Dr. Paul Conti on Huberman Lab: Why shame locks in trauma

1. 0:00 – 0:21

   Paul Conti

   1. AHAndrew Huberman0:00

      [upbeat music] Welcome to Huberman Lab Essentials, where we revisit past episodes for the most potent and actionable science-based tools for mental health, physical health, and performance. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. And now, for my discussion with Dr. Paul Conti.

2. 0:21 – 3:20

   What is Trauma?, Guilt & Shame

   1. AHAndrew Huberman0:21

      Paul, thank you so much for being here today.

   2. PCDr. Paul Conti0:23

      Well, thank you so much for having me.

   3. AHAndrew Huberman0:24

      If we could just start off very basic and just get everyone oriented, how should we define trauma?

   4. PCDr. Paul Conti0:30

      I think we have to look at trauma as not, oh, anything negative that happens to us, right? But something that overwhelms our coping skills and then leaves us different as we move forward. So it changes the way that our brains function, right? And then that change is evident in us as we move forward through life. We can see it in mood, anxiety, behavior, sleep, physical health. So we, so we can identify it, and we can also see it in brain changes. If trauma rises to the level of changing the functioning of our brains, then there's almost always a reflex of guilt and shame around the trauma that can lead us, and often leads us, to bury it, right? To avoid it, which is exactly the opposite of what needs to be done. We need to communicate and put words to what's going on inside of us. And, and very often, a, a person knows, but they're not admitting it to themselves because they're afraid of it, right? They don't know what to do. But if they start talking, then they'll, they'll talk about the event or the situation, could be something acute, or it could be something chronic, that really has been harmful to them, right? And then they feel different afterwards. But that doesn't always happen. Sometimes it's a process of exploration w- you know, through dialogue, right? Whether, whether it's written or whether it's spoken, of, of the person sort of exploring the changes inside of themselves, maybe changes to their self-talk inside, changes to their thoughts about the world, and whether they can navigate safely and readily in it. And, you know, it anchors, as I talk about this, the example I'll use at times is the example of my own life, where, you know, when I was much younger, in my early twenties, my younger brother took his life by suicide. And the, you know, the response of guilt and shame and, and hiding all of it inside of me was, was-- it, it's just very dramatic, but, but I wasn't acknowledging it, right? 'Cause I didn't know what to do about it, and I felt guilty, and I felt responsible, and I felt ashamed. So there was av-- an avoidance inside of me. So, so I didn't see that the change was in me, but I was taking care of myself poorly. Like, there was enough going on that was unhealthy, that I couldn't avoid the realization that like, "Hey, I'm different now," and in these ways that are automatic. You know, my reflex to: Can I make my way in the world? Can I have a good life? Can I be happy? Well, my reflexes to that were all different, and they were coming through the lens of heightened anxiety, heightened vigilance, a sense of guilt, a sense of shame, uh, and a sense of non-belonging in the world. And, and it was ultimately good and helpful people around me, um, and my own realization that, "Hey, things are not going well," right, that led me to, to then get some help and to be able to talk about it and realize, like, "Oh, my gosh, like I need to face these things that are going on inside of me."

3. 3:20 – 7:18

   Evolutionary Context of Trauma, Shame & Guilt

   1. AHAndrew Huberman3:20

      Why do you think that when we experience trauma, these things that we call guilt and shame surface? Those emotions must exist in us for some reason.

   2. PCDr. Paul Conti3:30

      Mm-hmm.

   3. AHAndrew Huberman3:31

      Um, but in this case, it seems like they, they don't serve us well. So why is it that we seem to be reflexively wired to feel guilty and feel ashamed when that's the exact opposite of what we need to do in the case of trauma?

   4. PCDr. Paul Conti3:44

      There's something adaptive that has happened in us through evolution that now becomes maladaptive i- in the way we live in the modern world, right? So if you think of through most of human development, you know, people weren't living that long, right? And the idea was to survive and reproduce. So, so traumatic things that happened to us, it would make sense for them to stay with us, right? So, you know, if you ate a new food and got really, really sick, it's like, you better remember that, right? You know, if you see someone from the group of people, you know, a couple miles away, right, and one of those people attacks you, right? It's like, you better remember that. So, so the traumatic things that are sort of emblazoned in our brain are built to last, right? Things that are positive will generate some emotion inside of us, but things that are profoundly negative are much more likely to stay with us. And I think that that was adaptive, right, when all of that was about survival, right? And I think the same thing is true with, with, say, shame. The limbic system, right, the, the system often is called the emotion system, right? In our, in our brains, has actually, of course, varying function, right? And one aspect is affect, right? So affect is aroused in us. It's created in us without our choice, right? So if, if we're walking down the road, and someone jumps in front of us or pushes us, right, then there's a response of fear, anger, right? Heart starts beating faster, you know, m- more blood to the muscles. You know, we- we're getting ready to, to fight, right, or, or run, right? And then we become aware of it. So the aroused affect in us is also about survival, and it has a very deep impact upon us, and shame is an aroused affect. So, so it, it can be raised in us without our choice, and it's very powerful, which, if you think about that, is an extremely strong deterrent. You know, imagine a, a tribe or a group of people, right, that are sheltered together, and, you know, someone eats half the food at night or something, [chuckles] right? And, like, there's a very negative response, right? And that person feels shame, because shame is so powerful to, to control behavior, right? So the way that trauma can change our brains and, and stay with us in a way that says, "Be more vigilant, look at the world in a different way, act more defensively," right? And, and how that links to shame and to guilt. And then guilt in, in v-- Guilt becomes what gets called feeling, technically, where we relate the aroused affect to ourselves.... right? So, so shame, the aroused affect, and guilt, the next step, right, when we, when the shame gets related to self, are such profound behavioral interventions and, and deterrents that you can see, I think, how evolutionarily, kind of all makes sense. If we're fighting for survival, you know, and we're an elder statesman if we make it to twenty, this makes sense, but it doesn't make sense in a world where we live much longer, right? We navigate in all sorts of different ways, and there's so much coming at us that can be traumatizing. Our brains are built to change from trauma, but not in the way we experience trauma, and not in the way that we live life in terms of the nature of living life and the duration of life in the modern world, where these traumas that happen to us are often so bad for us because they, they change how our brain is functioning, and then our entire orient- orientation to the world is different, and that could be for, you know, years and years.

4. 7:18 – 11:08

   Repetition Compulsion, Repeating Trauma

   1. AHAndrew Huberman7:18

      This idea that I've heard about before, I think it was a Freudian concept of a repetition compulsion.

   2. PCDr. Paul Conti7:24

      Yes.

   3. AHAndrew Huberman7:24

      My understanding of this concept of the repetition compulsion is that we all want to solve our traumas-

   4. PCDr. Paul Conti7:30

      Yes

   5. AHAndrew Huberman7:30

      ... and it allows us to put ourselves into micro or, um, again, macro versions of that over and over again. We get to run the experiment again and again-

   6. PCDr. Paul Conti7:40

      Right

   7. AHAndrew Huberman7:40

      ... in an attempt to solve it.

   8. PCDr. Paul Conti7:41

      Right.

   9. AHAndrew Huberman7:41

      Why is it that somebody who is in an abusive relationship goes on to have a second and third or fourth-

   10. PCDr. Paul Conti7:46

       Yes

   11. AHAndrew Huberman7:46

       ... verbally or physically abusive relationship?

   12. PCDr. Paul Conti7:48

       We see that over and over. It's not necessarily in everyone, but boy, it is in a lot of people who have suffered trauma. On the surface of it, it's like, it makes no sense. But then if we think, well, how does the bra-- how does our brains actually function, right? We're sort of trained, at least in Western society, I think, to think of ourselves as logical creatures, right? That like, oh, we're logical, and ultimately, everything in us can just boil down to logic, which is completely not true. The limbic system, right, the emotion system, so to speak, inside of us, always trumps logic, right? If you think about, does it ever make sense to run into a burning building? I mean, logic says no, right? But if someone you love is in the burning building, you-- people run right in, right? Because the limbic system says yes. So when logic and emotion come head to head, emotion wins all the time, and the limbic system does not care about the clock or the calendar. So how I would relate that to the repetition compulsion is, is wh- when people are repeating, what they're trying to do is to make things right, right? With the idea that if we can repeat the situation and make it right, it will fix everything, right? Which makes perfect sense if, if we think, well, where is that concept coming from, right? It's coming from the emotional part of the brain that wants relief from suffering of the trauma and does not understand the clock or the calendar. So if I can solve something now, I will also solve something in the past, right? Which is why I can't tell you how many times I've sat with someone, and say we're starting to do therapy, right? And the person will say, "My last seven relationships have been abusive." And I'll say back something sometimes like: "Well, look, if, if you tell me that you've had seven relationships that have been abusive in different ways, I'll agree with you." Like, I only say that 'cause that's never what someone says, right? "But I think what you're gonna tell me is you've kinda had the same relationship seven times." So for them, the light bulb that goes off, like, "I have not had seven different abusive relationships. I have had one that I have repeated seven times." And now we start getting to what's really going on and what needs to happen. That person needs to face what happened in that original abusive relationship, and it always comes down to the, the same sort of concepts of, of the person feeling terrified while the abuse was going on, feeling guilty, feeling ashamed, feeling like, oh, they brought it on themselves, they deserve it, they don't deserve anything better, right? Because the brain is trying to make sense of it, right? Or, "I, I thought I could make that okay, but I couldn't," right? And then there's more guilt and more shame, and if that's stuck inside of someone, like, that's bundled up inside of someone, you know, like a medical abscess inside a person, you know, a walled-off infection inside the body, this is the same concept in the brain, then, of course, the limbic system is gonna wanna fix that, and, and it fixes it by trying to, "Let's recreate that situation and make it right this time." I see that play out clinically over and over again, and why do things get better? Because we go to the trauma, and we unlock it. It's not hidden inside where it can control things, right? We bring it to the surface, and then we, we can take away its power.

5. 11:08 – 15:08

   Processing Trauma in Therapy or On Your Own, Grieving

   1. AHAndrew Huberman11:08

      The thought about the thing, the event-

   2. PCDr. Paul Conti11:10

      Mm-hmm

   3. AHAndrew Huberman11:11

      ... or events, plural, evokes this arousal, this internal state, makes some people feel sleepy and exhausted, other people feel really anxious, other people feel angry.

   4. PCDr. Paul Conti11:20

      Yes.

   5. AHAndrew Huberman11:20

      I mean, the arousal has all these different dimensions-

   6. PCDr. Paul Conti11:22

      Yes

   7. AHAndrew Huberman11:22

      ... as you know. It's clear we need to confront these things, and so how do we deal with arousal? How does one take what they feel inside about something shameful? What do you do with it in a moment, and does that have to be done in the presence of a skilled, trained therapist?

   8. PCDr. Paul Conti11:38

      Yeah.

   9. AHAndrew Huberman11:38

      How do we deal with that internal arousal?

   10. PCDr. Paul Conti11:41

       W- we so often try and change the trauma of the past in order to control the future, and what, what that really adds up to is the trauma of the past dominates our present. And, and then we're not really living in the present, right, as we're trying to control the future. We're not gonna do a great job of controlling our future if we're not really living in the present. And the, so the way to come at that, again, in the moment, if we're saying, okay, in the moment, if I need to fall asleep, right, I might say, "Okay, let me try and put that out of my mind. Let me try and thought redirect." So, so there are short-term strategies that can let us be functional in the context of these changes, but the answer is to-... go look directly at that thing. L- look at that trauma, explore that trauma, and sure, that can be done with a professional, and sometimes that's what makes sense, but not always, right? Sometimes it can be done by talking to another person, right? Writing it down, right? Looking at w- what's going on inside of me that my mind is so stuck to this? Let's explore that. We're so afraid, so often, of looking at the trauma that has changed us, that we'll look anywhere but at that. What ends up happening is, when the person puts words to it, right, it could be in writing, it could be talking to a trusted other or with a therapist, right? Things start to change. I mean, just the fact that you can talk about it, you can put words to it, and other people don't recoil. That, you know, that example of, of the person who says, "Okay, I was abused by a, a coach when I was a child," and once they start talking about it, then they start talking about how, you know, they were just innocent kids, right? Like, they didn't know, and, like, they really wanted to be on the team, where this coach was treating them as special, and, and now they can look at themselves from the outside, right? They can look at themselves like they would look at someone else. You think it's so easy for us to see what's real and true if it's someone else, right? If you ask someone, "You know, what do you think of someone who's ten, 11 years old, who's abused and manipulated and abused by an adult?" They say, "Oh, my goodness, I feel compassion for that person," right? But if it's us, [chuckles] right, then, oh no, it's guilt and shame, and we have to hide it away. And when the person starts looking at it, they can sort of see it from the outside, and it starts to take the energy out of it. All the guilt and shame inside the person gets juxtaposed to, like, what really happened there? And then they say, "Right, I was a terrified child," right? "I didn't understand at all," and they can come to a place of compassion, and now we are working against the guilt and shame. And if the person cries about it, then that's great, right? I mean, crying is one of the best coping mechanisms we have. It doesn't hurt us, and it lets us grieve things. You know, we can't grieve if there's guilt and shame inside of us. It just blocks grief, right? We have to-- w- there has to be a clean slate, in a sense, in order to feel sadness. And then y- you see that it, it shifts from anxiety, anger, and frustration, usually directed towards the self, guilt and shame, towards, uh, towards being able to process it and being able to bring to bear some compassion and being able to direct the negative emotions, so to speak, where they're warranted, and my goodness, the changes. It's remarkable how just getting it out there and having, like, one hour of talking like that, like, like what we're talking about now, can, can leave a person feeling immensely better.

   11. AHAndrew Huberman15:07

       How

6. 15:08 – 16:23

   Introspection, Tool: Processing Trauma Through Words

   1. AHAndrew Huberman15:08

      do we do that in a way that isn't re-traumatizing ourself in a major way or in a minor way?

   2. PCDr. Paul Conti15:13

      It starts with real introspection. You know, when things are bouncing around in our minds, often it's very non-productive, right? It's the same thing over and over again, and that's not helpful for us, right? So if we're just thinking about it, and we're thinking in the same way we sort of, in a sense, always think about it, then all we're doing is reinforcing the trauma, right? But if we can distance enough, then we can think in ways that allow us to have new thoughts, right, t- that, that we weren't having. It's not just bouncing around in our minds. And if we speak or write, there are even more mechanisms that come online in our brains, right, that, that are then sort of monitoring mechanisms. We think in a different way if we're using words, right? And we, we are better able, often, to bring in that observing ego, like, "What's going on inside of me?" So, so it can be very helpful to think, it can be helpful to talk to someone, to a trusted other, you know, friend, family, clergy, uh, to write. I mean, these are things that can be done without expending any resources. And sometimes, if, if the symptoms are significant enough, like, we really do need to talk to somebody professional who can, who can help us get to the root of the trauma.

7. 16:23 – 18:37

   Finding a Therapist, Rapport; Duration of Therapy

   1. AHAndrew Huberman16:23

      What are some of the characteristics that one should look for in looking for a therapist?

   2. PCDr. Paul Conti16:27

      If you look at what are the top ten, uh, important factors to find in a therapist, just repeat "rapport" ten times. It's trust, it's a back and forth, it's, it's like, yeah, even though I'm doing, I'm doing something difficult, I'm doing it with someone who's really helping me, and someone who's in it with me, right? Someone who's really paying attention, wants me to be better. That's indispensable. I think that good therapists are not pigeonholed by a certain modality. They, they may, you know, come at the world largely through a psychodynamic or a CBT or a DBT lens. There's lots of different, you know, ways to do therapy. But when you really talk to those people, really good, experienced therapists, it's all coming through the vehicle of the rapport, but they're practically shifting to what the person needs. If you have that, you've got a winning combination.

   3. AHAndrew Huberman17:15

      So people should perhaps try a few therapists and maybe have a session or two or three to see if they, the rapport feels like it's taking root.

   4. PCDr. Paul Conti17:22

      Yeah, and I think that's why word of mouth is important, right? If someone you trust tells you, "Hey, this is a good person," that says a lot, right? It already makes the pretest probability, you know, is quite high.

   5. AHAndrew Huberman17:32

      How does one gauge how much therapy they, they ought to be, um, doing, uh, and, uh, should it always be on the therapist to decide that?

   6. PCDr. Paul Conti17:41

      Yes, I think a lot of times it would be the therapist to say, "It looks more work, you know, more intensive work or c- can make a, uh, a difference." But I think the person also needs to, you know, take ownership, right, of their own therapy, and say, "If I don't feel helped enough, well, I have to think about that," right? "And, and talk to the therapist about that, 'cause it may be, it may be that therapist isn't a match." People can get into a rhythm of therapy where it's really not helping them, right? But they either feel sort of nihilistic about it, like, "Well, I'm no better, and I'm going to therapy." Do we really need to look at ourselves? And this is where the insurance systems often are very difficult, 'cause it's hard sometimes for a person to say, "Well, I need more therapy," 'cause that may not be possible. So there, there are sort of negative factors in the world around us, but ultimately, I think the answer to the question comes down to observing ourselves and taking ownership of, like, what's going on in us and how we're feeling, and, and then feeling that, that, um, commitment to self or to self-care to say, "I need to go change this."

   7. AHAndrew Huberman18:36

      Now, I'd

8. 18:37 – 21:16

   Prescriptions, Depression, Treating Core Issues

   1. AHAndrew Huberman18:37

      like to talk a little bit about chemistry.... yes, um, drugs. How do you think about prescription drugs in the context of treating, uh, trauma and other, and other conditions?

   2. PCDr. Paul Conti18:48

      And I think that we tend to overutilize medicines in this country because w-we have a healthcare system that, that often-- that's so based on throughput, that we want to polish the hood when there's a problem in the engine, right? So we overutilize medicines often as an endpoint, right? Oh, we're going to make that person's depression better with an antidepressant. Most of the time, for that person's depression to really get better and stay better, they need to unravel what's driving the depression. So the first kind of branch point can be: What is the diagnosis? What is the level of severity, right? And I think that, that's very, very important. And the vast majority of people who are helped by antidepressants, they're not-- they don't have clinically severe depression, right? Those medicines create more distress tolerance in us. If you can improve someone's distress tolerance, and you can use medicines that, that take away w-what clinically is rumination, right? Not a, not the standard meaning of that word, but the clinical meaning of it, where there are distress centers in our brain that are s- overactive, and then we get stuck in these maladaptive negative pathways, where we think about something over and over and over again with no real chance of solving it, because that's not what's going on inside of us. So medicines can help that, but we have to have some flexibility around their conception and, you know, the modern medical system of, like, fifteen-minute visits, you know, to, to a psychiatrist that are, that are weeks apart, I mean, I, I don't understand how that goes well. We use, I, I think, approximately five times as much medicine, I think, across the board as, say, the Dutch population. They have a healthcare system and a, and a cultural system that, to the best of my understanding, is more rooted in taking responsibility for oneself. So if a person comes in and cholesterol is high, right, the first order of business is, "Hey, you take better care of yourself," right? Like, this person really needs to lose some weight, exercise more, right? They're, they're not just jumping to, like, "Let me give you a medicine, and, and, you know, and shi- shift you through the healthcare system and out the other side of the door." So I think medicines get overused in large part for systemic reasons, um, and also for some of these categorization reasons. "Oh, that person meets some technical criteria for depression. We've got to give them this medicine," instead of really thinking, "Wait, what's going on in this person?" And I see this over and over again. I see someone who's on seven medicines-

   3. AHAndrew Huberman21:05

      Mm.

   4. PCDr. Paul Conti21:05

      -and they're on seven medicines to treat seven different symptoms, and now they have side effects from all those seven medicines. Maybe two of them are to treat the side effects from the other five, right? And that's bad.

9. 21:16 – 25:05

   Psychedelics & Overcoming Trauma, Psychedelic-Assisted Therapy

   1. AHAndrew Huberman21:16

      I'd love to talk about psychedelics, with the preface that, uh-

   2. PCDr. Paul Conti21:20

      Yes

   3. AHAndrew Huberman21:20

      ... we're talking about this in a, in a legal, clinical setting.

   4. PCDr. Paul Conti21:24

      Yes.

   5. AHAndrew Huberman21:24

      What are your thoughts on these drugs for therapeutic potential, also potential hazards, uh, et cetera?

   6. PCDr. Paul Conti21:30

      The data coming from the, the labs and the academic centers, um, is so powerfully positive. These are used in professional hands, and with the right kind of guidance, are extremely powerful tools, but used in the right way. What happens is we see less communication or less chatter in the outer parts of the brain, right? In the outer parts of the cortex. That's where language is, that's where vision is, that's where executive function is, so planning and tac- task execution. So, so much of that is about making our way in the world around us, and I think when we take the neurotransmission out of those places, right, and we set it in a part of the brain, in, say, the insular cortex, right? The parts of the brain that are sort of in the middle, right? Which, which I think, I believe, is where our humanness really is. So the psychedelics make there be less chatter, communication in these other parts of the brain, and then we become seated in the part of the brain that I, I believe is most about our experience of true humanness. You know, it's why people can sort of see with clarity that, "Oh, that trauma, that, like, that thing is not my fault." Right? Like, we feel a sense of compassion for ourselves. We relieve ourselves, release ourselves from guilt, and, and it's like, why is this so helpful to people? And I think it's because it can do what we are trying to get at in good therapy, but it can really catalyze that by just putting a person in that part of the brain that can see it for what it is, without all that chatter in the cortex about, "Hey, you gotta think it's your fault, or you won't avoid it again," and, and that makes the repetition compulsion. "How do I think ahead to the next thing that might happen, and what else bad might happen?" I mean, we don't get anywhere doing that. These psychedelics, the medicinal value, I believe, is putting us in that part of the brain where a person can really find truth. And that's why I think th-th-that it's come so far in these few years, because I, I, I think that is very clinically evident, and I think we're gonna see more and more the value of that and how what the psychedelics do can become, I believe, a heuristic for understanding, like, wait, how are our brains really functioning, and what are the parts that really matter to our experience of being human? It's those parts of the brain, right, the deep parts of the brain, the insular cortex, and the, and the areas around it, that, say, light up when a person has an, uh, an experience of spiritual ecstasy or an experience of connection with another person, right? So we, we kinda have these telltale markers that something is going on there that's very important and very special, and then when they come, in a sense, back online, with, uh, with-- in a normal cognitive way, they realize, like, "Wow, now I'm applying all those mechanisms of trying to understand truth and to, to that, and what, what I see is that it's true. And wow, it's true!" Like, I mean, we hear that all the time, which tells me, "Hey, something different is going on there." And of course, these are powerful tools, so misused, like, very bad things can happen. But you think about the clinical utility and what does it mean that so many people change for the healthier or even change their lives? I think we're likely to see that they are powerful anti-trauma mechanisms, again, used clinically in the right hands. And, and I think that we're also gonna see that they're a heuristic for understanding our brain that goes against what I see as some of the reflexive hubris of, "Well, the outer parts must be the best because that's what makes us human, and other animals don't have it, and we're better because we're human." I mean, it makes no sense, you

10. 25:05 – 27:01

    MDMA, Overcoming Fear

    1. PCDr. Paul Conti25:05

       know?

    2. AHAndrew Huberman25:05

       ... I'd like to talk about MDMA. What sorts of states do you think MDMA is creating-

    3. PCDr. Paul Conti25:11

       Right

    4. AHAndrew Huberman25:11

       -um, that can, uh, explain why it's a useful therapeutic tool in some cases, and, and what sorts of cases those might be?

    5. PCDr. Paul Conti25:19

       This is very different than the psychedelics, right? Which are seeding our consciousness in these deep centers of the brain, right? Whereas what MDMA is doing is sort of flooding with positive neurotransmitters, right, in certain parts of the brain. And I think what that creates is a greater permissiveness inside to entertain or approach different things. And when these systems are, are flooded with these neurotransmitters, it's more permissive to sort of think about that, right? And to think about that without, again, all the chatter of, "That's your fault," or, "You're never gonna get anywhere because of that," or, "You know what that means?" Or, right, they can kind of go away, and then we can think about it in a way that isn't through the lens of fear. And I think that's the power there, is that there- it's permissive of approaching something, contemplating something, um, you know, a different-- a, a novelty. As we talk about a de novo approach. And I think that's also why the experience can vary, because you could also see how if you're not thinking about something, right, so there's not a clinical guidance to it, you could, you could be in a state where like, "I just feel good." But it- but that's not necessarily problem-solving. So the clinical guidance says, "Hey, let's take that state and do something with it," right? Let's-- now, now that you're in this state, let's, hey, let's make hay while the sun is shining, right?

    6. AHAndrew Huberman26:37

       Mm-hmm.

    7. PCDr. Paul Conti26:37

       You're in a state where we can look at things that are traumatic, right? We can approach them from a de novo perspective, and we're coming to understand that they have immense potential to be helpful to us. But I think and hope that that only also increases our respect for th- those modalities and what can come, what negative can happen if we're, if we're not respectful.

11. 27:01 – 28:54

    Talking about Trauma, Language

    1. AHAndrew Huberman27:01

       I have a question about language. Um, in your book, you talk about how we need to be careful about the use of language around trauma.

    2. PCDr. Paul Conti27:09

       Yes.

    3. AHAndrew Huberman27:09

       And maybe problem-solving and problem describing in general. How should we think about language in parsing trauma? And in your book, you talk about, um, you give some cautionary notes about, um, talking about depression, trauma, and PTSD in terms that, that might diminish their real, um, [lips smack] severity in, in some cases.

    4. PCDr. Paul Conti27:29

       Mm-hmm.

    5. AHAndrew Huberman27:29

       And, uh, and I was r- really struck by that. So maybe just touch on, you know, how should we talk about these things in a way that, um, doesn't diminish them for ourselves or for other people?

    6. PCDr. Paul Conti27:39

       Yeah.

    7. AHAndrew Huberman27:39

       And, um, at the same time, honors the fact that there's a lot of trauma out there.

    8. PCDr. Paul Conti27:44

       Right.

    9. AHAndrew Huberman27:44

       And, um, there's a lot of depression out there, and, and we need to talk about it.

    10. PCDr. Paul Conti27:48

        We just have to be very careful what we're saying and what we're communicating. And I think this doesn't mean, because, you know, there's a sort of phenomenon now where, where people are trying to control language, I think, too much. Like, you can't say anything that someone else might find hurtful, or you have to refer to people in ways they choose to be referred to, even if those are ways that others don't understand or ways they themselves have decided, or ways that might be psychologically or clinically unhelpful. So I think the overcontrol of language is not good. But I think the specificity of language, of what are we trying to say, how are we defining it, or even the word trauma, right? We're talking about trauma, so we want to define what that means, right? It doesn't just mean, like, oh, anything kinda negative, right? Because then that dilutes it down to meaning nothing, right? It also doesn't just mean, n- you know, um, injury in combat, right? Like, we have to talk about what that is. So I think anchoring it to something that rises to the magnitude of overwhelming our coping skills and changing us, like, then at least I define it that way, and I can communicate that to you, and we can kn- understand what we're talking about.

    11. AHAndrew Huberman28:53

        I'd

12. 28:54 – 32:14

    Taking Care of Oneself, Tool: Self-Care Basics

    1. AHAndrew Huberman28:54

       like to talk about a concept of taking care of oneself.

    2. PCDr. Paul Conti28:58

       Mm-hmm.

    3. AHAndrew Huberman28:58

       We hear about this concept of taking care of oneself, and I, and I think, uh, at a surface level, um, it can sound a little bit light, you know?

    4. PCDr. Paul Conti29:07

       Mm-hmm.

    5. AHAndrew Huberman29:07

       "Oh, take care, t- take care, take good care," you know.

    6. PCDr. Paul Conti29:10

       Right.

    7. AHAndrew Huberman29:10

       "We..." Um, but to me, it's a deep and powerful concept.

    8. PCDr. Paul Conti29:13

       Yes.

    9. AHAndrew Huberman29:13

       And I was very, um, happy to see it in your book and also to learn a lot of, um-

    10. PCDr. Paul Conti29:18

        Thank you

    11. AHAndrew Huberman29:19

        ... of ideas about h- what that really looks like.

    12. PCDr. Paul Conti29:22

        Mm-hmm.

    13. AHAndrew Huberman29:22

        How should we think about taking care of oneself?

    14. PCDr. Paul Conti29:25

        I see here what I think is a very fascinating dichotomy, right? That in some ways, like, think about how complex our brains are, right? How complex our psyches, our unconscious minds are. There's so much complexity there. But, on the other hand, psychological concepts that are consistent with health are often very simple, right? Which, by which I don't mean light, right? But, but simple, straightforward, right? And, and I think self-care is absolutely one of them. I mean, how much is talked about how to take care of oneself that just skips over the basics that are necessary as a building block for all else? So it doesn't matter how many chefs or vacations or whatever a person has, if the basics of self-care aren't squared away, and it's not a light concept to say, like: "Look, are you sleeping enough?" Right? "Are you eating well? Are you getting natural light? Are you interacting with people who are good to interact with?" Right? "Are you accepting negative interactions in your life? Are you living in circumstances that make you feel okay or not?" They, they, they're very, very basic premises, but so often we're not looking at them at all, right? We're not looking at them at all because we tend to skip over them, and we tend to skip over them either because, again, in some automatic way that sometimes is trauma-driven, and we're not gonna look at that, right? And often not taking care of ourselves can have the punishment, distraction, right? There's so much that can come into that. Or our sense of power is, is tied to not taking care of ourselves. I mean, I'll give you an example is, I, I tend to, for whatever reason, do reasonably well, um, with very poor self-care.... right? And, like, that was very adaptive when I was in, say, medical training, right? And I'm like, "Okay, I can, I can eat a lot today, I can not eat," right? "I can sleep two hours, I can sleep eight," right? I mean, overall, that's not good, and it hasn't been good for me as I've aged. But then I, I, I realized at some point, look, I'm doing all these things to make myself healthier, but, like, what, I ignore that? Right, and why am I ignoring it? That was a key question: Why am I ignoring it? Because somewhere inside of me is, it was, and still to some extent is, this idea that my ability to be really functional, right, to generate success in the world around me, is tied to my ability to do that, right? That, oh, if I- but if I stop doing that, and now I'm like, I'm eating and sleeping regularly, then I'm gonna lose some edge, and so, so, and even I think about this all the time, but I, I may realize, "Hey, I'm also, I'm not doing it inside," you know? And, and I think it's really grounding to the basics, um, that really help us. Of like, what are the basics of what I'm doing and not doing in my life? Diet, exercise, sleep, people, circumstances, um, leisure activities, I mean, [chuckles] sunlight. I mean, I think immensely important and dramatically undervalued.

13. 32:14 – 33:23

    Acknowledgements

    1. AHAndrew Huberman32:14

       I wanna thank you for today's discussion. Um, I found it-

    2. PCDr. Paul Conti32:17

       Yeah

    3. AHAndrew Huberman32:17

       ... to be incredibly informative, and I know-

    4. PCDr. Paul Conti32:20

       Thank you

    5. AHAndrew Huberman32:20

       ... our listeners will also. I also wanna thank you for the work you do. I've done a wide and deep search for people, um, in these areas, and there are so few who have the background in medical training and physiology, in the psychoanalytic and psychiatric realm, and also have, um, a grounding toward the future, you know, of what's coming.

    6. PCDr. Paul Conti32:43

       Mm-hmm.

    7. AHAndrew Huberman32:43

       And who can encapsulate so many different orientations and, and bring them together into a coherent piece. And for your book, um, which is incredible, I will go on record saying I think this is the definitive book on trauma.

    8. PCDr. Paul Conti32:56

       Wow, thank you.

    9. AHAndrew Huberman32:57

       And I really encourage people to, to read it, and will continue to encourage people to read it. It's so many, uh, valuable takeaways and insights and tools there. So, uh, on behalf of the listeners and myself, thank you so much for joining us today.

    10. PCDr. Paul Conti33:11

        You're very welcome, a- and I, I take that to heart, and I'm very appreciative of being here. So you're very welcome, and thank you as well. [upbeat music]

    11. AHAndrew Huberman33:18

        Thank you.

Episode duration: 33:23