The pattern of stress (predictable, controllable, and manageable) is more important than the load of stress in determining outcomes; predictable stress allows the brain to adapt and build resilience, while unpredictable, uncontrollable stress sensitizes the stress response system and can lead to long-term health problems. Healing occurs through multiple brief activations of neural networks (like a piano, not an organ), and the best predictor of current functioning is relational connectedness in family, community, and culture—not the history of adversity.
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Fear Fueling Stress | Dr. Bruce Perry | Chung Huong InstituteAjouté :
There's a lot of BS. There's always somebody that's willing to take your money. It's a heartbreaking mess. How do you move the way we're doing certain things? Is there a way to actually be a little bit more targeted and more specific so that you are going to have a higher probability of having success?
What systems appear to be well organized? What systems appear to be underdeveloped? What systems appear to be poorly part of what has to happen?
So, we need to >> Hello, Dr. Bruce Perry. Thank you so much for being here with Chung Hung Institute podcast. Bruce, I am super excited that you're here. I have been watching your talks and reading your books, I think, since 2016 and have been thinking, oh, one day maybe talk to Bruce. And then someone suggested, why don't you talk to Bruce? [laughter] >> Then it became Thank you very much. I'm I'm happy to be here. I'm I'm flattered and um there's not a lot of people who've actually kind of started reading our work a long time ago. So, it's kind of nice to you probably saw the evolution of our thinking and some of the things that you saw. So, >> yes. Bruce, for those who maybe don't know you and maybe they're living under a rock and they should know you, can you share a little bit about who you are and the work that you do? I am formerly trained as a neuroscientist and a child and adolescent psychiatrist. And with that combination of those two perspectives, I have been looking at the impact of experiences on development for gosh 40 years now. And in part because I started out being trained in medicine, the experiences that we focused on were bad experiences, right? We we focused on pathology. So I I've studied the impact of neglect and abuse and trauma on the development of human beings and with a lot of focus on developmental exper you know experience because as we may talk about that's a really important time in life. Um but over time a lot of our work has shifted um out of the medical model and out of the clinic to be much more focused on both transgenerational uh experience and how that impacts both health and wellness. And then really the the power of human connectedness as the vehicle for healing and for buffering stress. So that's kind of what we're focusing on now is really, you know, we've looked a lot at the bad stuff and now we're looking more at kind of the good things that can counterbalance that.
>> Is it possible to actually prevent the intergenerational trauma from coming up?
You know, I it's it's interesting because one of the things that's been a really real gift of of the work that we do is the opportunity to meet people who are part of this transgenerational train of terrible things. You know, they may be uh an indigenous person who has a history in their heritage of overt intentional genocide, right? where there were efforts to destroy the people and then when that didn't work very well there were efforts to destroy the culture and now there are essentially kind of marginalized um participants in in the western world. So that cascade of adversity is pretty overwhelming. Yet many of the folks that I've had an opportunity to meet are joyful and creative and productive and kind and compassionate and so it is possible. Um I I think it's you know life is hard period and I think it's harder when you are growing up in an environment where all of those burdens get carried into your childhood and your experiences that your parents had. So that influences the way they raise you. And um but I do know a lot there's lots and lots of examples of people who have been able to kind of move past that and really in some ways and it's kind of a weird way to think about it. they've they've benefited from those experiences in ways that help them be more centered and more focused on what I would consider the good things, you know, in life as opposed to some of the negative things. And some of the most amazing people I've met have had lots of adversity and, you know, they've come to a place of safety in their lives. They've had people who have helped them and who have supported them and now they they take that gift of adversity and are able to use it to help other people. So, it's definitely possible, but it's hard, you know, and there's a cost to it. And and that's part of what we're trying to understand better so that we can create really more intentional ways to provide healing environments. And so, and I think we're learning a lot, but we're we're butdding up against the the traditional uh medical economic model and the traditional perspectives about how uh people are sick and how they need to be healed and it's kind of at odds with what we're seeing actually helps. So, that's an interesting place to be.
>> That kind of connects to your book, which I have here, right? um what happened to you? I think it was like chapter nine and you said that the problem in society is that science is gathering knowledge faster than society is gathering wisdom.
>> Yeah.
>> And I I I was so stuck with that because I'm thinking are is society gathering knowledge or society gathering delusion to you know >> well there's there's no doubt that it's it's interesting. I've seen some very very powerful graphics that talk about the process of gather gathering factoids, right? And so we're really good at gathering factoids, you know, if you look at the scientific literature, it's a bunch of disconnected factual statements, you know, and and in many ways the way you you your world view will determine to some degree how you organize those factoids in a way that reinforces the way you see the world, which might be delusional, right?
>> Wow. And and so um this is the difference between knowledge just sort of the accumulation of facts and wisdom. And um and I think it's I think wisdom is an elusive state.
It's an elusive capability. And um I think that the ingredients to create wisdom are increasingly difficult to find in our modern world that is relationally impoverished that uh creates developmental segmentation.
So we take the people with the most experience who are most likely to have an interesting perspective and sort of a shred of wisdom and we put them away from the children and we pull them out of society and we compartmentalize them and we visit them once a month, right?
Or let's go see grandpa this week and and um and then at the same time I think wisdom emerges ultimately from human interaction. We're creating a world that is relationally impoverished. You know that >> so many of us spend way too much time in front of screens like here we are.
[laughter] I mean this there are >> you know there are advantages to this technology but it would be very different if we were sitting in the same room.
>> You know different parts of my brain would we'd have the same conversation >> but we would literally have different physiological impacts on us. It would be a different experience. And I think when children, particularly children, as they're developing, as their brain's organizing and they're continually filling the repetitions and the activations in their brain with visual imagery on tele on TV and on screens, it leads to something very different than the quiet moments where you learn how to be capable of sitting with your own with what's in your own head.
and you you aren't continually pulled out of your thinking or your inner thought process or the capacity to develop this uh inner voice and inner dialogue where I think a lot of important things happen if you're continually exposed to music and TV and email and this appointment and that appointment and then you're exhausted at the end of the day and you scroll you know and then put your phone down and go to bed even in your sleeping hours, you've messed up the ability of the brain to do what it wants to do during sleep in healthy conditions. So, we've created this artificial world that's kind of putting our next generations at a disadvantage for expressing their full uh capacities to be creative and humane. I think >> of course I sound like an old man, right? back in the day, you know, >> then I'm also old for agreeing with you.
[gasps] What um what do you think then COVID 19 did to the kids? Like I think um so many of my old neighbors we just moved so old neighbors I will say like all the children they were online they graduated online and I mean I see a lot of developmental delays >> you and other it's it's interesting you know suchandra that we do a lot of work in education and obviously a lot of work in mental health too both of those systems are seeing um evidence of develop mental deficits and delays that they relate back to sort of that two-year artificial experience that many of us had. We, you know, and there have been studies that have shown this that children coming into kindergarten and prek are less socialized. You know, they have a harder time with fundamentals around motor development and social emotional development and even cognitive development. They're just they're just behind. And I just heard, you know, I've seen a number of studies and about the increased rates of anxiety and depression in adolescence and a lot not not all of it, but part of it is linked to that that incredibly socially isolating experience and um that took place while they were in these really important formative years in adolescence.
Yeah, >> there was again I just heard another person talking about they're a college professor and they're saying that they've had to have like entire remedial uh classes for mathematics and other topics for incoming um students because there was just this big gap in their education that was never really filled in even after they went back to school. So, I don't know. I I I think that it's an interesting for me. I wish I wish a lot, but I think it offers a really powerful example of the importance of developmental experiences and why we need to pay attention to that all of these things in in meaningful ways.
But I also think what happens is that the because of the world we've created everybody's got a very short attention span and you know you kind of look at the news cycle and you can see it you know there'll be some crisis and like every headlines and people will think about it think about it and all of a sudden there'll be another disaster and pretty soon oh I you know used to be that everybody in the US knew about Coline High School right [clears throat] everybody's heard of There's I would bet that there's at least 10 different shoot school shootings in the last five years where there were more kids killed where people don't even would not even go what what what school are you talking about? It didn't even make the headlines some of these things. It it's just crazy. But that's part of the that external frenziness and sort of inability to you know maintain focus. And of course we see that all of those all the social media are basically um both responding to and creating that interest and need to kind of get your information in you know very quick little bits of I I I remember when Twitter first came out and [clears throat] um you know just because I was trying to understand what was going on in the world. I would I had I still do have like an ex account, but in the beginning there would be people that would want to engage me in a very deep conversation about some complex topics and I was like impossible and it was so easy to get offended in these incomplete ways of communication. And it it's interesting over time I began to realize that there this is essentially kind of like Sesame Street for adults. You know we in the beginning we thought Sesame Street was such a great thing, right? Oh, Sesame Street public TV. Let's show these kids these really fast visually engaging things and here's a and this and that.
And of course that was perfect if you were four.
>> Yeah. But what happened was that created a preference for visually oriented fast stuff like that. And then along came really, it's interesting the first the first generation of kids that went through Sesame Street. It's no coincidence that MTV emerged from that and all of a sudden there's like oh instead of sitting and listening to an album, you have like a song and then a part of a song and then oh, you can't just listen to a song. It's got to be it's got to be this movie song. And then out of that that out of that generation came some of this the you know the social media stuff and Tik Tok and it's like it's really we are being driven cognitively in a direction that is um allowing us to be easily exploited economically and it's been monetized and clicks are monetized and the whole we're in a very weird place as a society. Oh, I'm off on a tangent. I feel like I like I I sorry off on a tangent. I'm sorry.
>> No, that was amazing. Thank you, Bruce.
Uh can I self-disclose a little on that?
>> Yeah, please. Yeah.
>> So, um my primary research is actually about how do we bring mindfulness as a core requirement in schools and academia? So, like universities and I'm like why do we have fizzed you know as a requirement? build the body but no requirement of get to know the mind like work through all of all the stuff.
>> I love that. I love that you're doing that. I think it's so important. It's it's same thing I you know many years ago I was you know I still we still encourage it but I don't know if it's going to go anywhere but we really thought it was important to think about integrating teaching about the importance of caregiving and attachment and touch and all that stuff into the public education curriculum for the same reasons that you know we require people to learn how to drive a car but we have no fundamental basics of training training about the how to be a good caregiver, how to be a good parent. Um, and it's, you know, if you sort of had to look at a society and go, what's more important? You can run a mile fast or you can sit and think and solve a problem using your cortex. I don't know.
I vote for the cortex. Even though I'm an athlete, I'm a big jock. I >> Cortex is good. It, you know, do you want somebody who can solve a quadratic equation, which is not bad. I'm glad I like those people, but I would re do we want to make sure that everybody knows how to be a decent parent and how important eye contact and touch and presence is in those first few months of life. I don't know. I think we'd have be a healthier society if we really focused on teaching people how to build a healthy mind and build healthy relationships.
>> Yeah. Do you think that that would actually make the consequences of the ASIS lower the potential consequences?
>> I do. I do actually. I think that um you know to some degree there is an inevitability to adversity in life. I mean you cannot get through nobody gets through unscathed.
There are all kinds of experiences where and it doesn't even have to be that classic aces but there are many what we would call sensitizing experiences and when I use the term sensitization I I'm referring to a change in the reactivity of the stress response networks in our body and you can change those systems with a trauma right like a divorce or get witness violence or being abused But you can also change that part of the brain if you are continually um in an environment where people are rejecting you. You know, you're the you're you're not the right body type, you're not the right religion, your peers look at you like you're weird because you have a shaved head and you would wear a certain garb, right?
>> All the time.
>> So you right and so you get these non-verbal cues of like what the hell.
Um, and it, you know, you have to be pretty centered to kind of make your way through life being continually viewed that way as an continually otherred.
>> And so those those things um if they're not counterbalanced by opportunities for meaningful connection and learning how to self-regulate.
And the easiest way to learn how to do some of those things is by taking advantage of the power of your mind.
Your mind is incredible and the power of your relationships.
So, and they're sort of mutually um they're mutually supporting, right?
Your ability to build your internal capacities to think and contemplate and be in good space is supported and grown by being in relational connection with people who are calm and who see you and who listen to you and who value you. And so when that happens, you can build more in your head to the point where you can actually do that in the absence of that community. Now, you can't do it non-stop, but it's good to go back to the community, get reentered, and the more you build that and grow that, the more capable you are being out in in the world and being impervious to being otherred. But that's hard, you know, and it's particularly hard if you're 10, 12, 14. You know, the older you are and the more practiced, the more centered you get, the more your values are internalized, the easier it is to kind of live in a valuebased way, but it's very hard for young developing kids to live in a value-based way if the people around them have very different values.
Um, anyway, I'm ready. How do [laughter] how do you how do you self-regulate when do you ever feel like the world I'm not going to ask you for any specifics, but do you ever feel like the world is almost like falling apart on you and you're like, I need to self-regulate right now or else I'm going to maybe show a side of myself I shouldn't that's not helpful. I you know it's interesting that that I have I'd mentioned I'm a jock and I am I mean I I have always found large motor regulatory activities to be regulating you know running hiking and for me hiking in particular because it's both a combination of this pattern repetitive rhythmic stuff and c you sort of breathing rhythms and moving rhythms but it's also in an environment that has beauty and sometimes stillness, but when it's not still, the noises and the rhythms are natural. You know, those things make me feel regulated. So, I spend a lot of time, you know, believe me, the work I do and the volume and the complexity sometimes is like, oh my god, I cannot do this.
And so, I'll just go take a long long hike and I'll be better. But, >> oh, I think I'm a jock also. in that case.
>> Yeah, there you go. Um, so I I that's mostly what I do. And I'm I'm also very lucky that I have control over when I do these hard things. And a big part of our research over the years has has been about how the pattern of stress is more important than sort of the load of stress.
So, and you can build strength in your stress response networks and make them more capable of have carrying a heavier load if you do stress weightlifting, right? Which is kind of moderate, predictable, controllable stress. And so since I and actually this is I I I really built that capability through sport, >> you know, there was training, there was competition, and it was, you know, I I knew that if I had control over whether or not I would perform well because if I trained well, I'd perform well. And the performance had stress and but there was also enough success that there was you know activation and then back to baseline and activation and back to baseline to the point where the my stress response capabilities and they still are they're they're pretty capable of tolerating a significant load. Um but you know it's like everybody who develops resilience it's it's finite.
You know you have to do things that put you back in uh in healthy forms of rest so you can sort of recharge and capable of going back and doing some of the work. But >> can you say more about the patterns of stress versus the load of stress?
So [clears throat] [snorts] the I'm trying to think of a good example.
I'll give you a simple example. So when when you're training in medicine, um you're told when you're on call, you know, you're told that every Wednesday, you know, every other day you have to work till midnight and then all all this other stuff. You don't have any control over it. You're told who you you're going to see and just you don't have any control over it. It's a lot of work and it it's brutalizing. It's hard. Now it's different. You know, back in the day when I did it, it was so much harder.
[laughter] But they've literally wisely passed laws about how many hours a resident can work without getting rest.
But when I was training, you know, there were periods where, you know, literally months where I wouldn't have a day off.
And during that time, you would have you'd be up at night every third night, all night long, working, and then you'd have to work the next day.
>> It was brutal, horrible. Um, and of course, I hated it. I was inefficient. I was exhausted. And then when it stopped and I had control over my schedule and I had things I wanted to do, what I found was, you know, if I stayed up all night, [laughter] nobody bothered me, no phone calls, no nothing. And I'd stay I loved staying up at night. I loved it. And I got more done writing. So I used to stay up every night. Every Thursday night, I was up all night. And then I'd go to work the next day. But I'd always schedule because I had control of it. I'd schedule the boring stuff for Fridays, you know, meetings that I had to go to.
You know, it's like if if I could if I didn't think very well in those meetings, nobody cared. I just had to show up. Um so >> if you and so if you looked at the the the work product and the stressors on me they were greater after that period of residency but I had control over it >> and it didn't feel stressful to me you know it was that this is part of the controllability part of uh challenging experiences.
So over time and again a lot of people have demonstrated this you know all of the work about learned helplessness that was done by Seligman way back in the day that's related to the controllability of distress and if if there's predictability you know every time there's a buzzer that goes off I'm going to get a shock but I'm going to get food right um your brain adapts to it >> and your brain goes all right it's it's predictable it's not good >> but because I know what's going to happen and I know that it's going to pass. I'm able to use my mind to calm down my stress response system. It only gets to a certain point and my mind goes, "All right, it's going to end and I'm going to get food at the end of this." But if you get these random shocks and you have no idea when this is going to happen, um you get sick. your stress response system gets sensitized and you will lose weight and sometimes you get so sick you'll die so exact same pattern of stress one is controllable and predictable one is unknown and has no connection with anything that I do I have no agency I can bar press I don't get any food I don't get anything and all of a sudden then I get food it's like what did I do you know was it was it because I raised my eyebrows and you start developing superstitions about okay if I raise my eyebrows and then it didn't that didn't work and then you try something else and pretty soon you give up. Nothing I do is connected to getting avoiding that pain or getting fed. And this is what happens with kids that grow up in environments where they have parents that are struggling with addiction, for example.
Sometimes they're loving and present, sometimes they're gone, sometimes they're nurturing, sometimes they're angry. And so internal representation of like my understanding of my controllability and the predictability is like out the window. And so you develop this living on eggshells internally and um it impacts your health and your wellness and so forth. So that's a lot of what we've been you know we we recognize life is filled with stressors.
It's inevitable. But what you can do is learn about it in a way that you're not that you don't that your own fear doesn't fuel your stress response system >> that you recognize that it will pass and it's uncomfortable and it hurts. And why does it hurt? Well, it hurts because my legs are getting a signal that A, B, and C is happening. And so you teach yourself how to essentially keep the stressor moderate and and you build in some predictability because you know what it is. You may not know when it's going to happen, but you know that it's going to end.
And and then the the agency part of it is that when you recognize that, you know what, if I actually do some deep breathing and I focus on things that I've learned, I can actually influence how this is experienced by me.
And this is why what you're interested in teaching in schools is could be so valuable for so many kids. It's an it's a way for them to deal with the inevitable stressors that they will run into um without necessarily experiencing that as a sensitizing pattern of stress as opposed to a resilience building pattern of stress.
>> Yeah. Because what happens in the brain when such intensities happen especially for kids I let's just say like both kids and adults like I look at myself when I was a child I had a lot of adverse experiences which I probably shouldn't publicly say but that's okay. Um and I noticed it impacted my memory severely and I had to retrain my brain and it took so long. It was such a hard process. And so there's a form of wisdom and strength that comes from that journey that you can't get any other way. I mean it's I mean this is the hard part of having bad things happen. I mean that it sucks.
But the good part is if you can find a pathway through it and if there are people along the way who can help you and and support you and listen to you and give you the the reward and regulation that all human beings need, you can get to a place where you're um you're capable of sharing that wisdom without the pain.
And that's that's such a gift to give back to other human beings. Is that something that inspired you? I mean, I think no one goes into learning about trauma without having some connection.
Well, it's a I I was there was sort of a serendipitous set of experiences I had when I was younger, particularly I think the formative intellectual experiences that I had that made me recognize how important early development was and to be interested in the stress response was because my freshman seminar at Stanford was led by a guy named Seymour Lavine who's sort of the godfather of all the people that study stress. us, you know, Michael Meanie and Megan Gunnar and, you know, Bob Sapolski and all of those folks trained with Seymour Lavine and I was in his freshman seminar. So, I learned all about the controllability of stress, the impact of early developmental stress and all the animal literature that was in in in neurobiology about this. And that really jumpst started my interest in the brain and in this topic. And so really from that moment forward, I was doing as an undergraduate, you know, research with animals and tissue culture and all kinds of things looking at the development of the stress response systems. And um, you know, along the way, like everybody, there were certain life challenges that sort of gave me more than an intellectual understanding of of loss and trauma. And it, you know, it it was um it sucked, but I, you know, you learn and I and I learned from it. And I think it really helped me understand a lot of people, oddly enough, it helped me understand my neuroscience work a lot better. And um the ability to kind of put together clinical what people were saying clinically with what I knew from the neurosciences was really kind of what led to um the work that we do now which was you know 40 years ago when I talked about it like this people thought I was people in in psychiatry were very unfamiliar with these concepts. Yeah.
>> And um there were a couple people but not not many people that were talking about the biology of trauma and the impact on development and stuff. So you know I just kind of tried to weave my neuroscience experiences in with my clinical expectations. And um you know over time it was clear that I mean there's a lot of stuff that that was sort of emerged. Um, one was that I was always I don't want to say a good kid, but I kind of always thought that like people at colleges knew a lot. You know, [laughter] you know, it's like, no, somebody must know this.
So, when you're trained in psychiatry, I there's a lot of BS that they they they teach. and um and so many obvious things that like you know I've been learning in the the neurosciences about how you know neuroplasticity how neurons change and I was like wow I don't know like one hour a week that's not really a good pattern for changing the biology of the brain I thought all right then what's the most plastic part of the brain the easiest part of the brain to change is the cortex right well it's up in the language Right? So if I wanted to learn Spanish, if I wanted to learn a whole new language, Spanish, if I wanted to change the brain so I could speak Spanish, how successful would one hour a week be? And I realized there's no [ __ ] way. There's just no way. So then I thought, what am I doing?
What are we doing here? And it's it led, you know, it was hard for me to finally say, you know what, the kid I'm working with isn't in this green book. He's not in and now it's a blue book. Or maybe it's not. I forgot what color it is now.
But in when I first started, it was green. The DSM.
>> Yeah.
>> And I'm like, is that in this book? So I kept thinking, somebody out there must be aware of all this and thinking about it. But it was like it's very was very hard. I had like sort of eternal imposttor syndrome like I can't be the first person to think about this.
>> And now I clearly wasn't but there was just because of the unique combination of the way I was trained there was a slightly different shift in the way I was thinking about it than the way other people had ever written about it. And so, um, that was kind of the beginning of my, um, [clears throat] choice to walk slowly away from the medical model.
[laughter] Back away from the medical model.
>> I wonder if that's why it's so hard like people people struggle to find a good psychiatrist. I remember working in neuroscience for a while, many many years ago, and it was terrible. like it was yeah the psychiatry part >> so Chandra it's still hard I mean I I and and I don't say this to sort of be negative about the field necessarily because there's a lot of good people that are doing the best they can with the models they're given but I you know I have like some of the most wealthy famous people in the world ask for referral >> and I'm like I I have nothing. I mean, I don't I know a handful of people who I would recommend and they're almost all so busy that they don't have space. And one of the reasons they're good is that they actually spend time with people.
So, and and they've got good boundaries.
They're like, I can't take on anybody else in a responsible way. So, you're right. I mean, there's always somebody that's willing to take your money. Um, but the irony is if some of these individuals with the exact same symptoms showed up to a public system, they wouldn't treat you.
>> Yeah.
>> Um, it's just it's the whole system's a mess. I mean, it really is it's it's a heartbreaking mess. So, >> do you think there's something that maybe current scholars or future scholars and practitioners, researchers may be able to do or you would like to see them do, even if it's controversial?
>> I I I really do think that part of what has to happen is that we need to reframe the whole concept of therapeutic.
Um, and I'm I'm going to go to some big psychotherapy. I've been resisting if I got to ask to give a big talk at a conference. It's mostly therapists. It's about psychotherapy. And I'm basically going to go and kick the beehive and say >> you're not very therapeutic. Sorry.
[laughter] >> I wish I was there.
>> Yeah, it's we'll see. I I can guarantee you I will never be asked back, but um I just feel responsible to say it. Right.
Um, and again, I know there's so many good people that are trained to do therapy and they probably do a very good job, but they're they're constrained by the medical economic model >> and kind of by their imagination, their their fear about doing things that are new. And I keep trying to use the analogy that I think that a therapist should be like the conductor of an orchestra that the conductor doesn't make any noise, doesn't make any sound. They're not the ones playing the instrument. There's people out there in the community that are playing the instruments, right?
There's the horns and then there's the percussion folks and there's the coaches and the parents and the grandparents.
They're the ones that are providing the therapeutic moments that are going to lead to change in social and emotional and motor capabilities, right? You know, the coaches will help with a little bit of motor stuff, a little bit of self-esteem, and the drama people will help with different things. And and that the collection of positive stuff that can happen, the symphony of healing is best when it's guided by somebody who understands psychology and the neurosciences and all kinds of other stuff. I mean that there's something of value to the way we're trained.
>> Yeah.
>> But we're not the only ones that can provide therapeutic experience. And in fact, um most of the therapeutic experiences will be taking place outside of the office. It might be in a in a kind interaction with an older kid in school sees you, right? The little seventh grade kid who's scared and you know, ninth grader sees him and says, "Hey, I saw you out there throwing a ball. You did a good job." Wow. That's that's a great therapeutic moment. Those little those things and it be if you understand the neurobiology of the brain.
Neural networks are are most responsive to multiple brief activations.
So the neuroplasticity needs to be thought of as a piano, not a not a not an organ. Right? When you put your finger down on the organ, it makes noise noise. Pianos will only make noise. You go tick again, again, again, again, again. And that's what we need. We need lots of little piano tinkles and sounds and noises every day, all week long. And then, sure, come see me once a week and I'll see whether or not you guys are playing on the same page. You have different sheet music than I do. No, I'm going to make sure you all have the right sheet music. You know, listen, you want to play like he's an eighth grader.
He's not an eighth grader. He's got the cognitive capabilities of a fifth grader. So, you play fifth grade music.
Socially, he's pretty third grade. You know, sport-wise, this kid's really gifted. Go ahead, eighth grade. But that's what you're going to be in the right sheet music. [clears throat] And we'll I will direct, you know, the symphony, >> but I got to get you all in the same You have to play get on the same sheet music.
>> I love that. That's really different than I studied clinical mental health counseling before and then I left and decided research was more up my alley.
Um because I felt like there was a lot of passivity of oh just let them direct everything but then they don't heal. And I'm like well does anybody realize that the majority of pat like people I should say patients people they just keep coming back again and again and again their whole life then they're 80 years old and nothing is solved.
>> Yeah. and the and the and because of the medical economic model and our practice models, if you look at a public mental health clinic, the average number of visits before somebody just stops coming is three >> and they have long waiting lists and everything is sort of crisis driven. You know, you get on a waiting list when there's a crisis at school and school demands that you see somebody. They make an appointment. You come in and you see somebody and they go, "Oh, because of doctor patient privilege, I'm not going to tell you anything, Mom." And what's the motivation for mom to take the day off and sit in a waiting room and not get any feedback about whether Billy's bad or not or what's going on? And so the school quiets down, Billy seems a little bit better. I'm not going to take another day of work off. I can't do it.
>> And so they drop out of treatment. I mean it it it is every public mental health clinic on the planet know has that experience but we don't change.
It's it's very frustrating.
>> Do you think that this is kind of especially western culture I should say I don't want to say all cultures but western culture I mean we love our little boxes so much.
>> It helps us understand things. How do we get a vacuum? We we do not like to have no explanation.
Yeah.
>> And I think that again that's one of the things that the stuff you do when where you can teach people how to sit with the discomfort of uncertainty that's a gift. It's really I think one of the most powerful things that anybody can learn is that I don't know and that's okay.
[laughter] >> Yeah. Yeah. It's it's interesting you say that like here at Chin Kong Institute, we really want people to be able to think for themselves. So, we're like, "Okay, what are the ways to do that?" And like the research I mentioned that I'm most interested in, I cannot tell you how many people have laughed at me said, "Huh, good luck with that." And I'm like, "Okay, it's fine. We're going to keep going." Because I think change, it's hard, right? Like the neuropathways in the brain change very hard.
>> Yeah. It's and and part of what again part of what we've been trying to understand better is how do you move I mean the way we're doing certain things very hard >> is there a way to actually be a little bit more targeted and more specific so that you are going to have a higher probability of having success and this is a big part of what our whole neurossequential model is it's sort of it's like we try to understand where what systems appear to be well organized, what systems appear to be underdeveloped, what systems appear to be poorly developed in or sort of disorganized. And depending upon that, there will be different patterns of recommended dosing and spacing and and that's kind of what we do. We we we we we're trying to figure out how each person's different and that's of course drives the mental health system crazy because it's not you know they want boxes like you said >> well what's the diagnosis I'm like I don't know but I'll tell you what they how they function I mean I can describe them I can't tell you what that is like it's a thing and oh god now I know what it is like how does that help you how does it help you to put a label on it >> it just decreases your fear is what it does. But I don't want to go, you know, I'm not going to say that to them. But so we we've actually been very successful in increasing the probability that something we do will work because we think we're targeting something in the right sequence and with the right pattern of experience and we're dosing it the right way, right?
We're do we're not doing one hour a week. We're saying, "All right, well, where can we get this kind of experience 10 times a day and who's going to be delivering it? And how do we equip them with the understanding and the patience and the kind of the practical tools to do that?" So, that's kind of what we do.
the people that we work with, the teams that we work with that are able to put together kind of a team of PTs and OT's and teachers and, you know, parents and they all kind of have an understanding of what part of this they should do.
There's really good success and I I I think a big challenge for a lot of parents is they feel like they have to do all of it.
>> So, we do a lot of work with everybody and say, "Listen, you know, you're you're the teacher. you don't have to be a therapist, you know, you don't have to worry about all that stuff and you just like, let's help them feel safe and seen and then we'll throw a few cognitive things in there. You know, they can learn that cognitive stuff, but they can only learn it when they feel regulated enough to have that part of their brain open.
And then we do the same thing with parents. Like, you know, you don't have to be the teacher. Listen, you be the parent. you know, if they need some help with cognitive stuff, there's always fighting over homework. Let's find some kid at college who wants to be a teacher and needs to make a little extra some extra bucks. And oh, by the way, he's also a cross-country runner and this kid loves running. And we so we'll create this little, you know, relationship where there will be an opportunity to essentially recruit more people into the life of the child and create what we call this therapeutic matrix. you know this therapeutic web >> and you know when we can do that works great. Now the problem is as I'm sure you're anticipating is the medical model only pays you know who who pays for all this and that's a dilemma. you know, we won't pay for animal assisted therapy or or therapeutic massage or yoga if it's an appropriate thing for somebody to sort of build into their toolkit.
And, you know, that's that's part of our challenge. We we we really do have to do sufficient education and uh accumulation of evidence so that we pressure some of these third party payers to do that.
So if someone's listening to this, they cannot afford many people have lost their insuranceances these this past year. I know. Um so people are listening to this they can't afford help. What can they do like right now?
>> Well, first of all, they should be hopeful because and recognize that, you know, you can actually have tremendous healing.
>> Yeah. from all kinds of things that are, you know, whether it label as either depression or anxiety or PTSD or whatever you want to label it. Um, you can heal from those things through natural routes of engagement in community and cultural activities. Um, you know, the most therapeutic person I ever met was a janitor.
He probably provided more positive healing for tremendously traumatized kids than any therapist I've ever met.
And he was at a residential treatment center and he was always present because he was, you know, he's working there. He [clears throat] was usually in parallel, you know, he was never too overly intimate. He's in parallel, always doing some pattern, repetitive rhythmic thing.
And the kids would come over and they'd make comments and he'd listen, he'd stop and he'd see them. And it was in iterative little doses. And they trusted him. They loved him. They told him things that they would tell nobody else.
And he he was not prescriptive, but he was reflective, right? So he wasn't like he was going to tell kids, you know, like don't do that, don't run away.
>> Yeah. He would reflect and go, "Well, after you run away, where where are you going to be?" You know, [laughter] [clears throat] just and and again, it wasn't like I'm I'm just curious where how's that going to work out? Like, use your mind to anticipate what it would be and you realize, wow, maybe that's not a good plan.
>> Yes.
>> And it it just he's like one, he was wonderful. I finally started. I was leaving. I worked at this residential treatment center and as a consultant early in my career and I was leaving one day. I used to stay late and have dinner with the the kids um one night a week and then you know go home like at 7 or 8 and I'm leaving and he's shoveling the driveway.
The snow was in Chicago and he was shoveling the stairs. Um, and he said, "Did you get a chance to talk to, you know, so and so today?" And I said, "No." He said, "You should probably talk to him." Like, "Wow, what's going on?"
He said, "Well, he's feeling pretty hopeless." Like, oh, okay. So, I went back in, talked to him. It was like, "Oh my god, thank you. That was great." You know, it was the right thing to do. And I started talking with the janitor. I'm like, "What's how did you know that?"
>> He said, "Oh, he talked to me."
>> And after similar thing happened about a week later and I said, "Listen, you know all these kids better than anybody." And he said, "Yeah, probably."
I said, "Will you come to our staff meetings?" And he's like, "I don't know if that's not my job description." I said, "That listen, it would be very helpful for me, please." So I would he came in and he would sit next to me and there would be like the teacher and the house and the residential mental health people and the social worker and the head of the place and they'd be talking about every every 3 months or so there was like a big staffing on one of the kids and they would make plans, you know, they adjust the treatment plan and everything and pe the teachers would say something and you know if the kid had had a hard day like a week earlier, They'd want, "Oh, you need to increase his medications."
And I'd look over at at the janitor and I'd go, "I don't know. Should I'm not sure I should increase the medications."
And he'd go.
He just shake his head and I go, "No, we'll we'll wait. Let's" [laughter] and he for the first year almost, he didn't talk that much. But ultimately, as he felt comfortable talking, he just was smarter than most of us. he knew more about these kids and he had tremendous um wisdom about what their experience was. And I never had a chance to really get too much detail about his life, but he came from the same communities, had the same losses, had friends get killed like all of these kids had.
>> And it was just a tremendous gift to that place. Uh, and it reminded me that how many people are walking around that could be such a transformative therapeutic presence in a community who we minimize because they don't have the right degree or or they don't fit into some evidence-based program or, you know, they're not using, you know, some pre-approved thing that we'll fund. And I I just think that if you look at a healing community, a community where people are able to deal with stressors, it's filled with with folks like that.
>> Yeah.
>> And over time, what our work has shown is that the best predictor of your current functioning is your relational connectedness in the moment in, you know, in and and in in family, community, and culture. better predictor of all kinds of, you know, ACEs and previous adversity and that your best predictor of risk during development isn't your history of adversity, it's your history of relational health.
>> So, if you've been connected and had adversity, they can counterbalance. And so, the long-term risk is minimal. If you've had lots of relational health and adversity, you literally have no symptomatic presentations. You are you you're doing pretty well. If you start to have relational poverty and a little bit of adversity, you have many more symptoms.
And um you know we're continuing to study this but you know just I think the further away we get from the traditional clinical office the more we're able to hear from wise people who understand that there are multiple dimensions to healing >> and and that if we don't pay attention to those dimensions we'll just kind of get a little bit of a tweak. we might get a little bit of an improvement in a symptom, you know, so like, you know, a kid may have fewer flashbacks or a little bit better sleep, but they still can't read and they still have crappy, you know, they're that good at relationships and they have terrible self-esteem. But if you did a study on that intervention and looked at only those overt PTSD symptoms, you go, "Oh, this is an evidence-based intervention."
and rather than treating the whole person, you know, you've treated a fragment of their presentation and you've patted yourself on the back that, oh, I'm a great doctor and we're so good at this and we know all about PTSD and let's have a conference and let's write a paper and it's an industry >> which is kind of it kind of >> I'm sorry. I'm sorry. No, no. It kind of goes back to what you said before how in the past like your uh focus was more on the clinical with the clinical model and that's all symptom based and now what I hear is like your focus is no longer let's just alleviate a few symptoms.
It's like let's really go into the deep healing and and transform this >> and and again I'm even you know I have a lot to learn yet. Um, it's I really think it's very challenging, but it's not just focusing on doing things that will help the individual. It's like it's a recognition that that individual is part of a larger hole. you know what's going on with the relational community that is it the the family and the culture that that's where tremendous potential resides that is untapped >> and it's I I I do and part of what I'm trying to write about now and learn about more is kind of the neurobiology of groups you know neuro neurosciology so how does uh a depressed child impact the neurobiology of everybody in the family or how does a a dis how does a discouraged, demoralized, marginalized, unemployed parent impact the emotional state of the children in the house?
>> No.
>> No. You know, it's everybody goes, "Oh, it's obvious. Just can't be good, right?
It's the kids not going to be overjoyed.
Yay. What? We have nothing to give.
You're preoccupied. You don't spend any time with me. You tell me to watch TV.
So, you can go literally do nothing because you're depressed."
that obviously we know that that's not going to be good. But the intervention is we let that poor family stew and stew and stew and stew until that kid acts out in school. Then we send them to a psychiatrist who puts him on rolin.
Does that help the situation at all? No.
>> Yeah.
>> Not one bit. I mean the mom's still unemployed, marginalized, disrespected.
We just have to have um complete we have to have our chin tip our chin up and stop looking down. We have to look at the whole the whole sort of the whole perspective the whole horizon of what's going on and I think that we'll make better choices about what to do.
>> Yeah. Thank you, Bruce. And I know we're completely out of time.
>> Wow.
>> Went a little over.
>> Wind me up and point me in the right [laughter] direction. Sorry. I didn't mean to over talk everything.
>> I love so much and I wish we actually had two or three hours and we just go ramble and not ramble but hopefully >> there was rambling in there. [laughter] >> Bruce, we have a ritual here um where the previous podcast guest asks a question for the next one.
>> Awesome.
>> Could we ask you one last question?
>> Yes, you may.
>> Okay. Actually, this is going to be two questions. [laughter] Okay. So the first question is um I'm going to read it here. Trauma awareness has really increased over the past decade and more people are acknowledging and seeking to understand the trauma in their lives and how it has affected their minds, bodies and behaviors. Does it seem to you that the word trauma is being overapplied in the common vernacular? I have noticed the tendency for people, especially millennials and younger, to use the term trauma refer referring to any adverse experiences in life. What are your thoughts on this and what words can you offer to help people distinguish between trauma and normal adversity in life?
>> That is a great question and I've had the same observation. I I you know as somebody who studies trauma you know one of the things that we try to do is clarify what does that exactly mean and I think for most people that are kind of in the more academic environment where they're thinking about this um maybe in deeper ways than kind of the general population so far there has been really an overuse of trauma. I mean, you'll hear people say, "Oh my god, I was traumatized because, you know, I my dry cleaning didn't come and I had might have to go to the party without the dresser."
>> What?
>> Yeah.
>> Gez, you want trauma? I got trauma, you know. So, [laughter] I I I do think that that's kind of a this is a phenomenon that's associated with movements.
And part of what's happened with the whole trauma stuff is that as part of the efforts to help people understand this, there have been well-intended but ill-informed um carriers of the message who who've made a movement, right? It's become like so now trauma-informed cities and trauma informed. It's like I just laugh, you know, Scotland want declare themselves a trauma-informed country and I'm like no, no, you really aren't. Sorry. No, you learn. And you know, it's like it's it's kind of like a pendulum swing. So, I think the language language is going to be loose.
The people that declare that they're experts, that's that's going to happen.
If you monetize anything, everybody puts up a shingle and they're happy to teach you all about trauma.
>> Yeah.
>> Ultimately, the just the power of the beautiful thing about things that are true, the truth is that it's like gravity. It's all you can't escape it.
ultimately it will emerge and clarity will emerge but right now it's it it is very foggy and messy and I we have a lot of we spent a lot of time thinking about how to clarify but not completely dis sort of throw a wet blanket on the enthusiasm that people have about this. I'm glad people want to learn about it and teach about it and um but it's sometimes it's it's hard to do that. That's why we're very careful about our language. I never use the term toxic stress because that's [ __ ] It really suggests that there's some damage going on. It's sort of like again it's really destructive language um because it it it leads people to a misunderstanding about the actual mechanisms that are going on. So when I talked about sensitization, making a system more sensitive, that's not toxic. It's just neuroplastic. It's just moving it in one direction. And um so I think as as we get better at um translating and communicating with better language, I think that that'll start to go away.
>> Thank you. And your second question, huh?
>> All right.
>> Okay.
>> Second question. I'm ready.
>> This one's going to be quick, hopefully.
Okay. You've been an integral part of the field's understanding of developmental trauma in children. Do you think we've finally got it figured out and we are on the right healing trajectory when it comes to treating trauma in children?
>> Well, first of all, that's very kind statement. Um, I I do think that there are I think that we're nowhere near fully understanding all of this. I mean I I it if you understand the complexity of of the brain period and then the complexity of human beings period and then complexity of history uh you know all of those things kind of have to be taken into consideration when you're trying to really understand some of this stuff.
>> So epigenetic phenomenon completely very very interesting stuff un kind of unexplored when it comes to trauma in humans.
We don't know enough about the the buffering things. We don't know and we don't talk as much or study as much about relational protective factors as we should. We don't talk as much about belief systems and culture as we should.
Um, and we'll get there, but it's it's we're starting to take steps in the right direction. So, I I do appreciate that. I do appreciate that people are looking at it, but like anything, if you do a really good job with your investigation, what you find is you create more questions >> and and I think that that's going to go on for quite a while. Human beings are very complex and and life is complex and multi-dimensional and and the scientific method almost by definition is one-dimensional. you know, we're trying to isolate factors and look at them through one lens, but you know, there's thousands of lenses that can inform any given phenomenon. So, part of what we're really going to be challenged by is how do we take those isolated factoids that we're accumulating and organize them in a way that's not delusional, >> we organize them in a way that actually is reflective of a true wisdom about the human condition. And I think that that's uh we're a ways away from that. We're still sort of creating factoids.
>> Yeah.
>> And they're floating around in the ether.
>> I hope one day we get organized >> and it's a this is a multi-generational process. I think we're moving in the right direction. But >> thank you so much, Bruce.
>> My pleasure. Thank you.
>> I appreciate >> keep up your good work. Thank you so much for being here tonight.
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