The Rich Roll Podcast - Paul Conti, MD: Face & Heal The Trauma That Dictates Your Life

Episode Date: September 19, 2022

Dr. Paul Conti is a graduate of Stanford University School of Medicine. He completed his training at Stanford and Harvard, where he served as Chief Resident. He then served on the medical faculty at H...arvard before moving to Portland, Oregon, and founding the Pacific Premiere Group—a clinical practice helping people heal and grow from trauma and other life challenges. Dr. Conti is also the author of Trauma, the Invisible Epidemic: How Trauma Works and How We Can Heal From It, which I feel strongly is required reading for everyone, particularly those of you looking to not only heal from your own trauma, and for anyone desiring to break cycles of generational trauma. This conversation is truly a master class on all things trauma. Dr. Conti begins by defining trauma, and explaining what trauma is and isn’t. We then look at the many ways in which unresolved trauma perniciously manifests in our lives, discuss the various ways in which the medical establishment fails us with respect to mental health, and explore a vision for how to improve it. And we close with tools available to effectively process, heal, and even prevent trauma from negatively impacting our lives and the lives of our loved ones. Watch: YouTube. Read: Show notes. Dr. Conti’s wisdom on this important subject is profound. This conversation is appointment listening. And it was an honor to host such a bright mind. Enjoy! Peace + Plants, Rich

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Starting point is 00:00:00 You don't have to be afraid of what's inside of you. And we often get very afraid of what's inside of us, especially after trauma, when the trauma itself makes fear and can make shame. Trauma is something that leaves the brain different going forward. And nowhere is it written that like, oh, that only happens if you're in a terrible accident or if a loved one dies or if someone assaults you, right? Those brain changes can happen in other situations as well.
Starting point is 00:00:34 If we keep it inside of us, it is very, very toxic because we are doing literally the exact opposite of what we need to do in order to heal. the exact opposite of what we need to do in order to heal. If we honor and validate that that's in us, but also recognize that it's not actually true that confronting the thing that makes shame or fear is going to make us fall apart. And in fact, quite the opposite. I mean, there's so much data and clinical experience telling us the exact opposite that we don't have to be afraid of it. And we don't have to rush headlong that we can be careful and judicious. And, you know, you can talk to somebody a little bit, or you can write a little bit, you know. We don't have to be afraid of it.
Starting point is 00:01:12 We can approach it like anything else, you know, judiciously, carefully, reflectively. That's how we make ourselves healthier. The Rich Roll Podcast. Over the course of the 10 years that I've been hosting this podcast, I've had the extreme good fortune to learn, alongside you, of course, from some of the world's most compelling minds.
Starting point is 00:01:42 And although I wanna be careful not to exaggerate, I would venture to say that this conversation ranks, at least to my mind, among the most important in the history of this show, because it contends with a subject matter, a terrain, that I truly believe negatively impacts all of us. often imperceptibly in profound ways we generally fail to properly notice or appreciate. I'm talking about trauma. What today's guest, Dr. Paul Conte, a psychiatrist and expert in treating trauma, personality disorders, and psychiatric illnesses illnesses calls the invisible epidemic.
Starting point is 00:02:27 Invisible in that it can hijack your entire body without notice. It can transfer easily between parent and child. If left untreated, it can perniciously erode and denigrate every aspect of your life. It can last a lifetime. and denigrate every aspect of your life. It can last a lifetime. And unless confronted, unless healed, can come with a potentially fatal prognosis. By way of background, Dr. Conti is a graduate
Starting point is 00:02:54 of Stanford University School of Medicine. He completed his training at Stanford and Harvard, where he served as chief resident. He then served on the medical faculty at Harvard before moving to Portland, Oregon and founding the Pacific Premier Group, a clinical practice helping people heal and grow from trauma and other life challenges. Dr. Conte is also the author of Trauma, the Invisible Epidemic, How Trauma Works and How We Can Heal From It, which I feel strongly is required reading for everyone, particularly those of you looking to not can heal from it, which I feel strongly is required reading for everyone,
Starting point is 00:03:26 particularly those of you looking to not only heal from your own trauma and for anyone desiring to break cycles of generational trauma. This conversation, in many ways, a masterclass on all things trauma, begins by defining trauma, understanding what trauma is and what it isn't. Second, it's a look at the many ways in which unresolved trauma perniciously manifests in our lives. Third, we discuss the various ways in which the medical establishment fails us with respect to mental health and a vision for how to improve it. And we close with tools available to effectively process, heal, and even prevent trauma from negatively impacting our lives
Starting point is 00:04:11 and the lives of our loved ones. Dr. Conte's wisdom on this important subject is profound. This conversation is appointment listening, and it was an honor to host. But before we begin, a few words from the fine sponsors who make this show possible. We're brought to you today by recovery.com.
Starting point is 00:04:37 I've been in recovery for a long time. It's not hyperbolic to say that I owe everything good in my life to sobriety. And it all began with treatment and experience that I had that quite literally saved my life. And in the many years since, I've in turn helped many suffering addicts and their loved ones find treatment. And with that, I know all too well just how confusing and how overwhelming and how challenging it can be to find the right place and the right level of care, especially because, unfortunately, not all treatment resources adhere to ethical practices.
Starting point is 00:05:12 It's a real problem, a problem I'm now happy and proud to share has been solved by the people at recovery.com who created an online support portal designed to guide, to support, and empower you to find the ideal level of care tailored to your personal needs. They've partnered with the best global behavioral health providers to cover the full spectrum of behavioral health disorders, including substance use disorders, depression, anxiety, eating disorders, gambling addictions, and more. depression, anxiety, eating disorders, gambling addictions, and more.
Starting point is 00:05:46 Navigating their site is simple. Search by insurance coverage, location, treatment type, you name it. Plus, you can read reviews from former patients to help you decide. Whether you're a busy exec, a parent of a struggling teen, or battling addiction yourself, I feel you. I empathize with you. I really do. And they have treatment options for you. Life in recovery is wonderful, and recovery.com is your partner in starting that journey.
Starting point is 00:06:14 When you or a loved one need help, go to recovery.com and take the first step towards recovery. To find the best treatment option for you or a loved one, again, go to recovery.com. We're brought to you today by recovery.com. I've been in recovery for a long time. It's not hyperbolic to say that I owe everything good in my life to sobriety. And it all began with treatment and experience that I had that quite literally saved my life. And in the many years since, I've in turn helped many suffering addicts and their loved ones find treatment. And with that, I know all too well just how confusing and how overwhelming and how challenging it can be to find the right place and the right level of care, especially because,
Starting point is 00:07:02 unfortunately, not all treatment resources adhere to ethical practices. It's a real problem. A problem I'm now happy and proud to share has been solved by the people at recovery.com, who created an online support portal designed to guide, to support, and empower you to find the ideal level of care tailored to your personal needs. They've partnered with the best global behavioral health providers to cover the full spectrum of behavioral health disorders, including substance use disorders, depression, anxiety, eating disorders, gambling addictions, and more. Navigating their site is simple. Search by insurance coverage, location, treatment type, you name it. Plus, you can read reviews from former patients to help you decide. Whether you're a busy exec, a parent of a struggling teen, or battling addiction yourself, I feel you. I empathize with you. I really do. And they have treatment options for you. And they have treatment options for you.
Starting point is 00:08:05 Life in recovery is wonderful. And recovery.com is your partner in starting that journey. When you or a loved one need help, go to recovery.com and take the first step towards recovery. To find the best treatment option for you or a loved one, again, go to recovery.com. And now, please enjoy my conversation with Dr. Paul Conte. Super nice to meet you. I'm honored to meet you and to be able to share this time and space with you this afternoon. I've been over the many, you know, kind of years endeavoring to understand how trauma has played a crucial role, surprisingly, in my many pathologies. And it's been instrumental
Starting point is 00:08:55 in informing how I've grappled with my own healing. And the more, and I know you'll agree with me on this, the more that I kind of learn and discover what trauma is, what it's about, the more convinced I personally have become that it really does lay at the root of so much mental and emotional pathology. So, it's really great to be able to kind of seize this opportunity to discuss what I think is, not only a crucial aspect of what it means
Starting point is 00:09:22 to live an examined life, but a piece that unfortunately is really all too often overlooked, the invisible epidemic, as you call it. Because I think trauma is something that we've all experienced to some degree. I think it lives on a spectrum much like addiction, but the extent to which, and the manner in which trauma
Starting point is 00:09:44 impacts our lives downstream is absolutely monumental, right? So in thinking about how to kind of enter into this conversation, in my mind, I'm sort of thinking of it in three parts. The first part being defining what we mean about trauma when we talk about trauma. Second, the many ways in which trauma manifests itself in our lives. And then third, the means by which we can effectively process, heal, and even prevent trauma and those downstream effects.
Starting point is 00:10:15 So why don't we start with defining our terms here? Like what is trauma? That term gets thrown around pretty cavalierly, right? So I think it's important that we understand what we're talking about. Right. I agree. I think we have to define it to have a meaningful conversation about it. Absolutely. And I think for purposes of the book that I wrote and for conversations about trauma, what I'm really interested in is trauma in the sense that something happens, which could be acute or could occur over time,
Starting point is 00:10:46 that overwhelms our coping mechanisms. It then leaves us different as we move forward. And that difference is rooted in brain biology. It's not a soft concept of, oh, I'm impacted by that because I remember it. I mean, all those things can be true, but there's actually a change in the brain, right? And that change pushes some things that we know about ourselves or know about the world out of our mind. Like we forget things that we knew and we then ground to the world in a different way, in a way that comes more through the lens of vulnerability and vigilance. And we often do not know that those changes have happened inside of us. So their brain changes, their psychological changes,
Starting point is 00:11:34 they're real, they're identifiable. And the reason is you talked about, there can be so much downstream effect is if it's impacting us so deeply and we don't know it, then how do we stave off the sort of domino effect of consequences? Yeah, in trying to differentiate or distinguish between a difficult experience or a painful experience and something that would be categorized as trauma,
Starting point is 00:11:58 there seems to be a concretized narrative that ensues, right? There's a storytelling piece that gets kind of instilled within us that becomes very difficult to break, like a looping that then kind of drives behavior. Right, it's a change in life narrative. So life narrative and like, what do I think about myself?
Starting point is 00:12:19 And what do I think about my life history? So it's retroactive, right? So the change in life narrative is not just going forward, right, but it's going forward as linked to the past. And it very often changes what we've thought about ourselves. So the whole foundational aspect of who we are and how we see ourselves becomes different.
Starting point is 00:12:40 Yeah, talk a little bit more about that, how the timeline, it pervades the timeline in both directions. And actually as a little bit more about that, how the timeline, it pervades the timeline in both directions and actually as a result prevents us from actually being present in what is truly real. Right, right. I think the best example I can give of this, which I write about to some degree in the book is the loss of my youngest brother to suicide. And it was a much earlier stage in my life, long before I went to medical school. And my whole view of myself and of life and what the world could hold for me was different. Now, at some point in time, I became aware of it, right?
Starting point is 00:13:18 But there was a whole space of time where I wasn't. That instead of feeling like, I'm a pretty smart guy and I work hard and I think I can make my way in the world. And like, I've achieved some things, which kind of tells me that I can achieve more things, even though in one's early twenties, it can be so daunting, right? Like, how am I going to get where I want to go? But I have faith in myself because I've gotten places. And there's a whole conception of self as being able to navigate the world. And after that, I thought of myself very differently in a way that was, oh, like I'm cursed, right? My family's cursed and like nothing really ever works out, right? And like, you know, you can try and you can work hard, but like, what does it really get you?
Starting point is 00:13:55 And then I felt very defensive and beleaguered and vulnerable. And there was a whole change in habits. My mood was different. My level of anxiety was different. My choices about who to spend time with were different, whether it's friends or dating, like it was a shift towards the unhealthy, right? Without a realization like,
Starting point is 00:14:15 hey, you don't actually think this way about yourself in the world, or at least you didn't before. And it was very much a shock to me to have that realization that like, oh, like this made everything different, not just going forward, but going backwards too. What was the journey towards that self-realization like? Like there was a period of time
Starting point is 00:14:37 in which you didn't have the awareness to understand that you were operating under, you know, the sort of downstream implications of this trauma, you were just living your life and then something changed where you were able to see it and evaluate it more objectively. Yeah. A couple of different factors, you know, one was I was aware of how I was sort of miserable in ways that weren't just related to the loss of my brother. Like, you know, there was that sort of hanging over me, but, you know, I was drinking too much and hanging out with unhealthy people
Starting point is 00:15:09 and not thinking ahead to like what I wanted next, right? And so realizing that like, oh, I'm pretty miserable, right? Like I'm not sleeping as well, my mood is low. I have a negative view of everything. Like, oh, like here's some new project at work. You know, I had a different career at the time. And instead of thinking like, oh, I can do this well. And like, where's that going to lead?
Starting point is 00:15:30 It was like, oh, what's going to go wrong? You know? And it was very clear the change in myself, which was a change towards limitation and misery, right? And then I also got a little bit of psychotherapy. You know, I'd come from a place, so to speak, where people didn't get psychotherapy, right? And then I also got a little bit of psychotherapy. I'd come from a place, so to speak, where people didn't get psychotherapy, right? And it was thought that if you're getting mental health care, that was for people who were really sick, right? So I didn't have this
Starting point is 00:15:53 understanding that, no, this is a tool that we can use to make our lives so much better. And I accessed just like 10 sessions or so through, you know, my insurance through work. And they were so elucidating, you know, to sit with somebody who then was able to say like, right, like you lost your brother and that's a problem, of course, but there's all these other problems now that are in you. Right, and that really opened, I mean, it did really open my eyes.
Starting point is 00:16:20 And in looking back at that experience, do you have a sense of how much of your reaction to your brother's suicide was driven by just your internal mechanisms? Or was there a piece where the way that you were parented through that had an implication as well? I mean, I wanna get into kind of generational aspects of this later, but like in looking at like,
Starting point is 00:16:44 how did your parents, whether that experience and how did they communicate to you about that at the time? And did that have some implications in terms of how you responded? Yeah, I think we all just, in a sense, slotted into what was the societal norm then, which was not talking about it, not processing it, right?
Starting point is 00:17:08 Not communicating about really deep changes, right? The idea that, well, what good would that do, right? Like all that's gonna do is make things worse, which of course the opposite is true, right? So I think that my parents and the people around me who wished of course to help me and themselves, right? Didn't understand, right? That our reaction to trauma.
Starting point is 00:17:29 So the reflexive guilt and shame, right? Plus the brain changes, which is all kind of part and parcel of the same thing, drives us inside. And the way we often reflexively handle it, well, this is something to be ashamed of. I mean, so the thought that, well, like I'm cursed or my family's cursed and like nothing good can come of it. Like that's not
Starting point is 00:17:48 something people generally feel proud of, right? So you want to hide that inside. And then, you know, so many people were suffering, but in ways that were isolated and isolated from one another. And I think that that took a very big toll. I think it took a very big toll, for example, on my mother, who then I think was depressed much of the rest of her life, which I think predisposed to some very bad health outcomes. Like I think where that goes, if we don't revisit that, if guilt, shame, fear, right, drives us inside of ourselves
Starting point is 00:18:21 and we live that new reality, that often is the story that it's like, oh, it's years of suffering and then an early death. I think that that often is the outcome of it, or it might not be years of suffering because people might accelerate themselves towards an early death. But that's the truth of it. If we keep it inside of us, it is very, very toxic because we are doing literally the exact opposite of what we need to do in order to heal. Sure. So this is the major key in the whole thing and why this is such an invisible epidemic because, and I know you talked about this with our mutual friend, Dr. Huberman, but the natural inclination when we suffer through or survive a traumatic experience
Starting point is 00:19:06 is to compartmentalize it, to repress it. And Dr. Huberman characterized that as maladaptive, but it's really a survival mechanism for some reason or another, this is our instinct in how to best weather these experiences. So talk a little bit about that and how that kind of drives
Starting point is 00:19:25 these negative outcomes over time. Right. I'm certainly, I'm not an expert on psychological anthropology, so to speak. But I think if we look at like what human history was like throughout most of human history, it makes sense, right? The response in us to compartmentalize and to hide something away with us probably makes sense in a time period where we just didn't live that long, right?
Starting point is 00:19:50 So, you know, if you're out on a hunt and like you have to get some food, right? And there's a bad outcome and somebody in the party is killed in front of you, right? Well, you still have to find food, right? I mean, there's a survival advantage to being able to compartmentalize in the short term in the service of immediate needs, right? Which doesn't fit at all with how we live our lives in the modern world, where like where we go and what we do is much more based upon our conception of self, right?
Starting point is 00:20:21 And we're not living lives that are limited into if you can get to your early 20s and reproduce, like when we call that self, right? And we're not living lives that are limited into if you can get to your early 20s and reproduce, like when we call that good, right? And if you make it further than that, you become an elder, right? I mean, if it's not like that, then these reflexive mechanisms in us designed to keep us going, right?
Starting point is 00:20:39 They're not adaptive anymore because we're not just looking at a short-term survival picture, right? But we're looking at a long-term survival picture, right? But we're looking at a long-term picture of like, how are you gonna live your life? How are you gonna thrive, right? How are you gonna strive?
Starting point is 00:20:52 And that's very, very different because it must be in us this strongly because of something adaptive, right? Like the reflex of guilt and shame and hiding it, it can't be from nowhere. It must serve an adaptive evolutionary purpose, but that doesn't mean that it serves a purpose in the world we live in now.
Starting point is 00:21:10 Right, in other words, in an era in which we weren't expected to live past 30 and all we're here to do is reproduce, push it down, survive, get through the next day, reproduce, and then who cares what happens? Yeah, and that would predispose to a tremendous salience to the negative, right? So the example I'll give some time is,
Starting point is 00:21:31 you imagine if in the hunter-gatherer era of humankind, if you're hungry and you're looking for something to eat and you find a berry and it looks like it might be good and it actually is, and it's nutritious and it's helpful, it's good to remember that, right? But if you find a berry and you get deathly ill, right? You better not forget that, right? So the salience of the negative
Starting point is 00:21:51 also has a survival advantage, but we build stories around that in the way we live modern life that just shut us down. So the example, I mean, it's so sad. I can't possibly count how many times I've talked to someone in my clinical work who's been a victim of a sexual assault, right? Has been maybe attacked somewhere, right?
Starting point is 00:22:13 It then takes away from that the lessons of guilt and shame and vulnerability. And like, I'm not safe out in the world. And now that person doesn't wanna leave their house, right? They don't wanna go out and live their lives, right? Because there's something that tells them that you doesn't want to leave their house, right? Or they don't want to go out and live their lives, right? Because there's something that tells them that you shouldn't do that. It's not safe to do that, right?
Starting point is 00:22:30 And look, you couldn't keep yourself safe. And then all the guilt and shame comes around that. And it's so shockingly maladaptive, but the person can't see that if they're sort of in the throes of the reflexive survival urges. It tells them, right, it's blaming yourself and never leaving the house
Starting point is 00:22:48 sounds like the best way to survive, right? Yeah, the fear and the sense that the world is an unsafe place seem like self-evident ideas. The guilt and the shame, however, are a little bit more challenging to understand. Like if somebody has suffered, is victimized by some act of violence, it does strike one as unusual that that person would then feel ashamed of that or guilty.
Starting point is 00:23:17 But these two emotions, and I'd like you to distinguish between the two, seem to go hand in hand with trauma and the kind of attempt to survive it. Right, I think the guilt and shame part is much more surprising, right? And as I came to realize over years of just doing clinical work, like, wait a second,
Starting point is 00:23:38 like I'm seeing this writ large across the vast majority of problems. So the vast majority of problems that I'm seeing and treating and the vast majority of problems. So the vast majority of problems that I'm seeing and treating and the vast majority of problems in myself, right? Are being driven by trauma and the power of the reflexive guilt and shame, which doesn't make the obvious sense that fear does.
Starting point is 00:23:58 And again, we don't know why that is, but my thought about that is, you know, neurobiologically, they're different parsed out definitions, right? And the idea that affect is something that's aroused in us, that's created in us without our choice. And affects very powerfully modulate our behavior. So like an affect of fear starts blood coursing through the body and our heart's racing more and we're ready for fight or flight. And then we know it, right? Because it's much more important
Starting point is 00:24:26 to prepare the mind and body than it is to have conscious awareness of it. So aroused affects drive us very strongly. And shame seems to be among the strongest modulators of behavior. You know, imagine like as an adult where I try to avoid this assiduously because it feels so bad, but where I do something that I feel ashamed of. It's like the worst feeling. At least I think for
Starting point is 00:24:52 me and a lot of people I think describe this, it's worse than being angry. It's worse than being afraid. It's this shame in me that I've done something and it feels so bad And I think it's such a strong behavior modulator that if you add shame to fear or to anger, then you have a very powerful behavioral modulator against the breadth of perspective that's exactly what we want to thrive in the world, right? It says, shut down your life, shut down your perspective. And so that's my thought about it. And again, I can't know for sure,
Starting point is 00:25:26 but I think that's why shame is so powerfully in the picture. Mm-hmm. Shame seems to be one of the most powerful drivers of unhealthy human behavior in so many ways. And I tend to look at things like this through the lens of addiction and sobriety. Like we were chatting before the podcast,
Starting point is 00:25:44 you live in Portland. Portland is where my sober journey began. I was in a treatment center there for quite some time in the late 90s. And that was the inception of me confronting my own shame of my addictive behaviors and the secrets that I was keeping. And over many years and thousands of AA meetings, one of the key kind of things that I've learned
Starting point is 00:26:11 that I've taken to heart through this experience of being sober is the extent to which 12 step and AA are able to normalize trauma, to eradicate that shame association, because you're sort of compelled to get up in front of a group of people and share your story, warts and all. And the liberating impact of seeing somebody else do that,
Starting point is 00:26:39 who can own their past without that shame instinct, gives another person permission to walk that same path. And there's something about freeing yourself from that association that then opens up unlimited possibilities for healing and growth. But it's so difficult. We're so locked up. We create these prisons around these secrets that we hold.
Starting point is 00:27:04 Yes, and I think what you're describing is it becomes then permissive to share, right? And to say, this is my truth and my reality. And I think that's retrospective too, right? That it becomes permissive to have had things happen or to have done things that have aroused shame, right? It ceases then to be this internal litmus test on am I a good person?
Starting point is 00:27:28 Am I a worthwhile person? You know, so much of that, I think, comes from the shame that's aroused in the moments over things we do that we don't feel great about. And it makes a story inside of us that says like, look, that's not okay. And you're not okay, right? So to have it be permissive, to be validated, like, look, that's not okay. And you're not okay, right? So to have it be permissive, to be validated,
Starting point is 00:27:46 like, look, this stuff can have happened and it's not a litmus test on who I am, right? I can define who I am now going forward. And I think that's why when AA and 12-step works really well, I think among its most powerful, if not maybe its most powerful impact is anti-shame. Yeah, I think of the opposite or the antidote to shame being vulnerability and a close cousin of that is courage
Starting point is 00:28:16 because it requires courage to be vulnerable. The added shame can't survive the light is very true, but in order to move towards that light, you have to summon the courage to be vulnerable. And in the sharing of that, there is this unbelievable release that's quite frankly astonishing. It's like having a two ton weight lifted off your shoulders.
Starting point is 00:28:41 And then in the wake of that realizing like, why did I haul that thing around for so long? Yes, yes. I agree completely. I think shame is so toxic. And when we sort of set that down inside of us, we start making like immutable judgments, right? About ourselves. And they take away our sense of us, we start making like immutable judgments, right? About ourselves and they take away our sense of agency,
Starting point is 00:29:09 our autonomy, our free will, right? So, you know, at times I've thought or said in clinical settings that, you know, in some sense feeling so ashamed and feeling like, oh, you're, you know, can't do or achieve anything. You're just a bad person, right? It sets you free from the risks of striving, right? And it's the risks of striving where, as you said,
Starting point is 00:29:33 we allow vulnerability, we show courage, right? We're really living, right? And I think having done a lot of substance work in my career, when something happens to a person that triggers a lot of shame, in my career, when something happens to a person that triggers a lot of shame, there's the time of greatest risk for the person because it's just so tempting to fit one story into some neat little entirely false premise, right?
Starting point is 00:29:58 Like I'm a bad person, I can't do good. Now something else happens again. I feel ashamed of myself. Look, I'm gonna go do the same behaviors I did before and in some self-abasing way, prove it all to myself. And that's the most dangerous thing that can happen. It's the opposite of looking at the truth in ourselves, good, bad, and otherwise, right?
Starting point is 00:30:17 Like, okay, this is it, right? And if I look at that and I see it, then I can take stock of it all and I can determine what comes next to me, next for me. I maintain, I keep, and I in fact foster my sense of agency by looking honestly at everything good, bad and otherwise. Yeah, shame being this kind of arbiter of worthlessness that then becomes a predictor of life outcomes
Starting point is 00:30:45 for the course of an entire lifetime and then getting passed on to the loved ones with whom you associate. Yes, yes. And that when a person is driven, it's guilt, shame, anger, fear. How could we possibly stop that from a cascade effect that impacts the people around us?
Starting point is 00:31:04 I mean, it colors the lens through which we see everything. So are we gonna say something really encouraging to someone who's down and feels bad about themselves and needs the encouragement? Or are we gonna say, right, that's life and it always sucks. So like, where are we gonna go with that? And we- But that encouragement falls on deaf ears
Starting point is 00:31:22 to the person who's unwilling to hear it or to confront that trauma. Right, true. But the thought would be inside of us, where are we going? What are we saying to someone? Because that other person may have ears for that, right? They may have ears for whatever we say, right? Maybe it's a good friend or it's someone who respects us.
Starting point is 00:31:43 It's a child, right? What we say can fall on fertile ground for the seeds of what we communicate to take root. So it matters what we say. It matters if we just look at everything through a negative lens and like, wait, that's right because nothing ever goes well. Is that what we're communicating out into the world
Starting point is 00:32:01 around us and to people who trust us and respect us? Or are we communicating like, right, things can happen that make us feel a certain way and it's valid how we feel, but that does not tell us if there are intrinsic limitations in us. There's not a limitation to our sense of agency. It matters whether we feel that for ourselves and also for the world around us, because there's no two ways about it. If that's inside of us, that's what we're projecting out into the world. Give me a sense of how pervasive this epidemic of trauma is, because I think a lot of people, when you say the word trauma, it conjures an image of being sexually abused or being victimized by some very violent act. When in fact, there's a broader definition at play here.
Starting point is 00:32:49 I just know that my kind of introduction to these ideas came at the hands of Gabor Mate. We had a podcast and he did what he does, which is he flips it and it becomes like a session. We start talking about my upbringing and I grew up, my parents took care of it. Everything was pretty good. I have nothing that I can point to in my past
Starting point is 00:33:11 that would ring a bell and say that was a traumatic experience. But the more I've kind of excavated that, the more I realized that I did suffer some, my parents are good people and they're well-intentioned, but there were some traumatic experiences there. And it's really reframed how I think about trauma in terms of how it lies on a spectrum. So, you know, talk a little bit about that. Sure. So remember going back to the very first aspect of this conversation, right? Like trauma is something that leaves the brain different
Starting point is 00:33:41 going forward, right? So it's not just anything negative that happens because people say, what about post-trauma resilience? Well, yes, if we define trauma differently, right? Something that really hurts us inside isn't something we're built to be resilient to, right? Something that doesn't do that, right? That strikes us as where, oh, that was negative. We can respond to with resilience, right? But what you're talking about
Starting point is 00:34:03 and how we're framing this is, like there's a neurobiological anchoring to trauma in that it overwhelms us. And then we are different going forward, right? And nowhere is it written that like, oh, that only happens if you're in a terrible accident or if a loved one dies or if someone assaults you, right? Those brain changes can happen in other situations as well.
Starting point is 00:34:29 We know that to be true. So for example, chronic trauma. So if we could break it down into, there are acute traumas, chronic traumas, and vicarious traumas. The acute, of course, more easy to understand, but the chronic trauma of, for example, being framed as less than in the world, whether that's because of sexuality or socioeconomic status or immigration status, whatever it may be, that often is imposed upon people.
Starting point is 00:34:54 That where there's just a constant message that says you're less than, right? Or of course there's equality, but then there's a wink that says, but not for you, right? there's equality, but then there's a wink that says, but not for you, right? Because you're this, whatever the minority characteristic is, right? That the majority is looking down upon and stigmatizing, right? And it's just so clear that if you sit with people
Starting point is 00:35:15 who've been subject to that for a long time, not all of them, but a significant subset have the same kind of clinically evident brain changes as people who've had the acute trauma, right? Now the world is not a safe place and you don't quite really believe anything positive. And even if it seems like everything is positive, it's still gonna go against you, right?
Starting point is 00:35:34 And then all of this is internalized. Why? Because that chronic trauma can change the brain the same as acute trauma. And sometimes it can even be things that are seen as positive, right? So the idea of, you know, the quote unquote special child who's like, wow, you're so good and you're so smart and like, you're going to go so far. Like there's all these expectations, right?
Starting point is 00:35:56 And then it becomes very hard to shoulder when there are disappointments around their things. So then a little bit of shame becomes a lot of shame, right? And then the thought of like, oh, I've been less than perfect or I've messed something up or whatever there may be can be intolerable to a person, right? And I think that was part of my problem having been like a firstborn child of a firstborn child and then having been pretty successful in school. And the thought was like, oh, you're just going to do great things.
Starting point is 00:36:21 Like everything's going to be great, right? Well, everything wasn't great, right? And I needed to realize like, look, everything wasn't great, right? And I needed to realize like, look, everything cannot be great and I can still go make a good life for myself, right? So I think it's part of why some of the things that happened to me made those changes because I was sort of set up to be intolerant
Starting point is 00:36:39 of anything less than perfection in myself, which came from a good loving place, you know, in the people who nurtured me, but nonetheless set me up to be very intolerant of anything that was less than how I thought it should be. So yes, the chronic traumas can come from lots of places. And we know that this can happen through vicarious trauma. They'll, you know, thank goodness we have empathy as humans
Starting point is 00:37:04 so we can feel for one another. And that's part of why we want to help one another, right? But empathy also means we can feel sometimes in very deep ways, other people's trauma, which is why in the last, I don't know, five to 10 years or so, I've found myself, and I think a lot of clinicians have found themselves much more saying to a person like, look, my prescription to you is no more news, right? Or check the news so that you learn what's new, right? But why is the person checking and rechecking and rechecking and rechecking? Because there are all these messages that tell us like we are not safe. And then the parent is reading over and over again the story of the parent who lost a child in a school shooting. I mean, things that are immensely difficult to shoulder, right? And they're out there and we become fascinated because we want to think inside like, look, I could survive something like that, right?
Starting point is 00:38:05 So we're fascinated with it and find it to be so abhorrent and unimaginable, but drawn to it in a way that if we can have more of an understanding, maybe there could be some sense of like, right, if awful things happen to me, I can survive them. But inadvertently, what we often do is just bring more and more and more trauma and more and more and more lessons, so to speak that say, hey, you just can't keep yourself safe in this world. Yeah, I mean, there is a neurochemical allure to that type of behavior, right?
Starting point is 00:38:35 Like the doom scrolling and you just can't put it down or you can't turn off the news in the background. It's gotta be on all the time. And even intellectually understanding that this is not good for you and it's making you progressively more and more unhappy, there is an inability to course correct that behavior. Absolutely.
Starting point is 00:38:54 The same way this happens in a lot of people, right? Where if there's something a person's really worried about, right, the person keeps themselves thinking about it, right? And we do that because there's a superstition sort of built into the species that says, if I'm really worried about something, but I'm thinking about it and I'm being vigilant about it in my thoughts,
Starting point is 00:39:13 it's likely to stave it off. If there's a cancer I'm really worried about, because my goodness, a couple of people in my family have had the cancer, then somewhere it occurs to me that if I keep think about that, it's not gonna sneak up and get me, right? And like, that's a human reflex that probably comes from, you know, way back when,
Starting point is 00:39:31 of like, if you're worried about something, think about it, it'll help keep you safe, but it doesn't serve us anymore. And then that's kind of the neurobiological function that's served by the doom scrolling or the, you know, always have the news on in the background of like, I'm being vigilant, I'm aware, right? Not just in terms of what is the news,
Starting point is 00:39:48 but I'm like, it's in my mind every moment and like somehow that's gonna keep me safe. And it doesn't keep us safe. I mean, it does quite, it is quite the opposite to us. Yeah, there's something about it that's wed to an illusion of being able to control outcomes in the future. But there's another piece that I think is important, which is about rewriting the past, right?
Starting point is 00:40:10 If you have suffered some event in the past, that kind of obsession, the looping mind on the facts of that scenario is an attempt to reconcile that event and perhaps figure out how to make it different or could it have been different had I done X, Y, or Z? Yes. It's great that you're bringing that up because I think that's absolutely true. And it is so poorly served by just having it go over and over again in our minds, right? We rarely figure out something new, right? If you've been ruminating about something bad in the past,
Starting point is 00:40:48 right, over and over and over and over again, what are the chances of thinking something new, right? Which is why sometimes a person will come in and they're willing to talk about trauma they haven't talked about before, right? And maybe I know this, like it's been telegraphed, but I haven't seen the person before. We haven't talked about the trauma before.
Starting point is 00:41:05 And then we'll start talking about it. And sometimes, sometimes I say almost nothing. I'm just, I'm a listening presence and I'm reassuring and encouraging and whatever, or whatever it sounds I may make. And then the person at the end will think, oh my God, that was, I can't believe it. I can't believe how much better I feel. It's like, I didn't do anything, right? But the person put
Starting point is 00:41:30 words to it, said it out loud to another person and therefore was able to think about it in a different way. So the thousands of times it goes over in the brain, we very rarely learn something new. But if we put words to it, there are different parts of our brain that come online. There's a part of our brain called the ventromedial prefrontal cortex that's involved in reversal learning. So unlearning things we've learned that are wrong, for example.
Starting point is 00:41:55 And we bring that much more online in the spoken word and with a witness, somebody hearing our words. So I think what you're saying is so important, but it's hard to achieve that when it's just running over and over again in our minds because it just becomes often the same oppressive self-narrative. Yeah, it's its own living pernicious entity, right?
Starting point is 00:42:20 Like we all know people who walk around with a rain cloud over their head and I'm fat, I'm ugly, I always get fired. And no matter what you say to that person, it's impossible to kind of trigger them out of that mindset, which isn't rooted in reality, but obviously basically predicts all their life outcomes
Starting point is 00:42:40 because that's the way they're navigating the world, that's the way that they're interacting with other people. And of course, that's gonna provoke the result that they seem not to desire, but which they continue to manifest time and time again. Right, the inaction like E-N not I-N, right? The inaction of a self-fulfilling prophecy, right? Is used as evidence that the prophecy was unavoidable,
Starting point is 00:43:02 right? And boy, that's hard to get out of, but we can get out of it. And I know it was the sort of third topic of like, how do we get better, right? But looking ahead a little bit to that is like how we get better is we stop the cycles that run over and over and over again in our minds by doing something different, right?
Starting point is 00:43:21 By putting words to something, whether that's writing, it's speaking to someone trusted, it's going to something, whether that's writing, it's speaking to someone trusted, it's going to psychotherapy. It's the thought of like, look, this, you know, this over and over and over and over again, that all it does is spin off misery and spin off negative symptoms and impacts us in mind and body, right? It impacts our immune system. It impacts our cardiovascular health, right? So all this negativity, if we see all that's going on in me is just spinning that off and like, it's time for me to do something different, right? That's when not just like,
Starting point is 00:43:51 oh, things can get better, but things can get dramatically better and sometimes dramatically better much more quickly than one might imagine, which kind of does make sense because now something different is happening that actually serves a solution state to the problems that have just been running over and over again and spinning off symptoms. I wanna go back to the chronic trauma piece that you were talking about a few minutes ago. In immersing myself in your world,
Starting point is 00:44:24 it's left me very reflective on kind of my own upbringing. And I'm gonna resist the temptation to make this too much about a personal session with you. But I do wanna share this one thing, cause I think it's illustrative of the many points that you're underscoring here, which is that, I grew up with a mother who suffered at least two pretty acute traumas that I can point my finger to,
Starting point is 00:44:51 one being the passing of her father when she was quite young in college. And by all accounts, he was an amazing human. He died before I was born. I'm named after him. He was a very important figure in her life. And then subsequently her brother passing away tragically in a car accident when she must have been 30,
Starting point is 00:45:10 late thirties, maybe 40, something like that. And I have a vivid memory as a very young person experiencing her grief and trauma as a result of that. But she's also somebody who didn't grow up in an environment where therapy and these modalities were kind of something that you do, right? So she repressed these experiences, compartmentalize them, and then just did her best to move on.
Starting point is 00:45:39 And over time, as my sister and I kind of grew up, it became very clear, and I wasn't aware of this until many, many years later, the extent to which we were raised in an environment where we were told in no uncertain terms that like the world is unsafe and it's scary and risk is unacceptable and you need to do the secure thing.
Starting point is 00:46:02 And there was a sort of pressure associated with that. Like the way to be safe and secure is to excel in education or to kind of distinguish yourself and perform. And then thereafter pursue a career that is very safe. And so it was an environment of fear, of catastrophizing, the shoe is about to drop, it's right around the corner and we should all be very afraid.
Starting point is 00:46:29 And in kind of recognizing this, I've experienced a rollercoaster of emotions over the years, anger, mostly resentment, like why couldn't she have gotten help? What would have happened if had she gotten the help that she needed? And I have to practice a tremendous amount of contrary action to forgive her,
Starting point is 00:46:52 to forgive myself for the behaviors and the decisions that I made as a result of that upbringing and to practice loving kindness. Because in truth, those traumas led her to become a person who, you know, was from her own heart centered, you know, love for her children was just trying to protect her kids. Like she was doing what she thought was in our best interest because she didn't want that to happen to us. Yes. But the extent to which that kind of metastasized and led to, you know, outcomes that none of us wanted is severe.
Starting point is 00:47:29 And I would have to imagine, you know, in talking about the pervasiveness of trauma, that this is a very, you know, garden variety story that is relatable to a lot of people. And I'm not trying to, you know, put my, you know, shove my mom under the bus or anything. I love my parents. They're fantastic.
Starting point is 00:47:43 And like all of us, we are all doing our best. And I think, you know, shove my mom under the bus and I love my parents, they're fantastic. And like all of us, we are all doing our best. And I think, you know, what I wanna kind of land on here is that I've had to literally, you know, move emotional and mental mountains over many years to transcend these behavior patterns, to make peace with all of this and find new strategies and kind of models for living. And I've succeeded in doing that.
Starting point is 00:48:09 And yet, as a parent of four kids, I will still find myself, like so much of my parenting is in opposition to that, right, like almost too much to the other direction. And yet in less conscious moments, I'll find myself repeating those behavior patterns. And it's my wife who's like, you're doing that thing again. And she catches me, then I catch myself.
Starting point is 00:48:33 So it's this autopilot that is so entrenched over many, many, many years that even myself being someone who really wants to excavate all of this and overcome it, it's still persists. It's still there, it's an ongoing thing. Yes, I think the story you just told is it's so powerful an example, precisely because of it's essentially it's normalcy, right? I mean, you think about like how someone
Starting point is 00:49:02 might just tell your mother's history of like, well, she lost a parent earlier and lost a brother in a car accident like we we kind of like gloss over these things like oh it's part of that person's history right but we don't stop and think like wait what like what what did those things do to a person what can those things do to a person right so there's a lot of us people in the world who've lost someone, right? In the way you're not describing, it was like three standard deviations from the mean trauma in your mother, right?
Starting point is 00:49:30 You're describing things that happen and they happen and they get carried forward because if we don't look at them, then we don't stop and think. And of course you said the world around your mother wasn't stopping saying, hey, what happened? How is this affecting you, right?
Starting point is 00:49:45 It's like life just runs along forward. And then there are these massive changes in people and they're just, they're not revisited, right? Then you can see how that can come across generations, right? I mean, you're describing some of the impact that it had on you and then how vigilant you have to be now in your own parenting, right? But there's an awareness of it that says,
Starting point is 00:50:07 hey, we don't wanna keep carrying this forward, right? And I think it's almost in many ways, the inevitability of it. You know, what family systems and people who are parents where there aren't some traumas. I mean, they're not there all the time, but the story you described is not an outlying story
Starting point is 00:50:22 to happen to a human, right? And then the fact that there's a cascade of effects, I think speaks to like, right, this is what trauma does to us. And there are real neurobiological correlates that probably after the loss of her brother, you know, if you looked at like, what's the connectivity among the parts of your mother's brain and with the vulnerability parts and how prominent are they, you would see like, oh, whoa, of your mother's brain and with the vulnerability parts and how prominent are they, you would see like, oh, whoa, there's a change there, right?
Starting point is 00:50:46 And that change then determines sense of vulnerability and fear and behavioral choices and conception of the world and what's communicated to children. And it doesn't have to be like that, but we've got to stop and be aware and help people be aware so that they don't just run along from it. And then there's a cascade of negative. And I think another thing to say there is, of course, as you're describing
Starting point is 00:51:12 the story that if I understood right, you and your sister were already had been born already, right? But, but isn't it amazing? I mean, just amazing that when a person is traumatized in the ways we're discussing that their children can be impacted biologically, right? Not through the parenting style, but purely biologically, right? Epigenetically, years down the road, right? So if you think about, sometimes a criticism of this can be like,
Starting point is 00:51:39 oh, it seems so soft and like everybody has trauma and it's not that, right? It's saying, hey, there's the science of epigenetics says that changes how genes are passed on, whether they're active or not years later. So it's so clear that there's a deep neurobiological and neurochemical effect in us through these epigenetic principles.
Starting point is 00:52:04 And so if that's the case, then of course there's psychological impacts too, right? That follow from all of that. So I just see that as among the strongest aspects of validation of how all this works, both the drama of the epigenetic changes years down the road, and then also really the commonality of some aspects of your story and some aspects of mine that like this stuff happens in the world. And just because it's common doesn't mean that the impact of it is not dramatic. Yeah, yeah, thank you for that.
Starting point is 00:52:35 I wanna double click on one piece, which is the fear. And I know it's related to shame and what we just talked about, but in thinking about certain personality types, there is such a resistance to looking at it, right? Like that is absolutely terrifying and they would rather live in a chronic state of low grade dysfunction or misery
Starting point is 00:53:02 than risk the experience of unpacking something out of, I don't know, like, what is that? Is it that they think it will dismantle their lives or the terror associated with actually looking inward and trying to excavate what is actually going on is so difficult for so many people. I mean, I know that in my own case, like pain drove the changes that I've made
Starting point is 00:53:30 and maybe they haven't reached a point where it's acute enough, where they're willing to conquer that fear. But talk a little bit about how you get somebody into a mindset where they feel safe and comfortable enough to do this kind of work. Yeah, often you have to speak directly to the threat of doing it, right?
Starting point is 00:53:48 Because if something generates shame and generates fear, well, it tells us to hide that thing, right? I mean, if something is creating fear in me, well, I don't wanna go poke that bear, right? And people will say things like, I hear this all the time, right? I'll just start crying and I'll never stop. Or I'll just curl up into a fetal position
Starting point is 00:54:06 and cry until I die. Like absolutely people will say that, right? And of course, shame, which comes along with it. It's like, why do I wanna, I'm gonna tell somebody else about something I'm so ashamed of, right? I can remember telling the therapist way back when about losing my brother to suicide
Starting point is 00:54:23 and feeling such shame as if, you know, she was gonna be like, oh my God, like you're a terrible person. How could you have not known it was coming? Like, you know, I had a whole set of expectations of how she might react to it. Right. And, and it leads us then to keep it inside, you know, because there's like the reflexive leap from what we're feeling inside to then what quote unquote logic tells us, right? But like, but it's a false leap. Like if I feel ashamed of it, I should keep it inside, right?
Starting point is 00:54:52 If I'm afraid and it's making me feel bad, I must keep it inside because if I let it out, I'll feel worse, right? And then we make these conclusions, but they're not true, right? And you can see how the reflexes in us, the fear, the shame, the guilt, have us keep something inside. And then we build up such fear around the idea of exposing it, right?
Starting point is 00:55:13 And you see this in movies, like it's a human theme where like something that someone is so, so, so, so, so afraid of, and then, oh, they go look at that thing and it's okay. They can navigate it, right? They can figure out, I think even like the Lord of the Rings with no one can say Mordor, right? And it's like, there's a place of oblivion. And, you know, but by marshalling the resources, taking some, what's really going on here? How can entities be and work together?
Starting point is 00:55:36 Like they can go defeat that, right? So it's a human theme, right? And we need to come directly at it and gently, but firmly challenge it of like well is it really true like you think if you talk about it you'll fall apart but is that true right and then you can start talking about how in the vast vast majority of people probably all people if it's done right it is the opposite and then the person feels emboldened because you take away the negatives of like, of course, I can't do that to like, well, wait a second. Can I do that? In
Starting point is 00:56:11 fact, is that the right thing? Is it the best thing to do? And sometimes people will say, including in very dramatic situations, you know, I can think of a man who talked about sexual abuse for the first time. It must've been 25, 30 years ago that it had happened. And just the immense relief and the rapid succession of positive changes who was in a serious but joking way saying like, I can't believe this. I hid this away in me for so long.
Starting point is 00:56:44 And then like that decision, that leap of faith in a secure environment, right? And it was a trusted person to start talking about it. And like almost immediately things are better, you know? And there can be like a real shock to that. But I think it speaks to how strongly those mechanisms are and the mechanisms of stigma in the world around us, which we might say, oh, it's so much different now
Starting point is 00:57:08 than in the 50s or in the 70s. And I'm not so sure it's that much different in terms of the societal mechanisms in us that tell us, if there's something you feel bad about, like keep that inside. Yeah, yeah. Well, I wanna explore that further when we get into part three.
Starting point is 00:57:24 So maybe put a pin in that for the moment and let's focus a little bit now on this second part, which is how trauma shows up in our lives. Obviously it's something that if untreated ends up disrupting all manner of mental and emotional processes, but let's start with addiction because that's, again, like kind of where my interest lies
Starting point is 00:57:46 as a starting point. You know, Gabor was among the people who began to speak about the tremendous impact that trauma, particularly childhood trauma has on, you know, addiction that we see later in life. So what is your perspective on the relationship between addiction and trauma? Yeah, I think it's very much along the lines of his and I'm in part impacted by his thought and by
Starting point is 00:58:11 my own experience throughout life, clinical and in my personal life of just seeing how strongly trauma and the earlier and the more severe the trauma is, the more it promotes abusive substances and addiction. And I think that is in a way that actually makes sense. If you think about the idea of short-term soothing, if there's thought to be no hope of things getting better, then it makes sense to soothe for the short term. There really is then no better option. And under that conception that the trauma is hidden away in someone,
Starting point is 00:59:00 or the person doesn't even know it's there, or if they know it's in fleeting ways that they're ashamed of. So what it really does is pose for the person an unsolvable dilemma, right? Which is like, you feel terrible and you're not going to feel better, right? And if that's true, which it isn't, but if the conception is that it's true, then the appeal of substances becomes much, much, much higher, right? The appeal of soothing in the short term, because there then appears to be no better answer, right? And I think the way to come at trauma and addiction
Starting point is 00:59:33 is to hold forth the truth and the hopeful truth that no, there is something way better than short-term soothing. In fact, there are ways of coming at it that can take away the desperation that makes the short-term soothing at some points irresistible. Does that make, does that?
Starting point is 00:59:54 No, it does, it does. I'm trying to understand the relationship between confronting this unresolved trauma and how that plays out in terms of building a foundation of long-term sobriety. And I repeat this often on the show, but I've got sober in 12 step. I'm very much a traditionalist in that modality
Starting point is 01:00:16 and that kind of toolbox and how that modality relates to a psychiatric modality that is related to trauma, like where those things intersect and where perhaps they're divergent. Yeah, so maybe one way of coming at that is actually approaching and addressing trauma can take away one of the most miserable
Starting point is 01:00:43 and destructive conditions humans can be in, which is a damned if you do, damned if you don't, right? Like I feel awful. I feel terrible. I want to feel better. And there's no way out of this, right? So I can go try and do something about it,
Starting point is 01:00:59 but all the things I do about it, which might sometimes be the use of substances, right? Make things worse. But there's no other, there's nothing else I do about it, which might sometimes be the use of substances, right? Make things worse, but there's no other, there's nothing else to do about it. There's no other way to make it better, right? And when we have what sometimes is called a central conflict or a damned if you do, damned if you don't, we can't stand that as human beings, right?
Starting point is 01:01:19 We feel we're confronted with helplessness and hopelessness, right? And the idea is then to come at that therapeutically, in a way like put words to that in a way that takes away the dilemma. It's not damned if you do, damned if you don't. There's a third path. There's a route through it.
Starting point is 01:01:39 In some ways, I don't know if you're familiar, there's a psychiatrist named Lance Dodes, who's at Harvard, who wrote a book called The Heart of Addiction. And he's basically writing how traumatic circumstances promoted relapse to addictive behaviors, right? And then it was a long time ago that he wrote that book. And I think it captures the concept
Starting point is 01:02:00 that even if a person say has gotten themselves back into a healthier state, unless they've resolved that central conflict, something can happen that makes them feel again, like they felt before. It's not really a resolution to the state so they can go back to the state and that that was telegraphing so many of the relapses
Starting point is 01:02:19 that he would see in his practice. And I think that there's an immense truth to that. I mean, on the one hand, addiction is a neurobiological illness, right? There are receptors that are operating in divergent manners and they're firing in ways that sort of demand reinforcement. And there's all sorts of things going on there, but that doesn't mean that that's necessarily at the heart of it. Like we can get to the point of that neurobiological state, but it arises often from a psychological dilemma and the psychological dilemma that arises from trauma. Does that?
Starting point is 01:02:53 Yeah, no, it makes a lot of sense. Makes a lot of sense. In healing, confronting healing, that historic trauma, I see a path forward towards building that foundation of sobriety, confronting, healing that historic trauma, I see a path forward towards building that foundation of sobriety. But I feel like it's just one, there are many other tools that still come into play. Sure.
Starting point is 01:03:15 Like it's not as simplistic as, deal with the trauma, then you're good. And I started, that's the one thing that I kind of like bristled back at, like because it's not a binary. Absolutely. We want everything that we can have in our favor to be healthy and happy in our favor, right? So addressing trauma and understanding
Starting point is 01:03:35 that comes through trauma that can resolve those stand if you do, dand if you don't dilemmas is important, but it's just one part of a structure, right? That a person can put around themselves to engender health, you know, self-awareness, right? Well-informed life choices, right? Reflectiveness, choices about, you know, the who, what, when, where of self-care. There's so much more to it, but a central heuristic to understanding it and navigating it would say, you can't expect a person to do that and to have the odds in their favor of doing it successfully if there's a central conflict inside of them that is still spinning off a damned if
Starting point is 01:04:20 you do, damned if you don't, or all the reflexes we were talking about the trauma of like, oh, nothing will ever go right for me, or it's never gonna be okay in the long run. Like how do you build that structure around you with that core belief? So we wanna make sure there is no core belief like that when the person is then building the healthy structure around them.
Starting point is 01:04:39 Yeah, no, that makes a lot of sense. That makes a lot of sense. What are some of the other ways beyond addiction that trauma manifests? Sure. So if we think about the hallmarks of a post-trauma syndrome, which often gets called PTSD, but like the word trauma, PTSD gets thrown around a lot, right?
Starting point is 01:05:00 And I think there are limitations. I mean, it's a DSM definition, right? And the DSM is a book of taxonomy, right? It doesn't say what truth is, right? So for example, PTSD can be vicarious if it's occupational, but not if it's not occupational. setting something so arbitrary. So if we look at it and we say, what actually goes on in human beings when there's a change in the brain and that change is a consequence of trauma? And a lot of it is very similar. It tracks along with PTSD criteria. So there's exposure to something,
Starting point is 01:05:38 whether it's acute or chronic or vicarious. It is then re-experienced, meaning that there are intrusive thoughts about it. There are recurrent thoughts about it. It's on the person's mind, right? It gets mapped to things they see in the world around them. Someone who is in an accident who sees the car go by and imagines the car hits something next, right? So it becomes ingrained in the person in a way that has a lot of re-experience to it, right? Then there's a shift towards brain mechanisms that are more about fear and vulnerability and vigilance, right? So people then become more
Starting point is 01:06:11 vigilant and want to maybe take less opportunities. The idea of like, you know what? I want to be safe. The best way I can be safe is to not leave the house. Ergo, I'm not leaving the house, right? And then like, look at how much of life is cut off, right? So the shift in us towards vigilance is negative. Then there can be shifts that raise baseline anxiety and tension inside of us that lower mood, that impact sleep and that lead to behavioral changes, right? So the idea would be that's what we're looking for, right? Because those are the manifestations of a change
Starting point is 01:06:45 that has happened in the brain. That's not a healthy change that we wanna recognize, right? Whether it's a clinician recognizing or someone who's being reflective about themselves or someone else in their life, right? We wanna recognize, hey, like that's a real change. And it warrants going in and looking at that and trying to fix it, right?
Starting point is 01:07:06 Trying to change that back to how it was before. The sleep impingement one is super interesting, right? I think a lot of people believe or they're operating under this idea that they have a sleep disorder or some form of insomnia when in reality, they're just looping these thoughts that are activating their brain and their neurochemistry in a way
Starting point is 01:07:28 that's just getting in the way of sleep, right? It's sort of like these patterns that, you know, are sort of hard to, you know, overcome or repress. I cannot say a strong enough yes to that. And over the years, amongst the conditions I've seen treated the absolute worst in mental health treatment and indeed in general medical treatment are sleep problems. Because we're living in an era of rapid fire throughput medicine, right? And as I often will describe it, it's like polish the hood if there's a problem in the engine, right? Then things look better for a little bit and we can call it good and shuffle
Starting point is 01:08:08 the person on down the road. And we see that so strongly with sleep or like anyone who has a sleep problem, right? Is, well, they're not sleeping, so they need a sleeping medicine, right? And it's like, it's so overly simplistic and it doesn't honor at all that there are things that can be in our mind in ways that are ruminative, right? These deep distress systems in our brains that feel so unsafe that they just have us ruminating going over and over.
Starting point is 01:08:36 And I cannot tell you how many times I've seen a person who quote unquote can't sleep and oh, they've been on four, six, 10 sleeping medicines. Oh my goodness, like they can't sleep. And, oh, they've been on four, six, 10 sleeping medicines. Oh my goodness, like they can't sleep. It's like, right, they don't have a sleeping system problem, right? They have a trauma problem. They have a rumination problem.
Starting point is 01:08:54 And if we look at it through that lens, which is the lens of truth, what's actually going on in them, we can resolve that problem. Whereas you will never resolve that problem with a sleeping medicine because that's not where the problem is. But in a system of reflexive medicine
Starting point is 01:09:09 and overburdened physicians, especially the primary care physicians where people are just overburdened. So of course they're looking for like, okay, like, wait, you're not sleeping. Let me give you sleeping medicine because they have 11 minutes with the person, right? And how else are they gonna do it?
Starting point is 01:09:22 And I think there's so much misery and sometimes death in people, so much needless suffering and so much needless cost because our healthcare system has become focused on throughput, not thinking. And then we impose that upon the people who are operating, who are working in the system. And we oppose that upon all of us
Starting point is 01:09:42 who are trying to get healthier within the system. And how can we be surprised that we often end up with dumbed down answers that don't work. Yeah, yeah, yeah, yeah. I would venture to imagine that the rumination factor is at root in the vast majority of people who would claim to have sleep disorders. I believe that to be true as well.
Starting point is 01:10:06 To the best of my knowledge, there's no data about it. I don't know if there ever will be, but it's just so, what is a clinically evident, right? Something where you just sit with a person, you just know what that is. Then you have the proof of concept, right? You come at it not by giving them the ninth sleep medicine, right?
Starting point is 01:10:23 But by coming at the reasons behind the rumination and sometimes coming at that pharmacologically. So you try and shut down the rumination while then working with words to solve the problems or you just come at it with the words and you see, oh, that made that better. So there's the proof of concept, which is obvious when a person presents
Starting point is 01:10:43 with that kind of rumination. Like they don't say like, oh, I just can't sleep or I'm tired, but I can't. No, they're telling you what's going on in their brain and it's scary and miserable and vulnerable. And it comes to the fore around bedtime, right? Like it's just part how our brains start relaxing a little bit that lets more of this in because we're less thinking about other things.
Starting point is 01:11:03 And in many cases, it's just so obvious and predictable, but the system doesn't identify it. Yeah. In my mind, that serves as sort of a micro example of these autopilot behaviors that we're semi-unconscious of, but a very common, you know, more macro pattern would be the example of the person who is in an abusive, romantic relationship, that relationship ends,
Starting point is 01:11:32 they're in another relationship, the same pattern emerges again and again and again. And they vary in the extent to which they're even aware that they're repeating this pattern. And there's a sense of powerlessness. Like you're continuing to seek out because of something that happened to you a long, long time ago,
Starting point is 01:11:52 you're recreating this situation in your life. Yes, yes. I find it really amazing how often this happens in us, in human beings. It gets called a repetition compulsion. Like we can put whatever words we want to it, but it's rooted in this like, I think amazing fact that like for the vast majority of my life, I wasn't aware of, right? Which is that, okay, there are logic systems in our brain and there are affective emotion systems,
Starting point is 01:12:27 what's called the limbic system in our brain. So there's logic and there's emotion, basically. And emotion overrides logic, like all the time, right? If emotion feels strongly about something, it always overrides logic, right? But we're not aware of that. And we're also aware of that. And we're also not aware that those emotion systems in our brain do not care about the clock and the calendar.
Starting point is 01:12:50 Because people say, well, why, if you've had four relationships that have been said, this is basically the same abusive relationship, but the person just had a different name, basically the same person. Why would you do that again? Why would you think you could fix the past
Starting point is 01:13:03 by doing that same thing in the future and gaining some mastery? It's the wrong question to ask because that part of the brain isn't discerning past from present, right? It's all immediate and the brain wants to solve it. It wants to release itself from the fear and the trauma of what happened in the past
Starting point is 01:13:22 to correct it by what happens in the present. Because it's not making those, it's not distinguishing like that, which is why people will say, well, how could that be true? Like everybody knows you're not gonna fix something in the past. That's not true.
Starting point is 01:13:35 The logical parts of our brain know that, but when there's highly charged emotion, the logical parts of our brain don't matter. And unless we honor that in us, how are we going to stop repeating the same cycles, whether they're individual and psychological or they're aggregate and sociological, right? Because history repeats itself, right? History repeats itself. Because if we're not aware, then we do the same things on aggregate scales that we do in our own individual lives.
Starting point is 01:14:05 And we engage in this repetition compulsion and everything else that we see out play on bigger historical stages. So I think what we're talking about now is actually intrinsic to the survival of the species. And it might be, I know it's a strong thing to say, but I really do believe that. I think that culture is the sociological equivalent of
Starting point is 01:14:27 free will. If we know ourselves and understand ourselves as best we can, we exercise free will as best we can, but we also establish a culture around us. Is it a culture of helping and supporting people? Is it a culture of repeating traumatic distress over and over and over again. Like we establish the culture and then the culture, I believe, determines whether or not we engage in these big repetition compulsions, you know, repetition compulsions of war and of lack of self-care to the environment around us. And as things get bigger and bigger, and we're truly on a world stage, for example, with climate change, we run the risk that we keep repeating those cycles
Starting point is 01:15:09 and we blow ourselves up with nuclear weapons or we drive the planet into inhabitability. Right, that is the ultimate macro example of all of this, right? But to extend the example of the person in the abusive relationship, ostensibly what you're saying is, let's say that person grew up with a father who was abusive.
Starting point is 01:15:31 So unconsciously they seek out partners that mimic their father's behavior. Because what they're attempting to do without their free will or awareness is to fix the past. Like if I get into this relationship with someone similar to my father and I can make it a healthy relationship that will rewrite how I feel about what happened
Starting point is 01:15:53 when I was a child. Yes. Yeah. Yes. That one I understand. The one that's harder to understand is the sort of converse example of the person who suffered, let's say a young boy was sexually molested
Starting point is 01:16:10 as a young person. That person quite often grows up to be somebody who then perpetrates that same abuse on other people. So what is that person unconsciously or consciously attempting to do? Like why did those people end up becoming the perpetrators of the harm that was so traumatic? Right, so again, great question.
Starting point is 01:16:34 And so there are different ways that our brains will try and solve the things that terrify us, right? Those central conflicts. I must have a good, I must have a romantic relationship with someone whoify us, right? Those central conflicts. I must have a good, I must have a romantic relationship with someone who loves me, right? But I can't, right? Because it wasn't even loved by my father, right?
Starting point is 01:16:52 And then, okay, well, the solution state is the repetition, right? That's one aspect. That's one way that we can come at it. Another way can be identification with the aggressor, right? That being on the recipient of sexual abuse is terrifying, right? And when people talk about it, their sensations and thoughts and feelings that are so inappropriate to the age and the situation that they're wildly confusing and frightening, right? So there's such a strong sense of helplessness
Starting point is 01:17:27 that the person then sometimes identifies with feeling powerful and feeling safe, right? It would be safer to feel like the abuser than the person who is being abused. And there's a truism that I believe, I think this goes back like over a hundred years in the field, but I believe it to be absolutely true, which is there's no internal victim
Starting point is 01:17:51 without an internal persecutor. So if someone internalizes being victimized, you know, not like, oh, someone did something to me and I was victimized under the eyes of the law, right? But like, I am a victim. I'm someone who people can do awful things to, right? Like that But like, I am a victim. I'm someone who people can do awful things to, right? Like that's me. I'm a victim. People also internalize the persecutor. And very often what they're doing then is persecuting themselves, right? So they're internalizing that person who
Starting point is 01:18:17 told them they were worthless is still telling them they're worthless because they took that person into themselves. But another way or direction that can go is internalizing the persecutor and identifying with the persecutor in order to feel safer, which is what can then lead to perpetrating the same, you know, crime that was perpetrated upon that person. So that person then goes out and tells other people they're worthless.
Starting point is 01:18:43 The person who was told they were worthless then repeats that pattern by trying to, basically becoming the perpetrator as a way of reconciling the victimhood. Yeah, and often not in a way of saying, oh, I'll either unconsciously or consciously, I'll feel better about myself by making someone else feel the way I felt. It's generally not that.
Starting point is 01:19:06 It's if I'm doing this, right? If I'm perpetrating crime, right? Then I'm safe. I feel powerful, right? I have a relief from the terror and the fear inside of me of the ruminative distress of the memories and the feelings of having been abused. It's usually, it's in the service of the person feeling safe, right? Now there may be a whole set of cognition around that that involve knowing that someone else is being hurt. You know, of course, that's why there's culpability and legal culpability for it.
Starting point is 01:19:38 But ultimately psychologically, you know, people are trying to find safety, right? They're trying to find some peace and some safety. And we can go about that in some ways that can be incredibly damaging and hurtful to ourselves and or others. If we don't understand that that's what we're trying to achieve in the world, the sense of safety, relief of fear and vulnerability. And if we look at that and we want to understand it and shine the light everywhere, right? Instead of running from it and hiding from it and guilt and shame and fear, then we navigate that in ways that are so much healthier for ourselves and for everyone
Starting point is 01:20:16 else too. You mentioned PTSD earlier. That's a term that is cavalierly kind of tossed about. The more that I think about trauma, the more I'm confused why this term even exists. Like, isn't there just trauma and our response to trauma? What, if anything, is different about something that would be clinically described or diagnosed as PTSD versus somebody else's, you know, downstream response to a traumatic event?
Starting point is 01:20:55 Well, it's a big question and I'll try and speak to it kind of concisely that, you know, there need to be criteria, right? For diagnoses, diagnoses in order to identify them and to communicate between clinicians and to enact treatment paradigms. But what I believe so strongly has happened in the field is that mental health or psychiatry, if we're thinking about medicine, wants to be like the rest of medicine,
Starting point is 01:21:22 where it's very clear, do you have a pneumonia or not? We can tell that, right? Because we're gonna get a chest X-ray and we're gonna do it's like very clear, do you have a pneumonia or not? We can tell that, right? Because we're gonna get a chest X-ray and we're gonna do blood draws. And like, we know you either have a pneumonia or you don't, right? So we want a taxonomy that tells us what something is and what something isn't.
Starting point is 01:21:35 And then we do what I think human beings often do is we glorify the taxonomy as if the taxonomy is the answer, right? Instead of saying, look, people can have trauma in all sorts of ways. And on the other side of that trauma, there can be a whole set of problems, right? And the problems often look like this, right? Now they don't always look like this, right?
Starting point is 01:21:57 But they often look like this. And they come from these changes in us that promote these problems. That's why you can see mood changes and anxiety changes and sleep changes because there are all these brain changes. But that's less absolute, right? Why? Because it's real, right? It's true.
Starting point is 01:22:15 It's less absolute than saying, look, there's either PTSD or not PTSD. And you have to have X criteria in this category and Y in that criteria. And it's like, it's false, right? But we look at it in a way that glorifies the taxonomy, right? I can remember years ago training a resident who went and saw someone who so clearly had a diagnosis that you could have told a middle schooler about like,
Starting point is 01:22:38 hey, here's a criteria, that person has it. But they didn't have, they only had like two from one category instead of three, right? So the person comes back, I have no idea what's going on. Because we are dumbing down the whole system and then the whole understanding in the broader community and world around us and in the training processes, where people will call the DSM the Bible.
Starting point is 01:23:01 Right, I was just gonna say this DSM being considered biblical and in its edicts. Terrible. It's terrible because it leads to, it perpetuates an overly rigid form of ignorance, right? That is not grounded to what's actually happening in people. So if we think, hey, here's this truth that if things happen to us that overwhelm our coping skills, our brains and bodies can be so different that we can pass on our genes
Starting point is 01:23:34 in a different way years down the road. So very clearly then the communication and the prioritization of different parts of our brain informing how we feel and what we decide can certainly be impacted. And we wanna be cognizant of that. And we wanna be cognizant that that can occur in like anyone who presents.
Starting point is 01:23:55 I doesn't mean it's in everyone, but I wanna think about that, right? I wanna think, has that thing happened that's changed the person, right? That is so, it's so much more of an application of judiciousness and intelligence, right? Than it is to say like, okay, you've presented to me, I don't know who you are, but like, I'm going to check some boxes. Do you have this? Do you have this? Do you have this? And then at the end of it, I get to the checklist and I tell you what's
Starting point is 01:24:16 wrong with you or not, right? It's just fake. And it's a product of a healthcare system that prioritizes throughput and decreasing costs by minimizing human interaction and throwing way too much medicines at people. Why? Because it's cheaper to throw medicines at people than it is to sit with them and try and understand them. And then we have over and over and over again, problems that aren't solved, right? Because we're not putting in the human time, which might cost say in the realm of like, I'm just making like several thousand dollars, right? But instead of that,
Starting point is 01:24:46 the healthcare system will spend hundreds of thousands of dollars when that person shows up again and again and again in an emergency room. And then, which is so terrible, but I've seen this so many times, so many times. Then sometimes there's a person in that position and then they die.
Starting point is 01:25:03 And that's the end of that story. There's no like learning or reflectiveness, like how many people are dying needlessly, right? Because we're so short sighted. You know, the same way I think often we're looking at, you know, corporate profits and, you know, end of the month or end of the quarter, right? Like there's so much in our world around us that focuses on the short term. Not that everyone is doing that in business or in medicine, but there's so much of that that we don't extrapolate forward to like, what are we doing to ourselves as a society?
Starting point is 01:25:34 And I think this is true of the downstream effect of trauma. Like in every time I see, oh, there's another mass shooting, right? Of course I think about like the horror of the lives that were lost, but then I'll think, oh my God, like how many dominoes are now tipped over and how many people who knew these people or knew people who knew these people or they're still alive and they're trying to cope with life or they're somewhere identifying with the terror those people feel.
Starting point is 01:26:00 And we just don't, it's very easy for us as a society, just, you know, we just polish the hood and we move forward. And we don't even, we don't provide enough resources to really take care of well, people who lost someone in the September 11th attacks. And I said, good, we have enough resources. We really get, how much are we going to really help them? Like, why are we not as a society saying, look, there's a clear group of people,
Starting point is 01:26:22 for goodness sakes, can't we really take care of them? right? Even in situations like that, that are so unambiguous, you know, there's limited resources, right? Because I think we waste a lot of resources and we don't look at the vulnerability of us all as individuals and as a population and see ourselves as stewards of the world around us, of our own health, of the health of people we love, certainly of our children and the next generation in a way that has us stop and really think outside of a, wait, what's the bottom line now? Or what can I consume now
Starting point is 01:26:54 to make me feel a little bit better? And as a society, I mean, I think it's hard to take stock of our society and feel a sense of pride in where we're at. Yeah, it's a dire indictment of how we think about and care for our brothers and sisters. And I often despair of our capacity to sort of overall our systems
Starting point is 01:27:19 and create a more compassionate, holistic means by which to care for people. Because I think it requires on a more compassionate, holistic means by which to care for people. Because I think it requires on a practical level, a complete change in the incentive structure, a total overhaul in how we think about healthcare from, you know, diagnosed and prescribed to this holistic, you know, approach to wellbeing more broadly.
Starting point is 01:27:40 And this is something that you're, you know, not only endeavoring to do, but succeeding at your clinic. And hopefully it's a model for more of this kind of thing, but the entrenched infrastructure in which healthcare operates systemically is utterly broken and incremental changes within it aren't going to really shift the equation very much. And then on top of that, without a revolution of consciousness, I don't know how we solve these problems because it requires not only a higher plane of thinking,
Starting point is 01:28:12 but a higher plane of awareness that really values compassion and loving kindness and these more kind of Eastern strains of thought and perspective that lead to creating systems and institutions and infrastructures that are value driven in the manner in which you just described. Yes, I agree with you completely. If there's anything I see as positive or hopeful,
Starting point is 01:28:46 it's that what you just described comes through a grounding really to common sense, to what we just see so obviously in front of us, right? The lessons that history tell us, the lessons that early childhood education tell us, the lessons that even the basics of religious values tell us. They say, come on, let's look at this for what's really going on, right? Can we just stop and look and just see with new eyes, with common sense eyes? And I think so often that's where the answers lie,
Starting point is 01:29:18 right? And sometimes we'll think, and I really kind of mean this, I'm exaggerating a little bit, maybe not, that we should have a bunch of like really smart middle schoolers look at our healthcare system and come up with like, what principles would you make? What would you do? What would you change to make this better?
Starting point is 01:29:35 Because by the time you're often at the level of adults, there are too many entrenched interests. There are too many, I can only see it the way I've seen it. And then we can't see what's obvious. And I think the biggest example of this, which I just make so much anger in me is the term burnout, right?
Starting point is 01:29:53 For physicians who just can't navigate in the system, right? Now I'm in my early fifties, but when I grew up, like the term burnout was an insult, right? That was someone who wasn't going anywhere, wasn't trying, like it was absolutely an insult. And now we apply this to physicians who find themselves unable to function in sick systems, right? We don't say, you know, that person actually
Starting point is 01:30:21 is on the receiving end of the sadism of a system that looks at them like a thing and says, oh, you know what? You're gonna see now four patient an hour. So you're a primary care physician. You're trying to figure out what's going on with people. You're gonna see four patients an hour and you're the person on call today in case there's a walk-in, so you might have five.
Starting point is 01:30:37 I mean, how is that person supposed to function, right? As a person who's taken care of a lot of doctors throughout my career, you know what I see the vast majority of times are good people who are trying, but this is not what they signed up for. They didn't sign up for denigration. They didn't sign up for it being literally impossible to care for the number of people in the range of acuity that's on their panel. And then the systems label them, oh, well, they're burnt out. I mean, I just think that that to me is the focal point.
Starting point is 01:31:12 And I find it outrages me because of course I feel for those physicians, but then also on the other side of it, how about the people, which is all of us, right? Who could come in the door to be taken care of by someone who doesn't have the time or the people, which is all of us, right? Who could come in the door to be taken care of by someone who doesn't have the time or the means, or even the freedom inside their own mind to actually take care of us.
Starting point is 01:31:33 So then how do you begin to make reparations for this? Like what is the path forward? Like if you found yourself in the position of running a massive healthcare organization, or perhaps you get appointed to be surgeon general, like what are the policies that you would like to see put forth and foster? Like what do we do? Right. Look, I don't want to pretend like I have all the answers, but I'll tell you this for sure is I'd come back to first principles. Like, okay, what is this system about?
Starting point is 01:32:06 It's about taking care of people, right? It's about health and happiness over the longterm. Okay, much of which presents to healthcare systems either is or has the capacity to be chronic, right? Or has its roots in things that are often chronic. So, okay, so let's look at that and look at how we're dealing with it. or has its roots in things that are often chronic. So, okay, so let's look at that and look at how we're dealing with it. How often are we polishing the hood
Starting point is 01:32:32 instead of looking into the engine, right? How do we look into the engine? What's at the root of dysfunction? If you think about how many medical costs come from mental health issues, right? It's well understood that at least half of what presents to all physical health doctors arises from a mental health condition.
Starting point is 01:32:54 Like we know that it's clear when you look at the studies, they're all saying it's half or it's more than half, right? So, wow, that's fascinating, right? Because that's a lot of morbidity, mortality cost, right? That's coming from that. So can we look and say, well, what, that's fascinating, right? Because that's a lot of morbidity, mortality cost, right? That's coming from that. So can we look and say, well, what is that? That's at the heart of it.
Starting point is 01:33:10 And look, so much of the time it is trauma, right? That is why that person is not taking care of themselves, right? And now, oh, guess what? They're 40 pounds overweight. Now they have diabetes and they have high blood pressure, right? And we want to throw this medicine, that medicine, instead of saying like, why, right? Where is this coming from? Can we help you to diffuse this, right? Can we help you to take care of yourself? When we actually look at it that way,
Starting point is 01:33:32 we do help people to be healthier. And ultimately, in addition to helping people be healthier and happier, we decrease costs within the system. But how often, I mean, it's maddening. And like, I worry sometimes there's a thought of like that I must be exaggerating, but like people who operate in the systems, you just see this all the time where, you know, something that would be so simple or so easy is not provided, right? And then you see the hundreds of thousands of dollars of medical costs that come of that, or you see the morbidity and mortality. I write about in the book of a, you know, person with clear mental health, bad mental health condition, right?
Starting point is 01:34:07 No help, no help, no help, no help, dead kids, right? And then what does society wanna say? What a bad person. Instead of saying, remember, we set up all of that to happen because every step of the way, we looked at that person and that situation in the most short-sighted way. And then there's the revolving door in and out of the emergency room, in and out of the hospital
Starting point is 01:34:27 until something catastrophic happens. And it's not that hard if we go back to first principles to make that better. What's hard is deciding, hey, this isn't working and we need to go back to first principles. Yeah. Well, you're successful in the clinic that you've created and there are other, there are many examples out there of integrative medicine, functional medicine practitioners, clinics large and small. And this is an ecosystem that seems to be growing, even compared to five or 10 years ago. And I think the more of these entities are successful,
Starting point is 01:35:03 it shows young doctors and healthcare practitioners who are coming up that there is a new and different way. So that is my kind of silver lining of hope in all of this. Yes, yes. And I do agree. I see that. I think the shift has to be where, what sort of private clinics or places are doing
Starting point is 01:35:25 that are providing, hey, how would you provide really good care to someone, shifts over into the standard systems, right? Because people are often paying out of pocket for, they're paying, right, for the really good care. And sure, if that's how it is in order to get really good care, I understand that and I'm a provider of that, right? But I lament that I think in many ways we're moving towards a bifurcated system
Starting point is 01:35:52 where it's like, well, if you have the knowledge and the savvy and the resources to go get that, you can. But if you're operating through insurance, hey, there's only so much you're gonna get. And I think that that is wrong, right? And part of how I feel morally and ethically that what I do, I feel good about, right? And I think part of it is,
Starting point is 01:36:09 yes, we can do things at a sliding scale or discount. Like we can choose to do that. And we're also showing that, hey, ultimately this is better, right? That if you look across time, people are happier, they're more productive, right? They have better lives. They're spending less on their healthcare.
Starting point is 01:36:26 That it's not just a model for wealth, right? That it can be a model that the insurance systems run from too, right? That then can really change our society and how our society is functioning. But it's not clear to me that we're gonna make that leap. I hope we are and I wish for us to, and it's part of why I wrote the book and it's part of why I'm here talking about it. I think we need to shift our whole system in that, in that way. And if we don't, again,
Starting point is 01:36:55 I do think we're in trouble. Yeah. Yeah. I would agree with that. I want to shift gears a little bit and get into healthy means by which we can process and deal with our own traumas. But just to put a bow on this kind of part two, are there other common personality disorders incident to trauma? You know what I mean? Like I'm thinking of, let's say a narcissist, right? Like, okay, somebody is like something happened to that.
Starting point is 01:37:26 Why are they that way, right? Like something happened that led them to behave in a certain way and that person, and maybe why I'm raising that as an example, has a very unique relationship to shame that is also relevant to kind of the cultural moment that we're in right now. That's distinct from the shame associated with trauma
Starting point is 01:37:46 that kind of imprisons us. It's sort of the opposite of that. Right, right. Yeah, so when you think about personality disorders or characterological problems, right? Problems in a person that kind of run through their interface with the world, right? Like something like you said, narcissism,
Starting point is 01:38:04 which the thought is, hey, it's then changing the lens through which the person is seeing and interfacing with the world, right? Like something like you said, narcissism, which the thought is, hey, it's then changing the lens through which the person is seeing and interfacing with the world, so it's pervasive. And we think of those kinds of problems from the perspective of a stress diathesis model, which like basically means there's a certain risk or predisposition in people, which varies by person and varies by condition.
Starting point is 01:38:26 And then that intrinsic risk interfaces with stressors in the world around us, right? So if the stressors are needlessly higher, so trauma driving guilt and shame and fear, then we are creating more stress. So we will create more of those pervasive problems. I mean, that's just sort of mathematical, right? If it's a, there's okay, there's an intrinsic and broadly spread set of risks, but those risks interface with stress and we're living and we're acting in the world in a way that I think is trauma promoting, right? Is not, we're not doing
Starting point is 01:39:07 the right things to try and prevent or decrease those problems. So we're making more risk, ergo, we'll make more of those problems. No two ways about that. Yeah. Yeah. In thinking about that, in the context of narcissism and shame, I'm trying to make sense of something that's confusing me, which is on the one hand, we're seeing this sort of ascent of certain narcissistic types that command public attention. And these people have a rather unique relationship
Starting point is 01:39:40 with shame or more specifically shamelessness. And that creates, it kind of percolates into culture in which there's now a lot of people who are rather shameless in certain regard. But on the flip side of that, we're also in this social media culture where it's becoming with increased frequency, we're seeing people being publicly shamed, right? So we're having like an intense relationship with shame and shamelessness at the
Starting point is 01:40:14 same time that I'm trying to understand and make sense of. And I'm just curious about whether you've kind of thought about this. Well, yeah, I think a lot about this. And a reason for that is that I think that narcissistic people, people who have problems of narcissism in their character, are by far the most destructive kind of person on the face of the planet. And narcissism is a manifestation of insecurity and vulnerability. It's a reaction formation to that, meaning what appears to be the opposite, right? So someone who's narcissistic, who's like, hey, I'm obviously the best and I know everything, right? Where's that coming from? It's a reaction to feeling ashamed of oneself and to feeling inadequate, right? But it goes to a defensive structure that becomes all about the self and all about assertion of the self
Starting point is 01:41:06 and all about doubling down on the assertion of the self. And admitting any weakness or fault is unacceptable because the defensive structure is all about the promotion then of the self to stave off the guilt or shame and the feeling of inadequacy. That's like a thin, this is just a thin veneer on top
Starting point is 01:41:25 of that. And then when people like that become figures in society, right? Others who are suffering from disempowerment, right? People who do not feel good about themselves, they don't feel safe, secure, successful, can then identify with the narcissist. Right. They're magnetized by it. Right. Because it's saying, hey, if I feel terrible about myself and you see how many disenfranchised people or voters, right, seem to have identified with the narcissist among us politically,
Starting point is 01:42:00 right? I don't mind saying Mr. Trump, the top of that list, right? A person who, to me, it seems quite obvious is leading with narcissism. And then people who may not share that narcissism, but who feel weak and disempowered attached to the symbol of that person's power, right? I can't be powerful, but you'll be powerful on my behalf.
Starting point is 01:42:20 Even if you don't have to scratch the surface too much to see that you actually despise me, right? And then people identify in the service of soothing Even if you don't have to scratch the surface too much to see that you actually despise me, right? And then people identify in the service of soothing, right? The weakness, the shame, the vulnerability inside of them instead of looking at themselves. Like, why do you feel that way about yourself, right? Are there ways of self-examining why a person becomes say angry, frustrated, resentful, right?
Starting point is 01:42:44 Are there ways that a person can understand that and either take pride in things in their life that are worth feeling proud of, right? Or strive for ways of feeling more proud of themselves, right? Of being a better person in the way they might wanna be in the world, right? But that's harder than the default state, which is to identify with someone who is proclaiming,
Starting point is 01:43:09 like, I'll be powerful on your behalf. I mean, populist movements, demagogues, right? This is how that goes. It's why that's so powerful because it's a way, an easy shortcut, right? But it doesn't have to be that. Can we look at how do you raise people up who don't like where they're at, who legitimately feel like they don't have to be that. Can we look at how do you raise people up who don't like where they're at,
Starting point is 01:43:26 who legitimately feel like they don't have opportunity in this world? And I can remember before the pandemic reading about how great the economy was, right? Because, oh, the unemployment was so low and people can just go get a job. Okay, at the same time, there was data telling us that an unexpected like500 to $800 expense can sink half the people who are just barely making it.
Starting point is 01:43:51 That's not okay. We need to look at why we have a social system and an economic system that puts people in such precarious positions. And then are we surprised that some subset of those people are going to react in ways that are aggressive or even desperate in their alliance with someone who says, right, I'll be powerful on your behalf. And you know what? It's the fault of other people, right? It's the fault of immigrants or people who think differently politically, or it's a fault of anyone but you, right? But that's not about responsibility of saying, we're not looking for whose fault it is, but like, can you take responsibility for what's in your life and make it better
Starting point is 01:44:25 so you can feel proud of yourself, right? But it's a much easier shortcut. And then people who are populist or who engage in demagoguery will wanna offer like, hey, you don't need any of that, just to lie with me. And look at the damage we've seen from that. Yeah. Yeah, the fallout is enormous.
Starting point is 01:44:44 And it is a very predictable outcome that is exacerbated or, you know, created actually by this growing divide in economic security between haves and have nots and the disappearance of the middle class. Right. That's driving all of this. And I think having, you know, a top down 10,000 foot view on that allows you to kind of better understand the social dynamics that are at play. Right, and plot out a middle ground, right?
Starting point is 01:45:14 Because I think many people who say have supported, for example, Trump, we don't want people leading with racism or feeling bad about themselves. They're just responding to the polarization politically, right? And they're saying, hey, there's not a moderate way forward anymore, right?
Starting point is 01:45:30 So then they're choosing between extremes. I mean, the political spectrum has become so dichotomized that is there a rational middle ground for most people to identify with? The middle ground where like, we can have my way of seeing it and your way of seeing it. We can talk about it and and able to come out my way to some degree and yours to another,
Starting point is 01:45:46 but it's okay because we're working in ways that we can both live with, right? If that's not the case, then of course, people seize to extremes. There's nothing else to seize to. Yeah, I mean, that's disappeared. And at the same time, this increase in the weaponization of shame being this powerful emotional driver
Starting point is 01:46:08 that we've discussed, you know, as a means of publicly shaming people as almost a cultural pastime right now, just seems to be such a perverse growing phenomenon that's only driving us further and further apart and denigrating our ability to create that middle ground or sort of consensus around ideas and allow us to kind of progress
Starting point is 01:46:33 and move forward as a society and make decisions and enact policies, et cetera. Right, absolutely, right, absolutely. Because we're not then, we're making things so dangerous, right? Because if everything or any misstep is shamed, right? Absolutely. Because we're not then, we're making things so dangerous, right? Because if everything or any misstep is shamed, right? Like, you know, you'd read about people who just like, they make a slip of the tongue
Starting point is 01:46:52 and they say some word that they're not supposed to say, right? You know, some racial insult or something, right? And it's just like, it's a slip of the tongue. Is it just like the wrong sound came out, right? But they're so humiliated and canceled, right? Or even the person made a mistake, right? Or they said something and it wasn't so dramatic,
Starting point is 01:47:09 but it was like, yeah, like you could learn from that, right? But they're subject to so much shame, then you take away people's ability to like take chances and navigate and say, let's have a real discussion about something, right? And it's the weaponization. I think you had said this, it's the weaponization. I think you said this, it's a weaponization of shame. And look, there are things that are worth feeling ashamed about,
Starting point is 01:47:30 right? I think if you're Josh Hawley and you put up your fist to the people who then stormed the Capitol and then you ran away, like that's a good reason. It's not like there should never be shame, but let's not equate that with somebody who made a mistake and learned from it. Someone who said something that was a slip of the tongue or something that went back to some word they said ages ago and have learned better. Like, let's make a distinction. There are things worthy of feeling ashamed about, like things that directly hurt other people, right? Things that denigrate other people, but we should reserve, right? What we're imposing shame for upon to those things, right? Not in a way that makes everyone afraid and then promotes polarization and promotes the opposite of rational dialogue. Let's turn our attention to healing, right? how do we think about and pursue a healthy modality
Starting point is 01:48:26 of grappling with our past and possible traumas? I'm just imagining the person who's listening or watching, who's saying, oh my God, I've never thought of this sort of thing in this way. I'm realizing that perhaps I have some things to look at. How do I do that? Yeah, I think this will be more positive than maybe some of what I've been saying.
Starting point is 01:48:48 We went down a dark alley here. Recently, right, right. And I can't help it. We'll bring it back. Right, because I think there's a truth to the dark parts of it that it's hard to say, but I think important. Well, I think, sorry to interrupt, but like that whole thing that we just,
Starting point is 01:49:01 to me, I look at that and I say, all of this can be tracked back to certain traumas. Like what's happening, the tectonic plates of culture, politics, economics, so much of where I think we're losing our way can be identified and rooted in certain individual and kind of institutional traumas that get played out and create these systems that seem to be going haywire.
Starting point is 01:49:27 Yes, and that's why this is a great topic, right? To have as the final topic, right? Because it's legitimately exciting, empowering, optimistic, right? And I believe that. It's not just that I wanna finish with something optimistic. And I wrote the last section of my book is about the same theme, like how do we get better? And I think it's not just a search for being optimistic. It's the truth that if we come at trauma, we do the opposite of what it
Starting point is 01:49:57 tells us to do, right? We do the opposite of I feel guilty, I feel ashamed, I'm hiding it inside of me. I'm going to do the opposite to that, right? I am going to let myself put words to it. I'm going to let myself write about it, communicate to it, think about it in new ways. What is it telling me, right? If it's telling me you should be ashamed. I remember the words going in my head of like, well, you should be ashamed. You didn't know how ill your brother was until you lost him to suicide. And right, you should feel ashamed.
Starting point is 01:50:25 And I'm thinking, can that really be true? That like, if I didn't see it, was it there so evidently for me to see? Like, what's going on inside of me? When you really confront what makes shame in us, it tells us something different, which is like, hey, that seems like pretty punitive and pretty negative. And like, what was really going on, you know, then? And I think, right, you know, like sadness and confusion really for both of us. And I didn't see what was going on in him. And like, you come to a more benign perspective,
Starting point is 01:50:57 not in the service of it being benign, but it's also true, right? And if we go against the grain of what guilt and shame and fear and often anger tell us to do, it's remarkable how quickly we can start get at that by going against the grain of what the society around us and our own internal mechanisms tell us to do, then that's very, very hopeful. Yeah. Not only in terms of, or in the context of that individual's lives and the generations that spawn from that individual, but in a macro sense and talking about like, how do we elevate consciousness? Like this is a very practical way and doable way of doing it.
Starting point is 01:51:47 Just imagine, you know, scaling up everything that you're talking about such that everybody can get the treatment that they need and people's heads are inured around these healing modalities where they're welcoming it as opposed to recoiling from it. How does that impact society at large as a macro organism? Yeah, I mean, I think what you just described is a very foundational level, right?
Starting point is 01:52:16 Upon which so much else is built. So if that is impacted in the positive way you described, I would expect that we would see remarkably positive effect on the structures that are built upon it. We would say, whoa, healthcare costs are becoming much less, not just in mental health, in physical health too, right? People are communicating better. People are being more civil.
Starting point is 01:52:43 People are functioning more adaptively in the world around us. Productivity goes up. I think we would just see so much because that's about as deep as one can get, I think, foundationally, right? Into the substructure that we build so many individual and societal constructs upon.
Starting point is 01:53:01 So let's get back to the idea of what to do, right? There are plenty of modalities out there. Not everybody is gonna be able to come and see you, but talk a little bit about the variety of, you know, therapeutics available for people who are willing to begin grappling with their own trauma. Sure. And I always say, it makes sense to say that,
Starting point is 01:53:22 look, if a person is having like very severe depressive symptoms, you know, they can't see the positive in anything or thoughts of not wanting to be alive or thoughts of suicide, then we need to get professional help. And even if you have to be very persistent about that, right? You know, you insist, you've got to see someone, you go to this ER and if that doesn't work, I go to another one, right? There are things, symptoms that mean we really need professional help. But in many cases, that's not it. What we need to do really is just take stock of ourselves. What is my self-talk inside?
Starting point is 01:53:56 What's my narrative of life? Is there something going on that I know, but don't wanna know, right, is going on? Have I been really different since something or other, right? Has someone I know been really different? If I know you really well and I know kind of something happened like nine months ago or 10 months ago
Starting point is 01:54:13 and like you seem different to me, can I just put some words to that? Whether it's me or it's another person, right? Can I put some words, like what might that be? And can they be like plain, simple, honest words, right? And if that's not what's running around inside of us, what are the emotions attached to them? Is it guilt?
Starting point is 01:54:31 Is it shame? Is it frustration? Is it anxiety? Is it anger? Is it fear, right? Because what that's gonna tell me is don't look at that, but exactly what I need to do is to look at that. And if I start looking at it,
Starting point is 01:54:46 what do I have to say about it? What do I have to write about it, right? Do I start saying new things in my mind? Sometimes that happens, but it's easier to say new things if we know someone well. If I say, hey, can I just talk to you for a little bit? Friend, family, clergy, whatever it may be,
Starting point is 01:55:01 then we start to open that up. Much the way the parallel here is a medical abscess, right? It's like, if there's an abscess, it's a walled off infection inside of a person and it's a cold, it can be difficult to identify, but it spins off often symptoms, right? If it's a little fatigue, lethargy, fever, right? And if we go and treat that, right?
Starting point is 01:55:21 Then those symptoms don't get spun off anymore. And if we see it kind of that way of, okay, I don't wanna be afraid of what's going on inside of me. I don't have treat that, right, then those symptoms don't get spun off anymore. And if we see it kind of that way of, okay, I don't wanna be afraid of what's going on inside of me. I don't have to be, right? I can look at it. I can put words to it. I can talk about it.
Starting point is 01:55:32 I can get help about it. I don't have to be afraid. That reflex of fear, guilt, shame, we come by it honestly, right? But we can identify that and make sure that it is not what drives us. And how important is it to be able to talk to another person about it?
Starting point is 01:55:54 There's a sense, and I know that I've experienced this myself, that I'm gonna solve this in my mind. The mind that created this problem is gonna somehow miraculously solve it because I'm so afraid of raising my hand and asking for help or the prospect of sharing these secrets with another person, even if it's in a therapeutic setting
Starting point is 01:56:15 where it's confidential, et cetera, is still too terrifying. So I will convince myself, like, I'll just fix it. I just listened to this podcast. I'm gonna read Paul's book. I'm gonna think about these things and I will resolve it somehow mysteriously and mystically within myself. I would say maybe, but that's not usually how it works.
Starting point is 01:56:38 So if we accept that there is a truth of how humans change inside and thinking about it over and over again is very rarely the answer to that. And that is in large part neurobiologically driven, that these mechanisms in us that are, for example, error-checking mechanisms, mechanisms of reversal learning, right? They don't come online
Starting point is 01:57:00 if it's just going over and over again inside of us. So hopefully, like listening to this podcast or reading the book or whatever it may be, can the change that it can engender in someone is a change that fights against the fear and the unacceptableness, right? Of putting words to it and saying, is that really true? Right. And the start of putting words to it can be in writing, right? Sometimes even in the spoken word out loud. So, so it's a way of putting words because then it comes out of us, right? And it comes down onto the paper or the computer. Can one put words to it that way? Right. I mean, it's pretty safe, right? Like you could delete
Starting point is 01:57:39 it afterwards if you don't, you know, if you don't like it, right? Can we start to do that and start to confront the given that like, hey, this is shameful and it's not safe to talk about. Like that's often, that's a given. Well, let's question the given, right? Because there are a lot of givens in life that don't actually hold water
Starting point is 01:57:54 once we go and look at them. Within that, is there a particular strain of therapy that is more effective than others? I think that varies a lot. You know. There are a lot of nuances about that we could talk about, but I think what I'd want to say about that is there are vastly different mechanisms of psychotherapy and sometimes one is really called for over another and that may be the case, but the greatest predictor of the ability to help someone in therapy is establishing rapport, right? Another way of looking at it, there's more than one way to skin a cat,
Starting point is 01:58:30 right? But you have to have an alliance first, right? And then you can go about that however way a person is trained to go about it. But what's most important is someone that a person can trust and relate to. So people ask me about this and I wrote about it in the book. It's just like really getting the basics of common sense. Is someone paying attention to me? Do you seem interested in me? Are you making eye contact with me? Do I feel safe with you? Right. Do you remember this week what I said last week? Like it's just the basics of human, you know, of humanness, right. In, in interacting and in building trust and very often if someone is is like that they can establish rapport like that then they're they're likely to have the undergirding skills to to be
Starting point is 01:59:12 of some help so i i think the establishment of rapport and the assessment of is this a person i can sit with and trust who seems interested in me has benign positive regard right for me you know wants to listen to me. We do that, we're over the majority of the hurdles. Yeah, that's very empowering because it's not a sense of like, oh, you need to find this person who's expert in this specific modality. And short of that, you're out of luck
Starting point is 01:59:37 and there's only a few of them. The idea that it's trust and somebody who's validating you, listening to you, making eye contact with you is like getting you all the way to the 20 yard line or whatever on the whole thing. Yes, yes, absolutely. What is your sense of the appropriateness or efficacy of pharmaceutical interventions, SSRIs,
Starting point is 02:00:02 things like that in the context of trauma? Yeah, pharmaceutical interventions can be helpful, right? But we have to look at what are we treating with them and what are they in the service of? Like meaning like SSRIs don't fix quote unquote trauma, right? But sometimes SSRIs can improve distress tolerance, decrease anxiety a little bit and make it easier thereby for the person to confront the trauma, right? Same thing, if you're not sleeping and you're ruminative, I mean, if we don't get good restorative sleep,
Starting point is 02:00:37 we're not solving our way out of a paper bag. I mean, that's just true of us as human beings, right? So if that's going on, is there a medicine we can bring to bear so that person can sleep and they can be at their best again, right? And they can face this from that perspective. So there are a lot of ways that medicines can help in a lot of circumstances, but we cannot mistake them for answers to the problems. And they should be prescribed with a very clear understanding of what are they in the service of. So if you come and see me and we're talking about trauma and I think,
Starting point is 02:01:08 hell, you could really benefit from an anti-ruminative at bedtime and you could really benefit from an anti-anxiety medicine because you're having seven panic attacks a day and it's so hard to live and solve one's problems then, then I should talk to you about that.
Starting point is 02:01:20 Like, here's what's going on. Here's what we would try and treat with these medicines. Here's the risks and benefits and side effects. And here's why they're temporary in nature, we expect, in the service of helping you do what you need to do so that you don't need them anymore. Right, so they're not specific to treating the trauma.
Starting point is 02:01:38 They're about getting you into a place where you can be receptive to therapy, right? Therapeutic interventions. Right, which is really an action of common sense in the provider of saying, hey, if you're coming to me, then we're gonna say, well, I have seven medicines I use for trauma. Like, I don't know who you are yet, right?
Starting point is 02:01:58 So you come and tell me what's going on with you. If I see, hey, there's a couple of things going on in you that are number one, making you miserable and number two, making it really hard to process your trauma. Well, let's talk about that. And let's decide, like, does that sound reasonable to you? Like, can I talk about it in a way
Starting point is 02:02:12 that you can understand well enough? If not, I'm not doing a good enough job of it, right? And then ultimately it's you who makes that decision. Yeah, I'm gonna serve my own cause, right? With this, right? Or these medicines, but I understand what they can do for me and what they can't. It's just the common sense use of medicines in the service of the greater good instead of medicines as mystery, right? And how many people,
Starting point is 02:02:36 I mean, how many people say they go and they see someone who's like not making eye contact, not making much eye contact, not talking to them about it, and then is writing prescriptions for them. I mean, how can that go? Well, there's no empowerment in that. There's no collaboration in that. Like we need to know what are medicines in the service of. And then we track along in a data-driven way. If we think we're gonna start two medicines
Starting point is 02:02:56 because there are two significant problems you've told me about that are standing in your way, well, then we're gonna track along. Like, is that actually helping you? Right, if it's not, we gotta do something different. If it's helping you, but causing some other problem, well, now we need to do something different. That there's just like a common sense collaboration to it
Starting point is 02:03:11 that makes the use of medicine so much more judicious and effective. Right, and what is your sense of the emerging science that's coming out around the use of psychedelics, specifically with respect to PTSD and addiction. I mean, there does seem to be a growing consensus and body of understanding that there are efficacious use cases for these things.
Starting point is 02:03:35 Although we are in the early phases of really understanding this. Yes, yes. The information that's out there, both in terms of the academic data, both in terms of academic data and also in terms of history of these substances, tell us that they can be incredibly powerful tools in the service of health and happiness.
Starting point is 02:03:55 Now, as with any powerful tool, it needs to be used judiciously, right? And we're figuring out, okay, how do we do this in ways that are judicious in terms of application that where we can track along how these tools are helping people, right? How do we utilize them in the service
Starting point is 02:04:12 of health and happiness? So we're learning that, but what we're learning is very, very promising. It's interesting and it's encouraging. I think part of my, and look, I'm just a lay person here, but part of my thinking around this is sort of coming from a place of caution because there does seem to be a narrative out there
Starting point is 02:04:36 that this is like a cure-all panacea. Like all you need is this, and don't worry about what we've been talking about for the last two hours, because the answers that you seek lie in this mind altering substance and you're gonna be just fine. So how do you think about that?
Starting point is 02:04:55 I agree with you completely, right? There's a temptation to quick solutions, right? But isn't that what we're talking against, right? In everything we're talking about today, like the quick solution isn't that what we're talking against in everything we're talking about today? Like the quick solution isn't someone who promises us politically someone's gonna make everything better for me. The quick solution isn't in the Western medicines. The quick solution isn't in anything.
Starting point is 02:05:17 And the more powerful something is, the more respectful we need to be of it. Powerful tools can also do powerful harm. So if we're respectful of what the tools we have at our disposal can do, what we know they can do, what we don't know yet about them, then we will employ them no matter what they are judiciously in the service of the actual process,
Starting point is 02:05:40 which is a process of human understanding, right? It's a process of looking at that thing inside of us that guilt and shame and fear may have told us to look away from. And like it's all the things we've been talking about. Like that's what it's all in the service of. Are there ways that we can help ourselves that are external tools?
Starting point is 02:05:58 Yes, but we need to be diligent, circumspect, respectful of those tools. To kind of close this out. And thank you for being so generous with your time. So welcome, thank you. Perhaps a few words for the person that we've kind of walked to the edge of the cliff here. You know, I'm thinking of the person
Starting point is 02:06:16 who hadn't really thought too deeply about these issues and now is in a place of thinking, maybe there's something I need to look at here. How do I begin to do that? Perhaps some encouragement and maybe a few really basic tools to help that person wrap their arms around, you know, the fantastic journey to come.
Starting point is 02:06:36 Yeah, you know, I would say, you don't have to be afraid of what's inside of you. And we often get very afraid of what's inside of us, especially after trauma, when the trauma itself makes fear and can make shame. That we become very afraid as if there's something magical just off, I can't see in my peripheral vision.
Starting point is 02:07:01 And if I like really look at that, that's the, I'll start crying and never stop or I'll stop functioning. And it's just not how it works, right? It's just not how we work that if we're careful about it, you know, we don't want to say, just go talk to everyone about it, right? But we're thoughtful. What's going on inside of me? Can I put words to it? Could I talk to someone, right? And running current to like the strength of what says, no, you can't do that, right? Everyone will be ashamed. No one, no, you can't do that. Everyone will be ashamed.
Starting point is 02:07:27 No one will look at you in the same way. You won't be able to function. As we talked about much earlier on, it's in the surface of survival. But that's through an aspect of human evolution that's not applying now in the ways that we're talking about. So if we honor and validate that that's in us, but also recognize that it's not actually true that confronting the thing that makes shame or fear is going to make us fall apart. And in fact,
Starting point is 02:07:49 quite the opposite. I mean, there's so much data and clinical experience telling us the exact opposite that we don't have to be afraid of it. And we don't have to rush headlong that we can be careful and judicious. And you can talk to somebody a little bit or you can write a little bit, that we don't have to be afraid of it. It's not some mystery that makes us deer in the headlights and then we can't function. It's just, we can approach it like anything else, judiciously, carefully, reflectively. That's how we make ourselves healthier.
Starting point is 02:08:20 Yeah, it's a very hopeful message and not for nothing. I just wouldn't be sitting here had I not embraced everything that you just said. Like I remember all too well and in quite vivid technicolor what it's like to live in the prison of shame and guilt and the fear of confronting that uncomfortable truth and secret that lived within inside myself until I was in so much pain
Starting point is 02:08:49 that I really was deprived of any other choices and was kind of compelled to confront it and kind of begrudgingly, you know, entered a world that made me feel safe and encouraged me to slowly, like you said, drip by drip, start to let go of my attachment to that fear and share a little bit at a time, a little bit at a time. And over a very long extended period of time,
Starting point is 02:09:16 that has resulted in not only healing beyond anything I could have imagined, but also in helping create a foundation for wholeness so that I could be in happy, successful relationships and professionally be somebody who could be relied upon and who could build something of meaning. And I credit my entire life to the courage of facing things that I really didn't wanna face.
Starting point is 02:09:46 So for anybody out there who feels stuck, who feels alone, who feels hopeless, I'm here to tell you, and Paul is here to tell you that there is help and there is hope. And it begins with raising your hand, asking for help. And it doesn't have to be a dramatic gesture. It can be a quiet, private gesture, but to anyone listening, I encourage you to take that first step because that first step could lead
Starting point is 02:10:11 you on a fantastic adventure beyond anything you could imagine. Yeah. And I can't imagine a more heartening and encouraging truth than what you just said. Thank you. As I said at the outset, I really think that the work you're doing is incredibly profound and I can't overstate how important it is. And I really think that this invisible epidemic is at the root of so much of what ails us, not just as individuals, but as a society
Starting point is 02:10:38 and as a global community. And I think that it's so important to get this message out and I'm at your service. If there's anything I can do to help further your work, I'm here for you and for everybody else listening. Thank you for listening. Please pick up Paul's book, "'Trauma, The Invisible Epidemic."
Starting point is 02:10:55 It's a must read to kind of extend the conversation that we've had today. And that's it. That's my big speech. Thank you. Thanks for having me on, I so appreciate it. I appreciate you as well. Is there anywhere else you wanna direct people
Starting point is 02:11:10 who wanna learn more about your work and your world? There's a website, it's just dr, and then my name, Paul Conti, and it has links to some of the podcasts and has links to purchase the book if someone chooses. That's it, I think that, but we're trying to help open the door, right? And I think listening to podcasts like this
Starting point is 02:11:31 or reading the book is, it just helps open the door. And once a person opens the door, the possibilities are endless. Yeah, absolutely. Well, hopefully we can extend this conversation. I'd love to have you back. I think there's, thank you. There's, you know, 50 other things in my outline
Starting point is 02:11:46 that we didn't even get to today. So I feel like we just scratched the surface of what we could potentially talk about. Thank you. All right, so to be continued. Yes. Peace, plants. That's it for today.
Starting point is 02:12:02 Thank you for listening. I truly hope you enjoyed the conversation. To learn more about today's guest, including links and resources related to everything discussed today, visit the episode page at richroll.com where you can find the entire podcast archive, as well as podcast merch,
Starting point is 02:12:22 my books, Finding Ultra, Voicing Change in the Plant Power Way, as well as the Plant, my books, Finding Ultra, Voicing Change in the Plant Power Way, as well as the Plant Power Meal Planner at meals.richroll.com. If you'd like to support the podcast, the easiest and most impactful thing you can do is to subscribe to the show on Apple Podcasts, on Spotify, and on YouTube, and leave a review and or comment. Supporting the sponsors who support the show is also important and appreciated. And sharing the show or your favorite episode with friends or on social media is of course awesome and very helpful. And finally, for podcast updates,
Starting point is 02:12:59 special offers on books, the meal planner, and other subjects, please subscribe to our newsletter, which you can find on the footer of any page at richroll.com. Today's show was produced and engineered by Jason Camiolo with additional audio engineering by Cale Curtis. The video edition of the podcast was created by Blake Curtis with assistance by our creative director, Dan Drake. Portraits by Davy Greenberg and Grayson Wilder. Graphic and social media assets, courtesy of Jessica Miranda, Daniel Solis, Dan Drake, and AJ Akpodiete.
Starting point is 02:13:34 Thank you, Georgia Whaley, for copywriting and website management. And of course, our theme music was created by Tyler Pyatt, Trapper Pyatt, and Harry Mathis. Appreciate the love, love the support. See you back here soon. Peace. Plants.
Starting point is 02:13:51 Namaste. Thank you.

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