The One You Feed - Bonus: Eric talk with Dr. Jon Mills about the effects of trauma on current behavioral patterns

Episode Date: October 7, 2017

In the first of a new series, Eric talks with good friend and Ph.D. Jon Mills. Today we talk about a seminal paper in our understanding of how adverse childhood experiences can influence our lives decades later. We first explored this work in the conversation with Gabor Mate. More about the study can be found here.See omnystudio.com/listener for privacy information.

I'm Jason Alexander. And I'm Peter Tilden. And together, our mission on the Really Know Really podcast is to get the true answers to life's baffling questions like why the bathroom door doesn't go all the way to the floor, what's in the museum of failure, and does your dog truly love you? We have the answer. Go to reallyknowreally.com

and register to win $500, a guest spot on our podcast, or a limited edition signed Jason bobblehead. The Really Know Really podcast. Follow us on the iHeartRadio app, Apple podcasts, or wherever you get your podcasts. Hey, everybody, it's Eric from the one you feed. You know, I'm not sure why I always feel the need to announce that. You probably have a pretty good idea who it is because you're listening to the show. Anyway, I'm here and I'm trying something new. And I've asked a friend of mine, John Mills, who is a PhD in public health, to join me.

And what we're going to try and do is pick a scientific paper that I think has some relation to the show and the things we talk about. And I'm going to ask John to walk us through it a little bit, help us understand it, and we can talk about how it applies in our own lives. So John, welcome to the show. Hi, Eric. Thanks for having me. I'm excited about this. Yeah, I think this could be fun for sure. So why don't you tell everybody what paper we picked for our first one? Yeah, so we picked a seminal paper in the research that has been looking at trying to identify the impact of trauma in the general population. And the name of the paper is called The Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. And it's also known more in a more shorter fashion,

the adverse child experiences study. So what this looked at is it went back and surveyed a large population of people that are actually members of an HMO. So we have to consider this population as probably not a very, not as vulnerable as someone like Medicaid. So these might be underestimates of the prevalence of trauma. But in any event, they were looking to link trauma experiences to significant health concerns and challenges in later adult life.

Yeah. And listeners who have listened to the show for a while will remember we had addiction specialist Gabor Mate on, and he talked a lot about the role of trauma and addiction, and he referenced some pretty important studies, and this paper is really the root of those studies. So what they did was, John, they looked at incidences of either behavioral health problems or other causes of death in people, and then they looked at tying those back to adverse childhood experiences. So what are some of these adverse childhood experiences we're talking about? Obviously, sexual abuse is one that comes to mind, but what are the other ones that fall into this category? Yeah, so they looked at sexual abuse. They also looked at psychological abuse and physical abuse as well that occurred in childhood. But in conjunction with that, they also wanted to account for the broader context in which these events might occur.

So they looked at, were you exposed to family members that had substance abuse issues, mental illness? Did you witness violence against your mother, probably from your father's, and then also was the criminal behavior in the house. Specifically, did a member of your house go to prison and the impact on you as a child watching that? What if you are the criminal in your house, in my case? Well, then there's no hope. Yeah, exactly. They looked at these experiences and then they were able to tie them later in life to depression, substance abuse. What are some of the other things that they found as outcomes? Yeah, they looked at suicide attempts, which is pretty impactful. The other day I was listening to somebody say that like 95% of people who try suicide have mental illness. What is that other 5%?

That's a, that's, well, I don't know what that could be, but potentially it could be just an error in the way that they're measuring it because any type of measure you do has some type of variance measure. But that pretty much says probably anyone that commits suicide has some type of mental illness going on. Yeah, that's kind of what I thought. Anyway, okay, back. Sorry to interrupt. So suicide was one of them?

Yes. So then they're looking at smoking. So like health behaviors beyond alcohol or substance use like smoking to deal with stress, overeating, so later life obesity. And obviously, these particular behavioral patterns can then lead to cardiovascular disease, stroke. They also looked at the incidence of diabetes, for example, cancer, stroke, that would be known to increase the risk of mortality as well. So basically, these bad things happen to you in childhood and lots of bad things happen to you as an adult. Yeah, it increases the risk of those happening. And so it doesn't mean that every person that has a traumatic experience as a child ends up having cancer or substance use disorder.

There's a lot of other mediating factors that can come into play during the, you know, as you grow older. Basically, social support is a huge mediating factor, meaning that can circumvent these negative outcomes. Also, one thing they're looking at is the impact and role of resilience. I'm not real sure. I'm not experienced with how they measure resilience, but they are doing that at this point. I know I've seen work and how that might stop. So, say, like, if you have a traumatic experience, even as an adult, and often that might stop. So say like if you have a traumatic experience, even as an adult, and often that leads to PTSD, post-traumatic stress disorder, right? They find that some people even don't end up having PTSD. Those people tend to be more resilient or have perception of a stronger social network or support system.

So there's a lot of things going on here, but it increases the risk. It's not necessarily your destiny, but it increases the risk. And they also show in the paper that the more of these adverse childhood experiences you've had, the higher the risk. Yeah, they call it what's called a dose-response relationship, so it's not just linear. So an increase from two to three, two incidences to three incidents, the increase in risk there is greater than the one that you would experience if you had from someone that goes from one to two. Does that make sense? this would be a good paper when you brought it to me was because a lot of the people who listen to this show have either depression, behavioral health challenges, whether that be addiction to substances or eating or all kinds of other patterns in their life that are challenging. And so I thought this was interesting, not as a way to say like, well, you're screwed, right? Like, you've got these issues, but really as a way to say that there are reasons that you are having

some of these challenges, that the behavior, the response to adverse childhood experiences makes a lot of sense. There's a reason that we are doing and have done these things. Yeah, that was a theme of the paper. It gets to the idea that trauma is often unrecognized, especially in primary care settings where a primary care physician, or even let's just say a specialty setting like a psychiatrist, not a psychiatrist, but in any other setting where physicians don't know that there's a trauma history. Patients don't want to report that. Also, sometimes physicians are not, what's the word I'm looking for, not, are concerned

about bringing that up. You know, you ask someone and it triggers problem, you know, could trigger things. So they don't, there's a lack of knowledge that that may be the underlying cause. And that's the point here of this paper, would is to say, hey, look, you know, over 50% of the population has exposure to at least one childhood adverse event. Probably if you're seeing someone with substance use disorder or depression, there could potentially be a childhood trauma experience underlying this, and it makes sense to screen for that, to understand that, hey, this has happened, this is something that's ingrained in this person.

For a long period of time, they've been dealing with pain associated with trauma in the best way they know how. Just didn't come out of, oh, I tried drinking because of peer pressure and now I'm addicted. No, they tried drinking because that was the best way they know how just didn't come out of, oh, I tried drinking because of peer pressure and now I'm addicted. No, they tried drinking because that was the only way they found out that time as a child to deal with that pain. Maybe not as a child, but as a teenager.

Right. Well, they may have started drinking out of peer pressure and found, as I did, like, holy mackerel, this is, wow, this really does something special for me that, you know, more than what it does for other people. Yeah, Gabor Mate had a phrase, he said, you know, don't ask why the addiction, ask why the pain, you know, what was, ask what the pain is that's underlying that. And so I think kind of what you're getting at is recognizing that, you know, there may be a role in trauma in how we change behavior. So when we look at changing behavior on the show, we focus on a lot of very, very practical tips. We talk

about acting your way into right thinking, talk about, you know, action over knowledge. It's a huge focus of what I talk about. From my own experience, I think that stuff is very relevant and is a part of the solution. But also, I don't talk about this as much experience, I think that stuff is very relevant and is a part of the solution. But also I don't talk about this as much, but there was also a lot of digging into previous aspects of my life and my childhood that I did as over the long process of, you know, I hate that phrase, the healing journey, but you know, for lack of a better word on that, on that journey, that was, you know, another part that played a role for me in getting better. Correct. I agree with everything you said. I just wanted to step back and recharacterize

what your previous guest, Gabor Mate, said about when you have someone that is struggling with addiction, don't ask why the addiction, but ask why the pain. He's getting at a very important piece of that. Alcohol didn't add to someone's life in that sense of the word. It's accounting for a deficit that existed. Yep. Right? It's solved a problem not to, oh, wow, this is really making my life better. It's solved a problem not to, oh, wow, this is really making my life better. It is more dealing with a deficit that is preexisting. And there's a difference there because you're starting from a hole rather than, you know, on the same plane as everyone else.

And trauma creates a specific hole that's incredibly tough to climb out of. And I think that's what this whole idea is, this trauma recognition and, you know, starting to build that into the recognition of even primary care is, okay, these people, this isn't simply some behavioral disorder or this behavior, you know, maladaptive behavior, we need to look deeper, like your previous guest said, before we can start this person on a process of healing and more effective behavior. Yeah, it's interesting to me because, as I was saying before, my belief in act your way into right thinking, I got sober, and you did originally also, really through a 12-step method that more or less completely ignores this entire concept. Yes. And so it... Yeah, go ahead. And it still exists in a lot of the professional treatment centers for substance abuse.

It's like, well, do you get it that this isn't working for you? Can't you see that yet? And that's missing the piece before. And so now you are seeing other treatment centers looking at the idea that any treatment of substance abuse has to incorporate some type of therapeutic approach that is for trauma. Because most of substance abuse that they're finding in this evidence shows is the ideology or the, you know, where it comes from is exposure to some type of trauma or household dysfunction. because the way they define this in the paper is quite broad. That was, you know, it's redefining it to be more realistic to, you know, obviously the relationship that strong evidence exists to support. So you're seeing a change in the philosophy and the way that we deal with substance use disorder in some places where they just trauma, trauma therapy is incorporated as a given.

Again, it's interesting because my recovery experience was very different, did not focus on that. You know, I'm always hesitant. Hesitant's not the right word. I'm trying to think of what I want to say here. I think that I get stuck sometimes on these ideas of that. I like where you're going. This is a good piece I'd like to talk about with my own personal thing too, when you get to it. So I think part of this for me, there's this part of me that was, you know, raised when I got sober in very, you know, very much in a strict 12 step program. And the idea was, you know, that stuff's not important. What's important is what you're doing now, how you're behaving, your actions. And I, I believe that to a certain extent. And in my

case, maybe the trauma wasn't severe enough, I was able to get sober via that method. And then I recognize the impacts it was having in other areas in my life, mainly, I think depression, right? The depression is what came after that, for me, that was so serious. And I always worry about this idea of, you know, am I blaming what's happening to me on other people and but it was about understanding who I am and why I am the way I am and working with that. Like I was the only one that could do that work. So again, it wasn't about a blame thing or my parents did this or my parents did that. It was really about here's who I am and here are some of the factors that got me to where I am. And having that full picture allowed me to grow in different ways. Yeah, I had a similar experience in getting sober in the 12-step approach.

And I missed a lot of that. It wasn't that I didn't talk about it. It wasn't the secret that I'd experienced. I was raped, certainly had some experiences as a child that were more psychological. It wasn't that we didn't talk about it, but the approach was trying to fit it into the idea of looking at your part, right? And what I missed, and it wasn't until later in my sobriety when I ended up finally becoming so depressed and so out of control and suicidal when I tried to commit suicide was learning that there's a word that was hard to say, that I was a victim. Right?

Because you don't want to say that in a lot of settings, right? The victim, you know, don't play the victim. Well, I did accept the fact that I was a victim of an experience. Right? And it had a profound effect on me and it was still reverberating in my life years later. That was a place that I had to start. And I had a lot of shame about becoming a victim. But what I was also told where I was getting this treatment was then you progress from there. Once you acknowledge that you are a victim, you become, you start to survive, which

is kind of, I think, where we get into changing our behavior and really working victim, you become, you start to survive, which is kind of, I think, where we get into changing our behavior and really working past, you know, like, okay, I've become destructive. I became very destructive and suicidal. Well, that I wanted to live, but I didn't know how to deal with this pain. So that was when you step into the survival phase. The nurse that I, the psychiatric nurse that I was saying said something very, very impactful to me. She's like, some people get stuck in survival mode, but the real goal is to come out of that and then just become human. And you no longer have to be a survivor. You just become a human. And what I've learned, I don't know, I think you vacillate back and forth in between those stages is what I've experienced at this point

in my life that really becoming human isn't giving up, you know, like, you know, I acknowledge I was a victim and I've learned a lot of ways to deal with it. And my humanity is just accepting that I am never going to be perfect at dealing with this, you know, that I'm, I'm making the best out of the life that I have, you know, and I have a good life. And I'm using all the skills and tools that I've learned that I've been, you know, privileged to be able to have access to and treatment to learn. And, but then I start to this, this change starts to happen in the way that I view myself and that it's just never going to be perfect, right? I'm never going to be perfect at these, you know, different trying to live a different way. And at my, and also just the perspective of things where I'll be going and I'm like, oh, I'm really getting into that blame role again.

But at first I had to start there because I was pissed, which is natural. Does that make sense, Eric? Does that make sense, Eric? I agree 100%. What comes to my mind is the, I've got it written on my wall behind me. I've got lots of things written on the wall. It's not like this is the one phrase. But one of them was the idea of fault versus responsibility, right? It was not your fault that you were raped, right? But it is your responsibility to get better, right?

No one else can do that for you. And that's, I think, where that gets tricky. So, and that for you and that's i think where that gets tricky so and that's and that is but there's a step before that that i think has been missed in the end it's a very important step is the way that i dealt with the pain after being raped and that i became that i used over the years that was not we would term now not effective, was effective for me for a long time. It helped me stay alive. Like, that's why I'm still alive, you know, because I think at some point if I hadn't, maybe, you know, when I relapsed, had I not relapsed, there was a piece that I think it gave me time. It took me away from suicide for a while because it covered the pain. Now, that's

not, I'm not saying go out and relapse and use, but it, I think when I look back upon it, even though it entered me into a very troubled period of time, it helped, you know, it helped deal with that pain. It, it calmed it just for a little bit. Now the responsibility part, it wasn't about fault, I guess, you know what I mean? Like that wasn't about fault. The responsibility part was, okay, I can have something better. And there is a way to not to deal with that pain that doesn't involve destruction. And so, but the other thing I wanted to say, Eric, I think is important is, and about this is that I, when I got raped, I had already developed a way of protecting myself from chaos and trauma. And a lot of these experiences they talk about in this paper, right? And one of the ways was to, I would go numb.

I figured that if I go numb and go on myself and I'm quiet when all this chaos is going on, people will, it will not see me and I won't get hurt. Right. I learned that as a child. Right. And to deal with chaos. When I got raped, I never fought because that that way of dealing with chaos instantly clicked in. Right. And I went numb and I didn't I didn't feel any pain when the guy was raping me. I didn't feel any pain. I didn't feel any pain when the guy was raping me. I didn't feel any pain. And the idea was if I'm quiet, he'll do his thing and he'll go away. Because if I fight, it'll make it worse and longer and he'll just get it done.

But I claimed, I didn't realize this until recently, I claimed a victory in the way that I dealt with that particular way of dealing with the trauma or dealing with being hurt was that the thing the man said to me afterwards was you didn't cry and it pissed him off jesus that but see what the thing is now you know and i that was a very important piece because he didn't get something that he wanted from me and the thing that i had developed over the years to protect me protected me at that point in time in a certain way, because rape is about power and he didn't get that in that piece. Now he hurt me very well, you know, like, and there was tons of pain later.

But what I'm saying is, is like, you know, the freeze mode is not an effective way to live your life for the rest of your life. But it was something I developed as a child because I didn't know how else to develop it. Right now it made me and it's a very confusing thing because it made me vulnerable to re-victimization which happened when i was raped but it also did something for me you know does am i coming yeah but now as an adult as i've grown and my knees have changed i don't want to be somebody that freezes you know because it reverberates in the rest part of my life in ways that are, you know, way complex beyond what we could talk about here.

So I'm starting to change that. But when I saw and recognized that piece, that success, oddly enough, it gave me release. And now I'm becoming a little more, I'm growing in the way that i am okay with yeah okay wait a minute i see i'm kind of numbing out here i'm gonna stop that and put myself out and be vulnerable and it started that release i don't you know have no way of explaining why that happened but it clicked in my head it clicked in the mind the way my body felt so i guess this whole point in a roundabout way of the study is that acknowledging like details of the trauma before like getting to that point of I'm taking responsibility for myself, there's a piece there that has to happen, or that's important to happen for some people,

just at least in my experience and what I've seen. Well, even by responsibility, all I mean is that if there's going to be any healing, it's going to come from you, right? That's all I mean is that it's the, it's the, nobody else is going to do this for us, fortunately or unfortunately. It's not fair, right? It's not fair that people can be victimized. It's not fair that people can be raped and then be the one who has to clean up the mess themselves, right? That's bullshit, but it's the way it is. And so, and I understand totally what you're saying.

I mean, I think, I believe most, I'll just use the term bad behavior, right? For lack of a better term, let's just sum it all up. Addiction of all kinds and all that stuff. Ineffective behavior. How about that? Yeah, is a coping mechanism. And the problem is, at least in my case, I've said it on the show several times, alcohol, two drinks is the best antidepressant still to this day that has ever been found for me, right? The problem is that the side effects in my case are pretty damn severe.

And so that coping mechanism did help me for a while, and then it outlived its usefulness. And so it was about finding a different way to do that. So yeah, I mean, I'm certainly not, I know that sounds harsh when I'm like, it's, you know, that person's responsibility. I think it's part of getting sober. Any of that is the responsibility is, okay, if I want to be better, I'm going to be the one who's going to have to lead that process. Now, I also don't mean to make it sound like you should go it alone because there's no need to do that and you shouldn't, but it's an internal like, okay, I'm the one responsible for getting better. Not, not in any way like I'm responsible for that. That happened to me is if that makes sense. not in any way like I'm responsible for that that happened to me, as if that makes sense. Right. Well, I think that, yeah, one of the pieces I forgot there is, and it's like the study kind of getting to the point of the study is, the piece before a person's responsible is a lot of people, even myself, I didn't realize, oh, that made me, like, well, I understood the rape part was a

victimization, but not the early childhood stuff, because nobody beat me, right? You know, like it wasn't. And so until somebody like it was like a provider or, you know, a physician that pointed that out to me, like, hey, these experiences are traumatic for you. And so that's what the paper is saying as well, is physicians need to acknowledge that. Yep. And maybe start to let the patient know, hey, these might be things that are causing that. And that acknowledgement, a lot of times, you know, some people will take it as an excuse to do whatever. But the acknowledgement also is a powerful point of getting someone set on the way to making positive

changes in their life. Our paper that we're talking about today, I think that's the scientific impact aside, the real, you know, we always hope that our research comes out and starts to affect the way real-world treatment is delivered. The message is, hey, primary care providers, it's important to start to be on alert that these particular diseases that one might not even connect to anything that happened in childhood might be connected to that. And understanding and helping the provider understanding that and letting the patient understand that might set them on a path that could help them start to take. And that's the main piece of the paper. Yep, I agree. I agree 100%. And that's the main for all of us, right? It's not like there's something wrong with me. But I think the same thing, recognizing trauma or childhood abuse is like, this is part of what's

happening here. And I'm not alone in it. And it's part of why I am the way I am. You know, I don't think, we tend to swing between two extremes. One is like, I'm not responsible for anything in my life that's happened to me. And the other is I'm responsible for everything that's happened for me. And so if I'm behaving badly, it's because I'm a piece of you know what, and I'm very abusive and awful to myself. And like everything, I find that the middle ground is the place to be with that. And in order to find a middle ground, one of the things you have to have is the self knowledge to be able to make your way there.

Absolutely. No, that's a good point. Going back to something you said about one of the goals of the show about acknowledging the self-knowledge of normalizing behavior and normalizing human experiences. normalizing behavior and normalizing human experiences. So I think what you're getting out there is someone, you know, like, hey, I was a victim of trauma and being able to take the stigma away from that and acknowledge it, right? Is that what you were? Yeah. Yep. I mean, in general, I think I try and do that with the show as a whole. In this case, yes, that's the specific. This is very important. This is another very important piece of the behavior, or the paper. One of the stigmas that you see in trauma, you know, we always had the same issue with, am I an alcoholic, right? Because I'm not the guy underneath the bridge in a trench coat

drinking Mad Dog, whatever, you know, the gut. I drank lots of Mad Dog, but okay. Yeah, Mad Dog. Yes. And so the same thing happens with trauma. I'm not a victim of trauma. My parents didn't beat me or I wasn't molested. Well, the way they define trauma in here, you know, they added this household dysfunction category. So it kind of expands it beyond what we might characterize as traumatic. So, we got to get away from this idea that I'm not deserving of, you know, acknowledging that I had experiences as a child that were incredibly impactful on my adult health. And that's really all it is. Now, it's not a, so, and some people's experience could be, you know, very violent. Other people's experience could be exposure to a mother that was mentally ill, or a father that was mentally ill, or a brother, or they're drinking. The line that we toed, I remember, was, well, okay, there was alcoholism in my family, but I'm completely responsible for, that has nothing to do with me becoming an alcoholic.

Well, that's bullshit. You know, that's just nonsense. So what this is saying is, okay, these are negative experiences as a child, whether it's just seeing your father drink or having your father beat you with a belt, whatever your experience is to the point where you bleed, one's more, one's, we can categorize those as more extreme one as the other. But the main idea here is, well, okay, that's fine. But in later adult life, both can increase your risk for some significant health problems. And like your point of your show, normalizing behavior, let's acknowledge this,

right? Let's acknowledge this and deal with it. And, you know, the big theme of your show about really learning how to build a life worth living and changing these effects, the first step, right, is acknowledging it. So, and we haven't yet with trauma. So I think we're starting to. All right. Well, this has gone way longer than I expected. I expected this to be a short conversation, but John, thank you. Listeners, let me know what you think of this. If you want, oh boy, that'll be tough though. If they come back and they're like, we don't want to hear from John. And I tell you that John, it's going to be a whole new kind of trauma. I'm not sure how we're going to handle that. Anyway, listeners, I'll deal with John's feelings.

Just hold me. You, you just tell me whether you like it or not. All right. Signing off. Thanks for having me. Yep. Bye, everyone. New episode out on Tuesday. As always, bye. you