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The cost & courage of caring - stories that spark resilience.
Welcome back to the Caregiver's
Podcast, everyone.
I'm your host, Dr.
Mark Ropaleski, and you can call
me Dr.
Mark.
When PTSD hits home, your response
can make it worse, even if you're
trying to help.
Dr.
Shaley Jane, psychiatrist and
clinical professor of psychiatry
at Stanford University,
is going to give caregivers a
playbook today for the first 30
seconds.
The language that de-escalates and
the boundaries that protect you
too.
Dr.
Jane, welcome to the Caregiver's
Podcast.
We're so happy you're here with us
today.
Dr.
Shaley Jane, welcome to the
Caregiver's Podcast.
We're so happy you're here.
Let's jump right in.
So in the first 30 seconds, when a
person you're caring for who has
PTSD and is starting to get
triggered and that starts taking
over, what should you prioritize
to de-escalate for their nervous
system?
So in those first 30 seconds, the
most important thing is to
regulate yourself first.
So lowering your voice, slowing
your breathing, reducing words,
decreasing stimulation in the
environment, and just offering
orienting cues.
So you're here, you're safe, I'm
right here.
You know, phrases, short,
succinct, that just ground on the
person who's been triggered in the
moment.
And, you know, things that aren't
so helpful is, you know, using
logic, arguing facts, asking for
explanations.
Touching without consent might not
be a good idea either when
somebody's been triggered.
Phrases like calm down are not
particularly helpful.
So regulating yourself is the most
important thing
you can do, I think.
I imagine that takes some
practice.
Absolutely.
I think you've got to start by
recognizing when you yourself are
dysregulated
and start recognizing your own
responses.
You know, it's very natural when
you're observing
someone who's triggered.
It's really natural, obviously,
for your own fight or flight to
kick
in and for your own reactions of
fear and anger and anxiety to go
up.
So I think just learning
how to regulate yourself, you
know, pattern recognition from how
you might have responded
in the past and how to correct
that.
But you're right, it is a
practice.
It's absolutely a practice.
So what's the most common thing
that a caregiver does in a moment
like that that might be well
intended, but that actually
results in escalation of the
moment as opposed to de-escalation
of the
I think maybe overstepping, maybe
trying to fix things, maybe trying
to, you know, use logic
or offer some kind of explanation
or insight.
I think that's a common mistake.
And I feel like,
you know, focusing on safety
first, lowering the threat level,
de-escalation, creating a calm
environment, a quiet environment,
that's a much better approach.
I hear you loud and clear.
We're so inclined to want to fix
it in the moment, but perhaps that
might
be the biggest sort of kicker off
of a process that might result in
more harm.
So in that triggered
state when it happens, what's the
person with PTSD actually not
capable of hearing or not capable
of
processing or doing, you know,
even if they want to or in that
moment, what do we need to
understand?
So essentially in the PTSD brain,
especially when someone living
with PTSD is triggered,
they have, I mean, I think best
analogy is kind of like having a
hypersensitive alarm system.
You know,
if you have like a house alarm or
a fire alarm and it just gets
triggered a little too easily,
you know, so that region, you
know, that, that brain, the area
of our brain that detects threat
in
particular, the amygdala that
detects danger that is easily
triggered.
A lot of times people with PTSD,
they see danger where danger does
not exist.
Stress hormones flood their body,
their heart rate increases,
their muscles tighten, and the
thinking part of the brain, you
know, the frontal lobe, it goes
kind of
partially offline.
So bearing that in mind, um, what
is hard for them to do is process
complicated
instructions, uh, uh, use a lot of
logic.
Um, you know, um, they're not able
to have perspective,
right?
You know, uh, when you're not
triggered, one of the, the most
common rationalizations human
beings is we, we try and use
perspective, right?
It could be worse.
It's not that bad.
When someone's
triggered just the very nature of
what's going on in their brain,
uh, in their, um, uh,
neurologically
and chemically, they're not able
to, um, take perspective.
They're not able to listen in a
sophisticated manner.
So you can't debate somebody out
of a body state, you know, and,
um, you know,
that's just something I always try
and bear in mind, especially in my
own clinical work when you're
dealing with people who have been
triggered or traumatized.
So what I'm hearing here is an
important
sort of conversation between the
frontal lobes or the prefrontal
cortex and the amygdala.
And
that's sort of a very important,
um, interplay.
Can we maybe review that a little
bit for our
listeners?
Cause not everyone may be familiar
with it, but can you just start by
telling us
about the amygdala and then its
actual relationship with the
prefrontal cortex and where things
go
awry?
Yeah.
So like I say, amygdala is kind of
where those big emotions are
processed,
anger, fear, um, you know, where
you detect, um, threats.
It's a very kind of, you know.
So it's an ancient part of the
brain.
Ancient part of the brain.
And we need it, right?
If you,
if you, you, you need it to be
aware of your, uh, have situation
on awareness, to be able to track
your environment.
It's, it's vital, but imagine if
it was overacting, right?
It overly active.
Imagine if
it was, um, you know, uh, like I
said, seeing danger where danger
doesn't exist, missing or putting
signals around.
And there is that complex
relationship between the frontal
lobe of the brain.
The frontal
lobe of the brain is where we kind
of use judgment, where we plan,
where we execute that kind of
thinking,
planning part of the brain.
And there is that relationship
that when the primitive part of
the
brain takes over, the frontal lobe
takes a backseat.
So again, behaving logically,
behaving rationally,
planning, execution, that takes a
backseat when the amygdala takes
over.
So that's the ultimate
dilemma with people who have PTSD,
that the amygdala is kind of front
and center.
And when that gets
triggered, it sets up a whole
cascade of, of reactions in the
brain, which impact the body,
which, like I said, like flooding
the body with noradrenaline,
adrenaline, all of that classic
fight or flight response.
And that's really what people who
are living with untreated PTSD are
dealing
with on a day-to-day basis because
they don't know what is triggering
them.
They just are triggered,
you know?
And so they are living in that
kind of fight or flight response.
And, um, the thinking,
planning part of the brain, the
frontal lobe is just, um, not
getting its due.
Um, and the amygdala
response is really what's
predominant.
Are individuals who suffer from
PTSD prone from earlier life
experiences to have that
disconnect
of communication between the
amygdala and the frontal cortex?
Or is that actually something
that's primed
an, uh, an event associated with
that actual traumatic event?
So PTSD is a highly heritable
condition, you know?
So, uh, I mean, it's a little bit
of a,
uh, maybe it's hard to imagine
this because the very nature of
that phrase, PTSD, post-traumatic
stress, it implies that you're
perfectly fine and then you have a
traumatic event and then you're
not
fine.
But actually it's a very heritable
condition.
About a third of people have this
predisposition,
this vulnerability that after
they're exposed to a traumatic
event during the course of their
life,
their body and their brain will
react in a way that is more
predisposed to them developing
PTSD.
Whereas another person who doesn't
have that heritability could go
through the same traumatic
event and not have that response.
So I do think there is a genetic
component in the way that we are
wired in our neuroanatomy that
makes some people vulnerable.
But to your point, early adversity
or
early trauma totally sets people
up for developing full-blown two
people.
So childhood trauma and those kind
of events.
Absolutely.
Because to me, it's that analogy.
It's a straw that broke the
camel's back, right?
Somebody could be exposed to
trauma at five, six different
times earlier on in their life and
they could respond perfectly fine
and they could recover and heal as
the vast majority of human
beings do.
We are definitely wired for
resiliency.
But then you just need that last
event and then
that's it.
You know, you just, the straw that
broke the camel's back and then
you have a full-blown PTSD
response that is no doubt
influenced by what came earlier,
you know, even if it didn't show
itself then.
Okay.
So if I understand correctly, for
someone who does not understand
PTSD, what's actually happening in
the brain and body when that
triggering occurs to the point
that even being in your own home
with the person you love who might
be your caregiver, none of that
feels safe anymore?
Is there a point of no return?
Or is it just the sum effect of
all of those sensations?
I think it would depend on the
degree to which you're being
triggered.
There's definitely like a
gradient, you know?
So let me give an example.
Let's say if you're somebody who
when you were young, you survived
a deadly house fire, right?
And you were very young and you
kind of got on with your life and
everything was okay.
And then now you live in
California and every year there's
a wildfire season.
It could be on a good day, just
the smell of smoke in the air,
even if you are not living in a
community that has been directly
impacted, even if you're like a
hundred miles away from a fire
that's burning, just the smell of
smoke in the air will just kind of
have you feeling sad, on edge,
jumpy, irritable.
So that's kind of one extreme.
And then when you're fully
triggered, you know, maybe if you
are closer to the fire or if you
see some footage or, you know,
online or if, you know, somehow
you're triggered in a way that
you're fully triggered and you're
having a full-blown triggering
event,
that's when you're almost
disconnected from your
environment, the present
environment you're in, whether
you're in your home, whether
you're with your family, you're
actually not there anymore.
You're kind of taken to the past.
That's the way I like to see it.
And then the past becomes more
important than the present.
And that's when you have a full
body triggering response, kind of
like what we've talked about with
the amygdala takes over.
Part of that triggering response
might involve a full-blown
flashback where there might be a
level of dissociation.
You know, and then where you are
really doesn't matter.
And if people around you can
ground you in the present and get
you back to the present, that can
be incredibly helpful.
So I would say there's a spectrum
of response to trauma and being
triggered.
And I think the key is for someone
who's living with PTSD, what helps
you go from being untreated to
treating is just much more
awareness of what is triggering
you.
So you can be one step ahead of
it.
So it doesn't get to that point
where you are totally disconnected
from your presence because that's
very hard to come back from.
And that's what you refer to in
your book about the explicit and
the implicit sort of triggers of
those exacerbations.
Yes, absolutely.
And I think making the implicit
more explicit, that's the work of
treatment so that you can be back
in charge and recognize those
triggers.
And what I find really cool as a
clinician to see when someone has
gotten treatment or is treated is
they can almost predict.
They're like, OK, so Sunday we're
going to this big concert.
And I know that seeing all these
people or being in an environment
where I don't have an exit track,
this is going to be upsetting for
me and this is what I'm going to
do to take into account.
So then again, putting that
planning part of your brain in the
front seat because you have that
knowledge now of what's triggering
for you.
So you can go about your life and
live your life.
That is the work of treatment and
that's what I feel like is so
empowering about getting treatment
for PTSD.
That word empowering is just
monumental.
To hear that individuals can
achieve that level of foresight
and control and be able to go back
to enjoying outings is tremendous.
So as a caregiver now, from that
lens, over months and years of
caregiving for someone with PTSD,
what can actually happen to a
caregiver's nervous system when
they're always scanning or sort of
anticipating or having to adjust
their tone or trying to prevent or
trigger themselves in someone
else's PTSD episode?
Do caregivers' brains get rewired
too?
Oh, absolutely.
I mean, your worst case scenario,
if you have years and months,
which unfortunately happens all
the time,
you know, months and years of
living with someone, loving
someone with PTSD.
And if you spend that, the best
phrase I have to describe it is
like walking on eggshells, right?
Because you're tiptoeing around
your loved one's moods, anger,
inflexibility, avoidance.
That is one of the worst scenarios
I think you can be in because it's
the worst scenario is when you
develop vicarious trauma,
when you become traumatized
yourself by loving someone.
On the other extreme, obviously,
minor discomfort, anxiety, stress
would probably be the other
extreme.
But yeah, it is not easy to love
someone who's living with PTSD.
Let's be clear about that.
To support someone and love
someone with PTSD is, you know,
it's a tremendous effort.
What I do like, though, what I'm
seeing now, Mark, which I think is
really, really hopeful is,
I do think there was a generation
and a time when it was just kind
of expected that people go above
and beyond.
And that was just their lot in
life when they love someone with
PTSD and they had to put up with a
lot
to the point where they made
themselves unwell.
I do think that's changing.
I do think we have a new
vernacular, a new language and a
new approach driven by science,
driven by what we know about the
science of PTSD that is really
empowering loved ones to navigate
that relationship in a much more
healthy way.
Well, and that parallels a lot of
changes in our society and, you
know, that individuals,
you know, we, I think more often
than not in those cases for
historically, at least it was
women who are caregiving
to a man with PTSD and their
voices are certainly louder than
ever before and want to be heard.
Can you tell me a little bit more
about the science of that, how
that new voice and conversation
is translating into benefits for
the caregiver?
Yeah, well, what I loved was there
was some randomized controlled
trials done by some amazing
Canadian researchers
who specifically did couples work,
right, in PTSD.
And what we saw was that the aim
of the game, I mean, I'll kind of
reduce it to a quick sentence,
but the aim of the game should be
that a couple or a dyad should
learn to cope with the symptoms
together.
You know, in an empowering,
healthy way, this walking on
eggshells, tiptoeing around or
letting
PTSD set the agenda for the
household, that is incredibly
unhealthy and that contributes to
what we have seen, certainly in
the veteran population, where
divorce rates are really high
with people with PTSD, with
comorbid substance abuse, intimate
partner violence can be really
high too, you know, that really
set the tone.
It was a JAMA article that was
published several years ago now,
but I think that set the tone
for what was happening in clinical
practice.
We're, you know, like you said,
very, very good point.
A lot of times it was women who
were put in that role and we tend
to expect that women go above and
beyond in caregiver roles.
We tend to just assume that that's
what they're there born to do and
that being in this kind of
sacrificing position is, you know,
makes them really happy and that's
what they want to do.
But of course, that's not right at
all.
People who are overburdened
caregivers do not take care of
themselves and nothing good comes
of not taking care of yourself.
So I think that was what the
thrust of the science was that
couples or if you love someone
with PTSD,
no matter what your relationship
is, you have to learn to cope with
the symptoms together.
So for example, textbook example
that comes to mind all the time,
people who live with PTSD,
a lot of times, depending on the
nature of the trauma, they will
avoid stuff.
They don't want to go to the mall.
They don't want to go out to big
party events.
They don't want to go to big, you
know, like graduations or
celebrations.
Generally, they're hypervigilant.
They're not comfortable in crowds.
So what starts to happen is the
home becomes organized around
preventing triggers.
So everybody's life becomes
constricted and narrow.
And that's like the most tragic,
sad thing.
Imagine not just a spouse, but
kids.
Everyone's living their life in
this narrow, constricted way just
so that
the person with PTSD doesn't get
triggered.
So coping with the symptoms
together in a healthy way.
So again, we have this event
coming up.
It's a family event.
We are all going to show up.
How are we going to do this?
Right?
More changing the narrative, you
know?
So one person isn't overburdened
and overly responsible for another
person's symptoms.
He said the word we, and I think
that really resonates because it's
not about
what each individual is going to
do for themselves,
but there's that relational aspect
that it's actually putting the
relationship first.
And how are we going to allow this
relationship to thrive with our
mutual conversation
and both people's input into how
it's going to move forward.
So I think that's wonderful.
So getting back to that trauma
lens, though, there's that sort
of, when a caregiver is facing
that constant anticipation, what
does that do to their attention
span, to their sleep,
to their own caregiver's body
stress response?
I mean, can you get almost like a
secondary PTSD from caregiving?
Yeah, absolutely.
We call it vicarious
traumatization, you know,
because...
Vicarious traumatization.
You know, hurt people, hurt
people, right?
And the reality is, is sometimes
people living with PTSD can
themselves use words or behave in
ways
that are traumatizing to other
people.
Again, no one's doing this
intentionally.
It's just part of the pathology of
the condition.
It's infectious.
Trauma is infectious, right?
So it can totally infiltrate into
a caregiver's life through this
vicarious traumatization.
So you can develop, you know,
low-grade symptoms of PTSD,
depending on what it is that you
are
exposed to.
You can develop low-grade symptoms
of PTSD yourself, just like we
said before, you can be triggered.
You can have destructive sleep.
You can start to have nightmares.
And then if you combine that with
not taking care of yourself in the
way that we know everyone
should be by getting adequate
sleep, by having healthy
nutrition, by exercising
regularly,
when you, you know, when you go
full on into that caregiver role,
I think that combination
can be really potentially very
problematic.
And, you know, we learn so much
these days about the importance of
setting boundaries, but
I could see in that dynamic where
if the caregiver tried to really
reinforce boundaries, it may not
actually work very well.
Do you agree?
Oh, totally.
But I think it depends.
It depends on many, many factors.
Like I said, part of what was
encouraging to me is I've
definitely seen in this era of
social
media, a new vernacular emerge
that has become widely available
to people from all walks of
life.
Just that word boundaries, right?
Like, I don't know when you or I
were growing up, I'm not sure that
was a word that was known
what it is, but I think nowadays
pretty much everybody knows what
that word means.
And it just gives you agency to
know that you can be your own
person and you can say yes
and no to what feels right or
wrong to you.
So I think that's a very important
concept.
I think what we need to pay
attention to is what are
caregivers coming into the dynamic
with, right?
You know, as physicians, you know,
what makes people sign up to be a
doctor, right?
You know, there might be some
obvious reasons, but I think a lot
of us, certainly in my experience,
the best doctors I've met
throughout my career, which is
like a 25 year career, they were
caregivers
well before they got their medical
diploma.
In some way or another, right?
Right.
So I think it's important to be
curious about the caregiver.
What's their background?
Who were they caregiving for
before they ended up in this
scenario?
What's their trauma exposure
history?
And that, because that I think
explains a lot of the dynamic in
that dyad.
Whereas let's say if you had
somebody who didn't grow up being
a caregiver, who didn't grow up
being a fixer, who didn't have a
large part of their identity tied
up in being a health healer
and making people better.
Maybe they're naturally going to
have more boundaries going into
it.
And then having boundaries sets
the tone for the relationship.
I think what's really hard is if
people have been in a relationship
for years, maybe decades,
and then the caregiver starts to
change their reaction and
responses, that's when it's really
difficult.
But I think if early on, there's a
language that kind of sets healthy
boundaries about what
can be done and what can't be
done, that can be really, really
helpful, I think, in the
overall trajectory of that
caregiving relationship.
So, as you can probably tell, it's
really complicated and nuanced.
Everybody is bringing their own.
We're all individuals, right?
Yeah.
People are infinitely complex,
right?
Human beings are infinitely
complex.
So, but yeah, but I got to
emphasize, though, there is a
societal context that really plays
a role.
Like I said, I think what was
acceptable 20, 30, 40 years ago is
not acceptable now.
And it's because as a society, we
have said it's not acceptable.
And I think that really helps an
individual caregiver set healthier
limits and boundaries about what
they're willing to accept and what
is not acceptable in that
relationship.
There's so much potential for
prevention in terms of even
preventive mental health care.
God only knows we have trouble
accessing it when illness is set
in.
But that whole notion of
preparation for caregiving and all
of its facets, there's so much we
can
learn about ourselves and the role
we're about to assume by some very
sort of didactic thinking
about what do I bring to the
relationship as I embark on this
journey of caregiving.
Right, right, which is why it's so
important, as you know, for
caregivers to have their own
support system
for exactly that reason.
So what is the quiet thing that a
partner's PTSD just quietly steals
from a caregiver?
Even in a relationship where
there's love and nobody's really
trying to hurt anyone.
But what's that, what's taken away
subtly?
I think predictability is taken
away, you know, because of the
chaos associated with PTSD.
So I think predictability, rhythm,
peace, all those things that you
need to thrive and enjoy
life, right?
I mean, what should life be about?
Like I always tell my patients,
life isn't just about surviving.
You want to be thriving, right?
And so PTSD definitely steals that
predictability, the day-to-day
kind of rhythm, the day-to-day
safety that is necessary for
creativity to flourish, for people
to flourish.
Homes become organized around
preventing triggers instead of
living.
And it's actually amazing how
subtly that can happen over time
in subtle ways.
So again, avoidance is a core
feature of PTSD.
It's actually one of the symptom
clusters.
If you look at the DSM-5 diagnosis
of PTSD and that avoidance of
living life to the full,
that can spread.
People's plans shrink, their
ambitions shrink.
All they're doing is looking
around for threat.
Like I said, that classic walking
on eggshells.
And I definitely think in this era
of digital online social media,
where it's very easy for
people to live in their own echo
chambers and to find exactly their
version of what they're
their perception is of what the
world is, that can become really
intense really, really fast.
And not just for the caregiver,
for anybody else who's in that
home, particularly children.
We count on certain anchors that
allow us to just stabilize or
things that are predictable,
that with the flurry of inputs
that life gives us today, we know
are there, that we can just
sort of assign and categorize
different things to deal with now
and later.
But when none of those can
predictably exist, I can see where
the household just sort of becomes
on edge.
When you're doing that arranging
of your life around the person
with PTSD so they don't get
triggered, how do you know
anymore?
Like what actually supports
healing versus what just keeps
reinforcing the PTSD?
Do we lose track of that?
Well, again, it depends.
If you've been doing it for years
and years and years, it's like any
other practice, you
may not be able to see the wood
from the trees.
But I think certain patterns show
that even if it's well intended,
you may have made some
missteps.
So over-accommodation, right?
We all want to be accommodating
with the people that we love, but
there's a subtle line between
accommodation and
over-accommodation, you know?
And in my mind, here's how I know
when I'm over-accommodating, when
it's coming at the
expense of my own self-care, when
I am losing oxygen because someone
else is sucking up a
little bit too much.
So over-accommodation, canceling
everything, avoiding every
stressor, shielding the loved
one from life.
I think that's a sign that you
have over-stepped.
It feels like love, but really
it's reinforcing the PTSD mindset
that there's danger everywhere.
That's a pathological mindset.
It's the nature of PTSD.
It's the hyper-vigilance of PTSD.
So if you over-accommodate, you're
reinforcing that.
Inadvertently, of course, no one
is doing this on purpose, but
that's what happens.
So what should replace it?
Gradual, supported engagement with
the world.
Like I said, we are going to go to
that family event.
If you want to go for half the
time, but I'm going to stay the
whole time, that's up to
you.
But we're going, we're showing up
as a family together.
We can go early on before all the
other guests are there, but we are
going small exposures,
shared confidence, sending out a
message that we can handle this
together.
That might be a healthier approach
as opposed to the
over-accommodation that I talked
about
earlier.
So what would be the first thing
that a caregiver could
realistically anticipate as a
positive
outcome in that direction to
eventually being able to go out as
a family and participate as
a couple in the outside world?
Like what are the first signs that
you're heading in the right
direction?
I think less chaos, right?
Less triggering.
So let's say you make that, you
know, you go to that family party
and you've decided beforehand
that, you know, you're all going
to show up together, exit strategy
available for the person
who's acutely suffering, but
you're going to enjoy that time
because you need that time.
And I think if it goes according
to plan, so a predictable tone, a
predictable routine,
I think that's success.
Because what is PTSD?
PTSD is chaos, right?
It's arguments.
It's family events gone wrong.
It's plans that have, you know,
just fallen apart.
So I think predictability, tone
and routine, you know, vocalizing
what the boundaries are.
So for example, in this case, the
boundary might be, I am staying
because I want to spend
time with my family.
If you choose to go home early,
that's totally fine.
And then being able to, having had
that happen and not have that be
overridden and everybody
ends up going home early.
And then, you know, I think that
kind of communication about
emotional validation, like
checking in
with people, where are you at?
And that can be bi-directional, by
the way.
It doesn't just have to be the
caregiver.
It can be the person with PTSD
checking in with that person too.
But I think to me, when things are
going right, it's when there's
less chaos and there's more
predictability and there's more
peace.
And it might not be perfect.
It might be messy.
And I think messy is okay.
But I think when there's less
chaos, you're, you're, you're
going in the right direction.
And the other thing I tell people
is, is, you know, improvement
isn't linear, right?
You might have a couple steps
back, but as long as overall your
trajectory is heading in a
positive
direction, you have to celebrate
those small wins.
Celebrate and be patient.
Yeah.
I could see where it would really
get murky if at the first sign of
discomfort and one
individual needed to leave, that
the other individual just packs up
and leaves with them.
Like that could really just
reinforce the behavior.
And I really like how you sort of
spoke of the fact, well, here's
our out strategy, but
I'm going to stay back because I
haven't seen our friends in a long
time.
And it's okay that you've had
enough and you need to leave, but
I'm going to stay.
And I could see how healthy that
can be for the caregiver in so
many circumstances.
Absolutely.
And also think about it.
PTSD isolates people.
And when the caregiver becomes
isolated too, I mean, there's only
so many events that you're
going to get invited to.
And if, if, if you're leaving
prematurely or not showing up for
the people, you're going
to stop getting invitations.
That is a reality of life.
Your own social network is going
to shrink.
So this is actually vital, right?
That you are also tapping into
your own social networks and
keeping those alive because social
support is one of the biggest
predictors of how people heal from
trauma.
Having an intact social support
network is absolutely vital.
So I think there are on so many
levels, that's why that is
important, you know, to have that
clear expectation that I
understand this might not be your
cup of tea right now, but it's
really
important for me.
So how do we figure this out?
It's a really important
conversation.
You know, it's, something struck
me before that, I mean, I, I know
that after the initial
traumatic event, we all process
and have to do some acute
processing.
But it's then in the secondary and
tertiary phases where some of the
real PTSD can set
in.
But when we get to that point
where the caregiver is very
enmeshed in that sequence of
caring,
I know that for patients with
PTSD, they benefit from cognitive
behavioral therapy.
But what I was hearing from what
you were telling me is that
caregivers probably need to be
cognitively
accountable also.
And they might actually benefit
from some cognitive reframing and
eliminating some thinking
errors and other things if they're
going to be able to show up not
only for the person
they're taking care of, but for
themselves.
And cognitive traps could really
alienate them from, from achieving
that balance.
I would say that if you are going
to be in a long-term relationship
with someone who's living
with PTSD, who still has untreated
PTSD, I think having your own
support network, whether
it's informal, like peer support,
or maybe through other people who
are going through a similar
thing, or whether it's formal
support, formal mental health
treatment support with a qualified
therapist, that's almost vital.
So I think it's really murky
territory to try and figure all
that out yourself in real
time.
You know?
So complex.
Yeah.
Like you say, I think you could
get in too deep without even
realizing it.
And then it's just really hard to
get out.
So I would encourage anybody who
is going to embark on that to make
sure they are getting
their own help.
And then speaking to what you were
saying about lack of access to
mental health resources and
stuff, the good news is, is
nowadays there's some excellent
resources just available online.
Sometimes I think people just need
a bit of education and they need
some phrases and they
need a way of, of naming these
things.
You know, I'm a really big
believer in that phrase, name it
to tame it.
Sometimes just, just being able to
describe what you're feeling and
know that other people
feel the same and there's a name
for it can do so much to empower
you to take care of yourself.
So I think there's plenty out
there, but, um, absolutely you
need your own resources to
be able to embark on that
relationship and not get pulled
in.
You know, um, you don't want to
get to that point where you've
crossed into control and where
your anxiety is driving decisions.
And then that's not a
collaborative relationship.
Um, you're not partnering there.
You've, you've got into this
situation where the relationship
has been controlling in an
unhealthy
way.
I, um, could think that you get to
that point as a caregiver where
you're monitoring everything,
you're hypervigilant, you're
trying to help, but you're
actually just almost becoming the,
the police or the man at like the,
the, the managerial, um, driver of
everything in the
environment, uh, trying to just
manage the relationship individual
with PTSD.
Where can that actually really
start making things worse?
Like, can you, is there a, is
there a point where it can just
explode?
Well, I, I think it can definitely
end up in resentment, right?
Resentment is not good.
Resentment leads to bitterness.
It relates, it leads to
relationship breakdown.
It leads to all sorts of unhealthy
mental health outcomes.
So I think resentment is a bad,
it's a red, red flag sign, right?
Absolutely.
Infantilization is another one,
right?
Where, where you literally start,
caregiving becomes the
predominant, you know, role.
This isn't a relationship between
two human beings anymore.
It's, it's literally, you are the
consummate caregiver.
And so then that leads to a loss
of the intimacy and the other
things that you might have been
getting out of the relationship.
Um, and then I think when you get
to controlling, it really erodes
the trust bi-directionally as
well.
So there's a lot of things that
can come undone, um, you know,
when you're in it too, too much.
And, and that's speaking to what I
was saying before, like I said, we
have documented divorce rates in
people who live with PTSD.
It's really, really high compared
to the general population.
So I think relationship breakdown
is almost inevitable in some
fashion, if we're not paying
attention to these early warning
signs.
Sure.
We're going to take a break,
folks.
We'll be right back.
Fred and Graham, any questions
from the production team?
You know, we've been talking about
different triggers.
Like you use the example of the
forest fire and smelling the smoke
and that taking someone out of the
present moment.
Um, so just curious, like what
happens if the primary caregiver,
and a lot of people are relying on
just one person.
What happens if the primary
caregiver was present or involved
in the original trauma event?
So that, you know, you're looking
at this person that is trying to
look after you, but they continue,
just their presence can bring you
back to the moment where the, you
know, sort of the PS, uh, PTSD was
originally formed, if that makes
sense.
They're part of that memory.
You mean they're part of that
traumatic memory?
Right.
Yeah.
Yeah.
So it's really messy because I
think a lot of it depends on the
survivor's cognitive
interpretation of that person's in
the memory, in that moment.
Right.
So, so let's say you walk, you're
a couple and you're walking down
the street and you get violently
attacked and mugged.
And, um, if in that traumatic
incident, the person who was most
traumatized perceived their
partner as being unhelpful or
abandoning them or did not show up
for them the way they expected.
Obviously that's going to be
interpreted in a totally different
way than if they were the heroic
savior and, you know, were pivotal
in them, you know, getting to
survive the event.
But these are really complicated
things, right?
Because there's a lot of guilt
around this.
There's a lot of pent up anger.
I mean, it really needs to be
processed.
And, and I don't believe it can be
processed.
People can't process this just for
themselves.
They need a qualified mental
health professional to really
break this down because you, you
might not be totally aware that
you're walking around without all
that resentment.
You know, so then when you get
triggered, that's why you're so
angry with your partner, but you
don't quite understand why you're
angry, but it's because you have
this cognitive distortion from the
past that, oh, that my partner
should have helped me there.
Whereas the reality is, is when
you get randomly assaulted on the
street, you know, everyone is
going to have all sorts of
reactions.
And so there needs to be a very
intentional process of what went
on and some healing from that.
I mean, I think any one of us
could react in suboptimal ways
faced with a traumatic situation.
You want to have the opportunity
to be able to make amends for that
or express your regret over that
and then to move on from that.
But if it continues to go
unchecked, then it's going to show
up in any subsequent trigger
responses.
And it's almost like a, it just
gets worse and worse.
I mean, you could see how this
could, you know, build up into
something built on a foundation of
unrealistic expectation, you know?
So, so like I say, I don't think
this is something people can
figure out by themselves.
They need a qualified mental
health professional to help direct
them through it.
Just another question.
One of the words that you
referenced recently on your social
media content was this word,
kinkeeping.
And when I heard your explanation
for that, I immediately started
thinking about how this sort of
defines the classic caregiver.
Could you explain to us what
kinkeeping means and how that sort
of might apply to caregiving?
Yes, so kinkeeping is that
classical, classic work.
It's a lot of invisible work,
which historically, let's face it,
has been done throughout the
centuries, mostly by women.
And I would argue as a social
psychiatrist that the very reason
it's been done mostly by women is
why it's totally unvalued and it's
invisible work.
But it is the work of keeping
communities and families glued
together.
So the gentle nudges, the
reminders for communication,
checking in with people who've
just had a surgery, bringing
people together to celebrate good
times, bringing people together to
celebrate holidays, organizing,
creating opportunities for
literally kinship, right?
This is such a vital activity,
kinkeeping.
It really makes me very sad and
frustrated how ignored it has been
throughout the centuries.
And I think we are living in a
time when kinkeeping is under
attack.
Because basically what's happened
is, is women have had access to a
lot more opportunities, a lot more
education.
A lot of women have just decided,
I'm not doing this anymore,
because it's thankless work.
And guess what we have now?
We are living in a loneliness
epidemic, right?
And loneliness is having a massive
toll on the mental health and the
physical health of populations,
especially as they age.
So to me, you know, kinkeeping is
that act of love and caregiving.
And it is a vital activity, but
until as a society we give it a
name and we honor it, and usually
in the world we live in, the way
you honor it is it's not unpaid
labor, right?
But, I mean, I think it's always
probably going to be unpaid labor,
but we need to honor the people
who are doing that work, just the
way we need to honor caregivers.
Then I think it gets the status
that it deserves.
So when people do that work, it's
appreciated more, it's respected
more, you understand how it's
enhancing your life more.
And then I think the person who's
doing it has more longevity in
that role.
You know, they don't burn out.
I'm a big fan of distributing
kinkeeping more, making sure
everybody's doing their bit,
raising our children so they
recognize the value of it.
You know, raising our boys the
same way we raise our girls so
that everybody's doing their bit.
I think it makes for a much
healthier society.
I think it will lead to a lot less
mental health conditions.
But I think that's how it
basically ties into caregiving,
the same way caregiving is
unacknowledged, unpaid, you know,
increasingly complex in this day
and age too, right?
I think it's the same for
kinkeeping.
So I hope that answered your
question.
You got me started on a topic
that's very close.
That's really cool.
And, you know, it's interesting is
that we're naming kinkeeping.
What we need to do is as perhaps
the family, but even on the
grander scheme, the community or
society, is name the value of
kinkeeping.
Not just naming the act of it, but
really digging deep and naming the
rich value that comes from
kinkeeping.
Which is historically, it hasn't
had that value.
And again, I think that's tied in
with who was doing the work.
But let's name it.
It's really valuable work.
Let's make this invisible labor
visible so we can see what it's
doing as this very therapeutic
glue that ties us all together,
you know?
So, yeah.
You mentioned it's gendered, which
is interesting.
But just beyond sort of having
majority women in these roles,
it's interesting to see who in the
family gets, if there's multiple,
say, daughters in the family, it's
interesting to see which one of
those people gets slotted into
that role and how that sort of
comes together.
Because there's all kinds of
dynamics, obviously, that are
involved in that.
But there's one person that sort
of always gets sort of the worst
job if you're looking at it as a
negative.
Well, yeah, and I think what's sad
about kinkeeping is it's actually
a great job, right?
It's when people don't appreciate
it that it starts to become, you
know, it's the same with
caregiving.
As you know, there is a robust
literature that shows when people
are caregiving, it's really good
for them, too.
It can be really good and
rewarding for them, too.
But when does it start to become
rewarding?
When does it start to become
associated with burnout and mental
health conditions?
A lot of time, when A, the burden
is too much, or B, they're not
appreciated.
They're not getting anything out
of it.
And actually, their vulnerability
is actually exposing them to being
mistreated.
That's when it's a problem, you
know.
And definitely when we live in a
culture and a society where
everyone is wearing a lot of
different hats and there's a lot
of competing demands on our time.
You know, I think in more
traditional societies and
traditional cultures, you know,
the eldest daughter took over the
kinkeeping.
But there was time for her to do
that because that was a job, if
you would like.
But clearly, when living in a
world which that is more rare and
rare and, you know, it could just
be people are rejecting those
roles because it doesn't really
fit in with who they are
intrinsically as people.
So many reasons.
But you're right.
I think the crux is why don't we
just name it that it's really,
really valuable.
And anybody in your life who is a
kingkeeper, you know, you need to
be telling them, showing them how
much you appreciate what they're
doing.
We all have a role to play.
I think that segues nicely into
the next phase.
So welcome back, everybody, from
the break.
We're here with Dr.
Shailie Jain, professor of
psychiatry at Stanford.
Dr.
Jain, when the person you're
caring for is shut down and
defensive after a moment where
their PTSD gets activated,
what's the cleanest way you can
actually ask for a conversation
with them?
To re-engage with them without
actually triggering shame or
resentment.
You know, you have to be feeling
okay too, right?
So if something very unpleasant
went down, if you were part of
something that was very hard, when
you're ready, just anything that
lowers the defensiveness.
So a phrase might be, is this a
good time for us to talk about
something that was hard for both
of us?
Like, you know, I'm not here to
blame you.
I just want us to feel safe
together, right?
Some phrases like that.
And again, re-emphasizing what I
was talking about, the Canadian
research on the couples therapy,
coping together, not avoiding
together, right?
So those might be some phrases,
anything that lowers
defensiveness, I think, is a good
way to start.
Is there, in that conversation, is
there one line that actually
communicates safety to the PTSD
patient, respecting, you know,
their traumatized nervous system,
as opposed to one line that might
accidentally communicate that
you're still an ongoing threat?
So things like, you know, help me
understand what that felt like, or
I can see that your body went into
threat.
So validating, I can see that you
were not yourself in that moment,
right?
There's an excuse.
I want to understand you.
You know, we're on the same team.
Just, you know, anything that
reduces defensiveness, helps them
be seen, speaks to the complexity
of what is going on.
What you want to avoid is things
like, you're overreacting, or
we've already talked about this.
Those type of statements just
generally, they're just not
helpful.
I think you've got to start with
the assumption, people aren't
doing this on purpose, right?
They're not doing this
intentionally.
No, no one would want to, right?
Yeah.
It's kind of beyond their control,
right?
To a certain degree.
So I think, you know, avoiding
statements that would shut them
down, that feel judgmental, that
induce the shame, and then using
those phrases that open things up.
We're in this together.
You know, speak to me.
What happened?
Open-ended questions.
Are the reactions in those moments
by individuals with PTSD kind of
protean and sort of, I won't say
cookie cutter, but are they kind
of fixed in their spans and in
their experiential moment, or do
they evolve over time too?
And does the caregiver actually
need to, through that
conversation, keep learning about
what their loved one's going
through and how the experience
changes from time to time?
Or is it pretty fixed, and once
you have an understanding of it,
you're good to go?
Like I said before, in my
experience of being a psychiatrist
and a doctor for over 25 years,
human beings are infinitely
complex.
I don't think anything is pretty
fixed.
I think it's dynamic.
It's moving all the time.
We're living in this world.
We are constantly being influenced
by our environment.
And then, if you bear in mind the
high rate of comorbidity with
PTSD, so PTSD goes hand-in-hand
with depression, it goes
hand-in-hand with anxiety
disorders, it goes hand-in-hand
with substance abuse.
So then, when you bring in all
those variables that might be
contributing to any given picture
on any given day, this is
complicated, hard work.
I don't think we've ever got it
down.
But I think it's like any other
important relationship in your
life.
Think about being a parent.
Who can ever say they've got
parenting down?
Do you know what I mean?
Like the minute you think you've
got it down, you're like up and
changing again.
So, I don't want to minimize that.
I think that's the richness of
human relationships.
I think that's what makes it fun.
But I would be worried if someone
would be rigid.
And oftentimes, you're not going
to see the growth and the
flexibility and the change, like I
said, without someone getting
professional help.
And so, I think you've got to bear
that in mind.
I would be really worried if
someone was having just the same
response day in, day out, day in,
day out, not changing or improving
in any way.
As you pointed out, we are human
and we have our strengths and we
have our flaws and we need to
acknowledge them.
And sometimes, the PTSD moment
between a recipient and the
caregiver just goes awry and it
ends badly.
Voices go up, someone shuts down,
there's an argument, things get
said, people get hurt.
But sometimes, by the next day,
things are calmer.
And I'd love to know for our
listeners, what are some of the
things a caregiver can do the next
day to sort of re-engage in a
repair conversation after the heat
of the moment has passed?
Because I think it's probably two
different approaches.
We spoke a little bit earlier
about one, but what do you do the
next day?
What should a caregiver say first?
So, you know, I do, I appreciate
this question and I really think
it's important that we are very
clear about something.
I see this a lot in regular media,
in regular pop culture, especially
on social media.
There is a lot of this, my PTSD
made me behave this way, or my
anxiety made me do this.
Which I don't think that type of
language is compatible with what a
lot of mental health
professionals, how we conceive of
mental health conditions.
When we talk about PTSD, we talk
about it as a way to explain
behavior.
It does not excuse behavior.
And it does not excuse harm caused
by behavior.
And it really makes me sad when I
meet couples or dyads or family
members who have got into this
rhythm where the person with PTSD
is basically being allowed to get
away with intimidation, threats,
emotional degradation.
Right?
In the name of, well, it was my
PTSD that made me behave that way.
It doesn't work that way.
We as human beings, we are
accountable for the consequences
of our actions.
And so that makes me really upset
when I see that as a mental health
professional, because it's almost
like the caregiver has given up
their own agency or their own
ability.
They've misunderstood the job
description, right?
Like I say, hurt people hurt
people.
It is part of the territory of
being a caregiver for someone with
PTSD, but it is never okay.
So what I would say, if things got
messy, if things got nasty, if
things goticky, the next day or
whenever things have calmed down,
I think it's okay to say, I
understand you were triggered
yesterday, but you need to know I
cannot accept being treated that
way.
It is not okay.
Right?
Sounds like relational honesty,
right?
What was that?
It sounds like relational honesty.
Yes.
And I don't think that happens
enough.
I do think we, like I say, because
of what's going on in the
zeitgeist, because of the messages
we're getting into, we've almost
enabled people who are living with
mental health conditions to have
behavior excused.
But no one should get, everyone
should be held accountable for
harming someone else, whether it's
with words or actions.
Everyone needs to be held
accountable for that.
The trick with someone who's
living with PTSD is to find the
right moment to bring it up.
But I think it is perfectly
acceptable.
And the other thing I tell people
who are caregiving for people with
PTSD, if your safety is
compromised, step away.
Seek some support immediately.
If you're in immediate danger, do
whatever you have to do to get
yourself safe.
And the other thing I say is,
especially because a lot of
people, they're living with
children, they're living with
dependent people.
You are role modeling to those
young people what is okay and what
is not okay in terms of your own
person.
So I would love to see a little
bit of recalibration.
I feel like we've gone the
opposite way.
I think we've gone from the 1980s
where we barely had a word for
PTSD and where people with PTSD
were ignored and mislabeled and
mistreated.
And now we've almost swung the
pendulum the other way, where it's
almost like it's a way to get out
of being held accountable for your
own actions.
It's interesting.
We hear a lot about
trauma-informed care these days.
And that can easily fall into that
sort of, on that slippery slope of
that, well, you can't say anything
because it's the trauma that's
determining the behaviors.
And again, accountability can be
lost in the wash.
But I think, you know,
trauma-informed caregiving, that
word sort of embraces the
accountability that comes between
the recipient and the caregiver.
And I would hope that, as you
point out, the trauma and the
experience doesn't shape the
relationship to the point where it
becomes an excuse.
Yeah, where it defines it.
I mean, I don't know who wins.
If a caregiving relationship
becomes defined by the PTSD, I
don't know who wins in that
situation.
You know?
So, yeah, no, there isn't.
You can't assign it that way.
You know, I have a follow-up
question to a conversation from
earlier, but it's really, it keeps
popping up on my grid in my head
as I'm listening to you.
And it's just so topical these
days.
We hear about the neurochemical
effects of social media and
short-form video on the brain and
dopamine levels, etc.
What happens to the neurochemistry
or the neuronal connections, let's
say, in an individual with PTSD
who's spending tons of time on
social media?
Are there added risks there for
that individual compared to the
general population that we may not
understand yet, but may actually
have some foreboding that it could
even compound and be worse?
So, I'm not sure, you know, I
can't, off the top of my head, I
can't think of any science that
has definitively shown this.
But I definitely know we know a
lot about addiction and dopamine
and what happens in the brains of
people with PTSD.
And I think, as a clinician, what
I can definitely share with you,
what we see day in, day out, all
the time, is that with people who
are living with PTSD, one of the
things they automatically want to
do is seek an altered state of
some description.
Why?
Because living in their head is
really painful, right?
The nightmares, the
hypervigilance, the memories, it's
painful.
So, they want to seek an altered
state.
And clinically, we know that
predisposes them to addiction.
What I've learned from being a
clinician and a PTSD expert is
that addiction can take any form.
You know, your old-fashioned one
of the alcohol, right?
Like, the World War II veteran who
is, you know, a functional
alcoholic for most of their life,
they could be a workaholic too,
right?
There's all sorts of addictions.
Food, sex, nicotine, gambling.
I have seen it all.
And now, problematic internet
usage.
Because it's reinforcing the same
pathway.
Where I think it becomes very
unhealthy is if you have people
who have PTSD and who are living
with hypervigilance, and they have
certain cognitive distortions
which make them feel that the
world is a dangerous place.
When they go online, they can feel
themselves to the brim of evidence
that supports their cognitive
distortion that the world is 100%
a fundamentally dangerous place.
And I think the load, because of
what's accessible, what they can
tap into in this age of non-stop
digital content, that's what's
really scary.
It's kind of like, you know, how
we live in an obesogenic world,
you know, where the whole world is
set up to kind of, you know, empty
calories, lack of opportunities
for exercise.
So even the most well-meaning
person can gain weight because the
society is set up to have you be,
you know, it's obesogenic.
I think it's the same with PTSD
and social media and problematic
internet use.
The way the digital world is set
up is just set up to reinforce
your PTSD.
And that's really sad.
And that's a question I ask people
all the time when I need them for
the first time.
Like, how many hours are you
spending on your phone?
How many hours are you spending on
your phone when you should be
sleeping?
How many hours are you spending on
your phone where you should be
going out in the world and
challenging those assumptions?
You know, the world is not 100%
dangerous 100% of the time.
It's not.
But if you spend enough time on
social media, you will become
convinced that it is.
I would say even people who don't
have PTSD could become convinced.
But yeah, there's definitely a
vulnerability.
I mean, absolutely.
And I think more and more now, I
mean, people are aware that really
it's a good idea to not have a TV
in the bedroom in your safe place
where you sleep, let alone your
phone plugged in on your night
table.
Yeah.
I think there's a movement towards
really trying to break from that
habit.
We talked a little bit earlier
about when things go awry and
arguments happen and words are
said.
But, you know, you made it very
clear that PTSD can explain
behaviors, but it can't be used as
an excuse for abuse.
What happens when that line
between sort of symptoms and harm
gets crossed?
And what should a caregiver do
when it goes too far and the first
signs of abuse start appearing in
the relationship?
What does the playbook tell us in
that case?
Is it any different than any other
circumstance or are they
particularly at risk?
I would always say safety first
for any individual involved.
I think where it becomes
complicated is people's definition
of what they perceive.
You know, perception is reality.
That's a phrase we use all the
time.
PTSD researchers, trauma
clinicians use it all the time.
Perception is reality.
My perception of what I feel is
abusive or what has gone over the
line is going to be different to
yours.
It's going to be different to a
third person and fourth person.
So that's where I think it becomes
complicated.
Generally speaking, I think if you
feel that line has been crossed,
stepping away and giving yourself
space has to be the utmost
priority.
But as you pose that question, I
just think it's easier said than
done because it depends on where
you feel that line is.
An objective outside, I might be
able to tell very clearly, whoa,
that was too much.
But if you don't perceive it that
way, therein lies the dilemma.
But I'm always in favor of people
prioritizing their own safety
first because I just think that's
part of a healthy sense of self
and a healthy sense of what you
feel is the way you want to
navigate the world.
Maybe another way I would look at
it is maybe keeping an eye on
basic foundational like biological
variables, you know, like a lot of
times that's when I can tell when
people are running into problems.
When they're sleeping, when
they're not eating as healthy,
when they're not exercising the
way they used to, you know, that
might be an easy way to tell that
you're starting to slip into that
territory when those biological
variables that we need to just
sustain our life and our
well-being are being eroded or
being ignored.
Or listening to the body and what
it's telling us even in the more
primordial ways, the chest
tightness, the muscle tightness,
the gut grief.
And those can often be the first
signs too.
Yeah, tension, headaches.
Yeah, yeah.
I mean, I think it attests to the
fact that caregivers just often
will minimize what happens in
those more complex scenarios
because they tell themselves,
well, it's their PTSD, they didn't
mean to do that to me, and oh, it
won't happen again.
But if we have someone watching
today or who's listening out there
and who may be realizing that
they're actually maybe minimizing
harm that they're experiencing,
what would be the big reality
check that you want them to hear
about that can help them move in
the right direction?
I think signs of vicarious
traumatization that we hinted to
before, that's a sign that you're
in the danger territory.
So if you're living with a
baseline elevated anxiety level,
if you feel hyper-vigilant
yourself, irritable, maybe
emotionally checked out, that
might be another way of showing
up, that you just shut down your
emotions because you're so
exhausted or because it's so
dangerous for you to feel or
you're scared of what you might
feel if you don't numb yourself.
So I think that is evidence of
secondary traumatization or
vicarious traumatization, and that
is a total signal that you need to
get your own support, your own
therapy, your own peer group, at
least one minimum safe outlet for
yourself.
You can't co-regulate with
somebody if you yourself are
dysregulated, you know.
So I think those would be some of
the signs that it's just too much.
And again, just your risk-benefit
analysis of what you're doing in
this relationship, you know.
I mean, I've referenced a lot of
the couples literature, and I've
kind of made an assumption that
the caregiver is also in a
romantic relationship.
But of course, you have children
taking care of elderly parents.
You have parents taking care of
dependent children.
So whatever that dyad is, I do
think we have a right as humans to
ask ourselves, okay, what are we
getting out of this relationship?
Why are we here?
Why are we caving?
You know, we're owed something in
this too.
I think we're allowed to say that,
right?
I don't think it should be
unidirectional.
It has to be bi-directional.
Why are we showing up for this
person?
What are they giving us?
And I think when that balance gets
tipped, that's when you're set up
for all of the mental health
consequences of being in an
unhealthy caregiving dynamic.
Yeah, and usually harm ensues in
some sort of way.
Yes.
Alluding to non-romantic care or
the care recipient not being a
romantic partner engaged in a
romantic relationship, but there's
so many other facets to caregiving
with family members.
But in your book, you alluded
really interestingly to that sort
of passive PTSD or partial PTSD
where, you know, you retire from
life and you have a whole lot of
time on your hand.
And you referred to that one
couple, elderly couple with one
individual who had dementia but
was lost in a very traumatic state
as they had so much more time on
their hands and they kept reliving
things that maybe were off the
grid because life was so busy
until they retired, until they
aged.
But then all of these memories
come to the forefront and so
seniors can have PTSD too just
from life events that were very
well buried for most of their life
but never really came to the
forefront.
Can you comment a little bit about
that so our senior caregivers
listening can gain a bit of an
appreciation of what they might
face subtly in certain
circumstances?
Yeah, so that incident where you
described, we have a name for
what's called late onset stress
symptomatology and like you said,
very important because we have an
aging population and as you know,
even as part of normal aging and
definitely as part of abnormal
aging, there it is, the brain
diminishes in its capacity, in its
capacity to retain fond memories.
And there is this observation in
the geriatric PTSD literature that
often what remains are the most
prominent memories, right?
And as you know, with the way
traumatic memories are coded in
the brain, they are kind of
over-consolidated memories.
So they remain.
So I've heard the story over and
over again and again, it is with
those certain generations.
It may change with subsequent
generations because we are so much
more comfortable about talking
about trauma now.
So we're kind of processing it in
real time or at least close to the
event.
But if you think about it, if you
think about people who are
octogenarians, people who are
non-genarians or, you know, even
in their 70s who came up in a
world where it was not okay to
talk about trauma, where you do
not admit negative emotions.
So you just tuck it away in your
head and no one ever talks about
it.
So you go about your life.
I would argue life was not normal.
I would argue that they would have
been suffering in many ways, but
whatever.
You go about your life without
being diagnosed.
You go about your life without
seeing a mental health
professional.
And then as you age and your
brain's capacity diminishes,
what's left is those memories.
And then they come out full
throttle.
And I think there's a lot of
caregivers who've been in that
position where they might be with
an elderly relative who is saying
the same story again and again and
again and again because they're
trying to rework through that
age-old memory that is 30 years
old, 50 years old.
You know, I've heard stories of
women who had raised many
children, but then in older age,
as their memory was slipping, all
they could talk about was that one
child they lost who died
prematurely.
That's all they talked about.
You know, so again, to me, it's
evidence that trauma doesn't go
away, right?
It remains in some form or
another, and it does need to be
processed in some way.
It doesn't have to be processed
via conventional mental health
networks.
You know, there's many ways trauma
can be processed before it becomes
PTSD.
But to me, these stories of
late-onset stress symptomatology,
these stories of PTSD prevalence
in older adults just speaks to why
it's so important we talk about
trauma and give it a name as soon
as possible so that it's not like
lying there, dormant, waiting to
be unleashed, you know?
At a later time.
One of the most important books I
ever read was Terry Reel's book, I
Don't Want to Talk About It.
And you can just see how this is
the culmination at age 80 and 90
of not having talked about it.
Yeah.
Before we wrap up, I just wanted
to thank you for the time you
spent with us today.
I think our listeners have learned
so much from all of your ideas and
your offerings.
To wrap it up, what would be the
best way a caregiver can support
PTSD recovery?
Without taking on the role of
being the home therapist.
So definitely, you don't want to
be the home therapist, right?
There's only so much that a
caregiver can do.
And sometimes I wonder why people
feel they can do way more than
that.
I mean, like I say, I feel like
looking into your own motivations
about what you are capable of.
You're not capable.
Any individual caregiver is not
capable of preventing episodes of
being triggered.
They are not, they're not
responsible for the trauma.
You know, more often than not, I
mean, I know there's complicated
situations, which we alluded to
earlier.
But I do think, you know, being
the only support system, these are
all things that they're not
sustainable, you know.
So, you know, advocating for a
bigger support structure, right?
So that you do have longevity in
your role, understanding that you
have a right to do that, accepting
what you can control, accepting
what you can't control.
Making sure the person you're
caring for is accountable for
their own role, right?
I think these are all ways that
can, A, help you, help your loved
one in a healthier way, but also
set you up for longevity in the
role.
But, yeah, sorry, I lost my train
of thought there.
Sorry.
Probably.
Good, well, it, you can't do it
all, you're right.
And in a time where we're more
isolated than ever, ever turned to
community and that village that
got us through everything probably
might be the best path to start
walking or to actually revisiting.
I just wanted to highlight your
book.
I really enjoyed reading it.
If anybody's looking to understand
PTSD and the science behind it,
but also the different forms it
takes and some of the basics that
we can embrace to try and look
after the individuals we care for,
I would certainly highly recommend
it.
And we'd like to, again, thank you
for joining us today and look
forward to reading more of your
work in the future.
Thanks so much, Mark.
And can I add one thing?
Sure, absolutely.
If this didn't come through, I
just do want to make it really
clear to your audience that PTSD
is a very treatable condition.
You know, with the help of a
qualified mental health
professional, you can go from, you
know, having trauma take over your
life, be in the front seat of the
car that is your life.
But when it's treated, you know, I
always tell people it's always
going to be there, but at least it
will be in the backseat.
You know, I just want to emphasize
that if it didn't come through,
that with the right mental health
help, people can be treated with
PTSD and it doesn't have to be a
disabling lifelong condition.
And seek that help out early.
Absolutely.
A hundred percent.
Wonderful.
That wraps up this week's episode
of the Caregiver's Podcast.
Thanks for joining us.
We look forward to hearing your
comments, your ideas.
Please share.
It's a dynamic and engaging
community and we're really happy
that you're all part of it.
We'll see you next week.
Before we wrap up, I wanted to
remind you of something important.
The conversations you hear on this
podcast are here to inform, to
support, to spark reflection.
You're not a substitute for
professional medical advice, care,
therapy, or crisis services.
Listening to this podcast does not
create a doctor-patient or
caregiver-client relationship
between us.
If you're facing a medical
concern, health challenge, a
mental health challenge, or a
caregiving situation that needs
guidance,
I encourage you to reach out to a
qualified professional who knows
your story.
If you're ever in crisis, please
don't wait.
Call your local emergency number
or recognize crisis hotline right
away.
You deserve real-time help and
support.
The views you hear on this show,
whether from me or my guests, are
our own.
They don't necessarily reflect any
organizations we work with, are
part of, or have worked with,
or been part of in the past.
This podcast is an independent
production.
It's not tied to any hospital,
university, or healthcare system.
Thank you for being here, for
listening, and most of all, for
taking the time to care for
yourself
while you continue to care for
others.
I look forward to hearing from
you.