we're going to be doing a deep dive today in the understanding trauma [Music] because trauma manifests as so many problems and it's the kind of thing where trauma is sort of a whole brain or whole person effect and so you can't slice it up into one piece because trauma sort of affects every aspect of who we are how our brain functions how we form relationships so it's the one topic that it's been really hard for me to try to chop up into pieces what does this mean for you what this means for you is that
a lot of what I'm going to teach today may not fit right at the beginning because what I'm trying to do is paint a picture of how trauma affects a human being and so I I ask y'all to bear with me and stay through to the end and hopefully what we can do is help things click so what is trauma and how does trauma manifest and this is where in my experience as a psychiatrist trauma is the great chameleon of mental illness and what do we mean by that that means that trauma looks like all
kinds of other stuff so what I've sort of found working with people over and over and over again is that they come in with a particular problem like a lack of motivation or even things like I keep on making the mistake the same mistake over and over again or I have chronic depression I've been depressed my whole life and it turns out even things like addictions all of these are trauma masquerading as something else and so this may sound kind of surprising but let's actually look at some of the manifestations of trauma okay so let's
start with this so trauma is the great chameleon and what that means is that trauma looks like other things so here's a list of things that trauma masquerades as chronic depression so what does this mean this means that there are some people out there who say I've been depressed my whole life so in Psychiatry we understand that mood disorders like major depressive disorder and bipolar disorder are episodic so they come and go but there are some people out there who have been depressed their whole life okay it turns out this is more likely to be
due to something like trauma there's also other interesting evidence to support this for example there was recently a meta-analysis that came out that challenged or made a very strong argument that depression is not caused by a serotonin imbalance in the brain and if you ask them okay if it's not caused by a serotonin imbalance in the brain what is it caused by and they basically said trauma okay so if you've been depressed your whole life or for extended periods of time could be trauma related second thing impulsivity or a lack of unifying Direction and how
are these two things related well I live my life kind of in an impulsive way so I don't have any sort of Direction I just kind of do what I feel like in the moment sound familiar okay next up vulnerability to repeated mistakes what does that mean this means you make the same damn mistakes over and over and over again sound familiar turns out there's data that that's related to trauma the inability to take risks afford to take risks turns out related to trauma number five being a people pleaser I am a people pleaser I
don't know how to stop turns out could be related to trauma this is another one okay really important one something called the paralysis of initiation what does this mean this means that sometimes we can't bring ourselves to start stuff we essentially live life in a reactive manner if something happens to me then I can respond to it if I have some sort of external stimulus I can act but I can't initiate things on my own turns out it's related to trauma number seven can't moderate relationships what do you mean by we can't moderate relationships or
maybe can't engage in moderate relationships so the relationships that I engage in are super extreme so it's like either it's like we're BFFs or we're enemies or I'm a doormat and this person like treats me however they want to I always call them they don't call me right it's like there isn't balance in relationships okay next thing really really common is somatic problems and what does this mean that means problems with your body and then you you may say but Dr K if you have problems with your body isn't that a medical illness sort of
so if there is a diagnosable medical illness then it is a diagnosable medical illness if you do something like a biopsy and you have inflammatory bowel disease and we understand that there's a pathophysiology to your physical problems right you have an illness then it's an illness but what we see in people with trauma is that they have all kinds of physical problems which if you go to a medical doctor they're going to tell you to see a psychiatrist these are things like IBS chronic fatigue syndrome fibromyalgia pots postural orthostatic hypertensive syndrome there's all kinds of
weird so if there's something weird going on with your body that a doctor is like eh I don't know what's wrong with you chances are it's related to trauma so if y'all are looking at this and you're saying but Dr K this sounds like really common stuff but I thought trauma was like pretty rare like and maybe you're listening to this and you're kind of thinking like wait a second like I wasn't abused or anything like that or maybe unfortunately you were but this sounds like really common stuff that everyone deals with you are correct
this is really common stuff that everyone deals with and it turns out that it's related to trauma so let's do a quick analysis of some statistics okay so remember when I said that major depressive disorder may not be caused by serotonin imbalance but could be related to things called adverse childhood experiences or Aces the percentage of the population that has had adverse childhood experiences could be up to 60 percent now what we've sort of discovered about trauma is that there are things called post-traumatic stress disorder which requires you to have like five out of nine
of these very discreet things like hyper vigilance and like re-experiencing and Nightmares and stuff like that but it turns out that the mechanisms of trauma like all of us basically have some kind of traumatic experience in life right because our parents aren't perfect schools aren't perfect kids aren't perfect and as we have these kinds of traumatic experiences we don't have to have five out of nine it can manifest as like one out of nine so even if you're not diagnosed with a trauma-related illness because your function is not impaired you can have this common crap
and you can have like two of them and it turns out that we understand the mechanism of this stuff relates to trauma trauma is sort of a unique illness and the reason it's so common is because trauma is not a pathology of the brain or the mind it is an a normal adaptation to a traumatic circumstance or experience so this is something that's that we have to understand when we look at mental illness we assume that mental illness is something in the mind that is not working the way that it's supposed to it's a pathology
so if you look at like autoimmune illness okay so this is when our immune system attacks us that is not what the immune system was designed for the immune system was designed to attack things that are not us okay so this is what we call a pathology it's a part of my body that is malfunctioning when we look at something like let's say bipolar disorder we're not and if we look at a manic episode in bipolar disorder or psychosis right so in a manic episode we don't sleep and we hallucinate so the brain is not
supposed to not sleep it's a normal thing to sleep every day it is also a normal thing for the things you see to actually be there right like our eyes are supposed to perceive things that are there not things that are made up bipolar disorder is a pathology it is a malfunction of the brain but trauma is different trauma is not a malfunction it is an adaptation to a circumstance okay so this is part of the other reason why it's so common and white can masquerade as so many different things because really what trauma is
is our brains attempt or our whole body's beings attempt to deal with crappy circumstances it's a survival mechanism right it's an adaptation this is something that really needs to be understood so if you have some kind of trauma and you're kind of screwed up as a result you're not actually screwed up and this is why I think there's a lot of Hope for people with trauma even though their problems seem really really insurmountable it's actually very surmountable because there's not actually anything busted with you it's just your body or brain's attempt to adapt to a
bad circumstance okay so the circuitry actually works and we'll get into that all right what is like the mechanism through which the Mind adapts to stuff okay this is where I'm going to draw a little bit on Eastern psychology because I think they explain it really really well so as we go through life we have experiences okay so something happens out there and if let's say someone I'm at the playground and someone throws a ball at the back of my head and it hits me in the back of the head so there's some kind of
sensory experiences that happen there are emotions that come with that sensory experience because what is an emotion an emotion is a very very rapid way to present information to my mind so I don't have time for analysis so instead what my mind is going to do is it's going to make me feel angry and anger is a way that I know how to respond rapidly in a situation so anger is like when we don't have time to sit down and think about what's going on our body has these scripts that it's like okay activate anger
now that we're activating anger like I know how to respond immediately within the situation so anytime there are experiences there are emotions that come with those experiences then what happens is those emotions either get processed and digested properly or they don't and if they don't get processed and digested properly they sink into us then what happens if we face that circumstance again like we see the kid who threw the ball then those emotions arise back up okay so they come back up and now all that has to happen is I have to see the kid
and I feel pissed off even though nothing has happened so our mind stores that emotion recognizes some kind of pattern the emotions arise again and this is a trigger okay now as we go into the science of trauma what we kind of discover is that there are five major domains that trauma affects within a person okay the first thing it affects is our affect which means our emotions so it changes the way that we relate to our emotions and specifically it does a lot of stuff with anger and also self-destructive Behavior you may Wonder wait
what does that have to do with emotions so if you think about like a lot of the self-destructive behaviors we engage in everything from cutting or self-harm to even things like addictive or shooting ourselves in the foot or procrastination all has to do with affect dysregulation trauma dysregulates the way that we manage our emotions second thing that affects is our sense our consciousness and attention so what do I mean by Consciousness so our ability to focus our ability to go to sleep or be mentally checked in right so we'll start to check out mentally third
domain that it affects is self-perception or identity as we go through traumatic experience and we'll go into all this detail okay it changes the way that we view ourselves fourth thing it affects is relationships the reason it affects relationships is because trauma is almost always inflicted by another human being and so when other human beings inflict trauma on us it changes the way that we view relationships okay and so we carry certain important learnings oh like water and cold crocodile we start to be scared of any body of water okay the fifth thing that it
affects is our somatic self so we sort of know is that there's tons of research that starts with even Freud who notice that people who have traumatic upbringings have changes to their body and they have lots of somatic complaints okay so these are the five domains that trauma affects so what does it take for something to be traumatic the most important element is coercive control an environment of coercive control now this is what's kind of confusing for people because people think okay hold on a second so isn't sexual assault traumatic and the answer is it
can be and then some people may say but hold on what about things like genocide isn't genocide traumatic and this is where like literally according to the data the answer is that it can be so if you look at a population that is affected by like a genocidal War right and hopefully some of them Escape which is why they're still alive what we discover is not everyone develops PTSD not everyone who's in a prisoner of war camp experiences PTSD not everyone who's a sexually assaulted experiences PTSD so what a trauma research has sort of figured
out is that a key aspect is coercive control and what does that mean that means that you grow up in an environment where someone is co- coercing you and controlling you so what people sort of figure out is and this is what's really interesting you can look at trauma research research and what you actually figure out is when researchers look at like guards from concentration camps and abusive parents what they figure out is everyone uses the same techniques and so human beings intrinsically know how to control other human beings it doesn't have to be taught
it's discovered so here's kind of what happens in the mind of an abuser what they want to try to do is destroy your autonomy and so what they the way that they destroy your autonomy is by imposing certain kinds of limits but this is what's really important so they make some sort of petty or arbitrary rule the rule doesn't have like much function right it doesn't really matter if I put my jacket away or put my shoes away but the abuser is like um you you do it in this order because I told you so
and so what they're doing in that moment is destroying your autonomy this is key key part of traumatic people abusers is that what they want to do is if they treat you unfairly all the time then you're gonna mentally check out because there's like this person is unreasonable they're like the weather there is nothing I can do to control them but the moment the person starts doing nice stuff to you now suddenly you know okay I can get the nasty parent or I can get the good parent and so the way that they chip away
your autonomy is by actually creating an environment where the person who is traumatized feels like they are in control by like not pissing this other person off so they know that this person is capable of kindness and so if I behave properly then this person will be nice to me there it engenders the dependence on the abuser for all things good and all things bad right because that's the only way it's going to happen so I become dependent on this person because this is the person that brings me the treats and this is the person
that brings me the punishment but if I ever get the treats from one person and the punishment from another person then I'm going to become independent because I'm going to say F this person so the in the abusive relationship what they actually do is they're very careful we sort of see this we'll call it love bombing right like this person is nasty to me and then they love mommy what happens in the mind of the abused person is that this abuser becomes God this is the bestower of health and happiness this is the bestower of
being able to go to bed at night without bruises on my body and so when this happens and this is what people will intentionally do they'll create Petty rules right things that are not justifiable and there's a lot of unpredictability because if there's unpredictability then the person kind of like engages in the behavior we sort of see this with loot boxes where when there's a random reinforcement schedule we play the game over and over and over again and so if I know that sometimes if I behave myself if I get a chocolate cake I'm gonna
keep playing the game over and over and over again traumatic abusers were the original loot box flute box 1.0 okay and so over time what this person will do is engender dependence on the person who has been traumatized as we become dependent on the abuser a couple of things start to happen the first is that independent action becomes insubordination and when independent action becomes insubordination what does that do to your sense of autonomy destroys it if your sense of autonomy is destroyed how can you initiate actions you can't because you were taught that independent action
is insubordination second thing is that in traumatic relationships there is no room for trial and error because if I talk back I'm gonna get beat I can't test boundaries it's about survival no Impala or gazelle goes up to the edge of the water and debates the crocodile it's insane we debate people in places like video games where there's no real consequence we do not debate crocodiles crocodiles we also don't debate crocodiles but so this is where we see another aspect of the paralysis of initiation for people who are traumatized which is that if I have
learned that trial and error is absolutely a mistake I can't try anything what that means if I can't try anything it has to be a perfect success and until I can get it to a perfect success I cannot start so if you are someone who looks for Perfection before you get started could be a trauma response so what we discover in research on people who've been traumatized is they have emotion focused coping so if I'm hurt I focus on fixing my emotions because I can't control anything outside of me so I can't stop my parents
from being abusive I can't stop the prisoner I mean the the guards from hitting me all I can do is focus on my internal emotional state because I fundamentally do not have control around me so then my brain learns when I am suffering don't change anything out there because changing stuff out there is futile what I need to fix is in here so I'm gonna do what I'm a dissociate or I'm going to use drugs right so there's very high correlation between substance use and people who have been traumatized because fundamentally the way that you
learn how to fix problems is within because I can't control anything outside then you carry that learning with you so now when my professor says your paper was due today and I did not receive a paper so I have to dock you 10 points but give it to me by the end of the weekend and you can still get a Beat this is a problem and how do we deal with problems we deal with them using emotionally focused coping so how do I fix this problem I get smashed because this hurts and what do I
do when things hurt on the inside can I fix things on the outside no no no no no I cannot fix them on the outside so I have to fix it on the inside so when I have problems problems are fixed by fixing emotions and in order to fix our emotions we're going to do stuff like get addicted to substances and now we begin to see like why this sort of becomes an addiction because instead of fixing the problem itself all I know how to do is use substances to fix the emotions because that's the
strategy that worked and if I'm fixing the emotions and that's the strategy that worked and I'm getting drunk let's say or smashed then Monday rolls around my paper is even later and now I get a c and now I get a c what am I going to do I'm going to drink more and so it becomes a cycle of increasing problems followed by worsening emotions followed by increased problematic behaviors so this is what's bizarre is there's so many different things going on there's relationships there's identity there's even the inability to concentrate there's emotional suppression there
is inability to think about the future there is living life reactively there is focus on emotional coping instead of actually fixing your problems all of this is related to trauma and it manifestes so many different things so many different things right our big list of chronic depression I'm a I can't stop watching porn I'm living my life like an NPC if someone comes up to me and initiates I can do stuff but I can't have Direction what do you want I want an amalgamation of what other people want now what do you want I don't
know what I want why don't you know what I want I don't know who I am why don't you know who you are well because my brain when I was growing up adaptively fractured different parts created problems like hemispheric lateralization and we are not even touching on things like cortisol and all this kind of crap and since I dissociate from my emotions and I have no upward momentum in life all of this negative energy and anger is going to start manifesting in weird ways in my body now asking the important questions can you change answer
is absolutely remember that our brain is fragmented but it isn't broken so I've had a ton of very positive experiences as a psychiatrist in helping people with trauma people think that things like borderline personality disorder or narcissism are permanent because it's the way I was wired right thankfully not correct you can put all these pieces together you can absolutely wind up here like this again absolutely and the data even supports this 91 percent of people have borderline personality disorder will be in remission at the 10-year mark the natural history of the human body and mind
is to heal that is the natural history of the human body and mind that's what's super cool about it don't give up hope because remember you're not actually broken nothing is I mean it's pathology but it's not a malfunction of some fundamental circuit right it's not like you've got like a lysosomal storage disease where there's some like neurotransmitter or some receptor that's just coded incorrectly and you're like Sol not like that at all we just have to put the pieces back together how do we do that number one safety and stabilization is like high cortisol
high stress High emotion leads to dissociation leads to fragmented identity right it's the first thing you've got to do is be safe very hard to heal trauma if you're actively getting traumatized a simple way to put it is you can't how to learn how to swim if you're drowning the right way to learn how to swim is get out of the water catch your breath and then go in slowly so this is where I hate to say this and I wish that we lived in a world where you could just listen to this lecture wake
up tomorrow and by force of will fix yourself but it starts by fixing your environment now what does fixing your environment look like thankfully it's so I would say strive for Independence or limitations around the toxic people so this is where you don't have to fix everything watch out for your mind that's like what it does with that right so look at the reactions of your mind sometimes it's as simple as seeing a therapist for one hour a week that can be enough of a platform for you to rest on and start to Branch out
in the rest of your life but safety and stabilization is the most important thing the second thing is we need to deal with anxiety and emotional coping we need to the foundation of a lot of this stuff is the disintegration of our emotions that doesn't mean the absence of emotions that means literally the disintegration so this is why things like DBT or dialectical behavioral therapy are so effective we also have things like EMDR Works somewhat differently these are two evidence-based treatments but we also know that things like meditation exercise Etc can all work for this
kind of stuff very practically what this means is that if you are experiencing some kind of negative emotion the most important thing to do is don't go towards the emotional coping mechanism okay so here's what happens when I have negative emotion there's emotional coping which reduces negative emotion and now what I've done is I've taken that right hemisphere and I've shut it off but the whole point is we need that emotion we literally need the emotion it's a part of the integration so we've got to stop doing this now this is what's super cool when
we do something like psychotherapy what we do is we help this person take that emotion go over to Broca's area and put it into language now if I'm about to say something that I do not expect many of y'all to believe but it is true language can substitute for action biggest misunderstanding in society today is that if you have a problem you have to fix the problem literally Freud came up with this concept and it has been tested language can substitute for action 100 percent we see it time and time again in our coaching program
we see it in Psychotherapy a lot of people don't sign up for the stuff because they're like I don't understand how talking about it makes any difference the problem still exists and literally what I hope I have done at this point is when you articulate there is integration when there is integration there is Flow State and when there is Flow State there is Improvement because here's the problem so here's the other thing to remember the frontal lobes are here too these are the parts of your brain that plan and execute tasks but as long as
this corpus callosum is severed that emotion you cannot use to fuel you so literally this is what we've seen there are people who have been traumatized and they will go to psychotherapy we will teach them how to integrate their emotions and they turn their life around you know how to find a job you know how to build a resume you know how to Google that crap you know how to ask GPT to do it for you the problem is not in not knowing how to do it the problem is that your brain doesn't do what
it's supposed to do why does your brain not do what it's supposed to do because it's split into a million pieces it's not a brain it is a thousand different fragments that are all dissociated from each other and can't actually do anything language is a substitute for action crazy but true and we kind of know this right so there's like stuff about cognitive dissonance just to give you all a random example if you get someone to say that they're gonna do something or believe that they're gonna do something it makes them more likely to do
it you know what I mean so like that cognitive like once you say something you're like it's hard for you to not do it there's all kinds of connections like literally in your [ __ ] brain Broca's area where we articulate things and the frontal lobes where we plan and execute action especially on the left side of the brain are connected and we sort of know that like if we look at things like motivational interviewing and coaching and stuff like that our methodologies we don't teach people anything we just get them to articulate it and
you can't articulate something unless you understand it once you understand it I'm not talking about information I'm talking about understanding then you start doing it and what do you do when you start doing it what is the thought that you have oh crap this was actually way easier than I thought this is the value of understanding understanding comes from integration integration comes from articulating your emotions so articulate your emotions the last thing I'm going to teach y'all a meditation ick tatva abias literally take 10 minutes a day 15 minutes a day and just do one
thing I'm not even saying make it productive if it's hard to do productive things you don't have to do productive things put this away when you eat when you're taking a poop poop completely grab a cup of tea and drink it completely when we do put your full attention into the one thing it can even be a breath for one moment do it with me now close your eyes feel the breath that's it and for a moment think about nothing else chop wood carry water focus on one thing at a time that's it if you
look at trauma treatments they're very very complicated but I hope today that if y'all have hopefully I don't know how to do this but I tried to explain what trauma is so don't give up hope because actually the majority of evidence suggests that you will get better there are things that you can do to accelerate it and the cool thing is that no matter which of these problems you have and maybe the reason that you don't have a diagnosis is because you don't have all of them because remember in mental illness we need the majority
of it but what I found time and time again is whether people are like directionless in life living life on autopilot can't concentrate keep on running away to emotional coping mechanisms this is a trauma is the gold mine to transform your life because it is the fundamental way that our brain works and the way that we interact with the world the way we find direction the way we execute tasks the way we form relationships all of it can be found in trauma which is why it is the great chameleon because it looks as like a
thousand different problems but it's all one problem and that problem has to do with the way that your brain works and if you can conquer this one thing and honestly it's not that hard you can start I mean it's really hard but it's very doable and start with simple things like don't run away from your emotions articulate your emotions the real tragedy of this stuff is that the reason we suffer the Buddha says the reason we suffer is avidya ignorance which really confuses a lot of people but this is why if you play a game
and you don't understand the rules it's going to be painful but once you understand the rules okay item timings rotations the flow of the map you can play the game well and if there's one thing you want to learn about how to play the game of life well understand trauma [Music]
