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Speaker A: Welcome to the Huberman Lab podcast, where we discuss science and science based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. Today, my guest is doctor Paul Conti. Doctor Conte is a psychiatrist who did his training at Stan... |
Speaker B: Thank you so much for having me. |
Speaker A: I've been looking forward to this, and I've received a ton of questions about trauma, about therapy, about how to assess where one is in their own arc of problems, and addressing familial issues and relationship issues and so forth. If we could just start off very basic and just get everyone oriented. |
Speaker B: Sure. |
Speaker A: How should we define trauma? We all have hard experiences. Some of them we might ruminate on more than others. But what is trauma? |
Speaker B: To make the definition relevant, I think we have to look at trauma as not anything negative that happens to us, but something that overwhelms our coping skills, then leaves us different as we move forward. So it changes the way that our brains function, and then that change is evident in us as we move forwar... |
Speaker A: So how do we know if we have trauma or not? I've heard before everyone has trauma. For instance, I've heard that if we are a child, or when we are a child and we request love from a parent or attention from a parent, if they dismiss us, that that's a micro trauma. Is that overstating or unfair to the real is... |
Speaker B: Right. I think traumas that we might categorize as disappointments. Right. Or things that are negative but not deeply impactful, I think is not a helpful definition. I think the helpful definition is something that rises to the magnitude of really changing us and something that we can see both in how we beha... |
Speaker A: So how do we know if we've been changed by something? I mean, I can think back to childhood events where some kid on the playground or in the classroom said something I didn't like, something negative about me. I think most people can do that. We have a great memory for the kid that said something awful, or ... |
Speaker B: Right? Right. That's difficult. It's doable, but it's difficult because the response. So if the trauma rises to the level of changing our brains, and I don't just mean, like, we have a new memory, right? So we can have memories of something that was negative, right? And in that sense, it changes the brain, b... |
Speaker A: From a psychoanalytic, psychological, and maybe even a neuroscience perspective, two questions. Why do you think that when we experience trauma, these things that we call guilt and shame surface? You know, everything you're telling me is that in the end, that's not adaptive. Why would we be built that way? S... |
Speaker B: Right? No, I think these are great questions, and I don't think anyone knows the answers for sure. But my read of all of that is that there's something adaptive that has happened in us through evolution that now becomes maladaptive in the way we live in the modern world, right? So if you think of through mos... |
Speaker A: You've actually written those prescriptions. |
Speaker B: Yes. So glance at the news. Like, look at the news for news. Anything going on, I need to know. Right. But what are people doing is they're looking at it and they're clicking and they're clicking, and there's a sense of being enthralled in a very frightening way with the horrors that are in front of us. And ... |
Speaker A: Incredible to me that this is the way it works. What I mean by that is this idea that I've heard about before. I think it was a freudian concept of a repetition compulsion, that this is what boggles my mind as I'm hearing this. Something happens to us, or we observe something traumatic, and instead of acknow... |
Speaker B: Yes. The first thing I would say about the validity of the repetition compulsion concept is a strong. Yes. Yes. We see that over and over. It's not necessarily in everyone, but, boy, it is in a lot of people who have suffered trauma. And I think there's a very good reason on the surface of it, it's like it m... |
Speaker A: I keep hearing in this narrative that so much of our reflexive response to trauma, both emotional and in the repetition compulsion in terms of behaviors, is about some very deep attempt to change the past. |
Speaker B: Yes. |
Speaker A: And in fact, in an offline conversation I recall you saying something about this, that, you know, the number of behaviors and thoughts and avoidance of behaviors and avoidance of thoughts that human beings put in to try and change the past is remarkable and eerie and maladaptive, it sounds like. And that rea... |
Speaker B: Yeah, yeah. We so often try and change the trauma of the past in order to control the future. And what that really adds up to is the trauma of the past dominates our present. And it doesn't have to be that way. And remember, we're talking about traumas that rise to the level of changing the brain. So as you'... |
Speaker A: It seems to me, in hearing this, that there's this weird wiring that we have. Because what I'm hearing is, when traumas happen to us, or we observe them, what we need to do most is to confront those and the emotions around that directly. But instead, our system defaults to guilt, shame and trying to hide it.... |
Speaker B: Yes. |
Speaker A: And this notion of trying to change the past by doing things now, when the exact opposite is what's going to be beneficial, also seems like complete. The whole system seems completely backwards. And I'm chuckling as I say this not because I'm amused, it's because I'm just baffled once again at how our wiring... |
Speaker B: Right. Again, those are. I think it's great questions, and I think it starts with real introspection. When things are bouncing around in our minds, often it's very non productive. It's the same thing over and over again, and that's not helpful for us. There's an idea which sometimes gets called an observing ... |
Speaker A: Do you think that people can start to have negative fantasies? I mean, you mentioned this woman who would take these long drives to berate herself. I'm not familiar with that, but I'll give a little bit of personal disclosure here. I've felt several times in my life that I will start to create a narrative ab... |
Speaker B: Yes. |
Speaker A: And for the longest time I would wonder, why am I doing this? And I have a couple ideas about why. One is that I was attempting to just avoid thinking about other things. It's just, you know, anger is such an attractive emotional force. It's an attract hint. It's not attractive. We don't like it. And yet oft... |
Speaker B: Yes. |
Speaker A: It's like, oh, well, then it's not that bad. And then the third possibility is, I have no idea why, but it seemed like a reflex. And I spent some time thinking about it. I can't say I've resolved it completely, but why would somebody have a narrative, a default narrative when driving or when walking, of I'm ... |
Speaker B: Yeah, yeah. I mean, I think there are three factors there, and they're all bad. And I think you spoke to at least two of them, right? They, I think, speak so powerfully to how insidious trauma is and how these are real brain changes inside of us. So I would say the three factors, punishment, avoidance, and c... |
Speaker A: I'm struck by your statement that these thoughts or behaviors can make us feel better, but they don't actually make anything better in that way. This mode of imagining terrible outcomes starts to immediately seem like taking opioids. You feel better in the moment, but it doesn't actually make anything better... |
Speaker B: Yes. |
Speaker A: And so I just want to just pause on that concept because I think that concept of makes us feel better but doesn't make anything better. I think it answers an earlier question about this, what seems to be a totally maladaptive wiring diagram. We need to confront the thing, but we don't want to go into the rep... |
Speaker B: Yes. |
Speaker A: Working with a very skilled clinician like yourself, I think, is the ideal circumstance for people. And of course, there are people who can't access support from somebody for whatever reason. You've talked about journaling. Yes. As a useful tool, could you maybe you highlight some of the other things that pe... |
Speaker B: Yeah. If I could add something to what you had just said before, the question that we have these short term coping mechanisms in us, and in a way it makes sense. If we find ourselves in just terrible situations, then a short term coping mechanism can get us through them. Our brains are built that way, and th... |
Speaker A: Yeah, I definitely want to know about how to assess and find the right therapist. Before we cover that, however, something came up in the course of your answer, I can immediately relate to this idea that certain behaviors are really maladaptive and are stuffing things down or avoiding the topic is problemati... |
Speaker B: It's a fuel, yes. |
Speaker A: And I, and I think in knowing some of the traumas of other people and their reluctance to work through those, obviously I'm not a therapist. I sense this over and over again, that one's positive identity can often be linked to something difficult in their past. And so people are reluctant to give up this fue... |
Speaker B: Yes. Yes. I think what you're describing maps, I think, clinically, to what gets called sublimation. So there's something negative inside of us, but we sort of transfer that energy. We transfer that into something that is adaptive or that is positive. So the idea of anger, when I think of that thing and it m... |
Speaker A: Thank you for that. |
Speaker B: Yeah, you're welcome. Yeah. |
Speaker A: Let's discuss how one could or should go about finding a really good therapist. Typically, in my experience, this is done by word of mouth. There's this person. You might want to work with them. They're really great. But what are some of the characteristics that one should look for? And should we take into a... |
Speaker B: Right. Right. Well, there's a lot of data about this over the years that if you look at, what are the top ten important factors to find in a therapist? Just repeat rapport ten times. I mean, that's the key. And if you think about that, that's pretty amazing. Right. Because therapeutic modalities can be so di... |
Speaker A: Great. So people should perhaps try a few therapists and maybe have a session or two or three to see if the rapport feels like it's taking root. Do you have that? Right? |
Speaker B: Yeah. And I think that's why word of mouth is important. Right. If someone you trust tells you, hey, this is a good person, that says a lot. Right. It already makes the pretest probability is quite high. But, yes, it's interesting to see when people have a therapist or they called her insurance and they're a... |
Speaker A: Maybe we could drill a little deeper into the mechanics of therapy. I put out a few questions to audience asking what they want to know about therapy. It was amazing. I got hundreds, if not thousands of responses saying, how should I show up to therapy? For instance, should people take a five minute meditati... |
Speaker B: Yeah, well, I'm not trying to duck the question, but I think it varies so much by person. So if you think about the first part of your question, I think, was how to show up to therapy. Right. And I think the answer would be whatever lets you be fully present when you're in therapy. Now, for some people, ther... |
Speaker A: If someone were thinking about embarking on therapy or more therapy to address trauma or just general issues of life, what is the frequency that you recommend? I could imagine two extreme models. One is, okay, I'm going to finally tackle this trauma. I'm going to do therapy three times a week, but for a shor... |
Speaker B: A. Right. Right. I think that also varies. And I work with people in varied ways, from someone who's doing well and, like, we meet for a half hour every six months. Right. To doing week long hourly sessions to spending three intense days with someone in a row. Right. So I think as far as, like, kind of guidi... |
Speaker A: This very deep, intensive work of 30 hours in a week. What brings somebody to some. The type of work of that sort? Is it a suicide risk or a severe addiction situation? I mean, how does one gauge how much therapy they ought to be doing? And should it always be on the therapist to decide that frequency? What ... |
Speaker B: It's usually a person who is really distressed by something, whether that's it's so negatively impacting their life, or sometimes a person comes to a realization, I just can't take this anymore. I'm sick of the cyclical depression. I got to stop having panic attacks. I need help. But it's usually some crisis... |
Speaker A: And for those that maybe don't have the means or insurance or access to do even one day a week therapy in the journaling model, could one perhaps take an entire day, as awful as it might seem, to do a lot of journaling and thinking and walking, do a self generated intensive. Do you think there's utility to t... |
Speaker B: I mean, there could be, but again, it depends by person, because there could also be something negative about that if it's someone who's not at the point, not ready for that. I mean, we don't come at. We don't come directly at the trauma immediately. At least most of the time we don't do that. And we often d... |
Speaker A: Thank you for that. |
Speaker B: Yeah, you're welcome. |
Speaker A: So we've been talking a lot about talking, and now I'd like to talk a little bit about chemistry. |
Speaker B: Yes. |
Speaker A: Drugs. Yes. So maybe first we could talk prescription drugs. I mean, you're a psychiatrist, so you're approved to, and presumably do prescribe medication where appropriate. I mean, this is a vast landscape. Of course, we've got ADHD. And I should just tell you, I get more questions about ADHD and the drugs r... |
Speaker B: Sure. I mean, I would first comment that there aren't tests for these things. And I think the test for metabolites, I mean, things are so different by the time what we're talking about has been metabolized, often to some very significant extent, left the brain. Now it's in the peripheral blood that we really... |
Speaker A: It is. It's a very helpful answer. I mean, I think at least in the spheres that I run these days, I hear a lot of negative statements about antidepressants. I think, you know, I'm old enough to remember the book, listening to Prozac, and I remember when Prozac and things like it first started showing up and ... |
Speaker B: Absolutely, yes. Yes. In american medicine, we are so much better at starting medicines than we are at taking them away. And part of that, I think, is driven by such a strong presence of the pharmaceutical industry. And the pharmaceutical industry does a lot of very good things, but there's such thing as too... |
Speaker A: What is your thought about anxiety and ADHD as a separate phenomenon in terms of medication? Again, ADHD is the thing that seems to come up most in questions. I can't tell you the number of especially students, but also young working professionals and even people who are outside those categories who are inte... |
Speaker B: Sure, I think medication for ADHD can be extremely effective, and the studies show us that. They show us that if there is ADD, then medication for ADD is very, very helpful. And that's true in youths. It seems to be true if adults have adult ADHD, or Add. We kind of know that, too. That's true. But all atten... |
Speaker A: Thank you for that answer. I'm very curious, what constitutes negative effects of stimulants? So if somebody's taking Adderall or Ritalin in order to work longer hours or focus because they have attention deficit, but not necessarily ADHD. And again, I'm not recommending anyone do this. I've just heard the n... |
Speaker B: Think a touchstone, maybe that's running through our conversation, is prioritizing the short term benefit over solving a long term problem, which we might say is a human tendency, and we see it across the topics that we're discussing. So short term use of stimulants, sure. People are more alert. They can sta... |
Speaker A: What are your thoughts on cannabis? I've said it many times on this podcast before, and I'll say again, I feel fortunate that I've never really been attracted to alcohol or drugs of any kind. So much so that if all the alcohol and all the marijuana and all the cocaine, amphetamine disappeared, I wouldn't not... |
Speaker B: Doctor Justin? Sure. If I could make an alcohol comment, right, the number of times I've seen alcohol, like having been a good idea for coping with something approaches zero. The alcohol for coping is just never good. And there's an additional risk factor that there are certain genetic profiles where people ... |
Speaker A: I'd love to talk about psychedelics for two reasons. One, there seems to be a tremendous amount of interest in psychedelics as a therapeutic, clinical tool. I know there's also recreational use, and I'll just preface all this by saying that my stance is, we absolutely know for sure that these are controlled ... |
Speaker B: Yeah, I think if we look at the true psychedelics, so psilocybin and LSD, because ketamine and MDMA, they're different categories of medicine, sort of novel tools to bring to bear. But if we start with psilocybin, LSD, true psychedelics, I think why they have gained so much momentum over the last several yea... |
Speaker A: I'm fascinated by this idea that in these middle brain structures is where our humanity lies. And as you say it, I also wonder whether or not other animals experience life more from that orientation. With less chatter, we can only guess. But you know, that dog lover and being in the presence of animals that ... |
Speaker B: What you're talking about is sentience is important, and sentience is extremely important. Right. And if we're going to overvalue, say, language, then I think we undervalue sentience. Right. Which is why I think we tend to undervalue animals, right. And they're suffering. Well, they're not saying anything ab... |
Speaker A: The hallucinations that accompany psychedelics like LSD and psilocybin have such an attractive force to them as a concept and as an experience. And so I think most often when people heard of hallucinogens, they think, and psychedelics, they think about hallucinating. It makes sense why they would. But what's... |
Speaker B: I think we're really getting into the philosophical, the ontological. There's this trying to understand being, and I don't claim to know the answer to that. I think that at times it seems like the hallucinations have a metaphorical or a symbolic way of being helpful, right? Because people will come to unders... |
Speaker A: You know, I'd like to talk about MDMA, and I'll preface this by saying I was a participant. Actually, technically, I'm still a participant in a clinical trial, so I have experience of doing it twice. The trial involves three separate dosings of this. I was reluctant to do it outside of a clinical trial, most... |
Speaker B: Sure, sure. To clarify, I think part of what we're starting with is this is very different than the psychedelics, which are seeding our consciousness in these deep centers of the brain, right. Whereas what MDMA is doing is sort of flooding with positive neurotransmitters in certain parts of the brain. And I ... |
Speaker A: Sit with that, which sort of seems like a waste to me. I mean, this is what I tell people when they ask about MDMA. I said, at least from my experience, the potential hazard there is that in that very high dopaminergic serotonergic state, there were moments where I felt like I could get excited about any one... |
Speaker B: Yes, 100%. 100%. These are such powerful tools, and if they're powerful tools and we're using them without respect for them, without clinical guidance, we incur risk. I mean, getting obsessed with water, well, on it probably isn't going to hurt you, but if someone is out using it around other people, what on... |
Speaker A: It's going to be very interesting to see where all of this goes in the next few years, not just in Oregon, but elsewhere. It's one way or another it's happening. It seems to have a momentum that is not going to stop. So very exciting area, to be sure. |
Speaker B: I agree. |
Speaker A: I have a question about language. In your book, you talk about how we need to be careful about the use of language around trauma, maybe problem solving and problem describing in general. At one extreme, you hear that your brain and your body hear every word you say, and we have to be so careful with language... |
Speaker B: Yeah, I think this is a very complicated and in many ways convoluted topic. Like, I think it's wonderful that we have language, but, boy, language leads us astray often, too. You think about how we help people define words. Like someone says a word, does a person know what that word means? What nuance are th... |
Speaker A: Yeah. And I'm. It really, to my mind, it really seeps down into the soil of everything that we're talking about on all sides. |
Speaker B: Yes. |
Speaker A: People are activated. People are upset about one thing or the other. Right. No one is immune from upset, regardless of political affiliation. And everybody seems to be upset nowadays. And as I was hearing you talk about this, I feel a lot of resonance with what you said, and I also am hoping you run for offi... |
Speaker B: I don't think I have the gumption for that, but thank you for that. |
Speaker A: Well, that would be wonderful. |
Speaker B: Thank you. |
Speaker A: I'd like to talk about a concept of taking care of oneself. This comes up in the book. |
Speaker B: Yes. |
Speaker A: This is something we talk a lot about on this podcast. I mean, I think people have heard me blab endlessly, and I'll probably go into the grave telling people to get sunlight in their eyes when they can and to try and get proper sleep and to have a few tools for reducing their anxiety in real time. And on an... |
Speaker B: Sure, I see here what I think is a very fascinating dichotomy, right? In some ways, think about how complex our brains are, how complex our psyches, our unconscious minds are. There's so much complexity there. But on the other hand, psychological concepts that are consistent with health are often very simple... |
Speaker A: That. |
Speaker B: Oh, but if I stop doing that and now I'm like, I'm eating and sleeping regularly, then I'm going to lose some edge. And so even I think about this all the time. But I realize, hey, I'm also, I'm not doing it inside, you know? And I think it's really grounding to the basics that really help us of, like, what ... |
Speaker A: I want to thank you for that. And I want to thank you for today's discussion. I found it to be incredibly informative, and I know our listeners will also. I also want to thank you for the work you do. I mean, you obviously run an incredibly robust clinical practice that I'm aware that you're constantly tryin... |
Speaker B: Wow. |
Speaker A: And I really encourage people to read it and will continue to encourage people to read it. It's so many valuable takeaways and insights and tools there. So on behalf of the listeners and myself, thank you so much for joining us today. |
Speaker B: You're very welcome. And I take that to heart and I'm very appreciative of being here. So you're very welcome. And thank you as well. |
Speaker A: Thank you. Thank you for joining me for my discussion with Doctor Paul Conti. I also highly recommend that you explore his new book, which is the invisible epidemic, how trauma works and how we can heal from it. It's an exceptional resource both for those that have trauma and those that don't have trauma or ... |
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