April 27, 2019 • 57 mins
After 20 years of working in the field and 10 years of research, Dr. Shaili Jain stops by to discuss her new book 'The Unspeakable Mind', and how PTSD is a public health issue that impacts all of us.
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Episode Transcript
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Speaker 1 (00:06):
Hey, this is Annie and you're listening to stuff I
never told you. And today Samantha and I have a
bonus episode for your lovely listeners. Bonus bonus, isn't we
(00:29):
always are trying to give you extra cons extra um.
So one of my good friends here in the house
Stuff Works office, his name is Alex. He's a fantastic
person to work with. I like that you're doing this
like my background. I'm going to do this. This is
(00:49):
my new role. Okay, I oh my gosh, please follow
me around to be my high person. Any Alex is fantastic.
And Alex put me in touch with a publicist who
represents Dr Shelley Jane, who is and Slash was depending
on when you listen to this Um coming out with
(01:10):
a book called The Unspeakable Mind, and UM, since we've
been doing this whole mini series, I almost hesitate to
call a mini series. I feel like it's like a series.
It's not many. It's a medium series, medium a medium series.
I think it's a season UM around trauma. It was
(01:33):
perfect because in the book she delves into the science
of PTSD and how it doesn't look like what a
lot of people think it looks like and how we
can prevent it, how we can treat it, the problems,
the solutions, all that stuff. It's an excellent wheat. I
read it in a day, loved it. Um. So we
thought we we didn't interview. We were fortunate enough to
(01:54):
get Dr Jane on the phone and we conducted a
fantastic interview and you've probably heard pieces of it in episodes,
but we wanted to present the whole thing lightly edited,
um for our our mishaps. There weren't many. Yeah, no,
there was a fire. No, no, now there were you
(02:16):
know there was chicken involved. That's true. We were eating chicken.
It wasn't like a chicken in the studio. But yeah,
we thought we'd present it to you largely unedited as
bonus content, so please enjoy. I like to start with
a basic question, which is could you tell us a
(02:37):
little bit about yourself and your background? Please? Sure? Absolutely so. UM,
I'm a psychiatrist by training, and about ten years ago
I um and to uh kind of postgraduate training to
become a pt special and so now, um that is
(02:59):
kind of my speciality. I'm a trauma scientists as well.
I do research um in PTSD and then a treat
patients and obviously I'm an educated too, so I'm training
a lot of um young doctors in PTSD and psychiatry.
So I spent two decades caring for thousands of patients
(03:21):
who have survived various forms of trauma from child abuse,
you know, rape, intimate partner's island, by straightening accidents, and war.
That's kind of a little bit about my background. Yeah,
I knew you discuss in the book how you had
this experience with your your father that kind of lad
(03:43):
you into this career. If you could speak to that
a little bit, Yeah, no, absolutely, So on a personal note,
you know, I have my own family history is one
of trauma and tragedy. Um So, during the nineteen partition
of British India, my paternal grandfather was murdered and my
(04:05):
dad was ten at that time, and he was offered
and forced to flee his home, you know, live as
a refugee in India, and he worked as a child laborer,
you know, because um uh, you know, there was no
other sources of income and both his parents were deceased.
Now two decades later, he ended up emigrating to England
(04:25):
and that's where I was born. And raised. So I
spent a lot of my life very disconnected from that
family history of trauma. You know, we never went back
to India barely with very little connection. But even though
there was that kind of geographical distance, I spent chunks
of my news living in the shadows that partitioner have
tasted on his life and kind of with this awareness
(04:47):
as a child. But no matter how much I loved
him and he loved me, it was a part of
him that was always going to be inaccessible. And somehow
I feel like as a child I did have this awareness,
but there was a collection between what happened to him
as a kid and why I was feeling this. But
it took me many years of training and many years
of being a clinician to really figure out, you know,
(05:11):
what that was and kind of give it a name.
Mm hmm. And um, you, through these these years of experience,
you have written a book, The Unspeakable Mind. And congratulations,
by the way, that's that's no small feet. Thank you,
(05:31):
thank you, thank you for a yeah, I don't want
to take that very granted. And you wrote a book
that's amazing. Um, so could you talk about what led
you to to write this? Book, and UM, yeah, I have,
I have. I read it in a day. I loved it.
I think it's very informative. But yeah, I would love
(05:53):
if you just talked about like the experience of reading, right,
and then also if you could just add why you
felt it was important to add personal accounts to it,
because I think as part of the thing that happens
that kind of lacks within all of these types of
UM books and sociological ideas, that they lacked the actual
personal background that people often want to connect to. But
what made you go that route as well? But well,
(06:14):
thanks so much journeys of saying you enjoyed the book.
That means a lot because there's literally been a tenure
labor of club. So you know, that's what makes me happy.
It makes me happy that people who are kind of
you know, a general audience and educated lay audience who
might not have UM the kind of training UM in
in psychology. Uh, I wanted to reach that audience by
(06:38):
writing this book. So obviously you know in my scholarly work,
I write all the time. Right, you do scholarly papers,
you you editual research, and you're basically preaching to the quiet.
You're talking to the people who are in your circle.
My the dress behind writing Me and supil mind is
I really wanted to reach a wider audience. Um, you know,
(06:58):
I think theater person is much more aware about things like,
you know, the imfortance of a heart healthy lifestyle or
getting cancer prevention screenings and say they say they were
like twenty thirty years ago. I really feel the time
has come where we have to elevate our society or
literacy about mental health and trauma and PTSD because we
have too much to lose if we don't write to
(07:21):
this challenge. So I wanted to tell the complete story
of PTSD in a way that it's accessible for anyone
who's curious to know more about this condition. And to me, um,
you know, I've read a lot of books written by
doctor writers, and to me, when they talk about clinical experiences,
at my heart, I'm a cleinish that that's my primary role.
(07:43):
I find I just tapped into the material so much easier, Um,
when you go at it from a humanistic point of view,
when you go at it from the personal point of view,
and definitely for me as a writer, that's how it's
happened to the material. It's it's experiences with people that
make me want to write. So I always, naturally, even
(08:05):
kind of my process as a writer, I start from that,
that is what motivates me to write. UM. So, so yeah,
I mean, I hope I answered your question. I wanted
to reach a wider orders because I think we have to.
PTSC is a press in public health concern. It's an
inextricable part of all of our lives, even if we
don't know it yet, it is, And so I really
wanted to reach a wider audience, but at the same
(08:27):
time present the mature in a way that people could digest.
You know, that was was I mean, it's hard. It's
hard to write about trauma. It's hard to read about trauma.
But I really wanted to do it in a way
that um would just make people more curious and help
understand the conditions that has really been widely misunderstood and
kind of alluded throughout history. UM. And then adds to
(08:51):
that this fact that the last twenty years has seen
such great research in PTSC, such wonderful science, and I
don't think that people are aware of that. I don't
think your average doctor is aware of how great scients,
how much great science has been PTC in the last
twenty years, and a lot of that has had to
do with major world events, like PTSC has really been
(09:12):
put on the map in the last twenty years, and
there's just some great stuff coming out. I mean, I'm
a PCC, especially my job to stay at tweed all
stay uncompable the science that's coming out, and it's hard
for me to stay on top of it. There's not
much of it. So really deconstructing that science and presenting
it um was very rewarding. UM because as they say,
(09:34):
I think people need to know, um, what we know
about this condition so that we can do more about it. Absolutely.
And one thing I want to expand on uh, and
that answer is you make the point. You make the
case several times in the book that it is a
public health issue, right if you could speak to you
(09:55):
why that is? Yeah, absolutely so, UM. You know, there
is this common perception out there that, um, you know,
when we think PTC, the automatic responses to think of
military and what we forget is that more than half
of Americans will say that at some point in their
(10:17):
lives they've lived through a major trauma, whether it's the
you know, grateful family violence, will being robbed at gunpoint
or escaping a house fire. I mean, there are so
many life threatened traumas that the average Americans go to
every single day, and we also know that a subset
of them will experience multiple traumas and a significant minority
(10:43):
of those people will not here naturally in the afternoon.
And what that means is that at any given second,
there are six million Americans who are suffering from PTSD,
like actively suffering. That's a huge number of people, right,
and then if on top of that refactoring, there's this
condition called partial PTSD. It's kind of like being prediabetic,
(11:04):
you know, like you don't quite meet the textbooks, but
that doesn't mean you're not suffering. And there are millions
upon millions of more people who we know have partial PTSD.
And you know, as you guys probably you know, PTC
doesn't live alone. It's often found amongst the depressed, the alcoholic,
drug addicted, the anxiety hidden all suffers or higher risks
(11:26):
of death by suicide. So if you think about the
collective mental health burden, that is huge, and so right
up until this point, I'm just talking about the survivor
formers awful, infectious. The family members of people with PTSD
the higher risk of having problems with depression and anxiety
PTSC themselves. So you know, if you think of this
stuff is the children and the parents, this network of people,
(11:50):
it's it's a big, um pressing public health concern and
a big problem is only a certain stuffware yet uman
because it's toes to diagnosed. It's a challenge to treat,
and suffers often don't want to be reached, you know.
The last thing they want to do oftentimes is compute
(12:11):
the mode like me and talk about the trauma. So
in totality you can kind of see the various dimensions
that makes it this messing in public health concern. And
definitely from my alcohol as the health services researcher, I
think diagnosing it quickly and getting prompt treatment is key
and that is not happening. It's not happening partly because
(12:34):
we have such a shortage of mental health professionals, especially
in our inner cities, especially in our rural towns. We're
often you know, the mental health bad and it's huge. Yeah, um,
And that's one thing that you talk about and the
book is not only prevention but in the case that
(12:56):
you can't prevent that golden our UM. Do you speak
about both of those things? Yeah, absolutely so. I think
when we think about PTSD, we we rarely think about
it as something that can be prevented UM. But I
(13:16):
do think that is the way forwards. From the last
twenty years, we've learned a lot about how to prevent it,
and there is this fascination from clinicians and scientists about
this period called the gold analysts. If you think about
that window between when someone's exposed two trauma, you know whatever,
family violence, sexual violence upon that, and then there's that
(13:38):
window between exposure and when they actually develop PTSD UM.
Now we don't know exactly how long that window is,
but a lot of people have made it very convincing
arguments that that is where we have a chance for
medical intervention UM. If we can interview early in that window,
we can set the path towards recovery UM. And there's
(14:00):
some coptle wheel promising interventions. There's been a lot of
use of the stress hormone cortisols in that window to
help tray and prevent PTC and then even kind of
psychological therapy. So there's a therapy that works for PTST
called exposure therapy, and some we search is out of Atlanta,
actually out of Emory. Have um yeah, have um uh.
(14:26):
Then a modified form of explosure therapy with Thomas survivors
right there in the ear, you know, like very soon
after they come in having survived a trauma, whether it's
a car accident or physical assaults or sexual assaults. So
so you know, I don't know the data is ready
for prime time. This isn't certainly what we're doing in
routine practice, but there's some really encouraging this research, and
(14:49):
I think that is the way to go. We don't
spend enough on prevention in the United States. We focus
a lot more on treatment. But I think that's the
way we need to think about what we can do either,
you know, evntional early intervention to help people right at
this point of trauma. You know, waiting ten, fifteen, twenty
years to people shut up achievement is not looking um.
(15:11):
So that that's what makes me excited about prevention, right
And I guess I was going to ask with the
prevention stuff because I did. You just had to small
like excerpts about UM and partner violence as well as
obviously sexual violence. Is that a part of like maybe
predicting within like economic status is about what is more
likely or more risk for those types of violence? Is
that part of what you would think would be trying
(15:33):
to do preventative treatment? How would you go about that?
I mean, what would we focus on educating in specific
like economic status areas and like specifically like what were
your thoughts on how to actually implement a preventative And
that's a great question because I mean, you know, if
we could have adequate into a partner violence, the sexual violence,
(15:53):
there's like you know, I mean, that would be miracles.
Cole questions. Yeah, but I things it takes a village
great and I think systems of health care have to
re engineer themselves to really think about this problem. And
I think too much htorically, um, you know, I mean
(16:15):
obviously you're you're wearing the same field from kind of
preaching to the choir by talking to about this, but
too often different medical systems they all want to talk
about domectric violence. It's really messy. They see there's a
a personal problem and something that they don't really know
how to respond to, and that culture just has to change.
Is you know, into a part of violence is a
(16:37):
major public health concern as well. It's really common and
a lot of points primary care is where these these
dickens are going to show up, you know, UM, and
that is an excellent opportunity for intervention. UM. The problem is,
I mean, I think the tide is turning. So there's
(16:58):
there's an excellent work that was by Kaiser UM and
they published their results in in the General Amical Medical Association.
And really they've described this effort that they had come
up with system wise to kind of re engineer their
whole systems so that they were better set up to
identify victims of intimate partner violence, to offer interventions to UM,
(17:25):
offer resources and the whole kind of system from the
electronic medical record, to provide education, to organizational buy in
from the powers that be. That whole thing was looked at,
and that to me is the way to go. You know,
it takes a village, I really believe want provided by themselves. Desming.
It's how much you can do just because of the
(17:47):
nature of the problem. It's not only a common problem,
it's a difficult problem. And as you point out, a
lot of people in these situations also have uh, you know,
they have psychosocial problems. You know, they might not have
them as weeks. They might not have the most money,
they might not have access to great healthcare. And so
that some pounds and already complicated and difficult problems. You know,
(18:08):
they call I TV into what probably it is called
a wicked problems in that general article. It's really difficult
to tackle. So I think to eat takes a village.
Just some have to be the engineed. The good news
is I think for at a point in a society
with people recognize now you know, we've got to do
(18:30):
more for victims of violence, and you know, in addition
to you know, in addition to spreading their physical injuries,
we have to provide them tastes for psychological rehabilitation too.
You know, I feel like people are more sensitive to
now that now it's it's compared to say, twenty years
ago when I first adopted. I think, I think the
tide is turning. But we've got to keep at it
(18:51):
because you know, it's so easy for these things to
kind of fall off with people's radar just because they're
so emotionally taxing to dealing is. But yes, since have
to be re engineered. They think education take place at
every single level. Um, and just gonna go with that.
You talked at one point about people who are at
most risk and you, um include low income women, which
(19:12):
is fascinating, UM, because I don't think I've directly thought
of that as one of the high risk of people,
but obviously when you think back on what they go through, yes,
they are at high risk. So out of curiosity, what
do you think, because I did see that you wrote
about TRIM as well as peer support, what is the
best way that we can actually get services and provide
treatment for women and individuals who are in that low
(19:36):
income that are not given the privilege of seeking help
or being able to afford help. Yeah, I mean, yeah,
that's a really good question. It's really tough. Um, access
to care, right, that's the biggest staruer, you know. Um,
if you can't have access either because you're un in
(19:57):
short or you're you you're under insured. Um, you know
that's a luxury then that you're going to show up
in your doctor's office and tell them about the nightmares
you've been having or the news interns you've been having.
So yeah, I worry a lot about these people that
we don't even reach. Um. So from my angle as
(20:17):
a physician, that's why access to health care, you know,
really have to be a right, not a privilege for everybody.
Um I think on the other end, like it's disciple,
and I do think just elevating the conversation about trauma,
just so people can kind of connect the doctor a
(20:38):
little bit and maybe be curious and maybe understand that's
really important because I think for too long it just
wasn't even a direct right. PTC just was denied, was hidden,
was not spoken about, not because not kind of intentionally,
it's just part of the nature of trauma, but your
(20:59):
natural inclination to not think of it it is unspeakable.
But I really am encouraged by the fact we're living
in a time where I do think the society was
kind of getting better. Obviously there's a long way to go,
so we are getting better at giving it a name,
and I can't help feel that that it's going to
(21:20):
have a good trickle down effect for everybody. But at
the same time, it doesn't take away the real problems.
I mean, access to health care is really really important,
and unfortunately it's just denied to turn any and it's
den likely that people who really really need it, you know, um,
and that's just a bigger problem for us. We have
to think of the society what we want, how we
(21:42):
want to care for people who don't have resources. It's
a bigger question. It's a policy question, obviously, it's a
prodical question. Access is important, and I think from my
angle as a psychiatrist, you know, my practice is in
primary care. I have moved my practice from a mental
health pointic too, primly care because I know a lot
of times people who have PTCC they show from time
(22:04):
with care. They don't come to someone like me. So
I do think there's still a lot more that can
be done on the s medical side, you know. So um,
So that takes down a lot of barriers. You know, Um,
they're seeing a psychiatrist right there in the time you
clip and make the regular timely care doctors introduced them
to the mental health professional. It breaks down a lot
of the stigma and a lot of the barriers to acent.
(22:25):
So there's a lot that can be done on on
many levels to help folks who are marginally social economically
get active to help We have some more of our interview,
but first we have a quick break for a word
from our sponsor, m and we're back. Thank you sponsor. Well,
(22:53):
I was going to ask you about the title specifically
you kind of touched on it and there, um, I
don't know if you wanna get into more detail about that,
how you came upon the title what it means. So
trauma often represents, you know, the violation everything we hold
(23:14):
to be dear and sacred and so almost simply too
terrible to utterly allowed. You know, the natural human connection
is to deny trauma it's existence, and so trauma becomes unspeakable. Um.
You know, sometimes the survivor wants to speak, but if
the wider community is unwilling or unable to bear witness
(23:37):
to their story, then the survivors boced into silence. But
either way, trauma becomes unspeakable. The problem is, we now
know definitively that PTSD tribes in such conditions. You know,
when traumatic thoughts and memories are unspeakable or unsinkable for
too long, we actually interfere with that brains natural processes
(24:01):
of propantly after trauma, you know, those memories become step
points that inhibit the mental reintegration that is so vital
for trauma survivors to heal. So, you know, the unspeakable
is at the core of what is the problem with PTSD.
Rendering the unspeakable permanently speakable is just crucial to the
(24:25):
coverage and a really integral part of what we know
works for PTSD in terms of trauma focused schatology. We UM,
we have a lot of international listeners. In one chapter
that I found really interesting is the one about the
Americanization of Human suffering and your experience at this conference
(24:48):
in India. UM. I was wondering if you could speak
to to that. UM. Yeah, very frustrating. UM. So you know,
I mean, this is an un news story, like if
you talked to some of the pioneers in PTSD research
(25:09):
and tatist treatment. You know, I had a conversation with
Charles Mama, who's UM care at any one US psychiatry,
and he gave testimony to Congress around the time of
the Vietnam War, UM about what PTSD is and why
we should say take it seriously and all those pioneering
(25:29):
you know, clinicians and researchers face such resistance. There is
something about patios that just book so many people that's
the same way a trauma survivor might want to deny
that trauma. On a society whole level. For some reason,
people want to remind a PTSTY resists. UM. Now, I
think in America and kind of you appear in American societies.
(25:53):
I think we've we've we've done a lot better at um,
you know, kind of giving it a name and um
in the to getting it so much and understanding it
so much that it has become parmp parcel of our
modern vernacular. Unfortunately, there is this kind of global controversy UM,
and this kind of theory that's put out there that
(26:13):
somehow PTSD is this kind of americanization of human suffering
and that um you know, um uh. People in low
and middle income countries, they they're essentially they're they're they're
much tougher than your average Americans who's just too whining,
(26:33):
and when they shove a trauma, they have to take
on this disorder and kind of take on this system role. UM.
A lot of the reasons for this controversy was data
from this World Mental Health Survey, which came back as
showing that rates of PTSD was really low in low
and middle income countries like close to zero percent, and
(26:54):
that's what started this massive controversy, Like, what's the point
of is diagnosedis if it doesn't have worldwide relevance, And um,
maybe people from low income countries are more accepting a
trauma and that they have this kind of paradoxical resiliency.
So my concern as PCC specialists and a trauma thing
because I think there's probably other explanations for why the
(27:15):
world's Mental Health Survey data came out that way. Um,
and I don't think the explanationalize in the fact that
PTC is just something that Americans experienced. I don't think
that is the explanation. My biggest concern is that as
you know, a lot of times the people who suffer
the most, they're the biggest trauma are women, children, the poor,
(27:39):
the marginalized group. They're the ones who have always been
harder to by trauma. But depending on the laws of
the country, they might not actually have a voyage to
speak of, you know. So as there's an example, you know,
homosexuality is still illegal in a lot of countries, right,
so if you're homosexual and you experienced some types of
(28:00):
homer in the context of your sexuality. Are you really
going to speak up about it? You know, you're you're
basically saying you're a criminal by speaking up by it.
And so I do believe that, like disiness instituously too quickly, Um,
there's a lot of silent suffering that's going to go dismissed.
And of more urgencies is if you dismissed PTSD, then
(28:23):
doctors are going to stop looking for it. No one's
going to pay money to research it, but it's still
going to be there, you know. So so that is
a very um, disconcerting argument that is out there that
I wanted to raise it awareness about. You know, it's
definitely just kind of seeing it's not Aslow's hierarchy of means.
I'm sure you guys are familiar with, is right that
you know, when physical survival is the problem, you know,
(28:48):
then you can't guarantee a roof over your hair, over
on the table, close on your back. Then psychological well
being does take a vacca. And I'm sure in a
lot of blowing your InCom countries too much to the
luxury to think of out your trauma to the luxury
to deal with the psychological symptoms. But I do think
it's important. It just takes a back seat. It doesn't disappear, right,
you know, That's that's what we have to remember. It's
(29:10):
still there. And I think what's happening is it just
get kicked down the road. You may never deal with
different thing that kids are going to have to deal with. It,
someone's going to have to deal with at some point. Um.
So you know, denying it restance in restance to me,
it's just too too extremes. You know, trauma happens. It
happens in every culture and society the world. We have
(29:33):
to get better identifying betweens of trauma and making sure
that their voice is heard and if they need psychological rehibilitation,
they get it absolutely. Um. One thing you you touched
on in that answer is something else that I really
resonated with me was, um, you have a chapter on
(29:54):
the idea of resilience, UM, and how it's shifts, like
some days you're stronger than other days. Um, it's a
it's a process that changes. I don't know if you
you would mind speaking about that a little bit. Yeah,
So the visilience is just as really interesting words, right,
(30:16):
I feel like you gets thrown about a lot and
you know, people are really praised for their you know,
resilience and um uh, but I think we're not. We're
kind of getting it's kind of thrown out in a
very reductive way. Um. I feel like there is this
tendency in our culture to make people into superheroes, you know, like,
(30:41):
oh my god, look what happens to person They stuffed
x YG, but yet they triumphed and they're amazing and
they went on to do this and that. And I
don't deny that those people exist, and I don't deny
that we can learn a lot some people like that.
(31:01):
I think from the point of view sing a physition
and from the point of view of someone who likes
to seeking from a kind of public house point of view,
the opposite problem is much more. You know, there's next
point in dealing with unicorns or outlies. We have a
very big problem in that not only one can access
ways to be residion. And I think we should really
(31:23):
think about how you can help everybody be resident, as
opposed to making the example of people who are really unusual. Um.
And the other thing that I think doesn't get addressed
is how much of your regidience is tied to your
social socioeconomic status. Right, So you know, if you underwent
a trauma and you have really supported parents, or you
(31:45):
come from background where you have access to education or
economic means. Um. You know, if you're a position of
privilege in society, you're not going to be pretty resilience
just by virtue of your discode in your geography. And
I don't think we give that enough. Um, we don't
weigh that into the equation. You know, we like to
(32:08):
think it's something inherent to that individual's character. We're looking
a lot of it to do with socio economic factors.
And then we don't do the opposite when people let
tonight that we don't. We don't see how my God,
as hard as they're trying to lead to be resilient,
that is really weighing them down. So so I think
(32:28):
I think unless we just way looking at exilians and
more evolved way of looking at the giant is that
it's multidimensional. There's different ways of being resilient, and it
actually the ways of the comment's life. So it depends
where you're meeting them on the journey of their life.
You know, you made someone who had put a lot
of childhood diversity who had experienced, um, you know, other
(32:51):
traumas in their life. Maybe they've been sectually assaulted or
or they had uh, you know, being physically assaulted, and
they may come through all of this and slide and
learn to be resilient. But then something else might happen
later in your life, which is kind of like the
store the books to come was back, you know, and
you might be needing them at a later stage. Image
(33:11):
And you just never know what people have been through.
So I think to say, oh, you're resilience and you're
not resilient, it doesn't make sense to me think shifts
of time people's ability to be resilient. So it's multidimensional. Um.
I think there's many external factors. There's also many inherent factors,
you know, because these highly heritable conditions. There's a lot
(33:33):
to do with the way we're wired and the kind
of genes that we have. Little too determines fur a
response to trauma. So so yeah, I mean, I'm all
four resilience, but I think we have to look at
it in a broad way and we really have to
think about leveling the plain fields so that all people
can do resilient, like regardless of the community they're from.
(33:55):
You know, these pathways for them to be a book
to be resilient in the face of trauma. Yeah, actually
can you? Um, and I was gonna ask if you
can talk a little more about the genetic idea because
I don't think we talked about that as a thing
honestly when it comes to PTSD, everything so um, environmental
it things. But in your book, I think it's really
fascinating that you go wonder a little more in depth
(34:15):
about the genetics as well. So can you talk a
little more about that? Yeah? So, so what emerging and
actient is is that even if the definition you know,
tuities linked to the jipternal traumatic events, so basically, you know,
you have to live for a trauma and then you
might develop PTSD. So we tend to think of it
as oh, well, it's quickly to do with what happens
in your life, right, But actually what this realized that
(34:38):
the last than years is the actual condition itself is
highly heritable. So you know, you can take two people
who exposed exposed to exactly the same trauma, one of
them will develop PTSD, one of them want and what
you tell in who will and who wants. Genetics plays
a big part, So you know, a bastard of the
(35:00):
overall risk of developing PTSD following exposure to trauma is
determined by genetics. And I think that's the way that
plays out, is you know, the way your brain is wired,
the way your body mounts a response to stress, all
of which is probably you know, um predicted by your
genes and factors that, like I said, are heritable. The
(35:22):
other thing that is really interesting is um this etogenetics,
the scientist etogenetics, which we are still in our instancy
of understanding, but I think it is really fascinating, And
it's this notion that when a man or a woman
is exposed to a really damaging psychological trauma, it impacts
(35:42):
the man or the women's eggs, and then these changes
are transmitted to their future children right into generational transmissions,
and so that leads these children vulnerable via alter duron
you and ast me and gene. So then these children
(36:02):
of the traumatized terms are at risk even though they
themselves they never have been exposed to traumatic events, right
I mean, I mean to me, that's just fastening to
then when you think the cases of mass traumatization rate.
When you think of atrocities like holocaust or genocide, or
(36:23):
or slavery or torture. You know, the TTFCS inprints can
last through generations. And you know, so again we're kind
of in our interncer of understanding epigenetics, but I really
do think, um, we have to understand the impact of
trauma and how long lasting it can be and how
(36:45):
it can it can have consequences not only for the survivor,
but for so many people beyond that. Yeah, I personally
am fascinated with epigemic so I'm interested to see where
they're that research goes. We have a little bit more
of our interview, but we have one more quick break
(37:06):
for a word from our sponsor, and we're back. Thank
you sponsoring. Another thing we talked about in the book
is how there is this research on going into things
that you you are very quick to say there's no
(37:28):
magic bullet, and people are eager for this magic bullet.
But in like the cannabis or m D M A.
But on the flip side of that, you talk about, um,
the opioid crisis, and yeah, I would love if you
could go into more detail on that. But on the crisis.
(37:49):
Thank so. Yeah, So this troubling relationship between addiction and PTSD, um,
I mean that's something I see a lot um So
just the general kind of overall observation that PTSD and
addictions will stand in hand a lot, right. So, some
studies have reported that of the six of addicted persons
(38:11):
also have PTSD, you know, and you can you can
understand why you know, self medicating with alcohol, drugs, food gambling.
Say that numb is emotional pain, you know, and it
can use anxiety and you can use lightness. The problem
is that in the long run this cooking strategy is
(38:33):
dangerous and so often it just morphed into the full
blown addiction. And there is specifically regards to the outfield crisis,
there is the troubling relationship between PTSD, chronic chain and
outfood addictions. You know, up to thirty five of chronic
pain patients also have PTSD. And there's a condition called
(38:58):
fibro mailger, which is another chronic pain condition. Some people
there have been report in the literature that some people
are kind of saying that PTC inside birounding actually the
same thing. So there's definitely something about this physical manifestation
of psychological pain that we're really in that infinitive understanding.
(39:20):
The problem is that pure related side effects, you know,
things like falls, being in an accident, overdosing, or attempting suicide.
They're much more common in pain patients who also have
PTSD compared to those who only have pain. Right, So
(39:45):
what's kind of emerging is this in plain that when
people are using pain tools to no emotional pain instead
of getting treatment for the emotional pain, you know, with
psychological treatments, there's some dangerous about that, right, That's part
of what he's emerging. There was a couple of big
data cities that kind of davages goods I view of
(40:08):
what was happening, and that's the kind of feature that's
coming through. And definitely polically a curis do that all
the time. I feel I see people non emotional pain
with prescription code that are given to them for other
reasons and it just doesn't end well. Unfortunately, I just
don't think that's a solution. So without let me ask you,
(40:30):
because it's just off top of the head we were
talking when you were talking about um PTSD is possibly
being a genetic h predictor, do you think there's a
common link to those who have addictive personalities as well,
because obviously when you look at addictive personalities, there's a
little that's just a little different than your everyday pain
(40:50):
medication addiction. Do you know what I'm saying? Is there
a link between those things? Do you think? I'm sure
there is, And it goes to right, So people with PTC,
we can see why they might be drawn to addictive behavior,
But it goes the other way too. I mean, you
think about specific textivity, who has an alcohol addiction problem? Right,
(41:11):
they're probably more likely to get into accidents, They're probably
more likely to be put in situations there where there where,
they're more at risk of being assaulted, and so they're
more likely to get PTSD as well. But that the
latanism the relationships to reversed, right, The addiction makes them
more likely to be exposed to trauma, and that makes
(41:31):
them more likely to get PTSD. So I think the
two really correlated and very much interrelated. And I'm sure
there's probably some shared gene pathways. I'm sure. Um, I
don't know of anything definitive, but I feel like, um, certainly,
from the collisal point of view, we see the two
go hand in hand. In fact, there's actually been treatment developed.
(41:54):
There's one for Seeking Safety UMI which aims to address
those problems at the same time. You know, trauma and addiction.
That's how much you're problem there is that we see
all the times clinicians that you know, they're both going
hand in hand and they both need to be addressed. UM.
So so yeah, I don't doubt there's some overlapp in
(42:17):
terms of you know, what's causing the addiction, what's causing
the contity. I just don't think they have a very
clear idea of exactly what that is. And and just
to ask one more more more a long with that
someone in the field, how often do you see that
for people who work in the nonprofit or insectors like
yourself that work with people UM they have to do
(42:38):
treatments for PTSD or see a lot of that UM
secondary trauma UM like first responders and such for the
addictive personality as well as the trauma. How often do
you see that and UM people who are considered first
responders Because I know many of I've seen that social
workers get caught up in UM psychiatric medication and involved
(43:00):
after certain situations, whether it's let's say a social worker
who's working with a mass shooting incident, that I end
up having an addictive personality hand in hand. How often
do you see that for those type of workers. So
I think anybody traumas infecture, right making, anybody who, through
the course of their profession is routinely exposed to traumatic
(43:22):
situations like bearing witness to trauma, whether it be like
first responders, whether it be in military, whether it be um.
You know, mental health professionals. To professionals, I think we
have to recognize it to what it is. We are
high risks of being exposed to trauma. So, you know,
the same way we make maybe things of like being
exposed to a violence, right like you know, all healthcare professionals,
(43:44):
we all have to get vaccinated, rights right have be
and we will have to get our influence that shot.
Why because we've got a high chance of being exposed
to someone who's ticked, and we have to inoctimate ourselves
and protect ourselves so that we don't get sticks. So
I think we have to think the same way about
homer Um. I see mental health professionals, we do a
bit of a better job about recognizing what's happening to
(44:07):
us um recognizing if we're feeling, um troubled by what
we're hearing and how it might impact our ability to
care for ourselves and care for other people. Certainly, I
feel like I grew up in a tradition where my
colleagues are more receptive to me talking to them if
I'm having a tough time. It's more acceptible for me,
not to my feelings. Of course I'm the link your face,
(44:29):
but I do feel the culture is accepting. I don't
feel the wider medical culture or the wider first responder culture,
you know, like he's firefighters don't don't think it is
acceptable to admit that you are betting troubled by these things.
And then what happens people self medicated, Right, It turned
(44:50):
to addictal substances to self medicate because just because you
don't admit it doesn't entertain it's not there. Um. So again, yeah,
one of the optimistic I do feel. I mean, there
are some really great programs to the first responded. Now
there's good to realdy programs to your programs for the
people are accepting that puts it's an occupational with right,
(45:12):
and they're they're they're recognizing it and people are talking
about it more and it had become more accessible, UM
for people to uh be vulnerable, you know, and it's
and and say that they're not to parent. Um, you know,
I'm encouraged when everyone around young people are very encouraged.
I feel like they use them much more in tune
(45:34):
with voicing how they are feeling about certain situations. So
I do feel like there's been a cultural shift. But again,
we just have to make it. We have to destigmatize
a lot of issues around mental health to make it,
to make it just really accessible and make it easier
for people to come out and say what's going on.
(45:55):
So I think not only caring for the people we're
trying to serve, but caring for ourselves. So stif cannot
be under underestimated when you're in the signe of books. Absolutely,
And one of the things UM, as we're kind of
wrapping up here, I wanted to touch on and you
can totally pass on this, but on a personal note, UM,
(46:18):
you've dedicated your life to this, Um, you've written a book,
your it's it's your livelihood. Um, do you are there
things that you do? Have you experienced this secondary trauma?
And what how do you manage it? Yeah, no, absolutely,
(46:39):
So you know, I'm this is like my twentieth year
of being a doctor actually national mark twenty years um.
I you know, I feel like um, as I was
reaching that twenty year mark, UM, I feel like there
(47:00):
was a lot of visage that had been building up. UM.
You know in your clinical experiences day today, when you're
trying to take care of patients, you know, there's there's
what happens in real time, right you meet them, you
make the different make dignilities, you can up position in turn,
but there is so much that happens in that visit.
There are so many other dimensions that get touched on, moral, ethical, philosophical, emotional, psychological,
(47:26):
not only for the patient but for me too, and
they often don't get the home with the real time righty.
You don't have time to deal with everything. You have
to kind of do the work that needs to be
get done to kind of getting moving um. You know.
And um, when those other dimensions do not get extended too,
(47:48):
I think, UM issue, you start to build up and
it's like a stubborn kind of ended your studdn thing,
you know, you start to lose your shine. And when
I was writing this book in peopople mind. I was
reaching at twenty m or for being a doctor, like
I said, And I think for me, writing this book
(48:12):
really allowed me to go through this process of paying
attention to that residue and leaving it all on the page. UM.
There's definitely something burning inside of me that needs to
get out. And I think from a kind of creative angle,
being able to draw on twenty years of clinical experiences
(48:38):
and kind of relived them and hashed them out through
the process of writing, UM was really valuable. UM. I
felt like I could leave a lot of stuff on
the page. I think I emerged feeling lighter, more rejuvenated,
and hopeful that you know, maybe I can do this
(48:58):
sort of the twenty years. UM. So for me, you
answered your question where think the writing is what helps
me personally? Let me ask you this. IM sorry, I
didn't mean to interrupt you, because I just I think
what you when you were talking about having to essentially
stabilize someone and can't hit on every note and n
feeling like for me, I've had many incidences where I've
(49:21):
had to do crisis management only and then walk away
and then things fall apart because I couldn't do everything
I felt needed to be done. And I call this
survivor's guilt or just guilt in general. Like, and I
know I read something about in your book about how
you talked about people who feel guilty for feeling for
feeling like they're having an emotional trauma even though they
(49:43):
survived um and things like that. How do you cope
with that? How Like for those of us that are
in this profession that don't always have the time because
I worked with the investigating child abuse and I work
with at riskines, how do you go on and not
get that a out not giving up hope? And I'm
feeling like, how do I get this? Because I didn't
(50:04):
get to do this, this and this, and now things
have fallen apart in different ways and I just feel guilty.
How do we go with that? How do we cope
with that? So, so one thing I don't think we
do in ourselves in this world. And I feel this
how I self is be eroded over the last twenty
years of being in this profession. But one thing I
don't think health care profession knowles and care givers, what
(50:26):
we don't do enough fast is just admit that what
we do. It's really really hard, right, what the work
we do and the circumstances under which operate are really hard.
Um And I do feel like we live in this
world that celebrates the trivial and um um, it doesn't
(50:50):
value doing complicated things where you're not necessarily going to
get a massive return on your investment. Um. So, I
think there's a cultural terne where we have to reclaim
that what we do is important, must be done. But
it's really really hard. So I think studying really realistic
(51:11):
expectations it's really important. UM. I am a realist. I'm
a pregntist, you know. I don't know if it goes
on an immigrant. I don't know if corund the door
an immigrants. But I don't think I'm an optimist. I
feel like kind of realist. I'm a pragnotist, and I
think that's helped keep me grounded because I set my
(51:32):
expectations accordingly. Um And I know that sometimes I'm not
able to help people in the minute, right, But that
doesn't mean that something you have not said to them
or something you have not done for them won't help
them future downline, and you may not be there to
witness that. So so we must keep trying, right, So,
(51:53):
I feel like setting realistic expectations in when we're living
in the world that so undermined and sot with so
many things that are trivial, is really hard. So I
I think that is really important, recognizing how itsporant is
what we do, the impact that we have in people's life.
(52:14):
And then I think the other thing is to me,
I feel like most of the mental health professionals, I know,
most of the health to professionals, I know, the one
you are really really good at their jobs, they probably
started doing that role way before they got their actual
professor qualification. So what need um the one who are
(52:34):
really passionate torank you to what they do, they're working
something else to reuters, And so I think we have
to acknowledge that, right, like how much of you, how
much of what you're feeling, how much is the survival
to go that you're feeling is about the current situation,
how much of it has to do with something else?
And then of course that's why it's really important. You
have your own ways of caring for yourself and getting
(52:57):
any any attention that you might need, you know, healthwise, um,
you know healthwise into self care I think is an
absolute non neglogiable if you're going to do this type
of world. Um, but it's not an easy I mean
your questions are really important one because you know we're
dealing with the record levels of the inquestion now, so
(53:20):
clearly this is not imagined, it's very real. But to me,
I feel like, you know, your careers should be American, right,
you want to be here twenty years from no, thiry
years from now. You don't want to be burning out
and linable to help people and um, and you have
to do what it takes to be able to have
that knowledge that you have that statina, you know. And
(53:40):
I feel like healthy professional to a kind of condemnital
caregivers there take care of themselves the way they should, right,
you know, they they put other people's needs too much,
and they think there's something to be said for having
boundaries and saying, okay, all right, I'm done to the
day and I'm not going to take this home and
I'm gonna do something for myself. But you don't. By
doing something for yourself, you're you're going to survive another
(54:03):
day to do something for somebody else. So it's not
being selfish. It's having healthy bounties. But you know, I
mean I I can talk this way, but it is
an ongoing battle, all trying to figure it out. Say today,
what to do? How to do it? You know? Right? Yeah,
I think. Um, that's a great wrap up point. Unless
(54:25):
you have something else you want to touch on, We'll
obviously give you a chance to plug your book and
where people can find you. But if there's anything else
you want to speak to you before that, now's the time. No, this,
this has been a lot of fun. Thanks for having
me on. I'm so um it's so awesome for me
to talk to people who have read the book. And um,
I really hope it was done little to you and
(54:46):
that that makes me be happy. So it was all
worth it, all the hard work as with it. Yes,
and congratulations again, Like I don't want to sweep under
the rug. You wrote a book. Um, it was very
well researched, very well written. So you wrote a bug
that was readable. It's like not just for people who
um are fascinated by trauma and all of the research,
(55:07):
but actual story, personal telling and and some new ideas.
And then I love that that's so um available for people,
And I love that. That's awesome. Thank you. It's really
nice to hear that. I mean, it was a labor
of love, you know, it took me tenuous, but that's
pretty That was the result that I wanted And if
that's what's happening, it was totally worth it. Thanks so
(55:27):
much for sharing a feedback. Keep reading in a lot awesome. Yeah.
So if you want to just shout out the book
and uh when it comes out, I believe it's in. Yeah,
you you do it and then all of your all
of your social media is so we can get to you. Yeah.
So it's um it's called The Unsuperable Mine, Stories of
(55:48):
Trauma and Hearing from the front Range of PTSD Science,
and it's published by Harper and it's coming out May seventh,
of theshes. It doesn't main keen and folks confined me
on Twitter at chetty Jane MD and I'm also on
Facebook and like which site is www dot Chetty Jane
MD dot com. Awesome, thank you so much for for
(56:13):
doing this, and yes, we try to figure this out.
That's no problem. Happy Friday. Need the weekend like we
needed the weekend absolutely all right, Thank you so much, care,
thank you, bye bye. That brings us to the end
(56:34):
of our interview with Dr Jane. I hope that you
found it as enjoyable and as informative as you did, Yes,
as therapeutic. Please go check out her book. Like I said,
it was very um. It was an informative and easy read.
Like I don't easy is not necessarily what I want
(56:56):
to use, but before something that is that kind of
complex and deep. It was very digestible, like a chicken
we have and the meconi and cheese. Yeah, we were
very hungry. Um. But yeah. Thank you so much to
her for joining us. Thank you to you, Samantha, Yes
(57:17):
as always, Thank you too, Andrew Howard are producing Andrew
beats some Chicken. Yes, and thank you listeners for listening.
If you would like to email as you can or
email is mom Stuff at out stapparks dot com. You
can find us on Twitter at mom Stuff podcast and
on Instagram as stuff I've Never told you. Thanks again
for listening.
Hey, this is Annie and you're listening to stuff I
never told you. And today Samantha and I have a
bonus episode for your lovely listeners. Bonus bonus, isn't we
(00:29):
always are trying to give you extra cons extra um.
So one of my good friends here in the house
Stuff Works office, his name is Alex. He's a fantastic
person to work with. I like that you're doing this
like my background. I'm going to do this. This is
(00:49):
my new role. Okay, I oh my gosh, please follow
me around to be my high person. Any Alex is fantastic.
And Alex put me in touch with a publicist who
represents Dr Shelley Jane, who is and Slash was depending
on when you listen to this Um coming out with
(01:10):
a book called The Unspeakable Mind, and UM, since we've
been doing this whole mini series, I almost hesitate to
call a mini series. I feel like it's like a series.
It's not many. It's a medium series, medium a medium series.
I think it's a season UM around trauma. It was
(01:33):
perfect because in the book she delves into the science
of PTSD and how it doesn't look like what a
lot of people think it looks like and how we
can prevent it, how we can treat it, the problems,
the solutions, all that stuff. It's an excellent wheat. I
read it in a day, loved it. Um. So we
thought we we didn't interview. We were fortunate enough to
(01:54):
get Dr Jane on the phone and we conducted a
fantastic interview and you've probably heard pieces of it in episodes,
but we wanted to present the whole thing lightly edited,
um for our our mishaps. There weren't many. Yeah, no,
there was a fire. No, no, now there were you
(02:16):
know there was chicken involved. That's true. We were eating chicken.
It wasn't like a chicken in the studio. But yeah,
we thought we'd present it to you largely unedited as
bonus content, so please enjoy. I like to start with
a basic question, which is could you tell us a
(02:37):
little bit about yourself and your background? Please? Sure? Absolutely so. UM,
I'm a psychiatrist by training, and about ten years ago
I um and to uh kind of postgraduate training to
become a pt special and so now, um that is
(02:59):
kind of my speciality. I'm a trauma scientists as well.
I do research um in PTSD and then a treat
patients and obviously I'm an educated too, so I'm training
a lot of um young doctors in PTSD and psychiatry.
So I spent two decades caring for thousands of patients
(03:21):
who have survived various forms of trauma from child abuse,
you know, rape, intimate partner's island, by straightening accidents, and war.
That's kind of a little bit about my background. Yeah,
I knew you discuss in the book how you had
this experience with your your father that kind of lad
(03:43):
you into this career. If you could speak to that
a little bit, Yeah, no, absolutely, So on a personal note,
you know, I have my own family history is one
of trauma and tragedy. Um So, during the nineteen partition
of British India, my paternal grandfather was murdered and my
(04:05):
dad was ten at that time, and he was offered
and forced to flee his home, you know, live as
a refugee in India, and he worked as a child laborer,
you know, because um uh, you know, there was no
other sources of income and both his parents were deceased.
Now two decades later, he ended up emigrating to England
(04:25):
and that's where I was born. And raised. So I
spent a lot of my life very disconnected from that
family history of trauma. You know, we never went back
to India barely with very little connection. But even though
there was that kind of geographical distance, I spent chunks
of my news living in the shadows that partitioner have
tasted on his life and kind of with this awareness
(04:47):
as a child. But no matter how much I loved
him and he loved me, it was a part of
him that was always going to be inaccessible. And somehow
I feel like as a child I did have this awareness,
but there was a collection between what happened to him
as a kid and why I was feeling this. But
it took me many years of training and many years
of being a clinician to really figure out, you know,
(05:11):
what that was and kind of give it a name.
Mm hmm. And um, you, through these these years of experience,
you have written a book, The Unspeakable Mind. And congratulations,
by the way, that's that's no small feet. Thank you,
(05:31):
thank you, thank you for a yeah, I don't want
to take that very granted. And you wrote a book
that's amazing. Um, so could you talk about what led
you to to write this? Book, and UM, yeah, I have,
I have. I read it in a day. I loved it.
I think it's very informative. But yeah, I would love
(05:53):
if you just talked about like the experience of reading, right,
and then also if you could just add why you
felt it was important to add personal accounts to it,
because I think as part of the thing that happens
that kind of lacks within all of these types of
UM books and sociological ideas, that they lacked the actual
personal background that people often want to connect to. But
what made you go that route as well? But well,
(06:14):
thanks so much journeys of saying you enjoyed the book.
That means a lot because there's literally been a tenure
labor of club. So you know, that's what makes me happy.
It makes me happy that people who are kind of
you know, a general audience and educated lay audience who
might not have UM the kind of training UM in
in psychology. Uh, I wanted to reach that audience by
(06:38):
writing this book. So obviously you know in my scholarly work,
I write all the time. Right, you do scholarly papers,
you you editual research, and you're basically preaching to the quiet.
You're talking to the people who are in your circle.
My the dress behind writing Me and supil mind is
I really wanted to reach a wider audience. Um, you know,
(06:58):
I think theater person is much more aware about things like,
you know, the imfortance of a heart healthy lifestyle or
getting cancer prevention screenings and say they say they were
like twenty thirty years ago. I really feel the time
has come where we have to elevate our society or
literacy about mental health and trauma and PTSD because we
have too much to lose if we don't write to
(07:21):
this challenge. So I wanted to tell the complete story
of PTSD in a way that it's accessible for anyone
who's curious to know more about this condition. And to me, um,
you know, I've read a lot of books written by
doctor writers, and to me, when they talk about clinical experiences,
at my heart, I'm a cleinish that that's my primary role.
(07:43):
I find I just tapped into the material so much easier, Um,
when you go at it from a humanistic point of view,
when you go at it from the personal point of view,
and definitely for me as a writer, that's how it's
happened to the material. It's it's experiences with people that
make me want to write. So I always, naturally, even
(08:05):
kind of my process as a writer, I start from that,
that is what motivates me to write. UM. So, so yeah,
I mean, I hope I answered your question. I wanted
to reach a wider orders because I think we have to.
PTSC is a press in public health concern. It's an
inextricable part of all of our lives, even if we
don't know it yet, it is, And so I really
wanted to reach a wider audience, but at the same
(08:27):
time present the mature in a way that people could digest.
You know, that was was I mean, it's hard. It's
hard to write about trauma. It's hard to read about trauma.
But I really wanted to do it in a way
that um would just make people more curious and help
understand the conditions that has really been widely misunderstood and
kind of alluded throughout history. UM. And then adds to
(08:51):
that this fact that the last twenty years has seen
such great research in PTSC, such wonderful science, and I
don't think that people are aware of that. I don't
think your average doctor is aware of how great scients,
how much great science has been PTC in the last
twenty years, and a lot of that has had to
do with major world events, like PTSC has really been
(09:12):
put on the map in the last twenty years, and
there's just some great stuff coming out. I mean, I'm
a PCC, especially my job to stay at tweed all
stay uncompable the science that's coming out, and it's hard
for me to stay on top of it. There's not
much of it. So really deconstructing that science and presenting
it um was very rewarding. UM because as they say,
(09:34):
I think people need to know, um, what we know
about this condition so that we can do more about it. Absolutely.
And one thing I want to expand on uh, and
that answer is you make the point. You make the
case several times in the book that it is a
public health issue, right if you could speak to you
(09:55):
why that is? Yeah, absolutely so, UM. You know, there
is this common perception out there that, um, you know,
when we think PTC, the automatic responses to think of
military and what we forget is that more than half
of Americans will say that at some point in their
(10:17):
lives they've lived through a major trauma, whether it's the
you know, grateful family violence, will being robbed at gunpoint
or escaping a house fire. I mean, there are so
many life threatened traumas that the average Americans go to
every single day, and we also know that a subset
of them will experience multiple traumas and a significant minority
(10:43):
of those people will not here naturally in the afternoon.
And what that means is that at any given second,
there are six million Americans who are suffering from PTSD,
like actively suffering. That's a huge number of people, right,
and then if on top of that refactoring, there's this
condition called partial PTSD. It's kind of like being prediabetic,
(11:04):
you know, like you don't quite meet the textbooks, but
that doesn't mean you're not suffering. And there are millions
upon millions of more people who we know have partial PTSD.
And you know, as you guys probably you know, PTC
doesn't live alone. It's often found amongst the depressed, the alcoholic,
drug addicted, the anxiety hidden all suffers or higher risks
(11:26):
of death by suicide. So if you think about the
collective mental health burden, that is huge, and so right
up until this point, I'm just talking about the survivor
formers awful, infectious. The family members of people with PTSD
the higher risk of having problems with depression and anxiety
PTSC themselves. So you know, if you think of this
stuff is the children and the parents, this network of people,
(11:50):
it's it's a big, um pressing public health concern and
a big problem is only a certain stuffware yet uman
because it's toes to diagnosed. It's a challenge to treat,
and suffers often don't want to be reached, you know.
The last thing they want to do oftentimes is compute
(12:11):
the mode like me and talk about the trauma. So
in totality you can kind of see the various dimensions
that makes it this messing in public health concern. And
definitely from my alcohol as the health services researcher, I
think diagnosing it quickly and getting prompt treatment is key
and that is not happening. It's not happening partly because
(12:34):
we have such a shortage of mental health professionals, especially
in our inner cities, especially in our rural towns. We're
often you know, the mental health bad and it's huge. Yeah, um,
And that's one thing that you talk about and the
book is not only prevention but in the case that
(12:56):
you can't prevent that golden our UM. Do you speak
about both of those things? Yeah, absolutely so. I think
when we think about PTSD, we we rarely think about
it as something that can be prevented UM. But I
(13:16):
do think that is the way forwards. From the last
twenty years, we've learned a lot about how to prevent it,
and there is this fascination from clinicians and scientists about
this period called the gold analysts. If you think about
that window between when someone's exposed two trauma, you know whatever,
family violence, sexual violence upon that, and then there's that
(13:38):
window between exposure and when they actually develop PTSD UM.
Now we don't know exactly how long that window is,
but a lot of people have made it very convincing
arguments that that is where we have a chance for
medical intervention UM. If we can interview early in that window,
we can set the path towards recovery UM. And there's
(14:00):
some coptle wheel promising interventions. There's been a lot of
use of the stress hormone cortisols in that window to
help tray and prevent PTC and then even kind of
psychological therapy. So there's a therapy that works for PTST
called exposure therapy, and some we search is out of Atlanta,
actually out of Emory. Have um yeah, have um uh.
(14:26):
Then a modified form of explosure therapy with Thomas survivors
right there in the ear, you know, like very soon
after they come in having survived a trauma, whether it's
a car accident or physical assaults or sexual assaults. So
so you know, I don't know the data is ready
for prime time. This isn't certainly what we're doing in
routine practice, but there's some really encouraging this research, and
(14:49):
I think that is the way to go. We don't
spend enough on prevention in the United States. We focus
a lot more on treatment. But I think that's the
way we need to think about what we can do either,
you know, evntional early intervention to help people right at
this point of trauma. You know, waiting ten, fifteen, twenty
years to people shut up achievement is not looking um.
(15:11):
So that that's what makes me excited about prevention, right
And I guess I was going to ask with the
prevention stuff because I did. You just had to small
like excerpts about UM and partner violence as well as
obviously sexual violence. Is that a part of like maybe
predicting within like economic status is about what is more
likely or more risk for those types of violence? Is
that part of what you would think would be trying
(15:33):
to do preventative treatment? How would you go about that?
I mean, what would we focus on educating in specific
like economic status areas and like specifically like what were
your thoughts on how to actually implement a preventative And
that's a great question because I mean, you know, if
we could have adequate into a partner violence, the sexual violence,
(15:53):
there's like you know, I mean, that would be miracles.
Cole questions. Yeah, but I things it takes a village
great and I think systems of health care have to
re engineer themselves to really think about this problem. And
I think too much htorically, um, you know, I mean
(16:15):
obviously you're you're wearing the same field from kind of
preaching to the choir by talking to about this, but
too often different medical systems they all want to talk
about domectric violence. It's really messy. They see there's a
a personal problem and something that they don't really know
how to respond to, and that culture just has to change.
Is you know, into a part of violence is a
(16:37):
major public health concern as well. It's really common and
a lot of points primary care is where these these
dickens are going to show up, you know, UM, and
that is an excellent opportunity for intervention. UM. The problem is,
I mean, I think the tide is turning. So there's
(16:58):
there's an excellent work that was by Kaiser UM and
they published their results in in the General Amical Medical Association.
And really they've described this effort that they had come
up with system wise to kind of re engineer their
whole systems so that they were better set up to
identify victims of intimate partner violence, to offer interventions to UM,
(17:25):
offer resources and the whole kind of system from the
electronic medical record, to provide education, to organizational buy in
from the powers that be. That whole thing was looked at,
and that to me is the way to go. You know,
it takes a village, I really believe want provided by themselves. Desming.
It's how much you can do just because of the
(17:47):
nature of the problem. It's not only a common problem,
it's a difficult problem. And as you point out, a
lot of people in these situations also have uh, you know,
they have psychosocial problems. You know, they might not have
them as weeks. They might not have the most money,
they might not have access to great healthcare. And so
that some pounds and already complicated and difficult problems. You know,
(18:08):
they call I TV into what probably it is called
a wicked problems in that general article. It's really difficult
to tackle. So I think to eat takes a village.
Just some have to be the engineed. The good news
is I think for at a point in a society
with people recognize now you know, we've got to do
(18:30):
more for victims of violence, and you know, in addition
to you know, in addition to spreading their physical injuries,
we have to provide them tastes for psychological rehabilitation too.
You know, I feel like people are more sensitive to
now that now it's it's compared to say, twenty years
ago when I first adopted. I think, I think the
tide is turning. But we've got to keep at it
(18:51):
because you know, it's so easy for these things to
kind of fall off with people's radar just because they're
so emotionally taxing to dealing is. But yes, since have
to be re engineered. They think education take place at
every single level. Um, and just gonna go with that.
You talked at one point about people who are at
most risk and you, um include low income women, which
(19:12):
is fascinating, UM, because I don't think I've directly thought
of that as one of the high risk of people,
but obviously when you think back on what they go through, yes,
they are at high risk. So out of curiosity, what
do you think, because I did see that you wrote
about TRIM as well as peer support, what is the
best way that we can actually get services and provide
treatment for women and individuals who are in that low
(19:36):
income that are not given the privilege of seeking help
or being able to afford help. Yeah, I mean, yeah,
that's a really good question. It's really tough. Um, access
to care, right, that's the biggest staruer, you know. Um,
if you can't have access either because you're un in
(19:57):
short or you're you you're under insured. Um, you know
that's a luxury then that you're going to show up
in your doctor's office and tell them about the nightmares
you've been having or the news interns you've been having.
So yeah, I worry a lot about these people that
we don't even reach. Um. So from my angle as
(20:17):
a physician, that's why access to health care, you know,
really have to be a right, not a privilege for everybody.
Um I think on the other end, like it's disciple,
and I do think just elevating the conversation about trauma,
just so people can kind of connect the doctor a
(20:38):
little bit and maybe be curious and maybe understand that's
really important because I think for too long it just
wasn't even a direct right. PTC just was denied, was hidden,
was not spoken about, not because not kind of intentionally,
it's just part of the nature of trauma, but your
(20:59):
natural inclination to not think of it it is unspeakable.
But I really am encouraged by the fact we're living
in a time where I do think the society was
kind of getting better. Obviously there's a long way to go,
so we are getting better at giving it a name,
and I can't help feel that that it's going to
(21:20):
have a good trickle down effect for everybody. But at
the same time, it doesn't take away the real problems.
I mean, access to health care is really really important,
and unfortunately it's just denied to turn any and it's
den likely that people who really really need it, you know, um,
and that's just a bigger problem for us. We have
to think of the society what we want, how we
(21:42):
want to care for people who don't have resources. It's
a bigger question. It's a policy question, obviously, it's a
prodical question. Access is important, and I think from my
angle as a psychiatrist, you know, my practice is in
primary care. I have moved my practice from a mental
health pointic too, primly care because I know a lot
of times people who have PTCC they show from time
(22:04):
with care. They don't come to someone like me. So
I do think there's still a lot more that can
be done on the s medical side, you know. So um,
So that takes down a lot of barriers. You know, Um,
they're seeing a psychiatrist right there in the time you
clip and make the regular timely care doctors introduced them
to the mental health professional. It breaks down a lot
of the stigma and a lot of the barriers to acent.
(22:25):
So there's a lot that can be done on on
many levels to help folks who are marginally social economically
get active to help We have some more of our interview,
but first we have a quick break for a word
from our sponsor, m and we're back. Thank you sponsor. Well,
(22:53):
I was going to ask you about the title specifically
you kind of touched on it and there, um, I
don't know if you wanna get into more detail about that,
how you came upon the title what it means. So
trauma often represents, you know, the violation everything we hold
(23:14):
to be dear and sacred and so almost simply too
terrible to utterly allowed. You know, the natural human connection
is to deny trauma it's existence, and so trauma becomes unspeakable. Um.
You know, sometimes the survivor wants to speak, but if
the wider community is unwilling or unable to bear witness
(23:37):
to their story, then the survivors boced into silence. But
either way, trauma becomes unspeakable. The problem is, we now
know definitively that PTSD tribes in such conditions. You know,
when traumatic thoughts and memories are unspeakable or unsinkable for
too long, we actually interfere with that brains natural processes
(24:01):
of propantly after trauma, you know, those memories become step
points that inhibit the mental reintegration that is so vital
for trauma survivors to heal. So, you know, the unspeakable
is at the core of what is the problem with PTSD.
Rendering the unspeakable permanently speakable is just crucial to the
(24:25):
coverage and a really integral part of what we know
works for PTSD in terms of trauma focused schatology. We UM,
we have a lot of international listeners. In one chapter
that I found really interesting is the one about the
Americanization of Human suffering and your experience at this conference
(24:48):
in India. UM. I was wondering if you could speak
to to that. UM. Yeah, very frustrating. UM. So you know,
I mean, this is an un news story, like if
you talked to some of the pioneers in PTSD research
(25:09):
and tatist treatment. You know, I had a conversation with
Charles Mama, who's UM care at any one US psychiatry,
and he gave testimony to Congress around the time of
the Vietnam War, UM about what PTSD is and why
we should say take it seriously and all those pioneering
(25:29):
you know, clinicians and researchers face such resistance. There is
something about patios that just book so many people that's
the same way a trauma survivor might want to deny
that trauma. On a society whole level. For some reason,
people want to remind a PTSTY resists. UM. Now, I
think in America and kind of you appear in American societies.
(25:53):
I think we've we've we've done a lot better at um,
you know, kind of giving it a name and um
in the to getting it so much and understanding it
so much that it has become parmp parcel of our
modern vernacular. Unfortunately, there is this kind of global controversy UM,
and this kind of theory that's put out there that
(26:13):
somehow PTSD is this kind of americanization of human suffering
and that um you know, um uh. People in low
and middle income countries, they they're essentially they're they're they're
much tougher than your average Americans who's just too whining,
(26:33):
and when they shove a trauma, they have to take
on this disorder and kind of take on this system role. UM.
A lot of the reasons for this controversy was data
from this World Mental Health Survey, which came back as
showing that rates of PTSD was really low in low
and middle income countries like close to zero percent, and
(26:54):
that's what started this massive controversy, Like, what's the point
of is diagnosedis if it doesn't have worldwide relevance, And um,
maybe people from low income countries are more accepting a
trauma and that they have this kind of paradoxical resiliency.
So my concern as PCC specialists and a trauma thing
because I think there's probably other explanations for why the
(27:15):
world's Mental Health Survey data came out that way. Um,
and I don't think the explanationalize in the fact that
PTC is just something that Americans experienced. I don't think
that is the explanation. My biggest concern is that as
you know, a lot of times the people who suffer
the most, they're the biggest trauma are women, children, the poor,
(27:39):
the marginalized group. They're the ones who have always been
harder to by trauma. But depending on the laws of
the country, they might not actually have a voyage to
speak of, you know. So as there's an example, you know,
homosexuality is still illegal in a lot of countries, right,
so if you're homosexual and you experienced some types of
(28:00):
homer in the context of your sexuality. Are you really
going to speak up about it? You know, you're you're
basically saying you're a criminal by speaking up by it.
And so I do believe that, like disiness instituously too quickly, Um,
there's a lot of silent suffering that's going to go dismissed.
And of more urgencies is if you dismissed PTSD, then
(28:23):
doctors are going to stop looking for it. No one's
going to pay money to research it, but it's still
going to be there, you know. So so that is
a very um, disconcerting argument that is out there that
I wanted to raise it awareness about. You know, it's
definitely just kind of seeing it's not Aslow's hierarchy of means.
I'm sure you guys are familiar with, is right that
you know, when physical survival is the problem, you know,
(28:48):
then you can't guarantee a roof over your hair, over
on the table, close on your back. Then psychological well
being does take a vacca. And I'm sure in a
lot of blowing your InCom countries too much to the
luxury to think of out your trauma to the luxury
to deal with the psychological symptoms. But I do think
it's important. It just takes a back seat. It doesn't disappear, right,
you know, That's that's what we have to remember. It's
(29:10):
still there. And I think what's happening is it just
get kicked down the road. You may never deal with
different thing that kids are going to have to deal with. It,
someone's going to have to deal with at some point. Um.
So you know, denying it restance in restance to me,
it's just too too extremes. You know, trauma happens. It
happens in every culture and society the world. We have
(29:33):
to get better identifying betweens of trauma and making sure
that their voice is heard and if they need psychological rehibilitation,
they get it absolutely. Um. One thing you you touched
on in that answer is something else that I really
resonated with me was, um, you have a chapter on
(29:54):
the idea of resilience, UM, and how it's shifts, like
some days you're stronger than other days. Um, it's a
it's a process that changes. I don't know if you
you would mind speaking about that a little bit. Yeah,
So the visilience is just as really interesting words, right,
(30:16):
I feel like you gets thrown about a lot and
you know, people are really praised for their you know,
resilience and um uh, but I think we're not. We're
kind of getting it's kind of thrown out in a
very reductive way. Um. I feel like there is this
tendency in our culture to make people into superheroes, you know, like,
(30:41):
oh my god, look what happens to person They stuffed
x YG, but yet they triumphed and they're amazing and
they went on to do this and that. And I
don't deny that those people exist, and I don't deny
that we can learn a lot some people like that.
(31:01):
I think from the point of view sing a physition
and from the point of view of someone who likes
to seeking from a kind of public house point of view,
the opposite problem is much more. You know, there's next
point in dealing with unicorns or outlies. We have a
very big problem in that not only one can access
ways to be residion. And I think we should really
(31:23):
think about how you can help everybody be resident, as
opposed to making the example of people who are really unusual. Um.
And the other thing that I think doesn't get addressed
is how much of your regidience is tied to your
social socioeconomic status. Right, So you know, if you underwent
a trauma and you have really supported parents, or you
(31:45):
come from background where you have access to education or
economic means. Um. You know, if you're a position of
privilege in society, you're not going to be pretty resilience
just by virtue of your discode in your geography. And
I don't think we give that enough. Um, we don't
weigh that into the equation. You know, we like to
(32:08):
think it's something inherent to that individual's character. We're looking
a lot of it to do with socio economic factors.
And then we don't do the opposite when people let
tonight that we don't. We don't see how my God,
as hard as they're trying to lead to be resilient,
that is really weighing them down. So so I think
(32:28):
I think unless we just way looking at exilians and
more evolved way of looking at the giant is that
it's multidimensional. There's different ways of being resilient, and it
actually the ways of the comment's life. So it depends
where you're meeting them on the journey of their life.
You know, you made someone who had put a lot
of childhood diversity who had experienced, um, you know, other
(32:51):
traumas in their life. Maybe they've been sectually assaulted or
or they had uh, you know, being physically assaulted, and
they may come through all of this and slide and
learn to be resilient. But then something else might happen
later in your life, which is kind of like the
store the books to come was back, you know, and
you might be needing them at a later stage. Image
(33:11):
And you just never know what people have been through.
So I think to say, oh, you're resilience and you're
not resilient, it doesn't make sense to me think shifts
of time people's ability to be resilient. So it's multidimensional. Um.
I think there's many external factors. There's also many inherent factors,
you know, because these highly heritable conditions. There's a lot
(33:33):
to do with the way we're wired and the kind
of genes that we have. Little too determines fur a
response to trauma. So so yeah, I mean, I'm all
four resilience, but I think we have to look at
it in a broad way and we really have to
think about leveling the plain fields so that all people
can do resilient, like regardless of the community they're from.
(33:55):
You know, these pathways for them to be a book
to be resilient in the face of trauma. Yeah, actually
can you? Um, and I was gonna ask if you
can talk a little more about the genetic idea because
I don't think we talked about that as a thing
honestly when it comes to PTSD, everything so um, environmental
it things. But in your book, I think it's really
fascinating that you go wonder a little more in depth
(34:15):
about the genetics as well. So can you talk a
little more about that? Yeah? So, so what emerging and
actient is is that even if the definition you know,
tuities linked to the jipternal traumatic events, so basically, you know,
you have to live for a trauma and then you
might develop PTSD. So we tend to think of it
as oh, well, it's quickly to do with what happens
in your life, right, But actually what this realized that
(34:38):
the last than years is the actual condition itself is
highly heritable. So you know, you can take two people
who exposed exposed to exactly the same trauma, one of
them will develop PTSD, one of them want and what
you tell in who will and who wants. Genetics plays
a big part, So you know, a bastard of the
(35:00):
overall risk of developing PTSD following exposure to trauma is
determined by genetics. And I think that's the way that
plays out, is you know, the way your brain is wired,
the way your body mounts a response to stress, all
of which is probably you know, um predicted by your
genes and factors that, like I said, are heritable. The
(35:22):
other thing that is really interesting is um this etogenetics,
the scientist etogenetics, which we are still in our instancy
of understanding, but I think it is really fascinating, And
it's this notion that when a man or a woman
is exposed to a really damaging psychological trauma, it impacts
(35:42):
the man or the women's eggs, and then these changes
are transmitted to their future children right into generational transmissions,
and so that leads these children vulnerable via alter duron
you and ast me and gene. So then these children
(36:02):
of the traumatized terms are at risk even though they
themselves they never have been exposed to traumatic events, right
I mean, I mean to me, that's just fastening to
then when you think the cases of mass traumatization rate.
When you think of atrocities like holocaust or genocide, or
(36:23):
or slavery or torture. You know, the TTFCS inprints can
last through generations. And you know, so again we're kind
of in our interncer of understanding epigenetics, but I really
do think, um, we have to understand the impact of
trauma and how long lasting it can be and how
(36:45):
it can it can have consequences not only for the survivor,
but for so many people beyond that. Yeah, I personally
am fascinated with epigemic so I'm interested to see where
they're that research goes. We have a little bit more
of our interview, but we have one more quick break
(37:06):
for a word from our sponsor, and we're back. Thank
you sponsoring. Another thing we talked about in the book
is how there is this research on going into things
that you you are very quick to say there's no
(37:28):
magic bullet, and people are eager for this magic bullet.
But in like the cannabis or m D M A.
But on the flip side of that, you talk about, um,
the opioid crisis, and yeah, I would love if you
could go into more detail on that. But on the crisis.
(37:49):
Thank so. Yeah, So this troubling relationship between addiction and PTSD, um,
I mean that's something I see a lot um So
just the general kind of overall observation that PTSD and
addictions will stand in hand a lot, right. So, some
studies have reported that of the six of addicted persons
(38:11):
also have PTSD, you know, and you can you can
understand why you know, self medicating with alcohol, drugs, food gambling.
Say that numb is emotional pain, you know, and it
can use anxiety and you can use lightness. The problem
is that in the long run this cooking strategy is
(38:33):
dangerous and so often it just morphed into the full
blown addiction. And there is specifically regards to the outfield crisis,
there is the troubling relationship between PTSD, chronic chain and
outfood addictions. You know, up to thirty five of chronic
pain patients also have PTSD. And there's a condition called
(38:58):
fibro mailger, which is another chronic pain condition. Some people
there have been report in the literature that some people
are kind of saying that PTC inside birounding actually the
same thing. So there's definitely something about this physical manifestation
of psychological pain that we're really in that infinitive understanding.
(39:20):
The problem is that pure related side effects, you know,
things like falls, being in an accident, overdosing, or attempting suicide.
They're much more common in pain patients who also have
PTSD compared to those who only have pain. Right, So
(39:45):
what's kind of emerging is this in plain that when
people are using pain tools to no emotional pain instead
of getting treatment for the emotional pain, you know, with
psychological treatments, there's some dangerous about that, right, That's part
of what he's emerging. There was a couple of big
data cities that kind of davages goods I view of
(40:08):
what was happening, and that's the kind of feature that's
coming through. And definitely polically a curis do that all
the time. I feel I see people non emotional pain
with prescription code that are given to them for other
reasons and it just doesn't end well. Unfortunately, I just
don't think that's a solution. So without let me ask you,
(40:30):
because it's just off top of the head we were
talking when you were talking about um PTSD is possibly
being a genetic h predictor, do you think there's a
common link to those who have addictive personalities as well,
because obviously when you look at addictive personalities, there's a
little that's just a little different than your everyday pain
(40:50):
medication addiction. Do you know what I'm saying? Is there
a link between those things? Do you think? I'm sure
there is, And it goes to right, So people with PTC,
we can see why they might be drawn to addictive behavior,
But it goes the other way too. I mean, you
think about specific textivity, who has an alcohol addiction problem? Right,
(41:11):
they're probably more likely to get into accidents, They're probably
more likely to be put in situations there where there where,
they're more at risk of being assaulted, and so they're
more likely to get PTSD as well. But that the
latanism the relationships to reversed, right, The addiction makes them
more likely to be exposed to trauma, and that makes
(41:31):
them more likely to get PTSD. So I think the
two really correlated and very much interrelated. And I'm sure
there's probably some shared gene pathways. I'm sure. Um, I
don't know of anything definitive, but I feel like, um, certainly,
from the collisal point of view, we see the two
go hand in hand. In fact, there's actually been treatment developed.
(41:54):
There's one for Seeking Safety UMI which aims to address
those problems at the same time. You know, trauma and addiction.
That's how much you're problem there is that we see
all the times clinicians that you know, they're both going
hand in hand and they both need to be addressed. UM.
So so yeah, I don't doubt there's some overlapp in
(42:17):
terms of you know, what's causing the addiction, what's causing
the contity. I just don't think they have a very
clear idea of exactly what that is. And and just
to ask one more more more a long with that
someone in the field, how often do you see that
for people who work in the nonprofit or insectors like
yourself that work with people UM they have to do
(42:38):
treatments for PTSD or see a lot of that UM
secondary trauma UM like first responders and such for the
addictive personality as well as the trauma. How often do
you see that and UM people who are considered first
responders Because I know many of I've seen that social
workers get caught up in UM psychiatric medication and involved
(43:00):
after certain situations, whether it's let's say a social worker
who's working with a mass shooting incident, that I end
up having an addictive personality hand in hand. How often
do you see that for those type of workers. So
I think anybody traumas infecture, right making, anybody who, through
the course of their profession is routinely exposed to traumatic
(43:22):
situations like bearing witness to trauma, whether it be like
first responders, whether it be in military, whether it be um.
You know, mental health professionals. To professionals, I think we
have to recognize it to what it is. We are
high risks of being exposed to trauma. So, you know,
the same way we make maybe things of like being
exposed to a violence, right like you know, all healthcare professionals,
(43:44):
we all have to get vaccinated, rights right have be
and we will have to get our influence that shot.
Why because we've got a high chance of being exposed
to someone who's ticked, and we have to inoctimate ourselves
and protect ourselves so that we don't get sticks. So
I think we have to think the same way about
homer Um. I see mental health professionals, we do a
bit of a better job about recognizing what's happening to
(44:07):
us um recognizing if we're feeling, um troubled by what
we're hearing and how it might impact our ability to
care for ourselves and care for other people. Certainly, I
feel like I grew up in a tradition where my
colleagues are more receptive to me talking to them if
I'm having a tough time. It's more acceptible for me,
not to my feelings. Of course I'm the link your face,
(44:29):
but I do feel the culture is accepting. I don't
feel the wider medical culture or the wider first responder culture,
you know, like he's firefighters don't don't think it is
acceptable to admit that you are betting troubled by these things.
And then what happens people self medicated, Right, It turned
(44:50):
to addictal substances to self medicate because just because you
don't admit it doesn't entertain it's not there. Um. So again, yeah,
one of the optimistic I do feel. I mean, there
are some really great programs to the first responded. Now
there's good to realdy programs to your programs for the
people are accepting that puts it's an occupational with right,
(45:12):
and they're they're they're recognizing it and people are talking
about it more and it had become more accessible, UM
for people to uh be vulnerable, you know, and it's
and and say that they're not to parent. Um, you know,
I'm encouraged when everyone around young people are very encouraged.
I feel like they use them much more in tune
(45:34):
with voicing how they are feeling about certain situations. So
I do feel like there's been a cultural shift. But again,
we just have to make it. We have to destigmatize
a lot of issues around mental health to make it,
to make it just really accessible and make it easier
for people to come out and say what's going on.
(45:55):
So I think not only caring for the people we're
trying to serve, but caring for ourselves. So stif cannot
be under underestimated when you're in the signe of books. Absolutely,
And one of the things UM, as we're kind of
wrapping up here, I wanted to touch on and you
can totally pass on this, but on a personal note, UM,
(46:18):
you've dedicated your life to this, Um, you've written a book,
your it's it's your livelihood. Um, do you are there
things that you do? Have you experienced this secondary trauma?
And what how do you manage it? Yeah, no, absolutely,
(46:39):
So you know, I'm this is like my twentieth year
of being a doctor actually national mark twenty years um.
I you know, I feel like um, as I was
reaching that twenty year mark, UM, I feel like there
(47:00):
was a lot of visage that had been building up. UM.
You know in your clinical experiences day today, when you're
trying to take care of patients, you know, there's there's
what happens in real time, right you meet them, you
make the different make dignilities, you can up position in turn,
but there is so much that happens in that visit.
There are so many other dimensions that get touched on, moral, ethical, philosophical, emotional, psychological,
(47:26):
not only for the patient but for me too, and
they often don't get the home with the real time righty.
You don't have time to deal with everything. You have
to kind of do the work that needs to be
get done to kind of getting moving um. You know.
And um, when those other dimensions do not get extended too,
(47:48):
I think, UM issue, you start to build up and
it's like a stubborn kind of ended your studdn thing,
you know, you start to lose your shine. And when
I was writing this book in peopople mind. I was
reaching at twenty m or for being a doctor, like
I said, And I think for me, writing this book
(48:12):
really allowed me to go through this process of paying
attention to that residue and leaving it all on the page. UM.
There's definitely something burning inside of me that needs to
get out. And I think from a kind of creative angle,
being able to draw on twenty years of clinical experiences
(48:38):
and kind of relived them and hashed them out through
the process of writing, UM was really valuable. UM. I
felt like I could leave a lot of stuff on
the page. I think I emerged feeling lighter, more rejuvenated,
and hopeful that you know, maybe I can do this
(48:58):
sort of the twenty years. UM. So for me, you
answered your question where think the writing is what helps
me personally? Let me ask you this. IM sorry, I
didn't mean to interrupt you, because I just I think
what you when you were talking about having to essentially
stabilize someone and can't hit on every note and n
feeling like for me, I've had many incidences where I've
(49:21):
had to do crisis management only and then walk away
and then things fall apart because I couldn't do everything
I felt needed to be done. And I call this
survivor's guilt or just guilt in general. Like, and I
know I read something about in your book about how
you talked about people who feel guilty for feeling for
feeling like they're having an emotional trauma even though they
(49:43):
survived um and things like that. How do you cope
with that? How Like for those of us that are
in this profession that don't always have the time because
I worked with the investigating child abuse and I work
with at riskines, how do you go on and not
get that a out not giving up hope? And I'm
feeling like, how do I get this? Because I didn't
(50:04):
get to do this, this and this, and now things
have fallen apart in different ways and I just feel guilty.
How do we go with that? How do we cope
with that? So, so one thing I don't think we
do in ourselves in this world. And I feel this
how I self is be eroded over the last twenty
years of being in this profession. But one thing I
don't think health care profession knowles and care givers, what
(50:26):
we don't do enough fast is just admit that what
we do. It's really really hard, right, what the work
we do and the circumstances under which operate are really hard.
Um And I do feel like we live in this
world that celebrates the trivial and um um, it doesn't
(50:50):
value doing complicated things where you're not necessarily going to
get a massive return on your investment. Um. So, I
think there's a cultural terne where we have to reclaim
that what we do is important, must be done. But
it's really really hard. So I think studying really realistic
(51:11):
expectations it's really important. UM. I am a realist. I'm
a pregntist, you know. I don't know if it goes
on an immigrant. I don't know if corund the door
an immigrants. But I don't think I'm an optimist. I
feel like kind of realist. I'm a pragnotist, and I
think that's helped keep me grounded because I set my
(51:32):
expectations accordingly. Um And I know that sometimes I'm not
able to help people in the minute, right, But that
doesn't mean that something you have not said to them
or something you have not done for them won't help
them future downline, and you may not be there to
witness that. So so we must keep trying, right, So,
(51:53):
I feel like setting realistic expectations in when we're living
in the world that so undermined and sot with so
many things that are trivial, is really hard. So I
I think that is really important, recognizing how itsporant is
what we do, the impact that we have in people's life.
(52:14):
And then I think the other thing is to me,
I feel like most of the mental health professionals, I know,
most of the health to professionals, I know, the one
you are really really good at their jobs, they probably
started doing that role way before they got their actual
professor qualification. So what need um the one who are
(52:34):
really passionate torank you to what they do, they're working
something else to reuters, And so I think we have
to acknowledge that, right, like how much of you, how
much of what you're feeling, how much is the survival
to go that you're feeling is about the current situation,
how much of it has to do with something else?
And then of course that's why it's really important. You
have your own ways of caring for yourself and getting
(52:57):
any any attention that you might need, you know, healthwise, um,
you know healthwise into self care I think is an
absolute non neglogiable if you're going to do this type
of world. Um, but it's not an easy I mean
your questions are really important one because you know we're
dealing with the record levels of the inquestion now, so
(53:20):
clearly this is not imagined, it's very real. But to me,
I feel like, you know, your careers should be American, right,
you want to be here twenty years from no, thiry
years from now. You don't want to be burning out
and linable to help people and um, and you have
to do what it takes to be able to have
that knowledge that you have that statina, you know. And
(53:40):
I feel like healthy professional to a kind of condemnital
caregivers there take care of themselves the way they should, right,
you know, they they put other people's needs too much,
and they think there's something to be said for having
boundaries and saying, okay, all right, I'm done to the
day and I'm not going to take this home and
I'm gonna do something for myself. But you don't. By
doing something for yourself, you're you're going to survive another
(54:03):
day to do something for somebody else. So it's not
being selfish. It's having healthy bounties. But you know, I
mean I I can talk this way, but it is
an ongoing battle, all trying to figure it out. Say today,
what to do? How to do it? You know? Right? Yeah,
I think. Um, that's a great wrap up point. Unless
(54:25):
you have something else you want to touch on, We'll
obviously give you a chance to plug your book and
where people can find you. But if there's anything else
you want to speak to you before that, now's the time. No, this,
this has been a lot of fun. Thanks for having
me on. I'm so um it's so awesome for me
to talk to people who have read the book. And um,
I really hope it was done little to you and
(54:46):
that that makes me be happy. So it was all
worth it, all the hard work as with it. Yes,
and congratulations again, Like I don't want to sweep under
the rug. You wrote a book. Um, it was very
well researched, very well written. So you wrote a bug
that was readable. It's like not just for people who
um are fascinated by trauma and all of the research,
(55:07):
but actual story, personal telling and and some new ideas.
And then I love that that's so um available for people,
And I love that. That's awesome. Thank you. It's really
nice to hear that. I mean, it was a labor
of love, you know, it took me tenuous, but that's
pretty That was the result that I wanted And if
that's what's happening, it was totally worth it. Thanks so
(55:27):
much for sharing a feedback. Keep reading in a lot awesome. Yeah.
So if you want to just shout out the book
and uh when it comes out, I believe it's in. Yeah,
you you do it and then all of your all
of your social media is so we can get to you. Yeah.
So it's um it's called The Unsuperable Mine, Stories of
(55:48):
Trauma and Hearing from the front Range of PTSD Science,
and it's published by Harper and it's coming out May seventh,
of theshes. It doesn't main keen and folks confined me
on Twitter at chetty Jane MD and I'm also on
Facebook and like which site is www dot Chetty Jane
MD dot com. Awesome, thank you so much for for
(56:13):
doing this, and yes, we try to figure this out.
That's no problem. Happy Friday. Need the weekend like we
needed the weekend absolutely all right, Thank you so much, care,
thank you, bye bye. That brings us to the end
(56:34):
of our interview with Dr Jane. I hope that you
found it as enjoyable and as informative as you did, Yes,
as therapeutic. Please go check out her book. Like I said,
it was very um. It was an informative and easy read.
Like I don't easy is not necessarily what I want
(56:56):
to use, but before something that is that kind of
complex and deep. It was very digestible, like a chicken
we have and the meconi and cheese. Yeah, we were
very hungry. Um. But yeah. Thank you so much to
her for joining us. Thank you to you, Samantha, Yes
(57:17):
as always, Thank you too, Andrew Howard are producing Andrew
beats some Chicken. Yes, and thank you listeners for listening.
If you would like to email as you can or
email is mom Stuff at out stapparks dot com. You
can find us on Twitter at mom Stuff podcast and
on Instagram as stuff I've Never told you. Thanks again
for listening.
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