First Conversation: How the Brain Understands the World

What I've learned from talking to countless victims of traumatic events, abuse and neglect, is that after absorbing these painful experiences, children begin to suffer.
There is a deep-seated desire to feel needed, accepted, and valuable.
As they grow up, these children have no idea what they deserve.

--- p.24

When a child experiences abuse, the child's brain associates the abuser's characteristics, such as hair color or speech, or the context of the abuse, such as the music playing in the background, with feelings of fear.
The complex and confusing associations created in this way can influence behavior for a long time.
For example, many years later, you might go to a restaurant and have a panic attack when you see a brown-haired waiter looking down at you and taking your order.
But because there is no persistent cognitive recall, or linear narrative memory, the panic attacks are often felt and interpreted as random events unrelated to previous experiences.
Experiencing trauma at a young age can lead to certain beliefs and behaviors that may last a lifetime.
--- p.44

Second Conversation: Finding Balance to Sustain Life

In my twenties, I first encountered a situation where managing stress was extremely difficult.
It was when I got a job as a reporter and was working 100 hours a week.
I wanted to be a team player, but I felt like I was increasingly out of sync with others.
(...) When I felt my body sending me stress signals, I ignored them and instead consoled myself with the most readily available medicine: food.
The further my life got out of sync, the more I sought solace in silencing those signals.
--- p.62

When parents provide consistent and predictable care, the child's stress response system becomes more flexible.
When the stress response system is activated over a long period of time or in a chaotic manner, as in cases of abuse or neglect, it becomes sensitized and unable to function properly.
--- p.79

When you ask someone, “What happened to you?” you often discover that the person experienced some form of trauma during their development.
Most people who have experienced 'developmental adversity' have chronic dysregulation.
It generally means that you are nervous and anxious.
Sometimes I get so shocked that I feel like I'm going to burst out of my body, and I feel an inner storm, as Russell Brand so well described.
(...) This is because the core control neural network is sensitized.
--- p.83

There is always a need to control, a need to find comfort, a need to fill a reward bucket.
But it turns out that the most powerful rewards are those that come from human relationships.
Positive interactions with people bring us the satisfaction of reward and the stability of control.
Without connections with people who care about you, spend time with you, and support you, it's nearly impossible to break free from harmful reward and conditioning patterns.
--- p.91

Third Conversation: How We Were Loved

Whether it's the President of the United States, the incredible Beyoncé, a mother spilling a painful secret, or a criminal asking for forgiveness, anyone I've ever spoken to has, after an interview, checked my expression to gauge my reaction, asking, "Did I do a good job?"
(...) Everyone has the same desire to be accepted by others and to have their truth confirmed.
Beyond science, I know that this feeling ultimately boils down to 'how you were loved.'
--- p.100~101

Our ability to connect in meaningful and healthy ways is built by our first relationships.
Love and affectionate care are the foundation of development.
--- p.101

Stress is not something to be feared or avoided.
What causes problems is the pattern and intensity of stress, and whether it is controllable.
The sad thing is that so many people have stress activation patterns that are unpredictable, uncontrollable, long-lasting, or extreme.
--- p.113

Fourth Conversation: What We Call Trauma

I believe trauma can also arise from less obvious and quiet events, such as emotional abuse, such as humiliation or shame from parents, or the marginalization of children from minority groups within the majority community.
--- p.137~138

A key finding is that the timing of adversity makes a big difference in determining overall risk.
Simply put, a trauma experienced at age 2 has a greater impact on health than the same trauma experienced at age 17.
--- p.145

If a child has been abused within an intimate relationship (for example, by a parent), the child may come to feel threatened by intimacy, that is, emotional and physical closeness.
These people often take a long time to form connections in relationships, and when they do get close to someone, they feel anxious, confused, or overwhelmed.
You end up avoiding the intimacy that comes from human relationships.
If you can't avoid intimacy, you'll end up doing things that will damage or ruin the relationship.
This is one of the most common and least recognized aspects of the impact of developmental trauma.
--- p.158

This means that countless adults continue to carry these wounds in their daily lives, at work, and in their relationships, passing them on to their children.
And those adults may not have realized what had happened to them.
Not only do they not know what happened, but their partners, doctors, and coworkers also do not know.
That's exactly why so many misunderstandings arise.
--- p.161

Conversation Five: Connecting the Dots

Connecting the dots to finally understand both the cause and effect of my sleep problems was a complete mind-altering experience for me.
I still feel myself reacting to the deep stress points created in my grandmother's bedroom long ago, but now I have the tools to understand the situation, step back, observe what I'm feeling, and choose how to move through that fear.
--- p.166~167

One of the most important ways we pass on 'information' to the next generation is through our genes.
Some aspects of our stress response system are also 'heritable'.

--- p.179

The good news is that the brain is still capable of change.
(...) Just as threats and trauma can cause epigenetic changes, the interplay of good care can reverse those changes.

--- p.181~182

Conversation Six: Moving from Coping to Healing

Why can't I finish what I'm doing when things get difficult? It's because my brain is trained to dissociate when things become uncomfortable or threatening.
Even though a math test isn't as big of a threat as someone trying to harm me, Harry's reactivity is so heightened that he'll react by blocking even to a math test.
--- p.236~237

If you don't notice the pattern, it's very difficult to change it.
The children and adults we worked with were so accustomed to chaos that they actually felt more comfortable in chaos than in calm.
So they were very uncomfortable going into a classroom or a new foster home with people who were predictable, consistent, and thoughtful.
As that discomfort gradually grew and reached a certain limit, they eventually provoked others into reacting in a way they could predict.
--- p.251~253

People think of psychotherapy as going back into something that happened in the past and trying to get it out of the way.
But whatever past experiences have created in our brains, (...) we can't just erase them.
You can't erase the past.

Rather, psychotherapy is more about building new associations and creating new, healthy basic pathways.
It's like driving on a two-lane dirt road and then building a new four-lane highway next to it.
The old road still remains, but it is no longer used as much as it once was.

--- p.255~256

Seventh Conversation: Wisdom from Trauma

We often use the belief that others will be 'resilient' as a shield to protect our emotions.
It's about protecting ourselves from the discomfort, confusion, and helplessness we feel in the face of their trauma.
This is a kind of externalization.
--- p.258~259

For tens of thousands of years, humans lived in small groups made up of several generations.
There were no mental hospitals, but there was a lot of trauma.
I think many of our ancestors suffered from post-traumatic stress disorders such as anxiety, depression, and sleep disorders.
But at the same time, I think they also experienced healing.


(...) Unfortunately, few modern approaches make good use of all four methods.
The medical model over-focuses on psychopharmacology (④) and cognitive-behavioral approaches (③), while greatly underestimating the value of connectivity (①) and rhythm (②).
--- p.280

Allie's healing power and continued resilience were possible because she had enduring relationships that provided her with safety and security, and through those relationships, she was able to 'make sense' of the horrific events and reframe them within the context of her own belief system.
Even people who seem to have incredible resilience can be depleted by poor relationships, persistent stress, distress, and trauma.
--- p.282

Conversation Eight: Our Brains, Our Biases, Our Systems

I don't think you can truly understand trauma unless you recognize the biases embedded within you and the structural biases in the systems you live in—bias around race, gender, and sexual orientation.
Being marginalized—being excluded, undervalued, and insulted—is traumatic.

--- p.308

Unfortunately, schools (...) tend to prohibit many of the behaviors that help children self-regulate.
This includes actions such as walking or swaying your body back and forth, fiddling with something while listening to class, or listening to music with earphones while doing homework.
(...) We also tend to underestimate the powerful healing and resilience-building activities like sports, music, and art.
(...) In fact, it contains regulatory and relational elements, which can be the most important foundation for academic study.
--- p.318~319

Ninth Conversation: Modern Society's Relationships

In modern life, we have fewer and fewer opportunities to share in relational interactions. (...) As a result, as a population, we have become more self-absorbed, anxious, depressed, and therefore less resilient.
--- p.364~365

One might argue that part of the reason for the rise in anxiety in the modern world is the influx of newness, especially social newness, coupled with the lack of relational connections that could provide a counterbalance.
--- p.374

Tenth Conversation: What We Need Now

Adversity, challenges, disappointments, losses, traumas—all of these things broadly cultivate our capacity to empathize with others and to grow in wisdom.
In some ways, trauma and adversity can be gifts.
What people do with these gifts will vary.

--- p.402