#533: Paul Conti, MD — How Trauma Works and How to Heal from It

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Yeah. At this altitude, I can run flat out for a half mile before my hands start shaking. So then I'll do a personal question. No, it is. My cybernetic organism living tissue over metal mental scale. Hello, boys and girls, ladies and germs, this is Tim Ferris, and welcome to another episode of the Tim Ferris Show. I am thrilled.

My guest with me today, Paul Conti MD. Paul 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, and then served on the medical faculty before moving to Portland and founding a clinic. Dr. Conti specializes in complex assessment and problem solving, as well as both health and performance optimization, serving patients and clients throughout the United States and internationally. including the executive leadership of large corporations. His new book is Trauma, The Invisible Epidemic, subtitle How Trauma Works and How We Can Heal From It, you can find him online at Dr Paulconti, C O N T I dot com, and also at Pacific Premier Group.

Dot. Calm Paul, so nice to see you, my friend. Thanks so much for having me. It's great to see you too. I appreciate it. And I have been Looking forward to this conversation in my mind's eye for some time.

Because we've known each other for a while. We met through our mutual friend, Peter Atia. And I saw a very early Manuscript. of trauma, the invisible epidemic. We were doing the math beforehand before we pressed record around two and a half

Or so years ago. And I was so thrilled. that you were putting your experiences and your approaches into book form. The fact of the matter is, most of the time when I have Every friend, acquaintance, and their cousin and grandma

Telling me they're going to write a book or asking if they should write a book, I spend most of my time dissuading people from writing books. A because I think they'll be just redundant or not a great value add. And then on top of that, I really just don't want to be forced to read them. And uh my feeling with you is c is very much the opposite. You are Such a

A deliberate, thoughtful, and skilled practitioner. And I also, of course, value you as a friend, but I've had a chance And I'm not gonna d disclose details necessarily. But I've seen you really intervene and quite likely save lives, and I I can't say that

For many. So it's a real Honor to have you on. I've been looking forward to doing this for a very long time. I have the highest opinion of you just to establish that upfront. And with all of that, let's Jump in and I would love to hear also because my memory needs refreshing, but for people listening, how you ended up in psychiatry.

Thank you. And I I wanna thank you for your support when I was really figuring all this out and deciding I really want to write a book. And it's such a leap to take that your your support and encouragement about how that would be a worthwhile endeavor and could could really make a difference was so helpful to me two and a half years ago in And before then too. So I'm so appreciative of that. And it's sort of part of my circuitous route, you know, that I had no pre medical classes in college and I had a business career. And and you know, at some point in time I I realized that what has unified my interests across time was really about people. So, you know, I studied history and political science and art and and I was very interested, but ultimately it was really in the people. This was also fueling my interest in business was the people I was engaging with and what were they like and how did they have these thoughts that got them to where they're at. And it was that sort of unifying element that led me to go back to medical school and think, okay, I'm gonna learn about human biology and just learn something about human beings. And it was there that I realized like Oh, you can take this medical knowledge and you can take the sort of life knowledge.

whether it's history or politics or sociology, just knowledge about human beings. And you can put that together with an individual person who's sitting in front of you and talking about them, like the specifics of their life and their experience. And you can put all that together and really be helpful to people, like really make a concrete difference that you can see there there's a change. And and that was Is ultimately so appealing. to me and I felt like I could get that through psychiatry. And I think I found that to be the case. I'm so grateful for the vagaries and the idiosyncrasies that ultimately led me to be able to see all of this and choose it as a career. Many follow up questions. But we're gonna kinda flash forward.

Two current day and then we're going to flash Backward. A little snippet. From the forward.

In your book. I think you'll recognize this. And then I'm gonna ask you to add context. Okay. Why didn't you bring me a real doctor? I asked the nurse. Paul replied by saying, I'm an Italian from New Jersey. And that's when I decided I was willing to talk to him. My dad is an Italian from New Jersey, so I figured I at least knew what I was dealing with. Whose words are these?

Those were the words of Stephanie Germanata, who's also Lady Gaga on our First meeting. I think uh what I would describe as I think our our auspicious first meeting. So she wrote. The Forward.

Of course. You didn't start off with clientele or clients, patients like her. Could you tell us a bit about Since we've mentioned the title a number of times.

Your own personal history. with trauma. If you'd be be open to sharing. In the first part of my life It say up until around early twenties.

I didn't have major trauma. In my life. And In some ways I was fortunate to get through the big developmental milestones without major trauma. And it gave me a sort of view of life that was then deeply challenged by a sequence of traumas that that sort of came in the second part of my life. And

Seeing how they made me Feel differently. about things because I had the a sort of foundation of confidence in myself and also in the predictability of the world that if I'm engaging and doing the right things, the good things are gonna come back to me. And how differently I shall.

One after my brother's suicide, which was the the first of a a series of quite traumatic things that unfolded over a number of years. But the challenge of that, of realizing that when trying to figure out my way through this and like how to go on with life and how to s support my parents and the people around me. While I I have an awareness that like I am different. that now I'm I'm seeing the world differently and all of a sudden I you know maybe I feel a little bit like Am I cursed? Is is my family cursed? Is is anything gonna be okay? Maybe bad things always happen. I was so off balance and in a way kind of it impacted, impaired even by all of this and realizing that we can I even trust how I'm thinking.

because I'm thinking differently, and then I'm trying to use the brain that's thinking differently to figure out what's different. And it was something quite scary. about that that I could also then I could see when I became a psychiatrist play out in the people I was trying to guide or advise or take care of that they also often had thoughtly. about themselves. They stopped seeing that they could make their way in the world, or that they had good things to offer, or that they could even stay safe. And and that for me, like really caught my attention that hey, there's something going on here that is That's very deep and also very insidious.

Thank you for sharing. And I just want to Echo. Some of what you're saying. in my own personal experience with Depressive episodes, which I've had as a a mainstay of sorts.

for most of my life, and it can be very terrifying and certainly disorienting. Say in the middle of a depressive episode. To be aware That You are looking at the world through a distorted lens, but to

have no confidence that you can correct that lens. It can be very Terrifying because you feel like your the prism through which you're looking at reality is broken and you're aware there's a problem, but you can't look through that broken prism to fix the broken prism or or so you might believe. And it can be Extremely

Disorienting and sometimes destabilizing, for sure. And I wanted to ask if you might be willing to speak to some of the other traumatic events and to Please. Us in time. Starting with perhaps your brother. How old were you when your brother committed suicide?

So I was twenty five. At the time. Twenty five years old. And Are you willing, if you are willing to share, would you be open to mentioning some of the other things that happened to you? And the reason I'm asking about this is not to

inflict pain in revisiting these things, but rather to share your personal experiences because there are very likely going to be people listening who will identify with different parts. Of your story. I understand and I think it is helpful. The context is helpful and I think it does it speaks to the impact of repeated traumas. that not long after my brother's death one of my Best friends, uh person I

Grew up with died. I died very unexpectedly, you know, we were in our mid twenties. Several years down the road my wife was injured and injured quite seriously. I lost another very close friend in under very tragic circumstances uh a couple years after that There were other traumas that were interspersed that weren't at that level. So there was this there's a sense of like continued negative things happening. My mother became

Ill with pancreatic cancer. And died not that. long after her diagnosis and that was very painful for very many reasons, in including the feeling that my brother's suicide and the impact upon the family had maybe predisposed her to getting sick, which, you know, there there may be some truth to that. There may not. We can't know the answer, but that oppressive feeling. of like there's one bad thing after another and I can't control any of it and amidst it if I'm not really grasping to get to keeping a hold on m my sense of self that I could potentially lose that to or a sense of my place in the world. The uh idea you described of say what amounts to learned helplessness that says I you know I see these bad things, I see what they're doing to me, but I don't think I can change any of it, that I could there was a real danger

of that throughout that whole period of time. And if we focus on This term we've used now a number of times. Trauma. How do you suggest people

Think about or define. This term. Now I'll probably do this quite a bit in our conversation just to ensure that everyone understands the way in which we're using certain Terms. But how would you suggest people think about trauma?

And if there are subsets or different types of trauma, perhaps what those are. I would describe Trauma is anything that causes us emotional or physical pain that surpasses our coping mechanisms that makes us feel then overwhelmed, often overwhelms our our nervous system, both body and mind, and then really leaves a mark on us as we

Move forward. And trauma. can be acute, right? A a single traumatic event, an assault, a car accident, an injury in combat. Trauma can be acute. It can also be chronic. So the the chronic impact of say ongoing abuse or ongoing neglect or even ongoing marginalization. And we see so much of this has come to the forefront, whether that's gender identity or it's racial how many people are trying to exist, and doing their best to not just to thrive, but doing their best to survive amid circumstances that are constantly telling them that they're less than or that they're at s at special risk.

That's chronic trauma and vicarious trauma comes from really this wonderful fact that we can be empathic and empathically attuned to other people and we can feel what they're feeling. I mean, that's a wonderful thing that we can do that for one another, but it also makes us so susceptible to other people's suffering and pain, and we can lose the boundaries of what is us and what is them. I mean, I'm not the only physician to say that at times, especially in the intensity of the training, period would would have to really stop and and say, okay, wait a second. That is happening to what is happening now is happening to someone else.

Not to me. Because if I don't maintain that boundary, I'm too overwhelmed to help them. But if one is em empathically attuned, which many, many people are, then we don't bound ourselves from other people's suffering. So there's acute trauma. Chronic trauma and vicarious trauma and of course an overlap. There can be an overlap between them too. I'd like to you know since we're all so you and I catching up

ourselves as friends, not just doing an interview. I'd love to sh yeah it's it's really really great to see you and I'd I'd like to share An experience maybe in the last Category. I don't want to give it a capital T But

I've had a a new experience and I've never passed through this type of shift in myself, I don't think. An acquaintance, uh I don't want to say friend, but someone I know. had a horrible family tragedy not long ago. His teenage daughter was killed in a head on collision with a large truck, like a Mac truck. And for reasons that I I don't think were necessarily determined, her car just swerved ever so slightly into the incoming lane and Dead on impact. And since that news

I get exposed to tragedies. Every day. I mean if you look at the news, you buy the newspaper I mean there are tragedies everywhere. So I don't know why this had such a Disproportionate. I don't want to say disproportionate, but such a large impact when I'm exposed to tragedy of other types all day long. But I have had

Extreme anxiety. While driving almost every day since that happened. Right, I can understand that. Yeah, and I don't want to take Necessarily.

an anxiolytic just to mute the anxiety or to suppress the symptom. But in a case like this, just because perhaps it's maybe easier to tackle than something like the childhood abuse that I experienced when I was really young. How might someone approach this? With or without professional

help. And maybe this isn't the forum in which to discuss it. But I'd love to hear any Thoughts you might have, because I've I've never experienced anything like this before. Tim, I think it's a great Forum?

for it because it speaks to A common problem? And a general principle in approaching the problem. We have to divert our attention From

our instability and the unpredictability of the world around us. Like on some level, like we know that like kinda anything could happen and and we're we're not safe from moment to moment from tragedy. But we have to sort of set that aside. where it's kind of in the periphery of our mind. And that's what lets us be able to go on and like live our lives. And things will happen sometimes that really resonate with a person. Now here it may be that something makes you really identify with this person, even though they're an acquaintance and say not one of your closest friends. Or it just may be that something about the story.

Or even something about your own condition, right? The fertile ground inside your mind when you hear the story. That makes it resonates with you and then in this like that's a very classic aspect of vicarious trauma. Then it resonates and you feel as if like That's happened you get some shadowing of like what that must feel like.

For that person. And then it shak your sense of stability and predictability and his ability to control the world around you and be safe. And that starts making you feel Insecure, vulnerable, like it's a natural response. And the thing to do about it is to validate it. That's the the primary point I would say in response is to validate it because what people most often do is the opposite.

It's unpleasant. It feels so bad that the person wants to say, Oh, there's something wrong with me. Why am I feeling this way? about this. Like it didn't happen to me. This isn't one of my someone in my close family. Like is and we try and to somehow invalidate what you're experiencing instead of saying, No, it's unstandable. This is reminding you of something that you do actually know is true. but it's bringing it to the forefront of your consciousness, the vulnerability, the unpredictability, difficulty controlling the world. And if we validate that and realize, okay, I'm not learning anything new from this, but I'm feeling something very strongly. And I wanna honor that I'm feeling that. And then to be able to put words to it with someone, you know, that you know and trust and to be able to to say that helps to pay down some of the anxiety and distress that often gets worse if the person is trying to shove it down and invalidate is what's wrong with me that I'm feeling this way. It just grows that tension.

Inside. Yeah, right. That makes perfect sense to me. I mean you have sort of a catalyzing event and then you have So let's just call that one I hesitate to use this term, but like one problem. And then if you have a very self Not defeating, but s but self critical judgmental response to it. Now you have another now you have quite another problem. As I'm thinking about this, I haven't really spoken to anyone about this, but I recall at the time.

'Cause you you have me wondering, like, why did I respond to this in this way? And I think that the circumstances Temporally, right? The circumstances at the time. had a lot to do with it. I think a number of very difficult, unexpected things had happened in my life. I then also got the news.

In a Somewhat. I don't want to say frantic, but Very urgent text. from a mutual friend of this acquaintance. And when I called, there was some type of help that I was

Potentially being asked to provide and I couldn't provide it and so I see. Uh I found it very jarring. In that respect. So I wanted to share that as an opportunity for discussion. If I could say back to him, that makes sense. Think about the the sense of vulnerability and the sense of I can't even do anything to help.

There's such a sense of vulnerability that then gets reinforced by that. And often people do want to help even when like there is nothing someone can do to help. And then the person feels bad. They can't make anything better, make the person feel better. And that adds to that sense of of terror. really. If we sort of validate within ourselves, I'm doing what I can do. Like I I can be here for this person. I can listen. I can let them cry or be upset around me. Like that is what there is to do, then that can take away

From the sense of desperation and vulnerability and I want to help, but I can't, because that critical voice that you referenced is very, very common in people who are conscientious, which is, you know, most people are conscientious people capable of feeling someone else's pain. So that critical voice comes to the force so readily. It's reflexive, right? Which is where the shame comes from. And there's a whole cascade of, as you said, secondary problems to the initial negative thing or the initial problem. Uh, thank you for listening and for Talking through it.

How would you describe the current state of Treating. Successfully. Or unsuccessfully, or anywhere in between.

Trauma. What is the current standard of care? And what do you make? Of some of the tools in the toolkit. The short answer to the question is by and large abysmal. And I think that's not because

You know, the people in the helping roles don't want to do their jobs or aren't capable of doing their jobs. But we've evolved a system. That purveys mental health care largely without attention to the actual human being. And this is a huge Problem.

If you think about the shortening of visits, I mean, how much can you really talk about who you are or what's going on in you in the kind of brief, often rushed and infrequent appointments. that we have in our health system. And an over reliance on medicines. Which leads to a paradigm just wants to basically take a symptom inventory.

Right. So well, tell me an inventory of your of your symptoms. And I used to say this sometimes when I was teaching where I would give an inventory of symptoms of a a person who had a rock in their shoe. And then often at the other end of that would be like well, what do you think is going on? And and people would have to say Attention deficit disorder. Because you know, the person's not paying attention to things or distractible. But if we just take symptoms, like we will get it wrong. Yeah. And we'll get it wrong a lot. And getting it wrong is it benign. It's just it's not that, oh, no help is given because

We got it wrong. No, it's actually that harm is done. And the symptom inventory, you know, make a diagnosis or several diagnoses and then throw by and large, medicines at the diagnosis just doesn't work. And what we end up doing is like so much in the American healthcare system. We spend so much. But we are at the bottom in terms of industrialized countries of outcomes. And that's because we waste so many resources by not looking in depth at the actual problems. And I think we we we do a very poor job at identify and processing trauma for all of those reasons.

Are there Any places This could be a country, a city, it could be specific clinics. That stand out to you. As

opposite end of the spectrum. Either highly effective or at the very least more effective. With addressing trauma. I have some

information and data about what's going on in in some of the European countries, but not enough to comment really with any authority. I think that most of what goes on in America ends up being a very low bar. in a very formulaic purveyance of care. There are exceptions. So for example, the bridge to recovery, which is a place uh Peter has talked about, and I think is a is a place that really sets an example of how to be different. And of course it's a residential facility and not everyone needs to or can go to a residential facility, but that route of approach of really understanding the people and understanding developmental trauma, even if the reason the person is coming to care isn't specifically the developmental trauma, but realizing that p people are are we all a whole. We're a whole person with our feelings, memories that evolve in us over time. And so they do a wonderful job of looking at the whole person. There's not certainly not the only

entity that does that, including individual practitioners. But by and large, it is hard to find systems that will treat trauma from a holistic perspective. How do you find the proverbial or metaphorical rock in the shoe. And by that.

Uh I I know you were giving an as sort of an illustration of a of an exercise when teaching but beyond Symptom inventory. How do you begin to unearth The

Causes. At play. With someone. What I find so interesting about this is it's actually not that hard.

If you can build a rapport With someone where they feel like, okay, you're not looking to fault me. And you you're not looking to stigmatise me. You're actually interested in me, interested in what's going on. in me. So I wouldn't say to everyone

I'm an Italian from New Jersey. But but the thought of That's not your opening salvo. But when someone is you could tell is in pain and you're thinking, look, is there is there a route in which we can connect? And Stephanie is an Italian from New York. There's a similarity that can then establish a rapport that can then lead the person with whom I'm trying to establish the rapport to really feel like I can talk to you. I can talk.

period, right? I can talk openly. And it often leads to right where We need to go. 'Cause people often are aware of like what's going on inside of them, what triggers them, what's going on in that the tape that's playing in their head. all the time? How do they feel badly about themselves? What's their internal dialogue about themselves? And when you let people start talking, very often they'll talk about it even if they never have before.

They might have had treatment for depression in fifteen different settings, never talked about trauma. I mean, by the way I see this a lot. That's not just theoretical example because no one's asked about it and been and been open to it. And that reinforces the idea of shame and stigma. No one's asking about this, even though we're ostensibly here to talk about my mental health. That reinforces the messaging of stigma and shame, but if you give people an open venue to talk. It's remarkable how it can come to the fore, be processed or validated or challenged.

however it may be, it's just an openness to it, which involves a milieu that allows for that to happen, which is something other than very, very rushed, like, okay, we have 15 minutes. Let me let me hear your symptom inventory so I can write a prescription and then the next person can come in. That's never conducive to openness and sharing, but if we make environments that are open to that. really good things happen. I would love to Ask a question that that might pop to mind for listeners as well. And

as just a backdrop, you know, I've thought a lot about trauma. I'm not I wouldn't consider myself a a domain expert, but Had experiences of sexual abuse when I was very small and consistent regular abuse for several years from two to four. at a babysitter's house and So I've

Thought and read quite a bit related to Trauma but I think it's important to note And please correct me if I'm not getting this right, but the You are not a hammer looking for nails with

Trauma in the sense that you Cover a very Broad spectrum. Uh Different.

Conditions, issues, wants, questions with patients. And It seems to me that there there's probably a potentially damaging just like the symptom in inventory isn't is not neutral necessarily. It can result in in very bad outcomes. I've done some reading on

controversy related to say suppressed memories. Right. So I'm sure there are therapists who actually do a lot of damage by trying to fit a narrative of trauma to every patient that they have in some way. I'd love to just hear you comment on the good, the bad, and the ugly within the Discipline, let's just say, or skill set of treating trauma.

The first thing I would say is I never made a conscious decision to say, Hey, I'm gonna be a trauma person. Right, right. Oh. This is running through like everything that I'm doing.

And at the time I really first started seeing it, I added open general practice. And I was seeing what are the commonalities across people that I'm seeing socioeconomic, demographic background, diagnosis, what are the commonalities? And of course I saw how often substances were playing into what was going on. And I saw even more strongly than that how often trauma. was playing into what was going on. Whether that was depression or anxiety or insomnia or even the evolution of psychosis or the triggering of bipolar episodes. I mean there was just so, so, so much that was keyed to Trauma And that's what really like captivated my attention and then grew my interest and my research and clinical approaches to it. I think it's there and it's quite pervasive, but it of course isn't the answer.

To everything. And yes, if you have the hammer and you want to see all nails, then then that's what we see. And I think we have to be very, very careful because We often as human beings we develop sort of allegorical ways of understanding things. And we can do that consciously and also unconsciously. So the idea of recovered memories from the perspective of, oh, that person had no idea that that thing had happened. And now they know that it has happened is something we just must be skeptical about.

In a way that's careful. I don't mean skeptical in a way of trying to invalidate a person, but but being careful because If a story that's not actually true becomes that person's touchstone for truth. That is not good for that person. And it can be it can be very damaging for others who then may be falsely accused of something, for example, right? Most of the time.

And they've been doing this for twenty years and I would say the vast majority of times when someone is now talking about a memory. that they haven't talked about before, it is not because they had did not have that memory before. It's because it was riding in the sort of boundary being above and below consciousness, right? And they they know that that's there, but they don't let it into consciousness or let alone put words to it. And then there's a way in which the memory or the experience the person has talked about fits with their internal world before it came to the fore.

as opposed to it in a sense kind of coming out of the blue, which we just need to be more careful about for the sake of that person who may have had that come out of the blue, because maybe that's true, but maybe that's not. And if it's not, it's not helpful to them. And it's potentially risky to others if that makes sense and and the more that we work against stigma, like I know I'm saying this because I believe with all my heart that it's true that your Willingness to talk about your own trauma. Is so

powerful. It's so powerfully helpful because you're pushing against reflexive stigma. Because trauma makes reflexive shame and reflexive stigma. And that's what makes people go underground, so to speak, with their trauma. And that's where confusion. Comes in. Misery gets compounded, confusion comes in because people are alone with something that's terrifying them and they're alone over time and their own brains can evolve. in ways that maybe sometimes are helpful, but maybe sometimes are not helpful.

So the more that we work against stigma and shame and say, look, what is there that's happened to a person that that person should not be able to talk about? with trusted others, right? Or clergy or or Helping people in helping fields. the a person should be able to talk about what's going on inside of them because it's burying those unhealthy seeds, so to speak, that then

compounds original trauma into something that can end up being far, far worse with a whole cascade of problems. Could be depression, could be substances, could be self harm, could be an eating disorder. There's so much that gets compounded when the original trauma gets pushed. outside of consciousness and outside of communication. It brings to mind for me. Something and I'm paraphrasing here that someone named Gabor Mate

And again, I'm not getting this word for word, but he spent a lot of time working with opiate addicts. Yeah. British Columbia and elsewhere. And He

is fond of saying we shouldn't ask why the addiction, we should ask why the pain. Yes. And Certainly in my exposure to addiction. My best friend from childhood died of a fentanyl overdose, and my brother's best friend from childhood Died in drunk driving accidents.

Lot of substance abuse where I grew up on Eastern Long Island. And My uncle Actually recently died of Yeah.

I'm not laughing'cause it's funny, but alcohol. induced cardiomyopathy. His wife, my aunt, died of Percocet plus alcohol. So I've seen A lot of addiction and What God war says really resonates.

With me. Just a quick thanks to one of our sponsors and we'll be right back to the show. This episode is brought to you by Athletic Greens. I get asked all the time what I would take if I could only take one supplement. The answer is invariably athletic greens. I view it as all in one nutritional insurance. I recommended it, in fact, in the four hour body. This is more than 10 years ago, and I did not get paid to do so.

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Some of the tools in the toolkit. And I'm not implying that you utilize all these modalities in your Practice but For those people out there who are wondering and we're gonna talk about the framework of the book and how you put it together and what people who don't have access to

Paul Carty. might expect to learn and be able to apply from the book. But before we get there, in the last handful of years As you know, I've been hoovering up A lot as a uh as an enthusiastic amateur and have found certain things personally very helpful, like IFS internal family systems I found very helpful.

I've helped fund some studies with different formats of therapy like CBT Or DBT dialectical behavioral therapy. Yes. I'm hoping I think I've already funded or my foundation has funded a study involving

These acronyms get really tricky after a while. Cojoint or conjoint. Something that is conjoint and similar to CBD, but the idea being that you are using in this case therapy MDMA assisted therapy for not just The individual who experienced trauma

And I think in this case it's veterans, but also the spouses. approaches people may have heard of EMDR, which I don't have much experience with, but all of these various tools in the toolkit. Are there particular

And this may not be a good question, but uh I'm curious, so I'll ask, are there particular Modalities. frameworks, tools that you have found to be particularly helpful. In Working.

with individuals who have Trauma in their background. There are many arrows in the quiver. And CBT is is an arrow in the quiver, DBT is an arrow in the quiver, medicines can be an arrow in the quiver. But where it all has to start. is a search for truth, right? Be because trauma changes our

emotions about things, feelings and emotions about things, it then changes what we how we think and what our memories mean. So we need to look at what is the person's narrative. About Trauma, if they're identifying that there's trauma, and if not, what is the narrative about self? Because unless we understand that, then it's like trying to solve a problem. So you're trying to solve a math problem, but you don't know what the equation is. We're not gonna pick the right tool, we're not gonna get to the right place. So because there's so much reflexive shame and then a cascade that comes after that.

And a lot of times that involves like a decrease in role performance, where now the person doesn't they're not performing their role, say as a parent or as an employee or as a friend. As well. Then the person begins to think of themselves in a different way. And the first thing to get at is what is the person's narrative. So someone who may present and say, Oh, I've I've really got physically hurt in my last relationship. I mean is it's always what happens, or it's never goes any differently, right? Let's look at the trauma from this thing that happened to you in your last relationship. You have to look at why is the person approaching

The whole question of relationships from a place that says things won't be okay for me. What are the lessons that that person has learned that are not actually true? And you have to go back to why when did the person start thinking of that? I mean, you know, people don't um saying it for effect, but people don't pop out of the womb thinking no one's gonna treat me well. I don't deserve to be treated well. I always get hurt in relationships. Where along did that conception? come into play and how much does that person also maybe feel they don't deserve anything better? Where did that come from? And if we go back and we look at the the formation of a narrative that then furthers and perpetuates trauma, then we can get at

changing it. But then you have to get at what are the the pain that the person felt, you know, the the the emotions involved. You have to go to a place that's emotional. But if you go to that place The actual events, the emotions, the change in conception of self or conception of the world, then you can come through and say, okay, what tools does it make sense for us to apply? Because the there are the arrows in the quiver that you noted and a lot more. The question is knowing, hey, when does one make sense versus another? And I try and I write a a lot about strategies, antidotes in the book. you know, in a sense, they're good ideas. I I think they're good ideas, but they're good ideas only if they're applied in the right situation to the right person. So it goes back again to understanding the person, what happened to them and how what is their narrative of themselves and what the world can or can't be for them.

Let's get personal and I'll be the one to get personal just as a way. Of exploring this, if you're open to it. Sure. It's hard, maybe it's impossible to say I feel X because of Y, right? I mean if it were a scientific study, it'd be very hard to get to conclusive results. None the less, there's certain events in my life and

abuse experiences and so on that I think have formed. my worldview or informed my worldview. I don't want to put it all on that. There's probably There must be more to the story, but I'd love to talk About hypervigilance for a second.

Sure. This is from your book. When people suffer from trauma, however, their threat sensor becomes hyperactive and hyper vigilant. Convincing them that things are dangerous and wrong right now constantly. It's like a threat center recognizes that it was unable to prevent the initial trauma and now it's trying to make up for it by being active and loud all the time. This is how I feel. a lot of the time and I've I've approached it from different angles. I've used heart rate variability training to kind of start from bottom up. In other words, not starting with the language and the concepts and the stories, but starting with the physiology. I found that quite helpful with uh Dr. Lea Lagos.

I feel like I've made progress here, but None the less. I do feel like my threat sensors are turned to high volume most of the time. And so I have these Fundamental stories and since I suppose our stories become filtering mechanisms for what we notice and remember, I can point to long laundry lists of

evidence that support what I'm about to say. Not saying they're true across the board. By any stretch, but the world is fundamentally unsafe. It's unpredictable. People should earn trust, but start

at a baseline of being. Distrusted or viewed with some suspicion. And These

Yeah. I recognize cause A lot. of anxiety, anger. Stress that is unhelpful in my life.

Yes, like I recognize I'm fulfilled and I beat myself up. with respect to my apparent inability To reformat my hard drive. Uh-huh. Uh-huh. Do you have any antidotes for hypervigilance?

Do you have a way of thinking about it or approaching it that we could discuss? I come back to The first step being to Assess and validate. Like think about the things that you said. There's fundamental truth to some degree. I mean the world is not an entirely safe. place. We can't control everything. So it's sort of like too much of a good thing.

And that's what hyper vigilance is, because we're not saying we should have no vigilance. I mean, there are threat sensors in all of us that that are supposed to be kind of firing in the background. You hear a loud noise, you pay attention. It's supposed to be in the background. But recognizing that probably what has push say that vigilance sensor in you up to a much sort of a higher place on the scale.

is the impact of trauma. Which takes reasonable concepts and then builds the whole story around the extrapolation of the concept to some end that is unhealthy and maladaptive. So take your your driving example. You're prompted, I I think, from or predisposed, say, from prior trauma to have something that kind of hits home, really increase the level of tension and vulnerability inside. So one way of looking at that is to validate and say, look, I do actually know that it's not completely safe to drive.

So I try and they say, have a safe car and drive carefully, right? Like I know all of that, but because I hear an example of of something really tragic that occurred while driving, then that vigilance sensor wants to build the whole story around that. and wants to say, that's gonna happen to you. the chances of that are happening are so high. And now it starts capturing your attention. And it starts reinforcing itself. And then if you're thinking on top of that, God, what's wrong with me that I keep thinking that that calls attention to it too.

and further reinforces it, but by validating that, hey, I'm an empathic person that heard about a terrible tragedy. And the circumstances of that tragedy are going to resonate within me and make the hypervigilance in me attached to that. I know this, I understand this, I can step back to say reality testing of saying, I do actually know that if there's some danger to driving, I do actually take precautions. Me learning about this tragedy isn't. actually making me less safe. And maybe it has me reflect, is my car as safe as I want it to be?

Is there actually something I can take away from it? And if I can't let me feel a sense of grief for this person's loss. And feel a sense of sadness, but make a a conscious boundary that that is actually not about Me or my risk in the world. I didn't learn anything new and I certainly don't want to then be beating up on myself because I'm what kind of hypervigilant from prior trauma and empathically attuned.

And that's a place where another example could be where medicines could be helpful. And again, I'm not saying this because I don't know enough of the specifics, but sometimes a little bit of medicine for a short period of time can help push back. the extra attention and the extra vigilance to the point where things can then go back towards normal. So there's so many psychotherapy and medication tactics that can be used, but it starts with what is the truth of this? What is it actually telling a person? What does it mean to them? What's the narrative about it? And how do we ground ourselves to the truth of it as opposed to shame and self-recrimination, even feeling bad that you feel bad? Just For

Clarity, the medicines in this case, say prescription medications, could be used to reintroduce my psychology And physiology. Two a state of non hypervigilance, so I can

Sort of recalibrate. And recognize it as a possible state. And that is done without the intention of chronic administration or never ending administration. It is given for a short period of time. Maybe it's short, I don't know. I guess that's relative. But

Right, but that that often is effective. And you can go, so to say, top down from brain to body, but you can also go, as you were saying a couple of minutes ago, you can go bottom up from body to brain. Because tension in the brain makes all sorts of problems in the body. And one very strong example of that is the impact of muscle tension. So there might be muscle tension, for example, between the ribs and now the person feels a little bit short of breath. Or there's muscle tension in the GI system and now the person is having IBS symptoms. Or muscle tension in the legs and now there's restless leg symptoms. And if we're we can go the other way of looking at the body and ways of trying to relax the body and decrease the tension in the body because that decreases the signaling that goes back to the brain. What we don't want is a cycle where brain is tense, sends those signals to body, body gets more tense, sends those signals to brain that gets more tense, and you can see we can be in a vicious cycle there. So you know, we have a mind-body connection, whether we choose to pay attention to it or not, it's still there.

And often if we're not paying attention to it, it's not that that's neutral either, but that that can be quite negative. So looking at the whole person, where do you hold your tension? How do you experience your tension? How much in the way of words do you need to put to this? How much in the way to physical interventions should you be doing? Should there be any medicines? But again, we're looking at the person. Like that becomes very specific to you. As it should be. I would love to ask a question that is specific to you and this might

I'm Personally very curious. If we could go Back to your brother's suicide. And I know it's probably not the easiest thing to talk about, but

That is a It sounds like It's hard for me to conceive of a of a larger event at least in the vicarious Trauma.

Category. What are the things? That helped the most. In terms of coming to terms with that or healing from that.

to the extent that you have. I'll start by saying You know, I had no mental health. Education or experience at the time? So my initial response is like weren't very healthy.

I felt like it was my fault. I should have known. I should have been a better brother. I was probably fairly depressed myself and drinking too much and I mean all sorts of other things that that I was still like going along with life. But feeling very oppressed. and feeling oppressed not just externally but inside.

So this idea that trauma changes how we think about ourselves. And then we're trying to recognize that. It's like trying looking in the mirror and saying, Is that me? But you don't really remember what you looked like yesterday. Right. Yeah. So that was very scary and a lot of the ways in which I handled it were not Helpful or healthy. So ultimately when I think how did I get

Through that. It was Interconnections with other people were absolutely indispensable. that there were people around me who cared about me, who were then reflecting back to me like, no, you're a good person and a terrible tragedy has happened to you. Which is like very helpful because they they could see me.

Because they knew me and they knew me before the tragedy. It was me who couldn't see me. And th they were basically communicating this something awful has happened, but you're the same person you were before. And that's a capable person and a caring person. And that was immensely helpful. to me. And and some of that was through friends and family. And also I went and got some psychotherapy, which people weren't really doing. Like where I grew up, people didn't go to

Therapy. Where did you grow up? Outside of Trenton, New Jersey. And it just wasn't in the culture. So for me going and getting therapy even was like something, do I feel embarrassed about that? Is it do healthy people ever do that? Is that just for crazy people? Like that, you know, that was that was how it was thought of. So I had to do something that I think did have some bravery to it of saying, like, hey, let me I gotta be honest with myself. I'm not doing okay. And I'm getting help from people.

There are people who care about me, but there's professional help too. And I you know, I just found a therapist and she was very, very helpful. to me in in that basic grounding way. So the impact of others was so helpful because otherwise I think I probably There's a good chance I would have never Is seeing myself the same way again?

in a way that could have just been worse and worse and worse. And that's ultimately what led me to instead kind of come to a full stop and look at how I was handling my life. And like their silver linings. I I do believe if we work hard enough towards them. There can be silver linings to anything. No matter how bad it is, and a silver lining was, I looked at myself and I you know, I had wanted to go to medical school, but I thought I'm too old. Why because I was twenty five.

Like that's not too old, but I I thought I was, or I couldn't leave my job because I was making a good income and and if I went to medical school, I'm not gonna I'm gonna pay and you know, all these things were in my head and people were saying to me. You're too old. You can't walk away from your job and it's gonna cost there were so many things that I realized like don't matter. I have my life and I'm healthy enough that I can go do what I want to do. Now Go do those things. And it was actually quite helpful to me in deciding I'm gonna leave my job. And even though I haven't taken a single pre-med course, I'm gonna go apply. And you know, it it led me to to feel emboldened, but I had to get to a place where I could see myself as a worthwhile and capable person.

That's how I saw myself before. His suicide. But there was a whole period of time when I didn't see myself that way. And it was really other people, both personally and professionally, that were sort of for me a bridge. to a place I was not going to be able to get on my own. And I think that's the case for many of us. And when people don't have access to people who care about them, people who can help them. Unfortunately, there's a lot of secondary tragedies.

that come of that because w we're interconnected as human beings and we are not kind enough and helpful enough. They, you know, I I write about like compassion, community and humanity and these basic principles that I think we should be following because I don't think they're rocket science. I think they're simple, yet we don't follow them and then we're not there for each other in ways that I think we want to think that we are. But we often we're not living that in the world around us. Thank you. For sharing.

And You've turned into one hell of a bridge yourself. So Thank you. Thank you. That means a lot to me to hear. Yeah, it's it's true. It's true. I would love to Here you

Because I I haven't seen the the latest and greatest I saw. V one. I saw version one of the manuscript. I mean he saw my uh I read it with great interest and and gave you probably more more feedback than uh any reasonable person would want. I needed it. I needed that feedback.

It was strong. I'm sure it's Grown and developed. What is the Format. of the book could you lay out

the basic structure of the book. You were very, very helpful to me and the few people that I asked to look over that original manuscript really guided me in the same two ways. Which was towards having more of a voice that is like the just a natural voice when I'm maybe talking to someone. And I can tend to become a little too academic, right, a as opposed to like look, that's not how I want to be. So I I I'm trying to write in a way or I've tried to write in a way that is just that's plain and clear.

and thereby hopefully effective. And the other recommendations were about incorporation of stories of y the the things in my own life or in my work, which is part of my life that really emphasize the concepts. And that's what the the book is is like. It's it's meant to be read by anyone and everyone who has an interest in the subject material and it's very personalized about me and the examples in the world around me that illustrate the concepts. And with that in mind, there are four parts to it. So the first is what is trauma and how does it work? So that's talking about the definition of trauma and the facets of post trauma syndromes and how they impact people.

So the cascade of henchmen of trauma, starting with shame and all the others that come along with shame. So that's with the first part of the book. The second part is the big picture. So that's the part that's the the sociology of trauma. Of looking at look, how is this happening in the world around us, which, my goodness, has come to a fever pitch with the pandemic and and just the spotlight on systemic racism and race racial injustice in the world around us, and also on this erosion of faith in our socioeconomic foundation. Can you work really hard and get ahead? How does that work now compared to how it worked fifty years ago? So that's the the second part of it. And in the third part That that's right. It's sort of called an owner's manual for your brain.

Where I'm trying to to really look at how does this work in the brain? What's the difference between the logic systems and the limbic or emotional systems in our brain? How do we find meaning in our memories? How do our memories change when our limbic system changes the emotion tied to memories? How does trauma cascade through mind and body? So that's the the third part of the book. And then the the fourth is like how we can beat trauma because I again I don't I do not want this to be esoteric in any way, shape, or form.

The idea is that this is well grounded in the practical of like what can we do and change now? Which means it has to be there have to be things that we can employ and that we can employ individually and in small groups of people and in larger groups of people, which brings us back to some things that Well, actually the majority of it really comes down to like simplicity and there's a common sense to it that I'm advocating for in the fourth part of the book, but I'm trying to use the whole book to get us to the place where like These doable practical things are really at the forefront of our minds. And as a person reading the book and feel like I can do those things. They can do them now.

And I can advocate for them in the world around me. And that's what really brings it the idea that we're gonna we're gonna have knowledge and the knowledge is gonna make change. Are there any particular stories in the book? I'm sure there are. That we haven't

Discussed that have resonated with Proofreaders. And those who have had a chance. To read it. Do any come to mind?

I'll start with so my favorite part of the book, maybe my favorite story ever in in my own life. Which I had uh shared, I don't know if you if I will remember it was a while ago, but you you really did like this and that made me feel good about the because it's a positive story. Like there are stories that are about how people get to the point where like really bad things have happened, and that's part of us understanding. But there are stories about overcoming too. And you know, my uncle Rango, who was

such a a dear beloved person in my life is someone whose early life didn't look like things were gonna go that well. He had a sixth grade education and not a lot of guidance and support, and then was drafted in the second world war and experienced some horrible Horrible things. during the war. But Through those experiences

Develop the sense of self. That said, I am a conscientious person. I am a strong person. I'm a person who can do difficult things and who can do difficult things for reasons. that are so strong that one can't look away. from them. And a person who can do that, those things should not feel ashamed of themselves, should feel a sense of pride amidst the recognition of tragedy. And even with a sixth grade education and the limits that that kind of lack of exposure to the bigger aspects of of the world and even of how our minds work.

was able to really understand that and have a very, very good life. And part of why he had a good life was the silver lining of the trauma that he experienced in the second world war because he came out of it with a sense of self that said, you know what, you're not a delinquent loser. You're the opposite of that. You're you're someone who leads men to safety. when they're otherwise likely to be killed. who does, and I won't sort of give away the the story, but does something incredibly difficult that haunted him his whole life because in his opinion, I don't understand what else there could have been to do but what he did, because that was what was in front of him, and he didn't see it as his fault in a sense that would have brought him shame.

If that makes sense. And that's why I think it's my favorite story. And even before when I was younger, I was able to put all this together, I could see reasons to feel proud and made me see hope in that even when I was quite young, his story was very empowering, even though we didn't know the details, he never would tell us the details, but we knew what he had come through and that he was this decorated war hero. And we felt proud of him because he felt a sense of pride in himself. That's right. I do remember. I do remember Uncle Rango. Yeah, I do remember. How could one forget? Could you speak

Two Or define selective abstraction. Because this this is something that might be worth Digging into Selective abstraction is when

We take one detail from a big picture. And we construct the story of that whole big picture around the detail. An example. Probably a common example, but even in my own life is like I can come to work and I can have a good day.

at work and feel like I'm doing good things and I'm helping people, I generally can feel good about things. But then if I can't find my keys when I'm leaving and this is what's really happened, and then you know, I'm frustrated now and I'm frustrated with myself. And when I finally find my keys, right, get people to help me find my keys, the narrative that's going on in my head is like what a loser. mean you can't even find your car keys to drive home. What the hell is wrong with you? Right. And and like that's the story. And then I can get home and like my wife could ask me, How was your day? Like ah You know, it's a terrible day because I'm incompetent. Because like I built the story of the whole day around what? The salient negative.

the thing that triggered in me, you know, my own susceptibility to thinking I'm not Good enough, and what I'm doing isn't worthwhile enough. And oh, look what's wrong with me. And that selective abstraction, because that was probably 10 minutes of my day. But my brain builds the whole story of the day, which is my story of myself. around that negative thing. Selective attention is a hell of a thing, right? You buy a new car and all of a sudden everyone's driving the same car, but of course those cars are already out there. You're just paying more attention now.

And that's so big because this is all about salience biases. What are we paying attention to? And trauma makes us pay attention to the negative. That's why we think the world is less safe of a place. Or that we're less competent people. Like this is the danger. We use selective abstraction and salience biases and attribution biases where something negative happens, then I'm gonna attribute it to me. And I see this all the time where, you know, something negative may happen next door, a person had nothing to do with, but they feel that it's their fault. Because we get enough of this in ourselves and we literally forget who we are.

or what we're worth, which is why people will stay in jobs that they hate when they could try something different, or they'll stay in abusive relationships when they could end the abusive relationship and not enter another one. Where does all that end up? It ends up in learned helplessness and Learned helplessness pushes people towards more trauma and very often towards death. Could you say more about that? When you say Towards death.

Because the the accumulation of trauma makes people more and more desperate. for ways of coping. It's like you know you had maybe you had talked about drug addiction, and we talk about the decrease in role performance and the shame that comes along with it and the stigma. Nobody decides, you know, I'm gonna use drugs because what I want to do is ruin my life. Like no one makes that decision. So if we look at as you were saying, uh Dr. Mate was saying, is like look at the pain in the person. Where did that come from? And not always, but a lot of times where drug abuse and drug addiction comes from is comes from pain and suffering and a desperation to feel different. So more pain and suffering means people are more likely to repeat maladaptive patterns that lead them to more trauma. And they're more likely to feel desperate for soothing in a way that can, for example, pave the way to substance use because the blind imagine like a set of blinders that it starts off, they're outside of our peripheral vision.

So they're not affecting us at all. But as time goes on, they can encroach more and more and more as the person has more trauma, less healthy coping mechanisms, a more negative view of self, a more negative view of the world. And then the blinders come in and at some point the blinders are so narrow that all the person sees, it could be ba is basically a helpless and hopeless picture. And that's where a lot of suicide comes from. And where a lot of accidental deaths come from. So the often the goal is when I think about what are we doing in trauma treatment and the image that's uh in my head a lot is we're trying to take those, I imagine a set of blinders, a person is just peeking through with one eye, and we're trying to pull them out. So they see the breadth

of truth. The breadth of their perspective allows that person to again see truth. And remember, oh, like an example. I you know I absolutely understood. At one point in time that violence is not acceptable in my life. I understood that and I don't believe that any less now than I did then.

But boy, I kind of forgot it in the middle. Because the person forgot that they could have a life free of violence or that they deserve a life free of violence. That's where this narrowing of blinders and the change in emotion and how emotion impacts our memories and tells us what our memories mean. The memory of something happy with other people can go from being a memory that says, right, I can do anything and I and I can interact with people and they like me and want me to be around, to a memory of something that's impossibly lost for the person. And again, that's not true, but if you see it as impossibly lost. It is. unless there's some process that leads you to a place where you remember what's true that you forgot.

You know, this brings to mind for me One tool in the toolkit. It's more of a category, but it's one I would love to hear your current thoughts on. Sure. I do think I'll get to the punchline in a second that It's very dangerous to view anything as a panacea.

Or uh you know, fix all of any type. And it's particularly common with what I'm gonna mention, which is psychedelics. But as we're talking, if we for the time being Include MDMA. in the category of of psychedelic just to

Make it a little easier to discuss even though One could argue it doesn't. cleanly fit in that category, but as an empathogen. It is remarkable to me how Patients.

say going through the Maps. Trials. phase three trials and so on can recontextualize Memories.

That for decades have had a fixed emotional. Tenner. Yes. And suddenly they're able to go back.

And with a decreased fear response. unwrap that memory, recontextualize it as an adult with better coping mechanisms. and sort of reinstall it, so to speak. It's really A fascinating replicable phenomenon uh for a lot of patients. How do you think about if you do it all?

Psychedelics, their use, abuse, roles, misapplications. Where's your current thinking? My understanding from The research, the really consistent reports. Tell me that

There's something immensely powerful here. That has the capacity to do an immense amount of good. But we have to be careful with anything that's even moderately powerful, let alone very powerful, and that we're figuring out how to deploy. these kinds of tools to do something Amazing. And I say that in like the full meaning

Of That word. Because what they seem to be able to to help people do is to look at Trauma? from the perspective of truth.

Without the reflexive shame. That's if someone else hurt me, what's wrong with me? Why am I being hurt? That's the reflex and it generates shame that imagine how our perspective is already immediately altered. If trauma arouses shame.

then the trauma itself immediately alters our perception mechanisms that we can use to understand the trauma. and navigate our way through it, and I think that goes hand in hand. with this idea that we value so highly as human beings the outer parts of the cerebral cortex, the parts that are uniquely human. The parts that let us, for example, have a language.

And the five senses, which I know I understand they're not uniquely human, but these are the parts, though, of the outer cortex of the brain, our ability to plan and to project into the future. And we value these so highly, but we do that in a reflexive way. Why do we value that just because The end point of the cortex is the farthest the brain is grown outward. That's the part that is a butting up against our skulls. But like we don't do that with roads. I don't say that if a road is going somewhere I want to go, that oh, but it's better to keep going, maybe that road dead ends in a muddy place I can't get out of. What may be happening is that there's a brain stem that's the earlier part of the brain, the first part of the brain that's about like the basics of survival.

temperature regulation, sex drive, appetite. And then At the other end of the spectrum, there's the cortex that is about the things that we need in order to sort of keep us alive. And that may be like what the five senses are about, for example. It's about, in a sense, vigilance and it's about keeping us alive. And that's important, but it may be that the brain stem, which is sort of about just staying alive, and the cortex, which is about staying alive in a different way by monitoring and navigating our environment, are less interesting than what is in between. So that's where the amygdala is.

Grand Central Station for negative emotion and the emotion that impacts vigilance. The hippocampus, which is about memory. What's the hippocampus connected to? The amygdala. So the limbic system and emotion is so important to how we remember things and the meaning we put in memories and to the insular cortex. a part of the brain that it may be that the insular cortex is really about. life lived or life felt and understood. And that these medicines, along with psychotherapeutic tactics can do this too, and judicious use of standard medicines can help do this, where we're living more in the part of the brain that can actually understand and assess

What life is about. And it may be that the psychedelics altering the default mode network. And changing how the brain is communicating, where the seat of the brain's existence, consciously and unconsciously, is at, opens up the ability to get out of the cortex. And into the part of the brain that says Gosh, something terrible happened, like

What is that and what does that mean? without all the the reflexive loading of guilt and shame, the million thoughts we may have had that can perpetuate guilt and shame in a narrowing of perspective. It's an excellent way to put it. It's almost as though Before we consciously think about trauma for

Many of the people who have Suffer trauma. If not most, there's almost a boot up sequence in the background, which is what you're about to think about or talk about was your fault because you're flawed. Yes. Colon, and then you have Right.

If that is the canvas upon which all subsequent Thoughts are painted. You can Predictably. Experience.

A very challenging interpretation of yourself and of of events. The thing gets reinforced. 'Cause that challenging interpretation gets reinforced the next time you think about it, and the next, and the next, and the next. Yeah. And you talked about the default mode network. I mean this is this is obviously a topic, sometimes a controversial conversation among the neuroanatomists and researchers looking at psychedelics. There are a number of aspects also that As we're talking

are of of great interest and of course a lot more research is needed to Delve deeper and even confirmed. The Therapeutic implications of what I'm about to say, but I'm not going to be able to You know, one is

sort of bottom up. Which is neurogenesis. So if certain psychedelics like psilocybin as found in Silosope mushrooms, or synthesized for that matter Has Neurogenerative effects.

Potentially the hippocampus and elsewhere. and at least anecdotally seems to have some effect on TBI in veterans, for instance. You know, is it plausible that any type of So neuronal You'd probably be able to speak better to this than I would, but

More eloquently, certainly. Any sort of chronic damage or atrophy or maladaptation from a neuronal perspective from chronic depression. also respond favorably, sort of bottom up by bathing in some of these compounds for a period of time. I do think th it's quite likely that there's something there. From a just a mechanistic

neuronal perspective. The other is that As we're talking about this. This overlay of I as we talk about or think about trauma. When You have

hypothetically, let's just say decrease in activity in the default mode network. And uh certainly if you experience ego dissolution in any capacity where the entire sort of skin encapsulated concept of I begins to loosen its grip on your perception. If you then revisit trauma If there is no I or uh less of an I, it becomes harder to blame

Yourself. if not impossible for what you are witnessing. So you have the ability also To become an observer Who is not just less prone to self judgment. And this this isn't always the case. In some instances you are incapable of self judgment. It's very peculiar.

But certainly. in the reports out of say sessions from Johns Hopkins and elsewhere. It's remarkable to see what these compounds can do and it's very tempting. To view them as the holy grail.

Which will solve all of our Miseries and pains and I think that That is feel like I'm talking too much, but just uh I'll finish in a second. That it's it's very tempting with anything new. Two Overestimate

The Applications and some early studies can also seem to overstate the efficacy, right? We and this is seen in medicine and psychiatry over and over again. I wanted to ask you We can come back to this this topic, of course, because My listeners know I'm happy to talk for hours about this. But I'm curious on the let's just call it more conventional side and with the caveat that we are not

Providing medical advice I am certainly not a doctor, w I do not play one on the internet, but this is for informational purposes only, and it's a conversation between you and I. In the case of say hyper vigilance Because within the Conventional.

Pharmacopia. You have I mean th there are incredible drugs available. And a Western Medicine, despite the tendency these days for a lot of folks to who poo poo Western medicine, I mean it is the The most effective healing system ever devised by humankind. Full stop.

And I'm curious within that Massive. list of options and uh all the available options. What are some of your preferred options? And feel free not to answer this if you don't want to, but If we were looking at a case, say

of hypervigilance and you wanted to put someone on a short cycle Or I should say a finite cycle of A compound or compounds. What are at the top of the list and how do you go about Sure.

Maybe I I'll comment this by saying First thing to say says we have all these arrows in the quiver. And the empathogens are potentially these new wonderful arrows in the quiver, but we need to understand that. And there can be a tendency to overestimate benefit and underestimate risk. So there's research going on that says

These can be just fantastic tools in the quiver. We need to understand them better. And as that research is coming along, what I believe we should also be doing is looking at the arrows we already have in the quiver that we are not utilizing effectively. And that includes all the the psychotherapy modalities that get under utilized because we're just taking inventories of symptoms and trying to treat a symptom and call it good.

The same is true of medications. That if we're really paying attention to people and to what's going on in them, we can then actually target symptoms, but we're targeting symptoms and understanding what the big picture is like. Right, exactly. There's a purpose, there's an outcome beyond suppression. Right. Or there there's a target there's an intention beyond just alleviation of symptoms. Right. So if you so if you told me that that now

after the the tragedy that you learned of that you've an increased sense of tension in you all the time. Then I would look to maybe an SSRI kind of medicine, a medicine that could improve your distress tolerance because that extra tension is in you all the time. If you said, No, it's actually only only in me when I'm driving and like I'm getting a little tremulous and I'm sweating, we might think about another medicine that can block the impact of that extra tension on you physically because then that's reinforcing and then you get into that mind, body, body, mind vicious cycle. What class of drug would that be?

So like a beta blocker. For example, would be a possibility in that scenario. Or if you told me like everything is okay, but I'm really having trouble getting to sleep. because I can't get this out of my mind, then I would not suggest a sleeping medicine because I would think there's nothing wrong with your sleeping system, but sleep is being blocked because your distress system is amped up when your brain's trying to sift down into a peaceful place, that's the time that the intrusive thoughts about this new trauma come into your mind. So can we use something that in a time limited way, like right around bedtime, decreases the distress signaling in your brain so that you can fall asleep, as opposed to like a heavy handed intervention, which would say, Well, let's put you on some sleep medicines when it's not really your sleep system that's broken, it's your distress that's higher.

That kind of thing. Just because I love the details of this kind of thing. What Class of compound or drug might fit that Last.

Example. Right, the distress signaling prior to bed. This is one of the interventions and it may actually be the intervention, I gotta think hard about that, that has the most success. If not, it's in the top three, which is using medicines that are called antipsychotics, but that's a terrible name. It's saying just because terrible medicines are But just because they're used for that doesn't mean that's all that they do. It's such a misnomer to name something by like what its first use is. I don't call the dollar a baseball card buyer.

Even though that's probably the first thing I bought was a dollar. So it it stigmatizes the medicines. And then they don't get used for this, but low dosing of those medicines blocks what are called D2 receptors, blocks receptors that are around distress transmission. And very low dosing is often immensely helpful. in situations where there's a lot of distress signaling and that's impacting sleep. So I can't count the number of people I've seen who can't sleep and they've tried quote unquote every sleeping medicine. And sometimes they actually seemingly have. But they're not gonna sleep then because to say oh they have a sleeping problem just pointing out the obvious that they're not sleeping. That's not a medical conclusion. But to point out their sleeping system isn't broken, hence no impact from the fifteen sleeping medicines.

But they're distress signalling. is now increased because of some new trauma or triggering of an old trauma or vicarious trauma, then we can solve that Often very readily. And that leads back to, you know, you were talking about the empathogens and the idea of neurogenesis and and it may be that neurogenesis is very helpful in certain parts of the brain. It may be that neuronal pruning is helpful in other ways too, right? That's good point. Really trying to understand is what

positively impacts connectivity. And that may be neurogenesis in certain parts of the brain, but it may be changing balances of neurons and maybe it's neurogenesis of inhibitory neurons. So things get complicated enough that like how we can look at that though in a practical sense, because we're not the like the core neuroscientists. How we can look at that practically is saying what we're trying to do is alter brain connectivity, whether we're using psychotherapy or a hug to a person that you care about. Or we're using medicines or we're using Western medicines or pathogens, what we're trying to do is change the sequence and patterning of brain connectivity from one that is stereotyped in a negative way. Like you said, that reflexive shame, ones that prime the audience before the curtain goes up to say the play is gonna be bad and you're gonna hate it. So when we shift that, we're really shifting connectivity. And that's how we can see old things.

In new and true ways. What's so Wild also, and these are just occurring to me as we're talking. What's so wild about some of the empathogens and also certainly psychedelics, many psychedelics is Is the phenomenon of hypernisia. I mean where you will be able to recall

the say in in my case, for instance, like the brown corduroy On The couch when I was two or three years old. And I immediately recognizing that that is a real Mm-hmm.

That is a real memory. I have photographs. You know, I can go find them. I just haven't seen them in deck decades. And it's really remarkable and It's so easy with Neo Mia to focus on, even though many of these compounds are f have been used by humans for millennia. They are new in their popularity as it exists today, and it's easy to discard

Things that Could be very, very effective, either as monotherapies or perhaps even in tandem, although you have to be careful, obviously, with combining things. When we take a look at the antipsychotics, since that's not at least categorically something I'm familiar with. What are some of the frontline Antipsychotics.

What are the na the the compounds of the names? I'm just wondering if there are any I would recognize. There are probably two dozen or so of these kinds of medicines. The ones that are they're very, very potent for actual psychosis are in general not what we're using. There's some older medicines. So even chlorpromazine, which is it's the generic name of thorazine. I was gonna say thorazine is probably the only one that I'm familiar with. But we've been around, that's the first one. It's been around for somewhere around seventy years now. And it's what's called a it's a low potency medicine, meaning that it doesn't block those receptors very much. But even a little bit of blockade can make a huge difference. So a medicine that was used in like 800 milligrams, a thousand milligrams to treat psychosis, very often at 25 milligrams, twelve and a half milligrams, maybe 50 milligrams, can decrease the distress signaling enough

that then rumination at bedtime, you know, the distress that pr that causes so much misery, then can go away. So it's the example I would cite because in low dosing, it it's a an overall, again, everyone has to Make their own medicine decisions with the person prescribing to them, but it's overall a safe and low side effect medicine at low dosing and often remarkably remarkably effective. So that would be the one that I would really highlight and I think then w we're decreasing the distress signaling, which creates stereotyping of our thoughts and feelings. If we're thinking the same thing over and over again, then think about how that would predispose to blocking memory. I mean, if you think of prior trauma and there's a reflex, it immediately feels shame and responsibility. You know, my God, how did that happen? How did I let that happen? All those things we beat up on ourselves, how are we going to remember details?

It may be that the connectivity changes in more peaceful states of mind, which could be through an empathogen or not. Again, the research is bearing that out. Let a person know and remember and understand more because that's not blocked by like trying to have calm thoughts in the midst of a hurricane. Right. You can have you're more likely to have calm thoughts in the midst of a calm setting. And as important as that is outside of us, it's got to be at least equally important inside of us, too. Absolutely. In what category does lithium? belong because I've also read quite a lot about I suppose as a as a monotherapy for something like and please fact check me on something like I wanna say bipolar, but maybe I'm getting at this. You were looking at like fifteen hundred milligrams or or something like that. But

I was sent some reading related to very low dose and there are different types of lithium, right? There's l lithium carbonate, lithium oratate, there are many different forms, but of really low dose, like five milligram, ten milligram. Pre bed and I'm wondering if that plausibly would have any similar effects or if it's Exerting its effects differently.

I I'm not familiar with how lithium works. The most helpful way to approach lithium as being two entirely different medicines depending upon dosing. And maybe an even better way to look at that is a medicinal dose versus a supplement. Kind of dose.

Right. In high dosing is a very effective medicine for bipolar disorder. And there are a lot of medicine choices now, so we can kind of nuance that to try and minimize side effect and get in a very effective medicine regimen with low side effect. But for a long period of time, there weren't a lot of other medicines and then high dose lithium monotherapy was what happened most of the time for bipolar disorder. Which is can be is often very effective, but has a lot of side effects. Like that's lithium as medicine. And that's also a reason lithium often has a stigma.

around it because it was used for bipolar disorder in a way when we didn't understand as much about it. Oftentimes the illness was out of control by the time it was treated, which can happen now, but was more so the case then. So that led to lithium having a stigma around it. But Everyone has lithium in them to some degree. We all do as human beings. There's lithium in all of us. And what seems to be the case, and again, it's hard to do great studies about this because it's just so big. big to try and do, but what seems to be the case is that more lithium including more lithium in the groundwater. So small amounts of lithium, but that are lithium that are higher in all of us seem to sort of make everything better. It seems like there's less depression, there's less violence, there may be less dementia. And one could think of putative mechanisms like if you think through the you know how lithium impacts ion channels and neurons in the brain, we can think of how that might make sense.

But we don't know that for sure. But what we do see, and I've seen just over and over and over again, is that in the right person, and again, you have to be guided towards it because there could be side effects from it and it can negatively interact with other medical conditions. So so if a person is getting the medical guidance to safely take low dose lithium, that that often in a way that really is looking at it like a supplement can often be very helpful to the person, including an increased sense of calm. an increased sense of peace. So for mild problems around sleep, a little bit of lithium can be very helpful. For bigger problems, once a person is getting ruminative and really can't sleep and you know the cat's out of the bag and it's going over and over and over again, then usually we are then beyond where a supplement of lithium is is likely to be helpful. Lithium is fascinating to me. I I agree. Recall at some point

being sent a piece an older piece I believe it was in the New York Times and the headline was something like, Maybe we just all need a little bit more lithium. Understanding the limitations of observational studies or what you can do by torturing the data. I mean, I understand the the shortcomings when something isn't controlled and See people controlled and randomized and so on. None the less I recall this piece Pointing to groundwater levels of lithium and there being an inverse correlation of

hospital admitteds related to homicides, suicide, psychosis, et cetera. And At the very least I found it very thought provoking. W how would you think about For instance, and I know this is a little bit of inside baseball, but I am so endlessly fascinated by all of this. I've heard very mixed things, but Trazidone is a sleep aid. And maybe you could speak you explain what that is. My understanding is that it is an SSRI, but that it was never effective as an antidepressant because people just fall asleep. And therefore, like many drugs in our pantheon was

Sort of repurposed. For Sleep. I don't know if that's accurate, but could you uh I'd love to hear your opinion of First thing I should say in the in the interest of full disclosure. I think I'm the person who sent that Lithium article. You know what? Right. Of course. So I wanna say whoever sent that article was brilliant and precious. But no, no, it's a full disclosure. I think it was me because I I do.

believe in that. I mean, as you said, it's very hard to do these population studies, but there is some good data that that points us in the direction of all that being true and to the very low risk of low dose lithium. So then you you have a a higher Likelihood of a benefit, you know, like high likelihood of some benefit with low risk. That being said, that the Trazadone question specifically is yes, the Trazodone. was found to be so sedating for most people. And it seems like there are probably some genetic idiosyncrasies because some people don't find it sedating at all. Wow. So there's probably just some idiosyncrasy there, but most people find it very sedating, which obviously works against the use of it as an antidepressant, right? But what was found is it's actually quite a safe medicine. And again, we want it to be prescribed and there are some risks to it. It's not entirely safe. But by and large, with appropriate prescribing, it's quite a safe medicine that often is sedating enough that it can really be helpful to people for

Sleep. So when it doesn't work or if the dose has to be too high and then it's sedating, it makes sense to shift away from it, but it's a good tool to have or good arrow in the quiver pharmacologically because it does help a lot of people with little to no side effect. You just got to get the dosing right and see, can the right dosing for sleep be be also non sedating enough for that person so they don't have a hangover from it essentially the next day. Is there any I suppose this is true with just about anything, but

Addiction potential. With Trazadone. Can it be physically? addictive or is it is is it more so a psychological Risk if any. Yeah, there could be a a psychological risk. Is it anything that we're sort of leaning on, so to speak, to some degree we can really habituate to and come to rely on, but that's different than the mechanisms of physiological addiction, which don't which aren't present in Trazana. Wouldn't apply.

What does the D and D two stand for in the receptor that you mentioned with respect to I believe it was the antipsychotics. Dopamine. Dope mine. Yeah. So dopamine is a currency. So you people say, what does dopamine do? It's like saying, What does a dollar do? It depends on where we're spending it. And in these particular circuits, dopamine then becomes a currency of distress and if there's enough of it, a currency of psychosis. So these'cause p sometimes people think of dopamine as pleasure. So why are we doing anti dopamine things in these particular circuits? That's not what dopamine's buying. It's a currency of distress and we want to

Play that down. Ah man, I could talk to you for hours and hours. We've done it before. Thank you. Yeah. Endlessly interesting. And what makes it also so fun to Spend time. One of the additional reasons it's so fun to spend time chatting with you is that

You are not isolated in In Ivory Tower. Working with hypothetical Cases like people come to you for help and solutions. So you are a an active

Clinician. who is working with real patients. You know, I I have a a note here and I'm definitely gonna need The stress diathesis model. Am I saying that correctly?

Stress diathesis, which also gets called a a vulnerability stress model. Dihathesis. Oh boy. I knew I was gonna fuck that one up. There's words we like in Messi, it sounds smart, but all it really means is a genetic vulnerability. Which is why that's also called like vulnerability stress model, which means we all have genetic vulnerabilities to certain things. It might be depression for me and panic attacks for you, or vice versa. our genes give us a a predisposition towards. And then the stressors. So so that's say maybe the nature of it, but then the nurture part is what can bring

A potential problem to the forefront. So you think about a post-trauma syndrome, we're all protected or vulnerable to different degrees, say at conception based upon genetics. Now, we don't understand that fully, but we know we have different risk profiles. And then it's the stress or the nurture part of it, right? What we experience in life that can determine what comes to the fore. And this is also where the multiple hit hypothesis of post-trauma syndromes comes to the fore, that it may be that something really traumatic happens to a person and they don't have a post-trauma syndrome, then something else happens, and something else happens. And we might think, well, they're pretty genetically protected, but the stress can take its toll where Maybe the third, fourth, fifth, sixth hit, even if it might be a relatively minor one compared to those that came before it now create a full blown post trauma syndrome.

You know, we could go in a million directions outside of your book, which I'm going to mention again. Are there any particular resources that you might recommend for people who are interested in learning more about Trauma from

Credible sources. No, I think Nami. Which is present throughout the the country and has local branches throughout the country, N A M I, that NAMI can be extremely helpful. We can often find resources and have links to good people. So what does NAMI stand for? So NAMI stands for the National Alliance on Mental Illness, and NAMI often has resources and links to support mechanisms in the community, and I think can be very, very helpful. The book, The Body Keeps the Score,

by That's all Vanderkal is is also a very, very helpful resource. Anything that helps a person to find some sort inner peace inside of them, something that takes away from the swirling inside of us that can happen post-trauma, and the swirling from the social circumstances around us. Anything that helps us get away from what's keeping us in the same loops that lead us further from truth, whether it's the truth of our own trauma, Or the truth of the trauma going on in the society. around us, the response to the pandemic, the impact of systemic racism, the erosion of faith in our socioeconomic model. Existential distress related to climate change and things like that, for instance. Right. I mean they these things can all be seen through a political lens and because they get politicized, it takes people away from actually looking at like what's really going on here, right? How is it impacting how I'm thinking and feeling? What's the truth of all of this?

Anything that takes us away from getting lost in the politicizing of things and more towards the apprehension of the true existential nature of these things. So there are a lot of helping resources and things that we can do to get us into a calmer place inside. And I know that's a kind of a non specific answer, but there's so many routes of of proceeding towards that that I I wanna mention that. Yeah, that too. Absolutely.

Paul Conti. Paulconti, Dr. Paulconti, C O N T I dot com, Pacificpreme Group.com. We will link to all of these things, everything we've mentioned in the show notes. The new book, which I highly, highly recommend. Everybody pick up, take a look at it, get it for people who need it. Is trauma, the invisible epidemic. Subtitle How Trauma Works and How We Can Heal From It.

I'm such a fan of yours. I don't say that lightly. We've spent real time together. I've seen The results of what you do. You are a in the trenches practitioner. And I'm just so glad that your work You

personally and this book are going to be Available to more people. So Thank you. Thank you for Means a lot of the time. Absolutely. And is there anything else you would like to say or uh any request of the audience, any suggestion, anything at all that you would like to

Say in Closing comments before we wrap up for today. I think the one thing I would say Is that Our lives and the world around us can

seem to us to be very helpless. And hopeless at times. We can feel helpless and the world can seem hopeless. And and that's Not the case. I mean I cannot describe the number of people I have Seen, worked with, who feel that way? and really are at risk when they're feeling that way and come out to a different place.

that if you're feeling that way, that probably means that those blinders have closed in and closed in and closed in. And there is help. for that. There really and truly is. And if you're not getting help the first, second, third time Keep trying. There's help there to be had and it can make just such A difference'cause those narrowed The narrowed blinders represent a risk to us that comes from trauma and that we can absolutely do something about and change.

Perfect place. To wrap up. And So nice to see you, Paul. Yeah.

Thank you. Thank you, you two. Thanks so much. It was fun. I knew that was gonna be fun. Yeah, yeah, absolutely. Yeah, this was uh a really Really enjoyable conversation, very dense. To everybody listening, once again, I will put links to everything we talked about in the show notes at Tim.blog slash podcast. You can just search Conti C O N T I. And it'll pop right up. And until next time. Be safe.

Be aware. Of blinders, we all have them. Pay attention to your stories. Because you are the author, not just the reader of those stories and they craft your reality. And as Paul said

You are not alone. This is part of the human condition and there are People and tools. and help available and there are things that work. So thank you for being here, Paul. And

Thanks to everybody for listening. Hey guys, this is Tim again. Just a few more things before you take off. Number one, this is Five Bullet Friday. Do you want to get a short email from me? Would you enjoy getting a short email from me every Friday that provides a little morsel of fun before the weekend? And Five Bullet Friday is a very short email where I share the coolest things I've found or that I've been pondering over the week. That could include favorite new albums that I've discovered. It could include gizmos and gadgets and all sorts of weird shit that I've somehow dug up in the world of the esoteric as I do. It could include favorite articles that I've read. and that I've shared with my close friends, for instance. And it's very short. It's just a little tiny bite of goodness before you head off. for the weekend. So if you want to receive that, check it out. Just go to fourhourworkweek.com, that's fourhourworkweek.com all spelled out and just drop in your email and you will get the very next one. And if you sign up, I hope you enjoy it.

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Fury. At least one item per day for the last few months and you can use it for everything. It's performance apparel. but it can be used for working out, it can be used for going out to dinner, at least in my case, I feel very comfortable with it. Super comfortable, super stylish, and I just want to read something that one of my employees said. She is an athlete. She is quite technical, although she would never say that. I asked her if she had ever used one. heard of Viore and this was her response. I do love their stuff, been using them for about a year. I think I found them at RAI first for my partner, T-shirts that are super soft but somehow last as he's hard on stuff, and then I got into the super soft cotton yoga pants and jogger sweatpants. I live in them and they too have lasted. They're stylish enough I can wear them out and about. The material is just super soft and durable.

I just got their Clementine running shorts for summer and love them. The brand seems pretty popular, constantly sold out, in closing, and I'm abbreviating here, but in closing, with the exception of when I need technical outdoor gear, they're the only brand I've bought in the last year or so for yoga running loungewear that lasts that I think look good also. I like the discreet logo. So that gives you some idea. That was not intended for the sponsor read. That was just her response via text. VRE, again spelled B-U-O-R-I, is designed for maximum comfort and versatility. You can wear it running, you can wear their stuff training, doing yoga, lounging, weekend errands, or in my case again, going out. Today, it really doesn't matter what you're doing. Their clothing is so comfortable and uh looks so good and it's it's non-offensive. You don't have a huge brand logo in your face. You'll just want to be in them all the time. And my girlfriend and I have been wearing them. for the last few months, their men's core short K-O-R-E, the most comfortable line athletic short, is your one short for every sport I've been using with kettlebell swings for runs, you name it, the Banks short. This is their go-to land to see short. is the Ultimate Versatility. It's made from recycled plastic bottles. And what I'm wearing right now, which I had to pick one to recommend to folks out there, or at least to men out there, is the Ponto Performance Pants. And you'll find these at the link I'm gonna give you guys. You can check out what I'm talking about. But I'm wearing them right now. They're

thin performance sweatpants, but that doesn't do them justice. So you gotta check it out. PONTO Ponto Performance Pant. For you ladies, the women's performance jogger is the softest jogger you'll ever own. Viore isn't just an investment in your clothing, it's an investment in your happiness. And for you, my dear listeners, they're offering 20% off your first purchase. So get yourself some of the most comfortable and versatile clothing on the planet. It's super popular. A lot of my friends have now noticed are wearing this. And so am I. Beoreclothing.com forward slash Tim. That's B-U-O-R-I Clothing.com slash Tim. Not only will you receive 20% off your first purchase, but you'll also enjoy free shipping on any US orders over$75 and free returns. So check it out. Vioriclothing.com slash Tim, that's V-U-O-R-I Clothing.com slash Tim, and discover the versatility of Viore Clothing.

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