Ep. 56 - How Trauma Shapes Mental Health and Why It Often Goes Unrecognized

Trauma affects far more than the moment it happens. In this conversation, psychiatrists Dr. David Gross and Dr. Andrew Rosen explore how both major life events and the smaller, repeated experiences of emotional pain can shape mental health, relationships, trust, and the way we move through the world. 

The discussion examines the difference between "big T" and "little t" trauma, why many people never connect their current anxiety, depression, relationship struggles, or substance use to experiences from years earlier, and how trauma can remain hidden until something unexpected brings it back to the surface. The hosts also explain how the brain stores traumatic memories, why not everyone develops post-traumatic stress disorder (PTSD), and how unresolved trauma can influence behavior long after the original event. 

Dr. Gross and Dr. Rosen also discuss why recognizing trauma is often the first step toward healing. They explore modern treatment approaches, including cognitive behavioral therapy (CBT) and EMDR, while emphasizing that trauma is not something to be ashamed of—it's a human experience that deserves understanding and compassionate care. The episode concludes with a thoughtful conversation about emerging concerns surrounding social media, AI, and their potential impact on future generations' mental health.

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Transcript

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SPEAKER_00 0:08

Hi, I'm Dr. David Gross, psychiatrist. And I'm Dr. Andrew Rosen, psychologist, and this is Do Shrinks in a Mike.

SPEAKER_01 0:15

Uh first, I'd like to give a shout-out to my grandson, Levi, who was 10, who just informed me that he's been listening to our podcast from camp, which I'm amazed that a 10-year-old would be listening. I'm going to have to test him to see how much he's learned. But today we're going to talk about a topic we've raised before on occasion. Uh, but uh from our view, it's become more and more central to a lot of psychopathology. Psychopathology is a concept of uh ongoing problematic emotional, psychological difficulties that can develop. And trauma, it turns out, when when you look for it, has been really central to a lot of uh of underlying uh the emotional difficulties, whether they be uh depression, anxiety, relationship problems, maladaptive personality traits. And I think I mentioned before, I got I got interested in the role that trauma plays um probably about 35 years ago. I was consulting to a uh woman's uh substance abuse rehabilitation facility in Delray Beach, Florida, that uh was unique in that it was sponsored by United Way. So it was not an insurance for profit type of facility. And so they the women they ended up getting there were women who had lost everything because of drugs, lost their families, lost their jobs, lost their self-respect, and they really had uh hit the bottom of the barrel of life function. And when I got to meet many of these women and doing consultations there, I was amazed at the percentage of individuals who had had traumatic life experiences, whether they were childhood related or or young adult related, but they were significant. And I began to realize that trauma plays a core role in a lot of different problems in our field. And that's when I became more sensitive to looking for trauma, because if you don't look for it, you're not gonna hear it. Because most people who have been traumatized uh for various reasons uh will keep it to themselves and not want to share it because they're embarrassed, uh, or their brains uh hide it in the deep recesses of the brain. So today we're gonna continue our discussion about trauma.

SPEAKER_00 2:21

You know, the concept of trauma and the uh treatment of it has kind of come full circle. Um back in the 1800s, I think it was the late 1800s or maybe early 1900s, uh Otto Ronk uh talked about something called birth trauma. And his uh theory was that the actual experience for the baby coming down the canal and coming out into the real world was our first uh experience with trauma. And depending upon how that went, uh he proposed that uh future psychiatric problems, psychological problems might ensue. Um later on, the DSM, our diagnostic manual, talked about trauma and PTSD, post-traumatic stress disorder, and was very, very uh rigid about the definition of trauma. It had to be something that was either a natural disaster like an earthquake or uh witnessing a murder or being assaulted, something very severe, but not just a normal human experience. It was considered to be uh had to be beyond the range of normal human experience to be traumatic. Uh then with the uh concept that was used in psychoanalysis, the concept was that if you're having problems in the present, there must have been some sort of trauma in your past, whether it was a traumatic relationship with your parent or some sort of event or difficult situation, sexual situation that was so traumatic that your uh brain repressed it, and the concept of uh psychoanalysis was to unrepress whatever this trauma was that you've suppressed. Uh after that, after psychoanalysis started to uh lose its uh center stage in our field, we then focused more on the present, and that's where uh cognitive behavior therapy and psychopharmacology really focused on. We we didn't ask too much about the past. We considered it to be uh almost irrelevant to what was going on in the present. And that further caused, as you were saying, David, us to not pay much attention to trauma, and we stopped asking about trauma because it was considered to be in the person's past, and and we don't talk about the past so much. So in the last number of years, things have again moved over on the spectrum, and we started to ask more questions about trauma, and we opened up the uh requirements for trauma. It didn't have to be a natural disaster or something beyond the range of normal human experience. It could be situations that happen to people, like you say, where it could be rape, it could be assault, it could be uh very traumatic loss would be considered trauma. So there's uh the concept of what we call complex trauma, which are much smaller scale traumas, but they still have an impact on the person and the brain. And that's where we are today talking about many disorders are related to even but not just big traumas, but little traumas that have accumulated in a person's life.

SPEAKER_01 5:36

Yeah. You remind me of uh the birth trauma concept uh and how a field can sometimes go in a variety of interesting directions in terms of treatment. I still remember when uh mental health professionals were pursuing primal scream therapy to help people get out of the uh pain of birth trauma. Um, we've we've experimented a variety of uh interesting and sometimes cockami uh treatment directions.

unknown 6:01

Right.

SPEAKER_01 6:01

One of the problems we've we've faced, I think, is the uh the Diagnostic and Statistical Manual, the DSM, has had a number of additions and they've improved as they move along, but they still are somewhat black and white and categorical. So either you have post-traumatic stress disorder and meet certain criteria within the DSM, or you don't. Um and unfortunately, the trauma really and the effects of trauma represents a spectrum. You know, that there are a whole variety of impacts of trauma, and you can't just make it black or white. So just because a person doesn't have uh the PTSD or post-traumatic stress disorder doesn't mean they suffer from a trauma syndrome. And as you had mentioned, uh that we've now broadened the concept of trauma so that it doesn't involve a life-threatening, I think I'm gonna die type of experience. In fact, people have even reported developing uh trauma from observing a loved one in the coronary care unit where they're hooked up to all sorts of uh IV lines and electrical uh beeping, et cetera, et cetera. And uh so one of the things we've learned about the brain is that it despite the fact that it's pretty fluid and plastic and is always changing, it also can be very rigid. Uh there's a part of the brain called the amygdala, which is a deep part of the brain, we've mentioned that before, that is a primitive part of the brain, present in uh primitive uh animals like crocodiles, which go back uh thousands of years. And it's the part of the brain that stores um uh life-related emergency experiences or experiences that are traumatic. So when the uh uh you see in the bear in the f see the bear in the forest while you're hiking and immediately go into a fight or flight mode and the adrenaline starts surging, the the experiences of that bear get stored in the amygdala. The real question is how how long it gets stored, so that if uh you got attacked by that bear uh and and ended up in a hospital and and had a recovery period, my bet would be that you're going to have some flashbacks and experiences of that bear attack uh over time. Uh that kind of traumatic experience is stored more tenaciously in the amygdala. And what happens is intermittently the amygdala releases the emotional experience and the and the memory. Uh individuals who have post-traumatic stress disorder uh suffer from that because they can be a Vietnam vet who is walking down the street and suddenly a car backfires and they have a startle response because immediately it brings them back to Vietnam when the uh mortars were landing and the explosions were going off and the traumatic experiences were occurring. But that part of the brain, the amygdala, um, can store this this uh this information, this experience almost indefinitely, and that becomes the problem. And so we've learned that uh trauma can varied, can be varied and exists on several levels. There can be people who have uh automobile accident and for the next week or two or three may have uh some hypervigilance driving and be fearful driving, or maybe even avoid driving for a period of time, but eventually they'll recover from it. So for most people going through traumatic episodes, they recover. The question that we need to answer over time, and and I don't think the research has really provided it yet, is what kind of traumatic experiences get recorded in the brain indelibly so that it becomes something that influences our future experience and our future coping with life. And so um uh trauma is something that we can't ignore and need to pay attention to.

SPEAKER_00 9:36

And it's difficult because you can go through a trauma and not really demonstrate any after effects of it and think that, well, maybe that trauma was uh uh quiet and it's gone away, and I don't have to worry about it anymore. But something a year from now or five years from now can actually uh bring it back to the surface, and then a person can become symptomatic, whereas they weren't before. Another tricky thing has to do with uh a number of years ago, probably about 20 years ago, people started to talk about this concept called past life regressions, which had to do with the idea that uh people may have had trauma in a previous life. And the uh clinicians who really believed in this concept would tell patients that even if you don't remember or have had traumas in the current life, you may have had traumas in a previous life that you don't recall, but those traumas might be affecting you. So they would regress patients in therapy to try to get them to recall what might have happened in a previous life. In effect, it looked like they were just planting seeds. And sometimes patients would remember things or think they were remembering things that really never happened, including assaults and rapes and other things. So very tricky stuff when it comes to trauma and identifying was something real that was traumatic, or was it not real? But at any rate, trauma is a range, like you say, Dave. It can be something huge and and a disaster like 9-11, or it could be like the example of the person who goes to see somebody in the ICU, or it could be the person in the ICU that's traumatic to go through surgery or bypass or not knowing what's going to happen and being in an IC recovery. So all of these things are traumatic. Not everybody will experience the symptoms from them, but it's up to us as clinicians to know if somebody comes in complaining of anxiety or insomnia or hyper stress reactions or uh depression to ask questions about situations that may have happened recently or may have happened years and years ago to see if it's related to the current symptoms.

SPEAKER_01 11:59

You know, what's what's impressed me the most over time in the folks that I've seen with with uh trauma, um, and uh uh we'll talk some more about the different types of traumas, is the fact that trauma can serve as a nucleus um for a variety of psychological psychiatric disorders. And so it's almost like um uh outside of the uh of the trauma network, one can see the development of substance abuse. Um how much of that is to self-medicate, the painful emotions related to the trauma that the individual is not aware of, but they suddenly find themselves that they're no longer in in as much emotional pain when they use the alcohol and marijuana or other more severe drugs. So one aspect of trauma can be substance use, another is eating disorders, interestingly. Um and and the question is why would there be that connection between traumatic life experiences and eating disorders? Oftentimes the type of trauma that individuals experience that lead to the eating disorder development is family of origin trauma. Um on a psychological level, one can understand that as perhaps a way of being in some kind of control. So if you can control your way to control food that comes in and nobody else is controlling you, then that's a positive thing, even though it's maladaptive and potentially very, very dangerous. Uh the other uh outgrowth of trauma is uh problematic relationships. Um if you go through uh repeated traumatic life experiences, it's difficult to believe that the world is a safe place. Uh and though therefore you end up uh uh believing that you can't trust anybody but yourself, and oftentimes it interferes with the ability to establish trusting, positive, healthy relationships. Um individuals will end up picking uh uh social and uh and and romantic uh partners who are uh problematic in their own personalities and and have uh maladaptive traits, et cetera. Uh maybe it's because they're safe. It's almost as if you come out of a traumatic experience and believe uh the notion that I'm not worthy. Um I don't have the value I should have. Rather than recognizing trauma for what it is, you you internalize it and and and that leads to negative self-image and negative self-belief systems. Um mood disorders, as you suggested, can be an outcome of of trauma, um, sleep difficulties, et cetera. So um individuals who are trauma survivors often uh uh don't flourish and and they don't succeed in life the way they'd like to and don't know why. Uh my experience has been once they begin to understand the impact of trauma, and there's a wonderful book that's been out for a number of years, uh called The Body Keeps the Score, that has been the most helpful book for a lot of people in understanding trauma. Once they understand it, suddenly it makes sense. And what that does is it sets the stage for the ability to I want to work on improving this, I want to get rid of the negative effects of trauma and move towards a more more successful life situation and and kind of empty out the excess baggage that I carried with me since either childhood or young adulthood or even older adulthood.

SPEAKER_00 15:08

First stage of psychological development, we all remember learning this in in introductory psychology class, was trust versus mistrust. And uh assuming that in the first years of life, nothing bad happens, nothing special happens, uh the child starts to develop a trust. It's not a not that they're aware of this, but they develop trust that from day to day everything is gonna be okay, I am safe. And that disappears when trauma happens, because now you go from a position of everything's gonna be okay, no news is good news, to a complete opposite of that, which is I can trust. The one in a million does happen. Bad things do happen. And depending upon the age of this and the severity of it, and whether it's repeated, which it often is, especially in in uh dysfunctional homes, trust goes out the window. And now a child and future adult goes into prevention mode. Don't trust. No news is bad news. Don't don't get comfortable because if it's good now, any minute now the shoe's gonna drop and something bad's gonna happen. So that gets into the nervous system, actually, and it goes from, in effect, what we talk about uh a s a parasympathetic mode in the nervous system, which is kind of like a peaceful, relaxed mode, to a sympathetic arousal mode, which is watch out. So you become, in effect, like the soldier on the battlefield or the policeman walking down the street. You better watch out. And that starts to happen in general ways, undefined ways, but it can happen in relationship ways. Don't trust the relationship, don't trust your partner. It can happen in don't trust that you're healthy. There's going to be something wrong with you. It can happen with money. Don't trust anybody, put your money under the, like they used to do under the mattress, and you become, in general, a mistrustful person, which not only causes anxiety and and even depression, but it it really inhibits the person's ability to have a full life and to grow and to experience all of the good things in life because they're on defense now. Our job is to help that person realize, you know, you don't need to be on defense now. I use the story, I may have said it on one of our previous podcasts, there's a guy walking around sightseeing in Times Square, and he notices on the other side of the street there's a man walking around with an elephant gun. So he's perplexed by this, and he finally crosses over and goes up to the man and says, Excuse me for being nosy, sir, but I notice you have an elephant gun ready to like use it. Why would you have an elephant gun in the middle of Times Square? So the man says, Well, I don't mind telling you. He says, I keep my elephant gun ready to keep the elephants away. So he says, What do you mean keep the elephants away? Do you see any elephants? And the man says, No, you see it works, doesn't it? And that is the concept that if somebody doesn't have trust because of trauma, they develop that. And that may be in a vague, general, abstract way, or it may be very specific to certain people, to certain situations, to certain types of events, and they just never get comfortable.

SPEAKER_01 18:46

I treated somebody like that years ago with a fellow who was walking around uh downtown Fort Lauderdale with a high-powered rifle because of his fear of uh enemies approaching him, but that was due to a different kind of problem than trauma, although he traumatized a whole lot of people, including myself when I had to treat him. But that's another story. One of the ways of I think of conceptualizing trauma is to view um trauma as having uh one form with a capital T and the other form with a small T. The capital T trauma is a t is a classic trauma. You know, I'm I survived a plane crash, or I I survived uh uh an IED in a Humvee in Afghanistan, or I survived a rape or or uh or molestation or survived uh an armed robbery. Um those are the big time traumas, and and uh that doesn't mean that they're necessarily more severe. One of the issues that I've I've I've wrestled with over the years is um take the individual who came out of a childhood where for years and years they were raised by emotionally abusive or even physically abusive parents. But just take the emotional abusive parent as an example, because there, you know, you don't really know that there was trauma, except there could be a parent who was uh always negative and self-critical and belittle belittling you, et cetera. Uh one of the last podcasts I told the Cinderella Part II story with Cinderella had to get rid of uh the belief systems that she developed in childhood. My belief is that the small T trauma can be as problematic, if more problematic, than the big T trauma. Um if you did an evaluation of uh Vietnam vets or even Afghanistan vets who are exposed to major uh um warfare and combat trauma, not everybody develops uh post-traumatic stress disorder. In fact, the number of individuals who develop it is not the majority. Uh there's some genetic reasons perhaps for that, but that some people learn how to cope with it better. Um, so the small T trauma is the one that falls through the cracks. They're the individuals who come into treatment with a mental health professional because of depression or because of anxiety or because of failed relationships or a failed marriage. And if you don't look for the presence of trauma, then you're not going to be uncovering the core process that's causing the difficulties. You can help somebody recover from a failed marriage or problematic relationships, but it still will not change the fact that they're programmed to have problems in the future. And so asking questions about childhood and what was it like and what were parents like and what was the environment that you lived in like. Um individuals, for example, who uh grow up in in in uh in the inner city where there's lots of violence and shooting, uh get t subtly traumatized by that and and they need to be able to recover from it. And and we don't have the capabilities now in our programs to provide that. So uh paying attention to the chronic, subtle, persistent trauma is uh very, very important and and needs to guide treatment. And and uh treatment can be effective for trauma now. It's it's more than just a primal scream. There are a variety of uh cognitive behavioral therapies that can be effective. One of the newer ones that is being utilized is uh uh uh uh EMDR, eye movement desensitization reprocessing trauma therapy that can be very effective for trauma. And more and more clinicians, thankfully, are getting trained in this area. But first step, really, as we've discussed it, is to identify the presence of trauma and to be able to define the nature of the traumatic experiences themselves.

SPEAKER_00 22:22

Aaron Powell You know, with the the little T trauma, one of the uh problems with that is that we we talk about something called stress adaptation syndrome, which means basically we all kind of adapt to the level of stress that we have in our lives. And uh that's a good thing because um some people have just to deal with more stress. So we learn to adapt to it. Um but that can also happen with repeated small tea trauma, where a person, even though they know that these things that are happening can't be good and they're and they're hurtful, they adapt to it because we're supposed to try to adapt to our environment, but if especially if we can't leave it. So what that does is it almost normalizes trauma, especially the little T trauma. So it's very important to be able to see that even if a person minimizes the importance of these little traumas and why they're having problems today, you know, our job is to help them realize, well, we don't want to magnify and make it worse than it was, but we also don't want to discount its presence in why you're having symptoms today. We do have much better uh methods to help uh people who have had trauma in their life and to help reduce the effects of those traumas on current symptomatology. Some of it is, as you were saying, David Cognitive behavior therapy, some of it is uh psychopharmacology. You know, there's interesting research now that shows that um depending upon the severity and the type of trauma, it can even become intergenerational, where it's actually some impact on DNA and and it can show up somehow in derivative form in the next generation. I mean, clearly that's happened as a result of uh the Holocaust is a perfect example of that. So trauma is a big deal. And um, even though many years have kind of gone by in the field of mental health where we minimized it and and uh required a different kind of perception of it than we have now, it is a big deal. It impacts on people in many different ways, and uh it's just it's our role to look at it and and it's our role to educate not only the patients who come to see us, but the public in general that trauma is the real deal, and it's not a form of trying to blame anybody or anything. Uh it's just uh our efforts to try to help people realize some of the things that impact on one's mental health.

SPEAKER_01 25:00

You know, and I I fear that we're entering into a new era of uh that's multi trauma, and that's the era of social media, uh artificial intelligence, and chatbots. I mean, think about the individuals who have uh ended up becoming self-destructive in response to chatbots that they interact with. Um the brain is very plastic, and uh brains are gullible, and uh really worry about the impact of uh uncontrolled social media uh on the development of traumatic experiences from the type of input that they're getting, uh especially in in younger people where their brains are still developing. And again, you can easily uh develop uh misconceptions about the world, misconceptions about yourself, uh similar to the what happens to uh uh young people who develop eating disorders because of all the exposure they have on social media to the importance of being thin. Uh and there are actually websites where they talk about the value of eating disorders and uh anorexia or vomiting or bulimia, where you end up eating, uh gorging yourself with food and then inducing vomiting. So uh social media, I'm afraid, is and and chatbots and AI is going to lead to a whole new generation of uh traumatic experiences that we need to pay attention to uh and not ignore. Um the good news of with all of this is that we've become pretty sophisticated and and we're no longer as rigid in in viewing trauma as a block or wide experience, but instead of uh as a spectrum. And uh hoping that uh individuals will who are listening to the podcast will think back in in their lives and think about whether or not they've had been exposed to significant trauma. And if they have, it's important to reach out for help and and get some help in that.

SPEAKER_00 26:55

Well, I think this was really uh I'd like to think of our talk today on trauma as a first step. Uh I think there's a lot more we can say on it, and both in terms of the types of traumas that can affect people and maybe get more into the different uh methods that we have uh so that people can really feel more comfortable with dealing with whatever traumas they might have and and to feel like they don't need to bury it, they don't need to hide it, there's no shame involved. It's just part of the human experience. And um just like good things, there are bad things. And uh if we can try to help people who have gone through some of the bad things, I think people will lead happier, healthier lives. So I'm Dr. Angela Rosen, psychologist. And I'm Dr.

SPEAKER_01 27:42

David Gross, psychiatrist, and we are at Two Shrinks in a Mike. Thank you for being here.

SPEAKER_00 27:46

Bye bye. The Two Shrinks in a Mike podcast is for informational and entertainment purposes only. The views expressed are those of the hosts and guests and do not constitute medical, legal, or professional advice.