Leading Childhood Trauma Doctor: 10 Lies They Told You About Your Childhood Trauma! - Paul Conti

Trauma is like a virus, and it gets passed along to your children even if their children are not born until years later because trauma can change the expression of our genes. So, we need to understand whether trauma is afflicting us, how it's afflicting us, and how we can treat it if it's there. Dr. Paul Conti psychiatrist, expert in treating trauma He's worked with Kim Kardashian and saved Lady Gaga's life. and been in clinical practice for over two decades. How many people have some form of trauma? Well over half the population. And trauma can change us in very negative ways. For example, the odds of traumatic brain changes are very very high. We know trauma makes us age faster than our calendar age. And we know that ultimately the root of depression, addiction, Parkinson's disease is from trauma. Modern science knows this, but we'll give them pills with the idea that pills is going to fix everything, and then we're surprised that tens of thousands of people die each year from prescribed pills. And we've let that happen. What should we be doing instead? The key to all of this is curiosity. So, for example, let's say someone is addicted to their phone. Oftentimes addictive behavior is meant as an escape from something or even to self-punish. But when you scratch the surface of that, you might learn about an episode of sexual abuse that happened when the person was a child. This is not uncommon. What are the telltale signs that I am traumatized? What can I do to alleviate the trauma? And then, can you completely get rid of a trauma? The answer is based in hard science. So, It's absolutely crazy to me that so many of you have decided to watch our show um and so many of you have decided to subscribe to our show. 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So, as always, if you appreciate what we're doing here, the simple free favor I'll ask from you is to hit the subscribe button. Let's get on with the episode. [music] Dr. Paul Conti On the front of your book, it says trauma, the invisible epidemic. Why did you use those two words, invisible and epidemic? [clears throat] Well, as a practicing psychiatrist, what I started seeing over and over and over again is that the the root cause of the vast majority of what I was treating, whether it was depression or addiction or panic, that that ultimately the root of it was trauma. That if we traced back, what we would learn is that there was something that had happened in that person's life. It could have been acute or it could have been chronic over time, but that changed their brain. So, that the brain is then different going forward, and that is the root of the problem. So, from that sense, I could see there's an epidemic because this is behind what is ailing us, right? The the 50% or more of complaints to general medical doctors are coming from mental health. Right? These are general physical medical medicine doctors. So, you imagine how much of what is going on inside of us is affecting our health. So, the the epidemic of trauma is touching us in so many ways, but we're not identifying it. We're identifying different illnesses. For example, like, "Oh, that that person has depression. That person has cardiovascular disease and had a heart attack." Right? But those things may be linked, including autoimmune diseases, all aspects of mental and physical health, but we're not seeing that at the heart of it is the trauma that then changes us. And our brains and our bodies are different as we move forward. So, to start seeing this commonality, that this is everywhere, and we're not identifying it because one of the impacts of trauma is to make a reflexive sense of guilt and shame in us. So, then we sort of hide things away. So, we're changed, made less healthier, and the the very trauma itself leads us to have a tendency to keep it inside, to not share, to not get help, to not do the kinds of things that would lead us to recognize the epidemic. How many people have some form of trauma? Because when we think of trauma, sometimes people think of PTSD, soldiers coming back from war. So, how many people does this subject speak to in some way? The numbers and estimates vary, but it'd be hard to imagine you wouldn't have roughly one in five. I mean, likely you have more than that. But if you look at, you know, data across demographics and data for occurrences of traumatic events and and the impacts we see downstream of these brain changes, we're talking about a very significant portion of the population. And then, if you think of people who are either experiencing the post-trauma effects themselves, right? The changes to themselves, or experiencing those changes through someone close to them, through someone they love, a parent, a child, a significant other. Right now, we're we're well over half the population that will that will experience a significant and negative life impact from something that either was with high likelihood avoidable or treatable. In other words, change for the worse that doesn't have to be that way. And again, it's not just as if just mental health, we're saying something small. I mean, mental health is how we interface with the world, but it's our bodies, too. It's Is that person going to get lupus? Is that person going to have a heart attack or a stroke? And how rapidly is that person aging? So, we know that trauma, by this definition that changes us because our coping mechanisms are overwhelmed, makes us age faster than our calendar age. So, you could say, "Well, that person is 40 years old by the calendar, but they're really 46." Right? "That person is 65, but really 73." If you look at the aging that occurs in us as a result of trauma. So, if, you know, I say this in part to to really speak to how like concrete and real this is. So, something that happens and changes you so that you are actually older than your calendar age, closer to death, right? Than the calendar might suggest, it is is so real and so tangible. And it's this is the effect of trauma. A trauma I said. And modern science knows this. Modern neurobiology, modern psychiatry, the research around us tells us this, but the things that we know aren't always at the forefront of our consciousness in society, which is a reason I think it's so important to spread the word about it. Why does this matter so much to you? I had a youngest brother who died by suicide when he was 20 years old. I was in my mid 20s, which which had um um just a a terrible effect on the family structure and upon me. And I and I felt the reflexive sense of of guilt and shame without really being aware of it. I hadn't felt that before. You know, I hadn't felt like I couldn't be in the world or make my way forward in the world. And I started feeling very very different about myself. And I started behaving in ways that weren't healthy. You know, they were very unhealthy. Drinking too much, unhealthy friendships and relationships, and real change in me that I was fortunate to be able to get help for. Um that really brought to the surface how much had changed after the trauma. That I felt very different about myself in the world. Like so cursed and maybe our family was cursed, and I couldn't make my way forward, and bad things were always going to happen. And it was the realization that like I'm really different, and this is not okay. And it wasn't like just grief, you know, in the sense that sadness and loss, of course, were were a huge part of that. But but realizing also like I am different. And you know, that had a very big effect on me. Um both the depression and the the the the issues in him that weren't seen and addressed that led to his suicide and then the downstream effect on the rest of us. And that led me to to leave. I had a business career, and I went back to college and took some pre-med classes and went to medical school and then became very interested in psychiatry and and and brain function, both the psychology of how we think and the the brain biology that underpins how we think. And I've been very much fascinated uh ever since. Did you process and or deal with the loss of your younger brother, Jonathan, by suicide at the time? No. No, at the at the time, I just went inside. Like people didn't talk about it, and we're overwhelmed, and you know, we became less healthy and felt different about the world, but there wasn't an outlet for talking about it. It just wasn't the the how I had grown up. Like there wasn't a way people would say, "Let's check in. Like, how are you doing? And maybe you should see someone." Like it like it didn't happen. And and it took a it took until I realized like I'm kind of in trouble here. I need to get some help to then, you know, I had an insurance card and to look on the back and say like, "Oh, maybe I should go talk to someone." But that was a stretch for me, and I felt even embarrassed about doing that. Like I really didn't understand neither what had happened and nor how to help myself. And and then you know, I went to someone, and you know, I just remember just how amazing it was to just have her tell me that, you know, I wasn't like I wasn't sick or crazy or or like not going to be okay because I felt this way that I helped normalize what I was feeling and and helped me put some of it into perspective and I realized like well, that was very basic what was just done for me and you know, many many many people do not get that and I almost didn't have it myself and I was I was very struck by it and by how much of a difference it made to have a better understanding and get some help. The impact it had on the rest of your family. I was reading that your mother was depressed for the rest of her life almost because of potentially because of that incident. Mhm. Yeah, and I think she was clearly different afterwards, too and and was much more isolated. Again, in hindsight, it's so clear to see, but I think the guilt and shame that she felt um was was overwhelming and she didn't was not able to get help, you know, no matter how much encouragement. You know, at some point I it was actually a psychiatrist and I still couldn't you know, couldn't get her to get help because I think she was just felt so ashamed and and felt that help was inaccessible or that it getting help was even more shameful. And you know, the patterns changed. I mean, there were still some happy times in her life, but the whole tenor changed and changed towards towards progressively more depression and again, it didn't have to be that way either, but there weren't support resources for, you know, mothers who lose a a child to suicide and and my father who was more extroverted you know, then just had more natural support mechanisms and that's what you see sometimes that that it shouldn't be that one person does better than the other because they just happen to have different proclivities. You know, but when we're not really paying attention to this and we're just kind of running forward, you know, and trampling people then maybe the person who's a little more introverted in a situation like that a little more inclined to be self-blaming, you know, like that's the person who doesn't do okay and you know, and my mother didn't and and died I think much younger than she should have of of cancer, but this kind of trauma predisposes to the immune system not functioning as it should and I can't say that this trauma caused her early death by cancer, but but certainly there there a lot of scientific reasons to think that um that it was likely a factor in it and again, unless we're aware of like what trauma is and what it's doing to us that like we can prevent it. We can identify it and treat it. These changes to us don't have to stay the same. Like the person who's blaming themselves and ashamed and depressed doesn't have to stay that way. The person who is abusing a substance to try and cope or to try and kill themselves because they feel so bad it doesn't have to be living like that. Like we really and truly can make change. The person who has an autoimmune disease or heart disease or rheumatoid arthritis that's inflamed after the trauma. Like everything is worse after the trauma doesn't have to be medically ill like that. Like it's the the message I'm bringing is is one based in hard science and it's one that has a real message of change that it's not an esoteric principle what we can and should be healthier. Even you think about more than 50% of complaints brought to physical medicine doctors that come from a mental health perspective. I mean, how much of that is based in trauma? It's the the majority of what is ailing us and the numbers actually do tell us that. At the top of this conversation you referred to aging and the impact that trauma has on aging. Mhm. How does that work? So, trauma makes me older? Mhm. There's there are there's cellular mechanisms in us, you know, people often talk about telomeres which is one aspect that change as we grow older cuz we're very interested in figuring out like why do we grow older? Right? So, there are processes in us that sort of mark time and that change across the aging process of humans. Now, I mean, we don't understand everything about this. If we did, we could change it and we'll live much much much longer, but we're trying to understand about it and and I think science has made a lot of very significant headway in understanding and part of that understanding is the biological age of a person is different from the calendar age. So, if you you know, an example would be if you took two identical twins at birth and you know, one of them is able to live in pretty good circumstances and free of trauma and you know, has a pretty good life going and the other person lives in a way that has has privation and a lot of trauma, maybe direct physical assault or seeming seen as less than denigrated by society. It's a theoretical example, but the idea would be you you go follow them 30, 40, 50 years later and you you find two people who are not the same age anymore. Right? The person who had the better life if they're 40, well, they're 40 and if you match up cellular aging mechanisms and again, we don't know how close a person is to death, but the aging mechanisms are telling us how far along our path we are so to speak. They say, okay, that kind of matches with being that person's age, but then you see the person who has been through so much trauma, the presumption here being there are the brain changes of trauma, there's a post-trauma syndrome. I that that person is going to actually be older in terms of how far they have traversed down that path of the machinery in them running itself forward than what the calendar tells you. Trying to figure out why and how that's happening. What is the mechanism that's causing them to apparently accelerate in age? So, the the less healthy environment within the person. So, some of that is is likely say the signaling molecules that we we talk about is just not as you know, the bloodstream isn't as as clean and healthy and you know, running in as lockstep a fashion as we might want, but there are inflammatory signaling markers and you know, that impacts cellular function and cells are more likely to die earlier than they might otherwise and and elements of neurotransmission and anxiety and tension states within us. You know, it's it's really environmental. One you know, one set of aging machinery is in a healthy environment and the other isn't, so it's going to deteriorate more quickly. I mean, it's it's one way of kind of trying to capture that. The environment is is very different in those two people. So, how what is functioning in that environment ages is going to change. Like having a car maybe in an in a a nice warm dry environment, you know, versus having a car where you know, there's snow and ice 6 months of the year and then it's terribly hot the other 6 months. You know, it's that it's going to be different. It's going to age differently so to speak. Right? If you go look at those two cars 10 years later and to some extent it's like that in us, too. Death, disease and trauma. A 2021 study by the British Medical Journal found that adults who experienced sexual abuse by the age of 16 have 2.6 times the chance of dying in middle age than those who didn't experience it. It's not commonly believed that trauma can result in disease like physical disease directly, but you argue that it can and you also talk about how it can result in new autoimmune disorders, things like arthritis um Crohn's disease Crohn's disease, ulcerative colitis, Parkinson's disease probably has an autoimmune component. We're learning that much much more is autoimmune. So, Do you believe that trauma is the underlying reason behind many diseases that lead to early death? Absolutely. And think about what you just read. Can can we take a look at that again? Like I think what you just read is absolutely momentous. So, think about that. Sexual assault in the teen years like leads to a two and a half fold increase in death risk. That's staggering. What's causing that? The whole cascade from the biological to the behavioral. So, gene transcription is changed. Healthier genes are more likely to be off. Unhealthier genes are more likely to be on. That's not good for our blood vessels. That's not good for heart disease or possibility of having a stroke and the immune system is more activated and more likely to attack itself and some of the mechanisms within us that are protective against cancers for example are less likely to function. All of those things change biologically, neurotransmission, endocrine function, signaling markers in the bloodstream. All of that is changing and at the same time behaviors are changing. Higher risks of depression, higher risks of addiction, higher risks of impulsive behaviors, risk-taking behaviors. You have to put a lot of things together before you get a death risk that is two and a half times higher, but that's how we get there because it does put a lot of things together from the genes all the way through to complex risky behavioral taking. Do you think there's anything killing more people than trauma? Fundamentally? [sighs] Not if we look for root cause. I've seen many many things that kill people and I I wrote about this in the book people that I was taking care of who at times died and I was always so struck by what the death certificate said versus why they had really died. You know, so the death certificate might have said car accident. Okay, I understand that, but why was that person driving 120 miles an hour in bad conditions or why were they being so reckless? Why they had five car accidents? I know that's the trauma. Right? Well, well, it's heart attack. Why did that person have a heart attack when they were 62? They didn't have huge risk factors from other any way except the trauma and its impact and so if we're looking at root cause analysis of what is hurting us, what is hurting our quality of life, what is hurting the quality of life of people that we love and what is killing us, I think that need we know more than even just that. And and there's so much we could we could pile the information a mile high that supports that piece of information which I think is quite staggering. What are the different types of trauma? Are there sort of different categorizations of of trauma from like small to big or If we're if we're using the definition that trauma is anything that overwhelms our coping mechanisms, so so there there are changes in the brain when our coping mechanisms are overwhelmed and on the other side of that our brains are different. So that's the biological definition. Then we would look at well, how how do we how do we get there, right? And and we it breaks down into three categories that are acute, chronic, or vicarious. So the acute trauma is how we've traditionally seen trauma. So if you think about the idea that people were shell-shocked after World War I, right? That was acute trauma, combat trauma. So our traditions of looking at trauma come from acute trauma and it's just more evident, you know, after someone dies or there's an injury or there's a car accident, like you know, we can see that oh, okay, gosh, that could what makes some difference in the in the person, like we can kind of get that and sometimes we can see the change in the person from before and after. So we have tended to equate trauma and post-trauma syndromes, like what happens to us after those changes in the brain are now with us, to acute trauma. But but again, it's not a soft definition. It's based on do those changes in the brain happen in other ways? And the answer to that is yes, that if a person is seen as less than, for example, in a society for whatever reason across time or even within a household, a person is being abused, in a household, a child is being neglected, or a child is being emotionally or physically abused. at school? Sure, bullied at school, absolutely. Right, this over So so nothing happens all at once, right? But that brain changes just the same. So it's a scientific definition of traumatic change and it is true in situations of chronic trauma just as it is in acute trauma. Now, it doesn't mean all acute traumas or all chronic traumas make these changes in the brain. And then the vicarious, so the third category there would be vicarious trauma, which means like human beings are empathetic, right? I mean, thank thank goodness, right? That's how all goodness comes in the world through our ability to have empathetic connection, but that also means that our trauma can communicate from one to another. And again, it's not a soft concept, so people who are very much involved in other people's trauma, so in health care settings, sometimes in in journalism settings, just in intimate home settings and just spending a lot of time with the news, right? Can become traumatized and have the changes in the brain that look the same as the person who lost two family members in the car accident. So it is true that vicarious trauma can change us in just the same way. The the modern field acknowledges that if it's in the context of professional endeavors, which actually makes no sense, right? Like what we're talking about are brain changes and brain changes can come through acute trauma, chronic trauma, or vicarious trauma because of our ability to have empathetic connection and compassion with other humans. I want to make sure that I've nailed this before we move on. So the acute trauma is I get it, it's the the big events, it's the going to war, it's the car accident, big events that happen typically in an instant. Mhm. Typically. Chronic trauma, this is things like racism, sexism, bullying that happen over a long period of time, gradually, that make you often feel less than Right. than other people. And the vicarious trauma is the trauma that as you say, you get from empathy. So feeling someone else's pain, feeling someone else's trauma Yes. and it becomes your own. Yes. Okay. Yes. And they can all lead us to the same brain changes. But people have different levels of susceptibility, right? So one person may have three big acute traumas and that person's brain is still doing okay, right? It's not changed towards greater vigilance, right? It's not changed towards greater inflammation in their blood vessels, then, you know, another person could have one incident that might seem more mild than the other three, the person and that person can then have brain changes. So part of this is who are we genetically, how are we built, what kind of life experience have we had, especially early life experience, how susceptible are we to one thing versus another? And then this idea of the multiple hit hypothesis that I could have a number of traumas and then on a certain trauma that might be even mild compared to the ones that came before it, now it makes the changes. What is that hypothesis? So the multiple hit, which which which says that this idea that what what doesn't kill us makes us stronger is completely wrong, I mean, in in absolutely every way. What what doesn't kill us often makes us weaker, right? And that's why we have to be attentive to what hurts us but doesn't kill us so that we don't get weaker, we get stronger. But what can happen is we can become more susceptible to the more likely that the next trauma, if we experience one, will then create the brain changes. Cuz I have I've often wondered, I'm the youngest of four kids. We all grew up in the same household. We experienced a variety of different traumas in my opinion. Much of it was chronic, but again, being the only black family in an all white area, all these kinds of things. But I thing I've always reflected on is for some reason, I think I experienced it much more, the trauma of that, than my older siblings. Yes. And I've pondered whether that's because of the timeline. Being the youngest, it was worse in the later years. So I I think my hypothesis has been that I experienced it more than my siblings. Mhm. And I think I've embodied the shame a lot more than my siblings have, yet we both went through the same thing. So Mhm. for whatever reason, I'm like really like I'm a workaholic and I'm exceptionally driven, not that my siblings are, but I'm obsessed in a way that's probably not completely healthy. Mhm. And I look at my siblings and I go, they're not [ __ ] up in the same way that I am, but we all went through the same thing. Part of what you're pointing out is that the the variables of life matter, right? So if circumstances are different, say for one child in formative years than for another, the those children could be affected differently, like economic circumstances. So some of it may be and and probably is impacted by the things that you're saying, but there probably are almost surely other factors, too. This kind of nature and nurture, that people have what sometimes gets called different levels of attunement of the of the emotional compass. So you know, some people are very sensitive and sensitized to things and very aware of what's going on around them and and aware of their own feeling states. You know, and other people can kind of go through life and, you know, emotionally buffeting things can happen, but they kind of keep going, you know, and and look, there pros and cons to both of those ways of being, but the person with the sort of more finely attuned emotional compass is the person who's likely to to register more things that are negative, like things like subtle expressions of prejudice, right? That that someone with a less attuned compass may just, you know, kind of not see that or just it doesn't make it, you know, into their conscious awareness, whereas someone else who would be very attuned might see a lot of those things. So it's this part, like what is the nature, like who is the person, right? And then what is the nurture, meaning like what are the variables, you know, that that that seed sort of falls into as we go through life. You must have seen this a lot in your practice where an individual went through a really traumatic early event Mhm. and you've got the person in your practice sat in front of you that is an alcoholic, they are experiencing sort of suicidal thoughts, but then when you look at the rest of the family, the family are just doing fine. To some whatever that means, fine, but Right. Well, one of the things to look at is the rest of the family doing fine cuz sometimes what it seems like on the outside is not true on the inside. And then we do think about genetics, especially around alcoholism. There are um we don't understand all of it, of course, but but there are genetic factors that can be very impactful. Then we'll look at personality structure, you know, is that person built to sort of internalize externalize blame, you know, so why alcohol for this person and not for someone else? How much is nature or nurture and how much may be formative? It may be that, for example, that person was in social circumstances, just real example that happens with some frequency, is they middle late teens where alcohol was accepted as a way of coping, right? And and maybe other people in the family weren't. The circumstances were just different. The way they went to school was different. Whatever and and they didn't have it modeled for them that this is how they cope. So maybe there genetic factors that that push alcoholism. Maybe there are social factors, right? That it was modeled for that person. So you know, you can put those things together and which is why and we follow patterns and there's a science underlying all of this, but we have to look at who is that person, right? You have to look at you know, the the family history, so the genetics that may have been passed on and what does that seem like may be the case in the person. How can you be informed by that? And what were their formative life experiences? And you start we start to build a picture of what's going on inside of us so that we can understand and change by looking at our history, which is why mental health doesn't often do this. You know, it takes an inventory of your symptoms now to reflexively prescribe a medicine, right? So we need to understand ourselves if we're going to understand whether trauma is afflicting us, how it's afflicting us, how we can prevent it, how we can treat it if it's there. And and I think that means accepting that this is real and this is real science, which which actually when you were talking, it made me think of an example. So if I say a an example to the science of it, one one of the earlier studies and I forget exactly how many years ago this was, but 15 or 20 years, maybe, was looking at immigrants. I believe they were immigrants from Somalia to Holland. I think I'm remembering that correctly. And and so the incidence of schizophrenia in the human population is about 1% across the human population. But when stressors are higher, right? It they can predispose people to to having to coming down to having the syndrome of schizophrenia. So it's about 1% of the population, but it's not evenly distributed. If there are, you know, people in sort of pressure cooker environment, so to speak, become more susceptible. And so they looked at at immigrants who integrated into the community in Holland versus immigrants who lived in primarily immigrant communities. And the incidence of schizophrenia was higher in the people who had integrated. Right? So the thought is, and again there've been subsequent studies and we don't know for sure, but this the the when you kind of look at that and say, "What what is that?" is the feeling of otherness, right? Is is different trying to integrate into a society that was looking at, you know, not everyone in that society, of course, but there was a much more pervasive sense of otherness when people were integrating than then when they were living in the communities where food and dress and like the the day-to-day of life was normalized. What's otherness? I'm mostly sort of cost of otherness. I think otherness in the way I'm defining is a sense of difference in a way that's not good. Right? A sense of difference in a way that involves either being seen as less than, and again sometimes it can be over prejudice, but it can be also stratification of opportunity. You know, just to seeing that, okay, like in some way I'm not on an equal I don't feel on an equal footing here, right? And then that there's a there's can be a sense of isolation there that that builds that the sense of otherness then say building inside the person, right? The person doesn't feel quite as safe, right? It doesn't feel quite as validated cuz you know, when we're especially when we're young, we look around us to see what's normal. And if, you know, people are looking, talking, dressing like us, like we just feel validated in ways that we might not feel if we see that we are different, especially if the difference isn't embraced, right? And we see this across immigrant communities who you at some point integrate, right? But initially people will tend more to stay together because there's there's a sense of validation in the community. Um so then the children often then will will integrate, right? Which is why it's such an interesting study to look at people who were first generation immigrants who would be likely to feel very strongly, you know, whether they were integrated or whether they were subsequent generations, right? They're the generation that just come from the home culture that either they could still sort of live in or live in a new culture and not that everyone felt a pervasive sense of otherness, but there's more of that sense of otherness. And the fact that that would change susceptibility to an illness that otherwise is distributes itself across the population, I think is a very profound you know, marker of scientific proof upon the things we don't pay attention to as much, you know, subtle prejudices, discriminations, whatever they may be that are in our society that we kind of look the other way and don't see that we're really harming people who then can come to the they come to the adult phase of life in in a place where we have marginalized them and we've we've made things different inside of them that makes it harder to make their way in the world. And I think we overlook very much whether it's bullying, many many things that can be based upon what can make people feel less than, but the effect of it is is seen in actual brain biology. And like we know this. We've known this for a long time, but in some ways I see that we're more fragmented and pushing more towards these experiences of otherness or experiences of vulnerability and lack of safety that push people towards the the the chronic aspects of of traumatic brain change. When we think about trauma, we often focus on childhood. But what you're saying now with this study of the Somalis that emigrated to Europe, um presumably those were adults. Yes, so the the highest incidence of schizophrenia is in people who are in young adulthood. Yeah. So so we're not seeing changes in people who are already deep into adulthood, but the but the the changes that we're seeing is in the sort of transition to it to adulthood, which honors both that yes, we are much more impressionable in all sorts of ways including how our brains are forming when we are younger. So these so these are people still their brains still have enough formative The idea is the thought would be they have enough formative processes going on in their brains that the brains can be changed by the trauma. But when we talk about these three types of trauma, the acute, chronic, and vicarious, can you experience these types of trauma in any age, phase, chapter of life? Yes. The earlier in the the lifespan, the the more impactful. Okay. Yes, absolutely, which is why childhood trauma is so important. My in the book I interview Darren Richer, who's a psychiatrist at Stanford, and Stephanie von Gutenburg, who's a child wellness advocate, because we're talking about trauma from both ends of the spectrum. So that the chapter that's the interview with Stephanie von Gutenburg talks about how childhood trauma so deeply impacts the the sense of self of the child. Like things that we know, but I dedicate a chapter to it because childhood trauma is so tremendously impactful. And again we don't pay enough attention to helping children who are traumatized and to to to projecting ahead to the increased burdens of illness and decreased role performance and all the awful things that happen. So so childhood trauma is one thing. On the other end of the spectrum, Dr. Richer's work has highlighted the fact that when people are traumatized, they are changed in ways that changes subsequent generations. So if we're talking about childhood trauma, we can talk about traumatized children. We can also talk about traumatized adults whose trauma changes their children even if their children are not born until years later. How do we know that trauma can and is being passed on? What is the best evidence we have to support that? So the the field of epigenetics, which has really come to the So so epi epigenetics really come to the forefront in the last two to three decades, which is the understanding that our life experiences can change the expression of our genes. So so you or I may have a gene that is active now because we inherited an active gene, for example. And then maybe that gene is producing something it's it's helping us in some way, bolstering mood, decreasing anxiety. Then something can happen, something can change in us that turns off the expression of that gene. Or turns on the expression of another gene. So then even though you have that gene, you don't have the benefit of it because the gene has been turned off. And and this is a very I mean it's a very revolutionary understanding that it's not just, well, your genes are your genes. You know, we could look when sperm and egg come together, well, that's telling us what's going on. And if we could understand that fully, we would see, oh, here's the array of genes that are active and the array of genes that are not active. But like that's not the story, right? That's just part of the story. The the the story continues that you that one's experiences of life changes how those genes function, which ones are on, which ones are off, and how they get passed along. So if the parent is not traumatized, the parent may pass along the active gene for something positive, say, to the child. If the child then is traumatized, the child may pass on that gene without it being expressed. So it's as if the gene isn't passed on. So if you you think about that, it's just amazing that our genetics in the sense of what's actually going on in us is not just the nature of what genes did we get. It's the nurture, how has what has happened to us affected the expression of those genes. There's one study that I I read about which says scientists at Emory University in Atlanta trained male mice to fear the smell of cherry blossom, shocking them whenever they smelled it. So the mice got to the point where they shuddered when they smelled it even when they were weren't even being shocked. Um the and I'm guessing the children then had the the same reaction. I mean, I guess that's what the study concludes. But also the the children of Holocaust survivors are another example of how trauma can be passed on because Yes. Yes. It's hard to think of a much more traumatic event than being involved in the Holocaust. Right. And for a long time the thought was that the the reason that children of Holocaust survivors had higher levels of anxiety and of anxiety spectrum illnesses was because of anxious parenting that understandably that the parents had a much more sense of vulnerability, you know, so so across the population they were they were more anxious and they were raising the children with more anxiety. And what we have have learned is that that the experiential aspect is part of it, but that exactly what you and I are talking about is part of it, too, because the the experience of what they went through changed genetic expression in the children. Right? So that's that's just a sea change in understanding that the the genes of the parents, the genetic expression of the parents, and the genetic expression that they pass along to their children is changed by the Holocaust experience itself. With this understanding of epigenetics, do you in your practice then consider deeply what someone's parents went through in their life and how that might have changed someone's sort of genetic expression that sat in front of you in your practice? Sure. Sure, I I think we all deserve, so to speak, to to think about our life narrative, right? And and and so many of us don't. I if we're trying to help ourselves, you know, whether someone listening to this like feels that they're depressed or that they they don't have any mental health issue, but they want to understand themselves better, it's like think about a narrative of okay, where Well, let me start with like where have I come from and like who came before me and And then wait, this happened and then that happened and And when we build a narrative, it's remarkable how much we can come to understand about ourselves cuz often we don't do that. Like we have isolated pieces of information about ourselves, but we don't knit it all together and and it's really remarkable what can happen, what can be elucidated by doing that. So, absolutely yes, just for the the general understanding of the person and also to understand what did the parents go through, you know, what what experiences did they have, how might that impact this person and you might then ask questions of let's say the family situation changed, you know, between say older siblings and younger siblings, right? Then by learning about that history and learning about older siblings versus younger siblings and the parents, I mean, think of how much you learn then not just about the person's experiences growing up, but but just about the the biological aspects of how were the parents functioning, how did it impact the children and what were the situations, how were the children similar or different? There's so much we can learn from that. You likened trauma to a virus. It's a very interesting way for us to start thinking about trauma because we seem to think of it at least I did as being sort of isolated to the person, but your idea that it somewhat has a contagion to it and that we can spread it vicariously to other people that are around us, but also down through the family tree via our epigenetics and via our our genes, makes you kind of understand both the importance of treating it, but Yeah, I've just never heard anyone describe it as a virus before. Yeah. It It'll because there's a reflexive guilt and shame to trauma and our society doesn't recognize it. It often gets hidden inside the person, right? But when it's hidden inside the person, it's still spinning off symptoms. So, I think the best analogy to use here is of an abscess in the body. So, an abscess is a walled-off area of infection in the body and it's good that the infection is walled off because if if it weren't it could be fatal, right? So, it's good that it's walled off, but the body is still aware that it's there and it's still spinning off symptoms because it's there. So, for example, a person might have an intermittent low-grade fever or just feel kind of jittery or you know, they're sweating and they're not sleeping well, right? So, there are pervasive symptoms that are impacting this person, but it's not obvious that the abscess is there, right? So, what often happens in general medicine is person is having non-specific symptoms, you know, people go looking, scan, they see oh, there's an abscess there, right? Once we know that, then we might have an understanding for why that person just never feels good, right? They always feel lethargic or they never feel comfortable. We know there's something there now and we can go in and fix it, right? And it involves, you know, there's a surgical process, right? So, something has to happen that's not a fun thing, right? You go through surgery and recovery. Now the abscess is gone. So, I think the the example of the abscess in the body is is a very good way to understand what trauma does to us in the mind. So, if we shove it down inside of us, there's reflexive guilt and shame, society isn't helping us take a look at it. Now it's there inside of us, it's going to spin off symptoms. And those symptoms aren't always symptoms that make say one person hurtful to another. They They They may not. That person may be very very vigilant and and just kind as can be to to someone else, but across the population, those symptoms inside of us are not good. So, they give us shorter tempers, right? We're more likely we're more anxious, so we may be more quick to anger or we're less functional in the world around us because of depression, anxiety, sleep problems, right? We can be more impulsive. Like it works against us being in the world as best we can be. Isn't that Isn't that what you refer to as post-trauma syndromes? Is that a similar thing? Yeah, yes, post-trauma syndromes are ways in which we can recognize the changes in ourselves. So, higher levels of anxiety, for example, lower levels of mood, right? Um different changes in sleep, uh physical health changes, um and then changes in just how comfortable we feel in the world, right? So, what we'll see is changes in behaviors that are driven by just feeling differently in the world. So, we have a we're in a different self states, we have different behaviors. The syndromes can do all sorts of different things to us from mood, anxiety, sleep, behavioral change. So, someone who might want to find a relationship partner, you know, stops going to places where they could meet someone, right? So, we we change our behaviors. This is what shows us that there is a post-trauma syndrome. That's how we know we're traumatized. Effectively cuz that's what I'm trying to figure out like people be listening to this now and hearing you talk about these different types of trauma, what are the sort of telltale signs? I'm assuming it's this, that I am traumatized. Right. Yeah, this is what we're looking for, right? So, so someone might present with uh that person is depressed now and they weren't before. That person is having panic attacks and they weren't before. That person is using alcohol to soothe and they weren't before because in medicine we look at just the surface, right? What we want to look at is like oh, why are you here? Oh, you're here because you're drinking too much. Let's talk about how you can drink less. You're here because you're depressed. Well, can we give you a depression medicine, right? So, then we're not looking at like why? Right? Why are you depressed? I mean, some people biologically will become depressed, you know, no matter what, even when things are going very very well, but this isn't the majority, right? Most most of us if we're depressed, there are likely factors. Like so, we should be curious. Why is that person depressed? Why is that person having panic attacks? Why is that person changed their behaviors, right? And so, now if we get curious, we get curious about the person, then we're going to figure we're going to figure out things we wouldn't have before, right? So, if a person gets depressed because everyone in their family gets depressed every 9 to 12 months, no matter what, like okay, let's let's come at that biologically. We don't that that doesn't necessarily map to trauma, right? But but if we start looking at that person being depressed, we see that they kind of started getting depressed, you know, a couple of years ago around the time their sleep started being a little bit different and you know, they started behaving differently and they you know, they didn't spend as much time with family or then you start getting more curious and and you start learning oh, you know, there's something happened then, right? Again, with acute traumas it's easiest to see, but when you look for the whole picture of like might there be a post-trauma syndrome going on here, you know, maybe that person who's depressed and is drinking too much started drinking too much when their mood started decreasing after the trauma or maybe they started drinking after the trauma and it's driving their mood down. Like again, it's not always this, but we're never going to know and understand unless we're curious. Like this is how we trace to the roots of it and this is how we get back to the narrative, right? Of of what is going on inside of me and have I changed, right? And then the idea we started talking about how the changes in behavior of the post-trauma syndrome are the changes that that make trauma like like a virus, right? Because we start behaving differently and for some people that is the the the their mood isn't good and it's not as healthy to be raised by a parent who's depressed, right? So, that can be a way in which the virus of trauma gets passed along to the next generation. Or maybe that person is drinking or using a drug to cope and that doesn't make for the best parenting. That's how the virus of trauma gets passed down to the next generation or there are times when when a reaction to trauma to the feeling of disempowerment can be aggression, right? Envious, aggressive behavior. So, so not all abusive children comes through the lens of trauma, but a lot of it does. I'm interested as well in the subtle symptoms of trauma. You know, we've talked about some of the big picture stuff, which is like suicidality, you know, becoming an alcoholic or all those kinds of things, but the subtle ways that trauma shows up in everyday life. I was I Some of them I was hypothesizing over are things like phone addiction, being addicted to your phone or video game addictions, these kind of things that I think maybe originate from the sort of more chronic traumas, but are less easy to spot. Right. Right. Yeah, I think the key to all of this is curiosity, right? So, let's say someone is like say addicted to their phone. Okay, maybe that's because phones are addictive and the person has just spent too much time on their phone, maybe, right? But addiction mechanisms in human beings are similar. Like it's the same machinery across addictions, right? And and often times addictive behavior is meant as an escape from something or to soothe against something or even to self-punish because of something. So, addictive behaviors that's similar brain machinery, whether it's cocaine, it's alcohol, it's brownies, it's a telephone, it's sex, it's exercise. I mean, there are things that people do in addictive ways as routes of unhealthy coping. So, so if we get curious, why Again, why the drug, why the phone addiction, why the things that might seem more subtle um and maybe are more subtle, but we should scratch on the surface of them to to try and understand if they mean something. Is that phone addiction the 14th addictive behavior in a row, right? Because that person has sort of particularly adapted addictive machinery inside of them and they're trying to escape from something. Like that doesn't happen all the time, but it is not untrue that when you scratch the surface of that, you might learn about an episode of sexual abuse that happened when the person was a child. Like these are real examples, right? And that the person isn't built to run from things through addiction. And maybe they're saying things about their own character that's negative. They're saying negative things about themselves and they feel disempowered and they're disempowering themselves. But if you go look at that narrative, you know, that that person that might have a dialogue running over and over again in their head of shame about something that happened 30, 40 years ago. Like, this is not uncommon. So, we need to be curious and we need to scratch on the surface of things, whether they're really big things or they're subtle things. Like, which is why a life narrative is so important. If you think about changes like after trauma that changes the brain, we respond differently when we see a new face. So, so without the trauma, it's I'm simplifying a little bit, but you see a new face we might be curious. Like, oh, like you know, could we could he be a friend? Or if someone's romantically interested, like, oh, my might that person like me? Or might they not? People are interested and curious. Whereas after trauma, there's a there's a difference of feeling a little bit on the back foot. So, people tend less to look up and engage and more to look away or to more have negative thoughts. So, you don't That person doesn't like me. You know, instead of something that might be more constructive. How do they test for this? Is there a test that able to be done to see if someone after trauma has like a different set of sunglasses that they view the world with? Mhm. Yes. Yeah, there's a there test from from the brain biology all the way through to to very clever psychological experiments. Like, we can see all of this. And it's these these signs we should be looking for in ourselves. Right? Because it is very obvious if someone who always was an extrovert now won't leave the house. Right? Like, we can tell something's wrong and someone's probably going to come ask something, right? But if we just change in these more subtle ways where we're just less interactive and, you know, people notice their friends a little bit different and less outgoing. It's these things that, as you're saying, the subtle ones, the subtle signs and the nuances are often very impactful and indicative of other things going on under the surface, you know, that can bring even greater problems. On the subject of soothing that you were talking about a second ago, there's this quote that you say in your book, "Trauma promotes pain, pain increases suffering, and suffering makes us desperate to soothe our pain." Whatever form it takes. Sadly, we're seeing the terrible cycle play out on a larger societal level with the opiate epidemic. Yes. This idea of soothing, we will find ways to soothe ourselves. And some of those ways that we find to soothe ourselves become destructive in and of themselves. And it almost makes me think that like our sometimes our attempt, we think of like alcoholism typically as people that are self-destructing, but when you understand the soothing component of drinking alcohol, it actually is them trying to not self-destruct, not destroy themselves, but to take care of themselves Right. in a weird way? If we're under huge amounts of distress, our perspective of the world narrows, right? Very, very dramatically. If there's an elephant standing on my foot, I only have one thing I'm guessing I would think about, which is the elephant not standing on my foot anymore, right? So, when we're under tremendous stress and strain, right? Something that soothes us in the short term, right? Becomes acceptable because there's a desperation in us that has us focused on the short term. Like, I know that may know that's not good in the long term, but I'm just trying to get through today. Right? And and it's this lack of perspective in the world and the society around us that if we're not recognizing what trauma does to us or can it that it can drive us to places of desperation, then is it any wonder that short-term soothing will have a big appeal to us? And that could be soothe soothing through excess eating. And now, you know, that person is overweight and has diabetes and wants to be healthier, but like doesn't really feel that they can stop and ping-pongs back on different diets. And, you know, what they're really doing is they learned self-soothing with food in a way that that was, you know, in the context of really feeling some sense of despair or desperation. The same way that person may have learned that, oh, alcohol soothes. Now, again, there's there are genetic factors and there there are all sorts of factors that come into play, too, but unhealthy coping mechanisms are beckoning to us all the time, which is why, you know, I did a lot of treatment of of opiates and opiate dependence over a number of years. And you know, it's just outrageous to me that these these are the most powerful psychoactive medicines on Earth, right? Opiates. Like, they soothe psychic distress. Like, you know, feeling not good mentally inside of us very, very rapidly and effectively and almost immediately start building tolerance and danger, right? But I had no education and training around opiates as psychoactive medicines. So, so here we are in a society that's so is under appreciating trauma and and where people are are at in a sense of isolation or otherness or desperation in so many facets of our society. And then we start handing them the most powerful short-term soothing mechanism with the absolute highest risk of long-term danger and death. And then we're surprised that how many tens of thousands of people die each year from prescribed opiates. What kind of opiates have people being prescribed? So, how the opiate epidemic really began was with opiates in pill form. So, so that they would be prescribed, say, for for conditions of pain, but conditions of pain that were more chronic conditions or conditions not so amenable to opiates. So, if you come out of surgery, an opiate is a great idea, right? Like, there's a lot of pain that needs medicine to soothe that pain until the pain decreases. But it's judicious use of a very powerful medicine in high acuity circumstances. What we started trying to do, and part of this was, you know, we know there's a whole story behind the politics and the business of this, was to say, "Well, people shouldn't be in pain, so there's a short-term solution." Right? No one should be in pain, we'll give them pills. Right? And opiates do not work in those situations. They soothe a lot early on, but they rapidly build tolerance, addiction, they suppress breathing drive. So, so we started doling out opiate pills with the idea that we're treating pain and isn't that good, but with an absolute inattention to the immense risks of that. And I think it fits with the short-term view of, you know, of relieving all pain. Like, we're human beings, we can't relieve all of our pain, right? Sometimes what there is to do is to work hard to mitigate pain. And that might be that might be pain, you know, from a mental health perspective, it might be pain from a physical health perspective. This idea that a pill is going to fix everything and now everyone has pain pills and won't be in pain, you know, has resulted in hundreds of thousands of deaths in this country alone from prescribed opiates. You know, let alone illicit opiates. So, there's the short-term thinking on the part of our society that then almost lures people into the the seduction of the short-term soothing, right? You feel miserable and you want things to be better, take this pill, now you're seduced and addicted and at huge risk. And, you know, we've let that happen. For us to know how to treat trauma, we have to understand the physiological consequences of it. How does trauma change our brain? When we look at brain scans, what do we see in a traumatized person? Brain scan data is more complicated and harder to interpret. You can see different patterns in the brain. We're not at the point where brain scan science can really can pinpoint. Right? But what we do see is parts of the brain that are sort of inflamed, so to speak, by trauma. So, so the amygdala and pathways around the amygdala, which is a part of the brain that gets called sometimes Grand Central Station for negative emotion, right? We see that pathways involving this part of the brain become more prominent. Right? So, we we see changes in brain connectivity. Right? Because how our brains function is by communicating from one place to another. They function through connectivity and which pathways are more prominent. So, what we see then is pathways that are involved in trust, say, and feeling a sense of safety are less prominent. Pathways that are more activated when we feel less safe and more vigilant or more activated. And then we see the climate, so to speak, in the brain change in a way that's less healthy. And you may also see specific aspects of a post-trauma syndrome. So, so mood regulation areas are not functioning as well because now there's depression intruding. So, we see patterns in the brain that show us this change, although the science hasn't come far enough to to pinpoint like at some point we'll be able to do with much greater accuracy. And I've heard you talk about how that creates cognitive blind spots, so blind spots in our brain following a traumatic event. What do you mean by cognitive blind spots and what's the the harm or risk of that? Right. So, a cognitive blind spot can occur when we take a lesson inside of us that is a lesson of trauma, not a lesson of truth. And then it changes how we may think about things. So, so for example, a a real and sadly many examples of this I that I can bring to mind and people's faces who come to mind as I say it, but someone who felt pretty good about themselves and able to navigate the world and striving for a better job and doing fun things who then is assaulted. Right? And after that assault, the person is much less present in the world and internalizes a bunch of different thoughts about themselves. Of I don't really like being out, I like being at home better, or never it goes well, I don't get along with other people. Like they think about themselves differently. So, there is a cognitive blind spot, which makes it very, very difficult to think with accuracy about say possibility. So, that person may have say been striving for a better job, right? But, if they think of themselves differently, I'm not the kind of person who can get ahead, and people don't really like me, then they don't strive for a better job. They just take for granted that they can't get it. It won't go well, they'll fail at it. But, they never thought that before. Is this what you kind of see when people refer to someone having daddy issues? And the I was thinking as you were saying that that my dad let So, is say my dad left when I was four. Mhm. And I internalized this idea that men don't love me, for example. Right. And then I go through life being an avoidant person in romantic situations, or self-sabotaging, or going for people that are unavailable to avoid the rejection. Right. Is that somewhat similar? Like I've created a cognitive blind spot, and now I'm living out that as an instruction manual for my life. Yes. Absolutely, yes. And the the earlier in life, the more powerful the lesson is. And the brain doesn't go [clears throat] back and revisit those lessons. So, I think this is this is so amazing and surprising to me that our brains are so incredibly complex, right? More complex than the greatest supercomputer, right? Yet, our brains don't do some very basic things. Like we don't reboot and see is there a patch, or is there something to fix, right? We don't go back and look at these earlier lessons. So, if you learn at age four, oh, men don't love me. That's a hard lesson to unlearn, because it gets solidified at an early age, and then once those lessons are there, there's an internalized danger to go revisit them. Like if you go revisit that lesson, could you be disappointed, right? The thought that's the way it is. And that's the way it's going to be. Like that's kind of how what we tell ourselves inside the trauma kind of walls it off, and then we don't just go back and look and say, is that really true? Like here I am, I'm an adult now, and now did I just carry forward something when when I was four years old that wasn't about me? Is it really about the four-year-old, right? Or is it about the adult? Like we learn all these things, but we don't go back and revisit the lesson. And then yes, there's a person who could be very, very avoidant in ways that that lesson, that quote-unquote truth that is not true, can change that person's life. And that's why if we go back and look at that, life can really change. We can go back and look at why do you feel that? It's interesting to feel that. Let's let's think about it, and you know, what's the story behind it? And we can get to a place where that can be undone and say, oh, I took that lesson inside because someone else made a choice that was about them and not me. No four-year-old is responsible for a parent leaving. Right? But, I took something in that was different, and it's really affected me, and I came to feel differently about myself. It's not that everything instantaneously changes, but boy, the world is different then. On that subject as well of say the father leaving at four years old, and me thinking that men were Well, let's say I was four years old, and my father was violent. What you sometimes see is people then are attracted to the familiar when they grow up. So, although it wasn't healthy, they have a sort of bias towards being attracted to something that was familiar, even if it wasn't healthy. Right. That gets complicated with sometimes people will talk about as repetition compulsions are are quite complicated. Often, what a person is doing then is trying to gain a sense of mastery over a situation in which they had no control. So, you will see this in abusive relationships, where you know, sometimes a person will come and say, okay, I'm coming to see you, but I know you can't help me, right? And then my last like eight relationships have been just awful. So, how can you possibly help me? And then I might say something like, if you can tell me how you had eight different relationships that didn't go well, maybe I'll believe you. But, you're going to tell me about the same relationship eight times over. Right? Something along those lines, because we repeat things that don't go well in an effort to gain a sense of control. So, what often is the case in that kind of situation is whether it's repeating an abuse cycle, or just someone who is inattentive, or isn't interested. The the person is trying to feel better about something from the past. So, if the father was inattentive, and that person has a romantic interest in men, that person may choose men who are inattentive, with a desire to make them inattentive, to fix the the to soothe the pain of the past, because the emotion systems in our brain don't care about the clock and the calendar. So, you can solve the past in the present as far as the emotion systems are concerned. And if the trauma is very strong in us, the emotion systems will rule the day. So, they said the father was violent, then maybe that person chooses a violent significant other, right? And then that relationship goes away, and the person chooses another violent significant other. And then sometimes the thought is, well, the person is choosing that because that's what they're comfortable with, or that's it. But, no the the the person is is trying to make sense of something, and there's some desperation inside to feel better about themselves, and to fix and heal something. Whereas why if we can intercede there and say the problem is, if you want someone who's attentive, choose people who are attentive Choose someone who's attentive, right? As opposed to choose someone who's not attentive and try and make them attentive. Can we become addicted to our victimhood? Sure. There's no internalized victim without an internalized persecutor. So, if someone is victimized in the sense of the law, right? Someone has done something bad to that person. That doesn't mean that person takes inside of them that they are a victim. Right? But, trauma can make us feel like victims. After the loss of my brother, when I felt like um maybe we're cursed, and I'm not I can't really get anywhere in the world. Like there's a black magic to that. Right? Then I feel like I'm a victim of something. I don't I'm behind the eight ball. I then have a sense of otherness, right? And and now I've taken something inside of myself, where we don't need a persecutor anymore. I feel like I'm less than. So, how's that going to go well? Right? So, what we end up doing is we take inside of us sometimes this sense of victimness, but that also takes inside of us the idea that we are less than, that there is something magical that is bad and negative. And what we need to strive it against is exactly that. That something may have happened that we might say, okay, that person is a victim in the eyes of the law. They were assaulted, right? But, that doesn't mean that person has to take victimness inside, guilt and shame. How many people have I seen who were assaulted, and they talk about how they're ashamed of it, and it's their fault. Someone else attacked them. Right? But, the reflexive guilt and shame of trauma can lead us to feel less than. Then we start feeling like victims. Then we feel less than, we embrace this, and we don't need someone to persecute us anymore. The limbic system, we're talking about the brain here. What is the limbic system, and what role is it playing in cementing our trauma? Yeah. So, the the limbic system is the name for the emotion systems in the brain. So, we're simplifying a little bit, but the idea that there are logic systems and emotion systems. The emotion systems are limbic. Those are the limbic systems, and they never lose when they come face to face with logic. Right? Like the limbic, the emotional always rules the logic if the two come head to head, which is why if the emotion of trauma, the fear of being less than, the need to repair something that was unfair in the past, if that is driving us, logic will not have its say. You know, logic would say, if you've dated six people who've all kind of seemed the same at the outset, and then all behaved in the same negative way, don't choose a seventh like that, right? I mean, logic very logic was saying that at the second person, not let alone the third, the fourth, the fifth. Why do we see repetition of unhealthy relationships? Because the limbic system, if it needs to feel different, it needs, so to speak, to solve that trauma by gaining mastery, it's going to go look for the seventh person who's just like the first six. But, once we take the energy, we lance the abscess, so to speak, of the trauma, then logic can have its say. And that person who says, you can't help me because the last eight relationships were all awful, sees, oh, I did the same things, chose the same person last eight relationships. That's one paradigm, and I'm changing it now. And then things are different when they thought they couldn't be. Because they can see now what they couldn't see before. The limbic system isn't ruling the day anymore. There's a whole balanced brain that has an understanding of self, and uses that understanding to move forward in life. It seems like the limbic system is against us. But, but there must be some sort of evolutionary reason, or rationale, or purpose of that limbic system that is I don't know malfunctioning in the modern world. Oh, sure. The limbic system isn't against us. Like all these parts of our brain, none of them hate us. They're all part of They're all parts of us. And some of the the research and observations through the psychedelic sciences are really telling us that much more, that there aren't parts of our brain that hate us. They may work against us because as you're say commenting, they're not built for the modern world. So, you know, if you think about the limbic system and the negative information, like something bad happened when you were four or five. Like take that in, and whatever lesson that is, never question it or change it, right? I mean, this is based upon survival mechanisms. The example I give is, you know, imagine for most of human history when people are hunting and gathering and living in small groups and and like having enough food was is very important for humans across human evolution. If you find a new food that it looks good, looks like something else that was good and you and you eat it and it tastes good and it's nourishing, like it's good to remember that. Right? But if you eat it and you get very, very sick, you better remember that forever. Right? So that the negative has much more salience in us and makes these lessons never go near that thing again. Never go near that person again. Never do this again. Right? They're designed to keep us alive. But we're trying to do more than that, right? We're trying to do more than stay alive. And these systems in us that evolved to keep us safe then can very much work against us. The person who's traumatized because someone attacks them and that system gives them panic attacks if they leave the front door. I mean, that's that person's brain trying to keep them safe. You used the word shame a lot when we were talking about trauma. In the same way that I asked um is the limbic system against us? What is the use of shame? Why do we experience shame? Can't we just program ourselves to get rid of shame and then we'll all be fine? Exactly the same with the limbic question. No, we kind of need shame, but we need shame for good reason. Right? So so these primary affects that that are very um primordial in us, anger, fear, love, shame. These are things that are just aroused in us. Like they can become other things once we start thinking about them, but they're states that that that are very deep within us. They all have a survival adaptation. So, you know, love feeling love is you know, being more than one. You know, if if we love someone, now you are two and you're and you're there with one another and that's going to help you survive, make your way forward in life. Love is adaptive. Right? Fear can be very adaptive that now you're in a fight or flight stage. You're trying to survive and get through life. Shame is the same way. They're things that people do that bring shame that change behavior. Shame changes behavior a lot cuz it feels so bad. So, you know, I give the example of I imagine that you know, in the old days, you know, someone who um you know, pees on the food in the cave instead of going outside, you know, and like now puts the whole tribe at risk or people and and then like there's a sense of shame that comes to that person. Like you can't do that anymore and the person feels bad and never does that again. And it's adaptive for the group, right? It's just one example of how shame can alter behavior. So, To keep us alive in that context. Right. To keep us alive. Like now you feel shame, you will not forget to not do that anymore, right? Like it's going to have an impression, it's going to change you because you feel so much shame, which we would think should be the case in the modern world, too, right? We there are things people do that are shameful that are worth feeling shame about. I mean, sometimes the problem is we don't have enough shame where we should. But we have a lot of new modern problems, don't we? With I was thinking about bullying for example. Like I I I imagine back in the days of our tribes, there wasn't internet, like obviously not, but there wasn't like mass internet bullying where a a huge group of strangers could just pepper you with insults and maybe our our modern brain still has the same old mechanisms of kind of perceiving that as our tribe are going to kick us off the island here. Right? So the brain malfunctions and experiences shame, which causes all the things you've described. And then even in the context of like sexual assault, I was trying to rationalize that, how the shame of sexual assault can make you feel shame when really it was someone else's right behavior. But how does that make that, you know, that woman feel or that guy feel shame about themselves when they were attacked? Right. Because it doesn't start with the thought of it. Cuz you're right. Because what you're saying, I think, is basically it makes no logical sense. Why would you feel ashamed of yourself if someone else came up behind you and jumped you and did something awful to you? Why would you feel ashamed of yourself? Right? But but the person doesn't get there by thought. Right? I didn't get the feeling ashamed of myself after losing my brother by suicide by thinking that is a shameful thing, I should feel ashamed. No no, the shame is aroused in us. It's created in us because it's behavior modifying. And there's there's the adaptive something bad has happened, feel something inside that creates aversion. The shame is created in us and then we make the meaning of it. I feel ashamed, the shame inside me and then we make the meaning of right because I shouldn't have been there when that happened and then then we make a story around it. It starts with the limbic system, with the affect and then we build a story around it, which is why we can build a different story where, for example, shame goes where it makes sense to go. Like that's very, very effective of processing through. So, okay, so this thing happened, you can process through with someone how they felt and you know, what was going on inside of them. Maybe they're in an ambulance or a hospital, they're filled with shame they realize what is happened to them and you know, and then that was a terrible state to be in. But then they start putting they start making trying to make meaning of that state and we can go back to oh, that's a that's a natural, completely understanding human state to be in after this happened. But now you get to decide what that means. So, in the context of our ancestors, I'm walking through the I don't know, Serengeti with my with my big spear [snorts] and I'm walking and a lion jumps out at me out of the blue. I managed to survive it, although I've been attacked. I the shame is created in me because as a response to make sure my behavior changes so it doesn't happen again. And then I write a story about that when I get back to the cave and tell myself like the story could be that I shouldn't have been walking out at night in the Serengeti alone when that lion attacked me and that's adaptive and useful because it stops me from doing that in the future. It's like a So I'm trying to think of it through that. Maybe. It's it's a little different. If you were out Okay, let's say you're out and you actually you're hunting a lion in the service of everyone else. And then you were attacked and hurt, that it's that's different because you're doing something then to to feel proud of. Yeah. Right? So so that is is different. We're we're That's a situation where the person is approaching the trauma on the front foot. And then when the you return back, the thought would be you would be respected and cared for. Like, you know, you went out to do something for everyone and got hurt. Like that is very different than how people normally would would ex- experience the their trauma, which is when there there isn't a sense of of pride and self-sacrifice behind it. So so if the person Let's say you're walking out in the Serengeti at night and you shouldn't be, then you should feel bad about that, right? Then the thought would be, yeah, I shouldn't have been doing that and how bad you feel about it will make you not do it again so you're not going to get killed, right? And then you're going to come back and talk about that or people are going to go, "What were you doing?" And well, you shouldn't have been out there. And like they may feel bad that you got hurt, but like there's there's then an experience that is a deterrent to others doing that, too. Right? So This says something really interesting about how we treat people who've been through a trauma. Right. The look at the difference in the United States between veterans coming back from World War II and veterans coming back from Vietnam. There was far more post-trauma syndromes post-traumatic stress disorder after Vietnam because people were not coming home to a hero's welcome. The thought The thought there would be they had gone out like the person who goes out into the Serengeti to hunt the lion to to save everybody else is that's what was going on when people went to fight in World War II and when when when people went to fight in Vietnam. But when people came back from World War II if they'd been hurt, they were treated as heroes. They were treated with respect and and that allows a person to shoulder that trauma without the brain changes happening. When people came back from Vietnam and were were treated differently, which didn't happen to everyone, but it happened as a societal phenomenon that was that was a terrible thing for the veterans who came back, you saw much greater rates of post-traumatic stress. I mean, that's that I think captures very clearly what the impressions and perspectives of the people around us mean. There may be a reflexive guilt and shame from trauma, but that doesn't have to win the day. Like but it was much more likely to win the day if there's a sense of otherness cuz now we're we're you know, we're we're talking about the same thing of the feeling less than chronically by society for some reason makes that person more susceptible. So that person who's been through combat trauma and then comes back and does not receive a hero's welcome is put at much, much greater risk for the brain changes of post-trauma syndromes. What role does vulnerability and being open with others about how we're feeling play in alleviating our shame? I'm sure it plays it plays in it for most of us in most cases, it plays a very big role. Because the reflex to the trauma is guilt and shame and the reflex to the guilt and shame is to hide it inside. What we are doing is cutting ourself off from the human contact that we need in order to process what has gone on with us. So very many times over 25 years of being a psychiatrist, I've sat with someone who is putting words to their trauma for the first time. You know, when I was 5 years old, I was assaulted in that way. This coach did this to me when I was a certain age. Uh I was hurt this way and I'm the only one who survived and my two buddies died. These are real things that I have that I have heard people say and then be shocked that I, the other human in the room, don't recoil from that. Because they've held so long inside of them that it is shameful that they were assaulted. It is shameful that they survived. That that it's so dangerous to even utter it. The fear of how person will react that someone is surprised like, "Wow, you could hear that?" Or they they say it in ways and kind of step back a little bit because there's such an expectation of rejection was what the person is telling me is something that from a any reasonable human being would only elicit compassion. Now, that person who's telling me would only ever be compassionate to someone saying that, but they're not compassionate to themselves. Is shame really the cause of what we kind of think of as these trauma cycles? Because someone experiences a trauma, they suppress it, which changes how they behave, which means that they're more likely to experience more trauma in some way or at least perceive it as a trauma via shame, and then they kind of their life gets more and more full of different types of trauma. Does that make sense? Cuz I'm wondering if trauma can be quite a self-fulfilling thing where you get into a cycle of Right. Trauma in your life. Well, it can be. I mean, in the case of the person who now finally puts words to something they've held inside of them that they would know is not shameful to anyone else, but they hold it shameful for them. Right, what is going on inside of them may or may not have caused further trauma. Right, I mean, it it's it's caused suffering. Right, there's no doubt about that. When a person is is is saying that and they're they're putting words to something that's so important has been inside of them. It has caused them suffering, so they haven't been as happy as they could be, enjoyed life as much as they could be, been as outgoing as they can be, been depressed when maybe they didn't have to be depressed. So, so the trauma is impacting them because they've hid it down inside. Right? If you can talk about it and bring light to it, let's say after that thing that happened when the the person was assaulted at 5 years old or survived an accident others didn't, if someone did trauma work with them of, "Hey, you're What are you feeling now?" Okay, let's get to the fact a person is feeling guilt and shame. And the naturalness that they are, but it doesn't tell them truth. Right, it's just telling them how they feel and in fact it comes from compassionate places inside of us. We can help to unwind that before it becomes a thing inside the person that yes, may make life less enjoyable or may also, in a way that's worse, push towards repeated trauma. So, the the trauma of choosing the same unhealthy partner or the same abusive partner over and over is an example of what you're saying. If a person doesn't look at the trauma and like, "Why am I doing this? What am I trying to solve here?" Right, I'm trying to solve something maybe from childhood that was somebody else's shortcoming or fault or somebody else's [ __ ] Okay, I can stop doing that. Then the person So, the answer to all I think the answer to what you're asking is absolutely yes. And if we're curious and we strive for understanding ourselves and we know that there are routes to change, this is how we heal from traumas. And ultimately, Invisible Epidemic is a is a message of warning, but it's not a a negative or a pessimistic message. It's a positive message. This is if we understand this and we look at it, well, guess what happens is we get better. We prevent trauma. We take care of the trauma in ourselves and others and we get healthier. Like, I see this play out in 25 years of doing this. Like, this is what happens. But we only get there if we have the curiosity. We we, you know, we're interested and we know enough to go looking and thinking and making a narrative and you know, talking about ourselves and wanting things to be different and knowing that they can be. So, it's a message of hope because when we do that, we really see change. So, clinically when doing this work, you see a lot of difference in people. And that's part of what's been so heartening and led me to write the book is it's not just a message of, "Oh, this is what's going on with us. Let's take a look at it." It's this is what's going on with us and if we look at it, absolutely we make life better. I want to talk about some of the ways that trauma impacts us that are less obvious. One of them I'm interested in is sleep. A lot of people are struggling with sleep these days. Is there a link between sleep issues and trauma? Yes. And how strong is that link? Yes, so so sleep is one of the symptoms of a post-trauma syndrome. It's not in all post-trauma syndrome, so higher anxiety, lower mood, behavioral changes, sleep is one of these factors and sleep is very often negatively impacted by trauma. So, the changes you had asked about in the brain and then we talked about how they go more towards vigilance, more towards activation, they make it harder for the brain to settle down and be in a restorative state. So, sometimes we get what's what's is called ruminative where there are just thought loops going on inside of us and the brain doesn't want to quiet down to a place where we can get restorative sleep. So, people have more fragmented sleep. They have shallower, less restorative sleep, more time until they can fall asleep, earlier awakenings. So, this is very, very bad for us across the board. I mean, talk about the union of physical and mental health, sleeping very poorly is terrible for us from head to toe. And very often, after trauma, if there is a post-trauma syndrome, which is not uncommon, sleep patterns are dramatically changed and and sleep restorative function is changed. What happens is we're in higher states of arousal. And neurobiologically, this isn't about sexual arousal. It's it's just state of alertness. Right, so we're in too high a state of arousal, too high a state of alertness, and then the brain systems inside of us that need to really simmer down and in order to restore aren't able to fully do that. I guess there must be some kind of link there as well because if I'm in that if I'm less comfortable with being with my own thoughts because they're ruminative, that I'm overthinking all the time, I'm then also more likely when I'm trying to settle down to be trying to stimulate myself. Like, a lot of people aren't comfortable with just being sitting in a room alone with their thoughts, especially if they're, you know, an overthinker. So, then they might grab their phone. They might Sure. be, you know, doing things to stimulate themselves at a later hour of night, but it all comes back to the trauma. Absolutely yes. Yes, and you're describing how the downstream effects of all of this are tremendous. So, absolutely yes. So, so we're saying getting less sleep is just bad for us from head to toe. Okay, and also, there's all the things that you're talking about. So, if you know you're going to try and sleep and it's going to be just going over and over again in your head and it might be I'm not safe or I'm going to get fired or I'm going to get hurt or it may just be something that's simple and negative that you don't even relate to trauma. Like, "Oh, this is awful." Or like, I mean, these are things that go over and over again in people's heads when they're trying to sleep. Like, "I'm not okay. What's going to happen?" And it's going over and over again. So, of course, you're going to want to distract from that. And you cuz the way we've kind of framed it there is that you're aware and conscious of that. But can that be taking place in like the back room of your mind where Oh, sure. Sure, sometimes people are aware and sometimes they are not. Sometimes they ask a person, "Why why aren't you sleeping well the last 4 months?" Which seems like a good question to ask instead of just giving the person a sleeping medicine. But in modern medicine, sometimes the question doesn't get asked. But you know, maybe the answer is is just I'm really different trying to fall asleep and like, I just don't feel peaceful anymore. But but the person has not thought of that until you ask them. Then what's the logical next question? Why? Right, what happened? Did anything change around then? And a lot of times you get an answer and that person has a trauma problem, not a sleep problem. You can probably pound the sleep system to sleep with medicine, but now we're doing something that ultimately is harmful for the person. So, yes. And also, you know, when you talked about avoidance behaviors of sleep, this is also why the person can avoid avoid avoid and then have three or four drinks to get to sleep. Right, so there's so much that is unhealthy that then perpetuates being unhealthy and it spreads and this is part of the epidemic aspect of this. And and then people often don't know why things are different in their sleep, but a lot of the time if you stop and you think and you talk about what's going on inside of them, they will tell you. And it may be that for the first time they're telling themselves, which is why we should ask ourselves this question. You said to Rich Roll, "Amongst the conditions I have seen treated, the absolute worst in mental health treatment and indeed in general medical treatment are sleep problems." Mhm. Mhm. Why? Because sleep underlies so much and because we when we we have a lot of hammers in medicine, so we see a lot of nails. So, if someone is not sleeping, the reflex in medicine, and not everyone does this and I'm not trying to say they're all physicians or practitioners are not behaving in the right way, but we we work in systems that are high volume and designed for throughput. So, they're designed for symptom identification. So, what we say is, "Okay, you're not sleeping. So, we'll give you a sleeping medicine." Like, it's that simple. But the reasons people are not sleeping are very, very often not related to their sleep systems. They're related to these vigilance and activation systems inside of us. So, if if that's what's going on in me and I'm agitated and have this highly aroused state after trauma and maybe it's been going on for 2 weeks or maybe it's been going on but getting worse for 2 years. But this is what's going on and I can't settle down and my sleep system can't overcome it, you know, if you give me a sleeping medicine for that, I'm probably going to need a lot of it. Right? Because we're trying to make the sleep system overcome the distress, I'm more likely to get addicted to it. Right, I mean, there's a lot of bad we do to people and I never have an opportunity to address my problem. What should we be doing instead? We should be asking why. Why is it that you are not sleeping? And maybe it came out of the blue. Maybe. Maybe your sleep system every now and then fails you. But when we start asking those questions, we get answers and more often than not, those answers are in the realm of trauma. Then the person does not get a trauma medicine. They may get a different medicine that in the short term can quiet the vigilance systems. This we do this a lot where the person has a sleeping problem, we learn the trauma history, we use a short course of a medicine that calms the vigilance systems. It's nothing to do with making the person sleep, and then they start sleeping well. And maybe this is true, they might not have slept well with five, six, 10 sleeping medicines. But that is not the medicine that they need. Right, they need a medicine to calm these distress systems inside of us so that the sleep system, which is not damaged, can go and do its thing. And and while we realize this, we can start talking about the trauma. And maybe the person can process some of the trauma. Now, the sleep problem is gone, everything is better, the person's not going to be on a sleep medicine for the next 20 years. It's healthier, it's safer. But we have to be more than reflexive. Right, there are a lot of reasons people don't sleep. What about a link between weight and trauma? I've heard I've heard a ton of studies over the years about how um various people who are obese have high levels of sort of traceable trauma. Is there any truth to this? Yes, so there are probably or almost surely a couple of factors. One is Look, it's hard enough to take care of ourselves, you know, even when things are going really well. Right, I mean life is so busy and so stressful, so it's hard to take care of oneself. If a person adds trauma to the mix, it becomes harder to take care of oneself. And one way we can not take care of ourselves is, you know, what we're eating and whether we're exercising. So, the trauma makes it harder to take care of ourselves and predisposes to poor self-care. Now we have, you know, a person who's overweight and then maybe pushing towards diabetes or heart disease or cardio or cerebrovascular disease. And also, just like we talked about epigenetics and and changes in gene transcription, what genes are active in us, trauma puts us in a place where we are more inflammatory within us. Like there are more inflammatory markers in our blood vessels. So, it's not as clean and clear as we would like it to be. We're not as healthy and this works against the health of our blood vessels and the health of our immune system. So, the soup we swim in, so to speak, is changed by the trauma, and then those higher levels of inflammatory markers, for example, that are circulating in our bloodstream can make it harder to lose weight. The body starts holding on to more calories, and it makes it harder for our blood vessels to stay healthy, and then we get less and less healthy. And part of that is the biological effect of trauma, just like the epigenetics, right? And part of it is the changes psychologically and the changes in self-care. How do you convince someone that comes into your practice and tells you that they can't change? They don't believe they can change. How do you convince them that they can? Well, I'm a huge believer in the power of knowledge and the power of information, which I think goes back to how powerless I felt as a kid when we couldn't understand medical information. It's like, I want to know, I want to understand. And I think I think a lot of people are like this. I think we as humans don't get enough credit that we want to understand. And I think so much in our society is reflexive. Like you know what you know and you feel how you feel, and then, you know, we have a whole set of beliefs about the world because we affiliate with some group or another, right? I think that's a reaction to feeling so disempowered and that what we really want is knowledge. And I think that's the reason why, for example, knowledge-imparting podcasts are so valued because you're not trying to tell people what to do or how to think, but you're you're giving them, bringing them knowledge. And and that's what I try and do of like, I know that's not true. Now, it may be that if you're a science-based or rational person, or you're an engineer or an accountant, it's like, I might try and get at you through this through the science, right? I might get try and get at you through that article. Right, so something that can like let you see that. Or I might try and get at it through examples of, hey, here's it like people do change. Like here's kind of really what the state of the art is now. And like can I get you excited about that? Give me an example. There are a lot I could cite, but the one that comes to mind is the one story in in my book that is just an amazing story of a person who had had a trauma in her life that had just changed everything. Mood, anxiety, behavior, choices in the world. I mean, so much had gone in a way that was not how this woman was built to live her life, how she was living her life. And it was so striking her telling me about who she was at some point in the past and contrasting that to how she was living and how she thought about herself. And it was really a night and day difference. And it became clear there was a very abrupt change at this at the time of this trauma. Like a night and day change towards dysfunction, poor health, poor social function, misery. And she had no thought or idea that she could be like she was before because all she knew was that things had changed and now she was like this and this was not okay and never going to change. But she was willing to see this darkness of the change and to hear my observations and examples. Like, look, I I see something here that's looking from the outside that's really striking. And And that's we could think about it, talk about it, understand it. And like changed her entire life. And it really is true that 10 years later, she looked 10 years younger. Absolutely. Is this a one-hit wonder though, or is it a training process? Like me being in the gym and picking up weights over and over again. Am I having to retrain my mind to view the situation differently? Yes. Yes, we are creatures of neuronal habit. So, if you think the example I give I usually use is let's say you and I just picked a word, random word, and we said it 500 times. Right, we'd each be saying it to this evening. Let's say we say it 2,000 times. You know, give it a couple days, it's still there on the mind. Why? Right, even though we know it's a silly example, why would it still stay with us? Because when we say that word so many times, we're strengthening memory connections. That word comes to mind more, it's stronger within us. And then the only way it goes away is it atrophies over time. You know, you can't just make that go away after you said it a couple thousand times. It'll go away over time. It gets less and less powerful over time. So, if you don't keep saying that word, you know, comes to mind maybe 10 times the next day, five the second day, three times, then not again. But this is how processes of change work inside of us. So, someone who has, for example, had self-talk in them that, "Oh, it'll never work out for me." Or like, "I suck and no one likes me." Or, "You know, I'm terrible." Or, "How could you, idiot?" Or, you know, things like I had a shadow voice saying these things to me for years. Like that doesn't want to go away at once because it's just habituated inside of us. So, we have to realize that is not real and true. I don't That is not what I think what I want to say to myself. So, I want to know when it's there. I want to realize I'm saying this to myself and I don't believe it. Then we make it less strong. Right, we make it less strong. Every time we say something that's a negative lie to ourselves, like no one will ever love me, right? People say that to themselves over and over, we make that more powerful as if it were true. And if it's as if it were true, is it true? Our brain can't tell the difference now. So, if we we understand that, and now we want to change it. Like I know why I said that because when I was growing up, that parent, that person always said that to me over and over and over. And then, you know, I chose bad relationships cuz I didn't think I was worth anything better, and they didn't go well, and it reinforced that to me. Like a person really understands that, we bring that understanding to bear in a way that you speak against that when it comes into your mind. Cuz we can't make it not come into your mind. It can atrophy, meaning this process of slowly over time it goes away. But we have to say, "Hey, the whole me," I call it the judge, in the middle of all the opinions, has to say, "Okay, I know I'm saying this to myself, right? But do I believe that or not?" Can you really completely get rid of a trauma? Can you take a trauma to zero? Well, we won't lose the memory of it. All right, something bad has happened. We're not going to entirely forget it. That means it can trigger us in the again in the future. Well, the the question is how much does it trigger? Right, how much does it trigger? The idea is to attenuate the response to it. So, if if it was a car accident, and every time the person looks at a car, they have a panic attack, right? It's probably it's probably not going to happen that someday they look at a car and don't even remember. Right? But they can look at a car and like they know they had a car accident. They're not trying to hide it from themselves and go, "Oh my god, I can't see a car. I had a car accident. It triggers me. Like I'm I'm understanding that. I understand the naturalness of the responses in me and how they maybe were perpetuated by the fear that I felt and and I wasn't working through it or working through the loss that happened. Now that I'm understanding that, well, I don't have to be afraid of this. So, I see a car and yes, it makes me kind of uncomfortable, but it's okay. A lot of people beat themselves up because they've done a lot of work. Right. And their trauma still remains. I think I'm one of those people where there's certain traumatic things from my childhood, done a lot of work. I logically know that it's not true. Like that that belief I had is not true. Yeah, I'm still prone to be triggered on a bad day about that particular thing. Right. Right, look, that's that's that's how it goes. When a person is navigating through trauma and really getting through it, getting over a lot of difficult things and getting to a much better place, but responds to the triggering in a way that inadvertently reinforces the trauma. So, I would say if you're having a bad day and you have a memory of something that you kind of know you got over but then it raises the same set of thoughts or feelings that aren't good. Right? Instead of my guess is that you're feeling bad about that. Like, "Oh, I did all this work and I didn't get over it." Right? To say, "Look, isn't it interesting like how strong this imprints us that this is still going to come to my head. Today it's going to come into my head like I'm having a bad day or I dropped something in the morning and I don't feel great about myself. Like, this stuff is very very powerful but still not telling me truth. You know, that shoulder shrug about it. Okay, it's going to come into your head. It was neuronally reinforced and sometimes you'll be having a bad day and it'll come in. It doesn't mean anything. Lady Gaga sits at the very top of your book and she's written the forward in your book. There's this wonderful quote inside there that says, "I can now say with certainty that this man saved my life. He made life worth living. But most importantly, he empowered me to find and reclaim myself again." That is an incredible thing for anyone to say to anyone else. Thank you. My first thought is she's eloquent and generous of spirit and I and I so appreciate that she wrote such lovely words and I and I so so appreciate that. Just thank you. Why did she say that? You know, as she has talked about there's trauma in her life and to gain an understanding a much better understanding and be able to ground to the things about her that are wonderful and she's a wonderful person. There's wonderful There's wonderfulness in us no matter who we are and I think from the perspective of her on such a big world stage acknowledging the trauma and the humanness in her and that like anyone else she needed some understanding. She needed um some help forward in different pathways of thought about self. Like the kind of thing any of us need after trauma and she had the the bravery, the fortitude to you know, to take chances to be different. You know, just like someone would say, "Oh, I can't be any different." We can all feel that when we have a lot of trauma inside of us and it's hard to think I'm going to really try and be different. I'm going to take that chance but you know, in order to to change our lives we have to do that and and and she also did that. It's a very It's a very very human story and I think a deeply feeling person who then wants to bring that message forward to others that we can change trauma and I'm I'm I'm so grateful she wrote the forward to my book but part of that is she's she believes in that message that trauma does not have to control us. We can understand it. We can get our arms around it and I think that's what she is You know, that's what she's communicating in that quote. That's the part of that quote that's important. The part that's about everyone reading it and the and the capacity for change. You have some incredible celebrities um on the book inside the book that have given [clears throat] you quotes for the book. People like Kim Kardashian, Tommy Hilfiger, etc. etc. Lady Gaga as I mentioned. I'm guessing these these people at some point came to you. Without sort of disclosing client confidentiality issues. I'm just wondering how you find yourself in a position as a psychiatrist that the this caliber of people are seeking out your support. Well, and does that ever feel a bit surreal? Yeah, I think I think it does. I mean, I like to think of myself as a diligent person who wants to continue working at things and moving them forward and and uh seeing where they can go and and I think at some point in time I realized I had the capacity to to perhaps reach people who reach a lot of other people. Right? And and there's been a real joy. I I think that people who have who are public facing, I mean, there are a lot of stresses to that. You know, we we people can think, "Oh, it it seems so wonderful from the outside." But there's a lot of extra stress to that from the inside. So, to be able to address some of the extra complexity of that and to be able to help people who have a big impact on the world around them uh um was um and sort of a joy to pursue. We have a closing tradition on this podcast where the last guest leaves a question for the next guest not knowing who they're going to be leaving it for. And the question that's been left for you feels quite fitting and very interesting. I really like this one. It just says it's not even written as a question. It just says, "Erase one regret from your life. Dot dot dot." Wow. You know, I think I should have paid more attention to the world around me when I was younger and more lost in trying to feel good enough at the moment and I think that it made it harder to sort of find my path and I think it made me harder. I think my brother hadn't found his path and I think there was a lot of frantic anxiety or fear driven forward movement without pausing and circumspection and it may be that we just talked about you know, we've talked about his suicide and we've talked about that in this podcast. So, it's it's kind of at the forefront of my memory but when I think back then, I probably knew well enough to be more circumspect including about what may have been going on in him or in me and um I'm happy I got myself on a path that's led to places that feel good and that I think are generative and productive. Um I wish I had more attention to the bigger picture when I was significantly younger. Why? Well, I think I would have made better decisions. I think I would have seen pathways that led away from health and happiness and maybe seen that in others, too. Um cuz some You're talking about Jonathan. And others where I where where I was born and raised. I think there were there were a lot of good people and a lot of forward movement but um we maybe could have looked around ourselves a little bit more and there'd be several people maybe still here as opposed to not being here and people being healthier and um I think I probably had it in me to look around myself more than I did at that time and I do sometimes feel I will feel regrets about that. Well, I have to say Dr. Paul Conti, the work you've committed your life to and the understanding you've committed your life to spreading um is going to save many many many many many many people's lives. Thank you. And not just save their lives but sometimes it's not always about saving a life. It's about improving the standard of someone's life which I think can have a generational impact if that person is to stay alive and they are to you know, if we look through the lens of epigenetics or just about the how internalized shame and guilt and all of this can be passed on through vicarious forms of trauma that the kids might feel and whatever. You know, your work and your your future work I deeply believe is going to save and improve thousands and thousands and tens of thousands, hundreds of thousands of people's lives. And that is an unbelievably remarkable thing to commit one's life to. Thank you. There's no words that I could say in the 30 seconds I have now that would would express the extent of the good that that's going to do in the world. Wow. And I I you know, I can't imagine those people that are here and not here how proud they would be and are of you Thank you. for turning your trauma into such a wonderful, healing, important thing. So, on behalf of all of those people that you'll never get to meet that you've helped with your work, I want to say thank you so much. Wow. Well, you're very welcome and thank you for those kind words which I take to heart and thank you for having me on. I appreciate it. [music]