The Myths of Trauma
Episode Stats
Summary
An overestimation of how common it is to develop PTSD after trauma is one of the misconceptions my guest Dr. Joel Paris thinks are leading to its over diagnosis and an underestimate of human resilience. Dr. Paris is a professor emeritus of psychiatry and the author of The Myths of Trauma: Why Adversity Does Not Make Us Sick, a book that takes readers on a tour of the history and oft overlooked research of post-traumatic stress disorder.
Transcript
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brett mckay here and welcome to another edition of the art of manliness podcast
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among people who experience some sort of trauma what percentage do you think go on to develop
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post-traumatic stress disorder a third a half more actually the answer is 10 an overestimation of
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how common it is to develop ptsd after trauma is one of the misconceptions my guest thinks are
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leading to its over diagnosis and an underestimation of human resilience dr joel paris is a professor
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emeritus of psychiatry and the author of myths of trauma why adversity does not necessarily make
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us sick today on the show joel explains what some of those myths of trauma are including the idea
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that it's trauma itself which causes ptsd joel argues that ptsd is instead created when exposure to trauma
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meets an individual susceptibility to it and he explains what psychological biological and even
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social factors contribute to the susceptibility we also get into how the methods used to prevent
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the triggering of trauma can backfire and how the treatment for ptsd will be ineffective if it only
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focuses on processing an adverse experience after the show's over check out our show notes at aom.is
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all right dr joel paris welcome to the show thank you very much for asking me so you are a psychiatrist
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who specializes in working with individuals with borderline personality disorder you also do a lot
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of research on borderline personality disorder but you recently published a book called the myths of
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trauma where you take readers on a tour of the history and oft overlooked research of post-traumatic
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stress disorder so why did a researcher and clinician of bpd decide to write a book about ptsd
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people think that bpd is caused by trauma and that's that you must have had trauma and that's the main
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reason that you have that disorder and it's simply not true it's an aggravating factor and it's one of the
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risk factors of several that lead to bpd but people of some people have wanted to actually redefine
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bpd as a post-traumatic disorder and also since i do a less specialized practice consulting for
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colleagues about various cases i find that both patients and doctors are all too ready to diagnose
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anyone with ptsd if they have something bad that's happened to them in their lives and this really doesn't
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make any sense it doesn't it's an attempt to explain very simply something which is complex interactive
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and multi-dimensional well we'll dig into these ideas more in our conversation but your book's
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called the myths of trauma you're not saying that trauma itself this idea is a myth but there are myths
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around this idea so what are the biggest ones and maybe throughout the conversation we flesh this out
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some more okay well definitely i'm not dismissing trauma it is important about 25 30 percent of the
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borderline patients that i see have histories like this but a lot of them don't and so the problems are
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are many first of all the way the trauma is defined the dsm is too broad and then there's a big discrepancy
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between exposure to trauma which is almost universal somewhere between 75 and 90 percent versus
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the frequency of ptsd after exposure to trauma which is like 10 so 90 percent of people who are exposed to a
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traumatic event don't develop ptsd and ptsd is most clear in a more narrow definition such as a threat of
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violence or threat to your life or threat of rape these are the things which are more likely to cause ptsd
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but when people say well i was emotionally abused in my family i mean that's a real thing
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but it's not the same thing as the other types of trauma in ptsd so i think too broad a definition
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of the traumatic event and a gap between exposure to trauma and actually developing post-traumatic
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symptoms are some main myths that i discuss in my book well let's talk about this definition
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of trauma so you said it's broad it's it's you're arguing that it's too broad how is it defined
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clinically and how has that definition changed over the past few decades ptsd got into the diagnostic
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manual in 1980 with the dsm-3 and that was the first time it appeared and at that time it had an
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narrow definition and it got broader over subsequent editions for example it's mentioned that sometimes
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just hearing about trauma from somebody else without being directly exposed to it or witnessing it or
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indirect exposure in the course of your job that these things could be causes of ptsd makes less
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sense than as a direct threat against yourself and i think this is where a beginning of the trouble
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begins well why did they make it more broad okay so originally it was if you experienced
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violence rape etc that was considered trauma it's gotten broader and broader like why why would
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they do that what's the reasoning behind it there's something called concept creep which a psychologist
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described a few years ago when you have a concept in psychology or a construct or a diagnosis it tends
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to be increasingly used with time now then the separate question is why do the writers of the manual
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agree to agree to expand it well they've expanded many of their diagnoses this is not the only example
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that's a whole other talk in itself you know about the problems with dsm there may be clinical reasons
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in that therapists like to make this diagnosis and there may also be political reasons because
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people have talked about whether we live in a kind of a post-traumatic society or a trauma or traumatic
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narrative and that people talk about their traumas and and these days i'm hearing from patients they
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use this language you know even if they haven't read the manual it's out there and it it's popular
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because i think people would rather be victims of something else than feel there's something inside
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them which made them more vulnerable to trauma one of the main points of my book is that ptsd is not
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only a result of the exposure but reflects a vulnerability a susceptibility to trauma
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of which there are many many causes okay so one of the arguments you make one of the myths of trauma
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is that we've broadened the definition too much possibly to make it a useful idea and this idea of concept
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creep we've actually had it was uh nick haslam that's that's that's who i was quoting yeah we had
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them on the podcast that's episode number 788 for those who want to listen to that i will look that
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up but you also so you mentioned one of the other myths of trauma i think it's kind of been embedded
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in our our popular culture psyche consciousness whatever you want to call it is that if someone
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experiences a traumatic event i think the assumption is well that person's going to have
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some sort of ptsd it's going to harm them but you highlighted numbers like actually it's very
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very few people who actually experience a traumatic event go on so what were those numbers again
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well in general about 10 percent of people who are exposed directly to trauma will develop ptsd
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later on and the numbers are somewhat higher for certain things like rape is the worst one
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and that gives you a 20 percent level although that still means that 80 percent of people after
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rape don't develop ptsd and why do you think this gets overlooked so i think people just yeah i
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automatically assume if someone experiences a really severe hardship they're going to have
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some kind of problem they need to go get professional help but you're showing the
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numbers actually i mean 10 percent i mean it's terrible for the people who do experience it
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but it's most people they're going to be okay it sounds like well yes this is called resilience and
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it's a very central concept in psychology and psychiatry and resilience is the rule after trauma
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and i always say if we weren't resilient we would have gone extinct 100 000 years ago i mean life is
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much more traumatic in the past than it is today in fact i would refer your listeners to stephen pinker
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on that subject and so i think from an evolutionary point of view we need to be resilient so i think one of
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the arguments you make in the book is that this sort of tight coupling between trauma and ptsd that we have
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in our not only amongst the public but also amongst a lot of clinicians that it might be increasing the
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diagnoses of ptsd because someone thinks well this person had a traumatic event they automatically have
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ptsd and you're saying maybe not well i see this all the time because i get rich because i'm evaluating
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patients i do hundreds of consultations a year so i have a lot of experience with this
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and if there's almost anything of this sort in the patient's past even just an adverse situation like
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a dysfunctional family people write in pt after the first diagnosis they still they stick in ptsd as
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the second diagnosis and some people and this goes into the latter part of my book where i talk about
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treatment some people will prescribe various kinds of what are called trauma focused therapies
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even in people who haven't had the kind of trauma which is most likely to produce ptsd
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and this is a an issue i've heard other clinicians raise concerns about this idea of diagnosing people
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who probably shouldn't receive a diagnosis because what it does it people begin to take that identity
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well the shrinks that i had ptsd so i must have ptsd and they start thinking well i have ptsd but
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then if they would have gone to another psychiatrist they probably wouldn't have gotten that diagnosis
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and they wouldn't have been thinking themselves as someone with ptsd probably not if they've seen
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probably less likely if they see somebody like me it doesn't even need a shrink to convince people
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that they have ptsd people are self-diagnosing all the time and then they talk about oh that's my ptsd
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acting up or that's my adhd acting up and all these diagnoses which are sort of fuzzy and uncertain
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become a part of your identity like you said it was a very important point well so okay so most people
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don't get ptsd let's say someone comes to you saying well i've got i think i got ptsd how do you
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like as a clinician how are you defining ptsd if you look at a patient like yeah you've got something
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here we need to help you out what's that look like for you well i i'm following the dsm criteria
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because the most precise if you look look at it it's basically exposure to trauma followed by certain
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characteristic symptoms most particularly flashbacks avoiding things that remind you of what happened to
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you the so-called triggers you know a kind of state of uh of expecting bad things to happen i mean
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there are all kinds of symptoms which are listed in the manual which are required for the diagnosis
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above and beyond the exposure and people who have ptsd will probably have them and people who don't
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will probably not so the research shows that most people who experience a traumatic event
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they're likely not going to have ptsd about 10 percent 20 in cases of rape so it sounds like if
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trauma itself doesn't cause ptsd if that's that's my whole point yeah okay trump the trauma itself
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doesn't cause ptsd but you say there are other factors that can contribute to it so what are those
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other factors well first of all it was noted many years ago there was a study of australian
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firefighters they were fighting bushfires which is pretty dangerous work and the nice thing about
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this study and other similar studies have been conducted since then but this was the first study
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what they did was they measured some of their personality traits when they started working as
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firefighters before anything had actually happened to them or before they'd been in a fire
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and they found that people who have what is called very high trait neuroticism
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were more likely to develop ptsd after something bad happened in firefighting so trait neuroticism
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basically is a central concept in personality theory which describes how easily you get upset
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and how hard it is to calm down and it could be called being thin-skinned or extremely sensitive
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so people who had more of this were more likely to develop ptsd after exposure and they've done
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studies like this with policemen and health workers and all kinds of people exposed to trauma so
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so personality is certainly one of them and i should point out here also that trait neuroticism is partially
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heritable like all personality traits there's about half of it which is you're born with and the other
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half is due to your life experience so it's it's a little little bit more complex than that but it
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has to do with things about you and how you respond to stressful events and not just the trauma itself
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okay so it sounds like some people are just more susceptible so if they experience a traumatic event
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if they're high on this neuroticism which as you said part of it is just genetic like just that's
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the luck of the the draw for you right you're more likely to possibly experience ptsd after that
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traumatic event absolutely okay anything else besides the the inherent like the the personality
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any other factors that contribute to a diagnosis or more people being susceptible what i propose in
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the book is what's called a biopsychosocial theory which has been for many decades a rather influential
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concept and it's not just for ptsd it's for everything in psychiatry so that you know let me
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take take a step back and say it's easier for people to think that a causes b and that there's one cause
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there's one effect and and the world isn't like that the world is multivariate everything is
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interactional everything that happens to you is complicated every response you have to what happens
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to you in life is equally complicated and so when we say biopsychosocial we're talking about
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hereditary propensity and i'll give you another example of the hereditary propensity
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while i'm at it there was a study of vietnam vets and i mean quite a lot of studies of vietnam vets but
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this one was a twin study of vietnam vets where they were able to measure the concordance of various
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mental disorders including ptsd and they found for every feature of ptsd there was a fairly strong
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heritable component which influenced whether you would get it so so what you're born with is really
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quite important some people are just born very nervous and it's not always a bad thing because
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cautious people sometimes live longer than risk takers but it's still something to be then there's a
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psychological aspect of it and this relates to other aspects of neuroticism and other personality
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traits and also your life experience so people who've had previous mental disorders particularly
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those related to anxiety and depression prior to ptsd are more likely to end up with ptsd so
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or even if there's just a family history we saw that in the australian study that even if there's just a
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family history they're more likely to develop ptsd so all these psychological factors which affect
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which increase the risk and then social factors well i do talk about this in the book which is i think
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the culture of ptsd is part of a larger issue in which people are using psychiatry to validate their
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sense of victimization in life and people are write memoirs about this and some of them are bestsellers
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and sometimes you see this on television so there's a whole social structure around it saying
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it's not only okay to have ptsd in a way it's kind of like almost you should have it because
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it's a tough world out there and we need to change the world so this some people believe so but the point
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about the biopsychosocial model is it's an interactive model so it one hit won't give you
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a mental illness usually it takes two hits three hits maybe more and they all sort of add up and
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have a cumulative effect and affect each other so that's the model i'm proposing and it leads to
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a different kind of treatment because i'm sure we'll get to this i don't think that spending all
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the time discussing the traumatic event itself is always the best idea okay so with this biopsychosocial
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model it's complex it's non-linear i think a lot of people i think particularly the public you know
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and just the lay lay individuals they think well if x happened then y happened they're very linear
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thinking and well it made that way to think linear yeah so i want to talk more about this the social
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aspects we talked about the the sort of the bio psycho part of this model some people are just born
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with a propensity to develop mental illnesses including ptsd if they experience severe adversity in their
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life there's this social model you call it like the culture of ptsd you also talk about the culture
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of trauma have there been studies done i think you particularly see this in the west in america
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especially have there been studies done across cultures where they look at say a country in africa
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or china for example where maybe this idea of trauma and ptsd isn't in the the popular psyche
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do they have about the same amount of ptsd diagnoses compared to the united states well there are very
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few systematic or large-scale studies of this kind i mean it's expensive and difficult to find out the
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prevalence of mental disorders in africa or other developing countries nevertheless i think somewhat
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partly anecdotally but also based on some of the things i've read from anthropologists
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and cultural psychiatrists people in other cultures they have to stress that it comes out differently
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for example fatigue people just take to their bed and they have no energy we used to call that in the
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19th century psychiatry neurasthenia so these kinds of symptoms tend to be more common in developing
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countries and i don't know of anybody who's gone out to measure ptsd i've been interested in even in
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the questions to whether or not there is borderline personality disorder outside the west and uh what i
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seem to have concluded is that yes in the large in very large cities but no not in places which haven't
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changed changed in a thousand years and there's something about there i think there's something
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about the stresses of modern life the pace of change maybe we could even put a little bit of blame on the
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internet and social media for spreading spreading all kinds of ideas of how to frame your
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your distress i mean the stress psychological stress is universal but how it comes out is not
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as universal there's a historian of psychiatry named edward shorter who i think would be interesting for
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your program he he describes something called the symptom pool and he he documented over the last
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couple of centuries how symptomatic presentations have changed even in the west and ptsd is probably
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an example of that but i can't prove it with heart data you cite some research let's see yeah duckers
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and bruin they noted a vulnerability paradox in that ptsd is much more common highly developed
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countries than those afflicted by widespread poverty and then mcnally did a study he said he suggested
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that the paradox could be resolved if ptsd is more frequent in subpopulations within wealthier
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countries who are more vulnerable so i guess the idea is that if you grow up in like a very affluent
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life and you don't have a lot of adversity your standard of what is what is considered adversity
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is probably lower than those who grew up in really trying circumstances i think that's very true
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thank you for the close reading of my book and those references because i did discuss them
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you know although they're not based on extensive data i think those ideas make a lot of sense
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okay yeah so the thing you're saying again it's like you're not saying that ptsd doesn't exist in
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these maybe like africa or china or whatever i'm sure i'm sure it does but i suspect at a lower much
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lower rate or it might manifest itself differently than here in the united states that's right that's
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what i'm saying yeah it may come out as something else which doesn't look like ptsd and maybe looks a
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little bit more like depression or anxiety we're gonna take a quick break for your words from our sponsors
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and now back to the show okay so yeah this bio psychosocial model shows how complex it is there's
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a lot of factors going on just the way you think about ptsd might influence whether you have will
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be prone to get ptsd if you think well if i have this traumatic experience because like that's what
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everyone's saying then if you experience a traumatic experience you think oh my gosh i'm going to get
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ptsd i need to go get help some other myths that you highlight in the book is this idea of repressed
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memories when it comes to ptsd yes what's going on there what's going on is as a fad well what i
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call a malignant fad within psychiatry it's not the only one but it was one of the worst it was most
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prominent in the 1990s and it was promoted by one psychiatrist who wrote in a book the usual response
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trauma is to is to forget about it which is totally untrue because the whole concept of ptsd
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is that you can't get it out of your mind you can't put it behind you and the treatment involves
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often involves helping people to put it behind them and accept that that happened and then they
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have to move on now but people are troubled by intense memories of what bad things have happened to
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them and that's a crucial element of ptsd the idea that trauma is repressed there's really almost no
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evidence for this at all it was an idea introduced by sigmund freud about 130 years ago and it just has
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not it has not been supported by research but what the fad consisted of was hypnotizing people or putting
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them into very intensive therapies and telling them you must have been traumatized because look at your
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symptoms i mean i had a patient with borderline personality disorder told me of her experience at
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as a teenager in a pediatric hospital in montreal and she said out with with some venom they try to
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convince me that my father must have molested me and are they wasting my time so this idea that you
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there was this book the courage to heal it sold millions of copies because it appealed to people
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said if you have these symptoms you probably will traumatize as a child if you can't remember it that
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proves that you were traumatized because you repressed it it was completely wacko in this respect and yet
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it appealed to too many people it was only a minority of psychotherapists who embraced or psychiatrists
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who ever embraced this idea but it was out there in the public and there was a small number of people
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who were promoting it and i think you'll still see it so the so these ideas of something terrible
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happened to me i just have to work to remember it and and then process it this is a very appealing
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idea for many people and you also maybe you highlight so you're saying this idea that you you'll if you
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experience a traumatic event you're likely to repress it i mean you look you go back to the historical
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record showing you know civil war soldiers who they didn't they weren't diagnosed with ptsd but they
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basically in their journal entries in their letters they're obviously they were traumatized and their
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problem was they couldn't forget it like they wanted to get it out of their head but they exactly
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flashbacks and by the way the soldiers in war also a majority of them never never developed ptsd but
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there's another thing which is particularly relevant for the usa which is that the veterans
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administration offers you great treatments of all kinds if you say you have ptsd and um or if
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somebody tells you you have ptsd it's an entry into treatments which tend to be not so easily available
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otherwise so let's talk about this this idea you mentioned trigger warnings you also you often hear that
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like i experienced something that triggered my ptsd right there might be something that you hear about
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you know people soldiers particularly who they might hear some sort of loud noise and it might remind
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them of there is it is definitely a real phenomenon but then you say there's some myths around this idea
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of trigger warnings that have creeped in into our how we talk about this stuff well if you hear a loud
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noise or even a low-flight bird or something like that and you want to duck that's that's a good example
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of a trigger that can bring back certain traumatic events i don't disagree with that at all
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but you know but then it starts becoming like i was rejected by my partner and that triggered me
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because because of my unhappy childhood i mean it starts to spread and haslam's concept creep into
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something which becomes all the the pathways to psychopathology can be can be seen in this model and it's very
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tempting yeah and it becomes so broad that it like it the idea of triggers becomes useless almost it's
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certainly overrated yeah and i think that you've highlighted research to this idea you're seeing this in
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college classrooms this idea of trigger warnings we're going to discuss something that's
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potentially you know if you experience this it might trigger use if you want to get out that's fine
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and then you highlight research in the book showing that those actually they don't do anything
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like no well in fact this is the whole problem of the whole culture in the university
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and the trigger warnings and i went to a lecture at my university from an expert
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in a rather controversial field which is gender identity and at the beginning of the and what before
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while he was being introduced the uh moderator announced that if you get too upset by anything
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this person says we have people in the back ready to talk to you i mean you know i think jonathan height
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and others christakis people academics have talked about this as something which is really undermining
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free speech universally because somebody's going to be triggered by it and it's kind of like a weird idea
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that young people could be so easily triggered that they they have to be in the words of these of these
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academics coddled rather than be in an environment where you can pose difficult questions and look
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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
00:39:57.260
well that wraps up another edition of the aom podcast make sure to check out our website at
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