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Melissa Harris-Perry: Welcome back to The Takeaway. I'm Melissa Harris-Perry. May is Mental Health Awareness Month, and about 12 million people on average will struggle with Post Traumatic Stress Disorder in any given year. The National Institute of Mental Health defines PTSD as a disorder that develops in some people who've experienced a shocking, scary, or dangerous event. Here event, as in singular.

What if someone has been exposed to trauma repeatedly? That can lead to a more complex experience of PTSD. This complex PTSD is not yet recognized in the American Psychiatric Association's official Diagnostic and Statistical Manual but for more than 30 years, some mental health experts have called for recognizing the unique challenges faced by people exposed to prolonged and repeated trauma.

Stephanie Foo is a journalist formerly with This American Life and Snap Judgment. She's the author of What My Bones Know: A Memoir of Healing from Complex Trauma. In her book, Foo details the challenges she faced with mental health due to repeated trauma experienced in childhood. As an adult, she received a diagnosis of complex PTSD and embarked on a journey of self-acceptance and healing.

Stephanie Foo: Traditional PTSD can occur with even a single traumatic incident. PTSD is essentially your brain encoding specific triggers that tell you that a loud noise or something should make your brain send panic signals to your body and get hyper-vigilant and be ready to run. Complex PTSD occurs when the trauma happens many, many, many times over the course of years. That means that the number of triggers swells. It's not just a specific sound or incident, sometimes that can trigger complex PTSD, but it can be more of a generalized fear of other people or of the world itself.

Melissa Harris-Perry: I'm realizing I want to actually even back up, maybe one step back from the first question I asked so that we can talk about triggers a little because it's a word that has ended up taking on these politicized social-cultural meetings. In addition, I don't know, maybe what we'd call them as more clinical or more lived experience meanings. I just want to be sure that, for everybody's listening that they're clear what we mean when we're talking about triggers.

Stephanie Foo: I think everyone actually has conscious and subconscious triggers. You just can't get through this one life of ours without experiencing pain and trauma. Triggers can be really helpful. It can show you if a bear is coming after you, you might want to run. Subconscious triggers are very real, too like if let's say, you are hit by a car. Even if you're not necessarily consciously processing the fact that you were hit by a car in front of a Dunkin Donuts or that the person in the car has a University of Santa Barbara sweater on.

Those things, if you see them, again, might make you feel a little uncomfortable, not necessarily panicked, or anything, but you might get an uneasy feeling because your brain might have encoded that as a potential danger. Conscious and subconscious triggers are in all of us in many aspects of our lives, and we honestly wouldn't necessarily be able to survive without them.

Melissa Harris-Perry: You were actually diagnosed with complex PTSD, and you find it difficult to even find any information about it. Why is it so little known and has that changed over time?

Stephanie Foo: Yes, so that's because complex PTSD is not actually real according to the DSM, which is the Bible of what psychiatry considers to be all the legitimate mental illnesses. There have been studies on people who have experienced traditional PTSD, a single or a couple of traumatic moments, and people who have experienced complex PTSD like child abuse or domestic abuse, where it's hundreds of traumatic incidents, and our brains do function differently.

Our symptoms are different, and the treatment is different. There are a lot of political reasons why it's not in the DSM yet, but the DSM essentially dictates what psychiatrists get treated for or what we can diagnose people with in order for their insurance to cover it. Which, of course, if it's not in there, it really makes the amount of literature and research on it very sparse.

Melissa Harris-Perry: Talk to us a bit about the roots of your complex PTSD and also what it has felt like to actually experience it.

Stephanie Foo: My complex PTSD comes from years of pretty extreme child abuse. Both of my parents were physically, verbally, and emotionally abusive. Both of my parents abandoned me at the ages of 13 and 16, I closed out high school living on my own. I just focused for a long time on success and taking care of myself and making enough money to put something into my 401(k), and I achieved it.

I was a pretty successful radio producer, and that to me meant I was probably healed. In reality, I was having problems with relationships, I was constantly anxious, I was plagued by something that I called the dread, which was this fear that I had done something terribly wrong. If I didn't fix it, everything would collapse. That all made sense when I was finally diagnosed at, 30, with complex PTSD because I was like, "I knew something wasn't right here."

It essentially meant that I had not really healed from the really brutal childhood trauma that I was raised with, so I quit my job and I really dedicated about two years of my life to researching and healing from complex PTSD.

Melissa Harris-Perry: I feel like there are some folks who will say no, but you managed to be successful, you manage to have precisely the kind of life that parents always want their children to have, what do you mean, you weren't healed, that sounds like the goal of life, and you've achieved it?

Stephanie Foo: For a lot of that time, I was in excruciating pain. My work was a crutch, honestly. It was a way for me to stop thinking about the loneliness that I felt about the relationships I felt like I was sabotaging. By the time I was diagnosed, it's true I had an astronomical career rise. At that point, I felt like I could not work anymore. I was totally burnt out, and if I hadn't healed it, I don't know what would have happened.

Melissa Harris-Perry: I think for me, part of what is so powerful and familiar about what you write about in the book is just to quote this one phrase, "My trauma is literally pumping through my blood, driving every decision in my brain." Can you talk about the physical aspects of complex PTSD?

Stephanie Foo: Complex PTSD untreated can be really, really dangerous for your brain and body. Being in that constant state of fear essentially means that your body is pumping out toxic amounts of cortisol and adrenaline into your body a lot of the time, which can age us just prematurely. It can put us at much higher risk of everything, from endometriosis to cancer, to lung disease, to heart disease. It can shorten our life expectancy.

Aside from that too, experiencing trauma literally changes our epigenome, which is a layer on top of our DNA which determines which of our genes get read. It's something that we can pass down from generation to generation. I realized that my trauma, my epigenome has been wracked by both the trauma that I experienced from my parents, but also their trauma and their parent's trauma. There's generations of my family, surviving colonization and war, and famine that has made us somewhat hyper-vigilant as a survival mechanism, as an adaptation. It's been interesting to try and unteach that and figure out how that can work for me in a decidedly more peaceful world.

Melissa Harris-Perry: Can you say a bit more about this intergenerational aspect as you talk about the experiences of repeated trauma?

Stephanie Foo: Like I said, it's essentially an evolutionary adaptation. There is evidence in Holocaust survivors that their children have an altered gene that manages stress regulation, they can be more hyper-alert. There's evidence too that experiencing famine can change your children's or your grandchildren's metabolism. Again, we are a constantly evolving species, but complex PTSD is really only a mental illness in times of peace.

Because if I were, right now, surviving what my great grandparents did, surviving the Japanese occupation of war against the British famine, all of my instincts would be correct. All my fear would be valid. Actually, it was during the pandemic. It's only in times of extreme peace and safety that this is out of place.

Melissa Harris-Perry: Cortisol is perfectly adaptive if you have to travel long distances or be on high alert for bombings, but it's not adaptive if your evening should be about watching Netflix.

Stephanie Foo: Yes, exactly.

Melissa Harris-Perry: Why is it that when you read about the symptoms initially that they felt like accusations to you?

Stephanie Foo: Because they were [laughs] different, they were phrased that way. When I read some literature and some-- a lot of the articles on the internet about complex PTSD, they were all like, "Cannot maintain relationships, bad at self-soothing, aggressive but cannot tolerate aggression from others." There was one book about childhood trauma that actually called people with childhood trauma burdens to themselves and others and people that others would prefer to avoid, [laughs] which, that's not an accusation. That's not an insult, I don't know what is. That's pretty horrible to hear about yourself.

They didn't say anything nuanced or positive about complex PTSD, which there are many positive things about it. Another main symptom of complex PTSD is immense self-loathing. Honestly, it was very counterintuitive to healing to be bombarded with these descriptions because it just seemed to validate my self-loathing, and validate me thinking, like, "I guess I'm a horrible human being."

Melissa Harris-Perry: Help us then to understand the difference between healing and fixing yourself?

Stephanie Foo: I don't think I will ever be fixed. I don't think that I can reprogram my brain to be a completely different brain. I don't think that I can change my genome to be a completely different genome, and truly what is "normal" anyway. I think healing has been really important in terms of learning how to live with this more creatively. Learning how to harness it and use it to its advantage when I can and how to let go of it and let that fear fall to the wayside when I don't need it.

Healing has been about changing my inner narrative about myself, about seeing myself as a worthless person, and now seeing myself as a very valued person and loved person. It's been about learning to manage my relationships a little bit differently. In terms of listening better, meta communicating with people, expressing my needs more healthily, and being able to meet theirs.

Melissa Harris-Perry: You mentioned the pandemic in the ways that complex PTSD at least had some adaptive aspects. Can you say more about that?

Stephanie Foo: One of the symptoms of complex PTSD according to the articles on the internet is dissociation. In which essentially, we turn off our emotions and are on robotic autopilot. I think sometimes would be one way to think about it, or maybe zoning out and not really present or there, which can be really dangerous if you're really losing time if you are unable to ever feel your feelings. One of the adaptations of dissociation is it makes us hyper-rational and unemotional in moments of extreme stress.

This is something that we've been slowly discovering is an advantage to complex PTSD. When faced with real actual fear, with real threat, I guess, people with complex PTSD can really just be super-rational and able to deal with it. That's how I felt during the pandemic, is I felt dissociated, but also really productive and unafraid and, okay, astonishingly okay. To that, I was very used to feeling like I was going to die and operating and being really productive anyway. I got my book deal in February 2020 and I wrote most of it during the pandemic.

Melissa Harris-Perry: I want to give some credit to your complex PTSD, in that case. I have to say, if you wrote your book in the year, let me just also, I'm going to give at least a little bit of credit to you, [laughs] to your mind, capacity, creativity, willingness to do it.

Stephanie Foo: I had spent two years before that journaling and researching. It was just taking everything I had been thinking about for a couple of years and putting it down on the page.

Melissa Harris-Perry: You write that the book has a happy ending. What's that happy ending?

Stephanie Foo: The Happy ending is that most of the time I think I'm pretty great. [laughs] The happy ending is I don't hate myself as much as I used to, that I have found a family like a found family, a community, that loves me and who I love very much. That I feel like I will always struggle with complex PTSD and I will wish that I did not have it every single day but I've learned to live with it with hope and joy.

Melissa Harris-Perry: Stephanie Foo is a journalist, and author of What My Bones Know: A Memoir of Healing from Complex Trauma. Thank you so much, Stephanie.

Stephanie Foo: Thank you for having me.

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