The Art of Manliness - The Myths of Trauma

00:00:00.000 brett mckay here and welcome to another edition of the art of manliness podcast

00:00:10.780 among people who experience some sort of trauma what percentage do you think go on to develop

00:00:15.880 post-traumatic stress disorder a third a half more actually the answer is 10 an overestimation of

00:00:24.280 how common it is to develop ptsd after trauma is one of the misconceptions my guest thinks are

00:00:29.320 leading to its over diagnosis and an underestimation of human resilience dr joel paris is a professor

00:00:35.140 emeritus of psychiatry and the author of myths of trauma why adversity does not necessarily make

00:00:41.040 us sick today on the show joel explains what some of those myths of trauma are including the idea

00:00:46.160 that it's trauma itself which causes ptsd joel argues that ptsd is instead created when exposure to trauma

00:00:52.360 meets an individual susceptibility to it and he explains what psychological biological and even

00:00:58.480 social factors contribute to the susceptibility we also get into how the methods used to prevent

00:01:03.380 the triggering of trauma can backfire and how the treatment for ptsd will be ineffective if it only

00:01:08.540 focuses on processing an adverse experience after the show's over check out our show notes at aom.is

00:01:13.800 all right dr joel paris welcome to the show thank you very much for asking me so you are a psychiatrist

00:01:38.420 who specializes in working with individuals with borderline personality disorder you also do a lot

00:01:43.540 of research on borderline personality disorder but you recently published a book called the myths of

00:01:49.460 trauma where you take readers on a tour of the history and oft overlooked research of post-traumatic

00:01:56.580 stress disorder so why did a researcher and clinician of bpd decide to write a book about ptsd

00:02:03.760 people think that bpd is caused by trauma and that's that you must have had trauma and that's the main

00:02:11.320 reason that you have that disorder and it's simply not true it's an aggravating factor and it's one of the

00:02:18.900 risk factors of several that lead to bpd but people of some people have wanted to actually redefine

00:02:27.040 bpd as a post-traumatic disorder and also since i do a less specialized practice consulting for

00:02:36.840 colleagues about various cases i find that both patients and doctors are all too ready to diagnose

00:02:43.800 anyone with ptsd if they have something bad that's happened to them in their lives and this really doesn't

00:02:49.480 make any sense it doesn't it's an attempt to explain very simply something which is complex interactive

00:02:55.420 and multi-dimensional well we'll dig into these ideas more in our conversation but your book's

00:03:01.680 called the myths of trauma you're not saying that trauma itself this idea is a myth but there are myths

00:03:07.380 around this idea so what are the biggest ones and maybe throughout the conversation we flesh this out

00:03:11.360 some more okay well definitely i'm not dismissing trauma it is important about 25 30 percent of the

00:03:21.480 borderline patients that i see have histories like this but a lot of them don't and so the problems are

00:03:29.100 are many first of all the way the trauma is defined the dsm is too broad and then there's a big discrepancy

00:03:38.880 between exposure to trauma which is almost universal somewhere between 75 and 90 percent versus

00:03:45.420 the frequency of ptsd after exposure to trauma which is like 10 so 90 percent of people who are exposed to a

00:03:53.360 traumatic event don't develop ptsd and ptsd is most clear in a more narrow definition such as a threat of

00:04:03.460 violence or threat to your life or threat of rape these are the things which are more likely to cause ptsd

00:04:11.300 but when people say well i was emotionally abused in my family i mean that's a real thing

00:04:18.300 but it's not the same thing as the other types of trauma in ptsd so i think too broad a definition

00:04:26.120 of the traumatic event and a gap between exposure to trauma and actually developing post-traumatic

00:04:35.500 symptoms are some main myths that i discuss in my book well let's talk about this definition

00:04:41.280 of trauma so you said it's broad it's it's you're arguing that it's too broad how is it defined

00:04:46.920 clinically and how has that definition changed over the past few decades ptsd got into the diagnostic

00:04:53.940 manual in 1980 with the dsm-3 and that was the first time it appeared and at that time it had an

00:05:00.780 narrow definition and it got broader over subsequent editions for example it's mentioned that sometimes

00:05:09.860 just hearing about trauma from somebody else without being directly exposed to it or witnessing it or

00:05:17.420 indirect exposure in the course of your job that these things could be causes of ptsd makes less

00:05:24.120 sense than as a direct threat against yourself and i think this is where a beginning of the trouble

00:05:30.980 begins well why did they make it more broad okay so originally it was if you experienced

00:05:36.120 violence rape etc that was considered trauma it's gotten broader and broader like why why would

00:05:43.340 they do that what's the reasoning behind it there's something called concept creep which a psychologist

00:05:48.820 described a few years ago when you have a concept in psychology or a construct or a diagnosis it tends

00:05:57.880 to be increasingly used with time now then the separate question is why do the writers of the manual

00:06:04.120 agree to agree to expand it well they've expanded many of their diagnoses this is not the only example

00:06:10.340 that's a whole other talk in itself you know about the problems with dsm there may be clinical reasons

00:06:16.880 in that therapists like to make this diagnosis and there may also be political reasons because

00:06:24.160 people have talked about whether we live in a kind of a post-traumatic society or a trauma or traumatic

00:06:31.380 narrative and that people talk about their traumas and and these days i'm hearing from patients they

00:06:38.300 use this language you know even if they haven't read the manual it's out there and it it's popular

00:06:45.120 because i think people would rather be victims of something else than feel there's something inside

00:06:52.780 them which made them more vulnerable to trauma one of the main points of my book is that ptsd is not

00:06:59.060 only a result of the exposure but reflects a vulnerability a susceptibility to trauma

00:07:07.520 of which there are many many causes okay so one of the arguments you make one of the myths of trauma

00:07:12.980 is that we've broadened the definition too much possibly to make it a useful idea and this idea of concept

00:07:18.380 creep we've actually had it was uh nick haslam that's that's that's who i was quoting yeah we had

00:07:23.180 them on the podcast that's episode number 788 for those who want to listen to that i will look that

00:07:27.740 up but you also so you mentioned one of the other myths of trauma i think it's kind of been embedded

00:07:32.140 in our our popular culture psyche consciousness whatever you want to call it is that if someone

00:07:38.200 experiences a traumatic event i think the assumption is well that person's going to have

00:07:42.440 some sort of ptsd it's going to harm them but you highlighted numbers like actually it's very

00:07:48.140 very few people who actually experience a traumatic event go on so what were those numbers again

00:07:51.840 well in general about 10 percent of people who are exposed directly to trauma will develop ptsd

00:08:00.180 later on and the numbers are somewhat higher for certain things like rape is the worst one

00:08:07.980 and that gives you a 20 percent level although that still means that 80 percent of people after

00:08:14.200 rape don't develop ptsd and why do you think this gets overlooked so i think people just yeah i

00:08:19.080 automatically assume if someone experiences a really severe hardship they're going to have

00:08:22.640 some kind of problem they need to go get professional help but you're showing the

00:08:25.660 numbers actually i mean 10 percent i mean it's terrible for the people who do experience it

00:08:30.180 but it's most people they're going to be okay it sounds like well yes this is called resilience and

00:08:36.860 it's a very central concept in psychology and psychiatry and resilience is the rule after trauma

00:08:44.740 and i always say if we weren't resilient we would have gone extinct 100 000 years ago i mean life is

00:08:51.660 much more traumatic in the past than it is today in fact i would refer your listeners to stephen pinker

00:08:58.560 on that subject and so i think from an evolutionary point of view we need to be resilient so i think one of

00:09:06.720 the arguments you make in the book is that this sort of tight coupling between trauma and ptsd that we have

00:09:11.360 in our not only amongst the public but also amongst a lot of clinicians that it might be increasing the

00:09:18.980 diagnoses of ptsd because someone thinks well this person had a traumatic event they automatically have

00:09:24.140 ptsd and you're saying maybe not well i see this all the time because i get rich because i'm evaluating

00:09:31.660 patients i do hundreds of consultations a year so i have a lot of experience with this

00:09:37.680 and if there's almost anything of this sort in the patient's past even just an adverse situation like

00:09:45.600 a dysfunctional family people write in pt after the first diagnosis they still they stick in ptsd as

00:09:52.780 the second diagnosis and some people and this goes into the latter part of my book where i talk about

00:10:00.460 treatment some people will prescribe various kinds of what are called trauma focused therapies

00:10:07.760 even in people who haven't had the kind of trauma which is most likely to produce ptsd

00:10:13.340 and this is a an issue i've heard other clinicians raise concerns about this idea of diagnosing people

00:10:21.880 who probably shouldn't receive a diagnosis because what it does it people begin to take that identity

00:10:27.600 well the shrinks that i had ptsd so i must have ptsd and they start thinking well i have ptsd but

00:10:34.520 then if they would have gone to another psychiatrist they probably wouldn't have gotten that diagnosis

00:10:38.800 and they wouldn't have been thinking themselves as someone with ptsd probably not if they've seen

00:10:43.200 probably less likely if they see somebody like me it doesn't even need a shrink to convince people

00:10:48.400 that they have ptsd people are self-diagnosing all the time and then they talk about oh that's my ptsd

00:10:57.120 acting up or that's my adhd acting up and all these diagnoses which are sort of fuzzy and uncertain

00:11:03.840 become a part of your identity like you said it was a very important point well so okay so most people

00:11:11.940 don't get ptsd let's say someone comes to you saying well i've got i think i got ptsd how do you

00:11:17.880 like as a clinician how are you defining ptsd if you look at a patient like yeah you've got something

00:11:22.700 here we need to help you out what's that look like for you well i i'm following the dsm criteria

00:11:29.820 because the most precise if you look look at it it's basically exposure to trauma followed by certain

00:11:37.020 characteristic symptoms most particularly flashbacks avoiding things that remind you of what happened to

00:11:44.260 you the so-called triggers you know a kind of state of uh of expecting bad things to happen i mean

00:11:52.180 there are all kinds of symptoms which are listed in the manual which are required for the diagnosis

00:11:59.460 above and beyond the exposure and people who have ptsd will probably have them and people who don't

00:12:05.860 will probably not so the research shows that most people who experience a traumatic event

00:12:10.340 they're likely not going to have ptsd about 10 percent 20 in cases of rape so it sounds like if

00:12:17.140 trauma itself doesn't cause ptsd if that's that's my whole point yeah okay trump the trauma itself

00:12:23.340 doesn't cause ptsd but you say there are other factors that can contribute to it so what are those

00:12:29.100 other factors well first of all it was noted many years ago there was a study of australian

00:12:35.680 firefighters they were fighting bushfires which is pretty dangerous work and the nice thing about

00:12:42.120 this study and other similar studies have been conducted since then but this was the first study

00:12:46.820 what they did was they measured some of their personality traits when they started working as

00:12:52.580 firefighters before anything had actually happened to them or before they'd been in a fire

00:12:56.360 and they found that people who have what is called very high trait neuroticism

00:13:01.460 were more likely to develop ptsd after something bad happened in firefighting so trait neuroticism

00:13:10.060 basically is a central concept in personality theory which describes how easily you get upset

00:13:17.260 and how hard it is to calm down and it could be called being thin-skinned or extremely sensitive

00:13:24.680 so people who had more of this were more likely to develop ptsd after exposure and they've done

00:13:31.080 studies like this with policemen and health workers and all kinds of people exposed to trauma so

00:13:37.280 so personality is certainly one of them and i should point out here also that trait neuroticism is partially

00:13:45.000 heritable like all personality traits there's about half of it which is you're born with and the other

00:13:52.300 half is due to your life experience so it's it's a little little bit more complex than that but it

00:13:58.640 has to do with things about you and how you respond to stressful events and not just the trauma itself

00:14:05.300 okay so it sounds like some people are just more susceptible so if they experience a traumatic event

00:14:10.080 if they're high on this neuroticism which as you said part of it is just genetic like just that's

00:14:15.780 the luck of the the draw for you right you're more likely to possibly experience ptsd after that

00:14:22.060 traumatic event absolutely okay anything else besides the the inherent like the the personality

00:14:28.260 any other factors that contribute to a diagnosis or more people being susceptible what i propose in

00:14:33.480 the book is what's called a biopsychosocial theory which has been for many decades a rather influential

00:14:41.720 concept and it's not just for ptsd it's for everything in psychiatry so that you know let me

00:14:49.000 take take a step back and say it's easier for people to think that a causes b and that there's one cause

00:14:55.980 there's one effect and and the world isn't like that the world is multivariate everything is

00:15:01.480 interactional everything that happens to you is complicated every response you have to what happens

00:15:07.600 to you in life is equally complicated and so when we say biopsychosocial we're talking about

00:15:14.080 hereditary propensity and i'll give you another example of the hereditary propensity

00:15:19.220 while i'm at it there was a study of vietnam vets and i mean quite a lot of studies of vietnam vets but

00:15:26.740 this one was a twin study of vietnam vets where they were able to measure the concordance of various

00:15:34.420 mental disorders including ptsd and they found for every feature of ptsd there was a fairly strong

00:15:40.780 heritable component which influenced whether you would get it so so what you're born with is really

00:15:46.360 quite important some people are just born very nervous and it's not always a bad thing because

00:15:51.400 cautious people sometimes live longer than risk takers but it's still something to be then there's a

00:15:58.580 psychological aspect of it and this relates to other aspects of neuroticism and other personality

00:16:06.420 traits and also your life experience so people who've had previous mental disorders particularly

00:16:14.040 those related to anxiety and depression prior to ptsd are more likely to end up with ptsd so

00:16:21.820 or even if there's just a family history we saw that in the australian study that even if there's just a

00:16:28.240 family history they're more likely to develop ptsd so all these psychological factors which affect

00:16:34.020 which increase the risk and then social factors well i do talk about this in the book which is i think

00:16:41.340 the culture of ptsd is part of a larger issue in which people are using psychiatry to validate their

00:16:49.440 sense of victimization in life and people are write memoirs about this and some of them are bestsellers

00:16:57.240 and sometimes you see this on television so there's a whole social structure around it saying

00:17:04.180 it's not only okay to have ptsd in a way it's kind of like almost you should have it because

00:17:10.680 it's a tough world out there and we need to change the world so this some people believe so but the point

00:17:17.780 about the biopsychosocial model is it's an interactive model so it one hit won't give you

00:17:24.300 a mental illness usually it takes two hits three hits maybe more and they all sort of add up and

00:17:31.420 have a cumulative effect and affect each other so that's the model i'm proposing and it leads to

00:17:37.340 a different kind of treatment because i'm sure we'll get to this i don't think that spending all

00:17:43.680 the time discussing the traumatic event itself is always the best idea okay so with this biopsychosocial

00:17:49.980 model it's complex it's non-linear i think a lot of people i think particularly the public you know

00:17:55.500 and just the lay lay individuals they think well if x happened then y happened they're very linear

00:18:00.820 thinking and well it made that way to think linear yeah so i want to talk more about this the social

00:18:06.640 aspects we talked about the the sort of the bio psycho part of this model some people are just born

00:18:11.780 with a propensity to develop mental illnesses including ptsd if they experience severe adversity in their

00:18:17.480 life there's this social model you call it like the culture of ptsd you also talk about the culture

00:18:22.220 of trauma have there been studies done i think you particularly see this in the west in america

00:18:27.600 especially have there been studies done across cultures where they look at say a country in africa

00:18:34.320 or china for example where maybe this idea of trauma and ptsd isn't in the the popular psyche

00:18:41.880 do they have about the same amount of ptsd diagnoses compared to the united states well there are very

00:18:49.180 few systematic or large-scale studies of this kind i mean it's expensive and difficult to find out the

00:18:58.420 prevalence of mental disorders in africa or other developing countries nevertheless i think somewhat

00:19:06.000 partly anecdotally but also based on some of the things i've read from anthropologists

00:19:11.700 and cultural psychiatrists people in other cultures they have to stress that it comes out differently

00:19:19.440 for example fatigue people just take to their bed and they have no energy we used to call that in the

00:19:26.980 19th century psychiatry neurasthenia so these kinds of symptoms tend to be more common in developing

00:19:35.300 countries and i don't know of anybody who's gone out to measure ptsd i've been interested in even in

00:19:43.580 the questions to whether or not there is borderline personality disorder outside the west and uh what i

00:19:51.300 seem to have concluded is that yes in the large in very large cities but no not in places which haven't

00:19:58.860 changed changed in a thousand years and there's something about there i think there's something

00:20:04.260 about the stresses of modern life the pace of change maybe we could even put a little bit of blame on the

00:20:12.120 internet and social media for spreading spreading all kinds of ideas of how to frame your

00:20:16.960 your distress i mean the stress psychological stress is universal but how it comes out is not

00:20:22.860 as universal there's a historian of psychiatry named edward shorter who i think would be interesting for

00:20:31.580 your program he he describes something called the symptom pool and he he documented over the last

00:20:38.020 couple of centuries how symptomatic presentations have changed even in the west and ptsd is probably

00:20:44.920 an example of that but i can't prove it with heart data you cite some research let's see yeah duckers 0.66

00:20:51.060 and bruin they noted a vulnerability paradox in that ptsd is much more common highly developed

00:20:57.660 countries than those afflicted by widespread poverty and then mcnally did a study he said he suggested

00:21:05.480 that the paradox could be resolved if ptsd is more frequent in subpopulations within wealthier

00:21:11.080 countries who are more vulnerable so i guess the idea is that if you grow up in like a very affluent

00:21:16.660 life and you don't have a lot of adversity your standard of what is what is considered adversity

00:21:21.660 is probably lower than those who grew up in really trying circumstances i think that's very true

00:21:28.600 thank you for the close reading of my book and those references because i did discuss them

00:21:33.820 you know although they're not based on extensive data i think those ideas make a lot of sense

00:21:40.060 okay yeah so the thing you're saying again it's like you're not saying that ptsd doesn't exist in

00:21:44.300 these maybe like africa or china or whatever i'm sure i'm sure it does but i suspect at a lower much

00:21:49.960 lower rate or it might manifest itself differently than here in the united states that's right that's

00:21:55.320 what i'm saying yeah it may come out as something else which doesn't look like ptsd and maybe looks a

00:22:00.860 little bit more like depression or anxiety we're gonna take a quick break for your words from our sponsors

00:22:05.240 and now back to the show okay so yeah this bio psychosocial model shows how complex it is there's

00:22:15.000 a lot of factors going on just the way you think about ptsd might influence whether you have will

00:22:20.200 be prone to get ptsd if you think well if i have this traumatic experience because like that's what

00:22:23.920 everyone's saying then if you experience a traumatic experience you think oh my gosh i'm going to get

00:22:28.860 ptsd i need to go get help some other myths that you highlight in the book is this idea of repressed

00:22:33.200 memories when it comes to ptsd yes what's going on there what's going on is as a fad well what i

00:22:41.080 call a malignant fad within psychiatry it's not the only one but it was one of the worst it was most 0.99

00:22:47.980 prominent in the 1990s and it was promoted by one psychiatrist who wrote in a book the usual response

00:22:58.260 trauma is to is to forget about it which is totally untrue because the whole concept of ptsd

00:23:04.840 is that you can't get it out of your mind you can't put it behind you and the treatment involves

00:23:11.900 often involves helping people to put it behind them and accept that that happened and then they

00:23:16.720 have to move on now but people are troubled by intense memories of what bad things have happened to

00:23:22.900 them and that's a crucial element of ptsd the idea that trauma is repressed there's really almost no

00:23:31.200 evidence for this at all it was an idea introduced by sigmund freud about 130 years ago and it just has

00:23:41.580 not it has not been supported by research but what the fad consisted of was hypnotizing people or putting

00:23:50.360 them into very intensive therapies and telling them you must have been traumatized because look at your

00:23:57.620 symptoms i mean i had a patient with borderline personality disorder told me of her experience at

00:24:03.860 as a teenager in a pediatric hospital in montreal and she said out with with some venom they try to

00:24:12.860 convince me that my father must have molested me and are they wasting my time so this idea that you

00:24:20.120 there was this book the courage to heal it sold millions of copies because it appealed to people

00:24:26.100 said if you have these symptoms you probably will traumatize as a child if you can't remember it that

00:24:31.000 proves that you were traumatized because you repressed it it was completely wacko in this respect and yet

00:24:38.020 it appealed to too many people it was only a minority of psychotherapists who embraced or psychiatrists

00:24:45.720 who ever embraced this idea but it was out there in the public and there was a small number of people

00:24:51.660 who were promoting it and i think you'll still see it so the so these ideas of something terrible

00:24:59.840 happened to me i just have to work to remember it and and then process it this is a very appealing

00:25:06.400 idea for many people and you also maybe you highlight so you're saying this idea that you you'll if you

00:25:11.380 experience a traumatic event you're likely to repress it i mean you look you go back to the historical

00:25:16.580 record showing you know civil war soldiers who they didn't they weren't diagnosed with ptsd but they

00:25:22.360 basically in their journal entries in their letters they're obviously they were traumatized and their

00:25:28.060 problem was they couldn't forget it like they wanted to get it out of their head but they exactly

00:25:31.640 flashbacks and by the way the soldiers in war also a majority of them never never developed ptsd but

00:25:40.500 there's another thing which is particularly relevant for the usa which is that the veterans

00:25:45.360 administration offers you great treatments of all kinds if you say you have ptsd and um or if

00:25:54.600 somebody tells you you have ptsd it's an entry into treatments which tend to be not so easily available

00:26:01.420 otherwise so let's talk about this this idea you mentioned trigger warnings you also you often hear that

00:26:07.600 like i experienced something that triggered my ptsd right there might be something that you hear about

00:26:12.540 you know people soldiers particularly who they might hear some sort of loud noise and it might remind

00:26:18.040 them of there is it is definitely a real phenomenon but then you say there's some myths around this idea

00:26:23.880 of trigger warnings that have creeped in into our how we talk about this stuff well if you hear a loud

00:26:29.460 noise or even a low-flight bird or something like that and you want to duck that's that's a good example

00:26:35.680 of a trigger that can bring back certain traumatic events i don't disagree with that at all

00:26:41.440 but you know but then it starts becoming like i was rejected by my partner and that triggered me

00:26:50.660 because because of my unhappy childhood i mean it starts to spread and haslam's concept creep into

00:26:59.140 something which becomes all the the pathways to psychopathology can be can be seen in this model and it's very

00:27:08.900 tempting yeah and it becomes so broad that it like it the idea of triggers becomes useless almost it's

00:27:15.840 certainly overrated yeah and i think that you've highlighted research to this idea you're seeing this in

00:27:20.780 college classrooms this idea of trigger warnings we're going to discuss something that's

00:27:24.820 potentially you know if you experience this it might trigger use if you want to get out that's fine

00:27:28.720 and then you highlight research in the book showing that those actually they don't do anything

00:27:32.300 like no well in fact this is the whole problem of the whole culture in the university

00:27:38.420 and the trigger warnings and i went to a lecture at my university from an expert

00:27:45.900 in a rather controversial field which is gender identity and at the beginning of the and what before

00:27:53.220 while he was being introduced the uh moderator announced that if you get too upset by anything

00:27:59.180 this person says we have people in the back ready to talk to you i mean you know i think jonathan height

00:28:05.700 and others christakis people academics have talked about this as something which is really undermining

00:28:13.820 free speech universally because somebody's going to be triggered by it and it's kind of like a weird idea

00:28:20.720 that young people could be so easily triggered that they they have to be in the words of these of these

00:28:27.620 academics coddled rather than be in an environment where you can pose difficult questions and look

00:28:35.100 for answers yeah you highlight research from bellet he has had to say i thought it was really interesting

00:28:40.060 he says uh trigger warnings may raise awareness of the difficulties of people suffering ptsd however they

00:28:46.680 may also create the impression that the experience of trauma always renders survivors emotionally

00:28:52.200 incapacitated and we talked about this in reality most trauma survivors are resilient and show few

00:28:57.460 symptoms of ptsd after an initial period of adjustment the perception of trauma survivors as dysregulated

00:29:03.040 victims may contribute to negative stigma concerning the very individuals trigger warnings are intended to

00:29:08.260 protect and it works somewhat against the idea of competence mastery you know getting a life you know

00:29:18.640 having an identity feeling realistically optimistic about one's options all these things it's infantilized

00:29:27.700 yeah so we talked about what can cause people to get ptsd and some of the myths around that

00:29:34.680 uh but again you highlight research most people aren't affected about 90 to 80 percent if they

00:29:39.880 experience a traumatic event they're they're going to be okay but then you also highlight research that

00:29:43.960 some people actually become more emotionally and mentally robust after a traumatic event what's going

00:29:50.700 on there that's called post-traumatic growth and people like to quote nature who said what doesn't kill

00:29:57.220 me makes me stronger but in terms of science there's a lot of research on the resilience

00:30:04.180 and and people who've been through been through terrible things you know most of them will cope

00:30:12.600 there's there's a whole enormous literature in psychology about resilience and it's probably

00:30:20.120 related to what's been called positive psychology whereas i think this trauma focus could be called

00:30:26.360 negative psychology on this idea of post-traumatic growth syndrome are there some people who just have

00:30:31.940 more of a propensity for that than others well again the highly neurotic people by nature are probably

00:30:39.000 going to have more difficulty getting out of their traumas than people who who could just there are some

00:30:46.180 people who just bad things happen to them and they just shake them off and move on they're very low in

00:30:51.540 neuroticism so i think i think this is a very important factor in terms of how much people either get better

00:30:59.060 without treatment and how much better they will get within treatment and this idea that okay some

00:31:04.920 people will experience growth some people will have a hard time after they experience traumatic events

00:31:09.760 this reminds me of a podcast we did a couple years ago about children and there's this idea that some

00:31:15.980 children are born orchids and some are born dandelions i love that i love that yeah yeah the dandelion

00:31:21.800 kids like you can put them in any situation and they'll be okay because like they're like they're like

00:31:26.420 weeds or they're like dandelions they're robust but then some kids because of genetics and whatever

00:31:31.820 they're more like orchids and they require a more a better environment they can't handle a lot of

00:31:36.480 stress and i think it's a interesting thing to keep in mind as you're thinking about this stuff

00:31:41.320 well jay belsky has written about this too he's a well-known psychologist and he he just calls a

00:31:48.500 differential sensitivity to the environment and he suggests that actually these people who are easily

00:31:53.780 upset are also more permeable to good things that happen to them so they may actually do better than

00:32:01.740 than the average person if they're in a very positive environment but they do much worse if

00:32:06.340 they're in the negative one so let's talk about treatment what are some of the biggest myths about

00:32:10.860 the treatment of ptsd and other trauma related disorders i think the biggest one is that is that the

00:32:17.180 treatment is should only be about processing the trauma and this is the problem with several of the

00:32:23.280 methods that i describe in my book i'm somewhat negative about emdr this eye movement thing

00:32:29.980 where if you have ever seen a video of this being done that it reminds me of mesmer from the 18th

00:32:38.000 century with a wand you know waving you know you know and then the eye movements which has not been

00:32:46.080 shown to make any difference emdr is no better than most standard therapies which are being offered to

00:32:53.100 these patients but it's trendy it was marketed very cleverly by this woman shapiro who developed it

00:33:01.960 and some people come in asking asking for it and so but in fact i think we can live without it

00:33:11.260 there are variations of cognitive behavior therapy which have a kind of a traumatic focus

00:33:17.980 which i think make more sense you do have to talk about the trauma i'm not suggesting in any way we

00:33:23.740 should avoid talking about it and i mean it's always worth going into it the question is whether or not

00:33:30.900 healing happens because you've processed the trauma or whether healing happens because something larger

00:33:38.180 you know like your sense of of self identity direction your relationships your career you've got

00:33:46.640 things to protect you and guide you through recovery which can be supported and reinforced

00:33:54.880 in psychotherapy and i think those broader aspects of therapy which have sometimes been called the

00:34:00.860 common factors in therapy the ones that make you feel that somebody's understood you and you can get

00:34:06.300 better and you don't have to give in give in to all these things this is what works i think for most

00:34:13.680 people in therapy and i think not seeing that broader picture may be a negative in terms of what we offer

00:34:22.520 patients who do have ptsd okay so what you're saying is the bottom line therapy for ptsd as long as

00:34:29.760 you're with a therapist who you feel like you're understood you have a good relationship with them

00:34:34.660 they give you a sense of hope that you can you know get over this and move on with your life and be

00:34:39.420 robust that's probably the more important thing compared to like the specific therapy you use

00:34:45.020 the research totally supports that there's a guy in wisconsin called bruce walpole who's been writing

00:34:50.580 about this for decades and the evidence overwhelmingly shows that techniques in therapy are much less

00:34:59.460 important in the relationship and that the ability to get people better is as much a talent a personal

00:35:05.940 talent of the person who provides the treatment as it is anything you know nuts and bolts specific

00:35:12.840 that they do and i think this could apply to other mental health things that you might you know if you

00:35:17.480 it's generally it's generally true and in all the non-psychotic mental health conditions anxiety

00:35:23.780 depression personality disorders i mean i mean we certainly do a bit of trauma work when we treat

00:35:30.840 our patients with borderline personality disorder and the clinics that i run but it's part of a larger

00:35:37.460 frame and we're very influenced by marshall lenehan's dbt which emphasizes something called

00:35:44.340 radical acceptance which goes back to the stoics and philosophy in some ways and that you encourage

00:35:53.480 people to say whatever's happened to you in the past it's in the past the future is in your hands

00:35:59.600 you can make it better i'll coach you to get there but you don't have to be hobbled by the past but

00:36:06.880 before you but in order to do that you have to accept that it's happened you can't change it

00:36:11.980 and but not see that yourself is doomed to be marked by for the rest of your life so this is a

00:36:19.080 this crucial concept in dialectical behavior therapy of radical acceptance we use it a lot

00:36:24.440 and i think it's just as relevant to trauma as some of the other more trauma specific things that have

00:36:30.540 been described and you know one of the arguments you make with this is bolstered by other researchers

00:36:35.060 you cite is that the focusing on treatment where you just talk about the trauma over and over again

00:36:39.580 it's not helpful and actually can backfire because it just ingrains in the person's head that well

00:36:44.580 i can't do anything about this this happened to me and there's no hope and i just kind of have to

00:36:49.800 muddle along through life they had these trauma counselors who were some at one point were being

00:36:56.660 flown into various disasters to talk to people right away and they found that that definitely made

00:37:01.460 people worse because they had they haven't even gotten past the stage of being in so-called shock

00:37:08.160 yet and i think you have to respect trauma validate the person's right to be upset about it

00:37:17.240 but not indicate that somehow by going over and over the same thing they can get better without doing

00:37:25.460 something in their present life to make a difference yeah that was interesting that the studies about the

00:37:30.520 the trauma counselors i remember hearing about that 10 15 years ago when there would be a natural

00:37:34.900 disaster or even at 9 11 they would fly in these trauma counselors so they could just talk to these

00:37:39.660 people right away and i i think it was well intended they thought well you know these people had a hard

00:37:44.200 time if we just talk to them right away maybe you can diminish the amount of uh ptsd they might

00:37:49.140 experience but it actually backfired because like i guess the body or in the mind they have we have a

00:37:53.660 natural way of sort of processing you know traumatic events and uh if we i don't talk about it too much

00:38:00.800 it might disrupt that natural process i totally agree with you yeah and i think you still see it

00:38:07.060 nowadays i mean i've seen it at schools where you know a teacher might die and they'll have like grief

00:38:13.080 counselors like right away and it reminded me of like the trauma counselors i don't know maybe it's helpful

00:38:19.220 maybe some students need that but i mean maybe maybe not maybe there's just kids just need to

00:38:24.040 kind of get together and talk about it on their own and they'll i mean maybe they'll they'll figure it

00:38:28.140 out absolutely i think yeah and then of course that also relates to the situation of trigger warnings

00:38:34.920 in university classrooms is the same issue they don't know the council they hear something which is

00:38:41.060 upsetting you have to learn about things which are upsetting that's part of education okay so when you

00:38:47.080 treat someone with you know borderline personality disorder or ptsd you're going to talk about the

00:38:52.160 trauma people need to feel they're heard and understood but i guess you're saying the better

00:38:56.680 thing to do instead of focusing on that continuing to focus on that is to talk about what are some

00:39:01.480 things i can do now to make things better take them like restore agency in people's lives agency is a

00:39:09.000 lovely word and i totally agree with what you've just said that's that's that's that's my position

00:39:13.780 okay well uh this has been a great conversation is there any place people can go to learn more

00:39:18.600 about the book in your work well i am on the author center at amazon i've written 25 books

00:39:25.900 mostly on personality disorders but also on psychiatry in general this one is published by

00:39:32.140 oxford university press it came out in october it's in a paperback it's not that expensive

00:39:37.060 some people want to look for it i think amazon is easiest place to go

00:39:42.380 fantastic well joel paris thanks for your time it's been a pleasure thank you

00:39:46.060 my guest there is dr joel paris he's the author of the book the myths of trauma it's available on

00:39:50.960 amazon.com check out our show notes at aom.is slash myths of trauma where you find links to resources

00:39:55.960 where you delve deeper into this topic

00:39:57.260 well that wraps up another edition of the aom podcast make sure to check out our website at

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The Art of Manliness - February 20, 2023

The Myths of Trauma

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