Stories from the World of Medicine

Season

4

Episode

7

|

Feb 8, 2022

Bearing Witness

Psychiatrist Shaili Jain tells the story of a pivotal experience on a road trip with her father, and how it catalyzed her career as a PTSD specialist.

0:00/1:34

Illustrations: Ashley Floréal

Illustration by Ashley Floréal

Stories from the World of Medicine

Season

4

Episode

7

|

Feb 8, 2022

Bearing Witness

Psychiatrist Shaili Jain tells the story of a pivotal experience on a road trip with her father, and how it catalyzed her career as a PTSD specialist.

0:00/1:34

Illustrations: Ashley Floréal

Illustration by Ashley Floréal

Stories from the World of Medicine

Season

4

Episode

7

|

2/8/22

Bearing Witness

Psychiatrist Shaili Jain tells the story of a pivotal experience on a road trip with her father, and how it catalyzed her career as a PTSD specialist.

0:00/1:34

Illustrations: Ashley Floréal

Illustration by Ashley Floréal

About Our Guest

Dr. Jain serves as a psychiatrist and PTSD specialist at the VA Palo Alto Health Care System and is a Clinical Associate Professor affiliated with the Department of Psychiatry at the Stanford University School of Medicine. She is the author of The Unspeakable Mind: Stories of Trauma and Healing from the Frontlines of PTSD Science, and her essays and commentaries on trauma and PTSD have been presented by the BBC, CNN, The New York Times, STAT, Newsweek, The Los Angeles Times, TEDx, public radio, and others.



About The Show

The Nocturnists is an award-winning medical storytelling podcast, hosted by physician Emily Silverman. We feature personal stories from frontline clinicians, conversations with healthcare-related authors, and art-makers. Our mission is to humanize healthcare and foster joy, wonder, and curiosity among clinicians and patients alike.

resources

Credits

About Our Guest

Dr. Jain serves as a psychiatrist and PTSD specialist at the VA Palo Alto Health Care System and is a Clinical Associate Professor affiliated with the Department of Psychiatry at the Stanford University School of Medicine. She is the author of The Unspeakable Mind: Stories of Trauma and Healing from the Frontlines of PTSD Science, and her essays and commentaries on trauma and PTSD have been presented by the BBC, CNN, The New York Times, STAT, Newsweek, The Los Angeles Times, TEDx, public radio, and others.



About The Show

The Nocturnists is an award-winning medical storytelling podcast, hosted by physician Emily Silverman. We feature personal stories from frontline clinicians, conversations with healthcare-related authors, and art-makers. Our mission is to humanize healthcare and foster joy, wonder, and curiosity among clinicians and patients alike.

resources

Credits

About Our Guest

Dr. Jain serves as a psychiatrist and PTSD specialist at the VA Palo Alto Health Care System and is a Clinical Associate Professor affiliated with the Department of Psychiatry at the Stanford University School of Medicine. She is the author of The Unspeakable Mind: Stories of Trauma and Healing from the Frontlines of PTSD Science, and her essays and commentaries on trauma and PTSD have been presented by the BBC, CNN, The New York Times, STAT, Newsweek, The Los Angeles Times, TEDx, public radio, and others.



About The Show

The Nocturnists is an award-winning medical storytelling podcast, hosted by physician Emily Silverman. We feature personal stories from frontline clinicians, conversations with healthcare-related authors, and art-makers. Our mission is to humanize healthcare and foster joy, wonder, and curiosity among clinicians and patients alike.

resources

Credits

The Nocturnists is made possible by the California Medical Association and people like you who have donated through our website and Patreon page. This episode of The Nocturnists is sponsored by Chartnote.

Transcript

Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.

Emily Silverman

We all come from somewhere. We have parents, grandparents, great grandparents, and other ancestors that extend backward in time. How do our family stories affect our lives today? What do we carry forward? And how might our histories inform our perspectives and even our careers in healthcare? You're listening to The Nocturnists: Stories from the World of Medicine. I'm Emily Silverman. Today I speak with Shaili Jain. Shaili is a psychiatrist and PTSD specialist at the VA Palo Alto healthcare system, and a clinical associate professor affiliated with the Department of Psychiatry at the Stanford University School of Medicine. She's the author of The Unspeakable Mind: Stories of Trauma and Healing from the Frontlines of PTSD Science, and her essays and commentaries on trauma and PTSD have been presented by the BBC, CNN, New York Times, Stat, Newsweek, the LA Times, and others. But before I speak with Shaili, we'll hear the story that she told live at The Nocturnists in San Francisco in January 2020. Here's Shaili.

Shaili Jain

It's 2007. There's five of us in a minivan on a road trip. My husband's driving, I'm next to him in the passenger seat. In the back is our four-and-a-half-year-old son, and my parents who are visiting from England. That's where I was born and raised. We're celebrating my dad's 70th birthday with this road trip across the United States.

This morning, we're leaving New York City. We left early in the morning to beat the traffic. Our son is already fast asleep. My mom has started to doze and I want a nap. I'm exhausted. I'm seven months pregnant, I really want to sleep. But then my dad starts talking. And he starts talking about 1947.

I knew the nuts and bolts of this story. 1947. The Partition of British India. Horrific intercommunal violence. Millions were killed. Many, many millions were forced to flee. I knew the nuts and bolts of the story. I knew how it had impacted our family. My dad had been orphaned at the age of 10. He'd been a refugee forced to work as a child laborer. But I had been born and raised in England, and I'd really been disconnected from this story. We didn't have any family photographs. We didn't have any family heirlooms. Our trips back home were scant to non-existent. So growing up this story felt anonymous, it felt distant.

But in the minivan as my dad is talking, I'm hearing details that I've never heard before. New details. Like about his sister, his youngest sister who at the age of two contracted smallpox, and she died in 1947.

I'm learning about my grandmother, his mother, a woman who was this accomplished cook. She played the harmonium beautifully, she spoke English. But after her youngest daughter died, she took to her bed and kind of withered away, and she died too in 1947.

And my grandfather, this senior civil servant, who on his days off would don jodhpurs and go horse riding. And later at home with his kids, he'd make them this really tasty sweet treat called anjeer barfi—this rich fudge of figs and pistachio, nuts and cream.

Growing up, when I would hear about 1947, it was usually bits of information just popped in at really inopportune moments. Often accompanied by my dad's anger and his bitterness and his sadness, I just didn't know what to make of these bits of information.

But now on the road trip when he's talking, his narration is totally different. It's smooth, it's cohesive. It's stripped of all those negative emotions, no anger, no bitterness. So I'm pulled into his story.

My dad, the orphaned refugee. My dad, who as a young man, moved to England and started over again. My dad, who at this moment in time, is the sole surviving member of his family of origin.

I'm a psychiatrist. I'm trained to listen closely. As my dad's words flowed to me from behind the minivan. I recognize them as testimony. Patients give you testimony all the time. They tell you their deepest darkest secrets, their worst fears. They tell you things they don't even tell their loved ones. Testimony goes beyond the casual. Testimony is a very intentional narration. Testimony requires the listener to act.

So after the road trip, my parents went back to England, and I went back to my private practice in Milwaukee, Wisconsin. But I couldn't stop thinking about India. My grandparents’ lives, what were they like? What were their habits? What were their personalities like? What were their quirks? What were their losses, their failures, their successes, their ambitions? And then what about their deaths? Two traumatic deaths.

My grandmother just took to her bed and died of this mysterious illness. She was in her early 40s. At the time of her death, she must have known that she'd leave the rest of her young children motherless. And my grandfather, his was a violent death. At the time of his death, he must have known that his surviving children were not only going to be orphaned, but they were going to be penniless, they were going to be destitute.

Two traumatic deaths. Deaths with a domino effect. Trauma filled lives for their children for sure. And a domino effect for me too. What was I going to do with this story?

Growing up in England, this story of 1947, it was like an inside of the house story. It wasn't meant for public consumption. Don't lie, but don't tell either. Proclaiming myself to be the daughter of an orphaned refugee was really not a smart strategy, not in class-obsessed British society.

So it's only now after the road trip in 2007, that for the first time in my life, I'm claiming this story. I'm owning it. I'm the daughter of a war orphan. I'm the granddaughter of a man who was murdered. I realized that I spent my whole life living in the shadow that 1947 had cast on my dad's life. But I hadn't really realized it because that was the only life I knew. On some level, I must have known, right?

Pretty early on in my medical career, I decided I was going to be a psychiatrist. And that was a wildly unpopular decision, by the way. My parents didn't understand it, they did not approve. My mentors did not approve. Everyone told me not to do that. But I chose. I wanted to submerge myself in this world of mental suffering—the only life I'd known. And then there was this peculiar trait of mine, I'd always been drawn to those who'd suffered the unspeakable, those who would survive tragedy. It was as though bearing witness was where I was always meant to be.

So this slow dawning. The displaced, the tragic, the traumatized, the misfits, the outsiders, the survivors. I had all along been of those people.

I'm a psychiatrist, so I know about post-traumatic stress. I know about trauma, but I want to know more. I want to become a specialist. I want to become a trauma scientist, so that I can understand PTSD and study it. But all of that requires a move. It will require a move to California where I can learn to become all of those things. So I leave my private practice. I leave that financial security. I leave a city that I love. A city where I trained. A city where I built my reputation brick by brick. And we moved to California. And again in California, I start over. I'm a nobody, I'm an outsider, I have to earn my way step by step. And I do so living off of my savings in the most expensive part of the world.

But the only thing that kept me going in all of the turmoil and the disappointments that the weeks and months and years would bring was this newfound connection to trauma survivors. I had all along been of these people. I had all along been of these people.

My patient John sits across from me in the clinic. His middle-aged stocky build–he's wearing sweatpants. He's telling me about his weekend trip to the mall. His story is all over the place. It's disorganized. It's chaotic. One minute, he's talking about a shopper in Old Navy. The next minute, he's talking about an IED explosion in Iraq. Old Navy, Iraq. Iraq, Old Navy. I struggled to track what he's saying. I feel this old urge rise up in me, this urge to interrupt, to organize, to put order on his disorder. But I resist that urge. I resist that urge and I continue listening.

He's getting louder now. He leans in, his face is intense, he's staring off into the distance. He's talking about a woman he saw in the mall who's cleaning tables in the food court. Her face reminded him of a woman who he had seen in Iraq. Her face reminded him of that day in Iraq, the day an IED exploded and he was sent in to clean up the mess. The smell of burning flesh, the blood spattered face of a mother, the woman cleaning the tables in the food court. I feel this urge rise up in me, an old urge, an urge to deny this story its existence. This did not happen. This is unspeakable. It's unthinkable. But I resist the urge and instead I stay present.

John's silent now. He seems distant. I feel like he's left the room so I try and pull him back in. "Setbacks are inevitable." "Tomorrow will be a better day." "You've come so far."

He nods his head. But his eyes betrayed the truth. His mind's pulling him elsewhere. His brain's networks are misfiring, they're awry. He's beyond my therapeutic reach today. I feel this urge rise up in me again, this urge to lean in, to try harder, to fix him. But I resist the urge because I know all too well, healing is not going to happen on my timeline. It's going to be two steps forward, one step back. It's going to be bumpy. It's going to be unpredictable. My job in all of this... to bear witness, to stay present, to keep my heart large, and to learn to tolerate the distress.

Emily Silverman

So I'm sitting here with Shaili Jain. Shaili, thank you so much for being here today.

Shaili Jain

Oh, it's my absolute pleasure. Thanks so much for having me, Emily.

Emily Silverman

It was so wonderful to revisit the story that you told on stage in January 2020. And I was wondering if you could bring us back to that night. What was that experience like for you?

Shaili Jain

It was a truly amazing experience because I really think it tapped into my love and passion for storytelling, which is such an integral part of what I do on a day-to-day basis as a psychiatrist, as a trauma specialist. I think in terms of that process of storytelling and connecting to an audience, it was an incredibly unique and fulfilling experience. I don't think I've ever spoken live to such a big audience. So that was a whole other experience that took me out of my comfort zone. But for the most part, I felt just really grateful to have had that opportunity to relay my story from a beginning to where I am today, in a way that was cohesive. And it was a flow that had not been present in my real life, so it was kind of nice to have a place to relay that story cohesively.

Emily Silverman

Just the other day, I was chatting with Charlie Varon. And for the listeners, Charlie is a very, very good friend of The Nocturnists, and he often steps up to do some coaching with our storytellers to prepare for the stage. And he just always glows so much when he talks about working with you. So I just wanted to share that with you and invite you to reflect a bit on what it was like working with him because he is a career performer, director, theater person. So what was that like?

Shaili Jain

Well, I'm so glad you brought that up, actually. Because when I was just listening to the playback earlier today before I interviewed, I was thinking of Charlie, because I worked really closely with him, he paid meticulous attention, he is a really careful listener. He brought the artistry to the story in terms of guiding me about what to edit, what to keep in, what to not keep in, what to emphasize. And in terms of performance, I mean, I'm not a performer. He gave me some really, really invaluable advice. So I'm really glad you brought Charlie up, because I was thinking about him this morning, that the story would not have presented itself if it wasn't for his expertise and his close guidance and his mentorship. And he just has such a gentle, tender manner, which was very much appreciated because this is a really, really personal story. I think about him in glowing terms, too.

Emily Silverman

I'd like to walk it back to your childhood because in the story you say that before this road trip in 2007, you didn't know as much about your family story. So what did you know before this revelation?

Shaili Jain

I knew the facts, I knew the nuts and bolts. I don't remember a time when I didn't know that my dad had been orphaned at the age of 10. So he didn't hide anything. I don't remember a time when I wasn't aware of this mega-event, the 1947 Partition of British India. And I always remember from a young age having a sense of how that one event had shaped my dad's life because it kind of always felt like it was present. Just his view of life, what he felt was important, what he did not feel was important. The way he watched the news—that he had this hawkish attention that he paid to the news because, like a lot of trauma survivors, you always expect something bad is going to happen, and you have to be on guard. His commitment to education. I think one benefit of that story for me, I think I'm a direct beneficiary, is my dad was really an unusual man for his generation and his time, in that he never viewed a girl child any different to a boy child. And I think part of that was because he knew what it was like to be viewed as less than or be viewed as a victim or feel disadvantaged. And I do believe his experiences as a young child informed his own parenting where he would never see a boy or girl as different. And that was really radical for that time. So I felt like the story was always there, but the details were missing. And like I say, the cohesion and the connection and how the story was still alive that whole time. It was not in the past. It was alive this whole time, and it was still shaping him, it was shaping me and would end up having a profound influence on my own life.

Emily Silverman

You open the story in the car on this road trip. And this is the moment where your dad starts to tell the story again, but this time he's telling it differently. So what was different about it and maybe bring us into that car with you?

Shaili Jain

I think the most noticeable difference was that he was very calm when he was relaying the story. And that was such a different experience to when I was growing up. Whenever he'd talk about 1947, it was often these bits of information just plopped in at these really strange times. And there's a lot of anger, a lot of bitterness, a lot of sadness associated with his recollections. So I think as a kid, my natural inclination was to want to distance myself from that, but in the car his narration was really smooth. It was cohesive, there was none of that negativity. And we'd both changed, right? I was a psychiatrist by that point. I'm trained to listen really carefully. He was retired by this point, the sole surviving member of his family of origin. I don't think he had the pressures on him that he'd had when I was growing up. I say in the piece, I recognized it for what it was, it was “testimony”, because patients give us testimony all the time. And I remember thinking, this is something really important, I have to pay attention to this moment and to this story. So that's how I remember it. It was probably one of the most important conversations in my life. I mean, he was doing the majority of the talking. But I was listening very attentively, and I asked a lot of questions, and I was able to elicit a lot of detail from him. And it was a really moving experience for me.

Emily Silverman

Do you have any sense for why he might have decided to open up in that moment? Or maybe it wasn't a decision, maybe it just happened organically and naturally. But was there something about being in the car, the movement of the car? Why then?

Shaili Jain

I think the mechanics definitely helped. I love road trips for that reason a lot. It's rare in modern day life that you can have people in one vehicle with very little distraction and time on your hands. And, you know, even if you're listening to music, or it's kind of in the background, I think road trips are really fertile grounds for meaningful conversation. So I definitely think the mechanics helped. I don't think my dad ever did anything by accident. I think he had a plan. He wanted me to know the story. They were visiting from England, and it was his 70th birthday. And I believe, I mean, I never got a chance to ask him this, but I believe he intended to tell me this story at some point. And then, that morning was the morning when the time was right. I just think there were some things he needed to communicate. And I was ready to listen. I mean, life is really, really, really hectic. And I definitely feel like when you're a physician, you know, I had been a physician in training, now I was a physician in private practice. There's just so many hurdles, and there's so much busyness going on all the time. And then you have your personal life, we had young children at that time. It's really hard to pay attention to the past, I think, when you're in this constant state of forward momentum. But in a way, the road trip, we didn't have anything else to do. We had like 10 hours of driving ahead of us, and I couldn't be busy doing anything else. I think it made a difference that I actually had the training of how to listen to the story and to recognize it for what it was. And the training informed the questions I was able to ask, and how we ultimately kept that dialogue going.

Emily Silverman

You mentioned that when you received this story from your dad, that you are already a practicing psychiatrist. Tell us about your path to psychiatry.

Shaili Jain

I was born and raised in England, and so when you make the decision to go to medical school, you make it really early, and you actually start medical school at 18. I loved science. I was academically strong. And that was the logical thing for an immigrant's daughter to do. There were very limited options for me. And that made sense because it was a very defined career path. And there was a respect inherent in that career path. And there was stability, which any of you who come from an immigrant family, that is the one thing we crave above all else. So I kind of fell into medicine in that regard, but it was absolutely the right choice for me. The psychiatry bit though was the non-conventional bit. I made a lot of people very unhappy. For the first time in my life, by the way, because otherwise, I was a very good girl. But yeah, I was drawn to it. In England, you do a three month rotation in psychiatry as a medical student. Actually, they take psychiatry very seriously. Every single medical student has to pass a very detailed exam in psychiatry before you can even become a doctor, like they take mental health so seriously as part of the training. And when I did my rotation, I was just absolutely captivated. I was so drawn into that world. There felt like there was nothing more important than listening to these stories, making sense of the stories, alleviating psychological suffering. It just felt like that was where I was always meant to be. But this was back in the 1990s when I made the decision, and it was in England, and tremendous amounts of stigma towards mental health and psychiatry, huge amounts. Not just externally. Like initially, my parents were very dissatisfied with my decision. They didn't understand it. They didn't see it as real medicine. They had a lot of preconceived notions. Luckily, I was able to bring them around. And eventually they understood my rationale and they were super, super supportive of my decision. But at the time, they didn't understand it. But the stigma came from inherently from within the profession too—many of my mentors in internal medicine or people who had hoped that I would pursue a different path. It was actually kind of astonishing how much stigma there is towards psychiatry within our own medical profession. That was a while ago, I think things have changed. I think things are heading in a better direction. But yeah, that was an unpopular decision. But again, I'm so glad I made it. Because now when I look back at the story, of course that was where I was always meant to be.

Emily Silverman

You said that when you were sitting in the car, part of what made you ready to receive the story was that you had the training, you were a psychiatrist, you knew how to listen. And I really love that you said that because I think it's really easy to think of listening as a passive process. How hard could it be, you just kind of sit silently. But listening is actually a very active process. And one could argue that it's a skill that can be developed. I was wondering if you could bring us into that a little bit. Like what does it mean to be a good listener?

Shaili Jain

I totally agree. It's a skill, it's not passive at all. I actually am very concerned that as a society, in our culture, we've become horrible listeners. I think whenever there's a lot of progress, and there's a lot of affluence, in some ways, humans become stupider. And I think that's where we're becoming stupider–we're forgetting how to listen. We're an incredibly distracted society. And unfortunately, I feel like within medicine itself, I've been a practicing physician for over 20 years now, and we're so bombarded with so much information from every angle. I feel like even a well-intentioned physician is really challenged to listen properly these days. For me, listening is also part of integrating what I'm hearing in the larger context of that person's life. That's when I think listening can really lead to meaningful conversation and meaningful interpretation. Sometimes I think in medicine, that's the most powerful tool we have.

Emily Silverman

The climax of your story is a realization, or what you call a "slow dawning." And the realization is "I had all along been of those people." Such a powerful sentence. Can you tell us about that slow dawning and how it changed the way you show up for your patients, if at all?

Shaili Jain

I think my medical training up until that point… I loved being a doctor, so proud of that accomplishment, I was so fulfilled by the work I was doing, but there was still this distance, in a way. I was the doctor, and I was treating a patient. And my training in England definitely reinforced that kind of rigid structure. And I think the slow dawning that you referred to, because it didn't happen instantly, still took me a bit of time to figure it out. It just made me aware of my own personal story that I had not fully integrated into my role as a physician. If I was going to be really good at what I was going to do, it was actually that personal story that was going to make me that good. It took me a while to understand that. It was something that was in the background, it was something that I would never have talked about. But that was actually the thing that I should have been talking about because this distance between doctors and patients is artificial. I think it really solidified the empathy, which I think over the course of a career, can get eroded. We talk about burnout, we talk about moral injury. And I do think there are these cumulative experiences over the course of a career that can make you feel distance from your patients. And I think the road trip came at a really good time because it reinforced my connection to my patients. That all along I had been of these people. These are my people. And somehow, by trying to heal them–I wasn't in a position where I could heal my own family–ut the notion of healing others, there's something corrective about that. There's something about that that makes sense to the obsessive part of my brain, you know. I think you need something that fuels your passion—that goes beyond whatever training or notions of duty and professional obligation—and I think that helped fuel me for sure.

Emily Silverman

And this new perspective actually precipitated for you a geographic move. So you upped and moved to California, and in the story you joke about how that was a horrible transition. Tell us about that.

Shaili Jain

I was in private practice and very settled in Wisconsin and I don't like to move. Part of that is rooted in my past. I mean, my dad was forcibly displaced as a child. And then he kind of had to come to England for a better life and better opportunities. He was a reluctant immigrant. He didn't want to leave his country. He was a patriot. He loved his country. But he didn't have a choice. I like to stay put, I really do. But somehow… I had already moved to America. I really thought we would stay in the Midwest. But after that road trip, it became clear to me that if I wanted to be serious about making a contribution to the science of PTSD, I would have to go where I could learn those skills and that knowledge. California is one of the sites of the National Center for PTSD, which is one of the most cutting edge organizations for understanding the science of PTSD. So we came here. It was a really strange time to move. We had a young family. Moving with kids is just not easy. I had to start all over again, I had to take a demotion, I had to be a research fellow. I don't mean to sound whiny. But I think on an existential level, again, being the child of immigrants, the first woman in my family to go to university, nevermind, attend medical school, this starting over, it really gets old after a while. And I remember vividly, you know, I was on a fellow's paycheck, living in the Bay Area, still adjusting to the sticker shock. All of my paycheck went to paying my daughter's preschool bill. So literally for the duration of me being a fellow I was in the hole, you know, because we weren't able to save any money. I'm also cognizant of the privilege you have being an educated person working in the United States. But I think it goes back to generational trauma. There's this massive need for stability, and a massive need to have control over your financial destiny. I just think it's in our genes, it's in our blood, because we know what it feels like not to have that. And that was an incredibly stressful two and a half years for those reasons. And I felt like I was taking this massive gamble, this massive risk, because if this foray into academic medicine didn't work out, it would have come at a big cost, not just financially, but in terms of uprooting our family. So, of course, it was a great move in the end. But at the time, I'd say it was probably the toughest couple years of my life because I really wasn't quite sure what I was doing. And it is just tough because I think if you don't have generational wealth, or if you don't come from a background where you have some financial security, moving to this part of the world is just not a good idea.

Emily Silverman

This question is a little bit out of left field, but it's just something I've been wondering. I was thinking about how if you look back in human history, there's been a lot of war, a lot of bloodshed, a lot of death, a lot of displacement, a lot of disease. And how trauma in some ways feels like a constant, like a part of human life. Are we less able to process our trauma now than we were hundreds of years ago?

Shaili Jain

I think on one hand we have to acknowledge that being able to talk about your trauma, being able to acknowledge the psychological consequences of it, that's a luxury. Take the example of my father, as I mentioned in The Nocturnists piece. We had an “inside of the house story” and an “outside of the house story”. He never hid anything, but he did not go around publicizing the fact that he was an orphaned refugee because that would come across as weakness. PTSD has always been there. I think in years gone by, people died prematurely because of those tragedies. So even if you look at the survivors of war, World War I, World War II, a lot of those soldiers would have died from the injuries of a traumatic event. In modern day times, they may survive because of advances in medical knowledge. But then they have to deal with the psychological trauma. It's almost like we've come to this stage in human history where we're actually starting to be able to talk about PTSD because we have the luxury of doing so and people are surviving to tell their stories. I also think we're at a stage in human history where there is more openness to hear about the stories of people who were previously invisible. You even look at, let's say, the MeToo movement. Rape is the trauma most likely to lead to PTSD. Yeah, rape is a crime that historically has been so shrouded in stigma, where the victim has been so ostracized and blamed, that I don't think there's ever been a right time where they've been able to speak up. On the flip-side of that is kind of the second prong answer. You'd mentioned how maybe, are we maybe less resilient in some ways because of the nature of modern day life? I hear you, I do think disconnection is a massive problem in our society, and like I was saying before, we don't know how to listen, we're very distracted. We're living in different worlds. We have digital worlds that we live in, we have the real world that we live in. And I certainly don't think that sets us up for good psychological health.

I feel like younger generations are more comfortable with expressing their own vulnerability. And I'm not sure that's a bad thing. Are we overdoing it? And will that be to our detriment? I guess time will tell. The one thing I do worry about with younger generations is the loss of perspective. I feel perspective is really, really important. Like seeing your own suffering in the context of collective human suffering is really, really important for you to keep perspective. And I think having good perspective is the basis of good mental health. I do worry, that perspective is being lost in younger generations, because we live in these increasingly curated worlds. If you want to spend your whole life only listening to people who think like you, you can do that today. Whereas I think in previous generations, we were kind of forced to interact and be part of worlds that were not familiar to us. Like I say, I think there's two sides to it. But for the most part, I think acknowledging trauma, talking about it, accepting what it's done to us, being curious about what it's done to us, I can only think that's a really good thing for us as a whole, as a whole society.

Emily Silverman

In the story, you talk about the importance of testimony, and you say, "Testimony goes beyond the casual. Testimony is a very intentional narration. Testimony requires the listener to act." So I was wondering if you could say more about that because I really loved that.

Shaili Jain

There is this sometimes misconception out there that, oh, okay, if you're a therapist or psychiatrist, what are you doing, you're just listening to somebody. But it's so much more than that. There's intent there, and the burden is on the listener to do something with that information. And that's what I love about being a physician, the kind of activism that's inherent in that role. I just don't think I saw it that way. But I do think that is ultimately what is going on. And when it's done, right, it's the most beautiful fulfilling thing in the world.

Emily Silverman

I've learned so much from this conversation. It's such a joy to speak with you. Is there anything else you'd like to share with our listeners before we end?

Shaili Jain

No, thanks so much. I really enjoyed our conversation too, Emily, and I really appreciated your thoughtful questions. When we did this recording, it was January 2020. It just feels surreal to think back to that time because it feels like the world has permanently changed since then. But I think what came through to me is the power of storytelling and how important it is. So just to share with you my respect for the work that you are doing, and I hope you continue to do it for many, many, many, many, many years because it really is an invaluable, very, very, very important thing.

Emily Silverman

I have been speaking to Dr. Shaili Jain. Shaili told her story "Bearing Witness" on stage at The Nocturnists in January 2020. And she's also the author of The Unspeakable Mind: Stories of Trauma and Healing. Pick it up if you'd like to explore more about this important topic. And thank you so much for being here with me today, Shaili.

Shaili Jain

Thanks so much, Emily.

Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.

Emily Silverman

We all come from somewhere. We have parents, grandparents, great grandparents, and other ancestors that extend backward in time. How do our family stories affect our lives today? What do we carry forward? And how might our histories inform our perspectives and even our careers in healthcare? You're listening to The Nocturnists: Stories from the World of Medicine. I'm Emily Silverman. Today I speak with Shaili Jain. Shaili is a psychiatrist and PTSD specialist at the VA Palo Alto healthcare system, and a clinical associate professor affiliated with the Department of Psychiatry at the Stanford University School of Medicine. She's the author of The Unspeakable Mind: Stories of Trauma and Healing from the Frontlines of PTSD Science, and her essays and commentaries on trauma and PTSD have been presented by the BBC, CNN, New York Times, Stat, Newsweek, the LA Times, and others. But before I speak with Shaili, we'll hear the story that she told live at The Nocturnists in San Francisco in January 2020. Here's Shaili.

Shaili Jain

It's 2007. There's five of us in a minivan on a road trip. My husband's driving, I'm next to him in the passenger seat. In the back is our four-and-a-half-year-old son, and my parents who are visiting from England. That's where I was born and raised. We're celebrating my dad's 70th birthday with this road trip across the United States.

This morning, we're leaving New York City. We left early in the morning to beat the traffic. Our son is already fast asleep. My mom has started to doze and I want a nap. I'm exhausted. I'm seven months pregnant, I really want to sleep. But then my dad starts talking. And he starts talking about 1947.

I knew the nuts and bolts of this story. 1947. The Partition of British India. Horrific intercommunal violence. Millions were killed. Many, many millions were forced to flee. I knew the nuts and bolts of the story. I knew how it had impacted our family. My dad had been orphaned at the age of 10. He'd been a refugee forced to work as a child laborer. But I had been born and raised in England, and I'd really been disconnected from this story. We didn't have any family photographs. We didn't have any family heirlooms. Our trips back home were scant to non-existent. So growing up this story felt anonymous, it felt distant.

But in the minivan as my dad is talking, I'm hearing details that I've never heard before. New details. Like about his sister, his youngest sister who at the age of two contracted smallpox, and she died in 1947.

I'm learning about my grandmother, his mother, a woman who was this accomplished cook. She played the harmonium beautifully, she spoke English. But after her youngest daughter died, she took to her bed and kind of withered away, and she died too in 1947.

And my grandfather, this senior civil servant, who on his days off would don jodhpurs and go horse riding. And later at home with his kids, he'd make them this really tasty sweet treat called anjeer barfi—this rich fudge of figs and pistachio, nuts and cream.

Growing up, when I would hear about 1947, it was usually bits of information just popped in at really inopportune moments. Often accompanied by my dad's anger and his bitterness and his sadness, I just didn't know what to make of these bits of information.

But now on the road trip when he's talking, his narration is totally different. It's smooth, it's cohesive. It's stripped of all those negative emotions, no anger, no bitterness. So I'm pulled into his story.

My dad, the orphaned refugee. My dad, who as a young man, moved to England and started over again. My dad, who at this moment in time, is the sole surviving member of his family of origin.

I'm a psychiatrist. I'm trained to listen closely. As my dad's words flowed to me from behind the minivan. I recognize them as testimony. Patients give you testimony all the time. They tell you their deepest darkest secrets, their worst fears. They tell you things they don't even tell their loved ones. Testimony goes beyond the casual. Testimony is a very intentional narration. Testimony requires the listener to act.

So after the road trip, my parents went back to England, and I went back to my private practice in Milwaukee, Wisconsin. But I couldn't stop thinking about India. My grandparents’ lives, what were they like? What were their habits? What were their personalities like? What were their quirks? What were their losses, their failures, their successes, their ambitions? And then what about their deaths? Two traumatic deaths.

My grandmother just took to her bed and died of this mysterious illness. She was in her early 40s. At the time of her death, she must have known that she'd leave the rest of her young children motherless. And my grandfather, his was a violent death. At the time of his death, he must have known that his surviving children were not only going to be orphaned, but they were going to be penniless, they were going to be destitute.

Two traumatic deaths. Deaths with a domino effect. Trauma filled lives for their children for sure. And a domino effect for me too. What was I going to do with this story?

Growing up in England, this story of 1947, it was like an inside of the house story. It wasn't meant for public consumption. Don't lie, but don't tell either. Proclaiming myself to be the daughter of an orphaned refugee was really not a smart strategy, not in class-obsessed British society.

So it's only now after the road trip in 2007, that for the first time in my life, I'm claiming this story. I'm owning it. I'm the daughter of a war orphan. I'm the granddaughter of a man who was murdered. I realized that I spent my whole life living in the shadow that 1947 had cast on my dad's life. But I hadn't really realized it because that was the only life I knew. On some level, I must have known, right?

Pretty early on in my medical career, I decided I was going to be a psychiatrist. And that was a wildly unpopular decision, by the way. My parents didn't understand it, they did not approve. My mentors did not approve. Everyone told me not to do that. But I chose. I wanted to submerge myself in this world of mental suffering—the only life I'd known. And then there was this peculiar trait of mine, I'd always been drawn to those who'd suffered the unspeakable, those who would survive tragedy. It was as though bearing witness was where I was always meant to be.

So this slow dawning. The displaced, the tragic, the traumatized, the misfits, the outsiders, the survivors. I had all along been of those people.

I'm a psychiatrist, so I know about post-traumatic stress. I know about trauma, but I want to know more. I want to become a specialist. I want to become a trauma scientist, so that I can understand PTSD and study it. But all of that requires a move. It will require a move to California where I can learn to become all of those things. So I leave my private practice. I leave that financial security. I leave a city that I love. A city where I trained. A city where I built my reputation brick by brick. And we moved to California. And again in California, I start over. I'm a nobody, I'm an outsider, I have to earn my way step by step. And I do so living off of my savings in the most expensive part of the world.

But the only thing that kept me going in all of the turmoil and the disappointments that the weeks and months and years would bring was this newfound connection to trauma survivors. I had all along been of these people. I had all along been of these people.

My patient John sits across from me in the clinic. His middle-aged stocky build–he's wearing sweatpants. He's telling me about his weekend trip to the mall. His story is all over the place. It's disorganized. It's chaotic. One minute, he's talking about a shopper in Old Navy. The next minute, he's talking about an IED explosion in Iraq. Old Navy, Iraq. Iraq, Old Navy. I struggled to track what he's saying. I feel this old urge rise up in me, this urge to interrupt, to organize, to put order on his disorder. But I resist that urge. I resist that urge and I continue listening.

He's getting louder now. He leans in, his face is intense, he's staring off into the distance. He's talking about a woman he saw in the mall who's cleaning tables in the food court. Her face reminded him of a woman who he had seen in Iraq. Her face reminded him of that day in Iraq, the day an IED exploded and he was sent in to clean up the mess. The smell of burning flesh, the blood spattered face of a mother, the woman cleaning the tables in the food court. I feel this urge rise up in me, an old urge, an urge to deny this story its existence. This did not happen. This is unspeakable. It's unthinkable. But I resist the urge and instead I stay present.

John's silent now. He seems distant. I feel like he's left the room so I try and pull him back in. "Setbacks are inevitable." "Tomorrow will be a better day." "You've come so far."

He nods his head. But his eyes betrayed the truth. His mind's pulling him elsewhere. His brain's networks are misfiring, they're awry. He's beyond my therapeutic reach today. I feel this urge rise up in me again, this urge to lean in, to try harder, to fix him. But I resist the urge because I know all too well, healing is not going to happen on my timeline. It's going to be two steps forward, one step back. It's going to be bumpy. It's going to be unpredictable. My job in all of this... to bear witness, to stay present, to keep my heart large, and to learn to tolerate the distress.

Emily Silverman

So I'm sitting here with Shaili Jain. Shaili, thank you so much for being here today.

Shaili Jain

Oh, it's my absolute pleasure. Thanks so much for having me, Emily.

Emily Silverman

It was so wonderful to revisit the story that you told on stage in January 2020. And I was wondering if you could bring us back to that night. What was that experience like for you?

Shaili Jain

It was a truly amazing experience because I really think it tapped into my love and passion for storytelling, which is such an integral part of what I do on a day-to-day basis as a psychiatrist, as a trauma specialist. I think in terms of that process of storytelling and connecting to an audience, it was an incredibly unique and fulfilling experience. I don't think I've ever spoken live to such a big audience. So that was a whole other experience that took me out of my comfort zone. But for the most part, I felt just really grateful to have had that opportunity to relay my story from a beginning to where I am today, in a way that was cohesive. And it was a flow that had not been present in my real life, so it was kind of nice to have a place to relay that story cohesively.

Emily Silverman

Just the other day, I was chatting with Charlie Varon. And for the listeners, Charlie is a very, very good friend of The Nocturnists, and he often steps up to do some coaching with our storytellers to prepare for the stage. And he just always glows so much when he talks about working with you. So I just wanted to share that with you and invite you to reflect a bit on what it was like working with him because he is a career performer, director, theater person. So what was that like?

Shaili Jain

Well, I'm so glad you brought that up, actually. Because when I was just listening to the playback earlier today before I interviewed, I was thinking of Charlie, because I worked really closely with him, he paid meticulous attention, he is a really careful listener. He brought the artistry to the story in terms of guiding me about what to edit, what to keep in, what to not keep in, what to emphasize. And in terms of performance, I mean, I'm not a performer. He gave me some really, really invaluable advice. So I'm really glad you brought Charlie up, because I was thinking about him this morning, that the story would not have presented itself if it wasn't for his expertise and his close guidance and his mentorship. And he just has such a gentle, tender manner, which was very much appreciated because this is a really, really personal story. I think about him in glowing terms, too.

Emily Silverman

I'd like to walk it back to your childhood because in the story you say that before this road trip in 2007, you didn't know as much about your family story. So what did you know before this revelation?

Shaili Jain

I knew the facts, I knew the nuts and bolts. I don't remember a time when I didn't know that my dad had been orphaned at the age of 10. So he didn't hide anything. I don't remember a time when I wasn't aware of this mega-event, the 1947 Partition of British India. And I always remember from a young age having a sense of how that one event had shaped my dad's life because it kind of always felt like it was present. Just his view of life, what he felt was important, what he did not feel was important. The way he watched the news—that he had this hawkish attention that he paid to the news because, like a lot of trauma survivors, you always expect something bad is going to happen, and you have to be on guard. His commitment to education. I think one benefit of that story for me, I think I'm a direct beneficiary, is my dad was really an unusual man for his generation and his time, in that he never viewed a girl child any different to a boy child. And I think part of that was because he knew what it was like to be viewed as less than or be viewed as a victim or feel disadvantaged. And I do believe his experiences as a young child informed his own parenting where he would never see a boy or girl as different. And that was really radical for that time. So I felt like the story was always there, but the details were missing. And like I say, the cohesion and the connection and how the story was still alive that whole time. It was not in the past. It was alive this whole time, and it was still shaping him, it was shaping me and would end up having a profound influence on my own life.

Emily Silverman

You open the story in the car on this road trip. And this is the moment where your dad starts to tell the story again, but this time he's telling it differently. So what was different about it and maybe bring us into that car with you?

Shaili Jain

I think the most noticeable difference was that he was very calm when he was relaying the story. And that was such a different experience to when I was growing up. Whenever he'd talk about 1947, it was often these bits of information just plopped in at these really strange times. And there's a lot of anger, a lot of bitterness, a lot of sadness associated with his recollections. So I think as a kid, my natural inclination was to want to distance myself from that, but in the car his narration was really smooth. It was cohesive, there was none of that negativity. And we'd both changed, right? I was a psychiatrist by that point. I'm trained to listen really carefully. He was retired by this point, the sole surviving member of his family of origin. I don't think he had the pressures on him that he'd had when I was growing up. I say in the piece, I recognized it for what it was, it was “testimony”, because patients give us testimony all the time. And I remember thinking, this is something really important, I have to pay attention to this moment and to this story. So that's how I remember it. It was probably one of the most important conversations in my life. I mean, he was doing the majority of the talking. But I was listening very attentively, and I asked a lot of questions, and I was able to elicit a lot of detail from him. And it was a really moving experience for me.

Emily Silverman

Do you have any sense for why he might have decided to open up in that moment? Or maybe it wasn't a decision, maybe it just happened organically and naturally. But was there something about being in the car, the movement of the car? Why then?

Shaili Jain

I think the mechanics definitely helped. I love road trips for that reason a lot. It's rare in modern day life that you can have people in one vehicle with very little distraction and time on your hands. And, you know, even if you're listening to music, or it's kind of in the background, I think road trips are really fertile grounds for meaningful conversation. So I definitely think the mechanics helped. I don't think my dad ever did anything by accident. I think he had a plan. He wanted me to know the story. They were visiting from England, and it was his 70th birthday. And I believe, I mean, I never got a chance to ask him this, but I believe he intended to tell me this story at some point. And then, that morning was the morning when the time was right. I just think there were some things he needed to communicate. And I was ready to listen. I mean, life is really, really, really hectic. And I definitely feel like when you're a physician, you know, I had been a physician in training, now I was a physician in private practice. There's just so many hurdles, and there's so much busyness going on all the time. And then you have your personal life, we had young children at that time. It's really hard to pay attention to the past, I think, when you're in this constant state of forward momentum. But in a way, the road trip, we didn't have anything else to do. We had like 10 hours of driving ahead of us, and I couldn't be busy doing anything else. I think it made a difference that I actually had the training of how to listen to the story and to recognize it for what it was. And the training informed the questions I was able to ask, and how we ultimately kept that dialogue going.

Emily Silverman

You mentioned that when you received this story from your dad, that you are already a practicing psychiatrist. Tell us about your path to psychiatry.

Shaili Jain

I was born and raised in England, and so when you make the decision to go to medical school, you make it really early, and you actually start medical school at 18. I loved science. I was academically strong. And that was the logical thing for an immigrant's daughter to do. There were very limited options for me. And that made sense because it was a very defined career path. And there was a respect inherent in that career path. And there was stability, which any of you who come from an immigrant family, that is the one thing we crave above all else. So I kind of fell into medicine in that regard, but it was absolutely the right choice for me. The psychiatry bit though was the non-conventional bit. I made a lot of people very unhappy. For the first time in my life, by the way, because otherwise, I was a very good girl. But yeah, I was drawn to it. In England, you do a three month rotation in psychiatry as a medical student. Actually, they take psychiatry very seriously. Every single medical student has to pass a very detailed exam in psychiatry before you can even become a doctor, like they take mental health so seriously as part of the training. And when I did my rotation, I was just absolutely captivated. I was so drawn into that world. There felt like there was nothing more important than listening to these stories, making sense of the stories, alleviating psychological suffering. It just felt like that was where I was always meant to be. But this was back in the 1990s when I made the decision, and it was in England, and tremendous amounts of stigma towards mental health and psychiatry, huge amounts. Not just externally. Like initially, my parents were very dissatisfied with my decision. They didn't understand it. They didn't see it as real medicine. They had a lot of preconceived notions. Luckily, I was able to bring them around. And eventually they understood my rationale and they were super, super supportive of my decision. But at the time, they didn't understand it. But the stigma came from inherently from within the profession too—many of my mentors in internal medicine or people who had hoped that I would pursue a different path. It was actually kind of astonishing how much stigma there is towards psychiatry within our own medical profession. That was a while ago, I think things have changed. I think things are heading in a better direction. But yeah, that was an unpopular decision. But again, I'm so glad I made it. Because now when I look back at the story, of course that was where I was always meant to be.

Emily Silverman

You said that when you were sitting in the car, part of what made you ready to receive the story was that you had the training, you were a psychiatrist, you knew how to listen. And I really love that you said that because I think it's really easy to think of listening as a passive process. How hard could it be, you just kind of sit silently. But listening is actually a very active process. And one could argue that it's a skill that can be developed. I was wondering if you could bring us into that a little bit. Like what does it mean to be a good listener?

Shaili Jain

I totally agree. It's a skill, it's not passive at all. I actually am very concerned that as a society, in our culture, we've become horrible listeners. I think whenever there's a lot of progress, and there's a lot of affluence, in some ways, humans become stupider. And I think that's where we're becoming stupider–we're forgetting how to listen. We're an incredibly distracted society. And unfortunately, I feel like within medicine itself, I've been a practicing physician for over 20 years now, and we're so bombarded with so much information from every angle. I feel like even a well-intentioned physician is really challenged to listen properly these days. For me, listening is also part of integrating what I'm hearing in the larger context of that person's life. That's when I think listening can really lead to meaningful conversation and meaningful interpretation. Sometimes I think in medicine, that's the most powerful tool we have.

Emily Silverman

The climax of your story is a realization, or what you call a "slow dawning." And the realization is "I had all along been of those people." Such a powerful sentence. Can you tell us about that slow dawning and how it changed the way you show up for your patients, if at all?

Shaili Jain

I think my medical training up until that point… I loved being a doctor, so proud of that accomplishment, I was so fulfilled by the work I was doing, but there was still this distance, in a way. I was the doctor, and I was treating a patient. And my training in England definitely reinforced that kind of rigid structure. And I think the slow dawning that you referred to, because it didn't happen instantly, still took me a bit of time to figure it out. It just made me aware of my own personal story that I had not fully integrated into my role as a physician. If I was going to be really good at what I was going to do, it was actually that personal story that was going to make me that good. It took me a while to understand that. It was something that was in the background, it was something that I would never have talked about. But that was actually the thing that I should have been talking about because this distance between doctors and patients is artificial. I think it really solidified the empathy, which I think over the course of a career, can get eroded. We talk about burnout, we talk about moral injury. And I do think there are these cumulative experiences over the course of a career that can make you feel distance from your patients. And I think the road trip came at a really good time because it reinforced my connection to my patients. That all along I had been of these people. These are my people. And somehow, by trying to heal them–I wasn't in a position where I could heal my own family–ut the notion of healing others, there's something corrective about that. There's something about that that makes sense to the obsessive part of my brain, you know. I think you need something that fuels your passion—that goes beyond whatever training or notions of duty and professional obligation—and I think that helped fuel me for sure.

Emily Silverman

And this new perspective actually precipitated for you a geographic move. So you upped and moved to California, and in the story you joke about how that was a horrible transition. Tell us about that.

Shaili Jain

I was in private practice and very settled in Wisconsin and I don't like to move. Part of that is rooted in my past. I mean, my dad was forcibly displaced as a child. And then he kind of had to come to England for a better life and better opportunities. He was a reluctant immigrant. He didn't want to leave his country. He was a patriot. He loved his country. But he didn't have a choice. I like to stay put, I really do. But somehow… I had already moved to America. I really thought we would stay in the Midwest. But after that road trip, it became clear to me that if I wanted to be serious about making a contribution to the science of PTSD, I would have to go where I could learn those skills and that knowledge. California is one of the sites of the National Center for PTSD, which is one of the most cutting edge organizations for understanding the science of PTSD. So we came here. It was a really strange time to move. We had a young family. Moving with kids is just not easy. I had to start all over again, I had to take a demotion, I had to be a research fellow. I don't mean to sound whiny. But I think on an existential level, again, being the child of immigrants, the first woman in my family to go to university, nevermind, attend medical school, this starting over, it really gets old after a while. And I remember vividly, you know, I was on a fellow's paycheck, living in the Bay Area, still adjusting to the sticker shock. All of my paycheck went to paying my daughter's preschool bill. So literally for the duration of me being a fellow I was in the hole, you know, because we weren't able to save any money. I'm also cognizant of the privilege you have being an educated person working in the United States. But I think it goes back to generational trauma. There's this massive need for stability, and a massive need to have control over your financial destiny. I just think it's in our genes, it's in our blood, because we know what it feels like not to have that. And that was an incredibly stressful two and a half years for those reasons. And I felt like I was taking this massive gamble, this massive risk, because if this foray into academic medicine didn't work out, it would have come at a big cost, not just financially, but in terms of uprooting our family. So, of course, it was a great move in the end. But at the time, I'd say it was probably the toughest couple years of my life because I really wasn't quite sure what I was doing. And it is just tough because I think if you don't have generational wealth, or if you don't come from a background where you have some financial security, moving to this part of the world is just not a good idea.

Emily Silverman

This question is a little bit out of left field, but it's just something I've been wondering. I was thinking about how if you look back in human history, there's been a lot of war, a lot of bloodshed, a lot of death, a lot of displacement, a lot of disease. And how trauma in some ways feels like a constant, like a part of human life. Are we less able to process our trauma now than we were hundreds of years ago?

Shaili Jain

I think on one hand we have to acknowledge that being able to talk about your trauma, being able to acknowledge the psychological consequences of it, that's a luxury. Take the example of my father, as I mentioned in The Nocturnists piece. We had an “inside of the house story” and an “outside of the house story”. He never hid anything, but he did not go around publicizing the fact that he was an orphaned refugee because that would come across as weakness. PTSD has always been there. I think in years gone by, people died prematurely because of those tragedies. So even if you look at the survivors of war, World War I, World War II, a lot of those soldiers would have died from the injuries of a traumatic event. In modern day times, they may survive because of advances in medical knowledge. But then they have to deal with the psychological trauma. It's almost like we've come to this stage in human history where we're actually starting to be able to talk about PTSD because we have the luxury of doing so and people are surviving to tell their stories. I also think we're at a stage in human history where there is more openness to hear about the stories of people who were previously invisible. You even look at, let's say, the MeToo movement. Rape is the trauma most likely to lead to PTSD. Yeah, rape is a crime that historically has been so shrouded in stigma, where the victim has been so ostracized and blamed, that I don't think there's ever been a right time where they've been able to speak up. On the flip-side of that is kind of the second prong answer. You'd mentioned how maybe, are we maybe less resilient in some ways because of the nature of modern day life? I hear you, I do think disconnection is a massive problem in our society, and like I was saying before, we don't know how to listen, we're very distracted. We're living in different worlds. We have digital worlds that we live in, we have the real world that we live in. And I certainly don't think that sets us up for good psychological health.

I feel like younger generations are more comfortable with expressing their own vulnerability. And I'm not sure that's a bad thing. Are we overdoing it? And will that be to our detriment? I guess time will tell. The one thing I do worry about with younger generations is the loss of perspective. I feel perspective is really, really important. Like seeing your own suffering in the context of collective human suffering is really, really important for you to keep perspective. And I think having good perspective is the basis of good mental health. I do worry, that perspective is being lost in younger generations, because we live in these increasingly curated worlds. If you want to spend your whole life only listening to people who think like you, you can do that today. Whereas I think in previous generations, we were kind of forced to interact and be part of worlds that were not familiar to us. Like I say, I think there's two sides to it. But for the most part, I think acknowledging trauma, talking about it, accepting what it's done to us, being curious about what it's done to us, I can only think that's a really good thing for us as a whole, as a whole society.

Emily Silverman

In the story, you talk about the importance of testimony, and you say, "Testimony goes beyond the casual. Testimony is a very intentional narration. Testimony requires the listener to act." So I was wondering if you could say more about that because I really loved that.

Shaili Jain

There is this sometimes misconception out there that, oh, okay, if you're a therapist or psychiatrist, what are you doing, you're just listening to somebody. But it's so much more than that. There's intent there, and the burden is on the listener to do something with that information. And that's what I love about being a physician, the kind of activism that's inherent in that role. I just don't think I saw it that way. But I do think that is ultimately what is going on. And when it's done, right, it's the most beautiful fulfilling thing in the world.

Emily Silverman

I've learned so much from this conversation. It's such a joy to speak with you. Is there anything else you'd like to share with our listeners before we end?

Shaili Jain

No, thanks so much. I really enjoyed our conversation too, Emily, and I really appreciated your thoughtful questions. When we did this recording, it was January 2020. It just feels surreal to think back to that time because it feels like the world has permanently changed since then. But I think what came through to me is the power of storytelling and how important it is. So just to share with you my respect for the work that you are doing, and I hope you continue to do it for many, many, many, many, many years because it really is an invaluable, very, very, very important thing.

Emily Silverman

I have been speaking to Dr. Shaili Jain. Shaili told her story "Bearing Witness" on stage at The Nocturnists in January 2020. And she's also the author of The Unspeakable Mind: Stories of Trauma and Healing. Pick it up if you'd like to explore more about this important topic. And thank you so much for being here with me today, Shaili.

Shaili Jain

Thanks so much, Emily.

Transcript

Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.

Emily Silverman

We all come from somewhere. We have parents, grandparents, great grandparents, and other ancestors that extend backward in time. How do our family stories affect our lives today? What do we carry forward? And how might our histories inform our perspectives and even our careers in healthcare? You're listening to The Nocturnists: Stories from the World of Medicine. I'm Emily Silverman. Today I speak with Shaili Jain. Shaili is a psychiatrist and PTSD specialist at the VA Palo Alto healthcare system, and a clinical associate professor affiliated with the Department of Psychiatry at the Stanford University School of Medicine. She's the author of The Unspeakable Mind: Stories of Trauma and Healing from the Frontlines of PTSD Science, and her essays and commentaries on trauma and PTSD have been presented by the BBC, CNN, New York Times, Stat, Newsweek, the LA Times, and others. But before I speak with Shaili, we'll hear the story that she told live at The Nocturnists in San Francisco in January 2020. Here's Shaili.

Shaili Jain

It's 2007. There's five of us in a minivan on a road trip. My husband's driving, I'm next to him in the passenger seat. In the back is our four-and-a-half-year-old son, and my parents who are visiting from England. That's where I was born and raised. We're celebrating my dad's 70th birthday with this road trip across the United States.

This morning, we're leaving New York City. We left early in the morning to beat the traffic. Our son is already fast asleep. My mom has started to doze and I want a nap. I'm exhausted. I'm seven months pregnant, I really want to sleep. But then my dad starts talking. And he starts talking about 1947.

I knew the nuts and bolts of this story. 1947. The Partition of British India. Horrific intercommunal violence. Millions were killed. Many, many millions were forced to flee. I knew the nuts and bolts of the story. I knew how it had impacted our family. My dad had been orphaned at the age of 10. He'd been a refugee forced to work as a child laborer. But I had been born and raised in England, and I'd really been disconnected from this story. We didn't have any family photographs. We didn't have any family heirlooms. Our trips back home were scant to non-existent. So growing up this story felt anonymous, it felt distant.

But in the minivan as my dad is talking, I'm hearing details that I've never heard before. New details. Like about his sister, his youngest sister who at the age of two contracted smallpox, and she died in 1947.

I'm learning about my grandmother, his mother, a woman who was this accomplished cook. She played the harmonium beautifully, she spoke English. But after her youngest daughter died, she took to her bed and kind of withered away, and she died too in 1947.

And my grandfather, this senior civil servant, who on his days off would don jodhpurs and go horse riding. And later at home with his kids, he'd make them this really tasty sweet treat called anjeer barfi—this rich fudge of figs and pistachio, nuts and cream.

Growing up, when I would hear about 1947, it was usually bits of information just popped in at really inopportune moments. Often accompanied by my dad's anger and his bitterness and his sadness, I just didn't know what to make of these bits of information.

But now on the road trip when he's talking, his narration is totally different. It's smooth, it's cohesive. It's stripped of all those negative emotions, no anger, no bitterness. So I'm pulled into his story.

My dad, the orphaned refugee. My dad, who as a young man, moved to England and started over again. My dad, who at this moment in time, is the sole surviving member of his family of origin.

I'm a psychiatrist. I'm trained to listen closely. As my dad's words flowed to me from behind the minivan. I recognize them as testimony. Patients give you testimony all the time. They tell you their deepest darkest secrets, their worst fears. They tell you things they don't even tell their loved ones. Testimony goes beyond the casual. Testimony is a very intentional narration. Testimony requires the listener to act.

So after the road trip, my parents went back to England, and I went back to my private practice in Milwaukee, Wisconsin. But I couldn't stop thinking about India. My grandparents’ lives, what were they like? What were their habits? What were their personalities like? What were their quirks? What were their losses, their failures, their successes, their ambitions? And then what about their deaths? Two traumatic deaths.

My grandmother just took to her bed and died of this mysterious illness. She was in her early 40s. At the time of her death, she must have known that she'd leave the rest of her young children motherless. And my grandfather, his was a violent death. At the time of his death, he must have known that his surviving children were not only going to be orphaned, but they were going to be penniless, they were going to be destitute.

Two traumatic deaths. Deaths with a domino effect. Trauma filled lives for their children for sure. And a domino effect for me too. What was I going to do with this story?

Growing up in England, this story of 1947, it was like an inside of the house story. It wasn't meant for public consumption. Don't lie, but don't tell either. Proclaiming myself to be the daughter of an orphaned refugee was really not a smart strategy, not in class-obsessed British society.

So it's only now after the road trip in 2007, that for the first time in my life, I'm claiming this story. I'm owning it. I'm the daughter of a war orphan. I'm the granddaughter of a man who was murdered. I realized that I spent my whole life living in the shadow that 1947 had cast on my dad's life. But I hadn't really realized it because that was the only life I knew. On some level, I must have known, right?

Pretty early on in my medical career, I decided I was going to be a psychiatrist. And that was a wildly unpopular decision, by the way. My parents didn't understand it, they did not approve. My mentors did not approve. Everyone told me not to do that. But I chose. I wanted to submerge myself in this world of mental suffering—the only life I'd known. And then there was this peculiar trait of mine, I'd always been drawn to those who'd suffered the unspeakable, those who would survive tragedy. It was as though bearing witness was where I was always meant to be.

So this slow dawning. The displaced, the tragic, the traumatized, the misfits, the outsiders, the survivors. I had all along been of those people.

I'm a psychiatrist, so I know about post-traumatic stress. I know about trauma, but I want to know more. I want to become a specialist. I want to become a trauma scientist, so that I can understand PTSD and study it. But all of that requires a move. It will require a move to California where I can learn to become all of those things. So I leave my private practice. I leave that financial security. I leave a city that I love. A city where I trained. A city where I built my reputation brick by brick. And we moved to California. And again in California, I start over. I'm a nobody, I'm an outsider, I have to earn my way step by step. And I do so living off of my savings in the most expensive part of the world.

But the only thing that kept me going in all of the turmoil and the disappointments that the weeks and months and years would bring was this newfound connection to trauma survivors. I had all along been of these people. I had all along been of these people.

My patient John sits across from me in the clinic. His middle-aged stocky build–he's wearing sweatpants. He's telling me about his weekend trip to the mall. His story is all over the place. It's disorganized. It's chaotic. One minute, he's talking about a shopper in Old Navy. The next minute, he's talking about an IED explosion in Iraq. Old Navy, Iraq. Iraq, Old Navy. I struggled to track what he's saying. I feel this old urge rise up in me, this urge to interrupt, to organize, to put order on his disorder. But I resist that urge. I resist that urge and I continue listening.

He's getting louder now. He leans in, his face is intense, he's staring off into the distance. He's talking about a woman he saw in the mall who's cleaning tables in the food court. Her face reminded him of a woman who he had seen in Iraq. Her face reminded him of that day in Iraq, the day an IED exploded and he was sent in to clean up the mess. The smell of burning flesh, the blood spattered face of a mother, the woman cleaning the tables in the food court. I feel this urge rise up in me, an old urge, an urge to deny this story its existence. This did not happen. This is unspeakable. It's unthinkable. But I resist the urge and instead I stay present.

John's silent now. He seems distant. I feel like he's left the room so I try and pull him back in. "Setbacks are inevitable." "Tomorrow will be a better day." "You've come so far."

He nods his head. But his eyes betrayed the truth. His mind's pulling him elsewhere. His brain's networks are misfiring, they're awry. He's beyond my therapeutic reach today. I feel this urge rise up in me again, this urge to lean in, to try harder, to fix him. But I resist the urge because I know all too well, healing is not going to happen on my timeline. It's going to be two steps forward, one step back. It's going to be bumpy. It's going to be unpredictable. My job in all of this... to bear witness, to stay present, to keep my heart large, and to learn to tolerate the distress.

Emily Silverman

So I'm sitting here with Shaili Jain. Shaili, thank you so much for being here today.

Shaili Jain

Oh, it's my absolute pleasure. Thanks so much for having me, Emily.

Emily Silverman

It was so wonderful to revisit the story that you told on stage in January 2020. And I was wondering if you could bring us back to that night. What was that experience like for you?

Shaili Jain

It was a truly amazing experience because I really think it tapped into my love and passion for storytelling, which is such an integral part of what I do on a day-to-day basis as a psychiatrist, as a trauma specialist. I think in terms of that process of storytelling and connecting to an audience, it was an incredibly unique and fulfilling experience. I don't think I've ever spoken live to such a big audience. So that was a whole other experience that took me out of my comfort zone. But for the most part, I felt just really grateful to have had that opportunity to relay my story from a beginning to where I am today, in a way that was cohesive. And it was a flow that had not been present in my real life, so it was kind of nice to have a place to relay that story cohesively.

Emily Silverman

Just the other day, I was chatting with Charlie Varon. And for the listeners, Charlie is a very, very good friend of The Nocturnists, and he often steps up to do some coaching with our storytellers to prepare for the stage. And he just always glows so much when he talks about working with you. So I just wanted to share that with you and invite you to reflect a bit on what it was like working with him because he is a career performer, director, theater person. So what was that like?

Shaili Jain

Well, I'm so glad you brought that up, actually. Because when I was just listening to the playback earlier today before I interviewed, I was thinking of Charlie, because I worked really closely with him, he paid meticulous attention, he is a really careful listener. He brought the artistry to the story in terms of guiding me about what to edit, what to keep in, what to not keep in, what to emphasize. And in terms of performance, I mean, I'm not a performer. He gave me some really, really invaluable advice. So I'm really glad you brought Charlie up, because I was thinking about him this morning, that the story would not have presented itself if it wasn't for his expertise and his close guidance and his mentorship. And he just has such a gentle, tender manner, which was very much appreciated because this is a really, really personal story. I think about him in glowing terms, too.

Emily Silverman

I'd like to walk it back to your childhood because in the story you say that before this road trip in 2007, you didn't know as much about your family story. So what did you know before this revelation?

Shaili Jain

I knew the facts, I knew the nuts and bolts. I don't remember a time when I didn't know that my dad had been orphaned at the age of 10. So he didn't hide anything. I don't remember a time when I wasn't aware of this mega-event, the 1947 Partition of British India. And I always remember from a young age having a sense of how that one event had shaped my dad's life because it kind of always felt like it was present. Just his view of life, what he felt was important, what he did not feel was important. The way he watched the news—that he had this hawkish attention that he paid to the news because, like a lot of trauma survivors, you always expect something bad is going to happen, and you have to be on guard. His commitment to education. I think one benefit of that story for me, I think I'm a direct beneficiary, is my dad was really an unusual man for his generation and his time, in that he never viewed a girl child any different to a boy child. And I think part of that was because he knew what it was like to be viewed as less than or be viewed as a victim or feel disadvantaged. And I do believe his experiences as a young child informed his own parenting where he would never see a boy or girl as different. And that was really radical for that time. So I felt like the story was always there, but the details were missing. And like I say, the cohesion and the connection and how the story was still alive that whole time. It was not in the past. It was alive this whole time, and it was still shaping him, it was shaping me and would end up having a profound influence on my own life.

Emily Silverman

You open the story in the car on this road trip. And this is the moment where your dad starts to tell the story again, but this time he's telling it differently. So what was different about it and maybe bring us into that car with you?

Shaili Jain

I think the most noticeable difference was that he was very calm when he was relaying the story. And that was such a different experience to when I was growing up. Whenever he'd talk about 1947, it was often these bits of information just plopped in at these really strange times. And there's a lot of anger, a lot of bitterness, a lot of sadness associated with his recollections. So I think as a kid, my natural inclination was to want to distance myself from that, but in the car his narration was really smooth. It was cohesive, there was none of that negativity. And we'd both changed, right? I was a psychiatrist by that point. I'm trained to listen really carefully. He was retired by this point, the sole surviving member of his family of origin. I don't think he had the pressures on him that he'd had when I was growing up. I say in the piece, I recognized it for what it was, it was “testimony”, because patients give us testimony all the time. And I remember thinking, this is something really important, I have to pay attention to this moment and to this story. So that's how I remember it. It was probably one of the most important conversations in my life. I mean, he was doing the majority of the talking. But I was listening very attentively, and I asked a lot of questions, and I was able to elicit a lot of detail from him. And it was a really moving experience for me.

Emily Silverman

Do you have any sense for why he might have decided to open up in that moment? Or maybe it wasn't a decision, maybe it just happened organically and naturally. But was there something about being in the car, the movement of the car? Why then?

Shaili Jain

I think the mechanics definitely helped. I love road trips for that reason a lot. It's rare in modern day life that you can have people in one vehicle with very little distraction and time on your hands. And, you know, even if you're listening to music, or it's kind of in the background, I think road trips are really fertile grounds for meaningful conversation. So I definitely think the mechanics helped. I don't think my dad ever did anything by accident. I think he had a plan. He wanted me to know the story. They were visiting from England, and it was his 70th birthday. And I believe, I mean, I never got a chance to ask him this, but I believe he intended to tell me this story at some point. And then, that morning was the morning when the time was right. I just think there were some things he needed to communicate. And I was ready to listen. I mean, life is really, really, really hectic. And I definitely feel like when you're a physician, you know, I had been a physician in training, now I was a physician in private practice. There's just so many hurdles, and there's so much busyness going on all the time. And then you have your personal life, we had young children at that time. It's really hard to pay attention to the past, I think, when you're in this constant state of forward momentum. But in a way, the road trip, we didn't have anything else to do. We had like 10 hours of driving ahead of us, and I couldn't be busy doing anything else. I think it made a difference that I actually had the training of how to listen to the story and to recognize it for what it was. And the training informed the questions I was able to ask, and how we ultimately kept that dialogue going.

Emily Silverman

You mentioned that when you received this story from your dad, that you are already a practicing psychiatrist. Tell us about your path to psychiatry.

Shaili Jain

I was born and raised in England, and so when you make the decision to go to medical school, you make it really early, and you actually start medical school at 18. I loved science. I was academically strong. And that was the logical thing for an immigrant's daughter to do. There were very limited options for me. And that made sense because it was a very defined career path. And there was a respect inherent in that career path. And there was stability, which any of you who come from an immigrant family, that is the one thing we crave above all else. So I kind of fell into medicine in that regard, but it was absolutely the right choice for me. The psychiatry bit though was the non-conventional bit. I made a lot of people very unhappy. For the first time in my life, by the way, because otherwise, I was a very good girl. But yeah, I was drawn to it. In England, you do a three month rotation in psychiatry as a medical student. Actually, they take psychiatry very seriously. Every single medical student has to pass a very detailed exam in psychiatry before you can even become a doctor, like they take mental health so seriously as part of the training. And when I did my rotation, I was just absolutely captivated. I was so drawn into that world. There felt like there was nothing more important than listening to these stories, making sense of the stories, alleviating psychological suffering. It just felt like that was where I was always meant to be. But this was back in the 1990s when I made the decision, and it was in England, and tremendous amounts of stigma towards mental health and psychiatry, huge amounts. Not just externally. Like initially, my parents were very dissatisfied with my decision. They didn't understand it. They didn't see it as real medicine. They had a lot of preconceived notions. Luckily, I was able to bring them around. And eventually they understood my rationale and they were super, super supportive of my decision. But at the time, they didn't understand it. But the stigma came from inherently from within the profession too—many of my mentors in internal medicine or people who had hoped that I would pursue a different path. It was actually kind of astonishing how much stigma there is towards psychiatry within our own medical profession. That was a while ago, I think things have changed. I think things are heading in a better direction. But yeah, that was an unpopular decision. But again, I'm so glad I made it. Because now when I look back at the story, of course that was where I was always meant to be.

Emily Silverman

You said that when you were sitting in the car, part of what made you ready to receive the story was that you had the training, you were a psychiatrist, you knew how to listen. And I really love that you said that because I think it's really easy to think of listening as a passive process. How hard could it be, you just kind of sit silently. But listening is actually a very active process. And one could argue that it's a skill that can be developed. I was wondering if you could bring us into that a little bit. Like what does it mean to be a good listener?

Shaili Jain

I totally agree. It's a skill, it's not passive at all. I actually am very concerned that as a society, in our culture, we've become horrible listeners. I think whenever there's a lot of progress, and there's a lot of affluence, in some ways, humans become stupider. And I think that's where we're becoming stupider–we're forgetting how to listen. We're an incredibly distracted society. And unfortunately, I feel like within medicine itself, I've been a practicing physician for over 20 years now, and we're so bombarded with so much information from every angle. I feel like even a well-intentioned physician is really challenged to listen properly these days. For me, listening is also part of integrating what I'm hearing in the larger context of that person's life. That's when I think listening can really lead to meaningful conversation and meaningful interpretation. Sometimes I think in medicine, that's the most powerful tool we have.

Emily Silverman

The climax of your story is a realization, or what you call a "slow dawning." And the realization is "I had all along been of those people." Such a powerful sentence. Can you tell us about that slow dawning and how it changed the way you show up for your patients, if at all?

Shaili Jain

I think my medical training up until that point… I loved being a doctor, so proud of that accomplishment, I was so fulfilled by the work I was doing, but there was still this distance, in a way. I was the doctor, and I was treating a patient. And my training in England definitely reinforced that kind of rigid structure. And I think the slow dawning that you referred to, because it didn't happen instantly, still took me a bit of time to figure it out. It just made me aware of my own personal story that I had not fully integrated into my role as a physician. If I was going to be really good at what I was going to do, it was actually that personal story that was going to make me that good. It took me a while to understand that. It was something that was in the background, it was something that I would never have talked about. But that was actually the thing that I should have been talking about because this distance between doctors and patients is artificial. I think it really solidified the empathy, which I think over the course of a career, can get eroded. We talk about burnout, we talk about moral injury. And I do think there are these cumulative experiences over the course of a career that can make you feel distance from your patients. And I think the road trip came at a really good time because it reinforced my connection to my patients. That all along I had been of these people. These are my people. And somehow, by trying to heal them–I wasn't in a position where I could heal my own family–ut the notion of healing others, there's something corrective about that. There's something about that that makes sense to the obsessive part of my brain, you know. I think you need something that fuels your passion—that goes beyond whatever training or notions of duty and professional obligation—and I think that helped fuel me for sure.

Emily Silverman

And this new perspective actually precipitated for you a geographic move. So you upped and moved to California, and in the story you joke about how that was a horrible transition. Tell us about that.

Shaili Jain

I was in private practice and very settled in Wisconsin and I don't like to move. Part of that is rooted in my past. I mean, my dad was forcibly displaced as a child. And then he kind of had to come to England for a better life and better opportunities. He was a reluctant immigrant. He didn't want to leave his country. He was a patriot. He loved his country. But he didn't have a choice. I like to stay put, I really do. But somehow… I had already moved to America. I really thought we would stay in the Midwest. But after that road trip, it became clear to me that if I wanted to be serious about making a contribution to the science of PTSD, I would have to go where I could learn those skills and that knowledge. California is one of the sites of the National Center for PTSD, which is one of the most cutting edge organizations for understanding the science of PTSD. So we came here. It was a really strange time to move. We had a young family. Moving with kids is just not easy. I had to start all over again, I had to take a demotion, I had to be a research fellow. I don't mean to sound whiny. But I think on an existential level, again, being the child of immigrants, the first woman in my family to go to university, nevermind, attend medical school, this starting over, it really gets old after a while. And I remember vividly, you know, I was on a fellow's paycheck, living in the Bay Area, still adjusting to the sticker shock. All of my paycheck went to paying my daughter's preschool bill. So literally for the duration of me being a fellow I was in the hole, you know, because we weren't able to save any money. I'm also cognizant of the privilege you have being an educated person working in the United States. But I think it goes back to generational trauma. There's this massive need for stability, and a massive need to have control over your financial destiny. I just think it's in our genes, it's in our blood, because we know what it feels like not to have that. And that was an incredibly stressful two and a half years for those reasons. And I felt like I was taking this massive gamble, this massive risk, because if this foray into academic medicine didn't work out, it would have come at a big cost, not just financially, but in terms of uprooting our family. So, of course, it was a great move in the end. But at the time, I'd say it was probably the toughest couple years of my life because I really wasn't quite sure what I was doing. And it is just tough because I think if you don't have generational wealth, or if you don't come from a background where you have some financial security, moving to this part of the world is just not a good idea.

Emily Silverman

This question is a little bit out of left field, but it's just something I've been wondering. I was thinking about how if you look back in human history, there's been a lot of war, a lot of bloodshed, a lot of death, a lot of displacement, a lot of disease. And how trauma in some ways feels like a constant, like a part of human life. Are we less able to process our trauma now than we were hundreds of years ago?

Shaili Jain

I think on one hand we have to acknowledge that being able to talk about your trauma, being able to acknowledge the psychological consequences of it, that's a luxury. Take the example of my father, as I mentioned in The Nocturnists piece. We had an “inside of the house story” and an “outside of the house story”. He never hid anything, but he did not go around publicizing the fact that he was an orphaned refugee because that would come across as weakness. PTSD has always been there. I think in years gone by, people died prematurely because of those tragedies. So even if you look at the survivors of war, World War I, World War II, a lot of those soldiers would have died from the injuries of a traumatic event. In modern day times, they may survive because of advances in medical knowledge. But then they have to deal with the psychological trauma. It's almost like we've come to this stage in human history where we're actually starting to be able to talk about PTSD because we have the luxury of doing so and people are surviving to tell their stories. I also think we're at a stage in human history where there is more openness to hear about the stories of people who were previously invisible. You even look at, let's say, the MeToo movement. Rape is the trauma most likely to lead to PTSD. Yeah, rape is a crime that historically has been so shrouded in stigma, where the victim has been so ostracized and blamed, that I don't think there's ever been a right time where they've been able to speak up. On the flip-side of that is kind of the second prong answer. You'd mentioned how maybe, are we maybe less resilient in some ways because of the nature of modern day life? I hear you, I do think disconnection is a massive problem in our society, and like I was saying before, we don't know how to listen, we're very distracted. We're living in different worlds. We have digital worlds that we live in, we have the real world that we live in. And I certainly don't think that sets us up for good psychological health.

I feel like younger generations are more comfortable with expressing their own vulnerability. And I'm not sure that's a bad thing. Are we overdoing it? And will that be to our detriment? I guess time will tell. The one thing I do worry about with younger generations is the loss of perspective. I feel perspective is really, really important. Like seeing your own suffering in the context of collective human suffering is really, really important for you to keep perspective. And I think having good perspective is the basis of good mental health. I do worry, that perspective is being lost in younger generations, because we live in these increasingly curated worlds. If you want to spend your whole life only listening to people who think like you, you can do that today. Whereas I think in previous generations, we were kind of forced to interact and be part of worlds that were not familiar to us. Like I say, I think there's two sides to it. But for the most part, I think acknowledging trauma, talking about it, accepting what it's done to us, being curious about what it's done to us, I can only think that's a really good thing for us as a whole, as a whole society.

Emily Silverman

In the story, you talk about the importance of testimony, and you say, "Testimony goes beyond the casual. Testimony is a very intentional narration. Testimony requires the listener to act." So I was wondering if you could say more about that because I really loved that.

Shaili Jain

There is this sometimes misconception out there that, oh, okay, if you're a therapist or psychiatrist, what are you doing, you're just listening to somebody. But it's so much more than that. There's intent there, and the burden is on the listener to do something with that information. And that's what I love about being a physician, the kind of activism that's inherent in that role. I just don't think I saw it that way. But I do think that is ultimately what is going on. And when it's done, right, it's the most beautiful fulfilling thing in the world.

Emily Silverman

I've learned so much from this conversation. It's such a joy to speak with you. Is there anything else you'd like to share with our listeners before we end?

Shaili Jain

No, thanks so much. I really enjoyed our conversation too, Emily, and I really appreciated your thoughtful questions. When we did this recording, it was January 2020. It just feels surreal to think back to that time because it feels like the world has permanently changed since then. But I think what came through to me is the power of storytelling and how important it is. So just to share with you my respect for the work that you are doing, and I hope you continue to do it for many, many, many, many, many years because it really is an invaluable, very, very, very important thing.

Emily Silverman

I have been speaking to Dr. Shaili Jain. Shaili told her story "Bearing Witness" on stage at The Nocturnists in January 2020. And she's also the author of The Unspeakable Mind: Stories of Trauma and Healing. Pick it up if you'd like to explore more about this important topic. And thank you so much for being here with me today, Shaili.

Shaili Jain

Thanks so much, Emily.

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