[Transcript] Episode 91: Paul Conti

Paul Conti [00:00:00]:
When people say, oh, whatever doesn't kill you makes you stronger, I think that is absolutely not true. Whatever doesn't kill you can almost kill you and leave you a lot weaker or leave you changed, or leave you not understanding yourself or lost in confusion and fear and guilt. So in order to have things be better after trauma, the vast majority of times we have to have an understanding of what has happened.

Dan Riley [00:00:30]:
Paul Conti, it's such an honor for me to do all these interviews, but particularly this one. Welcome to the show. It's really wonderful to have you and really looking forward to this conversation.

Paul Conti [00:00:41]:
Thank you so much. I appreciate your kind words and I appreciate you having me on. Thank you.

Dan Riley [00:00:45]:
Thank you. You got it. I wanted to start with a quote that I wrote down last night from an interview that you did with rich roll, I think, about a year ago. And I thought it might be a nice jumping off point for one of the themes I think we're going to talk about during this conversation, which is trauma. And I thought this was very eloquently said by you, and I thought it might be a nice transition into that space. And this is from you, quote, something happens. This is about trauma. Something happens, acute or over time, that overwhelms our coping mechanisms.

Dan Riley [00:01:20]:
It then leaves us different as we move forward. And that difference is rooted in brain biology. There's actually a change in the brain, and that change pushes some things that we know about ourselves out of our mind. We forget things that we knew, and we then ground through the world in a different way, in a way that comes more through the lens of vulnerability and vigilance. And we often do not know that those changes have happened inside of us. It's a change in life narrative in terms of what do I think about myself and what do I think of my life story? You made a comment after this quote that I thought might be helpful just to clarify, which is it seemed like you were telling of the definition of trauma, that it's really by definition, something that resilience cannot prevent one from experience, that trauma supersedes or goes beyond human resilience by its very definition. And I'd love to give you an opportunity to comment on that and any other details that you think might be interesting or important to add to the quote that I just read about trauma.

Paul Conti [00:02:31]:
Sure. Thank you for raising that clue, because it gives me an opportunity to say, if we're communicating about things, we have to define the words right. And trauma could have as many meanings as people who are saying it right. So we want to define. Okay, what is this that we're talking about? How do we want to define it? It makes sense, I think, because we want to understand it, and we want to be able to practically intervene to look at trauma as what does overcome our coping skills, which includes our resilience, and then changes us. So the idea is, it's not a soft concept, because the thought can be sometimes like, oh, trauma is anything that happens to somebody they don't like, or we all have trauma. Well, what we're trying to define here is something that's medical, something that's neurobiological, that says, look, there's a threshold that can be reached where we change, and we understand that this can happen from acute events. That's where it's much more obvious.

Paul Conti [00:03:41]:
Someone who witnesses a terrible accident, loses a loved one, something really bad happens, and that person, if the person's assaulted. Right. That person feels so differently afterwards, and it's a very acute change. And sometimes it happens that way. But sometimes our resilience and our coping skills get overwhelmed a little at a time. It's the multiple hit hypothesis, where your resilience takes a hit, takes a hit, takes a hit, and then there can be something that pushes the person over the edge, or it can be chronic trauma. Seeing denigrated, marginalized, seen as less than bullied. All the things that happen to people that, over time, can take their toll.

Paul Conti [00:04:25]:
In Portland, there are these beautiful japanese gardens, and you see where there'll be a fulcrum, and there's a drop, a drop, a drop. And then eventually it shifts on the fulcrum, and we can be like that, too, where the trauma is inculcated into us, and at a certain point in time, we change. And the point I'm really driving at is that this is medical. It's not a soft thing. It's changes in people, where vigilance levels change, our narratives change, our memories change. Because you may have a memory of the same thing before and after, but it was positive, what you attached to it and feel about it before and negative after. So these are real changes in people, which can have dramatic impact, can change the course and do. And do we see this all the time, where the course of someone's life is changed, and often they don't even know it.

Paul Conti [00:05:23]:
They don't know that they've changed because what are you trying to use to assess the change, the mechanism inside of us that's changed, but from the outside, doing the work I do or doing clinical work, you just see, like, oh, that is happening. Over and over and over again, and I see it happening in myself about some of the traumas I've been through and the surprise of, like, whoa, I am different and I need help after this.

Dan Riley [00:05:51]:
It's such an important point, and I don't think I'd ever heard trauma quite defined in that way. And I know you're a psychiatrist, and I know some about your personal story as well, which I'd love to get into during the conversation. How do we know when somebody has really experienced, technically, a traumatic event? Is it literally something, as you just said, you're trying to use your own system that has changed to determine this, which seems almost impossible, if not totally impossible. How do you, as a clinician, as a doctor, make that assessment? To conclusively know that somebody has really experienced a technically official traumatic experience.

Paul Conti [00:06:39]:
Even though it is often not obvious? Sometimes it is obvious, but there are a lot of signs that we can take stock of it, and sometimes the person can take stock of it themselves. We tend to ignore a lot of warning signs inside of us. Something hurts and it hurts, and we might ignore it for a while. Humans do this, so we certainly can do this with mental health things, but people often know, is your sleep different? Do you feel different as you navigate the world? When I had these bad traumas early on in life, I realized I thought differently about myself. I could tell I was confident and I thought I could do things, and I feel on the back foot of life, and I could tell that change in me. But it's a very scary change. It's often hard to say something and acknowledge something if you don't know what there is to do about it and you're afraid of it. And because trauma generates feelings of vulnerability, feelings of shame, feelings of guilt, we tend to then keep it inside and not acknowledge the warning signs.

Paul Conti [00:07:44]:
The signs of change we may see in ourselves. And people can often see from the outside, too, that that person is different. They're more distant, they're behaving differently, they're less gregarious. There's a lot of things we can see that are markers, and we can also do things to investigate, like writing a life narrative. How do I feel if I write out my narrative and I read that, or I talk to someone who's trusted about my life? Does that sit with me like, yeah, that's what you think of yourself, or am I surprised by it? So there are a lot of markers that people can be aware of themselves or from the outside we can see. But the huge problem is we tend to turn the other way, including about other people. Sometimes it's hard to tell someone, hey, you seem different and I'm concerned about you. So we often miss the opportunities to help someone or to help ourselves.

Paul Conti [00:08:38]:
And the fact that trauma reflexively makes guilt and shame is a tremendous barrier to getting help. And when we lost my brother to suicide, I realized I had to stop and realize I feel ashamed of this. But it took time for me to realize this is inside of me, a sense of guilt and a sense of shame. And I wasn't carrying this burden anymore. I wasn't carrying this burden before, and now I am. That's really different. And I had to be really struck by that in order to think, I need to get some help about this, because I don't actually feel that I or my family should feel ashamed, but I feel it anyway. I don't believe that we should, but I feel it.

Paul Conti [00:09:26]:
And I can't just make that go away because I logically don't believe it to be true. And that's what clicked if I was in an earlier stage of life in my mid twenty s and not gone to medical school yet, but it was that that triggered in me. You have to get some help now.

Dan Riley [00:09:41]:
Yeah. I know in reading your online biography that one of the words that's associated with your practice and your interest is holistic. And I think one of the things that's very admirable about your career, just in becoming more familiar with it, is how open you have been about your own life. And I think it's rare to find someone with your background and your credentials and your position in life to be so forthcoming about your own personal experience, not being this distant figure, this distant doctor, but somebody that is much more relatable because of what you've gone through. And you alluded to this just a second ago about what happened with your brother. And if you're open to it, I wanted to see if we could give a little time and space to talking through your own journey. And obviously the trauma that it sounds like you experienced with what happened with him and then how you worked through that. Because I think for a lot of people who might be listening to this, that's really right.

Dan Riley [00:10:44]:
It's hope that they're looking for and anything that you might have to share with that, I think would be extremely valuable.

Paul Conti [00:10:52]:
Happy to do that? Happy to do that, yes. So one, maybe a place to start is there's a lot written about post trauma resilience, how things that are traumatic can make us stronger and that can be a part of our stories too. But it is not true. When people say, oh, whatever doesn't kill you makes you stronger. I think that is absolutely not true. Whatever doesn't kill you can almost kill you and leave you a lot weaker, or leave you changed, or leave you not understanding yourself, or lost in confusion and fear and guilt. So in order to have things be better after trauma, the vast majority of times we have to have an understanding of what has happened. So for me, one of the things that happened afterwards was a sort of shutting down of my feelings about my own potential, what I could go out and do in the world, or what I could achieve, and to confront that in therapy.

Paul Conti [00:11:58]:
Like, what does this mean? What does it say about me? And what does it not say about me? Let me get to a place where there was some setting free to some degree after the trauma, because I was in my mid twenty s and had a job that was like a good job to have. I was working in the consulting field and it was a good job to have. And I felt like, oh, I can't change and do anything different. I have to keep doing this because I felt like so old, right? I was in my mid twenty s. I didn't have the perspective that you have later in life. And through the therapy process, it set me free in some ways to go do things I wanted to do. Like I'd been thinking, do I want to go back to medical school? And on the other side of that, I thought, wow, we have a much better understanding of what really matters in life and that I'm young enough and I'm alive, I'm healthy. If I really want to go do this thing, then I can go do it.

Paul Conti [00:12:53]:
And I did. I had to go back to college and take the premed classes I didn't take. I went through it. But in order to get to that place where there can be a silver lining even of the worst trauma, because it can set us free to do things that are inside of us to do, and also to want to make some change, it was inside of me that, hey, this is just so awful. And maybe I want to understand more and help people in some way. I didn't really know what that meant. It didn't mean for me, I'm going to go be a psychiatrist, but the idea that maybe I'll be a physician and I can kind of work against just badness and illness and loss. But I had to get to it by really confronting the guilt, the shame, the fear, the vulnerability, by having some help.

Paul Conti [00:13:41]:
So that the trauma didn't shut me down like it does. A lot of people who on the other side of trauma, being assaulted, losing a loved one, whatever it may be, or even chronic denigration, kind of are scared of the world and don't have the confidence in themselves that they once had. And unfortunately, a lot of times that's the person's story that can go on for the rest of people's lives. And that's one of the things we are absolutely trying to prevent. It's not just the really bad outcomes, but it's the outcomes where potential is not reached. The generative drive of striving and doing and being in the world as best we can be, whether that means growing a garden, finding a relationship partner, being a parent, having a better job, going hiking, whatever. It may mean that we are in a place where we appreciate what is inside of us and we want to express it, and we feel that we can really be in the world in the way we wish. And that's often a branch point in the road where trauma kind of takes the person down that kind of darker, more overgrown path.

Paul Conti [00:14:53]:
And it doesn't have to be that way. And I started seeing over and over and over in my clinical work, even when I was still in training. What's at the root of this? Whether it was substance dependence or it was violence, it was depression, it was panic attacks, it was poor role performance. Someone's not being the kind of parent they want to be, or they seem like someone who could have a partner in a relationship, but they don't. And you start seeing the root of so much of that, if you really trace back, was the root of that is trauma. And then if we would go at the trauma, let's try and understand this. What happened? How did things change then? We could make things better. And I think that's the real litmus test.

Paul Conti [00:15:37]:
Like, if you think that's the answer and you go and you try and understand it and help people move forward from it, does that work? And the answer was a uniform. Like, yes, that works. Not in every case, but the majority of times we can make a change then that we will not make. If we're just looking on the surface, the idea of let's take an inventory of symptoms, I guess you're depressed, okay? If it's this symptom that let's check a bunch of boxes. Okay, now let me give you a medicine that's not helping someone, right? That's putting a band aid on something that may need much, much more than that. So if we didn't stay on the surface and we go deeper, can people heal? Can people change? Can people be happy with their lives and excited about their lives when they weren't before? The answer to that is yes.

Dan Riley [00:16:25]:
There's a quote that I heard you say, which is related to this, which I love, which is, I think you're relating this to medicine in general, or just in terms of how the system attempts to deal with these symptoms, which is, quote, people tend to, quote, polish the hood if there's a problem in the engine, which I thought was a good way of putting that. And I wonder, with your own personal story, if we can get a little specific with this, because I know just in listening to prior interviews that you've given that psychotherapy, we were talking before we started recording that you're from New Jersey and that psychotherapy was not something encouraged in any way. As I understand it from your background. I'd love to know how you came to know that there was a change in you after your brother's suicide. If it was other people kind of cluing you into know, Paul, you're a different type of person now than you had been your entire life. Or if you felt that, how did you come to that conclusion personally?

Paul Conti [00:17:33]:
Well, I was very good. Like a lot of people are at faking normalcy. And that's why if something has happened to someone and they seem like they're the same, if you care about them or you want to help them, ask anyway. Because a lot of people are very good at that, of giving the outward presentation they want to give. And think about the drive of guilt and shame, then you don't want to seem any different. If something has happened that you feel ashamed of. So a lot of people can maintain the external presentation of self. And I was good at that.

Paul Conti [00:18:07]:
I was good at that. So it really came from inside me of not being able to deny that things were really different. And I wasn't recognizing myself and I was making unhealthy decisions. There's a lot of anger in me. Some of it was going outward, some of it was going inward. My healthy behaviors, I was not engaging in as many healthy behaviors. I was drinking too much. Relationships weren't good.

Paul Conti [00:18:30]:
And I could see this isn't good. And I have to look at this because I am different now. I had what might seem like, it may seem like this doesn't make sense, but I had an advantage there, which was that the trauma was so acute, so the thought would be losing a family member to suicide. That would seem like that's worse than, say, someone being chronically undermined, whether it's sexual orientation or it's gender orientation, it's socioeconomic. We say it seems worse to lose someone in suicide. In some ways, the acuteness of it is. But the danger is with chronic trauma is people notice less the changes in them. For me, it was hard not to see that I was different, because there was like a moment when things changed, and I couldn't really deny that or cover it up to myself, which is why, of course, acute traumas are so important, and they can make these changes in us, and we need to help people.

Paul Conti [00:19:33]:
But chronic traumas and vicarious traumas, where people can have these changes inside of them through the experience of other people's trauma, we know this is true. These are medical facts. They're not soft assertions. So it's not just the acute traumas that we need to pay attention to if we're really going to help people, but it is the chronic traumas and the vicarious traumas, too, because it is less obvious from the inside and from the out that those changes have occurred in us.

Dan Riley [00:20:03]:
We touched on this earlier in the conversation, but in terms of, you've been doing this a long time, I think your career has been decades long now at this point, and I know you have a lot of experience with this, but thank you. I've heard you mention that getting to, and this is partly why I love your work so much, is that you seem to be interested in getting to root cause, like the center of the bullseye, with what is actually causing human illness or human disease. And that takes time, I'm sure, to be able to sift through somebody's biography to learn about them and then try to get to root cause. What kind of practices do you have in place to try to unpeel the onion, to get to the heart of the matter with people that come to you and are suffering and looking for the reason for that.

Paul Conti [00:21:02]:
Yeah, you have to build rapport and trust with someone. So it's relationship building. If you build comfort, you build trust, you build a safe space, then you can engage in inquiry. I think a lot of it is common sense combined with practicality. It was very helpful to me, for example, to have minored in math, which was very much about like, let's understand what's going on here and prosecute forward to an answer. And that's not just about pure math, but a lot of things in life operate that way. They can operate that way if we look at them. That way.

Paul Conti [00:21:40]:
It's not just, oh, it's a mess, and there's so much going on. No, let's stop and think about this and try and understand this. And I often say, and I think it's quite true, that of all the education that I've been through, probably that math minor has helped me the most for life. It says you can figure out a lot more things than you might think, and a process of building trust, building safety, and rational inquiry is immensely helpful. I think it has also helped me. Linking to what you had said before. For me, maybe not for others, but for me, to have come to medicine as a second career was very, very helpful, because I came feeling like an outsider. I wasn't premed in college.

Paul Conti [00:22:22]:
I had to go back to school to take those classes. And I felt like a little off kilter as an outsider. And I thought, oh, I won't feel that way after a little while. And I think it's been very good for me that I still feel that way. I feel, in some sense, inside because I'm a practicing physician, but I also feel outside. And I think that has been very helpful, because if you stand outside of something, you can have a better view. Often, not always, but a better view of what's going on inside of it. And this idea that what's going on here is a lot of polishing the hood, then if you have 20 people that take their car and say, I'm not happy with my car, and you polish the hood on all 20, probably one person, that's going to be the answer.

Paul Conti [00:23:01]:
They needed the hood polished. The other 19 still have the problem. And just seeing that over and over and also seeing, I come from a family where a lot of, as people got older, they were immigrants, they spoke broken English, they spoke unclear English. They weren't educated, and they were treated very poorly as they started getting older and getting sick, not always, but a lot of times I saw they were intelligent people. They were just coming from a disempowered place, socioeconomically, linguistically, and just how confusing and infuriating it would be to see people in white coats when somebody was sick, coming out and saying things that no one understood. And it's like there's a common sense of, let's engage with people, let's build some realness between us, some back and forth between us, and we may not be able to solve everything, but I'll be damned if we can't get pretty far in our efforts to understand.

Dan Riley [00:23:59]:
Yeah, I love that approach. And I also think it's so important, which you started the conversation by commenting on as well, of defining terms for clarity. And I think there's something probably related to the math side of your brain that might go in that direction. I tend to be the same way. And I wonder, for people that are listening to this or getting familiar with your work, a decent question might be, how do we know when something is not trauma? Because I'm sure it's more in the zeitgeist. It seems like these days to link enduring issues in one's life to a traumatic event in the past. And I have no doubt that that is the case, probably in far more instances than we tend to appreciate. But to invert that, how do you, as a clinician, as a doctor, flip that on its head and have a sense of something that is an issue not necessarily being the result of trauma? I'm sure this is something you've given a decent amount of thought to.

Paul Conti [00:25:08]:
Yes, it's really all in the history taking. It's all in understanding. Did that person change? Because quote unquote traumatic things, things that may not make changes in the brain, can be rationalizations, which is not helpful to a person, right? So if we see that that wasn't real change, but say a person was going down a disempowered course and they're using denial and rationalization of why that's okay and why they're not good enough to do better, and then something happens and it just plays into that narrative of self, well, maybe there are other traumas predating that put the person in that place, but that particular thing doesn't then seem to have changed them. Whereas if people are very clearly different. And examples I give, again, this is black and white in many ways. I give an example often to real story of a woman who is coming from a disadvantaged place and had won some award earlier in life and was so proud of that because it showed, hey, you're smart and people recognize that and you can go do something. You can go do what you choose. She was so proud of that.

Paul Conti [00:26:22]:
But after trauma, she saw it in a different way and did not know that she ever saw it different. That was a mockery. Afterwards, you're never going to get anywhere. So that award is some joke, the best thing that will ever happen to you. And she was, in a sense, rubbing it in her own face that she couldn't do better than that. She knew better before the trauma and after the trauma, she didn't know that she ever knew better. So that's the kind of thing that you're looking for in the history taking and also just changes. So this idea, look, there's hard science behind this, that when people change after trauma.

Paul Conti [00:26:59]:
So one example is if you see a new face coming at you, people who aren't laboring under brain changes of trauma, if the face is neutral, can kind of see it with curiosity, are you going to smile at me? Or maybe have some good interaction? Or if the person's interested in romance, are you really smiling at me? They're curious. Right? They're interested. Right. But after trauma, there's a difference. Like, what lights up in the brain is vigilance. You're going to hurt me. Do you have it out for me? People just see life or come at life more on the back foot. It's like, that's real change in a person.

Paul Conti [00:27:32]:
It's change that at times can be seen on functional magnetic resonance imaging, like, scientific things show us this. Which is why I'm always trying to emphasize that it's not a soft concept, it's a hard concept. It doesn't mean 100% of the time we can know, but the vast majority of the time we can track back to, like, okay, gosh, if there's real change after this, let's understand that, because it doesn't have to be this way. That's why we talk about life narratives. What was your life narrative before? Why is it not your life narrative now? How do we get back to that life narrative? Then we start building empowerment. I mean, I work at a place where there are about 30 of us here in varying capacity, and there's Pacific Premier group, a bunch of us working together, and we're in the empowerment business. Like, what do we do? We're in the empowerment business. Sometimes that's through intensive work.

Paul Conti [00:28:23]:
Sometimes it's through consulting work, sometimes through hourly work. But whatever it is, it's the idea that people are stronger, healthier, empowered when they leave. And trauma isn't all that we do, but it ends up being at the root of most of what we do, because I think it's at the root of most of what is ailing people to me.

Dan Riley [00:28:45]:
Yeah. What's so fascinating about this, in part, is that people may not even be aware of it. They may have changed. And for people that I think you and I probably swim in these waters more than the average person, you definitely do in terms of thinking about human problems being rooted in this. But for people that don't, that are maybe hearing about this for the first time, what are the most common stories or the most common events in people's lives that tend to cause a truly traumatic event in somebody's. Obviously, you were talking about acute instances like what you experienced in your brother. But what typically do you come across if there are any prevailing events that are probably worth mentioning? Just to have people maybe put on their own personal radars.

Paul Conti [00:29:42]:
Right. Sometimes when we're talking with someone about how they're doing, whatever it may be, someone new, I'm just trying to come to understand them. It is remarkable how we, as humans, can just gloss over very, very big things. A woman I know very, very well and wrote a story about her for the book, and she's given me permission to talk about her in ways someone might identify. We've talked about this because her story, it's so compelling that when she first came to me, she had had this terrible trauma, but she was treating it as if it wasn't not meaningful because it was a long time ago. So she wasn't honoring like, she was different after that, but because of the passage of time. And I think the fact that others around her, the world around her, hadn't paid enough attention to it, and then she hadn't paid enough attention. Then she says it in an offhand way.

Paul Conti [00:30:39]:
I'm like, whoa, let's talk about that. That was the place where her life changed. But she had to realize that thing that I just say as part of my history is not a small thing. And it struck me from the outside of whoa. And that's not because I'm a psychiatrist. It would strike anybody who's hearing that you just said that in the same breath as smaller things. But let's stop on that. Right.

Paul Conti [00:31:04]:
One aspect of it is there can be big traumas that we gloss over in part because of guilt, shame, confusion, fear, whatever else may be in us. So that's one aspect. The other is to look for the things that are more subtle. So the multiple hit hypothesis, and we know this is true, we see it play out where sometimes a relatively small trauma compared to things that have come before it, is what changes that person. And then it's very hard. Well, how could that be anything? Look at these other things, right. But what happened is like, it's one hit, it's another hit again. What doesn't kill us very often weakens us.

Paul Conti [00:31:43]:
And another hit. And another hit. And now there are genetic expression changes, and there are endocrinological. There's changes and changes that ultimately push that person. It's like another drop goes in, then the fulcrum shifts. So this curiosity. Which is why I'll say, if a person cannot access therapy, not everyone has the ability to access therapy or even a trusted other. But you can write about your life and what has gone on in you and how you felt about yourself, how other people saw you.

Paul Conti [00:32:15]:
And you can ask people if you can. You can write a narrative or think a narrative, or talk a narrative that can let you see the change in you. As I say, no one comes out of the womb thinking that they're not good enough to not be in an abusive situation. They're not good enough to have a better job. They're not good enough to not be bullied. If we're thinking these things about ourselves, where did that come from? Let's understand that. Because if we understand that, we can change it. We can write what has been put into a place that is not a fair, not a.

Paul Conti [00:32:48]:
Just, not an okay place for things to.

Dan Riley [00:32:51]:
Yeah, I. One of the aspects of the. I was just watching this last night, your interview with rich roll, which I thought was a masterpiece. And there was so much, in part because he seemed to be one of the perfect interviewers to speak with you, given his own personal background with sobriety and going to wanted. And I thought the part of the conversation where you were talking about shame was so crucial because. And I don't know if you agree with this assessment, but that one of the reasons why these traumatic events stay with people is because they're ashamed to speak about them openly, and that there is this kind of. I don't know if I'd call it a depression, but kind of sucking in of air of burying something in yourself and not allowing you to go through something properly. And I just wanted to set the table for you with that and talk about the role of shame in maybe even.

Dan Riley [00:33:58]:
I don't know if you would agree with this as well, but of holding trauma in place for people and anything else that you might want to add to that idea.

Paul Conti [00:34:06]:
Sure. The first thing I would say, I say this often, is, don't make yourself special in a negative way. I hear over and over and over in the over quarter century or so I've been in medicine, that it would be okay, I would be compassionate, of course, for anyone else, but not me. And I was in that place, too. I would never say to someone else, like, you should be ashamed because you lost a family member to suicide. I can't imagine. Right. But I could say to me, why? Because I felt ashamed.

Paul Conti [00:34:45]:
So I am ashamed. Or was at the time, if I am ashamed or shame, inside of me, then that's different than if I'm not feeling ashamed and you're bringing me something that you feel ashamed about, and I'm like, oh, my goodness, you don't have to feel shamed about that. Right? So we make ourselves special in a negative way. And how many times I've seen a person who is just shutting themselves down, terribly terrible, negative self talk, guilt, shame, say because someone else assaulted them, they're just doing what they're doing, and someone else does something terrible to them, and they would never, never tell someone else, oh, you shouldn't have been out at that time of night. You should have been dressed that way. You should have been this or that. Would never say that. But they will say that to themselves all day long, because we're already feeling shame.

Paul Conti [00:35:30]:
We become more isolated, and then that's why we will hold this inside of us. And if we hold it inside of us, it is toxic. The analogy here, which I think is a good one, it maps very well. That's why I use it a lot, is to an abscess. An abscess is a walled off infection inside of the body. Now, it is good if there is infection inside the body to wall it off. If it's not walled off, it could threaten the person's life. But walled off infection spins off symptoms.

Paul Conti [00:36:02]:
That person has an intermittent low grade fever. They're jittery, they're distressed. Their sleep isn't so good. They're not functioning so well. They feel sick at times. And abscess will spin off those symptoms. And if you go looking for it, it's often hard to find. You need to follow the history.

Paul Conti [00:36:18]:
Then you see there's something going on in this person that needs attention. And the abscesses often, say, surgically addressed. And now the person has to go through a surgery. And a surgery is a difficult thing. Right? You have to go through something that involves some stepping away from your life and maybe some pain. Like a surgery is not a fun thing, right? But if you go through that thing on the other side of it, that abscess isn't in you anymore. And the same thing is true. It maps to the buried trauma, so to speak.

Paul Conti [00:36:47]:
An abscess, it's not really. But in here, right? It's inside of us that we have to deal with that. It spins off symptoms of not being confident, of being afraid, of avoiding people when I might not have before, of not taking a chance on myself when I might have before. Like, it's spinning off all of those symptoms. And people will say, people know it's inside, but if I think about it, people will say, I'll start crying and I'll never stop. I'll be in a fetal position. I'll never get out of it. No one starts crying and doesn't stop.

Paul Conti [00:37:17]:
No one gets into a fetal position, and, like, 10 hours later, you got to carry them somewhere, and they never come out of it. That's not how it works. That's what keeps us terrorized. Right? The shame terrorizes us into keeping the secret that spins off the symptoms that hurt us and create better ground for the shame and the terrorizing to happen. That's not what we want, but we have to look at what's inside of us and say, there's a hurdle I have to get over, but I have to think about this. I have to talk to someone about this. I have to do that thing that's the equivalent of the surgery. It's not easy to do, but if I do that thing on the other side of it, I can be different and better.

Paul Conti [00:37:58]:
And that's part of the news that I try and bring in, doing podcasts and writing the book that there are a lot of people laboring under this who absolutely can be better, but they have to have an understanding that society doesn't give us, like, it's not people's fault that this is inside of them. Our society doesn't tell us about this. We don't get educated about this. We can go seek medical care in a lot of ways. We can go seek medical care and not learn anything about this, but walk away with a medicine that's supposed to soothe some symptoms that are not going to be soothed because they're coming from something inside of us that's going to continue to spin off symptoms until we address it, but it doesn't have to be that way. So knowledge is power, right? So, knowing this can help a person, I think, and hope it has helped people to say, I got to look at this thing inside of me because this is not how. It does not have to be like this.

Dan Riley [00:38:52]:
To me, this seems like one of the great areas of hope, of modernity. There's a lot of downsides to modern technology, but this is not one of them, in my mind, of spreading this. And there's a line that rich gave during your conversation, and this is related to aa, that shame cannot stand the light. And as you were just speaking right now, I was thinking about so much of overcoming a lot of this seems to be rooted in a degree of courage, of being honest with yourself and being vulnerable in addressing things that you may not feel comfortable speaking about. And I was thinking about this a few minutes ago about how this is probably, I don't know if you'd agree with this, but that this might be a more difficult task for men, especially in our culture. You were just talking about how our culture doesn't educate people about this. And that if you're handed a brochure and given a pill, that probably even makes you feel even more isolated and ashamed because you've gone to the person that you think is there to help you, and there's been nothing that's really even gotten close to root cause of what you might be going through. Does anything about that resonate about.

Dan Riley [00:40:07]:
Obviously, this is extremely important knowledge for everyone, but that this is really potentially even more of a danger or an issue for men specifically.

Paul Conti [00:40:18]:
Yeah. So we know this, and it is the truth of it. The world is not a binary place in terms of gender, sexuality, almost anything. Right? But here, what you're pointing out is that if we say, okay, there's a locus of people in one place who access care less like men, and that creates other problems. So people aren't accessing care. It's still inside of them. And you see a lot of acting out. Right.

Paul Conti [00:40:47]:
You see more violence, you see more the kind of things of driving that creates an accident, gets somebody really hurt because there's frustration and tension inside of a person. They don't know where to go. Now, that doesn't just happen in men, but it's socially pushed forward more in men who are less likely to access care. Right. Then women are more likely to access care. Now, that's good. So they may be less likely to act out of that. It happens in women too, of course.

Paul Conti [00:41:16]:
But then they are more likely to walk away unhelp because they're seeking care more. So they're more likely to like, yeah, I kind of know I need to talk about this. And they come away with a symptom inventory, a medicine and a 15 minutes follow up appointment in six weeks. That's not going to work. So the way the system is now doesn't work for anyone. It doesn't work for any demographic or for the demographic of all of us taken together. But we do want to be aware of what particular liabilities are. And in men, it's less access to care, more acting out.

Paul Conti [00:41:50]:
It's women with more access to care and then the access to care, providing disappointment. And I think you're right. Sometimes it takes another time, another time. I've said to people things that a lot of times surprise people, that you went to a therapist and that didn't work out. Maybe that person was good at their job, but it wasn't a match. Like, a lot of times, maybe that person wasn't so good at their job. That's true of humans in whatever endeavor may be. So if that didn't work the first time, think about why maybe it didn't work because you were so shut down, and then you thought the other person couldn't help you.

Paul Conti [00:42:27]:
Or maybe the other person wasn't paying attention. Whatever it is, go at that again. Try again. This is your life, so try again and build that courage. I mean, I still remember going to therapy after the loss of my brother and feeling very sneaky about it. To go in as if I'm doing something shameful because of something shameful and then going in there. And I remember that the person didn't shame me. It meant so much that she wasn't handling me with kid gloves either, that she was just like, yeah, it makes sense that you're not doing so great and you had depressed, and you're acting out, and you're not like, yeah, it's so validating.

Paul Conti [00:43:14]:
Oftentimes, that's what people need. When people will say the thing that's been on their mind. I was abused. They'll say I was molested. They'll say it. And there's a way that they've said the shameful thing. For someone to recoil. So you build trust as best you can, and you let people hold up, like, is that shameful? And a lot of times, for me, having it validated, like, oh, right, that does make sense.

Paul Conti [00:43:40]:
And then I could map. It's not like I didn't understand that, because I could understand it for other people. And I'd had people around me who'd lost family members to suicide, and I certainly understood, I felt a sense of compassion and what could go on and change inside of them. So I could map to something I understood. But it's like the light bulb of like, hey, that's me, too. That's often when people are really turning the corner, when they can stand outside of themselves and say, that child that was really hurt was and is me. That person who was assaulted, I can stand out front of side, that's me. And they can stand outside enough to see, like, that happened to me, and then feel the compassion.

Paul Conti [00:44:20]:
Sometimes people will use the empty chair, say to another person, sometimes I would say, okay, we have another person coming in the patient is. It's not true, but it's in the service of helping them that, okay, someone's coming in next who has the same exact issue that you do. Can you please just stay around and tell them how bad they should feel about it because they were attacked or they were denigrated because of their gender, their sexuality? Please stay and tell that person how that's so horribly. Them recoil. Right, but they get it. But you're saying that to you, and it's not okay to say outward to someone. You can't even say the words that you would say to someone. It feels so.

Paul Conti [00:44:59]:
My God, I would never say that to someone. But you're saying it to yourself. And that's why part of understanding is, what is your narrative inside? It's not just what you write down. What is your self talk? And a lot of people have very, very negative self talk. And if you stop and you ask about that, yeah, I'm always saying, like, oh, you can't do that, or what's wrong with you? Or, there's a lot of this going on inside of you. Let's get curious about that, and let's not treat ourselves worse than we would treat anyone else on the planet. Oftentimes, that's a theme, man.

Dan Riley [00:45:32]:
It seems like so many people probably are not seeking help because of, we're both Americans, but because of our cultural conditioning that they've basically been persuaded that they're not worthy of healing something in themselves that's bothering them. And I wonder if you would agree that there is just an undercurrent, a message that people need to unlearn, that they've probably imbibed through the culture. Just in growing up in the United States, that would probably go a long way in encouraging people to seek help and very likely improve their negative self talk internally or the suffering that they're dealing with. If you agree with that, what is it that we need to unlearn, generally speaking, about trauma and anything else that we've already discussed today?

Paul Conti [00:46:26]:
Yeah, the problems are definitely present in this country. I think they're present a lot of other places, and maybe most other places, maybe all. I don't know. I haven't been everywhere. But this is a very common. It's a very common theme of, like, come on, you're supposed to move ahead, right? That's a very american thing. Come on, move ahead. Move ahead.

Paul Conti [00:46:45]:
Be resilient. Come on. That's what we want, right? In England. I've lived in England, too, so I have a stiff upper lip right. There's a lot of this that has its different cultural translation. But the idea that if you have been hurt, you get to feel hurt, right? If someone, you have an injury and your leg is badly broken, no one says, you don't get to be like, ow. You get to go, ow. And something happens, then maybe you need a surgery, you need something to repair the leg.

Paul Conti [00:47:13]:
We understand that that's true for the things that are what most important in our brains. We know if you are laboring under the brain changes of trauma, you are older than your age. What I mean by that, you may be like, oh, that person is 40 years old or 50 years old or 70 years old by the calendar. But really, they're older than that. Not 40. They're 45. They're not 50, they're 56. Because that's what happens as we think about this.

Paul Conti [00:47:41]:
We age greater than our calendar years from trauma. Like, this is real. And if we don't acknowledge that it's real, then we're laboring under something that's so false that it brings terrible things. Which is why I will say often, our medical system has evolved in a way that is all about throughput, because so much of it, if not all of it, the vast majority of it, is about money. So that's another route in to say we so look at a short term perspective. What do things look like now at the end of this week, at the end of this quarter, as opposed to being stewards of, say, a business or financial resources across time. But even if we just. It's what I'll say.

Paul Conti [00:48:27]:
Even if we just. Let's take out of the picture people and their suffering, which is not what we want to do, but let's say we do that. There is so much cost to this. There's billions of dollars of cost in lost productivity, emergency room visits, medical care, way more than half of people's complaints to physical medicine doctors, that's everyone practicing medicine who's not a psychiatrist, right. Are coming from mental health sources. Like, there's data that shows us that we are costing ourselves billions of dollars because we're looking so short term. So if you come in, instead of saying, let's try and understand what your symptoms are in 45 minutes, so we can write a couple of medicines without making eye contact, is that more efficient? I mean, it is. In the moment, you only paid for 45 minutes, some system of that person's time.

Paul Conti [00:49:23]:
And the medicines can be not that expensive. So is that saving money? It is. If you just look at it like this, it is not. If you look at what is the toll we see and the studies are out there, what is the toll of depression on the economy? It's huge. And not all depression comes from trauma, but a lot of it does. So it's this idea that let's go for what the systems that have, by and large, control are interested in. It is not better just from a dollars and cents perspective. In fact, it's just tragically wasteful.

Paul Conti [00:49:58]:
It's tragically wasteful of resources. Now, let's go back to what we factored out for sake of the argument, which is human suffering, astronomical. And so much of it is preventable. So much of it preventable. It's treatable. It's changeable.

Dan Riley [00:50:16]:
I mean, Paul, your energy for this, your vitality for this is palpable just in this one mean, I have a lot of admiration for how much of your life you've dedicated to trying to help with this. And I think a lot of people who have probably been patients would hear what you just said and completely agree with it. And you used the word earlier, rapport. That rapport is so important in navigating these waters to try to understand what might be at the root cause of somebody's suffering. How long does it typically take you when you have a new patient to understand their biography and the root of their own trauma? And I'm sure a lot of people who are listening to this are wondering, how have you made this work, just economically speaking, which I think we've all had that experience of going into a doctor's office and feeling like cattle, it's obvious that there's a clock that's ticking and it's time for me to go here pretty quickly.

Paul Conti [00:51:16]:
Yeah. Building rapport is as different as there are people one is trying to build rapport with. Usually, say, on average, it's maybe a curve to it. Maybe the more middle of that curve is maybe be some weeks or some months to really build a sense of trust. If you're more open and real with people, I think that happens more quickly, but that could happen in a shorter period of time. It might take a much longer period of time, and our systems aren't patient. It may be that you're going to build rapport with that person for six months if you're going to have any chance of helping them. But our systems gave him ten sessions, right? They failed their treatment after ten sessions.

Paul Conti [00:52:02]:
And there's a real talk about tragic. Now, that person is labeled. They failed this, they failed that. No, the system failed them. So rapport it's just about being attuned to people and talking with them, like how they feel. We can ask people this, how's your comfort level feel? We can talk to people more and get more feedback and just kind of be there with them. And then we're going to build rapport as fast as we can, even if that might still take a while. And then it's just very hard to work within systems.

Paul Conti [00:52:35]:
Most of what I do is outside of any of these systems because there's such a frustration inside of me and being beholden to a system that says, go do something helpful, like telling somebody, go walk over there and that'll really be helpful to someone. But we're going to tie your ankles and your arms together so you can't really do it even though otherwise you could. But there are ways around it. I remember early in my career being in a system that was 15 minutes appointments and then I had people like, I need to learn about them. So I realized, oh, you can have a lot of 15. They're not looking one to another. So they're going to come back for 15 minutes appointments four days in a row because then I'm going to get my hour with them. And I can remember with this is really a true story that there was a woman who I felt like I really was able to help this way and you could tell because she wasn't going into the hospital anymore.

Paul Conti [00:53:31]:
So it's not just like I feel I help her. Her average of x number of hospitalizations over a six month period has now gone like this. And part of it was, there's no way I was going to help that woman in 15 minutes every couple of months as a waste. Right? So she was coming in more frequently and then at some point it's really a true story. I got a letter from the insurance company and it's about her. And I'm feeling like I was naive as the other time, like I say, thank you, kept her out of the hospital and saved us a zillion dollars. Right? But it was like a veiled thread of are you abusing the system because you're seeing her too often? That's awful. That is awful.

Paul Conti [00:54:13]:
And who is it awful for? That person? And how many people like that and how short sighted those appointments cost that insurance company very little and saved them very much. But they couldn't see that. All they could see was that one little bucket. It was using more of the 15 minutes time and whatever $45 that was outgoing. That to me is a litmus sense of this system is broken, absolutely broken, and it will not. Sometimes there are good people, I'm saying everyone in it. I mean, there are good people in it working very hard. And I feel such compassion for people working within systems.

Paul Conti [00:54:52]:
But the systems are broken enough that you can't rely on them. You have to be your own advocate because the systems don't take care of us like they should. And to me, that's as good an example. As good an example as there's going to be.

Dan Riley [00:55:06]:
Yeah. And I think probably speaks to the power of incentives within a given system. And sometimes those incentives are terrible and lead to severely suboptimal results. And if I understood you correctly, there, am I right that you've primarily just opted out of the traditional system in general in order to have the kind of practice that you want?

Paul Conti [00:55:27]:
Yes, I'm built in a way that I want things to happen. I'm not a natural baby that just stop thinking, okay, it takes time. I can be that way. I believe. I think that I can allow time if time is what is indicated and needed. I can take six months to build rapport if that's what it takes. But to see that this should be different, but there's no ability to really change it, that doesn't sit so well with me. It's just like the immense frustration in me.

Paul Conti [00:55:56]:
I just guided myself. If I'm going to do what I do, I have to be able to do it in a way where it can really help people. And then part of what we do outside of insurance then can subsidize taking care of someone without cost to them. There are ways of doing that. I don't want to leave money in insurance systems, but if there's going to be money, have it paid to practitioners who can then utilize that to then take care of people who don't have the ability to pay. I think it's a better way of doing it. Now, is that good? No. It would be good if the systems were such that people could work within the systems, feel good, not feel that they're so devalued by the systems.

Paul Conti [00:56:35]:
And for many, many healthcare practitioners working within systems, they feel very much like the light bulb that's interchangeable. So these systems, many of them are miserable to work in. And we know that from rates of depression and rates of suicide and healthcare workers. How much, and this, may I look, with admiration, how much did people suffer who worked in hospitals during the pandemic? But they did it anyway. And what happened? Having worked in hospitals, I know what that means. I don't know what it means to work there during the pandemic, but I know it was much harder than what I did, which was very hard. What happened after the pandemic, not much difference. No one said, are we going to honor these people? What are we going to do to help them go forward? It's like they go back to what they were doing before, and we have this rush forward, rush forward, rush forward.

Paul Conti [00:57:24]:
And I've said this many times, and I think this is true. We do this as a society. This is more an american thing. It happens in other places, too, that we rush forward so quickly that we just trample people along the way, and we don't really see it, because when someone who has suffered from trauma, then their horizons change. The young woman I told you about that, who changed in her thought about the award, is she's dead. And there's no, like, oh, my God, she's dead. That's it. These things happen.

Paul Conti [00:57:53]:
And we don't, as a society say, oh, my God, that was a young person. That didn't have to happen. We just go along. And maybe, I think we as a society, trample people like that. And what we don't realize is, even if we can't say, hey, this is not right. What maybe we can anchor to is any one of us can be that person who is on the ground and potentially trampled. Like, I was there, and I've been there since I've been a physician, too. Just because you're not insulated from any of this, we're all people, and we could all be that person.

Paul Conti [00:58:25]:
Are we going to just move forward and trample or not? I think for us to stop and say, whoa, this healthcare system is broken. How we're handling so much of this, this is not okay. We need to change this, because this is about us, all of us.

Dan Riley [00:58:41]:
Yeah, beautifully said. And I know we've talked a lot about trauma and your work in trauma today, and I'd love to, if we can, maybe transition to some tactics that you often will offer to people to try to help relieve suffering. I mean, it's obvious just in speaking to you how much you must care about your patients. And one comment I heard you say in an interview that I was listening to is that one of your most common suggestions is that people stop watching the news. I'm sure it's case dependent and person dependent in terms of what you suggest, but what are some of the more common habits or lifestyle changes that you find may actually help people work through some of their trauma and mitigate a lot of the suffering that they're experiencing.

Paul Conti [00:59:37]:
This may sound simplistic, but I think it's not just starting from a basis of, like, are you taking care of yourself reasonably or not? Because there are two things that can come of that. One is, if the answer to that is no, there are things to change. There are things to change. One of those things might be, look, I need to get more rest. It that might be a thing. I need to get more exercise. I need to eat better. I can't be doing things the way I'm doing them, where I'm just running myself down.

Paul Conti [01:00:06]:
Maybe those are answers. Right? So it tells about things we can do better. And then it also begs the question of, why are you not taking care of yourself? So, starting with some of the real basics of self care in terms of inquiry regarding a desire to change and also a desire to understand, and there's a lot to do about that, and even things that can be as simple as the news thing. Do you think the system in psychiatry, which generally is like a book that DSM like this thick, which in my view, is designed to make sure that everybody's got five or six diagnoses so that the system can get people into care, and then the system is needed because everybody has a diagnosis, even though people don't get helped in their 15 minutes appointments? Like, I am against that. We need to understand categories of illness, what changes biologically in depression or an addiction. We need to understand these things. But if we decide that that's the metric by which we are determining things and we're really leading ourselves astray, one aspect of that is the idea that vicarious trauma. For ages, I think this is still the case, but I'm not paying attention because there are other things to pay attention to that are more important of vicarious trauma being acknowledged as making real PTSD, which is a post trauma syndrome, if it occurs in the context of one's work.

Paul Conti [01:01:40]:
Okay, that makes no sense. As you're saying, the brain change. We both have the same brain change through vicarious trauma. But yours has come through your work, say, in the medical field or in the military. Right? And mine has not. Mine has come through having a very, very sick neighbor or someone I know who lost a child. So that it's come through that, or it's come through the news of being so afraid and so worried or so connected to other people's suffering that the people can't stop looking at everything that's happening in the wars going on around us, that can change people just the same. If you have the brain change and I have the brain change, the system is going to validate you, but not me, because it came in terms of work.

Paul Conti [01:02:22]:
That's not medical, that's just a categorization mechanism. And we need to look beyond that and see what is the real truth of it. So if vicarious trauma can change our brain, then vicarious trauma can change our brain. And if a person is becoming more anxious, they're not sleeping as well. Their habits are changing because they cannot stop looking at what is going on. For example, in the Ukraine, they're so distraught by it that they cannot look away from it. Then we need to honor that and say, you need to stop that. It doesn't mean you're not compassionate or being vigilant about your own safety of people you love.

Paul Conti [01:03:03]:
You don't need to do that in order to be safe. It's hurting you. We need to just look with this idea of common sense plus inquiry tells us a lot. And for some people, in a way, that's humor, but well meant is, I'm going to write you a prescription and it's like, really important. And I'm building up to something with pseudohuman, it's no more news, right? Or you check the news to learn. Check, look, scan down the news now you're now go on to something different. So a lot of times, common sense plus inquiry tells us, hey, that person needs to eat better, sleep more. Sometimes you learn then, of things that are entirely unacceptable.

Paul Conti [01:03:42]:
Like, many people are in abusive settings in some part of their life, have just accepted, well, that's part of what it is. We did stuff like, that's not okay for anyone on earth and. Oh, right, okay. That's why there's some things that are very basic that we can gloss over in ourselves. So again, I'll start with common sense. And rational inquiry is going to get us far. You add some relationship building on top of it, and we're off to the races of understanding ourselves, helping understand others, and both helping and being helped. And that can happen in a treatment room between a therapist and a patient, but it can also happen between friends to some extent, right? That means no one's saying that's not a substitute for professional help if someone needs it, if somebody is suicidal or having significant symptoms.

Paul Conti [01:04:30]:
But there are many people who can't get to that, and we can do some of that for each other, just like just talking about what's going on in you, you seem different, or I'm your friend. And you're telling me that, man, you're really feeling down what's going on, or usually, if there's something fun to do, you're right there with it. But, man, the last couple of months, the last several months since that thing happened, or maybe I don't know what happened, maybe you don't know what happened, but I noticed that you've been different. We can have these conversations. We just have to be thoughtful about how we have them, but we can seek them out in others and we can seek to have them with others that we care about.

Dan Riley [01:05:06]:
Yeah, I know. This was something that I wanted to bring up with you, which is just where you think we are in the state of mental health. Mean, we've talked a couple of times during this conversation already about how intense the US is and how probably misguided it has been about human wellness for its citizens and having a rational and empathic approach to mental health care in the country. And it seems to me that many of these. I had Peter Levine on the show. He was the last guest and he came on the scene, I think, in the things that I think he was most known for is introducing the idea that trauma is physical. It's something in the body, and that that's something that is seen throughout nature. I mean, that wasn't that long ago that that very concept seemed to gain widespread recognition in America.

Dan Riley [01:06:03]:
And I don't know if you view where we are today as like being in the dark ages or the beginning of the enlightenment, that we're just beginning to have a candle in the dark with these subjects. But I did want to ask you about where in history you think we are in terms of our understanding, because so many of the modern ailments I've just seen in my life with friends and with people in the country seem to be rooted in mysterious disorders that are not very well understood in the brain. Put that to you just to give your assessment of where you think we are in just understanding these areas of knowledge in general.

Paul Conti [01:06:47]:
The first thing to say mental health care in America, on balance, is dismal. You asked me about the assessment of the state of mental health care. It doesn't mean there's not help to be had, but it means help is hard to find. And this idea that it's throughput, how can we get just people through the system? The other side, it's not like, what are we actually helping them? We have all these systems then built up where the system is serving itself. And how many people now who are supposed to be helping others who just click, click on that computer screen. They don't have time to help the person. The person doesn't feel helped because the person who's trying to help them is just clicking through a bunch of miz. And that person who's doing it feels miserable.

Paul Conti [01:07:25]:
That's going on all the time in thousands upon thousands upon thousands of places right now in the United States, other places, too, but in America. So the system is dismal. And I think we're at a stage where we know so many things that we're just not doing anything about. It's like if we're all huddling, we don't have electricity, so we don't have heat, and we don't have the things that we need. We don't have lights, but electricity exists. We don't know all about it. We just don't have it. And you can say, okay, it's things that people understood in the.

Paul Conti [01:08:02]:
It's not that long, but it is also a long time. If you look at how quickly things move in the modern world and that we're not doing anything with that information, really, right. On balance, these things that are known are not impactful. It is remarkable to me, and it shocked me, coming to medicine as an outsider and realizing the difference between how much is known and understood and how much actually gets put to, like, rubber hitting the road. Let's use that and help people. And that is very shocking to me. These systems have their inertia and their momentum. And I would say, if you have to live in the dark, make the best of it.

Paul Conti [01:08:48]:
If you don't have to live in the dark, know that and get the electricity so you don't have to live in the dark. That's what we as a society need to stop and look and say we're racing ahead so far in all these systems that we are not helping ourselves and each other, and we suffer losses because of it. Of people who die by suicide or by overdose or from medical consequences, autoimmune diseases, the cardiovascular heart disease that are promoted by mental health problems like this is hurting us as a group. So let's stop running forward so quickly that we leave ourselves behind people who are part of us, or we trample them along the way and say, let's stop and take stock of, like, what do we know? How can we be doing this in a way that would be different? And I think that can happen. I don't think it's going to happen from the bottom up. I think we have to realize this is broken. This must change. And then I think we can change things in big ways.

Paul Conti [01:09:52]:
It shows, like, people can do that, societies can do that, but we have to recognize like, enough. This isn't working and we're not going to fine tune it here or there. We have to stop and look at this and say, what are we doing and how can we do it differently?

Dan Riley [01:10:03]:
Yeah, brilliantly put. And I know to me again, this comes back to your comment about how you were a math minor about getting to root cause, getting to the real reason for people's ailments. And I know you've talked about this with other podcasters, that one of Gabor mate's most famous lines is ask not why the addiction, but why the pain. And I think that's such a pithy but important way to frame one of many areas in which trauma is inflicting suffering in our civilization. But I know we're getting towards the end of the conversation, and I could talk to you all day long, but I want to give a little bit of time for what you're hopeful about and the future. And I know just one thing, that I had an interview years ago on this show with a man who did MDMA work for maps in the early trials, and that I know specifically seems to show a lot of efficacy with trauma, with PTSD, and there's a reasonable chance that that may be greenlit for medical use by the FDA this year. I'll just put that to you in general of what you're hopeful about. It's clear to me again, just in talking to you that your heart is in the right place and that you're, you know, I think mostly you're interested in helping people, which I know most doctors are.

Dan Riley [01:11:33]:
But what to you are the big areas of real hope, specifically that you are looking forward to in the future to make people more?

Paul Conti [01:11:44]:
Well, I think there are two aspects of that. The first is we are learning and understanding regarding incredibly powerful potential tools. So you said MDMA for trauma, potentially a tremendously powerful tool. I think it is in the right hands and the studies and have shown that same thing with psychedelics, same things with what we learned through neuroimaging and epigenetics. We are learning a lot. That is very important, very important and potentially changing the ability of the field to help people in really, really robust ways. So, of course, I find that very encouraging. But in the context of what we just talked about, none of that matters if no one is accessing it.

Paul Conti [01:12:35]:
What I find more hope and promise is that people are really interested in mental health. It's getting attention. People are talking about it, acknowledging it. There's so much of this less reflexive shame about even the idea of mental health. And I'm not so ashamed if I've got something going on between here and the ground. But if it's here, I'm supposed to feel there's less of that and there's more of an interest and more of an openness. And it's that that makes change. Because again, it doesn't matter what tools you have if you can't access the toolbox.

Paul Conti [01:13:09]:
It doesn't matter what tools a system has if you don't know the tools are there and the system isn't going to open the toolbox for you. But if we're like, wait a second, there's something to understand better here, and we care about this and we want this to be different. Now we're harnessing the energy that can create change. Where hopefully two people aren't having this discussion 20 years down the road, or maybe you and I aren't having it. Well, we talked about a lot and learned there's a lot out there, but things aren't any different, really. We need to not have that conversation. I don't think a few years down the road, let alone far down the road, that maybe now there's the will, there's the wherewithal of saying, hey, enough is enough, because you know who's getting hurt and dying. Us.

Paul Conti [01:13:55]:
Very few people don't know anyone or don't know closely care about someone who knows someone who, say, died by suicide or died through substance use one way or another, it's common enough, which is tragic, but it also can make that light bulb go off. This isn't about other people. This is about us. And again, if you think this system isn't trampling people and that you or someone you love couldn't be trampled, you have your eyes closed. So it's the realization of that truth that I think starts giving the incentive, the will to look at this and say, enough is enough. We need to change.

Dan Riley [01:14:37]:
Fair enough. I think that's a great place to end. Paul, I just want to say again how much I admire your work and for your openness and for your willingness to share your stories. Absolutely. And I've benefited from it personally. And I know I speak for a lot of people in commending you for your openness to the public in the way that you have been over the past many years. So really appreciate you giving me the time. And to me, that's a great source of hope for the future.

Dan Riley [01:15:06]:
It's a turbulent time, obviously, as the world always is. But the fact that there are these tools and that the increasing knowledge that the mind is malleable and that there is hope for people that are really suffering is just an amazing, and I think, very optimistic fact about the world we live in. So thank you again so much for doing this. I really, really appreciate it.

Paul Conti [01:15:29]:
Thank you. I so appreciate you having me on and leading the discussion that gets this out to people. So thank you very much for what you're doing and for having me on. I very much appreciate it.

Dan Riley [01:15:38]:
Thank you. Paul.