn't necessarily map to trauma, right? But if we start looking at that person being depressed, do we see that they kind of started getting depressed a couple of years ago around the time their sleep started being a little bit different and, you know, they started behaving differently and they, you know, they didn't spend as much time with family. And then you start getting more curious and you start learning, oh, you know, something happened then, right? Again, with acute traumas, it's easiest to see, but when

you look for the whole picture of like, might there be a post-trauma syndrome going on here? You know, maybe that person who's depressed and is drinking too much started drinking too much when their mood started decreasing after the trauma, or maybe they started drinking after the trauma and it's driving their mood down. Like, and it's not always this, but we're never going to know and understand unless we're curious. Like this is how we trace to the roots of it. And this is how we get back to the narrative, right? Of what is going on inside of me and have I changed, right? And the idea, we started talking about how the changes in behavior of the post-trauma syndrome are the changes that make trauma like a virus, right? Because we start behaving differently. And for

some people that is, their mood isn't as good and it's not as healthy to be raised by a parent who's depressed, right? So that can be a way in which the virus of trauma gets passed along to the next generation. Or maybe that person is drinking or using a drug to cope and that doesn't make for the best parenting. That's how the virus of trauma gets passed down to the next generation. Or there are times when a reaction to trauma, to the feeling of disempowerment can be aggression, an envious, aggressive behavior. So not all abuse of children comes through the lens of trauma, but a lot of it does. I'm interested as well in the subtle symptoms of trauma. You know,

we've talked about some of the big picture stuff, which is like suicidality, you know, becoming an alcoholic or all those kinds of things, but the subtle ways that trauma shows up in everyday life. Some of them I was hypothesizing over are things like phone addiction, being addicted to your phone or video game addictions. These kinds of things that I think maybe originate from the sort of more chronic traumas, but are less easy to spot. Right. Right. Yeah. I think the key to all of this is curiosity, right? So let's say someone is addicted to their phone. Okay. Maybe that's because phones are addictive and the person has just spent too much time on their phone. Maybe. Right. But addiction mechanisms in human beings are similar, it's the telephone, it's sex, it's exercise. I mean, there are things that people do in addictive ways

as routes of unhealthy coping. So if we get curious, why the drug, why the phone addiction, why the things that might seem more subtle and maybe are more subtle, but we should scratch on the surface of them to try and understand if they mean something. Is that phone addiction the 14th addictive behavior in a row, right? Because that person has sort of particularly adept addictive machinery inside of them and they're trying to escape from something? Like that doesn't happen all the time, but it is not untrue that when you scratch the surface of that, you might learn about an episode of sexual abuse that happened when the person was a child. Like, these are real examples, right? And that the person isn't built to run from things through

addiction. And maybe they're saying things about their own character that's negative. They're saying negative things about themselves and they feel disempowered and they're disempowering themselves. But if you go look at that narrative, you know, that person that might have a dialogue running over and over again in their head of shame about something that happened 30, 40 years ago, this is not uncommon. So we need to be curious and we need to scratch on the surface of things,

whether they're really big things or they're subtle things, like, which is why a life narrative is so important. If you think about changes, like after trauma that changes the brain, we respond differently when we see a new face. So without the trauma, I'm simplifying a little bit, but you see a new face, we might be curious. Like, oh, could you be a friend? Or if someone's romantically interested, like, oh, might that person like me? Or am I them?

People are interested and curious. Whereas after trauma, there's a difference of feeling a little bit on the back foot. So people tend less to look up and engage and more to look away or to more have negative thoughts. So you don't, that person doesn't like me, you know, instead of something that might be more constructive. How do they test for this? Is there a test that are able to be done to see if someone after trauma has like a different set of sunglasses that they view the world with? Yes. There's a test from the brain biology all the way through to very clever psychological experiments. Like we can see all of this and it's these signs we should be looking for in ourselves, right?

Because it is very obvious if someone who always was an extrovert now won't leave the house, right? Like we can tell something's wrong and someone's probably going to come ask something, right? But if we just change in these more subtle ways where we're just less interactive and, you know, people notice their friends a little bit different and less outgoing, it's these things that, as you're saying, the subtle ones, the subtle signs and the nuances are often very impactful and indicative of other things going on under the surface, you know, that can bring even greater problems. On this subject of soothing that you were talking about a second ago, there's this quote that you say in your book, trauma promotes pain, pain increases suffering, and suffering

makes us desperate to soothe our pain, whatever form it takes. Sadly, we're seeing the terrible cycle play out on a larger societal level with the opiate epidemic. Yes. This idea of soothing, we will find ways to soothe ourselves. And some of those ways that we find to soothe ourselves become destructive in and of themselves. And it almost makes me think that like our, sometimes our attempt, we think of like alcoholism typically as people that are self-destructing. But when you understand the soothing component of drinking alcohol, it actually is them trying to not self-destruct, not destroy themselves, but to take care of themselves in a weird way? If we're under huge amounts of distress, our perspective of the world narrows, right? Very, very dramatically. I mean, if there's an elephant standing on my foot, I only have one thing I'm guessing I would think about, which is the elephant not standing on my foot anymore, right? So when we're under tremendous stress and strain, right? Something that soothes

us in the short term, right? Becomes acceptable because there's a desperation in us that has us focused on the short term. Like I know that, I know that's not good in the long term, but I'm just trying to get through today, right? And it's this lack of perspective in the world and the society around us that if we're not recognizing what trauma does to us, that it can drive us to places of desperation. That is it any wonder that short-term soothing will have a big appeal to us? And that could be soothing through excess eating. And now that person is overweight and has diabetes and wants to be healthier, but doesn't really feel that they can stop and ping-pongs back on

different diets. And what they're really doing is they learned self-soothing with food in a way that was, you know, in the context of really feeling some sense of despair or desperation, the same way that person may have learned that, oh, alcohol soothes. Now, again, there are genetic factors and there are all sorts of factors that come into play too, but unhealthy coping mechanisms are beckoning to us all the time, which is why, you know, I did a lot of treatment of, of opiates and opiate dependence over a number of years. And, you know, it's just outrageous to me that these, these are the most powerful psychoactive medicines on earth, right? Opiates, right? They soothe psychic distress, like, you know, feeling not good mentally inside of us very, very rapidly and effectively and almost immediately

start building tolerance and danger, right? But I had no education and training around opiates as psychoactive medicines. So here we are in a society that is underappreciating trauma and where people are at in a sense of isolation or otherness or desperation in so many facets of our society. And then we start handing them the most powerful short-term soothing mechanism with the absolute highest risk of long-term danger and death. And then we're surprised that how many tens of thousands of people die each year from prescribed opiates. What kind of opiates are people being prescribed? So how the opiate epidemic really began was with opiates in pill form. So that they would be prescribed, say, for conditions of pain,

but conditions of pain that were more chronic conditions or conditions not so amenable to opiate. So if you come out of surgery, an opiate is a great idea, right? Like there's a lot of pain that needs medicine to soothe that pain until the pain decreases. But it's judicious use of a very powerful medicine in high acuity circumstances. What we started trying to do, and part of this was, we know there's a whole story behind the politics and the business of this,

was to say, well, people shouldn't be in pain. So there's a short-term solution, right? No one should be in pain, we'll give them pills, right? And opiates do not work in those situations. They soothe a lot early on, but they rapidly them pills, right? And opiates do not work in those situations. They soothe a lot early on, but they rapidly build tolerance, addiction, they suppress breathing drive. So, so we started doling out opiate pills with the idea that we're treating pain and isn't that good, but with an absolute inattention to the immense risks of that. And I think it fits with the short-term view of, you know, of relieving all pain.

Like we're human beings. We can't relieve all of our pain, right? Sometimes what there is to do is to work hard to mitigate pain. And that might be pain, you know, from a mental health perspective. It might be pain from a physical health perspective. But this idea that a pill is going to fix everything and now everyone has pain pills and won't be in pain, you know, has resulted in hundreds of thousands of deaths in this country alone from prescribed opiates, let alone illicit opiates. So there's the short-term thinking on the part of our society that then almost lures people into the seduction of the

short-term soothing, right? You feel miserable and you want things to be better, take this pill, now you're seduced and addicted and at huge risk. And we've let that happen. For us to know how to treat trauma, we have to understand the physiological consequences of it. How does trauma change our brain? When we look at brain scans, what do we see in a traumatized person? Brain scan data is more complicated and harder to interpret. You can see different patterns in the brain. We're not at the point where brain scan science can really pinpoint. But what we do see is parts of the brain that are sort of inflamed, so to speak, by trauma. So the amygdala and pathways around the amygdala, which is a part of the brain that gets called sometimes grand central station for negative emotion, right?

We see that pathways involving this part of the brain become more prominent. So we see changes in brain connectivity because how our brains function is by communicating from one place to another. They function through connectivity and which pathways are more prominent. So what we see then is pathways that are involved in trust, say, and feeling a sense of safety are less prominent. Pathways that are more activated when we feel less safe and more vigilant are more activated. And then we see the climate, so to speak, in the brain change in a way that's less healthy. And you may also see specific aspects of a post-trauma syndrome. So mood regulation areas are not functioning as well because now there's depression intruding. So we see patterns in the brain that show us this change, although the

science hasn't come far enough to pinpoint like at some point we'll be able to do with much greater accuracy. And I've heard you talk about how that creates cognitive blind spots, so blind spots in our brain following a traumatic event. What do you mean by cognitive blind spots and what's the harm or risk of that? So a cognitive blind spot can occur when we take a lesson inside of us that is a lesson of trauma, not a lesson of truth. And then it changes how we may think about things. So for example, a real and sadly, many examples of this that I can bring to mind in people's faces who come to mind as I say it, but someone who felt pretty good about themselves

and able to navigate the world and striving for a better job and doing fun things who then is assaulted. And after that assault, the person is much less present in the world and internalizes a bunch of different thoughts about themselves. I don't really like being out. I like being at home better. Or it never goes well.

I don't get along with other people. They think about themselves differently. So there's a cognitive blind spot which makes it very, very difficult to think with accuracy about, say, possibilities. So that person may have, say, been striving for a better job. But if they think of themselves differently, I'm not the kind of person who can get ahead and people don't really like me, then they don't strive for a better job. They just take for granted that they can't get it. It won't go well. They'll fail at it. But they never thought that before. Is this what you kind of see when people refer to someone having daddy issues? I was thinking as you were saying that, that my dad left. So say my dad left when I was four and I internalized this idea that men don't love me, for example. And then I go through life being an avoidant person in romantic situations or self-sabotaging or going for people that are unavailable to avoid the rejection. Is that somewhat similar? Like I've created a cognitive blind spot and now I'm living out that

as an instruction manual for my life. Yes, absolutely. Yes. And the earlier in life, the more powerful the lesson is and the brain doesn't go back and revisit those lessons. So I think this is just so amazing and surprising to me that our brains are so incredibly complex, right? More complex than the greatest supercomputer, right? Yet our brains don't do some very basic things. Like we don't reboot and see, is there a patch or is there something to fix, right? We don't go back and look at these earlier lessons. So if you learn at age four, oh, men don't love me. That's a hard lesson to unlearn because it gets solidified at an early age. And then once those lessons are there, there's an internalized danger to go revisit them. Like if you go revisit that lesson,

could you be disappointed, right? The thought is that's the way it is and that's the way it's going to be. Like that's kind of what we tell ourselves inside the trauma kind of walls it off. And then we don't just go back and look and say, is that really true? Like, here I am, I'm an adult now. And no, did I just carry forward something when I was four years old that wasn't about me?

Is it really about the four-year-old, right? Or is it about the adult? Like we learn all these things, but we don't go back and revisit the lesson. And then yes, there's a person who could be very, very avoidant in ways that that lesson, that quote unquote truth that is not true can change that person's life. And that's why if we go back and look at that, life can really change. And we can go back and look at why do you feel that? It's interesting to feel that. Let's think about it. And what's the story behind it?

And we can get to a place where that can be undone and say, oh, I took that lesson inside because someone else made a choice that was about them and not me. No four-year-old is responsible for a parent leaving. But I took something in that was different and it's really affected me and I kind of feel differently about myself. It's not that everything instantaneously changes, but boy, the world is different then.

On that subject as well of, say, the father leaving at four years old and me thinking that men were... Let's say I was four years old and my father was violent. What you sometimes see is people then are trying to gain a sense of mastery over a situation in which they had no control. So you will see this in abusive relationships where sometimes a person will come and say, okay, I'm coming to see you, but I know you can't help me. But my last like eight relationships have been just awful. So how can you possibly help me? And then I might say something like, if you can tell me how you had eight different relationships

that didn't go well, maybe I'll believe you. But you're going to tell me about the same relationship eight times over, right? Something along those lines, because we repeat things that don't go well in an effort to gain a sense of control. So what often is the case in that kind of situation is whether it's repeating an abuse cycle or just someone who is inattentive or isn't interested.

The person is trying to feel better about something from the past. So if the father was inattentive and that person has a romantic interest in men, that person may choose men who are inattentive with a desire to make them inattentive to fix, to soothe the pain of the past. Because the emotion systems in our brain don't care about the clock and the calendar. So you can solve the past in the present as far as the emotion systems are concerned. And if the trauma is very strong in us, the emotion systems will rule the day. So they said the father was violent, then maybe that person chooses a violent significant other, right? And then that relationship goes away and the person chooses another violent significant other. And then sometimes the thought

is, well, the person is choosing that because that's what they're comfortable with. But no, the person is trying to make sense of something and there's some desperation inside to feel better about themselves and to fix and heal something. Whereas why, if we can intercede there and say, the problem is if you want someone who's attentive, choose people who are attentive, choose someone who's attentive, right? As opposed to choose someone who's not attentive and try and make them attentive. Can we become addicted to our victimhood? Sure. There's no internalized victim without an internalized persecutor.

So if someone is victimized in the sense of the law, right? Someone has done something bad to that person. That doesn't mean that person takes inside of them that they are a victim, right? But trauma can make us feel like victims. After the loss of my brother, when I felt like maybe we're cursed and I can't really get anywhere in the world,

like there's a black magic to that, right? Then I still feel like I'm a victim of something. I'm behind the eight ball. Then I have a sense of otherness, right? And now I've taken something inside of myself where we don't need a persecutor anymore. I feel like I'm less than. So how's that going to go well, right?

So what we end up doing is we take inside of us sometimes this sense of victimness, but that also takes inside of us the idea that we are less than, that there is something magical that is bad and negative. And what we need to strive against is exactly that, that something may have happened that we might say, okay, that person is a victim in the eyes of the law.

They were assaulted, right? But that doesn't mean that person has to take victimness inside, guilt and shame. How many people have I seen who are assaulted and they talk about how they're ashamed of it and it's their fault. Someone else attacked them. But the reflexive guilt and shame of trauma can lead us to feel less than, then we start feeling like victims. Then we feel less than, we embrace this and we don't need someone to persecute us anymore. The limbic system, we're talking about the brain here. What is the limbic system and what role is it playing in cementing our trauma? Yeah. So the limbic system is the name for the emotion systems in the brain. So we're simplifying a little bit, but the idea that there are logic systems and emotion systems, the emotion systems are limbic. Those are the limbic systems and they never lose when they come face to face with logic. The limbic, the emotional always rules the logic if the two come head to head, which is why if the emotion of trauma, the fear of being less than, the need to repair something that was unfair in the past,

if that is driving us, logic will not have its say. You know, logic would say, if you've dated six people who've all kind of seen the same at the outset and then all behaved in the same negative way, don't choose a seventh like that, right? I mean, logic was saying that at the second person, let alone the third, the fourth, the fifth. Why do we see repetition of unhealthy relationships?

Because the limbic system, if it needs to feel different, it needs, so to speak, to solve that trauma by gaining mastery, it's going to go look for the seventh person who's just like the first six. But once we take the energy, we lance the abscess, so to speak, of the trauma, then logic can have its say. And that person who says, you can't help me because the last eight relationships were all awful, sees, oh, I did the same things, chose the same person in the last eight relationships. That's one paradigm and I'm changing it now. And then things are different when they thought they couldn't be. Because they can see now thought they couldn't be because they can see now

what they couldn't see before. The limbic system isn't ruling the day anymore. There's a whole balanced brain that has an understanding of self and uses that understanding to move forward in life. It seems like the limbic system is against us, but there must be some sort of evolutionary reason or rationale or purpose of that limbic system that is, I don't know, malfunctioning in the modern world? Oh, sure. The limbic system isn't against us. All these parts of our brain, none of them hate us. They're all part of, they're all parts of us. And some of the research and observations through the psychedelic sciences are really telling us that much more, that there aren't parts of our brain that hate us. They may work against us because

as you're commenting, they're not built for the modern world. So, you know, if you think about the limbic system and the negative information, like something bad happened when you were four or five, like take that in and whatever lesson that is never questioned it or change it, right? I mean, this is based upon survival mechanisms. The example I give is, you know, imagine for most of human history and people's of hunting and gathering and living in small groups and, and like having enough food was, is very important for humans across human evolution. If you find a new food that it looks good, looks like something else that was good and you, and you eat it and it tastes good and it's nourishing, like it's good

to remember that. But if you eat it and you get very, very sick, you better remember that forever. So the negative has much more salience in us and makes these lessons never go near that thing again, never go near that person again, never do this again. They're designed to keep us alive, but we're trying to do more than that. We're trying to do more than stay alive and these systems in us that evolve to keep us safe then can very much work against us the person who's traumatized because someone attacks them and that system gives them panic attacks if they leave the front door i mean that's that person's brain trying to keep them safe. You use the word shame a lot when we're talking about trauma. In the same way that I asked, is the limbic system against us? What is the use of shame?

Why do we experience shame? Can't we just program ourselves to get rid of shame and then we'll all be fine? Exactly the same with the limbic question. No, we kind of need shame, but we need shame for good reason. So these primary affects that are very primordial in us, anger, fear, love, shame, these are things that are just aroused in us. They can become other things once we start thinking about them, but they're states that are very deep within us. They all have a survival adaptation. So feeling love is being more than one. If we love someone, now you are too, and

you're there with one another, and that's going to help you survive and make your way forward in life. Love is adaptive. Fear can be very adaptive that now you're in a fight or flight stage. You're trying to survive and get through life. Shame is the same way. There are things that people do that bring shame that change behavior. Shame changes behavior a lot because it feels so bad. So, you know, I give the example of, I imagine that, you know, in the old days, you know, someone who, you know, pees on the food in the cave instead of going outside,

you know, and like now puts the whole tribe at risk. And then like there's a sense of shame that comes to that person. Like you can't do that anymore. And the person feels bad and never does that again. And it's adaptive for the group, right? It's just one example of how shame can alter behavior. So- To keep us alive in that context.

Right, to keep us alive. Like now you feel shame, you will not forget to not do that anymore, right? Like it's going to have an impression and it's going to change you because you feel so much shame, which we would think should be the case in the modern world too, right?

There are things people do that are shameful that are worth feeling shame about. I mean, sometimes the problem is we don't have enough shame where we should. But we have a lot of new modern problems, don't we? With, I was thinking about bullying, for example. Like I imagine back in the days of our tribes there wasn't internet like obviously not but there wasn't like mass

internet bullying where a huge group of strangers could just pepper you with insults and maybe our our modern brain still has the same old mechanisms of kind of perceiving that as our tribe are going to kick us off the island here. Right. So the brain malfunctions and experiences shame, which causes all the things you described. And then even in the context of like sexual assault, I was trying to rationalize that, how the shame of sexual assault can make you feel shame when really it was someone else's behavior. But how does that make that, you know, that woman feel or that guy feel shame about themselves when they were attacked? Because it doesn't start with the thought of it.

Because you're right. Because what you're saying, I think, is basically it makes no logical sense. Why would you feel ashamed of yourself if someone else came up behind you and jumped you and did something awful to you? Why would you feel ashamed of yourself? But the person doesn't get there by thought. I didn't get to feeling ashamed of myself after losing my brother by suicide by thinking that is a shameful thing. I should feel ashamed. No, the shame is aroused in us. It's created in us because it's behavior modifying. There's the adaptive, something bad has happened, feel something inside that creates aversion. The shame is created in us and then we make the meaning of it. I feel ashamed, there's shame

inside me and then we make the meaning of, right, because I shouldn't have been there when that happened. And then we make a story around it. It starts with the limbic system, with the affect, and then we build a story around it, which is why we can build a different story where, for example, shame goes where it makes sense to go. Like that's very, very effective of processing through. So, okay, so this thing happened. You can process through with someone how they felt and what was going on inside of them. Maybe they're in an ambulance or a hospital and they're filled with shame as they realize what has happened to them. And, you know, and then that was a terrible state to be in but then they start put they start making trying to make meaning of that state and we can go back to oh that's a that's a

natural completely understanding human state to be in after this happened but now you get to decide what that means so in the context of our ancestors i I'm walking through the, I don't know, Serengeti with my, with my big spear and I'm walking and a lion jumps out at me out of the blue. I managed to survive it, although I've been attacked. The shame is created in me because as a response to make sure my behavior changes so it doesn't happen again and then i write a story about that when i get back to the cave and tell myself like the story could be that i shouldn't have been walking out at night in the serengeti alone when that lion attacked me and that's adaptive and useful because it stops me from doing that in

the future it's like a so i'm trying to think of it maybe it's a little different if you were out okay let's say you're out and you're actually you're hunting a lion in the future? It's like a, I'm trying to think of it through that. Maybe. It's a little different. If you were out, okay, let's say you're out and you're actually, you're hunting a lion in the service of everyone else and then you are attacked and hurt, that's different because you're doing something then

to feel proud of. Yeah. So that is different. That's a situation where the person is approaching the trauma on the front foot and then when you return back, the thought would be, you would be respected and cared for. that's a situation where the person is approaching the trauma on the front foot. And then when you return back, the thought would be,

you would be respected and cared for. Like, you know, you went out to do something for everyone and got hurt. That is very different than how people normally would experience their trauma, which is when there isn't a sense of pride and self-sacrifice behind it. So if the person, let's say you're walking out in the Serengeti at night and you shouldn't be, then you should feel bad about that, right? Then the thought would be, yeah, I shouldn't have been doing that.

And how bad you feel about it will make you not do it again. So you're not going to get killed, right? And then you're going to come back and talk about that or people are going to go, what were you doing? And well, you should have been out there and they may feel bad that you got hurt, but there's an experience that is a deterrent to others doing that too. Right. So.

This says something really interesting about how we treat people who've been through a trauma. Right. Look at the difference in the United States between veterans coming back from World War II and veterans coming back from Vietnam. There was far more post-trauma syndromes, post-traumatic stress disorder after Vietnam because people were not coming home to a hero's welcome. The thought there would be, they had gone out, like the person who goes out into the Serengeti to hunt the lion is to save everybody else is that's what was going on when people went to fight in World War II and when people went to fight in Vietnam. But when people came back from World War II, if they'd been hurt, they were treated as heroes. They were treated with

respect. And that allows a person to shoulder that trauma without the brain changes happening. When people came back from Vietnam and were treated differently, which didn't happen to everyone, but it happened as a societal phenomenon that was a terrible thing for the veterans who came back, you saw much greater rates of post-traumatic stress. I mean, that I think captures very clearly what the impressions and perspectives of the people around us mean. There may be a reflexive guilt and shame from trauma, but that doesn't have to win the day. But it was much more likely to win the day if there's a sense of otherness. Because now we're talking about the same thing of

feeling less than chronically by society for some reason makes that person more susceptible. So that person who's been through combat trauma and then comes back and does not receive a hero's welcome is put at much, much greater risk for the brain changes of post-trauma syndromes. What role does vulnerability and being open with others about how we're feeling play in alleviating our shame? For most of us, in most cases, it plays a very big role because the reflex to the trauma is guilt and shame. And the reflex to the guilt and shame is to hide it inside. What we are doing is cutting ourself off from the human contact that we need in order to process what has gone on with us.

So very many times over 25 years of being a psychiatrist, I've sat with someone who is putting words to their trauma for the first time. When I was five years old, I was assaulted in that way. This coach did this to me when I was a certain age. I was hurt this way and I'm the only one who survived and my two buddies died. These are real things that I have heard people say and then be shocked that I, the other human in the room, don't recoil from that. Because they've held so long inside of them that it is shameful that they were assaulted. It is shameful that they survived. That it's so dangerous to even utter it, the fear of how a person will react, that someone is surprised, like, wow, you could hear that. Or they say it in ways that kind of step back a little bit because there's such an expectation of rejection, whereas what the person

is telling me is something that from any reasonable human being would only elicit compassion. Now, that person who's telling me would only ever be compassionate to someone saying that, but they're not compassionate to themselves. Is shame really the cause of what we kind of think of as these trauma cycles? Because someone experiences a trauma, they suppress it, which changes how they behave, which means that they're more likely to experience more trauma in some way, or at least perceive it as a trauma via shame. And then they kind of, their life gets more and more

full of different types of trauma. Does that make sense? Because I'm wondering if like trauma can be quite a self-fulfilling thing where you get into a cycle of trauma in your life. Well, it can be. I mean, in the case of the person who now finally puts words to something they've held inside of them that they would know is not shameful to anyone else, but they hold as shameful for them, what is going on inside of them may or may not have caused further trauma. I mean, it's caused suffering.

There's no doubt about that. saying that and they're putting word to something that's so important has been inside of them, it has caused them suffering. So they haven't been as happy as they could be, enjoyed life as much as they could be, been as outgoing as they can be, been depressed when maybe they didn't have to be depressed. So the trauma is impacting them because they've hid it down inside, right? If you can talk about it and bring light to it, let's say after that thing that happened when the person was assaulted at five years old or survived an accident and others didn't, if someone did trauma work with them of, hey, what are you feeling now? Okay, let's get to the fact that person is feeling guilt and shame and the naturalness that they are, but it doesn't tell them truth. It's just telling them how they feel. that comes from compassionate places inside of us, we can help to unwind that before it becomes a thing inside the person that yes, may make life less enjoyable or may also in a way that's worse,

push towards repeated trauma. So the trauma of choosing the same unhealthy partner or the same abusive partner over and over is an example of what you're saying. If a person doesn't look at the trauma and like, why am I doing this? What am I trying to solve here? Right? I'm trying to solve something maybe from childhood that was somebody else's shortcoming or fault or someone else's shame. Okay. I can stop doing that. Then the person can stop with repeating the behavior. So the answer to all, I think the answer to what you're asking is absolutely yes.

And if we're curious and we strive for understanding ourselves and we know that there are routes to change, this is how we heal from trauma. That ultimately invisible epidemic is a message of warning, but it's not a negative or a pessimistic message. It's a positive message. If we understand this and we look at it, well, guess what happens is we get better. We prevent trauma. We take care of the trauma in ourselves and others and we look at it, well, guess what happens is we get better. We prevent trauma. We take care of the trauma in ourselves and others and we get healthier. Like I see this play out in 25 years of doing this.

Like this is what happens. But we only get there if we have the curiosity. We're interested and we know enough to go looking and thinking and making a narrative and talking about ourselves and wanting things to be different and knowing that they a narrative and talking about ourselves and wanting things to be different and knowing that they can be. So it's a message of hope because when we do that, we really see change. So clinically when doing this work, you see a lot of difference

in people. And that's part of what's been so heartening and led me to write the book is it's not just a message of, oh, this is what's going on with us. Let's take a look at it. This is what's going on with us. And if we look at it, absolutely, we make life better. I want to talk about some of the ways that trauma impacts us that are less obvious. One of them I'm interested in is sleep. A lot of people are struggling with sleep these days. Is there a link between sleep issues and trauma? Yes. And how strong is that link? So sleep is one of the symptoms of a post-trauma syndrome. It's not an all post-trauma syndrome. So higher anxiety, lower mood, behavioral changes.

Sleep is one of these factors. And sleep is very often negatively impacted by trauma. So the changes you had asked about in the brain, and then we talked about how they go more towards vigilance, more towards activation, they make it harder for the brain to settle down and be in a restorative state. So sometimes we get what's called ruminative, where there's just thought loops going on inside of us, and the brain doesn't want to quiet down to a place where we can get restorative sleep. So people have more

fragmented sleep, they have shallower, less restorative sleep, more time until they can fall asleep, earlier awakenings. So this is very, very bad for us across the board. I mean, talk about the union of physical and mental health. Sleeping very poorly is terrible for us from head to toe. And very often after trauma, if there is a post-trauma syndrome, which is not uncommon, sleep patterns are dramatically changed and sleep restorative function is changed. What happens is we're in higher states of arousal. And neurobiologically, this isn't about sexual arousal. It's just state of alertness, right? So we're in too high a state of arousal, too high a state of alertness. And then the brain systems inside of us that need

to really simmer down in order to restore aren't able to fully do that. I guess there must be some kind of link there as well, because if I'm in that, if I'm less comfortable with being with my own thoughts, because they're ruminative, that I'm overthinking all the time, I'm then also more likely when I'm trying to settle down to be trying to stimulate myself. Like a lot of people aren't comfortable with just being sitting in a room alone with their thoughts, especially if they're, you know, an overthinker. So then they might grab their phone. They might be, you know, doing things to stimulate themselves at a later hour of night, but it all comes back to the trauma. Absolutely. Yes. And you're describing how the downstream effects of all of this are tremendous.

So absolutely, yes. So we're saying getting less sleep is just bad for us from head to toe. Okay. And also there's all the things that you're talking about. So if you know you're going to try and sleep and it's going to be just going over and over again in your head, and it might be, I'm not safe, or I'm going to get fired, or I'm going to get hurt. Or it may just be something that's simple and negative that you don't even relate to trauma. Like, oh, this is awful. I mean, these are things that go over and over again in people's heads when they're trying to sleep. Like, I'm not okay, what's going to happen? And it's going over and over again. So of course, you're going to want to distract from that. And you, because the way we've kind of framed it there is that you're aware and conscious of that, but maybe the answer is,

this is some really different trying to fall asleep. And like, I just don't feel peaceful anymore. But the person has not thought of that until you ask them. Then what's the logical next question? Why? Right? What happened? Did anything change around then?

And a lot of times you get an answer and that person has a trauma problem, not a sleep problem. You can probably pound the sleep system to sleep with medicine, but now we're doing something that ultimately is harmful for the person. So yes. And also, you know, when you talk about avoidance behaviors of sleep, this is also why the person can avoid, avoid, avoid, and then have three or four drinks to get to sleep, right? So there's so much that is unhealthy that then perpetuates being unhealthy and it spreads. And this is part of the epidemic aspect of this. And then people often don't know why things are different in their sleep. But a lot of the time, if you stop and you think and you talk about what's going on inside of them, they will tell you. And it may be that for the

first time they're telling themselves, which is why we should ask ourselves this question. You said to Rich Roll, amongst the conditions I've seen treated, the absolute worst in mental health treatment, and indeed in general medical treatment, are sleep problems. Why? Sleep underlies so much. And because we have a we, we have a lot of hammers in medicine, so we see a lot of nails. So if someone is not sleeping, the reflex in medicine, and not everyone does this, and I'm not trying to say they're all physicians or practitioners or not behaving in the right way, but we, we work in systems that are high volume and designed for throughput. So they're designed for symptom identification.

So what we say is, okay, you're not sleeping. So we'll give you a sleeping medicine, like that simple. But the reasons people are not sleeping are very, very often not related to their sleep systems. They're related to these vigilance and activation systems inside of us. So if that's what's going on in me and I'm agitated and have this highly aroused state after trauma, and maybe it's been going on for two weeks or maybe it's been going on but getting worse for two years, but this is what's going on and I can't settle down

and my sleep system can't overcome it. If you give me a sleeping medicine for that, I'm probably going to need a lot of it, right? Because we're trying to make the sleep system overcome the distress. I'm more likely to get addicted to it. I mean, there's a lot of bad we do to people and I never have an opportunity to address my problem. What should we be doing instead? We should be asking why. Why is it that you are not sleeping? And maybe it came out of the blue. Maybe. Maybe your sleep system every now and then fails you. But when we start asking those questions, we get answers. And more often than not, those answers are in the realm of trauma. Then that person does not get a trauma medicine. They may

get a different medicine that in the short term can quiet the vigilance systems. We do this a lot where the person has a sleeping problem. We learn the trauma history. We use a short course of a medicine that calms the vigilance systems. It has nothing to do with making the person sleep and then they start sleeping well. And maybe, this is true, they might not have slept well with five, six, ten sleeping medicines, but that is not the medicine that they need. They need a medicine to calm these distress systems inside of us so that the sleep system, which is not damaged, can go and do its thing. And while we realize this, we can start talking about the trauma

and maybe the person can process some of the trauma. Now the sleep problem is gone. Everything is better. The person's not going to be on a sleep medicine for the next 20 years. It's healthier. It's safer. But we have to be more than reflexive. There are a lot of reasons people don't sleep. What about a link between weight and trauma?

I've heard a ton of studies over the years about how various people who are obese have high levels of sort of traceable trauma. Is there any truth to this? Yes. So there are probably or almost surely a couple of factors. One is it's hard enough to take care of ourselves, you know, even when things are going really well, right? I mean, life is so busy and so stressful, so it's hard to take care of oneself. If a person adds trauma to the mix, it becomes harder to take care of oneself. And one way we can not take care of ourselves is, you know, what we're eating and whether we're exercising. So the trauma makes it harder to take care of ourselves and predisposes to poor self-care. Now we have, you know, a person who's

overweight and then maybe pushing towards diabetes or heart disease or cardiovascular, or cerebrovascular disease. And also just like we talked about epigenetics and changes in gene transcription, what genes are active in us, trauma puts us in a place where we are more inflammatory within us. Like there are more inflammatory markers in our blood vessels. So it's not as clean and clear as we would like it to be. We're not as healthy and this works against the health of our blood vessels and the health of our immune system. So the soup we swim in, so to speak, is changed by the trauma. And then those higher levels of inflammatory markers, for example, that are circulating in our bloodstream can make it harder to lose weight. The body starts holding on to more calories and it makes it harder

for our blood vessels to stay healthy. And then we get less and less healthy. And part of that is the biological effect of trauma, just like the epigenetics. And part of it is the changes psychologically and the changes in self-care. How do you convince someone that comes into your practice and tells you that they can't change, they don't believe they can change, how do you convince them that they can? Well, I'm a huge believer in the power of knowledge and the power of information, which I think goes back to how powerless I felt as a kid when we couldn't understand medical information. It's like, I want to know, I want to understand. And I think, I think a lot of people are like this. I think we as humans don't

get enough credit that we want to understand. And I think so much in our society is reflexive. Like, you know what you know, and you feel how you feel. And then, you know, we have a whole set of beliefs about the world because we affiliate with some group or another, right? I think that's a reaction to feeling so disempowered and that what we really want is knowledge. And I think that's a reason why, for example, knowledge imparting podcasts are so valued because you're not trying to tell people what to do or how to think, but you're giving them, bringing them knowledge. And that's what I try and do of like, I know that's not true. Now, it may be that if you're a science-based or a rational person, or you're an engineer or an accountant, it's like, I might try and get at

you through the science, right? I might try and get at you through that article, right? This is something that can like let you see that. Or I might try and get at it through examples of, hey, here's like, people do change. Like, here's kind of really what the state of the art is now. And like, can I get you excited about that? Give me an example. There are a lot I could cite, but the one that comes to mind is the one story in my book that is just an amazing story of a person who had had a trauma in her life that had just changed everything, mood, anxiety, behavior, choices in the world. I mean, so much had gone in a way that was not how this woman was built to live her life or how she was living her life. And it was so striking her telling me about who she was at some point in the past and

contrasting that to how she was living and how she thought about herself. And it was really a night and day difference. And it became clear there was a very abrupt change at the time of this trauma, like a night and day change towards dysfunction, poor health, poor social function, misery. And she had no thought or idea that she could be like she was before because all she knew was that things had changed and now she was like this and this was not okay and never going to change. But she was willing to see the starkness of the change and to hear my observations and examples like, look, I see something here that's looking from the outside that's really striking and that we could think about and talk about and understand and like changed her entire life. And it really is true that 10 years later, she looked 10 years younger. Absolutely. Is this a one-hit wonder though? Or is it a training process like me being in the gym and picking up weights over and over again?

Am I having to retrain my mind to view that situation differently? Yes, yes. We are creatures of neuronal habit. So if you think the example I give, I usually use is, let's say you and I just picked a word, random word, and we said it 500 times, right?

We need to be saying it this evening. Let's say we say it 2000 times, you know, give it a couple of days, it's still there on the mind. Why? Even when we know it's a silly example, why would it still stay with us? Because when we say that word so many times, we're strengthening memory connections. That word comes to mind more, it's stronger within us. And then the only way it goes away is it atrophies over time. You know, as you can't just make that go away after you've said it a couple thousand times. It'll go away over time. It gets less and less powerful over time.

So if you don't keep saying that word, it comes to mind maybe 10 times the next day, five the second day, three times, then not again. But this is how processes of change work inside of us. So someone who has, for example, had self-talk in them said, oh, it'll never work out for me. Or like, I suck and no one likes me. Or, you know, I'm terrible. Or how could you, idiot? Or, you know, things like I had a shadow voice saying these things to me for years, like that doesn't want to go away at once because it's just habituated inside of us. So we have to realize that that is not real and true. I don't, that is not what I think, what I want to

say to myself. So I want to know when it's there. I want to realize I'm saying this to myself and I don't believe it. Then we make it less strong, right? We make it less strong. Every time we say something that's a negative lie to ourselves, like no one will ever love me, right? People say that to themselves over and over. We make that more powerful as if it were true. And if it's as if it were true, is it true? Our brain can't tell the difference now. So if we understand that, and now we want to change it. Like I know why I said that, because when I was growing up, that parent, that person always said that to me over and over and over. And then, you know, I chose bad relationships because I didn't think I was worth anything better and they didn't go well. And it

reinforced that to me. Like a person really understands that. We bring that understanding to bear in a way that you speak against that when it comes into your mind. Because we can't make it not come into your mind. It can atrophy me in this process of slowly over time it goes away. But we have to say, the whole me, I don't know what the judge in the middle of all the opinions has to say, okay, no, I'm saying this to myself, right? But do I believe that or not? Can you really completely get rid of a trauma? Can you take a trauma to zero? Well, we won't lose the memory of it. If something bad has happened, we're not going to entirely forget it. That means it can trigger us again in the future. Well, the question is how much does it trigger? How much does it trigger? The idea is to attenuate the response to it. So if it was a car accident and every time the person

looks at a car, they have a panic attack, right? It's probably not going to happen that someday they look at a car and don't even remember, right? But they can look at a car and like, they know they had a car accident. They're trying to hide it from themselves. They're like, oh my God, I can't see a car. I had a car accident. It triggers me. I'm understanding that. I understand the naturalness of the responses in me and how they maybe were perpetuated by the fear that I felt. And I wasn't working through it or working through the loss that happened. Now that I'm understanding that more, I don't have to be afraid of this. So I see a car and yes, it makes me kind of uncomfortable, but it's okay. A lot of people beat themselves up because they've done a lot of work.

Right. And this trauma still remains. I think I'm one of those people where there's certain traumatic things from my childhood. Done a lot of work. I logically know that it's not true. Like that belief I had is not true. Yeah, I'm still prone to be triggered on a bad day about that particular thing. Right.

Right. Look, that's how it goes. When a person is navigating through trauma and really getting through, like getting over a lot of difficult things and getting to a much better place, but responds to the triggering in a way that inadvertently reinforces the trauma. So I would say if you're having a bad day and you have a memory of something that you kind of know you got over, but then it raises the same set of thoughts or feelings that aren't good, right? Instead of my guess is that you're feeling bad about that. Like I did all this work and I didn't get over it, right?

To say, look, isn't it interesting? Like how strong this imprints us that this is still going to come to my head. Today's going to come into my head. Like, so I'm having a bad day or I dropped something in the morning and I don't feel great about myself. This stuff is very, very powerful, but still not telling me truth. You know, that shoulder shrug about it, okay, it's going to come into your head. It was neuronally reinforced and sometimes you'll be having a bad day and it'll come in. It doesn't mean anything.

Lady Gaga sits at the very top of your book and she's written the foreword in your book. There's this wonderful quote inside there that says, I can now say with certainty that this man saved my life. He made life worth living. But most importantly, he empowered me to find and reclaim myself again. That is an incredible thing for anyone to say to anyone else. Thank you. My first thought is she's eloquent and generous of spirit.

And I so appreciate that she wrote such lovely words. And I so, so appreciate that. Thank you. Why did she say that? She has talked about there's trauma in her life and to gain an understanding or much better understanding and be able to ground to the things about her that are wonderful and she's a wonderful person there's wonderful there's wonderfulness in us no matter who we are and i think from the perspective of her on such a big world stage, acknowledging the trauma and the humanness in her and that like anyone else, she needed some understanding. She

needed some help forward in different pathways of thought about self, like the kind of thing any of us need after trauma. And she had the bravery, the fortitude to take chances to be different. Just like someone would say, oh, I can't be any different. We can all feel that when we have a lot of trauma inside of us. And it's hard to think, I'm going to really try and be different. I'm going to take that chance. But in order to change our lives, we have to do that. And she also did that. It's a very, very human story in, I think, a deeply feeling person who then wants to bring that message forward to others that we can change trauma. And I'm so grateful she wrote the foreword to my book, but part of

that is she believes in that message that trauma does not have to control us. We can understand it. We can get our arms around it. And I think that's what she is. It's what she's communicating in that quote. That's the part of that quote that's important. The part that's about everyone reading it and the capacity for change. You have some incredible celebrities on the book, inside the book that have given you quotes for the book. People like Kim Kardashian, Tommy Hilfiger, et cetera, et cetera. Lady Gaga, as I mentioned. I'm guessing these people at some point came to you without sort of disclosing client confidentiality issues. I'm just wondering how you find yourself in a position as a psychiatrist

that this caliber of people are seeking out your support. Well. And does that ever feel a bit surreal yeah i think i think it does i mean i like to think of myself as a diligent person who wants to continue working at things and moving them forward and and uh seeing where they can go and and i think at some point in time i realized i had the capacity to to perhaps reach people who reach a lot of other people. And there's been a real joy. I think that people who are public facing, I mean, there are a lot of stresses to that.

People can think, oh, it seems so wonderful from the outside, but there's a lot of extra stress to that from the inside. So to be able to address some of the extra complexity of that and to be able to help people who have a big impact on the world around them was sort of a joy to pursue. We have a closing tradition on this podcast where the last guest leaves a question

for the next guest, not knowing who they're going to be leaving it for. And the question that's been left for you feels quite fitting and very interesting. I really like this one. It just says, it's not even written as a question, it just says, erase one regret from your life, dot, dot, dot.

Wow. You know, I think I should have paid more attention to the world around me when I was younger and more lost in trying to feel good enough at the moment. And I think that it made it harder to sort of find my path. And I think it made it harder. I think my brother hadn't found his path. And I think there was a lot of frantic anxiety or fear driven forward movement without pausing and circumspection. And it may be that we just talked about, we've talked about his suicide and we've talked about that in this podcast. So it's kind of at the forefront of my memory. But when I think back then,

I probably knew well enough to be more circumspect, including about what might have been going on in him or in me. And I'm happy I got myself on a path that's led to places that feel good and that I think are generative and productive. I wish I had more attention to the bigger picture when I was significantly younger. Why? Well, I think I would have made better decisions. I think I would have seen pathways that led away from health and happiness and maybe seen that in others too. You're talking about Jonathan?

And others where I was born and raised. I think there were a lot of good people in a lot of forward movement, but we maybe could have looked around ourselves a little bit more and there'd be several people maybe still here as opposed to not being here and people being healthier and um i think i probably had it in me to look around myself more than i did at that time and i do sometimes feel i will feel regrets about that well i have to say dr paul conti the work you've committed your life to and the understanding you've committed your life to spreading um is going to save many many many many many many people's lives thank you and not just

save their lives but sometimes it's not always about saving a life it's about improving the standard of someone's life which i think can have a generational impact if that person is to stay alive and they are to you know if we look through the lens of epigenetics or just about the how internalized shame and guilt and all of this can be passed on through vicarious forms of trauma that the kids might feel and whatever you know your work and your your future work i deeply believe is going to save and improve thousands and thousands and tens of thousands hundreds of thousands of people's lives and that is an unbelievably remarkable thing to commit one's life to.

Thank you. There's no words that I could say in the 30 seconds I have now that would express the extent of the good that that's going to do in the world. And I, you know, I can't imagine those people that are here and not here, how proud they would be and are of you.

Thank you. For turning your trauma into such a wonderful, healing, important thing. So on behalf of all of those people that you'll never get to meet, that you've helped with your work, I want to say thank you so much. Wow.

Well, you're very welcome. And thank you for those kind words, which I take to heart. And thank you for having me on. I appreciate it.