January 10, 2022

Mental & Emotional Health

#190 – Paul Conti, M.D.: How to heal from trauma and break the cycle of shame

“Trauma changes the instrument that we use to understand our trauma. It's changing our brain.” —Paul Conti

Read Time 66 minutes

Paul Conti, a returning guest on The Drive, is a practicing psychiatrist and recent author of Trauma: The Invisible Epidemic: How Trauma Works and How We Can Heal From It, in which he offers valuable insights on healing from trauma. In this episode, Paul explains how his personal experience with trauma and his many years seeing patients have shaped his understanding of trauma’s impact on the brain, its common patterns and manifestations, and how often people don’t recognize the implications of trauma in their own life. He discusses major challenges in recognizing trauma, including the lack of biomarkers in psychiatry and psychology, as well as the misguidance of the mental health system in targeting symptoms as opposed to root problems. He talks about shame as the biggest impediment to healing from trauma and offers solutions to how, as a society, we can start to change the stigma of mental health and allow more people to receive help. Finally, he concludes with a discussion about the potential role of psychedelics like psilocybin and MDMA in treating trauma.

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We discuss:

  • Paul’s background and unique path to psychiatry [2:30];
  • A personal tragedy that shaped Paul’s understanding of trauma and resulting feelings of shame and guilt [5:30];
  • The current state of psychiatry training and need for improvement [20:15]; 
  • The over-reliance on outdated metrics and lack of attention to past trauma as an impediment to patient care [28:30]; 
  • Defining trauma: various types, heterogeneity, and effects on the brain [34:30]; 
  • Importance of finding the roots of trauma and understanding the “why” [47:00];
  • The major challenge of recognizing trauma in patients [55:15];
  • How shame and guilt are barriers to treatment and healing [1:06:00];
  • How treating trauma compares to treating an abscess—a powerful analogy [1:11:30];
  • How evolutionary survival instincts create problems in modern society [1:15:15];
  • First step toward healing: overcoming the fear of talking about past trauma [1:19:00];
  • Shame: the biggest impediment to healing [1:25:15];
  • The antidote to shame and the need for discourse and understanding [1:34:15];
  • The emotional health component of healthspan [1:41:15];
  • How to reframe the conversation about mental health for a better future [1:52:00];
  • The growing impact of trauma on our society and the need for compassion [1:58:45];
  • Society’s antiquated way of treating manifestations of trauma rather than root issues [2:04:15];
  • Potential role of psychedelics like psilocybin and MDMA in treating trauma [2:11:15];
  • Parting thoughts and resources for getting help [2:16:30];
  • More.

§

Notes from intro:

  • Paul was one of our initial guests back in September 2018 in episode 15
  • Paul is a practicing psychiatrist and recent author of Trauma: The Invisible Epidemic: How Trauma Works and How We Can Heal From It
    • A book that brings his valuable insights about how we can collectively heal from trauma’s effects to a larger audience
  • Paul is a graduate of Stanford University Med School, which is where Peter met him
  • He completed his psychiatry training at Stanford and Harvard, where he was appointed chief resident
  • He then served on a medical faculty before moving to Portland and founding a clinic
  • This episode is focused primarily around trauma
  • We talk about Paul’s upbringing and his experience and how that got him interested in studying medicine and ultimately psychiatry and trauma
  • We look at the impact of trauma on the brain, patterns around trauma, and how often people don’t recognize the implications of trauma in their life
  • We talk about the lack of biomarkers in psychiatry and psychology, and the misguidance around trauma and the mental health system
  • We talk about how trauma is treated as a symptom instead of going after the problem
  • We talk about the importance of lowering the barrier around trauma so that people can begin to receive help
  • We look at the shame that comes with trauma
    • How shame is often the thing that prevents people from getting help
    • How we can start to change the stigma around that shame that comes with past trauma
  • We end the discussion with the conversation around suicide and the potential to use MDMA 

 

Paul’s background and unique path to psychiatry [2:30]

  • Paul trained as a psychiatrist 
  • A big part of his day job is being a clinical psychiatrist
  • He also does some consulting work along the lines of understanding brain function and how brain function can impact us in personal or professional settings
  • But by and large his work is really grounded in the clinical
    • He has a clinic of about 15 really great people he works side by side with in trying to meet the needs of people who bring whatever mental health questions there may be, which sometimes is clinical care

When he became interested in mental health:

  • He became interested in mental health around the clinical rotation part of medical school, probably into the last year
  • This is when he realized that he could really be a doctor and understand medical things 
    • He wanted to understand how they impact people and be grounded in that aspect of practicing medicine
  • But he also wanted to understand people’s experiences of life
    • What people think and feel as they’re going through their day
    • He wanted to combine these 2 things and be grounded to all the things one learns about life as they through it and help people in that way

Paul’s unique path to medicine:

  • Peter remembers that Paul did not come to medical school in a typical way; he was not a pre-med
  • Paul worked for a consulting firm in New York and really enjoyed many aspects of the work, the business and financial aspects of it, but there was something more that he wanted 
  • He wanted to know more and learn more and be more directly involved with people.
  • This led him to medical school to try and learn more and explore what he might be able to bring to others

 

A personal tragedy that shaped Paul’s understanding of trauma and resulting feelings of shame and guilt [5:30]

  • Peter asked about the events in his adolescence that shaped how he thinks about trauma
  • In the first half of his life, there wasn’t any major trauma
    • He was fortunate to have a stable family system around him and to develop a pretty stable sense of self
      • This is much easier to do if there aren’t big traumas
  • It was in the second half of his life that he started to have some very major traumas

“To experience the traumas after having developed an orientation to myself and to the world that had been free of them was very, very striking” – Paul Conti

  • He thinks it put him in a place to see what was going on in him and what was changing in him 
    • Even though he didn’t completely understand them
    • To see what the impacts of the trauma were was distressing and surprising
    • This is part of what led him towards mental health, the surprise at seeing what was happening to him
  • His sense of self was really thrown off by the traumas that happened even though he had gotten through his formative stages without any trauma
    • He wondered what happens to someone who experiences these traumas who doesn’t have a stable family system
  • He was 24 when his brother committed suicide
  • He felt shock and disbelief, which is common for families
  • Looking at the events from the outside, his brother had a huge trauma a few years before
    • He had a very significant medical issue that came out of the blue and was life threatening 
    • It really shook his sense of self
    • And he was very different after that in ways that Paul could see in some sense but not fully understand
  • From the outside, seeing these changes in his brother one might think his suicide may not be that shocking  
  • This is not how it was on the inside
    • Everyone has mechanisms of denial or rationalization that tell us think are okay when they aren’t 
    • Then the shock of it happening and realizing, “Oh, what could I have seen? Would I have seen?” contributes to the guilt and shame that people feel
  • It’s a bad combination; an immense amount of shock and then immediately thereafter a sense of guilt and responsibility
  • People get into a mindset that if this big trauma had not happened…
    • It offers some sort of psychological protection
    • But it can make the shock of a trauma more difficult because one starts to feel cursed or unworthy
    • There’s some mark of stigma that is very frightening
  • Peter asked how his other brother and parents coped

“I think my other brother and I are sort of built in somewhat the same way of continuing to persevere and trying to find something new that can make life feel better, which often means working toward achievements, applying ourselves, which can be quite a good defense against trauma” – Paul Conti

  • His parents were different
    • His father was more of an outgoing, gregarious person and was able to fall into a social network that was really supportive of him
    • His mother, who has since passed away, was more of a private person, less socially connected
      • Ultimately she suffered from a lot of depression without her or us really understanding it
  • This is part of what pushed his interest in trauma so strongly
  • The realization of all the things he and his family didn’t understand 
    • Or understood enough to know that they weren’t good, but they didn’t have the words or the understanding to really talk about all the changes and what it meant
    • They didn’t have a ready lexicon or environment to be able to talk about things
  • People at times sort of retreat into themselves, and then the trauma stays very immediate even though that immediacy can play out over years and years
  • So he thinks they were very ill-equipped, like most people 
    • Ill-equipped to handle a massive trauma and its impact upon all of us individually, let alone the greater complexity of all of us as a family
  • Is it more common that in a situation like this, where a child commits suicide and the parents and siblings are left picking up the pieces, that very little is spoken explicitly?

Common responses to suicide of a friend or family member

  • Peter reflects of the people he knew growing up who dealt with suicide
    • He had a girlfriend in college whose mom committed suicide
    • He had another girlfriend in high school whose dad committed suicide. And one of these had a very tragic outcome
    • He had a very close friend in high school whose dad committed suicide
      • This friend later committed suicide too
      • Peter felt very guilty about this friend because when he was in college, his mom called and told him he wasn’t doing well
      • It was April during finals and Peter told himself he would reconnect in 3 weeks when he was home but by then it was too late

Why is it hard to reach out for help?

  • Peter asks if Paul and his family ever talked about seeing a therapist to process the loss of his brother
  • There was some discussion about it, but partly because of his generation, he hadn’t been to medical school yet so he had no knowledge of anything; but he was a little more inclined to want to talk about things
    • He could tell that all of them were not doing well but didn’t know the words to put to it

“We don’t, in a sense, give ourselves permission to have words of immensity… Of impact… Of oh, my whole existence feels different.” – Paul Conti

  • Often the reflexive nature of shame causes us to go inside

“A primary point that I wish to make about trauma, is that there is a reflexive shame that comes of being traumatized” – Paul Conti

  • This is the same shame he sees if someone is assaulted and then presents talking about the assault through the lens of their shame that it happened
  • These powerful stories that reinforce the reflexive nature of a sense of shame that drives us inwards
    • One doesn’t have the words for it
    • Then they feel very, very bad about it

Impact of trauma and shame

{End of show notes preview}

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Paul Conti, M.D.

Dr. Paul M. Conti is a graduate of Stanford University School of Medicine. He completed his training at Stanford and at Harvard, where he served as Chief Resident. He then worked in private practice while serving on the medical faculty at Harvard. Dr. Conti was named as one of Oregon’s Top Psychiatrists in 2008, his first full year of practice in Oregon. He is a general psychiatrist, treating all aspects of both mental illness and the impact of life stressors. Dr. Conti is adept at helping people untangle complex problems, and he incorporates a holistic view of each client or patient into his work, knowing the far-reaching impacts trauma can have upon the systems and communities in which an individual resides, works, and serves. His practice includes the use of medications and psychotherapy, and he also treats complex cases, co-occurring alcohol and drug issues, and does neuropsychiatric assessments. In addition to clinical treatment, Dr. Conti provides business-related and legal consulting services.  He is the author of Trauma: The Invisible Epidemic, a book that brings his valuable insights about how we can collectively heal from trauma’s effects to a larger audience. [Pacific Premier Group]

Disclaimer: This blog is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user's own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.
  1. This was a beautiful conversation, thank you.
    I think what I would add is that the reason why trauma is so difficult to define or definitively predict from circumstances is because the trauma in a person is tied to the interpretation they gave to an event or situation. The presenting problem or internalized trauma is the BELIEF they end up having about self or the world based on their interpretation of the event. People can and have endured great traumatic events without internal trauma if they do not internalize or interpret the violence or neglect as something they deserved or caused — if they do not believe they are defective or worthless because of other’s actions or their circumstances.
    Beliefs run much deeper than knowledge/information in us and I believe this is a place where true spirituality plays a key role. How do we change what we know in our minds isn’t true, don’t want to be true, but can’t stop feeling IS true? How do we change what we believe?

  2. I don’t know why it surprises me that a podcast like this episode leaves me in a state of wanting to make a difference.

    There were multiple times while I was being treated for pemphigus vulgaris that my pcp offered antidepressants. I used them for a ptsd situation years ago and knew that adding them on top of all the drugs I was taking to get my immune system under control was a very bad idea…so I said no.

    Throughout this discussion, I was recalling multiple conversations with my pcp. I did go to counseling…so I wasn’t walking this journey alone…but I didn’t want to just drown out the emotions that basically CAUSED an autoimmune disease.

    Our system just doesn’t have time worked into it to actually take care of people. This podcast will be a driving aspect of the business plan I’m putting together.

    Thank you.

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