Dr Paul Conti Links Unresolved Childhood Trauma to Premature Mortality

Paul Conti 博士指出未化解的童年创伤与过早死亡存在关联 未妥善处理的童年创伤会从根本上改变基因表达和大脑结构，从而引发慢性躯体疾病与过早死亡；唯有通过针对性的情绪处理而非速效药物治疗，才能逆转这一过程。 Paul Conti 博士深入探讨了创伤如何作为一种隐性流行病，改变大脑结构、引发全身性炎症并加速细胞衰老。他反驳了有关心理韧性的流行陈词滥调，阐释了未化解的创伤如何引发创伤后综合征、成瘾、睡眠障碍以及羞耻感的代际传递。结合临床见解与生物学框架，Conti 博士提出了切实可行的策略，帮助人们重塑消极神经通路、通过展现脆弱来减轻羞耻感，并实现长久疗愈。 创伤如同一种“隐形流行病”，不仅加速细胞衰老与器官退化，还会改变基因转录并削弱免疫系统；研究显示16岁前遭受虐待的人群中年死亡风险增加达2.6倍。 (15:50) 创伤可细分为急性、慢性和替代性创伤，“杀不死你的会让你更强大”是错误的认知；根据多重打击假说，过往创伤会持续损耗心理韧性，让人在面对后续压力时变得更脆弱。 (23:30) 表观遗传学证实，环境创伤能在不改变底层DNA编码的前提下关闭有益基因的表达，并将这种生理性的焦虑与恐惧反应跨代遗传给后代。 (35:50) 未解的心理创伤如同体内的脓肿，会持续诱发高警觉、抑郁等创伤后综合征；药物成瘾、酗酒或手机依赖等自毁行为，本质上是人们为了逃避剧烈内心痛苦而采取的绝望自救尝试。 (41:00)

Dr. Paul Conti argues that unresolved trauma acts as an invisible epidemic, altering brain biology, accelerating cellular aging, and transmitting vulnerabilities across generations. He asserts that sustainable recovery requires identifying root developmental causes and retraining neural habits rather than relying on short-term symptom suppression through medication. Cellular Degradation, Accelerated Aging, and Epigenetics (15:50) Trauma induces profound biological changes that cause an individual's biological age to outpace their chronological calendar age. Circulating inflammatory markers damage blood vessels, impair immune function, and elevate the risk of autoimmune disorders such as arthritis, Crohn's disease, and lupus. Conti notes that this biological wear and tear, paired with self-neglect, dramatically raises mortality; he cites a 2021 British Medical Journal study finding that adults sexually abused before age 16 experienced a 2.6-fold increase in middle-age mortality risk. Beyond individual physiology, trauma alters genetic expression through epigenetics without changing underlying DNA sequences. Traumatic stress can biochemically switch off beneficial genes related to mood stability and stress regulation. Landmark animal research at Emory University demonstrated this transgenerational effect when mice conditioned to fear cherry blossom scents passed that fear reaction to unexposed offspring. Conti maintains that children can inherit altered gene expression from parental trauma sustained years prior to conception. Trauma Classification, Susceptibility, and Social Marginalization (19:51) Conti defines trauma biologically as anything that overwhelms an individual's coping mechanisms and results in lasting structural or functional brain alterations. He divides trauma into three categories: acute (sudden events like accidents or combat), chronic (repeated stressors such as ongoing neglect, domestic abuse, or systemic discrimination), and vicarious (empathy-driven distress absorbed by caretakers, medical staff, or family members). Rejecting the popular adage that adversity inherently builds resilience, Conti argues that trauma often weakens individuals via a "Multiple Hit Hypothesis," wherein initial wounds erode coping reserves and make people progressively vulnerable to subsequent stressors. Susceptibility is also mediated by environmental validation and innate emotional attunement. Individuals with highly sensitive emotional compasses absorb hostility and prejudice more acutely than their peers. Social context directly influences severe psychiatric outcomes; Conti cites psychiatric research on Somali immigrants to Holland showing that those living in culturally validating enclaves retained lower schizophrenia rates, whereas immigrants integrating directly into traditional Dutch communities faced pervasive feelings of "otherness" and discrimination that correlated with higher rates of schizophrenia relative to the global 1% baseline. The Internal Abscess, Repetition Compulsion, and Shame (41:00) Unprocessed trauma functions like an internal abscess: walling it off prevents immediate collapse, but it continuously produces secondary symptoms including panic, sleep disruption, and chronic irritability. Because early trauma often instills reflexive guilt, individuals frequently absorb an "internal persecutor" and believe themselves fundamentally flawed. This internal distress narrows cognitive perspective, prompting desperate attempts at short-term soothing through substance abuse, disordered eating, or compulsive behaviors. Conti highlights the opiate epidemic as a catastrophic institutional failure that handed potent, addictive painkillers to traumatized patients seeking relief for chronic distress. Trauma also impairs decision-making by prioritizing the emotional limbic system over rational logic. Through subconscious repetition compulsion, survivors often recreate abusive or neglectful dynamics in adulthood—such as repeatedly selecting emotionally unavailable partners. Conti explains that the brain disregards calendar time, attempting to resolve past powerlessness by replaying and attempting to master familiar scenarios in the present. Neural Retraining, Trigger Attenuation, and Societal Support Recovery does not achieve absolute amnesia; rather, its goal is attenuation—substantially dampening the emotional and physiological charge tied to traumatic memories. Because the brain functions as a creature of neuronal habit, repetitive internal narratives like feelings of unworthiness strengthen underlying neural circuits. Conti advocates establishing an objective internal observer ("the judge") to acknowledge automatic negative thoughts without reinforcing them, allowing unhelpful neural pathways to gradually atrophy. Societal reception plays an equally decisive role in whether trauma solidifies into chronic pathology. Historical precedents demonstrate that World War II veterans returning to public honor and social validation exhibited lower rates of long-term post-traumatic stress disorder than Vietnam War veterans, who encountered societal hostility and alienation. External compassion directly counteracts the isolation of reflexive shame, providing the social safety required to rewire threat-response networks and resolve post-trauma syndromes. While Conti maintains that post-traumatic brain alterations and metabolic dysfunctions are clinically reversible through curious self-inquiry and neuroplastic retraining, he cautions that modern medical infrastructure remains heavily skewed toward symptom suppression and sedative overprescription. An ongoing challenge lies in restructuring clinical care to address developmental narratives and dismantling the societal stigmas that compel individuals to conceal their trauma.

精神科医生保罗·孔蒂（Paul Conti）指出，创伤是一种能改变大脑结构、基因表达并跨代传递的隐性流行病，它往往是许多慢性疾病、成瘾与早逝的核心诱因，必须通过探究根源与重塑认知而非单纯依赖药物来治疗。 创伤的隐性流行与真实规模 (2:41) 社会通常将创伤局限于退伍军人的战斗后应激障碍等重大事件，但孔蒂指出创伤的真实影响范围极为广泛。保守估计普通人群中至少有20%直接遭受创伤引发的大脑改变和后遗症；若将家庭成员与伴侣所受的间接波及计算在内，超过50%的人口正承受创伤带来的负面影响。孔蒂将创伤定义为任何超出个体应对机制并导致大脑结构与功能发生改变的事件。在临床实践中，全科医生接诊的病患中有超过50%的诉求与心理健康直接相关，慢性抑郁、惊恐障碍及药物成瘾等多种病症的深层源头均常指向未化解的创伤。 然而现代医疗体系往往将这一问题“隐形化”，仅孤立处理心血管疾病、自身免疫性疾病或中风等末端生理症状，缺乏对其心理根源的探寻。此外，创伤在发生后会本能地在受害者内心引发强烈的内疚感与耻辱感，致使经历者倾向于隐瞒痛苦而非寻求外界帮助，这使得创伤如同无法被识别的体内暗疾，长期阻碍着及时而有效的系统干预。 创伤对细胞与生理机能的病理侵蚀 (13:11) 创伤不仅是情绪问题，更会在细胞层面引发不可逆的病理损耗，加速机体的生物老化进程。孔蒂通过双胞胎模型说明，尽管两者基因与日历年龄相同，处于慢性创伤或歧视环境中的个体其端粒缩短速度会显著加快，其生物年龄可能远超实际年龄，例如日历年龄40岁的人在生理机能上可能等同于46岁，65岁可能等同于73岁。未化解的创伤会使血液中持续循环高水平的炎性信号分子，损害血管内皮完整性，并促使免疫系统过度活跃而反噬自身组织，增加罹患红斑狼疮、类风湿性关节炎、克罗恩病、溃疡性结肠炎乃至帕金森病的风险。巴特利特援引《英国医学杂志》2021年发表的一项研究显示，16岁前遭受过性虐待的成年人，其中年死亡风险是非虐待人群的2.6倍。 这种生理退化还源于创伤对表观遗传的改变。现代表观遗传学证实，环境创伤能直接开启致病基因或关闭降低焦虑与稳定情绪的保护性基因，且该表达修饰会被传递给后代，例如埃默里大学对雄性小鼠的气味电击实验以及大屠杀幸存者后代的研究均证实了跨代遗传现象。在日常行为中，高水平的炎症标记物会向身体发出储备热量的防御信号，阻碍体重减轻，加之自理能力的瓦解，患者极易并发2型糖尿病与心血管疾病；同时神经系统的持续警觉也严重破坏睡眠机制，若仅通过镇静安眠药强行抑制中枢神经，不仅无法根治失眠，更会加剧药物依赖的风险。 三重分类、多重打击与敏感度差异 (19:51) 孔蒂将创伤系统划分为三类：第一类是急性创伤（Acute Trauma），由车祸、突发伤害或战争等单一高强度冲击引发；第二类是慢性创伤（Chronic Trauma），源于家庭忽视、长年虐待、校园霸凌或种族歧视等重复性压力源所造成的大脑渐进性改变；第三类是替代性创伤（Vicarious Trauma），医护人员、记者或目睹亲属痛苦的个体，通过共情机制同样会产生与亲历者相同的神经病理改变。他批判现行医疗指南将替代性创伤局限于专业工作环境的逻辑漏洞，指出家庭等私人场景中的共情暴露同样具备相同的神经破坏力。 面对创伤事件，个体的易感性存在显著差异，孔蒂明确驳斥了“杀不死你的会让你更强大”这一通俗说法，强调在神经生物学上“杀不死你的往往使你变得更脆弱”。依据“多重打击假说”（Multiple Hit Hypothesis），早期创伤会削弱个体的抗逆力基线，使后续看似轻微的外界刺激成为引发严重神经改变的临界点。此外，同一家庭内的不同成员也因年龄阶段、社会网络及“情绪罗盘”（Emotional Compass）灵敏度的不同而表现各异。高敏锐度的个体更容易捕捉到微妙的敌意与排斥，承受更深层的应激；而研究显示，融入传统荷兰社区的索马里移民其精神分裂症发病率显著高于居住在同质文化聚居区的移民，证实边缘感与“异己感”（Otherness）对大脑结构与精神病变具有明确的推波助澜作用。 重复强迫、边缘系统失控与认知盲区 (62:48) 创伤会在神经回路中造成显著的生理性改变，负责负面情绪调控的杏仁核过度活跃，警觉与恐惧通路的连接强化，而负责安全感与信任的网络则遭到抑制。这种失衡形成了孔蒂所称的“认知盲区”（Cognitive Blind Spots），即大脑在缺乏自我审计机制的情况下，直接将童年创伤期得出的错误结论（如“我不配得到爱”或“周围人都不喜欢我”）固化为不可动摇的生活脚本，并在成年期通过回避型依恋或自我设限的破坏性行为将其无休止地演绎。 这种神经模式外化为心理学上的“重复强迫”（Repetition Compulsion）。患者并非沉溺于痛苦，而是潜意识中试图在当下重演过去的无力处境，以期通过战胜当前的类似情境来“解决过去的旧伤”，从而在原本失控的领域夺回掌控权。在选择伴侣或社交圈时，负责原始生存保护的边缘系统会彻底压制理性逻辑的判断。加之耻辱感在远古部落进化中作为防止违规被逐的警示机制，在现代遭遇网络欺凌或侵犯时往往发生失控故障，导致受害者产生荒谬的内化自责，并在内心筑起“受害者与迫害者同在”的精神脓包，驱使个体通过酗酒、购物甚至滥用阿片类药物进行破坏性的即时镇痛。 打破创伤循环与神经通路的系统重塑 (79:57) 创伤的真正康复不在于抹除记忆或追求毫无波动的“绝对清零”，而在于神经冲动的“衰减”（Attenuation），即彻底剥离附着在记忆上的极端生理及情绪负荷，将原本引发惊恐发作的触发点降格为可被理性从容应对的轻微不适。孔蒂指出，人脑是“神经元习惯的产物”，就像连续数千次默念一个无意义的词汇会导致其反复侵入大脑一样，诸如“我一无是处”等负面自我对话也是通过成千上万次的神经重放被刻入回路的。患者需要在意识中建立中立客观的“内部观察者”（The Judge），在消极念头浮现时保持觉察而不附着情绪，切断其神经能量供给，使陈旧的病理通路逐步发生退化性萎缩。 打破这种代际恶性循环的关键在于构建完整的个人叙事与自我好奇心。通过系统梳理家庭历史、辨明自身早年创伤与责任归属，受害者得以将客观遭遇与“自身天生有缺陷”的内化耻感彻底剥离。临床实践表明，当患者首次在专业治疗环境中倾诉隐秘创伤并获得共情接纳而非审判时，长久禁锢的耻辱感便会开始瓦解。面对偶然发生的创伤重现，患者应采取自我包容的“耸肩”态度，将其视为残存神经回路的偶发激活，从而免于陷入自我苛责的二次创伤循环，实现长期的心理自愈与生理机能恢复。 孔蒂认为，现代医学过度依赖高通量就诊模式和短期镇静药物，掩盖了作为众多身心疾病根源的创伤本质。尽管通过神经重塑与叙事重构能够实现有效的创伤衰减，但在全社会层面如何打破制度化边缘感、减少对受害者的污名化，以及促使主流医疗体系转向以好奇心为导向的根本病因分析，依然是尚未解决的系统性挑战。

## Background 该视频由 YouTube 频道《The Diary Of A CEO》（主持人 Steven Bartlett）于 2024 年 3 月 21 日发布。视频内容围绕知名精神科医生、创伤治疗专家及 Pacific Premier Group 创始人保罗·孔蒂博士（Dr. Paul Conti）的专访展开，结合其服务包括 Lady Gaga、金·卡戴珊等名流在内的临床经验及其著作《创伤：隐形流行病》，深入揭露关于童年创伤的常见误区与深远影响。 ## TL;DR 孔蒂博士在对话中指出，创伤绝非局限于极端事件，它如同“隐形流行病”般压垮人体的应对机制，不仅在生物学层面加速细胞衰老、破坏免疫系统，甚至通过表观遗传学实现跨代遗传。针对“打不倒你的会让你更强大”这一流毒甚广的谬论，他以“多次打击假说”阐明未经处理的创伤只会让人更加脆弱，并驱动成瘾、睡眠崩溃及强迫性重复。唯有破除由创伤引发的条件反射式羞耻与内疚，以好奇心审视生命叙事并重塑神经回路，受创者才能真正夺回自我掌控权，终结代际创伤的恶性循环。 ## Atmosphere & style 整场对话沉静而极具穿透力，学术严谨性与直击灵魂的人性温度在对谈中交织。孔蒂博士以医者的慈悲与极度克制的坦诚，重访弟弟自杀离世的家族创伤，将晦涩的神经生物学机制化作令人共鸣的生命寓言；主持人 Bartlett 则以极具同理心的追问搭建起安全敞开的情感场域。听者在层层剥开自身隐秘伤痛与羞耻的同时，能真切感受到一种被深层理解的释然，以及将苦难炼化为新生力量的笃定与希望。 ## Bulletin - [16:25](https://www.youtube.com/watch?v=USE89i0kiiQ&t=985s) 创伤是现代多种慢性疾病与早逝的核心隐形诱因：全科门诊中超过 50% 的躯体主诉根源于心理创伤，16 岁前遭受性侵者的中年死亡风险甚至高出常人 2.6 倍。 - [35:57](https://www.youtube.com/watch?v=USE89i0kiiQ&t=2157s) 创伤并非不可遗传的个体体验，表观遗传学证实重大创伤会改变基因的开启与关闭状态，并通过生殖细胞跨代传递给未受直接刺激的后代。 - [23:30](https://www.youtube.com/watch?v=USE89i0kiiQ&t=1410s) 医学上反驳了“杀不死你的使你更强大”的成见，“多次打击假说”证明未被妥善处理的创伤只会持续削弱神经系统的承载力，使人对后续微小应激更加脆弱。 - [51:48](https://www.youtube.com/watch?v=USE89i0kiiQ&t=3108s) 成瘾行为本质上是绝望中寻求短期安抚与逃避现实的笨拙自救，而现代医疗滥用处方阿片类药物和安眠药的短视模式掩盖了创伤病根，酿成了严重的药物危机。 ## Key takeaways - [19:13](https://www.youtube.com/watch?v=USE89i0kiiQ&t=1153s) 创伤在生物学上被定义为“彻底压垮个体应对机制并重塑大脑神经回路的事件”，在全人群中波及面远超半数。 - [13:11](https://www.youtube.com/watch?v=USE89i0kiiQ&t=791s) 创伤通过加速端粒缩短、激增炎症信号分子并诱发细胞早衰，导致个体的生物学年龄显著大于历法年龄。 - [16:25](https://www.youtube.com/watch?v=USE89i0kiiQ&t=985s) 常规死亡证明上的物理死因（如车祸、器官衰竭）往往掩盖了深层真相——未愈合的创伤驱动着自我毁灭与极端冒险行为。 - [20:18](https://www.youtube.com/watch?v=USE89i0kiiQ&t=1218s) 创伤分为急性、慢性与替代性创伤三类，同理心可使医护人员或家属产生与亲历者完全相同的神经病理改变。 - [30:43](https://www.youtube.com/watch?v=USE89i0kiiQ&t=1843s) 在异质文化中体验到的“异类感”与微歧视会带来慢性心理孤立，显著提高特定人群的精神分裂症发病率并改写大脑结构。 - [38:04](https://www.youtube.com/watch?v=USE89i0kiiQ&t=2284s) 大屠杀幸存者及动物恐惧反射实验证明，创伤能够通过改变基因表达（表观遗传学）向下代际遗传。 - [41:00](https://www.youtube.com/watch?v=USE89i0kiiQ&t=2460s) 压抑创伤如同在体内包裹“脓肿”，虽然暂时隔离了致命危险，却会持续向全身外溢焦虑、易怒、低烧与失眠等慢性症状。 - [58:44](https://www.youtube.com/watch?v=USE89i0kiiQ&t=3524s) 创伤后大脑的杏仁核持续过度激活，安全回路被压制，导致个体把“创伤教训”误当成了人生的“客观真理”（认知盲区）。 - [01:03:03](https://www.youtube.com/watch?v=USE89i0kiiQ&t=3783s) “强迫性重复”并非受虐狂倾向，而是个体的情感系统试图在当下主动选择的恶劣关系中，重新夺回童年失去的掌控力。 - [01:05:42](https://www.youtube.com/watch?v=USE89i0kiiQ&t=3942s) 未经疗愈的创伤会催生“内化受害者”与“内化迫害者”，使个体在缺乏外部施害力量时仍日夜进行自我折磨与自贬。 - [01:10:27](https://www.youtube.com/watch?v=USE89i0kiiQ&t=4227s) 羞耻感原本是部落时代维系群体存续的进化工具，但在现代社会中它常被泛化并倒错为对自身受害的荒谬自责。 - [01:16:34](https://www.youtube.com/watch?v=USE89i0kiiQ&t=4594s) 外界对待受创者的社会反馈至关重要，二战老兵与越战老兵的创伤后综合征发病率差异印证了社会接纳能缓冲神经器质性改变。 - [01:27:33](https://www.youtube.com/watch?v=USE89i0kiiQ&t=5253s) 顽固性失眠多由神经高度戒备系统（Vigilance System）被创伤锁死所致，盲目开具安眠药往往加剧成瘾而掩盖了病根。 - [01:31:14](https://www.youtube.com/watch?v=USE89i0kiiQ&t=5474s) 系统性慢性炎症与自我关怀机制的崩溃共同促成了创伤与肥胖、代谢综合征之间的紧密病理关联。 - [01:35:05](https://www.youtube.com/watch?v=USE89i0kiiQ&t=5705s) 大脑重塑类似肌肉训练，面对脑中常年内化的自毁声音，必须建立超然的“内在法官”中止强化，促使其神经回路自然萎缩。 - [01:37:30](https://www.youtube.com/watch?v=USE89i0kiiQ&t=5850s) 创伤记忆无法被彻底抹去，疗愈的目标不是失忆，而是在再次被触发时学会钝化情绪反应、泰然与之相处。 ## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=USE89i0kiiQ&t=0s) 开场：创伤像病毒一样蔓延，药物并不是万能解药 创伤就像一种病毒，它能够代代相传；即使下一代在多年后才出生，创伤依旧可以通过改变基因表达对他们产生实质影响。因此，认清创伤是否在折磨我们、它是如何侵蚀我们的，以及在创伤出现时该如何科学治疗，是当代人必须面对的重大课题。精神病学家保罗·康蒂医生（Dr. Paul Conti）深耕创伤治疗二十余年，曾与金·卡戴珊（Kim Kardashian）合作，并挽救过 Lady Gaga 的生命。 根据康蒂医生的临床观察，全人群中超过半数的人都背负着某种形式的创伤。创伤对人类的改变是极其负面且深刻的：大脑发生器质性或功能性病变的概率极高，它会加速人体的生物学衰老，使其显著快于实际历法年龄。抑郁症、成瘾症乃至帕金森病（Parkinson's disease）的根源，往往都可以追溯到未愈合的创伤。现代医学和科学界其实清楚这一关联，但医疗系统的惯性做法却是给患者盲目开药，妄图靠几粒药片解决一切，结果每年导致成千上万的人死于处方药的滥用与副作用。 面对这种困局，关键在于保持“好奇心”。例如，当一个人深陷手机成瘾时，这种上瘾行为表面上是一种逃避现实的手段，甚至是一种隐蔽的自我惩罚；但如果顺着表象向下深挖，很可能会揭开其童年期遭遇性侵犯的痛苦秘密。要化解创伤、停止自毁，答案必须建立在扎实的硬核神经生物学与精神医学之上。 ```mermaid flowchart TD accTitle: 创伤的隐藏传导路径 accDescr: 展现创伤从基因表达与脑结构改变，经由羞耻隐藏，最终演变为成瘾与身体疾病的过程 subgraph Origin["根源：创伤机制"] A["创伤经历（急性/慢性）"] --> B["基因表达改变 & 脑部神经重塑"] end subgraph Defense["防御与掩盖"] B --> C["反射性内疚与羞耻感"] C --> D["向内隐藏，拒绝表达与求助"] end subgraph Manifestation["下游病症表现"] D --> E["上瘾行为（逃避与自我惩罚）"] D --> F["精神疾病（抑郁、恐慌）"] D --> G["身体病变（心血管病、自身免疫病、加速衰老）"] end ``` --- ### [01:31](https://www.youtube.com/watch?v=USE89i0kiiQ&t=91s) 主持人致谢与 2024 年《CEO日记》的全面升级 主持人史蒂文·巴特利特（Steven Bartlett）向所有观众表达了由衷的感谢。在节目开播三年多的时间里，YouTube 频道的订阅人数突破了难以置信的 500 万大关。主持人感慨道，这一成绩远远超出了他最初“三年能达到 10 万订阅”的奢望。为了回馈观众每周的陪伴，团队在过去 9 个月中筹备了一份重大惊喜，并在 2024 年对制作水准进行全面拔高：带来更深度的嘉宾对谈，讲述更多具有全球影响力的真实故事。 --- ### [02:41](https://www.youtube.com/watch?v=USE89i0kiiQ&t=161s) 隐形的流行病：为何创伤是现代万病的潜伏根源 保罗·康蒂医生在其著作中将创伤定义为“隐形的流行病”（The Invisible Epidemic）。解释为何选择这两个词时，他指出，在长期的精神科临床实践中，他反复发现绝大多数精神问题——不论是抑郁症、成瘾症还是恐慌症——追根溯源都是创伤所致。不论创伤是一次性的急性打击，还是经年累月的慢性摧残，它都会在物理层面重塑大脑，使其运作方式发生不可逆的恶化。 这构成了名副其实的“流行病”，因为创伤不仅摧毁心理防线，更是普通全科门诊中绝大多数生理疾病的隐秘源头： - 普通全科医生（General physical medicine doctors）接待的病患诉求中，有 50% 以上直接或间接由心理精神健康问题引发。 - 临床上往往将疾病孤立分类，例如给患者贴上“抑郁症”、“心血管疾病”或“突发心脏病”的标签，却忽略了这些病症与红斑狼疮等自身免疫性疾病之间存在着共同的创伤底色。 - 之所以被称为“隐形”，是因为创伤会引发一种强烈的“反射性内疚与羞耻感（reflexive sense of guilt and shame）”。经历创伤的人本能地想要掩盖秘密、封闭自我、抗拒求助，导致整个社会无法看清这一流行病的真实全貌。 --- ### [04:49](https://www.youtube.com/watch?v=USE89i0kiiQ&t=289s) 创伤的普遍性：加速生物衰老与生命倒计时 很多人一提到创伤，往往局限于战争归来士兵患上的创伤后应激障碍（PTSD）。康蒂医生指出，虽然统计数据各异，但哪怕保守估计，人群中也有大约五分之一（20%）的人直接遭受创伤。如果将范围扩大到那些因创伤而后天改变的人，以及因深爱身边的父母、子女或伴侣而间接受到创伤波及的人群，受创伤负面侵蚀的人口比例“远远超过半数（well over half the population）”。这些伤害大多原本是完全可以避免或能够被治愈的。 创伤不仅是认知与世界交互方式的崩塌，它还在细胞和生理层面造成巨大破坏： - **心理承载能力瓦解**：创伤的本质是外部冲击彻底压垮了个体的应对机制（coping mechanisms）。 - **生物学加速衰老**：医学研究表明，创伤会让人体的衰老速度大幅超越日历年龄。日历上显示一个人只有 40 岁，但其身体机能可能已经衰退至 46 岁；日历上写着 65 岁的人，生物学年龄可能已经高达 73 岁。 - **死亡时钟提前**：现代神经生物学和精神医学研究清晰地证明了创伤对身体寿命的剥夺，它使人类实质上更接近死亡。但现代社会并没有将这些实打实的科研证据置于公众意识的前沿。 --- ### [07:15](https://www.youtube.com/watch?v=USE89i0kiiQ&t=435s) 弟弟乔纳森自杀的创伤：从商界精英走向精神医学 当主持人询问为何对创伤课题如此执着时，保罗·康蒂医生分享了改变他人生轨道的至痛往事。在他二十多岁、正处于商业生涯起步阶段时，年仅 20 岁的小弟弟乔纳森（Jonathan）因自杀离世。这一噩耗击碎了原有的家庭结构，也彻底击垮了康蒂医生本人。 此前从未经历过精神崩塌的他，体内突然涌现出巨大的内疚和强烈的羞耻感。他感到自己仿佛受到了不可名状的诅咒，认为整个家庭在劫难逃，未来只会被厄运笼罩。面对这份无法排解的痛楚，他一度陷入了严重的酗酒，卷入了不健康的社交圈和破坏性的人际关系之中。那不仅仅是失去至亲的悲痛与哀伤，更是一种自我认同的异化——他明确意识到“自己变得彻底不正常了”。 在那个年代和家庭背景下，人们对精神痛苦极力回避，根本没有任何倾诉的出口，家人之间不会主动过问“你最近怎么样？要不要去找人聊聊？”。直到康蒂医生意识到自己已经深陷危机、快要走投无路时，才鼓起勇气翻开保险卡背面的电话去寻求专业心理援助。彼时，迈出求医这一步伴随着巨大的羞耻与窘迫感。 弟弟生前未被外界察觉和干预的抑郁症，以及自杀给整个家族带来的次生创伤灾难，促使康蒂医生毅然辞去了原有的商业工作。他重返大学修读医学预科课程，随后考入医学院，将全部心血倾注在精神病学、认知心理学以及支撑思维运作的脑生物学之中，走上了长达二十余年的创伤救赎之路。 ### [09:42](https://www.youtube.com/watch?v=USE89i0kiiQ&t=582s) 寻求帮助的转折点与家庭创伤的阴影 Dr. Paul Conti 回忆起自己在失去兄弟后陷入的巨大茫然与痛苦。当时的他既无法理解到底发生了什么，也不知道该如何拯救自己。直到他去见了一位专业人士，对方极其寻常却充满力量地告诉他：体验到这些感受并不代表他“疯了”或“病入膏肓”，更不意味着他的人生就此彻底完蛋。这种将痛苦体验予以“常态化”（normalization）并帮他重新梳理认知框架的沟通，起到了立竿见影的救赎作用。Conti 深刻体会到，这种支持看似基础简单，现实中却有无数人穷尽一生也未曾获得过；若非亲身经历，他也差点与这份生机擦肩而过。 随后，主持人探讨了这起自杀悲剧对 Conti 家庭其他成员造成的不可逆创伤。Conti 坦言，母亲的人生在此后彻底改变，陷入了长期的严重抑郁与极度孤立。事后复盘来看，母亲内心积压的内疚与羞耻感是压垮她的根源。即便后来 Conti 成为了一名专业精神科医生，拼尽全力鼓励母亲寻求外界帮助，母亲依然无法迈出那一步——对她而言，不仅求助渠道看起来遥不可及，而且“承认自己需要求助”本身就被她视作一种更深重的耻辱。与性格较为外向、拥有更多天然社会支持系统的父亲不同，母亲性格较为内倾且习惯于自责，在缺乏专门针对“痛失子女的母亲”这类支持机制的环境下，她再未能走出阴霾。母亲最终在远比预期年轻的年纪死于癌症，Conti 认为，严重的心理创伤破坏了她的免疫机能，极有可能是诱发癌症早逝的重要诱因。 Conti 强调，公众必须清醒认识到创伤的本质及其破坏力，因为这一切本是可以预防、识别和治疗的。自责、羞耻与抑郁并非宿命，靠滥用药物来麻痹痛苦甚至自杀的生活并非不可逆转。在生理层面，创伤会急剧恶化心血管疾病、自身免疫性疾病或类风湿性关节炎；据统计，向综合医院全科医生求诊的身体主诉中，有超过 50% 的根源来自心理健康层面，而其中绝大多数问题本质上都是由创伤驱动的。 - **心理疏导的关键作用**：专业人士将极端痛苦反应“常态化”，能迅速阻断个体陷入自我怀疑与绝望的恶性循环。 - **求助的羞耻壁垒**：即使直系亲属是专业精神科医生，深陷创伤愧疚的个体仍可能因强烈的羞耻感而排斥任何治疗。 - **身心医学的现实数据**：超过半数去医院就诊的躯体化症状，其潜在病因都可以追溯至未被解决的心理创伤。 --- ### [13:11](https://www.youtube.com/watch?v=USE89i0kiiQ&t=791s) 创伤如何从细胞层面加速人体衰老 当被问及“创伤是否真的会让人加速变老”时，Conti 给出了极其肯定的答复，并从生物学机制层面进行了解析。他指出，人体内部存在着记录衰老进程的细胞机制，例如大众熟知的端粒（telomeres）。虽然现代科学尚未完全破解衰老的终极奥秘，但已明确将一个人的“生物学年龄”（biological age）与其身份证上的“历法年龄”（calendar age）区分开来。 为了形象地阐明这一机制，Conti 提出了一个同卵双胞胎的思想实验：假设一对拥有完全相同基因的双胞胎从出生起走向两条不同的人生轨迹，一人生活在安全稳定、毫无创伤的良好环境中，另一人则长期经历匮乏、遭受直接的躯体暴力虐待或被社会边缘化侮辱。当在三四十或五十年后重新对两人进行生理评估时，他们早已不再是“同一个年龄”。生活在健康环境中的双胞胎，其细胞衰老指标与 40 岁的历法年龄高度吻合；而长期背负创伤应激综合征与大脑器质性改变的另一位双胞胎，其体内运转的生物机器已经过早严重损耗，在生物学年龄上显著老于日历上的真实年龄。 ```mermaid flowchart TD accTitle: 创伤加速生物衰老的作用路径 accDescr: 展示未愈创伤如何通过生物分子变化导致细胞早衰，拉开生物年龄与历法年龄的差距。 subgraph Internal_Stress["创伤引发的机体微环境恶化"] A["慢性创伤与应激状态"] --> B["神经递质失衡与焦虑张力"] A --> C["炎症信号分子激增"] end subgraph Cellular_Level["细胞与分子层面损伤"] B --> D["端粒缩短加速"] C --> D C --> E["细胞提早凋亡"] end subgraph Aging_Divergence["衰老结果分化"] D --> F["生物学年龄远超历法年龄"] E --> F end ``` Conti 解释道，创伤会彻底破坏人体内在微环境的健康平衡。创伤幸存者的血液中充斥着各类炎症信号分子，神经递质与内分泌系统处于长期的焦虑与紧绷状态，导致健康细胞提早凋亡。他打了一个贴切的比喻：这就像把两辆性能完全相同的汽车分别放置在不同环境中，一辆停在温暖干燥的车库中悉心保养，另一辆一年中有六个月暴露在严酷的冰雪严寒中，剩下的六个月又在极端酷暑中暴晒颠簸，十年后再去检验，两辆车的磨损与老化速度必然有着天壤之别。 --- ### [16:25](https://www.youtube.com/watch?v=USE89i0kiiQ&t=985s) 创伤作为隐形杀手：从致命疾病到行为失控 创伤不仅改变衰老速率，更是直接诱发严重躯体疾病与早逝的关键诱因。主持人引用了《英国医学杂志》（BMJ）2021 年发表的一项重磅研究：在 16 岁之前遭受过性侵犯的成年人，其中年死亡的概率是未受侵害者的高达 2.6 倍。面对这一惊人数据，Conti 连连感慨这一发现具有“划时代的沉重意义”（absolutely momentous），并详细拆解了导致死亡风险激增 2.5 倍背后的双重级联反应： ```mermaid flowchart LR accTitle: 创伤引发的双重级联致死反应 accDescr: 展示创伤如何同时通过生物学病变与高危行为两方面大幅提升个体的中年早逝风险。 subgraph Biological_Cascade["生物学生理级联反应"] T["童年期/青少年期严重创伤"] --> G["基因转录改变<br>健康基因关闭/有害基因开启"] G --> I["免疫亢进与自免疫攻击<br>(关节炎/克罗恩病/结肠炎)"] G --> V["血管与内分泌损伤<br>(心脏病/中风概率飙升)"] G --> O["抗癌防护机制失灵"] end subgraph Behavioral_Cascade["心理行为级联反应"] T --> M["重度抑郁与认知盲区"] T --> S["成瘾行为与物质滥用"] T --> R["冲动与极端冒险行为"] end Biological_Cascade --> D["全因死亡率激增 2.6 倍"] Behavioral_Cascade --> D ``` 首先是**生物学生理层面的级联恶化**。创伤会改变人体的表观遗传与基因转录过程，压制保护性基因的表达，激活促炎与易病基因。这种改变直接破坏血管壁健康，显著增加心脏病和中风的发病率；免疫系统转变为过度激活状态并攻击自身组织，进而诱发或加剧包括克罗恩病（Crohn's disease）、溃疡性结肠炎、类风湿性关节炎甚至具有自身免疫特质的帕金森病；同时，人体对抗恶性肿瘤的内在免疫监控机制也因长期耗竭而瘫痪。 其次是**心理与行为层面的恶性反应**。创伤导致个体罹患重度抑郁、产生药物滥用成瘾，并表现出高度冲动和寻求高危刺激的行为模式。当生物学层面的脆弱病变与行为层面的危险自残交织在一起时，便构成了高达 2.6 倍的惊人死亡率。 当主持人询问“从根本上来说，世上是否存在比创伤杀死更多人的元凶”时，Conti 叹息后断言：“如果追溯真正的底层原因，答案是没有。”作为常年见证生死的医生，他坦言自己对死亡证明书（Death Certificate）上写下的死因与病人真正致死原因之间的巨大脱节感到震惊：一份报告上的死因写着“车祸”，但这背后未被记录的真相，是一个内心充斥着创伤绝望的人，为什么要在恶劣天气下以 120 英里的时速疯狂飙车，甚至此前已经历过多次毁灭性的危险驾驶。死亡证明记录的是最后的物理事件，而隐藏在深处夺人性命的，自始至终都是未愈合的创伤。 - **BMJ 关键研究数据**：16 岁前遭遇性侵的个体，中年早逝风险比常人高出 2.6 倍（即增幅达 260%）。 - **自身免疫性关联**：包括溃疡性结肠炎、克罗恩病、类风湿性关节炎及帕金森病等均与创伤诱发的长期免疫异常高度相关。 - **死亡证明书的盲区**：常规医学死因（如车祸、器官衰竭）往往掩盖了更底层的驱动力——由创伤引发的自我毁灭倾向与极端冒险行为。 ### [19:13](https://www.youtube.com/watch?v=USE89i0kiiQ&t=1153s) 创伤作为隐形致死病因与创伤的生物学定义 在探寻现代人健康恶化的核心诱因时，保罗·孔蒂（Paul Conti）医生强调，我们必须进行根本原因分析（Root Cause Analysis）。很多人在 62 岁突然遭遇心脏病发作，或者遭遇严重的意外事故，表面上看并没有太多显性的传统生理风险指标，但深层诱因往往是创伤及其在体内引发的长期连锁反应。支持这一结论的临床与科学证据多到数不胜数。 从生物学机制来看，创伤被明确定义为：**任何压垮我们应对机制（coping mechanisms）的事物**。当人类的应对系统被彻底击溃时，大脑内部会发生实质性、器质性的改变；穿过这一事件后，人的大脑结构与功能已与从前截然不同。这种大脑神经回路与生理反应的剧烈转变，构成了创伤的生物学根基。 ```mermaid flowchart TD accTitle: 创伤的三种核心分类 accDescr: 展示从应对机制被击垮到三大类创伤（急性、慢性、替代性）导致大脑神经器质性病变的路径。 subgraph Trigger["触发机制"] A["重大应激事件 / 长期压力源"] --> B["应对机制被彻底击垮"] end subgraph Categories["创伤的三种临床类型"] B --> C["急性创伤 (Acute)<br/>瞬间发生，突发剧烈打击"] B --> D["慢性创伤 (Chronic)<br/>长期潜伏，剥夺尊严与安全感"] B --> E["替代性创伤 (Vicarious)<br/>同理心传递，接收他人苦痛"] end subgraph Outcome["生物学终局"] C --> F["大脑神经回路器质性重塑"] D --> F E --> F F --> G["创伤后综合征、慢性炎症与机体衰竭"] end ``` ### [20:18](https://www.youtube.com/watch?v=USE89i0kiiQ&t=1218s) 创伤的三大类型：急性、慢性与替代性创伤 传统医学与精神病学对创伤的理解主要始于**急性创伤（Acute Trauma）**。第一次世界大战期间所谓的“炮弹休克”（shell-shocked）以及现代战役中的战斗应激，都是典型的急性创伤案例；亲人猝逝、严重身体创伤或惨烈车祸也是如此。这类创伤往往在某个确切时刻爆发，前因后果肉眼可见，人们能明显察觉受害者在事件发生前后的判若两人，因此大众习惯性地将创伤后综合征与急性事件直接画上等号。 然而，神经生物学改变绝非仅由单次剧烈冲击引起，另外两种创伤形式同样致命： - **慢性创伤（Chronic Trauma）**：并非在某一瞬间轰然爆发，而是如同水滴石穿。在社会环境中因种族、身份长年被视为“低人一等”，在家庭内部持续遭受身体暴力、情感虐待或长年被冷漠忽视，在学校里经历日复一日的霸凌等，都会对大脑造成与急性创伤完全相同、不可逆转的神经生理重塑。 - **替代性创伤（Vicarious Trauma）**：源于人类最高贵的情感——同理心与同情心。由于人类天生具备共情连接的能力，创伤能够在人与人之间互相传染。医护工作者、战地或前线记者、在家中照料重症患者的亲属，甚至长年沉溺于负面暴力新闻的普通人，大脑都会呈现出与车祸中丧失两位挚亲者完全相同的脑部病理改变。 ### [23:30](https://www.youtube.com/watch?v=USE89i0kiiQ&t=1410s) “打不倒你的，往往让你更脆弱”：多次打击假说 即便面临同等强度的创伤，每个人的易感性（susceptibility）也截然不同。有人连续遭遇三次重大急性打击，大脑仍能维持稳态，未曾演化为过度警觉（hyper-vigilance）或引发严重的血管炎性反应；但另一个人可能经历了一件外人看似轻微的小事件，大脑就直接被击垮，发生不可逆的神经退变。个体的基因构成、童年早期成长经历，以及各异的生理脆弱点共同决定了创伤阈值。 针对尼采那句著名的名言，孔蒂医生发出了尖锐的驳斥： > “那种认为‘杀不死你的会让你更强大’的观点是彻底错误的，在各个层面都是错的。现实中，杀不死你的东西往往会让你变得更虚弱。” 这就是神经精神病学中的**多次打击假说（Multiple Hit Hypothesis）**。未被妥善疗愈的伤害并不会自动转化为韧性，反而会不断削弱生理与心理的承载力。经历过前序打击后，人对创伤的易感性会逐次累积；当后续某次看似微不足道、温和得多的事件降临，便足以成为压垮神经系统的“最后一根稻草”，直接诱发器质性病变。因此，必须对那些带来痛苦但未致死的创伤保持高度警觉与干预，防止自己一步步走向脆弱。 ### [24:51](https://www.youtube.com/watch?v=USE89i0kiiQ&t=1491s) 兄弟姐妹同境不同命：情感罗盘调谐与童年变量 主持人史蒂文·巴特利特（Steven Bartlett）分享了自己的亲身经历：他作为家中四个孩子中最小的一个，与兄姐在完全相同的家庭环境下长大——全镇唯一的黑人家庭、在以白人为主的环境中面临慢性种族隔阂。但他感到自己比兄姐吸收了多得多的创伤与羞耻感，最终演变成一个重度“工作狂”和极度偏执的事业驱动者。他困惑为何同样的成长背景，兄姐没有以同样“受损”的方式应对生活。 孔蒂医生深入剖析了造成这种家庭内部差异的先天与后天因素（Nature and Nurture）： - **时序与环境变量的细微差异**：小儿子所处的成长时间线可能正值家庭经济状况恶化或外部压力更严峻的阶段，成长关键期所承受的实际压力密度与兄姐并不均等。 - **情感罗盘的调谐度（Emotional Compass Attunement）**：每个人先天的感知敏锐度大不相同。调谐度极高的人对周遭人际信号、隐性歧视和偏见眼神极度敏感，所有的负面情绪都会被深度记录在大脑之中；而调谐度较钝感的人往往能对外界的情感冲击浑然不觉，直接跨过这些阻碍。两种特质各有利弊，但高调谐度者更容易遭受创伤侵害。 ### [27:06](https://www.youtube.com/watch?v=USE89i0kiiQ&t=1626s) 临床诊疗中的外强中干与成瘾分化 在实际临床中，精神科门诊常会遇到极为极端的家庭对照：坐在诊室里的患者不仅身陷酗酒泥潭，甚至频繁产生强烈的自杀冲动；而他的兄弟姐妹表面上却生活体面、一切安好。 对于这种现象，孔蒂医生提醒临床医生不可被表象蒙蔽： - **表面完好不等于内在无恙**：家庭其他成员展现出来的“生活正常”，往往只是粉饰太平，其内心深处的创伤可能正以其他隐秘方式侵蚀机体。 - **遗传倾向与人格结构的决定性作用**：特别是在酒精依赖等成瘾问题上，基因脆弱性扮演着极为关键的推手；此外，个体习惯于“内化自责”还是“外化归咎”的人格结构，也决定了创伤最终以何种症状显现。 - **成长转折期应对模型的习得**：青春期中后期（15-19岁）的社交圈层影响深远。如果某位成员在此阶段恰好身处一个将酒精视为常规解压方式的环境中，便会迅速习得并固化这种破坏性的应对模式，而缺乏这种负面示范的兄姐则可能走上完全不同的人生路径。 ### [28:24](https://www.youtube.com/watch?v=USE89i0kiiQ&t=1704s) 现代精神医学的盲区与“异类感”对精神分裂症的影响 面对心理困境与创伤，仅仅罗列当下的表面症状往往无法触及本质。当今的精神健康医疗体系常常陷入一种机械式的反应：迅速盘点患者当前的症状清单，然后不假思索地开出处方药。然而，要真正理解创伤是否在侵蚀一个人、如何侵蚀、如何预防以及如何根治，就必须把人视为一个由家族遗传背景和成长经历共同塑造的完整生命体，去探寻内在深层的动态全貌。 这种心理与环境的相互作用有着扎实的科学证据。在全人类群体中，精神分裂症（Schizophrenia）的基线发病率大约在 1% 左右，且在各个人群中的分布原本相对恒定。然而，当极端的环境压力将个体置于“高压锅”一般的处境中时，患病易感性便会显著提升。一项关于索马里移民定居荷兰的长期对比研究揭示了一个耐人寻味的现象：研究人员对比了完全融入荷兰当地普通社区的移民，与居住在传统移民聚集区内的同胞，结果发现，那些选择融入当地主流社区的移民，其精神分裂症的发病率反而显著更高。 导致这一反直觉现象的核心驱动力，正是弥漫于日常生活中的“异类感”（Sense of Otherness）。在移民聚居区中，熟悉的食物、服饰和言谈举止被视为常态，个体的自我认同能够获得持续的确认；而当一个人孤身融入异质社会时，即便没有遭遇明目张胆的敌意，无处不在的审视与格格不入也会让人产生强烈的疏离与被孤立感。 - **发病率基线**：精神分裂症在全人类中的自然发病率约为 1%，但在极端压力环境刺激下会显著上升。 - **群体对照发现**：融入荷兰本地主流社会的索马里移民，其精神分裂症发病率反而高于生活在移民聚集区内部的同胞。 ### [30:43](https://www.youtube.com/watch?v=USE89i0kiiQ&t=1843s) 何为“异类感”：微歧视与脑生物学改变 “异类感”并非中性的不同，而是“一种带来负面体验的差异感”。它往往伴随着被轻视、被排斥在主流之外，或是面临无形的机会分层与不公对待。置身其中的人会深切感受到自己无法与周围人处于平等的立足点上，长此以往，内心会滋生出强烈的孤立无援与不安全感。人类在年轻时天然需要通过观察周围环境来确认自我，若周围人的样貌、语言和穿着皆与自己不同，且这种差异未被包容与接纳，个体的自我认同就会被无形瓦解。 许多第一代移民往往本能地选择抱团聚居以寻求心理确认，而到了下一代才开始更广泛地融入。这恰恰印证了第一代移民在面对新旧文化撕裂时，心理承受的冲击最为剧烈。这种因隐形偏见、微歧视或校园霸凌所带来的被贬低感，不仅停留在心理层面，更能通过神经生物学机制真实地改写大脑结构与功能。现代社会在很多层面日益割裂，不断将人推向缺乏安全感和深感孤立的脆弱境地，最终诱发了慢性的大脑创伤性改变。 ```mermaid flowchart TD accTitle: 异类感引发创伤性脑改变路径 accDescr: 展示从社会环境中的差异感、缺乏安全感到神经生物学创伤性改变的因果逻辑链条。 subgraph ENV["社会环境诱因"] A["融入异质文化/缺乏认同"] --> B["体验到'异类感'与微歧视"] end subgraph PSY["心理与安全机制"] B --> C["失去安全感与心理确认"] C --> D["慢性心理孤立与高压应激"] end subgraph BIO["生理与神经病理"] D --> E["易感基因被异常激活/抑制"] E --> F["大脑神经生物学病理性改变"] end ``` ### [33:30](https://www.youtube.com/watch?v=USE89i0kiiQ&t=2010s) 创伤的年龄阶段：从童年塑造到成人大脑的可塑性 在探讨荷兰移民研究时，发病率升高的核心人群主要集中在青年早期。这恰好说明，向成年期过渡的关键阶段，个体大脑依然具备极强的可塑性与塑造空间，因而极易受到创伤的深刻冲击。无论是急性创伤（Acute trauma）、慢性创伤（Chronic trauma）还是替代性创伤（Vicarious trauma），在人生的任何年龄、阶段或篇章都有可能发生，但发生得越早，对一生的摧毁性影响就越深远。 童年创伤之所以具有毁灭性，是因为它在儿童自我认知建立的最基础层面造成了永久性的扭曲。未能及时疗愈的童年创伤，会直接转化为成年后更为沉重的躯体疾病负担与社会功能丧失。精神科医生达伦·赖歇尔特（Darren Reicherter）与儿童健康倡导者斯特凡妮·祖·古滕贝格（Stephanie zu Guttenberg）的研究与实践表明：创伤不仅会摧毁当下的儿童，更会改变遭受创伤的成年人；这种发生在成年人身上的改变，甚至会在数年后传递给他们尚未出生的后代。 - **高发易感窗口**：精神分裂症的高发期多处于青年早期，此时大脑仍处于塑形成熟的过渡期，极易被创伤改变。 - **生命周期规律**：创伤虽然可以发生在任何年龄阶段，但发生的生命节点越早，其影响程度越深重。 - **跨代双向谱系**：创伤既直接影响受创儿童的心智成型，也会改变成人的生理机能，进而影响下一代。 ### [35:57](https://www.youtube.com/watch?v=USE89i0kiiQ&t=2157s) 表观遗传学：创伤如何通过基因表达跨代遗传 关于“创伤究竟如何传递给下一代”的疑问，表观遗传学（Epigenetics）在近二三十年的突破性发展给出了科学回答。过去人们普遍认为，精子与卵子结合的那一刻，一个人的基因蓝图就已经彻底定型——哪些基因活跃、哪些不活跃似乎终生不变。然而事实远非如此，生命经历与创伤能够直接改变基因的表达模式，即在不改变底层 DNA 序列的前提下，决定特定基因的“开启”（On）或“关闭”（Off）。 一个人可能继承了能够提振情绪、缓解焦虑的有益基因，但重大的创伤经历可能会彻底关闭该基因的表达，导致个体失去其应有的生理保护机制；反之，创伤也可能异常激活有害的易感基因。更为惊人的是，如果父母在遭遇严重创伤后基因开关被改变，这种被沉默或被激活的状态会在生殖细胞中传递下去。换言之，即便后代继承了某个基因，若它在遗传时已被关闭，其生理效果就如同未曾遗传一样。基因绝不仅仅是先天的“自然”（Nature），更是被后天“滋养与际遇”（Nurture）不断重写的动态过程。 埃默里大学（Emory University）的一项经典神经科学实验有力地印证了这一点：研究人员对雄性小鼠进行恐惧条件反射训练，每当让它们闻到樱花香气（乙酰苯酮气味）时便同时施加电击。久而久之，这些小鼠只要一闻到樱花的味道，即使完全没有遭受电击，也会立刻陷入极度恐惧而浑身颤抖。这项实验揭开了创伤记忆跨代生理遗传的惊人面纱。 ### [38:04](https://www.youtube.com/watch?v=USE89i0kiiQ&t=2284s) 表观遗传学与跨代创伤：大屠杀幸存者的基因表达变化 谈话承接了先前关于恐惧条件反射与电击实验的探讨，史蒂芬·巴特利特（Steven Bartlett）指出，即便实验中的后代并没有真正受到电击，依然展现出相同的恐惧生理反应。这一结论不仅在动物实验中得到证实，大屠杀幸存者及其子女的研究更是人类跨代创伤的典型范例。大屠杀可以说是人类历史上最严重的创伤事件之一。保罗·康蒂博士（Dr. Paul Conti）解释道，长期以来，心理学和医学界普遍认为幸存者子女之所以表现出更高水平的焦虑及广泛的焦虑谱系障碍，完全是因为后天抚养环境中的“焦虑型养育”（anxious parenting）——经历过灭顶之灾的父母自然伴随着极其强烈的脆弱感与不安全感，从而在无意识中把这种焦虑传递给了孩子。 然而，现代医学和表观遗传学的进展带来了认知上的巨变：后天的成长经历固然是一部分原因，但更关键的是，幸存者所承受的惨烈经历直接改变了其自身的基因表达，并将这种发生改变的表观遗传特征遗传给了子女。这一认知是颠覆性的——父母承受的创伤直接雕刻并重构了下一代的生理与基因表达。 巴特利特随即询问，基于这种表观遗传学的理解，康蒂博士在临床中是否会深入考量来访者父母的人生遭遇，以此评估眼前的个体可能承载了怎样的遗传表达改变。康蒂博士给出了肯定的回答，并指出每个人都应当梳理并审视自己的“生命叙事”（life narrative）。许多人在面对抑郁或试图更深刻地理解自我时，往往掌握着碎片化的信息，却从未将它们串联成一张完整的图谱。梳理叙事需要追问：我从何处来？我的先辈经历了什么？其后发生了怎样的波折？康蒂博士强调，不仅要理解父母当年的经历及其生物学状态对子女的影响，甚至可以横向对比家庭动态的演变——例如较年长与较年幼的孩子在家庭环境变迁中的差异。通过这种立体的审视，人们不仅能看清当下的心理困境，更能发现深埋于生理与家庭历史之中的创伤脉络。 --- ### [41:00](https://www.youtube.com/watch?v=USE89i0kiiQ&t=2460s) 创伤就像脓肿与病毒：隐秘的内部蔓延 巴特利特提到，康蒂博士把创伤比作“病毒”（virus），这个比喻非常新颖且发人深省。人们通常以为创伤是高度个体化、封闭在某一人体内的体验，但实际上它具有极强的传染性——既能通过后天行为或替代性创伤感染身边的同伴，又能通过表观遗传学顺着家族树向下蔓延，这进一步突显了治疗创伤的紧迫性。 康蒂博士深入剖析了创伤的隐匿性：由于创伤往往伴随着本能般的内疚与羞耻感（reflexive guilt and shame），加之社会环境缺乏对其足够的包容与正视，受到创伤的人常常选择将痛苦死死压抑在心底。为了形象地说明这一机制，康蒂博士提出了一个医学比喻——体内的“脓肿”（abscess）： ```mermaid flowchart TD accTitle: 创伤在体内如脓肿般演变的机制 accDescr: 展示从未被处理的创伤被压抑后，如何如同体内被包裹的脓肿一般持续释放出弥漫性全身症状 subgraph Defense ["防御机制（封存）"] T["压抑创伤 / 羞耻与内疚"] --> W["在内心建立包裹壁 (Walled-off)"] W --> P["防止心理防御机制立刻崩溃"] end subgraph ChronicSymptom ["慢性症状外溢 (Spinning off symptoms)"] W -.-> S1["低烧 / 情绪紧绷焦躁"] W -.-> S2["夜间盗汗 / 睡眠障碍"] W -.-> S3["无名疲惫与易怒冲动"] end subgraph Resolution ["外科式干预 (根治)"] Diagnosis["临床探究与觉察病灶"] --> Surgery["直面创伤的痛苦剥离与恢复过程"] Surgery --> Heal["脓肿消除 / 彻底恢复生命机能"] end ChronicSymptom --> Diagnosis ``` 脓肿是身体为了防止感染扩散至致命程度而自动建立的一个“包裹隔离区”（walled-off area）。虽然脓肿被包裹住了，但身体系统依然能感知到其存在，并持续不断地向全身释放慢性症状：患者可能会出现断断续续的低烧、莫名烦躁（jittery）、出汗以及睡眠质量低下。在普通医学门诊中，患者往往表现为非特异性症状，直到影像学检查精确定位了那个隐藏的脓肿，医生和患者才恍然大悟为什么身体总是不适。彻底解决脓肿需要外科手术清创，过程往往痛苦难熬，但唯有排脓与修复，脓肿才能彻底消除。 内心深处的创伤亦是如此。将创伤硬塞进潜意识深处并不会让它消失，它会化作心理脓肿，不断外溢出慢性症状。即便部分人依然极力克制、表现得对他人极其友善与警觉，但从整体上看，未解决的创伤会让人脾气暴躁、易怒、冲动，或陷入抑郁、焦虑与严重的失眠，剥夺个体在世界上健康自处的能力。 --- ### [43:48](https://www.youtube.com/watch?v=USE89i0kiiQ&t=2628s) 创伤后综合征与表象背后的“好奇心”诊断 当巴特利特询问这是否正是康蒂博士所说的“创伤后综合征”（post-trauma syndromes）以及普通人如何察觉自己是否受到创伤时，康蒂博士给出了详尽的临床界定。创伤后综合征是创伤在个体身上具体显现的集合： - **情绪谱系变化**：焦虑水平显著升高、心境低落、莫名抑郁。 - **身心机能失调**：睡眠模式改变、惊恐发作（panic attacks）频发、躯体健康指标恶化。 - **行为与状态扭曲**：世界观和自我状态改变导致行为异化，例如原本渴望建立亲密关系的人，突然彻底回避所有可能结识伴侣的社交场合。 康蒂博士痛心疾首地批评了现行主流医疗模式的浮躁与表面化：现代医学往往只盯着最外在的症状，把疾病孤立处理—— - 看到患者酗酒，就只谈如何减少饮酒量； - 看到患者抑郁，就直接开抗抑郁药； - 看到惊恐发作，就针对惊恐开具镇静剂。 “这根本没有去探究‘为什么’（Why）。”康蒂博士强调。抑郁固然可能存在纯粹的生物学原因（比如家族中每隔 9 到 12 个月无论顺遂与否都会集体发作的内源性抑郁），但这仅是少数。在绝大多数情况下，抑郁与行为剧变背后都有迹可循，关键在于临床医生和个体自身是否抱有足够的“好奇心”（curiosity）： > “为什么那个人突然陷入了抑郁？为什么那个人会突发惊恐？为什么他的行为会发生这样的改变？” 一旦以好奇的态度去追溯整个生命叙事，隐秘的线索便会浮现：或许是在两年前，当事人的睡眠开始出现紊乱，与家人的互动急剧减少，其后逐渐借酒消愁，最终滑向深重抑郁。究竟是抑郁导致了酗酒，还是急性创伤后借酒浇愁反噬了心境？唯有带着好奇心层层剥开，才能顺藤摸瓜找到创伤的病根。而正是这些由创伤后综合征驱动的行为异化与防御反应，让创伤如同病毒一般在人际关系与社会交往中交叉感染、蔓延开来。 ### [47:06](https://www.youtube.com/watch?v=USE89i0kiiQ&t=2826s) 创伤的代际传递与日常中的隐性症状 创伤如同一种无形的病毒，在家庭和世代之间悄然蔓延。当为人父母者自身饱受抑郁困扰或情绪长期低落时，健康的养育环境便不复存在；抑或父母为了对抗内心的痛苦而诉诸酒精和药物，这种应对机制直接削弱了养护子女的能力。更甚者，因创伤带来的无力感（disempowerment）常常转化为攻击性与嫉妒行为，成为家庭虐待与暴力滋生的温床。虽然并非所有虐待儿童的行为都能完全归咎于创伤，但其中相当大一部分确实深植于未解的心灵伤痛之中。 除了自杀倾向、严重酗酒等宏观且剧烈的创伤表现，创伤在日常生活中往往以更为微妙的形式存在。现代人普遍存在的手机成瘾、电子游戏沉迷等，表面上看似只是对数码产品的单纯依赖，但其深层诱因往往源于慢性创伤。面对这些隐秘的表征，最核心的态度应当是保持“好奇心”（curiosity）。人类所有成瘾行为的底层大脑运作机制惊人地相似，无论是可卡因、酒精、布朗尼蛋糕、手机，还是性与过度健身，它们本质上都是为了达成逃避痛苦、自我安抚（soothing）甚至是自我惩罚的目的。 深入剥开这些成瘾行为的表象，常常能揭示出惊人的真相：某个看似普通的手机依赖者，可能已经经历了多达十几次不同形式的成瘾转移，其背后可能深藏着三四十年前童年期遭受的性侵经历。这类创伤在当事人的脑海中构建了一套挥之不去的羞耻叙事（dialogue of shame），促使他们持续进行自我贬低与自我赋权剥夺。唯有通过探究个体完整的生命叙事，深入地表之下进行挖掘，才能看清这些细微习惯所掩盖的巨大创伤根源。 - 创伤代际传递的途径包括：抑郁的情绪氛围、借酒消愁带来的照护缺失，以及由无力感转化而来的嫉妒与攻击性行为。 - 大脑处理成瘾的神经回路具有一致性，成瘾的根本动机通常包含三类：逃避现实、安抚痛苦、自我惩罚。 --- ### [50:06](https://www.youtube.com/watch?v=USE89i0kiiQ&t=3006s) 创伤后大脑视角的转变与认知实验 创伤会彻底重塑大脑的生理结构与认知滤镜，使人看待周围世界的视角发生根本性转变。未受创伤的人在面对一张陌生面孔时，通常会本能地展现出好奇与开放的姿态，思考彼此是否能成为朋友或发展出浪漫关系；然而，创伤幸存者往往长期处于“后足防守”（on the back foot）的防御姿态。面对新面孔时，他们更倾向于回避目光、减少眼神接触，并迅速在脑海中闪现负面预设，例如“那个人肯定讨厌我”。这种将外界默认视为威胁的认知模式，剥夺了他们建立建设性人际联结的可能。 这种由创伤带来的“世界观墨镜”，在神经生物学检测和精妙的心理学实验中均能得到清晰的验证。尽管那些剧烈的行为转变非常显眼——比如一个原本外向开朗的人突然闭门不出，必然会引来外界的关切与询问——但真正具有普遍杀伤力的往往是那些细微的变化。当一个人逐渐变得不愿与外界互动、在社交场合中悄悄退缩时，旁人可能只会觉得他“最近有点变了”，却很难意识到这正是创伤在潜意识层面持续发酵、侵蚀生命力的信号。 ```mermaid flowchart TD accTitle: 创伤对大脑认知与人际互动的影响机制 accDescr: 展示未受创伤与经历创伤后个体在面对陌生人时的认知反应差异 subgraph NormalState ["未受创伤状态"] A1["遭遇陌生面孔"] --> B1["唤起开放与好奇心"] B1 --> C1["探索联结可能（朋友/伴侣）"] C1 --> D1["积极眼神交流与互动"] end subgraph TraumaState ["创伤后状态"] A2["遭遇陌生面孔"] --> B2["触发后足防守机制"] B2 --> C2["负面灾难化预设（被讨厌/被排斥）"] C2 --> D2["回避目光与社交退缩"] end ``` --- ### [51:38](https://www.youtube.com/watch?v=USE89i0kiiQ&t=3098s) 自我安抚的陷阱：从恶性循环到阿片类药物危机 在探讨创伤的深层逻辑时，保罗·孔蒂博士指出了一条贯穿始终的核心链条：“创伤滋生痛苦，痛苦加剧折磨，而折磨让我们不顾一切地渴望安抚痛苦（Trauma promotes pain, pain increases suffering, and suffering makes us desperate to soothe our pain）。”大众往往习惯性地将酗酒、暴饮暴食等成瘾行为视作纯粹的“自毁”（self-destruction），但从心理安抚的角度来看，这些行为在本质上恰恰是当事人试图“阻止自己彻底毁灭”的极度笨拙的自救手段。 当人承受着排山倒海般的巨大痛苦时，视野会发生极端窄化。孔蒂博士形象地比喻道：如果有一头大象踩在你的脚上，你的脑海中绝对不会有任何长远规划，你唯一的念头就是“让大象赶紧把脚挪开”。极度的绝望让幸存者只能紧紧抓住眼前的短期解脱——即便理智上知道长期来看有害，但他们唯一的念头只是“撑过今天”。无论是通过暴饮暴食诱发肥胖与糖尿病，还是借助酒精麻痹神经，这些看似不理性的应对机制，都是在深重绝望感下习得的自我安抚途径。 这种对短期安抚的盲目渴求，在社会层面上演变为了触目惊心的阿片类药物泛滥危机（opiate epidemic）。阿片类药物作为地球上最强效的精神活性药物，能在极短时间内迅猛且有效地平息内心的精神折磨（psychic distress），但随之而来的是极快的耐药性积累与致命风险。荒谬的是，医学界长期缺乏将阿片类药物视为强效精神调节剂的系统培训。整个社会在一方面极度漠视创伤的破坏力、将个体推入孤立与绝望的同时，另一方面却将这种具有极高致死风险的短期强效止痛药丸随意分发给大众，最终酿成了每年数以万计的人死于处方阿片类药物的时代悲剧。 - 阿片类危机最初由片剂药物诱发，原本仅应在术后等高急性期严格审慎使用，却被错误地滥用于慢性疼痛治疗。 - 处方泛滥背后掺杂了深厚的政治与商业利益，迎合了社会“必须立刻消除一切痛苦”的短视幻觉。 - 药物无法一劳永逸地解决生活中的苦难，人类需要做的是通过深层心理与身体干预来逐步缓解和承受痛苦，而非妄想靠一颗药丸根除所有创伤。 ### [56:30](https://www.youtube.com/watch?v=USE89i0kiiQ&t=3390s) 短期抚慰的诱惑与阿片类药物危机的代价 整个社会的短视思维正在将人们推向一种危险的诱惑——“短期抚慰”（short-term soothing）。当人们感到痛苦、绝望，迫切渴望摆脱当下的折磨时，整个体制给出的回应往往只是：“吃下这片药吧”。仅仅在美国，这种“让人人有止痛药吃、不再感到疼痛”的短视解决方案，就已经导致了数十万人因处方阿片类药物丧生，这甚至还不包括非法街头毒品造成的死亡。社会默许了这种机制的蔓延：用快速、浅表的化学手段去压抑痛苦，最终诱惑并吞噬了患者，让他们深陷成瘾与极高致死风险的泥潭，而真正的病根——未被处理的创伤，却始终被遮蔽在药片之后。 ### [57:04](https://www.youtube.com/watch?v=USE89i0kiiQ&t=3424s) 创伤如何重塑大脑回路与连接 要治疗创伤，就必须先理解它在生理层面对人类大脑造成的实体改变。Dr. Paul Conti 指出，尽管脑部扫描技术目前仍极其复杂、难以做到像未来医学那样绝对精准的“定点诊断”，但现代神经科学已经能清晰捕捉到创伤在大脑中留下的痕迹与病理模式。 被创伤侵蚀的大脑往往处于一种类似“发炎”的病理状态。其中最显著的变化发生在被称为“负面情绪的大中央车站”（Grand Central Station for negative emotion）的杏仁核（amygdala）及其周围回路上。创伤改变了大脑的连接性（connectivity）与信号优先权： - **安全与信任回路被压制**：负责建立人际信任、体会安全感与平静的神经通路活性显著降低，难以正常调用。 - **警觉与威胁回路高度活跃**：与缺乏安全感、过度警觉（hypervigilance）和危险探测相关的回路被持续强化并占据主导。 - **情绪调节机制失灵**：创伤改变了整个大脑的内部微气候，情绪调节中枢功能受损，导致抑郁与创伤后应激症状频繁侵入日常生活。 ```mermaid flowchart TD accTitle: 创伤对大脑神经连接与心理模式的重构 accDescr: 展示创伤如何抑制安全回路、激活警觉中枢，并最终诱发认知盲区与强迫性重复 subgraph BrainChanges["大脑神经连接的改变"] T["经历严重创伤"] --> Amy["杏仁核持续过度激活<br>（负面情绪中枢）"] Amy --> PathUp["警觉与恐惧回路被病理性强化"] Amy --> PathDown["信任与安全感回路被抑制沉寂"] end subgraph CognitiveImpact["认知与行为模式异化"] PathUp --> BlindSpot["形成认知盲区<br>（将创伤烙印视作人生真理）"] BlindSpot --> Compulsion["强迫性重复与自我设限<br>（试图在当下掌控失控的过去）"] end ``` ### [58:43](https://www.youtube.com/watch?v=USE89i0kiiQ&t=3523s) 创伤带来的认知盲区：把“创伤教训”误当成“客观现实” 创伤不仅改变神经回路，更会在大脑中制造严重的“认知盲区”（cognitive blind spots）。Dr. Paul Conti 解释，认知盲区本质上是**个体把“创伤教训”（a lesson of trauma）误当成了“客观现实”（a lesson of truth）**。这种深层认知偏差彻底篡改了人们看待自我与世界的方式。 Dr. Paul Conti 举了一个令人心碎但极为普遍的临床案例：一个原本自我感觉良好、充满活力探索世界、积极争取更好工作并享受社交生活的个体，在遭遇暴力侵害（assault）之后，整个人的人生轨迹发生了断崖式的收缩。受害者开始退缩闭塞，内心深处内化了一整套自我贬低的预设——“我其实更喜欢待在家里”、“只要出门事情就绝不会顺利”、“我根本没法和别人好好相处”。当认知盲区形成后，个体便丧失了准确评估“未来可能性”的能力。他们可能原本雄心勃勃地追求职业晋升，受创后却理所当然地认为：“我不是那种能取得成功的人，大家都不喜欢我，去争取也注定会失败”，而在遭遇创伤之前，他们从未有过如此自暴自弃的念头。 ### [01:01:11](https://www.youtube.com/watch?v=USE89i0kiiQ&t=3671s) 童年早期的硬编码：大脑为什么不会自我打补丁？ 主持人 Steven Bartlett 随即提出共鸣：这正是通俗语境中常说的“原生家庭创伤”（例如俗称的 daddy issues）。例如，一个孩子在四岁时父亲抛弃家庭离去，幼小的心灵便内化出“男人不爱我”的认知设定；成年后，这个人便可能在恋爱中表现为极度回避型依恋、习惯性自我破坏，或者执着于寻找那些情感上冷漠疏离的对象，以提前回避被抛弃的痛苦。 Dr. Paul Conti 强烈认同这一观点，并指出一个令人震惊的神经生物学悖论：人类的大脑比世上最精密的超级计算机还要复杂千百倍，但它却缺乏某些最基础的维护机制——**我们的大脑从不会自动重启，也不会定期检索旧有认知去“安装漏洞补丁”（patch）**。 - **早期的致命教训难以逆转**：四岁时得出的结论（如“男人不爱我”）一旦固化，大脑便默认其为永恒规律，绝不会在成年后主动调出这套代码进行理性反思。 - **重访旧认知的危险感**：创伤会在记忆周围筑起高墙。大脑潜意识里认为重新审视那段创伤是极其危险的，甚至会再次带来灭顶的失望与痛楚，因此会用“事情本来就是这样，永远都不会改变”来封闭自我。 - **责任错位与解离治疗**：心理干预的关键，在于引导成年后的当事人重新审视那个四岁时形成的死结：“没有一个四岁的小孩需要为父母的离弃负责。那是成年人自己的选择，与你的价值无关。”唯有当潜意识看清这一点，深嵌一生的虚假“真理”才有可能被逐步拆解。 ### [01:03:03](https://www.youtube.com/watch?v=USE89i0kiiQ&t=3783s) 强迫性重复：试图在当下重演中修复过去的无力感 在亲密关系中，人们常常发现创伤幸存者对“熟悉的痛苦”有一种近乎自毁的倾向——即便生长在暴力或忽视的家庭环境中，长大后依然会被具有同样暴力或疏离特质的伴侣吸引。Dr. Paul Conti 将其归结为精神分析中极其复杂的**强迫性重复（repetition compulsion）**：个体并非受虐狂，而是**试图在一个如今能够主动选择的情境中，重新夺回当年童年无能为力时彻底丧失的控制感与掌控力（sense of mastery）**。 Dr. Paul Conti 分享了诊疗室中极为耐人寻味的对话片段。经常有绝望的来访者坐下来就说：“我知道你帮不了我，我过去谈了八段恋爱，每一段都糟糕透顶，你凭什么能帮我？”Dr. Paul Conti 则会平静地回应：“如果你能向我证明你谈的是‘八段完全不同但都不顺利’的感情，我或许会相信你的话；但我知道，你只是把同一段灾难性的关系翻来覆去重演了八遍。” 这种重复行为背后潜藏着极其强烈的内在心理动机： - **情感系统缺乏时钟与日历**：大脑的情感神经系统（emotion systems）根本分不清“过去”与“现在”。在强烈创伤的驱动下，情感中枢坚信只要能在现在的伴侣身上扭转局面，就能治愈多年前童年的隐痛。 - **拯救与被拯救的幻觉**：若父亲当年冷漠缺席，当事人往往不会去爱体贴关怀的伴侣，反而会狂热地爱上同样冷漠的男人，企图通过自己的努力去“感化他、让他变得专注”，以此抚平当年的被遗弃感；若父亲有暴力倾向，潜意识便会不断物色暴力伴侣去重演噩梦。 - **破局的干预思路**：这种行为表面上像是自甘堕落，实则是内心深处绝望地想要证明自我价值、渴望修复伤痛。治疗的核心正是打碎这套死循环：“如果你真正渴望的是一个懂得关爱、专注倾听的伴侣，直接去选择一个本来就懂得关爱的人，而不是去找一个冷漠的人，并妄图耗尽心力去改造他。” ### [01:05:16](https://www.youtube.com/watch?v=USE89i0kiiQ&t=3916s) 内化受害者身份与受害者心态成瘾 当谈及人是否会“对自己的受害者身份成瘾”（addicted to our victimhood）时，Dr. Paul Conti 给予了肯定的答复，并阐述了深层的心理机制：在心理学层面，**内化受害者（internalized victim）的诞生必然伴随着一个内化的迫害者（internalized persecutor）**。 在法律或客观事实上遭受侵害，并不必然意味着一个人会在精神内核中彻底将自己等同于“受害者”。但未经疗愈的严重创伤具有极其霸道的吞噬力，它会直接将这种受害感转化为个体的核心认同。Dr. Paul Conti 坦诚地以自己经历的至痛为例：在亲弟弟自杀离世后的漫长暗夜里，他也曾一度陷入这种深不见底的创伤陷阱之中，甚至内化出一种绝望的认知，觉得自己和整个家庭是不是“被彻底诅咒了”，认定自己在这个世界上无论怎么努力也走不出命运的泥淖。 ### [01:05:42](https://www.youtube.com/watch?v=USE89i0kiiQ&t=3942s) 内化受害者身份与“低人一等”的自我审判 保罗·孔蒂博士（Dr. Paul Conti）指出，创伤最危险的影响之一，在于它会在受害者内心种下一股近乎“黑魔法”般的破坏力量。当一个人遭遇创伤事件后，往往不仅在客观事实上成为了受害者，甚至会在潜意识中彻底认同“我是个低人一等的人（less than）”，并产生强烈的异化感与隔阂感。一旦这种信念在内心扎根，外界甚至不再需要真正的施害者或迫害力量，个体会自动接管施虐者的角色，用内疚和羞耻感日夜折磨自己。 孔蒂博士在临床中接触过大量暴力或侵犯事件的受害者。在法律层面上，他们毫无疑问是纯粹的受害者，然而极其反常且令人心碎的现象是，这些受害者往往会极度羞愧，甚至坚信“这一切都是我的错”。这种由创伤引发的条件反射式内疚与羞耻感，让个体不可避免地沉沦于“我不配、我不行”的自我矮化之中。他们把加害者强加的伤害吸收为自我认同的一部分，最终陷入长期的自我惩罚与精神内耗。 ```mermaid flowchart TD accTitle: 创伤内化与自我迫害循环 accDescr: 展示外界创伤如何通过边缘系统的内疚与羞耻，演变为受害者内化的自我迫害过程。 subgraph 外在创伤事件 A["遭受侵害或重大创伤"] --> B["客观法律事实上的受害者"] end subgraph 心理与情感内化 B --> C["反射性内疚与极端羞耻感"] C --> D["形成'我低人一等 (Less than)'的信念"] end subgraph 自我迫害循环 D --> E["内化受害者身份"] E --> F["无需外在施害者：转向持续的自我折磨"] end ``` ### [01:06:53](https://www.youtube.com/watch?v=USE89i0kiiQ&t=4013s) 边缘系统 vs. 逻辑系统：为什么我们总在重复有害的关系模式？ 当主持人史蒂芬·巴特利特（Steven Bartlett）问及边缘系统在大脑中如何固化创伤时，孔蒂博士将大脑运作简化为两大系统：**逻辑系统**与**边缘情感系统**。边缘系统掌控着人类原始的情感与生存本能，而当边缘系统与逻辑系统正面交锋时，逻辑几乎“逢战必败”。如果一个人内心被创伤、被“低人一等”的恐惧、或者一种迫切想要弥补过去不公经历的执念所驱动，再清晰的逻辑思维也会彻底失效。 孔蒂博士举了一个极其普遍的恋爱盲区作为例证：从纯逻辑的角度来看，如果你已经连续谈了六任伴侣，他们在一开始看起来都差不多，随后的行为表现也都一模一样地恶劣，理智早就在第二任时就该警告你“千万别找第七个同类人”了。然而，现实中人们却一再跳入同一条河流，陷入病态关系的强迫性重复。其核心原因正是边缘系统在作祟——它渴望通过“掌控局面”来治愈过去的创伤，于是驱使个体再次寻找第七个与前六任如出一辙的糟糕伴侣，试图在相同的剧本里逆转结局。只有当创伤的“脓疮被真正刺破（lance the abscess）”，被压抑的情感毒素释放出来，逻辑才能重新拿回话语权。此时，人们才会顿悟自己一直在重复同一种剧本，进而真正改变人生范式。 针对主持人提出的“边缘系统是否在与现代人作对”的疑问，孔蒂博士结合当代迷幻药物辅助科学的研究指出，大脑的任何结构都不是生来仇恨我们的，它们只是带着人类进化的古老烙印，尚未完全适应现代世界： - **负面记忆的高优先级**：在漫长的采猎时代，发现美味且有营养的食物固然重要；但如果你吃了一种食物后险些丧命，大脑必须将这份恐惧“刻进骨髓”，保证你终生不再碰它。 - **过度泛化的保护机制**：生存系统为了确保我们活下去，会迅速形成绝对化禁令（“永远不要靠近那类人”、“永远不要再迈出那扇门”）。但在现代社会，遭遇暴力袭击后的受害者一旦踏出家门便恐慌发作，这种原本用来保命的机制反而严重剥夺了正常生活的能力。 ### [01:10:27](https://www.youtube.com/watch?v=USE89i0kiiQ&t=4227s) 羞耻感的进化之谜：它如何保命，又为何在现代社会伤人最深？ 面对主持人关于“我们能否直接在大脑中删除羞耻感”的提问，孔蒂博士强调，愤怒、恐惧、爱与羞耻等基础原发情感（primary affects）都是刻进人类基因深处的生存适应工具。爱让人结成同盟共同对抗严苛环境，恐惧触发“战或逃”反应，而羞耻的核心功能在于**借助极度痛苦的心理体验来强制修正个体的行为**。 在原始部落生活中，羞耻感曾维系着整个群体的生死存亡。孔蒂博士形象地打了个比方：在远古时代，若有人不愿走出洞穴排泄，而是直接尿在全族人赖以生存的食物上，他就会立刻遭到整个部落的强烈羞辱与谴责。这种痛彻心扉的羞耻感会牢牢警告他“绝不能再犯”，从而消除了部落爆发传染病的灭顶之灾。然而在当今现代社会，这种机制面临着严重错配： - **网络暴力的无限放大**：远古时期没有互联网，而现代人面对社交媒体上成千上万陌生人的言语攻击时，古老的大脑仍会误判为“我的部落要彻底将我驱逐处死”，进而引发毁灭性的全身心崩溃。 - **创伤归因的倒错与重塑叙事**：在遭遇性侵等严重暴力侵害时，受害者本是无辜承受者，在逻辑上完全没有任何理由自责。孔蒂博士动情地结合自己失去至亲的经历谈到：当年他的弟弟自杀身亡时，他内心涌现的强烈羞耻感根本不是理性推理出来的产物。大脑的情感中枢感知到灾难性事件后，会本能地分泌出巨大的羞耻与厌恶感，逼迫意识层去“编造理由”——“一定是我当时不该去那里”、“一定是我做错了什么”。 孔蒂博士总结道，理解创伤的关键，在于明白**情绪和羞耻感起源于底层的边缘系统，而大脑随后才围绕这种情绪编造自圆其说的故事**。正因如此，治愈的希望也恰恰存在于此：既然故事是后天构建的，我们就可以重新理顺认知，将羞耻感归还给真正该承担责任的人与事，重构属于自己的全新生命叙事。 ### [01:14:14](https://www.youtube.com/watch?v=USE89i0kiiQ&t=4454s) 赋予创伤意义与羞耻感的进化机制 创伤发生后，人类的心智会本能地试图去理解和消化它。保罗·孔蒂医生（Dr. Paul Conti）指出，当一个人经历变故——无论是躺在救护车里还是身处病房——被强烈的羞耻感笼罩是完全自然且可以理解的人类反应。然而，真正决定创伤长期走向的，是个体随后如何为这一状态赋予意义。针对这一点，史蒂芬·巴特利特（Steven Bartlett）提出了一个远古祖先的假想场景：如果一个原始猎人手持长矛穿过塞伦盖蒂大草原时突然被狮子袭击并侥幸生还，体内升腾的羞耻感是否是一种适应性反应，促使他回到洞穴后写下一段“我不该在夜晚独自在草原上游荡”的叙事，从而改变行为以确保未来不再犯同样的错误？ 孔蒂医生对此做了细腻的区分：一个人是以主动出击的姿态还是被动受害的姿态面对危险，其心理机制大相径庭。如果是为了部落族人的利益而去主动狩猎狮子并不幸负伤，这种自豪感和自我牺牲感会让归来的猎人受到敬重与照料，这属于积极迎战创伤，极少会转化为病态的羞耻感；相反，如果是由于违规或鲁莽在夜晚独自游荡而遇袭，那种糟糕的负罪与自责确实具有威慑意义，既能阻止自己重蹈覆辙，也能警示群体中的其他人不要以身试险。 ```mermaid flowchart TD accTitle: 创伤反应与社会接纳的两种路径 accDescr: 展示主动牺牲获得赞誉与孤立羞耻导致创伤的对比机制 subgraph Protective ["主动承担与群体支持"] A["为群体奉献 / 迎战危险"] --> B["负伤生还"] B --> C["受到尊重与英雄式接纳"] C --> D["形成自豪感，大脑免受病理改变"] end subgraph Traumatic ["被动受害与社会孤立"] E["遭遇意外 / 违规涉险"] --> F["内生反射性负罪与羞耻"] F --> G["遭遇社会冷落或指责"] G --> H["诱发创伤后综合征与大脑病变"] end ``` ### [01:16:34](https://www.youtube.com/watch?v=USE89i0kiiQ&t=4594s) 社会对待创伤者的方式：二战与越战老兵的启示 周围人的态度与社会的反馈，在创伤是否会固化为长期大脑病理变化中扮演着决定性角色。孔蒂医生以美国军事史上的典型案例进行了深入剖析：二战老兵回国后被举国视为英雄并受到崇高敬意，这种强有力的社会肯定使许多人能够扛住战火带来的创伤，而不会发生持久的大脑神经回路改变；相反，参加越战的老兵回国时，面临的却是一个撕裂、冷漠甚至敌视的社会环境，他们没有迎来英雄般的欢迎，反而遭遇了社会层面的边缘化和“异质感”（otherness）。 这种巨大的社会对待差异，直接导致越战老兵的创伤后应激障碍（PTSD）和创伤后综合征的发病率远远高于二战老兵。尽管经历创伤后产生条件反射般的内疚与羞耻是一种普遍现象，但这种羞耻感本不一定会摧毁一个人。然而，一旦社会环境向当事人传递出“你低人一等”或“你做错了”的排斥信号，羞耻感就会占据上风，使受害者陷入神经病理改变的高危状态。 - **社会支持的缓冲作用**：被尊重的体验能够保护大脑免受创伤后综合征的侵蚀。 - **异类感（Otherness）的危险性**：长期感到被社会贬低，会显著放大个体的心理脆弱性，加剧创伤对大脑结构的实质损伤。 ### [01:18:12](https://www.youtube.com/watch?v=USE89i0kiiQ&t=4692s) 敞开脆弱与打破沉默：化解深层羞耻的路径 面对创伤，绝大多数人的第一直觉是感到负罪与羞愧，而随之而来的本能反应往往是将其深藏心底、对外界隐瞒。孔蒂医生强调，这种封闭行为恰恰切断了修复创伤所必需的“人际联结”。在长达25年的精神科医生执业生涯中，他经常接待那些人生中第一次将隐秘创伤诉诸语言的来访者——无论是5岁时遭遇的侵犯、童年时期教练施加的虐待，还是在重大事故中两名同伴丧生而唯独自己幸存的“幸存者负罪感”（Survivor's guilt）。 令孔蒂医生深感心碎的是，许多患者在首次吐露真相时，会本能地向后退缩或陷入惊恐，他们预设对方会产生厌恶并拒绝自己，甚至对医生没有表现出嫌弃而感到“难以置信”。这些患者能够毫无保留地同情他人遭受的类似苦难，却唯独对自己严苛残酷、毫无自悯之心。将埋藏多年的痛苦置于阳光之下并得到一个充满同理心的回应，是打破这种虚假耻辱感的唯一解药。 ### [01:19:57](https://www.youtube.com/watch?v=USE89i0kiiQ&t=4797s) 恶性创伤循环与自我重塑的治愈希望 创伤具有极强的“自我实现”倾向。当个体将羞耻深压心底时，不仅日常幸福感被剥夺，陷入长期的抑郁与退缩，更危险的是，未被处理的创伤会扭曲一个人的行为模式，从而诱发恶性循环。典型表现就是强迫性地重复自我毁灭：例如在亲密关系中一次又一次地选择不健康或虐待性的伴侣。孔蒂医生指出，这种行为的本质是当事人在潜意识里试图解决童年未竟的创伤，试图去修复某个曾经抛弃或伤害自己的客体。 只有当人们带着好奇心审视自己，停下来追问“我究竟在试图通过这段关系解决什么”，意识到那原本是别人的过错和缺陷时，这一破坏性的创伤循环才会被斩断。孔蒂医生最后总结道，他在著作《隐形流行病》（The Invisible Epidemic）中传达的信息虽然是一记严肃的警钟，但内核却充满乐观与希望：创伤并不是不可战胜的宿命，只要我们保持对自我的好奇心，愿意倾诉并构建新的叙事，人们就完全能够治愈创伤、重获健康。 ### [01:22:48](https://www.youtube.com/watch?v=USE89i0kiiQ&t=4968s) 创伤的隐性代价：当大脑拒绝进入修复状态 保罗·康蒂博士（Dr. Paul Conti）首先强调，正视创伤的核心在于带来希望——临床经验一再证明，当人们愿意审视自身所经历的一切并渴望改变时，转变就会真实发生。这正是他撰写《创伤：隐形流行病》（*Trauma: The Invisible Epidemic*）的初衷：直面创伤不仅是为了搞清“我们究竟怎么了”，更是为了切实让生活变得更好。主持人斯蒂芬·巴特利特（Steven Bartlett）随后将话题引向创伤那些更为隐蔽的表现，特别是如今困扰海量人群的睡眠障碍。 康蒂博士明确指出，创伤与睡眠问题之间存在极强的因果链条。睡眠异常是创伤后综合征（post-trauma syndrome）最典型的表征之一（常与高焦虑、低落情绪及行为改变并存）。创伤会在神经生物学层面重塑大脑，使其极度偏向“高度戒备”（vigilance）与持续激活状态，导致大脑神经系统无法自然冷却、进入修复状态。患者脑内常陷入所谓的“反刍思维”（ruminative thought loops），思维循环往复、停不下来。结果便是睡眠支离破碎、深度变浅、入睡极其困难、过早醒来。这种睡眠质量的崩塌对人体的摧残是“从头到脚、跨越生理与心理”的，因为大脑在神经生物学上处于过度觉醒（hyper-arousal）状态，原本应该自我休眠和修复的脑机制根本无法启动。 ```mermaid flowchart TD accTitle: 创伤导致睡眠障碍的机制图 accDescr: 展示创伤如何通过神经戒备系统过度激活引发睡眠崩溃并导致恶性循环 subgraph 神经反应机制 A["创伤经历 / 未解决的创伤"] --> B["神经生物学过度激活与戒备"] B --> C["脑神经无法冷却<br>缺乏修复性休眠"] end subgraph 临床症状与行为 C --> D["反刍思维与思维死循环"] D --> E["碎片化浅睡 / 入睡困难 / 早醒"] E --> F["逃避行为：刷手机、睡前饮酒、过量安眠药"] end F -->|加剧生理与心理损伤| B ``` --- ### [01:24:55](https://www.youtube.com/watch?v=USE89i0kiiQ&t=5095s) 反刍思维与逃避：为什么我们不敢与自己的念头独处 针对睡眠障碍的日常表现，斯蒂芬提出了一种普遍体验：现代人之所以在夜间疯狂寻求刺激（例如熄灯后刷手机），是因为他们极度抗拒独自面对自己的思绪；一旦安静下来，脑海中充斥的便是不可控的过度思考。康蒂博士对此深表认同，并指出这正是创伤巨大的下游连锁反应。当一个人躺在床上，脑中不断回响着“我不安全”、“我要被解雇了”、“我随时会受伤”，或是毫无缘由的负面预感（如“一切都太糟糕了”、“我撑不下去了”），人本能的反应就是去抓取刺激物来逃避痛苦。 值得注意的是，这种困扰往往潜伏在潜意识或意识边缘： - **无意识的内在紧绷**：许多人甚至没有意识到自己在反刍创伤，只觉得“这几个月来一躺下就心神不宁”、“感觉不再平静”。现代流水线医学往往直接开具安眠药，而不去追问“为什么这四个月你的睡眠变了”。 - **病态的逃避闭环**：因为害怕睡前脑海中的思绪折磨，患者会一拖再拖，最终可能依赖连续喝下三四杯酒来强行把自己“放倒”。 - **隐形流行病的扩散**：不健康的生活习惯与化学物依赖反过来强化了身体的失衡状态，使创伤后综合征像隐形流行病一样在个体生活和社会中不断蔓延。 --- ### [01:27:33](https://www.youtube.com/watch?v=USE89i0kiiQ&t=5253s) 现代医学的误区：用“安眠药锤子”去敲创伤的“钉子” 斯蒂芬援引了康蒂博士在里奇·罗尔（Rich Roll）播客中的尖锐言论：“在我所见过的所有精神疾病和通用医疗处理中，被处置得最糟糕、最差劲的绝对是睡眠问题。”康蒂博士对此做出了解释：现代医疗体系充斥着“拿锤子找钉子”的思维定势。由于医疗系统过度追求高门诊量和周转率（throughput），整个诊疗模式被简化为“症状识别—对症给药”。患者一旦主诉失眠，医生的条件反射就是开安眠药。 然而，患者睡不着绝大多数时候并不是“睡眠系统本身损坏了”，而是源自内在的警戒与激活系统在疯狂鸣笛： | 诊疗路径 | 传统对症治疗模式 | 根源性（创伤导向）治疗模式 | |:--- |:--- |:--- | | **核心假设** | 患者的睡眠系统损坏，需要外力压制催眠 | 睡眠系统本身完好，是高度戒备系统（Vigilance System）过度激活压制了睡眠 | | **典型方案** | 大剂量处方安眠药，或频繁更换多种助眠药 | 短期使用平息神经戒备/苦恼系统的药物，绝非安眠药物 | | **药物风险** | 容易耐药、剂量不断攀升、极高成瘾风险 | 避免长期药物依赖，短期平息警戒后机体自主恢复睡眠能力 | | **治疗终点** | 长期依赖药物维持睡眠，背后的创伤根源彻底被掩盖并恶化 | 随着警戒系统冷却，患者开始处理创伤，停药并获得根本性疗愈 | 康蒂博士强调：“必须停止机械式的反射用药，转而追问那个最朴素的‘为什么’。”在临床上，许多辗转尝试了五种、六种甚至十种安眠药依然彻夜难眠的重度患者，在改用针对平息警觉系统的针对性短期药物并梳理创伤史后，不仅睡眠迅速自然恢复，彻底避免了未来长达二十年的安眠药成瘾，更有机会在心理上真正消化和代谢掉压抑多年的创伤。 --- ### [01:30:16](https://www.youtube.com/watch?v=USE89i0kiiQ&t=5416s) 创伤与体重的深层关联：自我关怀的崩塌与代谢危机 在探讨了睡眠之后，斯蒂芬将话题转向创伤的另一大隐性影响——体重与肥胖。斯蒂芬提到大量研究表明，严重肥胖人群往往能追溯出极高的既往创伤史。康蒂博士证实了这一关联的真实性，并指出其背后交织着多重生理与行为机制： - **自我关怀（Self-Care）能力的系统性崩塌**：在现代社会中，即便生活一帆风顺，保持规律作息、健康饮食和持续运动本身已非易事。一旦叠加创伤带来的持续精神消耗与高唤醒内耗，个体的自我照顾机制会率先瓦解，极易演变为暴饮暴食与极度缺乏运动的恶性循环。 - **继发性慢性病风险激增**：自我关怀的破裂直接引发超重与肥胖，进而将身体推向二型糖尿病、冠心病及脑血管疾病的危险边缘。 - **表观遗传与代谢基因表达的改变**：正如创伤在细胞层面的破坏机制一样，未解决的创伤会通过表观遗传学（Epigenetics）途径改变特定基因的表达，进而深刻干扰人体的能量代谢与脂肪储存机制。 ### [01:31:14](https://www.youtube.com/watch?v=USE89i0kiiQ&t=5474s) 创伤的生理代价：慢性炎症与体重困境 创伤不仅停留在记忆与情绪层面，更在最微观的生物学水平上重塑我们的身体。Paul Conti 博士指出，创伤会直接影响基因转录，决定哪些基因在体内被激活。它会让整个机体陷入高度炎症状态，血液循环中充斥着过量的炎症标志物。这种失衡严重破坏了血管壁与免疫系统的微生态环境，正如 Conti 博士所形容的那样：“我们赖以生存的这碗‘内在浓汤’，已被创伤彻底改变了（the soup we swim in is changed by the trauma）。” 这种系统性炎症继而引发了一系列生理连锁反应。血液中高水平的炎症因子直接干扰代谢机制，促使身体本能地囤积更多热量，导致减重变得异常艰难；同时，受损的血管弹性使心血管功能每况愈下。这一恶性循环是双重的：一部分源自表观遗传学层面的直接生物学损伤，另一部分则来自心理崩溃导致的自我照料缺失。 - **基因与表观遗传**：创伤改变基因转录活性，使身体长期处于促炎性表达状态。 - **生理与代谢阻碍**：循环系统中的炎症因子不仅削弱血管与免疫机能，还会锁定身体对热量的储备，造成难以逆转的代谢停滞与肥胖。 --- ### [01:32:11](https://www.youtube.com/watch?v=USE89i0kiiQ&t=5531s) 用知识赋能：打破“我无法被改变”的心结 当来访者走进诊室，顽固地坚信“自己这辈子不可能改变”时，Conti 博士并不会急于说教，而是诉诸“知识与信息的力量”。这一信念源于他童年目睹亲人患病、却因医学信息匮乏而深感无能为力的痛苦记忆。他坚信人类天生渴求理解真相，而现代社会充斥着太多条件反射式的抱团与派系站队，这本质上是人们在感受到剥夺感与无力感后的代偿。优质的科普播客之所以具有巨大感召力，正是因为它们不强加立场，而是赋予受众客观的认知工具。 面对不同类型的来访者，Conti 博士会因人制宜地切入沟通路径：对待工程师、会计师等崇尚理性的科学思维者，他会拿出前沿实证文献与生理数据打破其思维坚冰；对待感性思维者，他则分享真实生动的疗愈案例。他在书中记录过一位典型的女性来访者：一场突如其来的创伤彻底击碎了她的人生轨迹，将其情绪、焦虑水平与行为选择拖入深渊。在创伤前后，她的状态呈现出“黑夜与白昼般的断崖式反差”，陷入长期的功能失调与病态痛苦中，一度认定自己永远无法重回正轨。但在 Conti 博士客观中立的引导下，她开始直面这股暗流并逐步看清创伤的运作机制。十年后，她不仅摆脱了阴霾，容貌与活力甚至比十年前显得更加年轻。 ```mermaid flowchart TD accTitle: 创伤信念打破与重塑路径 accDescr: 展示从无力感与自限信念到通过知识干预实现重构的流程 subgraph Trap["创伤禁锢期"] A["突发创伤打击"] --> B["生理/心理断崖式恶化"] B --> C["形成固着信念：<br/>'我不可能改变'"] end subgraph Intervention["认知破局与干预"] D["客观知识与科学机制注入"] --> E["建立观察者视角：<br/>看清创伤运作而非盲从情绪"] end subgraph Recovery["新生与逆转"] E --> F["重获赋权感与健康行为"] F --> G["机能逆龄改善与生活重建"] end C -.->|"引入定制化科学/案例证据"| D ``` --- ### [01:35:05](https://www.youtube.com/watch?v=USE89i0kiiQ&t=5705s) 大脑的重塑训练：让内在的消极声音自然萎缩 改变并非一蹴而就的顿悟，而是一场像在健身房推铁般的神经回路重训过程。人类本质上是“神经元习惯的造物”（creatures of neuronal habit）。Conti 博士举了一个直观的假想实验：若我们随机挑出一个无意义的词并连续重复 500 次甚至 2000 次，随后的几天里这个词依然会在脑海中不断回响。原因在于每一次重复都在物理层面强化突触连接；要让它消失，唯一的途径是停止强化，任由该神经回路随时间逐渐“废用性萎缩”（atrophy）。 受过创伤的人脑中往往盘踞着如影随形的消极自语，比如“我永远不会成功”、“我毫无价值也没人会喜欢我”或“你这个蠢货”。这些声音是成长经历中被父母或重要他人反复灌输并不断内化的产物。每一次自我贬低，大脑都会进一步误以为那是确凿无疑的事实。破局的关键在于在内心建立一个超然的“法官”（the judge）意识：当恶毒的念头再次浮现时，必须在意识层面当场捕获并予以驳斥——“我知道脑海里正冒出这句话，但我绝不相信它”。旧神经回路的彻底消亡需要漫长的时间，但只要不再被认同感所喂养，它的声量就会从每日数十次逐渐归于沉寂。 - **神经回路规律**：高频重复的语言或观念会固化突触联结，唯一的消退方式是通过中断强化令其自然萎缩。 - **内在法官角色**：在杂乱的心声中保持觉察，识别出童年创伤遗留的“阴影声音”，拒绝将谎言等同于现实。 --- ### [01:37:30](https://www.youtube.com/watch?v=USE89i0kiiQ&t=5850s) 创伤能否被彻底归零？学会在触发中淡然处之 面对“创伤能否被彻底清零”的追问，Conti 博士坦言，创伤记忆本身不可能像橡皮擦一样被凭空抹去。发生过的恶性事件注定留痕，疗愈的核心并非“失忆”，而是大幅削弱并钝化机体对创伤记忆的生理与情绪唤醒幅度（attenuate the response）。以严重车祸幸存者为例，疗愈的目标不是看到汽车就彻底想不起事故，而是当他们再次坐进车内时，能够泰然接纳轻微的不适感，而不再瞬间诱发崩溃式的惊恐发作。 Steven Bartlett 在对话中坦言，许多经历过长期自我疗愈的人常因偶然被再次触发而陷入深深的挫败与自责，觉得自己“做了那么多努力却依然脆弱”。对此，Conti 博士强调，这恰恰是创伤印记顽固的自然属性。在糟糕的日子里，疲惫或挫折会不可避免地重新激活旧有路径，此时最忌讳的是因为“被触发”而产生次生羞耻感，这反而会无意中二次强化创伤。面对再次浮现的阴霾，最健康的应对方式是轻耸双肩，带着好奇与宽容告诉自己：“看看这道印记有多深啊，今天它又跑出来捣乱了，但这并不代表它说的就是真理。” ### [01:39:38](https://www.youtube.com/watch?v=USE89i0kiiQ&t=5978s) Lady Gaga 的序言与创伤改变的力量 主持人和保罗·孔蒂医生（Dr. Paul Conti）探讨了大脑中的消极念头往往只是神经回路强化的残留，在状态不佳时浮现出来并不代表真实的自我。随后，主持人将话题引向孔蒂医生的著作《创伤：隐形流行病》（Trauma: The Invisible Epidemic），该书的序言正由流行巨星 Lady Gaga 亲笔撰写。主持人深情朗读了序言中一段极具分量的赞誉：“我现在可以无比笃定地说，这个男人拯救了我的生命。他让生活重新变得值得一过。但最重要的是，他赋予了我力量，让我重新找回并夺回了自我。” 孔蒂医生对此表达了由衷的谦逊与感激，称赞 Lady Gaga 拥有极其优美的文笔与宽阔慷慨的胸襟。谈及她为何会给出如此崇高的评价时，孔蒂医生解释道，正如 Lady Gaga 公开分享过的那样，她的人生曾饱受创伤折磨。她所经历的蜕变，在于真正看清创伤、深入理解它，并将自我重新锚定在自身内在的美好品质上。孔蒂医生指出，无论我们是谁，每个人内心都有美好的一面。身处如此宏大的世界舞台上，能够勇敢承认自己的创伤与人性的脆弱，承认自己和普通人一样需要被理解、需要走出新思维路径的引导，这展现了非凡的勇气与坚韧。 许多被创伤禁锢的人往往会自暴自弃地认为“我永远不可能改变”，而打破这种宿命感、敢于冒险去做出改变，需要巨大的魄力。孔蒂医生强调，Lady Gaga 的经历是一个极其真实、充满人性光辉的故事，她不仅战胜了自身的伤痛，更希望向全世界传递一个信念：创伤并不具有绝对的控制权，只要我们敢于直面并理解它，生命就拥有彻底重塑的无限可能。 ```mermaid flowchart TD accTitle: 创伤疗愈与自我重塑路径 accDescr: 展示从深陷创伤到通过理解、建立新思维路径从而重获自我的心理疗愈过程。 subgraph TraumaLoop["创伤禁锢"] A["深层创伤与神经残留"] --> B["产生无力感：认为自身无法改变"] end subgraph HealingJourney["疗愈与重塑"] C["直面脆弱与接纳人性"] --> D["构建全新思维路径"] D --> E["将自我锚定于内在美好"] end subgraph Reclamation["生命赋能"] F["摆脱创伤掌控"] --> G["夺回自我主导权并影响他人"] end B --> C E --> F ``` ### [01:41:59](https://www.youtube.com/watch?v=USE89i0kiiQ&t=6119s) 走进顶级名流的隐秘世界与成名重负 除了 Lady Gaga，孔蒂医生的著作中还汇聚了包括金·卡戴珊（Kim Kardashian）、汤米·希尔费格（Tommy Hilfiger）等多位国际名流的推荐语。主持人好奇地询问，作为一名精神科医生，孔蒂究竟是如何走到能够吸引并疗愈这群顶级人物的位置，以及面对这种高规格的信任是否曾感到某种“不真实感”。 孔蒂医生坦言，这种经历确实带有一种超现实的色彩。他将自己定义为一个踏实勤勉、始终专注于把专业工作推向深入的人。在职业生涯的某一阶段，他逐渐意识到自己具备一种特殊的能力——去触及并治愈那些能够影响千千万万公众的焦点人物。 针对外界对名利场的艳羡，孔蒂医生指出了聚光灯背后的残酷真相：外界看到的往往是璀璨夺目、令人向往的光环，但身处公众视线中心所承受的内部压力与心理复杂度，是常人难以想象的。能够帮助这些背负着巨大精神负荷并对世界拥有巨大影响力的人理清内心的混乱，不仅是对复杂心理机制的攻坚，更是他深感欣喜的一项使命，因为治愈这些传播者，其善意与力量最终会层层传递至更广阔的社会层面。 ### [01:43:19](https://www.youtube.com/watch?v=USE89i0kiiQ&t=6199s) 终极之问：抹去生命中的一段遗憾 节目的收尾保留了《CEO日记》（The Diary Of A CEO）的标志性传统：上一位受访嘉宾在完全不知道下位嘉宾是谁的情况下，留下了一个亲笔写下的盲盒问题。本期的问题耐人寻味，甚至算不上一个疑问句，而是一句沉甸甸的半截话：“从你的生命中抹去一个遗憾……（Erase one regret from your life...）” 面对这个直击灵魂的命题，孔蒂医生沉思良久后给出了坦诚且令人动容的回答。他最大的遗憾，是在年轻时没能更多地关注周遭的世界。那时他深陷于让自己在当下“感觉足够好”的执念与挣扎中，这不仅让他自己在寻找人生方向时步履维艰，也让他忽略了身旁亲人的痛苦。他反思道，当时的生活充斥着被焦虑和恐惧驱动的狂奔，缺乏停下脚步审视全局的审慎与洞察力。 这种悔恨直接关联到了他在前文提到的哥哥乔纳森（Jonathan）的自杀，以及他成长家乡的其他故人： - 孔蒂医生自责地表示，当年自己原本有能力更敏锐地察觉到哥哥内心正在经历的风暴，或是看清哪些生活路径正在偏离健康与幸福。 - 在他成长的地方，有许多优秀的人在盲目前行中凋零。如果当时能多停下来环顾四周、给予彼此更深层次的关注与守护，乔纳森和另外几个人或许至今仍然健在。 - 尽管他最终走出了一条充满创造力且富有成果的治愈之路，但那段因缺乏大局观和审慎反思而未能阻止悲剧发生的过往，依然是他心底挥之不去的阵痛与遗憾。 ### [01:45:21](https://www.youtube.com/watch?v=USE89i0kiiQ&t=6321s) 将创伤炼化为治愈世界的力量 在节目的尾声，主持人代表广大受众向孔蒂医生致以崇高的敬意与感谢。主持人动情地指出，孔蒂医生毕生致力于传播关于创伤的真知灼见，这项事业的意义远远超越了单纯的拯救生命——它真正提升了活着的人的生命品质。 主持人从表观遗传学和代际创伤的视角总结道，一个人如果能够摆脱内化的羞耻与内疚，便能斩断创伤通过潜移默化向下一代传递的恶性锁链。孔蒂医生的研究与临床实践，正在且必将改善成千上万、乃至数十万那些他或许素未谋面的人的命运。 能够将自身遭遇的家庭碎裂与创伤之痛，转化为如此深邃、宏大且能够普惠人间的疗愈工具，是对逝者最好的告慰，也是生命最了不起的升华。面对这份极高评价的致谢，孔蒂医生深受感动并铭记于心，两人在温馨而充满力量的互道珍重与致谢声中，为整场对谈画上了圆满的句号。 ## Notable quotes > [23:30](https://www.youtube.com/watch?v=USE89i0kiiQ&t=1410s) 那种认为‘杀不死你的会让你更强大’的观点是彻底错误的，在各个层面都是错的。现实中，杀不死你的东西往往会让你变得更虚弱。 — Paul Conti > [16:25](https://www.youtube.com/watch?v=USE89i0kiiQ&t=985s) 如果追溯真正的底层原因，答案是没有。 — Paul Conti > [43:48](https://www.youtube.com/watch?v=USE89i0kiiQ&t=2628s) 为什么那个人突然陷入了抑郁？为什么那个人会突发惊恐？为什么他的行为会发生这样的改变？ — Paul Conti > [51:38](https://www.youtube.com/watch?v=USE89i0kiiQ&t=3098s) Trauma promotes pain, pain increases suffering, and suffering makes us desperate to soothe our pain — Paul Conti > [01:01:11](https://www.youtube.com/watch?v=USE89i0kiiQ&t=3671s) 我们的大脑从不会自动重启，也不会定期检索旧有认知去‘安装漏洞补丁’。 — Paul Conti > [01:03:03](https://www.youtube.com/watch?v=USE89i0kiiQ&t=3783s) 如果你能向我证明你谈的是‘八段完全不同但都不顺利’的感情，我或许会相信你的话；但我知道，你只是把同一段灾难性的关系翻来覆去重演了八遍。 — Paul Conti > [01:27:33](https://www.youtube.com/watch?v=USE89i0kiiQ&t=5253s) 在我所见过的所有精神疾病和通用医疗处理中，被处置得最糟糕、最差劲的绝对是睡眠问题。 — Paul Conti > [01:31:14](https://www.youtube.com/watch?v=USE89i0kiiQ&t=5474s) 我们赖以生存的这碗‘内在浓汤’，已被创伤彻底改变了 — Paul Conti > [01:39:38](https://www.youtube.com/watch?v=USE89i0kiiQ&t=5978s) 我现在可以无比笃定地说，这个男人拯救了我的生命。他让生活重新变得值得一过。但最重要的是，他赋予了我力量，让我重新找回并夺回了自我。 — Lady Gaga > [01:43:19](https://www.youtube.com/watch?v=USE89i0kiiQ&t=6199s) 从你的生命中抹去一个遗憾…… — 上一位嘉宾 ## Mentioned Paul Conti, Steven Bartlett, Lady Gaga, Kim Kardashian, Tommy Hilfiger, Jonathan Conti, Darren Reicherter, Stephanie zu Guttenberg, Rich Roll, The Diary Of A CEO, Pacific Premier Group, PC, British Medical Journal (BMJ), Emory University, Trauma: The Invisible Epidemic: How Trauma Works and How We Can Heal From It ## Video description Dr. Paul Conti is a general psychiatrist and expert on treating trauma, he is also the founder and CEO of Pacific Premier Group, PC. Some of his clients include Lady Gaga, Kim Kardashian & Tommy Hilfiger 00:00 Intro 02:41 The Invisible Epidemic 04:48 What Percentage of the Population Has Traumas? 07:15 Your Brother's Suicide 10:19 Trauma Is Causing All Sorts of Illnesses in Our Bodies 13:11 How Trauma Speeds Up Your Ageing 15:07 How Trauma Affects Us at a Cellular Level 16:25 Trauma Leads to Early Death 18:37 Is There Anything Killing More Than Trauma? 19:51 The Different Types of Trauma 24:22 What Doesn't Kill You Makes You Weaker 27:06 Why Some People Experience Trauma Stronger Than Others 30:43 The Impact of Being Different 33:30 Developing Trauma Later in Life 36:57 How Do We Know If Trauma Is Being Passed On? 40:31 Do We Need to Understand Our Parents' Trauma to Understand Ours? 44:58 Post-Trauma Syndrome 45:47 How to Know If We Are Traumatised? 48:54 Trauma Shows Up as Addiction 51:54 What Tests Can Be Done to See If We Have Trauma? 52:48 Self-Destructive Shooting Methods 56:09 People Are Dying from Prescribed Meds 58:14 How Does Trauma Change Our Brains? 59:53 Trauma Creates Cognitive Blind Spots in Our Brain 01:03:50 We Tend to Seek What Harms Us in Order to Fix It 01:06:25 Becoming Addicted to Our Victimhood 01:08:03 What's the Role of the Limbic System in Our Traumas? 01:11:37 Shame Keeps Us Alive 01:13:33 You Can Build a Different Story Around Your Shame 01:17:44 How You Are Treated Determines Whether a Situation Becomes Traumatic or Not 01:19:22 How to Alleviate Our Shame 01:21:07 How Bringing Up the Trauma Helps 01:24:23 The Link Between Sleep and Trauma 01:26:04 The Importance of Sitting Alone with Your Thoughts 01:28:43 Sleep Problems Need to Be Urgently Addressed 01:30:09 Why You're Not Sleeping 01:31:26 Link Between Weight and Trauma 01:33:21 Advice for People That Think They Can't Change 01:36:16 Training Your Brain 01:38:40 Can You Completely Get Rid of a Trauma? 01:39:39 How to Stop Being Triggered by Trauma 01:40:54 Saving Lady Gaga's Life 01:44:29 Last Guest Question You can purchase Paul’s book, ‘Trauma: The Invisible Epidemic: How Trauma Works and How We Can Heal From It’, here: https://amzn.to/3wTDnXc Join this channel to get access to perks: https://www.youtube.com/channel/UCGq-a57w-aPwyi3pW7XLiHw/join Follow me: https://beacons.ai/diaryofaceo Shop the Conversation Cards: https://thediary.com/products/the-cards Studies mentioned in the episode: https://pubmed.ncbi.nlm.nih.gov/11282817/ This episode of The Diary Of A CEO was filmed at Gold Tree Studios, located in the heart of the Sunset Strip, West Hollywood, California [Source](https://www.youtube.com/watch?v=USE89i0kiiQ)

[23:30] Paul Conti: 那种认为‘杀不死你的会让你更强大’的观点是彻底错误的，在各个层面都是错的。现实中，杀不死你的东西往往会让你变得更虚弱。 [16:25] Paul Conti: 如果追溯真正的底层原因，答案是没有。 [43:48] Paul Conti: 为什么那个人突然陷入了抑郁？为什么那个人会突发惊恐？为什么他的行为会发生这样的改变？ [51:38] Paul Conti: Trauma promotes pain, pain increases suffering, and suffering makes us desperate to soothe our pain [61:11] Paul Conti: 我们的大脑从不会自动重启，也不会定期检索旧有认知去‘安装漏洞补丁’。 [63:03] Paul Conti: 如果你能向我证明你谈的是‘八段完全不同但都不顺利’的感情，我或许会相信你的话；但我知道，你只是把同一段灾难性的关系翻来覆去重演了八遍。 [87:33] Paul Conti: 在我所见过的所有精神疾病和通用医疗处理中，被处置得最糟糕、最差劲的绝对是睡眠问题。 [91:14] Paul Conti: 我们赖以生存的这碗‘内在浓汤’，已被创伤彻底改变了 [99:38] Lady Gaga: 我现在可以无比笃定地说，这个男人拯救了我的生命。他让生活重新变得值得一过。但最重要的是，他赋予了我力量，让我重新找回并夺回了自我。 [103:19] 上一位嘉宾: 从你的生命中抹去一个遗憾……

[18:37] Paul Conti: I was always so struck by what the death certificate said versus why they had really died. [51:38] Steven Bartlett: Trauma promotes pain, pain increases suffering, and suffering makes us desperate to soothe our pain. [51:38] Paul Conti: We start handing them the most powerful short-term soothing mechanism with the absolute highest risk of long-term danger and death. And then we're surprised at how many tens of thousands of people die each year from prescribed opiates. [78:12] Paul Conti: What the person is telling me is something that from any reasonable human being would only elicit compassion. Now, that person who's telling me would only ever be compassionate to someone saying that, but they're not compassionate to themeselves. [86:04] Paul Conti: Amongst the conditions I have seen treated, the absolute worst in mental health treatment and indeed in general medical treatment are sleep problems... They're related to these vigilance and activation systems inside of us. So if that's what's going on in me... and you give me a sleeping medicine for that, I'm probably going to need a lot of it. [97:30] Paul Conti: Instead of... feeling bad about that—like, 'Oh, I did all this work and I didn't get over it'—say, 'Look, isn't it interesting like how strong this imprints us that this is still going to come to my head... It was neuronally reinforced, and sometimes you'll be having a bad day and it'll come in. It doesn't mean anything.' [99:45] Lady Gaga: I can now say with certainty that this man saved my life. He made life worth living. But most importantly, he empowered me to find and reclaim myself again.

[0:00] Trauma is like a virus, and it gets [0:02] passed along to your children even if [0:04] their children are not born until years [0:06] later because trauma can change the [0:08] expression of our genes. So, we need to [0:11] understand whether trauma is afflicting [0:13] us, how it's afflicting us, and how we [0:14] can treat it if it's there. Dr. Paul [0:17] Conti psychiatrist, expert in treating [0:19] trauma [0:20] He's worked with Kim Kardashian and [0:22] saved Lady Gaga's life. [0:23] and been in clinical practice for over [0:25] two decades. How many people have some [0:27] form of trauma? Well over half the [0:29] population. And trauma can change us in [0:32] very negative ways. For example, the [0:34] odds of traumatic brain changes are very [0:36] very high. We know trauma makes us age [0:39] faster than our calendar age. And we [0:42] know that ultimately the root of [0:44] depression, addiction, Parkinson's [0:46] disease is from trauma. Modern science [0:48] knows this, but we'll give them pills [0:50] with the idea that pills is going to fix [0:52] everything, and then we're surprised [0:54] that tens of thousands of people die [0:56] each year from prescribed pills. And [0:58] we've let that happen. What should we be [1:00] doing instead? The key to all of this is [1:02] curiosity. So, for example, let's say [1:04] someone is addicted to their phone. [1:05] Oftentimes addictive behavior is meant [1:08] as an escape from something or even to [1:09] self-punish. But when you scratch the [1:11] surface of that, you might learn about [1:13] an episode of sexual abuse that happened [1:15] when the person was a child. This is not [1:17] uncommon. [1:18] What are the telltale signs that I am [1:21] traumatized? What can I do to alleviate [1:23] the trauma? And then, can you completely [1:25] get rid of a trauma? The answer is based [1:27] in hard science. So, [1:31] It's absolutely crazy to me that so many [1:33] of you have decided to watch our show um [1:35] and so many of you have decided to [1:36] subscribe to our show. We now have 5 [1:39] million subscribers on YouTube, which is [1:40] a number that I just can't comprehend. [1:42] And it's a dream that I absolutely never [1:45] could have had. We started The Diary of [1:46] a CEO just over 3 years ago now. And in [1:49] my wildest expectations, we might have [1:51] had 100,000 subscribers by now. So, you [1:53] can imagine how shocked I am that so [1:55] many of you have chosen to tune into [1:57] these conversations every week [2:00] um and spend some time with us. So, [2:02] thank you. And I made a deal with you. I [2:03] made a deal that if you subscribe to [2:05] this show, that we would continue to [2:07] raise the bar. And in 2024, [2:10] we're going to raise the bar like never [2:11] before. I've been working for the last 9 [2:13] months on a surprise for all of you that [2:16] have subscribed to this show. And I'm [2:17] very excited to deliver that for you. [2:20] The production's going to change. We're [2:21] going to go even further with our [2:23] guests. And we're going to tell even [2:24] more global stories. So, as always, if [2:27] you appreciate what we're doing here, [2:29] the simple free favor I'll ask from you [2:31] is to hit the subscribe button. Let's [2:33] get on with the episode. [2:35] [music] [2:39] [music] [2:41] Dr. Paul Conti [2:43] On the front of your book, it says [2:44] trauma, the invisible epidemic. [2:48] Why did you use those two words, [2:50] invisible and epidemic? [2:52] [clears throat] [2:53] Well, [2:54] as a practicing psychiatrist, what I [2:57] started seeing over and over and over [2:59] again is that the the root cause of the [3:03] vast majority of what I was treating, [3:05] whether it was depression or addiction [3:08] or panic, that that ultimately the root [3:11] of it was trauma. That if we traced [3:14] back, what we would learn is that there [3:16] was something that had happened in that [3:18] person's life. It could have been acute [3:20] or it could have been chronic over time, [3:22] but that changed their brain. So, that [3:24] the brain is then different going [3:26] forward, and that is the root of the [3:29] problem. So, from that sense, I could [3:31] see there's an epidemic because this is [3:33] behind what is ailing us, right? The the [3:36] 50% or more of complaints to general [3:39] medical doctors are coming from mental [3:41] health. Right? These are general [3:43] physical medical medicine doctors. So, [3:46] you imagine how much of what is going on [3:48] inside of us is affecting our health. [3:52] So, the the epidemic of trauma is [3:54] touching us in so many ways, but we're [3:56] not identifying it. We're identifying [3:58] different illnesses. For example, like, [4:00] "Oh, that that person has depression. [4:03] That person has cardiovascular disease [4:04] and had a heart attack." Right? But [4:06] those things may be linked, including [4:08] autoimmune diseases, all aspects of [4:10] mental and physical health, but we're [4:12] not seeing that at the heart of it is [4:16] the trauma that then changes us. And our [4:18] brains and our bodies are different as [4:20] we move forward. So, to start seeing [4:23] this commonality, that this is [4:24] everywhere, and we're not identifying it [4:27] because one of the impacts of trauma is [4:29] to make a reflexive sense of guilt and [4:31] shame in us. So, then we sort of hide [4:33] things away. So, we're changed, made [4:36] less healthier, and the the very trauma [4:39] itself leads us to have a tendency to [4:42] keep it inside, to not share, to not get [4:44] help, to not do the kinds of things that [4:46] would lead us to recognize the epidemic. [4:49] How many people [4:50] have some form of trauma? Because when [4:52] we think of trauma, sometimes people [4:53] think of PTSD, soldiers coming back from [4:56] war. [4:57] So, how many people does this subject [4:59] speak to in some way? The numbers and [5:01] estimates vary, but it'd be hard to [5:04] imagine you wouldn't have roughly one in [5:07] five. I mean, likely you have more than [5:10] that. But if you look at, you know, data [5:13] across demographics and data for [5:15] occurrences of traumatic events and and [5:18] the impacts we see downstream of these [5:20] brain changes, we're talking about a [5:21] very significant portion of the [5:24] population. And then, if you think of [5:25] people who are either [5:27] experiencing the post-trauma effects [5:29] themselves, right? The changes to [5:31] themselves, or experiencing those [5:33] changes through someone close to them, [5:35] through someone they love, a parent, a [5:37] child, a significant other. Right now, [5:39] we're we're well over half the [5:41] population that will that will [5:43] experience a significant and negative [5:46] life impact from something that either [5:49] was with high likelihood avoidable or [5:53] treatable. In other words, change [5:56] for the worse that doesn't have to be [5:58] that way. And again, it's not just as if [6:01] just mental health, we're saying [6:03] something small. I mean, mental health [6:04] is how we interface with the world, but [6:06] it's our bodies, too. It's Is that [6:08] person going to get lupus? Is that [6:09] person going to have a heart attack or a [6:11] stroke? And how rapidly is that person [6:13] aging? So, we know that trauma, by this [6:17] definition that changes us because our [6:19] coping mechanisms are overwhelmed, makes [6:21] us age faster than our calendar age. So, [6:25] you could say, "Well, that person is 40 [6:27] years old by the calendar, but they're [6:29] really 46." Right? "That person is 65, [6:32] but really 73." If you look at the aging [6:36] that occurs in us as a result of trauma. [6:38] So, if, you know, I say this in part to [6:41] to really speak to how like concrete and [6:43] real this is. So, something that happens [6:46] and changes you so that you are actually [6:48] older than your calendar age, closer to [6:51] death, right? Than the calendar might [6:53] suggest, it is is so real and so [6:56] tangible. And it's this is the effect of [6:59] trauma. A trauma I said. And modern [7:01] science knows this. Modern neurobiology, [7:03] modern psychiatry, the research around [7:05] us tells us this, but the things that we [7:07] know aren't always at the forefront of [7:09] our consciousness in society, which is a [7:12] reason I think it's so important to [7:13] spread the word about it. [7:15] Why does this matter so much to you? [7:18] I had a youngest brother who died by [7:21] suicide when he was 20 years old. I was [7:24] in my mid 20s, which which had [7:27] um [7:28] um just a a terrible effect on the [7:30] family structure and upon me. And I and [7:32] I felt the reflexive sense of of guilt [7:36] and shame without really being aware of [7:38] it. I hadn't felt that before. You know, [7:40] I hadn't felt like I couldn't be in the [7:42] world or make my way forward in the [7:44] world. And I started feeling very very [7:45] different about myself. And I started [7:47] behaving in ways that weren't healthy. [7:49] You know, they were very unhealthy. [7:50] Drinking too much, unhealthy friendships [7:52] and relationships, and real change in me [7:55] that I was fortunate to be able to get [7:58] help for. Um that really [8:01] brought to the surface how much had [8:03] changed after the trauma. That I felt [8:04] very different about myself in the [8:06] world. Like so cursed and maybe our [8:08] family was cursed, and I couldn't make [8:10] my way forward, and bad things were [8:11] always going to happen. And it was the [8:13] realization that like I'm really [8:15] different, and this is not okay. And it [8:17] wasn't like just grief, you know, in the [8:19] sense that sadness and loss, of course, [8:21] were were a huge part of that. But but [8:24] realizing also like I am different. And [8:27] you know, that had a very big [8:29] effect on me. Um [8:30] both the depression and the the the the [8:32] issues in him that weren't seen and [8:34] addressed that led to his suicide and [8:36] then the downstream effect on the rest [8:38] of us. And that led me to to leave. I [8:40] had a business career, and I went back [8:42] to college and took some pre-med classes [8:44] and went to medical school and then [8:45] became very interested in psychiatry and [8:48] and and brain function, both the [8:50] psychology of how we think and the the [8:52] brain biology that underpins how we [8:55] think. And I've been very much [8:57] fascinated [8:58] uh ever since. Did you [9:01] process and or deal with the loss of [9:03] your younger brother, Jonathan, by [9:04] suicide at the time? [9:08] No. No, at the at the time, I just went [9:11] inside. Like people didn't talk about [9:12] it, and we're overwhelmed, and you know, [9:14] we became less healthy and felt [9:16] different about the world, but there [9:17] wasn't an outlet [9:18] for talking about it. It just wasn't the [9:20] the how I had grown up. Like there [9:22] wasn't a way people would say, "Let's [9:23] check in. Like, how are you doing? And [9:25] maybe you should see someone." Like it [9:26] like it didn't happen. And and it took a [9:29] it took until I realized like I'm kind [9:31] of in trouble here. I need to get some [9:33] help to then, you know, I had an [9:34] insurance card and to look on the back [9:36] and say like, "Oh, maybe I should go [9:37] talk to someone." But that was a stretch [9:39] for me, and I felt even embarrassed [9:40] about doing that. Like I really didn't [9:42] understand neither what had happened and [9:45] nor how to help myself. And and then you [9:48] know, I went to someone, and you know, I [9:50] just remember just how amazing it was to [9:52] just have her tell me that, you know, I [9:54] wasn't [9:55] like I wasn't sick or crazy or or like [9:58] not going to be okay because I felt this [9:59] way that I helped normalize what I was [10:02] feeling and and helped me put some of it [10:03] into perspective and I realized like [10:06] well, that was very basic what was just [10:07] done for me and [10:10] you know, many many many people do not [10:11] get that and I almost didn't have it [10:12] myself and I was I was very struck by it [10:15] and by how much of a difference it made [10:17] to have a better understanding and get [10:18] some help. The impact it had on the rest [10:20] of your family. I was reading that your [10:22] mother was depressed for the rest of her [10:24] life almost because of [10:26] potentially because of that incident. [10:29] Mhm. [10:30] Yeah, and I think she was clearly [10:31] different afterwards, too and and was [10:34] much more isolated. Again, in hindsight, [10:36] it's so clear to see, but I think the [10:38] guilt and shame that she felt um [10:41] was was overwhelming and she didn't was [10:44] not able to get help, you know, no [10:45] matter how much encouragement. You know, [10:47] at some point I it was actually a [10:48] psychiatrist and I still couldn't you [10:51] know, couldn't get her to get help [10:52] because I think she was just felt so [10:55] ashamed and and [10:57] felt that help was inaccessible or that [10:59] it getting help was even more shameful. [11:00] And you know, the patterns changed. I [11:02] mean, there were still some happy times [11:04] in her life, but the whole tenor changed [11:08] and changed towards towards [11:10] progressively more depression and again, [11:12] it didn't have to be that way either, [11:14] but there weren't support resources for, [11:17] you know, mothers who lose a a child to [11:19] suicide and and my father who was more [11:21] extroverted you know, then just had more [11:23] natural support mechanisms and that's [11:25] what you see sometimes that that it [11:27] shouldn't be that one person does better [11:28] than the other because they just happen [11:30] to have different proclivities. You [11:32] know, but when we're not really paying [11:34] attention to this and we're just kind of [11:35] running forward, you know, and trampling [11:37] people then maybe the person who's a [11:39] little more introverted in a situation [11:40] like that a little more inclined to be [11:43] self-blaming, you know, like that's the [11:44] person who doesn't do okay and you know, [11:46] and my mother didn't and and died I [11:48] think much younger than she should have [11:50] of of cancer, but this kind of trauma [11:53] predisposes to the immune system not [11:55] functioning as it should and I can't say [11:57] that this trauma caused her early death [11:59] by cancer, but but certainly there there [12:02] a lot of scientific reasons to think [12:04] that [12:05] um [12:05] that it was likely a factor [12:07] in it and again, unless we're aware of [12:10] like what trauma is and what it's doing [12:12] to us that like we can prevent it. We [12:14] can identify it and treat it. These [12:16] changes to us don't have to stay the [12:19] same. Like the person who's blaming [12:21] themselves and ashamed and depressed [12:23] doesn't have to stay that way. The [12:24] person who is abusing a substance to try [12:26] and cope or to try and kill themselves [12:28] because they feel so bad it doesn't have [12:30] to be [12:31] living like that. Like we really and [12:33] truly can make change. The person who [12:35] has an autoimmune disease or heart [12:37] disease or rheumatoid arthritis that's [12:39] inflamed after the trauma. Like [12:41] everything is worse after the trauma [12:42] doesn't have to be medically [12:44] ill like that. Like it's the the message [12:46] I'm bringing is is one based in hard [12:48] science and it's one that has a real [12:51] message of change that it's not an [12:52] esoteric principle what we can and [12:55] should be healthier. Even you think [12:57] about more than 50% of complaints [13:00] brought to physical medicine doctors [13:02] that come from a mental health [13:03] perspective. I mean, how much of that is [13:05] based in trauma? It's the the majority [13:07] of what is ailing us and the numbers [13:09] actually do tell us that. [13:11] At the top of this conversation you [13:12] referred to aging and the impact that [13:14] trauma has on aging. Mhm. How does that [13:17] work? So, trauma makes me older? Mhm. [13:20] There's there are there's cellular [13:22] mechanisms in us, you know, people often [13:24] talk about telomeres which is one aspect [13:26] that change as we grow older cuz we're [13:29] very interested in figuring out like why [13:31] do we grow older? Right? So, there are [13:33] processes in us that sort of mark time [13:35] and that change across the aging process [13:38] of humans. Now, I mean, we don't [13:40] understand everything about this. If we [13:42] did, we could change it and we'll live [13:44] much much much longer, but we're trying [13:45] to understand about it and and I think [13:48] science has made a lot of very [13:50] significant headway in understanding and [13:52] part of that understanding is the [13:54] biological age of a person [13:57] is different from the calendar age. So, [13:59] if you you know, an example would be if [14:02] you took two identical twins at birth [14:04] and you know, one of them is able to [14:06] live in pretty good circumstances and [14:08] free of trauma and you know, has a [14:10] pretty good life going and the other [14:12] person lives in a way that has has [14:14] privation and a lot of trauma, maybe [14:17] direct physical assault or seeming seen [14:19] as less than denigrated by society. It's [14:21] a theoretical example, but the idea [14:24] would be you you go follow them 30, 40, [14:27] 50 years later and you you find two [14:29] people who are not the same age anymore. [14:32] Right? The person who had the better [14:33] life if they're 40, well, they're 40 and [14:35] if you match up cellular aging [14:37] mechanisms and again, we don't know how [14:39] close a person is to death, but the [14:40] aging mechanisms are telling us how far [14:42] along our path we are so to speak. They [14:44] say, okay, that kind of matches with [14:46] being that person's age, but then you [14:48] see the person who has been through so [14:50] much trauma, the presumption here being [14:52] there are the brain changes of trauma, [14:53] there's a post-trauma syndrome. I that [14:55] that person is going to actually be [14:58] older in terms of how far they have [15:00] traversed down that path of the [15:02] machinery in them running itself forward [15:04] than what the calendar tells you. [15:07] Trying to figure out why and how that's [15:09] happening. [15:10] What is the mechanism that's causing [15:12] them to apparently accelerate in age? [15:14] So, the the less healthy environment [15:16] within the person. So, some of that is [15:18] is likely say the signaling molecules [15:20] that we we talk about is just not as you [15:23] know, the bloodstream isn't as as clean [15:25] and healthy and you know, running in as [15:27] lockstep a fashion as we might want, but [15:29] there are inflammatory signaling markers [15:32] and you know, that impacts cellular [15:34] function and cells are more likely to [15:35] die earlier than they might otherwise [15:37] and and elements of neurotransmission [15:39] and anxiety and tension states within [15:42] us. You know, it's it's really [15:43] environmental. One you know, one set of [15:46] aging machinery is in a healthy [15:48] environment and the other isn't, so it's [15:50] going to deteriorate more quickly. I [15:52] mean, it's it's one way of kind of [15:54] trying to capture that. The environment [15:55] is is very different in those two [15:58] people. So, how what is functioning in [16:02] that environment ages is going to [16:04] change. Like having a car maybe in an in [16:06] a [16:07] a nice warm dry environment, you know, [16:09] versus having a car where you know, [16:11] there's snow and ice 6 months of the [16:12] year and then it's terribly hot the [16:14] other 6 months. You know, it's that it's [16:16] going to be different. It's going to age [16:18] differently so to speak. Right? If you [16:20] go look at those two cars 10 years later [16:21] and to some extent [16:23] it's like that in us, too. [16:25] Death, disease and trauma. [16:27] A 2021 study by the British Medical [16:29] Journal found that adults who [16:31] experienced sexual abuse by the age of [16:33] 16 have 2.6 times [16:35] the chance of dying in middle age than [16:37] those who didn't experience it. [16:40] It's [16:41] not commonly believed that trauma can [16:43] result in disease like physical disease [16:46] directly, but you argue that it can and [16:49] you also talk about how it can result in [16:50] new autoimmune disorders, things like [16:54] arthritis [16:56] um [16:57] Crohn's disease Crohn's disease, [16:59] ulcerative colitis, Parkinson's disease [17:02] probably has an autoimmune component. [17:03] We're learning that much much more [17:05] is autoimmune. So, [17:07] Do you believe that trauma is the [17:09] underlying reason behind many diseases [17:11] that lead to early death? Absolutely. [17:13] And think about what you just read. Can [17:15] can we take a look at that again? Like I [17:17] think what you just read is [17:19] absolutely momentous. So, think about [17:21] that. Sexual assault in the teen years [17:25] like [17:26] leads to a two and a half fold increase [17:29] in death risk. [17:31] That's staggering. What's causing that? [17:34] The whole cascade from the biological to [17:37] the behavioral. So, [17:39] gene transcription is changed. Healthier [17:42] genes are more likely to be off. [17:44] Unhealthier genes are more likely to be [17:46] on. That's not good for our blood [17:48] vessels. That's not good for heart [17:49] disease or possibility of having a [17:51] stroke and the immune system is more [17:53] activated and more likely to attack [17:55] itself and some of the mechanisms within [17:57] us that are protective against cancers [18:00] for example are less likely to function. [18:02] All of those things change biologically, [18:05] neurotransmission, endocrine function, [18:07] signaling markers in the bloodstream. [18:09] All of that is changing and at the same [18:11] time behaviors are changing. Higher [18:13] risks of depression, higher risks of [18:16] addiction, higher risks of impulsive [18:18] behaviors, risk-taking behaviors. You [18:21] have to put a lot of things together [18:23] before you get a death risk that is two [18:26] and a half times higher, but that's how [18:28] we get there because it does put a lot [18:31] of things together from the genes all [18:34] the way through to complex risky [18:36] behavioral taking. Do you think there's [18:37] anything killing more people than [18:38] trauma? [18:39] Fundamentally? [18:42] [sighs] [18:43] Not if we look for root cause. I've seen [18:45] many many things that kill people and I [18:48] I wrote about this in the book people [18:50] that I was taking care of who at times [18:54] died and I was always so struck by what [18:58] the death certificate said versus why [19:00] they had really died. You know, so the [19:03] death certificate might have said car [19:05] accident. Okay, I [19:06] understand that, but why was that person [19:08] driving 120 miles an hour in bad [19:11] conditions or why were they being so [19:12] reckless? Why they had five car [19:13] accidents? I know that's the trauma. [19:16] Right? Well, well, it's [19:18] heart attack. Why did that person have a [19:19] heart attack when they were [19:21] 62? They didn't have huge risk factors [19:23] from other any way except the trauma and [19:26] its impact and [19:28] so if we're looking at root cause [19:30] analysis of what is hurting us, [19:33] what is hurting our quality of life, [19:34] what is hurting the quality of life of [19:36] people that we love and what is killing [19:38] us, I think that need we know more than [19:41] even just that. [19:43] And and there's so much we could we [19:44] could pile the information a mile high [19:47] that supports that piece of information [19:49] which I think is quite staggering. What [19:51] are the different types of trauma? Are [19:53] there sort of different categorizations [19:54] of of trauma from like small to big or [19:57] If we're if we're using the definition [19:59] that trauma is anything that overwhelms [20:01] our coping mechanisms, so so there there [20:04] are changes in the brain when our coping [20:07] mechanisms are overwhelmed and on the [20:09] other side of that our brains are [20:10] different. So that's the biological [20:13] definition. Then we would look at well, [20:15] how how do we how do we get there, [20:17] right? And and we it breaks down into [20:18] three categories that are acute, [20:21] chronic, or vicarious. So the acute [20:23] trauma is how we've traditionally seen [20:26] trauma. So if you think about the idea [20:27] that people were shell-shocked after [20:29] World War I, [20:30] right? That was acute trauma, combat [20:32] trauma. So our traditions of looking at [20:34] trauma come from acute trauma and it's [20:37] just more evident, you know, after [20:38] someone dies or there's an injury or [20:40] there's a car accident, like you know, [20:41] we can see that oh, okay, gosh, that [20:44] could what makes some difference in the [20:46] in the person, like we can kind of get [20:48] that and sometimes we can see the change [20:50] in the person from before and after. So [20:52] we have tended to equate [20:55] trauma and post-trauma syndromes, like [20:57] what happens to us after those changes [20:59] in the brain are now with us, to acute [21:02] trauma. But but again, it's not a soft [21:04] definition. It's based on do those [21:06] changes in the brain happen in other [21:08] ways? And the answer to that is yes, [21:10] that if a person is seen as less than, [21:13] for example, in a society for whatever [21:16] reason across time or even within a [21:18] household, a person is being abused, in [21:21] a household, a child is being neglected, [21:23] or a child is being emotionally or [21:25] physically abused. [21:27] at school? Sure, bullied at school, [21:29] absolutely. Right, this over So so [21:32] nothing happens all at once, right? But [21:35] that brain changes just the same. So [21:38] it's a scientific definition of [21:41] traumatic change and it is true in [21:44] situations of chronic trauma just as it [21:46] is in acute trauma. Now, it doesn't mean [21:48] all acute traumas or all chronic traumas [21:51] make these changes in the brain. And [21:52] then the vicarious, so the third [21:54] category there would be vicarious [21:55] trauma, which means like human beings [21:58] are empathetic, right? I mean, thank [21:59] thank goodness, right? That's how all [22:01] goodness comes in the world through our [22:02] ability to have empathetic connection, [22:04] but that also means that our trauma can [22:07] communicate from one to another. And [22:09] again, it's not a soft concept, so [22:11] people who are very much involved in [22:13] other people's trauma, so in health care [22:15] settings, sometimes in in journalism [22:19] settings, just in intimate home settings [22:21] and just spending a lot of time with the [22:25] news, right? Can become traumatized and [22:29] have the changes in the brain that look [22:30] the same as the person who lost two [22:32] family members in the car accident. So [22:35] it is true that vicarious trauma can [22:37] change us in just the same way. The the [22:40] modern field acknowledges that if it's [22:43] in the context of professional [22:44] endeavors, which actually makes no [22:45] sense, right? Like what we're talking [22:47] about are brain changes and brain [22:49] changes can come through acute trauma, [22:51] chronic trauma, or vicarious trauma [22:53] because of our ability to have [22:55] empathetic connection and compassion [22:57] with other humans. I want to make sure [22:59] that I've nailed this before we move on. [23:00] So the acute trauma is I get it, it's [23:02] the the big events, it's the going to [23:04] war, it's the car accident, big events [23:06] that happen typically in an instant. [23:09] Mhm. Typically. Chronic trauma, this is [23:12] things like racism, sexism, bullying [23:14] that happen over a long period of time, [23:16] gradually, that make you often feel less [23:18] than Right. [23:20] than other people. And the vicarious [23:21] trauma is the trauma that as you say, [23:23] you get from empathy. So feeling someone [23:25] else's pain, feeling someone else's [23:27] trauma Yes. and it becomes your own. [23:29] Yes. Okay. [23:30] Yes. And they can all lead us to the [23:32] same brain changes. But people have [23:35] different levels of susceptibility, [23:37] right? So one person may have three big [23:40] acute traumas and that person's brain is [23:43] still doing okay, right? It's not [23:45] changed towards greater vigilance, [23:47] right? It's not changed towards greater [23:49] inflammation in their blood vessels, [23:51] then, you know, [23:52] another person could have one incident [23:55] that might seem more mild than the other [23:58] three, the person and that person can [23:59] then have brain changes. So part of this [24:02] is who are we genetically, how are we [24:04] built, what kind of life experience have [24:06] we had, especially early life [24:07] experience, how susceptible are we to [24:09] one thing versus another? And then this [24:12] idea of the multiple hit hypothesis that [24:14] I could have a number of traumas and [24:16] then on a certain trauma that might be [24:18] even mild compared to the ones that came [24:20] before it, now it makes the changes. [24:22] What is that hypothesis? So the multiple [24:24] hit, which which which says that this [24:27] idea that what what doesn't kill us [24:28] makes us stronger [24:30] is completely wrong, I mean, in in [24:32] absolutely every way. What what doesn't [24:34] kill us often makes us weaker, right? [24:36] And that's why we have to be attentive [24:38] to what hurts us but doesn't kill us so [24:39] that we don't get weaker, we get [24:40] stronger. But what can happen is we can [24:43] become more susceptible to the more [24:45] likely that the next trauma, if we [24:48] experience one, will then create the [24:50] brain changes. [24:51] Cuz I have I've often wondered, I'm [24:54] the youngest of four kids. We all grew [24:56] up in the same household. We experienced [24:58] a variety of different traumas in my [24:59] opinion. Much of it was chronic, but [25:02] again, being the only black family in an [25:03] all white area, all these kinds of [25:04] things. But I thing I've always [25:06] reflected on is for some reason, I think [25:08] I experienced it much more, the trauma [25:10] of that, than my older siblings. [25:13] Yes. And I've pondered whether that's [25:14] because of the timeline. Being the [25:15] youngest, it was worse in the later [25:18] years. So I I think my hypothesis has [25:20] been that I experienced it more than my [25:21] siblings. Mhm. And I think I've embodied [25:23] the shame a lot more than my siblings [25:25] have, yet we both went through the same [25:26] thing. So Mhm. for whatever reason, I'm [25:28] like really like I'm a workaholic and [25:31] I'm exceptionally driven, not that my [25:34] siblings are, but I'm obsessed in a way [25:35] that's probably not completely healthy. [25:37] Mhm. And I look at my siblings and I go, [25:39] they're not [ __ ] up in the same way [25:40] that I am, but we all went through the [25:41] same thing. Part of what you're pointing [25:43] out is that the the variables of life [25:46] matter, right? So if circumstances are [25:48] different, say for one child in [25:50] formative years than for another, [25:52] the those children could be affected [25:54] differently, like economic [25:55] circumstances. So some of it [25:57] may be and and probably is impacted by [25:59] the things that you're saying, but there [26:01] probably are almost surely other [26:03] factors, too. This kind of nature and [26:05] nurture, that people have what sometimes [26:07] gets called different levels of [26:09] attunement of the of the emotional [26:11] compass. So you know, some people are [26:13] very sensitive and sensitized to things [26:15] and very aware of what's going on around [26:17] them and and aware of their own feeling [26:19] states. You know, and other people can [26:21] kind of go through life and, you know, [26:23] emotionally buffeting things can happen, [26:24] but they kind of keep going, you know, [26:26] and and look, there pros and cons to [26:28] both of those ways of being, but the [26:30] person with the sort of more finely [26:32] attuned emotional compass is the person [26:35] who's likely to to register more things [26:38] that are negative, like things like [26:40] subtle expressions of prejudice, right? [26:42] That that someone with a less attuned [26:44] compass may just, you know, kind of not [26:46] see that or just it doesn't make it, you [26:48] know, into their conscious awareness, [26:50] whereas someone else who would be very [26:52] attuned might see a lot of those things. [26:55] So it's this part, like what is the [26:56] nature, like who is the person, right? [26:58] And then what is the nurture, meaning [27:00] like what are the variables, you know, [27:03] that that that seed sort of falls into [27:05] as we go through life. You must have [27:06] seen this a lot in your practice where [27:09] an individual went through a really [27:10] traumatic early event Mhm. and you've [27:12] got the person in your practice sat in [27:14] front of you that is an alcoholic, they [27:16] are [27:17] experiencing sort of suicidal thoughts, [27:20] but then when you look at the rest of [27:21] the family, the family are just doing [27:22] fine. [27:23] To some whatever that means, fine, but [27:26] Right. Well, one of the things to look [27:28] at is the rest of the family doing fine [27:29] cuz sometimes what it seems like on the [27:31] outside is not true on the inside. [27:34] And then we do think about genetics, [27:36] especially around alcoholism. There are [27:38] um we don't understand all of it, of [27:40] course, but but there are genetic [27:41] factors that can be very impactful. [27:45] Then we'll look at personality [27:47] structure, you know, is that person [27:48] built to sort of internalize externalize [27:50] blame, you know, so why alcohol for this [27:52] person and not for someone else? How [27:54] much is nature or nurture and how much [27:55] may be formative? It may be that, for [27:57] example, that person was in social [27:59] circumstances, just real example that [28:01] happens with some frequency, is they [28:03] middle late teens where alcohol was [28:06] accepted as a way of coping, right? And [28:09] and maybe other people in the family [28:10] weren't. The circumstances were just [28:12] different. The way they went to school [28:13] was different. Whatever and and they [28:14] didn't have it modeled for them that [28:16] this is how they cope. So maybe there [28:17] genetic factors that that push [28:21] alcoholism. Maybe there are social [28:24] factors, right? That it was modeled for [28:25] that person. So you know, you can put [28:27] those things together and which is why [28:29] and we follow patterns and there's a [28:31] science underlying all of this, but we [28:33] have to look at who is that person, [28:36] right? You have to look at [28:38] you know, the the family history, so the [28:40] genetics that may have been passed on [28:41] and what does that seem like may be the [28:43] case in the person. How can you be [28:44] informed by that? And what were their [28:46] formative life experiences? And you [28:48] start we start to [28:50] build a picture of what's going on [28:51] inside of us so that we can understand [28:53] and change by looking at our history, [28:54] which is why mental health doesn't often [28:56] do this. You know, it takes an inventory [28:58] of your symptoms now to reflexively [29:00] prescribe a medicine, right? So we need [29:02] to understand ourselves if we're going [29:04] to understand whether trauma is [29:06] afflicting us, how it's afflicting us, [29:08] how we can prevent it, how we can treat [29:09] it if it's there. And and I think that [29:12] means accepting that this is real and [29:14] this is real science, which which [29:16] actually when you were talking, it made [29:17] me think of an example. So if I say a an [29:19] example to the science of it, one one of [29:22] the earlier studies and I forget exactly [29:24] how many years ago this was, but 15 or [29:27] 20 years, maybe, was looking at [29:29] immigrants. I believe they were [29:30] immigrants from Somalia to Holland. I [29:32] think I'm remembering that correctly. [29:34] And and so the incidence of [29:36] schizophrenia in the human population is [29:38] about 1% across the human population. [29:42] But when stressors are higher, right? It [29:45] they can predispose people to to having [29:48] to coming down to having the syndrome of [29:49] schizophrenia. So it's about 1% of the [29:51] population, but it's not evenly [29:53] distributed. If there are, you know, [29:55] people in sort of pressure cooker [29:56] environment, so to speak, become more [29:58] susceptible. And so they looked at at [30:01] immigrants who integrated into the [30:04] community in Holland versus immigrants [30:06] who lived in primarily immigrant [30:08] communities. And the incidence of [30:11] schizophrenia was higher in the people [30:14] who had integrated. [30:15] Right? So the thought is, and again [30:17] there've been subsequent studies and we [30:19] don't know for sure, but this the the [30:21] when you kind of look at that and say, [30:22] "What what is that?" is the feeling of [30:24] otherness, right? Is is different trying [30:27] to integrate into a society that was [30:29] looking at, you know, not everyone in [30:30] that society, of course, but there was a [30:33] much more pervasive sense of otherness [30:35] when people were integrating than then [30:37] when they were living in the communities [30:38] where food and dress and like the the [30:40] day-to-day of life was normalized. [30:43] What's otherness? I'm mostly sort of [30:45] cost of otherness. [30:47] I think otherness in the way I'm [30:49] defining is a sense of difference in a [30:51] way that's not good. [30:52] Right? A sense of difference in a way [30:54] that [30:55] involves either [30:57] being seen as less than, and again [30:59] sometimes it can be over prejudice, but [31:01] it can be also stratification of [31:03] opportunity. You know, just to seeing [31:04] that, okay, like in some way I'm not on [31:07] an equal I don't feel on an equal [31:08] footing [31:09] here, right? And then that there's a [31:10] there's can be a sense of isolation [31:12] there that that builds that the sense of [31:14] otherness then say building inside the [31:17] person, right? The person doesn't feel [31:19] quite as safe, right? It doesn't feel [31:21] quite as validated cuz you know, when [31:22] we're especially when we're young, we [31:23] look around us to see what's normal. And [31:26] if, you know, people are looking, [31:28] talking, dressing like us, like we just [31:30] feel validated in ways that we might not [31:32] feel if we see that we are different, [31:34] especially if the difference isn't [31:36] embraced, right? And we see this across [31:38] immigrant communities who you at some [31:41] point integrate, right? But initially [31:44] people will tend more to stay together [31:46] because there's there's a sense of [31:47] validation in the community. Um so then [31:50] the children often then will will [31:52] integrate, right? Which is why it's such [31:53] an interesting study to look at people [31:55] who were first generation immigrants who [31:58] would be likely to feel very strongly, [32:01] you know, whether they were integrated [32:02] or whether they were subsequent [32:05] generations, right? They're the [32:06] generation that just come from the home [32:09] culture that either they could still [32:10] sort of live in or [32:13] live in a new culture and not that [32:16] everyone felt a pervasive sense of [32:17] otherness, but there's more of that [32:19] sense of otherness. And the fact that [32:22] that would change susceptibility [32:25] to an illness that otherwise is [32:27] distributes itself across the [32:28] population, I think is a very profound [32:32] you know, marker of scientific proof [32:34] upon the things we don't pay attention [32:37] to as much, you know, subtle prejudices, [32:39] discriminations, whatever they may be [32:41] that are in our society that we kind of [32:43] look the other way and don't see that [32:45] we're really harming people who then can [32:48] come to the they come to the adult phase [32:52] of life in in a place where we have [32:55] marginalized them and we've we've made [32:57] things different inside of them that [32:59] makes it harder to make their way in the [33:01] world. And I think we overlook very much [33:03] whether it's bullying, many many things [33:05] that can be based upon what can make [33:06] people feel less than, but the effect of [33:09] it is is seen in actual brain biology. [33:12] And like we know this. We've known this [33:14] for a long time, but [33:16] in some ways I see that we're more [33:17] fragmented and pushing more towards [33:20] these experiences of otherness or [33:21] experiences of vulnerability and lack of [33:23] safety that push people towards the the [33:26] the chronic aspects of of traumatic [33:29] brain change. When we think about [33:30] trauma, we often focus on childhood. But [33:33] what you're saying now with this study [33:35] of the Somalis that emigrated to Europe, [33:37] um presumably those were adults. [33:39] Yes, so the the highest incidence of [33:42] schizophrenia is in people who are in [33:44] young adulthood. Yeah. So so we're not [33:46] seeing changes in people who are already [33:47] deep into adulthood, but the but the the [33:50] changes that we're seeing is in the sort [33:51] of transition to it to adulthood, which [33:54] honors both that [33:55] yes, we are much more impressionable in [33:58] all sorts of ways including how our [33:59] brains are forming when we are younger. [34:01] So these so these are people still their [34:03] brains still have enough formative The [34:05] idea is the thought would be they have [34:06] enough formative processes going on in [34:09] their brains that the brains can be [34:11] changed by the trauma. But when we talk [34:14] about these three types of trauma, the [34:15] acute, chronic, and vicarious, can you [34:18] experience these types of trauma in any [34:21] age, phase, chapter of life? Yes. The [34:24] earlier in the the lifespan, the the [34:27] more impactful. Okay. Yes, absolutely, [34:30] which is why childhood trauma is so [34:31] important. My in the book I interview [34:35] Darren Richer, who's a psychiatrist at [34:37] Stanford, and Stephanie von Gutenburg, [34:39] who's a child wellness advocate, because [34:42] we're talking about trauma from both [34:44] ends of the spectrum. So that the [34:46] chapter that's the interview with [34:48] Stephanie von Gutenburg talks about how [34:51] childhood trauma so deeply impacts the [34:55] the sense of self of the child. Like [34:56] things that we know, but I dedicate a [34:58] chapter to it because childhood trauma [35:01] is so tremendously [35:04] impactful. And again we don't pay enough [35:07] attention to helping children who are [35:09] traumatized and to to to projecting [35:11] ahead to the increased burdens of [35:14] illness and decreased role performance [35:15] and all the awful things that happen. So [35:19] so childhood trauma is one thing. On the [35:21] other end of the spectrum, Dr. Richer's [35:23] work has highlighted the fact that when [35:25] people are traumatized, they are changed [35:28] in ways that changes subsequent [35:30] generations. So if we're talking about [35:33] childhood trauma, we can talk about [35:35] traumatized children. We can also talk [35:37] about traumatized adults [35:40] whose trauma changes [35:42] their children even if their children [35:45] are not born until years later. How do [35:47] we know [35:48] that trauma [35:50] can and is being passed on? What is the [35:53] best evidence we have to support that? [35:55] So the the field of epigenetics, which [35:57] has really come to the So so epi [36:00] epigenetics really come to the forefront [36:02] in the last [36:03] two to three decades, which is the [36:05] understanding that our life experiences [36:08] can change the expression of our genes. [36:12] So so [36:14] you or I may have a gene that is active [36:18] now because we inherited an active gene, [36:21] for example. And then maybe that gene is [36:23] producing something it's it's helping us [36:24] in some way, bolstering mood, decreasing [36:26] anxiety. Then something can happen, [36:29] something can change in us that turns [36:32] off the expression of that gene. Or [36:34] turns on the expression of another gene. [36:36] So then even though you have that gene, [36:39] you don't have the benefit of it because [36:41] the gene has been turned off. And and [36:44] this is a very [36:46] I mean it's a very revolutionary [36:47] understanding that it's not just, well, [36:49] your genes are your genes. You know, we [36:50] could look when sperm and egg come [36:52] together, well, that's telling us what's [36:54] going on. And if we could understand [36:55] that fully, we would see, oh, here's the [36:58] array of genes that are active and the [36:59] array of genes that are not active. But [37:01] like that's not the story, right? That's [37:04] just part of the story. The the the [37:06] story continues that you that one's [37:08] experiences of life changes how those [37:12] genes function, which ones are on, which [37:14] ones are off, and how they get passed [37:16] along. So if the parent is not [37:19] traumatized, the parent may pass along [37:21] the active gene for something positive, [37:23] say, to the child. If the child then is [37:25] traumatized, the child may pass on that [37:29] gene without it being expressed. So it's [37:31] as if the gene isn't passed on. [37:34] So if you you think about that, it's [37:35] just amazing that our genetics in the [37:38] sense of what's actually going on in us [37:40] is not just the nature of what genes did [37:42] we get. It's the nurture, how has what [37:45] has happened to us affected the [37:47] expression of those genes. [37:50] There's one study that I I read about [37:52] which says scientists at Emory [37:54] University in Atlanta trained male mice [37:56] to fear the smell of cherry blossom, [37:58] shocking them whenever they smelled it. [38:01] So the mice got to the point where they [38:02] shuddered when they smelled it even when [38:04] they were weren't even being shocked. Um [38:06] the and [38:08] I'm guessing the children then had the [38:10] the same reaction. I mean, I guess [38:12] that's what the study concludes. But [38:13] also the [38:14] the children of Holocaust survivors are [38:16] another example of how trauma can be [38:18] passed on because Yes. Yes. It's hard to [38:20] think of a much more traumatic event [38:22] than being involved in the Holocaust. [38:23] Right. And for a long time the thought [38:25] was that the the reason that children of [38:28] Holocaust survivors had higher levels of [38:31] anxiety and of anxiety spectrum [38:33] illnesses was because of anxious [38:36] parenting that understandably that the [38:38] parents had a much more sense of [38:41] vulnerability, you know, so so across [38:44] the population they were they were more [38:46] anxious and they were raising the [38:47] children with more anxiety. And what we [38:49] have have learned is that that the [38:52] experiential aspect is part of it, but [38:54] that exactly what you and I are talking [38:56] about is part of it, too, because the [38:58] the experience of what they went through [39:00] changed genetic expression in the [39:03] children. [39:04] Right? So that's that's [39:06] just a sea change in understanding that [39:09] the the genes of the parents, the [39:11] genetic expression of the parents, and [39:13] the genetic expression that they pass [39:14] along to their children is changed by [39:17] the Holocaust experience itself. With [39:21] this understanding of epigenetics, do [39:23] you in your practice then consider [39:25] deeply what someone's parents went [39:27] through in their life and how that might [39:29] have changed someone's sort of genetic [39:30] expression that sat in front of you in [39:32] your practice? [39:33] Sure. Sure, I I think we all deserve, so [39:36] to speak, to to [39:38] think about our life narrative, right? [39:40] And and and so many of us don't. I if [39:42] we're trying to help ourselves, you [39:44] know, whether someone listening to this [39:45] like feels that they're depressed or [39:47] that they they don't have any mental [39:48] health issue, but they want to [39:49] understand themselves better, it's like [39:51] think about a narrative of okay, where [39:53] Well, let me start with like where have [39:54] I come from and like who came before me [39:57] and And then wait, this happened and [39:59] then that happened and And when we build [40:01] a narrative, it's remarkable how much we [40:04] can come to understand about ourselves [40:06] cuz often we don't do that. Like we have [40:07] isolated pieces of information about [40:09] ourselves, but we don't knit it all [40:11] together and and it's really remarkable [40:14] what can happen, what can be elucidated [40:17] by doing that. So, absolutely yes, just [40:19] for the the general understanding of the [40:21] person and also to understand what did [40:23] the parents [40:24] go through, you know, what what [40:26] experiences did they have, how might [40:27] that impact this person and you might [40:29] then ask questions of [40:31] let's say the family situation changed, [40:34] you know, between say [40:37] older siblings and younger siblings, [40:38] right? Then by learning about that [40:40] history and learning about older [40:41] siblings versus younger siblings and the [40:43] parents, I mean, think of how much you [40:44] learn then not just about [40:46] the person's experiences growing up, but [40:49] but just about the the biological [40:50] aspects of how were the parents [40:52] functioning, how did it impact the [40:53] children and what were the situations, [40:55] how were the children similar or [40:56] different? There's so much we can learn [40:58] from that. [41:00] You likened trauma to a virus. It's a [41:02] very interesting way for us to start [41:03] thinking about trauma because we seem to [41:05] think of it at least I did as being sort [41:07] of isolated to the person, but your idea [41:10] that it somewhat has a contagion to it [41:12] and that we can spread it [41:14] vicariously to other people that are [41:15] around us, but also [41:17] down through the family tree via our [41:19] epigenetics and via our our genes, [41:22] makes you kind of [41:23] understand both the importance of [41:25] treating it, but Yeah, I've just never [41:26] heard anyone describe it as a virus [41:28] before. [41:30] Yeah. [41:31] It It'll because [41:32] there's a reflexive guilt and shame to [41:35] trauma and our society doesn't recognize [41:37] it. It often gets hidden inside the [41:40] person, right? But when it's hidden [41:42] inside the person, it's still spinning [41:45] off symptoms. So, I think the best [41:47] analogy to use here is of an abscess in [41:50] the body. So, an abscess is a walled-off [41:53] area of infection in the body and it's [41:56] good that the infection is walled off [41:58] because if if it weren't it could be [42:00] fatal, right? So, it's good that it's [42:01] walled off, but the body is still aware [42:04] that it's there and it's still spinning [42:06] off symptoms because it's there. So, for [42:09] example, a person might have an [42:10] intermittent low-grade fever or just [42:12] feel kind of jittery or you know, [42:14] they're sweating and they're not [42:15] sleeping well, right? So, there are [42:16] pervasive symptoms that are impacting [42:19] this person, but it's not obvious that [42:21] the abscess is there, [42:23] right? So, what often happens in general [42:26] medicine is person is having [42:27] non-specific symptoms, you know, people [42:29] go looking, scan, they see oh, there's [42:31] an abscess there, right? Once we know [42:33] that, then we might have an [42:34] understanding for why that person just [42:37] never feels good, right? They always [42:39] feel lethargic or they never feel [42:40] comfortable. We know there's something [42:42] there now and we can go in and fix it, [42:44] right? And it involves, you know, [42:46] there's a surgical process, right? So, [42:48] something has to happen that's not a fun [42:50] thing, right? You go through surgery and [42:51] recovery. Now the abscess is gone. So, I [42:53] think the the example of the abscess in [42:57] the body is is a very good way to [42:59] understand what trauma does to us in the [43:02] mind. So, if we shove it down inside of [43:04] us, there's reflexive guilt and shame, [43:06] society isn't helping us take a look at [43:08] it. Now it's there inside of us, it's [43:10] going to spin off symptoms. And those [43:13] symptoms aren't always symptoms that [43:15] make say one person hurtful to another. [43:17] They They They may not. That person may [43:18] be very very vigilant and and just kind [43:21] as can be to to someone else, but across [43:24] the population, those symptoms inside of [43:26] us are not good. So, they give us [43:28] shorter tempers, right? We're more [43:30] likely we're more anxious, so we may be [43:33] more [43:34] quick to anger or we're less functional [43:37] in the world around us because of [43:39] depression, anxiety, sleep problems, [43:41] right? We can be more impulsive. Like it [43:43] works against us being in the world as [43:46] best we can be. Isn't that Isn't that [43:48] what you refer to as post-trauma [43:50] syndromes? Is that a similar thing? [43:52] Yeah, yes, post-trauma syndromes are [43:54] ways in which we can recognize the [43:56] changes in ourselves. So, higher levels [43:57] of anxiety, for example, lower levels of [44:01] mood, right? Um different changes in [44:03] sleep, uh physical health changes, um [44:07] and then changes in just how comfortable [44:09] we feel [44:10] in the world, right? So, what we'll see [44:13] is changes in behaviors that are driven [44:15] by just feeling differently in the [44:17] world. So, we have a we're in a [44:18] different self states, we have different [44:20] behaviors. The syndromes can do all [44:22] sorts of different things to us from [44:24] mood, anxiety, sleep, behavioral change. [44:26] So, someone who might want to find a [44:27] relationship partner, you know, stops [44:30] going to places where they could meet [44:31] someone, right? So, we we change our [44:33] behaviors. This is what shows us that [44:36] there is a post-trauma syndrome. That's [44:38] how we know we're traumatized. [44:40] Effectively cuz that's what I'm trying [44:41] to figure out like people be listening [44:42] to this now and hearing you talk about [44:44] these different types of trauma, what [44:46] are the sort of telltale signs? I'm [44:48] assuming it's this, that I am [44:49] traumatized. Right. Yeah, this is what [44:52] we're looking for, right? So, so someone [44:53] might present with [44:55] uh that person is depressed now and they [44:57] weren't before. That person is having [44:58] panic attacks and they weren't before. [45:00] That person is using alcohol to soothe [45:03] and they weren't before because in [45:05] medicine we look at just the surface, [45:07] right? What we want to look at is like [45:08] oh, why are you here? Oh, you're here [45:10] because you're drinking too much. Let's [45:11] talk about how you can drink less. [45:12] You're here because you're depressed. [45:14] Well, can we give you a depression [45:15] medicine, right? So, then we're not [45:16] looking at like why? Right? Why are you [45:19] depressed? I mean, some people [45:20] biologically will become depressed, you [45:23] know, no matter what, even when things [45:24] are going very very well, but this isn't [45:26] the majority, right? Most most of us if [45:28] we're depressed, there are likely [45:30] factors. Like so, we should be curious. [45:33] Why is that person depressed? Why is [45:35] that person having panic attacks? Why is [45:36] that person changed their behaviors, [45:38] right? And so, now if we get curious, we [45:41] get curious about the person, then we're [45:43] going to figure [45:44] we're going to figure out things we [45:45] wouldn't have before, right? So, if a [45:47] person gets depressed because everyone [45:49] in their family gets depressed every 9 [45:51] to 12 months, no matter what, like okay, [45:53] let's let's come at that biologically. [45:55] We don't that that doesn't necessarily [45:56] map to trauma, right? But but if we [45:59] start looking at that person being [46:00] depressed, we see that [46:02] they kind of started getting depressed, [46:05] you know, a couple of years ago around [46:06] the time their sleep started being [46:08] a little bit different and you know, [46:10] they started behaving differently and [46:12] they you know, they didn't spend as much [46:14] time with family or then you start [46:15] getting more curious and and you start [46:17] learning oh, you know, there's something [46:19] happened then, right? Again, with acute [46:22] traumas it's easiest to see, but when [46:24] you look for the whole picture of like [46:26] might there be a post-trauma syndrome [46:28] going on here, you know, maybe that [46:29] person who's depressed and is drinking [46:31] too much started drinking too much when [46:33] their mood started decreasing after the [46:35] trauma or maybe they started drinking [46:37] after the trauma and it's driving their [46:39] mood down. Like again, it's not always [46:41] this, but we're never going to know and [46:43] understand unless we're curious. Like [46:46] this is how we trace to the roots of it [46:49] and this is how we get back to the [46:50] narrative, right? Of of what is going on [46:53] inside of me and have I changed, right? [46:55] And then the idea we started talking [46:56] about how the changes in behavior of the [46:58] post-trauma syndrome are the changes [47:01] that that make trauma like like a virus, [47:04] right? Because we start behaving [47:06] differently and for some people that is [47:08] the the the their mood isn't good and [47:11] it's not as healthy to be raised by a [47:12] parent who's depressed, [47:14] right? So, that can be a way in which [47:16] the virus of trauma gets passed along to [47:18] the next generation. Or maybe that [47:20] person is drinking or using a drug to [47:23] cope and that doesn't make for the best [47:25] parenting. That's how the virus of [47:27] trauma gets passed down [47:29] to the next generation or there are [47:31] times when when a reaction to trauma to [47:33] the feeling of disempowerment can be [47:36] aggression, right? Envious, aggressive [47:38] behavior. So, so not all abusive [47:41] children comes through the lens of [47:42] trauma, but a lot of it does. I'm [47:44] interested as well in the subtle [47:46] symptoms of trauma. You know, we've [47:48] talked about some of the big picture [47:49] stuff, which is like suicidality, you [47:51] know, becoming an alcoholic or all those [47:52] kinds of things, but the subtle ways [47:54] that trauma shows up in everyday life. I [47:57] was I Some of them I was hypothesizing [47:58] over are things like [48:00] phone addiction, being addicted to your [48:02] phone or video game addictions, these [48:04] kind of things that I think [48:06] maybe originate from the sort of more [48:08] chronic traumas, but are less easy to [48:10] spot. Right. Right. Yeah, I think the [48:14] key to all of this is curiosity, right? [48:17] So, let's say someone is like say [48:18] addicted to their phone. Okay, maybe [48:20] that's because phones are addictive and [48:22] the person has just spent too much time [48:23] on their phone, maybe, right? But [48:26] addiction mechanisms in human beings are [48:29] similar. Like it's the same machinery [48:31] across addictions, right? And and often [48:33] times addictive behavior is meant as an [48:36] escape from something or to soothe [48:39] against something or even to self-punish [48:41] because of something. So, addictive [48:43] behaviors that's similar brain [48:45] machinery, whether it's cocaine, it's [48:47] alcohol, it's brownies, it's a [48:49] telephone, it's sex, it's exercise. I [48:52] mean, there are things that people do in [48:53] addictive ways as routes of unhealthy [48:56] coping. So, so if we get curious, why [49:00] Again, why the drug, why the phone [49:02] addiction, why the things that might [49:04] seem more subtle [49:05] um and maybe are more subtle, but we [49:08] should scratch on the surface of them to [49:10] to try and understand if they mean [49:11] something. Is that phone addiction the [49:13] 14th addictive behavior in a row, right? [49:17] Because that person has sort of [49:19] particularly adapted addictive machinery [49:20] inside of them and they're trying to [49:22] escape from something. Like that doesn't [49:24] happen all the time, but it is not [49:26] untrue that when you scratch the surface [49:28] of that, you might learn about an [49:31] episode of sexual abuse that happened [49:32] when the person was a child. Like these [49:34] are real examples, right? And that the [49:35] person isn't built to run from things [49:38] through addiction. And maybe they're [49:39] saying things about their own character [49:41] that's negative. They're saying negative [49:43] things about themselves and they feel [49:44] disempowered and they're disempowering [49:45] themselves. But if you go look at that [49:48] narrative, you know, that that person [49:50] that might have a dialogue running over [49:51] and over again in their head of shame [49:53] about something that happened 30, 40 [49:54] years ago. Like, [49:56] this is not uncommon. So, we need to be [49:58] curious and we need to scratch on the [50:00] surface of things, whether they're [50:01] really big things or they're subtle [50:04] things. Like, which is why a life [50:06] narrative is so important. If you think [50:07] about changes like [50:09] after trauma that changes the brain, we [50:12] respond differently when we see a new [50:14] face. So, so without the trauma, it's [50:17] I'm simplifying a little bit, but you [50:18] see a new face we might be curious. [50:20] Like, oh, like [50:21] you know, could we could he be a friend? [50:22] Or if someone's romantically interested, [50:24] like, oh, my might that person like me? [50:25] Or might they not? People are interested [50:27] and curious. Whereas after trauma, [50:29] there's a there's a difference of [50:30] feeling a little bit on the back foot. [50:32] So, people tend less to look up and [50:34] engage and more to look away or to more [50:37] have negative thoughts. So, you don't [50:38] That person doesn't like me. You know, [50:40] instead of something that might be more [50:42] constructive. How do they test for this? [50:45] Is there a test that able to be done to [50:47] see if someone after trauma has like a [50:49] different set of sunglasses that they [50:51] view the world with? Mhm. Yes. [50:53] Yeah, there's a there test from from the [50:57] brain biology [50:58] all the way through to to very clever [51:00] psychological experiments. Like, we can [51:02] see all of this. And it's these these [51:04] signs we should be looking for in [51:07] ourselves. Right? Because it is very [51:08] obvious if someone who always was an [51:10] extrovert now won't leave the house. [51:12] Right? Like, we can tell something's [51:13] wrong and someone's probably going to [51:14] come ask something, right? But if we [51:16] just change in these more subtle ways [51:19] where we're just less interactive and, [51:21] you know, people notice their friends a [51:22] little bit different and less outgoing. [51:24] It's these things that, as you're [51:25] saying, the subtle ones, the subtle [51:27] signs and the nuances are often [51:30] very impactful and indicative of other [51:33] things going on under the surface, you [51:35] know, that can bring even greater [51:37] problems. [51:38] On the subject of soothing that you were [51:39] talking about a second ago, there's this [51:41] quote that you say in your book, "Trauma [51:42] promotes pain, pain increases suffering, [51:44] and suffering makes us desperate to [51:46] soothe our pain." [51:47] Whatever form it takes. Sadly, we're [51:49] seeing the terrible cycle play out on a [51:51] larger societal level [51:53] with the opiate epidemic. [51:56] Yes. This idea of soothing, we will find [51:58] ways to soothe ourselves. [52:00] And some of those ways that we find to [52:01] soothe ourselves become destructive in [52:03] and of themselves. And it almost makes [52:05] me think that like our [52:07] sometimes our attempt, we think of like [52:09] alcoholism typically as people that are [52:12] self-destructing, but when you [52:14] understand [52:15] the soothing component of drinking [52:18] alcohol, it actually is them trying to [52:22] not self-destruct, not destroy [52:24] themselves, but to take care of [52:25] themselves Right. [52:26] in a weird way? [52:27] If we're under huge amounts of distress, [52:30] our perspective of the world narrows, [52:33] right? Very, very dramatically. If [52:34] there's an elephant standing on my foot, [52:36] I only have one thing I'm guessing I [52:38] would think about, which is the elephant [52:39] not standing on my foot anymore, right? [52:41] So, when we're under tremendous stress [52:44] and strain, right? Something that [52:47] soothes us in the short term, right? [52:49] Becomes acceptable because there's a [52:52] desperation in us that has us focused on [52:54] the short term. Like, I know that may [52:56] know that's not good in the long term, [52:58] but I'm just trying to get through [52:58] today. [52:59] Right? And and it's this [53:02] lack of perspective in the world and the [53:04] society around us [53:06] that if we're not recognizing what [53:08] trauma does to us or can it that it can [53:09] drive us to places of desperation, then [53:12] is it any wonder that short-term [53:14] soothing will have a big appeal to us? [53:17] And that could be soothe soothing [53:19] through excess eating. And now, you [53:21] know, that person is overweight and has [53:22] diabetes and wants to be healthier, but [53:24] like doesn't really feel that they can [53:26] stop and ping-pongs back on different [53:28] diets. And, you know, what they're [53:29] really doing is they learned [53:31] self-soothing with food in a way that [53:34] that was, you know, in the context of [53:36] really feeling some sense of despair or [53:38] desperation. The same way that person [53:40] may have learned that, oh, alcohol [53:42] soothes. Now, again, there's there are [53:43] genetic factors and there there are all [53:44] sorts of factors that come into play, [53:46] too, but unhealthy coping mechanisms are [53:49] beckoning to us [53:51] all the time, which is why, you know, I [53:53] did a lot of treatment of of opiates and [53:56] opiate dependence [53:58] over a number of years. And you know, [54:00] it's just outrageous to me that these [54:03] these are the most powerful psychoactive [54:05] medicines on Earth, right? Opiates. [54:08] Like, they soothe psychic distress. [54:10] Like, you know, feeling not good [54:12] mentally inside of us very, very rapidly [54:15] and effectively and almost immediately [54:18] start building tolerance and danger, [54:21] right? But I had no education and [54:24] training around opiates as psychoactive [54:26] medicines. So, so here we are in a [54:28] society that's so [54:30] is under appreciating trauma and and [54:33] where people are are at in a sense of [54:36] isolation or otherness or desperation in [54:38] so many facets of our society. And then [54:41] we start handing them the most powerful [54:43] short-term soothing mechanism with the [54:46] absolute highest risk of long-term [54:49] danger and death. And then we're [54:51] surprised that [54:53] how many tens of thousands of people die [54:56] each year from prescribed [54:58] opiates. [54:59] What kind of opiates have people being [55:00] prescribed? [55:02] So, how the opiate epidemic really began [55:05] was with opiates in pill form. [55:07] So, so [55:08] that they would be prescribed, say, for [55:10] for conditions of pain, but conditions [55:13] of pain that were more chronic [55:16] conditions or conditions not so amenable [55:18] to opiates. So, if you come out of [55:19] surgery, an opiate is a great idea, [55:22] right? Like, there's a lot of pain that [55:24] needs medicine to soothe that pain until [55:26] the pain decreases. But it's judicious [55:29] use of a very powerful medicine in high [55:32] acuity circumstances. What we started [55:34] trying to do, and part of this was, you [55:36] know, we know there's a whole story [55:37] behind the politics and the business of [55:39] this, was to say, "Well, people [55:40] shouldn't be in pain, so there's a [55:42] short-term solution." Right? No one [55:44] should be in pain, we'll give them [55:45] pills. Right? And opiates do not work in [55:48] those situations. They soothe a lot [55:51] early on, but they rapidly build [55:53] tolerance, addiction, [55:55] they suppress breathing drive. So, so we [55:58] started doling out opiate pills with the [56:01] idea that we're treating pain and isn't [56:03] that good, but with an absolute [56:05] inattention to the immense risks of [56:09] that. And I think it fits with the [56:10] short-term view of, [56:12] you know, of relieving all pain. Like, [56:14] we're human beings, we can't relieve all [56:15] of our pain, right? Sometimes what there [56:17] is to do is to work hard to mitigate [56:20] pain. And that might be that might be [56:22] pain, you know, from a mental health [56:25] perspective, it might be pain from a [56:26] physical health perspective. This idea [56:28] that a pill is going to fix everything [56:30] and now everyone has pain pills and [56:31] won't be in pain, you know, has resulted [56:34] in hundreds of thousands of deaths in [56:37] this country alone from prescribed [56:40] opiates. You know, let alone illicit [56:43] opiates. So, there's the short-term [56:45] thinking on the part of our society that [56:48] then almost lures people into the the [56:52] seduction of the short-term soothing, [56:54] right? You feel miserable and you want [56:56] things to be better, take this pill, now [56:59] you're seduced and addicted and at huge [57:01] risk. And, you know, we've let that [57:03] happen. [57:04] For us to know how to treat trauma, we [57:06] have to understand the physiological [57:08] consequences of it. How does trauma [57:11] change our brain? When we look at brain [57:13] scans, what do we see in a traumatized [57:14] person? [57:16] Brain scan data is more complicated and [57:19] harder to interpret. You can see [57:21] different patterns in the brain. We're [57:23] not at the point where brain scan [57:25] science can really can pinpoint. Right? [57:28] But what we do see is parts of the brain [57:32] that are sort of inflamed, so to speak, [57:34] by trauma. So, so the amygdala and [57:37] pathways around the amygdala, which is a [57:39] part of the brain that gets called [57:41] sometimes Grand Central Station for [57:42] negative emotion, right? We see that [57:45] pathways involving this part of the [57:47] brain become more prominent. Right? So, [57:50] we we see changes in brain connectivity. [57:53] Right? Because how our brains function [57:55] is by communicating from one place to [57:57] another. They function through [57:58] connectivity and which pathways are more [58:02] prominent. So, what we see then is [58:04] pathways that are involved in trust, [58:06] say, and feeling a sense of safety are [58:08] less prominent. Pathways that are more [58:10] activated when we feel less safe and [58:13] more vigilant or more activated. And [58:15] then we see the climate, so to speak, in [58:18] the brain change in a way that's less [58:20] healthy. And you may also see specific [58:23] aspects of a post-trauma syndrome. So, [58:26] so mood regulation areas are not [58:28] functioning as well because now there's [58:31] depression intruding. So, we see [58:33] patterns in the brain that show us this [58:35] change, although the science hasn't come [58:37] far enough to to pinpoint like at some [58:40] point we'll be able to do with much [58:41] greater accuracy. [58:43] And I've heard you talk about how that [58:44] creates cognitive blind spots, so blind [58:46] spots in our brain following a traumatic [58:48] event. What do you mean by cognitive [58:49] blind spots and what's the the harm or [58:51] risk of that? Right. So, a cognitive [58:54] blind spot can occur when we take a [58:58] lesson inside of us that is a lesson of [59:00] trauma, not a lesson of truth. [59:03] And then it changes how we may think [59:06] about things. So, so for example, a a [59:08] real and sadly [59:10] many examples of this I that I can bring [59:12] to mind and people's faces who come to [59:14] mind as I say it, but someone who felt [59:16] pretty good about themselves and able to [59:18] navigate the world and [59:20] striving for a better job and doing fun [59:22] things who then is assaulted. [59:25] Right? And after that assault, the [59:27] person [59:29] is much less present in the world and [59:33] internalizes a bunch of different [59:35] thoughts about themselves. Of I don't [59:36] really like being out, I like being at [59:38] home better, or never it goes well, I [59:41] don't get along with other people. Like [59:42] they think about themselves differently. [59:44] So, there is a cognitive blind spot, [59:47] which makes it [59:48] very, very difficult to think [59:51] with accuracy about say possibility. So, [59:54] that person may have say been striving [59:56] for a better job, right? But, if they [59:58] think of themselves differently, I'm not [60:00] the kind of person who can get ahead, [60:01] and people don't really like me, then [60:03] they don't strive for a better job. They [60:05] just take for granted that they can't [60:06] get it. It won't go well, they'll fail [60:08] at it. But, they never thought that [60:10] before. [60:11] Is this what you kind of see when people [60:13] refer to someone having daddy issues? [60:16] And the I was thinking as you were [60:18] saying that that my dad let So, is say [60:20] my dad left when I was four. Mhm. And I [60:23] internalized this idea that men don't [60:25] love me, for example. Right. And then I [60:27] go through life being an avoidant person [60:29] in romantic situations, or [60:31] self-sabotaging, or going for people [60:32] that are unavailable to avoid the [60:34] rejection. Right. Is that somewhat [60:35] similar? Like I've created a cognitive [60:37] blind spot, and now I'm living out that [60:39] as an instruction manual for my life. [60:41] Yes. [60:42] Absolutely, yes. And the the earlier in [60:44] life, the more powerful the lesson is. [60:47] And the brain doesn't go [clears throat] [60:49] back and revisit those lessons. So, I [60:51] think this is this is so amazing and [60:54] surprising to me that our brains [60:56] are so incredibly complex, right? More [60:58] complex than the greatest supercomputer, [61:01] right? Yet, our brains don't do some [61:03] very basic things. Like we don't reboot [61:05] and see is there a patch, or is there [61:07] something to fix, right? We don't go [61:08] back and look at these earlier lessons. [61:11] So, if you learn at age four, oh, men [61:13] don't love me. That's a hard lesson to [61:16] unlearn, because it gets solidified at [61:19] an early age, and then once those [61:20] lessons are there, there's an [61:22] internalized danger to go revisit them. [61:25] Like if you go revisit that lesson, [61:26] could you be disappointed, right? The [61:28] thought that's the way it is. And that's [61:31] the way it's going to be. Like that's [61:32] kind of how what we tell ourselves [61:33] inside the trauma kind of walls it off, [61:35] and then we don't just go back and look [61:37] and say, is that really true? Like here [61:39] I am, I'm an adult now, and now did I [61:42] just carry forward something when when I [61:43] was four years old that wasn't about me? [61:46] Is it really about the four-year-old, [61:48] right? Or is it about the adult? Like we [61:49] learn all these things, but we don't go [61:51] back and revisit the lesson. And then [61:53] yes, there's a person who could be very, [61:55] very avoidant in ways that that lesson, [61:59] that quote-unquote truth that is not [62:01] true, can change that person's life. And [62:04] that's why if we go back and look at [62:05] that, life can really change. We can go [62:08] back and look at why do you feel that? [62:09] It's interesting to feel that. Let's [62:11] let's think about it, and you know, [62:13] what's the story behind it? And we can [62:16] get to a place where that can be undone [62:18] and say, oh, [62:19] I took that lesson inside because [62:22] someone else made a choice that was [62:23] about them and not me. No four-year-old [62:25] is responsible for a parent leaving. [62:28] Right? But, I took something in that was [62:29] different, and it's really affected me, [62:31] and I came to feel differently about [62:33] myself. It's not that everything [62:35] instantaneously changes, but boy, the [62:38] world is different then. [62:40] On that subject as well of say the [62:42] father leaving at four years old, and me [62:44] thinking that men were Well, let's say I [62:46] was four years old, and my father was [62:48] violent. What you sometimes see is [62:50] people then are attracted to the [62:52] familiar when they grow up. So, although [62:55] it wasn't healthy, [62:56] they have a sort of bias towards being [62:59] attracted to something that was [63:00] familiar, even if it wasn't healthy. [63:03] Right. That gets complicated with [63:05] sometimes people will talk about as [63:06] repetition compulsions are are quite [63:09] complicated. Often, what a person is [63:11] doing then is trying to gain a sense of [63:14] mastery over a situation in which they [63:17] had no control. [63:19] So, you will see this in abusive [63:20] relationships, where you know, sometimes [63:22] a person will come [63:24] and say, [63:25] okay, I'm coming to see you, but I know [63:26] you can't help me, right? And then my [63:28] last like eight relationships have been [63:29] just awful. So, how can you possibly [63:31] help me? And then I might say something [63:33] like, if you can tell me how you had [63:36] eight different relationships that [63:38] didn't go well, maybe I'll believe you. [63:40] But, you're going to tell me about the [63:41] same relationship eight times over. [63:43] Right? Something along those lines, [63:45] because we repeat things that don't go [63:47] well [63:49] in an effort to gain a sense of control. [63:52] So, what often is the case in that kind [63:54] of situation is whether it's repeating [63:57] an abuse cycle, or just someone who is [63:59] inattentive, or isn't interested. The [64:00] the person is trying to feel better [64:04] about something from the past. So, if [64:06] the father was inattentive, and that [64:08] person has a romantic interest in men, [64:11] that person may choose men who are [64:13] inattentive, with a desire to make them [64:15] inattentive, to fix the the to soothe [64:18] the pain of the past, because the [64:20] emotion systems in our brain don't care [64:23] about the clock and the calendar. So, [64:24] you can solve the past in the present as [64:27] far as the emotion systems are [64:28] concerned. And if the trauma is very [64:30] strong in us, the emotion systems will [64:33] rule the day. So, they said the father [64:35] was violent, then maybe that person [64:37] chooses [64:39] a violent significant other, right? And [64:41] then that relationship goes away, and [64:43] the person chooses another violent [64:44] significant other. And then sometimes [64:46] the thought is, well, the person is [64:47] choosing that because [64:49] that's what they're comfortable with, or [64:51] that's it. But, [64:52] no the the the person is is trying to [64:55] make sense of something, and there's [64:57] some desperation inside to feel better [64:59] about themselves, and to fix and heal [65:01] something. Whereas why if we can [65:03] intercede there and say the problem is, [65:06] if you want someone who's attentive, [65:08] choose people who are attentive Choose [65:10] someone who's attentive, right? As [65:11] opposed to choose someone who's not [65:13] attentive and try and make them [65:14] attentive. Can we become addicted to our [65:16] victimhood? [65:18] Sure. There's no internalized victim [65:21] without an internalized persecutor. [65:24] So, if someone is victimized in the [65:26] sense of the law, right? Someone has [65:28] done something bad to that person. That [65:29] doesn't mean that person takes inside of [65:31] them that they are a victim. [65:33] Right? But, trauma can make us feel like [65:35] victims. After the loss of my brother, [65:36] when I felt like [65:38] um maybe we're cursed, and I'm not I [65:41] can't really get anywhere in the world. [65:42] Like there's a black magic to that. [65:44] Right? Then I feel like I'm a victim of [65:46] something. I don't I'm behind the eight [65:47] ball. I then have a sense of otherness, [65:49] right? And and now I've taken something [65:52] inside of myself, where we don't need a [65:54] persecutor anymore. I feel like I'm less [65:56] than. So, how's that going to go well? [65:58] Right? So, what we end up doing is we [66:01] take inside of us sometimes this sense [66:04] of victimness, but that [66:08] also takes inside of us the idea that we [66:11] are less than, that there is something [66:13] magical that is bad and negative. And [66:16] what we need to strive it against is [66:19] exactly that. That something may have [66:21] happened that we might say, okay, that [66:22] person is a victim in the eyes of the [66:24] law. They were assaulted, right? But, [66:25] that doesn't mean that person has to [66:26] take victimness [66:28] inside, guilt and shame. How many people [66:30] have I seen who were assaulted, and they [66:32] talk about how they're ashamed of it, [66:34] and it's their fault. Someone else [66:36] attacked them. [66:37] Right? But, the reflexive guilt and [66:39] shame of trauma can lead us to feel less [66:42] than. Then we start feeling [66:45] like victims. Then we feel less than, we [66:48] embrace this, and we don't need someone [66:49] to persecute us [66:51] anymore. [66:53] The limbic system, we're talking about [66:54] the brain here. [66:56] What is the limbic system, and what role [66:57] is it playing in cementing our trauma? [67:01] Yeah. So, the the limbic system is the [67:03] name for the emotion systems in the [67:04] brain. So, we're simplifying a little [67:07] bit, but the idea that there are logic [67:08] systems and emotion systems. The emotion [67:11] systems are limbic. Those are the limbic [67:13] systems, and they never lose when they [67:16] come face to face with logic. Right? [67:18] Like the limbic, the emotional always [67:20] rules [67:21] the logic if the two come head to head, [67:23] which is why if [67:25] the emotion of trauma, the fear of being [67:28] less than, the need to repair something [67:30] that was unfair in the past, if that is [67:32] driving us, logic will not have its say. [67:36] You know, logic would say, [67:38] if you've dated six people who've all [67:40] kind of seemed the same at the outset, [67:42] and then all behaved in the same [67:45] negative way, don't choose a seventh [67:47] like that, right? I mean, logic very [67:49] logic was saying that at the second [67:50] person, not let alone the third, the [67:52] fourth, the fifth. Why do we see [67:54] repetition of unhealthy relationships? [67:56] Because the limbic system, if it needs [67:58] to feel different, it needs, so to [68:00] speak, to solve that trauma by gaining [68:03] mastery, it's going to go look for the [68:05] seventh person who's just like the first [68:06] six. [68:08] But, once we take the energy, we lance [68:09] the abscess, so to speak, of the trauma, [68:12] then logic can have its say. And that [68:14] person who says, you can't help me [68:16] because the last eight relationships [68:17] were all awful, sees, oh, I did the same [68:20] things, chose the same person last eight [68:22] relationships. That's one paradigm, and [68:24] I'm changing it now. [68:26] And then things are different when they [68:28] thought they couldn't be. [68:30] Because they can see now what they [68:31] couldn't see before. The limbic system [68:33] isn't ruling the day anymore. There's a [68:35] whole balanced brain that has an [68:38] understanding of self, and uses that [68:39] understanding to move forward in life. [68:42] It seems like the limbic system is [68:43] against us. But, but there must be some [68:45] sort of evolutionary [68:46] reason, or rationale, or purpose of that [68:49] limbic system that is I don't know [68:51] malfunctioning in the modern world. Oh, [68:53] sure. The limbic system isn't against [68:54] us. Like all these parts of our brain, [68:56] none of them hate us. They're all part [68:58] of They're all parts of us. And some of [69:00] the the research and observations [69:02] through the psychedelic sciences are [69:03] really telling us that much more, that [69:05] there aren't parts of our brain that [69:07] hate us. They may work against us [69:10] because as you're say commenting, [69:12] they're not built for the modern world. [69:15] So, you know, if you think about the [69:16] limbic system and the negative [69:18] information, like something bad happened [69:21] when you were four or five. Like take [69:22] that in, and whatever lesson that is, [69:24] never question it or change it, right? I [69:26] mean, this is based upon survival [69:29] mechanisms. The example I give is, you [69:31] know, imagine for most of human history [69:33] when people are hunting and gathering [69:34] and living in small groups and and like [69:36] having enough food was is very important [69:38] for humans across human evolution. If [69:41] you find a new food that it looks good, [69:44] looks like something else that was good [69:45] and you and you eat it and it tastes [69:47] good and it's nourishing, like it's good [69:48] to remember that. Right? But if you eat [69:51] it and you get very, very sick, you [69:53] better remember that forever. [69:55] Right? So that the negative has much [69:57] more salience in us and makes these [69:58] lessons never go near that [70:00] thing again. Never go near that person [70:02] again. Never do this again. Right? [70:03] They're designed to keep us alive. But [70:06] we're trying to do more than that, [70:07] right? We're trying to do more than stay [70:09] alive. And these systems in us that [70:12] evolved to keep us safe then can very [70:14] much work against us. The person who's [70:17] traumatized because someone attacks them [70:19] and that system gives them panic attacks [70:21] if they leave the front door. [70:23] I mean, that's that person's brain [70:24] trying to keep them safe. [70:27] You used the word shame a lot when we [70:29] were talking about trauma. [70:31] In the same way that I asked um [70:34] is the limbic system against us? What is [70:37] the use of shame? Why do we experience [70:39] shame? Can't we just program ourselves [70:41] to get rid of shame and then we'll all [70:42] be fine? [70:45] Exactly the same with the limbic [70:46] question. No, we kind of need shame, but [70:49] we need shame for good reason. Right? So [70:51] so these primary affects that that are [70:55] very um [70:56] primordial in us, anger, fear, love, [71:00] shame. These are things that are just [71:01] aroused in us. Like they can become [71:03] other things once we start thinking [71:05] about them, but they're states that that [71:07] that are very deep within us. They all [71:09] have a survival adaptation. So, you [71:12] know, love feeling love is you know, [71:15] being more than one. You know, if if we [71:17] love someone, now you are two and you're [71:18] and you're there with one another and [71:20] that's going to help you survive, make [71:21] your way forward in life. Love is [71:22] adaptive. Right? Fear can be very [71:25] adaptive that now you're in a fight or [71:26] flight stage. You're trying to survive [71:29] and get through life. Shame is the same [71:30] way. They're things that people do that [71:33] bring shame that change behavior. Shame [71:35] changes behavior a lot cuz it feels so [71:37] bad. So, you know, I give the example of [71:39] I imagine that you know, in the old [71:41] days, you know, someone who um [71:44] you know, pees on the food in the cave [71:45] instead of going outside, you know, and [71:47] like now puts the whole tribe at risk or [71:49] people and and then like there's a sense [71:51] of shame that comes to that person. Like [71:53] you can't do that anymore and the person [71:55] feels bad and never does that again. And [71:57] it's adaptive for the group, right? It's [71:58] just one example of how shame can alter [72:00] behavior. So, To keep us alive in that [72:02] context. [72:03] Right. To keep us alive. Like now you [72:04] feel shame, you will not forget to not [72:07] do that anymore, right? Like it's going [72:08] to have an impression, it's going to [72:09] change you because you feel so much [72:11] shame, which we would think should be [72:12] the case in the modern world, [72:15] too, right? We there are things people [72:17] do that are shameful that are worth [72:19] feeling shame about. I mean, sometimes [72:21] the problem is we don't have enough [72:22] shame where we should. But we have a lot [72:24] of new modern problems, don't we? With I [72:26] was thinking about bullying [72:28] for example. Like I I I imagine back in [72:31] the days of our tribes, there wasn't [72:34] internet, like obviously not, but there [72:36] wasn't like mass internet bullying where [72:38] a a huge group of strangers could just [72:41] pepper you with insults and maybe our [72:43] our modern brain still has the same old [72:45] mechanisms of kind of perceiving that as [72:48] our tribe are going to kick us off the [72:49] island here. [72:50] Right? So the brain malfunctions and [72:52] experiences shame, which causes all the [72:53] things you've described. And then even [72:55] in the context of like sexual assault, I [72:56] was trying to rationalize that, how [72:59] the shame of sexual assault can make you [73:01] feel [73:02] shame when really it was someone else's [73:05] right behavior. But how does that make [73:06] that, you know, that woman feel or that [73:08] guy feel [73:11] shame about themselves when they were [73:12] attacked? Right. Because it doesn't [73:14] start with the thought of it. Cuz you're [73:16] right. Because what you're saying, I [73:17] think, is basically it makes no logical [73:19] sense. Why would you feel ashamed of [73:21] yourself if someone else came up behind [73:23] you and jumped you and did something [73:24] awful to you? Why would you feel ashamed [73:26] of yourself? Right? But but the person [73:28] doesn't get there by thought. Right? I [73:31] didn't get the feeling ashamed of myself [73:32] after losing my brother by suicide by [73:34] thinking that is a shameful thing, I [73:36] should feel ashamed. No no, the shame is [73:38] aroused in us. It's created in us [73:40] because it's behavior modifying. And [73:43] there's there's the adaptive something [73:46] bad has happened, feel something inside [73:48] that creates aversion. The shame is [73:50] created in us and then we make the [73:51] meaning of it. [73:53] I feel ashamed, the shame inside me and [73:55] then we make the meaning of right [73:56] because I shouldn't have been there when [73:58] that happened and then then we make a [73:59] story around it. It starts with the [74:02] limbic system, with the affect and then [74:03] we build a story around it, which is why [74:06] we can build a different story where, [74:08] for example, shame [74:10] goes where it makes sense to go. Like [74:12] that's very, very effective of [74:14] processing through. So, okay, so this [74:15] thing happened, you can process through [74:17] with someone how they felt and you know, [74:19] what was going on inside of them. Maybe [74:20] they're in an ambulance or a hospital, [74:22] they're filled with shame they realize [74:23] what is [74:24] happened to them and you know, and then [74:27] that was a terrible state to be in. But [74:30] then they start putting they start [74:31] making trying to make meaning of that [74:32] state and we can go back to oh, [74:35] that's a that's a natural, completely [74:37] understanding human state to be in [74:41] after this happened. But now you get to [74:44] decide what that means. [74:46] So, in the context of our ancestors, I'm [74:49] walking through the I don't know, [74:50] Serengeti with my [74:53] with my big spear [74:55] [snorts] [74:55] and I'm walking and a lion jumps out at [74:58] me [74:59] out of the blue. [75:01] I managed to survive it, although I've [75:03] been attacked. I the shame is created in [75:05] me because as a [75:07] response to make sure my behavior [75:09] changes so it doesn't happen again. And [75:11] then I write a story about that when I [75:12] get back to the cave and tell myself [75:14] like [75:15] the story could be that I shouldn't have [75:17] been walking out at night in the [75:18] Serengeti alone when that lion attacked [75:20] me and that's adaptive and useful [75:23] because it stops me from doing that in [75:25] the future. [75:26] It's like a So I'm trying to think of it [75:27] through that. [75:28] Maybe. It's it's a little different. If [75:29] you were out Okay, let's say you're out [75:31] and you actually you're hunting a lion [75:33] in the service of everyone else. And [75:35] then you were attacked and hurt, that [75:37] it's that's different because you're [75:38] doing something then to to feel proud [75:41] of. Yeah. Right? So so that is is [75:43] different. We're we're [75:44] That's a situation where the person is [75:47] approaching the trauma on the front [75:49] foot. And then when the you return back, [75:51] the thought would be you would be [75:53] respected and cared for. Like, you know, [75:54] you went out to do something for [75:55] everyone and got hurt. Like that is very [75:57] different than how people normally would [76:00] would ex- experience the their trauma, [76:03] which is when there there isn't a sense [76:05] of of pride and self-sacrifice behind [76:07] it. So so if the person Let's say you're [76:09] walking out in the Serengeti at night [76:11] and you shouldn't be, then you should [76:13] feel bad about that, right? Then the [76:14] thought would be, yeah, I shouldn't have [76:16] been doing that and how bad you feel [76:18] about it will make you not do it again [76:19] so you're not going to get killed, [76:21] right? And then you're going to come [76:22] back and talk about that or people are [76:24] going to go, "What were you doing?" And [76:26] well, you shouldn't have been out there. [76:27] And like they may feel bad that you got [76:28] hurt, but like there's there's then an [76:30] experience that is a deterrent to others [76:32] doing that, too. [76:33] Right? So [76:34] This says something really interesting [76:35] about how we treat people who've been [76:37] through a trauma. [76:38] Right. The look at the difference in the [76:40] United States between veterans coming [76:42] back from World War II and veterans [76:44] coming back from Vietnam. There was far [76:47] more post-trauma syndromes [76:49] post-traumatic stress disorder after [76:51] Vietnam because people were not coming [76:53] home to a hero's welcome. The thought [76:55] The thought there would be they had gone [76:57] out like the person who goes out into [76:59] the Serengeti to hunt the lion to to [77:01] save everybody else is that's what was [77:03] going on when people went to fight in [77:05] World War II and when when when people [77:07] went to fight in Vietnam. But when [77:09] people came back from World War II if [77:10] they'd been hurt, they were treated as [77:12] heroes. They were treated with respect [77:15] and and that allows a person to shoulder [77:17] that trauma without the brain changes [77:21] happening. When people came back from [77:22] Vietnam and were were treated [77:24] differently, which didn't happen to [77:25] everyone, but it happened as a societal [77:27] phenomenon that was that was a terrible [77:29] thing for the veterans who came back, [77:31] you saw much greater rates of [77:33] post-traumatic stress. I mean, that's [77:35] that I think captures very clearly what [77:38] the impressions and perspectives of the [77:40] people around us mean. There may be a [77:42] reflexive [77:44] guilt and shame from trauma, but that [77:46] doesn't have to win the day. [77:48] Like but it was much more likely to win [77:50] the day if there's a sense of otherness [77:52] cuz now we're we're you know, we're [77:53] we're talking about the same thing of [77:55] the feeling less than chronically by [77:57] society for some reason makes that [77:59] person more susceptible. So that person [78:01] who's been through combat trauma and [78:03] then comes back and does not receive a [78:05] hero's welcome is put at much, much [78:08] greater risk for the brain changes of [78:10] post-trauma syndromes. [78:12] What role does vulnerability and being [78:14] open with others about how we're feeling [78:16] play in alleviating our shame? [78:19] I'm sure it plays it plays [78:21] in it for most of us in most cases, it [78:23] plays a very big role. Because the [78:26] reflex to the trauma is guilt and shame [78:28] and the reflex to the guilt and shame is [78:30] to hide it inside. What we are doing is [78:34] cutting ourself off from the human [78:36] contact that we need in order to process [78:40] what has gone on with us. So very many [78:43] times over 25 years of being a [78:45] psychiatrist, I've sat with someone who [78:48] is putting words to their trauma for the [78:51] first time. You know, when I was 5 years [78:53] old, I was assaulted in that way. This [78:56] coach did this to me when I was a [78:58] certain age. Uh I was hurt this way and [79:02] I'm the only one who survived and my two [79:03] buddies died. These are real things that [79:05] I have [79:06] that I have heard people say and then be [79:10] shocked that I, the other human in the [79:13] room, don't recoil from that. [79:17] Because they've held so [79:19] long inside of them that it is shameful [79:23] that they were assaulted. It is shameful [79:25] that they survived. That that it's so [79:28] dangerous to even utter it. The fear of [79:31] how person will react that someone is [79:32] surprised like, "Wow, [79:34] you could hear that?" Or they they say [79:35] it in ways and kind of step back a [79:37] little bit because there's such an [79:39] expectation of rejection was what the [79:41] person is telling me is something that [79:44] from a any reasonable human being would [79:46] only elicit compassion. [79:48] Now, that person who's telling me would [79:50] only ever be compassionate to someone [79:53] saying that, but they're not [79:55] compassionate to themselves. [79:57] Is shame really the cause of what we [79:59] kind of think of as these trauma cycles? [80:02] Because someone experiences a trauma, [80:03] they suppress it, [80:05] which changes how they behave, which [80:07] means that they're more likely to [80:09] experience more trauma in some way or at [80:11] least perceive it as a trauma via shame, [80:14] and then they kind of their life gets [80:15] more and more full of different types of [80:17] trauma. Does that make sense? Cuz I'm [80:19] wondering if trauma can be quite a [80:21] self-fulfilling thing where you get into [80:22] a cycle of Right. Trauma in your life. [80:25] Well, it can be. I mean, in the case of [80:26] the person who now finally puts words to [80:29] something they've held inside of them [80:31] that they would know is not shameful to [80:32] anyone else, but they hold it shameful [80:34] for them. Right, what is [80:37] going on inside of them may or may not [80:38] have caused further trauma. Right, I [80:40] mean, it it's it's caused suffering. [80:42] Right, there's no doubt about that. When [80:43] a person is is is saying that and [80:46] they're they're putting words to [80:47] something that's so important has been [80:48] inside of them. It has caused them [80:51] suffering, so they haven't been as happy [80:53] as they could be, enjoyed life as much [80:54] as they could be, been as outgoing as [80:56] they can be, [80:57] been depressed when maybe they didn't [80:58] have to be depressed. So, so the trauma [81:01] is impacting them because they've hid it [81:03] down inside. Right? If you can talk [81:06] about it and bring light to it, let's [81:07] say after that thing that happened when [81:10] the the person was assaulted at 5 years [81:11] old or survived an accident others [81:13] didn't, if someone did trauma work with [81:15] them of, "Hey, you're What are you [81:16] feeling now?" Okay, let's get to the [81:17] fact a person is feeling guilt and [81:19] shame. And the naturalness that they [81:21] are, but it doesn't tell them truth. [81:23] Right, it's just telling them how they [81:24] feel and in fact it comes from [81:25] compassionate places inside of us. We [81:27] can help to unwind that before it [81:31] becomes a thing inside the person that [81:33] yes, may make life less enjoyable or may [81:36] also, [81:38] in a way that's worse, push towards [81:40] repeated trauma. So, the the trauma of [81:42] choosing the same unhealthy partner or [81:44] the same abusive partner over and over [81:47] is an example of what you're saying. If [81:48] a person doesn't look at the trauma and [81:50] like, "Why am I doing this? What am I [81:52] trying to solve here?" Right, I'm trying [81:53] to solve something maybe from childhood [81:56] that was somebody else's [81:57] shortcoming or fault or somebody else's [81:59] [ __ ] Okay, I can stop doing that. Then [82:00] the person [82:04] So, the answer to all I think the answer [82:06] to what you're asking is absolutely yes. [82:08] And if we're curious and we strive for [82:11] understanding ourselves and we know that [82:13] there are routes to change, this is how [82:15] we heal from traumas. And ultimately, [82:17] Invisible Epidemic is a is a message of [82:20] warning, but it's not a a negative or a [82:22] pessimistic message. It's a positive [82:24] message. This is if we understand this [82:26] and we look at it, well, guess what [82:27] happens is we get better. We prevent [82:30] trauma. We take care of the trauma in [82:32] ourselves and others and we get [82:33] healthier. Like, I see this play out in [82:36] 25 years of doing this. Like, this is [82:38] what happens. [82:39] But we only get there if we have the [82:41] curiosity. We we, [82:43] you know, we're interested and we know [82:44] enough to go looking and thinking and [82:46] making a narrative and you know, talking [82:48] about ourselves and wanting things to be [82:50] different and knowing that they can be. [82:52] So, it's a message of hope because when [82:53] we do that, we really see change. So, [82:56] clinically when doing this work, [82:58] you see a lot of difference [83:00] in people. And that's part of what's [83:01] been so heartening and led me to write [83:03] the book is it's not just a message of, [83:05] "Oh, this is what's going on with us. [83:07] Let's take a look at it." It's this is [83:09] what's going on with us and if we look [83:10] at it, absolutely we make life better. I [83:13] want to talk about some of the ways that [83:14] trauma impacts us that are less obvious. [83:16] One of them [83:17] I'm interested in is sleep. A lot of [83:19] people are struggling with sleep these [83:20] days. Is there a link between sleep [83:23] issues and trauma? Yes. And how strong [83:25] is that link? Yes, so so sleep is one of [83:28] the symptoms of a post-trauma syndrome. [83:31] It's not in all post-trauma syndrome, so [83:34] higher anxiety, lower mood, behavioral [83:36] changes, sleep is one of these factors [83:38] and sleep is very often negatively [83:41] impacted by trauma. So, the changes you [83:44] had asked about in the brain and then we [83:46] talked about how they go more towards [83:47] vigilance, more towards activation, they [83:50] make it harder for the brain to settle [83:52] down and be in a restorative state. [83:55] So, sometimes we get what's what's is [83:57] called ruminative where there are just [83:58] thought loops going on inside of us and [84:01] the brain doesn't want to quiet down to [84:03] a place where we can get restorative [84:05] sleep. So, people have more fragmented [84:07] sleep. They have shallower, less [84:08] restorative sleep, more time until they [84:10] can fall asleep, earlier awakenings. So, [84:13] this is [84:14] very, very bad for us across the board. [84:16] I mean, talk about the union of physical [84:19] and mental health, sleeping very poorly [84:21] is terrible for us from head to toe. [84:23] And very often, [84:25] after trauma, if there is a post-trauma [84:27] syndrome, which is not uncommon, sleep [84:30] patterns are dramatically changed and [84:32] and sleep restorative function is [84:34] changed. What happens is we're in higher [84:37] states of arousal. And [84:38] neurobiologically, this isn't about [84:40] sexual arousal. It's it's just state of [84:42] alertness. Right, so we're in too high a [84:44] state of arousal, too high a state of [84:46] alertness, and then the brain systems [84:48] inside of us that need to really simmer [84:50] down and in order to restore aren't able [84:53] to fully do that. I guess there must be [84:55] some kind of link there as well because [84:56] if I'm in that if I'm less comfortable [84:58] with being with my own thoughts because [85:01] they're ruminative, that I'm [85:03] overthinking all the time, I'm then also [85:05] more likely when I'm trying to settle [85:07] down to be trying to stimulate myself. [85:09] Like, a lot of people aren't comfortable [85:11] with just being sitting in a room alone [85:12] with their thoughts, [85:14] especially if they're, you know, an [85:15] overthinker. So, then they might grab [85:17] their phone. They might Sure. [85:18] be, you know, doing things to stimulate [85:20] themselves at a later hour of night, but [85:22] it all comes back to the trauma. [85:24] Absolutely yes. Yes, and you're [85:25] describing how the downstream effects of [85:28] all of this are tremendous. [85:31] So, absolutely yes. So, so we're saying [85:33] getting less sleep is just bad for us [85:36] from head to toe. Okay, and also, [85:38] there's all the things that you're [85:40] talking about. So, if you know you're [85:42] going to try and sleep and it's going to [85:44] be just going over and over again in [85:46] your head and it might be I'm not safe [85:48] or I'm going to get fired or I'm going [85:49] to get hurt or it may just be something [85:52] that's simple and negative that you [85:53] don't even relate to trauma. Like, "Oh, [85:55] this is awful." Or like, I mean, these [85:56] are things that go over and over again [85:57] in people's heads when they're trying to [85:58] sleep. Like, "I'm not okay. What's going [86:00] to happen?" And it's going over and over [86:02] again. So, of course, you're going to [86:03] want to distract from that. And you cuz [86:07] the way we've kind of framed it there is [86:08] that you're aware and conscious of that. [86:10] But can that be taking place in like the [86:12] back room of your mind where [86:14] Oh, sure. [86:15] Sure, sometimes people are aware and [86:16] sometimes they are not. Sometimes they [86:17] ask a person, "Why [86:19] why aren't you sleeping well the last 4 [86:20] months?" Which seems like a good [86:21] question to ask instead of just giving [86:23] the person a sleeping medicine. But in [86:24] modern medicine, sometimes the question [86:26] doesn't get asked. But you know, maybe [86:28] the answer [86:29] is [86:30] is just I'm really different trying to [86:31] fall asleep and like, I just don't feel [86:33] peaceful anymore. But but the person has [86:34] not thought of that until you ask them. [86:37] Then what's the logical next question? [86:39] Why? Right, what happened? Did anything [86:40] change around then? And a lot of times [86:42] you get [86:43] an answer and that person has a trauma [86:45] problem, not a sleep problem. You can [86:47] probably pound the sleep system to sleep [86:50] with medicine, but now we're doing [86:51] something that ultimately is harmful [86:54] for the person. So, yes. And also, you [86:56] know, when you talked about avoidance [86:58] behaviors of sleep, this is also why the [87:00] person can avoid avoid avoid and then [87:01] have three or four drinks [87:03] to get to sleep. Right, so there's so [87:05] much that is unhealthy that then [87:08] perpetuates [87:10] being unhealthy and it spreads and this [87:12] is part of the epidemic [87:14] aspect of this. And and then people [87:16] often don't know [87:18] why things are different in their sleep, [87:21] but a lot of the time if you stop and [87:23] you think and you talk about what's [87:25] going on inside of them, they will tell [87:27] you. And it may be that for the first [87:29] time they're telling themselves, which [87:30] is why we should ask ourselves this [87:32] question. [87:33] You said to Rich Roll, "Amongst the [87:34] conditions I have seen treated, the [87:36] absolute worst in mental health [87:37] treatment and indeed in general medical [87:39] treatment are sleep problems." [87:42] Mhm. Mhm. [87:43] Why? Because sleep underlies so much and [87:48] because we when we we have a lot of [87:50] hammers in medicine, so we see a lot of [87:52] nails. So, if someone is not sleeping, [87:55] the reflex in medicine, and not everyone [87:58] does this and I'm not trying to say [88:00] they're all physicians or practitioners [88:02] are not behaving in the right way, but [88:04] we we work in systems that are high [88:06] volume and designed for throughput. So, [88:08] they're designed for symptom [88:09] identification. So, what we say is, [88:11] "Okay, you're not sleeping. So, we'll [88:13] give you a sleeping medicine." Like, [88:14] it's that simple. But [88:17] the reasons people are not sleeping are [88:18] very, very often not related to their [88:22] sleep systems. They're related to these [88:24] vigilance and activation systems inside [88:26] of us. So, if if that's what's going on [88:29] in me and I'm agitated and have this [88:32] highly aroused state after trauma and [88:35] maybe it's been going on for 2 weeks or [88:36] maybe it's been going on but getting [88:37] worse for 2 years. But this is what's [88:39] going on and I can't settle down and my [88:42] sleep system can't overcome it, [88:44] you know, if you give me a sleeping [88:45] medicine for that, I'm probably going to [88:47] need a lot of it. Right? Because we're [88:49] trying to make the sleep system overcome [88:51] the distress, I'm more likely to get [88:53] addicted to it. Right, I mean, there's a [88:54] lot of bad we do to people and I never [88:57] have an opportunity to address my [88:59] problem. What should we be doing [89:00] instead? We should be asking why. [89:02] Why is it that you are not sleeping? And [89:05] maybe it came out of the blue. Maybe. [89:08] Maybe your sleep system every now and [89:09] then fails you. But when we start asking [89:11] those questions, we get answers and more [89:14] often than not, those answers are in the [89:18] realm of trauma. Then the person does [89:19] not get a trauma medicine. They may get [89:22] a different medicine that in the short [89:24] term can quiet the vigilance systems. [89:26] This we do this a lot where the person [89:28] has a sleeping problem, we learn the [89:30] trauma history, we use a short course of [89:33] a medicine that calms the vigilance [89:35] systems. It's nothing to do with making [89:36] the person sleep, and then they start [89:38] sleeping well. [89:39] And maybe this is true, they might not [89:41] have slept well with five, six, 10 [89:43] sleeping medicines. [89:45] But that is not the medicine that they [89:47] need. Right, they need a medicine to [89:49] calm these distress systems inside of us [89:53] so that the sleep system, which is not [89:54] damaged, can go and do its thing. And [89:57] and while we realize this, we can start [89:59] talking about the trauma. And maybe the [90:01] person can process some of the trauma. [90:03] Now, the sleep problem is gone, [90:04] everything is better, the person's not [90:06] going to be on a sleep medicine for the [90:07] next 20 years. It's healthier, it's [90:09] safer. But we have to be more than [90:12] reflexive. [90:13] Right, there are a lot of reasons people [90:14] don't sleep. [90:16] What about a link between weight and [90:20] trauma? I've heard I've heard a ton of [90:22] studies over the years about how [90:24] um various people who are obese have [90:26] high levels of sort of traceable trauma. [90:29] Is there any truth to this? [90:31] Yes, so there are probably or almost [90:34] surely a couple of factors. One is Look, [90:38] it's hard enough to take care of [90:40] ourselves, you know, even when things [90:42] are going really well. Right, I mean [90:43] life is so busy and so stressful, so [90:46] it's hard to take care of oneself. If a [90:48] person adds trauma to the mix, it [90:50] becomes harder to take care of oneself. [90:53] And one way we can not take care of [90:55] ourselves is, you know, what we're [90:56] eating and whether we're exercising. So, [90:58] the trauma makes it harder to take care [91:00] of ourselves and predisposes to poor [91:02] self-care. Now we have, you know, a [91:04] person who's overweight and then maybe [91:06] pushing towards diabetes or heart [91:07] disease or cardio or cerebrovascular [91:09] disease. And also, just like we talked [91:11] about epigenetics and and changes in [91:13] gene [91:14] transcription, what genes are active in [91:16] us, trauma puts us in a place where we [91:20] are more inflammatory within us. Like [91:23] there are more inflammatory markers in [91:26] our blood vessels. So, it's not as clean [91:29] and clear as we would like it to be. [91:31] We're not as healthy and this works [91:33] against the health of our blood vessels [91:35] and the health of our immune system. So, [91:37] the soup we swim in, so to speak, is [91:40] changed by the trauma, and then those [91:45] higher levels of inflammatory markers, [91:47] for example, that are circulating in our [91:49] bloodstream can make it harder to lose [91:52] weight. The body starts holding on to [91:53] more calories, and it makes it harder [91:56] for our blood vessels to stay healthy, [91:59] and then we get less and less healthy. [92:00] And part of that is the biological [92:02] effect of trauma, just like the [92:04] epigenetics, right? And part of it is [92:06] the changes psychologically and the [92:08] changes in self-care. [92:11] How do you convince someone that comes [92:12] into your practice and tells you that [92:14] they can't change? They don't believe [92:16] they can change. How do you convince [92:17] them that they can? Well, I'm a huge [92:19] believer in the power of knowledge and [92:21] the power of information, which I think [92:23] goes back to how powerless I felt as a [92:25] kid when we couldn't understand medical [92:27] information. It's like, I want to know, [92:29] I want to understand. And I think I [92:32] think a lot of people are like this. I [92:34] think we as humans don't get enough [92:35] credit that we want to understand. And I [92:38] think so much in our society is [92:40] reflexive. Like you know what you know [92:41] and you feel how you feel, and then, you [92:43] know, we have a whole set of beliefs [92:44] about the world because we affiliate [92:46] with some group or another, right? I [92:48] think that's a reaction to feeling so [92:50] disempowered and that what we really [92:52] want is knowledge. And I think that's [92:54] the reason why, for example, [92:55] knowledge-imparting podcasts are so [92:57] valued because you're not trying to tell [92:59] people what to do or how to think, but [93:01] you're you're giving them, bringing them [93:03] knowledge. And and that's what I try and [93:06] do of like, I know that's not true. Now, [93:08] it may be that if you're a science-based [93:10] or rational person, or you're an [93:11] engineer or an accountant, it's like, I [93:13] might try and get at you through this [93:14] through the science, right? I might get [93:16] try and get at you through that article. [93:18] Right, so something that can like let [93:19] you see that. Or I might try and get at [93:21] it through examples of, hey, here's it [93:23] like people do change. Like here's kind [93:25] of really what the state of the art is [93:27] now. And like can I get you excited [93:28] about that? Give me an example. There [93:30] are a lot I could cite, but the one that [93:33] comes to mind is the one story in in my [93:37] book that is just an amazing story of a [93:40] person who had had a trauma in her life [93:44] that had just changed everything. Mood, [93:48] anxiety, behavior, choices in the world. [93:51] I mean, so much had gone in a way that [93:55] was not how this woman was built to live [93:57] her life, how she was [93:59] living her life. And it was so striking [94:02] her telling me about who she was at some [94:06] point in the past and contrasting that [94:09] to how she was living and how she [94:10] thought about herself. And it was really [94:13] a night and day difference. And it [94:15] became clear there was a very abrupt [94:17] change at this [94:19] at the time of this trauma. Like a night [94:21] and day change towards dysfunction, poor [94:24] health, poor social function, misery. [94:26] And [94:28] she had no thought or idea that she [94:30] could be like she was [94:32] before because all she knew was that [94:35] things had changed and now she was like [94:36] this and this was [94:38] not okay and never going to change. [94:40] But she was willing to see this darkness [94:43] of the change and to hear my [94:46] observations and examples. Like, look, I [94:48] I see something here that's looking from [94:50] the outside that's really striking. And [94:53] And that's we could think about it, talk [94:55] about it, understand it. And like [94:58] changed her entire life. And it really [95:00] is true that 10 years later, she looked [95:04] 10 years younger. [95:05] Absolutely. Is this a one-hit wonder [95:07] though, or is it a training process? [95:09] Like me being in the gym and picking up [95:11] weights over and over again. Am I having [95:12] to retrain my mind to view the situation [95:15] differently? Yes. [95:17] Yes, we are creatures of neuronal habit. [95:20] So, if you think the example I give I [95:23] usually use is let's say you and I just [95:24] picked a word, random word, and we said [95:26] it 500 times. Right, we'd each be saying [95:28] it to this evening. Let's say we say it [95:30] 2,000 times. You know, give it a couple [95:32] days, it's still there on the mind. Why? [95:34] Right, even though we know it's a silly [95:35] example, why would it still stay with [95:37] us? Because when we say that word so [95:39] many times, we're strengthening memory [95:41] connections. That word comes to mind [95:43] more, it's stronger within us. And then [95:45] the only way it goes away is it [95:47] atrophies over time. You know, you can't [95:50] just make that go away after you said it [95:51] a couple thousand times. It'll go away [95:53] over time. [95:54] It gets less and less powerful over [95:55] time. So, if you don't keep saying that [95:57] word, you know, comes to mind maybe 10 [95:59] times the next day, five the second day, [96:01] three times, then not again. But this is [96:03] how processes of change work inside of [96:06] us. So, someone who has, for example, [96:09] had self-talk in them that, "Oh, it'll [96:11] never work out for me." Or like, "I suck [96:13] and no one likes me." Or, "You know, I'm [96:14] terrible." Or, "How could you, idiot?" [96:16] Or, you know, things like I had a shadow [96:18] voice saying these things to me for [96:19] years. Like that doesn't want to go away [96:21] at once because it's just habituated [96:23] inside of us. So, we have to realize [96:25] that is not real and true. I don't That [96:28] is not what I think what I want to say [96:30] to myself. So, I want to know when it's [96:33] there. I want to realize I'm saying this [96:34] to myself and I don't believe it. Then [96:36] we make it less strong. [96:38] Right, we make it less strong. Every [96:39] time we say something that's a negative [96:41] lie to ourselves, like no one will ever [96:42] love me, right? People say that to [96:44] themselves over and over, we make that [96:46] more powerful as if it were true. And if [96:49] it's as if it were true, is it true? Our [96:51] brain can't tell the difference now. So, [96:53] if we we understand that, and now we [96:55] want to change it. Like I know why I [96:56] said that because when I was growing up, [96:59] that parent, that person always said [97:00] that to me over and over and over. And [97:02] then, [97:03] you know, I chose bad relationships cuz [97:04] I didn't think I was worth anything [97:06] better, and they didn't go well, and it [97:07] reinforced that to me. Like a person [97:08] really understands that, we bring that [97:11] understanding to bear in a way that you [97:13] speak against that when it comes into [97:15] your mind. Cuz we can't make it not come [97:17] into your mind. It can atrophy, meaning [97:19] this process of slowly over time it goes [97:21] away. But we have to say, "Hey, the [97:23] whole me," I call it the judge, in the [97:25] middle of all the opinions, has to say, [97:27] "Okay, I know I'm saying this to myself, [97:28] right? But do I believe that or not?" [97:30] Can you really completely get rid of a [97:32] trauma? Can you take a trauma to zero? [97:35] Well, [97:36] we won't [97:38] lose the memory of it. All right, [97:39] something bad has happened. [97:41] We're not going to entirely forget it. [97:43] That means it can trigger us in the [97:45] again in the future. Well, the the [97:46] question is how much does it trigger? [97:48] Right, how much does it trigger? The [97:49] idea is to attenuate the response to it. [97:53] So, if [97:55] if it was a car accident, and every time [97:56] the person looks at a car, they have a [97:58] panic attack, right? It's probably [98:02] it's probably not going to happen that [98:03] someday they look at a car and don't [98:04] even remember. [98:06] Right? But they can look at a car and [98:07] like they know they had a car accident. [98:09] They're not trying to hide it from [98:10] themselves and go, "Oh my god, I can't [98:11] see a car. I had a car accident. It [98:13] triggers me. Like I'm I'm understanding [98:15] that. I understand the naturalness of [98:16] the responses in me and how they maybe [98:18] were perpetuated by the fear that I felt [98:21] and and I wasn't working through it or [98:23] working through the loss that happened. [98:24] Now that I'm understanding that, well, I [98:26] don't have to be afraid of this. So, I [98:27] see a car and yes, it makes me kind of [98:28] uncomfortable, but it's okay. A lot of [98:30] people beat themselves up because [98:32] they've done a lot of work. Right. And [98:34] their trauma still remains. I think I'm [98:36] one of those people where there's [98:38] certain traumatic things from my [98:39] childhood, done a lot of work. I [98:40] logically know that it's not true. Like [98:43] that that belief I had is not true. [98:45] Yeah, I'm still prone to be triggered on [98:46] a bad day about that particular thing. [98:49] Right. Right, look, that's that's that's [98:52] how it goes. When a person is navigating [98:54] through trauma and really getting [98:57] through it, getting over a lot of [98:58] difficult things and getting to a much [99:00] better place, but responds to the [99:03] triggering in a way that inadvertently [99:06] reinforces the trauma. So, I would say [99:08] if you're having a bad day and you have [99:10] a memory of something that you kind of [99:11] know you got over but then it raises the [99:13] same set of thoughts or feelings that [99:15] aren't good. Right? Instead of my guess [99:17] is that you're feeling bad about that. [99:18] Like, "Oh, I did all this work and I [99:19] didn't get over it." Right? To say, [99:21] "Look, isn't it interesting like how [99:24] strong this imprints us that this is [99:26] still going to come to my head. Today [99:28] it's going to come into my head like I'm [99:29] having a bad day or I dropped something [99:31] in the morning and I don't feel great [99:32] about myself. Like, this stuff is very [99:33] very powerful but still not telling me [99:35] truth. You know, that shoulder shrug [99:37] about it. Okay, it's going to come into [99:38] your head. It was neuronally reinforced [99:41] and sometimes you'll be having a bad day [99:42] and it'll come in. It doesn't mean [99:43] anything. [99:45] Lady Gaga sits at the very top of your [99:47] book and she's written the forward in [99:49] your book. [99:51] There's this wonderful quote inside [99:53] there that says, [99:55] "I can now say with certainty that this [99:58] man saved my life. [100:00] He made life worth living. [100:03] But most importantly, he empowered me to [100:04] find and reclaim myself again." [100:10] That is an incredible thing for anyone [100:12] to say to anyone else. [100:15] Thank you. My first thought is she's [100:16] eloquent and generous of spirit and I [100:18] and I so appreciate that she [100:20] wrote such lovely words and I and I so [100:24] so appreciate that. Just thank you. Why [100:26] did she say that? [100:27] You know, as she has talked about [100:29] there's trauma in her [100:31] life and to gain an understanding a much [100:35] better understanding and be able to [100:38] ground to the things about her that are [100:40] wonderful and she's a wonderful person. [100:41] There's wonderful There's wonderfulness [100:44] in us no matter who we are and I think [100:46] from the perspective of her on such a [100:48] big world stage acknowledging [100:52] the trauma and the humanness in her and [100:55] that like anyone else she needed some [100:58] understanding. She needed [101:00] um [101:01] some help forward in different pathways [101:03] of thought about self. Like the kind of [101:05] thing any of us need after trauma and [101:08] she had the the bravery, the fortitude [101:10] to you know, to take chances to be [101:13] different. You know, just like someone [101:14] would say, "Oh, I can't be any [101:15] different." We can all feel that when we [101:17] have a lot of trauma inside of us and [101:19] it's hard to think I'm going to really [101:21] try and be different. I'm going to take [101:22] that chance but you know, in order to to [101:25] change our lives we have to do that and [101:27] and and she also did that. It's a very [101:30] It's a very very human story and I think [101:32] a deeply feeling person who then wants [101:35] to bring that message [101:36] forward to others that we can change [101:39] trauma and I'm I'm I'm so grateful she [101:41] wrote the forward to my book but part of [101:42] that is she's she believes in that [101:44] message that trauma does not have to [101:46] control us. We can understand it. We can [101:48] get our arms around it and I think [101:49] that's what she is [101:51] You know, that's what she's [101:51] communicating in that quote. That's the [101:53] part of that quote that's important. The [101:54] part that's about everyone reading it [101:56] and the and the capacity for change. You [101:59] have some incredible celebrities um [102:01] on the book inside the book that have [102:03] given [clears throat] you quotes for the [102:04] book. People like Kim Kardashian, Tommy [102:05] Hilfiger, etc. etc. Lady Gaga as I [102:08] mentioned. [102:09] I'm guessing these these people at some [102:10] point [102:12] came to you. [102:13] Without sort of disclosing client [102:15] confidentiality issues. [102:17] I'm just wondering how you find yourself [102:18] in a position as a [102:20] psychiatrist that [102:22] the this caliber of people are seeking [102:24] out your support. [102:26] Well, [102:28] and does that ever feel a bit surreal? [102:30] Yeah, I think I think it does. I mean, I [102:32] like to think of myself as [102:34] a diligent person who wants to continue [102:37] working at things and moving them [102:39] forward and and uh seeing where they can [102:43] go and and I think at some point in time [102:46] I realized I had the capacity to to [102:49] perhaps reach people who reach a lot of [102:51] other people. Right? And and there's [102:53] been a real joy. I I think that people [102:56] who have who are public facing, I mean, [102:58] there are a lot of stresses to that. You [103:00] know, we we people can think, "Oh, it it [103:01] seems so wonderful from the outside." [103:03] But there's a lot of extra stress to [103:05] that from the inside. So, to be able to [103:08] address some of the extra complexity of [103:10] that and to be able to help people who [103:11] have a [103:12] big impact on the world around them [103:15] uh um [103:15] was um [103:17] and sort of a joy to pursue. [103:19] We have a closing tradition on this [103:20] podcast where the last guest leaves a [103:21] question for the next guest not knowing [103:23] who they're going to be leaving it for. [103:25] And the question that's been left for [103:26] you feels quite fitting and very [103:27] interesting. I really like this one. [103:31] It just says it's not even written as a [103:33] question. It just says, [103:35] "Erase one regret from your life. Dot [103:39] dot dot." [103:40] Wow. [103:43] You know, I think I should have [103:45] paid more attention [103:48] to the world around me when I was [103:51] younger and more lost in [103:56] trying to feel good enough at the moment [103:58] and I think that it [104:02] made it harder to sort of find my path [104:04] and I think it made me harder. I think [104:05] my brother hadn't found his path and I [104:07] think there was a lot of [104:09] frantic anxiety or fear driven forward [104:12] movement without pausing and [104:15] circumspection and it may be that we [104:16] just talked about you know, we've talked [104:18] about his suicide and we've talked about [104:19] that in this podcast. So, it's it's kind [104:21] of at the forefront of my memory but [104:23] when I think back then, I probably knew [104:25] well enough to be more circumspect [104:27] including about what may have been going [104:28] on in him or in me and um [104:32] I'm happy I got myself on a path that's [104:35] led to places that feel good and that I [104:37] think are generative and productive. Um [104:40] I wish I had more attention to the [104:42] bigger picture when I was significantly [104:44] younger. Why? [104:46] Well, I think I would have made better [104:47] decisions. I think I would have seen [104:50] pathways that led away from health and [104:52] happiness and maybe seen that in others, [104:54] too. Um cuz some You're talking about [104:56] Jonathan. And others where I where where [104:58] I was born and raised. I think there [104:59] were there were a lot of good people and [105:00] a lot of forward movement but um [105:03] we maybe could have looked around [105:04] ourselves a little bit more and there'd [105:06] be several people maybe still here as [105:08] opposed to not being here and people [105:09] being healthier and um I think I [105:11] probably had it in me to look around [105:13] myself more [105:15] than I did at that time and I do [105:17] sometimes feel I will feel regrets [105:19] about that. [105:21] Well, I have to say Dr. Paul Conti, [105:24] the work you've committed your life to [105:26] and the understanding you've committed [105:27] your life to spreading um [105:31] is going to save many many many many [105:32] many many people's lives. [105:33] Thank you. And not just save their lives [105:35] but sometimes it's not always about [105:37] saving a life. It's about improving the [105:39] standard of someone's life which I think [105:41] can have a generational impact if that [105:43] person is to stay alive and they are to [105:45] you know, if we look through the lens of [105:46] epigenetics or just about the how [105:49] internalized shame and guilt and all of [105:51] this can be passed on through vicarious [105:54] forms of trauma that the kids might feel [105:57] and whatever. [105:58] You know, your work and your your future [106:01] work I deeply believe is going to save [106:04] and improve thousands and thousands and [106:06] tens of thousands, hundreds of thousands [106:08] of people's lives. And that is an [106:10] unbelievably remarkable thing to commit [106:12] one's life to. Thank you. [106:14] There's no words that I could say in the [106:15] 30 seconds I have now that would would [106:16] express the extent of the good that [106:18] that's going to do in the world. Wow. [106:20] And I I you know, [106:22] I can't imagine those people that are [106:24] here and not here how [106:27] proud they would be and are of you Thank [106:29] you. for turning your trauma [106:32] into such a wonderful, healing, [106:34] important thing. [106:36] So, on behalf of all of those people [106:37] that you'll never get to meet that [106:38] you've helped with your work, I want to [106:39] say thank you so much. Wow. [106:41] Well, you're very welcome and thank you [106:43] for those kind words which I take to [106:44] heart and thank you for having me on. I [106:46] appreciate it. [106:49] [music] [106:55] [music] [107:06] [music]