The Trauma Script  ## Metadata - Author: [[Hidden Brain]] - Full Title: The Trauma Script - Category: #podcasts - URL: https://share.snipd.com/episode/deba00c4-4856-4b3a-8c02-2a40e18dda4d ## Document Notes ## Highlights - **Unexpected Quiet After A Father's Death** - George Bonanno describes silence and calm after his father's death instead of expected tears. - He walked in snow and felt relief that his father's pain was over. Transcript: Shankar Vendantam You grew up in Chicago. How would you describe your relationship with your dad? I would say it was a very complicated and fraught relationship. George Bonanno The neighborhood I grew up in was a Sicilian neighborhood, Sicilian immigrants, and it was a tough neighborhood. My father would beat us at times. The beatings were not as bad as the anger that he exhibited. He would go into these rages, and he was a very scary human being then. Shankar Vendantam I understand that he himself was someone who took on a lot as he went through his life. And in some ways, you saw that, and perhaps alone among your siblings, you actually empathized with what he was going through. Can you describe what that was like, George? George Bonanno Yeah, my father worked very, very hard and I think was becoming depressed. He'd also had serious health problems. He'd had several heart attacks. He's becoming diabetic. So his life was kind of slipping away from him. And I would catch him at times lying in the dark in bed, and I would go in and talk with him. And he would say to me basically, you know, don't try to talk with me. And so I think there was a kind of a sense that he gave up what he wanted to do, or he gave up this sense of he could have done other things in life. So this all came to a head when I finished high school, barely finished high school, and then I left home. And my father had said quite infamously in my mind, if you leave now, don't come crawling back. And that, you know, was emblazoned on my mind after that. Shankar Vendantam So you did end up leaving at the age of 17. You traveled widely, including to other countries. Sometimes you slept outside. When you were 23, you found yourself in Colorado and you got a call in the middle of the night. I understand that initially you decided to ignore the ringing phone. George Bonanno Well, the phone rang repeatedly and I was with somebody. I was with a woman that I was very interested in and I didn't answer the phone. After several repeats of this ringing, I decided there was something very much important. Got up, answered the phone, and it was my older brother telling me that my father had died. Shankar Vendantam What went through your mind in the hours and days that followed, George? George Bonanno Well, we were beginning actually to move towards some sort of reconciliation. I don't think that was likely to happen, but we were kind of somehow trying to find each other a little bit. And I was not sure at that point, I had not experienced this kind of death before. And I was wondering what would I experience. And And what I experienced was essentially silence. It was in the wintertime, everything was more or less frozen and covered with snow. ([Time 0:05:40](https://share.snipd.com/snip/0d77f0b7-fef3-4f9b-90ec-0ce0d662d191)) - **College Student Who 'Moved On' Quickly** - Julia returned to school after her father's sudden death and focused on work and friends instead of dwelling on grief. - Her mother worried she was 'denying' grief and pushed therapy, which Julia stopped when sessions ended. Transcript: George Bonanno A college student whom George calls Julia. Julia was home from college, and she was at her family's home. She was preparing dinner with her mother, and the phone rang, and she heard her mother cry out in anguish. And the news was that the father had been bicycling home from work and was hit by a car, and he was in the ICU, the intensive care unit. Julia and her mother drove to the hospital, and just as they arrived, he died. Julia reports that she was absolutely stunned, and she remembers crying a lot, but everything else is kind of a blur. She fell into this state where she was very upset, was having difficulty sleeping, etc. Shankar Vendantam So after the initial shock of her father's death, Julia went back to school, plunged into her schoolwork. When friends asked her if she wanted to talk about her father's death, how did she respond? For the most part, she did not want to talk about her father's death. George Bonanno She wanted to simply be with her friends, as friends, as companions. And she really didn't want to think about it, to dwell on it. She'd already suffered some before she went back to school. And I think now she was very clearly focused on simply doing what she was doing there, engaging in that work and not dwelling on it. She, I think, did well. And then she came home quite excited because she got an internship at a newspaper. She was excited to be doing that. Shankar Vendantam I understand that Julia's mother had some firm ideas about how Julia ought to be responding to her father's death. How did her mother respond, George? George Bonanno Well, her mother was quite worried that Julia seemed to have forgotten her father. She was acting essentially as if life had returned to normal. And her mother worried that she had denied her grief. This was the phrase that Julia used, that she denied her grief and suggested that she, Julia, see a grief counselor to get at the bottom of it. And did she? She did. And it was interesting because the counselor asked her a lot of questions about her relationship with her father. And Julia said something to the effect of, I'm not stupid. I could see what he was aiming at. She was not happy about this, but she played along with it for a period. And then I think what happened was, if I remember correctly, the number of sessions that would be covered, perhaps by insurance, had run out. And it was sort ([Time 0:09:50](https://share.snipd.com/snip/cd36850a-3b02-4db8-9bff-38f97ba67d78)) - **Survivor Who Recovered Faster Than Expected** - Jed was conscious during a catastrophic accident that cost him a leg and experienced vivid intrusive memories for about a week. - Those intrusive memories then faded and he later completed a PhD and became a psychologist. Transcript: George Bonanno Was working at an upscale restaurant in the West Greenwich Village. It was about 1.30 in the morning on December 21st. It was very cold, about 20 degrees Fahrenheit, and he walked to the corner. He remembers seeing the walk signal shimmering off the frozen pavement. So he walked into the intersection and a garbage truck, a sanitation truck, made an illegal right turn very fast and clipped him and pulled him under the truck. It ran over his left leg and hip and just crushed it to a mass of blood and bone. It was a horrific accident. Shankar Vendantam I'm assuming he must have been rushed to the hospital immediately. George Bonanno Not immediately, unfortunately. So the emergency responders came. He recalls this all vividly because he was awake for the whole thing. He was screaming wildly. The police arrived, the firefighters arrived. He remembers that the ambulance was delayed. I believe he thought it was delayed in traffic at 1.30 in the morning. That's possible in New York. He remembers hearing the first responders yelling, put a rush on the bus, which is first responders speak for get the ambulance here. And they told him afterwards that if it wasn't so cold, he probably would have bled out and died because he was bleeding so profusely. But the cold weather slowed the flow of blood. And then eventually the ambulance came and they got him to the hospital. Shankar Vendantam What happened there? George Bonanno They put him into a coma and kept him into a medically induced coma for six weeks. I believe he had 20 surgeries, if I'm remembering the number correctly. And he'd also experienced a number of infections. And they kind of rebuilt his body to function without so much of it. About a quarter of his body was lost in this accident. Shankar Vendantam Did he end up losing the leg? George Bonanno He lost the entire leg and part of his hip. So he's a handsome man. And when you see him on the street, people sometimes do double takes because so much of him is gone. At first, it seems not possible that so much of a person could be gone. And yeah, so he gets around quite well different kinds of equipment, crutches and such, but yeah, a lot of him is gone. Shankar Vendantam So describe for me what happened in the days and weeks that followed this horrific accident and his recovery in the hospital. I mean, he comes out of this, but he's clearly mangled in some ways. George Bonanno Yeah. Shankar Vendantam What happens to him mentally, psychically? George Bonanno Well, his family was first very worried at how he would react when he woke up and found so much of him was gone. He woke up with tubes coming out of him and a chunk of his body missing. But he said that he already knew. It's somehow gotten into his consciousness through sleep. It's not clear how, but he already knew. But then he began to have these just vividly intense memories of the entire accident, because as I mentioned, he was fully conscious for this accident. So he was replaying all of these memories for several days. And then to his surprise, and I think to maybe everybody's surprise, it more or less just stopped. It took about a week. And then all of these intrusive memories and intense replaying of the accident simply just stopped. And he was confused by that. Shankar Vendantam In some ways, his confusion seems to reflect the same concerns that Julia's mother had. In other words, Jed was doing relatively well, but he found himself asking why he was not doing worse. George Bonanno Yes, he was wondering his exact words, why was I doing okay? And he said, this is really my question, why was I doing okay? He'd already taken psychology classes before this accident, but he went back and finished his master's degree and then he ended up getting a PhD in clinical psychology. Actually, he came to work with me, which is how I know him. ([Time 0:13:10](https://share.snipd.com/snip/7aed050d-e58b-4244-9ef9-7acb7d9d266e)) - **Initial Distress Often Subsides** - Initial spikes in distress after mass trauma often fall back to baseline within months. - Early high estimates of PTSD after 9/11 dropped precipitously by six months. Transcript: Shankar Vendantam Experts were very sure about what would happen in the aftermath of the horrific attacks. George Bonanno The general consensus really was that this was going to be a mental health crisis of unprecedented proportions. People were basically arguing that there were simply not enough resources for the kind of mental health problems that were coming. Famously, FEMA, the Federal Emergency Management Agency, allocated I believe about $130 million, which at the time was a lot more than it is now, for emergency funds in New York, mostly To provide free therapy for New Yorkers. So there was this overarching belief that this is going to completely overwhelm the population. We're going to be basically a city of traumatized people. Shankar Vendantam And early research did seem to confirm that there was widespread distress. Even sitting in Washington, D.C., I was a reporter at the Washington Post at the time. I still remember sitting on the edge of my bed one evening, a couple of weeks after 9-11, and I remember wondering if I would ever feel better. George Bonanno So the effects of this were real, and they affected a lot of people, not just in New York, but around the country. Yes, and actually, I think it affected people around the country in some ways even more because there were no cues that this had happened in the past. I vividly remember, you know, I was having nightmares about planes crashing where I lived in New York City. Shankar Vendantam It was a lot of uncertainty, and uncertainty makes people uneasy. There were reports in the New England Journal of Medicine that 7.5% of Manhattan residents met criteria for post-traumatic stress disorder or PTSD, and that proportion rose to 20% For those in lower Manhattan who were close to the World Trade Center and maybe 30% for people directly affected by the attack. So the numbers were incredibly high in terms of the expectations and the predictions right after the attacks took place. George Bonanno So initially, it looked like, I wouldn't say it looked like an unprecedented epidemic, even at that point, though, because those numbers are not that different from other kinds of Shankar Vendantam Major stressors. But they were high. Yes, they were very high. So researchers continue to survey New Yorkers in the months and years following 9-11. What did they find, George? George Bonanno Well, the numbers dropped precipitously, and by six months, they were more or less back to normal. They were quite low by six months for the city on the whole. ([Time 0:19:24](https://share.snipd.com/snip/6b129c82-ea1b-419a-b197-016cace9200e)) - **Stages Of Grief Lack Scientific Backing** - Kubler-Ross stages became a prescriptive roadmap but lack strong empirical support for bereavement. - Research shows people do not reliably pass through fixed sequential stages of grief. Transcript: George Bonanno Well, initially the theory, Kubler-Ross had proposed the theory to account for how people face their own death. And there's hardly any data on that, any research on that, for obvious reasons. People are not interested in participating in research as they face their own death. But then it got foisted onto how people deal with the loss of a loved one. And she didn't actually do that. That was really other people that did that, other theorists. And it became very popular. I think the reason that it became popular, because it's sort of a roadmap. You know, something like grief has got lots of existential threat involved in it. We, you know, we don't think about death very much and life and death. And suddenly somebody's, we've lost somebody. We don't know where they are, what that means. And this theory provided very clear answers. Unfortunately, it's far too neat and tidy to actually be true. And the research has never supported it. There's not really been any evidence that it's actually what people go through. And a lot of research contradicts it. Shankar Vendantam I understand that one of the tenets of the theory is that you have to go through each stage in order to get to the next stage. So if you try and skip a stage, you'll end up suffering for a longer period of time. So in some ways, the theory is surprisingly prescriptive, if you will. It says that you have to go through stage one before you get to stage two, or stage three comes before stage four. And again, this doesn't quite match the scientific evidence on loss and bereavement, right? It does not match the evidence at all. George Bonanno You know, many people don't go through any of these experiences. There's a lot of idiosyncrasies to how people cope, how they react to things like the death of a loved one. And this precision, this sort of sequential perfection, in a sense, doesn't really accommodate it. ([Time 0:25:14](https://share.snipd.com/snip/09be9fdb-80f9-4a44-b022-dd0b49a2cee5)) - **Resilience Is The Most Common Trajectory** - The most common trajectory is resilient functioning: short distress then return to baseline. - Most people experience temporary upheaval but continue to function normally afterward. Transcript: George Bonanno They still have an identity that that's not lost. Shankar Vendantam You found that there are many trajectories that characterize how people respond to adversity and loss. One of these patterns is, in fact, marked by what you call chronic grief. What is this, George? Chronic grief is simply put the inability to get over the loss. George Bonanno We measure it in very clear ways, having a lot of the kind of symptoms we associate with grieving, but struggling to function, struggling to think, to concentrate, to be close to other People. And it just simply can't get past that. So they're suffering and suffering for months and often years. Shankar Vendantam How many people experience this kind of chronic grief, George? Best estimates, I would say, are at the most about 10% and usually less. A second trajectory that you've identified is what you call the recovery pattern. What is the recovery pattern? George Bonanno The recovery pattern is very interesting. It's a pattern that begins with a lot of difficulty, struggle, difficulty, high levels of symptoms and distress. And then gradually over the course of a year or two, the symptoms and the distress diminish and the person moves back toward their baseline, where they were before. It takes time, but they're steadily getting better. A third pattern that you've noticed is characterized by a delayed onset of symptoms. Shankar Vendantam What do you mean by this? Well, delayed symptoms, first of all, we don't really see that with grief. George Bonanno There is really no evidence for something called delayed grief. We do see this when there's a trauma, a potentially traumatic event, but we don't see the classic idea of delayed PTSD. Classically, it was a thought that people would be functioning just fine, and maybe this would be connected to the idea that perhaps they're in denial. And then out of nowhere, they would suddenly develop PTSD. And the same thing was said for grief as well, that people aren't grieving like Julia, perhaps her mother might've thought she's going to have a full blown grief reaction. It's just going to take up on her. So dwelling inside her as if it's a thing, it's dwelling inside her and is going to come out and grab her and then she's going to really be suffering. But the mind and the body don't work that way. The grief and emotions are not dwelling inside us as things. And when we have seen those patterns, they're not quite as dramatic as that. We see with delayed PTSD, for example, people are struggling, not doing very well, but they're barely getting by, and they get a little bit worse. Their level of distress, their symptoms increase slowly, and they cross a line to where they're now sort of officially really suffering. But they've actually been struggling all along. That's the pattern we see. Shankar Vendantam You say that the most surprising pattern is also the most common pattern in how people respond to setbacks and tragedy and grief. George Bonanno What is this pattern, George? It's very interesting. It was assumed that very few people would show this kind of pattern. They might struggle for a week or two, maybe a little bit longer, have some upheaval in their life, they're kind of preoccupied. And then that kind of dissipates and they're more or less functioning normally. We call this a stable trajectory of healthy functioning. And when I first began my career, it was assumed that hardly anybody would show that pattern. And if they did show that pattern, there was something wrong with them. That was the denial idea. When we began to actually look, is what I did in my research, which was the only novel thing about this research was that we just looked and measured the range of possible responses to See how many people were showing these responses. When we actually did that, we found that the majority, it's almost always the majority that's showing that pattern. Most people experience short-term distress, upheaval, and then they continue to function normally after that. It's not that they don't care. ([Time 0:28:33](https://share.snipd.com/snip/53e53705-c79f-4617-b208-7b0bc45464a5)) - **Patterns Hold Across Types Of Trauma** - These response patterns appear across many adversities from injury to divorce and job loss. - Researchers have replicated the trajectories in about 100 different studies. Transcript: George Bonanno Yes, absolutely. We've now done this. My team has done a lot of this, but other research teams are also doing this. We've seen these patterns in now about 100 different studies actually for everything from the worst kinds of events like traumatic injury, mass shooting, spinal cord injury, to things That are like loss and relationship divorce. We've seen it for financial problems, losing a job, etc. So it's the range of anything that's sort of a serious event that somebody's going to go through that's going to upheave them, cause upheaval in their life for a while. ([Time 0:33:20](https://share.snipd.com/snip/120a5d51-8d0e-461f-988d-0877a55e9138)) - **Therapists Overestimate Trauma Prevalence** - Early resistance came from clinicians who saw mostly chronic cases in practice and generalized them. - Bonanno spent decades building evidence to show resilience is common despite pushback. Transcript: George Bonanno Well, I've been doing this for a long time, Shankar. I've been doing this for about 35 years now. So initially, it was difficult. We began to report these findings in scientific journals, and they were more or less ignored. And I was young, and I'm told that I had kind of an extremely young face. So it was easy to dismiss, this is just some young guy doing this research. But over time, as we began to pile up the evidence, the negative reactions began to happen, and particularly from the trauma world. People in the trauma world would tell me, you're a good researcher, but there's something wrong about what you're doing. And therapists would come up to me if I'd given a public lecture and tell me, I'm sure you're a good scientist, but you're just wrong about this. It's just wrong. I know, and you're wrong. And that happened for quite some years. I'd say 15, maybe 20 years even, and it's slowed down a bit. But oddly, there's been a revival of this idea in recent years, a revival of the idea that everybody is traumatized. Shankar Vendantam Where do you think that comes from, George? George Bonanno Well, it took me by surprise. ([Time 0:34:23](https://share.snipd.com/snip/fb41fae8-f622-4e73-88c8-5b0f4a76cd69)) - **Avoid Presuming Long-Term Harm** - Do not assume every painful event will lead to prolonged suffering; watch and respond to real need. - Let children and others resume normal routines unless persistent problems appear. Transcript: George Bonanno I think that there's been a tendency in the last decade in particular of focusing far too much on human frailty, I think, as if people are easily breakable. And there's been a sense of not wanting people to suffer in any way. There's a Greek concept called eudaimonia, which many people might know about, which is the kind of companion to happiness, but it's not happiness in the sense of joy and hedonic pleasure. It's a sense of reward from achieving something. And that isn't always fun. So I think a lot of what's valuable in life requires a little bit of struggle. And there's a tendency right now to avoid any and all signs of that. Shankar Vendantam One implication of this idea, George says, is to not assume that painful and unpleasant life events will lead to prolonged mental suffering. That could be the case, of course, and if it is, it should be taken seriously, and people who are suffering should seek help. But it's not useful to assume that everyone, or even most people, will have prolonged grief or long-term trauma. George Bonanno I've had many experiences like this. You know, I recall once when my children were smaller and there was the preschool they were going to, and one of the teachers told me that one of the children's parents had lost a parent Over the summer break, and she didn't know what to do when the child came back to the class. She asked me if she could talk with me about it. And she said, what should I do? And I said, maybe nothing. And she was quite taken aback by that. But the point I made to her was, you know, maybe this child doesn't want a lot of attention called to him. Maybe he wants to just be a normal kid in the class. Shankar Vendantam Let it play out and see what happens. ([Time 0:41:29](https://share.snipd.com/snip/f65bbf8c-323f-4197-99f0-3662df48d7e0)) - **Use Trigger Warnings Sparingly** - Avoid routine trigger warnings for all content because they can increase anxiety or cause harm. - Use warnings selectively and do not assume many people carry unresolved traumas. Transcript: George Bonanno Trigger warnings were born out of the idea that everybody's, well, there's a widespread idea that people have hidden traumas lurking inside them or past traumas that were unresolved And they're kind of somehow raw inside people. That became a very common assumption. And the trigger warning idea emerged from that as a kind of a way to say, you know, if anybody's got a trauma here in this room or has a trauma lurking inside them, we're going to show some Content here. You're going to experience something if you stay for this presentation that might trigger that. And it was based on the idea that everybody's kind of walking around with these barely below the surface traumas that can explode at any point. And that's really not accurate in any sense of the word. I think we couldn't function as human beings if we were actually built like that. And the research on trigger warnings has shown fairly convincingly that they either don't help or they cause harm. People who are given trigger warnings often are more anxious than people who didn't give trigger warnings, didn't receive them. In ([Time 0:43:42](https://share.snipd.com/snip/396d2cfc-9add-4716-92eb-4a61e9cb5d11)) - **Laughter Can Be Part Of Healthy Grief** - Smiling and laughter during acute grief are common and linked to better long-term mental health. - These expressions help reconnect socially and are part of normal grieving. Transcript: George Bonanno Long-term mental health. The research shows quite clearly that most people, even people who've recently lost a spouse within the last few months, when we did interviews, we found that the majority of people Were showing genuine laughter and smiling during the interview. And that's because these are very social processes. Most of the time when we laugh and smile, almost all the time, it's with other people. And they're very pro-social. They're contagious. They connect us to other people. And what we've seen in our research with grief is that people kind of go in and out of these phases. You might see somebody crying and holding their head and, you know, shaking their head because they're so upset. And then 30 seconds later, they're laughing. They still have tears on their face and they're laughing about something they remembered. And that laughter, we posited, is laughter is a kind of a way to reconnect with the person and almost reward the person for listening, but also rewarding ourselves, letting us feel connected To somebody else. ([Time 0:45:10](https://share.snipd.com/snip/e9e08008-613e-4953-9ab1-8587c6cda6d0)) - **Behavioral Flexibility Drives Resilience** - Behavioral flexibility—adapting actions to current demands—underlies resilient coping. - Resilient people ask, 'What do I need to do now?' and adjust behavior accordingly. Transcript: George Bonanno It's a matter of really working out what is the right way to behave in this situation? What's the right way to cope in that situation? And that led me to this idea of what we call behavioral flexibility. It's a set of skills that we see in people that solve this problem. What do I need to do now? What's the problem I'm facing now and what do I need to do about it? ([Time 0:48:58](https://share.snipd.com/snip/7b0dc7d6-557e-41d9-bb6f-a052f734bcc7))