What if the popular narrative about trauma is incomplete? What if trauma isn’t just a psychological phenomenon, but a fundamentally biological process that gets encoded in your cells, mitochondria, and nervous system?
Dr. Aimie Apigian is a double board-certified physician in preventive and addiction medicine who’s revolutionizing how we understand and treat trauma.
Her groundbreaking new book, “The Biology of Trauma,” reveals the hidden physiological mechanisms behind trauma responses.
In this conversation, she explains where traditional talk therapy falls short, how trauma creates a feedback loop of oxidative stress and cellular shutdown, and her innovative approach to healing trauma from the inside out, starting with cellular safety before diving into the emotional work.
Table of Contents
In this podcast, Dr. Aimie and I discuss:
- Why trauma is defined by specific physiological changes, not just the events that happened to you
- The five universal steps every trauma response follows—from startle to cellular shutdown
- Connecting the dots between trauma and the cell danger response…why trauma gets “stuck” in your biology and creates chronic illness
- Why high-functioning people can be deeply traumatized while appearing completely successful on the outside
- The biochemical connection between unresolved trauma and oxidative stress, mitochondrial dysfunction, and chronic fatigue
- How your first thought upon waking reveals which nervous system state you’re operating from
- Why “time heals all wounds” is complete BS—and what actually accumulates under the surface instead
- The essential differences between stress and trauma
- How trauma creates a biological feedback loop where your physiology generates negative thoughts and stories
- The “baby chicken in the shell” analogy—why you’re saying no to external pressure but can say yes to the internal pressure that creates life
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Transcript
Ari: Hey, this is Ari. Welcome back to the show. With me on the show for the second time is my good friend, Dr. Aimie Apigian, who is a brilliant expert in the field of understanding trauma, how it works in our biology, and how to heal it. She is a double board-certified physician in preventive and addiction medicine with master’s degrees in biochemistry and public health.
She’s also the author of the groundbreaking new book, The Biology of Trauma, which is launching in just a few days and is really the subject of what we’re talking about in this episode. Just a bit about her work. She is pioneering a really novel and revolutionary approach to how we understand and how we deal with trauma, how it gets stored in the body. Given this understanding of how it works, not just at the level of psychology, at the level of the mind, but how it interacts with our physiology, she’s really focused on how we rewire our physiology to heal that trauma and create lasting change.
What I find most compelling about her work is how she’s connected the dots between trauma, cellular energy, mitochondrial health, and chronic health and chronic illness more broadly. She’s showing us that trauma isn’t just a psychological phenomenon, but that it’s fundamentally biological. Really, this changes, this frame changes everything about how we approach the healing of trauma.
This conversation gets deep into some really fascinating territory. I think it takes some unexpected twists and turns that probably are not typical of most conversations on this topic. I try to introduce maybe some different angles. I think her answers to my questions were brilliant. I think you’re going to get a lot of value from it. With no further ado, enjoy this conversation with Dr. Aimie Apigian.
If you are really interested in this topic, and if you suspect you might be dealing with some trauma, I strongly encourage you to go to Amazon.com right now or wherever you buy books from. Go pick yourself up a copy of her wonderful new book. I had an advance copy of it several weeks ago, so I’ve already read it on my computer in PDF version, the manuscript with all the little edits and stuff like that that haven’t been fully corrected for the final one yet. It’s a phenomenal book. I highly recommend it. I think you’re going to get a lot of value from that and from this conversation. Enjoy. [silence] All right, let’s do it. Dr. Apigian, such a pleasure to have you back on.
Dr. Apigian: It is always good to be here, and it’s always fun to talk about the biochemistry with you.
The Biology of Trauma
Ari: It’s been a while since we did this in podcast format. We’ve hung out a few times in person at local health food spots in San Diego, Guidonia, and Nectarine Grove, and places like that. We always have a good chat whenever we hang out. It’s awesome to have you back on the podcast for the second time. For good reason, you have a new book coming out. Why don’t you tell us about that, and what inspired you to write this book?
Dr. Apigian: The book is The Biology of Trauma. As I look at it, Ari, this is the accumulation of everything that I’ve learned and experienced so far. I know that that will continue to evolve. This is just my learnings up until this point, and this is what I’ve learned about the human body and its experience of trauma and surviving things that we often may not think that we are going to survive. We may not think that we’re going to be okay.
How does the human body actually survive these circumstances or these events? What is the inner experience? So many people think that it’s just emotional or psychological, and they look at that impact that it’s had on their life, not realizing that the definition of trauma is that it created a very specific physiological change, and that’s how we then can define it, which also means, help the body come out of it, and we haven’t really known how to do that well because we haven’t been looking at the science of it.
The current views on trauma
Ari: That was a very succinct way of describing several hundred pages of writing. There’s a few distinctions that I want to get into here. One of which, I’d be interested to get your perspective on this. In my perception, there are, and you might see this landscape differently than I do, given this is your field and your field of expertise, but as I see it, we have two camps, if you will, as it pertains to trauma.
One is the trauma-unaware folks, which historically most of humanity, I would say, has been in that camp. Now the pendulum has swung in the opposite direction. Now we have a lot of people, especially the younger generation, and a lot of other health experts, influencers, tons of people who are talking about trauma and being triggered, and that there is this hyper-awareness and attentiveness to one’s traumas.
It’s become a normal everyday topic of conversation, whereas in the past, it certainly wouldn’t have been. I’m curious where you see yourself and your own philosophy and your own understanding of trauma as it relates to that landscape, that sort of continuum that I just presented there.
Dr. Apigian: Well, I want to take you back several years before it became this almost Me Too type of movement. I first really started studying trauma when I became a foster parent. In that space, it’s very normal to talk about trauma because we’re working with kids who have been through trauma. I ended up adopting my foster son, and he had been in the foster care system since age nine months.
There were countless of events that I could look at in his paperwork and say, “Oh my goodness, my heart is absolutely breaking for what he went through, even as a two-month-old. As a six-month-old, that is trauma,” and I never questioned it. Then, as I developed chronic health conditions, I had this moment of waking up when I realized that every single thing that I had, it was related to adverse childhood experiences.
This confused me greatly. This threw me into this existential crisis, almost because I’m looking at my body and saying, “Okay, you are the body of someone who’s had all these adverse events, and yet I didn’t.” I hadn’t had those events. It’s not like I could look back at my childhood and be like, “Yes, this makes sense.” It didn’t make sense to me, which is the first time that I remember questioning a lot of the language that I was even using as a physician, which was around, “You’re stressed. Oh, this is chronic stress.”
We may have even called it toxic stress if we were really trauma-informed. I started questioning the language around that as I developed my own health conditions. That’s really when I started studying my nervous system and taking me into what is the actual physiology that’s happening, so that now my approach is very much based on what’s happening inside of the body, rather than what’s happening outside and labeling it as, “Oh, well, that’s a trauma, or that’s not that bad. That shouldn’t be labeled a trauma.”
It actually has nothing to do with the event and the external circumstances. Everything has to do with what’s happening inside of our biology and isn’t going into these five physiological steps that has to happen for the body to say, “I’ve had a trauma response, that was not just a stress response.”
Ari: Okay. I want to get into those five steps and several other things that you mentioned there in passing. I want to ask you about one other distinction. This may or may not disrupt the flow of how you want to introduce concepts. If it does, feel free to redirect in the better flow as you see it. There’s one other distinction that I’m curious about. One is, I think, historically there’s been a tendency to see trauma as a purely psychological phenomena, something of the mind.
On the other hand, in recent years, there has been this emergence of people who are very much centered on the body and this sort of body-based understanding of trauma. The body keeps the score. There are a number of other things in that vein. I’m curious how you conceptualize that continuum and where you land on it, or what differentiations you would make as far as where you see those different camps going wrong or being accurate.
How the body can respond to trauma
Amy: Yes. Now, I came from a background of a very conservative Christian family. Ari, we were so conservative that yoga was of the devil. [laughter] That’s where I was coming from, which means that my whole life perspective was all about your mind and mindset and understanding and making conscious decisions because that’s the human brain and the power that we have.
This whole idea of body stuff, for me, was almost taboo and not only not really clear, but just bad and wrong that I reveled in the science. I wanted to see that the evidence-based science was our gold standard for everything. I did very well in medical school as a result because I’m focused on the pure science and evidence that we have to be able to measure things objectively, and if we can’t measure it objectively, well, then it’s woo-woo science, which was all bad.
Again, coming from that background, this was such an incredible shift for me then to realize, “Whether you like it or not, Aimie, whether you understand it or not, you’ve got some trauma work to do, and let’s start doing this.” Without even knowing what trauma I had, I’m starting to now put myself into different therapies and try a bunch of different things because I want my life back. I want my health back. I want my career back.
I’d had to take a medical leave because my physical health was so bad. As I’m doing these trauma therapies, I’m recognizing a very clear pattern, which was that I would think that I had had this amazing session, and it was deep, and we had processed a lot, and I had told a lot of stories, and I had cried a lot, and I was so proud of myself for having done such a great job in therapy. “Good job, Aimie.”
I’d come home, and I’d find myself curled up into a ball on my couch with a tub of ice cream, binge-watching movies, and just numbing out. It happened enough times that I saw the pattern, and I realized in some way, my mind seems to think that this is working, and this is good, and this is helpful, and my body seems to have a mind of its own, but that’s as far as I went at that time because I didn’t understand it.
You have to understand, I’m also in a general surgery residency. I don’t talk about feelings. I asked the anesthesiologist to put you out, and then I’d cut things out. That’s what I do. [laughs] This was so foreign to me to even just have this idea of “My body could have a mind of its own.” I even enrolled in in different trauma therapy trainings, so I’m now showing up to somatic experiencing, for example, because I’ve watched this video on YouTube that says polar bear and watched it go into this, what they call the freeze response, and somehow I related to that experience.
I was like, “I’ve been in that place before.” It was a polar bear, but I’m like, “I want to go and find out more about this. Why am I relating to this polar bear?” I show up to my first somatic experiencing training, and my whole body is in anxiety. It’s in overwhelm. I have the sweating, the digestive issues, the cramps, the whole thing. I’m now at the point where I can watch my body as a third-person observer and be like, “Isn’t this interesting?”
My mind says, “What’s the problem? We’re here to learn.” My body says, “Oh, no. We are being opened up, and we are feeling things that we don’t think is safe to feel. We are having an adult temper tantrum and meltdown.” It was beyond my conscious control. I couldn’t think my way out of my body’s responses. That, for me, was then the first shift that I had ever experienced of realizing that this is not just psychological.
My body has responses to people, places, things, smells, memories. It’s not just my thought process; it’s my whole body having a physiological response. What does that mean, and what does that mean for the healing journey that’s ahead of me?
Ari: I think you’re alluding to this in a lot of what you said, but there’s this classic distinction between mind and body. How do you deal with that and reconcile that and create a new understanding? I think you did a beautiful job of this in your book, helping us to develop and to unfold this new, more integrated understanding of this classical mind-body distinction.
Aimie: Yes. This has been, really, the concept of The Biology of Trauma. Many people only see the one concept, which is, trauma creates damage to your biology. We’re all like, “Yes, we get that. If we haven’t read the book, we know the book, the body keeps the score. What are you telling me that’s new?” There’s this whole second half of the concept, which is that that same biology creates a feedback loop and actually keeps us stuck in these trauma responses so that the stories that we have, the stories that we tell ourselves about ourselves, about other people, we have these stories that are state-dependent, meaning my inner physiology is creating the story that I’m playing in my head right now.
When my physiology is in parasympathetic, then the story that I have playing in my head is, “Isn’t the world a wonderful place? It’s so good to be alive. What can I create next?” If my inner state is one of the sympathetic, well, then the story is, “Oh, this is a lot. I don’t know if I can keep up with this. Am I going to be okay? Let me try harder. Let me push harder.”
Whereas if the inner state that I have is one in that trauma response, the story becomes, “It’s pointless to even keep trying. I’m useless. I’m not enough. I am a failure.” That’s the story playing. My inner physiology is what creates the story. Now it is true that that story then creates more physiology, so state creates story, story creates state, and now we’re just in a loop because now they’re feeding each other.
That’s why it can be so hard to break out of that, because it’s not just, “Well, I’m just going to stop the story.” “Well, what about your state?” “Okay, let me change the state.” “Well, then what about the story?” It has to be both. When we talk about the separation between mind and body, there is no separation. There absolutely is no separation. This is what you do with your research and work. You’re showing how it’s all one system. In order for it to perform well, then we have to work on all these different levels because it all is just one big system.
Ari: Absolutely. Well said. Now there are some people out there who are somewhat skeptical of the body-based stuff. The body keeps the score. There are a lot of people in traditional evidence-based medicine that scoff at that perspective and say, “Oh, that’s a bunch of pseudoscience. The traumas aren’t somehow stored in the body. That’s really this woo-woo kind of stuff.” How would you respond to somebody who’s skeptical of the idea that trauma is “stored in the body”?
Aimie: I understand their skepticism because I used to be the skeptic. [laughs] I’ve even had some people come up to me and ask, “What? Is it stored in my kidney? Is it stored in my liver? Where exactly does it get stored?”
Ari: Pinky toe. Pinky toe.
[laughter]
Aimie: The pinky toe.
Ari: What do you say when they ask you that? You’re like, “Your trauma? You don’t want to know where that thing is [unintelligible 00:18:50]“
Aimie: For you, it probably is in your liver.
[laughter]
Ari: Could be, [crosstalk] or even worse. I’m not going to say where.
Aimie: It’s probably metastasized, and it’s now everywhere.
[laughter]
Ari: Traveling through your bloodstream as we speak, and it’s in your armpit.
Aimie: “Oh, I see it just lodged in your frontal cortex.” [laughter] When we say the body, it’s really helpful to differentiate the different branches of the nervous system. People aren’t often aware that we have different branches of our nervous system so that when we talk about the nervous system, many people automatically think the brain and the central nervous system, and actually, trauma gets more stored in the autonomic nervous system.
How that happens is that it then creates our responses to change. Our autonomic nervous system is responsible for adapting in a very dynamic way to everything that’s changing in our life, even to the point where we walk outside on a hot day, and our autonomic nervous system is responsible for opening our sweat glands and cooling us off so that we stay alive. Our autonomic nervous system keeps us alive by constantly monitoring everything, has this dashboard of all of the numbers, and being able to make very fine pivots and changes and fine tuning of different parameters in our physiology in order to make things just right for what we need at that time. Sometimes it is the best thing for us to be in a stress mode, and our nervous system can do that for us. Sometimes it’s best for us to be in that shutdown.
The stress response evolved for a reason
Ari: Wait. Are you trying to say the stress response evolved for a reason?
Dr. Apigian: I might be suggesting that.
Ari: Sorry, just one of my pet peeves that there’s so much of the modern household messaging, is that we interpret “stress,” which is a very poorly defined and misunderstood term, that we have this just purely negative association with the idea of stress like any amount of stress in any context is “bad” for us.
Dr. Apigian: Right. To the point where when I was going to medical school, we were taught to always, with every single patient, talk about stress management. You need to manage your stress or stress reduction techniques, because we need to reduce stress. Now I’m like, “No, turn it up, please, at the right time, in the right moments, because that’s how we grow, is stress and rest. Stress and rest, that’s the equation for resilience.”
Ari: Actually, this is a perfect segue into something that I’ve written quite a bit about recently, and that I’d be curious to get your take on. You just alluded to it, which, talking about resilience, stress, and rest being the formula for resilience, is itself a very unusual way of speaking for somebody in the trauma-informed community. Most people who are talking about trauma are not speaking that sort of language.
They are speaking more the language of conceptualizing stress and bad experiences as this purely negative, purely harmful thing that we need to work on healing from. Going back to what you said about the messaging that you learned, talking to your patients about managing stress and so on, there is actually this broad misunderstanding of stress as we imagine that because we can do experiments with animals and because we know that in humans, large amounts of stress are clearly linked with negative health outcomes, we imagine that the relationship between those two things is linear, that there is a linear, direct correlation between any amount of stress is bad for you and the worse the stress is, the worse it is for you.
Therefore, we need to “manage” our stress and keep our stress levels low. What’s interesting is that the research really does not bear this out in almost every dimension. What’s amazing is, almost nobody actually has looked into the research because we’ve had so many decades of this public messaging about how stress is bad for us, all the public experts, all the doctors, conventional, alternative, everybody talks about how stress is bad for us.
I feel like there’s this really interesting blind spot where nobody actually bothers anymore to actually look at the evidence on stress and health outcomes, because if you look at more moderate levels of stress, it really does not support a lot of this public messaging and a lot of this narrative. In fact, speaking more in the realm of trauma specifically, there are some really interesting studies.
I’m curious if you’re aware of this. One in particular that I’m thinking of, I could probably, maybe we edit this out and I have a moment to look it up to find the name of this. I’d be curious if you might remember it. You might know it off the top of your head. There was a group of researchers that looked at the relationship between early life adversity and metrics of thriving later in life, like the tendency towards depression.
They looked at a number of different outcomes. I forget the specific metrics, but life success more broadly, mental health outcomes. Basically, what they found is that, as expected, extreme amounts of adversity in early life were linked with bad outcomes. They also found that extremely low levels of stress and adversity were also linked with very bad outcomes and that there was a U-curve where there was a Goldilocks zone in between those two, of very low and very high, where moderate amounts of life stress and adversity actually were linked with the best long-term mental health and life success outcomes. In other words, we need some degree of adversity and stress in order to develop our capacities and to learn grit, to learn resilience, and to become mentally stronger.
Dr. Apigian: The studies that really fascinated me at first were the ones on early adversity and mitochondria. These were fascinating because I went to the same place that your brain went to, which is really trying to understand, “Well, what is that relationship? Is it a dose relationship that some adversity is bad and a lot of adversity is just really, really bad? What is this relationship?”
We see these principles both in mitochondria and in the immune system. I’m going to argue in all of our systems, especially our nervous system, in a minute, which is even looking at the research with the immune system, those kids who grew up in a so toxic environment, their immune systems are a mess. Also, the kids who grew up in a super clean environment, germ-phobic, “We are going to super clean this. We’re never going to allow them to play in the dirt because it’s dirty,” their immune systems were also a mess.
It’s the same thing when we look at mitochondria. Mitochondria, they grow under stress. It’s called biogenesis, right? You talk about this all the time. They grow under stress. If they don’t get that stress, then they’re like, “Well, we’re fine. Why do we need to make more mitochondria? We are easily able to keep up with our current capacity.” This idea of capacity grows when we stretch that, and we say, “No, we need more capacity now,” which is a stress.
There is this thing called the cell danger response. The cell danger response is when the mitochondria fall apart. The membranes fall apart. They start secreting proteins that then go and signal danger to the nucleus and to the extracellular matrix. If you look at them at the microscope, the mitochondria are no longer even creating energy efficiently. They have fallen apart.
That reaches a new level. That, in my definition, would no longer be stress. That is no longer adversity. That’s no longer growing our mitochondria. They’ve just shut down. One of the patients that I talk about in my book is Kenneth. He showed up as a veteran to the VA hospital where I was on the general surgery rotation. Literally, Ari, his bicep muscle was a ball in the middle of his arm.
Of course, we’re looking at that being like, “Well, that’s a problem. It’s supposed to be attached to your shoulder.” It’s the same idea that he’s going to the gym. He’s lifting weights. When we lift weights within our window of tolerance, but putting us in that upper zone of stress, we can grow our muscles, but that’s not what Kenneth had done. That day, he had gone in, and he didn’t have the capacity to lift that amount of weight.
Instead of growing his muscles, it just broke them, and we had to do surgery. This, for me, is that real defining line between what will grow us, which is stress, and what will break us, which is something else other than stress. For me, that’s really what I laid out then, is, we have this critical line of overwhelm. Up until that line, we can recover, and we can rest, and we can do what our body needs after a stress in order to be able to grow.
Whether that’s grow on an emotional level, or personal development, trauma work, or at a cellular level, mitochondria, it’s all the same. It’s all the same principles. If we cross that line and we do more than what we have the capacity to do, that’s no longer growth zone; that’s shutdown zone. That is what the body will do. It’s the equivalent of our bodies throwing on the emergency brake and saying, “You’re not stopping yourself, so I will step in and stop you because my job is to keep you alive.”
Why stress affects us differently
Ari: It’s interesting you just explained all of that in an almost identical way to how I would have explained those principles. This is really getting at what I wanted to ask you next, and it sounds like a very simple question, but it’s a very important one, which is, what is the definition of trauma? What is trauma? Is trauma just bad stuff that happened to you? How do we distinguish between the bad stuff that happens to us that people later in life attribute, “Well, the reason I’m so successful now, or the reason that I’m so mentally strong now, is because I went through X, Y, Z, bad thing, hard times earlier in life”?
Obviously, life is full of examples of how we learn, how we grow stronger and wiser and more resilient through bad experiences, through difficulties, through obstacles, through stresses and adversities in our life. We also know that a given experience, objectively, this thing happened to this person, for one person could be the reason for their strength and their thriving, and for another person could debilitate them and could be this lasting, lifelong trauma that prevents them from living well or living happily or being healthy.
Given that it’s not just the experience, it’s not just any bad experience that happens to you is trauma, and given that the same experience could be beneficial for one person or harmful for another, what is trauma?
Aimie: There’s so much to this, as you’ve alluded to. If we really break it down to, “No, we just want to know, what is a trauma? That’s all we want to know. We don’t want to know all the factors going into it. We just want to know, at that moment, what makes it be a trauma?” It’s our neuroception, our perception of our nervous system, saying that the size of the danger that we see is so much bigger than our current capacity.
I use those words intentionally because then it alludes to so many other factors that are playing a role here. It is on a biochemical level. Our nervous system, our autonomic nervous system, I already mentioned, has this dashboard of information. It knows how much ATP we have. It knows our capacity to make new ATP and in what timeframe so that if I’ve got a tiger chasing me, it can quickly calculate, “Do I have the capacity to even try to outrun this tiger?”
Because if I don’t, the best survival strategy is not to even try to run; the best survival strategy is to play dead, is to freeze, is to give in, give up, surrender. We see that in the animal kingdom as well. Our bodies are no different. It’s just this idea of “We have a capacity that includes our perception of our capacity, and then we have this danger or demands. It can be the daily responsibilities, but it can also be a real-life danger.
It doesn’t matter to ourselves. It’s all the same. It can be physical. It can be emotional. It can be psychological. It’s all the same because, at the end of the day, it’s coming down to that simple equation: does my capacity match the size of the danger that I see? Now, what’s super interesting is that the amount of adrenaline that we secrete in a stress response is in direct proportion to the size of the danger that we see.
As adrenaline gets secreted by our adrenal glands and the sympathetic nervous system, telling it that we need adrenaline because that’s what gets us up-leveling our energy production and utilization, it surrounds our cells and gives our cells all of these messages of, “Okay, let’s go. Come on, let’s go.” Depending on the amount of adrenaline, our cells can say, “Yes, I can do that for you,” or our cells can say, “I can’t do that level for you. There’s no way I can up-regulate that much.
“If I can’t up-regulate that much, well, then the best thing for me to do,” again, it’s a very different survival strategy than the stress response, which is, “Go, go, go.” The survival strategy of the trauma physiology is to say, “Shut down and don’t even try.” That’s the cell danger response.
Ari: It’s interesting that you’ve chosen the cell danger response as an explanatory model for this. Obviously, it’s something that I’ve referenced a lot over the years. Years ago, when I first started getting into Dr. Naviaux’s work, I had the privilege of– I actually had a friend, maybe a mutual friend of ours, Dr. Maya Shetreat. Do you know her?
Aimie: I do. She’s wonderful.
Ari: Yes. When I first met her, I don’t know, maybe six or eight years ago, and I started talking to her about Naviaux, she’s like, “Oh, yes, Bob, he’s my good buddy.” She’s like, “Yes, I’ll give you an intro.” I ended up going to his lab at UCSD and meeting him, and he gave me a private one-on-one lecture, talking to me about all this cool stuff, and I got to ask him all these questions. Really beautiful, brilliant guy. He’s actually been a guest on the podcast as well.
The reason it’s interesting that you’ve chosen that is because there are so many options of different physiological ways of explaining different phenomenon. Of course, trauma isn’t purely a mitochondrial phenomenon. It isn’t purely a cell danger response phenomenon. That’s one key aspect of it, and I agree with you that it’s a major aspect, but there are other ways that someone might choose to talk about this, right?
The language of the autonomic nervous system, the language of the adrenals and cortisol, the language of the thyroid, which is pretty common in functional medicine circles, the vagus nerve. You have Stephen Porges’s sort of polyvagal theory. You can pick and choose whatever your personal preferences of whatever sort of aspect of biology you want to reduce things down to.
Of course, as we were just discussing before we started recording, it isn’t just this or that thing; it’s always all of it. I’d be curious to know what you think also of all the hype around the vagus nerve and Stephen Porges’s work, which is in some circles put on this pedestal, and everybody thinks it’s like, “Wow, it’s the most brilliant thing ever, and we have to interpret everything through this paradigm,” whereas in some more evidence-based circles, they sort of poo-poo the whole thing and say, “Oh, this is a bunch of pseudoscience. It’s not really legit.”
Aimie: Yes. It has been very difficult to study because one of the challenges is that when you’re looking at the stress response, you have measurable hormones. You have adrenaline that you can measure. You can have cortisol that you can measure. You have these measurable changes. How do you measure the fact that another nerve can come in, like the vagus nerve, and switch that off because it’s still there?
It’s still present. If we do a blood draw, you’re still going to have high cortisol. In some cases, it’s become so chronic that PTSD people can have low cortisol. How do you measure the physiological state if we can’t measure actual numbers of a nutrient, or a hormone, or something that we can objectively look at? As I started studying the nervous system, it became very clear from my personal experience that I could feel three different physiological states.
I could feel that state where I’m good. I’m comfortable. I’m calm. I’m not scared. I’m in the flow, if you want to call it that way. Then I could definitely feel that high energy of anxiety. Of course, being at that time that I was a general surgery resident, that’s where I lived a lot of the time, in that rush, rush, rush, go, go, go, always in that higher energy level. Then there would be this other thing. That’s what I didn’t understand. I didn’t understand how and where my body went to that it would do this. Wow, my camera says that we’re talking about such an important thing that it stunned and shocked my camera.
Ari: It gave you a thumbs up there.
Aimie: It gave me a thumbs up. I started seeing that there are these three different states. That helped me, Ari, be able to understand that it wasn’t just my digestive system that was the problem, and that’s where I needed to put all my focus, because all disease starts in the gut, like I was told.
Ari: Oh, I left that off my list. I mentioned the adrenals, and cortisol, and thyroid. I left the gut out. Jeez, what [unintelligible 00:39:06]
Aimie: You did. I know. Of all the things to leave out.
Ari: I know, seriously. Thank you for adding that.
Aimie: Didn’t want it to feel left out. It would be a trauma for the gut, truly.
Ari: The gut was traumatized by that.
The physiological hallmarks of trauma
Aimie: It allowed me to stop chasing this, “Well, could it be this? Could it be that? No, I felt some relief with this, but no, it wasn’t it. There must be some other magic pill. There must be some other one thing that I’m missing.” The one thing that I was missing was, “No, it’s your whole state. It’s the state in which your physiology is operating. That’s the problem.”
Once I learned how to start to shift out of that, I could feel the difference in all of those areas. That’s what I knew, that I was on the right track, that I was doing what was better for my body is when I started noticing it’s my state, and when I can shift that, everything gets better. It happens relatively quickly, which again was also confirming to me that this is a state shift. It wasn’t like, “Oh, no, it’ll be your thyroid that you’re shifting because thyroid hormone takes a while,” or your immune system, right?
It takes 90 days to get a whole new immune system. If I’m doing something that’s specific for my immune system, it might take a while to really feel that full effect. I’m feeling the full effect in minutes as I shift my state. On the contrary, when I’m going into that trauma state, I am definitely feeling everything shutting down, from my energy to my brain fog to just the heaviness and my metabolism. I could feel all of that shifting and being able to start to track things like my aura ring and see very physiological changes in the parameters that I was measuring.
Ari: Let’s dig deeper into that. What are the biological physiological hallmarks of trauma? This may be too big of a question. Answer it in parts if you need to, but what are the mechanisms by which this gets encoded in our physiology and what are the signs that a person may look to physiologically that indicate trauma rather than, as differentiated from what we were alluding to earlier, stress in life that hasn’t necessarily left its mark in the form of lifelong harm, in the form of permanent harm or semi-permanent harm to our biology, but as maybe we’re fine or maybe it has actually enhanced us? What are the marks of actual trauma?
Aimie: One of the greatest marks is oxidative stress. The reason that I say that is that as our body goes into a trauma response and things shut down, things just aren’t working as well, and our survival strategy becomes energy conservation, not energy production, not energy utilization, energy conservation. If I’m now conserving energy above all costs, then I’m only going to be making the amount of energy that I absolutely have to, to survive today.
Along those lines, this is not the time, then, that I have the energy to engage my detoxification pathways. This is not the time that I have the energy to have all of this digestive health and vitality. I’m doing the bare minimum to expend energy. We even see that in the breath, which then has its own downstream effect. The breath will go shallow but very, very slow so that a person can sometimes look like they’re not even breathing because their chest is not moving much because the body is like, “I’m conserving energy.
“It takes energy to breathe, so I’m going to breathe, but just enough to not die and not use up a lot of energy.” Even then, that affects the diaphragm because now the diaphragm is a muscle. Muscles take energy, so the diaphragm isn’t moving as much. It creates all these changes that then have their own downstream effects, and one of the many is this oxidative stress. We see the oxidative stress accumulating inside of the cells, inside of mitochondria, and then traveling to the nucleus, where it starts damaging DNA, which is fine. We get DNA damage all the time, every day.
Ari: Speak for yourself, I don’t. No, I’m just kidding.
Aimie: Okay, superhuman. [laughter] We have innate repair mechanisms. This is what I studied when I worked in Dr. Larry Loeb’s cancer lab. We have innate mechanisms that repair our DNA. What happens is that the damage of the oxidative stress, the amount of oxidative stress, starts to become more than what our repair mechanisms can keep up with. That’s what [unintelligible 00:44:31]
Ari: It’s all amplified by being in that cell danger response as well.
Aimie: Exactly. These repair mechanisms, all of the innate repair mechanisms that the body has, whether the DNA repair mechanisms, detoxification repair mechanisms, all of the repair mechanisms, are not able to be utilized when the body is in shutdown mode, which is energy conservation mode. It’s allowing all of this danger to accumulate because we’re needing to wait and have the monster pass and go away, and then we can come out of this trauma response.
That’s where we, humans, get in our own way because we’re not actually completing that response. It feels like the danger still lingers. It feels like we’re never in true safety. Our body then lingers with that background anxiety of, “But the danger could still be there. But it might come back, but we’re not safe yet, so we can’t really let our guard down.” If we can’t let our guard down, we can’t repair things.
That’s not the time to repair. Repair means being safe enough to slow down and stop because I’m not needing to protect myself. I’m able to be in repair mode and restore myself from the damage that’s happened. Then that’s how the damage accumulates, which, because of the role of oxidative stress, that is just another feedback loop for creating more oxidative stress, which then creates more mitochondrial compromise and more cellular membrane damage.
That’s how things accumulate over time. This idea that time heals all wounds is bullshit. No. What time does is it only accumulates the damage underneath the surface until, like me, you wake up one day and you can’t get out of bed because it’s built up over time, and you didn’t even feel it building up. You were so disconnected and just going through your busy life, unaware.
Ari: Maybe I’ll save that, actually. Staying on the topic of markers, oxidative stress certainly is one, but requires maybe a test that one can do to identify if they have significant, more elevated levels of oxidative stress. I’m curious subjectively how one might look into their own physiology or look into their own subjective psychological experience of how they go through their days to be able to discern as a strong indicator of, yes, you have past trauma, or I would put myself more in the camp of, “Yes, I’ve been through some real bad experiences in my life, but I don’t conceptualize myself as being traumatized; I conceptualize myself as I went through periods that were very difficult, very depressing, extremely stressful.”
I was telling you about writing two books for the last year. I’ve had parts of the last year that have been somewhat of a nightmare with two different publishers breathing down my neck, very angry at me. None of this I would conceptualize as trauma, right? I would conceptualize all of this as like, “These are difficult, stressful experiences, even if I’m lying awake at night, even if I’m occasionally having bits of panic attacks, even if I’m et cetera, et cetera, but I don’t conceptualize myself as somebody who is traumatized.” What would be the indications, subjectively, that someone has genuinely been traumatized from their life?
Aimie: Sometimes the best thing that we can do, Ari, is ask the people around us, and they tell us how we are acting. Sometimes our friends or our spouse may say, “Ari, I think you’re actually more traumatized than what you think.”
Ari: Is this your way of trying to tell me something?
Aimie: This might be my way of saying–
Ari: “All right, I admit it.” No.
Aimie: In all seriousness, we struggle with the science of knowing how to measure something objectively because, again, if we do a lab test, it’s hard to measure the exact moment in time. Are we measuring “You’re in a trauma response right now,” or are we measuring the accumulative damage on your body and biology over time? It’s very hard to catch something right in the moment because you’re out doing life when moments happen.
The other challenge is that, with that sympathetic tone, we’ve secreted the adrenaline. We’ve secreted the cortisol. Even though once we go into that trauma physiology, they’re no longer operating as well, they’re not as effective, their messages are not being received by the cell, just like with insulin resistance, right? The insulin is there, but it’s still not doing its job.
If we measure their insulin levels, their insulin levels are high. We can measure their cortisol levels. Their cortisol levels are high. Oh, this must mean, and it’s like, “No, that doesn’t mean. That just means that their cortisol is high, not that it’s actually effective because we’ve shifted states.” The subjective has actually become one of the better ways to measure, in the moment, am I in a trauma response? Whereas some of the labs are still the more helpful for realizing the impact on the body over time.
Ari: Right. The labs are all going to be non-specific to psychological stress in particular.
Aimie: Absolutely. As our friend Reed Davis would say, like metabolic chaos, the more metabolic chaos there is, the more imbalances, the more, especially that range where it’s like, “Well, it’s not healthy, but it’s not autoimmune yet. It’s not healthy, but it’s not something we would start you on medication yet.” That’s the range that you’re looking at. This is your body saying, “We’ve been under damage and attack for a long time, and it’s only going to continue over time.”
Ari: Which probabilistically gives us a good indication, if we know the person’s history and that there appears to be a high potential for trauma, you can probabilistically say, “Well, there’s a good chance that this physiological dysfunction is resultant from this, or at least played a big role. The trauma of this person’s life played a big role in this physiological dysfunction.”
Aimie: Exactly. Again, swinging back to that point around, and then that same physiological dysfunction perpetuates these trauma responses, and that’s how it accumulates over time is it really picks up speed like a roller coaster. It just creates that loop where they’re both now feeding off of each other. Subjectively, this is where I’ve landed. I give my people a nervous system journal.
It’s a three-day journal. I’m teaching them how to feel the difference in their inner state between the calm, alive, or parasympathetic, the stress, and that trauma shutdown state so that they know the difference between how it feels, and they’re tracking their nervous system all throughout the day for three days for us to really get good insights on how much time are you realistically spending in that overwhelmed state.
The difference then becomes, can you feel your energy level? Can you notice your thoughts? Can you notice your emotions without getting pulled into them? Can you just notice them as sources of information for, “Isn’t that interesting? It looks like my body might be in this state right now.” I’m often asking people, “What’s your very first thought of the morning? Before you have the thought that you want to change your thought, I want to know the very first thought, because that’s going to be a window into your autonomic nervous system. How are you even starting your mornings? Most people, Ari, most people are starting their mornings in overwhelm. They’re like, “Oh, I don’t want to get up.”
Ari: Aimie, that’s the story of my last six months.
Aimie: For example. We’re looking for those moments when I’m not asking you what you would like to be thinking. I’m not asking you what mantra you have decided to tell yourself right now. I’m not looking for that thought.
Ari: I’m good enough, I’m smart enough, and gosh darn it, people like me.
Aimie: Keep telling yourself that, Ari, keep telling yourself that. It might be true one day.
Ari: Hopefully.
Aimie: This idea that we can create changes in our thoughts, and then we’ve missed the whole thing. We’ve missed the point that actually, that thought was information for me that my state, my physiology, is in a state that’s really creating damage right now. Once I have the ability to shift that state, then that’s what I do with that thought, rather than what many people do is just they chase that thought, and they let that thought go even further into their stories or their beliefs, rather than just seeing it as it’s just information. It’s just information, and once I get that piece of information of “Oh, my body’s just gone into overwhelm, let me pull it out of overwhelm now that I know the damage that it’s creating to my biology.”
The five physiological steps of trauma
Ari: I want to come back to this more because this is really getting at your core methodology and philosophy about what we actually need to do to heal trauma, if that’s the right phrasing. I want to come back to something you alluded to at the beginning of our conversation, which is the five steps or this process of how trauma takes place. Can you talk about those five steps?
Aimie: Yes. There are five physiological steps, and every trauma response is the same, whether this is a car accident, a sexual abuse, a child who’s being bullied in school, doesn’t matter. The body has one trauma response. That was really helpful for me in being able to understand how I could have had trauma when I didn’t see trauma in my past. The first step is always the startle. This is so often overlooked, and people don’t realize the power of the startle moment, and really, the ability for them to divert their body back to safety rather than let it just become a runaway train that takes them all the way into a trauma response.
The startle is the first step where our sympathetic nervous system is turned on because our autonomic nervous system has sensed that something might be wrong, and sensing, right? It’s picked up something in our senses. Whether we heard something, whether we smelled something, whether we saw something, there’s a sense. I want to differentiate that from the brain noticing something because we can startle before we realize that we’ve startled. If we’re out hiking and we hear a snake, we will be jumping before our brain registers that we heard the sound. That’s how fast the startle response is. It comes into our nervous system through the sensory information, and we just get that sense that something might be wrong.
Now, the other purpose of the startle response is also to prime our system for needing to take action if we need to escalate it to the stress response. Let’s say that after we startle, we do confirm that, yes, this is a real problem and we need to do something, that then takes our body, up-regulates the energy production and utilization through adrenaline primarily, and now we are in full response mode, meaning taking action and moving.
The stress response is all about movement and using that adrenaline, and muscles are the primary way in which we use up or release, or I want to say metabolize that adrenaline that’s being released, which is a really important aspect because the excess adrenaline is what causes so much damage to our tissues and creates a whole setup for the fibromyalgia and some of the chronic fatigue that can develop as a result of these chronic trauma becoming a syndrome in my book.
Ari: We are creatures that are meant to move.
Aimie: Move, yes. Just stepping out away from the word trauma for a moment and just looking at our everyday, we have so many sources of adrenaline, even down to the coffee that we may be drinking. When we drink coffee on an empty stomach, we’re secreting more adrenaline with that than if we drink coffee with food in our stomach, which is fine, but are we actually discharging that adrenaline, or then are we sitting at our desk all day drinking our coffee with all of this excess adrenaline and we’re not discharging it because we’re not moving it? That’s when we have sleep problems and we have digestive problems, we have tissue problems, we have pain problems.
So much of it can come back to this idea of adrenaline is there to move us, and if we’re not moving to the equivalent amount of the adrenaline that we’re secreting every day, we will have problems. Then after the stress, what happens next is if we’re going to go into a trauma response, something has to change, and what changes is we realize that our stress response is not enough for the danger that we see, and in this moment, I call it hitting the wall. Whereas if we are running down an alley and we’re running away from something dangerous, we hit a wall. Like there’s nowhere else to go. You are stuck. You are powerless. You are trapped.
That’s then this switch to a survival strategy other than keep running because I can’t keep running. I just hit the wall. There’s nowhere to run. It’s this idea that I’ve done my best, my cells have done their best, and my best was not good enough. Physiologically, it’s like having our foot on the gas pedal all the way. The stress response is foot on the gas pedal. That’s the adrenaline. It’s burning through ATP and trying to create as much ATP as we need to burn through in order to upregulate our performance. This is truly when we are superhuman, and the mom can lift a car off of her child. It’s an incredible state to be in with that adrenaline.
At that point, if nothing that I can do will make a difference, then I shouldn’t keep my foot on the gas pedal. I’m just going to be burning through fuel for no reason at all. That’s when, again, it’s our autonomic nervous system that makes this decision. It’s not a conscious decision. Our autonomic nervous system says, “Woof, we’ve got to change strategy here.” Now, our best survival strategy is not to fight or flight. Now, it’s to freeze and shut down. Hitting the wall then becomes step number four, which is the freeze response.
Many people have heard about the freeze response. In the trauma space, we then talk about how that freeze response immobilizes us, it paralyzes us, and it’s that moment when the panic has reached its peak, and it’s like the full inhalation of the shock of the moment, so it’s [inhales], like the full inhalation. It’s that immobilization of the shock that stuns us. The reason why it stuns us is because we can’t believe what is happening. That is an important element to a trauma response. We can’t believe that this is happening. Then there is this physical sensation that that creates, like the sensation of the fear, the sensation of the shame, and all of that is so awful to feel that it then becomes something that’s unbearable.
In this moment of the freeze response, that is unsustainable. It’s this moment where our body is like, this is such high panic and high energy to stay in this frozen state, it’s better for me to let down and shut down. That’s then the last step. That fifth step of the trauma response is now the actual shutdown, and I learned to be able to feel that in my body. I remember a moment standing in front of my attending surgeon as he was getting me in trouble for something that I had done or didn’t do. I don’t know. All of a sudden, he became my father, and I was the little girl again. [chuckles] I’m a grown-ass woman, but in that moment, I became a little girl again and I could feel this wave of heaviness wash down my body.
It was the first time actually that I remember being able to feel that trauma response happening in real time, and as a scientist, it became very interesting for me. Emotionally, it was very devastating for me, but scientifically, it was very interesting to actually be able to feel what feels like the vagus nerve as this message of shutting down travels through my body and taking me from this really high anxiety like, “We got to get this done. He’s going to be mad at us,” to like, “Shoot, he is mad at us, and now my world’s going to fall apart, and I’m going to fall apart because I’m going to die homeless on the street because he’s upset with me.”
Being high functioning and carrying around trauma
Ari: I think you might be a good example of this, but I’m curious to how you would conceptualize, is it possible to be highly functional and well-adapted in your life and also be traumatized? To what degree does being traumatized entail also being functionally disabled in your life to some degree?
Aimie: I see very high-functioning people carrying around a lot of trauma. Looking back at my experience, I had two master’s degrees. I was in general surgery residency. I was very high functioning, even physically, running five marathons and doing century bike rides.
Ari: Geez. A high achiever. Just looking for attention for all your accolades, huh?
Aimie: Thank you.
[laughter]
Ari: Just have to be perfect at everything, huh?
Aimie: Well, looking back, that’s what I was trying to do. That’s exactly what I was trying to do. My drive for that was not from a place of health and vitality necessarily, even though at the time I wouldn’t have recognized that. My drive was, I need to stay busy because I don’t like to be with myself. I’ve now talked with many women, and I’ve met many entrepreneur women, multi-million-dollar businesses, and when they hear what I do for work, they stop and they say, “Wow. Yes, no, I wouldn’t want to work with you. I pack my trauma really well so that I can function.”
Ari: That’s interesting. To what degree is that adaptive in a healthy sense or pathological? I mean, if somebody has gone through circumstances in their life that have surpassed the threshold of their capacity to handle those circumstances, i.e., they’ve been traumatized, is it arguably better to– obviously, it’s better to not be traumatized in a perfect world, but if you do go through experiences that do traumatize you, is it better to cope with them in that way, where maybe you compartmentalize, maybe you somehow suppress those experiences, those aspects of you to still be able to be very high-functioning, as opposed to maybe an alternative– and this is a false binary, but an alternative where you maybe are very debilitated by those same roughly equivalent circumstances?
Aimie: Oh, what a great question. I am definitely at the point in my life where I look at any aspects of the trauma response and our adaptations to it, and nothing is bad. If at this point in your life, that’s what allows you to get up every morning, then okay. Then okay. The body is so incredibly able to adapt. It is so adaptive, and so it will be like, “Oh, you want me to hold this trauma for you? Okay, I’ll hold this trauma for you,” and it will do it for us. I see a lot of complexities of life, and there’s so much gray. There’s not much black and white when it comes to trauma.
There are definite benefits to the numbing and the living disconnected and protecting our heart and not letting people in. That can be the best thing for us at that time. What we do need to know is that even though we’re able to successfully do that for a time, it will come at a cost. As long as we know that and we’re okay with that, okay. Pay the cost later on. Just be prepared for that. Make plans for that. Don’t plan to never have to deal with this because that’s when life will bring you something where it’s like, “No, you’re going to have to deal with this now,” and it’s never at a good time.
I do see that there have been times in people’s life, for whatever reason, and I’m even especially thinking of people in war zones, that’s not the time to sit around in a circle and open up and talk about your feelings, like, you’re being bombed. No. The body will help you survive what feels unsurvivable and just know that it will come at a cost. Eventually, you will want to then create space for healing so that you can repair that cost, and that’s really then the message of the Biology of Trauma book is now that we have this damage, now that we’re aware of the damage, let’s repair, because that’s where we can regain so much of what we’ve lost or how we’ve adapted.
Even in that, we don’t want to label that as bad or wrong. It’s not. It’s just how the body helps us survive. I think back to when I was helping my patients detox off of substances as an addiction medicine doctor, and there’s a lot of people who would say all substances are bad. Yet, I’m working with these people, and I remember many gentlemen who had started using as a teenager because their life as a teenager was so awful, that was the only relief that they found. They’re now in their 50s. They’re now in their 60s. Are you going to tell them that starting to use substances to help them survive their childhood was wrong, was bad? I’m not.
I’m going to say, “Good on you for surviving. Now, let’s do the repair, unless you really want to live this way for the rest of your life.” That’s how I see the difference is a person being able to see, what am I needing to do to function this way? There we go with my camera again. What are we needing to do to function this way? If what I’m needing to do to function is not aligned with my values, it’s making me into somebody that I don’t want to be, or maybe I’m starting to drink more alcohol than I really know is healthy or than I want to, then that’s the time for us to re-evaluate. I’m paying the cost, is it still worth it to pay the cost, or is it time to unpack, open up, and heal that pain that I’m carrying so that I don’t have to keep functioning around it and trying to still adapt?
How our beliefs change our trauma responses
Ari: I have a couple more questions for you. One is, I’m going to try to formulate this in real time as I ask it here. In terms of vulnerabilities to being traumatized, we might conceptualize that as on an individual level, and I know you discussed this in the book, talking about individual vulnerabilities to making one susceptible to being traumatized, but if we were to expand that idea out to a cultural phenomenon, we might conceptualize certain cultures. This occurs across cultures, but also across time periods.
The way that, let’s say, the generations who went through the Great Depression, World War I, World War II, mostly World War II, look at the young generations. Like my grandpa, for example, fought in World War II. He was in Pearl Harbor. My dad grew up as a little kid right on the heels of that experience, like many in his generation did, and that very much shaped their worldview of actually going through an experience like that, and they look at the young generations of today and they say, “Oh, you’re a bunch of pansies, toughen up,” that sort of thing.
As we mentioned earlier, a lot of the young generations now have this hyper-attentiveness to trauma being triggered, needing to be protected from things that people might do or say that hurt their feelings or offend them, and things like that, to– this also, let me expand this across cultures as well, where we might see, let’s say, contrast that young generation of modern American culture, let’s say, to somebody of equivalent ages in Zimbabwe or something like that, just to mention a random place where maybe you grow up on the streets, maybe you grow up in poverty, maybe you grow up having to deal with famines, maybe you grow up dealing with wars, maybe you grow up having your brother kidnapped, who then becomes a child soldier, and really, really horrible things that you might experience, where in contrast to, let’s say, the typical American youth who doesn’t experience bad experiences anywhere close to that magnitude or intensity.
Yet those two cultures might have radically different conceptualizations of trauma or whether they are personally traumatized or not. Somebody can go through those in like, let’s say, a culture like that, they might go through really horrible experiences, yet not have any real concept of being traumatized. If you were to describe trauma to them and say, “Do you feel this way?” They would say, “No, bad stuff happens.”
Maybe this is not universally true. I’m painting with broad brushstrokes here, but I imagine, and I’ve traveled to many places all over the world, so I have a good sense of cultural differences in this regard, but it seems to me that modern American culture has currently this hyper-attentiveness to trauma, this hyper-awareness and focus on the bad experiences of one’s life and how we have been permanently or semi-permanently harmed by those bad experiences.
“I am this way,” “I’m all screwed up now because my parents did this,” or “I went through this early in life,” and so on. What I’m curious is, on the meta level, to what degree does that kind of belief system of that hyper-focus on hyper-attentiveness to trauma, the belief that bad experiences lead to permanent harm, to what extent does that actually make you, ironically, more susceptible to being traumatized?
Dr. Apigian: There was a research study done in the 1960s that was not intending to study one’s belief, but that’s exactly what the study looked at. It was a study done on dogs, I’m so sorry, and it was done by a behavioral psychologist, Seligman. He took a group of dogs. He put them into a container that had two sides. One side of the container had a mat that provided electrical shocks. The other side of the container was perfectly safe. They were separated by a very low barrier that the dogs could easily jump over. Half of the dogs, he tied to the wall by their harness. The other half of the dogs were roaming free. He turned on the electrical shocks. All of the dogs tried to jump. All of the dogs tried to jump. The only dogs that successfully jumped were the ones that were free to jump. The other ones tried but couldn’t.
Ari: I’m going to cover my dog’s ears right now because my two dogs are listening to this discussion right next to me.
Dr. Apigian: This could be traumatizing for your dog.
Ari: Yes.
Dr. Apigian: He does the same experiment. This time, he doesn’t tie any of the dogs up. They are all free. Same dogs, same container, puts them in the same side, same mat, same process, turns on the electrical shocks. The dogs who had jumped over before, Ari, this wasn’t even a stress for them anymore. They knew what to do. It was more of an inconvenience. “Oh, darn it. I’ve got to use the energy to jump over this wall,” but it wasn’t the surprise and the panic and the, “What is this?” and “I don’t know what to do,” and “Oh, I’m so glad that I can be safe now.”
It was just, “Ugh, we’ve been through this before.” That speaks to some of what we’ve talked about already, which is just this idea of having the nervous system flexibility, of having experienced hard things before, that our nervous system is like, “I got this. It’s not a problem. I’ve got this.” Now, the other dogs, did the other dogs who had previously been tied up even try to jump over? They did not. They didn’t even try. They watched their friends jump over. Do you know what they did? Those dogs laid down on the mat and whimpered.
Ari: This is a really fascinating way to answer my question. I’m surprised that you went here. I think it’s really interesting. I’m a little surprised that– because, actually, normally, if you were going to talk about belief, you would almost rule out animal experiments because we have a sense. We can’t know or directly understand what an animal believes. Where we can, with a human, we can just ask them. This is very interesting that you’re getting into this nuance of where we can assess to what degree these dogs formed the belief that they cannot escape and to which that belief was persistent even in the absence of being physically constrained to that space where they’re being shocked.
Dr. Apigian: That belief led them to be susceptible to more and more trauma unnecessarily. That’s how deep trauma responses get wired into our nervous system, that this now became something where I’m not even going to try. It’s, this is my default response. When we look at this at a cultural level, we can see this. This becomes the default response to everything so that it’s now even wired into our neuroplasticity. We don’t even think about it. We don’t think about how we’re going to respond.
Our body just responds for us to the point where we won’t even try to do hard things because we have the belief that has been learned from previous experiences that we can’t do hard things, or whatever that belief is. Whatever the believe is, that’s what I wanted to show you, is just how deep those beliefs are inextricable from our nervous system. They are part of our nervous system. It’s not like you can separate your beliefs from your autonomic nervous system. They are part of what your nervous system has perceived as the size of the danger and your capacity to meet a size of danger.
How to learn more about trauma – safely
Ari: It’s a lovely way of answering that. Now, let me ask you this. There is this balance between educating people and trying to help people who are traumatized, for example, writing a book, like you’ve done on the subject and doing the work that you do, and not wanting people to be so overly attentive or overly fearful of going through adversity or bad experiences. Having this awareness, just the awareness of all of the harm that bad experiences can potentially do could theoretically create a nocebo effect, which is essentially what we’re talking about here, which is having the beliefs about how bad bad experiences are for you essentially makes them much worse.
This relates to also Alia Crum’s research out of Stanford on people who either believe stress is harmful or stress is enhancing, and how that differentially affects their physiology as they go through the same objectively stressful experiences. Anyway, but there’s this really interesting fine line between how do I educate and help people with trauma and teach them about all the bad stuff that trauma does to their physiology and avoid setting them up to be more vulnerable to trauma. How would you conceptualize or communicate that distinction?
Dr. Apigian: You know what you’re reminding me of is the motivational interviewing that I was taught in medical school. It’s a whole class. How do you motivate your patients to do things that will help them have better lives and better health? This is, I think that we can look at it in terms of theory, but we can also look at it in terms of the really hard life experiences that people have where they have family members who are stuck, and how do I even approach them? How do I work with them?
For me, how do I help people not have that fear so that they’re able to do the work? It is a fine balance, and what I keep coming back to is just this idea that when we actually are entering into whatever process we are, how important it is to stay within our window of tolerance. Like you and I can talk about homeostatic capacity and that window. For other people, it’s just this idea of we have a window of tolerance, and that’s where we can feel safe enough.
Even though we’re going into stress zone, it’s still our growth zone, and we’re feeling safe enough. That’s where we need to stay within that range. Once we start getting past that range, there is no growth, but the painful reality of human nature is that sometimes that’s where a person has to be to be motivated to change, and so I do not protect people from their, I want to say their realization of just how bad the situation is, how serious this is, how much damage there has been done. I don’t protect them from that. My job is to educate and then provide the way and the path forward.
Until they’re ready to take that path forward, they’re sitting with all of this information, “Oh, can I keep going? Can I keep functioning? Can I keep adapting? Can I push this off longer?” It’s almost my job as the physician and educator to, this is what they taught me in the motivational interviewing, to paint the picture of how bad it is, and that’s a hard realization. That’s a moment where many people just sit there in silence. It’s like when I give them a diagnosis, “How bad is it, Doc?” “Well, it’s really bad,” and it sometimes needs to be really bad for people to then be motivated to actually do something about it, because if it’s not bad, then they’re like, “Okay, I’ll keep doing my life and I’ll be back in a year. Maybe we’ll do something about it then.”
Ari: It needs to be bad enough to serve as a catalyst for change.
Dr. Apigian: Yes. It needs to be painful enough to create the catalyst for the change.
Ari: Aimie, hold on one second. My laptop’s about to run out of batteries. I’m just going to grab the charger and then we’ll wrap up. I’ll ask you to talk about your approach to healing and then we’ll wrap it up.
Dr. Apigian: Okay.
Ari: Thank you for staying on extra time with me.
Dr. Apigian: Yes. If this is the only way that I can see you, well, then [laughs] this is what we got to do. Now I understand why it’s been so difficult to get responses from you.
[pause 01:24:55]
Ari: All right. I’m ready.
Dr. Apigian: Hopefully, I didn’t become one more trauma with your two publishers being like, “What’s going on?” Then Aimie’s like, “Ari, where are you?”
[laughter]
Dr. Apigian: You’re like, “Get away, people. Give me space to breathe.”
Ari: I’ve needed a lot of alone time, for sure, lately. Definitely, that’s true.
Dr. Apigian: Are you an introvert?
Ari: Very much so, yes. I like my alone time. It’s hard to motivate me to go be social, for sure. I haven’t been to Mindshare, I don’t know how many years at this point, if it’s two or three or what. It’s hard for me to do that. I think you are too, right?
Dr. Apigian: I am a very strong introvert, yes, to the point where I am afraid to get into a relationship and marry.
Ari: Uh-oh, do you want to talk about your trauma?
Dr. Apigian: Oh, that would be interesting. That would be interesting. Do you know that I was in a relationship that I definitely should not have been? It definitely was not healthy.
Ari: Recently or a long time ago?
Dr. Apigian: It was a few years ago. I’m in this relationship and I’m like, “Well, it’s okay for the moment. It’s okay for the time being,” even though I know that this really is unhealthy, and I’ll even use the word toxic for me, “But it’s not painful enough yet. I’ll adapt and I’ll function with it.” The week that I was like, “No. No. Nope, no, no, we’re done,” and I actually brought closure to the whole thing, a few days later, I passed a parasite.
Ari: Wow.
Dr. Apigian: This kind of stuff, you just can’t make up. This connection [crosstalk]–
Ari: Is that your way of saying you killed the guy?
Dr. Apigian: [laughs]
Ari: Is he the parasite that passed?
Dr. Apigian: Right, exactly. The code word for how I really brought closure to that relationship.
Ari: Talk about closure, geez.
Dr. Apigian: Talk about closure, but it was fascinating to me. It was just this moment of realizing truly how deep the connection goes between emotional toxins and actual real-life parasite toxins. To the body, they’re just toxins. It’s all the same, and when we release and get out of something, then we have the space to be able to release other toxins. It’s truly fascinating how deep this stuff can go.
Ari: Scientifically, the parasite could be a confounding variable in your perception of the relationship. Maybe the guy was actually a really nice guy and you were just Ms. Crankypants, irritable. He was doing his best. He was awesome. You were just too hard to please because you were irritable from all these parasites in your belly. Have you ever considered that possibility?
Dr. Apigian: I’m so offended that you would think that I could ever be irritable.
[laughter]
Dr. Apigian: No. For me, that’s the whole concept of The Biology of Trauma, is that, wait a second, the more toxins that I have, the less health I’m going to have, and the more bad decisions I’m going to make about my emotional health, about my environment, about the people that I hang out with, so those toxins. One of the key factors for me was discovering that I had a copper excess. What happened was that I was–
Ari: How did you develop that? From copper plumbing or from taking supplements or what?
Dr. Apigian: Yes.
Ari: Were you influenced by Morley Robbins’ work?
Dr. Apigian: [chuckles] I’ll tell you the story. I didn’t know, had no idea until I got into a bad car accident in 2016, and I was not recovering. I remember two, three months later and I’m still sitting in the bathtub taking Epsom salt baths every single night as I’m feeling like I’m going deeper into chronic pain, and I’m going into depression and anxiety. I’m gaining all my weight back, and here comes the fatigue back. I’m like, “No, I’ve done so much work. Why is this happening? Why is my body not recovering?” I had remembered being introduced to some of these ideas around the biochemical imbalances, and I was just like, “Oh, isn’t that interesting?” but I had never looked into it or done those tests myself.
At that point, I’m like, we got to go find what’s wrong. I do a bunch of tests, including biochemical imbalances specifically looking at the copper and zinc as part of that. Sure enough, this huge copper excess came back. Huge copper excess. As I looked at what was happening, I did have a copper IUD at the time. Then I likely also had some form of genetics, because we were supposed to be able to clear copper and some people have just a decreased ability. Now, whether that was my stored trauma that was impacting my detoxification pathways or my snips in my DNA, I don’t know.
Ari: You had a genetic intolerance to having copper objects inserted into your body.
Dr. Apigian: I did. Here’s one of the crazy things–
Ari: I hate it when I have genes that do that.
Dr. Apigian: I know, right? I had started to develop symptoms from that copper IUD, and I had gone to my OBGYN who had put the thing in and I was like, “We got to get this out. I know this sounds weird, but it’s causing burning, and I think it’s creating bladder infections.” She’s like, “That’s impossible. This is in your uterus. The bladder is not connected to the uterus. That’s impossible.” I’m like, “Look, honey, I’m a doctor too, so stop [crosstalk]–“
Ari: Did you call her honey?
Dr. Apigian: I think I may have missed the honey, but it was just like, “Don’t talk down to me,” because that’s exactly what she was doing. I was like, “If you talk down to me as a colleague, how are you talking to your patients?” She was literally saying, “This is all in your head,” and I was like, “Whether it’s in my head or in my uterus, we’re taking it out because I feel that there’s something going on and it’s different than before I had this.”
Ari: Which responded, “You’re acting hysterical. Maybe we need to cut your whole uterus out to get rid of this hysteria.”
Dr. Apigian: [laughs] Yes. Then we need to look at your hormones and put you on some type of hormone therapy because you’re obviously a hysterical woman and incompetent and shouldn’t probably even be a doctor.
How to help people resolve life trauma
Ari: [laughs] All right. I have just a few more minutes and my wife, I’m going to go pick up my son from school and take him to soccer practice. I want to make sure we speak to your methods and then we do a proper wrap-up and let people know about your book. The last thing that I want to get to is what do we do about this? What is your method for helping people actually resolve or heal from their life trauma?
Dr. Apigian: Again, I am reminded of my journey and my previous philosophy of, can I just cut it out and go under anesthesia and not have to deal with it? I don’t like to talk about feelings. I don’t like to feel feelings. I don’t even like to talk. I just want to cut things out. I have come a long way. What has been that process is realizing that there’s a reason why I was scared to actually feel my feelings. I should be scared to feel these feelings that were so intense that I probably would have fallen apart if I allowed myself to feel them. In fact, when we go into a trauma response, the feelings that are created are so intense. That’s what the trauma response does. That’s part of the trauma response.
I think to disrespect that or to poo-poo the fear that people can have of, “You mean I have to actually feel that grief?” We’re talking about real things. People lose their child. Their child dies. All the stories that can happen, and we’re asking them to feel that right. I realized that so much of what we need to do is actually very similar to surgery. When a person would come to me and they would have something that needed surgery, we were not taking them to surgery that moment.
We were not saying, “Okay, it needs to come out. Let’s do this right now.” It was, “Let’s stabilize your physiology so that we can do the surgery safely,” and it would be weeks, sometimes months. Sometimes they would need a whole nutrition plan to get their protein levels up high enough, all for the purpose of when we do the surgery, we want to do it safely. That started to give me this idea, maybe I need to do trauma work safely. Maybe I actually need to do some form of preparation phase to create the safety to open up and do the surgery, the trauma surgery.
Then I started asking a very different question, what would that safety look like? What would it mean to actually feel safe to open up and feel? That then became my study, how do we create this safety? That’s the process. The process is not, “Okay, let’s just jump in,” or “Okay, give me the laundry list of everything that happened to you in your childhood, and let’s go through the stories one by one.” It’s this idea of how do we make it safe to feel? We’re not even talking about the past now. We’re talking about the present moment. How do we make it safe to feel what is going on in your life right now? That’s the preparation phase.
Then when we’ve gotten really good at shifting our nervous system state in the moment, being able to feel what we’re feeling and shift in the moment, then we’re starting to bring in that nervous system flexibility that we’ve talked about how many kids do not have when they’re sheltered too much. They don’t have the nervous system flexibility. One hard thing comes, and they’re like, “Oh,” they’re wilting, and they’re calling it trauma. It’s like, oh, we’ve got to actually build these skills of nervous system flexibility, and then we can do a little deeper work.
Then we can do a little deeper work, but we’re going to do it in such a way that we’re staying within our window of tolerance, we’re staying within the window in which our nervous system can move through and be flexible so that we’re not going into overwhelm, because there is no healing in overwhelm, and so we can heal in stress, and trauma work is stressful. We need to be able to tolerate that stress without going into overwhelm. That’s why we create this foundation of safe enough and even finding what is my window of tolerance right now? How can I find that and stay within that?
You alluded to this idea that a lot of people just, then just stay safe, and that’s not the idea. Staying safe, finding safety is just the first step. Then we do the stress part. Now we’re actually engaging just like we would go to the gym and exercise and grow our muscles. We have to engage in that stress of our nervous system, but staying within our window of capacity to build our capacity and [unintelligible 01:37:16].
Ari: It’s analogous to or maybe I’m curious to what extent you would conceptualize this as essentially exposure therapy.
Dr. Apigian: Exposure to your feelings. [laughs] Yes, that’s exactly it. It’s to the degree, Ari, that some people come into my programs, they are so unable to feel anything. They’ve been so numbed and shut off and disconnected that five seconds of connecting with their body and they’re like, “Okay, I’m done,” and I’m good with that. If that’s where we need to start, then we start with five seconds. I call it micro-dosing safety where we start. It has to be a micro-dose because even sometimes when we’ve lived guarded and hyper-vigilant our whole entire life, when we experience safety and we relax, it’s all of a sudden our body’s like, no, that’s not safe to relax.
We have to stay guarded. It really is coming and just doing micro doses of safety to be like, we’re going to start here, and then we can build on that over time. Expecting to be able to relax, be able to feel our feelings and connect with our bodies after we’ve never done that is unrealistic, and that’s why I think people try to do too much too fast and then give up on the whole thing because it is overwhelming to do that.
How does healing from trauma look physiologically?
Ari: Last question. Physiologically, what is healing from trauma?
Dr. Apigian: You know what I think of? I think of a little baby chicken inside of its shell. That’s where we often go when we’ve experienced trauma and we’re afraid of the world. We’re afraid to be alive. We’re afraid to have an open heart. We’re afraid to love. We’re afraid to be loved. We’re afraid to be seen, and so we can hide in this shell. Oftentimes, it can feel like people are tapping on that shell and trying to force us to come out of the shell. We’re like, nope, that sounds dangerous. That feels dangerous. If we are applying a lot of external force, the shell will break and then we die.
Instead, what happens is that as that baby chicken starts to grow and it starts to feel safe and says, “I do want to grow up. I do want to live outside of this shell. I do want to see the world,” and as it grows, it starts to apply that pressure from within and the shell starts to break. When the pressure is applied from within, then life emerges. That’s when we’re coming out and we’re seeing the world with new eyes, and we have a joy for life, and then we continue to grow as we build our capacity. To me, that’s what the healing journey looks like.
Physiologically, what does that look like? Physiologically, that means right now your body may be in a shutdown state. Everything is shut down from your metabolism to your gut, to your nervous system, lymphatics, detoxification system, all of it, so your capacity is so small that, yes, you are inside of that shell. If you wake up one day and you’re like, “Okay, I’m just done with this, and I’m going to live differently,” and you try to live differently, you can’t, because now this has become your physiology. This has become your current capacity. We come in and we say, okay, if this is your current capacity, let me meet you where you’re at.
Now what I’m going to do, though, is I’m going to be providing you things to provide a cellular safety. I’m going to be identifying what imbalances do you have? What deficiencies do you have? Ah, you’ve got the common magnesium deficiency. Let me start there, because I know that magnesium is so important for all the thousands of reactions that we have in our body that if you’re running low, of course, you’re going to stay in danger zone. Of course, you’re going to stay with your lower capacity. I’m looking for ways to bring energy and resources into the cells at that level. What about clearing the oxidative stress?
That will help shift out of this cellular overwhelm and into more of a biology of safety. I look at what can I do to increase energy? I can take away things that are draining energy and being able to allow that to fuel the increase of our capacity so that that’s then the healing journey at that physiological level is being able to come out of that shell because at a cellular level, we have now resourced ourselves. We’re not still running on fumes and trying to just push ourselves. We are resourced and being able to have this surplus of energy fuel our ongoing growth.
Ari: Beautiful answer. Dr. Apigian, I have enjoyed this conversation immensely. It is always a pleasure to hang out with you and to do these conversations and to get to explore your mind. Normally, I do a lot more talking in our conversations when we hang out. I share ideas with you. I enjoy the back and forth, and this has been all about you and your wonderful, brilliant new work and your new book, The Biology of Trauma, which I’m super excited about. I highly recommend everybody go out and buy that right away. This podcast is going to come out in early-ish September. The book is coming out September 23rd. Is that right?
Dr. Apigian: Yes, September 23.
Ari: Okay. I got an advance copy of it several weeks ago, and I wrote an endorsement for it. My endorsement better be on it, by the way. Better have made one of the covers, back cover or something, hopefully.
Dr. Apigian: Yes.
Ari: Awesome. It is a brilliant new book, and I truly mean that. I love how you’ve put the pieces together in a novel way. I love how you’ve integrated a really scientific physiological understanding of what trauma is in a way that no other book has. I especially love how you’ve integrated mitochondria and the cell danger response into this book, which, to my knowledge, no one else has really done in your field. It’s just phenomenal. I love the work you’re doing, and I want to support you in every way I can. For everybody listening to this, I encourage you to go out and get this book on Amazon or wherever you buy books. Dr. Apigian, what do you want to let people know? Where else can they follow you, learn about your work, work with you? Tell them whatever you want to tell them.
Dr. Apigian: Yes. If they’re buying my book now, then that means that it hasn’t come out yet, and I will share my first three chapters of the book for them to be able to start reading now. If they want to order it and then come to my website, biologyoftrauma.com/book, and I’ll be able to give them the first three chapters to start reading.
Ari: Beautiful. Thank you so much for your time. I know we’ve both been busy with our respective books in recent months, but it would be awesome to get together for lunch with you sometime soon.
Dr. Apigian: Absolutely. Thank you for the work that you do, Ari.
Ari: Yes. Likewise. Thank you for the work that you do. It’s brilliant, and thank you for coming on the podcast again. I hope to talk to you again soon.
Show Notes
00:00 – Intro
01:41 – Guest Intro – Dr. Aimie Apigian
04:23 – The Biology of Trauma
06:04 – The current views on trauma
11:33 – How the body can respond to trauma
22:08 – The stress response evolved for a reason
30:53 – Why stress affects us differently
40:41 – The physiological hallmarks of trauma
55:43 – The five physiological steps of trauma
1:04:12 – Being high functioning and carrying around trauma
1:11:24 – How our beliefs change our trauma responses
1:21:03 – How to learn more about trauma – safely
1:33:10 – How to help people resolve life trauma
1:39:46 – How does healing from trauma look physiologically?
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