OVERVIEW
Trauma: The Invisible Epidemic provides readers with a deep and insightful exploration of the complex world of trauma and its profound effects on individuals and society as a whole. Psychiatrist Dr. Paul Conti draws upon his experience specializing in trauma and presents a comprehensive and compassionate approach to understanding and healing from traumatic experiences.
One of the book’s notable strengths is Conti’s ability to communicate complex psychological concepts in a clear and accessible manner. From the very beginning, he establishes a strong foundation by defining trauma, providing useful analogies for trauma, and differentiating between acute, chronic, and vicarious forms of trauma. By breaking down these terms, he enables readers to grasp the various dimensions of trauma and how they manifest in different individuals.
Dr. Conti combines scientific research, clinical anecdotes, and personal stories to illustrate the wide range of traumatic experiences that individuals may encounter throughout their lives. These narratives not only help to contextualize the discussion but also create an empathetic connection between the reader and those who have endured trauma. This humanistic approach is a testament to Dr. Conti’s commitment to destigmatizing trauma and fostering a sense of understanding and support.
Dr. Conti presents a holistic and compassionate exploration of a topic that affects millions of individuals worldwide. As impressive as his wealth of knowledge and clinical expertise are, they pale in comparison to his genuine empathy and compassion, which is what I feel makes Dr. Conti so unique, and so inspirational.
NOTE: Italicized words included in this review are direct passages from the book.
WHAT TRAUMA IS AND HOW IT WORKS
Trauma affects everything. Dr. Conti’s first words are bold, but appropriate. He uses the opening chapters to define the different forms of trauma and the mark that it leaves.
Trauma is compared to a virus, pollution, and Toxoplasma, a parasite that is passed from mouse to cat (and yes, sometimes to humans). Toxoplasma actually changes the brain of the mouse to make it less fearful of cats; thereby, increasing the mouse-to-cat transmission. In a similar manner, trauma changes our brains, it makes us forget our worth, our dreams, our gifts, and our aspirations. And sometimes, the trauma parasite is so bad that we even forget the basics of how to keep ourselves safe.
Types of traumas:
ACUTE TRAUMA results from a particular event that most people would recognize as severe: a vicious attack, an injury in combat, witnessing violent death, a bad car accident, a life-threatening crisis.
Instead of one big event, CHRONIC TRAUMA comes from prolonged exposure to harmful situations and people: living under siege in wartime, experiencing ongoing sexual abuse as a child, enduring prejudice or racism.
Due to our capacity to empathize and show compassion, often times the boundary between what happened to us and what happened to others becomes blurred, leading to what Dr. Conti refers to as VICARIOUS TRAUMA. The amount of vicarious trauma is often determined by the types and amount of trauma experienced by the person doing the listening.
Post-Trauma Syndromes:
Dr. Conti provides a list of seven (7) criteria to establish post-trauma syndrome, they are:
- Exposure
- Re-experiencing the traumatic event(s)
- Hypervigilance
- Increased baseline anxiety
- Decreased baseline mood
- Inadequate sleep
- Behaviour change
SHAME AND ITS ACCOMPLICES
Trauma doesn’t operate by itself. Regardless of the type, trauma gets a lot of help from a number of accomplices, chief amount them is shame. I think of shame as trauma’s number one henchman – the thug who does the dirty work as well as the one who supervises trauma’s other lackeys.
Psychology Today defines shame as “a self-conscious emotion that informs us of an internal state of inadequacy, unworthiness, dishonour, regret, or disconnection”. Shame is often expressed with the words “should” or “shouldn’t” included; as in, “I should have been there” or “I shouldn’t have done that”. Our logical brain is impotent to talk the emotional brain out of its beliefs, which is why the input from those around us is rarely a remedy for our shame.
I’ve heard Dr. Conti state (in several podcast appearances) that we should have many “arrows in the quiver”, and In Chapter 3, he provides a list of antidotes (arrows) to fight back against trauma’s many accomplices: shame; poor self-care; risk-taking behaviour; poor sleep; mood decline; anxiety; damaged immunity; nightmares & flashbacks.
We might not experience all of trauma’s accomplices, nor are we constantly impact by those that we do have. I view this more of a checklist; for me, I deal with shame, poor sleep and mood decline. My immune system is great, I hardly experience nightmares or anxiety, and never engage in risk-taking behaviour. For me, it is the internal dialogue that causes me distress.
The antidote that Dr. Conti offers for that inner dialogue is Uncovering Self-Talk. Pay attention to the way you talk to yourself about yourself. You’d be surprised at how many people feel terrible about themselves without having any idea why. When I get may patients to examine their internal dialogue, they often report that they have a habit of repeating negative phrases to themselves – such as “I’m a loser” and “No one really likes me.” Uncovering this first type of self-talk might not make it change right away, but it’s a good first step.
This resonated with me quite a bit. Not only as it has been such a challenge for me for decades; but also, as working with that internal dialogue is the basis of my training in mental health.
COMPASSION, COMMUNITY, AND HUMANITY
At the heart of the book is Dr. Conti’s desire to help people work with their trauma. Sometimes it shows up as practical tools for individuals (such as the third chapter’s antidotes referenced above) to a philosophical approach for society as a whole. Compassion, community, and humanity are our birthright. For people, they are what makes the world go around. They’re also some of the first things to go when trauma finds its way into our homes.
Dr. Conti believes that we are all born with the ability and desire for compassion, community, and humanity; however, the trauma we experience hides them from us. As a side note, this belief is share by Dr. Richard Schwartz, creator of Internal Family Systems. Dr. Schwartz believes that we are all born with certain characteristics (compassion, confidence, clarity, etc…) that are “exiled” due to incidences in our lives. Both experts have shown through their work that the healing of trauma (be it Acute, Chronic, or Vicarious) re-establishes those characteristics innate to all of us. Said differently, we don’t need to “build confidence”; instead, we need to remove the barrier(s) that are preventing us from feeling the innate confidence we were born with.
You ever watch a child learning to walk? Falling down over-and-over. Do they look around to see who saw them? Are they embarrassed? Do they lack confidence, clarity, of self-compassion? We don’t need to establish those characteristics; instead, we need to re-establish them. Our previous experiences (traumas included) have buried those qualities, or ‘exiled’ them in Dr. Schwartz’s terminology.
The next time you feel compelled to think “why can’t I just do…”; or, “I don’t understand why they won’t do…”; keep the above in mind. Perhaps it is because we don’t always have access to the parts of our psyche that a specific situation requires.
It may not be our lack of desire to show compassion, community, and humanity; it may be because those parts of us are buried, they’ve been exiled. It’s not a lack of desire or ability, it is because we’re unable to access them.
The ultimate goal is to prevent trauma in the first place, although it’s just as important to heal the trauma that’s already occurred – the trauma that’s already in us. This means healing ourselves, but compassion, community, and humanity are also about healing others. The two efforts aren’t separable; in fact, they’re interdependent.
THE SOCIOLOGY OF TRAUMA
Of course, compassion, community, and humanity don’t simply come down to individual choices. The social systems that affect all of us either promote well-being or they don’t, and this is not truer than when it comes to health care.
Dr. Conti uses Part 2 of his book to discuss the role society plays with respect to trauma. In Chapter 6, Dr. Conti provides his critique, not of the individuals within the health care system; but instead, of the system itself. He shares his perspectives on the challenges presented by the health care system and the influence insurance companies have. Instead of providing a summary, I will simply say that although he does offer a stern critique, he does it with compassion and professionalism. Additionally, within Chapter 6 he offers several pages to what he calls a Therapeutic Antidote: What To Look For In a Therapist and includes a breakdown on characteristics including: Eye Contact; Expression of Interest; Empathy; Follow-Through; and others.
In chapter 8 (Social Ills, Social Traumas) Dr. Conti shares his experiences in Hungry after the fall of the iron curtain, living through the cold war, Covid-19, and racial injustice to illustrate the roll that society plays on establishing and managing trauma; highlighted by the phrase Trauma pushes us to take steps away from life and away from each other.
Once again, Dr. Conti (within chapter 9) offers Antidotes to help his readers.
- Humility: allows us to learn from our interactions and enables us to compromise.
- Opening Ourselves to Other
- Managing Fear:
- Maintain Healthy Routines
- Reduce Exposure: know your limits when it comes to media exposure, stressful conversations, and negative thought patterns.
- Focus on what’s important.
- Ask for help.
- Avoid Quick Fixes: whatever stressor you’re facing, do your best to analyze whether the options being considered are actually going to solve the issue down the road.
AN OWNER’S MANUAL FOR YOUR BRAIN
LOGICAL & EMOTIONAL BRAINS
We like to think of ourselves as mostly logical creatures, but the truth is we have complex systems in our brains both for logic and for emotion.
Ultimately, emotion is more deeply rooted in the brain than logic because our emotional aspects are evolutionary older. That means in important matters, if our brain is tallying two votes – one for logic and one for emotion – it defaults to however emotion votes.
Of course, the brain is more nuanced than simple all-or-nothing decision making. If possible, it will do what it can to integrate both logic and emotion.
ESTABLISHING ’MEANING’
Memories are just the raw data, and they themselves don’t carry meaning. To finish the equation we need to consider a couple aspects of our Limbic System.
- Affect: internal sensation, such as a rapid heartbeat or butterflies in our stomach.
- Feelings: our association with the affect. Is the affect welcome, or not?
- Emotions: our association with the feelings. Are we excited, or scared?
Meaning is the combination of our raw data (memories) and associated affect, feelings, and emotions. Clients sometimes share with me the expression “facts don’t care about feelings”. With compassion, I will expand that person’s understanding of how our nervous systems works, often resulting in them getting angry or stonewalling. Ironic, isn’t it?!
MEANING EQUATION
Meaning = Affect + Feelings + Emotions + Memories
OUR ACTIONS ARE BASED ON THE MEANING WE HAVE APPLIED TO A SITUATION
Our actions are based on the meaning we have applied to a situation. As trauma changes our emotions, and our emotions change our meaning; therefore, trauma plays a prominent role in our actions.
THE PHYSICAL AND MENTAL RAVAGES OF TRAUMA
Trauma begets more trauma. Trauma leaves us with fewer resources to fight the effects of trauma.
INFLAMMATION AND CHRONIC PAIN
Inflammation naturally occurs in the body to help us recover from injuries and fight off infections, but inflammation can also be caused by trauma.
Trauma creates stress which in turn causes inflammation. This is ideal for physical trauma such as a hard workout, or a cut. However, in scenarios where previous trauma is causing present moment stress, all that inflammation is circulating without anything to do. When you hear that stress causes health problems such as heart disease and cancer, this is why.
AUTOIMMUNE DISEASES
Inflammation creates a cascade of dysfunction that triggers the immune system, confuses it, and can cause it to turn its weapons against us. And when the immune system turns against the body and brain it’s designed to protect, it can lead to low-level symptoms such as fatigue, nausea, increased pain, rashes, and hair loss, or it can result in more impactful and large-scale autoimmune disorders.
ACCELERATED AGING
Trauma makes naturally occurring DNA changes progress further than what would be expected at a given age, such that a person is actually older than their lived age! We also know that suffering from depression is also a factor when it comes to aging, and depression is often associated with trauma.
NEW NORMALS AREN’T SO NORMAL
It’s true that the outcomes of trauma are regularly grim, but it doesn’t have to be that way. The more we learn about trauma and how it works in our lives, the more we can counter it.
We don’t simply have to suffer from trauma’s new normal; we don’t have to give trauma a free pass in our lives as individuals or as a society.
HOW WE CAN BEAT TRAUMA TOGETHER
The final part of Dr. Conti’s book centers on how we can – as individuals and as a society – see progress in the becoming aware of, and managing, trauma. Trauma is a problem for each and every one of us, and we all must work together to counter trauma’s assault on compassion, community, and humanity.
In Chapter 13, titled “The Way Home”, Dr. Conti lists his five critical links for changing our lives and the word for the better, they are:
- Knowledge: Gain a better understanding of roots of trauma and its accomplices.
- Power: As the saying goes, “knowledge is power”. But it still needs to be applied.
- Healing: For healing to take place, we all must use numbers 1 & 2 for mutual good.
- Hope: Hope reminds us that no matter the past, the future can be better.
- Urgency: Understand and accept that we are already in a trauma crisis.
LEADING WITH WISDOM AND PATIENCE
Wisdom and patience come with compassionate, common-sense changes in our lives. They aren’t qualities we have or don’t have; they are embodied attributes that grow stronger with practice.
Dr. Conti uses much of Chapter 14 to speak about important role communication plays in the battle against trauma. Fake news outlets, the spread of internet rumours and lies, and public leaders that flout the truth…we all could do a better job at paying attention to the language we use. He goes on to list the following practical ways to communicate more clearly:
- Avoid exaggerations: Words like “horrible” should be used to describe natural disasters, not outcomes to a democratic election.
- Abstain from labelling: avoid using generalizations to form false similarities or differences.
- Don’t trivialize: trivializing trauma creates more trauma. Stop saying “get over it”.
- Think about the impact: words matter, actions matter.
Exercising kindness, clarity, and mindfulness in our communications isn’t all it will take to limit or halt trauma, but it’s a good place to start.
INFORMATION ON AUTHOR
Paul Conti, MD, is a graduate of Stanford University School of Medicine. He completed his psychiatry training at Stanford and at Harvard, where he was appointed chief resident. He then served on the medical faculty at Harvard before moving to Portland, Oregon, and founding his clinic. For more, see Pacific Premier Group.
LINKS TO PURCHASE THE BOOK
AUTHOR’S APPEARANCES ON PODCASTS