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<v 0>Welcome to the Adelaide Festival of Ideas.</v>

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Today's session is the Psychology of Trauma. Today.

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We are very privileged to have professor Alexander McFarlane AO,

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and Mr. Gary Outten with us to talk about the Psychology of

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Trauma. We will have 10 minutes for questions at the end.

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Sandy was starting out as a psychiatrist when the 1983 Ash

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Wednesday bushfires struck in the aftermath of the devastating

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fires.

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Sandy worked with affected communities and became interested in the effects of

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traumatic stress in the decades,

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since he has become an international expert on the impact of disasters and

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post-traumatic stress disorder.

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He's currently the director of the center for trauma studies at the university

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of Adelaide.

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Gary is a psychologist by training and he has had 30 years of work with the

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community sector. He's currently working as a trauma counselor with stars,

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and that's an acronym which stands for survivors of torture and trauma

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assistance and rehabilitation services from 2012 to

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2017.

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Gary worked as a trauma counselor at the menace island and our crew of shore

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detention centers. I'll just start us off today.

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I was I would like to ask Sandy about the meanings that

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clinicians attached to the word trauma and traumatized in our popular

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vocabulary. We use these words,

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but I'm aware that clinicians might need something a little bit different when

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they use these words, trauma and traumatic stress.

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<v Alexander McFarlane AO>Well,</v>

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I think that's a very interesting place to start because I think the way we

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use these words and their meaning has actually changed a lot over the last

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four decades.

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And I think it's always one of the risks because I think words can become

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commonplace and in the course of becoming commonplace can

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lose their meaning.

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And I think one of the fascinating things is that when this field really started

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to grow,

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which was in 1980 the idea of traumatic stress really had no

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sort of currency in the, in the psychological literature.

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So all life events, you know,

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stressful life events would seem to be of the same type,

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but I think what then came to be understood.

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There was one type of events and here we're talking about events that involve,

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you know, the,

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the death of people or the serious threat of injury or death or witnessing those

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sorts of events.

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And that's what we really call traumatic stress.

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But I think the way we actually, where we draw the boundaries,

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I think has also shifted with time. I mean,

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I'll never forget having a conversation with a Norwegian psychiatrist.

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He was the professor in Oslo who at the age of 30, was the doctor in,

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he was Jewish and he was able to calculate his life expectancy.

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We had a 3% chance of being alive and he use time.

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Now he was absolutely enraged at the idea that people who were involved in

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severe car accidents for example, claimed to be traumatized.

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So I think it's a very interesting question.

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I don't think there's a simple answer to it.

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<v 0>Okay. Thank you, Sandy.</v>

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And there's an interesting intersection in your lives in that Sandy,

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you were instrumental in founding stars and you were chair from

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1989 to 1993, and that's where you work now in there.

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And I'm interested that I noted that in the,

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in the name of the organizations, you separate it,

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survivors of torture from survivors of trauma.

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If you're giving them a separate mention, Gary, in your work with refugees,

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can you can you describe a bit,

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or tell us a bit about survivors of torture?

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<v 2>Surprisingly.</v>

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<v Gary Outten>There's very little work being done specifically on on</v>

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survivors of torture.

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There are very difficult client group to to work with.

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They have quite unique needs if you like. Em, and

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some of the the symptoms would be that they have this profound

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feeling of profound.

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<v 2>Betrayal.</v>

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<v Gary Outten>That the complete breakdown of our,</v>

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the relationship the sense of shame and guilt

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that that goes along with humiliation that goes along with their road with their

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experiences. It can be, I mean, that, as you were saying,

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my most of my work has been done with survivors of torture

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on, in offshore detention. And they,

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it can take a really long time to actually get to a point where

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you start to make some inroads,

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really because of that lack of trust and that sense of of betrayal.

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So really what we,

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what we need to try and concentrate on with with our

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clients is just establishing that that relationship.

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And sometimes it's that relationships that that's the only thing that we can

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provide quite,

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it can be quite difficult for for a for a therapist as all the structure that we

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place around ourselves in terms of the the the

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strategies and the techniques as we notice that that starts to have less and

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less of an impact,

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trying to find some way of being able to to sit with those lines,

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it can be really confronting for a therapist. It's like,

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you're kind of taking that. What makes us well me anyway,

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I won't speak for every trauma counselor or therapist,

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but what made me feel quite, quite secure was that sort of like that structure,

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looking through all the, all the the information,

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all the other studies looking for strategies and techniques,

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and then gradually having that whittled away and I'm thinking, well,

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what's the very least that I can do. And, and it comes down to, I mean,

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the literature also mentions that one of the one of the biggest

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indicators of,

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of positive progress within the healing in that healing process

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is around creating a trusting relationship,

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a safe place for people sometimes in the work that I did,

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that's all we could we could offer. As I said,

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it's really challenging to tour a therapist. And just sitting with that,

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with that, the pain that the horrific stories of torture,

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I need to find a way of,

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of processing that ourselves so that we could actually offer our clients

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something something useful starting from a very

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low base. What is it that you have survived?

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Torture survivors often feel like their,

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their life is never going to be the same again,

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and that they're probably not going to recover. There's a sense of hopelessness.

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That is, so that is so profound.

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So trying to find something that reassures or,

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or reinforces the fact that they actually have survived some amazing

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experiences people are very resilient and

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trying to try and make that connection on a really genuine level,

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provide that space for them and build on that so that they can actually get into

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that role or into that begin that journey if you like,

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of of that healing process. Hmm.

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<v 0>One of the words that stood out to me is the words, betrayal and a humiliation.</v>

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And it sounds to me as,

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as if the experience of torture has so isolated them from humanity,

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being betrayed by the rest of you mentioning that they are isolated in their own

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own world. And if you really separated from the rest,

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and I would ask for Sandy, perhaps,

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what could you paint a picture for us?

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What is it like to be a survivor of traumatic stress

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and of torture?

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<v Alexander McFarlane AO>Let's talk about, I mean,</v>

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torch is not the best thing to be talking about at this time on a Sunday

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morning, we got into the conversation. Look,

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I think one of the awful things about torture is that tortures are extremely

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sophisticated people because they want information.

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And it,

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one of the things that torture is trying to do is to form a relationship with

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the person who they're torturing and then it's inconsistencies that they create

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in that relationship, as well as the physical violence.

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So that it being tortured is an intensely personal experience. I mean,

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I'll, I w one,

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one thing I had to do once was write a report for the United nations

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compensation commission about the Iraqi occupation of Kuwait,

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which involved looking, looking at all the records of the human rights abuses.

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For example, one way they would torture people would be to paint,

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draw a bicycle on the, and then assist this person, ride the bicycle.

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And then when they couldn't do it, of course they'd beat him because I said,

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we told you to ride the bicycle. So there is an extraordinary quandaries.

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And the other thing that occurs is that in the, in the,

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in the intense interpersonal process of being tortured, you know,

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I'll never forget one man who said the worst thing about it was that would make

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him look into their eyes as they were torturing him. Now,

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every time he looks into somebody whose eyes he then is, he's taken to that,

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that moment of his life,

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which destroys really one of the key things about intimacy we have with anybody.

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So you, you know, what was stripped from him was, you know,

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the capacity to really access the warmth that he really needed in his recovery

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once he got out of that place. So look, I think one of the things about,

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you know, every type of traumatic event, I think has its own elements.

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You see, I mean, I think one of, one of the, one of the things that we, we,

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we always assume is that we can describe things and

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you know, the word, the word horror, for example,

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once I had to do an appraisal on a on an American

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textbook of it and they said, look, we'll pay $150. We'll give you a book.

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So I got a book called the American handbook of marsh, a hundred,

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it's about 500 pages. I four, I looked up the word horror in the index,

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and there was only one reference. Horror is the least studied emotion.

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And it's a fascinating issue about what is horror.

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So when you asking me these questions, you see,

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I think there's actually a huge void of reflection at knowledge.

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We S you know, everybody assumes, we know what horror is. I mean,

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is it disgust? Is it fear? What is it? And in fact,

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maybe we really actually haven't explored enough of that in language

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to really be able to express it. So.

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<v 0>We have a difficult task today because we have to talk about this boy now.</v>

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So Gary,

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could you try to describe to us what you see in some of your clients?

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What is it they're going through to help us try to understand.

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<v 4>What is it like?</v>

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<v Gary Outten>It's a big question when you're actually looking at somebody face to face</v>

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and realizing initially there might just be a, a kind of a blank look,

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there'll be a real mistrust.

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There'll be a real sense of what is it that that you're after most

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of our,

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our clients come from from communities that they don't really have any

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any history or any sense of mental health,

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if you like and mental health treatment. So that is I'm,

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I'm certainly not going to open up to you. I'm I,

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I don't want to be seen as as going crazy.

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So it's almost like that there can be a real emptiness in that,

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and you're slowly try to to whittle away,

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you can't just go in and jump in and questions,

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where were you tortured and what happened?

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You gotta be so careful about how you how you

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approach that how you allow that to happen in their own time.

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It's a process that allows them to start to feel

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safe and, and, and comfortable, and have to say that it's, I mean,

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it's actually been quite a privilege to work with many of the clients that I

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worked with. I've heard some horrific stories and just, you know,

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within my own within my own world,

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it's just so hard to conceive of how anybody could actually survive

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that. As people start to you start to see that,

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that level of trust what Sandy was saying about the eye contact

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is is,

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is something that we always kind of look for people looking away or

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having that kind of,

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that kind of emptiness behind their eyes feeling like there really is no way

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back from their, from their experiences. And it can,

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it can take such a long time to to just try and make some connection,

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some connection on the very smallest level,

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trying to make it a genuine and,

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and a genuine approach people pick up on on

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a superficial reality.

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If you like you really have to think about why am I asking these

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questions?

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Is it just out of idle curiosity or is this somehow going to

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enhance this therapeutic process, allowing our clients to,

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to take their, take their own time about it, and when they're ready to talk,

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it might take months, it might take three sessions.

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There's no there's no saying they might be ready to do it.

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Some people never are.

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Some people will hold on to hold onto that it'll have an impact.

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And I'm sure that this is been a part of the crossover of the,

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of a lot of Sandy's work with some, with a war veterans. I think holding,

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holding on to onto that the kind of the shame of having to admit that you're not

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in control holding it, and then watching the, you know,

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the symptoms kind of come to the surface in so many different ways.

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And I'm just trying,

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it's a very human response that we have these experiences,

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and we just want to be rid of them. We just want to push them away.

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We want to have create so much distance from them,

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but unfortunately it just kind of doesn't work that way.

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And that's maybe a little, counter-intuitive a,

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but to say the beginning of that healing process is starting to acknowledge the

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experiences and it might take a very long time to get to that point.

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And then further on from that is beginning to accept them as this

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is, these are experiences that I've had, and these are, they are, they,

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this is the impact of this on my lot can learn to

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to live a life. Having had these at first, the answer is no,

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you gradually start to see that that maybe they start to think that there's a

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possibility of being able to live with to live with these experiences.

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And they're the things that we kind of grab hold of and try and build on again,

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just allowing that person to go at their own pace.

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Let it develop naturally it can take, it can take a long time about it.

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So.

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<v 0>Would I be right in saying it's counter intuitive,</v>

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because perhaps it's too painful to talk about the memory.

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And so you are trapped in a room, a small room with that memory.

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You can't tell anyone else about it,

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but the memory is so big when you're facing it. Is the, is that something.

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<v Alexander McFarlane AO>I think it's, again, you know, these, these are really look,</v>

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I think there are lots of different circumstances, but as she,

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I'm not sure how many people saw the film, the railway man,

256
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it's a fabulous book. And it's, it's about this,

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this British war veteran who had been tortured on the Burma railway and how

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his torturer actually wanted to find him and apologize.

259
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And this is many years later, it's an extraordinary sort of generation of,

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of reconnection because see, I th I think, you know,

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there are two things that happen when you're interviewing somebody.

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They are watching you as much as you watching them.

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And and I think what the rest of my, I mentioned the railway man,

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because he describes this experience of coming back from the Burma railway

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and his sense of rage at the lack of

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imagination of people and what they'd been through. And,

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and that of itself creates a silence. They know that the people,

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he knew that the people he was sitting with had no contemplation of what he'd

269
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been through. So nobody,

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somebody is not going to talk to you as a patient if they think

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you're incapable of engaging with them imaginatively. And I've, I mean, I've,

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I've interviewed many police officers for extensive periods of time.

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And one of the things that in new south Wales,

274
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the police try and do is to get them on occasions,

275
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to speak to the two counselors on a regular basis.

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The trouble is they get 23 year old psychology graduates who start crying

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when they tell them what they've been through. So that,

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of course they don't talk to them.

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And and equally they get these people who have this voyeuristic sort of

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fascination in what actually happened at the crime scene rather than

281
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actually being able to help them encompass the experience that it's

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imprinted on, on, on the person who's been there.

283
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So it's a very complex dynamic process. And I, and I think it's

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it's, it's, it's, it's a process that, you know,

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that not everybody's cut out for in a way, I mean

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and, and, and it is about oh, you have to, you know,

287
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you do actually have to imagine it really engaged because I think often the

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people who are traumatized actually don't quite have the language to speak of

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what is in their mind,

290
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because we've got to remember the memories of these events are not verbal

291
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memories often that,

292
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that some of the century memories that smells the sounds,

293
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the sensations and often they're not properly connected.

294
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I mean,

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I think one way of understanding what trauma is

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at a neurophysiological basis. You know,

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if I put an object in your hand,

298
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you don't have like a like a set of car keys.

299
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You don't have a receptor in your hand for a set of car keys.

300
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You judge the white, you judge the temperature,

301
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you judge the anatomical area that it activates and your,

302
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your brain slowly builds that up. And then your memory comes into play saying,

303
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how have I ever felt anything like this before?

304
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But you can see any experience before the brain grows through that

305
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process of integration. It has got all these different senses.

306
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And I think sometimes what's happened with traumatic experiences is that they

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stay in those pieces.

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So what your task is with the person is to help them slowly build that jigsaw

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00:19:06.090 --> 00:19:10.750
puzzle and to actually hold them in because, you know, there's, you don't,

310
00:19:10.751 --> 00:19:12.810
you don't want them to go back to where they were.

311
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It's about being able to look at where they were with a sense of safety. And,

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you know,

313
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I guess one of what one thing that can provide that sense of safety is doing

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it in the presence of somebody else who can actually sit there and listen to

315
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what you're saying.

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<v 0>We'll come back to what you try to achieve as a clinicians,</v>

317
00:19:31.380 --> 00:19:33.170
how you help them piece together, their memory.

318
00:19:33.200 --> 00:19:37.490
But I just want to go back for a moment to what you've told me before

319
00:19:37.940 --> 00:19:39.470
about conspiracy of silence.

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You say there was a conspiracy of silence around trauma,

321
00:19:42.260 --> 00:19:44.540
and that immediately raised the question in my head,

322
00:19:44.660 --> 00:19:47.930
who is the one who is conspiring and what kind of silence is it?

323
00:19:47.931 --> 00:19:51.440
Is it the kind of silence that, of the inadequacy of words?

324
00:19:51.920 --> 00:19:53.540
Or is it something else?

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<v Alexander McFarlane AO>Oh, look, I think there, there are a number of issues there. I,</v>

326
00:19:59.000 --> 00:20:03.950
I told my Quander when I was 16, I played the role of [inaudible] in Macbeth.

327
00:20:04.030 --> 00:20:06.350
And I only wish I could go back and play that role again,

328
00:20:06.830 --> 00:20:11.660
because there's this scene where he finds slain king Duncan

329
00:20:11.720 --> 00:20:16.430
and his two body guards, and he ran down the stairs and he said, oh,

330
00:20:16.431 --> 00:20:19.730
horror, horror, horror, tongue,

331
00:20:19.760 --> 00:20:23.660
nor heart can conceive nor namely.

332
00:20:24.620 --> 00:20:28.910
And and I think so part of the

333
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conspiracy is that there just isn't a word. I mean,

334
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I,

335
00:20:34.071 --> 00:20:38.690
I was involved in a lot of the Melbourne voyage litigation and I was involved in

336
00:20:39.200 --> 00:20:39.861
one case,

337
00:20:39.861 --> 00:20:44.150
which was actually held and there's a very beautiful old Supreme courtroom

338
00:20:44.540 --> 00:20:48.810
behind the church in Hyde park, in, in Sydney. And the judge,

339
00:20:49.090 --> 00:20:52.090
the court was being held in that courtroom because it was his last case.

340
00:20:52.091 --> 00:20:55.570
It was actually Johnny O'Keeffe's brother. He was a Supreme court judge,

341
00:20:56.530 --> 00:21:00.250
and I'll never forget the barrister because this,

342
00:21:00.930 --> 00:21:03.090
this cider had been on to just remind you,

343
00:21:03.110 --> 00:21:06.010
the Melbourne was an aircraft carrier that cut this destroyer in half killed 82

344
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people. He was in the starboard sponsored. So he was literally just underwear.

345
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The vessel passed under the Melbourne's bow when it got hit and then blew up.

346
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And one of the things that he found on the deck was literally a sailor's

347
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brains in his cap.

348
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<v 2>Now.</v>

349
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<v Alexander McFarlane AO>The barrister for the Commonwealth said, because the man didn't use the words,</v>

350
00:21:30.430 --> 00:21:33.100
helplessness, horror, or fear,

351
00:21:33.460 --> 00:21:36.490
which are in the diagnostic criteria criteria for PTSD.

352
00:21:37.240 --> 00:21:41.380
He therefore couldn't have suffered from post-traumatic stress disorder because

353
00:21:41.381 --> 00:21:43.760
it wasn't what wasn't, you know,

354
00:21:43.790 --> 00:21:47.350
horrific experience because he didn't use those words. So after that,

355
00:21:47.351 --> 00:21:49.180
when I was interviewing further of these survivors,

356
00:21:49.840 --> 00:21:54.550
I always made the point of them of saying to them, okay, you know, what, what,

357
00:21:55.660 --> 00:21:57.250
what's the word that you would use?

358
00:21:57.251 --> 00:22:01.990
And so often they would just shake their head or say shock,

359
00:22:01.991 --> 00:22:05.590
or just wouldn't have a word for it. So,

360
00:22:06.010 --> 00:22:10.270
and the point is that barrister didn't want to hear, see he wanted to,

361
00:22:10.810 --> 00:22:14.830
he, he was, he was really finding every reason to push these people away.

362
00:22:15.490 --> 00:22:16.091
And I think, you know,

363
00:22:16.091 --> 00:22:19.510
there are times that societies want to push people away who is suffering.

364
00:22:19.570 --> 00:22:23.930
They don't want to hear because they, you know, it,

365
00:22:24.120 --> 00:22:29.050
the week is I could be deemed, could be seen as a threat to the society.

366
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So there are reasons why society is sometimes will exclude the

367
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maimed in the engine. And.

368
00:22:37.500 --> 00:22:42.450
<v Gary Outten>I think there is a a real disconnect as Sandy is</v>

369
00:22:42.451 --> 00:22:46.020
saying it's really hard for for us,

370
00:22:46.021 --> 00:22:47.730
like it's nearly impossible for us to,

371
00:22:48.510 --> 00:22:51.660
to have any context for the stories that we're hearing.

372
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And, and there's a real fear around, around that.

373
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And a fear.

374
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<v 2>Of kind of almost kind of.</v>

375
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<v Gary Outten>Contamination may be too strong, a word,</v>

376
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but of that that impacting on us too much.

377
00:23:08.370 --> 00:23:12.930
And so we actually do we do push that away. And,

378
00:23:13.590 --> 00:23:15.810
and that's also something that the the,

379
00:23:15.811 --> 00:23:19.620
the torture survivor has to live with because they're trying to,

380
00:23:19.950 --> 00:23:24.090
to to make some make their way in a in a new light

381
00:23:24.630 --> 00:23:29.550
somehow. And, and coming across that it's, it's not,

382
00:23:29.610 --> 00:23:32.880
anybody's, it's not anybody's fault. I mean, it's easy to,

383
00:23:33.390 --> 00:23:35.370
to kind of apportion blame.

384
00:23:36.450 --> 00:23:41.190
But but I th I think the the disconnect is is certainly

385
00:23:41.191 --> 00:23:43.470
there. And, you know, maybe that's a,

386
00:23:43.471 --> 00:23:48.350
that that becomes a political tool sometimes, but often,

387
00:23:48.530 --> 00:23:52.910
I mean, that, that society really don't have words, you know,

388
00:23:52.970 --> 00:23:56.480
like you're saying to actually describe that. And even when we do use the words,

389
00:23:56.510 --> 00:24:00.350
they're just so inadequate. Because again,

390
00:24:00.380 --> 00:24:02.600
as Sandy pointed out,

391
00:24:03.560 --> 00:24:06.530
the descriptions are not verbal. I mean, they're not,

392
00:24:07.160 --> 00:24:09.320
this is the word that describes that

393
00:24:12.220 --> 00:24:16.310
a torture survivor will have great difficulty articulating that.

394
00:24:16.311 --> 00:24:21.170
So we really do need to find ways through that through that

395
00:24:21.171 --> 00:24:24.790
maze, if you like. And that, that, that.

396
00:24:25.490 --> 00:24:28.610
<v 2>Trying to, trying to reintegrate.</v>

397
00:24:29.090 --> 00:24:31.730
<v Gary Outten>You know, I don't really like that that, that term,</v>

398
00:24:31.731 --> 00:24:36.560
but there's a real fragmentation of how this is. I mean,

399
00:24:36.561 --> 00:24:38.000
this is how people survive. I mean,

400
00:24:38.001 --> 00:24:42.950
we have mechanisms to to survive and get through the most the most horrific of

401
00:24:43.940 --> 00:24:46.970
of experiences that are maybe nothing human beings are

402
00:24:48.260 --> 00:24:50.600
amazingly, amazingly resilient.

403
00:24:51.620 --> 00:24:53.510
They do they do kind of bounce back,

404
00:24:54.020 --> 00:24:58.310
but the way we describe that is the way we describe those those

405
00:24:58.311 --> 00:25:01.850
experiences is in,

406
00:25:01.880 --> 00:25:06.560
in feelings and and trying to grapple with the emotions that that are

407
00:25:06.590 --> 00:25:07.423
coming up.

408
00:25:07.720 --> 00:25:12.580
<v 0>So there's this great big Gulf then to bridge between those who</v>

409
00:25:12.581 --> 00:25:17.530
have experienced traumatic stress and who do not have the words or words

410
00:25:17.531 --> 00:25:22.120
do not exist to describe what it is they're feeling and the society,

411
00:25:22.121 --> 00:25:26.680
which you said is afraid of the main and the weakened or the

412
00:25:26.681 --> 00:25:30.520
tortured, because that's evidence of the worst of ourselves.

413
00:25:30.550 --> 00:25:34.150
Maybe it's a kind of never into who we are as a people,

414
00:25:34.300 --> 00:25:38.710
we are capable of doing such things. So how do you suggest,

415
00:25:38.740 --> 00:25:43.230
could you suggest ways to us as a society? How can we bridge this Gulf,

416
00:25:43.360 --> 00:25:47.800
the literature have a role to play, or, well, anything else,

417
00:25:47.860 --> 00:25:48.880
any other ideas.

418
00:25:50.380 --> 00:25:51.213
<v 4>It's really.</v>

419
00:25:51.300 --> 00:25:53.770
<v Alexander McFarlane AO>You know, this is a really fascinating conversation.</v>

420
00:25:54.220 --> 00:25:56.260
It's really what I'm going to be talking about in my, in my,

421
00:25:56.350 --> 00:25:59.440
in my talk this afternoon about, about that process,

422
00:25:59.441 --> 00:26:04.270
because actually one of the things that I'm doing at the moment I'm 66 and I

423
00:26:04.271 --> 00:26:05.790
got involved in the traumatic stress field,

424
00:26:05.980 --> 00:26:08.830
but it's beginning and many of my colleagues and friends internationally,

425
00:26:09.150 --> 00:26:13.480
but the people who started the field and I'm going around interviewing them

426
00:26:14.200 --> 00:26:16.330
too, because many of them had extraordinary lives.

427
00:26:16.331 --> 00:26:19.120
So the way that this field really, I think,

428
00:26:19.150 --> 00:26:23.470
began to sort of get drawn from this world of silence was

429
00:26:23.710 --> 00:26:28.480
by a very interesting coalition between groups of

430
00:26:28.960 --> 00:26:31.150
victims and particularly the victims of crime,

431
00:26:31.690 --> 00:26:35.230
the women's movement in the Vietnam veterans and a group of activists,

432
00:26:35.231 --> 00:26:38.140
clinicians. So it was really something that came out of the

433
00:26:39.670 --> 00:26:42.160
the Vietnam veteran cohort.

434
00:26:43.100 --> 00:26:47.490
And many of actually the psychiatrist who'd be an [inaudible] psychologist had

435
00:26:47.491 --> 00:26:52.000
actually been in the U S military, but, you know, like an Israeli colleague who,

436
00:26:52.001 --> 00:26:54.030
who is one of the world leaders in the field,

437
00:26:54.031 --> 00:26:57.180
he actually had been a general duties, military officer,

438
00:26:57.780 --> 00:27:00.720
and she was one of the medical offices on the tibia. Right. In fact,

439
00:27:00.721 --> 00:27:03.540
I know both medical officers on, do you remember the NTB? Right?

440
00:27:03.541 --> 00:27:08.280
That was when the Palestinians hijacked ill algae and took it to

441
00:27:08.281 --> 00:27:09.990
Uganda. And the,

442
00:27:09.991 --> 00:27:13.290
these rotting successfully rescued all of the passengers,

443
00:27:13.980 --> 00:27:17.490
but both of the doctors on that journey and now psychiatrists.

444
00:27:18.300 --> 00:27:22.610
So you know, they're unusual people. And so I, you know, I think it's, it's,

445
00:27:22.611 --> 00:27:25.840
it's one of those fascinating parts and of,

446
00:27:26.090 --> 00:27:30.570
of where you get this conglomeration of advocacy

447
00:27:31.410 --> 00:27:36.270
and signs and clinicians who sort of see the value of

448
00:27:36.271 --> 00:27:40.890
knowledge. And it's not, it's not sort of just cold, hard statistics.

449
00:27:41.220 --> 00:27:45.510
It's, it's really about how you document the meaning of these issues to people's

450
00:27:45.511 --> 00:27:47.700
lives. And I think also literature, you know,

451
00:27:47.701 --> 00:27:51.540
I think one thing that has happened after every,

452
00:27:52.230 --> 00:27:53.160
after all the big,

453
00:27:53.190 --> 00:27:57.780
big wars of the last century is that some of the best literature was written by

454
00:27:57.781 --> 00:28:02.760
war veterans and many of the great writers of the 20th century war veterans,

455
00:28:02.910 --> 00:28:06.690
you know, it w H Auden fought in the Spanish civil war, Kevin White,

456
00:28:06.780 --> 00:28:10.470
first of all, remark who wrote all quiet on the Western book front,

457
00:28:10.700 --> 00:28:13.290
there's the one book that ever outsold the Bible.

458
00:28:13.740 --> 00:28:18.600
And it's because what he somehow managed to capture was something of what

459
00:28:18.601 --> 00:28:20.070
so many people were struggling with.

460
00:28:20.340 --> 00:28:24.270
So I think this is a really interesting world where, you know,

461
00:28:24.271 --> 00:28:28.830
there's no one sort of group and and then there's the

462
00:28:28.831 --> 00:28:33.660
politicians who themselves have sometimes been the victims of these sorts of

463
00:28:33.661 --> 00:28:38.210
events who then will champion the cause of people. So, you know, I think it,

464
00:28:38.211 --> 00:28:41.190
it's, it's a real measure of a vibrant,

465
00:28:41.191 --> 00:28:46.140
healthy society where people don't just stand by and turn their back.

466
00:28:46.560 --> 00:28:50.490
They look at what the issue is and do something about it.

467
00:28:50.491 --> 00:28:51.360
And I think we've come a long way.

468
00:28:52.070 --> 00:28:54.350
<v 0>I'd like to direct a question to Gary. Now,</v>

469
00:28:55.460 --> 00:29:00.170
what if I have a loved one or a friend who is suffering from the

470
00:29:00.171 --> 00:29:01.700
effects of traumatic stress?

471
00:29:02.270 --> 00:29:04.460
What are some of the things I shouldn't say to them?

472
00:29:04.760 --> 00:29:09.650
And what are some of the things that I could do that would perhaps be helpful as

473
00:29:09.651 --> 00:29:10.484
I.

474
00:29:10.580 --> 00:29:14.900
<v Gary Outten>As I mentioned before, just be careful what you ask,</v>

475
00:29:14.901 --> 00:29:19.250
ask yourself, why you're, why you're asking a specific question,

476
00:29:20.000 --> 00:29:21.530
idle curiosity

477
00:29:23.150 --> 00:29:26.810
is is not going to be very, very helpful.

478
00:29:28.430 --> 00:29:29.300
<v 2>I think the other.</v>

479
00:29:29.330 --> 00:29:33.830
<v Gary Outten>The other thing that I that I used to stress to to workers</v>

480
00:29:34.220 --> 00:29:36.770
without poachers survivors up in Manafort island,

481
00:29:37.340 --> 00:29:39.320
was be careful what you do ask,

482
00:29:39.620 --> 00:29:44.530
because unless prepared to hear the answer and be prepared to

483
00:29:44.531 --> 00:29:48.310
actually sit with that, you might hear things that are very,

484
00:29:48.311 --> 00:29:52.450
very stressful or traumatic or beyond your, your comprehension.

485
00:29:52.720 --> 00:29:57.700
Essentially. One of the things that is taken away from from torches of IVUS

486
00:29:58.481 --> 00:30:03.430
is that sense of who's listening to me when they are ready to

487
00:30:03.820 --> 00:30:08.740
to speak. It's so important to actually have somebody who will sit and listen,

488
00:30:09.700 --> 00:30:12.970
not solve their problems, not say, oh, well, you've just got to do this.

489
00:30:13.120 --> 00:30:17.710
And if you just do that, and I'd like set it up as a, as a set of tasks.

490
00:30:18.150 --> 00:30:21.430
And as you reach the next thing, everything been, you know, gradually you're,

491
00:30:21.600 --> 00:30:26.500
you're cured, you know, once you get to the to the end it just doesn't work.

492
00:30:26.820 --> 00:30:29.620
It just doesn't work that way. So you really need to be careful.

493
00:30:29.621 --> 00:30:34.510
It can be so helpful to to sit and listen to somebody and allow that story

494
00:30:34.511 --> 00:30:37.480
to come out, maybe in lots of fragments and,

495
00:30:37.840 --> 00:30:41.500
and lots of little bits and pieces. One of the things that I used to,

496
00:30:42.100 --> 00:30:46.060
I used to do with with clients, we would kind of come to a,

497
00:30:46.370 --> 00:30:48.430
a dead end defect if you like.

498
00:30:49.240 --> 00:30:53.440
But I would always have a little things items in the in the office,

499
00:30:53.650 --> 00:30:56.040
stress balls. There's,

500
00:30:56.041 --> 00:31:00.060
there's a bead balls that are made weed out of hemp and wool,

501
00:31:00.061 --> 00:31:01.110
and those,

502
00:31:01.140 --> 00:31:05.370
those little really annoying little bull bearings puzzles

503
00:31:06.390 --> 00:31:09.310
those wooden puzzles that it takes you,

504
00:31:09.311 --> 00:31:14.280
you need a post-graduate degree to actually pull them apart,

505
00:31:14.430 --> 00:31:15.810
let alone, get them back together again

506
00:31:17.340 --> 00:31:20.820
things like that that would actually stimulate a little bit of

507
00:31:21.750 --> 00:31:25.590
creative thinking, allowing a book.

508
00:31:26.010 --> 00:31:30.810
I guess what we know is that within our own fight flight freeze kind of

509
00:31:30.811 --> 00:31:35.550
mechanism, it's not something that we can just switch on and off complex

510
00:31:35.850 --> 00:31:40.770
PTSD really means prolonged pro prolonged

511
00:31:42.271 --> 00:31:46.140
trauma experiences of trauma.

512
00:31:47.340 --> 00:31:49.680
And so that, that whole mechanism just it doesn't,

513
00:31:49.681 --> 00:31:52.770
isn't really working properly. The brain kind of starts to shut down.

514
00:31:53.160 --> 00:31:56.220
It's such shutting down connections and, and things. I mean,

515
00:31:56.221 --> 00:32:00.210
we've made so many advances in neurophysiology with imaging and whatever.

516
00:32:00.540 --> 00:32:04.530
We're kind of understanding a lot more about how the brain is functioning,

517
00:32:04.531 --> 00:32:08.670
where those kinds of neurons are firing and, and, and not firing.

518
00:32:09.060 --> 00:32:11.580
So allowing somebody that some,

519
00:32:11.640 --> 00:32:16.560
some creative space is really about trying to re-engage,

520
00:32:16.830 --> 00:32:21.300
it's a very slow process. There's kind of no tablet that you can give,

521
00:32:21.301 --> 00:32:22.590
and that kind of helps it.

522
00:32:23.130 --> 00:32:27.990
But so being prepared to sit and listen in a really fragmentary way

523
00:32:28.080 --> 00:32:32.200
about somebody's story and kind of being silent, you,

524
00:32:32.290 --> 00:32:35.370
you don't have to prop it. You don't have to say, well, what happened next?

525
00:32:35.371 --> 00:32:39.800
You know, if they're ready to to talk, they are, that's absolutely invaluable.

526
00:32:41.300 --> 00:32:46.030
Many very reluctant to talk on a personal level two friends.

527
00:32:46.510 --> 00:32:48.460
Oh there is a real,

528
00:32:48.520 --> 00:32:52.270
a real fear that they're going to contaminate somebody so much that they'll be

529
00:32:52.271 --> 00:32:53.110
rejected. I mean,

530
00:32:53.111 --> 00:32:57.340
that's all always in the back of their mind that they might be betrayed or,

531
00:32:57.370 --> 00:32:58.480
or rigid if at all,

532
00:32:58.481 --> 00:33:03.160
that will be seen to be so so awful that that they can't be tolerated.

533
00:33:03.730 --> 00:33:07.210
So giving somebody that, that you can tolerate,

534
00:33:07.211 --> 00:33:09.660
that is probably the most valuable thing that you can do.