The School of Greatness - Trauma: The Invisible Epidemic & How To Heal From It w/Dr. Paul Conti EP 1202

Episode Date: December 15, 2021

Today’s guest is Psychiatrist Dr. Paul Conti. He’s a graduate of Stanford University School of Medicine. He completed his psychiatry training at Stanford and at Harvard, where he was appointed chief resident. He then served on the medical faculty at Harvard before founding his own clinic. He’s written a new book called Trauma: The Invisible Epidemic: How Trauma Works and How We Can Heal From It.In this episode we discuss how trauma is the root of so many problems, yet it’s not easy for us to discuss, how to better understand and heal from trauma, the first steps to take with yourself before seeing a therapist, why your inner dialogue heavily affects your mental health and so much more!For more go to: www.lewishowes.com/1202Get Dr. Conti's new book: TraumaMel Robbins: The “Secret” Mindset Habit to Building Confidence and Overcoming Scarcity: https://link.chtbl.com/970-podDr. Joe Dispenza on Healing the Body and Transforming the Mind: https://link.chtbl.com/826-podMaster Your Mind and Defy the Odds with David Goggins: https://link.chtbl.com/715-pod  

This is episode number 1202 with Dr. Paul Conte. Welcome to the School of Greatness. My name is Lewis Howes, former pro athlete turned lifestyle entrepreneur. And each week we bring you an inspiring person or message to help you discover how to unlock your inner greatness. Thanks for spending some time with me today. Now let the class begin. Welcome back, my friend. Today's guest is psychiatrist Dr. Paul Conte, and he is a

graduate of Stanford University School of Medicine. He completed his psychiatry training at Stanford and at Harvard, where he was appointed chief resident. He then served on the medical faculty at Harvard before founding his own clinic. He's written a new book called Trauma, The Invisible Epidemic, How Trauma Works and How We Can Heal From It. I was so inspired by this work because I feel like so many of us have dealt

with different types of traumas in our life, from our childhood to adolescence to our adult lives. And sometimes we're not even aware of the types of trauma we're facing. So in this episode, we discuss how trauma is the root of so many problems, yet it's not easy for us to discuss. How to better understand and heal from trauma, the first step to take with yourself before seeing a therapist, why your inner dialogue heavily affects your mental health, and so much more. Again, I was moved by this. I was inspired by this. I think it's extremely important for us to take on this

type of information to help us improve the quality of our thoughts, our emotions and our life. So if you're inspired and moved as well and find this helpful for yourself, then please share this with a few friends that you think would love this message as well. Post it over on social media and make sure to tag me, Lewis Howes, and make sure to check out Dr. Paul Conti as well. And I want to give a shout out to our fan of the week from Amanda, who left us a review over on Apple Podcast. And Amanda said, if you could bottle motivation and fuel for action, this would be it. It's like drinking motivation every time I listen. I had been feeling invisible and like I didn't know myself. And somehow I feel like I'm back.

I have the power to remove the cloak of invisibility and make my dreams come alive. Thanks for a great podcast with so many wonderful guests and words of wisdom. So big shout out to Amanda for being a fan of the week and leaving us a review over on Apple Podcast. And again, if you want a chance to be shouted out on the podcast, just go to Apple Podcast right now. Click subscribe to stay notified every week of our incredible content and leave us a review with a part of this episode that you enjoy the most. But before the episode starts, I want to give a quick trigger warning that we do discuss different forms of sexual abuse and healing from those experiences. Okay, in just a moment, the one and only Dr. Paul Conte. This podcast is sponsored by BetterHelp Online Therapy. And I know there's a stigma around

going to therapy. And I'll admit it, I used to be embarrassed about it. But I've realized how important and normal it is going to therapy. And going to therapy doesn't mean something's wrong with you. It just means you're investing in yourself to keep your mind and your emotions healthy. And we get our cars tuned up to prevent bigger issues down the road. We get annual checkups and we go to the gym to maintain physical wellness and prevent injury and disease. We do chores regularly, or at least most of the time, to avoid a giant mess in our houses. So why do we not do the same upkeep for our mental health? Well, BetterHelp is customized online therapy that offers video, phone, and even live chat sessions with your therapist.

So you don't have to see anyone on camera if you don't want to. And it's much more affordable than in-person therapy. And you can start communicating with your therapist in under 48 hours. Why invest in everything else and not in your own mind? The School of Greatness listeners get 10% off their first month at betterhelp.com slash greatness. That's B-E-T-T-E-R-H-E-L-P.com slash greatness. It's no secret that my style puts comfort very high on the priority list for me. And I'm all about the simple t-shirts, the joggers or the jeans, and of course,

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reverse climate change. They are a B Corp making the environment a stakeholder in their business, which is pretty cool. And we can create a more sustainable future together, but only if we tread lighter on the planet. So give comfort and feel joy this holiday season. Find your own pair or one to gift at allbirds.com today. That's A-L-L-B-I-R-D-S dot com. That's A-L-L-B-I-R-D-S dot com. Welcome back, everyone, to the School of Greatness. Very excited about our guest. Paul Conte is in the house.

Good to see you, sir. Thank you so much. Thanks for having me. Of course. I'm so glad you're here. You've got decades of experience on how trauma works and how we can heal from it. You this new book called trauma the invisible epidemic that I think is so exciting for me because I Truly believe that it's hard to have a meaningful fulfilling

Peaceful life if you haven't dealt with your own traumas. Yes, you can achieve you can accomplish you can explore the world You can have you know build a big business. You can meet lots of great people You can explore the world. You can build a big business. You can meet lots of great people. But there's like this something inside that is kind of like creates this anxiety or stress or not enoughness. I don't know what it is. And I had this for many years of my life.

I've talked about this publicly many times going through sexual abuse as a kid. in your book you say you don't want to compare people's trauma but you say sexual abuse for a kid is probably one of the most the biggest traumas that there is yes I'm glad you say that because I think the stat is one in four women have been sexually abused I don't know if they're all children but the you know abuse there for women and one in six in men and again it may not be as a kid but there's abuse for men that way. And I feel like it's hard for people to understand trauma. It's hard for them to understand it.

It's hard for them to deal with the shame behind it. And then how to heal the trauma. So I wanna unpack some of this, but I wanted to set the stage for this conversation because you've been doing this work for 20-ish years. Yes. And why did you decide to talk about trauma in this way? And what have you seen from your experience on how it impacts people in the negative way

if it's not dealt with properly? Yeah. I didn't set out to be a trauma person or to focus on trauma, but as I gained more and more experience, I thought, wow, this is an undercurrent of almost everything I'm doing. Everything. Right. Give me an example. So it's depression, anxiety, panic attacks, sleep problems, even addiction problems, even psychosis, right? Like trauma pushing people to a point where there's a predisposition to not be able to cope with reality, but it's the trauma that sends the person over the edge.

Really? Or triggering bipolar episodes. So if you think about the more severe mental health problems, all the way through to problems that have a scale of severity, depression, anxiety, and then certainly trauma pushing and promoting abusive substances, right? Depression, anxiety, and then certainly trauma, pushing and promoting abusive substances, drugs and alcohol, and addiction,

which then of course furthers trauma, right? So I started seeing, hey, it kind of doesn't matter really what I'm engaging with someone about, right? More often than not, there's an undercurrent of trauma that unless that's thought about and addressed, we're kind of like polishing the hood, right? When we need to get under the hood and really get into the engine, right? And there's a mental health system that loves polishing the hood, right? Like a lot of things we do in life in this country now, we kind of want to spruce things up and make

them look a certain way and not look at what's really going on underneath the surface. And then I started seeing that the sort of reflexive creation of shame when a person suffers trauma, the sort of immediacy of that sense of shame and the response to it to keep everything inside. To not communicate about it. Right. Why do we not want to communicate about the shame that we have? Why is that so hard for us? Well, it's the shame itself. Like, shame is synonymous with the message of, like, you must keep this secret, right?

And if shame is evoked, so if it's in a reflexive way created by trauma, in the vast majority of circumstances, I believe that to be true because I've seen that play out in front of me over 20 years, that the reflexive shame is in and of itself a message of secrecy. are carrying burdens around with them. And you can look from the outside and say, oh, look, this person has achieved this, and this person has achieved that. And what we see from the outside is so often not at all reflective of what's going on in the inside. And part of the wonderful privilege of being a psychiatrist

and consulting to people through the psychiatric lens is you get to learn what's on the inside. And then you see a commonality that I've seen across the whole socioeconomic spectrum, across any different factor you can identify. This is present in people across that spectrum. Yeah. What would you say is the percentage, rough estimate, of people in America that have experienced some type of trauma in their life? You have to stratify by severity, right? And if you could say, okay, we can identify, like trauma is negatively impactful in that person's life, and we can take stock of it and

describe it. I think we're well over half the population. We just have to be. The clinical work bears it out. The statistics bear it out. The mental health challenges, yeah. Right. If you have one in four women suffering from sexual assault, right? One in six men. I mean, so that's one aspect of trauma, and we're already up to 20, 25% of people, right? So then there's the fact that trauma just pervades the environment we all live in, right? I mean, we experience it vicariously. We look at the news, which is now really more, you know, it's more marketing, right? Trauma marketing. Trauma marketing. Right. It's repetitive, incessant trauma marketing. Look at what could

happen to you. Look at what could happen to your kids. Look at what could happen to anyone around you, right? Over and over and over again. And you combine that with the political strife in the country, the worries about terrorism. And we're living kind of like this. We're living in it with a sense of very much escalated tension in us. So I think it pervades the whole world around us. So I think in that way, we're all subject to it. I mean, I don't know anyone who doesn't know someone closely or intimately that has identifiable significant trauma. So in that way, it does affect all of us. Yeah. What are the common, you know, if you could talk about the theme of all the people that come to you, what would you say

are like the five to seven main reasons they come to you? Maybe it's not what's under the hood, but the main things that come to you. Is it stress, anxiety? Is it depression? What are the main kind of themes that you're seeing consistently? Yeah, what people mostly present with

is just a sense of angst, a sense of frustration. You know, like sometimes a person will present and say, well, I have depression, right? And they may know that because maybe they do have very clearly delineated cyclical depressive episodes, right? Or they've been diagnosed with depression, right? But when people present kind of de novo of like, well, I don't, let's say if I say, I don't care what your diagnoses are, right? Let's just talk about like what's going on in you. Like why did you come in, right? Then what people talk is that that sense of angst inside of them, right? The sense that something isn't right. And if they've checked a lot of boxes,

right, then we have an expectation, right, that, you know, if I'm doing the right things, right, and I have a good stable career, right, and I have a good roof over my head, and, you know, everyone's healthy around me, like, I should feel good, right? And, you know, that was part of my own challenges where like I saw that develop even in myself where I start to develop an anger and a resentment that I don't feel good even though I've worked hard enough to check all of these boxes so I think even in those situations let alone how many people are struggling with financial insecurity occupational insecurity

housing insecurity it's so you add that on top of it, and we just keep raising and raising and raising the level of tension, which then of course propagates and perpetuates trauma. And we thought of it as an epidemic, predates the pandemic. Like that we started writing this and thinking about it that way a long time ago

with the idea that we don't know this is here and it's spreading from one of us to another, another and back and we're not aware of it. It's invisible. Yeah. Yeah. But it's spreading quickly and it constantly stays with us. Like you were writing in the book about how just because an event happened in the past 5, 10, 20, 30 years ago doesn't mean it's not still carrying with you today until you address it, until you start to really process the integrating of healing, right? Right. I saw that over and over again. Maybe, gosh, it was probably 17, 18 years ago, I covered about a dozen nursing homes along the seaboard of Massachusetts. And a lot of people in the

nursing homes you could do therapy with, right? And I would see over and over again, what's plaguing this person, right? It could be trauma from 10, 20, 30, 40, 50 years ago that was so fresh and alive as if it had happened yesterday or last week, yet it could be a half a century ago. And that struck me so strongly that we tuck these things away inside of us, and then they're sort of sealed in us. And if we don't go back and look at them, we carry with us the burdens, which are often burdens of shame. They're burdens of self-blame. They're burdens of inadequacy. And unless we go back and look at that, we don't challenge those lessons.

Trauma teaches us these terrible lessons. And then we just hide it away. And then it becomes immutable. There's no way of then going and accessing and saying, well, what's actually true about that? What do you actually believe about that? And how many people have told me about something so so very clearly traumatic done to them right so walking down the street and they're attacked right and they talk about it through the lens of shame right that it was their fault it shows that they're not a worthwhile person they can't really

make the way the way in the world they can't keep themselves safe no one will ever like them right no one will ever care for them and and like these lessons are there for years and years about something. Once you start talking about it and unpacking it, they logically know there's no shame to feel, right? But the logic doesn't matter if the emotion is telling us something different. Right. Now, if we go through a traumatic experience and we hold on to this shame, can it change our biology, our genes? What's it do to the chemistry in our brain, to our heart? What does it do to us physically? What is so amazing is we have proof of things that even 20 years ago, if one had said,

oh, trauma can change the genes that you pass on, right? Not necessarily maybe the actual gene itself, but whether it's active or not, which makes all the difference, right? If you have it and it's not active, you may as well not have it, right? If you don't have it, that's the same as like you got a good gene, right? But now it's not turned on, right? And the thought that like how we genetically present, right present what's going on inside of us can be impacted by trauma that happened years before conception would have sounded crazy. So someone who is deeply traumatized, you look at rape as a tool of warfare. And the thought having been that it's a okay, it's a crime committed on one day by one person against another, right? That narrow conception doesn't even begin to touch

what actually happens. That person is, without the right intervention, likely changed for the rest of their life. And if they have a child five years later, right, the genes that are active in that child are changed as a result of the trauma. Really? And it sounds shocking. I interviewed Darren Richarder, who's a friend of mine and an academic psychiatrist who's done a lot of the work around this. And he speaks to it so eloquently that, yes, what's going on here is not, oh, that crime happened on that day, but that trauma is transgenerational. Wow. And it impacts us from head to toe. It impacts our cardiovascular health, so therefore our risk of heart attack, our risk of stroke,

our risk of autoimmune diseases. So it's not theoretical and esoteric. It impacts us from head to toe. And we know that now. We have the physical proof of it, which is in ways very gratifying, as opposed to making assertions like this even a decade ago or closer to 20 years ago when you couldn't really get any traction. What's esoteric? It's something you have. The person looks the same, so they're still okay.

Just suck it up. It was 20 years ago, so let it go or whatever. Right, right. What was a trauma that was extremely hard for you to heal or that took you the longest to kind of overcome? And does it still impact you today? Or is there hope for us that, hey, if you go through something traumatic, there are ways to heal so it doesn't have to impact you in a negative way for the rest of your life? Yeah. I think there's definitely hope for that. And since you'd asked about me, my brother's

suicide when I was in then my early 20s was so dramatically impactful on me, on my family. And at the time, I was very fortunate. I didn't know nothing about mental health. I was in an entirely different career field. And, you know, I was fortunate to have good people around me, like really good supportive people. And that helped get me through it. And the knowledge of, hey, maybe I should get some help, right? Like, you know, no one really got therapy. You know, it was an interesting, strange thing to do, right? Because, you know, no one really got therapy. You know, it was an interesting, strange thing to do, right? But as well, there's this helping resource there.

And it was immensely helpful. Yeah. To just, you know, someone just asking me, like, well, how do you feel about that? And this sense of, like, I feel doomed. I feel ashamed. I feel despondent. And, you know, that doesn't lead a person to good places, right? That leads a person to depression, to self-destruction, to drugs and alcohol. And even just having some basic help like that helped me stay on track, right? And then as

time has gone on and I've accumulated more really significant traumas since then, in the first half of my life, I didn't have major trauma. And then sort of the second half I've had a bunch of major trauma and and being able to sort of see it through that lens of like Oh, I just naturally felt differently, right? I had a different view of the world as a place where I could make myself Felt and seen and I could impact and like good things would come to me like I had a whole set of beliefs that then Really changed really, you know it changed in a way that made me feel much more defensive

of the world and afraid of the world. And it was really getting very, very good psychotherapy in that second part of my life. I went to medical school and started training as a psychiatrist and started really getting good therapy that I realized, yes, this doesn't have to control your life but it is a struggle, right? Like it's on my mind,

it's an active part of my self-care and my psychotherapy and sometimes use of medicines. So I have to actively really take care of myself to maintain a perspective where I'm aware that it's there, but it's not, in a sense, pulling the wool over my eyes and telling me things that can really lead us down a path of, sometimes a path of destruction, but other times just a path of sadness and sort of despondency and not living up to what we want to be, not just career-wise, but interpersonally, like the kind of parent I want to be and the kind of husband and friend. And I think with a real awareness that, like, hey, I'm laboring against this, right? Then it doesn't have to control me.

And I found that in so, so many of the people that I take care of, I found that to be true. Wow. So the first half of your life, pretty happy, normal, healthy lifestyle, no major traumas. Second half, a bunch of major traumas, it it sounds like starting with a suicide to your brother. Where do you think you would be without having healing therapeutic modalities to process over the second half of your life?

Where do you think your life would be if you could think about it? I think probably not in a good place. and I don't know exactly what that means like like one worry would be the specter of depression which runs in me and runs in the family and and I mean I I could see getting lost in that in a way that then narrows one's horizons and you know that promotes frustration and anger you know and and at times even bitterness in people. And it can lead us away from, it can just like being a good person in the world, right? That we become more isolated from care and concern

to or from other people. And then I think it's a very small step from that to abusive substances. I mean, they're just so there in front of us to say, yeah, like, you feel awful, right? And you feel awful and angry and frustrated and an injustice about feeling awful, right? Don't you want to soothe this now? Don't you deserve that now?

Like, that's a very, it's a self-seduction. But it's a self-seduction that leads so many of us to a path of, like, short-term healing at the expense of, you know, the long-term of the rest of our lives. Is almost all addiction stemming from some type of shame based on a trauma, would you say? Or can addiction happen from other ways? I think addiction can happen in other ways, especially their genetic components to how we respond to certain substances. And there can be substances that are, well, some of them for everyone, like opiates, are always so powerful that it probably doesn't matter what our genetic predispositions are. Like, that can get the best of any of us.

Right? By creating such euphoria, followed by such withdrawal from that euphoria, that there are substances that can just take a hold of us, you know, no matter what our state of health is, right? But there are also then genetic predispositions of one person to another of what we may be exceptionally vulnerable to. So substances, I think, can have a life of, essentially have a life of their own in creating problems in us. essentially have a life of their own and creating problems in us.

But that being said, the vast majority of dysfunction I see in people, whether it's substances or it's acting out against the self. It may be self-harm, physically, or it may be just keeping a sort of sadistic accounting in our minds. Like what? Of, well, I'm not doing well enough in life. So like, you don't get to go do that, right? You don't get to do that enjoyable thing. You don't deserve it.

Right. You don't deserve to like have a good meal tonight, right? You don't deserve to get enough rest, right? You don't deserve to go out with that person who might really be a really good partner, right? This sense of like there being an accounting inside of us that oppresses us. We've known for many, many years, you know,

in my field, people thought about people a lot more like a hundred years ago, right? Because we didn't have the advancements we have, which in many ways are wonderful, right? But we think less about people. And this idea- What do you mean we think less about like how other people are doing? Is that what you mean? Or what do you mean? No, we think less about like how other people are doing is that what you mean or what do you mean no we think less like in my

field we think less about like okay if you're my patient or what's going on in you like how do you feel about life right and what are the dynamics of that we've stepped away from that in very much a polish the hood kind of way well whatever is going on with you like your insurance authorizes ten sessions of CB and you'll get that and you'll take a medicine and then you're going to be better or you will have failed the intervention, right? Like that's not helpful in most cases. And when people thought more about other people, they thought about ideas like, for example, there's no internal victim without an internal persecutor, right? Which I don't mean like feeling victimized, like somebody steals your wallet.

You're like, look, I'm a victim. I fill out a report, right? But the idea that, no, no, I'm a victim. I stand out as a mark to people, right? That if people are looking for someone to hurt in a relationship, they're gonna look to me. People are looking to someone to abuse and bully around, whether it's on the playground or it's in the office, right?

It's gonna be me, right? When people think like that, they also internalize the in the office, right? It's going to be me, right? When people think like that, they also internalize the persecutor, right? There doesn't need, I've worked with people who are still in their minds being actively persecuted by someone who's been dead for 20 years, right? Because that person doesn't need to be alive anymore because they're doing it to themselves. And we can get like that. In fact, I think the internal dialogue in us that can say, oh, what an awful person, or you're never going to get anywhere,

and how stupid, right? Like, how many of us have that going on inside of us? And that arises from trauma, and it blinds us to like, look, who am I? Who do I want to be in the world? What do I have to offer? How are you going to make the best of that if there's a running dialogue in your mind

saying, oh, you're so so stupid you messed that up again or and like that's present in so so many of us is there a way around trauma like i used to i grew up thinking to myself a lot like you're stupid you're never gonna mount any like saying these things internally all the time as a child in like elementary school not knowing why i was doing it, but I just kept doing it. You know, I didn't have the tools to heal. And there wasn't, when I was growing up in the 80s, early 90s, there wasn't models of, you know, grown men that I could look to on TV or athletes or whatever, who were openly talking about their emotions, talking about traumas, talking about here, here's what you should do to heal if you've been hurt or something. And so I felt like I had to

stuff it in until I turned 30. And then I started to realize, wow, I've accomplished all these external things, but feel like something's still missing. I feel like, why am I not fulfilled? Why am I not peaceful? And then I went on a journey for many years of of healing and and letting go of the shame and and as my therapist says now uh healing is not an event it's not a one-time moment where you're like I'm healed because I talked about it it's right it's a journey yes it's a process of integration yes um is there a way to go around trauma to just shine the hood and be okay? Or do you feel like the only way is to go to the core root of it and deal with the process of healing it? Yeah.

I think the only way is to go to the root of it and try and heal that core process. I mean, sometimes, you know, there are always outlying situations, right, where, you know, a person can just polish the hood a little bit, go on with their life, and sort of have things be okay. Be functional, but not like, yeah. But that's the rarity, though. And I've seen over and over and over again that it festers inside of us. And some people are blessed with a sort of resilience gene. Like, you know, people have thought about this since the Second World War. Like, why did some people have thought about this since the Second World War. Like, why did some people, like, survive concentration camps? Why were some people able to, like, still see hope, right? Still persevere, still be resilient, right? And there are some

genetics around that that we just don't understand well. And if a person is blessed with that, then when, like, you feel despairing, then what you may do is is something that's that seems productive or positive in the outside world right that you that you do in order to get some like legitimate feeling of something good right and it may be that you have that gene where you're the genetics for that right and I think I have the genetics for that right and and those are like but those are blessings right like we don't want to count on like I have the genetics for that, right? And those are blessings, right? Like we don't want to count on, like I have a gene for resilience. So, you know, I didn't drink my life away after my brother's suicide, right?

Like we don't want to rely on that because if a person has enough resilience, you can get yourself maybe to where you found yourself at 30. We're like, oh, wait, I've achieved a lot. And then something inside says, wait, is all that really true about me? Right? Because if I really am this like awful person, like how do I, wait, how do I do this? And then you can have a greater breadth of perspective. And then what you probably started,

say, doing for yourself then was reconstructing a narrative. And that's why the construction of a life narrative. Right. We're like, wait, is that story true? Right? Because it's gotten a pass, right right because it's gotten a pass right like it's gotten a pass and i see people who for years and years and years the story of you know

why they're not worth anything right has just come forward without any challenge right but when if you start helping them talk about it and think about it like you know a lot of times i'll say well look from what you're telling me there's i mean there's there's some shame to be had in this story but it sounds like it's not yours right and that that's the case in in the case of acute trauma right we can look at oh look so wait so somebody hurt you right and and then you can start thinking what but you feel ashamed right like how does that work inside like, why does it work that way, right? Like, why do we have this reflexive shame? And like, where do you actually want that to go, right?

Or do you feel anger or frustration about it, right? And people know, and often when people don't, how do you not feel that, right? It's just that it's coming back in towards them. And then you say, well, what is it like? Like, what do you say to yourself when you wake up in the morning, when you're driving in the car? I remember working with someone who was driving this really long drive to work. And I learned as part of working with her that she loved music, loved listening to music.

And then it just came up that she never turned the music on in the car. Why not? I'm like, well, it was going to be a long drive, right? Because she didn't want to block the narrative in her head. The negative narrative. Right, the negative narrativeative that was like you're worth nothing you were because there was that their films that was in her mind justified, right? That was the justifiable self punishment for what for being hurt by other people Right and when we unpack that like wow and how long do we hold on to that? Punishment for potentially potentially forever unless we go in and look at it so the first prescription I

wrote was turn music on in car right and and then as she became more aware so great there's there's like a whole story in my head and that's where he plays over and over and over again and it plays over in that summarized manner if you're not worth anything no one will ever love you right and you know this mean, the reason this person comes to mind, there's a lot of people like this whose lives have really, really changed. Once like, wait, that's actually not my story, right? And logic tells me something different, but logic hasn't had one thing to say about it. It's all been through emotion. So let's talk about that emotion, reconstruct the narrative, and then it's remarkable

how much better things can get because it's not a hocus pocus, right? It's a way from the black magic, hocus pocus, towards what's actually true. There's a simplicity to it. And that's why the book is designed to be very practical, right? It's not designed to make an academic treatise. It's designed to say, like, we can make this better now. And we can start making it better right now by just saying, what's going on in my head? What am I saying to myself? What's going on in the people around me?

You know, someone who may be a little different, I don't know why, or a little different after something difficult happened. Can I talk with them, right? Like there's so much that we can do, but we become more and more isolated in society. You know, we're busy, we're running around, we're at odds with each other in lots and lots of ways that are politically or socially driven. And then we're so isolated that we never challenge these

narratives. And that was like the amazing thing that I saw with such sadness in the, you know, doing nursing homework so many years ago it's like so many people are carrying with them the trauma of so many years ago and it's just as alive as it was in there you know when it happened and it's been it's since the pivotal force of how their life has gone forward I mean not everyone but there was a lot of that you were mentioning how you know there's a narrative that we say you know I'm not lovable I'll never be good enough or I don't deserve this right what would you say are the three biggest lies we tell ourselves maybe that you hear from people when they come into your office what would those three big lies be yeah

look I think you just you said I'm not lovable yeah right I'm not good enough and what was that I don't deserve everything right yeah right so the not think about what not lovable means right is that there's something i'm intrinsically flawed right i mean to say one is not lovable it's such a blanket statement of persecution right if you think about what it would be like saying that outwardly to someone right like you're just making a blanket statement you are not lovable right I mean, it's awful. And it's why the persecutor inside of us can say things to us that people outside of us generally don't. We wouldn't tolerate from other people. How dare one say it?

But it's going on inside of our minds. The practical shift of that is like that. I'm not good enough, right? Because I'm not lovable as an intrinsic characteristic then that translates Well, I'm not good enough to do what I set out to do right? I'm not good enough to achieve whatever that may be and and and then yes I got and then of course one isn't deserving right? I mean if all that is true Then you're not deserving of anything. I think about how Talk about blanket statements, right? And I think the proof of like, why do I think for sure that this is true? Like, you know, psychiatry isn't math, right? But maybe it's because I was a math minor way back when. I love mathematical proof of things, right? I've seen more people than I could possibly count who I

know them are personally, professionally, they're people people in my life and I see them before trauma and after right and and and Sometimes I marvel at how not only do they think about themselves entirely different But they don't know that they fought any differently before they think they've always been thinking this way Yeah, I've never been good enough Wow, right? This has always been true We no one's ever loved like what Like, what do you mean? Like, before the trauma, you know, you had, like, a great job and friends and a wonderful girlfriend. Like, things were great before. But they don't, you know, because the consequences of trauma change our memories, right? Like,

our memories only have meaning through the emotion that's attached to them. Interesting. Right? So, if you change memories and now there's a negative spin on it, you can say, well, what about, you know, I can remember a person who would tell me about some award, I think it was high school or early in college, like something to feel really proud of. And would talk about that and like anchor to that, of like, hey, that says like I can do things, right?

Who then on the other side of the trauma remembered that in a very negative way of, you know, something was given to me I didn't deserve Like I can do things right who then on the other side of the trauma Remembered that in a very negative way. I really you know something was given to me. I didn't deserve and you know and I got lucky or whatever yeah You know it's show like we didn't mean anything like all it did was make pressure on me I could never live up to and and you know now so I over so there's an explanation for like avoiding the better job Right or from going from a lousy relationship partner, maybe even an abusive one, to someone who could be better. Why would you do that if you have an expectation of failure? And if the expectation of failure is based on the false lessons of trauma,

well, we have very powerful examples of what this does to us. We forget our own histories. Wow. You said memories have meaning through the emotions we've attached to them. Is that right? Yes. It's so true. And if we have a memory, it sounds like what I'm hearing you say, if you have a memory of the past that could be a good event for many years,

and then you go through a trauma, and somehow you reconnect it to that event or whatever you can completely shift your emotions toward that event to being a negative experience. That's crazy. It really is and this is shocking. Some people ask me what are the shocking things you've learned being a psychiatrist? And that may be the top of the list. I mean, it's certainly near the top of the list. Our own histories are malleable inside of us. And people have brought up a couple times, I write examples in there, and the railway station in London, St. Pancras, I'm sure not pronouncing it in the correct English

way, but it sounds like pancreas, right? And then I love England. I spent some time in college in England, and I love being in England. I love being in London. And I was walking to meet a friend at the St. Pancras Rail Station, right? And you think that should be a joyful thing. And as I'm walking there, I felt awful. I felt terrible, and I felt like, what am I doing here?

I deserve to be here. I'm going to see my friend. Why is my friend? I felt so terrible about myself. And then I realized 100% what that was. My mother died of pancreatic cancer. Oh, wow. And pancreas sounds a lot like pancreas. And it was that realization of, that's absolutely what I'm thinking about.

And I'm thinking, what a thinking what a person you can go home enough when your mom was sick and you know I Thinking all these things in my mind and it really is like so my memory of like what that place was evoking in me had Changed right and it changed my feeling and I and I needed so you thought can we get better we can But we have to have it in my hand. I need to stop and think. Look, these are different things. And you're triggered to feel a certain way about this. You can actually feel that way.

You're happy to be here. And you think you did a decent job as a good son when your mother was sick. You actually believe that. And you can't wait to see this person. He can't wait to see you either. That's why he took a train down from Northern England. And I could feel differently about it, but there's a lot of work on that, to not just be carried away to some very negative feeling state

where my self-talk went strongly along with that negative feeling state. So how do we, let's say we don't have a therapist as a resource for us. Or we don't have the funds or for whatever reason we're not comfortable doing that yet, which I'm a big fan of. I love therapy. What can someone do if they realize,

you know what, I'm feeling some of these lies or these symptoms of angst, frustration, depression. Maybe I'm using a substance already. Maybe I'm addicted to something. Maybe I'm in denial that I'm addicted to something, whatever it may be, or just feeling depressed or depressed feelings. Yes.

What are some practical things that people can do on their own before they go and start processing with a trained professional? Yeah, I think it's such a good question, right? Because not everyone has access to that, and certainly it's not something we can get immediately, even if we have access to it, right? And I would give two very strong answers to that, of to that and certainly it's not something we can get immediately even if we have access to it. And I would give two very strong answers to that of to stop and think hey what's going

on inside of me? We take what's going on inside of us as a given. That woman who drove 50 minutes to work and back every day and didn't turn the radio on so she could say awful things to herself never thought once about it until that offhand comment about why there's no music in the car right wait a second right now we still now for the first time she thinks about it right so you know what is actually going on inside of me which is really closely tied to the second point which is what's my narrative about myself in my life and like what do I actually

think it's going back and looking at the things that we now take as a given and if you think trauma so predisposes to that, I mean, I know trauma is not a thing, but I would say trauma loves that, right? Because then we don't go back and look at it. We just take all that off of us. Well, that's a given, that's that. And now like, here I am.

And it's like, that's not a given. It's not that's that, right? We can go look at what's going on inside of me. What's the narrative I'm constructing? And that can be very, very helpful to people who have no access to outside resources. And if you can find one trusted person, you can talk to about it. Once you start doing that, if you can just sit with somebody, friend, family, clergy, it doesn't matter, somebody that's trusted, because we have error-checking mechanisms inside of us that we don't use when we're thinking, but we use when we're talking.

And that's why putting it, it's amazing how many times it's, oh, I said that, and now I feel totally different even though I've thought about it 10,000 times. I hear that all the time. So start putting words to it, writing, writing about it, speaking about it to someone else, even speaking about it to ourselves, putting it into words, then we bring our whole brain online.

How important is it what we think and what we say to and about ourselves on a daily basis? It's hugely important. Really? It's hugely important. So you think when I was a kid, people would talk about, oh, that's the soup you're swimming in, right? It was just a turn of phrase, right? And that is the soup that we're swimming in the environment that we're in a Lot of it does come from outside. Mm-hmm, but not as much as comes from inside, right?

Right, so it's absolutely affecting us all day Every day, which is which is I think is how we can perpetuate over years and years and years The trauma inside of us because you know, you think why don't our brains? I mean our brains are very sophisticated in a lot of ways Why don't we go back and do some inventory or like reboot the system and look at everything in the past? Why don't we do that? You know, it's like like constantly being a hurricane, right? Yeah, you just like trying to survive in the hurricane, right? But you give a person a little bit of peace and like okay wait what's i can i now can think about that whereas

i couldn't before so i think it's immensely important and i've seen that play out clinically really over and over and over like you know that person doesn't realize they're living in a hurricane and and it's coming from in here and they've been struggling with and they might say something what's not kippy can't be from that. That was 15 years ago. Like, people will look at me like, I'm, what do you think? That was 20 years ago.

That's not affecting me now. But then as we look through it, it's affected them every day from then until now. And that's the last story in the book speaks to that, right? It speaks to someone whose life changed so much by being able to realize, no, that thing from 20 years ago has absolutely been oppressing me every single day since then. And I don't want that to be the case anymore.

I want to look at that and say, is it true? Should I feel that way? And if I do, I'll keep doing it. But I'm going to give myself the chance of looking at it anew. Yes. Whole life is different. And so asking yourself what's going on inside of me and what's my narrative about myself, the first two things that we should be doing. I mean,

is that what that would happen if you go to a therapist? It'd be essentially going through that process as well. And then how could they start to, where does healing actually begin? Is it an awareness? Is it the talking? Is it rewriting the narrative? Is it just takes time? You know, how does healing actually occur? It can begin in a moment's notice, right? Like just the thought that, oh, there's like, there's something new. Like there's like a new way to think about this or new data.

A lot of times what will happen is someone comes in, say, succumbs in to do therapy, right? And then I can look and say if we work together for a while, oh, they're so much better over months or even over years, right? But oftentimes we can trace the improvement back to the very first session of saying, you know, I hear what you're saying and, you know, there's another way of seeing this that I think is not just a sleight of hand but is a way that's actually consistent with truth, right? And I can say that to you because we're all unique, but we fit patterns. And I've seen this pattern over and over again,

which gives me the hope that through the unique lens of you, there's a different way of thinking about this is real and true and can really change. And, you know, there's like, sometimes it's an amazed look because, you know, we don't like damned if you do, damned if you don't, right? And we often have these conflicts in us, these central conflicts of damned if you do, damned if you don't. Right.

I've got to change this. I can't change this, right? And then I feel like, look, that's not the only two options and it's not a sleight of hand. And that's very important because often people think, well psychotherapy is about getting you to feel better. It's not about getting you to feel better if that's through a lens of falsehood.

Right, if a person's really doing things to feel ashamed about, let's talk about that and change it. Right, like the idea isn't to make you feel good about things that you should feel bad about, right? The idea is to help you not feel bad about things that you shouldn't feel bad about. Usually that's what we're doing. And sometimes it involves medicines.

And like, is there other things to do? And sometimes there are medical problems involved. There's a thyroid problem. Like there's so many other aspects of it that need to be taken stock of. But the healthcare system is in a shambles. And the mental health system is so surface focused that I don't mean to be critical.

Like there's so many good practitioners within the systems, but the systems are broken. So you could very well go in and get treatment and not have anyone actually talk about trauma. And I've seen this over and over. People who've had, and I'm not making this up or exaggerating, Four, five, six residential stays for addiction. And addiction where if you just sit and talk with that person, it's very obvious. The person's trying to kill themselves. It's not, oh, they can't stay away from that substance. I mean, sometimes you see that.

But you see stories that's about, hey, what is this person looking for? They're looking for escape from suffering. Or they're trying to be not alive anymore because they want to end their own suffering, or because they think they deserve that. That's just punishment they feel, right? And the majority, the majority of times, no one has taken any trauma history from that person. Really? So that is a failure of our systems. When very clearly, if you start talking about like, that's where the money's at, so to speak, the majority of times.

Like, why is that person doing that? Then you start learning, what's their inner dialogue? What happened to them? Was it acute trauma, chronic trauma, vicarious trauma? But you come down to the trauma, and if you get under the hood and you address the problems, right, then the drive to the substance changes. problems, right, then the drive to the substance changes. I mean, that is, in my strong opinion, the way most people who are in remission from substance use, they're not using substance anymore. It's not in their life, right? That illness, that disease, that addiction is over, right? How did that happen? By addressing trauma. Oh, by addressing trauma. By addressing trauma.

Really? Absolutely. The vast majority. addressing trauma. Oh, by addressing trauma. By addressing trauma. Really? Absolutely, the vast majority. Because trauma's the drive. Almost all addiction is stemming from a trauma. Like a substance abuse addiction, let's say. Yeah, the majority of it. Can I say it's 70% or 90%?

But we're talking about very high numbers, which is why when you talk with people who have quote unquote failed addiction treatment, right, which I think is a very awful way to put it, often why have they failed addiction treatment? Because the addiction treatment didn't address what's actually going on in them. The trauma.

Right. It didn't address trauma. It says, look, you're gonna buckle down and you're gonna, you know, I'm not, I think AA does people a lot of good service, right? But there's a way in which like this can get extrapolated. We'll give it up to your higher power and take an inventory,

but you're not really looking at what's driving the dysfunction, right? And that appeals to the aspects of our society that want quick fixes, right? We want quick fixes and we want them to be inexpensive. And not painful. Right, right. And not painful, right.

And it's painful to talk about trauma, to go through that. Now, people, when they see they're getting healthier, it's very interesting how people, in a sense, welcome the pain. Really good, like pain of working out. Like, this is difficult, but you know you get healthier. Right?

Yes, of course. So the same thing can happen where the trauma treatment is arduous, but the person says, look, I know I'm getting healthier. But our systems, really I come back to this analogy that our systems are built to polish the hood. And trauma treatment, it's more expensive, right? It takes place over time. It involves human beings who are well-trained interacting with other human beings.

And it's a lot easier to just say, look, we can polish the surface of anything and spruce it up a little bit and then throw some medicines at people. And that's why we absolutely do not solve these problems. And they're not rocket science problems to solve. Like by a redirection of priority and resources and recognizing what a problem this is, we can appropriately help the people who are suffering from it and often have no route to help, even if they're well insured. Yeah. What will happen in the world over the next 20 years if we don't start addressing our traumas sooner?

I think we're in real trouble. And I don't want to be a doomsayer, like, oh, things are just going to get worse. But our increased interconnectedness So say through social media, which which can do a lot of good but also is a route to Instantaneously do a lot of bad right and the ability to instantaneously reach one another often in aggressive ways and I Believe that it's trauma that unhinges us from fact Right. I mean how many factual disputes has there been? I mean, a classic is like, look at crowd size.

Like, you know, you could have a third grader in any country in the world. Look, is this crowd bigger than this crowd? Okay, that's like, that's pretty obvious, right? Why would people insist that what's smaller is bigger, right? How do we get that way, right? I think we get that way through trauma, which says, so what does that say? I mean, if you and I can both add one plus one, but I insist it's three, right? When you're saying it's two and I'm going to stick to my guns, you might say, well, what's wrong with me, right?

Well, what's wrong is I'm not actually prioritizing what's right. I mean, it's a way of saying, look, I don't actually care what's right. What I want to do is assert myself, right? I'm angry, right? I feel denigrated. I feel dismissed. I want to do is assert myself. I'm angry. I feel denigrated. I feel dismissed. I feel lousy about myself. I'm going to have my way. And if I say one plus one is three, I'll fight you to the death about it. Why? Because it's not about what's true. It's about the fact that I feel hurt and angry. And how is that not running through our society in all sorts of ways? And the ability to reach one another so quickly

being detached from facts right which I think that comes from trauma then escalates and we're more and more aggressive with one another right we're more and more I think there was some of the behavior and demeanor like you know you and I grew up in a similar era some of what people say and do on a public stage social media social media, yeah, yeah. Right. I mean, you think about the criticism. You would never go up to someone's face and do that. We would never do that.

Even the criticism of, it's almost like hard to say, but the criticism of people who died or were captured in combat for our country, right? To have criticized someone, it was unimaginable, right? I mean, you know, he's raised in a Christian church. I would just assume going into church and screen profanity, right? It's such shame to do that. But yet somehow the aggression in that appeals to people who have their own frustrated aggressions.

And somehow that's okay. Right. And I think this loss of demeanor and comportment, like what does that actually mean to say that? Like, who are you hurting? Right. How many people are you hurting? We have a dead loved one, right? A loved one captured in combat who's missing in action. And we're just going to denigrate that wholesale. Like, how do we get at a point in society where we accept that from people in positions of power instead of saying, hey, I don't care what your agenda is. Your agenda could be make my life better. That's your whole political agenda. Make this guy's life better. I will still vote against you because there's a higher set of ethics and morals in me that says even if like what you're saying I think

is good for me I'm going to reject that anyway right and we don't we don't see that like we used to see it right and we need to reground to what are our values right what are the things that are more important than like me being right or me getting my way or having some political say and and it's sorry it's a long answer to your question, but it speaks to why I think like, how's that gonna be better unless we look at what's undergirding us that would lead us in the most basic of ways

to argue that one plus one is three, when like, clearly it's not. Like we have to go and look at that and that is driven by trauma. So trauma, what I'm hearing you say is people who are hurt and angry, there's a trauma underneath that. Otherwise you wouldn't be angry

if you didn't have a trauma that you haven't dealt with. Right, right, and if we don't see that, we continue to not understand. How is it that we can't understand one another, right? Because I'm trying to convince you and you're trying to convince me. But if we're both coming from that hurt, angry place, what I often will witness is these two people are arguing. I'll see this in some political debate. And not one of them gives

a shit about what the facts are. They both just want to be right. And how does that not come from a place of hurt? If you feel reasonably good about yourself and you feel like, I've been able to make my way in life. And if I put in five cents of of effort I can get five cents back for it right if you really feel that you have opportunity right then then how are you hurt and angry enough to you know to argue over what's true and what's not true or it is I just want to be right I don't care it doesn't happen except through that lens of trauma. Yeah. What would you say are the main symptoms that you see then from people majority of the time?

Is it more based on a depression or an angst? Or is it…and where is that? What's the trauma underneath that? If you see depression, angst, frustration when they come in, is it sexual trauma? Is it, you know, their parents got divorced early? Is it that they were bullied? Is it that they just didn't feel loved? Or they got something happened?

Kinda what's the main traumas that you're seeing underneath the depression and angst? Well, so it's a complicated answer, but to try and simplify, like the most common traumas I see are the most common traumas right like so sexual abuse is so prevalent neglect is so prevalent So that's what I see the most of but simply because it's most prevalent right how traumas impact us is so Unique right to each individual person and and some of that involves will what when did the trauma occur? So the more formative the years, the more difficult it is or the deeper the impact can be.

So part of it is what was the timing of the trauma? Part of it is also what is the person internalizing or externalizing? So people who are externalizing can become very sort of outspoken and impactful on the world in negative ways, right? Whether that's through a political lens or it's through a lens of being violent, right? Of abusing and hurting others. Like there are people who are traumatized and they repeat that trauma on others. That's certainly not everyone, but like that's a known phenomenon, right? And that's the externalizing of feeling such fury and such vulnerability inside that the way to try and gain mastery is to then be abusive to others, right? Which can start with like kids bullying other kids, right?

To kids repeating the same sexual or relationship trauma as adults as was perpetrated on them, right? So we see, so is someone more likely to be externalizing? More often than not, people are internalizing. And that's when we see depression, anxiety, isolation, right? Sleep disturbance, because they can't get it to stop in their brains. And then the last factor is like what kind of sort of emotional compass we have. I mean, there are people who can be very resilient and have a lot of trauma, right? And then there are people for whom things that we might, on a grand scale of things, consider relatively mild, impact them very significantly because there's such a finely

tuned than emotional trauma. So we have to say, okay, what is the trauma? What is the trauma doing in this person? Then we have to look to the, what kind of support mechanisms do they have? Like, you know, there's so much to it. So it's maybe a non-answer to the question, but it brings out like the factors involved. Yes. What happens to our brain when we experience a big trauma, especially at a form of formal years?

Yeah, so the brain, we have the ability now to look at like what's going on in the brain. Like, you know, not in the way, hopefully we will someday, but to say, look, how's your brain functioning? What parts of it are more active, right? What parts of it are communicating with other parts, right? And so trauma, for example, it makes the vigilance systems in us much more active, right? So you will see if you take people who, you know, some, they're similar in many ways, as most we can get them, but one group has really significant trauma, the other doesn't, right? Now, again, it's an inexact science, right? But, like, you can divide it into two groups. And then you see if someone without trauma sees a person coming towards them, right?

The parts of the brain that are interested in like, well, who are you? How are you approaching me? What's the context, right? Is there something collaborative or interesting? Do you want to shake your hand? I'm interested, right? But if you see through the lens of trauma,

it's all coming through vigilance, which is all like, I'm just looking at you for, are you going to hurt me? Wow. Right? And like the changes in the brain are so profound so if you think about how do you navigate life in an optimal way if like you know instead of like seeing your boss come towards you and thinking like oh i'm doing a good job like you know this person is coming towards me we could have a conversation like i'm gonna get a promotion out of this you know i can i can make a good point for myself if you just think like how's that person going to harm me you know

you act entirely different right or people seeking relationships you know if if everything is scanning for who's going to be hurtful right how do you find the person right who who could be a good relationship partner and by the way people who are predatory can absolutely tell that right because you do really see people who are predatory can absolutely tell that, right? Because when you see people who are predatory and decide, how do they decide who to date, who to work with? They're scanning the room for the person who looks like that. Absolutely. And the predatory people who then are sociopathic, and predatory is a form of sociopathy, right? Often have gone through their own trauma, but they're externalizing. And then they're absolutely, they're so good.

Because I'll see this sometimes, when I'm in a room full of people, and I know, say most of the people, I know people in the room, and I know who's vulnerable, right? Now there's someone else in the room who I also know is predatory, and that person's sort of sharing with me

who they're interested in. And I'm like, wow. Wow. They're probably not even thinking about it, though. No, they're not. It's probably just like unconsciously happening. Right. Right, because they can see things like body language, microaffective changes, how you keep someone else's gaze, whether you look away.

It's, you know, having some sort of training in it, I can see some aspects of that myself, but not nearly. I mean, as a psychiatrist for 20 years, I'm not nearly as good at that as someone who's predatory because that's in them now that's just in them yeah there's a lot of talk about narcissists in the world today is a narcissist someone who's just been heavily traumatized and is externally externally communicating that as opposed to internally doing it really yes externally communicating that as opposed to internally doing it? Really? Yes.

I think narcissists, it's a relatively small portion of the population that does the majority of the damage. And I would say it that strongly because people who are narcissistic, so there's that externalizing element, right? And that has nothing, there's no interrelation there with like intelligence, capability, right? So people who are narcissistic can be very capable people in the world. And often those resources inside of them, the way they're imposing themselves on the world is in a way that's about destruction, right? Because narcissism comes through the lens of envy, right? And envy is different, like There's different lexicons.

But the way that I sort of learned this in the lexicon I use, jealousy is sort of benign. If you have something I want, I'd like to have it too. Maybe I'll work hard for it. Or maybe I can't get it. Someone's younger than I am. I can't make myself younger. Okay. There are other things I can hang my hat on and how I feel about myself.

Envy is very different. Envy is destructive. And it wants to bring others down. It says, hey, if I'm here and I think you're here, I don't need to come here. I can bring you down here. And people do that. Like a classic example is like the old example of men whistling at women. I mean, how many times has a woman turned around and said, oh, you whistled at me.

Like, let's go out on a date. Never. So it's not designed to be effective, right, in what one might think. Like, oh, it's a way of opening up some possibility, right? It's not that. It's a sense of desire and a sense of anger and frustration that then says, hey, I can't take away that person's, whatever it is, their beauty or their youth. I can't take that away, but I can't take away that person's whatever it is their beauty or their youth I can't take that away but I can make that person feel awful right so you can whistle at them and now they know they feel

predatory and be set upon and you know people you know describe what that doesn't feel good right that's envy they're saying I can't have what you have right and I can't actually take it away from you but I can do just as good right I can make you feel awful about yourself it doesn't matter you have. And I can't actually take it away from you, but I can do just as good. I can make you feel awful about yourself. It doesn't matter you have those things I want. I took them away from you. And that's where narcissism, coming through that lens of envy and capability, when I see mass destruction, whether it's in a family or perhaps on our political landscape, and you look at what's the roots of that, more often than not, you come to narcissism. We don't realize the immense dangers that not recognizing what is that about,

right? And that's about the self. And that person is trying to fill a bottomless pit. You don't ever feel a bottom. You can take everything away from everybody. You're not full. Right. And you're not full because you threw it all into a bottom. You can take everything away from everybody. You're not full. Right. And you're not full because you threw it all into a bottomless pit. How does a narcissist learn how to heal their own trauma when they typically would never want to say that something's wrong with them? Right. Yeah, it's very hard. People who are suffering from narcissism, whether it's internalized, it's more like if it's internalizing.

But even then, it's hard because there's so much shame associated with that. And with admitting or acknowledging anything, it takes what's called ego strength. In the old sense of ego as like, what's good about us? Us at our best, our most knowledgeable. It takes ego strength to say difficult things about the self. So people who suffer from narcissism very, very rarely will bring themselves to treatment. Really? Yeah. They'll resist therapy for years, right?

Very, very rarely. When they come to treatment, it's often because there's some external impetus. Like they're obligated to or they feel like they're forced to. Their family says, look, you really just can't come back unless you're behaving differently, right? Or they've gotten in some legal trouble somewhere. behaving differently, right? Or they've gotten in some legal trouble somewhere, and you have to go do some therapy work.

There often is some element of compulsion. There are things we are more likely to seek help for as humans and things we are less likely. And because narcissism is such a strong defense against shame and inadequacy, then you can see how that kind of falls into the category where people are much less likely. So when we go get help for that, And it's a whole defensive structure, right? It's not about like, people can often separate, like, I kind of know who I am. And I know how I am when I get depressed. And I don't like that. Because like, that's not me to be like lethargic, and I'm

not getting out of bed, and I'm not there for people I love. And like, I don't like that. And I want to be back to me. It's different when what's going on is like, that is part of the character structure. Like, well, that is the person. And it takes a lot of courage to recognize something like that. And say, look, I wanna make that better of myself, and I know I've gotta look at really difficult things.

And I've worked with people who do that. Really? You just don't see it. It's rare. Yeah. When does that usually happen, when they come to you? with people who do that really you just don't you just don't see it it's rare yeah when does uh that usually happen where they come to you is it like their world is falling apart or they're just you know have a massive breakdown or yes that's when they're finally like okay I surrender that's what kind of makes the compulsion right because like something in the world falling apart means

like hey you have to go or your you know your family doesn't want to see you anymore something like that right but even then there's often a push and pull. Like, you know, we can all do this in therapy. Sometimes we try and keep things on the surface because, like, let it go a little deeper and it's going to be painful. But there can be a lot of that because the idea is how I'm going to come to therapy because I think I should or someone tells me I should,

but I don't want the vulnerability, which is why you need to build a relationship and trust before you can start talking about difficult things. Is there any way to heal trauma which is why you need to build a relationship and trust before you can start talking about difficult things. Is there any way to heal trauma without re-experiencing the pain of the trauma? Or do you just, you've got to go through the pain in order to get to the other side? I mean, to some degree,

I think you have to go through the pain. Again, there are exceptions where someone, you know, is sort of blessed with a lot of ego strength and a lot of resilience and can look and say, look, I know this, this, and this is true about me. And this is like something I don't want it to be there for me. And they can sort of compartmentalize and partition it. But that's usually not how that goes. Yeah. Right?

Usually we have to look at the pain of it. But that doesn't mean mean reliving every detail. And a lot of times people sort of think, if I'm going to go, even in my own mind, do trauma work, let alone with another person, I'm going to have to say every detail about something. You won't say every detail. Is that what you're saying? Or you will? Most often a person doesn't have to. Sometimes it's necessary when the sense of shame is so lodged in the detail.

Sometimes you do have to go through all of it. But more often than not, we're talking about the idea of not having to go through every detail also emphasizes the shared humanity of it. How many of us are traumatized? There's a commonality to that, that by someone telling me about what their trauma is and how that makes them feel, there's still vulnerability and exposure to that, then we can have a shared understanding of it. Like I can put words and they can put words to where like they can feel that I get what's going on inside of them without them having to, the person I have to go through and say, you know, every last aspect of it.

What's your definition of shame so so shame there's this idea of of like core affect in us and and it's just it's kind of a technicality but affects are sort of aroused in us right and like we think often of arouse as a sexual word you could see how it's that way like something turns a person on without choice right yes but but but lots of things are aroused in us. Right? Somebody stands, comes in front of you and pushes you, you know, like fear or anger are aroused. Right?

And we know that because that courses through the person's body. Right? And you see like changes in skin conductance, person's getting ready for fight or flight. Right? And the brain patterns change and then they know it. Right?

So that's interesting, right? The knowledge of it comes after so that's interesting right the knowledge of it comes after because that's actually less important right for say staying alive right and the same is true with shame like shame is aroused in us and and and it's just this awful feeling right of like terribleness of the self right and you think why are these core affects in us, right? It's very clearly about survival, right? I mean, that example of someone appears in front of you and pushes you and your whole body gets ready to fight or flight and then you know it, says, right, that's about survival. Right. And shame has a function in us too, right? Imagine like doing something shameful, say when humans, we still do in some cases, live in small groups. If you got up in the middle of the night and ate all the food, it's okay if you feel ashamed.

You have shame imposed on you the next day because it's like, don't do that again. Because that could take everybody's life. So there's a function to it. But when it's aroused in us, and it's not aroused in a sense for good reason. One hasn't done something shameful. But it's aroused because us, and it's not aroused in a sense for good reason, like one hasn't done something shameful, right? But it's aroused because of that feeling of vulnerability, right? And, you know, trauma can be chronic, like, you know, the chronic trauma of systemic racism that tells somebody, like, oh, you are less than. They get that message over and over and over again, right?

Like, it's a different kind of trauma, but it's no less valid, right? Where we see it, of course, most dramatically is in acute trauma, but it's no less valid, right? Where we see it, of course, most dramatically is in acute trauma, right? You know, the person I would see in an emergency room after a rape who's talking about how ashamed they feel, right? And it's like, why? Okay, because the shame is aroused in the person, it's created, right, from the sense of vulnerability, the sense of terror, right? And then if that person doesn't have a route, like that says, of course that was created in you, right? And now we need to talk about what to do with it. Because if we don't, we know what it will do. It will go inside of you, right? There starts the changes to the immune system. And that person is more likely to then have an autoimmune problem

later on in life, more likely to get cardiovascular disease, more likely to become depressed, more likely to abuse substances. It's like that's what happens because that shame becomes the persecutor inside of you. Wow. So let's look at that. And if we can look at that in an emergency room right after something has happened, that's a great time to do that because you can be of most help to that person acutely. But what's amazing is we can do that 40 years later too and still get an impact.

Because a parallel to physical health is like an abscess, right? It's like infection inside of us that's walled off, right? And sometimes there can be an abscess that doesn't do anything to us, right? But more often than not, it spins off symptoms. Low-grade fever, feeling of fatigue, jittery. It's not good to have inside of us. And we'll see it track forward like an abscess would but over years and years and years where that thing inside is spinning off all these negative thoughts and feelings and

And choices right and we can go get it that unlock it expose it to the light of day And then it doesn't have to be doing that anymore. There's actually kind of a simplicity How would shape how trauma makes shame that's arousing us comes back in towards us, gets walled off. It then changes our feelings about ourselves, which then changes our memories. It then changes our mood, anxiety, behavior, and everything else. There's a simplicity to that story. And truth in mental health is grounded in simplicity. Lots of things brains are, lots of things are complicated, but like things that are true doesn't mean they're easy,

but there's a simplicity to understanding them. And so it's a long answer to the question, but that's how we get at what happens from trauma and aroused shame and how we get to like 40 years later and something's walled off inside the person and has harmed them now for all those years. Yeah, the sooner you can address it, the better. Yeah, absolutely. The sooner, the better. inside the person and has harmed them now for all those years?

The sooner you can address it, the better. Yeah, absolutely. The sooner, the better. For 25 years, I wasn't able to sleep at night. It would take me an hour, two hours every night to fall asleep. And I didn't know why. I was just like, you know, my mind was racing, but I didn't understand why it happened for so long. Literally, within a few days after I opened up about sexual abuse

for the first time at 30 years old, it's like I could fall asleep within about five to ten minutes. And I'd go, my whole life I haven't gone to sleep. Or just I'd lay there in bed for hours, finally asleep, then I'd have to wake up late. I never felt like I could really get a rhythm going. And now I can. How amazing that is.

It's freedom. It's so amazing what you said sadly just by talking about it opening up about it and then something that deeply impactful for years like you probably had a conception of like that's me that's me right right yeah right that's not gonna change so so I'm up against that all the time and then oh lo and behold, it changes. And I think there's brain biology behind that. And I would even locate that I think areas like the ventral tegmentum, the amygdala, I can think of parts of your brain

that I think were so spun up because when you internalize that feeling of responsibility or shame or whatever was inside of you, that it comes with vulnerability and it makes hypervigilance. And then those parts of the brain don't want to sleep. They sound like you weren't sleeping. Like protect yourself, protect yourself. Right. It says part of your brain is saying this is good for you because this inability to sleep may keep you alive. So if that part of the brain has its say that's why that gets perpetuated because

the brain decides right this isn't great but it's the best it gets right but then when you even opening up about it which must have relieved like glancing and abscess right yes oh my gosh then those parts of the brain quiet down and your whole brain decides you know what's good at night restful sleep right why don't we get some of that? Because I am actually safe. I'm safe. I think I can go to sleep. I don't think anything bad's going to happen to me when I'm sleeping. Look at the immensity of

that change just by talking about it. It's so powerful because it's so deeply impactful. It can happen with such a rapid shift of just letting it out and I think why because it's a shift what must have happened in you is a shift towards truth absolutely yeah talking about it and then rewriting the story like you said right which is huge right and

the story for me was you know I'm not enough I'm not lovable I'm abused I'm taking I get taken advantage of there was like a constant so I was always on guard looking out for that right as opposed to rewriting the story and I think that's and isn't it fascinating so that that's the same words I hear put to it from people across the spectrum right right? No matter what, demographics, age, gender, type of trauma in myself. Like that's my dialogue too, right? Because that's what shame makes us, right? You're not good enough.

No one will love you. You can never be safe. That's the messaging. And that's the reason that I wrote that book. It was the realization over years of doing this that like I hear that all the time no matter what type of trauma or what type of person is in front of me I thought well there's something going on here at a sort of foundational level of our brains right and then if you think

about the the psychology and the neuroscience of it it tells us the answer to it yeah this is powerful stuff what else do we need to know about trauma? Or for anyone listening or watching, if they haven't started to process certain things or maybe they feel this angst or frustration or depression feeling, what else would you say to them listening about what they could do next?

Yeah, so I think the first thing I would say is to emphasize what's going on inside of you is not too complicated to be solved right because that that's the thought like we get thoughts on top of thoughts on top of thoughts and we we it seems so impossible like I tried to untie a Gordian knot right like how am I going to figure my way out of this right and to know that like that's not actually true right it's not too complicated to be solved right but we come at it in a different way it's probably why the story of the gordian knot is thousands of years old right i think right it's it's mythology right that like

that's not what you do there are things that we can't unravel but but that we don't have to right and and the idea of put make a new narrative look at what's inside of you, means you don't have to untie that anymore. So know that, in a sense, simplicity is your friend. And that gives us a great deal of hope. And that we can start to feel better very soon. Just as I think it's wonderful how you described how your life changed in just a few days. That's really the truth. When I first went in and saw a therapist,

I didn't know what to do with the person. How am I supposed to perform? All these thoughts in my head. I remember saying, my brother killed himself. It's like feeling so much. I'm putting it to words because there's an immensity to it

that was beyond me. Instead of that's my my fault i should have seen i should have known i should have done right on bad because i went off to college and i got this job so i wasn't around home i wasn't close to him like all these things just saying that was like whoa this is bigger than you right and and things that are bigger than us give us some freedom from them but even the idea that like people do do terrible things to other people, right? So because we get so lost in, like, the idea that our traumas are unique, but the idea that, like, this never happens to anyone else, right? And the idea that, no, like, people abuse other people.

And, you know, people die in accidents. And people commit suicide. And, like, there's a shared humanness to this. And I think that's so important in doing the work. I don't understand hiding who we are in our work, right? Because we're all traumatized, right, in my view of things, because that's what I see in the world around me, and sharing that, have an idea of what you feel,

because my trauma is not yours, and I'm not being presumptuous in a way of saying I understand that but the underlying feelings of shame and frustration like I understand that and that's mostly what really what people want yes is is a sense of because if I feel so isolated and then I talk to you and I get a feeling like you're looking back at me like you could understand me and you're you're not recoiling from me right in? In fact, you may be coming closer metaphorically, right? Because you can relate to what's going on in me. It takes away

the idea that, oh, if I share any of this, I expose to the world what an awful, unlovable, undesirable person. It's like the old adage of like turn on the lights and show the child the close tree, right? That looks like a monster, right? And that's how we get inside of us. I can't look at this. It's incredibly complicated. And what shame will it make in me to talk about it? It's like, no, it's the exact opposite of turn the lights on, look at it. We can look everywhere around it. And what does that make? Makes things better. By talking about your shame. Yeah. I mean, shining the light everywhere. Like, how do you, I've talked to people about their feeling of shame and responsibility.

Let's talk about all of it. It's got to be done over time and in a careful way. And then a person can talk about the nuances of what they feel inside and that they hold on to responsibility and can get to a point of saying, look, my responsibility is to take care of myself and be a good person in the world. I'm not responsible for things that I had no control

yeah over and like that's very very liberating where you're not on the one hand you're acknowledging the uniqueness of that experience in that person and on the other hand you're mapping that to the shared humanity that says you are not singled out by humanity for awful things to happen right to you and like that's a, that can be a tremendous relief. Yeah, when I started opening up about it, I remember quickly being able to fall asleep at night, but it probably took me eight or nine months to be able to fully talk about it openly

with friends, family, and not feel like stressed. Right. You know, every time I talked about it, first to family, I was a little worried what they're gonna think, then to kind of close friends, then I started through my podcast and my work, I felt more of an opportunity to really serve people.

And I felt like this kind of nagging thing, like I should probably be vulnerable on my show. So, but I was afraid to talk about it for many months because I was like, what if it ruins my business and my life? People look at me differently in the public. My friends and family have to love me, but you know, publicly it might be different. I felt more of a duty because as a young kid,

I didn't see older men talking about it. You know, in the eighties and nineties, I didn't see men saying I was sexually abused on TV or at least I wasn't exposed to it. Right. Maybe they were, but I wasn't seeing it. Well, I didn't exposed to it. Maybe they were, but I wasn't seeing it. Well, I didn't see it either. If they were, we both missed it.

Exactly. And so I felt more like, the more I realized like one in six boys, I was like, man, someone's gotta speak up about it. I might as well do it, you know, if I have this opportunity. But it was a process, it was a journey. It took, you know, eight, nine months

till I felt more and more comfortable talking about things. But at least I was feeling more peaceful inside within days of exposing the light to shame. Yes. And two really important points that that brings to the surface. One is you're saying, what can people do today? And it's remarkable. It's not just some shallow thing to say. When you do good for other people, you know that there's good in you to do. You see your worth. I think from understanding, you're describing part of your healing was, I can talk about this in a way that has to help other people. That puts the lie to those thoughts inside.

How can you not be good enough? How can you not make any positive impact if you can do this and make life better for people? That's often what people start doing is they take a meal to the person down the road who lost someone in their life. They smile at someone when they might have been annoyed because they held them up in line. These things are really, really important. They're important because they are good for other people, but they reinforce, like, hey, there's good in the self, right? So that part is very important. And then another aspect of this that I think is a huge deterrent in our society that wants immediate results, right?

It's why we use, like, five times as much medicines as, say, the Dutch, right? Because they don't want immediate results. If you're overweight, like, exercise more. Why don't we just give you the Dutch, right? Because they don't want immediate results. If you're overweight, exercise more. Let me just give you a medicine, right? But we want immediate results, and then we get frustrated that things don't change in our brain immediately. There's an adage in neuroscience that the neurons that fire together wire together, right?

So if you and I just picked a word right now, and we said it over and over again 500 times Like a guarantee you'll be saying it tonight right right. I'll be saying it over my brain. It's one more right why Right because just the fact that we said it 500 times our brains gonna hold on to it It essentially doesn't believe us if we say that was a silly experiment like eject it from the brain Please it doesn't do that right and and these patterns inside of us only atrophy right you know so so people talk to people a lot about this right because otherwise people start feeling better and doing better but they still have like that same thought in their head it may be there

less frequently right and someone needs to say to them like hey here's how this goes away it atrophies right over time yeah it's less and less. And I've worked with people who maybe had 10, 20 years of nonstop negativity. Then they change their lives and they'll say, wow, it's 10 years later. And I'm like, that'll still come into my head, right? I do something, I dropped, you know, I dropped a big, one person dropped a big thing of milk in a store and it shatters and everyone's looking at them. And then they're like, you should kill yourself, right? Because that was in their head before but they've gotten to the point where they know like hey i don't actually believe that right that there's the proof that

those neuronal connections die hard if you reinforce them over time so that's why we need to do like longitudinal work whether it's on ourselves or in therapy and to realize like it's okay that it doesn't go away all at once, right? Like, that's actually the best it happened. And what you described, in a sense, is very classic. Like, you felt better in really strong, identifiable ways very quickly. But then the cognitive patterns in you took much longer to change. Yeah, my comeback, yeah.

Right, because that's the way it works in us, right? But we don't learn that, you know? I joke, half joke, I'm going to write a book on everything I learned about, everything I need to learn about life or needed to know about life, I learned as a post-medical school psychiatry resident. Because I really believe we should be learning these things in elementary school. I'm not the only one to think that. Why are we not teaching about why is that bully behaving that way? Why don't we look at how that person can feel better about themselves in a different way look at what's going on at home right tell help the people understand who are being bullied right

like that person is something is hurting that person right so they're coming after you and they're making fun of like your clothes or your looks or whatever it is right but like but that's you know who that's about it's about them yes right so you then externalize them but we don't do that and then we we grow up without all this like really basic knowledge and i remember being a second year psychiatry resident so i was you know i had another career before this so by then i'm in my early 30s right and i'm 30 years old and i'm a second year postgraduate resident i was like oh, oh my God, why didn't I learn this in second grade? And I think we need to start teaching ourselves these things as adults and then also to kids because that's how we protect children. And there's a chapter in there where I talk with Stephanie von Guttenberg who's a child advocate, a child abuse advocate.

And I think that chapter brings out how we can educate and empower children in ways that we just don't now. And sometimes there are dramatic things that happen then, but sometimes there are things that are, in a sense, more insidious if they're less dramatic, like somebody who's just bullied for whatever reason, or they look different than everybody else, or they have less resources than everyone else and there's nothing dramatic happened right no one identified that as problematic but that person is every bit as traumatized and their their sense of self is changing we just have to change this it's so it's so clear and obvious that we have to change it well if you could teach three things to second graders what would you teach them would pay attention to what's going on inside of you.

Right, the idea that we think, you know, I have a daughter who's seven, and she likes, she wants to count together, but in our heads, right? Because like, it's interesting to her now that like she could say things, but she can think them in her heads, right? And engendering that kind of reflective,

is what's going on inside of you, we can do with children, right? And we can help them put words to whatever that is, right? That and what we wouldn't use these words, but attribution, right? Whose fault is something, right? And again, the classic element of bullying. I mean, if you ask kids, like, what's going on? The kids who are being bullied.

I mean, they always, they blame it on themselves, right? There's not the cognitive mechanism. Look, I've sat with kids who, who's with horrible things. They've been burned with cigarettes and locked in closets, right? And they have a story of how that's their fault. Wow. Because the brain doesn't know enough to think differently. Like, you know, if you're, you're that age, you can't make it a more esoteric attribution. You don't know enough, right? But if someone helps you to look and say, oh, look, you feel ashamed of yourself because that person tells you to, right? But what's

actually going on? Like, it's not that hard to communicate in, like, age-appropriate language. So, like, don't just blame everything on you, right? And you can also go, what are you, are you doing things that you should feel bad about? If you're talking to the bully, right, do you want that person to understand, like, you're hurting these other kids, right? And does that feel good? If so, why? Right, same way we would with adults. Like, why does it, if it feels good that you're hurting people, let's talk about why is that, right? Because where do we get to that 100% of the time?

We get to trauma. We get to something that's some version of, I don't feel good about myself and it feels powerful to hurt other people But boy you get at that in second grade Instead of 20 30 40 50 years old that you can really change that like this There's an aspect of this that I do Feel kind of regresses back to the mean of just common sense, you know, and and I think that is in the book I don't know if it were an academic book I wouldn't have had it in me to put the time and effort into writing.

But the idea that there's a simplicity and a common sense here that can really, like the light bulb can go off. I know how I can make this better. I can look at what's going on in my head. I can rethink the narrative. I can do something good for someone else. That can all start happening today. This is powerful stuff, Paul. I want people to get the book.

It's called Trauma, epidemic how trauma works and how we can heal from it What to have you come back on and do a couple more hours on this stuff because I feel like it's fascinating work that you're doing You've worked with a lot of big, you know entrepreneurs, you know CEOs celebrities Thank you world-class athletes and individuals and also people in day-to-day life, living their lives, working their careers in relationships and dealing with their own challenges. Film Courage, You see that we are all people.

You work across the socioeconomic spectrum and you just see that we are so all the same and we are kidding ourselves if we think that whatever we've gotten for ourselves Some status something that it's good to celebrate good things we make in our lives But we let's not mistake that for the shared humanity in all of us Which I think is very very hopeful the shared humanity of trauma is absolutely true. And if we think of it that way well, that's how we heal from it as a as a And if we think of it that way, well that's how we heal from it as a society. Is it harder to heal trauma if you have a bigger platform or if you're a celebrity would you say as opposed to maybe not that many people know about you?

Yes. It's harder. Yes. Because fame brings to other people the feeling of they have a right to make some sort of pronouncement about a person, right? And sometimes that comes through the lens of someone who really legitimately admires someone, right? But there are a significant subset of people who are externalizing their trauma, right?

Who are in a sense attractive to people who are famous in order to tear them down, right? And we see that in the media, right? Like fame is, they can bring good things, but it also brings danger. Yeah. I have two final questions for you, but again, I want people to get the book,

The Invisible Epidemic, How Trauma Works and How We Can Heal From It. Lots of practical stuff in here. I see Peter Attia, who we've had on the show, who's left a quote for you as well, and a lot of other great people. So make sure you guys get the book. You're not on social media, but they can, or are you?

I didn't see you. Yeah, LinkedIn. LinkedIn, okay. It's my one social media platform. But drpaulconti.com is where they can learn more about you and the book, and they can go get it on Amazon, obviously, and Barnes & Noble and things like that. So check out the book.

Thank you. This question is called The Three Truths. And maybe you've already kind of answered a little bit, but I ask everyone of this at the end of our interviews. And I'd like you to imagine that it's your last day on earth many years away. You get to live as long as you want to live, but then eventually it's the last day for you. And you get to accomplish all your dreams,

all the things you want to create, they come true. But for whatever reason, all of your written work and content and videos and audios, for whatever reason, they go somewhere else. So we don't have access to this content anymore or the book. But you could leave behind three things you know to be true, three lessons you would share with the world. And this is all we would have from you. What would you say would be those three truths for you look at what's going on inside of you how are you treating other people how are you treating yourself

before i ask the final question paul i want to acknowledge you for the incredible work you're doing you know to to be doing this for, you know, two decades, to be helping so many people in your practice consistently to be creating this book so that we can have tools and information to help heal ourselves and get to the root of why we're frustrated or angry or depressed or something's off. Thank you. It's all based on the traumas that we've dealt with and we haven't, or we've experienced and haven't dealt with yet and integrated through healing. So I really acknowledge you for putting your work out there

in a way that we can consume it and understand something that is so scary to look at for so many of us. It's terrifying for a lot of people to face their shame. And so I acknowledge you for doing this work. And I hope- Thank you so much. Yeah, of course. And I hope people get the book. It's forwarded by Lady Gaga. So, uh, make sure people

check this out. This is, um, the final question is what's your definition of greatness, perseverance, and humility. Thank you so much for listening. I hope you enjoyed today's episode and it inspired you on your journey towards greatness. Make sure to check out the show notes in the description for a full rundown of today's show with all the important links. And also make sure to share this with a friend and subscribe over on Apple Podcasts as well. I really love hearing feedback from you guys. So share a review over on Apple and let me know what part of this episode resonated with you the most. And if no one's told you lately, I want to remind you that you are loved, you are worthy, and you matter. And now it's time to go out there and do something great.