How to Talk about Your Trauma

Go slow and give it time to land. Plus, the mental health of doctors.

Last week’s post struck a chord. I had three folks write me back, specifically asking about how to make intergenerational trauma not feel so heavy.

So this week, I’m answering a reader question on that topic. Then after that, I’m sharing some thoughts on the mental health of doctors (trigger warning: suicide).

Let’s start with the reader question, shared here with permission, and lightly edited to further conceal identifying details:

Hi Pooja,

The trauma I hold IS heavy and I would love for it to be lighter - and here I don't mean through therapy. The trauma I experienced is core to who I am and I want to be able to show up in the world and in my relationships with my whole, authentic self. I don't need or want the trauma to be the only thing people see or assign to me - but not owning it has felt like masking - and that's exhausting. 

How can one share lightly the stuff that's hurt and caused harm? 

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Who I am and what I hold: I'm a first generation university graduate. My parents both grew up in low socio-economic households and one escaped a former dictatorship. On the ACES Index, I "score" seven out of 10 including sexual abuse perpetuated by my father; I have always suspected that my father was sexually abused as a child. I lost my youngest sister to suicide. Misogyny, patriarchary and capitalism are the systemic roots of my trauma. 

- Authentically Broken + Almost Whole

Hi Authentically Broken + Almost Whole,

First, thank you for sending me this really thoughtful question. It hits on so many important aspects of living with trauma, and I’m excited to provide some thoughts. When I’m answering reader questions, I usually end up asking more questions in response because the reality is that trauma and life and psychology are all complicated, and there is never One Right Answer. There are usually Multiple Right Answers that will work for you, and those Multiple Right Answers depend on your unique responses to more questions.

So, my immediate questions for you are:

1. Lighter for whom?

2. What is your definition of “lighter”?

To me there are two issues at play here— the actual inner experience of living with and healing from substantial trauma, and then the representation/ public display of how you perform (my word) being a person who has experienced intergenerational trauma.

Those two processes are separate and interconnected, perhaps best thought of as in a dance with one another. I read your ask of “Don’t just tell me to go to therapy” as meaning that you have spent time and energy working on healing your internal wounds (an accomplishment in itself, but I think you know that).

I’m going to focus on the performance of being a person who has lived with intergenerational trauma, and how to show up in that role in public. I’m using the word performance to draw attention to the fact that it is a public and interpersonal role, not to imply superficiality. The way we represent our identities and roles can be just as important as how we embody those identities and roles internally.

So, after that long-winded context setting, let’s dive in.

Does your significant trauma history feel heavy because you are worried about how it makes others feel when they find out? I know you are worried about being pigeon-holed, and also simultaneously exhausted by masking. In psychodynamic therapy speak (that’s the Freud kind), we would say that you are conflicted in how you portray your trauma and in if your intergenerational trauma history needs to be portrayed in order for you to show up as authentically whole. Because you are conflicted internally, this issue feels unresolved or unsettled, which leads to the heaviness.

I suspect your heaviness has less to do with how others respond to you, and more to do with your messy feelings about how you present yourself.

That brings me to another important point. I think, if you are doing it right (with reflection, flexibility, and compassion for yourself), then you will portray yourself as someone with a varying trauma history depending on context. I don’t think this is disingenuous or inauthentic — I think this is meeting people where they are at and protecting yourself. Protecting yourself does not mean you are showing up inauthentically.

Let’s say you have a friend who is not particularly attentive or caring (but whom you like to spend time with for other reasons). Does this person need to know your whole story for you to be showing up authentically? I would say no. I do not think you need to feel bad or like you are not representing yourself authentically by holding back your trauma in some settings. But, the annoying thing about feelings is we can’t control what we feel.

Source: IG @softcore_trauma

The trauma you describe is what therapists colloquially refer to as Big T Trauma. Most people WILL put you in a box when you share Big T trauma. That’s just the truth. It’s especially true if you share it earlier on in the friendship/relationship because most people have not done the self-exploration that is needed to avoid projecting themselves into that situation. So, from most people, you will get some version of trauma porn sympathy and assumptions about who you are and what you went through. This is a reflection on them, not on you.

Without knowing you and the full extent of your story, based on what you’ve shared and on my experience as a psychiatrist, I think self-protection should be your number one priority. I think that sharing this part of yourself is riskier than you might think, and you should not beat yourself up for keeping it private.¹

If you’ll bear with me for a brief digression, I have a personal story that I think tangentially applies here. A couple weeks ago I reviewed a recording of one of my most recent keynote talks. In it, I briefly mention my own most dramatic trauma (being in a cult-like group for two years- I also consider living through medical training a traumatic experience, but for these purposes, it was the cult thing). I don’t get into details, but I do share that this is part of my story. I asked my team to review the footage and give me feedback. One of my team members said, “You didn’t need to tell that story. I don’t think the audience had earned it yet.” Her words have been knocking around in my mind since then. I wonder if that line resonates with you. Has the person you are considering earned this story yet?

Some other thoughts for you to consider before we get to the last bit of your question:

• I do think that leading with your trauma will always be riskier than you assume it to be (not because of how others feel, but because it exposes you emotionally).

• Think of revealing your story not as a binary choice, but as if there is a volume dial on it. To some, it might be “I had a pretty crappy childhood” and leaving it at that. If someone presses you more, that’s a data point for you to be weary, and you can say “I don’t like to get into it.” People who make it to your inner circle should be people who over time got to know more bits and pieces of your story, and have responded with care and respect each time you shared more. Notice I say, your story and not your trauma. The reality is that you are the only one who fully holds your trauma — that’s the cost of being human. Your significant other and your closest friends may not always say the exact right thing, they will mess up, and they can never fully hold all that is there. But, they can treat your story with respect and care, and see you as a multifaceted individual — and they should, otherwise they haven’t earned being in your inner circle.

• The burden of controlling the volume dial (and, in turn, who you let in) falls on you, and this sucks. It will always fall on you and that sucks even more. People with a history of big T trauma can be prone to picking the wrong people and then risk being re-traumatized, which also makes this hard (I’m guessing you know this already, otherwise you wouldn’t be asking this question). I know you mentioned that you didn’t want me to say “go to therapy” in my answer. I’m sorry to say this, but I do think with Big T trauma, long-term therapy (with a good, trauma-focused therapist), helps to lessen the burden. The cadence of therapy could vary based on what’s going on: maybe it’s a once a month check in, maybe every two weeks or even every couple of months. The reason I bring this up is because a good therapist is someone who is there with you to help hold the trauma, and, has no vested interest in the personal decisions you might — unlike a partner or a family member.

• A good rule of thumb might be: go slow, collect data, give it time to see how it lands for you.

Feeling pretty proud that I worked a Beyoncé pic into this post. Source: Beyoncé’s IG

Now, on to the last bit of your question — how to have all of this feel lighter and less burdensome, especially when you are “masking”. As I was writing my response to you over the past two days, I had a thought - would it be possible to use another word besides “masking” to describe what’s happening in those moments? For example, when Beyoncé forays into country music, we don’t say she’s masking her authentic self; we say she’s trying out a new genre. What if these aren’t masks, per say, but instead different styles. What if you can be authentic in multiple genres?

Okay, we are now finally in the last leg of my response (now you know why I am a therapist, ha). In psychological terms, we use the word “resolution” when describing the conclusion of a conflict. When a conflict is resolved in your mind you aren’t litigating it anymore, and you also aren’t feeling guilty or ashamed about said decision. Your paradox is that you don’t want to be defined or boxed in by your trauma, and you worry about the heaviness of masking if you hold back.

Here’s where I land: You can portray your whole authentic self to others without naming your trauma. You don’t have to name it for others to feel a representation of it, and to experience you as whole.

I think the the lightness you are craving is actually acceptance. Acceptance is the final stage of grief. I think you might be asking for permission to grieve that this paradox is one you will forever hold.

The painful reality is that you cannot control who accepts the whole you and who does not. You can only control what you accept about yourself. Because of your history, you will always be someone who is in a dance between public and private. You could view that as heaviness and burden, or you could view it as multifaceted and textured. In the end, you get to decide how to be whole.

xo,

Pooja

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Trigger warning: suicide

Healthcare workers need to stop eating their own

Last week there was another tragic physician suicide. We lost the life of Dr. William West, an ophthalmology resident at George Washington University.

Right after I found out this terrible news, I was set to address a group of about 200 Kaiser Permanente doctors in Maryland as a keynote speaker for their wellness weekend. I decided to start my remarks off with a moment of silence for Dr. West. Later in my remarks, I also decided to read on stage a tweet I had come across from another doctor responding to the news that Dr. West had died by suicide.

I read this tweet not to shame anyone, but to ask an audience of my peers why we treat each other this way?

Medicine is broken- that’s no shocker to anyone who has interacted with our healthcare system in the United States. But healthcare workers are broken too. Here are some stats from the American College of Emergency Physicians:

• Women physicians have a suicide rate that is 130% higher than women in the general population.

• Male physicians have a suicide rate that is 40% higher than than men in the general population.

• Every year 300-400 physicians die by suicide.

In the United States, physicians grow up up in system that is incredibly hostile to them. In 2023, the average medical student graduated with $200,000 of debt. This does not include college debt — only debt from four years of medical school. Imagine signing up to do a job that you’ve never really experienced or tried out, spending four years raking up debt, only to start the job and not like it. It’s horrific.

The Federation of State Medical Boards (FSMB) in 2018 came out with four recommendations so that state medical licensing boards could be in compliance with the ADA in terms of how they treat doctors who have mental health struggles.

A 2023 JAMA paper found that only three (!!) states met all four of those recommendations. This means that in most states, a physician’s medical license (eg. the source of their livelihood) could be at risk if they seek mental health services.

I don’t know anything about the person who tweeted the terrible response above — but what I suspect is, just like his peers, he was broken down by a masochistic system and is inflicting that pain on others. Pop into any hospital cafeteria, doctors lounge, physician Facebook group and you’ll hear this type of rhetoric. And, it’s not considered rude or gross because the culture of healthcare is sick. My heart goes out to Dr. West’s family. We need to do better for our doctors.

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Other things:

• Book Birthday: Real Self-Care came out exactly one year ago, on March 14, 2023. I actually forgot that it was my book birthday until my mom texted me a video of K just starting to crawl from one year ago. When Real Self-Care was published, my life changed. And, I hope some of yours did, too. Thank you deeply to all of my readers. I am forever grateful for how you have made my words your own.

• Read me: It was very cool to be featured in last week’s Big Salad Therapy Issue by

  Joanna Goddard
  . Big thank you to Joanna and to
  Kaitlyn Teer
  for helping to bring my work to a bigger audience!

• See me: On Friday morning I’ll be speaking at The Report on the Status of Women and Girls in California at Mount Saint Mary’s University in LA. Tickets are sold out, but there is a livestream you can watch! You can register here.

• Bring me to your job: I’m booking speaking gigs for May (Mental Health Awareness month). If your organization needs a mental health speaker, I’m your gal! I particularly love speaking to healthcare workers but I also have keynoted for educators (higher ed faculty, early childhood), tech folks, corporate consulting folks. I’m agnostic. Check out my speaking page here.

• Just for fun: the comments section of these new Free People “shorts” had me rolling.

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This is your reminder that my answers to reader questions do not constitute a diagnosis, treatment or medical advice. This newsletter is not a substitute for therapy.

1. As Dr. Lakshmin, in sessions with patients, I rarely tell them what I think. A fun part of writing to you all as “Pooja” is that it’s okay for me to tell you what I think because I’m not your therapist or your psychiatrist.