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

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If you've listened to the School of Greatness podcast for a while, you know how important acceptance is when it comes to personal growth. And you know who else is big on acceptance? acceptance, Discover. You see, Discover is accepted at 99% of places that take credit cards nationwide. That's a whole lot of places and a whole lot of acceptance, which is great for Discover, but even better for you. Based on the February 2024 Nielsen report, learn more@discover.com/creditcard. This is episode number 1202 with Dr. Paul Conte. Welcome to the School of Greatness. My name is Lewis Howes, a former pro athlete turned lifestyle entrepreneur. And each week we bring you an inspiring person or message to help you discover how to unlock your inner greatness. Thanks for spending some time with me today. Now let the class begin. Welcome back my friend. Today's guest is psychiatrist Dr. Paul Conti. And he is a graduate of Stanford University School of Medicine. He completed his psychiatry training at Stanford and at Harvard, where he was appointed chief resident. He then served on the medical faculty at Harvard before found his own clinic. He's written a new book called Trauma: the Invisible Epidemic: How Trauma Works and How We Can Heal From It. I was so inspired by this work because I feel like so many of us have dealt with different types of traumas in our life, from our childhood to adolescence to our adult lives. And sometimes we're not even aware of the types of trauma we're facing. So in this episode, we discuss how trauma is the root of so many problems, yet it's not easy for us to discuss how to better understand and heal from trauma. The first step to take with yourself before seeing a therapist, why your inner dialogue heavily affects your mental health, and so much more. Again, I was moved by this. I was inspired by this. 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Thank you so much. Thanks for having me.

Of course, I'm so glad you're here. You've got decades of experience on how trauma works and how we can heal from it. You have this new book called Trauma: the Invisible epidemic that I think is so exciting for me because I truly believe that it's hard to have a meaningful, fulfilling, peaceful life if you haven't dealt with your own traumas. You can achieve, you can accomplish, you can explore the world, you can build a big business, you can meet lots of great people, but there's this something inside that creates this anxiety or stress or not enoughness, I don't know what it is. And I had this for many years of my life. I've talked about this publicly many times going through sexual abuse as a kid. In your book, you say you don't want to compare people's trauma, but you say sexual abuse for a kid is probably one of the biggest traumas that there is. I'm glad you say that because I think the stat is one in four women have been sexually abused. I don't know if they're all children, but the abuse there, For women and one in six in men. And again, it may not be as a kid, but there's abuse for men that way. And I feel like it's hard for people to understand trauma. It's hard for them to understand it. It's hard for them to deal with the shame behind it. And then how to heal the trauma. So I want to unpack some of this. But I wanted to set the stage for this conversation because you've been doing this work for 20-ish years. And why did you decide to talk about trauma in this way? And what have you seen from your experience on how it impacts people in a negative way if it's not dealt with properly?

Yeah, I didn't set out to be a trauma person or to focus on trauma, but as I gained more and more experience, I thought, wow, this is an undercurrent of almost everything I'm doing.

Everything, right? Give me an example.

So depression, anxiety, panic attacks, sleep problems, even addiction problems, even psychosis, right? Like trauma pushing people to a point where there's a predisposition to not be able to cope with reality, but it's the trauma that sends the person over the edge, right? Or triggering bipolar episodes. So if you think about the more severe mental health problems, right, all the way through to problems that have a a scale of severity, right? Depression, anxiety, and then certainly trauma, pushing and promoting abusive substances, drugs and alcohol, and addiction, which then of course furthers trauma, right? So I started seeing, hey, kind of does it matter really what I'm engaging with someone about, right? More often than not, there's an undercurrent of trauma that unless that's thought about and addressed, We're kind of like polishing the hood, right? When we need to get under the hood and really get into the engine, right? And there's a mental health system that loves polishing the hood, right? Like a lot of things we do in life in this country now, we kind of want to spruce things up and make them look a certain way and not look at what's really going on underneath the surface. And then I started seeing that the sort of reflexive creation of shame, When a person suffers trauma, the immediacy of that sense of shame and the response to it to keep everything inside, right?

You cannot communicate about it.

Right.

Why do we not want to communicate about the shame that we have? Why is that so hard for us?

Well, it's the shame itself. Shame is synonymous with the message of you must keep this secret, right? And if shame is evoked, so if it's in a reflexive way created by trauma in the vast majority of circumstances, I believe that to be true because I've seen that play out in front of me over 20 years, that the reflexive shame is in and of itself a message of secrecy. And that's why, as you were saying at the beginning, people are carrying burdens around with them and you can look from the outside and see like this person has achieved this and this person has achieved that. what we see from the outside is so often not at all reflective of what's going on in the inside. And part of the wonderful privilege of being a psychiatrist and consulting to people through the psychiatric lens is you get to learn what's on the inside. And then you see a commonality that I've seen across the whole socioeconomic spectrum, across any different factor you can identify, right? This is present in people across that spectrum.

Yeah. What would you say is the percentage, rough estimate of people in America that have faced, that have experienced some type of trauma in their life?

You have to stratify by severity, right? And if you could say, okay, we can identify, like trauma is negatively impactful in that person's life, and we can take stock of it and describe it, I think we're well over half the population. We just have to be. The clinical work bears it out, the statistics bear it out, mental health challenges, yeah. Right, if you're one in four women suffering from sexual assault, right, one in six men, I mean, so that's one aspect of trauma and we're already up to 20-25% of people, right? So then there's the fact that trauma just pervades the environment we all live in. Right? I mean, we experience it vicariously. We look at the news, which is now really more, you know, it's more marketing, right? Of like a-- Trauma marketing is. Right, it's repetitive, incessant trauma marketing. Look at what could happen to you. Look at what could happen to your kids. Look at what could happen to anyone around you, right? Over and over and over again. And you combine that with the political strife in the country, the worries about terrorism, and, you know, we're living kind of like this. We're living in it with a sense of very much escalated tension in us. So I think it pervades the whole world around us. And so I think in that way we're all subject to it. I mean, I don't know anyone who doesn't know someone closely or intimately that has identifiable significant trauma. So in that way it does affect all of us.

What are the common, you know, if you could talk about the theme of all the people that come to you, what would you say are like the five to seven main reasons they come to you? Maybe it's not what's under the hood, but the main things that come to you. Is it stress, anxiety? Is it depression? What are the main kind of themes that you're seeing consistently?

What people mostly present with is just a sense of angst, a sense of frustration. Sometimes a person will present and say, well, I have depression. And they may know that because maybe they do have very clearly delineated cyclical depressive episodes, right? Or they've been diagnosed with depression, right? But when people present kind of de novo of like, well, I don't say if I say, I don't care what your diagnoses are, right? Let's just talk about like what's going on in you. Like why did you come in, right? Then what people talk is that that sense of angst inside of them, right? The sense that something isn't right, right? And if they've checked a lot of boxes, right? Then we have an expectation, right? if I'm doing the right things, right, and I have a good stable career, right, and I have a good roof over my head and everyone's healthy around me, like I should feel good, right? And that was part of my own challenges where I saw that develop even in myself, where I start to develop an anger and a resentment that I don't feel good even though I've worked hard enough to check all of these boxes. So I think even in those situations, let alone how many people are struggling with financial insecurity, occupational insecurity, housing insecurity, security. So you add that on top of it and we just keep raising and raising and raising the level of tension, which then of course propagates and perpetuates trauma. I mean, we thought of it as an epidemic, predates the pandemic. That was started writing this and thinking about it that way a long time ago with the idea that we don't know this is here and it's spreading from one of us to another to another and back and we're not aware of it.

It's invisible.

Yeah. Yeah.

But it's spreading quickly and it constantly stays with us. You're writing in the book about how just because an event happened in the past 5, 10, 20, 30 years ago doesn't mean it's not still carrying with you today until you address it, until you start to really process the integrating of healing.

Right? Right. I saw that over and over again. Maybe gosh, it was probably 17, 18 years ago, I covered about a dozen nursing homes along the seaboard of Massachusetts. And a lot of people in the nursing homes you could do therapy with. And I would see over and over again what's plaguing this person. And it could be trauma from 10, 20, 30, 40, 50 years ago that was so fresh and alive. as if it had happened yesterday or last week, yet it could be a half a century ago. And that struck me so strongly that we tuck these things away inside of us, and then they're sort of sealed in us. And if we don't go back and look at them, we carry with us the burdens, which are often burdens of shame, right? They're burdens of self-blame, they're burdens of inadequacy. And unless we go back and look at that, we don't challenge those like trauma teaches us these terrible lessons and then we just hide it away and then it becomes immutable. There's no way of then going and accessing saying, well, what's actually true about that? Right. Right, what do you actually believe about that? And how many people have told me about something so very clearly traumatic done to them? So walking down the street and they're attacked. And they talk about it through the lens of shame, that it was their fault. It shows that they're not a worthwhile person. They can't really make the way in the world. They can't keep themselves safe. No one will ever like them, right? No one will ever care for them. And like these lessons are there for years and years about something, once you start talking about it and unpacking it, they logically know there's no shame to feel, right? But the logic doesn't matter if the emotion is telling us something different. Right.

Now, if we go through a traumatic experience and we hold on to this shame, can it change our biology, our genes, Does it, you know, what's it do to the chemistry in our brain, to our heart? What does it do to us physically?

What is so amazing is we have proof of things that even 20 years ago, if one had said, you know, oh, trauma can change the genes that you pass on, right? Not necessarily maybe the actual gene itself, but whether it's active or not, which makes all the difference, right? If you have it and it's not active, you may as well not have it. if you don't have it, that's the same as like you got a good gene, but now it's not turned on. And the thought that like how we genetically present, what's going on inside of us can be impacted by trauma that happened years before conception would have sounded crazy. So someone who is deeply traumatized, you look at rape as a tool of warfare. Right? And the thought having been that there's, okay, it's a crime committed on one day by one person against another, right? That narrow conception doesn't even begin to touch what actually happens. That person is, without the right intervention, likely changed for the rest of their life. And if they have a child five years later, right? The genes that are active in that child are changed as a result of the trauma.

Really?

And it sounds shocking. I interviewed Darren Richarder, who's a friend of mine and an academic psychiatrist who's done a lot of the work around this. And he speaks to it so eloquently that, yes, what's going on here is not, oh, that crime happened on that day, but that trauma is transgenerational. And it impacts us from head to toe. It impacts our cardiovascular health, so therefore our risk of heart attack, our risk of stroke, our risk of autoimmune diseases. So it's not theoretical and esoteric, right? It impacts us from head to toe. And we know that now. We have the physical proof of it, which is in ways very gratifying, right? As opposed to making assertions like this even a decade ago or closer to 20 years ago when you couldn't really get any traction. What's esoteric? It's something, the person looks the same, so they're still okay, right?

Just suck it up. It was 20 years ago, so let it go or whatever.

Right, right.

What was a trauma that was extremely hard for you to heal or that took you the longest to kind of overcome? And does it still impact you today or is there hope for us that, hey, if you go through something traumatic, there are ways to heal so it doesn't have to impact you in a negative way for the rest of your life?

Yeah, I think there's definitely hope for that. And, and since you'd asked about me, you know, my, my brother's suicide when I was in, then my early 20s was so dramatically impactful on me, on my family. And, you know, at the time, I was very fortunate. I knew nothing about mental health. I was in an entirely different career field, and, you know, I was fortunate to have good people around me, like, it was really good, supportive people. And that helped get me through it. And the knowledge of, hey, maybe I should get some help. No one really got therapy. It was an interesting, strange thing to do. There's this helping resource there, and it was immensely helpful. Someone just asking me, well, how do you feel about that? And this sense of, I feel doomed. I feel ashamed. I feel despondent. That doesn't lead person to good places. That leads a person to, from depression to self-destruction, to addiction, to alcohol, and even just having some basic help like that helped me stay on track. And then as time has gone on and I've accumulated more really significant traumas since then, in the first half of my life, I didn't have major trauma. And then sort of the second half, I've had a bunch of major trauma. And being able to see it through that lens of oh, I just naturally felt differently, right? I had a different view of the world as a place where I could make myself felt and seen and I could impact and like good things would come to me. Like I had a whole set of beliefs that then really changed. Really? You know, and it changed in a way that made me feel much more defensive of the world and afraid of the world. And it was really getting very, very good psychotherapy in that second part of my life. I went to medical school and started started training as a psychiatrist and started really getting good therapy that I realized, yes, this doesn't have to control your life, but it is a struggle, right? Like it's on my mind, it's an active part of my self-care and my psychotherapy and sometimes use of medicines. So I have to actively really take care of myself to maintain a perspective where I'm aware that it's there, but it's not in a sense pulling the wool over my eyes and telling me things that can really lead us down a path of sometimes a path of destruction.

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But other times just a path of sadness and sort of despondency and not living up to what we want to be, not just career-wise, but interpersonally, like the kind of parent I want to be and the kind of husband and friend and I think with a real awareness that like, hey, I'm laboring against this, right? Then it doesn't have to control me. And I found that in so, so many of the people that I take care of, I found that to be true.

Wow. So the first half of your life, pretty happy, normal, healthy lifestyle, no major traumas. Second half, a bunch of major traumas, it sounds like, starting with a suicide to your brother. Where do you think you would be without having healing therapeutic modalities to process over the second half of your life? Where do you think your life would be if you could think about it?

I think not in a good place. Really? I don't know exactly what that means. One worry would be the specter of depression, which runs in me and runs in the family. and I could see getting lost in that in a way that then narrows one's horizons and promotes frustration and anger, and at times even bitterness in people. And it can lead us away from, it's like being a good person in the world, right? We become more isolated from care and concern to or from other people. And then I think it's a very small step from that to abusive I mean, they're just so there in front of us. You say, yeah, you feel awful, right? And you feel awful and angry and frustrated and an injustice about feeling awful, right? Don't you want to sue this now? Don't you deserve that now? That's a very, it's a self seduction, but it's a self seduction that leads so many of us to a path of short-term healing at the expense of the long-term or the rest of our lives.

Is almost all addiction stemming from some type of shame based on a trauma, would you say? Or can addiction happen from other ways?

I think addiction can happen in other ways, especially their genetic components to how we respond to certain substances. And there can be substances that are, well some of them for everyone, like opiates, are so powerful that it probably doesn't matter what our genetic predispositions are, like that can get the best of any of us, right? By creating such euphoria, followed by such withdrawal from that euphoria, right? That there are substances that can just take a hold of us, you know, no matter what our state of health is, right? But there are also then genetic predispositions of one person to another of what we may be exceptionally vulnerable to. So substances, I think, can have a life of, essentially have a life of their own and creating problems in us. But that being said, the vast majority of dysfunction I see in people, whether it's substances or it's acting out against the self, you know, it may be self-harm, right? Physically, or it may be just keeping a sort of sadistic accounting in our minds, right? Like, well, I'm not doing well enough in life. you don't get to go do that, right? You don't get to do that enjoyable thing or-- you- don't deserve it. Right, you don't deserve to have a good meal tonight, right? You don't deserve to get enough rest, right? You don't deserve to go out with that person who might really be a really good partner, right? This sense of there being an accounting inside of us that oppresses us, we've known for many, many years. In my field, people thought about people a lot more like 100 years ago, right? Because we didn't have the advancements we have, which in many ways are wonderful, right? But we think less about people and this idea of-- what do you mean.

We think less about how other people are doing? Is that what you mean or what do you mean?

No, we think less. Like in my field, we think less about like, okay, if you're my patient, what's going on in you? How do you feel about life, right? And what are the dynamics of that? We've stepped away from that in very much a polish to the hood kind of way? Well, whatever is going on with you, like your insurance authorizes 10 sessions of CBT, and you'll get that and you'll take a medicine, then you're going to be better, or you will have failed the intervention. That's not helpful in most cases. And when people thought more about other people, they thought about ideas like, for example, there's no internal victim without an internal persecutor. Which I don't mean feeling victimized, like somebody steals your wallet. Look, I'm a victim. I fill out a report. But the idea that, no, no, I'm a victim. I stand out as a mark to people, right? That if people are looking for someone to hurt in a relationship, they're going to look to me. People are looking to someone to abuse and bully around, whether it's on the playground or it's in the office, right? It's going to be me, right? When people think like that, they also internalize the persecutor. There doesn't need... I've worked with people who are still in their minds being being actively persecuted by someone who's been dead for 20 years. Right. Because that person doesn't need to be alive anymore because they're doing it to themselves. And we can get like that. In fact, I think the internal dialogue in us that can say, oh, what an awful person, or, you know, you're never gonna get anywhere. And how stupid, right? Like, how many of us have that going on inside of us? And that arises from trauma, and it blinds us to, like, look, who am I? Who do I want to be in the world? What do I have to offer. How are you gonna make the best of that if there's a running dialogue in your mind saying, oh, you're so stupid, you messed that up again? And that's present in so many of us.

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

Right.

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

Yeah, I think the only way is to go to the root of it and try and heal that core process. I mean, sometimes, you know, there are always outlying situations, right? Where, you know, a person can just polish the hood a little bit, go on with their life and sort of have things be okay.

But that's- It's functional, but not like.

Yeah, Right, that's the rarity though. And I've seen over and over and over again that it festers inside of us. And some people are blessed with a sort of resilience gene. Like, you know, people have thought about this since the second world war. Like, well, why did some people like survive concentration camps? Why were some people able to like still see hope, right? Still persevere, still be resilient, right? And there are some genetics around that that we just don't understand. and if a person is blessed with that, then when you feel despairing, then what you may do is something that seems productive or positive in the outside world that you do in order to get some legitimate feeling of something good. And it may be that you have that gene where you have the genetics for that. I think I have the genetics for that. But those are blessings. right? Like we don't want to count on, like I have a gene for resilience, so you know, I didn't drink my life away after my brother's suicide, right? Like we don't want to rely on that because if a person has enough resilience, you can get yourself maybe to where you found yourself at 30, where like, oh, wait, I've achieved a lot. And then something inside says, wait, is all that really true about me? Right? Because if I really am this like awful person, like how do I, wait, how do I do this? And then you can have a greater breadth of perspective. And then what you probably started doing for yourself then was reconstructing a narrative. And that's why the construction-- You're telling a story. Right. We're like, wait, is that story true? Because it's gotten a pass. It's gotten a pass. And I see people who for years and years and years, the story of why they're not worth anything has just come forward without any challenge. Right, but when you start helping them talk about it and think about it, like, you know, a lot of times I'll say, well, look, from what you're telling me, there's, I mean, there's some shame to be had in this story, but it sounds like it's not yours. Right? And that's the case in the case of acute trauma, right? We can look at, oh, look, so wait, so somebody hurt you, right? And then you can start thinking, well, but you feel ashamed, right? Like, how does that work inside? Like, why does it work that way? why do we have this reflexive shame and where do you actually want that to go? Or do you feel anger or frustration about it? And often when people don't, how do you not feel that? It's just that it's coming back in towards them. And then you say, what is it like? What do you say to yourself when you wake up in the morning, when you're driving in the car? I remember working with someone who was driving this really long drive to work. And I learned as part of working with her that She loved music, loved listening to music. And then, like, it just came up that she never turned the music on in the car.

Why not?

Well, it was going on a long drive, right? Because she didn't want to block the narrative in her head.

The negative narrative.

Right, the negative narrative that was like, you,'re worth nothing. Because there was, the film was that was, in her mind, justified, right? That was the justifiable self-punishment for being hurt by other people. Right? And when we unpack that, we're like, wow.

And how long do we hold on to that punishment for?

Potentially forever unless we go in and look at it. So the first prescription I wrote was turn music on in car, right? And then as she became more aware, she's like, great, there's a whole story in my head. And that story plays over and over and over again and it plays over in that summarized manner. You're not worth anything. No one will ever love you, right? And the reason this person comes to mind, there's a lot of people like this whose lives have really, really changed. Once they're like, wait, that's actually not my story. And logic tells me something different, but logic hasn't had one thing to say about it. It's all been through emotion. So let's talk about that emotion, reconstruct the narrative, and then it's remarkable how much better things can get because it's not a hocus pocus. pocus, right? It's away from like the black magic, hocus pocus, towards what's actually true. There's a simplicity to it. And that's why the book is designed to be very practical, right? It's not designed to like an academic treatise. It's designed to say like, we can make this better now. And we can start making it better right now by just thinking what's going on in my head? What am I saying to myself? What's going on in the people around me? You know, someone who may be a little different I don't know why or a little different after something difficult. Can I talk with them? There's so much that we can do, but we become more and more isolated in society. We're busy, we're running around, we're at odds with each other in lots and lots of ways that are politically or socially driven. And then we're so isolated that we never challenge these narratives. And that was like the amazing thing that I saw with such sadness in the doing nursing homework so many years ago. It was like so many people are carrying with them the trauma of so many years ago and it's just as alive as it was in that, you know, when it happened. And it's been since the pivotal force of how their life has gone forward. I mean, not everyone, but there was a lot of that.

You were mentioning how, you know, there's a narrative that we say, you know, I'm not lovable, I'll never be good enough, or I don't deserve this. What would you say are the three biggest lies we tell ourselves. Maybe that you hear from people when they come into your office, what would those three big lies be?

Yeah, look, I think you just, you said, I'm not lovable. Yeah. Right. I'm not good enough. And what was that?

I don't deserve.

Right. Yeah. Right. So the not, think about what not lovable means, right? It's that means there's something, I'm intrinsically flawed, right? I mean, to say one is not lovable, it's such a blanket statement of persecution, right? If you think about what it would be like saying that outwardly to someone, right? Look, you're just making a blanket statement. You are not lovable, right? I mean, it's awful, right? And it's why the persecutor inside of us can say things to us that like people outside of us generally don't, right? We wouldn't tolerate from other people. How dare one say it, right? But it's going on inside of our minds. That's, you know, the practical The practical shift of that is like the I'm not good enough, right? Because if I'm not lovable is an intrinsic characteristic, then that translates, well, I'm not good enough to do what I set out to do, right? I'm not good enough to achieve whatever that may be. And then, yes, of course, one isn't deserving, right? I mean, if all that is true, then you're not deserving of anything. Think about how, talk about blanket statements, right? And I think the proof of like, why do I think for sure that this is true? Like, you know, psychiatry isn't math, right? But maybe it's because I was a math minor. Way back when I love mathematical proof of things, right? Is I've seen more people than I could possibly count who I know them personally, professionally, other people in my life. And I see them before trauma and after, right? And sometimes I marvel at how Not only do they think about themselves entirely different, but they don't know that they thought any differently before.

They think they've always been thinking this way.

Yeah, I've never been good enough.

Wow.

Right? This has always been true. I mean, no one's ever loved you. What do you mean? Like before the trauma, you know, you had like a great job and friends and a wonderful girlfriend. Things were great before, but they don't, you know, because the consequences of trauma change our memory. our memories only have meaning through the emotion that's attached to them. Interesting. So if you change memories and now there's a negative spin on that, you can say, well, what about, I could remember a person who would tell me about some award, I think it was when it was high school or early in college, something to feel really proud of. And we'd talk about that and anchor to that of, hey, that says I can do things. Who then, on the other side of the trauma, remembered that in a very negative way of, Really? you know, something was given to me, I didn't deserve and, you know, and.

I got lucky or whatever. Yeah.

And, you know, it showed like it didn't mean anything. Like all it did was make pressure on me I could never live up to. And, you know, now so I also there's an explanation for like avoiding the better job, right? Or from going from a lousy relationship partner, maybe even an abusive one to someone who could be better. Like why do you, why would you do that if you have an expectation of failure? and if the expectation of failure is based on the false lessons of trauma, well, we have very powerful examples of what this does to us. We forget our own histories.

Wow. You said memories have meaning through the emotions we've attached to them. Is that right? Yes. It's so true. And if we have a memory, it sounds like what I'm hearing you say, if you have a memory of the past, that could be a good event for many years, and then you go through a trauma, and somehow you reconnect it to that event or whatever, you can completely shift your emotions toward that event to being a negative experience. That's crazy.

It really is, and this is the thing, like shocking. Some people ask me, what's shocking things you've learned, like being a psychiatrist? That may be the top of the list. I mean, it's certainly near the top of the list. Our own history, histories are malleable inside of us. And people have brought up a couple times, I write examples in there, and there's a railway station in London, right? Saint Pancras, I'm sure not pronouncing it in the correct English way, but it sounds like Pancras, right? And then I love England. I spent some time in college in England, and I just, I love being in England, I love being in London, and I was walking to meet a friend at the Saint Pancras rail station. Right? And you think that that's like, it should be a joyful thing. And as I'm walking there, I felt awful. You know, I felt terrible. And I felt like, what am I doing here? And I deserve to be here. I'm going to see my friend. Like, why is my friend like, I felt so terrible about myself. And then I realized 100% like what that was is, you know, my mother died of pancreatic cancer. Oh, wow. And pancreas sounds a lot like pancreas. And like it was that realization of like, that's absolutely what I'm thinking about. thinking, what a person, you didn't go home enough when your mom was sick. And, you know, I'm thinking all these things in my mind and I realize, so my memory of like what that place was evoking in me had changed, right? And it changed my feeling and I need it so you thought, can we get better? We can, but we have to have it in my head, like I need to stop and think, like look, these are different things, right? And you're triggered to feel a certain way about this, you don't actually feel that way. right? You're happy to be here. And you think you did a decent job as a good son when your mother was sick. You actually believe that. And you can't wait to see this person. He can't wait to see you either. That's why he took a train down from Northern England, right? And I could feel differently about it, but I mean, there's a lot of like work on that, right? To not just be carried away to some very negative feeling state where this, my self-talk went strongly along with that negative feeling state.

So how do we, let's say we don't have a therapist to our, you know, as a resource for us.

Yeah.

Or we don't have the funds or for whatever reason we're not comfortable doing that yet, which I'm a big fan of. I love therapy. What can someone do if they realize, you know what, I'm feeling some of these lies or these symptoms of angst, frustration, depression, Maybe I'm using a substance already. Maybe I'm addicted to something. Maybe I'm in denial that I'm addicted to something, whatever it may be, or just feeling depressed or depressed feelings. Yes. What are some practical things that people.

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

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On inside of us as a given. You know, that woman who drove 50 minutes to work and back every day, and didn't turn the radio on so she could say awful things to herself. Never thought once about it until that offhand comment about why there's no music in the car. Right, wait a second. Now for the first time she thinks about it. So what is actually going on inside of me, which is really closely tied to the second point, which is what's my narrative about myself and my life? And what do I actually think? It's going back and looking at the things that we now take as a given. And if you think trauma so predisposes to that. I mean, you know, trauma is not a thing, but I would say trauma loves that, right? Because then we don't go back and look at it. We just take all that off of us. Well, that's a given. That's that. And now, like, here I am. It's like, that's not a given. It's not that's that. Right? We can go look at what's going on inside of me. What's the narrative I'm constructing? And that can be very, very helpful to people who have no access to outside resources. And if you can find, like, one trusted person. You can talk to about once you start doing that, if you can just sit with somebody, friend, family, clergy, it doesn't matter, somebody that's trusted because we have error checking mechanisms inside of us that we don't use when we're thinking, but we use when we're talking. And that's why putting it in, it's amazing how many times I said that and now I feel totally different, even though I thought about it 10,000 times. I heard all the time. So start putting words to it. Writing about it, speaking about it to someone else, even speaking about it to ourselves, right? Putting it into words. Then we bring our whole brain online.

How important is it what we think and what we say to and about ourselves on a daily basis?

It's hugely important.

Really?

It's hugely important. So you think when I was a kid, people would talk about oh, that's the soup you're swimming in. It was just a turn of phrase. And that is the soup that we're swimming in, the environment that we're in. A lot of it does come from outside, but not as much as comes from inside. So it's absolutely affecting us all day, every day, which I think is how we can perpetuate over years and years and years the trauma inside of us. Because you think, why don't our brains I mean our brains are very sophisticated in a lot of ways. Why don't we go back and do some inventory? Reboot the system and look at everything in the past. Why don't we do that? It's like constantly being in a hurricane. You're just trying to survive in the hurricane. But you give a person a little bit of peace and you're like, okay, wait, what's... I now can think about that, whereas I couldn't before. I think it's immensely important and I've seen that play out clinically over and over and over. That person doesn't realize they're living in a hurricane. and it's coming from in here and they've been struggling with it and they might say something, well, it's not, can't be from that. That was 15 years ago. People will look at me like, I'm, what do you think? That was 20 years ago. It's not affecting me now. But then as we look through it, it's affected them every day from then until now. And that's the last story in the book speaks to that, right? It speaks to someone whose life changed so much by being able to realize, no, that thing from 20 years ago has absolutely been depressing me every single day since then. And I don't want that to be the case anymore. I want to look at that and say, is it true? Should I feel that way? And if I do, I'll keep doing it. But I'm gonna give myself the chance of looking at it anew.

Yes.

Whole life is different.

And so asking yourself what's going on inside of me and what's my narrative about myself, the first two things that we should be doing. I mean, is that what that would happen if you go to a therapist? It'd be, essentially going through that process as well. And then how could they start to. Where does healing actually begin? Is it an awareness? Is it the talking? Is it rewriting the narrative? Is it just takes time? You know, how does healing actually occur?

It can begin in a moment's notice. Right? Like, just the, I, I just the thought that, oh, there's like, there's something new. Like, there's like a, there's like a new way to think about this or new data. That's a lot of times what will happen if someone comes in. say, so it comes in to do therapy, right? And then I can look and say if we work together for a while, oh, there's so much better over months or even over years, right? But oftentimes we can trace the improvement back to the very first session of saying, you know, there's, I hear what you're saying and, you know, there's another way of seeing this that I think is not just a sleight of hand, but is a way that's actually consistent with truth, right? And I can say that to you because we're all unique, but we fit patterns. And I've seen this pattern over and over again, which gives me the hope that through the unique lens of you, there's a different way of thinking that this is real and true and can really change. And, you know, there's like sometimes it's an amaze look because, you know, we don't like damned if you do, damned if you don't. Right. And we often have these conflicts in us, these central conflicts of damned if you do, damned if you don't. Right. I gotta change this. this, and I can't change this. And then if you look, that's not the only two options and it's not a sleight of hand. And that's very important because often people think, well, psychotherapy is about getting you to feel better. It's not about getting you to feel better if that's through a lens of falsehood. If a person is really doing things to feel ashamed about, let's talk about that and change it. The idea isn't to make you feel good about things that you should feel bad about. The idea is to help not feel bad about things that you shouldn't feel bad about. Usually that's what we're doing. And sometimes it involves medicines and like, is there other things to do? And sometimes there are medical problems involved. There's a thyroid problem. Like there's so many other aspects of it that need to be taken stock of. But the healthcare system is in a shambles and the mental health system is so surface focused that I don't mean to be critical of like there's so many good individual like practitioners within the systems, but the systems are broken. So you could very well go in and get treatment and not have anyone actually talk about trauma. And I've seen this over and over, people who've had, and I'm not making this up or exaggerating, four, five, six residential stays for addiction, right? And addiction where if you just sit and talk with that person, it's very obvious, like you're trying to, the person's trying to kill themselves, right? It's not, oh they can't stay away from that substance. sometimes you see that. But you see stories, it's about, hey, what is this person looking for? They're looking for escape from suffering or they're trying to be not alive anymore because they want to end their own suffering or because they think they deserve that. That's just punishment they feel. And the majority of times, no one has taken any trauma history from that person. Really? So that is a failure. of our systems. When very clearly, if you start talking about trauma, like that's where the money's at, so to speak, the majority of times. Like why is that person doing that? Then you start learning what's their inner dialogue? What happened to them? Was it acute trauma, chronic trauma, vicarious trauma? But you come down to the trauma and if you get under the hood and you address the problems, right? Then the drive to the substance changes. I mean that's, that is In my strong opinion, the way most people who are in remission from substances, they're not using substances anymore, it's not in their life, right? That illness, that disease, that addiction is over, right? How did that happen? What are you doing? By addressing trauma. Oh, by addressing trauma.

By addressing trauma.

Really? Absolutely. The vast majority of trauma.

Almost all addiction is the drive. Almost all addiction is stemming from a trauma.

Like a substance abuse addiction, let's say. The majority of it. Can I say it's 70% or 90%? But we're talking about very high numbers, which is why when you look at, when you talk with people who have quote unquote failed addiction treatment, right, which I think is a very awful way to put it, often they've, why have they failed addiction treatment? Because the addiction treatment didn't address what's.

Actually going on in them.

The trauma. Right. It didn't address trauma. It says, look, you're gonna buckle down and you're gonna, you know, I'm not, I think AA does people a lot of good service, right? But there's a way in which this can get extrapolated. Give it up to your higher power and take an inventory, but you're not really looking at what's driving the dysfunction, right? And that appeals to the aspects of our society that want quick fixes, right? We want quick fixes and we want them to be inexpensive.

And not painful.

Right. And not painful. Right, and it's painful to talk about trauma, to go through that. Now, people, when they see they're getting healthier, it's very interesting how people will in a sense welcome the pain. They have the pain of working out, like it's difficult, but you know you get healthier, right?

Of course.

So the same thing can happen where the trauma treatment is arduous, but the person's like, I know I'm getting healthier. But our systems, really, I come back to this analogy that our systems are built to polish the hood. And trauma treatment is, it's more expensive, right? It takes place over time. It involves human beings who are well trained, interacting with other human beings. And it's a lot easier to just say, look, let's polish the surface of anything and spruce it up a little bit and then throw some medicines at people. And that's why we absolutely do not solve these problems. And they're not rocket science problems to solve, like by a redirection of priority and resources and recognizing what a problem this is. we can appropriately help the people who are suffering from it and often have no route to help, even if they're well insured. Yeah.

What will happen in the world over the next 20 years if we don't start addressing our traumas sooner?

I think we're in real trouble. And I don't want to be a doomsayer, like, oh, things are just gonna get worse. But our increased interconnectedness so say through social media, which can do a lot of good but also is a route to instantaneously do a lot of bad, right? And the ability to instantaneously reach one another often in aggressive ways. And I believe that it's trauma that unhinges us from fact, right? I mean, how many factual disputes has there been? I mean, a classic is look at crowd size. You know, you could have a third grader in any country in the world look at this crowd bigger than this crowd. Okay, that's like, that's pretty obvious, right? Why would people insist that what's smaller is bigger? How do we get that way? I think we get that way through trauma, which says, what does that say? I mean, if you and I can both add one plus one, but I insist it's three, right? When you're saying it's two and I'm gonna stick to my guns, you might say, what's wrong with me? Well, what's wrong is I'm not actually prioritizing what's right. I mean, it's a way of saying, look, I don't actually care what's right. What I want to do is assert myself. I'm angry. I feel denigrated. I feel dismissed. I feel lousy about myself. Now I'm going to have my way. And if I say one plus one is three, I'll fight you to the death about it. Why? Because it's not about what's true. It's about the fact that I feel hurt and angry. And how is that not running through our society in all sorts of ways? And the ability to reach one another so quickly being detached from facts, right, which I think that comes from trauma, then escalates and we're more and more aggressive with one another, right? We're more and more, I think, there was some of the behavior and demeanor, like, you know, you and I grew up in a similar era. Some of what people say and do.

On a public stage-- Social media, yeah, yeah.

Right, I mean, do you think about the criticism-- you- would never go up.

To someone's face and do that.

We would never, no, do that. Even the criticism of, it's almost hard to say, the criticism of people who died or were captured in combat for our country, to have criticized someone, it was unimaginable. I was raised in a Christian church, I would just assume going into church and scream profanity. It's such shame to do that, but yet somehow the aggression in that appeals to people who have their own frustrated aggressions and somehow that's okay. And I think this loss of demeanor and comportment, what does that actually mean? To say that, who are you hurting? How many people are you hurting who have a dead loved one or a loved one captured in combat who's missing in action and we're just gonna denigrate that wholesale? How do we get at point in society where we trust, we accept that from people in positions of power instead of saying, hey, I don't care what your agenda is. Like, you know, your agenda could be make my life better, right? That's your whole political agenda. Make this guy's life better. I will still vote against you because there's a higher set of ethics and morals in me that says even if like what you're saying I think is good for me, I'm gonna reject that anyway, right? And we don't we don't see that like we used to see it, right? And we need to reground to what are our values, right? What are the things that are more important than like me being right or me getting my way or having some political say? And it's a sorry, it's a long answer to your question, but it speaks to why I think like how's that going to be better unless we look at what's undergirding us that would lead us in the most basic of ways to argue that one plus one is three when like Clearly it's not. We have to go and look at that and that is driven by trauma.

So trauma, what I'm hearing you say is people who are hurt and angry, there's a trauma underneath that. Otherwise you want to be angry if you didn't have a trauma that you haven't dealt with.

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

Right.

Right? They both just want to be right and how does that not come from a place of hurt? Like if you feel reasonably good about yourself and you feel like, you know, I've been able to make my way in life, right? And if I, you know, if I put in five cents of effort, I can get five cents back for it, right? If you really feel that you have opportunity, Right? Then how are you hurt and angry enough to argue over what's true and what's not true? Or it is, I just want to be right, I don't care. It doesn't happen except through that lens of trauma.

Yeah. What would you say are the main symptoms that you see then from people, majority of the time? Is it more based on a depression or an angst? Or is it... And where's that, what's the trauma underneath that? If you see depression, angst, frustration when they come in, Is it sexual trauma? Is it, you know, the parents got divorced early? Is it they were bullied? Is it they just didn't feel loved? Or they got something happened? Kind of what's the main traumas that you're seeing underneath the depression and angst?

Well, so it's a complicated answer. But to try and simplify, like the most common traumas I see are the most common traumas, right? Like, so sexual abuse, is so prevalent, neglect is so prevalent. So that's what I see the most of, but simply because it's most prevalent. How traumas impact us is so unique to each individual person. And some of that involves, well, when did the trauma occur? So the more formative the years, the more difficult it is, or the deeper the impact can be. So part of it is what was the timing of the trauma? Part of it is also, what is the person, is the person internalizing or externalizing, right? So people who are externalizing can become very sort of outspoken and impactful on the world in negative ways, right? Whether that's through a political lens or it's through a lens of being violent, right, of abusing and hurting others. Like there are people who are traumatized and they repeat that trauma on others. That's certainly not everyone, but like that's a known phenomenon. Right? And that's the externalizing of feeling such fury and such vulnerability inside that the way to try and gain mastery is to then be abusive to others, right? Which can start with like kids bullying other kids, right? To kids repeating the same sexual or relationship trauma as was as adults as was perpetrated on them, right? So we see, so as someone more likely to be externalizing, more often than not people are internalizing and that's when we see depression, anxiety, isolation, right, sleep disturbance because they can't get it to stop in their brains. And then the last factor is like what kind of sort of emotional compass we have. I mean there are people who can be very resilient and have a lot of trauma, right, and then there are people for whom things that we might on a grand scale of things consider relatively mild impact them very significantly because there's such a finely tuned than emotional trauma. So we have to say, okay, what is the trauma? What is the trauma doing in this person? Then we have to look to the, what kind of support mechanisms do they have? There's so much to it. So it's maybe a non-answer to the question, but it brings out the factors involved.

Yes. What happens to our brain when we experience a big trauma, especially at a formative formal years.

Yeah. The brain, we have the ability now to look at like what's going on in the brain, like, you know, not in the way hopefully we will someday, but to say, look, how's your brain functioning? What parts of it are more active? Right? What parts of it are communicating with other parts? Right? And so trauma, for example, makes the vigilance systems in us much more active. Right? So you you'll see if you take people who, you know, some, they're similar in many ways as most, we can get them, but one group has really significant trauma, the other doesn't. Now again, it's an inexact science, but you can divide it into two groups. And then you see if someone without trauma sees a person coming towards them, the parts of the brain that are interested in, like, well, who are you? How are you approaching me? what's the context, right? Is there something like collaborative or interesting? Do I want to shake your hand? Like, you know, I'm interested, right? But if you see through the lens of trauma, it's all coming through vigilance, which is all like, I'm just looking at you for, are you gonna hurt me? Wow. And like the changes in the brain are so profound. So if you think about how do you navigate life in an optimal way? If like, you know, instead of like seeing your boss come towards you and thinking like, oh, I'm doing a good job. this person is coming towards me, we can have a conversation like, I can get a promotion out of this. I can make a good point for myself. If you just think like, how's that person going to harm me? You act entirely different. Or people seeking relationships. If everything is scanning for who's going to be hurtful, how do you find the person who could be a good relationship partner? And by the way, people who are predatory can absolutely tell that. Really? Because you see people who are predatory and you say, how do they decide who to date, who to work with? They're scanning the room for the person who looks like that. Oh, absolutely. And predatory people who then are sociopathic and predatory is a form of sociopathy, often have gone through their own trauma, but they're externalizing. And then they're absolutely, they're so good, because I'll see this sometimes when I'm in a room full of people and I know say most of the people in, I know people in the room and I know who's vulnerable, right? Now there's someone else in the room who I also know is predatory and that person sort of sharing with me who they're interested in. And I'm like, wow. Whoa.

They're probably not even thinking about it though. No, they're not. Or just like unconsciously happening.

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That's just in them. Yeah. There's a lot of talk about narcissists in the world today. Is a narcissist someone who's just been heavily traumatized and is externally communicating that as opposed to internally doing it?

Yes.

Really?

Yes. I think narcissists, it's a relatively small portion of the population that does the majority of the damage. And I would say it that strongly because people who are narcissistic, so there's that externalizing element, right? And that has nothing, there's no interrelation there with like intelligence capability, right? So people who are narcissistic can be very capable people in the world and often those resources inside of them, the way they're imposing themselves on the world is in a way that's about destruction. Because narcissism comes through the lens of envy. And envy is different, there's different lexicons, but the way that I sort of learned this and the lexicon I use, jealousy is sort of benign. If you have something I want, I'd like to have it too, maybe I'll work hard for it, or maybe I can't get it. Right? Like someone's younger than I am. I can't make myself younger. Okay, there are other things I can hang my hat on of how I feel about myself. Envy is very different. Envy is destructive and it wants to bring others down. It says, if I'm here and I think you're here, I don't need to come here. I can bring you down here. And people do that. Like a classic example is, like the old example of men whistling at women. I mean, how many times has a woman turned around and said, oh, you whistled at me like, let's go out on a date? No. So it's not designed to be effective in what one might think. It's a way of opening up some possibility. It's not that. It's a sense of desire and a sense of anger and frustration that then says, hey, I can't take away that person's whatever it is, their beauty or their youth. I can't take that away, but I can make that feel awful. Right? So you could whistle at them and now they feel predatory and be set upon and people describe it with that, it doesn't feel good. That's envy. They're saying, I can't have what you have. And I can't actually take it away from you, but I can do just as good. I can make you feel awful about yourself. It doesn't matter you have those things I want. I took them away from you. And that's where narcissism coming through that lens of envy and capability when I see mass destruction, whether it's in a family or perhaps on our political landscape, and you look at what's the roots of that? More often than not, you come to narcissism. We don't realize the immense dangers that not recognizing what is that about? And that's about the self. And that person is trying to fill a bottomless pit. You don't ever feel about it. You can take everything away from everybody.

-You'Re not full.

-And you're not full.

You just threw it all into a bottomless pit. -How does a narcissist learn how to heal their own trauma when they typically.

Would never want to say that something's wrong with them? -It's very hard. People who are suffering from narcissism, whether it's internal, it's more like if it's internalizing. But even then, it's hard because there's so much shame associated with that and with admitting or acknowledging anything. It takes what's called ego strength. In the old sense of ego as like what's good about us, us at our best, our most knowledgeable, It takes ego strength to say difficult things about the self. So people who suffer from narcissism very, very rarely will bring themselves to treatment. Really? Yeah.

They'll resist therapy for years, right?

Very, very rarely. When they come to treatment, it's often because there's some external impetus.

Like if they are obligated to or they feel like they have to.

Well, that person's family says, Look, you really just can't come back. unless you're behaving differently. Right. They've gotten in some legal trouble somewhere. You have to go to some therapy work. There often is some element of compulsion. There are things we are more likely to seek help for as humans and things we are less likely. And because narcissism is such a strong defense against shame and inadequacy, then you can see how that kind of falls into the category where people are much less likely. So when we go get help, for that. And it's a whole defensive structure, right? It's not about like people can often separate. I kind of know who I am and I know how I am when I get depressed and I don't like that because that's not me to be lethargic and I'm not getting out of bed and I'm not there for people I love and I don't like that and I want to be back to me. It's different when what's going on is like that is part of the character structure. That is the person and it takes a lot of courage to recognize something like that and say, Look, I want to make that better in myself. And I know I've got to look at really difficult things. I've worked with people who do that.

Really?

You just don't see it.

It's rare. When does that usually happen where they come to you? Is it like their world is falling apart or they're just, you know, have a massive breakdown?

Yes.

That's when they're finally like, okay, I surrender.

And that's what kind of makes the compulsion.

Right?

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

Build a relationship and trust before you.

Can start talking about difficult things.

Is there any way to heal trauma without re-experiencing the pain of the trauma? Or do you just, you've got to go through the pain in order to get through the other side?

I mean, to some degree, I think you have to go through the pain. Again, there are exceptions where someone is sort of blessed with a lot of ego strength and a lot of resilience and can look and say, look, I know This, this, and this is true about me. And this is something I don't want it to be there for me. And they can sort of compartmentalize and partition it, but that's usually not how that goes. Usually we have to look at the pain of it, but that doesn't mean reliving every detail. And a lot of times people sort of think, if I'm going to go, even in my own mind, do trauma work let alone with another person, I'm going to have to say every detail. about something.

You won't see every detail. Is that what you're saying, or you will?

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

What's your definition of shame?

Shame There's this idea of core affect in us, and it's kind of a technicality, but affects are sort of aroused in us, right? And we think often of aroused as a sexual word. You could see how it's that way, like something turns a person on without choice, right? Yes. But lots of things are aroused in us, right? Somebody comes in front of you and pushes you, like fear or anger are aroused, right? And we know that because that courses through the person's body, right? And you see like changes in skin conductance, the person is getting ready for fight or flight, right? And the brain patterns change and then they know it. Right? So that's interesting, right? The knowledge of it comes after because that's actually less important, right? For say staying alive, right? And the same is true with shame, like shame is aroused in us and it's just this awful feeling, right? Of like terribleness of the self. self. And you think, why are these core affects in us? It's very clearly about survival. That example of someone appears in front of you and pushes you and your whole body gets ready to fight or flight and then you know it. It says, all right, that's about survival. And shame has a function in us too. Imagine doing something shameful. Humans, we still do in some cases, live in small groups. If you got up in the middle of the night and ate all the It's okay if you feel ashamed, you have shame imposed on you the next day because it's like don't do that again, because that could take everybody's life. So there's a function to it, but when it's aroused in us and it's not aroused in a sense for good reason, like one hasn't done something shameful, but it's aroused because of that feeling of vulnerability. And trauma can be chronic, the chronic of systemic racism that tells somebody like, oh, you are less than. They get that message over and over and over again, right? Like it's a different kind of trauma, but it's no less valid, right? Where we see it, of course, most dramatically is in acute trauma, right? You're the person I would see in an emergency room after a rape who's talking about how ashamed they feel, right? And it's like, why? Okay, because the shame is aroused in the person, it's created. right, from the sense of vulnerability, the sense of terror, right? And then if that person doesn't have a route like that says, of course that was created in you, right? And now we need to talk about what to do with it. Because if we don't, we know what it will do. It will go inside of you, right? There starts the changes to the immune system and that person is more likely to then have an autoimmune problem later on in life, more likely to get cardiovascular disease, more likely to become depressed, more likely abuse substances. That's what happens because that shame becomes the persecutor inside of you. So let's look at that and if we can look at that in an emergency room right after something has happened, that's a great time to do that because you can be most helpful to that person acutely. But what's amazing is we can do that 40 years later too and still get an impact. A parallel to physical health is like an abscess, right? It's like infection inside of us that's walled off.

Off.

And sometimes there can be an abcess that doesn't do anything to us, but more often than not, it spins off symptoms. Low grade fever, feeling of fatigue, jittery, it's not good to have inside of us and we'll see it track forward like an abscess would, but over years and years and years where that thing inside is spinning off all these negative thoughts and feelings and choices. And we can go get at that unlock it, expose it to the light of day, and then it doesn't have to be doing that anymore. There's actually kind of a simplicity. How trauma makes shame that's arousing us comes back in towards us, gets walled off, it then changes our feelings about ourselves, which then changes our memories, and then changes our mood, anxiety, behavior, and everything else. There's a simplicity to that story, and truth and mental health is grounded in simplicity. You know, our brains are comp, lots of things are complicated, but like things that are true just may mean they're easy, but there's a simplicity to understanding them. And so it's a long answer to the question, but that's how we get at what happens from trauma and arouse shame and how we get to like 40 years later and something's walled off inside the person and has harmed them now for all those years.

Yeah, the sooner you can address it, the better.

Yeah, absolutely.

The sooner the better. For 25 years, I wasn't able to sleep at night. It would take me an hour or two hours every night to fall asleep. I didn't know why. I was just like, you know, my mind was racing, but I didn't understand why it happened for so long. Literally, within a few days after I opened up about sexual abuse for the first time at 30 years old, it's like I could fall asleep within like five to ten minutes. My whole life I haven't gone to sleep, you know, or just I'd lay there in bed for hours finally asleep then have to you know wake up late I never felt like I could really get a rhythm going and now.

I can amazing that it's like so amazing what you said like just by talking about it opening up about it is then something that Deeply impactful for years like you probably had a conception of like that's me. That's me right yeah, right that's not gonna change so so I'm up against that all the time. And then, oh, lo and behold, it changes. And I think there's brain biology behind that, and I would even locate that I think areas like the ventral tegmentum, the amygdala, like I can think of like the parts of your brain that I think were so spun up because when you internalize that feeling of responsibility or shame or whatever was inside of you, that it comes with vulnerability and it makes hypervigilance. And then those parts of the brain don't want to sleep. It's not like you weren't sleeping. Protect yourself, protect yourself. Right, it says, part of your brain is saying, this is good for you because this inability to sleep may keep you alive.

Right.

So if that part of the brain has its say, that's why that gets perpetuated because the brain decides, right, this isn't great, but it's the best it gets. But then when you, even opening up about it, which must have relieved, like glancing in abscess, right? oh my gosh, then those parts of the brain quiet down and your whole brain decides, you know what's good at night?

Restful sleep.

Why don't we get some of that? Because I am actually safe, right? If you just had that feeling, I'm safe, I take care of myself, I can go to sleep, and like, I don't think anything bad's gonna happen to me when I'm sleeping. And like, look at the immensity of that change just by talking about it. Like, it's so powerful, 'cause it's so deeply impactful. and it can happen with such a rapid shift of just letting it out. And I think why? Because it's a shift. What must have happened in you is a shift towards truth.

Absolutely, yeah. Talking about it and then rewriting the story like you said.

Right.

Which is huge. And the story for me was, you know, I'm not enough, I'm not lovable, I'm abused, I get taken advantage of. It was like a constant, so I was always on guard. looking out for that.

Right.

As opposed to rewriting the story. And I think that's.

And isn't it fascinating that that's the same words I hear put to it from people across the spectrum, right? No matter what, you know, demographics, age, gender, type of trauma in myself. Like that's it was, that's my dialogue too, right? Because that's what shame makes of us, right? That the you're not good enough, no one will love you, you can never be safe. That's the messaging and that's the reason that I wrote that book. It was the realization over years of doing this that I hear that all the time, no matter what type of trauma or what type of person is in front of me, I thought, well, there's something going on here at a sort of foundational level of our brains, right? And then if you think about the psychology and the neuroscience of it, it tells us the answer.

To it.

Yeah.

This is powerful stuff. What else do we need to know about trauma or for anyone listening or watching if they haven't started to process certain things or maybe they feel this angst or frustration or depression feeling, what else would you say to them listening about what they could do next?

Yeah. So I think the first thing I would say is to emphasize what's going on inside of you is not not too complicated to be solved. Because that's the thought. We get thoughts on top of thoughts on top of thoughts and it seems so impossible. Like trying to untie a Gordian knot. How am I going to figure my way out of this? And to know that that's not actually true. It's not too complicated to be solved. But we come at it in different ways. Probably why the story of the Gordian knot is thousands of years old, I think. It's mythology. that's not what you do. There are things that we can't unravel but that we don't have to. And the idea of making a new narrative, look at what's inside of you, means you don't have to untie that anymore. So know that in a sense, simplicity is your friend. And that gives us a great deal of hope and that we can start to feel better very soon, just as I think it's wonderfully how you describe how your life changed in just a few days, right? And like that's really the truth. I mean when I first went and went in and saw a therapist, I didn't know what to do with the person. Like how am I supposed to perform? Like all these thoughts in my head. I can remember saying like, my brother killed himself. It was like feeling so much. He's even putting it to words because like there's an immensity to it that was beyond me, right? So instead of like, that's my fault, I should have seen I should have known, I should have done, right? On bad because I went off to college and I got this job so I wasn't around home. I wasn't close to him. Like all these things, just saying that was like, whoa, this is bigger than you, right? And things that are bigger than us give us some freedom from them. But even the idea that like people do terrible things to other people, right? So because we get so lost in like, the idea that our traumas are unique, but the idea that like this never happens to anyone else, right? And the idea that no, like, people abuse other people and, you know, people die in accidents and people commit suicide and, like, there's a shared humanness to this. And I think that's so important in doing the work that, like, I don't understand, like, hiding who we are in our work, right? Because we're all traumatized, right? In my view of things, because that's what I see in the world around me and sharing that have an idea of what you feel, because my trauma is not yours and I'm not being presumptuous in a way of saying I understand that but the underlying feelings of shame and frustration, like I understand that and that's mostly what really what people want is a sense of, because if I feel so isolated and then I talk to you and I get a feeling like you're looking back at me like you could understand me and you're not recoiling from me, right? In fact, you may be coming closer to me metaphorically, right? Because you can relate to what's going on in me. It takes away the idea that, oh, if I share any of this, I expose to the world what an awful, unlovable, undesirable person. It's like the old adage of turn on the lights and show the child the clothes tree, right? That looks like a monster, right? And that's how we get inside of us. I can't look at this. It's incredibly complicated. And what shame will it make in me to talk about it? It's like, no, it's the exact opposite of turn the lights on, look at it. We can look at it. everywhere around it. And what does that make? Makes things better. By talking about your shame. Yeah, and by shining the light everywhere. How do you, I've talked to people about their feeling of shame and responsibility. Let's talk about all of it. Again, it's got to be done over time and in a careful way. And then a person can talk about the nuances of what they feel inside and that they hold on to responsibility and can get to a point of saying, look, my responsibility is to take care of myself. myself and be a good person in the world. I'm not responsible for things that I had no control over. And that's very, very liberating where on the one hand you're acknowledging the uniqueness of that experience in that person, and on the other hand you're mapping that to the shared humanity that says you are not singled out by humanity for awful things to happen to you. And that's a wow, that can be tremendous relief.

Yeah, when I started opening up about it, I remember quickly being able to fall asleep at night, but it probably took me eight or nine months to be able to fully talk about it openly with friends, family, and not feel like stressed. Right. You know, every time I talked about it, first to family, I was a little worried what they're gonna think, then to kind of close friends, then I started through my podcast and my work, I felt more of an an opportunity to really serve people. And I felt like this kind of nagging thing, like I should probably be vulnerable on my show. But I was afraid to talk about it for many months because I was like, what if it ruins my business and my life? People look at me differently in the public. My friends and family have to love me, but publicly it might be different. I felt more of a duty because as a young kid, I didn't see older men talking about it. In the 80s and 90s, I didn't see men saying I was sexually abused on TV or at least I wasn't exposed to it. Maybe they were, but I wasn't seeing it.

I didn't see it either. If they were, we both were. Exactly.

And so I felt more like the more I realized one in six boys, I was like, man, someone's got to speak up about it. I might as well do it if I have this opportunity. But it was a process, it was a journey. It took eight, nine months till I felt more and more comfortable talking about things. But at least I was feeling more peaceful inside within days of exposing the light to shame.

Yes, and two really important points that brings to the surface. One is you're saying, what can people do today? And it's remarkable, it's not just some shallow thing to say. When you do good for other people, you know that there's good in you to do. You see your worth. I think from understanding you're describing part of your healing was, I can talk about this in a way that has to help other people, right? And then what's that, that puts the lie to those thoughts inside. How can you not be good enough? How can you not make any positive impact if you can do this and make life better for people? And that's often what people start doing is they take a meal to the person down the road who lost someone in their life or they smile at someone when they might have been annoyed because they held them up in line or something. These things are really, really important. they're important because they are good for other people, but they reinforce like, hey, there's good in the self, right? So that part is very important. And then another aspect of this that I think is a huge deterrent in our society that wants immediate results, right? It's why we use like five times as much medicines as say the Dutch, right? Because they don't want immediate results, right? If you're overweight, like exercise more, like that, right? Let me just give you a medicine, right? But we want immediate results, and then we get frustrated that things don't change in our brain immediately. There's an adage in neuroscience that the neurons that fire together wire together. So if you and I just picked a word right now and we said it over and over again 500 times, like a guarantee you'll be saying it tonight. I'll be saying it over my brain to you tomorrow morning.

Why?

Because just the fact that we said it 500 times, our brain's gonna hold it essentially doesn't believe us. If we say that was a silly experiment, like eject it from the brain please. It doesn't do that. Right? And these patterns inside of us only atrophy. So people talk to people a lot about this because otherwise people start feeling better and doing better, but they still have that same thought in their head. It may be there less frequently. And someone needs to say to them like, hey, here's how this goes away. It atrophies over time. It's less and less. And I've worked with people who maybe had 10-20 years of non-stop negativity. Then they change their lives and they'll say, wow, it's 10 years later. That'll still come into my head. I do something, I dropped, I dropped a big, one person dropped a big thing of milk in a store and it shatters and everyone's looking at them and then they're like, you should kill yourself. Because that was in their head before, but they've gotten to the point where they know, like, I don't actually believe that, right? There's the proof that those neuronal connections die hard if you reinforce them over time. So that's why we need to do longitudinal work, whether it's on ourselves or in therapy, and to realize it's okay that it doesn't go away all at once, right? That's actually the best it happened. And what you described, in a sense, is very classic. You felt better in really strong identifiable ways very quickly, but then the cognitive patterns in you took much longer to come back. Right, because that's the way it works in us. But we don't learn that. I joke, half-joke, I'm going to write a book on everything I learned about life, or needed to know about life, I learned as a post-medical school psychiatry resident. Because I really believe we should be learning these things in elementary school. I'm not the only one Think that, like why are we not teaching about like why is that bully behaving that way? Right? Why don't we look at how that person can feel better about themselves in a different way? Look at what's going on at home, right? Help the people understand who are being bullied, right? Like that person is something is hurting that person, right? So they're coming after you and they're making fun of like your clothes or your looks or whatever it is, right? But like but that's you know who that's about? It's about them.

Yes.

Right? So you then externalize them but we don't do that. And then we grow up without all this like really basic knowledge. And I remember being a second year psychiatry resident. So I had another career before this. So by then I'm in my early 30s. I'm probably 30 years old and I'm a second year postgraduate resident. I was like oh my god, why did I learn this in second grade? And I think we need to start teaching ourselves these things as adults and then also to kids because that's how we protect protect children. And there's a chapter in there where I talk with Stephanie von Gutenburg, who's a child advocate, a child abuse advocate. And I think that chapter brings out how we can educate and empower children in ways that we just don't now. And sometimes they're dramatic things that happen then, but sometimes they're things that are, in a sense, insidious if they're less dramatic, like somebody who's just bullied, for whatever reason, or they look different than everybody else. They have less resources than everyone else and there's nothing dramatic happened, right? No one identified that as problematic, but that person is every bit as traumatized and their sense of self is changing. We just have to change this. It's so clear and obvious that we have to change it.

Well, if you could teach three things to second graders, what would you teach them?

Pay attention to what's going on inside of you, right? The idea that we think, you know, I have a daughter who's seven and she wants to count together but in our heads, right? Because it's interesting to her now that she could say things but she can think them in her heads, right? And engendering that kind of reflectiveness, what's going on inside of you, we can do with children, right? And we can help them put words to whatever that is, right? That and what we wouldn't use these words, but attribution, right? whose fault is something? And again, the classic element of bullying. If you ask kids, what's going on? The kids who are being bullied, they blame it on themselves. There's not the cognitive mechanism. Look, I've sat with kids who have horrible things. They've been burned with cigarettes and locked in closets. And they have a story of how that's their fault. Because the brain doesn't know enough to think differently. you're that age, you can't make it a more esoteric attribution. You don't know enough, right? But if someone helps you to look and say, oh, you feel ashamed of yourself because that person tells you to, right? But what's actually going on? It's not that hard to communicate in age-appropriate language. So don't just blame everything on you. Then you can also go, are you doing things that you should feel feel bad about it? If you're talking to the bully, right, do you want that person to understand, like you're hurting these other kids, right? And does that feel good? If so, why? Same way we would with adults. Like why does it, if it feels good that you're hurting people, let's talk about why is that, right? Because where do we get to that? 100% of the time, we get to trauma. We get to something that's some version of, I don't feel good about myself and it feels powerful to hurt other people. But boy, you get at that in second grade instead 20, 30, 40, 50 years old, that you can really change that. There's an aspect of this that I do feel kind of regresses back to the mean of just common sense. And I think that is in the book. If it were an academic book, I wouldn't have had it in me to put the time and effort into writing it. But the idea that there's a simplicity and a common sense here that can really, like the light bulb can go off, like I know how I can make this better. I can look at what's going on in my head, I can rethink the narrative, I can do something good for someone else. That can all start happening today.

This is powerful stuff, Paul. I want people to get the book. Thank you. It's called Trauma: the Invisible Epidemic, How Trauma Works and How We Can Heal From It. We'll have to have you come back on and do a couple more hours on this stuff because I feel like it's fascinating work that you're doing. You've worked with a lot of big entrepreneurs, CEOs, celebrities, world-class athletes and individuals, and also people in day-to-day life, you know, living their lives, working their careers in relationships and dealing with their own challenges.

You see that we're all people.

Yeah, right.

I mean, you work across the socioeconomic spectrum and you just see that, like, we are so all the same and we're kidding ourselves if we think that whatever we've gotten for ourselves, some status, something that is good to celebrate good things we make in our lives. But we, let's not mistake that for the shared humanity in all of us, which I think is very, very hopeful. The shared humanity of trauma is absolutely true. And if we think of it that way, well, that's how we heal from it as a society.

Is it harder to heal trauma if you have a bigger platform or if you're a celebrity, would you say, as opposed to, you know, maybe not that many people know about you? Yes, it's harder.

Because fame brings to other people the feeling of they have a right to make some sort of pronouncement about a person. And sometimes that comes through the lens of someone who really legitimately admires someone. But there are a significant subset of people who are externalizing their trauma who are, in a sense, attracted to people who are famous in order to them down. And we see that in the media, right? Like fame is, they can bring good things, but it also brings danger. I have two final questions for you, but again, I want people to get.

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

Yeah, LinkedIn. LinkedIn, okay.

One social media platform. But drpaulconti.com is where they can learn more about you and the book and they can go get it on Amazon, obviously, and Barnes & Noble and things like that. So check out the book. Thank you. This question is called the Three Truths and maybe you've already kind of answered a little bit, but I ask everyone of this at the end of our interviews and I'd like you to imagine that it's your last day on Earth many years away. to live as long as you want to live, but then eventually it's the last day for you. And you get to accomplish all your dreams, all the things you want to create, they come true. But for whatever reason, all of your written and written work and content and videos and audios, for whatever reason, they go somewhere else. So we don't have access to this content anymore. Okay.

Or the book. Okay.

But you could leave behind three things you know to be true, three lessons you would share with the world. and this is all we would have from you. What would you say would be those three truths for you?

Look at what's going on inside of you. How are you treating other people? How are you treating yourself?

Before I ask the final question, Paul, I want to acknowledge you for the incredible work you're doing, you know, to, to be doing this for, you know, two decades, to be helping so many people in your practice consistently, to be creating this book so that we and have tools and information to help heal ourselves and get to the root of why we're frustrated or angry or depressed or something's off. It's all based on the traumas that we've dealt with and we haven't, or we've experienced and haven't dealt with yet and integrated through healing. So I really acknowledge you for putting your work out there in a way that we can consume it and understand something that is so scary to look at for so many of us. It's terrifying for a lot of people to face their shame. And so I acknowledge you for doing this work and I hope so much. Yeah, of course. And I hope people get the book. It's forwarded by Lady Gaga. So make sure people check this out. This is the final question. What's your definition of greatness?

Perseverance and humility.

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

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