How Trauma Works and How to Heal From It — Paul Conti, MD

1. 0:00 – 1:07

   Start

   1. TFTim Ferriss0:00

      [upbeat music] Hello, boys and girls, ladies and germs. This is Tim Ferriss, and welcome to another episode of The Tim Ferriss Show. I am thrilled to have my guest with me today, Paul Conti, MD. Paul is a graduate of Stanford University School of Medicine. He completed his psychiatry training at Stanford and at Harvard, where he was appointed chief resident, and then served on the medical faculty before moving to Portland and founding a clinic. Dr. Conti specializes in complex assessment and problem-solving, as well as both health and performance optimization, serving patients and clients throughout the United States and internationally, including the executive leadership of large corporations. His new book is Trauma: The Invisible Epidemic, subtitle How Trauma Works and How We Can Heal From It. You can find him online at drpaulconti, C-O-N-T-I, .com, and also at pacificpremiergroup.com.

2. 1:07 – 6:18

   Journey to psychiatry

   1. TFTim Ferriss1:07

      Paul, so nice to see you, my friend.

   2. PCDr. Paul Conti1:09

      Thanks so much for having me. It's great to see you, too. I appreciate it.

   3. TFTim Ferriss1:13

      And I have been looking forward to this conversation in my mind's eye for some time, uh, because we've known each other for a while. We met-

   4. PCDr. Paul Conti1:24

      Yes

   5. TFTim Ferriss1:24

      ... through our mutual friend, Peter-

   6. PCDr. Paul Conti1:26

      Yes

   7. TFTim Ferriss1:26

      ... Attia. And I saw a very early manuscript of Trauma: The Invisible Epidemic. We were doing the math beforehand before we pressed record around two and a half-

   8. PCDr. Paul Conti1:40

      Yep

   9. TFTim Ferriss1:41

      ... or so years ago. And I was so thrilled that you were putting your experiences and your approaches into book form. The fact of the matter is, most of the time when I have every friend, acquaintance, and their cousin and grandma telling me they're going to write a book or asking if they should write a book, I spend most of my time dissuading people from writing books. A, because I think they'll be just redundant or not a great value add, and then on top of that, I really just don't want to be forced to read them.

   10. PCDr. Paul Conti2:15

       [laughs]

   11. TFTim Ferriss2:16

       And my feeling with you is very much the opposite. You're such a deliberate, thoughtful, and skilled practitioner.

   12. PCDr. Paul Conti2:24

       Thank you.

   13. TFTim Ferriss2:25

       And I also, of course, value you as a friend. But I've had a chance, and I'm not gonna disclose details necessarily, uh, but, uh, I've seen you really intervene and quite likely save lives. And I, I can't say that for many people. So it's a real honor to have you on. I've been looking forward to doing this for a very long time. I have the highest opinion of you.

   14. PCDr. Paul Conti2:53

       Thank you.

   15. TFTim Ferriss2:54

       Just to establish that upfront. And, uh, with all of that, let's jump in. And I would love to hear, also because my memory needs refreshing, but for people listening, how you ended up in psychiatry.

   16. PCDr. Paul Conti3:10

       Yeah. Thank you. And, uh, I want to thank you for your support when I was really figuring all this out and deciding I really want to write a book. And it's such a leap to take that your, your support and encouragement about how that would be a worthwhile endeavor and could, could really make a difference was so helpful to me two and a half years ago and, and before then, too. So I, I, I'm so appreciative of that. And it's sort of part of my circuitous route, you know, that, um, I had no pre-medical classes, uh, in college, and I had a business career and, and, you know, at some point in time, I, I realized that my, my... what has unified my interests across time was really about people. So, you know, I studied history and political science and art and, and I was very interested, but ultimately it was really in the people, right? And, and that's what... And this was also fueling my interest in business, was the people I was engaging with, and what were they like, and how did they have these thoughts that got them to where they're at. And, and it was that sort of unifying element that led me to go back to medical school and think, "Okay, I'm gonna learn about human biology and just learn something about human beings." And it was there that I realized, like, oh, you can take this medical knowledge, right, and, and you can take the sort of life knowledge, right, of whether it's history or politics or sociology, just knowledge about human beings, right? And you can, you can put that together with an individual person, right, who's sitting in front of you and talking about them, like the specifics of their life and their experience, and you can put all that together and, and really be helpful to people, like really make a, a, a concrete difference that you can see that there's a change. And, and that was ultimately so appealing to me, and I felt like I could get that through psychiatry. And I think I found that to be the case. I'm so grateful for the vagaries and the idiosyncrasies that ultimately led me to be able to see all of this and choose it as a career.

   17. TFTim Ferriss5:08

       Hmm. I have many follow-up questions, uh, but we're going to... We're, we're gonna kind of flash forward to current day, and then we're going to flash backwards. So I want to read a little snippet from the forward in your book. And I think you'll recognize this. [laughs]

   18. PCDr. Paul Conti5:28

       Okay.

   19. TFTim Ferriss5:29

       And then I'm gonna ask you to add context.

   20. PCDr. Paul Conti5:31

       Okay.

   21. TFTim Ferriss5:32

       "Why didn't you bring me a real doctor?" I asked the nurse.

   22. PCDr. Paul Conti5:35

       [laughs]

   23. TFTim Ferriss5:36

       Paul replied by saying, "I'm an Italian from New Jersey."

   24. PCDr. Paul Conti5:39

       [laughs]

   25. TFTim Ferriss5:39

       And that's when I decided I was willing to talk to him. My dad is an Italian from New Jersey, so I figured I at least knew what I was dealing with. Whose words are these?

   26. PCDr. Paul Conti5:49

       Th- those were the words of Stefani Germanotta, who's also Lady Gaga, uh, on our, our first meeting. I think our... What I would describe as, I think our, our auspicious first meeting.

   27. TFTim Ferriss6:00

       [laughs] So, so she wrote the forward. Uh, to Trauma: The Invisible Epidemic. Of course, you didn't start off with clientele or clients, patients, uh, like her.

3. 6:18 – 12:29

   Paul’s personal history with trauma

   1. TFTim Ferriss6:18

      Uh, could you tell us a bit about, since we've mentioned the title a number of times, uh, your own personal history with trauma, if you'd be, be open to sharing?

   2. PCDr. Paul Conti6:30

      Sure. You know, in the first part of my life, say up until around early 20s, um, I didn't have major trauma in my life, and i- in some ways I was fortunate to get through the big developmental milestones without major trauma. And, and it gave me a sort of view of life that was then deeply challenged by a, a sequence of traumas that, that sort of came in the second part of my life. And seeing how they made me feel differently about things because I had the, a sort of foundation of confidence, right, in myself, and also in the predictability of the world, that if I'm engaging and doing the right things, the good things are gonna come back to me, right? And, and how differently I felt, you know, one, after my brother's suicide, which was the f- the first of a, a series of, of, of, of quite traumatic things that unfolded over a number of years. The, the, the challenge of that, of realizing that while I'm trying to figure out my way through this, and like how to go on with life and how to s- support my parents, right, and, and the people around me, while I, I have an awareness that like I am different, right? That now I'm, I'm seeing the world differently, and all of a sudden I, you know, maybe I feel a little bit like, like, am I cursed? Is, is my family cursed? Is, is anything gonna be okay? Maybe bad things always happen, right? And, and it w- was, i- it was... Once, so I was so off balance, right? And, and in a way, kind of i- impacted, impaired even by all of this, and realizing that, wait, can I even trust how I'm thinking?

   3. TFTim Ferriss8:08

      Hmm.

   4. PCDr. Paul Conti8:08

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

   5. TFTim Ferriss8:47

      Thank you for sharing. Uh, and I just want to echo, uh, some of what you're saying in my own personal experience with depressive episodes, which I've-

   6. PCDr. Paul Conti8:59

      Yeah

   7. TFTim Ferriss8:59

      ... had as a, a mainstay [laughs] of sorts-

   8. PCDr. Paul Conti9:03

      Uh-huh

   9. TFTim Ferriss9:04

      ... for most of my life, and it's, it's, it's, it can be very terrifying and certainly disorienting, say, in the middle of a depressive episode, to be aware that you are looking at the world through a distorted lens, but to have no confidence that you can correct that lens.

   10. PCDr. Paul Conti9:26

       Right.

   11. TFTim Ferriss9:26

       It can be very terrifying because you feel like your, uh, the prism through which you're looking at reality is broken, and you're aware there's a problem, but you can't look through that broken prism to fix the broken prism, or, or so you might believe. And it can be, uh, extremely, uh, disorienting and sometimes destabilizing, for sure.

   12. PCDr. Paul Conti9:51

       Right.

   13. TFTim Ferriss9:51

       And I, I wanted to ask if you might be willing to speak to some of the other traumatic events and to, to place us in time, uh, starting with perhaps your brother. How old were you when your brother committed suicide?

   14. PCDr. Paul Conti10:07

       So I was 25 at the time. 25 years old.

   15. TFTim Ferriss10:11

       Hmm. And, uh, are you willing, if you are, uh, willing to share, would you be open to mentioning some of the other things that happened to you? And the reason I'm asking about this is not to, uh, sort of inflict pain in revisiting these things-

   16. PCDr. Paul Conti10:29

       Sure

   17. TFTim Ferriss10:30

       ... but rather to share your personal experiences because there are very likely going to be people listening who will identify with different parts of your story.

   18. PCDr. Paul Conti10:40

       Sure. No, I, I, I understand, and I think it, it is helpful. The context is, is helpful, and I think it does... it, it speaks to the impact of repeated traumas, right? That not long after my brother's death, one of my best friends, a person I grew up with, uh, died, uh, died very unexpectedly. You know, we were in our mid-20s. Um, several years down the road, my wife was injured, and injured quite seriously. I lost another very close friend in, under very tragic circumstances a, a couple years after that. Um, there were other traumas i- i- that, that were interspersed that weren't at that level, so there was a, there was a sense of like continued negative things happening. My mother, uh, became ill with pancreatic cancer, um, and died not that long after her diagnosis. And, um, and that was very painful for, for very many reasons in- including the feeling that my brother's suicide and the impact upon the family had maybe pr- predisposed her, right-

   19. TFTim Ferriss11:48

       Hmm

   20. PCDr. Paul Conti11:48

       ... to getting sick, which, you know, there, there may be some truth to that, there may not. We can't know the answer. But the- but that oppressive feeling of, of like there's one bad thing after another, and I can't control any of it. And, and a- amidst it, if I'm not really grasping to- ... g- to keeping a hold on m- my sense of self, that I could potentially lose that too, or a sense of my place in the world, right? The, uh, idea-

   21. TFTim Ferriss12:15

       Right

   22. PCDr. Paul Conti12:15

       ... you described of say, what amounts to learned helplessness, right? That says I, you know, I-

   23. TFTim Ferriss12:19

       Absolutely

   24. PCDr. Paul Conti12:19

       ... I see these bad things. I see what they're doing to me, but I don't think I can change any of it, that I c- there was a real danger of that, you know, throughout that whole period of time.

4. 12:29 – 15:08

   Defining trauma

   1. TFTim Ferriss12:29

      And if we focus on this term we've used now a number of times, trauma, uh, how do you suggest people think about or define this term? Uh, now I'll probably do this quite a bit in our conversation just to ensure that everyone understands the way in which we're using certain-

   2. PCDr. Paul Conti12:49

      Mm-hmm

   3. TFTim Ferriss12:49

      ... terms. Uh, but how, how would you suggest people think of, think about trauma and if there are subsets or different types of trauma, perhaps what those are?

   4. PCDr. Paul Conti13:02

      Sure. I would describe trauma as anything that causes us emotional or physical pain that surpasses our coping mechanisms, that makes us feel then overwhelmed, often overwhelms our, our nervous system, right? B- both m- body and mind. Uh, and then really leaves a mark on us as we move forward. And, and trauma can be acute, right? A, a single traumatic event, a, an assault, a car accident, um, a, an injury in combat, right? Uh, these trauma can be acute. It can also be chronic, so the, the chronic impact of say, ongoing abuse or ongoing neglect or even ongoing marginalization, right? And we see so much of this has come to the forefront, whether that's gender identity or it's, it's racial, right? I mean, how, how many people are trying to exist and doing their best to not just to thrive but doing their best to survive amid circumstances that are constantly telling them that they're less than or that they're at s- at special risk, right? That- that's chronic trauma. And vicarious trauma comes from really this wonderful fact that we can, we can be empathic and empathically attuned to other people, and we can feel what they're feeling. I mean, that's a wonderful thing that we can do that for one another, but it also makes us so susceptible to other people's suffering and pain, and we can lose the boundaries of what is us and what is them. I mean, I'm not the only physician to, to, to say that, that, that at times, especially in the intensity of the training period, would, would have to really stop and, and say, "Okay. W- wait a second. What is happening now is happening to someone else, not to me," because if I don't maintain that boundary, I'm, I'm too overwhelmed to help them, right? But, but i- i- if one is em- empathically attuned, which many, many people are, then, then we don't bound ourselves from other people's suffering. So there's acute trauma, chronic trauma, and vicarious trauma and, of course, an overlap. There can be an overlap between them, too.

5. 15:08 – 22:45

   Dealing with trauma

   1. TFTim Ferriss15:09

      S- I'd like to, you know, since we're also, you and I, catching up ourselves as friends-

   2. PCDr. Paul Conti15:14

      Yeah

   3. TFTim Ferriss15:14

      ... not just doing an interview-

   4. PCDr. Paul Conti15:15

      Mm-hmm

   5. TFTim Ferriss15:16

      ... I'd like to share an experience maybe in the last category.

   6. PCDr. Paul Conti15:23

      Okay.

   7. TFTim Ferriss15:23

      And, you know, I, I don't wanna g- it's not, I don't wanna give it a capital T. Uh, but, uh, I've had a, a new experience, and I've never passed through this type of shift in myself, I don't think.

   8. PCDr. Paul Conti15:38

      Huh.

   9. TFTim Ferriss15:38

      Uh, an acquaintance, uh, I don't wanna say friend, but someone I know had a horrible family tragedy not long ago.

   10. PCDr. Paul Conti15:45

       Oh, goodness.

   11. TFTim Ferriss15:46

       His teenage daughter was killed in a head-on collision-

   12. PCDr. Paul Conti15:49

       Oh my

   13. TFTim Ferriss15:50

       ... with a, uh, a large truck, like a Mack truck. And, uh, for reasons that I, I don't think w- were necessarily determined, her car just s- just swerved ever so slightly into the incoming lane and dead, dead on impact. And since that news... And I've, I get exposed to tragedies every day. I mean, if you look at the news-

   14. PCDr. Paul Conti16:14

       Right

   15. TFTim Ferriss16:14

       ... you buy the newspaper, I mean, there are tragedies everywhere. So I don't know why this had such a, a disproportionate, I don't wanna say disproportionate, but such a large impact when I'm exposed to tragedy of other types all day long. But I have had, uh, extreme anxiety while driving almost every day since that happened.

   16. PCDr. Paul Conti16:39

       Right. I can understand that.

   17. TFTim Ferriss16:40

       Yeah. And I don't wanna take necessarily an anxiolytic just to mute the anxiety or to suppress the symptom. But in a, in a case like this, just because perhaps it's, um, maybe easier to tackle than something like the childhood abuse that I experienced, uh, when I was really young-

   18. PCDr. Paul Conti17:02

       Yes

   19. TFTim Ferriss17:02

       ... how might someone approach this or th- with or without professional help?

   20. PCDr. Paul Conti17:08

       Mm-hmm.

   21. TFTim Ferriss17:08

       And maybe this isn't the, the forum in which to discuss it, but I'd love to hear any thoughts you might have because I've, I've never experienced anything like this before.

   22. PCDr. Paul Conti17:18

       Mm-hmm. Ac- uh, Tim, I think it's a great forum for it be- because it, it, it speaks to a, a common problem, right? And a, and a general principle in, in approaching the problem. We have to divert our attention from our instability a- a- at the unpredictability, right, o- of the world around us. Like, on some level, like, we know that kinda anything could happen, right? And, and we're, we're not safe from moment to moment from tragedy, right? But we have to sort of set that aside, where it's kind of in the periphery of our mind, and that's what lets us be able to go on and, like, live our lives, right?

   23. TFTim Ferriss18:00

       Right.

   24. PCDr. Paul Conti18:00

       And, and things will happen sometimes that really resonate with a person. Now, here it may be that something makes you really identify with, with this person even though they're an, an acquaintance and, say, not one of your closest friends, right? Or it just may be that something about the story or even something about your own condition, right, the fertile ground inside your mind when you hear the story- Right?

   25. TFTim Ferriss18:25

       Yeah.

   26. PCDr. Paul Conti18:25

       That, that, that makes it, it resonates with you, and then in this, like, that's a very classic aspect of vicarious trauma. Then, then it resonates and you feel as if, like, that's happened. You get some shadowing of, like, what that must feel like for that person.

   27. TFTim Ferriss18:43

       Yeah.

   28. PCDr. Paul Conti18:43

       Right? And then it shakes y- your sense of stability and predictability, and its ability to control the world around you and be safe.

   29. TFTim Ferriss18:50

       Yeah.

   30. PCDr. Paul Conti18:51

       And that starts making you feel insecure, vulnerable, right? Like, it's a natural response, and the thing to do about it is to validate it, right? So that's, that's really the, the primary point I would say in response, is to validate it, because what people most often do is the opposite. It's, it's unpleasant. It's, it, it, it feels so bad that the person wants to say, "Oh, there's something wrong with me. Why am I feeling this way about, uh, about this? Like, it didn't happen to me. This isn't one of my, someone in my close family." Like, and, and we try and, try and to, to somehow invalidate, right, what you're experiencing instead of saying, "No, it's, it's understandable. This is reminding you of something that you do actually know is true, but, but it's bringing it to the forefront of your consciousness, the vulnerability, the unpredictability-
6. 22:45 – 25:24

   The current state of trauma treatment

   1. TFTim Ferriss22:45

      Uh, thank you for listening and for, uh-

   2. PCDr. Paul Conti22:49

      Okay

   3. TFTim Ferriss22:49

      ... s- talking through it.

   4. PCDr. Paul Conti22:50

      Okay.

   5. TFTim Ferriss22:51

      How would you describe the current state of treating successfully or unsuccessfully, or anywhere in between, trauma? What is, what is the, the sort of current standard of care and, and what do you make of, of some of the tools in the toolkit?

   6. PCDr. Paul Conti23:12

      I, I, I think the, the, the short answer to the question is by and large abysmal.

   7. TFTim Ferriss23:18

      Yeah.

   8. PCDr. Paul Conti23:19

      And I think that's not because, you know, the people in the helping roles, like, don't want to do their jobs or aren't capable of doing their jobs, but we, we've evolved a system that, that pervades mental health care w- largely without attention to the actual human being, right? And this is a huge problem, right? If you think about the shortening of visits. I mean, h- how much can you really talk about even who you are or what's going on in you in, in the kind of brief, often rushed and infrequent appointments that we have i, i- in our health system? And an over-reliance on medicines, right? Which, which leads to a paradigm that just wants to basically take a symptom inventory.

   9. TFTim Ferriss24:05

      Right.

   10. PCDr. Paul Conti24:06

       Say, "Well, tell me an inventory of your symptoms." And I used to say this sometimes when I was teaching, where I would give an inventory of symptoms of a, of a, a person who had a rock in their shoe, right?

   11. TFTim Ferriss24:17

       [laughs]

   12. PCDr. Paul Conti24:17

       And then often at the other end of that would be like, "Well, what do you think is going on?" And, and people would often say, "Attention deficit disorder," right? Because, you know, the person's not paying attention to things or distractible, right? But, but i- if we just take symptoms, like, we will get it wrong.

   13. TFTim Ferriss24:33

       Yeah, absolutely.

   14. PCDr. Paul Conti24:34

       And we'll get it wrong a lot, and getting it wrong isn't benign. It's just n- it's not that, oh, no help is given because it w- because- We got it wrong. No, it's actually that harm is done, and the symptom inventory, you know, make a diagnosis or several diagnoses and then throw, by and large, medicines at the diagnosis, um, just doesn't work. And what we end up doing is, like so much in the American healthcare system, we spend so much, right? But we are at the bottom in terms of ad- industrialized countries of, of outcomes, right? And that's because we waste so many resources by not looking in depth at the actual problems, and I think we, we, we do a very poor job at identifying and processing trauma for, for all of those reasons.

7. 25:24 – 27:02

   Better trauma treatment outside the US

   1. TFTim Ferriss25:24

      Are there any places, this could be a country, a city, it could be specific clinics, that stand out to you as being on the opposite end of the spectrum?

   2. PCDr. Paul Conti25:38

      Sure.

   3. TFTim Ferriss25:39

      Either highly effective or, at the very least, more effective with addressing trauma.

   4. PCDr. Paul Conti25:45

      You know, I have some information and, and data about what's going on in, in some of the European countries, but not enough to comment really with any authority. Um, I think that most of what goes on in America ends up being, uh, a very low bar, right, and a very formulaic purveyance of care. There are exceptions, so for example, The Bridge to Recovery, which is a place that Peter has talked about and I think is a, is a place that really sets an example of, of, of how to be different. And of course, it's a residential facility, right? And not everyone needs to or can go to a residential facility. But that route of approach of really understanding the people, right, and, and understanding developmental trauma, even if the, the reason the person is coming to care isn't specifically the developmental trauma, but realizing that p- people are, are... We're all a whole, right? We're, we're a whole person with our feelings, memories, right, th- that evolve in us over time. And, uh, so they do a, a wonderful job of looking at the whole person. They're certain- certainly not the only entity that does that, including, you know, individual practitioners, right? But by and large, it is, it's hard to find systems that, that will treat trauma from a holistic perspective.

8. 27:02 – 29:49

   Unearthing the cause of trauma

   1. TFTim Ferriss27:02

      How do you find the proverbial [laughs] or metaphorical rock in the shoe? And by, and by that, uh, I know you were giving an, a sort of an illustration of a, of an exercise when teaching, but beyond symptom inventory, how do you begin to unearth the causes at play with someone?

   2. PCDr. Paul Conti27:30

      What I find so interesting about this is it's actually not that hard if you can build a rapport with someone-

   3. TFTim Ferriss27:38

      Mm

   4. PCDr. Paul Conti27:38

      ... where they feel like, "Okay, you're not looking to fault me," right? "And y- you're not looking to stigmatize me," right? "And you're, you're actually interested in me, interested in what's going on in me." So you know, I, I, I wouldn't say to everyone, "I'm an Italian from New Jersey," right?

   5. TFTim Ferriss27:56

      [laughs]

   6. PCDr. Paul Conti27:56

      But, but the thought of, "Hey, this could-

   7. TFTim Ferriss27:58

      That's not your opening salvo. [laughs]

   8. PCDr. Paul Conti27:59

      It's, it's not my consistent opening salvo, right?

   9. TFTim Ferriss28:02

      [laughs]

   10. PCDr. Paul Conti28:02

       But when someone is, is, you know, you could tell is in pain and you're thinking, "Look, uh, is there, is there a route i- in which we can connect?" Right? And you know, Stephanie is an Italian from New York, right? [laughs] There's a similarity, right, that can then establish a rapport that can then lead the person with whom I'm trying to establish the rapport to, to really feel like, "I, I can talk to you," right? "I can, I can talk, period. I can talk openly." And, and it's, it often leads to right where we need to go, right? 'Cause, you know, people often are aware of, like, what's going on inside of them, what triggers them, what's going on in that, the tape that's playing in their head all the time, right? H- how do they feel badly about themselves? What's their internal dialogue about themselves? And when, when you let people start talking, very often they'll talk about it even if they never have before. They might have had treatment for depression in 15 different settings, never talked about trauma. I mean, by the way, I see this a lot. That's not just, you know, a theoretical example, because no one's asked about it and been, and been open to it, and that reinforces the idea of, of shame and stigma. No one's even a- no one's asking about this, even though we're ostensibly here to talk about my mental health, right? That reinforces the messaging of stigma and shame. But if you give people an open venue to talk, it's, it's, it's remarkable how it can come to the fore, be processed or validated or challenged, however may be. It's just an, an, an openness to it which involves a milieu that allows for that to happen, which is something other than very, very rushed, like, "Okay, we have 15 minutes. Let me, let me hear your symptom inventory so I can write a prescription, and then the next person can come in."

   11. TFTim Ferriss29:41

       Yeah.

   12. PCDr. Paul Conti29:41

       Like, that's never conducive to, to openness and sharing, but if we make environments that are open to that, really good things happen.

9. 29:49 – 36:00

   The good, the bad, and the ugly of treating trauma

   1. TFTim Ferriss29:49

      I would love to ask a question that, that might pop to mind for listeners as well. And w- as just a backdrop, you know, I've thought a lot about trauma. I'm not... I wouldn't consider myself a, a domain and expert, but, uh, had experiences of sexual abuse when I was very small and, uh, cons- you know, consistent regular abuse for several years from two to four-

   2. PCDr. Paul Conti30:13

      Sorry

   3. TFTim Ferriss30:13

      ... at a babysitter's house. And so I've thought and read, uh, quite a bit related to trauma, but I think it's important to note, and please correct me if I'm not getting this right, but that you are not a hammer looking for nails with trauma in the sense that you-

   4. PCDr. Paul Conti30:33

      Right

   5. TFTim Ferriss30:33

      ... cover a very broad spectrum of-

   6. PCDr. Paul Conti30:36

      Yes

   7. TFTim Ferriss30:37

      ... different conditions, issues, wants, questions with, uh, with patients. And- It seems to me that there, there's probably a potentially damaging, just like the symptom in- inventory is, is not neutral necessarily. It can result in, in very bad outcomes.

   8. PCDr. Paul Conti30:57

      Right.

   9. TFTim Ferriss30:57

      I've done some reading on controversy related to, say, suppressed memories, right?

   10. PCDr. Paul Conti31:03

       Right.

   11. TFTim Ferriss31:03

       So I'm sure there are therapists who actually do a lot of damage by trying to fit a narrative of trauma to every patient that they have-

   12. PCDr. Paul Conti31:13

       Absolutely

   13. TFTim Ferriss31:13

       ... in some way. And so I'd, I'd love to just hear you comment on, uh, sort of the, the good, the bad, and the ugly within the discipline, let's just say, or skill set of, of treating trauma.

   14. PCDr. Paul Conti31:28

       So the first thing I would say is, you know, I never made a conscious decision to say, "Hey, I'm gonna be a trauma person." Right?

   15. TFTim Ferriss31:35

       Right, right.

   16. PCDr. Paul Conti31:36

       I mean, w- what I saw was, "Oh, this is running through, like, everything that I'm doing." And at the time I really first started seeing it, I had an open general practice, and I was seeing what are the commonalities across people that I'm seeing, right? Socioeconomic, demographic background, you know, diagnosis, right? What, what are the commonalities? And of course, I saw how often substances w- were playing i- into what was going on, and I saw even more strongly than that how often trauma was playing into what was going on, whether that was depression or anxiety or insomnia or even the evolution of psychosis or the triggering of bipolar episodes. I mean, there was just so, so, so much that was keyed to trauma. And, and that's what really, like, captivated my attention and then grew my interest and my research and clinical approaches to it. So I, I, I think it's, it's there, and it's, it's quite pervasive, but it, of course, isn't the answer to everything, right? And, and yes, if, if, if you have the hammer and you want to see all nails, then, then that's what we see, right? And I think we have to be very, very careful because, you know, w- we often, as, as human beings, we develop sort of allegorical ways of understanding things, right? And we can do that consciously and also unconsciously. So the idea of recovered memories from the, from the perspective of, oh, that person had no idea that that thing had happened, right, and now they know that it has happened, is something we, we just must be skeptical about in a way that's careful, right? I don't mean skeptical in a way of trying to invalidate a person, but, but being careful because if a story that's not actually true becomes that person's touchstone for truth, right, that is not good for that person. And it can be, it can be very damaging for others who then may be falsely accused of something, for example, right? Most of the time, a- a- and I've been doing this for 20 years, and I would say the vast majority of times when someone is now talking about a memory that they haven't talked about before, it is not because they had, did not have that memory before. It's because it was riding i- in the sort of boundary being ab- above and below consciousness, and they, they know that that's there, but they don't let it into consciousness or let alone put words to it, right? And then there's a way in which the memory or the experience the person has talked about fits with their internal world before it came to the fore, right? As opposed to it, in a sense, kind of coming out of the blue, which we just need to be more careful about for the sake of that person who may have had that come out of the blue, right? Because maybe that's true, but maybe that's not. And if it's not, it's not helpful to them. And it's potentially risky to others if that makes sense. And, and I think the more that we work against stigma, like, you know, I'm saying this because I believe with all my heart that it's true, that, that your willingness to talk about your own trauma, right, is, is so powerful and so powerfully helpful because you're pushing against reflexive stigma, right? Because trauma makes reflexive shame and reflexive stigma, and that's what makes people go underground, so to speak, with their trauma. And, and that's where confusion comes in, right? A, misery gets compounded. Confusion comes in because people are alone with something that's terrifying them, and they're alone over time, and their own brains can evolve in ways that maybe sometimes are helpful but maybe sometimes are not helpful, right? So the more that we work against stigma and shame and say, "Look, w- w- what is there that's happened to a person that that person should not be able to talk about with trusted others?" Whether, whether that's trusted friends and family or clergy or, or helping, people in helping fields, right? That, that a person should be able to, to talk about what's going on inside of them because it's, it's burying those unhealthy seeds, so to speak, that, that then compounds, you know, compounds original trauma into something that can end up being far, far worse with a whole cascade of problems. Could be depression, could be substances, could be self-harm, could be an eating disorder. There's so much that gets compounded when the original trauma gets pushed outside of consciousness and outside of communication.

10. 36:00 – 37:15

    Not why the addiction but why the pain. —Dr. Gabor Maté

    1. TFTim Ferriss36:00

       It brings to mind for me something, and I'm paraphrasing here, that someone named Gabor Maté shared on the-

    2. PCDr. Paul Conti36:08

       Yes

    3. TFTim Ferriss36:08

       ... podcast quite a few years ago. And again, I'm not getting this word for word, but [clears throat] he spent a lot of time working with, uh, opiate addicts in British Columbia and elsewhere.

    4. PCDr. Paul Conti36:20

       Yes.

    5. TFTim Ferriss36:21

       And he is fond of saying we shouldn't ask why the addiction. We should ask why the pain.

    6. PCDr. Paul Conti36:29

       Yes.

    7. TFTim Ferriss36:30

       And certainly in my exposure to addiction, my best friend from childhood died of a fentanyl overdose and, uh-

    8. PCDr. Paul Conti36:40

       Sorry

    9. TFTim Ferriss36:40

       ... brother's best friend from childhood, uh, you know, died in a drunk driving accident. Um-

    10. PCDr. Paul Conti36:46

        Mm-hmm

    11. TFTim Ferriss36:47

        ... lot of substance abuse, uh, where I grew up on eastern Long Island. And my uncle actually recently died of [laughs] I'm not laughing because it's funny, but, uh, alcohol-induced, uh, cardiomyopathy. His wife, my aunt, died of Percocet plus alcohol. So I've seen a lot of addiction, and I, what Gabor says really resonates with me.

    12. PCDr. Paul Conti37:13

        Yes.

    13. TFTim Ferriss37:14

        And

11. 37:15 – 45:40

    Most effective treatments

    1. TFTim Ferriss37:15

       I would love to, if you're open to exploring some of the tools in the toolkit, and I'm not implying that, uh, you have all of-- you utilize all these modalities in your, uh, clinic, in your practice. But for those people out there who are wondering, and we're gonna talk about the framework of the book and how you put it together and what people who don't have access to Paul Conti might expect to learn and, uh, be able to apply from the book. But before we get there, you know, in the last handful of years, as you know, I've been hoovering up [laughs] a lot as a, as an enthusiastic amateur and have found certain things personally very helpful.

    2. PCDr. Paul Conti38:03

       Mm-hmm.

    3. TFTim Ferriss38:03

       Uh, like IFS, Internal Family Systems, I found very helpful. I've helped fund some studies with different formats of therapy like CBT or is it DBT?

    4. PCDr. Paul Conti38:16

       Yes.

    5. TFTim Ferriss38:16

       Dialectical Behavioral Therapy.

    6. PCDr. Paul Conti38:18

       Yes.

    7. TFTim Ferriss38:18

       And then I'm hoping, I think I am in the-- I think I've already funded or my s- my foundation has funded a study involving... These acronyms get really tricky after a while. Uh, Cojoint or Conjoint, something that is conjoint and similar to [laughs] CBT. But-

    8. PCDr. Paul Conti38:36

       Okay

    9. TFTim Ferriss38:36

       ... uh, D maybe. But the, the idea being that you are using, in this case, therapy, MDMA-assisted therapy for not just the s- the individual who experienced trauma, and I think-

    10. PCDr. Paul Conti38:53

        Okay

    11. TFTim Ferriss38:53

        ... in this case, it's veterans, but also the spouses.

    12. PCDr. Paul Conti38:56

        Yes.

    13. TFTim Ferriss38:57

        Uh, so there are all these different approaches. People may have heard of EMDR, which I don't have much experience with. But all of these various tools in the toolkit. Are there particular... And this may not be a good question, but, uh, I'm curious, so I'll ask. Are there particular modalities, frameworks, tools that you have found to be particularly helpful in working with individuals who have trauma in their background?

    14. PCDr. Paul Conti39:27

        Sure. No, I think it's a, it's a great question. And I mean, there are many arrows in the quiver, right? And CBT is, is an arrow in the quiver. DBT is an arrow in the quiver. Medicines can be an arrow in the quiver. But where it all has to start is, is a, a search for truth, right? B-because trauma changes our, our emotions about things, right, our feelings and emotions about things. It then changes what w- how we think, right, and what our memories mean. So we need to look at what is the person's narrative about trauma, if they're identifying that there's trauma, and if not, what is the narrative about self, right?

    15. TFTim Ferriss40:09

        Mm.

    16. PCDr. Paul Conti40:09

        Because un- unless we, we understand that, then it's like trying to solve a problem. Say you're trying to solve a math problem, but you don't know what the equation is.

    17. TFTim Ferriss40:18

        Right.

    18. PCDr. Paul Conti40:18

        Like, we're not gonna pick the right tool. We're not gonna get to the right place. So because there's so much reflexive shame and then a cascade that comes after that, right? And a lot of times, that involves, like, a decrease in role performance, right? Where now the person doesn't... They're, they're not performing their role, say, as a parent or as an employee or as a friend as well, right? Then the, the person begins to think of themselves in a different way. And the first thing to get at is what is the person's narrative? So someone who may present and say, "Well, I've, I've, you know, I was really got physically hurt in my last relationship," but, you know, I mean, this is always what happens, or it's never, you know, it's never goes any differently, right? I mean, you have to, you know, instead of looking, okay, let's look at the trauma from this thing that happened to you in your last relationship, you have to look at why is the person approaching the, the whole question of relationships from a place that says things won't be okay for me.

    19. TFTim Ferriss41:18

        Right.

    20. PCDr. Paul Conti41:18

        What are the lessons that that person has learned that are not actually true, right? And you have to go back to why, when did the person start thinking of that? I mean, people don't... I mean, I'm saying it for effect, right? But people don't pop out of the womb thinking, "No one's gonna treat me well. I don't deserve to be treated well," right? "I always get hurt in relationships." Like, where along did that conception come into to play, and how much does that person also maybe feel they don't deserve anything better? Where did that come from, right? And if we go back and we look at the, the formation of a narrative that then furthers and perpetuates trauma, then we can get at changing it, right? But then you have to get at what are the, the pain that the person felt, right, you know, the, the, the emotions involved. You have to go to a place that's emotional. But if you go to that place, the actual events, the emotions, the change in conception of self or conception of the world, then you can come through and say, "Okay, what tools does it make sense for us to apply?" Right? Because there, the arrows in the quiver that you noted and a lot more. But the question is knowing, hey, when does one make sense versus another? And I try and I write a, a lot about strategies, antidotes in the book, right? And, and I, I think they're, they're, you know, in a sense, they're good ideas, but I, I think they're good ideas, but they're good ideas only if they're applied in the right situation to the right person. So it goes back again to understanding the person, what happened to them, and how, what is their narrative of themselves and what the world can or can't be for them.

    21. TFTim Ferriss42:51

        Well, let's, uh, get personal, and I'll be the one to get personal just as a way-

    22. PCDr. Paul Conti42:56

        Okay

    23. TFTim Ferriss42:56

        ... of exploring this.

    24. PCDr. Paul Conti42:57

        Sure.

    25. TFTim Ferriss42:58

        Uh, if you're, if you're open to it.

    26. PCDr. Paul Conti42:59

        Sure.

    27. TFTim Ferriss43:00

        And it's hard, maybe it's impossible to say, "I feel X because of Y," right? I mean, [laughs] if it were a scientific study, it'd be very hard to-

    28. PCDr. Paul Conti43:08

        Mm-hmm

    29. TFTim Ferriss43:08

        ... get to conclusive results. Nonetheless, there's certain, you know, events in my life and abuse, abuse experiences and so on that I think have formed my worldview or informed my worldview.

    30. PCDr. Paul Conti43:26

        Yes.
12. 45:40 – 51:43

    Antidotes for hypervigilance

    1. PCDr. Paul Conti45:40

       uh-huh.

    2. TFTim Ferriss45:41

       Do you have any antidotes for hypervigilance? Do you have, uh, a way of thinking about it or approaching it that we could, we could discuss?

    3. PCDr. Paul Conti45:51

       I come back to the first step being to assess and validate. Like, think about the things that you said. There's fundamental truth to some degree, right? I mean, the world-

    4. TFTim Ferriss46:02

       Yeah

    5. PCDr. Paul Conti46:02

       ... is not an entirely safe place, right?

    6. TFTim Ferriss46:05

       Yeah.

    7. PCDr. Paul Conti46:05

       Um, we can't control everything. So it's sort of like too much of a good thing.

    8. TFTim Ferriss46:10

       Right.

    9. PCDr. Paul Conti46:11

       And that's what hypervigilance is, right? Because we're not saying we should have no vigilance, right? I mean, there are threat sensors in all of us that, that are supposed to be kind of firing in the background. You hear a loud noise, you pay attention, right? It's supposed to be in the background. But recognizing that, that probably what has pushed, say, that vigilance sensor in you, right, up to, to a much sort of h- a higher place on the scale is, is the impact of trauma, right? Which, which takes reasonable concepts and then builds a whole story around the extrapolation of the concept to some end that is unhealthy and maladaptive, right? So take your, your driving example.

    10. TFTim Ferriss46:53

        Mm-hmm.

    11. PCDr. Paul Conti46:53

        You're, you're prompted, I, I think, from or predisposed, say, from prior trauma, right, to, to have something that kinda hits home really increase the level of tension and vulnerability inside, right? So, so one way of looking at that is to, to validate and say, "Look, I do actually know that it's not completely safe to drive, so I try and have a safe car and drive carefully." Like, I, I know all of that, right? But because I hear an example of, of something really tragic that occurred while driving, then that vigilance sensor wants to build the whole story around that and wants to say, "That's gonna happen to you."

    12. TFTim Ferriss47:32

        Right.

    13. PCDr. Paul Conti47:32

        The chances of that are happening are so high, right? And now it starts capturing your attention, and it starts reinforcing itself, right? And then if you're thinking on top of that, "God, what's wrong with me that I keep thinking that?" That calls attention to it too, right, and further reinforces it. But by validating that, "Hey, I'm an empathic person that, that heard about a terrible tragedy, and the circumstances of that tragedy are gonna resonate within me and, and make the hypervigilance in me a- attached to that. I, I know this. I understand this." I can step back to, say, reality testing, of saying, "I do actually know that there's some danger to driving. I do actually take precautions," right? I... The... Me learning about this tragedy isn't actually making me less safe, and maybe it has me reflect. Is my car as safe as I want it to be? Is there actually something I can take away from it, right?

    14. TFTim Ferriss48:24

        Mm-hmm.

    15. PCDr. Paul Conti48:25

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

    16. TFTim Ferriss48:48

        Yeah.

    17. PCDr. Paul Conti48:49

        And that's a place where another example could be where medicines could be helpful. And again, I'm not saying this because I don't know n- enough of the specifics, but sometimes a little bit of medicine for a short period of time can help push back- The extra attention and the extra vigilance to the point where things can then go back towards normal. So, so there's so many psychotherapy and, and medication tactics that can be used, but it starts with what is the truth of this?

    18. TFTim Ferriss49:13

        Yeah.

    19. PCDr. Paul Conti49:13

        What is it actually telling a person? What does it mean to them? What's the narrative about it, and how do we ground ourselves to the truth of it as opposed to shame and self-recrimination, even feeling bad that you feel bad, right?

    20. TFTim Ferriss49:25

        Right. And just for clarity, the, the medicines in this case, say prescription medications, could be used to reintroduce my psychology and physiology to a state of non-hypervigilance so I can sort of recalibrate and recognize it as a possible state, and that is done without the intention of chronic administration or never-ending administration. It is, it is given for a short period of time.

    21. PCDr. Paul Conti50:02

        Right.

    22. TFTim Ferriss50:02

        Or maybe it's short. I don't know. I guess that's relative.

    23. PCDr. Paul Conti50:05

        But that, that often is effective, and you can go sort of, say, top-down from brain to body, but you can also go, as you were saying a couple minutes ago, you can go bottom-up from body to brain, right? Because tension in the brain makes all sorts of problems in the body, and one, one very strong example of that is the impact of muscle tension. So there might be muscle tension, for example, between the ribs, and now the person feels a little bit short of breath, right? Or there's muscle tension in the GI system, and now the person is having IBS symptoms, right? Or muscle tension in the legs, and now there's restless leg symptoms. We can go the other way of looking at the body and ways of trying to relax the body and decrease the tension in the body because that decreases the signaling that goes back to the brain.

    24. TFTim Ferriss50:48

        Mm-hmm.

    25. PCDr. Paul Conti50:48

        What we don't want is a cycle where brain is tense, sends those signals to body, body gets more tense, sends those signals to brain. That gets more tense, and you can see we can be in a vicious cycle there. So, you know, we have a mind-body connection. Whether, whether we choose to pay attention to it or not, it's still there, and often if we're not paying attention to it, it's not that that's neutral either, but that that can, can be quite negative. So looking at the whole person, where do you hold your tension? How do you experience your tension? How much in the way of words do you need to put to this? How much in the way to physical interventions should you be doing? Should there be any medicines? But a- again, we're looking at the person. Like, that becomes very specific to you, as it should be, right?

    26. TFTim Ferriss51:32

        Mm-hmm. Well, I, I would love to ask a question that is specific to you, and this might be a, a bit of a left turn, but I think it would be... I, I'm personally very curious,

13. 51:43 – 57:49

    Coming to terms with his brother’s death by suicide

    1. TFTim Ferriss51:43

       if we could go back to your brother's suicide, and I know it's probably not the easiest thing to talk about, but that is a... I mean, it's, it, it sounds like, uh, it's hard for me to conceive of a, of a larger event, at least in the vicarious trauma category. What are the things that helped the most in terms of coming to terms with that or healing from that to the extent that you have?

    2. PCDr. Paul Conti52:18

       Sure. I mean, I'll start by saying, you know, I had no mental health e- education or experience at the time, so my initial responses, like, weren't very healthy, right? I mean, I felt like, "Oh, it's my fault. I should have known," right? "I, I should have been a better brother," right? I was probably fairly depressed myself and drinking too much and, and all sorts of other things that, that I was still, like, going along with life but feeling very oppressed and, and feeling oppressed not just externally but inside, right? So, so this idea that trauma changes how we think about ourselves, and then we're trying to recognize that. It's like trying... looking in the mirror and saying, "Is that me?" But you don't really remember what you looked like yesterday.

    3. TFTim Ferriss53:07

       Right. Yeah.

    4. PCDr. Paul Conti53:08

       So that was very scary and, and a lot of the ways in which I handled it were not helpful or healthy. So ultimately, when I think how did I get through that, it, it was interconnections with other people were absolutely indispensable, that there were people around me who cared about me, who were then reflecting back to me like, "No, you're a good person and a, and a terrible tragedy has happened to you," which is, like, very helpful because they, they could see me because they, they knew me and they knew me before the tragedy. It was me who couldn't see me, and they were basically communicating, you know, "This, something awful has happened, but you're the same person you were before, and that's a capable person and a caring person," right? And that was immensely helpful to me and, and some of that was through friends and family, and also I went and got some psychotherapy, which people weren't really doing. Like, where I grew up, you know, people didn't go to therapy, right?

    5. TFTim Ferriss54:07

       Where did you grow up?

    6. PCDr. Paul Conti54:08

       Outside of Trenton, New Jersey.

    7. TFTim Ferriss54:10

       Mm-hmm.

    8. PCDr. Paul Conti54:11

       And it just wasn't in the culture. So for me, going and getting therapy even was like something, do I feel embarrassed about that? Is it... Do, do, you know, do healthy people ever do that? Is that just for crazy people? Like, that, you know, that was, that was how it was thought of. So I had to do something that I think did have some bravery to it of saying like, "Hey, l- let me..." I had to be honest with myself is, "I, I'm not doing okay," and, and I'm getting help from people, right? And there are people who care about me, but there's professional help too. And I, you know, I just found a therapist, and she was very, very helpful to me in, in that basic grounding way. So the, the, the impact of others was so helpful because otherwise I, I think I probably... There's a good chance I would have never w- seen myself the same way again in, in a way that could have just been worse and worse and worse, and that's ultimately what led me to is just kinda come to a full stop and, and look at how I was handling my life. And, and like there's silver linings. I, I do believe if we work hard enough towards them, there can be silver linings to anything, no matter how bad it is. And a silver lining was I looked at myself and I, you know, I'd wanted to go to medical school, but I thought, "I'm too old." Why? Because I was 25, right? [laughs] Like, that's not too old, right?

    9. TFTim Ferriss55:26

       No.

    10. PCDr. Paul Conti55:26

        But I, I thought I was, or I couldn't leave my job 'cause I was making a good income, and, and if I went to medical school, I'm not gonna... I'm gonna pay. And, you know, all these things were in my head, and people were saying to me, "You're too old. You can't walk away from your job, and it's gonna cost..." There were so many things that I realized, like, don't matter. I'm like, "Look, I, um, I have my life and I'm, I'm, you know, healthy enough that I can go do what I want to do. Now, go do those things." Right? And, and it was actually quite helpful to me in deciding I am gonna leave my job, and even though I haven't taken a single pre-med course, I'm gonna go apply. And, you know, it, it led me to, to feel emboldened, but I had to get to a place where I could see myself as a worthwhile and capable person. That's how I saw myself before his suicide, but there was a whole period of time when I didn't see myself that way, and it was really other people, both personally and professionally, that were sort of, for me, a bridge to a place I was not gonna be able to get on my own.

    11. TFTim Ferriss56:24

        Mm-hmm.

    12. PCDr. Paul Conti56:25

        And I think that's the case for many of us, and when people don't have access to people who care about them, people who can help them, you know, we... unfortunately, there's a lot of secondary tragedies that, that come of that because we're interconnected as human beings, and we are not kind enough and helpful enough. They, you know, I, I write about like compassion, community, and humanity, and these basic principles that I think we should be following because I don't think they're rocket science. I think they're simple, yet we don't follow them and then we're not there for each other in ways that I think we wanna think that we are, right? But we often, we're not living that in the world around us.

    13. TFTim Ferriss57:04

        Thank you for sharing.

    14. PCDr. Paul Conti57:06

        You're welcome.

    15. TFTim Ferriss57:06

        And you've turned into one hell of a bridge yourself, so.

    16. PCDr. Paul Conti57:11

        Thank you. That means a lot to me to hear.

    17. TFTim Ferriss57:13

        Yeah, it's, it's true. It's true. I, I would love to hear you, uh, because I, I haven't seen the, the latest and greatest. I saw V1. I saw version one of the-

    18. PCDr. Paul Conti57:26

        Uh-huh

    19. TFTim Ferriss57:26

        ... manuscript and [laughs] you saw, you saw my... [laughs] Uh, I read it with great interest and, and gave you a, a, a, probably more, more feedback than, uh, [laughs] any reasonable person would want. Uh, but it was-

    20. PCDr. Paul Conti57:41

        I needed it. I needed that feedback.

    21. TFTim Ferriss57:44

        It was strong. I'm sure it's, it's grown and developed.

14. 57:49 – 1:01:18

    Paul’s new book, Trauma: The Invisible Epidemic

    1. TFTim Ferriss57:50

       What is the format of the book? Could you lay out the basic structure of the book?

    2. PCDr. Paul Conti57:58

       Sure. You were very, very helpful to me and, and the few people that I asked to look over that original manuscript really guided me in, in the same two ways, which was towards having more of a voice that is like just a natural voice when I'm maybe talking to someone. And I can tend to become a little too academic as opposed to like, look, uh, that's not how I want to be, right? So I, I, I'm trying to write in a way, or I've tried to write in a way that is just, it's plain and clear and, and thereby hopefully effective, right? And, and the other recommendations were about incorporation of stories.

    3. TFTim Ferriss58:34

       Yeah.

    4. PCDr. Paul Conti58:35

       The things in my own life or in my work, which is part of my life, right, that, that, that really emphasize the concepts. And, and that's what the, the book is, is like. It's, it's m- meant to be read by anyone and everyone who has an interest in the subject material, and it's very personalized about me and the examples in the world around me that illustrate the concepts. And with that in mind, there are four parts to it. So the first is what is trauma and how does it work? So that's talking about, you know, the, the definition of trauma and the facets of, of post-trauma syndromes and how they impact people. So the cascade of henchmen of trauma, right? Starting with shame and, and, and the, all the others that come along with shame. So that's with the first part of the book. The second part is the big picture, so that's the part that's the, the sociology of trauma, of looking at, look, how is this happening in the world around us, which, my goodness, has come to a fever pitch with the pandemic and, and just the spotlight on systemic racism and race- racial injustice in the world around us, and also on this erosion of faith in our socioeconomic foundation. Can you work really hard and get ahead? Like, how, how does that work now compared to how it worked fifty years ago? So that's the, the second part of it. And in the third part, I- I'm... That, that's where it's sort of called an owner's manual for your brain, right? Where I'm trying to, to really look at how does this work in the brain? H- what's the difference between the logic systems and the limbic or emotional systems in our brain? How do we find meaning in our memories? How do our memories change when our limbic system changes the emotion tied to memories? How does trauma cascade through mind and body? So that's the, the third part of the book. And then the, the fourth is like how we can beat trauma. Because I, again, I do not want this to be esoteric in any way, shape, or form. Like, the idea is that this is well-grounded in the practical. Like, what can we do and change now? Which means it has to be... there have to be things that we can employ and that we can employ individually and in small groups of people and in larger groups of people, which brings us back to some things that, that... Well, actually, the majority of it really comes down to, like, simplicity, and there's a common sense to it that I'm advocating for in the fourth part of the book. But I'm trying to use the whole book to get us to the place where, like, these doable, practical things are, are really at the forefront of our minds, and, uh, the person reading the book can feel like, "Right, I can do those things, and I can do them now." And I can advocate for them in the world around me, and that's what really, you know, brings it, th- the idea that we're gonna, we're to have knowledge and the knowledge is gonna make change.

15. 1:01:18 – 1:04:20

    Paul favorite story from the book

    1. TFTim Ferriss1:01:18

       Are there any particular stories in the book, I'm sure there are, that we haven't discussed that have resonated with proofreaders and those who have had a chance to read it? Do any come to mind?

    2. PCDr. Paul Conti1:01:35

       So m- my favorite story, my favorite part of the book, might be my favorite story ever in, in my own life, which I had, uh, shared. You, I don't know if you... If I remember, it was a while ago, but you, you really did like this, and that made me feel good.

    3. TFTim Ferriss1:01:49

       [laughs] I believe it.

    4. PCDr. Paul Conti1:01:50

       Because it's a positive story. Like, there are stories that are about how people get to the point where, like, really bad things have happened, right? And that's part of us understanding. But there, there are stories about overcoming, too. And, you know, my Uncle Rango, who was such a, a, a dear, beloved person in my life, is someone whose early life didn't look like things were gonna go that well, right? He had a sixth-grade education and not a lot of guidance and support, and then was drafted in the Second World War and experienced some horrible, horrible things during the war. But through those experiences, developed a sense of self that, that said, "I am a conscientious person. I am a strong person. I'm a person who can do difficult things, and who can do difficult things for reasons that are so s- strong that they, that one can't look away from them." And a person who can do that, those things should not feel ashamed of themselves, right? Should feel a sense of pride amidst a recognition of tragedy. And, and even with a sixth-grade education and the limits that that kind of, of, you know, lack of exposure to the bigger aspects of, of the world and even of how our minds work, was able to really understand that and have a very, very good life. And part of why he had a good life, I think, was the silver lining of the trauma that he experienced in the Second World War because he came out of it with a sense of self that said, "You know what? You're not a delinquent loser," right? "You're the opposite of that. You're, you're someone who leads men to safety when they're otherwise likely to be killed," who, who does, and I won't sort of give away the, the story, but does something incredibly difficult that haunted him his whole life because in his opinion, uh, which I, I think I don't understand what else there could have been to do but what he did, because that was what was in front of him, and he didn't see it as his fault in a sense that would have brought him shame.

    5. TFTim Ferriss1:03:48

       Hmm.

    6. PCDr. Paul Conti1:03:48

       If that makes sense. And that's why I think it's my favorite story. And even before, when I was younger, I was able to put all this together, I could see reasons to feel... that made me feel proud and made me see hope in that. Even when I was quite young, his story was very empowering, even though we didn't know the details. He never would tell us the details. But we knew what he had come through and that he was this decorated war hero, and we felt proud of him because he felt a sense of pride in himself.

    7. TFTim Ferriss1:04:14

       Hmm. That's right. I do remember Uncle Rango.

    8. PCDr. Paul Conti1:04:17

       [laughs] Yes.

    9. TFTim Ferriss1:04:18

       I do. How could one forget?

16. 1:04:20 – 1:05:55

    What is selective abstraction?

    1. TFTim Ferriss1:04:20

       [laughs] Could you speak to or define selective abstraction? Because this, this is something that might be worth digging into.

    2. PCDr. Paul Conti1:04:31

       Sure. Selective abstraction is when we take one detail from a big picture, and we construct the story of that whole big picture around the detail.

    3. TFTim Ferriss1:04:45

       Mm-hmm.

    4. PCDr. Paul Conti1:04:45

       An example, it's probably a common example, but even in my own life, is, like, I can come to work and I can have a good day at work and feel like I'm doing good things and I'm helping people. I generally can feel good about things. But then if I can't find my keys when I'm leaving, and this is like what's really happened, and then, you know, I'm frustrated now, and I'm frustrated with myself. And when I finally find my keys, or I get people to help me find my keys, the narrative that's going on in my head is like, "What a loser," right? "I mean, you can't even find your car keys to drive home. What the hell is wrong with you?"

    5. TFTim Ferriss1:05:17

       [laughs]

    6. PCDr. Paul Conti1:05:17

       And like, that's the story, and then I can get home, and, like, my wife could ask me, "How was your day?" I'm like, "Ugh," you know [laughs] "It was a terrible day because I'm incompetent," right? Because, like, I built the story of the whole day around what? The salient negative.

    7. TFTim Ferriss1:05:32

       Right.

    8. PCDr. Paul Conti1:05:32

       The thing that triggered in me, you know, my own susceptibility to thinking I'm not, I'm not good enough, and what I'm doing isn't worthwhile enough, and oh, look what's wrong with me. And that's selective abstraction because that was probably ten minutes of my day, but my brain builds the whole story of the day, which is my story of myself, right, around that negative thing.

    9. TFTim Ferriss1:05:54

       Hmm.

17. 1:05:55 – 1:10:39

    On learned helplessness

    1. TFTim Ferriss1:05:55

       Yeah, it's, uh, selective attention is a hell of a thing, right? It's, uh, [laughs] it's like you buy that n- you buy a new car, [laughs] and all of a sudden everyone's driving the same car. But of course, [laughs] those cars are already out there. You're, you're just paying more attention now.

    2. PCDr. Paul Conti1:06:13

       And that's so big because this is all about salience biases. What are we paying attention to, right? And trauma makes us pay attention to the negative. That's why we think the world is less safe of a place or that we're less competent people. Like, this is the danger that we, we, we use selective abstraction and salience biases and attribution biases, where something negative happens, then I'm gonna attribute it to me. And I see this all the time where, you know, something negative may happen next door a person had nothing to do with, but they, they feel that it's their fault. Because we get enough of this in ourselves, and we, we literally forget who we are or what we're worth, which is why people will stay in jobs that they hate when they could try something different, or they'll stay in abusive relationships when they could end the abusive relationship and not enter another one, right? It's this, this... Where does all that end up? It ends up in learned helplessness, and learned helplessness pushes people towards more trauma and very often towards death.

    3. TFTim Ferriss1:07:16

       Could you say more about that? When you say towards death

    4. PCDr. Paul Conti1:07:20

       Because the, the accumulation of trauma makes people more and more desperate for ways of, of coping.

    5. TFTim Ferriss1:07:27

       Yeah.

    6. PCDr. Paul Conti1:07:27

       It's like, you know, you had maybe, you had talked about drug addiction, and we talked about the decrease in role performance and the shame that comes along with it and the stigma.

    7. TFTim Ferriss1:07:35

       Right.

    8. PCDr. Paul Conti1:07:35

       I mean, nobody decides, "You know, I'm gonna use drugs because what I, what I wanna do is ruin my life." Like, no one makes that decision, right?

    9. TFTim Ferriss1:07:43

       Yeah.

    10. PCDr. Paul Conti1:07:43

        So if we look at, as you were saying, Dr. Maté was saying, is like look at the pain in the person. Like, where did that come from? And not always, but a lot of times, where, where drug abuse and drug addiction comes from is it's p- comes from pain and suffering and a desperation to feel different. So more pain and suffering means people are more likely to repeat maladaptive patterns that lead them to more trauma, and they're more likely to feel desperate for soothing in a way that can, for example, pave the way to substance use.

    11. TFTim Ferriss1:08:17

        Hmm.

    12. PCDr. Paul Conti1:08:17

        Because the bli- imagine like a set of blinders that it starts off, they're outside of our peripheral vision. So they're not affecting us at all. But as time goes on, they can encroach more and more and more as a person has more trauma, less healthy coping mechanisms, a more negative view of self, a more negative view of the world. And then the blinders come in, and at some point, the blinders are so narrow that all the person sees, it could be ba- is basically a helpless and hopeless picture.

    13. TFTim Ferriss1:08:45

        Hmm.

    14. PCDr. Paul Conti1:08:45

        Right? And that's where a lot of suicide comes from-

    15. TFTim Ferriss1:08:48

        Yeah, absolutely

    16. PCDr. Paul Conti1:08:49

        ... and where a lot of accidental deaths come from. So often the goal is when I think about what are we doing in trauma treatment, and the image that's, uh, in my head a lot is I imagine a set of, of blinders. A person is just peeking through with one eye, and we're trying to pull them out so they see the breadth of truth, right? The breadth of their perspective allows that person to again see truth. And remember, oh, like an example. You know, I absolutely understood at one point in time that violence is not acceptable in my life, right? I understood that, and I don't believe that any less now than I did then. But boy, I kind of forgot it in the middle.

    17. TFTim Ferriss1:09:30

        Mm-hmm.

    18. PCDr. Paul Conti1:09:30

        Because the person forgot that they could have a life free of violence or that they deserve a life free of violence. That's where this narrowing of blinders and the, the change in emotion and how emotion impacts our memories and tells us what our memories mean, right? The memory of something happy with other people can go from being a memory that says, "Right, I can do anything and I can interact with people and they like me and want me to be around," to a, a memory of something that's impossibly lost for the person.

    19. TFTim Ferriss1:09:58

        Yeah.

    20. PCDr. Paul Conti1:09:58

        And again, that's not true. But if you see it as impossibly lost, it is, unless there's some process that leads you to a place where you remember what's true that you forgot.

    21. TFTim Ferriss1:10:11

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

    22. PCDr. Paul Conti1:10:33

        Right

    23. TFTim Ferriss1:10:33

        ... fix-all of any type, and it's particularly common with what I'm gonna mention, which is psychedelics.

    24. PCDr. Paul Conti1:10:38

        Yes.

18. 1:10:39 – 1:21:20

    On the place of psychedelics

    1. TFTim Ferriss1:10:39

       But as we're talking, if we, for the time being, include MDMA in the category of, of psychedelic just to make it a little easier to discuss even though one could argue it doesn't cleanly fit in that category.

    2. PCDr. Paul Conti1:10:55

       Right.

    3. TFTim Ferriss1:10:55

       But as an empathogen, it is remarkable to me how patients, say, going through the MAPPs trials, phase III trials, and so on, can recontextualize memories that for decades have had a fixed emotional tenor.

    4. PCDr. Paul Conti1:11:19

       Yes.

    5. TFTim Ferriss1:11:20

       And suddenly they're able to go back and, with a decreased fear response, unwrap that memory, recontextualize it as an adult with better coping mechanisms-

    6. PCDr. Paul Conti1:11:33

       Yes

    7. TFTim Ferriss1:11:33

       ... and sort of reinstall it, so to speak.

    8. PCDr. Paul Conti1:11:37

       Yes.

    9. TFTim Ferriss1:11:37

       It's really a fascinating, replicable phenomenon-

    10. PCDr. Paul Conti1:11:42

        Yes

    11. TFTim Ferriss1:11:43

        ... for a lot of patients. How do you think about, i- if you do at all, psychedelics, their use, abuse, roles, misapplications? Where's your current thinking?

    12. PCDr. Paul Conti1:11:54

        So my understanding from the research, the really consistent reports, right, it tell me that there's something immensely powerful here that has the capacity to do an immense amount of good. But we have to be careful with anything that's even moderately powerful, let alone very powerful, and that we're figuring out how to deploy these kinds of tools to do something amazing. And, and I say that in like the full meaning of that word, right? Because what they seem to be able to, to help people do is to look at trauma, right, from the perspective of truth without the reflexive shame that says, "Someone else hurt me. What's wrong with me?" Right? "Why am I being hurt?" Right? Like, that's the reflex, and it generates shame that imagine how our perspective is already immediately altered, right? If trauma arouses shame, then the trauma itself immediately alters our perception mechanisms that we can use to understand the trauma and navigate our way through it. And I think that goes hand in hand with this idea that, you know, we value so highly as human beings the outer parts of the cerebral cortex, the parts that are uniquely human. The parts that let us, for example, have a language, and, and the five senses, which I know, understand they're not uniquely human, but th- these are the parts, though, of the outer cortex of the brain, our ability to plan and to pr- project into the future, and we value these so highly. But we do that in a reflexive way. Why do we value that just because the endpoint of the cortex is the farthest the brain has grown outward, right? That's the part that is abutting up against our skulls, right? But, like, we don't do that with roads. I don't say that i- if-

    13. TFTim Ferriss1:13:51

        [laughs]

    14. PCDr. Paul Conti1:13:51

        ... a road is going somewhere I want to go, that, oh, but it's better to keep going. Maybe that road dead ends in a muddy place I can't get out.

    15. TFTim Ferriss1:13:59

        Yeah.

    16. PCDr. Paul Conti1:13:59

        I mean, what may be happening is that there's a brain stem that's the earlier part of the brain, right? The first part of the brain that's about, like, the basics of survival, right? Temperature regulation, sex drive, appetite, right? And then at the other end of the spectrum, there's the cortex that is about the things that we need in order to sort of keep us alive, and that may be, like, what the five senses are about, for example. That this is about, like, in a sense, vigilance, and it's about keeping us alive, and that's important. But it may be that the brain stem, whi- which is sort of about just staying alive, and the cortex, which is about staying alive in a different way by monitoring and navigating our environment, are less interesting than what is in between, right? So that's where the amygdala is, Grand Central Station for negative emotion and the, the emotion that impacts vigilance. The hippocampus, which is about memory. What's the hippocampus connected to? The amygdala, right? So the limbic system and emotion is so important to what, w- how we remember things and the meaning we put in memories. And to the insular cortex, a part of the brain that it may be that the insular cortex is really about life lived or life felt and understood, and that these medicines, along with psychotherapeutic tactics can do this, too, and judicious use of standard medicines can help do this, where we're living more in the part of the brain that can actually understand and assess what life is about, right? And it may be that the psychedelics altering the default mode network and changing how the brain is communicating, where the seat of the brain's existence consciously and unconsciously is at, opens up the ability to get out of the cortex and into the part of the brain that says, "Gosh, something terrible happened. Like, what is that and what does that mean?" Right?

    17. TFTim Ferriss1:15:53

        Right.

    18. PCDr. Paul Conti1:15:54

        Without all the, the reflexive loading of guilt and shame, the million thoughts we may have had that can perpetuate guilt and shame and a narrowing of perspective.

    19. TFTim Ferriss1:16:04

        Yeah, that's an excellent way to put it. It's almost as though, you know, before we consciously think about trauma, for, uh, many of the people who have suffered trauma, if not most, there's almost a boot up sequence in the background, which is what you're about to think about or talk about was your fault because you're flawed.

    20. PCDr. Paul Conti1:16:27

        Yes.

    21. TFTim Ferriss1:16:28

        And if that is the canvas upon which all subsequent thoughts are painted-

    22. PCDr. Paul Conti1:16:33

        Right

    23. TFTim Ferriss1:16:34

        ... you can predictably experience [laughs] a very challenging interpretation of yourself and of, of events.

    24. PCDr. Paul Conti1:16:46

        That then gets reinforced, right? 'Cause that challenging interpretation gets reinforced the next time you think about it, and the next, and the next, and the next.

    25. TFTim Ferriss1:16:52

        Yeah. You talked about the default mode network. I mean, this is, this is obviously a, a topic, uh, sometimes a controversial topic of conversation among the neuroanatomists and researchers looking at psychedelics. There are a number of aspects also that as we're talking are of, of great interest and, of course, a lot more research is needed to delve deeper and even confirm the sort of therapeutic implications of what I'm about to, to say. But-

    26. PCDr. Paul Conti1:17:19

        Right

    27. TFTim Ferriss1:17:19

        ... you know, one is sort of bottom up, which is neurogenesis.

    28. PCDr. Paul Conti1:17:25

        Mm-hmm.

    29. TFTim Ferriss1:17:25

        So if, if certain psychedelics like psilocybin, as found in psilocybe mushrooms, uh, or synthesized for that matter, has, uh, neurogenerative effects in places like potentially the hippocampus and elsewhere, and at least anecdotally seems to have some effect on TBI in veterans, for instance.

    30. PCDr. Paul Conti1:17:50

        Mm-hmm.
19. 1:21:20 – 1:38:42

    Treatment options

    1. PCDr. Paul Conti1:21:20

       Yes.

    2. TFTim Ferriss1:21:20

       So within that massive list of options and, uh, all of the available options, what are some of your preferred options? And feel free not to answer this if you don't want to. But i- if we were looking at a case, say, of hypervigilance and you-

    3. PCDr. Paul Conti1:21:36

       Yes

    4. TFTim Ferriss1:21:36

       ... you wanted to put someone on a short cycle, uh, or I should say a, a l- a finite cycle of a compound or compounds, um, what, what are at the top of the list, and how do you go about selecting for someone?

    5. PCDr. Paul Conti1:21:55

       The first thing to say is, is we have all these arrows in the quiver, right? And, and the empathogens are, are potentially these new wonderful arrows in the quiver, but we need to understand them, and there can be a tendency to overestimate benefit and underestimate risk. So there's research going on that says, "Hey, th- these can be just fantastic tools in the quiver. We need to understand them better," right? And as that research is coming along, what I believe we should also be doing is looking at the arrows we already have in the quiver that we are not utilizing effectively.

    6. TFTim Ferriss1:22:32

       Definitely.

    7. PCDr. Paul Conti1:22:32

       And that includes all the psychotherapy modalities that get underutilized, right? Because we're just taking inventories of symptoms and trying to treat a symptom and call it good. The same is true of medications, that if we're really paying attention to people and to what's going on in them, we can then actually target symptoms, but we're targeting symptoms and understanding what the big picture is like.

    8. TFTim Ferriss1:22:56

       Right.

    9. PCDr. Paul Conti1:22:56

       Right?

    10. TFTim Ferriss1:22:56

        Exactly. There's an outcome beyond suppression.

    11. PCDr. Paul Conti1:22:59

        Right.

    12. TFTim Ferriss1:23:00

        Or there, there's a target, there's an intention beyond just alleviation of symptoms.

    13. PCDr. Paul Conti1:23:05

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

    14. TFTim Ferriss1:23:42

        What class of, of drug would that be?

    15. PCDr. Paul Conti1:23:45

        So, like, a beta blocker, for ex-

    16. TFTim Ferriss1:23:46

        Beta blocker

    17. PCDr. Paul Conti1:23:46

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

    18. TFTim Ferriss1:24:37

        Yeah. Just because I, I, I love the, the details of this kind of thing, what class of, of compound or drug might fit that last example, right? The distress signaling prior to bed.

    19. PCDr. Paul Conti1:24:52

        Yeah. This is one of the interventions, it may actually be the intervention, I gotta think hard about that, that has the most success. If not, it's in the top three, which is using medicines that are called antipsychotics, but that's a terrible name. It's saying just because-

    20. TFTim Ferriss1:25:08

        [laughs] Terrible branding, yeah

    21. PCDr. Paul Conti1:25:09

        ... the medicines are... Yeah, but just because they're used for that doesn't mean that's all that they do, right?

    22. TFTim Ferriss1:25:15

        Absolutely.

    23. PCDr. Paul Conti1:25:16

        It's such a misnomer to name something by, like, what its first use is, right? Like, I don't call a, a dollar a baseball card buyer, even though that's probably the first thing I bought with a dollar, right?

    24. TFTim Ferriss1:25:26

        [laughs]

    25. PCDr. Paul Conti1:25:26

        So it, it stigmatizes the medicines, and then they don't get used for this. But, but low dosing of those medicines blocks what are called D2 receptors, blocks receptors that are around distress transmission, and very low dosing is often immensely helpful in situations where there's a lot of distress signaling and that's impacting sleep. So I can't count the number of people I've seen who can't sleep, and they've tried, quote-unquote, every sleeping medicine, and sometimes they actually seemingly have, right? But th- but they're not gonna sleep then because to say, oh, they have a sleeping problem, just pointing out the obvious that they're not sleeping. That's not a medical conclusion, right? But to point out their sleeping system isn't broken, hence no impact from the 15 sleeping medicines, but, but they're distress signaling. ... is now increased because of some tr- new trauma or triggering of an old trauma or vicarious trauma, then we can solve that often very readily.

    26. TFTim Ferriss1:26:23

        Yeah.

    27. PCDr. Paul Conti1:26:23

        And, and that leads back to, you know, you were talking about the empathogens and the idea of neurogenesis and, and it may be that y- neurogenesis is very helpful in certain parts of the brain. It may be that neuronal pruning is helpful in other ways, too, right?

    28. TFTim Ferriss1:26:37

        Yeah, that's a good point.

    29. PCDr. Paul Conti1:26:38

        What we're, what we're really trying to understand is what positively impacts connectivity.

    30. TFTim Ferriss1:26:43

        Mm-hmm.
20. 1:38:42 – 1:39:02

    Dopamine as a currency of distress

    1. TFTim Ferriss1:38:42

       apply.

    2. PCDr. Paul Conti1:38:42

       Right.

    3. TFTim Ferriss1:38:42

       What does the D in D2 stand for in the receptor that you mentioned with respect to, I believe it was the antipsychotics?

    4. PCDr. Paul Conti1:38:50

       Dopamine.

    5. TFTim Ferriss1:38:51

       Dopamine?

    6. PCDr. Paul Conti1:38:51

       Yeah.

    7. TFTim Ferriss1:38:51

       Yeah. All right. Just wanted to check.

    8. PCDr. Paul Conti1:38:53

       Dopamine is a currency, right? So these people say, "What does dopamine do?" It's like saying, "What does a dollar do," right? It depends on where we're spending it.

    9. TFTim Ferriss1:39:00

       Yeah.

    10. PCDr. Paul Conti1:39:00

        And in these particular

21. 1:39:02 – 1:42:07

    What is a diathesis–stress model?

    1. PCDr. Paul Conti1:39:02

       circuits, dopamine then becomes a currency of distress, and if there's enough of it, a currency of psychosis. So, so these ... 'Cause sometimes people think of dopamine as pleasure, right?

    2. TFTim Ferriss1:39:12

       Yeah.

    3. PCDr. Paul Conti1:39:12

       So why are we doing anti-dopamine things? In these particular circuits, that's not what dopamine's buying, right?

    4. TFTim Ferriss1:39:18

       Yeah.

    5. PCDr. Paul Conti1:39:18

       It's a currency of distress, and we wanna play that down.

    6. TFTim Ferriss1:39:22

       All right, man, I could talk to you for hours and hours. We've done it before.

    7. PCDr. Paul Conti1:39:26

       Thank you. [laughs]

    8. TFTim Ferriss1:39:27

       Uh, yeah.

    9. PCDr. Paul Conti1:39:27

       Yeah.

    10. TFTim Ferriss1:39:27

        This is-

    11. PCDr. Paul Conti1:39:28

        Yeah

    12. TFTim Ferriss1:39:28

        ... I just, I find it so endlessly interesting. And what, what, what makes it-

    13. PCDr. Paul Conti1:39:33

        Thank you

    14. TFTim Ferriss1:39:33

        ... also so fun to spend time, uh ... One of the, the additional reasons it's so fun to spend time chatting with you is that you are not isolated in an ivory tower working with-

    15. PCDr. Paul Conti1:39:48

        Right

    16. TFTim Ferriss1:39:48

        ... hypothetical cases. Like, people come to you for help and solutions. [laughs]

    17. PCDr. Paul Conti1:39:55

        Yeah.

    18. TFTim Ferriss1:39:55

        So you are a, [laughs] an active clinician who is working with, with real patients. You know, I, I have a, a note here, and I'm definitely gonna need you to, to help me elucidate this, but the stress diathesis model?

    19. PCDr. Paul Conti1:40:12

        Oh, sure.

    20. TFTim Ferriss1:40:13

        Am I saying that correctly?

    21. PCDr. Paul Conti1:40:14

        Well, uh-

    22. TFTim Ferriss1:40:14

        What i-

    23. PCDr. Paul Conti1:40:15

        ... stress diathesis, which also-

    24. TFTim Ferriss1:40:17

        Oh

    25. PCDr. Paul Conti1:40:17

        ... gets called a, a vulnerability stress model.

    26. TFTim Ferriss1:40:19

        Diathesis.

    27. PCDr. Paul Conti1:40:20

        [laughs]

    28. TFTim Ferriss1:40:21

        Oh, boy. I knew I was gonna fuck that one up. All right.

    29. PCDr. Paul Conti1:40:23

        Some of those words we like in medicine-

    30. TFTim Ferriss1:40:25

        [laughs]
22. 1:42:07 – 1:44:26

    Resources for more information

    1. TFTim Ferriss1:42:08

       are there any particular resources that you might recommend for people who are interested in, in learning more about trauma from credible sources?

    2. PCDr. Paul Conti1:42:23

       You know, I think NAMI, which is, which is present throughout the, the country and has local branches throughout the country, N-A-M-I, that, that NAMI can be extremely helpful. Uh, the, we can often find resources and have links to good people.

    3. TFTim Ferriss1:42:40

       What does NAMI stand for?

    4. PCDr. Paul Conti1:42:42

       NAMI stands for the National Alliance on Mental Illness.

    5. TFTim Ferriss1:42:46

       National-

    6. PCDr. Paul Conti1:42:47

       And NAMI often has resources and links to support mechanisms in the community, and I think can be very, very helpful. The book The Body Keeps the Score by Dr. van der Kolk i- is also a very, very helpful resource. And a- a- anything that helps a person to, to, to find some s- inner peace i- inside of them, something that takes away from the swirling inside of us that can happen post-trauma, and the swirling from the social circumstances around us. Anything that helps us get away from what's keeping us in the same loops that lead us further from truth, whether it's the truth of our own trauma or the truth of the trauma going on in the society around us. The response to the pandemic, the impact of systemic racism, the erosion of faith in our socioeconomic model, like, these, these can be seen through a political lens.

    7. TFTim Ferriss1:43:38

       Existential distress related to climate change and things like that, for instance.

    8. PCDr. Paul Conti1:43:43

       Right. Right. I mean, the- these things can all be seen through a political lens, and because they get politicized, it takes people away from actually looking at, like, what's really going on here? How is it impacting how I'm thinking and feeling? What's the truth of all of this, right? Anything that takes us away from, from getting lost in the politicizing of things and more towards the apprehension of the true existential nature of these things. So, so there are a lot of helping resources and things that we can do to get us into a calmer place inside. Um, and I know that's a kind of a nonspecific answer, but there's so many routes of, of proceeding towards that, that I, I wanna mention that, you know, that too.

    9. TFTim Ferriss1:44:24

       Absolutely.

23. 1:44:26 – 1:47:40

    Parting thoughts

    1. TFTim Ferriss1:44:26

       Paul Conti. Paul Conti. Dr. Paul Conti, C-O-N-T-I, .com. PacificPremierGroup.com. We will link to all of these things, everything we've mentioned in the show notes. The new book, which I highly, highly recommend everybody pick up, take a look at it, get it for people who need it, is Trauma: The Invisible Epidemic, subtitle How Trauma Works and How We Can Heal From It. I'm such a fan of yours. I don't say that lightly. We've spent real time together. I've seen the results of, of what you do. You are a, a, a in the trenches practitioner, and, uh, I'm just so glad that your work, you personally, and this book are going to be available, uh, to more people. So thank you for, for taking the time.

    2. PCDr. Paul Conti1:45:20

       Thanks so much, Tim. Absolutely.

    3. TFTim Ferriss1:45:21

       It means a lot to me. Thank you. Is there anything else you would like to say or, uh, any request of the audience, any suggestion, anything at all that you would like to say in closing comments before we wrap up for today?

    4. PCDr. Paul Conti1:45:38

       I think the one thing I would say is that, you know, our lives and the world around us can seem to us to be very helpless and hopeless at times. We can feel helpless, and the world can seem hopeless, and, and that's not the case. I mean, I cannot describe the number of people I have seen, worked with, who feel that way and really are at risk when they're feeling that way and come out to a different place. That if you're feeling that way, that probably means that those blinders have closed in and closed in and closed in, and there is help for that. There, there really and truly is, and if you're not getting help the first, second, third time, keep trying. There's help there to be had, and it can make just such a difference because those narrowed, the narrowed blinders represent a risk to us that comes from trauma and that we can absolutely do something about and change.

    5. TFTim Ferriss1:46:31

       Perfect place to wrap up, and so nice to see you, Paul.

    6. PCDr. Paul Conti1:46:37

       Thank you. You too.

    7. TFTim Ferriss1:46:38

       Yeah, man.

    8. PCDr. Paul Conti1:46:38

       Thanks so much. It was fun. I knew it was gonna be fun, you know?

    9. TFTim Ferriss1:46:41

       Yeah, yeah, absolutely.

    10. PCDr. Paul Conti1:46:42

        It was fun.

    11. TFTim Ferriss1:46:43

        Yeah, this was, this was a, a really, really enjoyable conversation, uh, very dense. To everybody listening, once again, uh, I will put links to everything we talked about in the show notes at tim.blog/podcast. You can just search Conti, C-O-N-T-I, and it'll pop right up. And until next time, be safe. Uh, be aware of blinders. We all have them.

    12. PCDr. Paul Conti1:47:10

        Yes.

    13. TFTim Ferriss1:47:10

        Pay attention to your stories because you are the author, not just the reader of those stories-

    14. PCDr. Paul Conti1:47:16

        Yes

    15. TFTim Ferriss1:47:16

        ... and they craft your reality. And as Paul said, uh, you are not alone. Uh, this is part of the human condition, uh, and there are people and tools and help available, and there are things that work. So thank you for being here, Paul.

    16. PCDr. Paul Conti1:47:36

        You're very welcome. Thank you for having me.

    17. TFTim Ferriss1:47:38

        And thanks to everybody for listening

Episode duration: 1:48:01