Paul Conti: Moment 174: Trauma Doctor Reveals Every Type Of Trauma & It’s Effects In 10 Minutes

00:02What are the different types of trauma? Are there sort of different categorizations of trauma from like small to big? If we're using the definition that trauma is anything that overwhelms our coping mechanisms, so there are changes in the brain when our coping mechanisms are overwhelmed, and on the other side of that, our brains are different. So that's the biological definition. Then we would look at, well, how do we get there? right and and we it breaks down into three categories then of acute chronic or vicarious so the acute trauma is how we've traditionally seen trauma so if you think about the idea that people were shell-shocked after world war one right that was acute trauma combat trauma so our traditions of looking at trauma come from acute trauma and it's just more evident you know after someone dies or there's an injury or there's a car accident like you know we can see that oh okay gosh, that could, what makes some difference in the person, like we can kind of get that.

01:00And sometimes we can see the change in the person from before and after. So we have tended to equate trauma and post-trauma syndromes, like what happens to us after those changes in the brain are now with us to acute trauma. But again, it's not a soft definition. It's based on, do those changes in the brain happen in other ways? And the answer to that is yes. That if a person is seen as less than, for example, in a society for whatever reason across time, or even within a household, a person is being abused in a household, a child is being neglected, or a child is being emotionally or physically abused. Bullied at school? Sure, bullied at school, absolutely.

01:42Right? This over, so nothing happens all at once, right? But that brain changes just the same. So So it's a scientific definition of traumatic change. And it is true in situations of chronic trauma, just as it is in acute trauma. Now, it doesn't mean all acute traumas or all chronic traumas make these changes in the brain. And then the vicarious, so the third category, there would be vicarious trauma, which means human beings are empathic, right?

02:11I mean, thank goodness, right? That's how all goodness comes in the world through our ability to have empathic connection. But that also means that our trauma can communicate from one to another. And again, it's not a soft concept. So people who are very much involved in other people's trauma, so in healthcare settings, sometimes in journalism settings, just in intimate home settings, in just spending a lot of time with the news, right, can become traumatized and have the changes in the brain that look the same as the person who lost two family members in the car accident.

02:46So it is true that vicarious trauma can change us in just the same way. The modern field acknowledges that if it's in the context of professional endeavors, which really makes no sense, right? Like what we're talking about are brain changes, and brain changes can come through acute trauma, chronic trauma, or vicarious trauma because of our ability to have empathic connection and compassion with other humans. I want to make sure that I've nailed this before we move on. So the acute trauma, I get it, it's the big events, it's the going to war, it's the car accident, big events that happen typically in an instant, typically. Chronic trauma, this is things like racism, sexism, bullying that happen over a long period of time gradually that make you often feel less than other people.

03:32And the vicarious trauma is the trauma that, as you say, you get from empathy. So feeling someone else's pain, feeling someone else's trauma, and it becomes your own. Yes. Okay. Yes. And they can all lead us to the same brain changes. But people have different levels of susceptibility, right? So one person may have three big acute traumas, and that person's brain is still doing okay, right? It's not changed towards greater vigilance, right? It's not changed towards greater inflammation.

04:01in their blood vessels, then, you know, another person could have one incident that might seem more mild than the other three, and that person can then have brain changes. So part of it is, who are we genetically? How are we built? What kind of life experience have we had, especially early life experience? How susceptible are we to one thing versus another? And then this idea of the multiple hit hypothesis that I could have a number of traumas and then on a certain trauma that might be even mild compared to ones that came before it. Now it makes the changes. What is that hypothesis? So that multiple hit, which, which, which says that this idea that what, what doesn't kill us makes us stronger is completely wrong. I mean, in absolutely every way, what, what doesn't kill us often makes us weaker. And that's why we have to be attentive to what hurts us, but doesn't kill us so that we don't get weaker, we get stronger.

04:53But what can happen is we can become more susceptible to the more likely that the next trauma, if we experience one, will then create the brain changes. because i've often wondered i'm the youngest of four kids we all grew up in the same household we experienced a variety of different traumas in my opinion much of it was chronic but again being the only black family in the Norwalk area all these kinds of things but i think i've always reflected on is for some reason i think i experienced it much more the trauma of that than my older siblings yes and i've pondered whether that's because of the timeline being the youngest, it was worse in the later years. So I think my hypothesis has been that I experienced it more than my siblings. And I think I've embodied the shame a lot more than my siblings have. Yet we both went through the same thing. So for whatever reason, I'm like, really like I'm a workaholic and I'm exceptionally driven. Not that my siblings are, but I'm obsessed in a way that's probably not completely healthy. And I look at my siblings and I go, they're not fucked up in the same way that I am, but we all went through the same thing. Part of what you're pointing out is that the variables of life matter, right? So if circumstances are different, say for one child

06:02in formative years than for another, those children could be affected differently, like economic circumstances. So some of it may be, and probably is impacted by the things that you're saying, but there probably are almost surely other factors to this kind of nature and nurture that people have what sometimes gets called different levels of attunement of the emotional compass. So, you know, some people are very sensitive and sensitized to things and very aware of what's going on around them and aware of their own feeling states. And, you know, and other people can kind of go through life and, you know, emotionally buffeting things can happen, but they kind of keep going, you know, and look, there are pros and cons to both of those ways of being, but the person with the sort of more finely attuned emotional compass is the person who's likely to register more things that are negative, like things like subtle expressions of prejudice, right? That someone with a less attuned compass may just, you know, kind of not see that or just it doesn't make it, you know, into their conscious awareness, whereas someone else who would be very attuned might see a lot of those things. So it's this part of like, what is the nature? Like,

07:09who is the person, right? And then what is the nurture? Meaning like, what are the variables, you know that that seed sort of falls into as we go through life you must have seen this a lot in your practice where an individual went through a really traumatic early event and you've got the person in your practice sat in front of you that is an alcoholic they are experiencing sort of suicidal thoughts but then when you look at the rest of the family the family just doing fine to some whatever that means fine but right well one of them look at is the rest of the family doing fine because sometimes what it seems like on the outside is not true on the inside. And then we do think about genetics, especially around alcoholism. There are, we don't understand all of it, of course, but there are genetic factors that can be very impactful. Then we'll look at personality structure. You know, is that person built to sort of internalize or externalize blame?

08:03You know, so why alcohol for this person and not for someone else? How much is nature or nurture and how much may be formative. It may be that, for example, that person was in social circumstances. Just real example that happens with some frequency is a mid to late teens where alcohol was accepted as a way of coping, right? And maybe other people in the family weren't. This circumstances were just different. Where they went to school was different.

08:26And they didn't have it modeled for them that this is how they cope. So maybe they're genetic factors that push more towards alcoholism. Maybe there are social factors, right? that it was modeled for that person. So you need to kind of put those things together, which is why we follow patterns, and there's a science underlying all of this, but we have to look at who is that person, right? You have to look at the family history, so the genetics that may have been passed on, and what does that seem like may be the case in the person.

08:56How can you be informed by that, and what were the formative life experiences? And we start to build a picture of what's going on inside of us so that we can understand and change by looking at our history. which is why mental health doesn't often do this. You know, it takes an inventory of your symptoms now to reflexively prescribe a medicine, right? So we need to understand ourselves if we're going to understand whether trauma is afflicting us, how it's afflicting us, how we can prevent it, how we can treat it if it's there.

09:23And I think that means accepting that this is real and this is real science.