Dr Rupy: So and so took your lunch from the fridge at lunch at work. It's pretty annoying. But maybe that's like a three out of ten. What did you do? You threw your computer out of the room and burned the building down. That's a nine out of ten. So where's that six come from? The additional response, where did it come from? And the answer of course is it came from the past and something has happened which has happened over and over and over again and there's an accumulation of potential to respond to this trigger, which then all comes out in one go.
Dr Rupy: Welcome to The Doctor's Kitchen podcast. The show about food, lifestyle, medicine and how to improve your health today. I'm Dr Rupy, your host. I'm a medical doctor, I study nutrition and I'm a firm believer in the power of food and lifestyle as medicine. Join me and my expert guests where we discuss the multiple determinants of what allows you to lead your best life.
Dr Rupy: There is a growing recognition that many mental health issues such as depression, anxiety, insomnia, poor cognition and memory, as well as physical issues, are the results of the high prevalence of trauma, post-traumatic stress and adverse childhood experiences, also known as ACEs. And that only by addressing trauma and rebalancing the nervous system can we address these mental and physical health issues successfully and sustainably. And what I wanted to know from my guest today, Benjamin Fry, a leading psychotherapist in the UK, was what are the signs someone has unhealed trauma in their life? And how can somebody heal from that trauma without necessarily using supplements, medications or even novel therapeutic agents like psychedelics? Throughout my medical career, I've suspected the role of trauma in the root cause of patient's conditions beyond the diagnoses of typical mental health illnesses like anxiety and depression, but actually in autoimmune conditions such as inflammatory bowel disease and even type one diabetes. And so to have the opportunity to explore some of these ideas with Ben today was a pleasure. We discuss internal threats, perception, gratitude, one of my favourite topics, and how we can reframe our natural negative dispositions and why we reflect and respond to trauma differently. Remember, you can watch the podcast on YouTube, just go to The Doctor's Kitchen on YouTube. You can download The Doctor's Kitchen app for free from the app store and you can subscribe to the Eat, Listen, Read newsletter. Every single week I send you something to eat, something to listen to, something to read, some mindfully curated content to help you have a healthier, happier week. On to my podcast with Benjamin Fry.
Dr Rupy: Ben, I'm going to ask you a very direct question. What are the signs that somebody has unhealed trauma in their life?
Benjamin Fry: Well, it's a great question. Probably numerous and multiple and sometimes a little bit baffling. And also things that we've kind of gotten used to and taken for granted and think are normal that probably aren't. I think I'd like to back you up one step and ask the question to you, what is, what do you understand by trauma? And you can answer if you like, or I can answer it for you.
Dr Rupy: Well, I mean, in my, the first thing that comes to mind when I think of trauma, having worked for many years in A&E, is physical trauma and being in a trauma centre. Although I am widening the aperture of what I understand trauma to encompass being as much of a mental health issue as it is a physical health and the connections between both, obviously.
Benjamin Fry: So where, I mean, if you think about physical medicine, let's say you're in A&E, what, how do you know something's a trauma injury rather than not? What, what makes that distinction for you there?
Dr Rupy: Yeah, so for me, most people come in with a physical injury.
Benjamin Fry: So something that's kind of happened from the outside? Is that the idea of what trauma is?
Dr Rupy: Yes. Yeah, yeah. That that's the the the externality. It's very, I guess, you know, very.
Benjamin Fry: And obviously they're unrecovered. That's why you see them. If you know, if a conker hits me on the head and bounces off, that's an external event, but so what? No big deal. I think it's very much the same in the psychological frame of reference. So, interestingly, you'll be aware as a GP that the body has these kind of twin currents that are very important called the parasympathetic and the sympathetic nervous system. And they actually mediate the response to threat in your environment. So, the typical arc of a response to threat is, as we might be aware, you know, I get, I get a kind of activation of adrenaline and I get charged up to deal with something. The threat goes away and then I kind of discharge and relax. So you think about you're in the kitchen and you hear a plate break behind you. There's that kind of shock. And you can probably notice your heart's racing before your brain is saying what's this. And everything's slightly out of sync. And you notice there are these different systems running, which is like there's a hardwired response to threat. And then there's a cognitive catch up. And then a kind of story you tell yourself, oh, you know, Bob's always breaking plates in the kitchen. And then a calming down. And your brain has said there's no threat here, long before your heart stops pumping and the adrenal stop. So these, there are these mismatched systems in the body, all mediated by different areas of the brain, which you'll know about, like the limbic system and the prefrontal cortex. And they're all doing, they're like in parallel circuits, just up to their own thing independently. Interestingly, when we think of psychological trauma, it's a little bit more complex than that because what's happened is that something threatening has occurred. Now, it may be perceived as threatening or actually threatening, it doesn't make any difference. The moment the body is triggered to go into a threat response, we're off and running on that arc. And then, as you know, there's a kind of override to threat response, which we might call freeze. When something is so threatening that accelerating the body's response would actually just burn it out, we tend to just give up. And this is usually a response to overwhelming threat. Now, you can think about things like a war where, you know, it seems like you're outnumbered and outgunned and it's just a disaster. Or think about something like being a small child where you literally can't survive without benign parenting. And so any sign that the situation around you is maybe a little bit wonky is actually a life and death threat and can be overwhelming. So freeze happens to different people in different situations for different reasons. The point of it though, is that in order to complete your response to threat, you have to unfreeze at some point later and go back to the energy of fight and flight, go back to activation and complete the discharge of that. The same way you did in the kitchen when the plate smashed and you felt activated and then you calmed down. This is what you see in mammals in the wild, like a gazelle being chased by a cheetah will freak out and occasionally they get caught and they'll go completely rigid and freeze and sometimes the predator will be disturbed. They will then kick their legs, twitch, run around. Five minutes later, back at the water hole, no harm, no harm done. So the problem with humans is that we are so complicated that we've actually managed to interrupt our own biological, normal biological process of a, of a normal arc in responding to threat. And we don't unfreeze very well. And I think the reason for this is that we have an extra layer of mental activity, which I might call self-awareness. So, take the example of the gazelle, the lion has moved off, the gazelle has sort of frozen for 90 seconds and then the biology starts to reboot. And the first thing it does is behave as if a lion is about to eat it because that's what it was doing when it froze. So that's the arc, that's what needs to be completed. Now if you and me are at the bus stop and we start behaving like we're about to be eaten by a lion, there's a, there's an observer in us that looks at us and goes, don't be bonkers. This is going to worry the people standing next to us. What's wrong with you? You're so crazy. Everyone always said you'd be a loser. Oh my God, your life's a disaster. You'll never get to work and you'll get fired and your girlfriend will leave you and you'll lose your home. And all of that happens in a, you know, few moments. And so what we do is we push back. You know, from the prefrontal cortex, we push back on the limbic system that's just trying to do what it's been doing for about a million years. And it doesn't know any other way of doing it. And you'll know it's called the autonomic nervous system. And autonomic means out of conscious awareness and control. So you have these two currents working, which is the, the million-year-old learned evolutionary arc of response to threat, which is very important because there's nothing more important to evolutionary success than surviving threat and predation. And then you have this more modern, very adaptive response of becoming an intelligent, sentient being that can control its environment. I mean, look, you know, the advantage of being human is we control nature rather than we're at the whim of it. But we're now controlling our own nature and screwing it up. And so what you end up with is you're trying to come out of this well of being frozen, but you just keep dropping yourself back into it. You try and come out, you keep dropping yourself back into it. So you actually live in a vortex of running away from the gazelle, from the lion forever. And this then impacts into a kind of frozen sense of your biology somewhere, your biophysiology is altered. But it's also always trying to emerge. So you tend to gravitate towards people, places and things that are likely to restimulate the thing that was most difficult for you in the past. And then you're like, well, why does my life go around in circles? Why is everything always like this? Why am I always marrying the same woman? You know, why is it always going, and it's very frustrating. So coming back to your idea of what's, what it's like in A&E. Yes, it's, probably the genesis of most trauma is an external event, just like a, you know, a car accident. But the real key thing is that it's not yet finished. So we talk about PTSD, that's post-traumatic. Post-traumatic means you must have frozen in response to this threat. You will never have PTSD if you never froze. You just, you know, you go up the arc and down the arc and you're good, you're done. And stress disorder means that you're still in a disordered relationship with your stress response system because that threat's not happening right now, but the stress response is still going on. So, it's, it's all about the, the impact from the outside, but also the scale and the fact that it's unfinished. So, getting back to your actual question of, you know, what, what, what does trauma look like in daily life? Do you know or have you ever met anyone who seems to respond to something in a slightly exaggerated or understated way?
Dr Rupy: Oh, absolutely.
Benjamin Fry: And that's the legacy of trauma. Right? Because if you're, if you've got a completely clear system, the kind of homeostasis that you would hope to be born with, your response to external stimuli will, will match. It'll be, you know, if you're slightly annoying, I'll be slightly annoyed. If you're hugely annoying, I'll be hugely annoyed, and so on. And you can see this in relationships so clearly, is that some people are always like over the top, some people are kind of totally shut down. And these are disordered responses to the actual level of threat in your environment. You can even think about it kind of quasi-mathematically. You could think, well, what's the scale of this trigger? And you could ask a friend, you could take, I mean, it's why groups are great processes for this. You say, well, you know, okay, so so-and-so took your lunch from the fridge at lunch at work. It's pretty annoying. But maybe that's like a three out of ten. What did you do? You threw your computer out of the room and burned the building down. That's a nine out of ten. So where's that six come from? The, the additional response, where did it come from? And the answer of course is it came from the past. And something has happened, which has happened over and over and over again. And there's an accumulation of potential to respond to this trigger, which then all comes out in one go. So, that's kind of the first layer. It's like, my, my thinking and my behaviour and my reactions to things are either overblown because everything comes up all at once, or underblown because everything really comes up all at once. And once again, I'm tripped over my switch and I go into freeze. Um, but then what does that do to a person's life? Well, one of the things it does is it makes us, it makes us have a slightly skew-whiff relationship with reality, because the only way I can think I'm not crazy is by believing that the danger is really happening right now. Otherwise, I, if, if I'm feeling like I've got a nine out of ten reaction to you, and everyone's telling me that it's not that big a deal, then I'm going to feel like I'm the problem. And people don't like that. So there's a lot of projection, um, there's a lot of, uh, self-deception, I suppose. And then what you'll usually see is that this creates difficulty in relationships. So it's quite hard to be in a relationship with someone who thinks that you're a huge threat or is kind of so shut down that you get nothing back from them, even when you're annoying them, you get nothing back. Because you know, sometimes people are trying to make a bid for connection by being provocative and you get nothing back. Uh, so if you've screwed up your, your biology, your sense of reality, your ability to have relationships, uh, and in the broader sense, I mean, like you can't hold down a job because you so hate your boss because he's reminds you of your father and that's unfinished stuff like that. Um, you just have multiple problems in your life and life gets more difficult. And the tragic thing is that those are all the things which can contribute to creating a sense of safety in an adult's life. So if I have a good career, if I have good relationships, I have good health, I have good sleep, all these things, it's a virtuous circle to having a better regulated nervous system. Take them all away, and life really does become more challenging, and it really does become less safe. And then the wrinkles in what I would call my dysregulated nervous system, or what you might think of as a lack of homeostasis in the autonomic nervous system, those wrinkles are just exaggerated by real, again, real events from the outside. Like the car crash happens every single day. Um, so this is why I think it can be so pernicious is that if we, and if you just get down the wrong side of the mountain, the ball just keeps rolling. And what we want to do is help people to find strategies and treatments to help their nervous system become better regulated, restore a sense of homeostasis, make it easier for them to live with themselves and live with others and live a productive, cooperative life in the world. Uh, and thereby establish a little bit more robustness from the outside, which then gets mirrored as you grow robustness on the inside, which interestingly, is kind of like what people hope for to give children, infants. Is that there's a, there's a sort of maternal bubble that holds while they grow and learn from that example. And then there's an internal boundary that that comes into play somewhere in childhood and people start to be able to hold themselves. So once you've lost your holding inside and outside, you're in trouble. And at the most extreme end of that, that's why I think it's, you know, it's necessary to do residential treatment sometimes for people because you literally have to kind of create a new sense of holding. And then you can start to build the layers from the outside in.
Dr Rupy: Does any of that make any sense?
Benjamin Fry: That makes sense to me. I want to get to the different modalities of treatment on the one side being perhaps the most extreme because I can't find another word, being residential, I guess, where you have to really take a a truly holistic um treatment modality versus some other practices that perhaps somebody could do with the guidance of a practitioner or even even simpler than that, an app or some some reading materials. To summarise what you were talking about in terms of the way in which we process emotions, it sounds like there are advantages of being human because we're sentient and we can interrupt certain cycles, whereas for lesser developed mammals, there is a normal sort of response to threats and then a dissipation of that energy after the threat has has gone. Whereas we have the option of holding onto that threat and it's something that can stay with us for months, years, entire lifetimes. At the two ends of the extremes there, you might have somebody who has PTSD from what many people would regard as a very stressful event. But then you also have levels of similar responses that you might expect from an extreme event, but from something that's slightly more subtle. And I wonder if there are ways in which people, perhaps listening or watching this, can determine if they have unhealed trauma in their life in the most subtlest sense as well. And what are the physical and mental manifestations of that beyond the throwing the computer out the window and burning the building down, that perhaps are a little bit more insidious and perhaps something that you wouldn't initially think of as as necessarily trauma.
Benjamin Fry: Sure. I mean, in a way, it's a good question because look, probably everyone has unfinished response to threat somewhere in their system. So the question is, when does it really matter and when is it really a problem? Um, most of what we think of as fairly complicated and severe mental illness is probably sitting on top of a reservoir of, uh, quite disruptive, um, body physiology due to this trauma mechanism. So that's probably at the, you know, that extreme, people who present to like psychiatric hospitals, many of them will be dealing with the legacy of these problems. Then you come right down to the other end of the spectrum where people are having hugely productive, mainly happy lives, but they might find that there's some very specific wrinkles that are very difficult, like they really struggle with, say, their relationship with food, or they really struggle with their, their romantic relationship, or they've got one child that drives them mad. You know, there are these things that seem like outliers. And I think in anything where you find that your, your response to life is quite strong, there's an opportunity to investigate, is this me or is this the world? And obviously you can take a consensus from other people, you know, is my husband really that awful? And you might get many different responses. But interestingly, I think that the, there's a kind of like a spiritual discipline of, uh, how many fingers do I want to point out versus how many fingers do I want to point in and what do I want to look at? And I think for people in their, in their, in the spectrum of just normal daily life, you can do a lot to shift the needle because if we think about this problem as being effectively a battle between the mammal and the reptile part of the brain and the human part of the brain, which I often call the limbic system and prefrontal cortex, we spend an enormous amount of our bandwidth and energy fueling the prefrontal cortex. We're very, very pleased with ourselves. We're pleased with our ability to think. And we sit and we have like internal monologues with ourselves and dialogues all the time. It's what we're always doing. And it leaves very little room for other processes that are lower in the brainstem and more connected with the body to occur. So there's been a massive uptake in things like mindfulness and meditation in the last decade or two. I would see this as a direct correlation to people beginning to realise or discover that actually the more you quieten the prefrontal cortex and the more you allow the rest of the body to have a bit of bandwidth, that things get better, things get easier. The body has its own wisdom. The wonderful thing about this is that anything that has been emerging through evolution for a million years is ready to go. You just have to get out of its way. And the first thing you do with the prefrontal cortex is you educate it because it loves to learn. It loves to understand the causality, the aetiology. That's what we're doing right now. Anyone listening to this who doesn't know this already is actually reprogramming their prefrontal cortex to be a bit more forgiving when they're trying to maybe release or complete some experience they've had in the past. Um, so I think you were asking kind of what could people do or what, what could people notice that they might need to do? It slightly depends on the severity of the problems you're experiencing in life. Um, I think you can start with self-help. So you can start with this, this kind of psycho-education is great. And if, you know, people want to look at my website and see more information, which is all free, that's great. Uh, then you can start to take action on things like that. So if it appeals to you, if the, if the theory kind of grabs you and you think, oh yeah, this sounds like me, and you think, well, what can I do about this? And so things like mindfulness, meditation, yoga, tai chi, anything that quietens the mind and gets the body back, um, online is usually quite helpful. You kind of see, does this, is this contributing to me being more regulated? Is this contributing to me being, uh, more in sync with my environment? Are my, are my reactions more appropriate and more proportional to what's really going on? That's a sign that you needed extra regulation, right? You needed extra holding in that space. Then if you're interested, you can start to think, well, where does this really come from? Because it's one thing to be successfully plugging the leak in the dam. It's another thing to have a dam that doesn't have any leaks in it at all. So then you can go a bit deeper. And usually, uh, I mean, I think if you're, if you meditate up a mountain in a cave for 25 years, the system will deepen and do this automatically. But I think a lot of people like to have a bit of help. Um, so you can access things like somatic referencing therapies, like somatic experiencing or sensory motor psychotherapy, or even EMDR is the same channel. Um,
Dr Rupy: What, what are those for people that?
Benjamin Fry: Well, they're, they're psychotherapies. So you would be sitting like you and me talking, but I would be more likely to say to you, rather than what are you feeling or what are you thinking, what sensations are you aware of? So we'd actually be using the wisdom of your body to connect over time to the events that are unfinished in your, in your body, in your nervous system. Um, you can also access these kind of things in groups, which I think is very powerful. The problem is that these are fairly specialist modalities and they're not really available at scale and certainly not always free or cheap. So the best thing if you can't access them is to really help your prefrontal cortex learn what it is you would be trying to do for yourself and then try and do it. And, you know, things like nutrition also very important. If you're not driving signals of threat through eating toxic substances or eating things that overwhelm your nervous system, then you'll be creating space for these things to emerge. But, here's the bad news. If you think that the problem is an unfinished response to an overwhelming threat, what do you think the solution is going to feel like once you start making some progress? What it's going to feel like is I'm two years old and I'm experiencing an overwhelming threat. And nobody wants to go there. So once you start to withdraw the things that keep us from ourselves, then the healing emerges, the healing is not always easy or or pleasant. So there's a lot of resistance. I mean, we all know we should like sleep more, exercise, eat well, meditate. But why don't we do it? Multiple reasons perhaps, but I think one of the deeper reasons is that actually it will, it will introduce us to ourselves and the places in us that we've been running from for our whole lives. Nonetheless, that's a short-term problem. And if you can stick with it, you've got a long-term gain.
Dr Rupy: There's a couple of points I want to pick up on there. Um, you mentioned, uh, what I heard is being more intuitive about how your body truly is physically and, and, uh, from a psychological point of view, how you're feeling on a day-to-day basis, which is why meditation modalities are so, um, popular right now. And I think even more so given the number of distractions we have, whether it's music, social media, email, etc, etc. We're becoming more disconnected from actually how we feel. And there are less moments in our 24-hour day cycle where we have the opportunity to sit down and be quiet and just breathe, for example. The other thing, um, is that it is quite uncomfortable to do some of these practices like you've just talked about. It's easier to, uh, expect a pill or expect, uh, something else that is slightly more acceptable, improving one's diet, improving one's sleep and going to the gym a bit more as a mechanism as a treatment, uh, rather than, you know, doing the more uncomfortable work of perhaps revisiting experiences in the past. And I wonder how people approach that in your experience. I mean, for sure, even for myself, I approach it with a lot of hesitation because it is painful and uncomfortable. Is this something that you think is becoming a lot more popular? And I guess the other question to that is, can you treat the most severe conditions with the this kind of treatment, revisiting the traumatic experiences and and completing the cycle, so to speak?
Benjamin Fry: Well, look, I'm a living example of that. I mean, I would say my life was saved by this work. And 12 years ago, I was just sort of beyond, beyond anxious and I had a very extended nervous breakdown for about a year. And I ended up in a clinic in Arizona for five months, which is where I discovered this kind of work. Um, and you know, I went to the fancy hospitals, I went to the fancy doctors, that was a disaster. I mean, I went to everything. I went to the faith healer, I went to the witch doctor. And there was as many opinions about what was wrong with me as there were people I could go and ask. Um, it turned out they were basically all wrong. And that I had PTSD from my early childhood, um, which had kind of flared up as I approached 40 and life on the outside was genuinely complicated and difficult. Um, it was the time of that global financial crash in like 2008, 9, which was affecting me and I had a young family. You know, it was just normal things that people survive when they've got an intact basement. But I didn't have an intact basement. My mother died when I was a baby and there was all that waiting to be dealt with. So, for me, the only thing that helped me in the most serious mental health crisis I could imagine surviving was somatic therapies. Um, I had a little bit of medication, but I was very, very sensitive to medication. So a lot of time people with trauma are because their, their injury effectively is things have happened to them from the outside. And medication can feel like something you get very hypervigilant about because it's a change, right? It doesn't feel good. So, yes, I mean, I would say these are, I mean, these are very appropriate modalities for very severely affected people. But before you can, if you like, um, move on from the past, you have to stabilise the system enough to be able to bear to kind of briefly, even momentarily revisit and to resolve things. And yet, at the most, uh, unsevere level, these things have a lot to be recommended for them as well. I think that there's, there's a distinction to be made between kind of managing a problem and removing a problem. So if you just think about it in a different way, you might have, say, a thorn in your foot, right? And it's making you uncomfortable. So, you might go to the doctor and the doctor says, well, you've got thorn in your foot disorder. And what you should need to do is get some nice soft Crocs and put an ointment on your toe every day and maybe occasionally you need a bit of antiseptic. And you manage and it's okay and life goes on and you can now, you know, function again. But it's, um, probably intuitively more attractive to have someone to remove the thorn from your foot. A lot of the problem with mental health, um, well, mental health medicine, if you like, is that we have a thing called the DSM-5 or, um, I mean, there are other, other,
Dr Rupy: ICD.
Benjamin Fry: ICD, exactly. And what it does is it codifies symptoms into disorders, but they tend to be just the disorders labelling the symptoms. So when I went to hospital, I spilled my guts to the medical director and he's like, right, well, you've got general anxiety, generalized anxiety disorder. And I said, I know, I've just told you. But what's wrong with me? He said, no, no, you don't understand. You have generalized anxiety disorder. And he actually literally, I was there with my wife at the time, he said, we were so disbelieving of this, the low-tech response. He said, look, it's in a book. I can get it for you and show it to you. Um, and that's when I realised I was really in trouble because I thought if I go to a hospital, they might be able to help. And that was a problem. So, I think the great thing about all of these ideas as they relate to mental health is that you get an aetiological story. This is no longer just a sweeping up of your symptoms into a label with some capital letters. We can actually say, here's, here's something that makes sense to us causally. You've got a body, it has these components in it, you have a history, the components have malfunctioned relative to each other, and the natural consequence of that would be you would either be overreactive or underreactive. And look, your body is, your behaviour is, your thinking is, your reality is. And guess what, even in, even in a session, even in a group session, you can take someone from being obsessed about, say, you know, my ex-boyfriend, and return them into working through the body to resolve something, to discharge something briefly. And you can see that the power of that obsession moving from a nine out of ten to a three out of ten in ten minutes. And that's just not possible with any other kind of explanation. I mean, you couldn't do that with medication. I don't think you can even do it with CBT. It's like, the power of us, the power we have to disregulate ourselves from being not connected to these original injuries is, is phenomenal. And you know, the body has enormous power. I mean, the, the things that can go on in the physiology from a shift in awareness from, this is the nicest, most safest, most cosy place I've ever been in, to I'm in the wilderness and a lion is chasing me. I mean, if you were an alien and you visited Earth and you saw those two humans in those two different states, you would think these cannot be related. These are not things that seem to have anything in common with each other. Someone like smiling, laughing, cuddling, sleeping, and someone wildly running for their life, manically trying to destroy another organism to survive. You know, the, the strength of that in the body is, that's, I mean, that's the extremes of it, right? And so what we're talking about, we're talking about that spectrum, but we're wandering around Westminster ordering a sandwich. And that can get really complicated.
Dr Rupy: You mentioned your own experience having a nervous breakdown a few years ago now. You mentioned the loss of your mother, uh, in your childhood. What, would you have recognised those traumatic experiences prior to your breakdown around the global financial crisis? And, and can you speak to a bit more about those, those experiences that you, you had that could have been the foundation for you experiencing later in life?
Benjamin Fry: You mean my early childhood? Yeah, so, you know, my, my mother got ill with aplastic anaemia when I was a few months old and then died when I was 11 months old. And I was the only child and my father was young and so I went to live with another family for a year and then he remarried, I went back to live with them a couple of years later after that. So there's a lot of disruption, a lot of attachments broken, um, a lot of moving house. And as you probably know, people say, look, if you can get the first three years okay for a child, they've got a reasonably good platform for things that are difficult later on. The first three years of my life were not great. I mean, they were sort of almost prescriptively the opposite of great. So, uh, that was all, that was all there waiting to, you know, bite me as I grew up and got older. Um, and in terms of what happened when I got older, nothing so out of the ordinary. You know, it was just like life. I mean, life gets more stressful as you get older. If you get married, you have children, or you buy a house, or you, you know, work and everything gets just a little bit more acute, right? So, ideally, your childhood is a preparation for your nervous system to become more and more robust and for your regulation to be a little bit more stronger and for you to understand where your internal resources are for dealing with threat because you had great external resources that modelled it for you. I didn't really get that piece. But I did later on, um, think I was amazing because I went to like great schools, I went to Oxford. The world was my oyster, right? So it's a very bad combination to be expecting everything to be easy and to actually find everything overwhelmingly difficult, um, and to not know why. And to your question of, did I really understand all of this? I mean, look, embarrassingly, I'm a trained psychotherapist and I was a trained psychotherapist before I had a nervous breakdown. Obviously, I knew that, um, you know, if you ask the classic Freudian question, tell me about your mother, there was not going to be a great story. So, I knew I had, I had a legacy of trouble, but I didn't understand how it became so biophysiological, how it was so in the body, how it was something that could not be, um, within my grasp to just take control of. And people say, well, just stop worrying about it. You know, you're just, you can just get a job or just do it. It's like, yeah, I'd love to. Nothing I would love more than just to stop worrying about it. But meanwhile, there was an engine that was loose inside my body that could not stop. I couldn't sleep and I couldn't think and I couldn't relate and I couldn't laugh, I couldn't do anything. Um, and there was nothing I could do about it just by wanting to, because I was addressing the wrong system. It's a bit like, you've got a car and you're obsessed with putting water in the radiator to fix the fact that the fly, the, the tires are flat. It's just never going to work. However good you are at dealing with radiators, if you're in the wrong system, there's nothing you can do there. So, for example, CBT for, um, what I was going through, just hopelessly mismatched. I needed to get into the place that was the opposite of where CBT works, which is the, uh, the non-verbal space in the brain. And, and actually, once we, once we got going there, I mean, I was very badly ill for over a year, and I was, you know, within, I guess, two, three, four weeks beginning to have a strong recovery. And I remember I went, so I went to this clinic in America, and there was like this big hospital type piece of it, and then the aftercare unit was where they did the trauma work, which I kind of accidentally ended up in. Um, and so when I went there, I was in extremely bad shape. And I was initially admitted to like the nursing unit, the nurses' station. And then when I was later on, like a couple of months later, um, I was in the aftercare unit, and we would go out shopping as a gang to go and buy food and stuff in a sort of bus driven by some colourful local characters, the highlight of our week, so exciting. So we're going to this enormous cathedral of food, which is called a supermarket in America. And, um, I bumped into this lady in the kind of processed meats aisle, and she just looked at me, she's like, Benjamin? I was like, yeah. And I was just hanging out with my roommate and we were chatting and laughing. She's like, she just looked at me, she's like, Benjamin? I was like, yes. I'm sorry, do we know each other? She said, yes, I'm Mary, I'm one of the nurses. I was like, oh, yeah, okay. And she started crying. I was like, what's wrong? She's like, I can't believe how well you're doing. I can't believe that you're okay. I honestly thought you were going to die. She's like, I've rarely seen anyone in bad shape as you. And this is like two months later, I'm in the processed meats aisle at the local supermarket, cracking gags with my roommate. I mean, obviously, I'm still struggling a lot, but I'm on the way, right? And all we've done is somatic psychotherapy, EMDR, somatic experiencing, a bit of group work. And this is what's so, in a way, terrifying about the mental health treatment spectrum, is that if you can just find the right explanation of the problem, then that leads to the right treatment for the problem, which can often lead to recovery. It's a bit like, you know, you, in normal medicine, a branch of like general practice, typically someone comes with something, you're like, yeah, we know what this is. We know what causes this. So because we know what causes it, we know how to fix it. And if you know how to fix it, you can help people quickly. But if they come in and you're like, I have no idea what this is. And you know, it's a much more longer, sadder, more painful journey that you both have to go on as a clinician and as a patient. And I, I do worry that the tragedy of mental health is that, I mean, in general practice, you'll have this idea of medically unexplained symptoms, right? Which is sort of a basket of stuff where it's like, I don't really know what's wrong with you, so we'll have to investigate. I actually think that mental health is a, is a flawed concept. I think mental health is another, is another umbrella term for medically unexplained symptoms. I don't think it's, I think it's smoke and mirrors. I don't think it really has adopted a proper medical method in terms of, let's really understand the mechanism and then let's design treatments and then let's see what works. It's just like, we randomly try this stuff and we research it and we come up with statistics and we think that we're doing better and it's okay. Which I understand. I mean, it's very, very punishing to be on the treatment side and for people to come and, and to be just able to say, we don't really know what's wrong with you, but we'll try something. Um, but I kind of think that's where we are with mental health. And the nice thing is that thing, these emerging ideas, which really come out of pioneers in America, people like Bessel van der Kolk or Stephen Porges or Peter Levine, which you may or may not know about, they're, they're a kind of psychotherapy 2.0. They're saying, okay, it's not all about, tell me a story about your mother. The, the work is not in the narrative, the work is in the consequence for the physiology. And can we go into, can we connect your prefrontal cortex with your limbic system in a way where they can collaborate to clean up your physiology and to move on from the narrative of your past? Because what you want, people say, oh, you know, you're endlessly trying to make me talk about my past because you're a therapist. What I actually want is for people to no longer be living the past in the room right now. So the body is no longer living in the vortex of a trauma response and that the past becomes exactly that. It becomes the past. It becomes a memory. It becomes a story you could tell or not tell and it's not that big a deal. But if you, you know, if you think about something, you talk about something and you're having a physiological reaction, either you're shutting down or you're getting activated, it's not over. It's not over yet. And that's something that you're going to carry with you. And it may be explicit when someone triggers it, but it's always in there implicitly anyway, affecting everything in your life. So, um, you know, my thesis about mental health is that it's really a concept that ideally we would drop. If you could get to the point where you think, well, trauma is not a mental health problem, trauma is in the body. And the body is something measurable, the body is something, I mean, you can autopsy a body and take out the sympathetic and the parasympathetic nervous system. You can't take out worry. You can't take out the mental. You can't take out the mind. You know, these things are just ideas. And they're very seductive ideas. And we all, we all think we have a mind. We all, we all, uh, in love with our thoughts. We all, we all love with our personality, our ego. Um, but these things are, you know, they're really, they're ideas versus biochemistry is real. So, if my heart rate is elevated, it's a real thing that I can know about and measure. And they're all connected, they're all linked.
Dr Rupy: I feel like we're just scratching the surface, but um, I've got so many questions to ask around relationships, uh, within the work environment, colleagues, um, but this has been awesome and uh, uh, I'll definitely put links to your website and uh, your work as well with the residential clinics and uh, uh, I'll be looking for your to, to your talks as well. Um, but this has been great. Thank you so much for your time. Appreciate it.
Benjamin Fry: Sure. Well, thank you very much for having me.
Dr Rupy: Thanks, Ben.
Dr Rupy: Thanks so much for listening to this episode of The Doctor's Kitchen podcast. Remember, you can support the pod by rating on Apple, follow along by hitting the subscribe button on Spotify, and you can catch all of our podcasts on YouTube if you enjoy seeing our smiley faces. Review show notes on the doctorskitchen.com website and sign up to our free weekly newsletters where we do deep dives into ingredients, the latest nutrition news, and of course, lots of recipes by subscribing to the Eat, Listen, Read newsletter by going to the doctorskitchen.com/newsletter. And if you're looking to take your health further, why not download The Doctor's Kitchen app for free from the App Store? I will see you here next time.
